Before Seniors in Florida, Gore Widens His Plans for Medicare

Vice President Al Gore expanded his plan to revamp Medicare on Monday, proposing new coverage for preventive health care and penalties for health maintenance organizations that reduce their Medicare work.

Speaking across the street from the shuffleboard courts that made this Gulf Coast community synonymous with retirement, Gore said the presidential election six weeks from today will come down to a choice over which candidate “stands up and fights for the seniors who need health care.”

The Gore campaign is hoping that differences over health care with Texas Gov. George W. Bush, the Republican presidential nominee, will prove a powerful incentive to bring undecided voters to the Gore side.

That is particularly so in Florida. With 25 electoral votes, the largest percentage of elderly voters of any state and a race that is up for grabs, the state is getting more and more attention from both camps.

Gore, campaigning with his wife, Tipper, unveiled new details of his Medicare program in a speech at the Coliseum, an Art Deco public meeting and dance hall once the center of social and civic life here, and in a 74-page booklet he issued Monday called “Medicare at a Crossroads.”

The vice president has long been pressing his differences with Bush over Medicare, which serves 40 million Americans, and the program he presented Monday builds on earlier proposals to extend the Medicare trust fund from 2025 to 2030 and make prescription drug benefits available to all beneficiaries.

On Monday, Gore proposed eliminating most deductibles and co-payments for Medicare’s preventive services. Thus, beneficiaries would not have to pay separate fees for various screenings, among them those for prostate and colon cancer. Under current regulations, Medicare charges a $100 deductible and, for preventive care, a 20% co-payment.

In addition, the vice president would make such tests available under Medicare at rates recommended by health experts. For example, Medicare pays for colon cancer screenings once every two years, but experts recommend that those at high risk be tested annually.

Gore would also offer Medicare coverage that would make cutting-edge preventive screenings available in what he called a timely manner, rather than delaying coverage under an arduous approval procedure.

With HMOs under fire for moving to restrict their dealings with Medicare--some 65 such groups will not renew their contracts covering approximately 1 million people next year, the government has said--Gore proposed new restrictions.

He would require the HMOs to commit themselves to two-year contracts, rather than one-year commitments, to stabilize health coverage. Health maintenance organizations that drop coverage in a particular community are now prohibited from returning for two years; Gore would extend that penalty to four years to discourage them from opting out of the program.

He would also step up efforts to limit HMOs from participating only in the most profitable, healthful communities, first giving them a warning against such practices and then banning them from any Medicare work if the practice continues.

Karen Igagni, president of the American Assn. of Health Plans, said Gore’s proposed four-year ban on HMOs that opt out of Medicare was a “step backwards.”

But she also said HMOs are encouraged that Gore would increase government reimbursement levels and other revenue. For example, while seniors would save money on preventive screenings, Gore’s plan would allow the existing $100 deductible for doctor visits to increase with inflation and he would add more co-payments for laboratory services.

“This is the first time that the vice president has weighed in on the concept of health plans being included in budget relief,” said Igagni, whose group represents about 1,000 plans nationwide.

Gore took the rare step of reading his 19-minute address from the screens of a prompting device, an indication of the care that went into its preparation and the political importance attached to the precise elements of the program.

“Good health is no longer an unattainable luxury, but a basic right for families,” he said.

He added: “But let’s be clear. There are powerful forces that want to block our progress, putting short-term profits over human health. The HMOs and insurance companies want to measure your health and well-being on a spreadsheet. And we’re no longer going to let that happen.”

Making a clear reference to Bush, Gore said that some see the current Medicare surplus, estimated at $360 billion over the next decade, “as a piggy bank they can use for a tax cut that primarily benefits the wealthiest Americans, at the expense of everyone else.”

From across the audience of approximately 1,000 people--many of them senior citizens, some depending on walkers--a growing chorus of “No” erupted.

A Bush spokesman, Dan Bartlett, said of the plan: “Al Gore may think Medicare is at a crossroads, but his plan puts it on a highway to bankruptcy.

“This administration created the problems he claims he’s fixing,” Bartlett said of Gore’s proposals. He said the penalties proposed for HMOs “would create more of a disincentive” for the groups to continue or expand their Medicare coverage.

Gore aides also tried to taint Bush on Medicare Monday by releasing part of a 1995 television interview in which the Texas governor lauded the Republican-controlled Congress for its “political courage” in cutting the Medicare budget.

The proposed cuts to Medicare played a major role in the 1996 government shutdown during which President Clinton made the Republican cuts a political issue. But Monday, Bush aides accused Gore of “hypocrisy” because the Clinton administration eventually signed Medicare cuts into law in 1997.

“I think it’s Al Gore grasping at straws by attacking Gov. Bush for what Gore’s own administration signed into law,” Bartlett said.

The proposals Gore and Bush have made for Medicare are intended to address both the approaching demands the baby-boom generation will make on the government health care program for the elderly and disabled, and to take account of the changes in medical practice since Medicare was established in 1965, particularly the expanded use of pharmaceuticals and preventive medicine.

Bush has proposed a system under which states would be given an expanded role in administering the prescription program, a course that Gore argues would force the elderly to visit welfare offices to obtain their benefits. Five states now follow such a course, he said.

Speaking with reporters aboard Air Force Two as he flew here at the start of a three-day trip that will take him to two other competitive states, Michigan and Iowa, the vice president said income limitations in his opponent’s program would restrict it to low-income people.

And, he argues, differing state plans would result in variations in coverage regardless of what a person paid into the plan.

From St. Petersburg, the vice president flew to Miami, where he attended two Democratic National Committee fund-raising parties.

*

Times staff writers Alissa Rubin and Megan Garvey contributed to this story.