MEDICARE HMOS: Pullouts Felt More Harshly By Some
The San Francisco Chronicle reports that HMO withdrawals from all or parts of Bay Area counties have brought charges from senior advocates that managed care plans are engaging in "medical redlining." Thousands of seniors are "facing a very real prospect that they will come out of these changes worse off than if they had never signed up with an HMO in the first place," as Medigap policies that were dropped in favor of Medicare HMOs may be difficult to reacquire. Monterey County's only Medicare HMO, Secure Horizons, is pulling out, leaving 4,300 enrollees with extremely limited options. The Chronicle reports that "[h]ardest hit are the disabled," because of new federal rules that "limit the responsibilities of insurers to cover those who are dumped from HMOs." In response to the HMO pullouts, seniors have been flooding HICAP -- "a state- financed service that helps seniors steer through the health care maze" -- with calls.
Consumer health care advocates decry the targeting of disabled and rural seniors. California Nurses Association Executive Director Rose Ann DeMoro said, "When you have to make a profit by denying medical care, you look for the people who need less care. That's where the money is." Bonnie Burns, education director of California's Health Insurance Counseling and Advocacy Program, pointed the finger at both Congress and HMOs: "They've taken an elegant and easy-to-understand national health insurance plan for seniors and turned it into something totally unrecognizable."
The controversy has come home to roost in San Mateo County, where Aetna notified the San Mateo IPA -- "a medical group that refers patients to Sequoia and Seton hospitals" -- that it was dropping the physician's group for an exclusive contract with Mills-Peninsula Medical Group. As a result, approximately 7,900 Medicare HMO recipients in the county will be forced to find new doctors. Aetna blamed the need for a switch on the region's low reimbursement rate, which is far below the rate paid in urban areas like Los Angeles and San Francisco. Hospitals in low-reimbursement regions "are being punished by Medicare for their efficiency" in keeping costs down, charged Mills-Peninsula Medical Group's Roxanne Loose. Secure Horizons USA President Craig Schub defended his company's actions, noting that its "pullouts affect only 2.5% of its members, mostly in rural areas." He said, "The kind of trimming we've done has been around the margins, like retail chains closing unprofitable stores" (Russell, 11/9).