Legistorm: Transparency's Sidekick

Key problems that undermine the ability of the Health Care Financing Administration (HCFA) to manage Medicare effectively can be solved. Currently, no one senior official in HCFA is responsible for managing only Medicare; instead, HCFA's Administrator oversees Medicaid and other state-centered programs' worthy competitors for agency management attention. Frequent changes in agency leadership make it difficult to develop and implement a consistent long-term vision. And constraints on HCFA's ability to acquire appropriate resources and expertise limit its ability to modernize Medicare's operations and carry out the program's growing responsibilities. Elements of recent Medicare reform proposals, together with alternatives from other federal agencies, suggest ways of addressing the focus, leadership, and capacity issues. Options could include creating an entity that would administer Medicare without any non-Medicare responsibilities; establishing a tenure for the program's administrator that, at minimum, would overlap presidential terms; and granting the entity administering Medicare greater operational flexibility.