Health Care Bill Reveals Rising Premiums and Reductions in Medicare Benefits; Rural Hospitals Fear Health Care Overhaul Won't Help Them

Health Bill Clears Hurdle with Support from Snowe

October 13, 2009

AP - Historic legislation to expand U.S. health care and control costs won its first Republican supporter Tuesday and cleared a key Senate hurdle, a double-barreled triumph that propelled President Barack Obama's signature issue toward votes this fall in both houses of Congress.

"When history calls, history calls," said Maine Republican Olympia Snowe, whose declaration of support ended weeks of suspense and provided the only drama of a 14-9 vote in the Senate Finance Committee. With her decision, the 62-year-old lawmaker bucked her own leadership on the most high-profile issue of the year in Congress, and gave the drive to remake health care at least a hint of the bipartisanship that Obama seeks.

At the White House, Obama called the events "a critical milestone" toward remaking the nation's health care system. He praised Snowe as well as Sen. Max Baucus, D-Mont., chairman of the committee, and declared, "We are going to get this done."

There were fresh challenges. Within minutes of the vote, labor unions and large business organizations both demanded changes in the bill, which was an attempt at a middle-of-the-road measure fashioned by the committee under Baucus' leadership.

Still, nearly nine months after the president pledged in his Inaugural Address to tackle health care, legislation to expand coverage to millions who lack it has now advanced further than President Bill Clinton's ill-fated effort more than a decade ago — or any other attempt in more than a generation.

The next move in the Senate is up to Majority Leader Harry Reid, whose office said the full Senate would begin debate on the issue the week of Oct. 26.

Nominally, Reid must first blend the bill that cleared during the day with a version that passed earlier in the Health, Education, Labor and Pensions Committee. But in reality, the majority leader — with the participation of the White House — has a virtual free hand in fashioning a measure to wind up gaining the 60 votes needed to overcome a threatened Republican filibuster.

"The bottom line here is we need a final bill, a merged bill, that gets 60 votes," Baucus said. "Our goal is to pass health care reform not just talk about it."

Reid's most politically sensitive decision revolves around proposals for the federal government to sell insurance in competition with private industry. The Senate bill approved in committee during the day omits the provision, while the one passed earlier includes it and many House Democrats support it as well.

In general, bills moving toward floor votes in both houses would require most Americans to purchase insurance, provide federal subsidies to help those of lower incomes afford coverage and give small businesses help in defraying the cost of coverage for their workers.

The measures would bar insurance companies from denying coverage on the basis of pre-existing medical conditions, and for the first time limit their ability to charge higher premiums on the basis of age or family size. Expanded coverage would be paid for by cutting hundreds of billions of dollars from future Medicare payments to health care providers. Each house also envisions higher taxes — an income tax surcharge on million-dollar wage-earners in the case of the House, and a new excise levy on insurance companies selling high-cost policies in the case of the Senate Finance Committee bill...

Ironically, the insurance industry launched its attack against the version of the legislation that omits the government option — the one provision above all others that insurers oppose. Officials said they were motivated by a provision that would have excused millions from a requirement to have insurance, thus reducing the pool of new customers seeking coverage.

Democrats said that industry representatives had also complained in private conversations about a provision that would have limited insurance companies' ability to write off the cost of any executive salary in excess of $500,000 a year. The committee inserted the provision into the measure at the request of Sen. Blanche Lincoln, D-Ark.

Audit of Health Care Bill Reveals Rising Premiums

October 12, 2009

Townhall - As the Senate Finance Committee prepares to vote on Chairman Max Baucus’ (D-M.T.) 10-year, $830 billion health care overhaul plan tomorrow, a new audit by private insurance companies sheds new light on its potential costs.

Industry trade group America’s Health Insurance Plans have released a new study by PricewaterhouseCoopers that “projects the legislation would add $1,700 a year to the cost of family coverage in 2013, when most of the major provisions in the bill would be in effect.”

Premiums for a single person would go up by $600 more than would be the case without the legislation, the PricewaterhouseCoopers analysis concluded in the study commissioned by the insurance group.

“Several major provisions in the current legislative proposal will cause health care costs to increase far faster and higher than they would under the current system,” Karen Ignagni, the top industry lobbyist in Washington, wrote in a memo to insurance company CEOs.

