The Senate's version of health care reform approved Thursday has a provision to protect Florida seniors from losing a rich benefit package they have as members of Medicare Advantage Plans.
Sen. Bill Nelson, D-Fla., inserted the language to help 800,000 Florida seniors enrolled in the HMO plans, including 300,000 in South Florida.
"He's proud he's able to protect Florida's seniors,'' said press secretary Brian Gulley, who notes the provision will also help some seniors in New York and Southern California.
With the Senate's passage, the next step in healthcare reform will come next month, with leaders of the House and Senate working out the differences between the two bills. That process is expected to take several weeks.
Both bills, which will extend coverage to at least 30 million uninsured Americans, also seek to reduce the costs of Medicare Advantage plans, which cost 12 percent more than regular Medicare on a national average.
The House version seeks to reduce all Medicare Advantage plans to rates no more than regular Medicare while the Senate version would set up competitive bidding among insurers -- a process that many experts believe will drive HMO rates well below regular Medicare costs in many places.
At present, South Florida's Medicare Advantage plans get much higher rates from the federal government than do HMOs elsewhere, because they're based on the average costs of regular Medicare in the area.
The plans in South Florida use this extra money in many cases to offer customers zero co-payments for doctor visits, little or no costs for drugs, or free dental and vision coverage. Such benefits would be endangered or outright eliminated if Congress reduced HMO rates.
"The real issue once again is costs,'' said Steven Ullmann, a healthcare policy expert at the University of Miami. ``Our Medicare costs are twice as high as other parts of the country and how do you deal with that?''
At present, the Medicare HMOs in South Florida generally cost taxpayers no more -- and sometimes considerably less -- than the average senior's expenses in traditional Medicare. That's because regular Medicare recipients run up huge numbers of visits to specialists and take many expensive tests.
Since the Senate plan would drive down rates -- and thus benefits -- Nelson pushed a clause ``grandfathering in'' some of those who already are in the HMOs so that they don't lose benefits.
The Kaiser Family Foundation estimates that this provision is worth up to $5 billion as ``a transitional extra benefit'' between 2012 and 2019.
In fact, the provision helps HMOs that currently cost less than traditional Medicare -- and that's primarily in Florida, where healthcare is so expensive.
Conservative critics have decried the provisions inserted in the Senate bill to help certain locations. On Wednesday, The Wall Street Journal ran an editorial complaining that a "crafty'' Nelson had figured out a way to get $3 billion to $5 billion for Florida seniors.
The editorial lumped Florida's Nelson with Sen. Ben Nelson, D-Neb. -- no relation -- who was reluctant to support an overhaul until Senate leaders added a provision giving Nebraska $100 million to help the state's Medicaid program. Earlier, $300 million in Medicaid support had been steered to Louisiana to ensure the support of Sen. Mary Landrieu.
Richard Pfenniger, chief executive of Continucare, said the House version is still much better for South Florida seniors than the Senate's, because it seeks to cut the reimbursement rates for Medicare Advantage back to regular Medicare levels -- and this region's HMOs are already below that, meaning they won't be affected.
The competitive bidding under the Senate version would drive rates below Miami's levels, said Pfenniger, and even with Nelson's subsidies would likely mean reduced benefits for local HMOs.
``The House bill saves more money, if you look at the [Congressional Budget Office] scores,'' said Pfenniger, because under the Senate provision, many areas of the country might still end up with competitive bids above regular Medicare costs.
Continucare provides physician services to the Medicare HMOs, and Pfenniger said the present reimbursement rate improves care.
"Participants have no co-pays, and that means they're free to see their doctors whenever they want. . . .
"That means we emphasize more preventive care and wellness, and our patients are less likely to have hospital stays, or shorter stays,'' Pfenniger said.
Ullmann, the University of Miami expert, said, ``Ultimately, we have to get costs down here. We have the highest costs in the country -- and in the world -- and they have to come down, both for regular Medicare and Medicare Advantage.''
Even so, he could see the reasoning behind protecting the present seniors. ``Change is difficult for everyone, but especially the elderly, that there's something to be said for letting them keep their present plans,'' Ullmann said.
But, he noted, Nelson's stance was protecting not only the seniors, but also the private insurance providers who find it lucrative to run the HMOs.