Correction to This Article
A Sept. 6 article about the resignation of Mark B. McClellan as administrator of the federal Centers for Medicare and Medicaid Services said more than 3 million people are covered by the Medicare prescription drug benefit. More than 33 million people are covered.

. . . and a Departure

By Christopher Lee
Washington Post Staff Writer
Wednesday, September 6, 2006

The resignation of the head of the Centers for Medicare and Medicaid Services creates a critical vacancy as the Bush administration enters its final two years, a time when skilled political appointees typically think of leaving the government rather than joining it.

Mark B. McClellan, who has overseen the two largest public health insurance programs since 2004, announced yesterday that he will leave by early October.

"This was a hard decision, because this is the most exciting and rewarding place that anyone could ever work," McClellan said in an e-mail to CMS employees yesterday.

In an interview, McClellan, 43, said that he is contemplating a return to academia or a position in a Washington think tank. The Texan, older brother of former White House press secretary Scott McClellan, had also served as commissioner of the Food and Drug Administration, from 2002 to 2004, and, before that, as a member of the White House Council of Economic Advisers and as a senior health policy aide to the president.

McClellan "has served my administration in a number of pivotal positions, and in doing so has bettered the lives of millions of Americans," President Bush said yesterday.

Possible successors, at least on an interim basis, include Leslie V. Norwalk, the deputy administrator of CMS; Herb Kuhn, director of the agency's Center for Medicare Management; and Julie Goon, a special assistant to Bush and formerly the director of Medicare outreach at the Department of Health and Human Services.

The CMS administrator oversees Medicare, Medicaid and the federally subsidized State Children's Health Insurance Program (SCHIP), which together serve about 90 million Americans and account for more than $535 billion a year in federal spending.

"It takes a skilled administrator to juggle the agency's competing interests of offering the highest possible service to beneficiaries while keeping down costs to preserve the programs for future beneficiaries," said Sen. Charles E. Grassley (R-Iowa), chairman of the Senate Finance Committee, which would have to approve the next head of CMS.

McClellan's successor will have to cope with a report, due at year's end, from a special Medicaid commission that is expected to recommend big cost cuts in the program. Next year, Congress will debate whether to reauthorize SCHIP, which serves about 4 million children. And if the Democrats regain control of the House in the November elections, the next administrator can expect to be grilled repeatedly at congressional hearings designed to spotlight Bush policies that Democrats oppose.

McClellan's signature task was overseeing the implementation of the new Medicare prescription drug benefit, which now helps more than 3 million seniors pay for their prescription medications. The start-up was anything but smooth. Seniors complained of confusion during the enrollment process, and more than a dozen states stepped in with emergency measures after many of the poorest beneficiaries were turned away or overcharged at pharmacies. Despite that rough transition, recent polls have found that most beneficiaries are satisfied with their choice of plan.

Ken Johnson, a senior vice president of the Pharmaceutical Research and Manufacturers of America, said McClellan overcame bureaucratic challenges and political attacks. "He never panicked, he made important mid-course corrections and, frankly, he's a big reason why the new prescription drug program is viewed as a success," he said.

Ron Pollack, executive director of Families USA, an advocacy group that has been critical of the administration's policies, called McClellan "a terrific person."

"In the context of an administration that doesn't make health care a high priority and that has made a series of harmful proposals that will exacerbate the health-care crisis, Mark McClellan served in an admirable way to try to implement the administration's policies in the best way possible," he said.

McClellan said his successor should be prepared to accept help from people and organizations all over the political spectrum.

"And, you know, a flak jacket wouldn't hurt either -- or at least some thick skin," he said.

© 2006 The Washington Post Company