Thompson brings pragmatic approach to HHS

Tommy G. Thompson, President Bush's Secretary of Health and Human Services, has been calling himself a compassionate conservative for years. Indeed, he may be best remembered in Wisconsin, where he was governor, for aggressively getting more than 80 percent of the state's welfare population off the dole, while at the same time substantially increasing spending on state child care, health care, and other programs to support people who leave welfare for low-paying jobs.Policy-makers are hoping that Thompson's reputation as a pragmatist--not an ideologue--will help to advance Bush's health care agenda at a time when close party ratios in Congress demand moderation and cooperation."The people of Wisconsin know Tommy Thompson to be a problem solver, improving the lives of real people," Senate Finance Committee Chairman-to-be Charles Grassley, R-Iowa, said at the panel's nomination hearing, where Thompson won praise from Senators of both parties. "He's shown through his work that he's not bound by the old, tired approaches," Grassley said. Much of Bush's priority agenda will fall within HHS's sphere of influence. Bush has vowed to create a prescription drug benefit for seniors, reform Medicare, partially privatize Social Security, and attack the problem of the medically uninsured (who now number 43 million). Moreover, the Welfare Reform Act of 1996 must be reauthorized in 2002. Thompson has been a pioneer among governors in both welfare and health care. He established a timeline to move people from welfare to work two years before Congress required states to do so in the Welfare Reform Act of 1996. He was also one of the first governors to make health insurance available to low-income parents whose kids were being enrolled in the state Children's Health Insurance Program. Still, it remains unclear whether this dynamic, independent leader will be able to adjust to a hierarchy in which he's not ultimately in command. "I don't know the last time he worked for somebody else," said David R. Riemer, director of administration for the City of Milwaukee under Democratic Mayor John Norquist. Riemer, who worked closely with Thompson on Wisconsin's welfare reform efforts during the 1990s, credits him with being an effective governor. "But can he work for somebody? That's the right question to ask," he said. "You have a President who wants this and who wants that, and he's giving directions to this [59-year-old] guy who's used to calling the shots."Outgoing HHS Secretary Donna Shalala was not granted the leading role in President Clinton's health care reform initiative--his biggest domestic policy effort during 1993-94. Instead, first lady Hillary Rodham Clinton and then-White House adviser Ira Magaziner ran the 500-person task force that formed the President's health care reform blueprint. "Maybe Tommy will say, `See what happens when you let that happen?' " said Riemer. "In [welfare reform] Shalala played second fiddle to [Clinton's top domestic policy adviser] Bruce Reed." Shalala urged Clinton to veto the welfare bill, but he signed it. Thompson likes being in charge, said Riemer. "He likes making decisions and not being told what's going to happen." Thompson has been calling the shots in some capacity for more than three decades. He was elected to Wisconsin's state Legislature in 1966 and served as both assistant minority leader and minority leader. He was elected governor of Wisconsin in 1986, and was easily re-elected in 1990, 1994, and 1998. Still, Riemer says, Thompson has the ability to adjust to varying political situations. For example, he approached his position as minority leader of the Legislature and his post as governor very differently. "In the Legislature, he was attack, attack, attack. He wasn't a consensus builder. He was partisan," Riemer said. But Thompson became a different kind of politician when he won the governorship of a state that's more Democratic than Republican. "He was Tommy Thompson the right-wing conservative, and he became Tommy Thompson who was able to work with Democrats and be a cheerleader," said Riemer. "He has a capacity, when performing a different role, to reorganize the way he goes about it. The old dog learned some new tricks once. Will he learn a new set of tricks twice? I think he can. He's very flexible, creative." That's why it's difficult to pigeonhole Thompson. Democrats have chided Bush for picking a conservative Cabinet, but even some of Bush's harshest critics are pausing before labeling Thompson. "He's potentially innovative, he thinks out of the box," said Ronald F. Pollack, executive director of Families USA, a consumer advocacy group. "You can't rigidly typecast him. Those who read him as a straight-line supporter or opponent" are mistaken. It should help that Thompson already has a solid relationship with Bush. "The most important characteristic a Cabinet member can have is to have access to the President," said Edward F. Howard, executive vice president of the Alliance for Health Reform, a nonpartisan Washington group that educates congressional staff and reporters on health care matters, "and I would say that Tommy Thompson is likely to have better access than any Health Secretary in my memory." After Thompson decided not to enter the presidential race in 2000, he became part of a group of governors who supported Bush, encouraging him to campaign hard and early. Thompson is a "politically active guy, and he played an important role in the campaign," Howard said. Thompson also has a history with HHS, albeit from an adversarial position, and career staff at HHS are a bit nervous about what's coming. Thompson has expressed frustration--particularly with the Health Care Financing Administration--that state waivers have been hard to get, and that the process is painfully prolonged. "He's frustrated because there seems to be a sense of fear [at HCFA] that states will race to the bottom or not do it right," said Joe Leean, secretary of the Department of Health and Family Services in Wisconsin. "It's frustrating with HCFA because they're the ones with the biggest impact on our program." When Wisconsin created BadgerCare, which extends insurance to some low-income parents, HCFA took two years to approve the program, Leean said. "It's frustrating for a governor who wants to do what's right." Thompson has already indicated he plans to make some changes at HHS. "I have spent much of my career fighting the bureaucracy in Washington. Wisconsin has sought more waivers from federal programs than any other state. Now, it's time for me to put up." Specifically, he wants to streamline rules and regulations and to reduce paperwork, particularly at the Health Care Financing Administration. Another Thompson run-in with HHS involved organ donations. He has sued HHS to fight regulations requiring Wisconsin to offer some of the organs harvested within its borders to people in other states first. Thompson argues that if Wisconsin does a good job encouraging organ donations, its residents should have priority for transplants, even if patients in neighboring states have a greater need. Thompson demands a lot from his staff, Leean said. "He expects people around him to work as hard as he does, and I've never seen anyone who works as hard as he does." Nevertheless, he tends to retain staff and to enjoy loyalty. "All of us who work for him at any level have to go home at times and explain why we put in 60 hours a week." At a press briefing following his nomination, Thompson said that his priorities for HHS would include improving the long-term-care system for seniors, ensuring opportunities for the disabled, helping the poor find work, and enabling scientific research. Thompson's first order of business is likely to be Medicare. At his nomination hearing before the Senate Finance Committee on Jan. 18, Thompson said that Bush intends to push for early consideration of an initiative that would immediately give money to states to help low-income seniors with the cost of prescription drugs. That move would give Congress and the Administration time to work on broader Medicare reforms. Thompson also said he wants to reduce the numbers of medically uninsured people, and indicated a desire to do so by allowing states the flexibility to try new approaches. "What we need to do is allow states to take the lead and develop exciting, innovative programs that work for their citizens, and hold them accountable for the results." Welfare reform will need reauthorization in 2002, and Thompson is hoping to add support services for low-income people trying to move from welfare to work. Abortion-rights advocates are concerned that Thompson will play an active role in next year's reauthorization of the Hyde Amendment, which says that government-sponsored health insurance can cover abortion only in cases of incest, rape, or danger to the life of the mother. They're also concerned that he'll ignore states that fail to cover those abortions under Medicaid. "There are all kinds of regulations that HHS could develop that could be problematic," said Vicki Saporta, executive director of the National Abortion Federation, which represents abortion providers. "Thompson is one of the most anti-choice governors," she said. The political strain over Thompson's abortion position, though, does not appear to carry over to other policy areas that will be at the top of the new Administration's agenda, including Medicare reform and prescription drug benefits.