[Congressional Record Volume 141, Number 64 (Thursday, April 6, 1995)]
[House]
[Pages H4383-H4394]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                       MEDICARE SELECT EXPANSION

  The SPEAKER pro tempore. Pursuant to House Resolution 130 and rule 
XXIII, the Chair declares the House in the Committee of the Whole House 
on the State of the Union for the consideration of the bill, H.R. 483.

                              {time}  1641


                     in the committee of the whole

  Accordingly, the House resolved itself into the Committee of the 
Whole House on the State of the Union for the consideration of the bill 
(H.R. 483) to amend title XVIII of the Social Security Act to permit 
Medicare Select policies to be offered in all States, and for other 
purposes, with Mr. Bonilla in the chair.
  The Clerk read the title of the bill.
  The CHAIRMAN. Pursuant to the rule, the bill is considered as having 
been read the first time.
  Under the rule, the gentleman from Virginia [Mr. Bliley] will be 
recognized for 30 minutes, and the gentleman from Michigan [Mr. 
Dingell] will be recognized for 30 minutes.
  The Chair recognizes the gentleman from Virginia [Mr. Bliley].
  (Mr. BLILEY asked and was given permission to revise and extend his 
remarks.)
  Mr. BLILEY. Mr. Chairman, I yield myself such time as I may consume.
  Mr. Chairman, I urge my colleagues to join me in supporting the 
extension of the Medicare Select Program. The bill before the House was 
worked out between the members of the Commerce and Ways and Means 
Committees. The bill provides for a 5-year extension of the program and 
permits it to be offered in all 50 States. The bill also requires the 
secretary of the Department of Health and Human Services to conduct a 
study comparing the health care costs, quality of care, and access to 
services under Medicare select policies with other Medigap policies. 
The secretary is required to establish Medicare select on a permanent 
basis unless the study finds that: First, Medicare select has not 
resulted in savings to Medicare select enrollees, second, it has led to 
significant expenditures in the Medicare program, or third, it has 
significantly diminished access to and quality of care. I think the 
bill provides for a reasonable balance that will permit a valuable and 
innovative program for 
[[Page H4384]] our senior citizens to be continued while permitting a 
more informed evaluation of the program. We must remember that Medicare 
select is a MediGap insurance policy which provides seniors with 
another option to receive medical care. By giving the elderly more 
choices within MediGap we give them the option to pick plans which meet 
their individual needs.
  In my view, we must not allow this program to expire. It is unfair to 
both participants and insurers alike to have to worry about what the 
Congress will do next. Medicare Select is a small but important 
program--and, I might add, a highly regulated program. It is regulated 
under the Federal MediGap standards. There are additional Federal 
statutory standards for select policies, plus our States insurance 
departments regulate them under State law. Medicare Select saves senior 
citizens money, provides more choice for senior citizens than the 
current Medicare risk contract HMO, and has given them the opportunity 
to secure a more comprehensive benefits package. If we do not act to 
extend this program, no new enrollees will be permitted to enroll in 
Select plans and we will see the ultimate demise of these plans. The 
end result is bound to be significant increases in premiums for current 
enrollees. Medicare beneficiaries will be denied a product that saves 
them money and which has served them well. There is no reason not to 
extend this program in a responsible fashion.
  Mr. Chairman, I urge my colleagues to join me in supporting this 
bill.
  Mr. Chairman, I reserve the balance of my time.
  Mr. DINGELL. Mr. Chairman, I yield myself 4 minutes.
  (Mr. DINGELL asked and was given permission to revise and extend his 
remarks.)
  Mr. DINGELL. Mr. Chairman, I will not burden the House with the 
discussions which took place during the consideration of the rule. 
Suffice it to say my displeasure with the way the rule has been handled 
in its substance and the way the rights of the minority have been 
constrained remain. I observe also that those constraints affect the 
ability of this House to legislate well, as they affect the rights of 
the people who look to us to see to it that their concerns are properly 
protected in the consideration of legislation.

