[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[H.R. 406 Introduced in House (IH)]







105th CONGRESS
  1st Session
                                H. R. 406

      To establish the Independent Commission on Medicare to make 
  recommendations on how to best match the structure of the Medicare 
program with the funding made available for the program by Congress, to 
  provide for expedited consideration in Congress of the Commission's 
    recommendations, and to establish a default process for meeting 
  Congressional spending targets for the Medicare program if Congress 
               rejects the Commission's recommendations.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            January 9, 1997

 Mr. English of Pennsylvania (for himself, Mr. McHale, Mr. Saxton, Mr. 
Canady of Florida, Mr. Graham, Mr. Ehlers, and Mr. LoBiondo) introduced 
  the following bill; which was referred to the Committee on Ways and 
 Means, and in addition to the Committees on Commerce, Rules, and the 
 Budget, for a period to be subsequently determined by the Speaker, in 
   each case for consideration of such provisions as fall within the 
                jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
      To establish the Independent Commission on Medicare to make 
  recommendations on how to best match the structure of the Medicare 
program with the funding made available for the program by Congress, to 
  provide for expedited consideration in Congress of the Commission's 
    recommendations, and to establish a default process for meeting 
  Congressional spending targets for the Medicare program if Congress 
               rejects the Commission's recommendations.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Commission to Save Medicare Act of 
1997''.

              TITLE I--INDEPENDENT COMMISSION ON MEDICARE

SEC. 101. ESTABLISHMENT OF COMMISSION.

    (a) In General.--There is established a commission to be known as 
the Independent Commission on Medicare (hereinafter in this Act 
referred to as the ``Commission'').
    (b) Membership.--
            (1) Composition.--The Commission shall be composed of 7 
        members appointed by the President, by and with the advice and 
        consent of the Senate.
            (2) Chair.--The President shall designate one of the 
        members to chair the Commission.
            (3) Qualifications.--The membership of the Commission shall 
        consist of individuals with national recognition for expertise 
        in fields related to health care.
    (c) Terms.--
            (1) In general.--Except as provided in paragraphs (2) and 
        (3), each member of the Commission shall be appointed for a 
        term of 9 years.
            (2) Terms of initial appointment.--As designated by the 
        President at the time of appointment, of the members first 
        appointed--
                    (A) 3 shall be appointed for a term of 3 years; and
                    (B) 3 shall be appointed for a term of 6 years.
            (3) Vacancies.--Any member appointed to fill a vacancy 
        occurring before the expiration of the term for which the 
        member's predecessor was appointed shall be appointed only for 
        the remainder of that term. A vacancy in the Commission shall 
        not affect its powers, but shall be filled in the manner in 
        which the original appointment was made.
            (4) Exclusive employment.--During the term of appointment, 
        members shall serve as employees of the Federal Government and 
        shall hold no other employment.
            (5) Compensation of members.--Each member of the Commission 
        (other than the chair) shall receive an annual salary at the 
        annual rate payable from time to time for level IV of the 
        Executive Schedule. The chair of the Commission, during the 
        period of service as chair, shall receive an annual salary at 
        the annual rate payable from time to time for level III of the 
        Executive Schedule.
            (6) Removal.--A member of the Commission may be removed by 
        the President only for neglect of duty or malfeasance in 
        office.
    (d) Meetings.--Each meeting of the Commission shall be open to the 
public, except that the Commission may meet in executive session to 
address matters relating to personnel and other internal matters of the 
Commission unrelated to the duties specified in section 102.
    (e) Staff.--
            (1) In general.--The Commission shall appoint a Director, 
        who shall be paid at a rate the Commission considers 
        appropriate. The Director may appoint and fix the pay of such 
        additional personnel as the Director (with the approval of the 
        Chair of the Commission) considers appropriate, without regard 
        to provisions of title 5, United States Code, governing 
        appointments in the competitive service.
            (2) Experts and consultants.--The Commission may procure 
        temporary and intermittent services under section 3109(b) of 
        title 5, United States Code.
            (3) Staff of federal agencies.--Upon request of the 
        Director, the head of any Federal department or agency may 
        detail, on a reimbursable basis, any of the personnel of that 
        department or agency to the Commission to assist it in carrying 
        out its duties under this Act.
    (f) Powers.--
            (1) Hearings and sessions.--The Commission may, for the 
        purpose of carrying out its duties under this Act, hold 
        hearings, sit and act at times and places, take testimony, and 
        receive evidence as the Commission considers appropriate. The 
        Commission may administer oaths or affirmations to witnesses 
        appearing before it.
            (2) Powers of members and agents.--Any member or agent of 
        the Commission may, if authorized by the Commission, take any 
        action which the Commission is authorized to take by this 
        section.
            (3) Obtaining official data.--The Commission may secure 
        directly from any department or agency of the United States 
        information necessary to enable it to carry out this Act. Upon 
        request of the Chair of the Commission, the head of that 
        department or agency shall furnish that information to the 
        Commission.
            (4) Gifts, bequests, and devises.--The Commission may 
        accept, use, and dispose of gifts, bequests, or devises of 
        services or property, both real and personal, for the purpose 
        of aiding or facilitating the work of the Commission. Gifts, 
        bequests, or devises of money and proceeds from sales of other 
        property received as gifts, bequests, or devises shall be 
        deposited in the Treasury and shall be available for 
        disbursement upon order of the Chair of the Commission.
            (5) Mails.--The Commission may use the United States mails 
        in the same manner and under the same conditions as other 
        departments and agencies of the United States.
            (6) Administrative support services.--Upon the request of 
        the Commission, the Administrator of General Services shall 
        provide to the Commission, on a reimbursable basis, the 
        administrative support services necessary for the Commission to 
        carry out its duties under this Act.

