The Cincinnati Enquirer
Anthem Blue Cross and Blue Shield's decision last month to drop its Medicare HMO services for about 20,000 senior citizens proves a need for federal officials to revamp how health-care providers are reimbursed under Medicare, U.S. Rep. Rob Portman said Monday. Mr. Portman, R-Terrace Park, asked the House Ways and Means Committee to urge the Health Care Financing Administration (HCFA), which operates the Medicare program, to help bring other Medicare HMO options into the region affected by the Anthem pullout.
Congress and the HCFA should develop new guidelines for Medicare reimbursement, he said.
"Some constituents in these areas inform me that they bought this product in good faith after Anthem conducted an aggressive marketing campaign, only to find shortly afterward that your company announced it is dropping the plan," Mr. Portman wrote to Anthem officials.
Anthem spokeswoman Lauren Green-Caldwell said Anthem officials likely will meet with Mr. Portman to discuss his concerns and ideas. "We have been very forthcoming on providing information to anyone who asks and will work directly to find alternatives," she said.
The change takes effect Jan. 1 for Anthem Senior Advantage members in 19 counties and parts of three others. Locally, it affects Brown, Clinton, Highland and northern Warren counties. Rural residents outside Columbus, Dayton and Youngstown also will lose their coverage. The move means Anthem is dropping about one-third of its 63,000 Medicare HMO members.
The decision was driven heavily by low federal reimbursement rates, Anthem officials said. The larger concern for rural seniors is that other Medicare HMOs may follow suit.
Medicare is the federal health plan for the elderly and disabled. Medicare HMOs have been a fast-growing alternative to traditional Medicare.
Anthem's move is the latest in a continuing trend of Medicare HMOs concentrating where federal reimbursement rates are highest. Low rural rates already have made many HMOs cautious about expanding their territories.
Anthem will continue coverage for members in Butler, Hamilton, Clermont and southern Warren counties.
