Analysis: Triple trouble for Medicare law

WASHINGTON, March 18 (UPI) -- The Medicare bill that squeaked through Congress in late fall and was signed into law by President Bush in December barely got off the ground before becoming embroiled in controversy and investigation on three different fronts.

The complex, multifaceted Medicare Prescription Drug Improvement and Modernization Act of 2003 added a drug benefit and mapped out a route toward further privatizing the senior health insurance program beginning in 2006.

Recent polls have found many seniors either are not aware of or do not understand the new Medicare law, and there are fears what is going on inside the Washington Beltway will translate into further confusion among the very constituency the legislation was enacted to help.

The first piece of controversy surrounds cost estimates for the bill itself. The Congressional Budget Office projected a $400 billion cost throughout the bill negotiations. After enactment, the Bush administration estimated the expenditures could reach $534 billion or more.

The critical issue is the administration withheld its data until after the law was signed, fearing a skittish conservative Republican wing would balk at voting for it if they saw a potentially larger price tag.

Democrats have cried foul, but the White House has said its budgetary process was ongoing and its numbers were in flux as it analyzed the legislation. There does not seem to be any consensus, however, regarding just how widely circulated any CMS numbers were in the months leading up to the final votes on the bill.

Growing out of this controversy is the new scandal involving Richard Foster, the chief actuary for the Centers for Medicare and Medicaid Services. In e-mail and interviews, Foster has said he feared being fired -- and possibly even was threatened with that punishment -- if he had released his budget numbers showing a cost estimate higher than the CBO prior to votes on the bill.

Democrats have called for a re-vote and congressional hearings, and the Department of Health and Human Services office of inspector general is investigating as well. Some lawmakers contend if such threats are substantiated, it not only is an ethical question but also, potentially, a criminal investigation, touching the legality of withholding information from Congress.

The Bush administration and HHS Secretary Tommy Thompson have agreed an investigation is needed. Thus, the blame game has begun in Washington, settling mainly on former CMS administrator Tom Scully, who has responded that he only told Foster once not to release any early figures and denies making any threats.

The administration has pointed out Congress is bound by law to consider only the CBO numbers anyway, while Democrats argue lawmakers should have been given a full range of estimates and information before voting.

The second Medicare controversy stems from the Nov. 22 vote in the House of Representatives, which approved the bill 220 to 215 but only after Republican leadership kept the vote open for three hours to arm-twist enough members to gain passage.

Sometime during the wee hours of that morning the leadership went to Rep. Nick Smith, D-Mich., who later alleged they had bribed him to vote for the bill by offering money in support of his son's candidacy for the House. Smith backed off the allegation later and said the offer of support was done in more general terms. He did not vote in favor of the bill.

The House Committee on Standards of Official Conduct this week voted to begin a formal inquiry through a special investigative subcommittee. The FBI and Justice Department already have opened investigations into the matter.

The third front of this controversy is the only one playing itself out away from Capitol Hill -- the TV ads the administration is running nationwide to inform seniors about provisions of the new Medicare law. When the ads first came out -- accompanied by written materials mailed to seniors claiming Medicare is the same but better -- the Democrats alleged that federal Medicare funds were used to create, in effect, Bush re-election campaign commercials.

The General Accounting Office investigated the claim and determined the ads were legal, but noted problems with how the administration handled them.

Now, the GAO has decided to reopen its investigation after it was discovered the video segments, scheduled to air during TV news programs, were made to look like actual news reports, yet used paid actors reading HHS written copy.

The Medicare Rights Center in New York City has said it is tripling its volunteer force and expanding hours to deal with the questions and fear of seniors regarding the new Medicare law.

A Kaiser Family Foundation telephone survey of 1,201 seniors last month found, even with the TV ads in play, 68 percent did not know the law had passed. Also, when seniors were asked if they understood it, 60 percent responded "not too well" or "not well at all."

AARP, which has taken a lot of heat for supporting the administration and urging passage of the legislation, has seen its membership ranks shrink by the tens of thousands as seniors cut up their membership cards in protest over the law.

In the months to come, the presidential campaign likely will muddy seniors' understanding further as each political party will attempt to frame the new Medicare law to its advantage.

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Ellen Beck's e-mail is ebeck@upi.com