[Congressional Record Volume 140, Number 140 (Friday, September 30, 1994)]
[Senate]
[Page S]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: September 30, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
 DISTRICT OF COLUMBIA APPROPRIATIONS ACT OF 1995, DISTRICT OF COLUMBIA 
SUPPLEMENTAL APPROPRIATIONS AND RECISSIONS ACT, 1994--MESSAGE FROM THE 
                                 HOUSE

  The Senate continued with the consideration of the message.
  Mr. DURENBERGER. Mr. President, I ask unanimous consent to set aside 
the pending amendment to offer an amendment.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.


         Amendment No. 2602 to Amendment in Disagreement No. 12

  Mr. DURENBERGER. Mr. President, I send an amendment to the desk and 
ask for its immediate consideration.
  The PRESIDING OFFICER. The clerk will report.
  The legislative clerk read as follows:

       The Senator from Minnesota [Mr. Durenberger], for himself, 
     Mr. Conrad, Mr. Chafee, Mrs. Feinstein, Mr. Bond, Mr. Heflin, 
     Mrs. Hutchison, Mr. Danforth, Mr. DeConcini, and Mr. 
     Rockefeller, proposes an amendment numbered 2602.

  Mr. DURENBERGER. Mr. President, I ask unanimous consent that reading 
of the amendment be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment is as follows:

     SEC.  . MEDICARE SELECT.

       Section 4358(c) of the Omnibus Budget Reconciliation Act of 
     1990 is amended by striking ``3-year period''.