The study projected that in 2019, family premiums could be $4,000 higher and individual premiums could be $1,500 higher.

Baucus’ spokesman, Scott Malhauser, contests the industry’s price study, calling it a “health insurance company hatchet job, plain and simple.”

Baucus spokesman Mulhauser said the study is “seriously flawed” because it doesn’t take into account provisions in the legislation that would lower the cost of coverage, such as tax credits to help people buy private insurance, protections for current policies and administrative savings from a revamped marketplace.

White House health care spokeswoman Linda Douglass concurred. “This is an insurance industry analysis that is designed to reach a conclusion which benefits the industry, and does not represent what the bill does,” she said.

The bill’s review from the Congressional Budget Office last week estimated it would cover 94% of eligible Americans and reduce the federal deficit. But the PwC study was specifically aimed at measuring the cost burden for privately insured individuals. [The PwC study] concluded that a combination of factors in the bill – and decisions by lawmakers as they amended it – would raise costs.

The chief reason, said the report, is a decision by lawmakers to weaken proposed penalties for failing to get health insurance. The bill would require insurers to take all applicants, doing away with denials for pre-existing health problems. In return, all Americans would be required to carry coverage, either through an employer or a government program, or by buying it themselves.

But the CBO estimated that even with new federal subsidies, some 17 million Americans would still be unable to afford health insurance. Faced with that affordability problem, senators opted to ease the fines for going without coverage from the levels Baucus originally proposed. The industry says that will only let people postpone getting coverage until they get sick.

Other factors leading to higher costs include a new tax on high-cost health insurance plans, cuts in Medicare payments to hospitals and doctors, and a series of new taxes on insurers and other health care industries, the report said.

“Health reform could have a significant impact on the cost of private health insurance coverage,” it concluded.

Insurers played a major role in defeating then-President Bill Clinton’s health care plan in the 1990s. Sunday, the industry stopped short of signaling all-out opposition. “We will continue to work with policymakers in support of workable bipartisan reform,” Ignagni said in her memo.

Rural Hospitals Fear Health Care Overhaul Won't Help Them

October 9, 2009

McClatchy Newspapers - The Peach County Regional Medical Center, a small, Cold War-era hospital in Fort Valley, Ga., 40 miles from the nearest trauma center in Macon, is in critical condition.

Medical specialists and surgeons -- physicians who are hard to recruit to rural areas -- often take one look at the hospital's worn and soiled carpet and peeling wallpaper and decide to hang their shingles elsewhere.

The emergency room has only five beds, so when patients with serious injuries or illnesses are admitted other less critical patients must get out of bed and walk or are rolled to a nearby waiting room.

Most of those patients are uninsured and can pay little, if anything, toward their treatment, forcing the hospital to absorb the costs. When the hospital does receive payment, often from Medicare and Medicaid, the reimbursements are slow in coming and don't fully cover treatments costs.

"You live lean and make hard choices every day," said Nancy Peed, Peach County Regional's CEO and administrator. "That's why the carpet doesn't look good, that's why the wallpaper is old. When I have money I put it into health care, quality nurses and medicine. My chairs and waiting room may not look great and sometimes that's a turn-off for people. But we give great quality health care."

Physicians and hospital administrators at facilities in rural counties like Peach County are closely watching the health care debate now taking place in Washington.

Overhauling the system could offer a lifeline to hospitals, doctors and nurses that serve the nation's small towns and agricultural communities, they say. But they also fear that Congress might not provide either enough money or the right incentives to allow rural hospitals to cover their costs and recruit talented medical professionals. That, they fear, will make it nearly impossible for smaller hospitals to remains in business.

"Medicare underpays everyone for service right now," Peed said. "That's one of the things we're worried about. If they have a program like Medicare which underpays with millions more people (using the system) it will make it more difficult. There needs to be true reform, not just cuts to providers, or sticking everyone in a plan and underpaying providers."

As lawmakers hammer out a comprehensive healthcare reform package, Congressional Blue Dog Democrats, many of whom represent rural communities in the South and Midwest, are pushing for "rural health equity" with higher reimbursement rates for physicians and hospitals in areas of the country that struggle to recruit and retain health care providers. However, including that type of language in the final bill will require lots of negotiation, said Rep. Jim Marshall, a Blue Dog Democrat from Macon.