SEC. 102. DUTIES OF THE COMMISSION.

    (a) In General.--The Commission shall--
            (1) transmit to Congress and the President during December 
        of each year (beginning with 1997) a report on the aspects of 
        the Medicare program specified in subsection (b); and
            (2) transmit to Congress during July of each year 
        (beginning with 1998) a report containing specific 
        recommendations on the matters specified in subsection (c).
    (b) Aspects of Medicare.--
            (1) In general.--The report transmitted pursuant to 
        subsection (a)(1) during December of a year shall include 
        information on the following:
                    (A) The total outlays made under the medicare 
                program for each of the 10 most recently completed 
                fiscal years.
                    (B) Projections of the outlays under such program 
                for the fiscal year beginning on October 1 of the next 
                calendar year and each of the 4 succeeding fiscal 
                years, on an aggregate and a per capita basis.
                    (C) Projections of the actuarial value of the 
                package of benefits provided to medicare beneficiaries 
                for each of the fiscal years specified in subparagraph 
                (B), on an aggregate and a per capita basis.
                    (D) A comparison of each of the projections made 
                under subparagraph (B) for a fiscal year with the 
                projections made for the year under subparagraph (C).
                    (E) The health status of medicare beneficiaries, 
                the access of beneficiaries to health services covered 
under the medicare program, and the utilization of such services by 
beneficiaries.
                    (F) Methods to improve the methodologies used to 
                determine the payments made under the medicare program 
                to or on behalf of medicare beneficiaries (including 
                the use of risk adjustment in the determination of the 
                amount of such payments) and methods to encourage 
                efficiency and cost-effectiveness in the delivery of 
                health care services.
                    (G) Such other matters as the Commission determines 
                to be appropriate.
            (2) Actuarial value defined.--For purposes of projecting 
        the actuarial value of the package of benefits provided to 
        medicare beneficiaries under paragraph (1)(C), the Commission 
        shall determine actuarial value by measuring the costs of 
        resources used to provide health care services covered under 
        the medicare program and adjusting such costs to take into 
        account--
                    (A) inflation in the costs of health care services 
                and all costs generally;
                    (B) demographic changes in the population of 
                beneficiaries, including population growth, age 
                distribution, health status, and access to care;
                    (C) changes in the mix and intensity of services 
                provided to beneficiaries and the sites at which 
                services are furnished;
                    (D) scientific and technological advances;
                    (E) the quality of care provided, including the 
                effect on quality of the overutilization of services 
                and other factors;
                    (F) other factors affecting the demand of 
                beneficiaries for services; and
                    (G) such other factors as the Commission considers 
                appropriate.
    (c) Recommendations on Controlling Outlays.--The report transmitted 
to Congress pursuant to subsection (a)(2) during July of a year shall 
include specific recommendations on changes in the medicare program, 
including changes in eligibility, benefits (including the mode of 
delivery of such benefits), cost-sharing, or payments made to or on 
behalf of beneficiaries, sufficient to ensure that total outlays for 
the program for the fiscal year beginning on the following October 1 do 
not exceed the limit established for that fiscal year under section 
201, except that such recommendations may not include changes relating 
to the payment of payroll taxes for financing the program.

SEC. 103. EXPEDITED CONGRESSIONAL CONSIDERATION OF RECOMMENDATIONS.