  Mr. DURENBERGER. Mr. President, this amendment is designed to extend 
what is called the Medicare Select Program. The program is scheduled to 
expire in 3 months, on December 31. At this point in my remarks, for 
the benefit of the 20 to 25 of my colleagues who are lined up at an 
airport waiting to leave, I intend to withdraw this amendment at an 
appropriate point in time, when there is an agreement relative to the 
disposition of the underlying bill. I also say that for the Mayor of 
the District of Columbia, and everybody else.
  Mr. President, I ask unanimous consent that Senator Rockefeller be 
included as a cosponsor.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DURENBERGER. The Medicare Select Program is a demonstration 
program which is well known to many of our colleagues. It was initiated 
in OPRA 90 to provide beneficiaries with a managed care option for 
supplemental benefits. The program is working. Its authority to operate 
needs to be extended, and it is that simple. Every once in a while we 
do something right around this place.
  Medicare Select is a name attached to an opportunity, if you will. It 
has strong bipartisan support. It was included this year in the 
majority leader's health care reform bill, the Finance Committee bill, 
in the minority leader's bill, and in the mainstream bill--I imagine 
every bill but the single payer bill. I understand the Senators from 
Florida, Mr. Mack and Mr. Graham, support the program as well.
  Mr. President, these bills included provisions to extend and expand 
the program to allow all States to participate. It is currently limited 
in participation to 15 States. My amendment only attempts to guarantee 
continuity for the program in the States where it is already 
operational, not to extend its authority.
  I will explain why it is so important to extend its authority. Over 
400,000 Medicare beneficiaries currently are enrolled in this program 
in these 15 demonstration States.
  The impact of not extending Medicare Select will be, very simply, 
higher premiums for the elderly, less choice for beneficiaries, and 
higher costs to the current part A, part B Medicare system.
  What does all of this mean to elderly Americans? It means that 
congressional gridlock could cause rate increases to many Medicare 
beneficiaries in 1995. It means that some beneficiaries will lose the 
option of continuing with their current plan variety. In my State of 
Minnesota, for example, it will impact 2 of the 5 current managed care 
choices. I have a chart here which looks like it is done in fine print, 
but in order to get all of the benefits and all of the choices 
available to seniors in my State, thanks to Medicare Select, and also 
thanks to the even older contract programs, that we still are managing 
to operate in my State, we put them all on this chart.
  Many elderly Americans are used to just getting part A and part B 
from the Government and then getting sold a bunch of supplementals that 
fill the gaps in their Government program, sold to them by they used to 
say ``over-aged movie actors''--but the closer I get to that age, the 
less I say that--on TV. If you need a drug benefit, buy a supplemental; 
if you want to cover your deductible in the hospital, buy a 
supplemental.
  Thanks to the current occupant of the Chair, the majority leader, and 
many others who worked on the Finance Committee to try to improve 
choices for the elderly in my State of Minnesota--particularly in the 
Minneapolis-Saint Paul area--this is the kind of choice currently 
available to people under Medicare.
  On the left-hand side of this chart we list the benefits that are 
available to seniors: Hospital inpatient, hospital outpatient, or 
physician network services, and emergency services. Then if you look 
across the top, you see Medicare parts A and B; you see Medicare basic 
supplemental; you see Medicare extended basic supplemental. Then you 
see two more choices, and these are the Medicare Select choices. The 
Blue Cross/Blue Shield of Minnesota choice, called Senior Gold. And 
then the med centers choice called Seniors Choice II. These are the 
Medicare Select choices, followed in my State by what is called Health 
Care Prepayment Plans. These are under a different approach which we 
authorized way back in 1983. There again, you see a Blue Cross/Blue 
Shield product called Blue Plus, a Medicare project, and a plan from 
Physician's Health Plan, now called Medica.
  In my State, seniors have really six choices with two supplementals 
to their Government plan. What happens with all of this choice and with 
this ability to make comparisons, of course, is that seniors are 
actually shopping health plans that suit their needs, not the 
Government's needs, not your needs or mine, but their needs. The cost 
of care and of access is going down. The quality of care is improving. 
The costs are coming down.
  So the two plans in the middle--Medicare Select plans--are the 
alternatives for the seniors we are trying to preserve in Minnesota. 
There are two like that in some of the metropolitan areas in Florida--
we discussed that with the Senator from Florida --the Humana plan and 
Blue Cross/Blue Shield plan. And in 13 other States in this country, 
there are supplemental options for seniors who are enrolled in the 
traditional fee-for-service program.
  For example, Medicare Select offers full coverage of the deductibles 
and copayments. That is one of these choices. You can have, in one 
plan, your deductible and your copayments could be covered. Medigap 
does not offer that guarantee. You can take that choice. You may still 
pay charges to the physician above the Medicare accepted amounts, and 
depending on the policy you buy, you may still have to pay the Medicare 
required deductible.
  We struggled this year in health care reform to balance two 
potentially conflicting goals. One was how to save money in Medicare 
and how to finance more benefits, such as prescription drugs and long-
term care. Medicare Select plans are able to offer beneficiaries 
supplemental benefits at a lower cost than traditional Medigap 
policies. When the program expires at the end of this year--and this is 
why I am here--when the program expires, the plans will not be able to 
enroll new members.
  So the present people in Minnesota or in Florida who are having 
choices of Medicare will continue to have those choices.
