-- 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.
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.
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.
Sue Myrick of North Carolina, one of the 13
Republicans, said she was "very upset"
when she learned of the higher estimate.
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.
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
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
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."
Ridder obtained a copy of the e-mail.
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.
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.
and Human Services Department officials turned
down repeated requests to interview Foster.
The Medicare office falls under the control
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.
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,"
just said, 'Look, (Foster) works for the executive
branch; he's not going to do it, period,'"
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."
said Liz Fowler, the chief health lawyer for
the Democrats on the Senate Finance Committee,
could confirm the actuary's independence.
a liar," she said of Scully.
a Ways and Means Committee hearing last month,
HHS Secretary Tommy Thompson all but repudiated
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."
asked Thompson on Feb. 3 and March 3 for a
complete record of Foster's estimates. They've
yet to get it.
HHS spokesman Bill Pierce: "We respond
to all inquiries in time and we will do the
same" with these.
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.
February, the White House announced that President
Bush's appointees no longer would be permitted
to job-hunt while on the federal payroll.
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.
didn't think the episode was an effort to
"pull the wool over our eyes."
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
years before Scully's arrival in 2001, key
lawmakers had direct access to Medicare actuaries.
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
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
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.
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