California Representatives Discuss Difficulties with Medicare+Choice Reimbursements, Prescription Drug Benefit
Two California lawmakers recently discussed the difficulties that they faced in Congress over the past few years with plans to increase Medicare+Choice reimbursements and create a Medicare prescription drug benefit, issues that could play a role in the November elections, the Ventura County Star reports. Rep. Lois Capps (D), who campaigned in 1998 on the "availability of health care, particularly prescription drug coverage" for Medicare beneficiaries in 1998, said that she helped to increase reimbursement rates for Medicare HMOs in her district. According to Capps, a registered nurse, many Medicare HMOs -- which often cover the cost of prescription drugs and other services not provided under traditional fee-for-service Medicare -- would not offer plans to seniors in "mostly rural" Santa Barbara and San Luis Obispo counties, part of her district, as Medicare in 1997 established higher reimbursement rates for Medicare HMOs in urban areas than in rural areas. Capps last year successfully lobbied for a 12% increase in Medicare+Choice reimbursements for Santa Barbara County and a 12.5% increase for San Luis Obispo County. "Changing the reimbursement rates was the hue and cry, and we worked our tails off to get them adjusted," Capps said. However, she said that when "we got that increase ... it still didn't prevent the HMOs from leaving" Medicare+Choice markets in Santa Barbara and San Luis Obispo counties. No Medicare HMOs operate in north San Luis Obispo County, and only one operates in the southern part of the county, the Star reports. Rep. Elton Gallegly (R), who represents most of Ventura County, said that he has "tried repeatedly" without success in the past two years to increase Medicare+Choice reimbursement rates in the county. Medicare HMOs receive a reimbursement rate of $537 per month in Ventura County, compared to $650 per month in most of Los Angeles County, $553 per month in Santa Barbara County and $500 per month in San Luis Obispo County.
However, Capps said that increased reimbursement rates for Medicare HMOs represent only a "partial solution" to offering seniors prescription drug coverage. "We need to reform Medicare. We need a prescription drug benefit that's available and affordable to all," she said. Congress has debated a number of proposals to add a prescription drug benefit to Medicare, and analysts predict that issue may play a role in the elections in November. "The elderly vote, and at some point it may reach critical mass. And it may be by November," University of Southern California political science professor Sherry Bebitch Jeffe said (Smith, Ventura County Star, 3/10).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.