Presidential Personnel Appointments That Affect Healthcare Policy

April 11, 2017 by Alec Stone MA, MPA, ONS Government Affairs Director
Alec Stone
Alec Stone MA, MPA, ONS Public Affairs Director

There is a difference between campaigning and governing. Running for office is about putting out bold ideas and galvanizing a base of supporters who are energized by the opportunity for real change. It’s exhilarating and fluid. The momentum can be like a rock concert, and people are carried away with excitement about the future.

But once a candidate wins an election, putting those themes into practice can be a little more difficult and the minutia of implementing public policy is far more difficult. Followers demand immediate action and have little enthusiasm for the protocol of procedure. Supporters expect the candidate to remain the same, but the environment—and many of the rules—have changed once elected. Nowhere is this more evident than the quadrennial presidential election.

The Process of Presidential Appointments

The U.S. president has approximately 4,000 political appointees at his discretion. About 1,000 of those require confirmation from the Senate. Most of these are not reported outside of the Washington, DC, political structure but are essential in making and implementing regulatory policy. Health care tops this list.

After careful vetting and often some public trial balloons, names are presented to the Senate. For high-level appointments, the dance of confirmation begins with a press conference to announce the nominee, who makes brief comments and then sets up meetings with senators to speak privately about policy issues. Eventually, formal hearings are held that can either conclude with bipartisan support or become fodder for political mayhem, ending in the withdrawal of the nominee against perceived negative publicity.

Regardless, very important slots must be filled and it is incumbent on the new administration to spend the early days appointing Cabinet secretaries and a cadre of deputy, under, and assistant secretaries, commissioners, and administrators to complete the work of government.

Notable Health Policy Appointments

One of the most public federal agencies, with broad authority over large policy domains, is the Department of Health and Human Services and its many subdivisions. Former U.S. Representative Tom Price (R-GA), a physician by training, was confirmed in February as secretary. The secretary is the point person for the entire department, and the ideologic interpretations of the presidential administration will flow from that office to the directed agencies. Other notable Department of Health and Human Services subdivisions and their associated or predicted appointments include the following:

Elections matter, and how a presidential administration enacts law has real consequences. The workings of government are simultaneously complex and straightforward. Participatory democracy requires the consent of the governed, but it also demands that those same people be engaged in the process: not just during the election, but throughout the entire term of office.

ONS is on the front lines of advocacy. Our members are testifying before Congress, meeting with their elected officials, writing policy alternatives to clarify information about healthcare issues for patients with cancer, and tracking legislation that is important to nurses. Like a beacon in the night, ONS is a guiding light in public policy.


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