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Medicare changes are reassuring -- and worrisome

This article first appeared in the St. Louis Beacon, April 27, 2011 - Judith Parker has bittersweet thoughts about Medicare. She's pleased with the new and expanded health benefits for seniors like herself.  But she's worried about what the future holds.

New Medicare benefits include numerous preventive tests and services, with no copayments or deductibles, such as a "Welcome to Medicare" physical exam for those new to the program, annual mammograms, tests for diabetes and bone density, and cancer screening.

But some of Missouri's elderly apparently are so preoccupied with the many controversies involving the federal health-reform law (the Affordable Care Act) that they haven't had time to think about their new Medicare benefits. Several states have filed suit to overturn the ACA, which includes the enhanced Medicare benefits. In addition, Democrats and Republicans are fighting over efforts to scrap or rewrite parts of the legislation.

On Wednesday afternoon, some of Missouri's older adults say they will take part in a "Don't Make Us Work Till We Die" rally at the state capitol in Jefferson City to complain about U.S. House GOP legislation to remake Medicare.

Among other things, the House proposal by U.S. Rep. Paul Ryan, R-Wisc., would turn Medicare into an insurance voucher program. Ryan's proposal also calls for eliminating subsidies to help seniors close the so-called doughnut hole, the gap in the cost of prescription drug coverage. The new health law would eventually close the hole.

The new law also would shave $136 billion from the Medicare Advantage program over a decade. The Obama administration wants to reduce funding to these plans because they cost the federal government more.

The Medicare Advantage program is an alternative to traditional fee-for-service Medicare in which Medicare contracts with private insurers to provide services. The Advantage plans usually require enrollees to use the plan's doctors and hospitals. The lure of these private programs is that they offer additional benefits -- such as hearing and dental services and physical fitness programs -- not provided by traditional Medicare.

Perhaps that is one reason participation in Medicare Advantage plans is growing in Missouri.

At least 992,000 Missourians receive Medicare. About 21 percent of them are choosing Medicare Advantage programs, up from about 14 percent a decade ago.

Parker is among Missourians who chose Medicare Advantage. But, she's also a strong opponent of GOP efforts to remake traditional Medicare. She says Medicare Advantage costs her more, but she likes the perks, such as a health club membership.

She also is grateful that her Medicare Advantage program was a lifeline when her husband was dying and needed expensive hospital care.

"I was absolutely dumbfounded because he had very high medical and hospital bills," she says. "I kept waiting for the next shoe to drop. But it didn't.  It was a blessing" that she had to pay relatively little of the cost because of her Medicare Advantage plan. (With traditional Medicare, she would also have had to have a supplemental insurance to cover all the costs.)

Many Missouri doctors apparently are not fans of Medicare Advantage. Patients complain of having difficulty finding physicians who participate in the Advantage plans.

Jeffrey Howell, head of legal research and government relations for the Missouri State Medical Association, believes doctors dislike Advantage plans because they are run by insurers.

"When you insert a big insurance company in the middle, you create just another layer of bureaucracy and paperwork to deal with. That requires hiring additional employees and extra time. It's just another layer between you and your paycheck."

In addition to concerns about the federal Medicare program, many Missouri seniors are jittery about the future of some state assistance programs, such as the MO Rx program which helps some seniors and others cover the cost of medications. Eighty percent of the funding comes from the state's tobacco settlement fund, and 20 percent comes from rebates from pharmaceuticals. A Missouri resident with income of less than $21,660 is eligible for the program. The Missouri House has voted to extend the $20 million program, which expires in August, but the Senate has not.

Catherine Edwards, statewide executive director of the Area Agency on Aging, says: "If you cut out MO Rx, it will mean lots of seniors won't be able to afford their medicine. That's not only going to aggravate their health conditions, it's going to make health care costs go up in the long run."

Funding for the Beacon's health reporting is provided in part by the Missouri Foundation for Health, a philanthropic organization that aims to improve the health of the people in the communities it serves.

Robert Joiner has carved a niche in providing informed reporting about a range of medical issues. He won a Dennis A. Hunt Journalism Award for the Beacon’s "Worlds Apart" series on health-care disparities. His journalism experience includes working at the St. Louis American and the St. Louis Post-Dispatch, where he was a beat reporter, wire editor, editorial writer, columnist, and member of the Washington bureau.