Reflections on HCFA: Former Administrators Speak Their Minds
February 23, 2001
Created in 1977 to administer the Medicare and Medicaid programs, the Health Care Financing Administration (HCFA) took on significant new administrative and regulatory responsibilities in the succeeding decades. As its importance increased, scrutiny and criticism of the agency intensified, with several proposals being offered in Congress to restructure and/or abolish HCFA. This Forum session brought together the previous four HCFA administrators to help policymakers learn from their experience and gain perspective on the multi-faceted roles and functions of HCFA, the agency's evolvution over time, and the possible effects of proposed changes. Each of the presenters agreed that the climate around HCFA had become more adversarial in the previous ten years because of greater complexity, better organized interest groups, a polarized political environment between Congress and administrations, and efforts to deal with fraud and abuse in the Medicare program. Overall, however, they agreed that HCFA's greatest challenge was that the agency had been given too much to do with too few resources.
Nancy-Ann Min DeParle, Former Administrator, Health Care Financing Administration; William Roper, MD, Dean, School of Public Health, University of North Carolina at Chapel Hill; Bruce Vladeck, PhD, Senior Vice President for Policy, Mount Sinai NYU Health; Gail Wilensky, PhD, John M. Olin Senior Fellow, Project HOPE.