"Cash flow for rural hospitals is a challenge," Marshall said. "An awful lot of our decisions concerning reimbursement flow from decisions in the 80s and we use a big city hospital model for determining costs for what reimbursement rates should be provided. It's unrealistic to expect the same cost efficiencies in low volume rural hospitals that you can obtain in high volume urban hospitals."

Of Georgia's 159 counties, 109 are rural. Those areas of the state have more than two million residents and 67 hospitals, according to the state's Department of Community Health's office of rural health. There are more than 5,700 hospitals in the U.S., most of them concentrated in urban centers, according to the American Hospital Association.

Years of cuts in reimbursements for Medicaid -- the program that pays the medical expenses of impoverished residents -- have hurt rural hospitals badly, a Georgia state legislative study on rural health care found. Rural hospitals' revenues are declining, their patient loads are increasing and there is no money available to improve or expand facilities, the study found.

The problem feeds on itself.

With fewer doctors willing to open practice in rural areas, patients -- many of them uninsured or on Medicaid or Medicare -- crowd local, financially-strapped hospitals for everything from help monitoring diabetes to medicine for whooping cough. The hospital in turn has less cash available to buy state-of-the art equipment or pay potential doctors higher salaries as an incentive to work in an underserved area.

Often the hospitals operate in the red or are forced to close.

Before the nation's credit crunch, several larger banks had programs that allowed smaller hospitals to borrow money to make improvements. Now those loans are virtually impossible to get, said Greg Dent, president and CEO of Community Health Works, a non-profit organization that focuses on improving health care in central Georgia.

"These hospitals are in dire straits," Dent said. "They can't afford new equipment, they can't afford bricks and mortar. They're trying to build new hospitals and get financing but getting the initial financing can be tough."

Researchers at the Morehouse School of Medicine in Atlanta examined emergency room visits by uninsured people in rural Georgia and found that in counties without an adequate number of doctors' offices or clinics, uninsured emergency room visits are 33 percent higher than in areas with such facilities.

Nationally, rural hospitals are treating an increasing number of uninsured patients, largely through emergency room visits, and are struggling under the financial weight of uncompensated care, according to the National Association of Community Health Centers.

For the past five years, Peach County has struggled to raise money to build a new $27 million facility just 20 minutes north in Byron near Interstate 75, an area that has experienced greater population growth and is more likely to attract physicians. A feasibility study by the Dixon Hughes accounting firm found the hospital could stay afloat if it closed the old facility, made the move to a new location, secures loans and draws the number of physicians and patients predicted in the report.

So far, the hospital has just $2.5 million for the project.

"I hear the powers that be say we need regional health care systems, but those systems don't have room for people outside of the area," Peed said, adding that in the meantime, the Peach County hospital fills the void. "If I have someone who is sick with a stroke and needed neurosurgery, here we can get to them ahead of time and get them stabilized."

Daughter Saves Mother, 80, Left to Die Under Britain's Health Care System

October 11, 2009

Times Online - An 80-year-old grandmother who doctors identified as terminally ill and left to starve to death has recovered after her outraged daughter intervened.

Hazel Fenton, from East Sussex, is alive nine months after medics ruled she had only days to live, withdrew her antibiotics and denied her artificial feeding. The former school matron had been placed on a controversial care plan intended to ease the last days of dying patients.

Doctors say Fenton is an example of patients who have been condemned to death on the Liverpool care pathway plan. They argue that while it is suitable for patients who do have only days to live, it is being used more widely in the NHS, denying treatment to elderly patients who are not dying.

Fenton’s daughter, Christine Ball, who had been looking after her mother before she was admitted to the Conquest hospital in Hastings, East Sussex, on January 11, says she had to fight hospital staff for weeks before her mother was taken off the plan and given artificial feeding.

Ball, 42, from Robertsbridge, East Sussex, said:

“My mother was going to be left to starve and dehydrate to death. It really is a subterfuge for legalised euthanasia of the elderly on the NHS. ”

Fenton was admitted to hospital suffering from pneumonia. Although Ball acknowledged that her mother was very ill she was astonished when a junior doctor told her she was going to be placed on the plan to “make her more comfortable” in her last days.

Ball insisted that her mother was not dying but her objections were ignored. A nurse even approached her to say: “What do you want done with your mother’s body?”

