ANNAPOLIS – A Montgomery County legislator has a message for Eastern Shore, Western and Southern Maryland seniors in a huff over new, $75-a-month Medicare premiums: get over it.
“When those people are yelling and screaming about it not being equitable, I say, `Join the club,'” said Sen. Jennie Forehand, D-Montgomery, after a hearing on the subject last week.
Forehand said Montgomery County residents have a higher cost of living and have to watch as other counties get state help for services, like parking costs, while they get nothing.
Rural counties usually receive more favorable consideration when it comes to state regulation, she said, adding that residents in urban areas of the state deserve any break they get on Medicare costs.
Her comments bemused rural lawmakers, who found it hard to accept Forehand’s suggestion that the state’s wealthiest county is also the most put-upon.
“Normally, we get things crammed down our throats by the urban areas whether we like it or not,” said Del. George Edwards, R-Garrett.
“Whatever’s good for the Baltimore-Washington corridor,” usually becomes state policy, he continued.
He said that while rural residents may not have to pay for as many services as urbanites, “everyday things” like food and clothing are more expensive in rural areas because of shipping costs.
Their remarks were sparked by a briefing last week for the Joint Committee on Federal Relations, of which Forehand is co- chairman, on disparities in Medicare premiums around the state.
Most Maryland health maintenance organizations have stopped offering Medicare-risk plans on the Eastern Shore, in Western Maryland and in three Southern Maryland counties, where they were unprofitable last year.
Blue Cross and Blue Shield of Maryland is the only provider offering the supplemental service statewide and it tacked a $75- a-month premium per person onto its Medi-Care First plan in those rural areas.
That premium, which took effect Jan. 1, was not applied in urban areas, where competition has driven health costs down.
Del. D. Bruce Poole, D-Washington, called the new fee, “half a grocery bill.” He said his constituents who are on fixed incomes are being forced to pay for a premium they cannot afford because of a lack of competition between HMOs.
“Companies can pretty much cherry-pick,” if government regulators do not require them to offer the same coverage in every part of the state, Poole said.
Del. Adelaide Eckardt, R-Dorchester, introduced a bill Monday that would require insurers to charge the same premium all across the state.
While she said seniors in her district are “incensed” over the new premium, Eckardt said she is worried that her bill could drive the remaining HMOs offering Medicare-risk plans out of her area.
Fran Tracy, an official with Blue Cross, said the company must charge the premium because health care providers in rural counties charge more than the federal government will provide in reimbursement. That difference amounted to $7 million in losses for Blue Cross last year.
Forehand, who has a 93-year-old mother, said plans like Medi-Care First are still a good deal, even with the higher premium. Seniors would otherwise have to pay hundreds of dollars more for similar coverage that does not accept Medicare reimbursement.
Tracy agreed that Blue Cross still offers a bargain for senior citizens who need insurance that goes beyond normal Medicare coverage to include longer hospital stays, prescription drugs, and vision and hearing screening.
But other lawmakers are alarmed by the price hike.
Maryland Reps. Steny Hoyer, a Democrat, and Republicans Roscoe Bartlett and Wayne Gilchrest, wrote to the Health Care Financing Administration in December expressing concern over the new charges. HCFA sets Medicare reimbursement rates by county.
“Considering that there was no monthly premium last year, it is easy to understand the anxiety and potential hardship the proposal generates for our constituents,” the letter stated.
Lisa Wright, a spokeswoman for Bartlett, said a provision in the Balanced Budget Act of 1997 will require HMOs to charge the same premium within a given “contract region” by 1999. But while the entire state of Maryland is currently listed as a single contract region, HMOs could easily divvy it up next year, she said.
That prospect annoys Evelyn Robinson, 72, a retired insurance inspector who has followed the issue closely.
Robinson, of Toddville, has joined other seniors who met three times with insurance companies, with little success. She says she would like to see some of the state budget surplus go to paying Medicare premiums this year, in hopes that future legislation will get rid of the extra charges permanently.
As for now, Robinson remains frustrated but philosophical.
“It’s a scam, but we must work on. You can’t get things straight by getting angry all the time,” she said.
Robinson, a part-time waterman and lifelong Shore resident, scoffed at Forehand’s suggestion that rural residents get a lot of help from the state. Shore residents, who she described as “a healthy breed,” usually end up having to pay for sewage treatment, street lighting, and public libraries out of their own pockets, she said.
“We feel over the years, we’ve had to look out for ourselves,” Robinson said.