By Christopher Clough
News-Chronicle
Medicare recipients are better off getting sick or injured in Louisiana than in Wisconsin. Or at least, they get larger reimbursements from the program and more choices about the types of coverage they can have.
That could change in the future if U.S. Sen. Russ Feingold has his way. Feingold announced at St. Vincent Hospital Monday morning that the Senate Finance Committee unanimously approved an amendment he cosponsored that would promote what he called "Medicare fairness."
"We've taken at least the first tiny step in Congress to promote fairness in the Medicare system," Feingold said to an audience of health care workers and senior citizens. "(The amendment) requires legislators to address Medicare discrimination against Wisconsin seniors and providers simply because they're from Wisconsin."
The legislation would rework the formula established in the 1980s for determining Medicare payment rates, establish pilot programs to reward states keeping their medical costs down, provide a rotation of clinical services to benefit rural and inner-city areas, and promote equity in nursing home payments.
Feingold said that although everyone across the country pays the same payroll tax rate to Medicare, benefits are not distributed equally. In fact, Wisconsin Medicare beneficiaries receive $3,795 a year, which ranks 42nd out of the 50 states.
He compared the average Wisconsin Medicare recipient to an average Medicare recipient in Louisiana, who at $6,720 receives more annual benefits than recipients in any other state.
"Say there's two identical twins over age 65," Feingold said. "Both worked at the same company all their lives, paid the same taxes. One retired to New Orleans, the other to Green Bay.
"The one in New Orleans would have vastly different health care options than in Green Bay. He can choose between an HMO or traditional service plans. In Green Bay, there's no options and fewer health care agencies that can provide them."
The problems go beyond hospital and doctor bills, as other health care systems such as nursing homes and counseling centers take Medicare patients.
"You see a lot of nursing homes limited in the number of Medicare patients they take," St. Vincent administrator Joe Neidenbach said. Feingold and the health care professionals said the inequities in the system hurt more than just Medicare recipients, because providers must compensate elsewhere for the lack of revenue coming from Medicare.
"Folks buying private health insurance have higher premiums," said Steve Brenton, president of the Wisconsin Hospital Association. "It's a direct result of cost shifting because of losses in Medicare programs."
"In 2002, our Medicare reimbursements will be about 36 percent of our charges," said Tom Huffer, medical director of Prevea Clinic. "If we ran a business that way, we'd lose money, so we have to charge other patients more to make up the difference."
Huffer said the decreased revenues also make it difficult to hire qualified physicians and other staff, especially in geriatrics, when they can get paid more by working in a state with higher Medicare payments.
Feingold said states that have controlled their medical costs efficiently have been penalized under the formula Medicare uses to make payments. Basically, the lower the expenses, the lower the payments the states are reimbursed.
The discrepancies are markedly top-heavy regarding who gets the benefits: The average Medicare recipient in the nation receives just over $5,000 in benefits annually. However, the average Medicare recipient in just 13 states receives more than that, while 37 states fall below that line.
Feingold said that statistic is one reason he is optimistic the discrepancies will be legislated out in the future. He also said some senators from the 13 states above the average are supporting the equalization.
"The advantage we have here is that the majority of states don't do well in the system," he said."(And) the discrepancies are so outrageous that states at the high end are arguing for (equalization). I think support for this is very strong, there's such frustration in so many states."
He noted that senators who voted for the amendment included Texas Republican Phil Gramm and New York Democrat Hillary Clinton. Texas and New York ranked fourth and seventh respectively in average payments per Medicare recipient.
The amendment does not take specific action to solve the discrepancies, other than to require Congress to address it when lawmakers work on any future Medicare reform package.
Feingold said he wasn't sure when the Senate would take up Medicare reform, but he said he would push to make it happen.
"It could be this minute, it could be in five minutes, it could be in 20 years," he said. "This is not exactly like the call for campaign finance reform, but the squeaky wheel gets the attention."
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