                              {time}  1645

  I will speak, rather, Mr. Chairman, of the substitute which will be 
offered by the gentleman from California [Mr. Waxman], and I point out 
that this substitute is a reasonable alternative. It permits Members to 
support an extension of the program and an expansion of the program 
while providing very important consumer protections.
  First, the substitute differs from the newly-drafted underlying bill 
in three particulars.
  It expands the Medicare Select Program to all 50 States for a 5-year 
period, just like the bill reported out of the Committee on Commerce. 
Five years permits an ample opportunity to execute the program, to 
evaluate it, and to permit the Congress to come back and to extend the 
period, if necessary, or to make whatever changes might appear 
appropriate at the conclusion of 5 years.
  Second, it bans attained age rating that lets insurance companies 
raise rates on elderly people as they age.
  I want to comment a little on this. One of the perils of the people 
who would be seeking insurance under this program is that they will 
find that their initial purchase of insurance will be done on the basis 
that the prices are going to be very reasonable. Under the attained age 
rating practices of insurance companies, it means that there can be a 
substantial annual increase in cost to the insured. This is a deceptive 
practice. It is increasingly employed. It has the function of 
misleading consumers, and it makes it impossible for them to make 
meaningful comparisons of products of insurance.
  It also arranges matters so that misrepresentations can be made by 
unscrupulous insurance salesmen and that the consequences of the annual 
rating increases are not known to the purchaser of insurance at the 
time the insurance is first negotiated for.
  Third, the substitute allows people in restricted networks, that is, 
Medicare Select plans of the type we are dealing with here, to get out 
of those plans, something which they may very well want to do and 
something which is consistent with their rights as insured and enables 
them to get into an unrestricted Medigap plan.
  Specifically, it requires select insurers also to offer to 
individuals who disenroll from a select plan a fee-for-service plan 
under terms comparable to the terms they would have enjoyed had they 
initially joined a fee-for-service plan. Thus, choice is maintained for 
the persons who would enroll in these, fairness in achieving the kind 
of service they might want, protection of their basic liberties and 
their economic and other concerns.
  It is a fair way of addressing the failures which exist with regard 
to the legislation before us. These proposals do nothing to disturb the 
underlying bill. They do provide important consumer protections to the 
elderly. They create a level playing field for insurers, stabilize the 
marketplace and assure that insurers who would behave fairly toward 
their insured are not placed at a disadvantage by the behavior of 
unscrupulous insurers who would utilize these kinds of devices to the 
detriment not only of the more responsible insurers but also to the 
different holders of the policies that we are talking about.
  I urge my colleagues to adopt the substitute at the time that it is 
offered.
  Mr. Chairman, I reserve the balance of my time.
  Mr. BLILEY. Mr. Chairman, I yield such time as he may consume to the 
gentleman from Florida [Mr. Bilirakis], chairman of the Subcommittee on 
Health and Environment of the Committee on Commerce.
  (Mr. BILIRAKIS asked and was given permission to revise and extend 
his remarks.)
  Mr. BILIRAKIS. Mr. Chairman, I thank the gentleman for yielding time 
to me.
  Mr. Chairman, I rise in support of legislation to extend the current 
Medicare Select Program which is scheduled to expire in June.
  On January 11, 1995, our colleague, the gentlewoman from Connecticut 
[Mrs. Johnson] introduced H.R. 483, a bill to amend title 18 of the 
Social Security Act to permit Medicare select policies to be offered in 
all States, and for other purposes. That bill was referred to the 
Committee on Commerce, the principal committee of jurisdiction and in 
addition to the Committee on Ways and Means.
  On February 15, 1995, the Health and Environment Subcommittee held an 
oversight hearing on Medicare select and issues related to Medicare 
managed care. On March 22, 1995, the subcommittee met and marked up 
H.R. 483 and approved the bill for full committee consideration, as 
amended, by a voice vote. On Monday, April 3, 1995, the full Commerce 
Committee met and ordered H.R. 483 reported to the House. as amended, 
by a voice vote.
  As ordered reported by the Commerce Committee, H.R. 483 would extend 
the Medicare Select Program for an additional 5 years and expand the 
coverage to include all 50 States and this provides for a more true 
analyses as a demonstration project.
  The Committee on Ways and Means also completed action on H.R. 483, 
and reported a different version of the legislation to the House. The 
Ways and Means Committee version of the bill extends the Medicare 
Select Program to all 50 States on a permanent basis.
  Since the time that both committees completed action on H.R. 483, the 
committees have met and have developed a consensus bill, H.R. 1391, 
which was introduced in the House on April 4. The rule the House just 
passed makes in order the text of H.R. 1391.
  The bill the House is considering would extend the Medicare Select 
Program for a 5 year period and expands the coverage to all 50 States.
  The bill would also require the Secretary of the Department of Health 
and Human Services to conduct a study comparing the health care costs, 
quality of care, and access to services under Medicare select policies 
with other MediGap policies. This study must be
 completed by the end of 1998. Based on the results of this study. The 
Secretary must make a determination that the Medicare Select Program is 
permanent unless the study finds that: (1) Medicare select has not 
resulted in savings to Medicare select enrollees. (2) it has 
[[Page H4385]] led to significant expenditures in the Medicare Program, 
or (3) it has significantly diminished access to and quality of care.
  Congress needs to enact legislation to extend this program now.
  The National Association of Insurance Commissioners [NAIC] has 
testified in favor of the program and stated that out of the 10 
Medicare select States that report into the NAIC's Complaint Data 
System, there were only 9 Medicare select complaints last year.
  The program has been a very good one for senior citizens. In August 
1994, Consumer Reports rated the top Medigap insurers nationwide. Eight 
out of 10 of the top-rated 15 MediGap plans were Medicare select plans. 
It is a very popular program in my home State of Florida where some 
13,000 Medicare beneficiaries are enrolled.
  I urge my colleagues to support this legislation so we may continue 
to provide older Americans with an often needed and in my opinion, 
necessary option.
  Mr. DINGELL. Mr. Chairman, I yield 5 minutes to the distinguished 
gentleman from California [Mr. Stark], a member of the Committee on 
Ways and Means.
  Mr. STARK. Mr. Chairman, I would like first to congratulate the 
distinguished gentlewoman from Connecticut, the sponsor of H.R. 483. 
While I may agree with what is in the bill, it is the absence of a few 
things with which she and I would differ. But she gets my highest 
admiration for tenacity. She has done an excellent job in bringing this 
bill to the floor promptly.
  I do believe that there is a need for strong beneficiary protections. 
These may be prophylactic. They may be only a safety net, but we have 
had anecdotal evidence of abuses. And this program is new, and the 
administration had hoped that we would only extend it for 18 months. 
Many of us feel that Federal standards, which would be enforced or 
reinforced by States, would be in order.
  The few States that choose not, like my own State of California, to 
regulate this through the insurance code, might be required to.
  Had we had the opportunity, and we will have a partial opportunity in 
the substitute to be offered by the distinguished gentleman from 
California later in the proceedings, I would have suggested that we 
perhaps extend this for 5 years; also, that we have
 Federal oversight of Medicare select.

  The amendment that I would offer perhaps would require Medicare 
select plans to have similar requirements as we now require for 
Medicare approved HMO's, called risk contractors. Those would include 
community rating.
  For example, in California, to compare identical plans with 
Prudential, AARP's plan, and Blue Cross, the only offeror of Medicare 
select, there is, indeed, a savings for the first 4 years. From 1965 to 
1969, Medicare select only costs $780. AARP's Prudential plan is $957, 
but it is $957 until you expire or stop paying your premiums.
  The Medicare select plan jumps to $1,080 at age 70, $1,260 at 75 and, 
over 80, it is $1,380, almost a 40 percent increase. This, I believe, 
is improper and impacts most on seniors when they can lest afford to 
pay those premiums.
  I think we should consider the idea of forbidding premiums that are 
age-related.
  We should have State certification of these plans and an amendment to 
define the benefit package, not so as to limit it, but so as to put it 
into context with the plans that are now offered under MediGap so that 
seniors will have the opportunity to use free market choice and pick a 
plan that is, in fact, one that they can compare on a price basis.
  Many of these amendments will be in the substitute offered by the 
gentleman from California [Mr. Waxman]. I would urge that that be 
supported.
  I think that we will revisit this. One of the reasons I do not want 
to belabor this, and I will in a moment yield back my time, is that my 
guess is that some of these provisions may be added later in the 
legislative process. I hope then we can consider them at some more 
deliberate pace and consider which of these amendments will make 
Medicare select a better product, more consumer friendly than what 
might appear without the regulations that are missing from the current 
bill.
  I thank the distinguished gentleman for yielding time to me.
  Mr. DINGELL. Mr. Chairman, I yield 3 minutes to the gentleman from 
North Dakota [Mr. Pomeroy].
                              {time}  1700