  But when the plan is not able to enroll new members and the present 
membership ages, what happens? The cost of their care goes up and so 
the price of caring for them goes up.
  The benefit of extending Medicare Select is to continue to encourage 
these plans to continually enroll new members giving new people 
arriving at age 65 an opportunity to have this choice, and the risk 
gets spread across many more people thus keeping the cost low. If we 
let this close up at the end of this year and freeze in the existing 
members what happens over time is the sick stay in, the costly stay in, 
some other people may leave as the prices go up, and pretty soon you 
have a worthless demonstration.
  I ask unanimous consent that Senator Kohl be added as a cosponsor of 
Medicare Select.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DURENBERGER. Mr. President, it is really self-defeating not to 
continue this program. It would be helpful to expand this program to 
many more States, to all 50 States, but we are not asking to do that. 
We will not ask to do that program. But at least in the States where it 
is working and it is saving beneficiaries money and it is saving the 
taxpayers' money, we need to continue it in existence.
  I have spent the last 16 years working to bring Medicare up to date 
with private health care systems. Medicare Select is the working 
example of what the private system can do to help Medicare 
beneficiaries offer quality health care at a better price.
  Medicare beneficiaries have a generous Federal subsidy of 75 percent, 
yet Medicare costs continue to soar. Today's elderly Americans must pay 
$41.10 per month for Medicare part B coverage. In addition, they pay a 
really large hospital deductible of $696. They pay hospital coinsurance 
which depending on the period of hospitalization, can be $174 or $348 
per day. They pay $100 part B deductible and they pay at least 20 
percent of physician's charges. All that adds up and then you shop 
around for supplement coverage, and that really adds up.
  So recognizing all of that burden, all of that complication, that we 
are only too well aware of for our elderly parents, for elders 
generally, we created the Medicare Select program to bring more 
affordable coverage to seniors. Medicare Select gives them the choice 
of purchasing their standard Medigap insurance policy through managed 
care networks. It operates like the point of service option like we 
discussed under health care, through benefits provided by doctors with 
contracts with the plan, standard Medicare benefits provided by any 
physicians of their choice, and all the savings are passed on to the 
beneficiaries.
  Those purchasing Medicare Select policies save from 10 percent to 37 
percent on their premiums over those who buy the traditional fee-for-
service Medigap insurance policies. This translates into saving as much 
$25 a month for a senior or $300 per year. It does not seem like much 
to some. But it is tangible real savings for people on fixed incomes.
  In addition, these Medicare Select policies are proving to be of high 
quality and very desirable among Medicare beneficiaries.
  Consumer Reports in the August 1994 issue rated the top Medigap 
policies in the Nation. Of the top 15 Medigap policies, 8 were Medicare 
Select. And we have only been in business for 3 years, believe it or 
not. I mean, we all know from watching TV and looking at the literature 
that our parents get how much of this supplemental Medigap stuff is 
being foisted on them.
  To know that after not quite 3 years--1992 was the first year, 1993 
and now we are into 1994--maybe just 2 full years under our belt of 
experimenting, Consumer Reports says 8 of the top 15 medigap policies 
in the country--supplemental policies--are Medicare Select plans, and 
we are only operating in 15 States. Wow, that is terrific. It is really 
terrific. I use the word ``we'' to give some sense of ownership over 
the authorship of this, but it is not our plan. Unlike part A part B, 
these are private plans. These are the same kind of plans that people 
had access to when they were ordinary working stiffs in America. It is 
the private health plan that President Clinton said everybody ought to 
have from a choice of private health plans. It is a wonderful 
opportunity for seniors, and you can see how the market is responding. 
If 8 out of the top 15 are rated among the best in the country, the 
market is really there.
  Mr. President, I know that amendments on appropriations bills are not 
the vehicle of choice in this place. This was one of the few vehicles 
left, and I know that health reform will not happen this year, and I 
know that the medical technical corrections bill is not ready for easy 
passage in the House, or so I am told.
  I know that one of our colleagues whom the present Presiding Officer 
and I know only too well on the House side who has jurisdiction over 
this program does not seem to like it at all, although it is working 
wonderfully well out in the part of the district that he represents out 
in California.
  So we have some problems. It is not so much our problems. We have 
still the opportunity. The problem is 400,000 Americans and another 
maybe 20 million Americans or 18 million Americans in these 15 States 
could have opportunities like the 400,000 people have already.
  So, this does not seem to me to be helpful that someone who disagrees 
with the value of this program in the face of some proven results can 
put us in the position where it is very difficult just to continue a 
demonstration in an appropriate way.
  Clearly, in my State the select plans will continue to be offered, 
but they can only be offered to the people who presently own them. 
Eventually, in just a matter of a couple short years, that means the 
program is going to go down in value.
  So I would certainly appeal to my colleagues, who may have some 
ownership over some other vehicles that might come through here next 
week and my colleagues who are considering what they are going to do 
about the District of Columbia appropriations bill, that they consider 
this is not just some Senator trying to make a name for himself who is 
standing up here trying to foist off a piece of legislation on to the 
citizens of the District of Columbia. Certainly I am not trying to hold 
up appropriations for them.
  We did not do the national Federal part of health reform this year. 
