Counties not exempt in reform bill
January 24, 2010
Several Times-Union readers want to know:
Did Sen. Bill Nelson surreptitiously put a provision into the health care reform bill that exempts only three counties in Florida from Medicare Advantage cuts?
Karl Rove called it the "Sunshine State Sweepstakes" in an interview with Fox News. And in a C-Span2 video, according to Sen. Mike Crapo, R-Idaho, "buried deep in the bill, on Page 894, has a $5 billion provision drafted to prevent the drastic cuts in Medicare Advantage programs from impacting those enrollees who reside primarily in three counties in Florida - Broward, Miami-Dade and Palm Beach."
And Sen. John McCain, R-Ariz.,referred to it as the "Florida Flim Flam."
Despite such august names behind this claim, it's not true.
Health care in the U.S. probably won't undergo sweeping reform because of the Democrats' loss of majority in the Senate. And many parts of the current bill might not survive if there is an attempt to pass a scaled-down version. But we're here to set the record straight.
First, anyone can look at a copy of the health care reform bill at the Library of Congress' Thomas Web site, http://thomas.loc.gov/. A search of H.R. 3590, the Patient Protection and Affordable Care Act that passed both houses, finds no mention of Florida or Broward, Miami-Dade and Palm Beach counties - not on Page 894 or any other page.
But Florida will benefit from what is there. And so will other states. PolitiFact, the independent, nonpartisan Pulitzer Prize-winning project of The St. Petersburg Times, explains what happened:
Medicare Advantage is the program that lets recipients get benefits through private insurers instead of through traditional Medicare. Those recipients usually get additional benefits such as dental and vision care because the government reimburses the private companies for them at a higher rate than for regular Medicare patients. To help bankroll health care reform, lawmakers targeted cuts in Medicare Advantage reimbursements.
Concern over cost
Nelson, D-Fla.,voted against establishing Medicare Advantage because he thought the cost was too high, his spokesman Dan McLaughlin said. But when the cuts were discussed, the senator didn't want to take benefits from seniors who already had them.
He asked for the 11 million seniors enrolled in Medicare Advantage to be grandfathered into the new system, McLaughlin told PolitiFact.com. The $35 billion that would cost was too high, so Senate leaders offered $5 billion. Nelson proposed an amendment to the health care bill that protects seniors most affected by any cuts.
The exemption would allow seniors to keep Medicare Advantage under the old rules if they live in areas where services cost the highest. The health care bill creates a formula to identify just who should be protected from the changes, PolitiFact.com reports.
"The amendment protects some 800,000 seniors all across Florida - not just 300,000 in three counties [as critics charge]. It also helps others in states similar to Florida where seniors face especially high health care costs, like in California and New York," McLaughlin told The Times-Union. "Further, Sen. Nelson actually brought the amendment up in the Senate Finance Committee's public meeting last October, at which time it was fully debated and the committee approved it. In other words, there was no hush-hush deal."
Yes, Miami-Dade, Palm Beach and Broward counties would benefit from the exemption because medical care for the many seniors there is expensive. But so would other Floridians and other seniors that live in high-cost areas and who are most at risk of big cutbacks.