On January 19, Fenton’s 80th birthday, Ball says her mother was feeling better and chatting to her family, but it took another four days to persuade doctors to give her artificial feeding.

Fenton is now being looked after in a nursing home five minutes from where her daughter lives.

Peter Hargreaves, a consultant in palliative medicine, is concerned that other patients who could recover are left to die. He said: “As they are spreading out across the country, the training is getting probably more and more diluted.”

A spokesman for East Sussex Hospitals NHS Trust, said: “Patients’ needs are assessed before they are placed on the [plan]. Daily reviews are undertaken by clinicians whenever possible.”

In a separate case, the family of an 87-year-old woman say the plan is being used as a way of giving minimum care to dying patients.

Susan Budden, whose mother, Iris Griffin, from Norwich, died in a nursing home in July 2008 from a brain tumour, said:

“When she was started on the [plan] her medication was withdrawn. As a result she became agitated and distressed.

“It would appear that the [plan] is . . . used purely as a protocol which can be ticked off to justify the management of a patient.”

Deborah Murphy, the national lead nurse for the care pathway, said: “If the education and training is not in place, the [plan] should not be used.” She said 3% of patients placed on the plan recovered.

Robert Reich on Health Care: Old People Have to Die

October 9, 2009

Infowars - Robert Reich, Clinton’s Secretary of Labor and avid Obama supporter, wants to deny health care to old folks. They’re too expensive. He also told an audience in 2007 that most people will not live longer than their parents. Again, too expensive. He wants to force medical technology corporations to stop developing new life-saving technology.

Reich, of course, supports the so-called “public option,” the government’s take-over of the health care industry. In order to push the Obamacare scam, Reich proposed a march on Washington by the liberals to demand the public option. He wanted to do this on Grandparents Day, September 13.

Reich wanted people to march in favor of a plan that would mandate old people die on a day set aside for old people. You can’t make this stuff up.



Mr. Reich’s pronouncement is yet another confirmation that the government wants to kill old people who are after all — according to our eugenicist rulers — nothing if not useless eaters.

Democrats and liberals went ballistic when Sarah Palin mentioned the fact that the government wants to use the “level of productivity in society” as the basis for determining access to medical care. This Darwinian and Malthusian concept is supported by Dr. Ezekial Emanuel, brother of Chief of Staff Rahm Emanuel and White House health care policy adviser.

Emanuel does not use the term “death panels” and the term does not appear in the Obamacare bill. That would be political suicide. Instead he argues in favor of “The Complete Lives System,” a system that “produces a priority curve on which individuals aged between roughly 15 and 40 years get the most chance, whereas the youngest and oldest people get chances that are attenuated.”

In 1996, Emanuel said health care should be rationed for those who are not “participating citizens,” that is to say the old, the infirm, and those suffering from irreversible medical conditions.

As a good liberal, Emanuel would like to avoid the perception that he proposes killing old people simply because they are old — that would be “ageist” — and instead argues that they have used up their “life-years” and basically need to get out of the way and stop using up precious medical resources.

Robert Reich reduces the academic gobbledygook of Emanuel’s “Complete Lives System” down to language the average person can understand. In the above video, he spells it out — the government will intervene in medical decisions made by you and your family. Grandaddy is a burden on society and has nothing left to contribute because he no longer works and pays half or more of his income to the government in the form of confiscatory taxes.

The sad and frightening thing is, when Reich told the audience they will have to die, they applauded.

Reid ‘Likely’ to Make Entire Health Bill an Amendment to Unrelated Tax Bill That House Passed in March

The congressional bills would require all Americans to get health insurance, either through an employer, through a government program, or on their own. Tax credits would be offered for many of those who buy their own coverage, but failure to comply could result in a fine. - Assoicated Press, AP Poll: Health Care Overhaul Has a Pulse, October 7, 2009



October 7, 2009

CNSNews.com - A senior aide to Senate Majority Leader Harry Reid (D-Nev.) told CNSNews.com that it is “likely” that Reid will use H.R. 1586—a bill passed by the House in March to impose a 90-percent tax on bonuses paid to employees of certain bailed-out financial institutions—as a “shell” for enacting the final version of the Senate’s health care bill, which Reid is responsible for crafting. Under the procedure, the substance of House Resolution 1586 would be removed and replaced with the entire Senate health care package...

