WASHINGTON — Based on a study of insurance plans in five states, including Utah, Democrats say seniors may soon face a tough choice: Keep the doctors they like or leave them if they want affordable new prescription drug coverage through Medicare.
Democrats complained Thursday that President Bush and his GOP allies appear to be considering offering significant prescription drug coverage only to those Medicare recipients who choose to enroll in private
preferred provider organization, or PPO, insurance plans, which limit which doctors may be visited.
"If this plan were to pass, many seniors would be forced to choose between staying with their doctors and paying more for prescription drug coverage or switching to new doctors just to receive coverage," said Ben Peck, author of a study by the Public Citizen watchdog group about possible effects of such proposals.
Plans on how to reform Medicare and how to provide a new prescription drug benefit through it are still fluid. The Senate Finance Committee, on which Sen. Orrin Hatch, R-Utah, is a key member, is scheduled to begin debate on it next week.
Frank Clemente, president of Public Citizens Congress Watch, said Utah was included in the new study because of Hatch's membership on the committee.
The report looked at how many of the doctors who now accept Medicare patients also participate in PPOs in Utah, Maine, Oregon, Vermont and West Virginia.
However, it looked at only four counties in
each state. Clemente said the study chose them by dividing a state's counties into four groups according to population, then studying the median county in each quartile. The counties studied in Utah were Weber, Sanpete, Emery and Wayne.
That Utah sample suggests that only about half of the doctors who accept Medicare patients there also participate in PPOs, so their patients might have to go to other doctors to obtain the most generous drug benefits under some scenarios proposed.
In that sample, only 94 of the 178 generalists — 53 percent — who accept Medicare in Weber County participated in the largest PPO there, the study said.
In Sanpete, 84 percent of the 32 generalists are in its largest PPO. In Emery, none of its four generalists participate in PPOs. However, in Wayne, its two generalists who take Medicare patients also are in PPOs, so their patients would see no difference in availability, the study said.
The study also looked at two types of physicians: cardiologists, heart specialists, and oncologists, who treat cancer. It found that none of such specialists in Wayne, Emery and Sanpete now participate in Medicare.
In Weber, 13 of the 21 cardiologists who take Medicare patients (62 percent) are also in the largest PPO there. And seven of the nine oncologists who take them (78 percent) are in that largest PPO.
In the five states combined, the study said samples showed that 43 percent of generalists who take Medicare patients also are in the largest PPO in their county, as are 52 percent of cardiologists and just 25 percent of oncologists.
Sen. John D. Rockefeller IV, D-W.V., said at a press conference releasing the report, "Our seniors shouldn't be forced to choose between a doctor they trust and prescription drugs. They deserve both."
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Our seniors shouldn't be forced to choose between a doctor they trust and prescription drugs. They deserve both.
John D. Rockefeller IV
senator, West Virginia
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In Weber, 13 of the 21 cardiologists who take Medicare patients (62 percent) are also in the largest PPO there.