HCFA: Experts Call For End To Agency Neglect
A bipartisan group of three former HCFA administrators and other health care luminaries are calling on Congress and the Clinton administration to give the agency financial and human resources commensurate with its duties. Published in the special Medicare issue of Health Affairs, former HCFA heads William Roper, Gail Wilensky and Leonard Schaeffer and other health care experts say a funding shortfall is crippling the agency and warn of "a management crisis for the agency and thus for millions of Americans who rely on it." They charge that "both Democrats and Republicans are culpable for the failure to equip HCFA ... [whose] ability to provide assistance to beneficiaries, monitor the quality of provider services and protect against fraud has been increasingly compromised by the failure to provide the agency with adequate administrative resources."
The Worst Of Times?
At a press conference, former Congressional Budget Office Director Robert Reischauer said the agency "faces a daunting challenge," and that "from HCFA's standpoint, these are not the best of times." The authors report that as Medicare spending has exploded from $21.5 billion in 1977 to $207 billion in 1997, with the number of beneficiaries served growing from 26 million to 39 million, the agency's workforce was actually smaller than it had been two decades earlier. The increased HCFA workload does not stem merely from Medicare: Congress has assigned substantial new regulatory responsibilities through the Health Insurance Portability and Accountability Act (HIPAA), the reforms -- especially the Medicare+Choice plan -- contained in the 1997 Balanced Budget Act and the Children's Health Insurance Program. Reischauer noted that many of the initiatives passed by Congress were ambiguous in their instructions to the agency. He said, "In our political system, when we wish to make a compromise, we often hand the ball to the administrative agency.
Exacerbating these problems, the authors note that the agency has suffered from a brain drain as some of its most accomplished staffers have left or been reassigned. Reischauer stressed that securing adequate human resources is essential to HCFA's success, and that the agency struggles to compete with the private sector in the current tight job market. The staffing shortages are striking in light of the fact that HCFA spends less than 3% of Medicare's budget on administrative expenses, compared to 12% to 14% for private-sector health insurance companies. Also, the authors argue that HCFA has faced "unrealistic implementation schedules" and has been hamstrung at times by meddling from Congress and the White House. They recommend that the National Bipartisan Commission on the Future of Medicare "consider ways in which the micromanagement of the agency by Congress and the [executive-branch] Office of Management and Budget could be reduced."
'State Of Disrepair'
The authors of the missive conclude, "Congress and the administration must reexamine the organization, funding, management and oversight of the Medicare program. Doing anything less is short-changing the public and leaving HCFA in a state of disrepair." The complete list of signatories: Stuart Butler, Heritage Foundation; Patricia Danzon, University of Pennsylvania; Bill Gradison, Health Insurance Association of America; Robert Helms, American Enterprise Institute; Marilyn Moon, Urban Institute; Joseph Newhouse, Harvard University; Mark Pauly, University of Pennsylvania; Martha Phillips, Concord Coalition; Uwe Reinhardt, Princeton University; Robert Reischauer, Brookings Institution; William Roper, University of North Carolina; John Rother, AARP; Leonard Scaeffer, WellPoint Health Networks; Gail Wilensky, Project HOPE (Adam Pasick, American Health Line).