Major points and what they mean
Week 2 - Appointees
The President has to appoint people to a wide range of roles in the federal government. This is similar to how Governor Brown selects people (for example, Nancy Bargmann as Director of the Department of Developmental Services). In the case of the federal government, though, there are over 4,000 spots to fill. 689 must be confirmed by the Senate, allowing extra scrutiny and public awareness.
At the top level, people like the Secretary of Health and Human Services can have a big-picture impact on the way policies are made, changed, and run. But there are other, lesser-known people and positions that more directly impact the developmental services world.
So what are some of the most relevant positions for appointments?
Secretary, Department of Health and Human Services (HHS) - This role oversees all the work of HHS, including the Affordable Care Act, CMS (see next item), and national health policies and goals. Major changes to programs or funding will likely involve input from the Secretary, but he or she may not be directly involved with smaller program elements.
Administrator, Centers for Medicare and Medicaid Services (CMS) - This person administers both Medicare and Medicaid. He/she is also responsible for many specific health programs and funding sources (waiver programs) that impact our community. The Administrator's work more directly affects services in, and money for, California.
Administrator, Administration for Community Living (ACL) - The ACL is the part of HHS that is most directly focused on disability services. Many programs focused on our community are found here, including funding for the State Council, University Centers for Excellence in Developmental Disabilities (UCEDDs), Protection and Advocacy Systems (locally, Disability Rights California) and policies and regulations that affect people with disabilities.
Director, Region IX, Health and Human Services - This role is, in essence, the local office of HHS. This is particularly important because this person works to help California make state goals mesh with federal policies - like the Affordable Care Act (ACA), the HCBS final rule, and the Self-Determination Program.
Director, Office of Management and Budget (OMB) - This office is responsible for helping the President prepare the Federal budget. While the budget process always goes through the legislature, this work shows the President's goals and priorities, and has a huge impact on the negotiations that happen as the U.S. budget is created. Cuts to programs, or the creation of new ones, can start with ideas developed by the OMB.
Currently, there are nominees for three of these positions. The background of each person gives us some idea of how they may do their work, and what is important to them.
So who are the people currently nominated?
- Secretary of HHS - Tom Price is a Georgia Republican member of the House of Representatives. Price has been a long-time critic of the ACA. Last year, he introduced the Empowering Patients First Act, a potential replacement for the ACA. Because of his policy work, the authority of the position of Secretary, and his background as a doctor, he will play a major role in any proposal to replace the ACA in 2017. He would also be involved in any potential changes to Medicare and Medicaid.
- Administrator of CMS - Seema Verma is a health policy consultant known for her work on developing Indiana's expansion of Medicaid. She has also been involved in ACA coverage expansions for other (Republican-led) states. Her experience with health policy will give her views credibility, particularly when smaller but more important details, like coverage of behavioral health treatments, begin to be addressed.
- Director of OMB - Mick Mulvaney is a South Carolina Republican member of the House of Representatives. Mulvaney has been a leading voice in the Tea Party movement, which maintains its focus on (among other issues) reduced government spending. He is a co-founder of the Freedom Caucus, a group of legislators whose common interests are rooted in the Tea Party. He has been a strong advocate for cutting federal spending and the national debt. He has also urged major changes to Medicare in the past. His selection will add an extremely fiscally conservative voice to the ranks of those individuals close to President-Elect Trump.