Senate Democrats Ask GAO To Investigate Medicare Actuary’s Claims
Eighteen Senate Democrats on Thursday asked the General Accounting Office to look into allegations that the Bush administration prevented CMS' chief actuary from releasing his cost estimates for the Medicare legislation to Congress, the AP/Houston Chronicle reports (AP/Houston Chronicle, 3/18). A letter sent to GAO that was signed by 18 Democratic senators, including Minority Leader Tom Daschle (S.D.) and presidential candidate John Kerry (Mass.), asks the agency to determine whether the administration violated a provision barring use of federal funds to pay the salary of any government worker who "prohibits or prevents, or threatens to prohibit or prevent" another employee from communicating with Congress (Stolberg, New York Times, 3/19). The Philadelphia Inquirer last week reported that an e-mail from Medicare actuary Richard Foster to colleagues at CMS indicated he believed he might lose his job if he revealed his cost estimates for the Medicare legislation. Foster confirmed the allegations in interviews published in several newspapers Monday. According to Office of Management and Budget estimates released after Congress passed the legislation, the Medicare law will cost $534 billion over the next 10 years, $134 billion more than estimated by the Congressional Budget Office. Foster has said that the higher cost projection was known before the final House and Senate votes on the legislation in November but that Scully told him, "We can't let that get out." Scully has said that he did not threaten to fire Foster if the higher estimates were released. Scully also said that he "curbed Foster on only one specific request" made by Democrats at the time of the first House vote on the Medicare bill. Scully said, "They were trying to be politically cute" and get Foster to give an estimate on the bill "and put something out publicly so they [could] walk out on the House floor and cause a political crisis, which is bogus." Earlier this week, HHS Secretary Tommy Thompson requested that the department's Office of Inspector General look into the issue (California Healthline, 3/18).
Sen. Frank Lautenberg (D-N.J.), lead author of the letter to GAO, said, "I believe these actions by Bush administration officials to block Mr. Foster from providing Congress the true costs of the prescription drug bill clearly break federal law." He added, "The questions that need to be answered are: how many administration officials knew about it, and who in the administration gave the order to conceal the information." Rep. Henry Waxman (D-Calif.) on Thursday said he is drafting a letter to the White House asking for names of people involved in preventing the release of Foster's estimates. In addition, Sen. Edward Kennedy (D-Mass.) is considering drafting legislation that would make CMS an independent agency, according to a spokesperson for the senator (New York Times, 3/19).
The Wall Street Journal on Thursday reported that Jeffrey Flick, Scully's top aide, sent Foster an e-mail on June 20 saying, "Work on the numbers, and share them with Tom Scully only. NO ONE ELSE." In a second warning in bold-type in the same e-mail, Flick wrote, "The consequences for insubordination are extremely severe." Flick also instructed Foster to answer a request for information made by a Republican but to withhold answers to requests made by Democrats "until Mr. Scully authorizes the release," the Journal reported (California Healthline, 3/18). Foster said that that e-mail marked the only time his job had been threatened explicitly, but he added that "there were other instances in which Tom in an e-mail or just over the phone would clearly be unhappy and would say less formally something to the effect, 'If you want to work for the Ways and Means Committee, I can arrange that.'" In an interview with the Washington Post, Foster said that he believes the White House "participated in the decision to withhold analyses" of the Medicare legislation, adding that he thought Scully was "acting at times on White House instructions, probably coming from" Doug Badger, Bush's health policy adviser. According to Foster, Badger was "the White House official most steeped in the administration's negotiations with Congress over Medicare legislation" and "was intimately familiar with the analyses [Foster's] office produced," the Post reports. Foster said, "I just remember Tom being upset, saying he was caught in the middle. It was like he was getting dumped on" (Goldstein, Washington Post, 3/19). Foster is scheduled to testify before the House Ways and Means Committee next week (New York Times, 3/19).
Trent Duffy, White House deputy press secretary, said, "It is my understanding that Mr. Badger did not in any way ask anyone to withhold information from Congress or pressure anyone to do the same." Foster's account "diverges sharply" from what Thompson and other administration officials have said about why cost estimates were withheld, the Post reports. The administration has implied that Scully "acted unilaterally" in ordering Foster to withhold the estimates, according to the Post. According to Thompson, the administration did not have final cost estimates for the Medicare legislation until late December. Foster has said that his estimates from as early as last spring showed the legislation would be about $500 billion over 10 years (Washington Post, 3/19).
Robert Laszewski, a health consultant and former health insurance executive, said, "Everyone inside the Beltway -- Republicans, Democrats, liberals and conservatives -- all knew that the $400 billion was a very low, low side of what this was really going to cost." Robert Moffitt, a health official at the Heritage Foundation, said, "We have said the same thing from day one. This is an entitlement expansion of unknown cost. You've just got to face that fact." Rep. Jeff Flake (R-Ariz.) said, "It's safe to say that the votes would not have been there with a higher number. It was a bitter enough pill for many to swallow at $400 billion. At $550 billion, it would have been a bridge too far" (Welch, USA Today, 3/19). But Rep. Jim McCrery (R-La.) said, "My view is, it's much ado about nothing. ... It doesn't change the fact that a health care plan for senior citizens without prescription drugs is sorely deficient, and we cured that" (New York Times, 3/19).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.