This story has gotten very little press coverage -- despite being a huge problem for our community. I thought I'd bounce this off of those here. Any thoughts? Barely a year old, the US government's attempt to make Medicare more efficient by turning to HMO's, is failing. Of the six initial health insurance companies in the Harris County Area, five announced they would not attempt to renew their contracts for 2001. No negotiation or discussion -- they are just bailing out. The reason -- reimbursement doesn't cover their costs, and expensive burecratic red tape. There were several stories on this last week -- but here's an editorial from today's Chronicle. http://www.chron.com/cs/CDA/story.hts/editorial/597120 Medicare maze -- Alternatives to explore for seniors' HMO options Houston-area senior citizens on Medicare are down to but a single health maintenance organization option -- PacifiCare Health Systems' Secure Horizons. All over the country private managed-care plans are declining to renew their contracts with the government, leaving millions of seniors in the same dilemma. The companies that are bailing out say the government is not providing sufficient funding to cover the costs of providing this care and that a costly mountain of bureaucratic red tape is involved. Health Care Finance Administration officials say the HMOs get funding sufficient to cover basic benefits and that the agency has taken steps to address complaints of too much red tape and has simplified regulations. It's a complicated and perplexing business for most of us. For instance, as Chronicle business writer Mary Sit-Duvall wrote in a recent story, "Health plans get reimbursed a set amount per person enrolled, an amount that varies by county. For example, the government's average reimbursement for each HMO enrollee is $644.22 in Harris County vs. an average of $532.21 in adjacent Fort Bend County. The complexity makes it difficult to determine which side is telling the truth. But the Congress created the Medicare+Choice program in the Balanced Budget Act of 1997 to broaden patient access to health plans. The net result is that so many retirees are left with a narrower choice, that is, between fewer -- or no -- HMO options and returning to traditional Medicare, which does not offer prescription drug benefits but allows beneficiaries to choose any doctor they want. The Medicare issue is, of course, just one part of a larger and even more complex health-care debate going on across the board in this country. However, there is one possible solution to the Medicare part of this crisis that hasn't yet gotten sufficient attention and now deserves a closer look. The National Bipartisan Commission on the future of Medicare, chaired by U.S. Sen. John Breaux, D-La., and Rep. William Thomas, R-Calif., proposed a reform model based on the Federal Employees Health Benefits Program, a system of competing private plans with minimal regulation that now covers about 9 million federal workers, retirees, their families and the president and the Congress. Robert E. Moffit, director of Domestic Policy Studies at the Heritage Foundation (www.heritage.org) has taken a closer look at this issue and has studied how a program modeled on the FEHBP plan would avoid the Medicare+Choice pitfalls such as its complex system of administrative pricing, its inflexibility, its overregulation and the artificial limits set by Congress on the annual rate of growth of payments to participating plans. At the least, Congress needs to revisit the level of detailed regulation imposed on private plans by government regulators and the funding requirements. In fairness, it also should be looking at the profit/loss figures claimed by the private insurers. But a closer look at the plan that covers the president and the lawmakers themselves is long overdue. ------------------ Stay Cool...
