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Study Finds that Bush Medicare “Reform” Plan Will Limit

May 15, 2003

Study Finds that Bush Medicare “Reform” Plan Will Limit
Iowa Seniors’ Choice of Doctors

WASHINGTON, D.C. – A Bush administration plan to push Medicare beneficiaries into private insurance plans to receive drug coverage would mean reduced choice of doctors for Iowa’s Medicare beneficiaries, according to a study released today by Public Citizen. The report is being released as U.S. Sen. Charles Grassley (R-Iowa), who chairs the Senate Finance Committee, which has jurisdiction over Medicare issues, is about to consider such privatization proposals.

The study, conducted in early May, compared the number of Iowa doctors in 23 counties participating in the Medicare program with the number of doctors participating in seven preferred provider organizations (PPO) that participate in the Federal Employees Health Benefits Program (FEHBP), which the Bush administration frequently refers to as its model for reforming Medicare. PPOs give patients more opportunity to choose a provider than HMOs, which are the current form of private insurance plan offered to Medicare beneficiaries.

The report found that in nearly every county, with respect to all categories of physicians studied, the total number of doctors participating in Medicare is much greater than the number participating in any of the private plan PPOs in FEHBP. In 20 non-urban Iowa counties studied, more than twice as many “generalist” physicians are participating in Medicare (579) than in Blue Cross and Blue Shield standard option (265), the private plan with the broadest network of providers.

“The report demonstrates that the Bush administration’s claim that enrollees who switch out of the traditional Medicare program into a private managed care plan would still be able to ‘choose any doctor’ is misleading,” said Ben Peck, legislative representative for Public Citizen’s Congress Watch. “If Medicare enrollees were to leave the traditional Medicare program and enroll in a PPO, they very likely would find that their doctor was not a participating provider, forcing them to pay more, perhaps significantly more, to continue to see that doctor.”

Among the report’s other findings:

Comparative Coverage for Cardiovascular Disease Specialists

  • In the 20 non-urban counties, the study found that Medicare has 81 cardiac specialists participating. The Blue Cross and Blue Shield standard option has only 48 participating cardiac specialists, or 41 percent fewer than Medicare.
  • For enrollees in the six private plans that are smaller than Blue Cross Blue Shield, choices of covered cardiac specialists would be even more limited if they had to switch from Medicare. The best of the second tier plans, Mail Handlers, has 24 specialists – 70 percent fewer than Medicare.
  • In the urban counties studied – Black Hawk (Waterloo), Polk (Des Moines) and Woodbury (Sioux City) – at least 19 percent of beneficiaries switching out of traditional Medicare would find that their cardiologist does not participate with their private plan, and they could be forced to pay more to continue seeing their doctor than they had paid in traditional Medicare.

Comparative Coverage for Oncologists

  • In the 20 non-urban counties, the study found that there are 11 participating oncologists in Medicare. The private plans with the widest network of oncology specialists after Medicare – Mail Handlers and the National Association of Letter Carriers – each have six. This means that there are 44 percent fewer participating doctors in these private plans than in Medicare.
  • In the three urban counties studied, one (Black Hawk) has more oncologists participating in a private plan, one (Woodbury) has an equal number participating in Medicare as in the plan with the most providers, and one (Polk) has fewer oncologists participating in the private plan with the broadest network.

Comparative Coverage for Generalists

  • In the 20 non-urban counties, after Blue Cross and Blue Shield, which has 54 percent fewer participating generalists than Medicare, the other six PPO plans all have fewer than 15 percent of the generalists that participate in Medicare. For beneficiaries concerned about continuing to see their doctors, this indicates that the other smaller plans may not be a serious option for them.

The counties studied were: Adair, Benton, Black Hawk, Buena Vista, Cedar, Clay, Davis, Dubuque, Fremont, Hancock, Humboldt, Jefferson, Lee, Madison, Mitchell, O’Brien, Pocahontas, Polk, Sac, Tama, Warren, Winneshiek, Woodbury. In the three urban counties of Polk, Woodbury and Black Hawk, only the numbers of cardiac and oncology specialists were examined.

Click here to view a copy of the report.