English stunned by president’s refusal to reevaluate
Medicare+Choice
English: Surplus should cement program,
not finance others
WASHINGTON, Oct. 25, 1999 – With President Clinton’s opposition
to restoring cuts in Medicare that have forced insurance rates for
seniors up and benefits down, U.S. Rep. Phil English expressed his
dismay at the administration’s lack of interest in seniors’ needs.
In a letter to Congressional leaders, Clinton refused to slow
implementation of the “risk adjustment” system saying that a further
slow down of it’s implementation is “unwarranted.” Medicare+Choice
is the program which funds Security Blue in northwestern
Pennsylvania. Security Blue officials have said that the risk
adjuster system short changes northwestern Pennsylvania seniors.
English has already said he would seek a legislative solution
after a “disappointing” meeting in August with the Health Care
Financing Administration (HCFA), which oversees the program.
“I was highly disappointed to read that President Clinton has
refused to make adjustments to the Medicare+Choice program,” English
said. “Instead, the president choose to turn his back on seniors
some of whom will be forced to choose between paying for health care
or paying the rent because of his unwillingness to recognize their
suffering.”
English and the health subcommittee maintain that the
administration could restore at least $5.6 billion in cuts during
the next five years through changes in the regulations. English also
put his views on the record during a House Ways and Means hearing on
a measure that would strengthen Medicare through refinements to the
Balanced Budget Act.
“With the creation of Medicare+Choice program, Congress intended
to create a system that offered seniors a choice in their health
care coverage,” English said in the statement. “Congress never
wanted the program to be a vehicle for the Clinton Administration
and the Health Care Financing Administration to vacuum huge savings
from the Medicare program.”
English has requested that the Health and Human Services
Secretary and HCFA to reevaluate the risk adjuster for
Medicare+Choice and put the savings created by the program back into
programs for seniors “instead of using the Medicare+Choice system as
a cash cow to finance other programs.”
“In my Congressional district, seniors -- many of whom are on a
fixed income -- are faced with reduction of benefits and an increase
of premiums effective January 1, 2000 and all because the
Administration has failed to provide adequate reimbursements to
cover the costs of health care in northwestern Pennsylvania,” he
said.
HCFA 's reimbursement system uses a complicated series of
“factors” to determine the amount of money they are willing to pay
an HMO for Medicare+Choice clients. Reimbursement rates can vary by
almost 100 percent from region to region. The factors are based on
information from 1996 and include such things as the average number
of hospital visits, length of stay, costs for senior
hospitalizations and average doctor costs in any given county.
Final rates are then calculated by employing a “risk adjustment
system” which “fine tunes” reimbursements to reflect actual medical
claims by individual seniors. The risk adjustment system is being
phased in this year.
“Reevaluating the risk adjusters would reaffirm the commitment of
the Congress and the Administration to expanding choice and
achieving stability in the Medicare+Choice marketplace which is what
President Clinton has maintained is his intention,” English said. “I
urge the President to recognize the devastating effect his decisions
concerning Medicare+Choice program is having on seniors.”
The system has the effect of rewarding high-cost urban centers
with higher reimbursements, while more rural and inexpensive areas
like northwestern Pennsylvania are punished, English said, adding
that the system fails to account for the current medical needs of
seniors, and it completely ignores outpatient costs in it's
calculation.
“The initial intention of Congress in the Balanced Budget Act of
1997 was not to push seniors to their economic limits but rather
create a more efficient health care system with more choices,”
English said. “A refined Medicare+Choice would expand access to
quality health care, including prescription benefit programs. With
this risk adjuster system the opposite is happening. Both the
Administration and Health Care Financing Administration need to
recognize that they are hurting seniors with their actions.”
The Ways and Means Committee approved a bipartisan plan Thursday
to strengthen the Medicare program for current and future
recipients. The Medicare Balanced Budget Refinement Act of 1999
(H.R. 3075) will increase seniors' access to health care by giving
more flexibility to the providers who care for them. he plan passed
the committee 26-11. The administration offered an amendment to the
plan that proposed Medicare reductions, which would have cut
billions of dollars from the Medicare program, English said.
The plan calls for an increase of payments for skilled nursing
facilities and long-term care while allowing for separate billing
for items such as prosthetics. It also establishes a process for
urban hospitals to re-classify to rural status, allows rural
hospitals to take advantage of technological updates, creates
uniform policies for lab tests and removes the strict caps on the
reimbursements seniors receive for speech, occupational and physical
therapy.
“Strengthening Medicare is of the upmost importance so that it is
there when seniors need it,” English said. “Our plan clearly does
that by addressing various areas where unintended cuts to benefits
were made.” | 
U.S. REP. PHIL ENGLISH