Saturday marks an anniversary of sorts for Kerry Weems, the acting administrator of the Centers for Medicare and Medicaid Services (CMS).

On May 3, 2007, President Bush delivered Weems’s nomination for the job to the Senate. But little has happened since, leaving Weems with neither the seal of approval nor the sense of full authority brought by confirmation.

“In general, it’s not good to go this long without a confirmed appointee,” said Gail Wilensky, who ran the agency from 1990 to 1992. “There are decisions that come up from time to time when having that imprimatur of a confirmed appointment allows someone to take more decisive actions,” said Wilensky, now a senior fellow at the Project HOPE educational foundation.

The Weems nomination has become collateral damage in the fight between the Democratic Congress and Bush.

The absence of a confirmed administrator certainly has not prevented the Bush administration from putting in place controversial policies regarding Medicare, Medicaid and the State Children’s Health Insurance Program (SCHIP). Those actions, however, make it more difficult for Weems to earn confirmation, a Senate aide said.

“Mr. Weems has encountered opposition among senators who hold him responsible for the actions of the CMS, particularly in the regulations that CMS has issued. We have heard these objections from Senate offices and are continuing our committee’s deliberate consideration of his nomination,” an aide to Finance Committee Chairman Max Baucus (D-Mont.) wrote in an e-mail. CMS did not respond to a request for comment by press time.

The Finance Committee’s consideration of Weems has indeed been “deliberate.” The panel’s only action so far on the nomination was to hold a confirmation hearing last July. The panel has not returned to Weems’s nomination, even though he has testified before the panel several times since on CMS issues.

Though Weems came to CMS after more than two decades as a civil servant at the Department of Health and Human Services (HHS), where he never held a political appointment, his tenure at CMS has been beset with the political tension always connected to Medicare and other CMS programs.

CMS also has been aggressive in implementing policies opposed by the congressional majority, something typical of a large agency facing the end of a president’s term.

Last August, one of Weems’s subordinates issued a directive to the states outlining strict new limits on their ability to enroll more children in SCHIP. The directive drew condemnation from congressional Democrats, particularly because it appeared while Congress and the White House were trying to negotiate a deal on legislation to renew and expand SCHIP. The Government Accountability Office this month decreed that the SCHIP directive was unlawfully made because it circumvented congressional review.

Last week, the House repudiated a series of Medicaid regulations put forward by the administration. In an overwhelmingly bipartisan tally, the House voted to postpone the regulations, which would limit mechanisms used by states to maximize federal Medicaid funding, for one year. The matter is pending in the Senate.

CMS also has come under fire for its management of the Medicare Part D prescription drug benefit, which continues to generate partisan bitterness nearly five years after the Republican Congress created it.

Not being confirmed can make it more difficult for an agency head with such a large and controversial portfolio to carry out his duties, Wilensky said. “It does tend to make decision-making in a sense more conservative than it might be,” she said, since Congress and agency employees may not view an official as being fully in control.

In such a position, an acting agency head is squeezed from both sides. The official lacks the full sense of authority that comes with confirmation but has to fulfill the duties of the office just the same, Wilensky said. “You don’t work any less hard and you don’t have any less grief,” she said.

Vacancies in political appointments abound as presidents near the ends of their second terms. Presidents commonly avoid difficult confirmation battles during these times by appointing individuals to jobs in acting capacities, leaving them to manage agencies without Senate approval until they wait out the inauguration of a new president and the appointment of a replacement.

Wilensky suggested that having a confirmed administrator could be less important in a president’s waning days in office. “It may well be at this stage that it doesn’t matter in the sense that there isn’t much time left in the administration,” she said.

Weems can stay on the job for as long as the president wants, despite not being confirmed. The Federal Vacancies Reform Act is supposed to prevent political appointees from staying in office for lengthy stretches of time, even specifying that no one should be “acting” for more than 210 days. Bush, however, got around this restriction by designating Weems as acting administrator after Weems had already been nominated for the position. Nominees can remain in acting positions indefinitely unless the Senate rejects their nomination.

Uncertain leadership also can affect an official’s ability to get the agency’s employees to buy into significant changes, another former senior CMS official said. “The bureaucrats are there for the long haul. Political appointees come and go,” said Tom Gustafson, a senior health policy adviser at Arent Fox who worked at HHS for three decades, including a stint as acting chief of CMS’s Medicare division. “Whoever is in charge is who they obey,” he emphasized, however.

Longevity in the agency’s workforce can be a source of stability during such times, Gustafson said. “Bureaucracies have their own inertia. People carry on carrying on,” he said.