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Example research essay topic: Medicare Beneficiaries Prescription Drugs - 1,867 words

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Congress Asked To Take Action As HMOs Flee Managed See end of article for an opportunity to comment on Medicare+Choice, the system that was supposed to nation's senior citizens, will be lucky if it next year. Thanks mainly to the increasing cost of drug benefit, HMOs are exiting the program in Congress can save Medicare+Choice, experts believe, have the political will to do so this election year This is not exactly a bolt out of the blue. Last organizations chose not to renew their contracts for reduced service areas, affecting more than 327, 000 79, 000 of whom were left without any Medicare The previous year, non renewals and reductions beneficiaries -- leaving more than a tenth of them A recent Kaiser Family Foundation report on "involuntarily dis enrolled" from their HMOs after beneficiaries "fared well, " but nearly 40 percent and more than 20 percent had to find a new personal who experienced the greatest problems after their tended to be the under-age- 65 disabled, racial and beneficiaries, the poor and near-poor, and those Currently, 6. 2 million (16 percent of all) Medicare "Expensive red tape" and "inadequate government Medicare managed care program into "code blue, " says in June by the Health Insurance Association of The paper's author, Bruce Merlin Fried, former head program, concludes that while Medicare HMOs receive increases, the cost of medical care increases around cost of prescription drugs (offered by most Medicare annually. "Inadequate payments, as well as the government regulation, are causing HMOs to withdraw Enrollment growth of private Medicare HMOs dropped to less than 1 percent in the first four months of most recent wave of withdrawals, 86 HMOs have coverage since 1998, while another 112 have pulled Fried, now a partner in the Washington law firm of findings "not a surprise, but a disappointment. " To counter the trend, Fried urges Congress to HMOs to keep up with medical inflation, and for HCFA the expense of prescriptive government regulation. " Congress to require HCFA to implement risk basis, and for the Department of Health and Human HCFA's responsibility for overseeing Medicare+Choice "These steps would stabilize the program, " Fried Congress and the administration continue to ignore will die a slow and painful death, and it will be impossible -- to generate industry support for, and Last month, Philadelphia-based Cigna Corp. , the operator, announced it would pull out of most forcing about 104, 000 people to switch plans or Other managed care companies were also indicating advance of the July 3 reporting date. Aetna, the insurer, had reported that it intends to cut back which now covers 670, 000 people, in 2001. Health Metrix Research Inc. , in Columbus, Ohio, Medicare HMO enrollees could be affected. During the year, notes Health Metrix President Alan Mittermaier, curtailment" of marketing activity by Medicare HMOs which saw increasing numbers of the HMOs advertising The American Association of Health Plans wants $ 13 Medicare+ Choice over the next five years, as well AAHP spokesman Mohit Ghose says the government has commitment to Medicare beneficiaries who switched to belief that their care, in fact, would be managed.

he maintains, are not interested in contracting with given the payment differential between fee-for-service Medicare and managed care plans. "You can't blame a doctor or hospital HCFA Administrator Nancy-Ann De Parle says Medicare enough to provide basic Medicare benefits, " but payment formula "does not always pay enough for enough profit. " A mandated drug benefit plus contends, would make Medicare attractive to private Regarding prescription drugs, California Democratic Medicare recipients "are not clamoring for more clamoring for a prescription drug benefit. No one managed care plan to get the basic care they need. "You won't hear that from the managed care industry. in fee-for-service Medicare, there is no way most restrict their choice of doctors and hospitals. " Suggesting that there appears to be little sympathy addressing the issues that frustrate Medicare HMOs, Health Metrix, points to a 1999 General Accounting concluded that Medicare overpays HMOs. "The financing required for underwriting any of the Bibliography: Congress Asked To Take Action As HMOs Flee Managed > Medicare > See end of article for an opportunity to comment on > this issue. > Medicare+Choice, the system that was supposed to > manage the health of the > nation's senior citizens, will be lucky if it > manages to stay afloat into > next year. Thanks mainly to the increasing cost of > providing a prescription > drug benefit, HMOs are exiting the program in > droves. Only an act of > Congress can save Medicare+Choice, experts believe, > but whether legislators > have the political will to do so this election year > seems doubtful. > > This is not exactly a bolt out of the blue.

