National

California awaits Obama nominees to make federal decisions

WASHINGTON — Obama administration vacancies could complicate efforts to solve San Joaquin Valley in California problems, local officials fear.

From dairy farmers to family physicians, Valley residents await federal government decisions typically made by political appointees. Without authoritative leaders in place, critical decisions get deferred and people get frustrated.

"We're in this nebulous period," Stanislaus County Chief Executive Officer Rick Robinson said Thursday.

Robinson is seeking federal support in a high-stakes medical dispute. Millions of dollars are on the line, along with the care provided to the county's poor and uninsured population. But until top positions are filled, Robinson noted, the Department of Health and Human Services will remain "in a state of flux."

This week, Robinson and more than a dozen other Stanislaus County leaders have been lobbying on a range of issues, from police radios to park funding. They've had no problem securing Valley lawmaker support, including in the dispute over a family physician training program.

To really win, though, county officials need the secretary of health and human services and her top agency lieutenants. The problem is, those seats are vacant.

"We need Washington to fix this," Stanislaus County Supervisor William O'Brien said Thursday.

Obama's first nominee as health and human services secretary, former Senate Majority Leader Tom Daschle, withdrew in the face of tax-and-lobbying questions. A confirmation hearing has not yet been set for Kansas Gov. Kathleen Sebelius, Obama's second pick.

Sixteen other positions requiring Senate confirmation likewise remain unfilled at the Department of Health and Human Services. One is for head of the Center for Medicare and Medicaid Services, the agency Stanislaus County is trying to sway in the family physician dispute.

Under its prior administrator, the Center for Medicare and Medicaid Services directed Modesto's Doctors Medical Center to pay back $19 million. The county is responsible for half of this. The federal agency also declared it would stop future reimbursements for the Stanislaus Family Medicine Residency Program.

O'Brien on Thursday pinned the dispute on federal "bureaucrats," and a full-color booklet distributed by county officials questioned whether "the president (can) stop an out-of-control bureaucracy?"

This is where political appointees come in. Typically, they are the ones lawmakers write, telephone and lean on when trying to influence a policy decision.

Obama has been faster in making nominations than other recent presidents. Even with departmental vacancies, moreover, some decisions are getting made.

For instance, 12 Agriculture Department positions requiring Senate confirmation remain vacant, including the positions overseeing food safety, the Forest Service and the department's multi-billion dollar research program. Nonetheless, the department has made various decisions including banning the commercial slaughter of disabled cattle - a decision stalled during the Bush administration.

In a similar vein, department officials cite the adoption of various reform measures.

"From day one, the Obama administration and Secretary (Tom) Vilsack have acted on their commitment to reform," Agriculture Department spokeswoman Nayyela Haq (cq) said.

Still, Obama has 488 Senate-approved positions yet to fill, according to a Washington Post database. Roughly 3,000 additional Executive Branch positions must be filled that do not require Senate confirmation.

"The follow-up has been a little slow," acknowledged Bret Rumbeck, spokesman for Rep. Jim Costa, D-Fresno, "but we're pretty confident they'll get the positions filled by summer."

Last month, for instance, Obama nominated Kathleen Merrigan of Tufts University as deputy secretary of agriculture. Merrigan has not yet been confirmed. In the meantime, Valley lawmakers have been talking to assorted White House and Agriculture Department officials about the prospects for dairy industry relief, in the wake of low prices and industry anxiety.

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