Rep. Gallegly Seeks Medicare Reimbursement Increase
Newly re-elected U.S. House Rep. Elton Gallegly (R-Calif.) is preparing to make a fourth attempt to raise Medicare reimbursement rates for Ventura County hospitals to the same levels that Los Angeles County facilities receive, the Ventura County Star reports. According to the Star, an HMO that covers a Medicare beneficiary in Los Angeles County receives $67.36 a month more than it would receive for a similar patient in Ventura County. Gallegly, whose district encompasses most of Ventura County, this year has asked for reimbursement "reclassification" through either the Medicare "
giveback" legislation or the "2001 appropriations package." In September, Gallegly was "rebuffed" by Republican leaders on the House health subcommittee when he asked for reclassification under the federal
health budget bill. Last month, Gallegly sent a direct request to House Speaker Dennis Hastert (R-Ill.). Gallegly wrote, "The cost structure of Ventura County hospitals is similar to Los Angeles County hospitals. The costs for recruiting and retaining qualified personnel is comparable [and] the average cost per case in Ventura County hospitals is actually above the level in Los Angeles County hospitals." According Tom Pfeiffer, a GOP spokesperson, Gallegly's requests have been denied because the Republican leadership "decided they didn't want to put any specific district requests in the bills because it would draw a potential veto threat" from President Clinton. While Gallegly "hopes to get the request reconsidered" when the 107th Congress convenes next year, he is pessimistic about its chances. "The issue is, if you address this in one area of the country (such as Ventura County), it would follow around (nationally) and ultimately costs billions of dollars," Gallegly said, adding, "So it's still a possibility, but it would be very difficult to address Ventura County and not the rest of the country."
Both the managed care industry and the California Medical Association supported Gallegly's call for higher reimbursement rates. According to the CMA, the state's health care system "receives almost $1 billion a year less -- from both public and private insurers -- than the national average of per-patient funding would provide." CMA CEO Jack Lewin said, "Californians need to understand that our health (revenues) are 30% lower than the rest of the country. What results are bankruptcies and a vast exodus of doctors from California. We can't provide quality care on the cheap." HCFA responded that making Medicare reimbursement rates uniform across the country "would pose even greater risks." HCFA spokesperson Barbara Weller said that it has to vary from state to state (Smith, Ventura County Star, 11/14).