As you might know, Medicare patients have two enrollment choices: the traditional fee-for-service Medicare program, or a Medicare+Choice managed care organization. Proponents of Medicare+Choice argue that it lowers costs through more efficient service delivery and gives seniors more choices because plans compete for patients by offering greater benefits. In Washington, PacifiCare, Group Health, Regence Blue Shield, Premera Blue Cross, and First Choice all offer Medicare+Choice.

A very complicated formula determines how much doctors, hospitals, health maintenance organizations, and other providers are reimbursed for providing Medicare services. The formula leads to different reimbursement rates in each county around the nation. 

Some differences in reimbursement rates make sense; for example, operating and labor costs are more expensive in some areas of the country than others, and some counties serve a disproportionately low-income population. However, one of the biggest reasons for discrepancies in reimbursement rates stems from something called "practice patterns."

In short, "practice patterns" simply means that if a county has traditionally had high Medicare costs, insurers and providers in these counties continues to receive high funding. On the other hand, if a county – like all Washington state counties – has had traditionally low Medicare costs, it receives a lower reimbursement rate. In essence, the senior citizens living in these counties are punished for the insurers' and providers' efficiencies, hardly the message we want to be sending when we're trying to make government more fiscally responsible.

For example, a managed care organization receives a base reimbursement rate of $465.97 for a Medicare patient in Pierce County but $809.90 for a Medicare patient in Dade County (Miami, Florida). Not only does this create a preference for serving patients in Miami, as any good businessperson will tell you, but this vast disparity in payments allows seniors in Miami to receive far better benefits than seniors in Pierce County. This means that while Washington state seniors are seeing their benefits decline and the Medicare+Choice option disappear from their region altogether, Miami seniors are enjoying Medicare benefits that include prescription drugs, vision coverage, and even health club memberships.

Unfortunately, this is a very complex problem that is difficult to solve and won't be done overnight. However, there is an immediate threat of losing Medicare+Choice in Washington state altogether. Only 16 of our 36 counties have the Medicare+Choice option today, and there is real concern that the remaining Medicare+Choice providers will leave the state altogether after this year. In fact, First Choice has already indicated to the Medicare program that they plan to stop covering Medicare+Choice patients after this year. Health care analysts and industry insiders have told me that it's more likely than not that the Medicare+Choice option will be taken away from Washington seniors within the next year or two.

That's why I am working with the Medicare+Choice providers to encourage them to renew their contracts in Washington state by the July 3 deadline so that thousands of seniors do not have to find a new health care provider as Congress works on a solution. I have also asked the agency that oversees Medicare to implement a few regulatory changes that would encourage Medicare+Choice providers to continue offering services to Washington state seniors.

Furthermore, I am also looking closely at a lawsuit filed by the state of Minnesota to ensure more equality in the Medicare system. Attorney General Christine Gregoire and I are working together to determine if a similar action would be helpful to Washington state.

It's simply unfair that seniors in Washington are suffering from the scaling back of critical health care services simply because our state had already taken the tough steps to trim waste and deliver health care efficiently. Medicare patients should have quality health care choices no matter where they live.

I believe competition in the Medicare program is valuable and giving seniors choices should be a fundamental part of Medicare. When health care organizations compete for patients, they find ways to offer more and better services. Seniors can choose the health plan that best fits their needs.

However, competition can only work if Congress changes the law to make the Medicare system fair around the country. We should ensure that traditionally-inefficient states tighten their belts instead of requiring states like Washington to cut back funding, leaving seniors with no choices at all. It simply wouldn't be fair if Washington seniors are denied the choice of enrolling in a managed care organization while Medicare patients around the rest of the country have that option."