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A Missed Opportunity with 'Mister Goodwrench' at the Ways and Means Committee

June 14, 2006 -- The House Ways and Means Committee hearing on Wednesday was supposed to be a chance to grill Centers for Medicare and Medicaid Services (CMS) Administrator Mark B. McClellan—dubbed "Mister Goodwrench" at the event because of his technical mastery of the issue—on the nuts and bolts of making Medicare prescription drug coverage function more smoothly.

But as is often the case at the committee's hearings, policy hopped into the backseat behind politics, with campaign-minded members seemingly more focused on what story line the press would take from the hearing than on the grimy details of fixing implementation glitches.

Nor did the hearing shed much light on one of its ostensible purposes—determining whether and when the committee's chairman, Bill Thomas, R-Calif., would support legislation waiving the penalty this year for late enrollment in the drug benefit.

Republicans offered up superlatives to McClellan and Department of Health and Human Services Secretary Michael O. Leavitt for the job they did implementing the benefit, which left only four million of Medicare's 43 million beneficiaries without prescription drug coverage. "It was just an amazing accomplishment," said Louisiana Republican Jim McCrery. Connecticut Republican Nancy L. Johnson said that in her 23 years on the Hill she had never seen such an aggressive effort to build a federal program. And Rep. Jim Ramstad, R-Minn., recounted how one elderly constituent expressed her gratitude for the benefit with "tears of joy."

Republicans also wasted no time blaming Democrats and the media for making enrollment more difficult. "I do want to say at the outset of the hearing that this success has come in spite of some pretty bitter partisan politics," Thomas said in his opening statement. "America's seniors have been able to see through the enormous negativity from many individuals in trying to convince anyone who would listen that this benefit is a farce. It was that negativity that the media reported on for most of the six-month enrollment period."

Arizona Republican J.D. Hayworth called Democratic carping about the benefit the result of an "ingestion of a massive dose of sour grapes."

Hayworth accused the other party of urging seniors not to enroll in the benefit—a charge much protested by Democrat after Democrat, with a number of them listing how many town meetings they held and pamphlets they distributed urging seniors to enroll.

"One example! One example!" Rep. Earl Pomeroy, D-N.D., demanded of Hayworth. "To suggest in any way that we discouraged people to sign up I think counters the facts," said Rep. Pete Stark, D-Calif. "It's a misrepresentation, it's a lie and I'm pissed about them saying [that]!" said Rep. Stephanie Tubbs Jones, D-Ohio.

But Rep. John Lewis, D-Ga., probably went farthest in disrupting any story line Republicans might have been trying to develop for the press at the hearing. Lewis told Leavitt, "I'm very concerned and really disgusted" about his reported use of a Centers for Disease Control and Prevention jet to travel to meetings around the country to promote the benefit.

Lewis called the travel public relations trips on a jet that costs taxpayers $3,000 an hour to fly. Leavitt could have used commercial airlines to travel to the events much more cheaply, Lewis said, adding that the jet is only supposed to be used for public health emergencies.

Leavitt countered that Congress authorized his use of the jet and that he also used it to travel to states to encourage planning for a potential flu pandemic. Both of those activities are worthwhile uses of the jet, he suggested, but he also noted the importance of reserving it for public health emergencies. Leavitt's office issued a statement saying that since January 11 he used the CDC jet on 19 trips to visit more than 90 cities at a cost of about $720,000. "This estimate includes the cost for other travelers on the aircraft including, depending on the trip, senior policy staff, subject matter experts, security personnel, and support staff," the statement said. The use of the aircraft "allowed him to participate in several events in multiple cities in a single business day," the statement continued. "For example, on his April 3–5 trip, the secretary would have had at least 43 hours less to perform important duties if he had not used the leased aircraft and extra travel time would have forced him to spend extra days on the road to accomplish the same events." His office said HHS checked first to see if there was a more pressing need for the jet and that "when feasible and less expensive, the secretary used other modes of travel."

When Lewis kept pressing Leavitt on the wisdom of using the jet, Johnson cut him off, saying his allotted time for questioning was over. "Regular order! Regular order!" shouted other Republicans as Lewis nevertheless persisted.

When the questioning got back to the drug benefit, Democrats emphasized that of those eligible for the low-income Medicare drug benefit who were not automatically enrolled, only one of every four have signed up for coverage. Rep. Xavier Becerra, D-Calif., said the government is paying a lot for a program in which many of the people who need help the most are not getting it.

McClellan said CMS is stepping up its efforts to enroll that population but said the administration has been more successful in its efforts than previous administrations have been in enrolling low-income Americans in assistance programs.

But Families USA Executive Director Ron Pollack claimed that the 25 percent enrollment rate means that "over five million of our neediest seniors remain without the help promised to them by Congress and [the] administration."

The National Council on Aging (NCOA), a coalition of grass-roots organizations that has helped enroll beneficiaries in the low-income benefit, has recommended new steps to target those not yet enrolled, including specialty call centers, added public and private sector funding of enrollment efforts, and more one-on-one enrollment counseling. The NCOA also urged Congress to eliminate the asset test for the low-income benefit. The test is used to limit the amount of assets a beneficiary can have and still qualify for low-income assistance.

More than half of the applications rejected for the benefit were ineligible because of failure to meet the asset test, the coalition said. "People who scrimped and saved to keep a modest nest egg but still have limited incomes should be encouraged and rewarded, not denied the extra help they need," NCOA said.

Thomas said he might hold at least one other hearing on implementation issues. "I think oversight activities are absolutely critical," he said. His inquiry is being timed to wait until the most opportune time in the congressional election season to decide on waiving the late fee, some analysts say.

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