[Congressional Record Volume 144, Number 55 (Wednesday, May 6, 1998)]
[Extensions of Remarks]
[Page E779]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




              MEDICARE: THE NEED FOR ADMINISTRATIVE FUNDS

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                         Wednesday, May 6, 1998

  Mr. STARK. Mr. Speaker, members constantly decry the problem of 
fraud, waste, and abuse in Medicare--and constantly underfund the 
agency that is responsible for administering Medicare.
  It is Congressional hypocrisy at its height. No one should criticize 
the administration of Medicare who does not support more resources for 
the beleaguered Health Care Financing Administration.
  Following is an excellent article by Julie Rovner of the National 
Journal's Congress Daily, entitled Congress v. HCFA: Bureaucracy 
Bashing 101.
  I would just add to Ms. Rovner's article that when HCFA sought $16 
million this spring it paid for it by offering to slash $16 million 
from another Medicare-related account--but even that was denied by the 
micro-managing Congress.
  Medicare beneficiaries should know who to blame when they are unable 
to get their questions answered from HCFA: it is the Congress that 
should be blamed.

      [From the National Journal's Congress Daily, Apr. 23, 1998]

               Congress v. HCFA: Bureaucracy Bashing 101

                           (By Julie Rovner)

       Frustrated politicians like to point out how hard it can be 
     to please constituents who simultaneously demand 
     contradictory things--like those voters who all at once want 
     increased spending, tax cuts, and no new additions to the 
     deficit. But sometimes, the politicians themselves behave 
     just as inconsistently.
       Take the Health Care Financing Administration, known--and 
     almost universally derided--as HCFA (pronounced Hickfa). The 
     HHS subunit that oversees Medicare, Medicaid, and, since last 
     year, the new children's health insurance program, HCFA is 
     the agency politicians most love to hate. In 1992, when he 
     was running for president, candidate Clinton in his ``Putting 
     People First'' manifesto vowed to ``scrap [HCFA] and replace 
     it with a health standards board made up of consumers, 
     providers, business, labor and government.''
       In short, anybody except bureaucrats.
       During the heated Medicare debate of 1995, Speaker Gingrich 
     claimed he never meant to suggest Medicare would ``wither on 
     the vine'' under the GOP's budget plan, merely HCFA.
       But Congress' second favorite pastime, after beating up on 
     HCFA, seems to be giving the agency even more work to do. 
     Since 1996, three different bills have increased HCFA's 
     responsibilities exponentially.
       ``It's the greatest workload in the history of the 
     agency,'' said Harvard Professor Joseph Newhouse, vice 
     chairman of the Medicare Payment Advisory Commission.
       And it is not like HCFA was a sleepy bureaucratic 
     backwater: Running Medicare and Medicaid already required it 
     to supervise the healthcare programs that will serve nearly 
     75 million Americans in 1998 and cost the federal government 
     $300 billion in 1997, 18 percent of the entire federal 
     budget.
       HCFA's latest onslaught began in 1996, with passage of the 
     Health Insurance Portability and Accountability Act. Not only 
     did HIPAA give the agency broad new responsibility to root 
     out fraud and abuse in Medicare (the accountability part), it 
     also made HCFA the fallback enforcement agency for states 
     that failed to pass their own laws to implement the 
     portability part. As of now, that includes five states: Rhode 
     Island, Massachusetts, Missouri, Michigan, and California.
       Later that fall, Congress ordered HCFA to implement 
     provisions tacked onto the VA-HUD appropriations bill barring 
     ``drive through'' baby deliveries and requiring limited 
     parity for mental health coverage.
       But that was only an appetizer. Last year's Balanced Budget 
     Act, according to HCFA Administrator Nancy-Ann Min DeParle, 
     gave the agency about 300 new tasks.
       In Medicare alone, the agency is expected to devise new 
     payment systems for home health, hospital outpatient, and 
     nursing home care; a new ``risk adjuster'' and new payment 
     methodologies for managed care plans; and rules for new 
     ``provider-sponsored organizations.'' And that is not to 
     mention devising how to inform Medicare's 39 million 
     beneficiaries about a vast array of new ``choices'' available 
     to them this fall.
       At the same time, HCFA is responsible for approving each 
     state's new children's health insurance program, and for 
     helping states locate and enroll the millions of children 
     eligible but not yet signed up for Medicaid.
       With that much more to do, you might think Congress would 
     also give HCFA more money to do it with. But it is so easy to 
     bash the bureaucracy that the Senate could not resist 
     striking HCFA's request for an additional $16 million for 
     FY98 during consideration of the supplemental appropriations 
     bill last month.
       HCFA officials said $6 million of that request was to hire 
     workers to enforce HIPAA in states that have yet to pass 
     their own legislation. The states in question contain a total 
     of 54 million citizens. ``The work requires knowledge and 
     expertise in the area of health insurance regulation at the 
     state level,'' said the agency in its supplemental request. 
     ``The nature of this work is totally unlike that performed by 
     HCFA's workforce.''
       But that plea fell on deaf ears. ``Do we want to turn that 
     much additional bureaucracy over to HCFA, that much more 
     money, or can't they borrow some more of those employees that 
     they now have who are probably reading through reports that 
     are obsolete and maybe not doing so much good?'' asked Senate 
     Majority Whip Nickles on the floor March 25.
       Evidently they can, according to the Senate. Members 
     adopted Nickles' amendment to strip the funding from the bill 
     after defeating, 51-49, an attempt by Senate Labor and Human 
     Resources ranking member Edward Kennedy, D-Mass., to keep 
     only half the money.
       The result of all this, says former CBO Director 
     Reischauer, is ``setting HCFA up'' for failure. ``It's 
     classic Congress,'' he said. ``There's no way HCFA can 
     accomplish the changes Congress has asked [it] to do. Then 
     [Congress] will be back in two years having oversight 
     hearings about how HCFA failed to do its job.''
       Mark your calendars now.

       

                          ____________________