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Foster: White House Had Role In Withholding Medicare Data
HHS Actuary Feels Bush Aide Put Hold on Medicare Data

By Amy Goldstein
Washington Post Staff Writer
Friday, March 19, 2004; Page A02

Richard S. Foster, the government's chief analyst of Medicare costs who was threatened with firing last year if he disclosed too much information to Congress, said last night that he believes the White House participated in the decision to withhold analyses that Medicare legislation President Bush sought would be far more expensive than lawmakers knew.

Foster has said publicly in recent days that he was warned repeatedly by his former boss, Thomas A. Scully, the Medicare administrator for three years, that he would be dismissed if he replied directly to legislative requests for information about prescription drug bills pending in Congress. In an interview last night, Foster went further, saying that he understood Scully to be acting at times on White House instructions, probably coming from Bush's senior health policy adviser.

Foster said that he did not have concrete proof of a White House role, but that his inference was based on the nature of several conversations he had with Scully over data that Congress had asked for and that Foster wanted to release. "I just remember Tom being upset, saying he was caught in the middle. It was like he was getting dumped on," Foster said.

Foster added that he believed, but did not know for certain, that Scully had been referring to Doug Badger, the senior health policy analyst. He said that he concluded that Badger probably was involved because he was the White House official most steeped in the administration's negotiations with Congress over Medicare legislation enacted late last year and because Badger was intimately familiar with the analyses his office produced.

The account by Foster, a longtime civil servant who has been the Medicare program's chief actuary for nine years, diverges sharply from the explanations of why cost estimates were withheld that were given this week by White House spokesmen and Health and Human Services Secretary Tommy G. Thompson. They suggested that Scully, who left for jobs with law and investment firms four months ago, had acted unilaterally and that he was chastised by his superiors when they learned of the blocked information and the threat.

Two days ago, Thompson told reporters: "Tom Scully was running this. Tom Scully was making those decisions." Thompson said the administration did not have final cost estimates until late December predicting that the law would cost $534 billion over 10 years, $139 billion more than the Congressional Budget Office's prediction. Foster has said his own analyses as early as last spring showed that the legislation's cost would exceed $500 billion.

Last night, White House deputy press secretary Trent Duffy said, "It is my understanding that Mr. Badger did not in any way ask anyone to withhold information from Congress or pressure anyone to do the same." Duffy said he asked Badger this week whether he had done so and that Badger replied he had not. Duffy said that Badger was traveling last night and was unreachable to comment. Calls to his home were not returned.

Foster suggested the White House had been involved as new details emerged of the manner in which he had been threatened. The actuary released an e-mail, dated last June 20, from Scully's top assistant at the time regarding one GOP request and two Democratic requests for information about the impact of provisions of the Medicare bill on which the House would vote a week later.

In a bold-faced section of the three-paragraph note -- reported in yesterday's Wall Street Journal -- Scully's assistant, Jeffrey Flick, instructed Foster to answer the Republican's question but warned him not to disclose answers to the Democratic queries "with anyone else until Tom Scully explicitly talks with you -- authorizing release of information. The consequences for insubordination are extremely severe."

The warning came in response to an e-mail Foster had sent to Scully that same Friday afternoon, 22 minutes earlier, in which he said the three questions "strike me as straightforward requests for technical information that would be useful in assessing drug and competition provisions in the House reform package." Foster offered in that e-mail to show Scully his proposed replies in advance.

Flick, who now oversees the Medicare agency's regional office in San Francisco, did not return several phone calls.

Scully was out of town and did not respond to efforts to reach him via e-mail last night. He said in an interview this week that he and Foster had disagreed over how helpful an executive branch employee needed to be to Congress. He called it "a separation of powers issue."

In 1997 budget legislation, Congress sought unsuccessfully to require the Medicare actuary to respond to all of its requests. Such language was included in a conference report on the bill but does not carry the force of law.

Foster said that the e-mail was the only instance in which he had been explicitly threatened in writing, but that "there were other instances in which Tom in an e-mail or just over the phone would clearly be unhappy and would say less formally something to the effect, 'If you want to work for the Ways and Means Committee, I can arrange that.' "

The actuary said that in June 2001, shortly after Scully arrived, he directed Foster to send weekly reports of any requests for information he had received from Capitol Hill or elsewhere in the administration.

Congressional Democrats yesterday called for the General Accounting Office to investigate the episode. Thompson announced Tuesday he had ordered HHS's inspector general to conduct an inquiry.

© 2004 The Washington Post Company



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