Another partisan year ahead for Medicare

How to end the hemorrhage of insurers from the federal Medicare program will surely dominate Congressional debates during 2002, but as in past debates, those answers will depend on which side of the aisle they are coming from.

Medicare reform will await Senate action when Congress reconvenes in February 2002. The House unanimously approved the primary reform bill, "Medicare Regulatory and Contracting Reform Act" on Dec. 4, but lingering issues -- privatization, reimbursement levels, choice of Medicare's HMO

program, Medicare+Choice, or the traditional fee-for-service program, customer service, and prescription drugs -- promise to take center stage in upcoming Senate debates, and any final version that goes before Pres. Bush.

A spokesman for a leading critic of the president, Senate Majority Leader U.S. Sen. Tom Daschle (D-South Dakota), told UPI, "The senator will not support any so-called 'reforms' which cut benefits of seniors. Sen. Daschle is committed to the Medicare program in ways that strengthen the program and protect seniors' benefits." While the House bill does not specifically cut

benefits, its emphasis on privatization could likely contain ceilings on reimbursements to accommodate private insurers..

These same sentiments hold true for Pres. Bush's proposed prescription discount card, which the administration had to fight in federal court last September before being able to proceed with even the planning stage, according to news reports.

Daschle -- and with him the Democratic majority -- opposes the cards, said his spokesman, because "they benefit large drug companies as opposed to the Mom and Pop pharmacies." The White House maintains that such cards would provide up to 25 percent off many prescriptions and possibly up to 50 percent off certain generic brands. There are currently 14 million seniors paying

full retail price for prescriptions, according to a press spokeswoman from CMS.

Latest CMS estimates are that in 2002, 58 insurance providers will either leave or reduce services in Medicare's HMO program, Medicare+Choice created in 1997, affecting more than a half-million beneficiaries. Among the nearly 40 million Americans in Medicare, only about 15 percent, or 5.6 million,

chose Medicare+Choice. It's lost more than 1 million members and hundreds of plans have dropped out. In 2000 alone, the number dropped to 474 insurance plans compared to 1,200 in 1999.

The American Association of Health Plans issued a carefully worded wish list for 2002, including praise for the HMO option. "The task before the nation is to build on this contribution while developing plans to protect Medicare for future generations of seniors," they said. But Congress should, they continued, expand choices for beneficiaries and make them affordable; provide a government contribution that adequately funds choice; and develop an improved regulatory framework.

Looking ahead, a CMS spokeswoman said they are instituting a "culture of responsiveness" for both seniors and insurers. To that end, the agency has expanded the 800-number customer service phone line, by adding 1,000 operators. Moreover, on Jan. 7, 2002, the first hearing of a newly created advisory committee, promising to cut red tape for both patients and health

care providers, will take place. Health and Human Services Secretary Tommy Thompson promised this will be one of a number of hearings across the nation to get input from doctors, consumers and insurers. ``When we flood doctors and hospitals with excessive paperwork, patients suffer the consequences," Thompson said.

Another selling point, according to CMS, will be unprecedented coverage for preventive services: screening for ovarian, breast cancer, prostate and cervical cancers, for example. But Judith Stein, executive director of the consumer advocacy group, Center for Medicare Advocacy Inc.,

said that coverage of hearing aids, eye exams, contacts and eyeglasses, is equally urgent but not available through Medicare.

Moreover, said Stein, the Bush administration's widely touted delay of the "lock-in" provision doesn't go far enough. Beneficiaries were recently told they have an additional month to choose between the traditional, fee-for-service Medicare plan or the HMO. Yet an extra month will not seem like much of a bonus to seniors who opt into an HMO only to see them leave

the system in 2002, said Stein. "They need to be able to move between HMOs and traditional Medicare coverage" throughout 2002, she said.

Stein said their group is also concerned that, in 2002, the benefits appeals process is moving from the Social Security Administration to Medicare. "We're very concerned that Administrative Law Judges retain their independence, and their geographic diversity." There's an inherent conflict of interest, she said, that tips the scales against seniors.

The problems of privatization will remain the biggest issue for seniors, said Stein. "I think (it) is misguided and isn't based on the experience of the last five years," she said. Insurance firms have repeatedly voted with their feet away from Medicare HMOs because "they found they will not make a profit with the old and the sick."

The prescription cards are "not even a band-aid for a big wound," she said. And besides, "It's absolutely not what people want. They want a choice of treatments, not a choice of pharmacies."

While unpopular, what needs to happen, she said, is for the employee tax to increase, as opposed to reimbursement caps or dipping into any Medicare surplus. "There needs to be an increase because of our aging population," she said. "There's no free lunch."

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