  Mr. POMEROY. Mr. Chairman, I thank the distinguished ranking member 
for yielding time to me.
  Mr. Chairman, Medicare select is an issue I have followed for several 
years. I am the only former insurance regulator in the 104th Congress.
  At the time the Medicare Select Program came into being, I was 
regulating the insurance market in North Dakota, the State I now 
represent in this body. I favored very strongly the Medicare select 
component. I thought perhaps the 15-State limitation at that time was 
unduly restrictive, in light of fairly prevalent practices throughout 
the Medicare supplement market at that time to allow the type of 
discounting and favorable premium impact it had for the senior citizen 
consumers under the operation explicitly allowed for the 15 States 
under the program.
  I believe with the Medicare select, those who would believe we are 
engaged in an experiment here have it exactly wrong. The Medicare 
select restrictions actually constricted discounting activity that was 
allowing seniors lower insurance prices throughout the 50 States.
  I fought as an insurance regulator to make sure North Dakota got to 
be one of the 15 States allowed, and was pleased that the Department of 
Health and Human Services allowed North Dakota to be one of the States. 
The experience has been significant. It has allowed a 17-percent 
premium deduction for senior citizens.
  I called in the course of the Medicare select legislation to see 
whether or not problems, some kind of consumer complaints had arisen 
because of the restricted delivery system that might bring about this 
kind of discount. I was told by the North Dakota insurance department 
they did not have one, not a single complaint on their Medicare select 
book of business allowed in the State of North Dakota, now amounting to 
about 10,000 policyholders.
  Having regulated this market for 8 years, I would say it is rather 
incredible that any product, no matter how perfect, does not generate 
one consumer complaint to the insurance department.
  I think when it comes to senior citizens, this body owes them the 
same range of choices allowed throughout the rest of the insurance 
marketplace. We have discounting arrangements being made with providers 
to pass a better value on to the policy holder. Why, when it comes to 
senior citizens, should we somehow become so protectionist as to try 
and keep them from being able to access that same kind of discounted 
premium?
  Are there questions in the senior MediGap market? Of course there 
are. Attained age rating is a concern that I believe needs to be 
addressed. It needs to be addressed, in my opinion, first by the 
regulatory entities responsible for regulating insurance, State 
insurance departments.
  I believe if the State insurance departments adn their collective 
organization, the National Association of Insurance Commissioners, a 
body I formerly served in as president, do not in the very near term 
address that forcefully, action should be considered in this body to 
preclude attained age rating. I feel that strongly about it.
  However, the vehicle before us certainly is not the one to try in 
this body to revamp the regulatory structure in this way. This is a 
simple bill. It serves a positive purpose. Give seniors a choice, give 
seniors a break, and pass this legislation.
  Mr. BLILEY. Mr. Chairman, to close debate on our side, I yield 5 
minutes to the gentlewoman from Connecticut [Mrs. Johnson], who knows 
more about this subject, certainly, than anybody on this side of the 
aisle. It has been a pleasure to work with her.
  Mrs. JOHNSON of Connecticut. Mr. Chairman, I rise in strong support 
of this bill, and urge my colleagues to support it with enthusiasm. A 
number of issues have been raised from the other side, but they are 
issues that were thoroughly addressed in the hearings that we have had 
on this bill.
  First of all, this is not a failed program. This is a very strong 
program that seniors are choosing, and they are 
[[Page H4386]] choosing it because it offers them lower cost health 
care that is also high-quality health care. Their premiums are anywhere 
from 10 to almost 40 percent less than the premiums of other Medigap 
policies. That is why they choose it. That is why seniors all over 
America should have the right to choose it.
  Are these good policies? According to the Consumer Reports, 8 of the 
15 top-ranked policies were Medicare select policies. That is pretty 
good.
  Second, there have been essentially no complaints. Members heard my 
colleague, who was an insurance commissioner himself, say in his State 
there was not a single complaint. Nationwide in 1994 there were only 9 
complaints in regard to select plans, when there were 967 complaints 
for regular Medigap policies, another reason why seniors choose these 
policies in the Medigap market. They are good.
  Third, when we look at the consumer satisfaction surveys, Medicare 
select rates very high, another good sign.
  Lastly, no program that was not well regarded would be supported by 
the National Governors Association, the National Council of State 
Legislatures, and the insurance commissioners of 50 States, so this is 
a good program, it is a successful program and, futhermore, it is a 
well-regulated program. It is regulated by the States; it is regulated 
by the Federal Government; it is regulated in exactly the same way that 
plans are regulated for people of other ages.
  There is no problem with seniors who choose this option getting 
locked in. Later we will hear an amendment that says that these plans 
ought to be required to offer a fee-for-service option.
  In every single State, in every single State, there are at least 
seven policies offered by Blue Cross or Blue Shield or AARP that 
guarantee issue at predetermined rates for seniors, so anyone in a 
Medicare select policy has a choice of choosing another Medigap policy 
at the same rate anyone else would be able to buy that policy, and 
without any danger of exclusion for preexisting medical conditions. 
Therefore, there is no need to pass a law that would force this kind of 
policy to do something that none of its competitors have to do.
  This is a good bill. It is strictly structured. This program has 
succeeded. I ask Members' support of it, and I ask the Members' 
opposition to the following substitute, because it would force this 
plan, in certain States, to offer benefits that no other Medigap policy 
has to offer. That would effectively kill this low-cost choice for 
seniors. If it was forced to age rate its premiums, base its premiums 
on attained age rating, premiums for young seniors would go up.
  In the market now, seniors of every age can choose whether they want 
to buy an attained-age-rating Medigap policy or a community-rated 
Medigap policy or an issued age-rated Medigap policy. They are all 
there. Seniors can choose that. Why should we not allow a 67-year-old 
healthy senior to choose a lower cost policy, if that is what he 
prefers, and face the higher rates of a 70-year-old when he hits 70, if 
that
 is what he wants? He has the right under current circumstances to 
choose a community-rated or an attained-age-related policy when he is 
67, if he wants to do that.

