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A bitter pill to swallow

Jilted by HMOs, Hernando County seniors who depend on Medicare for medicine look anxiously to the future. Will benefits cover their needs, they wonder.

By SAUNDRA AMRHEIN

© St. Petersburg Times, published October 30, 2000


SPRING HILL -- The attacks hit quickly and with little warning. If Lucy Maimone doesn't regulate her meals, snacks and medicine, she will wake up on the floor, or, if no one finds her, maybe not at all.

It's a fragile but common balancing act among diabetics struggling to control blood sugar, and one Maimone has sometimes gotten wrong. Once she passed out in the kitchen, another time at Busch Gardens.

But what might not be as common is the struggle the 73-year-old faces every month to stock her cabinets and freezer with the food and medicines that keep her alive.

Once she pays for rent, bills, groceries and prescription drug co-payments, Maimone has $4.84 a month left over despite working half a century as a seamstress. Any change in the arrangement could send her into a tailspin, as she nears the limits of her yearly Medicare HMO benefits for prescription drugs. Already, her doctor has stopped her cholesterol pills and told her to walk several miles a day instead. More cuts would endanger her health.

"There's nothing I can cut," Maimone says. "If I cut my food, my prescriptions are no good. I can't cut either one of them."

Maimone is one of 10,000 people whose lives were turned upside down in Hernando County this summer when the last two Medicare HMO companies announced that they were leaving town with their prescription drug plans. Since then, two other companies have been approved to enter the market.

But the panic felt by Maimone and hundreds of other seniors who stormed public meetings before those approvals shows the thin line separating many seniors from poverty.

The majority of Medicare patients have their prescriptions covered through HMOs or retiree programs. But almost 1-million seniors nationwide were tossed out of HMO plans this year as companies continue to leave profit-draining counties. Most of those people had access to another HMO plan.

For many Hernando residents, and thousands like them whose concerns show up in national polls, the future of prescription drugs will be the deciding factor when they pick a president in November.

From stories of seniors either looking for part-time work, supplementing their pill supply with free samples from doctors or taking antacids in place of prescriptions, the Times chose two examples to illustrate the difficult questions seniors are facing.

One is Maimone; the other is a family in eastern Hernando County's Ridge Manor West whose father may be forced to sell his home because of rising prescription drug costs.

"This is a proud generation," said Marie Nielsen, vice president of the grassroots group Florida Citizens to Keep HMOs. "They don't like to ask for anything. But they're only asking for what they deserve."

A decision not easy to make, three lives not easy to live

The trip to Spring Hill Regional Hospital takes Jim and Frances Nico through a patchwork of sleepy country roads, past stooped horses and hilly green pastures.

Behind the wheel, Nico cracks jokes, even though he's headed for a skin cancer biopsy.

At 60, he's no stranger to health problems and can tick them off with a survivor's relish for anyone who asks. There's the bullet that shattered his hip bone when he was an off-duty police officer in Georgia. Now he's going deaf in one ear and losing sight in both eyes.

His wife, Frances, 55, sitting in the passenger seat, has lupus.

But the one they worry about is Frances' father, who is legally blind.

John Grabinski, 87, lives alone next to his daughter and son-in-law. His wife died Aug. 31 following a massive stroke.

The Nicos say they don't think either of the two Medicare HMO plans coming into Hernando County in January will help Grabinski. They likely won't fully cover hospital visits and his four or five prescription drugs for osteoporosis, arthritis and cholesterol.

While the premiums are lower than what he now pays, so are the limits on what the new companies will spend in a year's time for prescriptions. Medicine for his cholesterol only comes in brand names, which are more expensive under the new plans by Well Care and United-Healthcare.

And nothing is stopping the private companies from raising premiums next year or even leaving Hernando County as AvMed Health Plan and Humana are doing this year. Counties such as Hernando are not attractive places for Medicare HMOs, industry officials say, because federal reimbursement rates are lower after patient history is calculated and provider networks are smaller.

If things get bad enough, the Nicos say, the family could always sell Grabinski's house and build an additional room for him in their home.

"We can't really afford to take on another financial burden," says Mrs. Nico, sorting through hundreds of coupons she has clipped for her next trip to the grocery store. "If it comes to that, Dad would have to move in with us."

But Grabinski, who can see shapes and figures but not small details, knows his way around his house. He bought it with his wife 16 years ago when they moved from New York to Ridge Manor West. It's his retirement house, the house he said he'd die in.

"If I moved him to (our) house and sold his house, I'd be taking away two things: his pride and his will to live," Jim Nico says.

The other option is for Mrs. Nico to go back to work. As it stands, they receive too much money from disability and pension checks to qualify for public assistance. But it's barely enough to keep their heads above water.

