Who is CMS? How are they appointed? Can CMS be ‘Federalist-Society-ized’ by Congress or executive?
Paul Krugman has a pithy, fast look at the functionality of the US government that is very relevant to the Center for Medicare and Medicaid Services (CMS):
A general reminder whenever budget issues are discussed: the U.S. government is — this isn’t original — best thought of as a giant insurance company with an army. When you talk about federal spending, you’re overwhelmingly talking about Social Security, Medicare, Medicaid, and defense.
CMS is the biggest part of the federally run health insurance program. It controls about $900 billion in federal spending. It sets policy for Medicare and Medicaid. It hires contractors to process all of Medicare claims. It writes the checks to the states for Medicaid. It audits Medicare Advantage. It sets the rules for the ACA exchanges.
CMS is part of the Department of Health and Human Services. It’s leader, currently Seema Verma, is a Senate confirmed political appointee. The CMS Administrator reports to the Secretary of Health and Human Services. There is another layer of political appointees of the deputy assistant administrator type of role or communications/public affairs positions. CMS employs about 6,000 career civil servants.
The political appointees are whomever the President can get the Senate to confirm. The appointees set policy while career staff inform the option trees and execute policy. And right now that policy is very conservative because a very conservative set of political appointees have been confirmed by the Senate.