  I ask Members to support the bill, to oppose the alternative, and to 
guarantee that seniors in our Nation will have the choice of a lower 
cost, high-quality Medigap policy.

         National Governors' Association, National Conference of 
           State Legislatures, National Association of Insurance 
           Commissioners,
                                                   March 15, 1995.
     Hon. Bill Thomas,
     Chairman, Subcommittee on Health of the Committee on Ways and 
         Means,
     Washington, DC.
       Dear Chairman Thomas: In an effort to promote consumer 
     choice and the offering of affordable health care coverage 
     for senior citizens, the National Governors' Association 
     (NGA), the National Conference of State Legislatures (NCSL), 
     and the National Association of Insurance Commissioners 
     (NAIC) call to your attention an urgent problem facing over 
     400,000 Medicare beneficiaries: the imminent expiration of 
     the medicare SELECT program. This program has provided 
     significant savings to Medicare beneficiaries in 
     demonstration project states. We urge its permanent extension 
     and expansion to all fifty states.
       As you are aware, the Medicare SELECT program is a three 
     year demonstration project (extended another six months by 
     the 103rd Congress) that authorizes managed care networks to 
     offer Medicare Supplement policies in the fifteen 
     demonstration states. Medicare SELECT offers significant 
     savings to seniors, many of whom live on fixed incomes. It 
     also offers seniors a choice among health plans.
       In the absence of Congressional action on this issue, more 
     than 400,000 Medicare beneficiaries will be faced with higher 
     premiums and less choice. If the Medicare SELECT program is 
     not continued, Medicare SELECT carriers could not enroll new 
     members after June 30, 1995. This will result in significant 
     increases in premiums for Medicare beneficiaries already 
     enrolled in the program. Further, those beneficiaries not 
     enrolled in the program will no longer have the opportunity 
     to choose this low-cost and choice-enhancing option.
       Nearly every federal health reform proposal before the 
     103rd Congress included a permanent extension of this program 
     to all fifty states. The momentum and broad-based political 
     support behind this program should not be allowed to 
     dissipate simply due to the absence of more comprehensive 
     Congressional action in the health care reform area. The 
     health care coverage of too many Americans is at stake.
       As we testified before two House subcommittees on this 
     issue, we urge you to support the provisions of H.R. 483 that 
     extend and expand the Medicare SELECT program to all fifty 
     states.
       The NGA, NCSL and NAIC would be happy to answer any 
     questions and provide you with any additional technical 
     background upon request. Please contact Mary Beth Senkewicz 
     at the NAIC Washington office at 624-7790. Thank you for 
     consideration of this recommendation.
           Sincerely,
     Raymond C. Scheppach,
                                          Executive Director, NGA.
     Carl Tubbesing,
                                Director, Washington Office, NCSL.
     Kevin T. Cronin,
                                         Washington Counsel, NAIC.


                       medicare select: the facts

       Medicare Select is Point of Service coverage--Beneficiaries 
     can go out of the Select network at any time and Medicare 
     still pays for covered care.
       Medicare Select Saves Seniors $'s--Premium savings range 
     from 10 to 38% over regular Medigap policies.
       Medicare Select provides Quality and Value--Consumer 
     Reports ranked 8 Select plans among the top 15 plans.


                         more med select facts

       Medicare Select Works for Seniors--In 1994 the National 
     Association of Insurance Commissioners reported only 9 
     complaints on Select plans vs. 967 for regular Medigap.
       Medicare Select Offers Choice--Gives seniors an option 
     similar to that enjoyed by millions of working Americans.


                       even more med select facts

       Medicare Select Satisfies Seniors--Select plans are highly 
     rated in consumer satisfaction surveys.
       Medicare Select has bipartisan Support--Ways and Means bill 
     passed 31 to 2, Commerce bill passed by voice vote.
       Medicare Select Wanted by States--NGA, NAIC, and NCSL 
     support the 50 state option.

  The CHAIRMAN. All time for general debate has expired.
  Pursuant to the rule, the amendment in the nature of a substitute 
consisting of the text of H.R. 1391 is considered as an original bill 
for the purpose of amendment and is considered as having been read.
  The text of the amendment in the nature of a substitute is as 
follows:

                               H.R. 1391

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

     SECTION 1. PERMITTING MEDICARE SELECT POLICIES TO BE OFFERED 
                   IN ALL STATES FOR AN EXTENDED PERIOD.

       Section 4358(c) of the Omnibus Budget Reconciliation Act of 
     1990, as amended by section 172(a) of the Social Security Act 
     Amendments of 1994, is amended to read as follows:
       ``(c) Effective Date.--(1) The amendments made by this 
     section shall only apply--
       ``(A) in 15 States (as determined by the Secretary of 
     Health and Human Services) and such other States as elect 
     such amendments to apply to them, and
       ``(B) subject to paragraph (2), during the 8\1/2\ year 
     period beginning with 1992.
       ``(2)(A) The Secretary of Health and Human Services shall 
     conduct a study that compares the health care costs, quality 
     of care, and access to services under medicare select 
     policies with that under other mediare supplemental policies. 
     The study shall be based on surveys of appropriate age-
     adjusted sample populations. The study shall be completed by 
     December 31, 1998.
       ``(B) The Secretary shall determine during 1999 whether the 
     amendments made by this section shall remain in effect beyond 
     the 8\1/2\ year period described in paragraph (1)(B). Such 
     amendments shall remain in effect beyond such period unless 
     the Secretary determines (based on the results of the study 
     under subparagraph (A)) that--
       ``(i) such amendments have not resulted in savings of 
     premiums costs to these enrolled 
     [[Page H4387]] in medicare select policies (in comparison to 
     their enrollment in medicare supplemental policies that are 
     not medicare select policies and that provide comparable 
     coverage),
       ``(ii) there have been significant additional expenditures 
     under the medicare program as a result of such amendments, or
       ``(iii) access to and quality of care has been 
     significantly diminished as a result of such amendments.''.

