Preserving the Medicare+Choice program, expected to lose several hundred thousand enrollees next year as HMOs drop coverage, is among a handful of critical healthcare issues that Congress is likely to address before adjourning for 2001, Thomas Scully, administrator of the Centers for Medicare and Medicaid Services, said last week.
In a wide-ranging speech at a National Health Council breakfast in Washington, and briefing reporters afterward, Scully also said the Bush administration would appeal a court order blocking, at least temporarily, a prescription-drug discount program for Medicare. Enrollment in the program, the administration's short-term fix for the high drug costs faced by the elderly, was to begin in November, but the U.S. District Court in Washington earlier this month ruled that the administration's plans may exceed HHS' authority (Sept. 10, p. 6).
After the terrorist attacks on Sept. 11, healthcare lobbyists had said that healthcare issues would take a back seat to national security issues in Congress and major healthcare bills were unlikely this year. However, Scully told the council he expects legislation will be introduced this fall to boost reimbursement for urban and suburban health plans participating in Medicare+Choice, provide new funding for rural healthcare and address unspecified "outpatient issues."
The council includes public health interests such as the American Cancer Society and the American Diabetes Association, business and industry, and not-for-profit healthcare organizations.
Scully also said he continues to push for enactment of a Medicare prescription-drug benefit, previously a high-profile congressional project, and approval of Medicare contractor reform. In fact, Scully said the Bush administration remains committed to creating a drug benefit, and he believes the benefit remains fiscally possible despite its $300 billion price tag.
The Medicare+Choice deadline for health plans to propose benefit packages and premiums for 2002 was Sept. 17. Although the government's final count of HMOs leaving the program and the number of enrollees affected won't be available until this week, Scully said the program would lose fewer enrollees than he had feared: a few hundred thousand rather than 1 million.
The American Association of Health Plans projected last week that approximately 450,000 enrollees would withdraw from the Medicare+Choice program in 2002.
Last year, more than 100 HMOs either pulled out of the program entirely or scrapped service areas, leaving more than 1 million seniors to seek new coverage. Of the nation's nearly 40 million Medicare beneficiaries, about 5.6 million, or 15%, receive their health benefits through 179 contracting managed-care plans.
"The Medicare+Choice plan is going to shrivel up and blow away if Congress doesn't focus on it," Scully said.