If you are a senior citizen in San Luis Obispo County, President Bush’s 2009 budget may not be good for your health.

The proposed budget would cut about $180 billion a year in Medicare spending over the next five years. The California Hospital Association said that would amount to $18 billion a year for the state.

But one local lawmaker doesn’t see the president’s budget proposal getting very far in Congress. The proposed cuts in Medicare are “dead on arrival as far as Congress is concerned,” said Rep. Lois Capps, D-Santa Barbara.

As proposed, the cuts would make senior access to Medicare-paid health care even more difficult.

“We’re already in a bind,” said Ahmad Amir, an ophthalmologist and former president of the San Luis Obispo County Medical Association. “This will further exacerbate access to care.”

Amir said it’s getting harder and harder for senior citizens to find doctors who accept Medicare because its policies don’t pay physicians enough for their services.

Those that could be worst hit are seniors steering clear of the private Medicare Advantage insurance program and relying on traditional fee-for-service Medicare coverage.

Barbara Kennelly, head of the Committee to Preserve Social Security and Medicare, told a Senate committee here Thursday that the budget proposal achieves its savings by moving aggressively toward the private plans.

“We are concerned that cuts of this magnitude will undermine the strength of traditional Medicare and negatively impact the health out-
comes of beneficiaries by limiting their access to care,”Kennelly said in submitted testimony.

The Medicare Advantage program, with three dozen different plans offered in San Luis Obispo County, has been under intense scrutiny in Congress. Democrats charge that the government is heavily subsidizing the plans and that they are marketed through insurance salesmen whose pitches can be misleading.

“Medicare Advantage overpayments contribute to the undermining of the long-term stability of the Medicare program,” Mark E. Miller, director of the independent Medicare Payment Advisory Commission, told a Senate panel last month.

The result is that the private plans that were supposed to be rewarded for efficiency by financing additional services to attract clients are less efficient than the traditional Medicare program, he said.

Amir said he would like to see the Medicare Advantage subsidies eliminated — not expanded. Yet expansion is what the proposed budget would mean, according to analysts at the California Budget Project in Sacramento.

More than reforms of the Medicare Advantage subsidies, Amir said, local physicians need to be encouraged to serve Medicare patients by eliminating the pay disparities between what they are paid and the higher rates for doctors in urbanized areas such as San Francisco and Los Angeles.

Capps said the pay disparity issue is getting attention on Capitol Hill but has yet to be solved.

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