  The CHAIRMAN. No amendment to the amendment in the nature of a 
substitute is in order except a further amendment in the nature of a 
substitute, which may be offered only by the gentleman from Michigan 
[Mr. Dingell], or his designee, is considered as read, is debatable for 
1 hour, equally divided and controlled by a proponent and opponent of 
the amendment, and is not subject to amendment.
  Pursuant to the rule, the gentleman from California [Mr. Waxman] will 
be recognized for 30 minutes.


     amendment in the nature of a substitute offered by Mr. Waxman.

  Mr. WAXMAN. Mr. Chairman, I offer an amendment in the nature of a 
substitute.
  The CHAIRMAN. The Clerk will designate the amendment.
  The text of the amendment in the nature of a substitute is as 
follows:

       Amendment in the nature of a substitute offered by Mr. 
     Waxman:
       Strike all after the enacting clause and insert the 
     following:

     SECTION 1. EXTENDING MEDICARE SELECT POLICIES TO ALL STATES 
                   FOR AN ADDITIONAL 5-YEAR PERIOD.

       Section 4358(c) of the Omnibus Budget Reconciliation Act of 
     1990, as amended by section 172(a) of the Social Security Act 
     Amendments of 1994, is amended--
       (1) by striking ``The amendments'' and inserting ``(1) 
     Subject to paragraph (2), the amendments'';
       (2) by inserting ``and, subject to paragraph (3), those 
     other States that elect them to apply'' after ``15 States (as 
     determined by the Secretary of Health and Human Services)'';
       (3) by striking ``3\1/2\-year'' and inserting ``8\1/2\-
     year''; and
       (4) by adding at the end the following new paragraphs:
       ``(2) The amendments made by this section shall apply to a 
     State after the first 3\1/2\ years of the 8\1/2\-year period 
     described in paragraph (1) only if the State provides that 
     the premiums for a medicare select policy do not vary at 
     renewal (or at any other time premiums change) on the basis 
     of the age attained by the policy-holder or 
     certificateholder.
       ``(3)(A) The amendments made by this section shall apply to 
     a State other than the 15 States referred to in paragraph (1) 
     only if the State provides that the issuer of a medicare 
     select policy makes available to a policy-holder or 
     certificateholder, at each of the times described in 
     subparagraph (B), a policy described in subparagraph (C) 
     (whether or not otherwise offered by the issuer to 
     individuals in the State and whether issued directly by that 
     issuer or under an arrangement with another issuer) under 
     terms and conditions described in subparagraph (C).
       ``(B) The times described in this subparagraph are--
       ``(i) the time the policyholder or certificateholder moves 
     out of the service area of the issuer of the medicare select 
     policy,
       ``(ii) the time of renewal of such policy, and
       ``(iii) at the end of the 12-month-period beginning on the 
     date such policy first becomes effective if the policy is 
     canceled or nonrenewed by the policyholder or 
     certificateholder at the end of such period.
       ``(C) A policy described in this subparagraph is a policy 
     that meets the 1991 Model NAIC Regulation or 1991 Federal 
     Regulation and other requirements of section 1882 of the 
     Social Security Act (without regard to subsection (t)) and 
     the terms and conditions (including premium levels) described 
     in this subparagraph are terms and conditions comparable to 
     the terms and conditions that the policyholder or 
     certificateholder would have had if the policyholder or 
     certificateholder had been enrolled in a policy not under 
     section 1882(t) of such Act during the period in which the 
     policyholder or certificateholder was enrolled in a policy 
     under such section 1882(t).
       ``(D) The Secretary of Health and Human Services is 
     authorized to issue such regulations as may be necessary to 
     carry out this paragraph.''.

  Mr. WAXMAN. Mr. Chairman, I offer this amendment in order to improve 
this legislation before us. The argument on the floor before us today 
is not whether we ought to have Medicare select policies or not. A 
number of States are already marketing these policies. It has been used 
on an experimental basis in those States. All of us agree that we ought 
to expand that to other States as well.
  However, our amendment would make three changes in the underlying 
bill. First of all, while we extend Medicare select programs to all 50 
States, we would do it for a 5-year period so we can take a look, 
again, at that period of time to see whether this program is working 
the way we envision it.
  Second, we would in this amendment say that the Medicare select 
policies would not permit attained age rating that lets insurers raise 
rates on elderly people as they age. This is a deceptive practice that 
is increasingly employed to mislead consumers and make meaningful 
comparison between various insurance options possible.
  Third, the substitute allows people in restricted networks, like 
Medicare select plans, where they only have a panel to choose from of 
their health care providers, allows them to leave the Medicare select 
and go to a choice of provider that they may wish to have Medicare and 
this gap policy pay.
  These provisions do nothing to disturb the underlying bill. However, 
they are important consumer protections for the elderly, they create a 
level playing field for insurers, and they stabilize the market.
  Mr. Chairman, let me elaborate on these points. The gentlewoman from 
Connecticut [Mrs. Johnson], who is the original author of the bill 
before us, has argued that people have choices now, and we should not 
have any guarantee in the bill that they will have choices in the 
future.
  My concern is we do not know what the future will bring, except we 
have some idea of what is going on now in the competitive marketplace 
dealing with health insurance. As there is competition, there is 
competition for insurance companies to try to offer the lowest-priced 
plan to induce people to sign up.
  However, if they do not have a community rating, if they do not keep 
that low price for everybody except for the newcomers in their plan, as 
people get older, what we call attain an older age, and are therefore 
more likely to get sick, insurance companies can turn around and say 
``You signed up a number of years ago at a certain level, but now we 
are going to double or triple your premiums.''
  That, Members could imagine, would be a terrible thing for an elderly 
person who has a Medigap policy for which they now think they have 
security, to suddenly find that there rates have gone up so 
dramatically.
  Sometimes, however, people do not like these preferred provider 
organizations where they have only a certain list of physicians and 
health care providers to choose from. They may think it is okay when 
they are younger, let us say 65, but if they have some experiences 
later on with a specific illness where they need the expertise of 
someone who is not on that panel, they may want to choose to leave.
  I believe a fundamental value in health insurance for this country 
ought to be that we give people the right to choose what insurance they 
will have. We have offered in this substitute a guarantee that when 
people sign up in these Medicare select policies, that they will have a 
right to choose to join another Medigap plan. When people turn 65, they 
can sign up
 in any MediGap plan available.

