Proposed cuts to Medicare Advantage concern South Florida seniors: Federal government looks at Medicare program to help pay for health-care reform [Sun Sentinel, Fort Lauderdale, Fla.]

Dec. 18--WASHINGTON -- For more than five years, the federal government has spent billions to entice senior citizens into private Medicare Advantage plans run by HMOs that offer special care for low premiums.

Now that millions more patients have enrolled in these health plans, which are wildly popular in South Florida, Congress is poised to pass reform legislation that would yank billions away them.

Many South Floridians resent this turnabout and want to hang on to their extra benefits, such as dental and vision care. On the other hand, many patients in the traditional Medicare program say they resent subsidizing those who get gold-plated treatment at bargain rates.

The controversy over Medicare Advantage -- unfolding across the country but especially intense in South Florida -- is one of the thorniest issues complicating final passage of landmark legislation to overhaul the nation's health-care system.

The Senate is grinding toward a vote this month on a bill that would cut Medicare Advantage by roughly $120 billion over 10 years. The bill, however, would preserve benefits for current users in South Florida and other places with competitive rates.

If it passes, the Senate bill would have to be reconciled with a House-passed version that would cut Medicare Advantage funding by roughly $170 billion.

Many Medicare recipients say they are confused and torn about health reform, saying they support the idea of covering millions of the uninsured but worry that financing it through cuts to Medicare will diminish their coverage.

At the L.A. Lee Family YMCA in Fort Lauderdale, several senior citizens this week said they were worried that their HMOs might feel compelled to cut their free membership in the Silver Sneakers exercise program.

"I can afford the $10 a month if the HMO stops paying for this, but some of the people here can't," said Gracie Davis, 70, who has been in the program for several months.

She said passing health reform is so important she would be willing pay for Silver Sneakers, but she hoped it wouldn't come to that.

Claude Counts, 80, who credits his exercise routine with easing the ache in his knees, said no one needs to lose benefits to pay for health reform.

"If they cut out the fraud and all the tax subsidies for these big [health insurance] companies, and give it back to the people, they won't have to cut any of our benefits," he said.

Reformers point to government estimates that Medicare Advantage plans on average cost 14 percent more than traditional service, soaking up money that could keep the system solvent and help cover the uninsured.

"Maybe I'm a little jealous of Medicare Advantage people when I see them get these special benefits," said David Condron, 67, a former school principal in Pompano Beach who is covered by an insurance plan through his former job in Massachusetts. "It's just not equitable. When so many people in this county are not insured, we all need to sacrifice a little bit."

President Barack Obama and many Democrats in Congress also resent what they call over-payments to Medicare Advantage.

The shift in Washington reflects a larger debate between Democrats who want to expand the government's role in health care versus Republicans who want private insurers to control the system, including some aspects of Medicare.

Medicare Advantage was created in 2003 when then- President George W. Bush and Republicans in Congress argued that the government needed to pay more to private insurers operating Medicare health plans, notably those run by Health Maintenance Organizations. They assumed these plans eventually would be more efficient than the traditional Medicare program, which reimburses doctors and hospitals.

"They decided to put additional money into the private plans to attract more Medicare beneficiaries. The argument was that it would lead to greater efficiency," said Stuart Guterman, an expert on health-care reform at The Commonwealth Fund, a non-partisan research group in Washington. "As it has turned out, the private plans in Medicare have remained more expensive, and their costs have risen over time. If you are paid more than it costs, there's not a lot of incentive to keep costs low."

"The problem now is that once that money is in the pot, it's very hard to withdraw it," he said. "Then you have private plans telling enrollees: 'If Congress does what it says, we are not going to be able to offer these perks.' "

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