"With Jim being disabled, the only other alternative is for me to go get a job," she says. "It's hard for me to work and take care of both of them."

Life was never supposed to boil down to such bitter choices.

Grabinski worked most of his life as a machinist. He and his wife, Muriel, raised their three children in New Jersey. But after he retired, the company cut his health benefits from his retirement package.

"Retirement is far from what you think it's going to be," Grabinski says. "It's the golden years all right. They're trying to take all the gold away from us."

He doesn't know what is going to happen with his insurance.

"I probably will go off my medicine," he threatens. But just cutting his arthritis pills would force his hands to curl in tight, excruciating knots. His legs would cramp up, unable to move.

The idea of selling his house is out of the question.

"I prefer to live by myself," he says simply. Though alone, his house is filled with memories of his wife, memories of the Friday night card games with friends, most of whom have died.

There is the picture on the wall of his wife and the portrait yet to be framed. The organ she tried to learn how to play sits in the living room. In the dining room, his magnifying reading machine sits next to the china closet. Some nights he lies in bed and hears his wife calling from the living room.

The Nicos see their futures in Grabinski. The biopsy on Jim Nico's face came back positive. He has cancer. His growing health bills, though, are covered by his military insurance. It also covers his wife, until she turns 65. After that, she'll take her chances with Medicare.

When skimping and scrimping are synonymous with survival

Lucy Maimone pricks her finger and smears a dot of blood onto a small box that reads blood sugar levels.

One fourteen. "That's good," she says. Ready for the first of two daily walks, she is dressed in her white sneakers and maroon windbreaker.

The 73-year-old woman has been treading through her neighborhood twice a day after morning toast and late afternoon supper on the advice of her doctor, who cut off Maimone's cholesterol pills because her Medicare HMO insurance won't stretch to the end of the year.

The cholesterol pills could go; the medicine for her diabetes could not, Maimone says before munching on three quarter-size peach glucose tablets to avoid going into shock during the walk.

The walking may not be as effective as the cholesterol pills, she says. "But it helps."

On the small screen of the television set, which carries seven channels, grainly political commercials repeatedly interrupt rowdy guests on Maury Povich who wait to learn "Whose Baby Is It?"

The commercials aim straight at Maimone.

"See, I don't want an HMO," she yells as the commercial accuses Republican presidential candidate George W. Bush of relying too heavily on Medicare HMOs to cover seniors' prescription drugs. "I've been stuck with HMOs for four and five years, and all of a sudden they are pulling out. What's to say they won't pull out?"

Like the Nicos, Maimone falls between the cracks. Her $860 monthly income is too much to qualify for state Medicaid assistance for her prescription drugs. But it's too little to afford much more than that.

She skimps with both the heat and the air conditioning. She leaves the temperature at 85 degrees in summer.

There's no car for grocery shopping; a two-wheeled cart makes do. Forget cable or any outside recreation, like dinner and movies. Aside from these walks, the highlights of her day consist of cuddling with her salmon-colored cat, Bingo.

"She is my life right now," Maimone says of Bingo. "That's what really keeps me going, when she comes and sits with me." Her warm brown eyes well with tears behind her brown-rimmed glasses. "Sometimes I get so depressed, I cry. I came here to have a good life, and what do I have? Worries."

Maimone worked as a seamstress for a company outside of Boston from the time she was 16 until she was forced to retire at 62, when the company moved overseas.

Maimone blew through her savings taking care of her sick mother before she died. She moved to Florida because living here is cheaper than up North.

She likes to make quilts but can't afford the materials. They sit unfinished in her closets.

A few days later, a niece tells her to call an indigent medicine program.

She calls two pharmaceutical companies and learns she may qualify for a six months' supply of free medicine. She must submit the paperwork to find out.

That will free up a little less than $100 a month for her.

"I can breathe. I can go out to a movie or buy some clothes," she says. "I'm not going to be rich, but I'm going to be able to breathe. I can do more than sit around."

The question remains how long the free supplies will last.

Danny Hogg is the administrator of the Medicine Program, a Missouri-based clearinghouse for patients' assistance programs sponsored by drug manufacturers. The companies give away pills for tax write-offs.

The programs target people who don't qualify for public assistance but can't afford all their medicine.

While some patients have received free medicine for years, the decision rests with the companies, said Hogg, whose organization processes paperwork.

"It is not a lifelong program," Hogg said.

That's what worries Nielsen of Florida Citizens to Keep HMOs.

"Yes, (Lucy) qualifies for indigent (medicine), but for how long," Nielsen says. "Even if it's for a year, what happens after that? She's back to square one if they don't fix Medicare.

"Her life is in the balance all the time."

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