We are failing to make good things available to our constituents, if we 
do not pass something like this.
  So until I find out exactly what is going on with the underlying 
appropriations bill and until I find out what other vehicles might be 
available in the early part of next week that are moving out of the 
parking lot and have some success maybe on the House side as well and 
with an appeal to people at HCFA and the appeal to some of our 
colleagues on the House side, I will at this stage just simply yield 
the floor to my colleague from Texas, who has reported to me personally 
and privately the success in a fairly high-priced State, Texas, where 
it cost money to see a doc in a hospital, reports the early success and 
fairly good success of Medicare Select in her State.
  So I will yield the floor at this point.
  The PRESIDING OFFICER. The Senator from Texas.
  Mrs. HUTCHISON. Mr. President, I commend the Senator from Minnesota 
for taking this leadership role in trying to make sure that in this 
year, when we have talked about health care reform and are trying to 
give more access to affordable health care to more people, for not 
letting this very important program expire, and I do hope very much 
that the Senator from Minnesota gets the opportunity to put this 
amendment forward.
  We must act, and I am pleased to see that the Presiding Officer is 
also a sponsor of this amendment and wants to do the same thing, that 
is to make sure that we have this program in place.
  The Medicare Select option is something that is working. It is a 
program we should encourage and promote. To think that in a year when 
we have focused so much on health care we would let it die is something 
we should not allow to happen. It is unthinkable.
  Our senior citizens have a hard time when they are on a fixed income, 
and this Medicare Select program does give them options. In Texas more 
than 8,000 senior citizens are enrolled in Medicare Select plans, which 
saves them an average of 15 to 30 percent of the cost of Medicare 
supplemental plans. This is really significant savings to people who 
are on a fixed income. Nationwide, 400,000 people are participating in 
this program in 15 States.
  If we allow this program to expire at the end of this year, all of 
those 400,000 seniors are going to be faced with higher premiums. That 
is something that we cannot let happen.
  Medicare Select policies are highly rated by Consumer Reports 
magazine. In its August 1994 issue, Consumer Reports included Medicare 
Select policies in the top 15 best value medigap products nationwide. 
In fact, almost every health care bill that was introduced on this 
floor--from the majority leader's bill to the Dole-Packwood bill, to 
the mainstream bill, every one of them--would have made this a 
permanent part of our health care system. It would have been a 
permanent extension to 50 States. Right now, people in 15 States are 
able to have this very important program.
  So I commend my colleague from Minnesota and I commend my colleague 
from West Virginia and the others who are cosponsoring this proposal. I 
hope that all of us will be able to look for a vehicle to make sure 
that Medicare Select does continue next year so that this option will 
be available to our senior citizens. They are trying to insure 
themselves. They are doing their best to be responsible citizens, and 
to have the security that they need for health care. I think we should 
help them get it.
  I commend Senator Durenberger, and I thank you Mr. President.
  Mr. DURENBERGER addressed the Chair.
  The PRESIDING OFFICER. The Senator from Minnesota.
  Mr. DURENBERGER. Mr. President, I appreciate very much the comments 
by my colleague from Texas.
  As one who has been, as the Presiding Officer knows, spending a fair 
amount of time both on Medicare and health care reform and so forth, I 
have been waiting a long time for other people to get interested in 
health care and health care reform and so forth.
  It was such a pleasure, when the now majority leader took over as 
subcommittee chair, to see his enthusiasm, and then when he become 
majority leader to see the junior Senator from West Virginia take over 
and get very enthusiastic about the subject.
  But I will tell you, when a brandnew Senator shows up and has the 
enthusiasm for the subject that Senator Hutchison has, it really kind 
of surprises you, particularly because, since Senator Hutchison has 
been here, she has had the right to be preoccupied with other things. I 
mean, she has had two elections, as I recall, or 1\1/2\ elections, 
since she got here. But, obviously, she is not only aware of the fact 
that the cost of health care and so forth is a problem, she represents 
a State that in one way or another has been trying to do something 
about it.
  My impression, from sitting through a lot of meetings on the 
Republican side with her, as we try to evaluate what is the best 
approach to health care reform, is that as I leave here, at least 
looking at my side of the aisle, in particular, as I leave here I am so 
pleased to know that the citizens of Texas have the opportunity to be 
so well represented on health care issues. And just the very brief 
statement this afternoon in recognition of the need by Medicare Select 
is only a small part of the contribution she already made.
  Mrs. HUTCHISON. Will the Senator yield for a question?
  Mr. DURENBERGER. Yes.
  Mrs. HUTCHISON. Mr. President, as a freshman in the Senate, I am 
certainly number 100 out of 100 in this august body.
  But, of course, the Senator from Minnesota has been in the forefront 
of health care reform even before this year when the President brought 
it forward as an issue. I appreciate his leadership. I want to say that 
he will certainly be missed as we take up health care reform next year. 
I plan to be here. I am sorry that he will not be here, because he has 
chosen not to run for reelection. But I do think that we will go 
forward and we will, I think, improve our health care system.
  I wanted to mention one other thing, and that is that our colleague 
on the other side of this Capitol, Congresswoman Nancy Johnson, has 
been so tenacious in trying to make sure that Medicare Select does not 
die. I know she has talked to Senator Durenberger, she has talked to 
me, she has talked to many others in the Senate to say, ``Please, don't 
let this very important program die. It is important.''
