01-27-2001

WELFARE: A Pragmatist Takes the Reins

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.


Marilyn Werber Serafini

National Journal