Bush picks health program innovator Tommy Thompson as HHS secretary

Wisconsin physicians praise the nominee's past work on patients' appeals rights and medical records privacy.

By Susan J. Landers, amednews staff. Jan. 22, 2001.

Washington -- What happens when a governor who has greatly expanded low-income residents' access to health care is placed in charge of national health programs? Many hope for a similar outcome on a grander scale.

Wisconsin Gov. Tommy Thompson was nominated late last month by then-President-elect George W. Bush to head the U.S. Dept. of Health and Human Services, with its $420 billion annual budget and control over numerous federal health programs, including Medicare, Medicaid and the State Children's Health Insurance Program.

"I'm personally pleased with the nomination," said Timothy T. Flaherty, MD, a Wisconsin radiologist and chair-elect of the AMA Board of Trustees. "I know he has a deep interest in health care." The success of the state's health insurance program for low-income people, which Thompson strongly promoted, has resulted in one of the country's lowest uninsured rates, Dr. Flaherty noted.

During Thompson's 14 years as governor, Wisconsin has been a leader in innovative reforms that resulted not only in broader health coverage for residents but also a drastic paring down of welfare rolls, added attention to the need for organ donations and increased funding for biotechnology in the state's university and medical communities.

To carry out certain reforms, Thompson pursued waivers of federal requirements, sometimes clashing with HHS over what he believed to be onerous regulations.

For example, a two-plus-year pursuit of a Medicaid waiver resulted in BadgerCare, the first state program to provide health coverage to parents as well as children. The program, funded with Medicaid and SCHIP funds, was cited as a model initiative during a recent forum on state approaches to health care.

Following Wisconsin's success, many expect Thompson to continue as HHS secretary to advocate for increased state flexibility.

Tom Frazier, executive director of the Coalition of Wisconsin Aging Groups, sees advantages to increased state flexibility.

"I think the federal government ought to be encouraging [states], not discouraging them with a bureaucratic morass," he said.

But others urged caution. Anne Arnesen, executive director of the Wisconsin Council on Children and Families, warned against abandoning the entitlement aspect of state medical assistance programs by turning them into block grants. "That would be very worrisome," she said.

Thompson is probably best known for efforts to move people from welfare to work. His recognition of the need to provide such supporting programs as health insurance and child care for those leaving the welfare program has garnered much praise.

The State Medical Society of Wisconsin has worked with Thompson for many years and found the governor "very sympathetic toward medical issues," said society President Ayaz Samadani, MD.

For example, Wisconsin has a new law establishing an independent external review process for patients who contest their health insurers' denials of coverage for certain procedures or tests. "This is quite an achievement for the patient," Dr. Samadani said.

The patients' rights law, which Thompson signed in May 2000, includes internal and external grievance procedures but stops short of expanding patients' rights to sue their health plans. Health plan liability is a major point of contention in federal patients' rights legislation that is certain to occupy the Bush administration and Congress this year.

The Thompson administration and the medical society also worked together to amend a data collection law to ensure individual privacy, said Dr. Samadani. The law originally had required physicians to send identifiable outpatient data to a new state data bank. Under the change advocated by the medical society and Thompson, physicians report only "blind" data.

Ensuring the privacy of medical records has been a prominent federal issue for the past several years and could be revisited soon by Congress and the Bush administration as a result of complaints generated by privacy regulations released in the Clinton administration's waning days.

Dr. Samadani also praised the governor's efforts to promote increased organ and tissue donations. Wisconsin is now among the state leaders in donations.

Wisconsin's success, however, has pitted the state against HHS and Thompson's predecessor, Donna Shalala, PhD. Thompson filed an unsuccessful lawsuit contesting Dr. Shalala's efforts to have organs distributed nationally and strictly by need. Thompson charged that the federal effort unfairly benefits states with poor procurement rates.

Some room for improvement

While presenting a mostly favorable report of Thompson's performance as governor, Dr. Samadani did fault Thompson's decision to use only $23.5 million of the $160 million in tobacco settlement funds received by the state for health-related purposes.

And although Dr. Samadani praised BadgerCare and personally has treated increasing numbers of patients who are insured under the program, he would like to see reimbursement rates increase and regulations decrease. Physicians in the state currently lose $6.11 per office visit under the program, he said.

Several Wisconsin physicians praised the governor's leadership abilities. Thompson is "creative and innovative," said David Kindig, MD, director of the Wisconsin Network for Health Policy Research at the University of Wisconsin, Madison. However, he cautions, "It's really different being a cabinet secretary from being a governor."

Thompson has been a very good governor, said Richard Roberts, MD, a family physician who also teaches at the University of Wisconsin.

As a member of the minority party in the state Assembly for many years before becoming governor, Thompson learned what it takes to be a good negotiator, Dr. Roberts said.

Thompson will take from his state experience "the ability to be flexible and focus on what needs to be done," Dr. Roberts predicted. "I think he will be a successful secretary."

Senate hearings to confirm Thompson's nomination had not been scheduled by press time. Although few obstacles to Thompson's approval were expected, questions were being raised about his close relationships with tobacco companies, particularly Philip Morris and its Wisconsin subsidiaries, which include Miller Brewing Co.