New Medicare Law Will Be Difficult To Implement, Former CMS Administrators Say
CMS faces "an immense task" in implementing the new Medicare law in time for the January 2006 start of the law's prescription drug benefit, two former administrators told members of the Senate Governmental Affairs Subcommittee on Government Management on Thursday, CongressDaily reports. Gail Wilensky, CMS administrator in the first Bush administration, said that implementing the Medicare law "is a very tight squeeze," adding, "Controversial regulations are very difficult to deal with." Responding to lawmakers' complaints about the time between the law's passage and implementation of the prescription drug benefit, Wilensky said that "corporate America does not have to go through the Administrative Procedures Act process." Nancy-Ann Min DeParle, CMS administrator in the Clinton administration, said that she is concerned about the regulatory process but is "even more worried" about some of the steps that must be taken once the regulations are written, CongressDaily reports. "There are a lot of details that will have to be final when (beneficiaries) get that piece of paper in the mail" in October 2005, she said. Both Wilensky and DeParle suggested that Congress and the Bush administration develop a contingency plan if deadlines for implementing the drug benefit are missed, according to CongressDaily. They both also warned about the continued "brain drain" at CMS. Subcommittee Chair George Voinovich (R-Ohio) noted that about 30% of senior career employees at CMS are eligible to retire and 25% of CMS career executives have left over the last three years. DeParle added that she is concerned about the expected departure of HHS Secretary Tommy Thompson, who has announced his intentions to leave after the November election. She added that the secretary has the ability to "marsha[l] the resources of the department to get things done." Michael McMullan, a CMS official who is managing the implementation of the new prescription drug discount cards, said that the new Medicare law will require CMS "to acquire expertise it currently lacks," CongressDaily reports. McMullan said that CMS must hire personnel who understand pharmacy benefit and disease management, as well as personnel "experienced with the types of payment systems contemplated by the law." McMullan added that the agency is "making good headway" in implementing the law (Rovner, CongressDaily, 4/8).
The Washington Post on Friday examined the debate surrounding the prescription drug prices under the new Medicare law. Although the General Accounting Office, some lawmakers and others have recommended that the federal government negotiate prices with drug companies as the Department of Veterans Affairs does, the new law prohibits the practice. Sen. Edward Kennedy (D-Mass.), who has filed legislation that would eliminate the ban, said in a statement, "The single most irresponsible provision in the Medicare bill is the prohibition that prevents Medicare from negotiating lower-priced prescription drugs." Rep. Tom Allen (D-Maine) said that using the government's bulk purchasing power "would drive down prices for Medicare first and eventually across the board." However, opponents of using the government's purchasing power contend that it would "amount to a government monopoly and a system of price controls," the Post reports. James Pinkerton, a fellow at the New America Foundation, said that using the government's purchasing power would lead to drug shortages and large reductions in pharmaceutical research. Leslie Norwalk, acting deputy administrator of CMS, said that by letting insurance companies and pharmacy benefit managers run the new drug benefit, Medicare will benefit from "seasoned private sector negotiators," the Post reports. "I am confident that beneficiaries will get prices similar to those we see in the commercial market," Norwalk said, adding, "The same companies that are negotiating on behalf of senators, congressmen and Cabinet secretaries will also be negotiating on behalf of Medicare beneficiaries" (Connolly, Washington Post, 4/9). NPR's "Morning Edition" Friday reported on early reaction to the Medicare prescription drug discount card at town hall meetings with seniors. The segment includes comments from Thompson (Silberner, "Morning Edition," NPR, 4/9). The complete segment is available online in RealPlayer.This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.