  What they do not realize is if they sign on to Medicare select, 
unless we have this substitute adopted, in the future they may not be 
able to leave and go to another what is called fee-for-service or 
choice-of-provider plan. They will be faced with either being in the 
Medicare select or having to go outside of that list and then pay out 
of their own pockets, not only for their insurance, but they would have 
to pay for the costs of the doctor who is not on that panel.
  Let us keep in mind, we are dealing with Medicare select. It is only 
a very small issue in the scheme of the Medicare issues that we have 
already faced and are going to face in this Congress, but what we do in 
this instance may well become a benchmark for what we are going to do 
in the future.
  There is a lot of talk that the Republicans would like to take the 
Medicare program and, rather than let people have choices of doctors 
and other health care providers, to put them in managed care.

                              {time}  1715

  Managed care is a reasonable option but it ought to be an option at 
the choice of the beneficiary, not something which they are forced into 
whether they like it or not. In fact, if 
[[Page H4388]] we really believe in managed choice being a good option, 
it is only a good option when people have the ability in a free market 
to walk away and leave and join another alternative plan. But if they 
only have one choice, you can be sure that when they are captive in 
that one choice, that they are not going to be as important a customer, 
since they are a captive customer of the Medicare select plans.
  Members will hear in this debate about how well these Medicare select 
plans are doing. I do not deny they are doing well. The consumers 
generally seem happy in most States. Our fear is what the marketplace 
will look like not right now but in a couple of years.
  Let us put in this substitute which gives us a 5-year period in which 
to watch, to see how it is working; second, protect people from this 
sort of bait-and-switch of signing up and then finding your rates are 
going to double and triple because there is no protection against 
insurance companies raising your rates as you get older; and third, a 
guarantee that when you sign up in a Medicare select system, that that 
Medicare select system will give you an option which almost all of them 
do now, to choose another system, a fee-for-service system that will 
give you unlimited choice.
  This is an important consumer protection amendment. It is consistent 
with the idea of having Medicare select policies. I do not think 
anybody is arguing against the idea of Medicare select although some 
people may. But most Members would argue let us allow this Medicare 
select way of handling MediGap insurance, a supplemental insurance to 
Medicare, in the most consumer-oriented manner.
  I urge support for the substitute amendment.
  Mr. Chairman, I reserve the balance of my time.
  Mr. BLILEY. Mr. Chairman, I yield 5 minutes to the gentleman from 
California [Mr. Thomas], the chairman of the Subcommittee on Health of 
the Committee on Ways and Means.
  Mr. THOMAS. I thank the gentleman for yielding me the time.
  Mr. Chairman, if Members will examine the proponents of the 
substitute's argument, what they are saying is that we really do want 
Medicare select, we just want to improve it, we want to help. That 
would be akin to having you cross the street against the light. Urge 
you to go down a tunnel with a light ahead and say it is daylight. Turn 
on the gas with the pilot light out.
  They do not want to improve the Medicare program. Their position is 
clear. They stalled in the last Congress, hoping it would die. It took 
a Herculean effort at the 11th hour to get the pilot program renewed. 
And here they are once again, a wolf in sheep's clothing saying all we 
want to do is try to improve the program.
  The substitute says it is going to extend for only 5 years. The 
underlying bill says if after 5 years on a finding of the Secretary of 
HHS it saves money, we make it permanent. If it is good and it works, 
we make it permanent. What does the substitute do?
  Notwithstanding saving money after 5 years, the program is dead. That 
is improving? That is helping? That is a wolf in sheep's clothing.
  All they say they want is a level playing field. In fact, what they 
are trying to do is set up hurdles specific to Medicare select. If what 
they advocated for Medicare select is good, why is it not applied 
across-the-board to all MediGap programs? If in fact what they are 
urging for Medicare select is something that creates 15 States having 
one program and 35 States having another, so that you are guaranteed 
not to have a uniform program over 50 States, that is helping? That is 
creating an impossible standard to meet.
  Let's talk about really taking care of seniors.
  The gentleman from North Dakota is the only person in the Congress 
who has done this kind of work. I have great admiration for his courage 
to stand up and say, after 8 years, not one complaint. He is someone 
who has been in the trenches. He was a member of the National 
Association of Insurance Commissioners, and I received a letter from 
those commissioners, from the National Council of State Legislatures, 
and from the National Governors Association. This is what they said to 
me:

       Dear Chairman Thomas, in an effort to promote consumer 
     choice in the offering of affordable health care coverage for 
     senior citizens, the National Governors Association, the 
     National Conference of State Legislatures, the National 
     Association of Insurance Commissioners call to your attention 
     an urgent problem facing over 400,000 Medicare beneficiaries: 
     the imminent expiration of the Medicare select program. This 
     program has provided significant savings to Medicare 
     beneficiaries in demonstration project States. We urge its 
     permanent extension and expansion to all 50 States.

