Executive Session

Floor Speech

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Mr. KAINE. Mr. President, I rise today in support of a nomination as well. One of the other votes we will be casting at 4 o'clock is on the nomination of Marilyn Tavenner of Virginia to be the head of the Centers for Medicare and Medicaid Services, CMS.

I am so excited that we are voting on this matter today. CMS is the largest line item in the Federal budget. It is larger than the Department of Defense because both Medicare and Medicaid are such significant budgetary items.

We have not had a confirmed Administrator of CMS in the United States since 2006. We have been operating this program on which tens of millions of vulnerable Americans rely on a daily basis with a succession of part-time, acting, interim Administrators. It will be good for the country and for the mission of CMS to confirm an Administrator. I am excited that we are taking that vote today.

A few words about the nominee Marilyn Tavenner. First is her experience: Marilyn is from a rural community in Southside, VA. She grew up and wanted to be a nurse. She started her career as a nurse and served at hospitals, first rural and then urban hospitals, in Virginia for many years.

Her leadership skills and traits were recognized, and she became a nursing supervisor, obtaining greater education along the way.

At one point, she was working at a hospital in Virginia that lost their CEO, and as the board wrestled with who should be an interim CEO, whether they should do a search or bring someone in from the outside, it was suggested Marilyn might be the person to do it. She wasn't interim CEO for long before the board decided she was, in fact, the person who should run the hospital.

She then had a career of running that hospital, then multiple hospitals and eventually worked for the HCA hospital chain running an entire region of hospitals and eventually became a vice president for HCA running all of their outpatient surgery centers for all of the United States.

At that point, I reached out to Marilyn--I had been elected Governor of Virginia in 2005--and asked her to be my secretary of Health and Human Services. Marilyn performed in an exemplary way as a cabinet secretary in my administration from 2006 to 2010 and helped me tackle all manner of Health and Human Services challenges, some of which she had significant background in--nursing education, for example--and others that might have been new--cessation of youth smoking--and some that were not even on the health side but were in the human services portfolio that had not been her work--foster care and mental health reform. In all those areas, Marilyn proved herself to be very able.

She has been essentially the chief operating deputy at CMS since early 2010. She was the No. 2 at CMS to the Administrator nominee Donald Berwick--a nominee who was never confirmed by the Senate--and in that role she worked closely with Donald Berwick and did wonderful work within CMS through the very challenging time of drafting, passing, and now the implementation of the Affordable Care Act.

Marilyn is the right person for the job for three reasons: First, if you care about patients, then Marilyn is your person. Marilyn, through all of her work, whether as a nurse, a hospital administrator, a regional health care executive, a cabinet secretary or a CMS administrator, has never forgotten it is fundamentally about patients and that before we get to health care we have to care about health. Marilyn brings a nurse's attitude, and what a great thing it would be for the nursing profession to have a nurse as the agency director of the Centers for Medicaid and Medicare Services. She brings a nurse's mentality, and she will do that every day on the job. That is her first priority.

The second reason Marilyn would be a strong CMS Administrator is that she is an expert, frankly, at finding savings and finding ways to reduce and control costs. We all know in the country we spend too high a percentage of GDP on health care--18 to 19 percent of our GDP on health care. Other nations in the world--Switzerland and others--spend 11 or 12 percent. We have a system that produces some spectacular professionals and some procedures that are second to none in the world, but we don't live as healthy as other nations and some of our outcomes are not quite as strong and we spend too much. So one of the subjects we talk about on this floor all the time is budgetary issues and what are the right ways the Federal Government can find savings in our own programs.

But also if we do innovative things in Medicaid and Medicare that would save money, those also become examples that can be learned throughout the health care industry to help us find appropriate savings. When I was Governor and we were dealing with the national recession and we were having to make cuts, there was no one in my cabinet or no other senior official whom I had who worked with me who was more creative and compassionate about trying to find targeted ways to achieve savings as Marilyn Tavenner. She is a whiz at this and yet never sacrifices her focus on patient care, which was the primary attribute of hers I mentioned. So as we wrestle with Medicaid and Medicare and the growth of those budgetary items, and we need to find ways to try to deal with them, I couldn't think of a better person than Marilyn Tavenner to be in that position.

The last attribute of hers that I think is truly an amazing one and a reason I support her is that she is a creative person and is always driven by finding true results. I could tell numerous stories from my time as Governor of her efforts to successfully help us ban smoking in restaurants and bars to improve our health, her efforts to help us improve our foster care system outcomes, to train more nurses, and expand the number of physicians in the State, but the story I will tell is one that was a shame for Virginia, but Marilyn helped us solve it by being creative and helping us focus on results, which is what we need at the national level.

Here is a conundrum about Virginia. When I was elected Governor, we were in the top 10 in the Nation in per capita income, but in infant mortality we were about 35th in the Nation. It just didn't seem like those two things matched up; a high-income State with a successful economy and a low unemployment rate should be doing better in infant mortality. That had occurred to Governors before me; that this just didn't make sense. Why would we not be a better State when it comes to the health of our newborns?

I gave Marilyn the challenge--because I didn't know the answer and I didn't know what to do--as my Health and Human Services secretary, to dramatically reduce our infant mortality rate. You can do everything else you want, but the No. 1 thing I want you to do during my single 4-year term as Governor is help us figure out a way to dramatically reduce our infant mortality rate.

Others had made the effort, and the other efforts hadn't produced any results. But largely through a creative and exhaustive analysis of data--why did we have a problem--Marilyn approached the challenge and figured out why we had the problem. She figured out the myths and the facts and separated the myths and put them aside. She devised a very targeted strategy for dealing with the particular reasons we had a problem and, lo and behold, within a very few years, this intractable challenge we had in Virginia of an unacceptably high infant mortality rate began to dramatically change, and the changes continue because the changes Marilyn put into the system are what no one would ever want to undo.

Marilyn's experience, her focus on patients from her background as a nurse, her spectacular success at smart cost cutting but then especially her proven capacity to be creative and innovative in reaching results merit our support for her. I am excited we will be casting this vote today. I think the fact the United States will have a confirmed CMS Administrator who can then take that confirmation and plow forward on important initiatives will be for the good of this country.

I yield the floor, and I suggest the absence of a quorum.

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