BY MICHAEL D. CLARK
The Cincinnati Enquirer
Area seniors Friday complained that a new health care compromise only compromises their health and wallet.
Seniors -- mostly in Warren and Butler counties -- covered under the Anthem Blue Cross and Blue Shield's Senior Advantage Medicare HMO will be paying more for less health care coverage next year under a compromise agreement with federal health insurance officials.
"I don't know what I'll do," said Hattie Pursley, a 72-year-old Franklin resident who lives on a fixed income that must now cover more of her medical expenses.
"It's shocking. I don't see why we should pay more," said Ms. Pursley, who will now have to spend at least $500 more annually for prescription drugs crucial for maintaining her health.
On Thursday, a compromise was reached and approved by the Health Care Financing Administration (HCFA), the agency that runs Medicare. The compromise was to soothe the sting of Anthem's original plan to drop 20,000 seniors in 19 counties, including Warren, and parts of three others. Butler had not been included.
After taking heat from enrollees and politicians, Anthem agreed to continue offering its Senior Advantage Medicare HMO to about 7,000 people in six counties (Brown, Darke, Greene, Miami, Preble and Shelby) and parts of three others (Warren, Madison and Columbiana). Anthem will still drop 13 counties as of Jan. 1.
But because HCFA refused to increase Anthem's reimbursement rate -- the reason for the pullout -- the company is charging more to enrollees and cutting some benefits for about 47,000 Ohio seniors. Letters informing enrollees of their benefit changes for 1999 will be mailed next week.
Details of the changes vary by county. Seniors in Warren and Butler counties will become part of a new Dayton region. They will be charged:
- $39 monthly premiums (up from no charge).
- $300 co-payments for hospital stays (up from no co-payment).
- $10 for doctor visits instead of $5.
- $50 for emergency room visits instead $25.
- Prescription benefits will be cut to $500 a year, down from $1,000.
The change means Butler County seniors are taking a hit in their health coverage similar to what Warren County seniors have suffered.
A spokesman from the office of U.S. Rep. John Boehner, whose 8th Congressional District includes Butler County, said the health care coverage reduction hits seniors, many of whom are on fixed incomes.
"This is fundamentally unfair for the seniors in Butler County and the blame falls squarely at the feet of the federal government's failure to modernize Medicare," said spokesman Dave Schnittger.
Lynne Gross, Anthem vice president of government products, said in a statement released Friday, "In the past we had a one-size-fits-all product in Ohio.
"However, with the changes required of Medicare HMOs like Anthem Senior Advantage in Medicare + Choice programs established in the Federal Balanced Budget Act in 1997, Anthem needed to find a method in which it could continue to offer Anthem Senior Advantage to its members within the reimbursement limits . . .
"The regional plan approach is Anthem's solution for 1999," said Ms. Gross.
Anthem plans to offer new discounts in the Cincinnati region for hearing aids and eyeglasses, but not in the Dayton region.
U.S. Rep. Rob Portman, who helped broker the Anthem compromise, described it as "a positive step for seniors in Warren and Butler counties."
"I urged Anthem not to drop the Senior Advantage program. But once they made the decision to pull out, we worked hard to keep similar managed care options for seniors in Brown County and the affected parts of Warren County," he said.
"Many seniors in our area may find that the new Medicare HMO option will still make more sense for them than traditional fee-for-service Medicare."
Tim Bonfield contributed to this report.