From The Heritage Foundation (Excerpt):

Obamacare will be ready to hitch a ride on an unrelated bill from the House. Sen. Reid will move to proceed to H.R. 1586, a bill to impose a tax on bonuses received by certain TARP recipients. This bill was passed by the House in the wake of the AIG bonus controversy and is currently sitting on the Senate Legislative Calendar.

The move to proceed needs 60 votes to start debate. After the motion is approved, Sen. Reid will offer Obamacare as a complete substitute to the unrelated House-passed bill. This means that the entire healthcare reform effort will be included as an amendment to a TARP bill that has been collecting dust in the Senate for months.

For this strategy to work, the proponents would need to hold together the liberal caucus of 58 Democrats (including Paul Kirk who was named last Thursday to replace Sen. Kennedy), and the two Independent senators (Joe Lieberman of Connecticut and Bernie Sanders of Vermont). These members will have to all hold hands and vote against any filibuster. Once the Senate takes up the bill, only a simple majority of members will be needed for passage. It's possible one of the endangered moderate Democrats, such as Sen. Blanche Lincoln (Ark.), could vote to stop a filibuster then vote against Obamacare so as not to offend angry constituents.

Once the Senate passes a bill and sends it to the House, all the House would have to do is pass the bill without changes and President Obama will be presented with his health care reform measure. If this plan does not work, the Senate and House leadership may go back to considering using reconciliation to pass the legislation.

Adopting this secret plan will not strike most Americans as a transparent, bipartisan, effective way to change how millions of Americans get their health care.

Senate Health Care Bill May Be Finished, But Divisions Remain

October 2, 2009

McClatchy Newspapers - Both houses of Congress are poised to start a historic debate on sweeping legislation to overhaul America's health care system, yet despite months of committee deliberations, some major issues remain unsettled.

This week, the Senate Finance Committee is expected to take the last step that sets the stage for the full chamber's debate when it votes on its version of a bill. Since the committee has a 13-10 Democratic majority, and Sen. Olympia Snowe, R-Maine, may vote yes, approval is expected.
President Barack Obama hailed the committee, which wrapped up its bill-writing work Friday, as achieving "another milestone," saying in a statement, "We are now closer than ever before to finally passing reform." The committee is delaying its final vote until the nonpartisan Congressional Budget Office estimates its proposals' cost and effects on consumers. The Finance committee staff pegged the cost at nearly $900 billion over 10 years.

The five congressional committees that spent the summer and early fall drafting health care legislation have found agreement, at least among Democrats, that nearly everyone should be required to have basic insurance, get subsidies if their incomes are low, and have easy access to "exchanges," or marketplaces, where they can shop for coverage.

Insurers would be barred from denying policies because of someone's health status, and be subject to limits on premiums because of age or family size.

However, the Senate Finance Committee also exposed sharp divisions among Democrats about the extent of government involvement in health insurance and how to pay for any changes, while Republicans are all but universally opposed to the Democrats' terms.

Shortly after this week's final Finance vote, Senate Democratic leaders, with White House help, will combine the Finance measure with a more liberal bill that the Senate Health Committee approved over the summer. The full Senate is expected to start debating it on Oct. 13.

Senate Finance is only one of five committees, including three in the House of Representatives, that rejected creating a government-run insurance plan, or public option, as an alternative to private health insurance. Finance Committee members also had no interest in the kind of income tax surcharge on the wealthy that House Democratic leaders have endorsed...

The committees' work made it clear that the ultimate bill must meet three basic criteria: Coverage has to be affordable, easily available and paid for, so federal deficits don't expand. There may also be a fourth standard to meet if anything is to pass: Constituents may have to understand and be comfortable with the proposed new system, or lawmakers facing midterm elections in 2010 may not dare vote for it.

The House and Senate will consider different versions of the legislation. Both chambers are expected to begin debate later this month. Because House rules make it easier for the leadership to control debate, deliberations there should take only a few days.

In the 100-member Senate, however, where 60 votes are needed to overcome procedural hurdles, virtually every issue is sure to be subject to roll call votes, and the process could consume several weeks.

Under a rules change that permits the health care bill to be processed under what's known as "budget reconciliation," 51 votes will be enough to settle issues on the measure after Oct. 15. Details of how that would work remain murky, however, and Democratic leaders are reluctant to use that procedure, fearing that they'd be attacked for muscling through a profound change with a dubious bending of the rules, which could expose them to retaliation at the polls.

