Oxygen cap: Beneficiaries wait and worry

Sunday, January 15, 2006

YARMOUTH, Maine - If a proposal to cap Medicare oxygen reimbursement passes, providers aren't the only ones who will feel the pressure.

"Who's bright idea is it to put a cap on oxygen?" asked Pat Reichert, a realtor and community activist in Bloomington Minn. "Do they want to kill off seniors that have oxygen?"

Reichert suffers from asthma, emphysema and bronchitis and has used oxygen for five years. Her portable liquid system allows her to keep moving. Without it, she's nowhere.

"I couldn't work. I'd be absolutely homebound in a chair," she said.

Reichert said her limited income consists of commissions and Social Security. She has Blue Cross, long-term health insurance and Medicare. She says she can't afford any hits to her healthcare pocketbook.

The cap proposal would stop reimbursement at 36 months and transfer equipment ownership to users at that time. House and Senate members approved the change last month as part of a Medicare-Medicaid spending package. But because the Senate made some minor changes in the bill, House members must vote on it again and were expected to do so in early to mid-February, following their return from the holiday break.

As the industry rolls out its grassroots efforts to defeat the proposal, beneficiaries have begun to take part in those efforts and to express their outrage and dismay.

Another portable user, Marty Lannon, a former factory worker in Prairie Lake, Minn., has Medicare and supplemental insurance. He said shouldering maintenance and service costs would be tough. He already has trouble keeping up with his 50% prescription drug co-pays.

"I do have extra filters here to change them once in a while," said Lannon.

He has used oxygen for nine years. His tanks are filled every two weeks, and he's on a regular maintenance schedule.

Vlady Rozenbaum, a former government worker, operates a 400-member listserv called COPD Alert (www.copd-alert.com). He's concerned about the proposal but said it could be much worse.

"While COPD patients can definitely benefit from a better bill, this one is not a calamity," said Rozenbaum. "It clearly states that when it is required medically, then oxygen will be provided."

The Silver Springs, Md.-based Rozenbaum has used oxygen for about six years. He uses primarily liquid, and rents and owns equipment. He said he believes one reason for the proposed cuts is that maintenance reporting by providers hasn't been great.

"The assumption was that many of them reported maintenance when there was none given," he said. "From my own experience, and many of the members of my group, even with the biggest [providers], they are not always on time with maintenance. They are not maintaining it very well. If I call, they respond."

Gary Bain is retired but owns a truck brokerage company in Kansas City, Mo. He uses about four tanks of liquid oxygen each week but is not on a regular maintenance schedule. If there's a problem, he calls. Bain operates a 2,600-member listserv called Efforts (www.emphysema.net). He describes his current insurance situation as "up in the air." He said cuts to oxygen would be a hardship all around.

"You take away somebody's oxygen and they die or they live with a much-reduced activity level," said Bain.

And, while most oxygen beneficiaries cannot afford to absorb any cuts, neither can the government, they say.

"They'd have to put full-time nursing help in my home," said Reichert. "I'd cost them a whole lot more."