Sen. Tom Harkin (D-IA) has put a halt to what appeared to be smooth sailing for Marilyn Tavenner to officially take the helm of the Medicare program. At a budget hearing Wednesday, Harkin said he wants answers on why funding for wellness is to be cut from the federal budget.

Harkin told the Associated Press earlier this week that he temporarily put a hold on the full Senate vote to approve Tavenner until an ongoing discussion is established on prevention funding. It is not clear when he would “lift” his hold, and his office failed to respond to inquiries from Healthcare IT News.

Tavenner, who has temporarily been heading CMS since 2011, faced a confirmation hearing April 9 and was unanimously vetted for the position by the Senate Finance Committee on April 23. She has wide bipartisan support, and a full Senate vote was expected to take place soon. CMS has not had an official administrator for the past six year.

"I am beyond upset," Harkin told Department of Health and Human Services Secretary, Kathleen Sebelius at the April 24 HHS appropriations hearing. "You don’t know how angry I am about this."

Harkin, chairman of the Subcommittee on Labor, Health and Human Services, and Education said he has spent the better part of two decades promoting disease prevention and wellness in America. He helped to write prevention measures into the ACA, which included – for the first time – a federal budget for preventing disease, the Prevention and Public Health Fund.

[See also: Tavenner draws wide bipartisan support at senate conafirmation hearing.] 

"The Prevention Fund works," Harkin said. "Thanks to this funding, more children are being immunized. More people are quitting smoking. More communities are fighting chronic disease. More people are being screened for hepatitis C," he said at the hearing.

"Raiding the prevention fund to figure out how we pay the bills just perpetuates our unique costly American sick care system. I’m sorry to say that this administration just doesn’t seem to get it," Harkin said.

Particularly disturbing to Harkin is the proposed elimination of the Racial and Ethnic Approaches to Community Health (REACH) program, which Harkin calls "a staggering success." The program was funded at $54 million in 2012, but has been cut completely from the proposed fiscal 2014 HHS budget. Harkin said he plans to propose another bill this year that would continue to allocate funding to the REACH program and other wellness programs. 

Sebelius told Harkin the Obama Administration is also concerned about prevention, but has chosen to put the funding into ensuring every American has access to a medical home and health insurance, which includes disease prevention education. Federal funding is also proposed to support other wellness movements, such as First Lady Michelle Obama’s obesity prevention program, and efforts to eliminate food deserts and tamp out tobacco use.