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July 24, 2000
"Medicare+Choice: Can it Work?"
AIM sponsored a July 24 briefing for Congressional staff
on problems confronting the Medicare+Choice program, including participating plans and beneficiaries. Speakers included Dr. Murray Ross, PhD, Executive Director, Medicare Payment Advisory Commission (MedPAC);
Mr. George Renaudin II, Senior Vice President, Ochsner Health Plan, Metairie, Louisiana; and Mr. Alfred Couture, a senior citizen from Worcester, Massachusetts.
The briefing was the sixth in a series hosted by AIM to
help Congressional members and staff understand the need for comprehensive Medicare reform and the importance of "fixing Medicare first" by restoring cuts to providers and stabilizing Medicare+Choice.
Dr. Ross outlined the 1997 Balanced Budget Act's (BBA)
goals for the Medicare+Choice program and pointed out that the goals compete with each other - often to the detriment of the program.
He noted that, although spending growth has been "controlled," there are few new products or plans, benefit packages continue to shrink, plans continue to withdraw and enrollment is stagnant. Dr. Ross also discussed the Balanced Budget Refinement Act of 1999 (BBRA) and the efforts to alleviate some of the problems in the Medicare+Choice program. He noted that Congress must decide on an overall goal for the Medicare+Choice program - either to control costs or to offer better benefits. Congress must also consider alternatives to full risk assessment by plans and improve risk adjustment mechanisms. MedPAC's future work, according Dr. Ross, will include a December 2000 study on risk adjustment, a March 2001 report on payment policies, a June 2001 report on Medicare in rural areas, and a December 2001 report on regulatory burdens.
Mr. Renaudin outlined Ochsner Health Plan's (OHP)
experiences in the Medicare+Choice program.
He described OHP as serving more than 35% of the Louisiana Medicare+Choice market and noted that OHP is 70% owned by physicians. OHP's 2001 withdrawals will affect six mostly rural Louisiana parishes and nearly 6,000 plan participants. OHP will continue to serve more than 30,000 Medicare+Choice enrollees in 2001 in 12 parishes. Mr. Renaudin stated that OHP's reasons for withdraw include inadequate funding, lack of local provider cooperation, and increased regulatory burden and risks. Specifically, he estimated that OHP would have lost $6.8 million in 2001 in the six withdrawal parishes. Further, Mr. Renaudin cited the heavy volume of HCFA's "Operational Policy Letters" (OPLs) as the largest regulatory compliance problem.
Mr. Couture discussed his positive experiences with Fallon
Health Plan, one of the original
Medicare HMO participating plans, and provided an overview of how beneficiaries can be well served under Medicare+Choice. Mr. Couture offered compelling testimony for providing adequate funding for providers in the Medicare+Choice program.
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