Former HCFA Administrators Testify Before Congress, Call for More Agency Funding, Greater Administrative Flexibility
HCFA needs additional resources, including money and staff, if the agency is to maintain its current responsibilities, four former HCFA administrators -- dubbed the "Mount Rushmore of HCFA" by Rep. James Greenwood (R-Pa.) -- told members of the House Energy and Commerce Committee health and oversight and investigations subcommittees yesterday. With HCFA administrator nominee Thomas Scully observing from the audience, William Roper, Gail Wilensky, Bruce Vladeck and Nancy-Ann DeParle testified in the third hearing of the subcommittees' "Patients First: A 21st Century Promise to Ensure Quality and Affordable Health Coverage" series. Roper, dean of the University of North Carolina-Chapel Hill Public Health School, said, "When I hear people brag about how little Medicare spends on administration, I cringe. That should be a source of embarrassment, not pride." Roper called for HCFA to have an "adequate" workforce, "new legislative and regulatory flexibility" and the ability to "work in an environment of reasonable expectations from the public, the [Bush] administration and the Congress." Saying that HCFA's dual responsibility for traditional Medicare and Medicare+Choice programs is not a "stable, viable and long term option," Wilensky, chair of the Medicare Payment Advisory Committee and a senior fellow for Project Hope, suggested that HCFA should be reorganized to focus strictly on running a "modernized, traditional Medicare program." But she cautioned that any changes that are made should be timed in such a manner as to not disrupt HCFA's operations. Vladeck, senior vice president for policy at the Mount Sinai School of Medicine Institute for Medicare Practice, said that the agency should place an emphasis on educating providers about Medicare regulations, a practice that HCFA is doing much less of now because of insufficient funding. DeParle, a health policy consultant and senior adviser at JP Morgan Partners LLC, echoed concerns that HCFA does not have the funding, nor the flexibility, to fulfill all the tasks Congress has required of it. In particular, she called for greater resources for improved "customer service," saying that every provider should have a manual that clearly describes Medicare rules and guidelines. DeParle also said that HCFA needs greater authority in selecting and overseeing government contractors -- mostly insurance companies that are responsible for paying Medicare claims.
Funding and Resource Issues
Congress has had "no qualms" about increasing HCFA's workload without simultaneously increasing the agency's funding, health subcommittee ranking member Sherrod Brown (D-Ohio) said, later asking witnesses to specify how much of an increase the agency would need and where that money should go. Roper suggested the agency needed "at least" a 25% budget increase, which could be used to hire "new kinds" of staff; people who are familiar with private insurance and those who could "enhance" communication with providers and beneficiaries. Also calling for an increase in the number of staff, Vladeck suggested that each Social Security Administration office have a specialist trained in Medicare issues and that HCFA have account executives serving in customer service areas. DeParle added that the agency needs funding to implement information technology systems. DeParle suggested that the agency's budget double over five years. Wilensky suggested a 10% to 15% increase, adding that if HCFA implemented a more modernized billing system, the agency could also save money spent on operations. While Health subcommittee Chair Michael Bilirakis (R-Fla.) noted that there is "no disagreement" among congressional members and health officials that HCFA has a "constrained" budget, he suggested that the former administrators in the past perhaps had not properly emphasized the agency's need for funding. Bilirakis added that President Bush's FY 2002 budget calls for an increase in HCFA's budget (Amanda Wolfe, Kaiser Daily Health Policy Report, 5/11). CongressDaily reports that Bush has proposed a 9% increase in the agency's operating budget (CongressDaily, 5/10). For more information on the hearing, including written witness testimony and an audio file of the proceedings, go to http://energycommerce.house.gov/107/hearings/05102001Hearing212/hearing.htm.