Last > year, 41 Medicare+Choice > organizations chose not to renew their contracts for > 2000, while another 58 > reduced service areas, affecting more than 327, 000 > Medicare beneficiaries -- > 79, 000 of whom were left without any Medicare > managed care option at all. > The previous year, non renewals and reductions > affected about 407, 000 > beneficiaries -- leaving more than a tenth of them > without managed care > options. > > A recent Kaiser Family Foundation report on > beneficiaries who were > "involuntarily dis enrolled" from their HMOs after > 1998 indicates that most > beneficiaries "fared well, " but nearly 40 percent > incurred higher premiums, > and more than 20 percent had to find a new personal > doctor. "Beneficiaries > who experienced the greatest problems after their > HMO terminated coverage > tended to be the under-age- 65 disabled, racial and > ethnic minority > beneficiaries, the poor and near-poor, and those > reporting fair or poor > health, " the foundation said. > > "Not a surprise" > Currently, 6. 2 million (16 percent of all) Medicare > beneficiaries are > enrolled in HMOs. > > "Expensive red tape" and "inadequate government > funding" are pushing the > Medicare managed care program into "code blue, " says > a white paper released > in June by the Health Insurance Association of > America. > > The paper's author, Bruce Merlin Fried, former head > of the Medicare HMO > program, concludes that while Medicare HMOs receive > annual 2 -percent funding > increases, the cost of medical care increases around > 8 percent a year; the > cost of prescription drugs (offered by most Medicare > HMOs), about 15 percent > annually. "Inadequate payments, as well as the > crushing cost of excessive > government regulation, are causing HMOs to withdraw > from Medicare at an > alarming rate, " Fried writes. > > Enrollment drops > Enrollment growth of private Medicare HMOs dropped > from 36 percent in 1996 > to less than 1 percent in the first four months of > 2000. Not including the > most recent wave of withdrawals, 86 HMOs have > stopped providing Medicare > coverage since 1998, while another 112 have pulled > out of various counties. > Fried, now a partner in the Washington law firm of > Shaw Pittman, calls the > findings "not a surprise, but a disappointment. " > > To counter the trend, Fried urges Congress to > increase payments to Medicare > HMOs to keep up with medical inflation, and for HCFA > and Congress to "reduce > the expense of prescriptive government regulation. " > He also calls on > Congress to require HCFA to implement risk > adjustment on a budget-neutral > basis, and for the Department of Health and Human > Services to consolidate > HCFA's responsibility for overseeing Medicare+Choice > into one division. > > "These steps would stabilize the program, " Fried > says, but warns that "If > Congress and the administration continue to ignore > these issues, the program > will die a slow and painful death, and it will be > difficult -- if not > impossible -- to generate industry support for, and > involvement in, future > market-oriented approaches. " > > Last month, Philadelphia-based Cigna Corp. , the > nation's sixth largest HMO > operator, announced it would pull out of most > Medicare markets Jan. 1, > forcing about 104, 000 people to switch plans or > return to traditional > Medicare. > > Other managed care companies were also indicating > plans for cutbacks well in > advance of the July 3 reporting date. Aetna, the > nation's largest health > insurer, had reported that it intends to cut back > its Medicare HMO business, > which now covers 670, 000 people, in 2001. > > Health Metrix Research Inc. , in Columbus, Ohio, > estimates that 1 million > Medicare HMO enrollees could be affected. During the > first quarter of this > year, notes Health Metrix President Alan Mittermaier, > there was "widespread > curtailment" of marketing activity by Medicare HMOs > -- unlike past years, > which saw increasing numbers of the HMOs advertising > and recruiting in > metropolitan markets. > > The American Association of Health Plans wants $ 13 > billion put back into > Medicare+ Choice over the next five years, as well > as other comprehensive > changes. > > AAHP spokesman Mohit Ghose says the government has > failed to meet its > commitment to Medicare beneficiaries who switched to > managed care in the > belief that their care, in fact, would be managed. > Physicians and hospitals, > he maintains, are not interested in contracting with > Medicare+Choice plans, > given the payment differential between > fee-for-service Medicare and managed > care plans. "You can't blame a doctor or hospital > for not wanting to take 80 > cents on the dollar, " says Ghose. > > HCFA Administrator Nancy-Ann De Parle says Medicare > HMOs "are paid more than > enough to provide basic Medicare benefits, " but > acknowledges that the > payment formula "does not always pay enough for > extra benefits...

to make > enough profit. " A mandated drug benefit plus > administrative changes, she > contends, would make Medicare attractive to private > plans. > > Regarding prescription drugs, California Democratic > Rep. Pete Stark thinks > Medicare recipients "are not clamoring for more > managed care plans. They are > clamoring for a prescription drug benefit. No one > should be forced to join a > managed care plan to get the basic care they need. " > With a jab, Stark adds, > "You won't hear that from the managed care industry. > If drugs are included > in fee-for-service Medicare, there is no way most > people would choose to > restrict their choice of doctors and hospitals. " > > Of Peter, Paul, and robbers > Suggesting that there appears to be little sympathy > in Washington for > addressing the issues that frustrate Medicare HMOs, > Mittermaier, of > Health Metrix, points to a 1999 General Accounting > Office study that > concluded that Medicare overpays HMOs. > > "The financing required for underwriting any of the > Medicare


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Research essay sample on Medicare Beneficiaries Prescription Drugs

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