The most closely watched issue in the weeks ahead is likely to be the fate of the public option. Supporters will argue that a government plan, which Obama backs and which is expected to win House approval, will make coverage less expensive and easier to get.

Such a plan, said Sen. Jay Rockefeller, D-W.Va., "would simply guarantee that there is at least one health insurance plan in the exchange ... that ordinary Americans can afford and can count on to have more moderate premiums and yet the same benefits or perhaps more."

Senate Republicans, and some Democrats, are concerned that their constituents will see this not as an alternative to private insurance, but as an expensive first step toward a government takeover of the health care system.

"It would be a disaster," said Sen. Orrin Hatch, R-Utah. "The American people will lose an awful lot of control over their health care needs."

Senators are weighing other options. "We've gotten locked in a really sterile debate that says the only alternatives are what we've got now or public option. Those are not the only alternatives," said Sen. Kent Conrad, D-N.D.

The Finance Committee draft includes co-ops, or nonprofit member-run companies organized on a state, local or regional basis to purchase insurance, an idea that Conrad championed. In addition, Sen. Thomas Carper, D-Del., is floating a proposal to allow states to create their own public options. Snowe has proposed allowing public options only if state health-insurance markets prove uncompetitive.

What's important, Carper said, is that lawmakers can go home and explain, in simple terms, not only how coverage will be more easily available, but also that it's "affordable enough for middle-class people in most places."

Among concerns still unresolved for the final bill: Will the Finance Committee's excise tax on high-end insurance policies be passed along to middle-class consumers? Will tax credits for families who earn less than $88,000 annually be enough to assure affordability? Are penalties for not buying coverage too much of a burden on the middle class?

"People will be barely emerging from this economic recession ... they're wondering how they're going to make it, and we're talking about onerous penalties?" Snowe asked.

Debates over a host of other incendiary issues also loom: abortion, coverage for illegal immigrants, Medicare reimbursement and more. The Finance Committee rejected proposals to make it easier for federal agencies to verify the immigration status of applicants for insurance through co-ops, and to bar federal and state governments from requiring physicians to perform abortions.

In each case, the votes were 13-10, suggesting lengthy floor debates ahead.

"These are all legitimate questions," said Senate Majority Whip Richard Durbin, D-Ill., "and nothing will be resolved until we really get into the bill."

Medicare Advantage Premiums Will Rise for Some in 2010

October 2, 2009

McClatchy Newspapers - In Miami next year, seniors once again won't have to pay any monthly premiums for a Medicare health plan sold by HMO giant Humana Inc.

Meanwhile, in Philadelphia, seniors will pay premiums of $52 — up from zero — for the least expensive HMO plan from Independence Blue Cross.

The new information underscores the drastic differences in how federal funding cuts next year to the private Medicare health plans known as Medicare Advantage will affect seniors, depending on where they live.

On average, beneficiaries who currently are enrolled in Medicare Advantage plans can expect to pay average premiums of about $39 a month next year, a $7 increase from this year, according to data that the Centers for Medicare and Medicaid Services released Thursday. 


The benefits details also showed that about 660,000 seniors — nearly 7 percent of Medicare Advantage members — will have to change plans or enroll in traditional Medicare because some insurers are dropping coverage. Nearly all those seniors are enrolled in private fee-for-service plans, which are being subjected to much tighter regulations because of consumer complaints.

Most seniors in Medicare Advantage are enrolled in HMOs or preferred provider organizations.

Major changes in some Medicare Advantage plans were expected because of a previously announced 4 percent cut in federal funding for the plans next year. Not all seniors are affected, however. In areas where Medicare pays the highest rates to health plans, such as Miami and New York, seniors will be affected the least and continue to receive the richest benefits.

The changes to Medicare Advantage plans are being closely watched because the program — which covers 10 million seniors — has been at the center of the health care-overhaul debate.

The reduction in federal payments to the plans next year is separate from proposals by President Barack Obama and congressional Democrats to eliminate more than $130 billion in funding to Medicare Advantage over 10 years to help finance health insurance coverage for the uninsured and eliminate what they say are overpayments to the industry.

Those cuts wouldn't begin until 2013. According to the independent Medicare Payment Advisory Commission, the government now is spending an average of 14 percent more on seniors in Medicare Advantage than on those in traditional Medicare.

