MEDICARE+CHOICE: Clinton To The Rescue?
In a White House ceremony today, President Clinton is expected to "announce several steps" to assist Medicare HMO enrollees whose coverage will be dropped at the end of the year. The president also is expected to assail the HMO industry for abdicating its responsibility to seniors. The New York Times reports that Clinton's "intervention represents a swift turnabout for the administration, which initially played down the significance of the HMO actions, saying they were mere business decisions." Already, HMOs have announced that they will withdraw Medicare coverage in 300 counties in 22 states (Pear, 10/8). The Medicare HMO exodus, as it stands, will affect 412,000 people beginning Jan. 1.
The Wall Street Journal reports that the president "will pledge to expedite approvals for health plans that want to start operations in locations" where others are backing out. Although 43 plans are ceasing all Medicare operations, and 51 others will withdraw from certain areas, 48 other HMOs have already applied to begin Medicare service. Also, the Department of Health and Human Services will begin an education campaign to inform seniors that they have the option of returning to a traditional Medicare fee-for-service plan and purchasing Medigap policies (10/8). "In addition," the Times notes, "a White House official said Mr. Clinton would ask" HHS Secretary Donna Shalala to draft legislation to "make sure this never happens again." Such legislation would "assure an adequate range of health plan options for beneficiaries and reduce the likelihood that they will face this kind of turmoil in the future" (10/8).
A Sharp Rebuke
The Washington Post reports that Clinton plans to reprimand the HMO industry, "accusing it of holding elderly patients hostage while the HMOs pursue higher profits" (Goldstein, 10/8). "Medicare should not and will not be held hostage to threats by HMOs to leave the program," said a White House memo previewing the president's comments (New York Times, 10/8). Clinton also is prepared to defend the Health Care Financing Administration's decision not to allow HMOs to resubmit their 1999 rates, a step the industry contends would have averted the widespread pullout. The Washington Post also reports that in at least one case, HCFA is trying to "choreograph [HMOs'] notification to patients" that Medicare HMO coverage will be terminated. AvMed Health Plan, a Florida HMO, said federal officials told the company it could not make an announcement to 6,400 Medicare patients until after today's comments by the president (10/8).
It's Time For Action
In a statement released this morning, American Association of Health Plans President Karen Ignagni contends that "[t]here are serious structural problems -- payment, compliance, and transition issues -- that need to be addressed with the new Medicare+Choice program." Ignagni calls on Congress and the Clinton administration "to make these structural matters their top priority" (AAHP release, 10/8). In addition, an AAHP spokesperson confirmed this morning that Ignagni will send a letter to HHS Secretary Shalala urging a meeting where industry and government officials can discuss solutions to the Medicare HMO issue.