Senate approves Bush's choice to lead Medicare

Majority leader vows to help develop measure to allow drug imports

March 13, 2004|By NEW YORK TIMES NEWS SERVICE

WASHINGTON - The Senate confirmed Dr. Mark B. McClellan, President Bush's nominee to run Medicare and Medicaid, yesterday after the Senate majority leader promised to help develop legislation to allow imports of lower-cost prescription drugs, with safeguards to protect consumers.

The nomination was approved without a roll-call vote.

Administration officials wanted to get McClellan into his new job so he could carry out and defend the sweeping Medicare law that Bush signed Dec. 8. The law will expand Medicare to cover prescription drugs and gives private health insurance companies a big new role in the program.

As commissioner of the Food and Drug Administration for the past 16 months, McClellan has led an aggressive campaign to block unauthorized imports of low-cost medicines. Such products, he says, are often counterfeit or contaminated.

But support for drug imports has been growing among consumers, state and local officials and members of Congress, who say the new Medicare law does not do nearly enough to make drugs affordable.

Sen. Byron L. Dorgan, a North Dakota Democrat and an outspoken advocate of drug imports, had blocked a Senate vote on McClellan by placing a "hold" on the nomination. Dorgan yielded after extracting the promise from the majority leader, Tennessee Sen. Bill Frist.

On the Senate floor, Frist declared, "The Senate will begin a process for developing proposals that would allow for the safe reimportation of FDA-approved prescription drugs."

Dorgan said: "This is a significant shift. It will inevitably lead to a change in public policy that will allow for the safe importation of prescription drugs. The question is not whether. The question is how."

Dorgan said he expected a Senate vote before the November elections. But an aide to Frist said the majority leader had not promised "a vote on a date certain." The House voted in July to allow Americans to import prescription drugs from Canada and Europe.

A new furor erupted over the Medicare law yesterday as lawmakers reacted to a newspaper report that the Bush administration had threatened to fire the chief Medicare actuary if he disclosed details of his cost estimates to Congress last June.

The estimates by the actuary, Richard S. Foster, were much higher than the estimates of the Congressional Budget Office, which said the legislation would cost $400 billion over 10 years.

Knight Ridder newspapers reported that in an e-mail message to colleagues on June 26, Foster wrote, "I'm perhaps no longer in grave danger of being fired, but there remains a strong likelihood that I will have to resign in protest of the withholding of important technical information from key policy-makers for political reasons."

The Medicare legislation was constantly in flux. But if Foster's cost estimates had been known at the time, the House might not have passed the bill. The House version of the legislation was approved by one vote, 216-215, on June 27.

The Senate Democratic leader, Tom Daschle of South Dakota, said the withholding of the actuary's cost estimates was "one of the most reprehensible actions that I have seen since coming to Congress."

Daschle, a harsh critic of the Medicare law, said yesterday that "we ought to bring this bill back for another vote" because it was passed on the basis of what he called "untruthful misrepresentations."

Thomas A. Scully, who was administrator of the Medicare program at the time, acknowledged yesterday that he had had disagreements with Foster, but denied having threatened to fire him.

"I can't believe Rick sent that e-mail," Scully said in an interview. "Rick was never in danger of being fired. I never told Rick he would be fired."

Federal law gives the chief actuary an unusual degree of job security, saying he "may be removed only for cause." In 1997, Congress declared that the actuary should provide impartial advice to Congress on the effects of legislative proposals.

Scully said Foster "may have felt some pressure from me" because Scully had told him not to prepare certain cost estimates requested by House Democrats. Scully said he feared Democrats would use the data to attack Republican Rep. Bill Thomas of California, the chief architect of the Medicare bill.

Kevin W. Keane, a spokesman for the Department of Health and Human Services, said: "In the heat of the moment, there was some frustration, but we are not interested in rehashing the issue. We are focused on carrying out the Medicare law, to save money for seniors on their prescription drugs."

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