IMPEACH BUSH

The county's elderly are caught in the middle of a health care tussle in Washington that shows little sign of letting up amid fierce election-year posturing.

Congress last week allowed a scheduled 10.6 percent cut in Medicare reimbursements to proceed, meaning local doctors will soon get less money to cover the costs of treating seniors and disabled patients enrolled in the federal insurance program.

The cuts are slated to take effect Friday unless House and Senate efforts to spare the federal payments are more successful this week than they were last.

"To have a 10 percent cut on the horizon is completely unacceptable," said Rama Khalsa, director of the county Health Services Agency. "Doctors will simply stop accepting new patients."

Already that's become a problem in Santa Cruz County, where an estimated 30,000 people rely on Medicare and many have reported problems finding a local doctor who will treat them.

The handful of physician groups in the county report fewer doctors enrolling new Medicare patients, largely because of the cost. Consequently, Medicare patients are increasingly forced to seek treatment at county-run clinics as well as at hospital emergency rooms, according to county officials.

"Do you want to get preventive care or do you want to wait for a crisis?" asked Dr. Larry deGhetaldi with the Santa Cruz Medical Foundation, noting the cyclical and increasingly expensive problem that arises when primary care is squeezed out of the insurance loop.

The high cost of treating Medicare patients is not new to local physicians. Santa Cruz County doctors have long received lower reimbursement rates than doctors in many California counties because of the area's "rural" designation. County supervisors have gone to court to recoup more of the medical costs while Rep.. Sam Farr, D-Carmel, has taken up the issue in Congress, though neither has had success.

Coincidentally, federal lawmakers are taking up the issue of lower Medicare reimbursement at the same time the state lowers reimbursement rates for Medi-Cal providers.

Medi-Cal is the state's insurance program for the poor, serving about 28,000 people in Santa Cruz County. Like Medicare, Medi-Cal has drawn criticism for shorting doctors and medical facilities on the costs of treatment.

The state reimbursement rates were reduced July 1 in light of California's $15 billion budget deficit. They could be altered in budget negotiations that continue this summer.

Meanwhile, in Washington, D.C. last week Congress failed to get the votes necessary to block the pending Medicare cuts. It has left the issue at the top of lawmakers' agenda this week, while the Bush administration, given the debate, has postponed processing Medicare claims until Friday.

Neither Democrats nor Republicans want to see doctor reimbursements scaled back nearly 11 percent, but the two parties can't agree on how to fund them. Democratic proposals have included reductions in payments to insurance companies that participate in the privatized Medicare equivalent known as Medicare Advantage. Republicans don't want to see this program weakened.

With the presidential contest just months away and several congressional seats on the line, both sides have been reluctant to compromise their position.

"This issue should be a top priority, but instead we're seeing partisan politics," said Farr, who supported last week's Democratic proposal that passed in the House but failed to get a vote on the Senate floor.

"Not only are Republicans balking at the bill, but President Bush has said he will veto it," Farr said. "My only hope is that the Senate will come to its senses this week and the president will [sign] this necessary bill into law."

Contact Kurtis Alexander at 706-3267 or kalexander@santacruzsentinel.com.