Copyright 2000 The Hartford Courant Company
THE
HARTFORD COURANT
September 16, 2000 Saturday, STATEWIDE
SECTION: EDITORIAL; Pg. A10
LENGTH: 524 words
HEADLINE:
CONGRESS MUST BOLSTER MEDICARE HMOS
BYLINE: John K. Springer; Chairman of the Board;
MedSpan Health Options Inc.; Hartford
BODY:
The
Courant's Aug. 8 news story "Your Medicare HMO Dropped You; Now What?" clearly
portrays the grim reality facing one of the nation's most needy health care
populations -- the elderly and disabled.
What it fails to point out is
that millions of American seniors and people with disabilities are losing today
because the government has refused to adequately fund Medicare HMOs. The
unfortunate result is that HMOs that deliver these benefits are being forced
either to withdraw from Medicare markets around the nation or to decrease
benefits and increase out-of-pocket costs to beneficiaries.
In
Connecticut, the number of enrollees affected by the Medicare HMO withdrawals is
52,000, or half of Connecticut beneficiaries and 5 percent of the approximately
934,000 receiving care from Medicare HMOs nationwide.
Approximately one
in five Connecticut seniors, many of whom are financially vulnerable, have
joined Medicare HMOs because they get better benefits at lower costs. Many
simply cannot afford to go back to the old fee-for-service structure which is
much more cumbersome, confusing and fragmented than the Medicare HMO program.
Connecticut currently ranks below the national midpoint for Medicare HMO
payments. It is projected that by 2004 the government payments for traditional
fee-for-service Medicare will exceed government payments to Medicare HMO plans
by $1,000 or more per beneficiary.
At this rate, with the increase in
Medicare reimbursement pegged at 2 percent per year and the projected medical
inflation rate at somewhere between 8 and 10 percent, it is inevitable that more
HMOs will pull out of the Medicare market.
The Balanced Budget
Refinement Act of 1999 attempted to address the crisis in the Medicare HMO
program, but it provided only a small fraction of the resources that were needed
to fully stabilize the program on a long-term basis.
Washington fails to
recognize that seniors and the disabled who return to traditional
fee-for-service Medicare will face higher out-of-pocket costs and reduced
benefit coverage. It also is unclear whether the traditional fee-for-service
system can support the entire Medicare population if Medicare HMOs fail to
thrive.
In an effort to gain state and federal support for Medicare HMO
reform, MedSpan Health Options, a provider-sponsored health maintenance
organization with more than 13,000 Medicare members, has joined forces with
State Sen. Edith Prague, Connecticut's Select Committee on Aging and the
American Association of Health Plans.
Our collective goals are to
achieve reform in two areas:
Washington must adequately fund Medicare
HMO plans and should require the Health Care Finance Administration to implement
risk adjustment in a budget-neutral manner.
HCFA should
streamline administration of the Medicare HMO program by reducing the burden and
expense of prescriptive government regulation.
The future of Medicare
depends on the revitalization of a strong and sound Medicare HMO program. As a
growing number of individuals are aging into the system each day, Congress must
step up to the plate and adequately fund a proven solution.
GRAPHIC: GRAPHIC: (b&w), PEDRO MOLINA
LOAD-DATE: September 18, 2000
