Dr. Donald Berwick

A group of Republican senators are signalling a new front in their effort to stall healthcare reform: Go after the guy who controls its implementation, Medicare chief Dr. Donald Berwick.

Forty-two GOP senators — two more than the 40 votes needed to veto Berwick’s impending confirmation — sent a letter to President Barack Obama asking him to withdraw Berwick’s nomination to lead the Centers for Medicare & Medicaid Services.

Obama slid Berwick into the position last summer via a recess appointment, causing consternation among his Republican opponents champing at the bit to grill Berwick in a nomination hearing. Obama re-nominated Berwick in January, setting the stage for a confrontation over who should have the job of implementing Obama’s signature healthcare reform law. Berwick faced a grilling last month on the other side of the Capitol from Republican representatives on the House Ways & Means Committee. That experience will likely pale in comparison to his reception before the Senate during a confirmation heraing, judging by the tone of the letter sent out today.

The senators wrote that Berwick’s lack of experience in the insurance arena and years-old statements about the British healthcare system make him an unsuitable pick for the job.

"His past record of controversial statements, and general lack of experience managing an organization as large and complex as CMS should disqualify him being confirmed as the CMS administrator," according to the letter.

The legislators are also unhappy with Obama and weren’t shy about letting him know.

"You repeatedly pledged, both as a candidate and as president, that you would usher in a new era of transparency in our government,” they wrote. "However, the process used in the enactment of the healthcare law, combined with the end-run around Congress with the recess appointment of Dr. Berwick, both contradict your pledge."