Ex-Medicare chiefs say agency managers face massive task

Two former Medicare heads -- one Democrat and one Republican -- warned a Senate subcommittee today that the agency faced an immense task implementing last year's Medicare law in time for a January 2006 launch of the new drug benefit, and suggested that Congress and the administration develop a contingency plan in case the deadlines cannot be met.

"This is a very tight squeeze," Gail Wilensky, who ran Medicare in the first Bush administration, told the Senate Governmental Affairs Government Management Subcommittee. "Controversial regulations are very difficult to deal with." She responded to panel members' complaints about the length of the period between passage of the law and the start of the drug benefit by pointing out that "corporate America does not have to go through the Administrative Procedures Act process."

The Clinton administration's Medicare chief, Nancy-Ann Min DeParle, said that she was also concerned about the regulatory process, but that she was even more worried about some of the actions that would need to occur once the regulations were written -- including the bidding process for plans and beneficiary education. "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 warned about a continuing "brain drain" at the Centers for Medicare and Medicaid Services. An estimated 30 percent of its senior career employees are eligible to retire, said Government Management Subcommittee Chairman George Voinovich, R-Ohio, and in the last three years, a quarter of its career executives have left.

DeParle added that while the Senate should be commended for its quick confirmation of Mark McClellan to head the agency, she remained worried about the impending departure of Health and Human Services Secretary Tommy Thompson, who has announced he will leave after the November election. When she was struggling to implement the more than 400 separate changes imposed by the 1997 Balanced Budget Act, DeParle said, "I relied heavily upon Secretary [Donna] Shalala's judgment and especially her support in marshaling the resources of the department to get things done."

Michael McMullan, a career CMS employee, who is overseeing implementation of the new drug discount cards, acknowledged in her testimony that the new law would require the agency to acquire expertise it currently lacks -- including hiring personnel who understand pharmacy benefits management and disease management, as well as information technology personnel "experienced with the types of payment systems contemplated by the law." McMullan added that the agency "is making good headway" with the enormous task before it.