Health insurers are fighting the proposed cuts in the health overhaul bills, saying they'd be forced to curtail benefits sharply and leave markets that would become unprofitable. The industry's main lobbying group, America's Health Insurance Plans, said Thursday that the changes to the Medicare Advantage plans in 2010 showed what could happen when funding was reduced. This "demonstrates the real impact that policy changes can have on the health security of seniors in Medicare Advantage," Karen Ignagni, the CEO of the insurance group, said in a statement. "These unintended consequences could have been avoided."

The Obama administration noted, however, that most seniors still will have a choice of numerous free or low-cost health plans. "Medicare beneficiaries enrolled in Medicare health plans will continue to have a wide range of plan options in 2010, and those beneficiaries who decide to change plans should find choosing a new plan simpler than in previous years," the Centers for Medicare and Medicaid Services said in a statement.

Next year, nearly all Medicare beneficiaries will have access to Medicare Advantage plans, and almost 87 percent of Medicare beneficiaries will have access to Medicare Advantage plans that don't require premiums, CMS said.

Health plans began marketing their 2010 plans Thursday. Enrollees have from Nov. 15 to Dec. 31 to enroll.

How the Health Care Overhaul Could Change Medicare

October 2, 2009

Associated Press - More than 10 million seniors — nearly 1 in 4 — are covered by Medicare Advantage, an alternative that pays for-profit insurance companies to run their own versions of the government program. But the government is spending 14 percent more per patient in Medicare Advantage, so Congress wants to cut some of that — up to $160 billion over 10 years.

That means seniors covered by the plans may lose extra benefits like hearing aids and health club memberships. Some commercial insurers may pull out of Medicare Advantage, forcing some seniors to switch plans.

"There's no way to sugarcoat it and say there's no harm here," said Dr. Robert Berenson, a Medicare official during the Clinton administration and a senior fellow at the Urban Institute.

Everyone in Medicare pays $3 a month extra to subsidize the Medicare Advantage plans, the Leadership Council of Aging Organizations estimates. Berenson tells seniors in Medicare Advantage it's a matter of fairness: "You've been getting extra benefits for many years beyond what the program really promised you."

Free preventive services would be more common in Medicare under the congressional plans. Medicare would pay 100 percent for mammograms, diabetes classes and other preventive services. The Senate bill would include a free annual wellness exam too.

"It starts to change the nature of the relationship from one where you go to the doctor when you're feeling sick to one that's more focused on proactive prevention," said Ken Thorpe, executive director of the Partnership to Fight Chronic Disease.

Paying doctors fairly sharpens the focus on prevention. Democrats in the House and Senate want to delay scheduled decreases in doctors' fees and provide bonus payments that would make it more lucrative to see Medicare patients.

Nearly one in five Medicare patients lands back in the hospital within a month of getting out, costing billions annually.

To attack the problem, social workers in Chicago telephone patients after they leave Rush University Medical Center. The social workers find out what patients need to avoid repeat hospital trips. They help arrange rides to doctors and make sure seniors can afford their medicine.

"It can be one call or 30 calls," said Robyn Golden, who directs the hospital's older adult programs. "We call the providers to make sure they're following through when the patient says they're not."

Congress wants more hospitals to think like this. The leading Senate legislation would penalize hospitals with the highest readmission rates by reducing Medicare payments for repeat visits that could have been avoided.

A recent study found the typical primary care doctor must coordinate their Medicare patients' care with hundreds of other doctors. But rarely does any one doctor take charge of one patient's care from start to finish of a health problem.

"As it is now, the doctor asks the patient, 'What did the specialist say?'" said Joseph Baker of the nonprofit Medicare Rights Center.

Proposals in the House and Senate would set up pilot programs to better coordinate care with the goals of saving money and improving quality. Buzzwords are "medical homes" and "accountable care organizations," but the goals are the same, Baker said, "a more seamless provision of care without the bumps or gaps people experience now."

When Congress created the Medicare drug program it left a coverage gap called the "doughnut hole." More than 3 million Medicare beneficiaries a year hit this gap and start paying the full cost of their drugs until they qualify for catastrophic coverage.

Drug companies have promised a 50 percent discount on brand-name prescriptions for people in the doughnut hole. House Democrats want to eliminate the gap entirely by 2023.