NOTE: The following is one of a series of case studies produced by the Union of Concerned Scientists' Scientific Integrity Program between 2004 and 2010 to document the abuses highlighted in our 2004 report, Scientific Integrity in Policy Making.

The administrator of Medicare threatened to fire his chief actuary if he communicated to Congress his cost estimates for the Medicare Prescription Drug Mobilization Act of 2003. As a result, members of Congress only saw a lower estimate of the cost of the bill before narrowly voting to approve it. The censored Medicare estimate was in line with the subsequent White House budget request for the program, although the estimate was not released until after the bill's passage.

On December 8, 2003 President Bush signed the Medicare bill into law following a contentious debate in Congress and an unusually long roll call vote.1 Weeks after the signing, the White House's 2004 budget request estimated the price of the Act at over $540 billion. This request was 35% higher than the $395 billion Congressional Budget Office (CBO) estimate that was used to pitch the bill to lawmakers. It is not unusual for the CBO's program cost estimates to differ from the White House's, but allegations of censorship by Medicare's chief actuary raised the possibility that higher estimates were suppressed for political reasons therefore skewing the information available to policy makers.

In March 2004, Richard Foster, the chief actuary for the Centers for Medicare and Medicaid Services, went public with claims that his boss, Medicare administrator Thomas Scully, had actively prevented him from releasing higher cost estimates—$551 billion over 10 years—in response to Congressional inquiries during the debate over the bill. In an interview, Foster said "In June 2003, the Medicare administrator, Tom Scully, decided to restrict the practice of our responding directly to Congressional requests and ordered us to provide responses to him so he could decide what to do with them. There was a pattern of withholding information for what I perceived to be political purposes, which I thought was inappropriate."2

Foster also said that Scully threatened to fire him if he told lawmakers about the higher numbers, an accusation that Scully initially denied. Cybele Bjorklund, a health policy staffer working for Democratic members of the House Ways and Means Committee also claimed that Scully told her that if Foster gave her the cost estimates, "I'll fire him so fast his head will spin."3