Fred Schulte

A few years ago, fistfights would break out in the parking lots of state offices in Miami as HMO salesmen rushed to sign up welfare mothers arriving to pick up food stamps. Some marketers parceled out gifts of diapers or cheap medicines to make a sale. Some falsely told women they would be stripped of Medicaid coverage unless they joined the HMO on the spot. A few agents weren’t above forging signatures on enrollment forms. Florida decided to crack down after media reports of HMO sales alarmed legislators. Last December, state officials agreed to spend $39 million over four years to hire a Medicaid enrollment “broker,” a firm that presents people on welfare with truthful and “unbiased” information about their health care options. Enrollment brokers are the latest hope for states eager to improve the quality of welfare medicine and slow down, if not stop, exploitation of the poor by some managed care plans. About 20 states are using brokers, mostly out of concern that Medicaid HMOs cannot be trusted to market their coverage honestly

WHEATON, Md.—On a muggy August morning at Hot Shoppes cafeteria, salesman Matt Buckley tells a group of retirees over coffee that Medicare is changing and they must adapt. The seniors seem worried by the prospect. Yet they know Medicare, the U.S. government’s $211-billion-a-year, health-care system for the elderly and disabled, is going broke and must slash costs. Buckley tries to calm fears and sell his guests on Aetna US Healthcare, one of dozens of cost-cutting health maintenance organizations that are hotly pursuing senior citizens across the country. “This is the first step toward privatizing Medicare. This is the way things are moving,” says Buckley, straining a bit to be heard above the clatter of dishes as the serving staff gears up for the early lunch crowd. “We want to become your Medicare.” Aetna US Healthcare hopes to persuade thousands more seniors to accept managed care, a few tablesful at a time if need be. Toward that end, the company has put on dozens of free Medicare “informational meetings,” mostly at budget eateries, libraries or community

Florida health czar Doug Cook said he was “sick for a week” after he learned two of his HMO regulators had accepted more than $90,000 in consulting fees from two Medicaid health plans. “Common sense would indicate this is extremely improper,” said Cook, director of the Agency for Health Care Administration. “Ninety-nine point nine percent of our employees would not even consider this. Unfortunately, these two women did.” Douge Cook The health agency fired Elizabeth Page Anderson-McGivern and Rosemary Arbuckle-Anderman last spring for violating restrictions on moonlighting within the health care industry. Both workers were program analysts, helping decide which HMOs got Medicaid contracts. The state alleges they took money from HMOs in exchange for preparing applications for Medicaid contracts. A week after the firings, prosecutors in Tallahassee took the unusual step of charging the women, both of whom have law degrees, with official misconduct, a felony. Both have denied wrongdoing. Whatever the outcome in court, the cases reflect some of the ethical and legal dilemmas emerging as more than 40 states turn to managed