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Executive Summary

HCFA TOP POST STILL OPEN: SEN. DOLE's AIDE WITHDRAWS from consideration for the position of administrator of the Health Care Financing Administration. Sheila Burke, the first choice for the HCFA post, took her name out of consideration on April 17 due to a potential conflict of interest between HCFA's role administering Medicare and the Aetna insurance business, where her husband David Chew is vice president for strategic planning. "Some limits" could have been imposed on direct dealings between the HCFA and Aetna had she assumed the post, Burke said April 18. However, Burke added that she was sensitive to the "appearance" of a conflict of interest. Burke, a registered nurse, plans to remain in her present post as chief of staff to Senate Minority Leader Dole (R-Kan.). Burke's withdrawal after a protracted consideration for the position leaves HHS in a quandary three months into the new administration. The HCFA post is crucial to the attempts to cut $2.7 bil. from the 1990 budget. HCFA is also faced with the responsibility of implementing the Catastrophic Health Care Act at the same time that Capitol Hill is having second thoughts on the program. It is not unheard of an Washington for the White House to delay appointments for certain important subcabinet posts to keep budget control decisions at a higher level. Office of Management & Budget Director Darman has already emerged as a leading figure on health care expenditure discussions. Even if the HCFA delay is not a conscious ploy, it has the effect of taking some of the budget initiative for HCFA out of HHS. One of the new top HHS officials, new Assistant Secretary for Health James Mason, moved out of limbo on April 19. Mason was confirmed by the Senate that day. Undersecretary-designate Horner's nomination ran into a quorum problem on April 21 and she will have to wait until early May for confirmation. The Senate Finance Committee fulfilled a formality of the confirmation process for Horner on April 21. Chairman Bentsen (D-Tex.) and committee Republicans Durenberger (Minn.) and Packwood (Ore.) held a hearing despite the lack of quorum to expedite the nomination when the Senate reconvenes on May 1 from a brief recess. As HHS undersecretary, Horner said she would bring "strong management underpinnings to the complex and difficult policy deliberations" facing the department. In other HHS personnel matters, Susan Zagame is expected to be HHS deputy chief counsel and acting general counsel. Zagame has been with the Department of Housing and Urban Development since 1985, assisting the HUD secretary with policy and financial issues. General counsel Malcom Sternett, a Reagan Administration appointee, recently left his post. House Ways and Means health subcommittee staffer Chip Kahn withdrew from consideration for HHS assistant secretary for planning and evaluation April 14, citing personal reasons.

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