For Eli Bess, 85, of Sunrise, the healthcare reform debate has gotten personal. As a member of a Humana HMO, he gets a free gym membership, a benefit he says has changed his life. After some medical setbacks several years ago, ``my wife brought me the first time to the gym in a wheelchair. Now I can do anything I want.''

At the moment, both House and Senate healthcare reform proposals are seeking to slash funds to the HMOs that have attracted Bess and 283,000 other South Florida seniors because of rich benefit packages that can include free dental care and many other perks.

At present, the House bill, which has already passed, and the main Senate proposal, still in committee, offer widely different specifics for reducing benefits for South Florida's elderly.

Local congressional leaders are battling for regional protection, but Robert Berenson, a healthcare specialist with the Washington-based Urban Institute, warns that the result won't make everyone happy. ``I'm not saying nobody will feel any pain over this.''

The underlying issue is that reformers want to cut healthcare costs to make insurance more affordable for the uninsured, causing many to look at South Florida -- where healthcare is far more expensive than other areas. Still, as Congress works out details, cost reduction is becoming increasingly uncertain because of opposition from patients and the healthcare industry.

With Medicare, the cost issues are well known. Miami seniors cost more than two times their counterpart in Minneapolis, and local Medicare HMOs are reimbursed based on what local seniors cost in basic Medicare -- known as fee-for-service because providers like doctors and hospitals are paid their fees directly by Medicare.

``There's a real geographic food fight on this,'' says Berenson, with different regions having much different interests.

Nationwide, the Medicare HMOs -- known as Medicare Advantage plans -- are on average 14 percent more expensive than traditional Medicare. Both House and Senate leaders want to get those costs down to the traditional Medicare level, and perhaps less. In the Miami area, the HMOs are reimbursed on average at 101 percent of fee-for-service costs, says Jean LeMasurier of Gorman Health Group, a consulting firm specializing in Medicare managed care.

But the HMOs tend to be much more efficient than fee-for-service, emphasizing primary and preventive care that keeps patients out of emergency rooms and reduces the number of visits to specialists. These cost savings allow South Florida Medicare HMOs to offer many benefits not available through regular Medicare, such as zero co-pays for hospitals stays, mostly free prescription drugs, free vision and free dental.

Leon Medical Centers in Miami-Dade was praised recently in the prestigious journal Health Affairs after a study concluded it delivered quality care at costs 15 to 20 percent lower than the national average.

The benefits have certainly made the HMOs popular. About 950,000 seniors in Florida -- 29.2 percent of the Medicare population -- are members of Medicare HMOs, according to America's Health Insurance Plans. That includes 110,000 in Broward and 173,000 in Miami-Dade. Nationally, 24.2 percent of seniors belong to HMOs.

HOUSE BILL

The House bill proposes cutting the HMOs down to the same level as fee-for-service plans. Some areas could be extremely hard hit by that provision -- since they are far higher than the average of 14 percent. South Florida would hardly be touched, except for one small provision.

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