P.A. asked a good question in comments yesterday:
Who is CMS? How are they appointed? Can CMS be ‘Federalist-Society-ized’ by Congress or executive?
Paul Krugman has a pithy, fast look at the functionality of the US government that is very relevant to the Center for Medicare and Medicaid Services (CMS):
A general reminder whenever budget issues are discussed: the U.S. government is — this isn’t original — best thought of as a giant insurance company with an army. When you talk about federal spending, you’re overwhelmingly talking about Social Security, Medicare, Medicaid, and defense.
CMS is the biggest part of the federally run health insurance program. It controls about $900 billion in federal spending. It sets policy for Medicare and Medicaid. It hires contractors to process all of Medicare claims. It writes the checks to the states for Medicaid. It audits Medicare Advantage. It sets the rules for the ACA exchanges.
CMS is part of the Department of Health and Human Services. It’s leader, currently Seema Verma, is a Senate confirmed political appointee. The CMS Administrator reports to the Secretary of Health and Human Services. There is another layer of political appointees of the deputy assistant administrator type of role or communications/public affairs positions. CMS employs about 6,000 career civil servants.
The political appointees are whomever the President can get the Senate to confirm. The appointees set policy while career staff inform the option trees and execute policy. And right now that policy is very conservative because a very conservative set of political appointees have been confirmed by the Senate.
waratah
I think they have changed a lot of things in CMS and this needs to be a major priority.
dnfree
Good explanation. I’m sure a lot of people see “CMS” and don’t know exactly what they do and how they get there.
germy
mediamatters.org/blog/2019/01/14/social-security-official-criticized-immigration-diversity-agenda-an…
dnfree
@waratah: Agreed. We have seen some articles in the news about policy changes but I’m sure that’s far from everything that has gone or is going on.
Steve in the ATL
@germy: I never tire of pointing out that most of the problems in Central America were caused by the CIA, then exacerbated by the drug trade. In which the CIA was involved.
narya
I will add that it seems to me–as someone who deals with the career folks all the time (the project officers and grants management specialists and the like)–that the line staff are treading very carefully, trying to ensure that programs are funded properly, that grantees get what they need to serve the people we’re supposed to serve, while also not making any waves. There is one very large program that would work better if it could be overhauled–but a lot of the program is set in legislation with a young Indiana man’s name attached to it, and the beneficiaries of services are reviled by the political right. Fixing the legislation so it worked better to serve folks (e.g., by taking into account how treatment has changed in 20+ years) would be non-problematic if we didn’t have a bunch of RWNJ loons in charge, but, given that the RWNJLs are in charge, it’s safer to work within the existing rules/legislation as best we all can.
MattF
When you get Medicare, you get CMS as well. One thing to bear in mind is the connection between Medicare and Social Security. I discovered this myself when I made an attempt to call ‘Medicare’ about an unfilled blank spot on my initial application (I neglected to specify a start-date). The call got through, eventually, and it all got straightened out, eventually. I think.
evodevo
Are the CMS employees affected by the shutdown? Are they getting paid? As a Medicare recipient and senior citizen, I am concerned.
hoosierspud
I contract for a company that surveys laboratories to ensure compliance with CLIA 88 (Clnincal Laboratoy Improvement Act). Our directors have been very impressed with the commitment of the CMS people they work with and they feel that our company is one of their success stories.
sheila in nc
@evodevo: Since the Labor-HHS appropriations bill was one of the ones passed on time before the end of September, I am sure that the CMS employees are on the job and being paid (i.e. not furloughed).
Ted Doolittle
CMS is the Centers for Medicare & Medicaid Service.
“Centers” plural; not “Center”
CMS is composed of various centers (i.e. divisions): Center for Medicare; Center for Program Integrity; Center for Medicaid & CHIP Services; Center for Medicare & Medicaid Innovation; etc.
Also, actually the political leadership is mostly appointed exclusively by the administration. Only one position at CMS is Senate-confirmed: the Administrator herself.