    (a) In General.--The recommendations submitted by the Commission 
under section 102(c) for a fiscal year shall take effect if a joint 
resolution (described in subsection (b)) approving such recommendations 
is enacted, in accordance with the provisions of subsection (c), before 
the first day of the fiscal year.
    (b) Joint Resolution of Approval.--A joint resolution described in 
this subsection means only a joint resolution which is introduced 
within the 10-day period beginning on the date on which the Commission 
submits recommendations under section 102(c) and--
            (1) which does not have a preamble;
            (2) the matter after the resolving clause of which is as 
        follows: ``That Congress approves the recommendations of the 
        Independent Commission on Medicare concerning methods to 
        control outlays under the medicare program for fiscal year 
        ________, as submitted by the Commission on ______________.'', 
        the first blank space being filled in with the appropriate 
        fiscal year and the second blank space being filled in with the 
        appropriate date; and
            (3) the title of which is as follows: ``Joint resolution 
        approving recommendations of the Independent Commission on 
        Medicare concerning methods to control outlays under the 
        medicare program for fiscal year ________, as submitted by the 
        Commission on ______________.'', the first blank space being 
        filled in with the appropriate fiscal year and the second blank 
        space being filled in with the appropriate date.
    (c) Procedures for Consideration of Resolution of Approval.--
Subject to subsection (d), the provisions of section 2908 (other than 
subsection (a)) of the Defense Base Closure and Realignment Act of 1990 
shall apply to the consideration of a joint resolution described in 
subsection (b) in the same manner as such provisions apply to a joint 
resolution described in section 2908(a) of such Act.
    (d) Special Rules.--For purposes of applying subsection (c) with 
respect to such provisions--
            (1) any reference to the Committee on Armed Services of the 
        House of Representatives shall be deemed a reference to an 
        appropriate Committee of the House of Representatives 
        (specified by the Speaker of the House of Representatives at 
the time of submission of recommendations by the Commission under 
section 102(c)) and any reference to the Committee on Armed Services of 
the Senate shall be deemed a reference to an appropriate Committee of 
the Senate (specified by the majority leader of the Senate at the time 
of submission of recommendations by the Commission under section 
102(c)); and
            (2) any reference to the date on which the President 
        transmits a report shall be deemed a reference to the date on 
        which the Commission submits recommendations under section 
        102(c).

SEC. 104. NO TERMINATION OF COMMISSION.

    Section 14(a)(2)(B) of the Federal Advisory Committee Act (5 U.S.C. 
App.; relating to the termination of advisory committees) shall not 
apply to the Commission.

          TITLE II--CONTROLLING OUTLAYS UNDER MEDICARE PROGRAM

SEC. 201. ESTABLISHMENT OF ANNUAL LIMITS ON OUTLAYS.

    Not later than April 15 of each year (beginning with 1998), 
Congress shall in the concurrent resolution on the budget for the 
fiscal year beginning on the following October 1 establish a limit on 
total outlays to be made under the medicare program for the fiscal 
year.

SEC. 202. ENFORCEMENT OF LIMITS THROUGH SEQUESTRATION.

    (a) In General.--Part C of the Balanced Budget and Emergency 
Deficit Control Act of 1985 (2 U.S.C. 900 et seq.) is amended by 
inserting after section 252 the following new section:

``SEC. 252A. SEQUESTRATION WITH RESPECT TO MEDICARE.

    ``(a) Sequestration.--If, with respect to a fiscal year (beginning 
with fiscal year 1999), Congress has not enacted a joint resolution 
under section 103(b) of the Commission to Save Medicare Act of 1997 
before the first day of the fiscal year, there shall be a sequestration 
to eliminate any budgetary excess in the medicare program as described 
in subsection (b).
    ``(b) Eliminating a Budgetary Excess.--
            ``(1) In general.--Outlays under the medicare program shall 
        be reduced during a fiscal year as provided by paragraph (2), 
        as necessary to eliminate any amount by which estimated outlays 
        under the program in the year exceed the limit for such outlays 
        established for the year by Congress pursuant to section 201 of 
        the Commission to Save Medicare Act of 1997.
            ``(2) Reductions described.--In carrying out paragraph (1), 
        the President shall--
                    ``(A) reduce payments made under the medicare 
                program by a uniform percentage sufficient to reduce 50 
                percent of the amount described in paragraph (1); and
                    ``(B) increase premiums, deductibles, copayments, 
                and coinsurance required to be paid under the program 
                by a uniform percentage sufficient to reduce 50 percent 
                of the amount described in paragraph (1).
    ``(c) Part-Year Appropriations and OMB Estimates.--Paragraphs (4) 
and (7) of section 251(a) shall apply to sequestration of amounts under 
this section in the same manner as those paragraphs apply to 
discretionary appropriations and sequestrations under that section.
    ``(d) Coordination With Other Sequestration.--
            ``(1) In general.--Reductions under subsection (b) for a 
        fiscal year shall supersede any reduction otherwise made under 
        section 252 or 253.
            ``(2) Reports.--On the dates specified in section 254(a), 
        OMB and CBO shall issue preview, update, and final reports on 
        medicare sequestration under this section. Such reports shall 
        specify--
                    ``(A) the estimated amount described in subsection 
                (b)(1) for the fiscal year;
                    ``(B) the estimated uniform percentage described in 
                subsection (b)(2)(A) of the fiscal year; and
                    ``(C) the estimated uniform percentage described in 
                subsection (b)(2)(B) of the fiscal year.
            ``(3) Rules for application of reductions.--The provisions 
        of section 256(d) shall apply to reductions under this 
        section.''.
    (b) Clerical Amendment.--The table of contents for part C of the 
Balanced Budget and Emergency Deficit Control Act of 1985 (2 U.S.C. 900 
et seq.) is amended by inserting after the item relating to section 252 
the following:

        ``Sec. 252A. Sequestration with respect to medicare.''.
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