  They have seen these programs every day. They do not have the nine 
pages of improvements. They do not have the 45 points of consumer 
protection. They agree with our colleague from North Dakota, the 
program is good the way it is. It should be permanent. The underlying 
bill says if we save money, it is going to be permanent. Under the 
guise of protecting seniors, they want to guarantee that this program 
will not succeed.
  Why in the world would they do that? The answer is very simple. The 
gentleman from California exposed his hole card. He told you what we 
were going to do with Medicare.
  I will tell you what their great fear is, that we will be able to 
convert an old-fashioned, bloated, government-run, fee-for-service 
program into an efficient, cost-effective program that gives seniors 
more than they are getting now. This is the good step in the right 
direction. His old program will be changed. He does not want the new 
program. Their substitute will kill Medicare select. Vote against it. 
Vote for the underlying bill.

         National Governors' Association, National Conference of 
           State Legislatures, National Association of Insurance 
           Commissioners,
                                                   March 15, 1995.
     Hon. Bill Thomas,
     Chairman, Subcommittee on Health of the Committee on Ways and 
         Means, Longworth House Office Building, Washington, DC.
       Dear Chairman Thomas: In an effort to promote consumer 
     choice and the offering of affordable health care coverage 
     for senior citizens, the National Governors' Association 
     (NGA), the National Conference of State Legislatures (NCSL), 
     and the National Association of Insurance Commissioners 
     (NAIC) call to your attention an urgent problem facing over 
     400,000 Medicare beneficiaries: the imminent expiration of 
     the Medicare SELECT program. This program has provided 
     significant savings to Medicare beneficiaries in 
     demonstration project states. We urge its permanent extension 
     and expansion to all fifty states.
       As you are aware, the Medicare SELECT program is a three 
     year demonstration project (extended another six months by 
     the 103rd Congress) that authorizes managed care networks to 
     offer Medicare Supplement policies in the fifteen 
     demonstration states. Medicare SELECT offers significant 
     savings to seniors, many of whom live on fixed incomes. It 
     also offers seniors a choice among health plans.
       In the absence of Congressional action on this issue, more 
     than 400,000 Medicare beneficiaries will be faced with higher 
     premiums and less choice. If the Medicare SELECT program is 
     not continued, Medicare SELECT carriers could not enroll new 
     members after June 30, 1995. This will result in significant 
     increases in premiums for Medicare beneficiaries already 
     enrolled in the program. Further, those beneficiaries not 
     enrolled in the program will no longer have the opportunity 
     to choose this low-cost and choice-enhancing option.
       Nearly every federal health reform proposal before the 
     103rd Congress included a permanent extension of this program 
     to all fifty states. The momentum and broad-based political 
     support behind this program should not be allowed to 
     dissipate simply due to the absence of more comprehensive 
     Congressional action in the health care reform area. The 
     health care coverage of too many Americans is at stake.
       As we testified before two House subcommittees on this 
     issue, we urge you to support the provisions of H.R. 483 that 
     extend and expand the Medicare SELECT program to all fifty 
     states.
       The NGA, NCSL and NAIC would be happy to answer any 
     questions and provide you with any additional technical 
     background upon request. Please contact Mary Beth Senkewicz 
     at the NAIC Washington office. Thank you for consideration of 
     this recommendation.
           Sincerely,
     Raymond C. Scheppach,
                                          Executive Director, NGA.
     Carl Tubbesing,
                                Director, Washington Office, NCSL.
     Kevin T. Cronin,
                                         Washington Counsel, NAIC.

  Mr. WAXMAN. Mr. Chairman, I yield 3 minutes to the gentleman from 
Oregon [Mr. Wyden].
  (Mr. WYDEN asked and was given permission to revise and extend his 
remarks.)
  [[Page H4389]] Mr. WYDEN. Mr. Chairman, I found the comments of the 
gentleman from California very interesting because many of us who 
support the Waxman amendment are strong supporters of 21st century 
Medicare that uses managed care to a much greater extent. In fact, in 
my community, we have one of the highest concentrations in the country 
of managed care participation. We have seen the future, and we know it 
can work.
  But the fact is that as part of that future, we should incorporate 
two principles that the Waxman amendment addresses.
  First and foremost, the Waxman amendment will protect the hundreds of 
thousands of older people in this country from rate shock. I have 
listened to my colleagues talk, for example, about how consumers are 
satisfied with Medicare slack. Of course they are, because many of them 
have had this product for maybe 18 months or so, under attained age 
pricing, and they have not seen the big rate hikes that are going to 
hit them down the road.
  Under the Waxman proposal, there is a floor of protection for older 
people from those rate hikes. I would urge my colleagues in the 
strongest way, the seniors of America do not know what is coming in the 
days ahead in terms of these rate hikes. The Waxman amendment offers 
some real protection.
  Second, with respect to choice, and again in our area, managed care 
works because there is real choice, the Waxman amendment offers more 
choices. Frankly, a lot of us think that is especially important now. 
We have got the chairman of the Senate Finance Committee saying that 
there are going to be 400 billion dollars' worth of cuts in Medicare 
and Medicaid. That will inevitably take choice from the senior 
citizens. The Waxman amendment again gives to older people more 
choices, more protection to deal with what we think is going to come in 
the days ahead from the other side.
  Finally, I would say that I have worked very closely with the 
gentlewoman from Connecticut often. She is a sincere and dedicated 
leader in the health policy field. I wish to make Medicare select work. 
I support managed care. My community has been a leader nationwide in 
this area. We can make managed care work better if we adopt the Waxman 
amendment so seniors across this country do not get clobbered with rate 
hikes that they do not expect and that we give them more real choice.
  Mr. BLILEY. Mr. Chairman, I yield 2 minutes to the gentleman from 
North Dakota [Mr. Pomeroy].
  Mr. WAXMAN. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman 
from North Dakota [Mr. Pomeroy].
  The CHAIRMAN. The gentleman from North Dakota [Mr. Pomeroy] is 
recognized for 3\1/2\ minutes.
  Mr. POMEROY. Mr. Chairman, this debate brings up two points of 
frustration that I have got with Congress:
  The first is partisanship. There are technical policy questions that 
come before this House and they do not need to be debated in a bashing, 
partisan manner with which we bring to the debates. There clearly are 
those issues that will divide us along partisan and ideological lines. 
This is a technical little public policy question we face and we do not 
need to turn it into a partisan free-for-all. We have had enough of 
those already.
  Second frustration. Sometimes on the floor of this House we try and 
imagine everything that can go wrong and figure out how to fix it 
regardless of whether in real life it has been a problem at all. 
Inevitably that produces the law of unintended consequences and we can 
foul things up pretty well.
  I believe the substitute, while wholly well-intentioned, represents 
that sort of approach. Having regulated this market, having tracked it 
since I left regulation, I do not believe we see the practices that 
would be fairly addressed by this regulation. Even if there were those 
circumstances
 out there, the worst place to fashion the right regulatory response 
would be on the floor of the House with amendments and substitutes. 
There are experts that do this every day. They are called insurance 
regulators. They ought to have first crack at this.

