- WASHINGTON -- The government's
top expert on Medicare costs was warned that he would be fired if he told
key lawmakers about a series of Bush administration cost estimates that
could have torpedoed congressional passage of the White House-backed Medicare
prescription-drug plan.
-
- When the House of Representatives passed the controversial
benefit by five votes last November, the White House was embracing an estimate
by the Congressional Budget Office that it would cost $395 billion in the
first 10 years. But for months the administration's own analysts in the
Centers for Medicare and Medicaid Services had concluded repeatedly that
the drug benefit could cost upward of $100 billion more than that.
-
- Withholding the higher cost projections was important
because the White House was facing a revolt from 13 conservative House
Republicans who'd vowed to vote against the Medicare drug bill if it cost
more than $400 billion.
-
- Rep. Sue Myrick of North Carolina, one of the 13 Republicans,
said she was "very upset" when she learned of the higher estimate.
-
- "I think a lot of people probably would have reconsidered
(voting for the bill) because we said that $400 billion was our top of
the line," Myrick said.
-
- Five months before the November House vote, the government's
chief Medicare actuary had estimated that a similar plan the Senate was
considering would cost $551 billion over 10 years. Two months after Congress
approved the new benefit, White House Budget Director Joshua Bolten disclosed
that he expected it to cost $534 billion.
-
- Richard S. Foster, the chief actuary for the Centers
for Medicare and Medicaid Services, which produced the $551 billion estimate,
told colleagues last June that he would be fired if he revealed numbers
relating to the higher estimate to lawmakers.
-
- "This whole episode which has now gone on for three
weeks has been pretty nightmarish," Foster wrote in an e-mail to some
of his colleagues June 26, just before the first congressional vote on
the drug bill. "I'm perhaps no longer in grave danger of being fired,
but there remains a strong likelihood that I will have to resign in protest
of the withholding of important technical information from key policy makers
for political reasons."
-
- Knight Ridder obtained a copy of the e-mail.
-
- Foster didn't quit, but congressional staffers and lawmakers
who worked on the bill said he no longer was permitted to answer important
questions about the bill's cost.
-
- Cybele Bjorklund, the Democratic staff director for the
House Ways and Means health subcommittee, which worked on the drug benefit,
said Thomas A. Scully - then the director of the Medicare office - told
her he ordered Foster to withhold information and that Foster would be
fired for insubordination if he disobeyed.
-
- Health and Human Services Department officials turned
down repeated requests to interview Foster. The Medicare office falls under
the control of HHS.
-
- In an interview with Knight Ridder, Scully, a former
health-industry lobbyist deeply involved in the administration's campaign
to pass the drug benefit, denied Bjorklund's assertion that he'd threatened
to fire Foster. He said he curbed Foster on only one specific request,
made by Democrats on the eve of the first House vote in June, because he
felt they'd use the cost estimates to disrupt the debate.
-
- "They were trying to be politically cute and get
(Foster) to score (estimate the cost of the bill) and put something out
publicly so they can walk out on the House floor and cause a political
crisis, which is bogus," Scully said.
-
- "I just said, 'Look, (Foster) works for the executive
branch; he's not going to do it, period,'" he said.
-
- Otherwise, Scully said, Foster was available to lawmakers
and their staffs.
-
- " ... I don't think he ever felt - I don't think
anybody (in the actuary's office) ever felt - that I restricted access.
... I think it's a very nice tradition that (the actuary) is perceived
to be very nonpartisan and very accessible, and I continued that tradition."
-
- Scully said Liz Fowler, the chief health lawyer for the
Democrats on the Senate Finance Committee, could confirm the actuary's
independence. Fowler didn't.
-
- "He's a liar," she said of Scully.
-
- At a Ways and Means Committee hearing last month, HHS
Secretary Tommy Thompson all but repudiated Scully's tactics.
-
- "I may have been derelict in allowing my administrator,
Tom Scully, to have more control over it than I should have. ... And maybe
he micromanaged the actuary and the actuary services too much. ... I can
assure you that from now (on), the remaining days that I am secretary you
will have as much access as you want to anybody or anything in the department.
All you have to do is call me."
-
- Democrats asked Thompson on Feb. 3 and March 3 for a
complete record of Foster's estimates. They've yet to get it.
-
- Said HHS spokesman Bill Pierce: "We respond to all
inquiries in time and we will do the same" with these.
-
-
- Scully left the administration and in January took a
job with Alston & Bird, an Atlanta-based law firm that represents numerous
hospitals and health insurers. He was exploring jobs in the private sector
while he was pushing for passage of the prescription drug bill, thanks
to a waiver from Thompson that allowed him to conduct job interviews while
he was still a federal employee.
-
- In February, the White House announced that President
Bush's appointees no longer would be permitted to job-hunt while on the
federal payroll.
-
- Members of Congress and congressional staffers complained
that Scully's handling of Foster has deepened congressional mistrust of
the Bush administration and that withholding information makes it harder
for Congress to draft good legislation.
-
- Myrick didn't think the episode was an effort to "pull
the wool over our eyes."
-
- But Democratic Rep. Pete Stark of California felt otherwise.
"This `need to know, our eyes only' stuff is getting too restrictive
for us to do a decent job," said Stark, the ranking Democrat on the
House Ways and Means health subcommittee.
-
- For years before Scully's arrival in 2001, key lawmakers
had direct access to Medicare actuaries.
-
- In 1997, when Republicans were having trouble getting
health-care cost information out of the Clinton administration, Rep. Bill
Thomas, R-Calif., who's now the chairman of the House Ways and Means Committee,
added language to the Balanced Budget Act conference report to emphasize
the importance of free access to Foster.
-
- "The process of monitoring, updating and reforming
the Medicare and Medicaid programs is greatly enhanced by the free flow
of actuarial information from the Office of the Actuary to the committees
of jurisdiction in the Congress," the report says.
-
- "When information is delayed or circumscribed by
the operation of an internal Administration clearance process or the inadequacy
of actuarial resources, the Committees' ability to make informed decisions
based on the best available information is compromised."
-
- © 2004 KR Washington Bureau and wire service sources.
All Rights Reserved.
-
- http://www.realcities.com/mld/krwashington/8164060.htm
|
