If Rep. Jim Greenwood (R-Pa.) wants to pass long-term reform of the Medicare system, he may need to sell his allies on it first.
Greenwood returned to his district in southeastern Pennsylvania during this month's congressional recess to talk to senior citizens about the still-incomplete Medicare reform plan he is helping to write. He is part of an eight-person team appointed by House Speaker Newt Gingrich (R-Ga.).
In presentations to senior citizens, he stressed the plan's reliance on managed care, its guarantees of existing Medicare benefits and continuing fee-for-service care, and the need to roll out the plan in September and pass it in October to avert the projected bankruptcy of the program.
But Anne Somers wasn't buying the whole package.
Somers, 81, a Newtown resident who participated in a district Medicare advisory group convened by Greenwood, agreed with the need to reform Medicare but disagreed with Greenwood's schedule.
Addressing Greenwood at a town meeting, Somers-a former healthcare author and educator who was inducted into the Health Care Hall of Fame in 1992-invoked the memory of the Medicare catastrophic illness insurance legislation passed in 1988 and repealed in 1989 after seniors protested new charges. She left Greenwood with a simple message: "Don't rush the long-term restructuring through."
That's but one of the myriad messages House Republicans were hearing as they returned to their districts this month-armed with a party-produced packet of Medicare-related slides, data and talking points-to sell an often skeptical public on the need to implement long-term Medicare reform.
Gingrich himself faced protesters as he tried to address Medicare reform in Atlanta. Numerous other Republicans, meanwhile, hosted similar meetings, as did Democrats and seniors groups such as the American Association of Retired Persons that are gearing up to fight GOP reform plans.
Greenwood and other Republicans trying to sell the developing Medicare reform plan faced tough questions from beneficiaries, ranging from the simple-what will it cost beneficiaries?-to pleas to preserve the doctor-patient relationship in a Medicare managed-care framework.
But Greenwood appeared undeterred, saying he has yet to hear from a constituent in a Medicare managed-care plan who didn't like it.
"I think that these meetings have caused me to conclude that we are headed generally in the right direction," Greenwood said in an interview in his Doylestown, Pa., office.
As for objections to the GOP timetable, he said, "I think (the schedule is) fair as long as we are not saying we're going to force you to do something you won't like. We're saying those of you who like the status quo can stay there. And then we're saying we are in a hurry, for a lot of reasons having to do with the larger budgetary picture."
That explanation is not sufficient for such groups as the National Council of Senior Citizens.
"Our message has been.....`You have a lot of explaining to do,'*" said Patrick Burns, the council's spokesman. "The message of the Republican Party is, `We are here trying to save Medicare.' They are here to bury Medicare, not praise it."
Hospitals should embrace the plan, Greenwood said, because the GOP reform proposal also may pave the way for more managed-care plans run by hospitals and other providers, perhaps by easing antitrust rules and solvency requirements that often block such networks.
"I think it will be in the interest of hospitals that there be significant migration into managed care because the only other alternative is more draconian reductions," he said.
Congressional balanced-budget plans call for trimming $270 billion from $1.7 trillion in projected Medicare spending over the next seven years. But beyond the initial savings, Republicans are seeking long-term reforms to put the program on a sound fiscal footing.
Medicare trustees earlier this year projected that the Hospital Insurance Trust Fund could be bankrupt in 2002 under the current program, which is expected to increase expenditures by more than 10% a year through 2002.
Congressional Republicans want to slow Medicare inflation to about 5% a year, increasing per-person expenditures from $4,800 now to $6,700 in 2002.
Congressional Democrats and the Clinton administration, meanwhile, charge that the Republicans are developing a "secret plan" and challenged the Republicans to be more specific about how they plan to enroll more seniors in managed care.
"I think what they're hearing is questions: `What is it you're specifically doing and how is it going to affect me?"' said HHS Secretary Donna Shalala. "No Republican who's out there can answer those questions."
Congressional Republicans, however, are not taking the Democrats' bait, although they have given constituents a glimpse of the plan.
Greenwood described increased enrollment in managed care as a significant part of the restructuring, although other Republicans touting Medicare reform have avoided discussing managed care because they thought it might frighten beneficiaries.
A reformed Medicare program would bear some similarities to the Federal Employees Health Benefit Program, or FEHBP, which pays a limited amount toward the cost of health insurance that beneficiaries choose and allows them to pay extra for more generous coverage, Greenwood said.
But he added, "I think it will be a better deal than FEHBP because the beneficiaries' share of the cost will be less."
Federal employees in FEHBP pay at least 25% of their premiums, averaging about 40%.