  I want to commend the Congresswoman from Connecticut, Nancy Johnson, 
for her leadership in trying to make sure that this important program 
stays in place.
  I thank the Senator from Minnesota for his kind remarks. I will say 
that when we do pass health care reform next year, it will be because 
of the efforts that the Senator has made that built up this crescendo 
of awareness of the very important need that we have in this country to 
have more access to affordable health care coverage while we maintain 
the quality in the system. That is the goal we will try to meet once 
again next year, in his absence.
  Thank you, Mr. President.
  Mr. DURENBERGER addressed the Chair.
  The PRESIDING OFFICER. The Senator from Minnesota.
  Mr. DURENBERGER. Mr. President, I acknowledge and appreciate very 
much the comments of my colleague from Texas.
  I am glad she mentioned Nancy Johnson, because I have had so many 
telephone messages from Nancy Johnson in the last 2 weeks that I keep 
asking the people who hand me the messages, is this the one that has 
come in the last hour or is the one from the previous hour?
  There is no one more tenacious than she on this subject. And those of 
us who have been in conferences with the Congresswoman from Connecticut 
know how committed she is, particularly on this particular program. She 
is on the subcommittee of jurisdiction and certainly has a tremendous 
opportunity, even though she is in the minority party over there.
  I also was just informed that the chair of the District of Columbia 
authorizing committee on the House side is the same person who is the 
chair of the Health Subcommittee of the committee of jurisdiction on 
the House side. And that is sort of an incongruous position for us to 
be in right now, that the same gentleman who at least suggested he has 
some difficulties with extending Medicare Select even for a year or two 
is also the person who has authorizing responsibility for the District 
of Columbia.
  And so, perhaps, if Members of the House are still around, he will 
hear that there is a bit of a quandary here and maybe he will find a 
way to help us resolve it.
  Mrs. FEINSTEIN. Mr. President, I rise in support of Senator 
Durenberger's amendment to extend the Medicare Select Program, which 
currently provides MediGap health benefits to roughly 400,000 older 
Americans by using a managed care model.
  Like many of the other original cosponsors of Senator Durenberger's 
amendment--Senators Rockefeller, Kohl, Conrad, Chafee, Hutchison, Bond, 
and Heflin--I come from 1 of the 15 States where the Medicare Select 
demonstration program has proved its popularity during the last 3 
years.
  Medicare Select, which currently provides 100,000 Californians with 
low-cost MediGap insurance using a managed care model, was enacted in 
1990 as a 3-year demonstration program and has proved to be extremely 
popular, enrolling 400,000 seniors in 15 States. This program used a 
network of providers to cut premium costs by 10-30 percent over fee-
for-service MediGap products--those services and costs not covered by 
Medicare.
  In California, roughly 100,000 seniors have signed up for the 
program, and Blue Cross of California alone is enrolling an additional 
2,200 per month. These Medicare enrollees are signing up because the 
Medicare Select Program can provide low-cost, high-quality health 
benefits while still retaining a high degree of choice over their 
physician.
  The reasons for the program's popularity are simple. In order to save 
money or receive added drug benefits, more and more older Americans are 
enrolling in managed care plans. In fact, Consumer Reports lists many 
Medicare Select products as its highest-rated values, and extension of 
the Medicare Select Program is strongly endorsed by California 
Insurance Commissioner Garamendi, as well as the National Association 
of Insurance Commissioners. In addition, the Mainstream plan--and 
nearly every other health reform proposed this Congress--provided for a 
continuation and expansion of Medicare Select and other forms of 
managed Medicare.
  Certainly, managed Medicare programs like Medicare Select must be 
implemented carefully, in order to ensure that Medicare enrollees are 
appropriately informed of the benefits of this program, provided with 
high-quality services, and ensured access to highly trained physicians. 
In addition, managed care programs must be shown to provide lower costs 
to the Federal Government in addition to consumer discounts.
  However, without the extension of the Medicare Select Program, which 
has already proven its initial success, new enrollments will be cut off 
at the end of 1994--before a national report has been issued or 
additional health car reform has been enacted. In the absence of 
national health care reform, I believe that this successful and popular 
managed Medicare Program should be allowed to continue.
  Mr. CHAFEE. Mr. President, I am pleased to join as a cosponsor of 
this amendment to permanently extend the Medicare Select Program.
  Based on legislation which I introduced in 1990, Medicare Select is a 
demonstration project operating in 15 States with more than 400,000 
participants. Under this program, Medicare beneficiaries have the 
option to purchase Medicare supplemental insurance policies--otherwise 
known as MediGap policies--through non-HMO managed care networks.
  The program has been a huge success. Recent data show that Medicare 
beneficiaries who purchase Medicare Select products pay premiums which 
are 10 to 37 percent less expensive than the premiums for traditional 
Medigap products. Moreover, consumer satisfaction with these products 
is extremely high. Of the to 15 Medigap products ranked by Consumer 
Reports in its August 1994 issue, 8 were Medicare Select policies. 
Unfortunately, under current law, Medicare Select carriers will have to 
halt enrollment on December 31, 1994.
  Almost all the major health care reform plans introduced during this 
session of Congress included provisions to expand the Medicare Select 
Program to all 50 States. As we all know now, however, health care 
reform is not going to happen this year. Therefore, at the very least, 
we should enact legislation which will allow the current 15 State 
demonstration project, which has been such a success, to continue. This 
amendment will do just that, and I urge my colleagues to support it.

                          ____________________