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Recently in Salon Health & Body

Health Urge: Nancy Chan
The other cheek
Matt grants me my bed rest; Allison waxes New Age.
By Tracy Quan
[12/16/99]

Orphans of managed care
Sickle cell patients are in the middle of a dilemma over the cost of effective drugs.
By Arthur Allen
[12/15/99]

Urge: Naked World
Acidic Cambodian sex scandal
A karaoke star is burned when a jealous politician's wife has her splashed with battery acid.
By Hank Hyena
[12/15/99]

Column
Descending into the dungeon
At the Black Rose, leather-clad sadomasochists walk the tightrope between pleasure and pain.
By Virginia Vitzthum
[12/14/99]

Urge: Naked World
Kill the yeast beast!
Yogurt-soaked tampons, carnivorous tree bark and boiled panties all crush vaginal thrush.
By Hank Hyena
[12/14/99]

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This fall, when Grigsby moved back to her native Minnesota, she found that the local Medicare HMOs not only wouldn't pay for the gym; they wouldn't cover one of her high-blood-pressure medications, either. While her Minnesota plan does cover the two inhalers she needs to battle asthma, Grigsby now pays $270 a month for coverage more limited than her $50 plan in Arizona.

"It burns the heck out of me that I can't get decent coverage here, but I get great coverage if I go to Arizona," says the retired business owner.

Grigsby pays hundreds more out of her fixed income because the alternative was worse: dying among strangers. "I wanted to be near my family," she says. "I'd seen people down there in Arizona, living in nursing homes, all alone. That wasn't going to be me. So I said to heck with it -- I'm coming back here, and if I go broke, I go broke."

Luckily, she says, she is still doing OK financially. "[But] if I was somebody in real need, I wouldn't dare come back here, even if it meant not living close to my family," she says.

Like Grigsby, Charles and Margaret Van Guilder will keep living in Minnesota -- but they may get divorced to do so. Margaret suffers from advanced Parkinson's disease, and Charles says Medicare reimbursements are so small that they pay $595 a month more than they would in south Florida, where even taxi rides to the doctor get covered. Divorcing Margaret would allow Charles to shelter assets that will otherwise be drained until she qualifies for indigent care. They say this is their only choice, because they refuse to move out of state.

"We want to live where we want to live," Charles Van Guilder says. "Why should we move to a [high-reimbursement] state when the money should be equitably distributed in the first place?"

Minnesota residents are not suffering from bad health care; treatment costs are among the lowest in the country. But they are victims, a new suit claims, to geographic discrimination by the federal government. Millions of Americans are affected by Medicare's varying subsidies to local HMOs, but Minnesota is the first state to do something about it.

Residents of places as diverse as Honolulu, Albuquerque, Salt Lake City and Rochester, N.Y., as well as most rural towns, are paying hundreds more for far less coverage than those throughout the urbanized Sun Belt and in many big Eastern cities, according to a study by the Dartmouth Atlas of Health Care.

"This is a nationwide rural health-care issue," says Peter Wyckoff, executive director of the Minnesota Senior Federation, Metropolitan (Minneapolis-St. Paul) region, a consumer rights group. "[But] Minnesota is one of the few states where nearly everyone has gotten the shaft."

A federal lawsuit filed here last month alleges that reimbursements in the 39-million-person program are so geographically irrational that they are unconstitutional. The suit claims that individuals such as Grigsby are denied the Fifth Amendment right to equal protection under the law.

"It's as if you could double your Social Security check by moving from Minnesota to Miami. Nobody would think that was fair," says Megan McAndrew Cooper, editor of the Dartmouth Atlas of Health Care, which tracks local coverage differences. "Everyone pays into Medicare at the same rate, but some people are getting twice as much out of it."

Next page | Why HMOs abandoned certain cities