Bush Nominates FDA Commissioner Mark McClellan as CMS Administrator

As expected, President Bush on Friday nominated FDA Commissioner Mark McClellan to serve as the new CMS administrator, the Washington Post reports. If McClellan's nomination wins the Senate's confirmation, the job will be the third senior health policy position he has held in the Bush administration (Goldstein, Washington Post, 2/21). Former CMS Administrator Tom Scully resigned last month and accepted a position in the Washington, D.C., office of the Atlanta-based law firm Alston & Bird (California Healthline, 2/19). As CMS commissioner, McClellan, a physician with a doctorate in economics, will be responsible for Medicaid and Medicare, which together provide about $700 billion annually in benefits to an estimated 83 million people (Washington Post, 2/21). According to the New York Times, McClellan faces "a huge logistical and political challenge" in his new role: enacting the prescription drug benefit included in the new Medicare law (HR 1) "while fending off Democratic attacks" of the new law (Pear, New York Times, 2/21). McClellan "could face sharp questioning from Democrats" over "his stated faith in the ability of private-sector companies to reduce spending and improve quality of health care," the Wall Street Journal reports (Lueck, Wall Street Journal, 2/23). At FDA, McClellan "pushed for quicker reviews of drug and other product applications, successfully lobbied Congress to expand industry user-fee programs that fund FDA activities and made tough decisions on controversial issues, such as banning the diet supplement ephedra and reversing an advisory panel [decision] to keep silicone breast implants off the market," the Post reports (Washington Post, 2/21). McClellan also focused on "stamp[ing] out, on safety grounds," support for the reimportation of lower-priced, U.S.-made prescription drugs from Canada, the Times reports. According to the Times, McClellan "has shown a knack for working with members of both parties in a pragmatic way that blends science, economic and politics" (New York Times, 2/21).

The Post reports that McClellan's nomination is predicted to be quickly confirmed by the Senate (Washington Post, 2/21). Analysts said that the nomination "reflects the administration's desire to avoid a bruising confirmation battle that would give Democratic lawmakers another opportunity to tear down Medicare reform," the Los Angeles Times reports (Kemper, Los Angeles Times, 2/21). Sen. Edward Kennedy (D-Mass.) called McClellan "a superb choice" to run CMS, adding, "He brings to the job a powerful intellect, a deep knowledge of the programs and a commitment to public service." Senate Finance Committee Chair Chuck Grassley (R-Iowa) said McClellan "is well regarded on Capitol Hill, and his background and expertise make him a strong candidate." Grassley added that he would schedule the nomination hearing as soon as possible, the Baltimore Sun reports (Greene, Baltimore Sun, 2/21). Jonathan Skinner, a Dartmouth economist who has written articles with McClellan, said that while McClellan has "strong opinions about how to make the system better, I think he understands that in Washington you try to get done what you can get done" (Wall Street Journal, 2/23). Dr. Sidney Wolfe, director of Public Citizen's Health Research Group, said McClellan could become "a cheerleader for the privatization and serious weakening of Medicare" because he might "approach the job more as an economist than a physician" (Los Angeles Times, 2/21).

With McClellan's expected departure from FDA, the agency likely "will once again return to bureaucratic autopilot, and to its institutional overcaution in approving even life-saving new drugs," a Wall Street Journal editorial states, noting that McClellan has "the political skills that will be essential to giving the new Medicare reform law even tiny chance to succeed by attracting private insurance options." The editorial concludes, "We hope Mr. Bush challenges the Senate with a replacement who is every bit as aware as Dr. McClellan has been of how bureaucratic delay costs lives" (Wall Street Journal, 2/23).