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Medicare recipients ask about life after HMOs

At a Brooksville meeting, the answers are troubling _ when they're comprehensible.

If they could have, William Coward and his wife, Audrey, might have stormed out of the meeting hall. Instead, they slid slowly behind William Coward's walker, a back brace holding him up straight.

"It's hard to live like this," said Coward, 72.

The Cowards, among thousands of Hernando County residents losing prescription drug coverage because of the departure of Medicare HMOs, angrily left the Florida National Guard Armory after hearing about several alternatives for which they do not qualify or which they cannot afford.

"We're not eligible for Medicaid, we're on the borderline. We're falling through the cracks," said Mrs. Coward, 62, who moved to Hernando when Medicare HMOs pulled out of Citrus County several years ago.

The agonized faces behind the political debate over health coverage were on full display Thursday in the spartan, concrete block armory. Nearly 200 anxious seniors scribbled notes and listened intently as federal Medicare officials recited the limited options for residents abandoned by their Medicare HMOs.

In Congress, on the presidential campaign trail, and in TV ads for Florida's U.S. Senate hopefuls, the issues of prescription drugs and health care for seniors are taking center stage. The stakes are high in communities around the country.

In Hernando County alone, nearly 10,000 people learned in July that the last two Medicare HMOs were pulling out of the county, saying they couldn't afford to do business there. Come January, many of these fixed-income retirees say they may have to choose between prescription drugs and food.

Many of the fretful men and and women streaming out of the armory Thursday knew of the competing proposals offered by Texas Gov. George W. Bush and Vice President Al Gore. And most said the health care crisis will be on their minds in November as they step into the voting booth.

"You bet it will," snapped 73-year-old Ray VanDenburg, a retired trucker who had open heart surgery last year. He and his wife have an annual income of $25,000 and can't afford supplemental insurance if a new Medicare HMO doesn't come into Hernando soon.

"We can give billions of dollars to all these other countries," VanDenburg said. "We ought to start taking care of our own people first."

Limited options

Federal officials wanted to make sure Thursday's informational session did not degenerate into the screamfest that similar meetings have become.

They stressed they wanted simply to clear up confusion and steer people in the right direction. They accepted only written questions.

One such query, from a resident with a fixed annual income of $33,000 and medical expenses of $55,000, wondered about the future:

"At this rate I should be bankrupt within about three years, depending on the stock market. What are my options?"

Responded Rick Jones of the federal Health Care Financing Administration:

"I would encourage you to share that with your legislator."

The Hernando County crisis reflects a critical failure in the Medicare system nationwide. An estimated 934,000 people will be affected by the withdrawal of managed care plans from the HMO system in 2001. About 17 percent of those will not have access to any other Medicare HMO plans. In Florida, some 26,000 people are expected to become HMO orphans.

Unless a new Medicare HMO pops up in Hernando _ and two companies have applied _ many of these residents will be left with only standard Medicare coverage, which charges higher co-payments and doesn't cover prescription drugs.

Or they could spend hundreds of dollars a month on supplemental insurance. That's no easy option for couples already struggling on fixed incomes of $25,000 and less.

"We worked all our lives and paid our taxes. Our little bit of savings keeps us afloat," said Inge Mahnken, 70, of Brooksville. She said she and her husband, Bruno, will not be able to afford Medicare supplements and the four medications she takes, which would cost $300 a month.

"I might have to cut back," she said of her medicine, which she takes for ulcers, cholesterol, blood thinning and hip problems. "Either you eat or you take pills."

Medicare HMOs were supposed to be a godsend, a way to save money for Congress. But federal studies found that Medicare HMOs were overpaid. They had initially attracted younger, healthier patients with lower medical bills than traditional Medicare and could afford lots of extras for patients.

Congress put the brakes on that with the 1997 Balanced Budget Act, limiting reimbursement rate increases for many plans to 2 percent, from 10 percent. Medicare HMOs say that prompted the current crisis.

Insurance companies like the ones leaving Hernando County _ AvMed Health Plan and Humana _ say they are pulling out of mostly rural counties because the federal reimbursement rates are too low.

Many Hernando residents can't see the fairness in a system that ensures residents in urban counties have access to affordable health coverage, while they lose out by virtue of where they live.

Said Joao Ledo of Spring Hill: "We want to know why there's discrimination in our county."

Tough solutions

To hear the rhetoric, seniors won't find prescription drugs out of reach for long.

Medicare and prescription drugs are high-profile issues in presidential and U.S. Senate races, with just about everybody promising to offer new drug benefits.

While the promises have a familiar ring, the proposals are quite different.

Bush would rely heavily on private insurers and health maintenance organizations to develop a variety of Medicare plans for seniors, including options that include prescription drug coverage. Republican Senate candidate Bill McCollum also supports the concept, which Republicans contend would give seniors more options and keep prices down.

Gore and Democratic Senate candidate Bill Nelson favor a more traditional approach. They would add a prescription drug benefit option to the existing Medicare program.

At a time when Medicare HMOs are pulling out of Florida, Bush would seem to have the more difficult argument.

But Bush's brother, Gov. Jeb Bush, said this week that the problems are largely confined to the North Suncoast. He estimated up to 80 percent of the state's residents are happy with their health care plans.

Jeb Bush blamed the pullout of Medicare HMOs on the Clinton administration, arguing that it backed cuts in reimbursement rates that proved too deep for the HMOs to survive. He said the situation bolsters the argument for his brother's proposal, which would reform the entire system.

Gore contends that the Republican plan would still leave millions of seniors without coverage for prescription drugs and that they would remain hostage to the decisions by private insurers over what drugs to cover and how much to charge.

In Hernando County, the majority of registered voters are Republican, but they backed Clinton in the last two presidential elections. Outside the armory, most people said they preferred Gore's plan over relying mainly on insurance companies.

"I don't believe these ads you see that say, "Don't get big government involved in prescription drugs.' I think we need big government to get more involved to stop the drug companies from robbing us," said Maynard Morrison, a Republican 52-year-old plasterer retired on disability.

But 81-year-old Terry Hammond, a retired secretary, preferred Bush's plan for more fundamental Medicare reforms.

"Gore wants to give too much. The money you just give to people, they come to expect and that means the more it costs in the long run," she said.

At least for now, William and Audrey Coward have little confidence in a solution.

"I guess," said William Coward, sitting on a bench outside the armory, "we'll have to move from here and go to Canada."

_ Times political editor Tim Nickens contributed to this report.