  Second, in the event that they are remiss, we ought to have a good 
solid hearing in the committees on this issue. Believe me, when I was 
commissioner, I can remember some very rigorous days in congressional 
committees as we discussed these matters. Not on the floor of the 
House, not in the context of substitute motions.
  I urge a defeat of the gentleman's motion, although I have the 
greatest respect for what he is trying to accomplish, and the passage 
of the bill.
  Mr. WAXMAN. Mr. Chairman, will the gentleman yield?
  Mr. POMEROY. I yield to the gentleman from California.
  Mr. WAXMAN. I thank the gentleman for yielding.
  Mr. Chairman, I want to commend the gentleman for his leadership in 
this area, and particularly for saying to the audience that may be 
watching this debate, we are arguing in good faith over some policy 
differences. I do find it startling to think that people would come in 
and question others' motives.
  Questioning people's motives just seems to me so out of place in a 
debate where we are trying to make the best decisions we can.
  We look at the insurance market today, the non-Medicare insurance 
market, and it is not just in anticipation of problems that may happen 
but most likely will not, we look at the insurance market today and it 
just makes more sense for an insurance company to try to offer the 
lowest possible price to those people that are the healthiest, and they 
do not really want to insure people who are going to be the sickest, 
because the sickest are going to cost them more money. Rather than 
spread the cost out across the broad population, we see a segmentation 
of the market and lowest prices for the healthiest.
  I fear that we see that reality now in regular insurance practices, 
that in the MediGap policies, we are going to find the same thing, the 
lowest price for healthier people, and then they get older and sicker, 
a higher price.
  That is why we have offered the substitute. I would like to have the 
gentleman's thoughts on it.
  Mr. POMEROY. I believe attained age rating of the Medicare supplement 
business generally is inappropriate. I think that it is dead wrong for 
people whose finances are diminishing in advancing age, whose health is 
deteriorating in advancing age, to be finding themselves on the upper 
range of an attained age premium scale. I think that it needs to be 
addressed in the context of the entire Medicare supplement marketplace, 
not simply the Medicare select product. Right issue, wrong vehicle. 
That is why I oppose this substitute. But the gentleman is on to 
something. This is unacceptable and the insurance commissioners better 
move quickly on this or Congress should take action.
                              {time}  1730

  Mr. WAXMAN. Mr. Chairman, I yield 6 minutes to the gentleman from 
Michigan [Mr. Dingell].
  (Mr. DINGELL asked and was given permission to revise and extend his 
remarks.)
  Mr. DINGELL. Mr. Chairman, I thank the distinguished gentleman from 
California for yielding me this time.
  Mr. Chairman, this is a very important question. It is not something 
which is arcane. Attained age rating, which this amendment would compel 
to be not used, permits an insurer to raise his rates on a policy 
solely on the basis of a policyholder's age.
  Some States have sought to place limitations on this practice, and a 
number of States have already banned that outright, or have community 
rating.
  In all of the States where this has been done, there remains plenty 
of competition for good Medigap products.
  Attained age rating removes the ability of consumers to meaningfully 
compare different premiums: Hence, this is a practice which undermines 
the major objective of the 1990 reforms, to standardize policies.
  Second, attained age rating can cost consumers thousands of dollars 
more over the long run than a fairly nicely priced product because it 
allows insurers to play games with premiums that are hard for 
regulators to control or consumers to make an intelligent judgment on.
  [[Page H4390]] Third, attained age rating is forcing good insurers 
who want to use community rating to move away from that method of 
rating. This will cause the kind of fragmentation that occurred in the 
health insurance marketplace that led to so many of the problems we 
have today.
  Now with thanks to my good friend from California, Mr. Stark, let me 
go through some of the differences which exist. If you take a policy 
where premiums do not vary by age, for example the AARP Prudential 
plan, the plan is, at all times, every year of the life of the insured, 
$957 a year. But, if you take any of the other plans where attained age 
rating is used, then you come up with quite a different one.
  For example, under Bankers Life and Casualty you start out at age 65 
with $892.57, but at age 70 it is $1,060. Your savings are beginning to 
vanish and, as matter of fact, have done so. By the time you are age 80 
it is $1,590.66.
  In the case of Blue Cross/Blue Shield of California, at age 65 to 69 
it is $780 if they use attained age rating. But by the time they reach 
80 it goes to $1,300.80.
  In the case of other offerors, for example Life Investors Insurance 
Co., it starts out at age 65 at $966. It goes at age 70 to $1,200.67. 
The advantages which you got are now gone. And by the age of 80 it goes 
to $1,629. In the case of MedCare Plus, it starts at 65 at $833, a 
saving, but by the time you are at age 80 it is $1,487.
  What does the Waxman-Dingell amendment do? Very simple: it says first 
of all no attained age rating, so that you cannot hook a senior 
citizen. And if you want to get a senior citizen by selling him an 
attained age rating insurance policy on the basis he is going to make 
some massive savings, looks good because he says oh, yeah, I will sign 
on that, but all of a sudden, by the time he is age 80 and his needs 
are great, his medical costs and the risks to his pocketbook are 
greatest, the amount he is paying is almost doubled.
  Now under the bill as drawn, a retiree is not able to get out. The 
Waxman-Dingell amendment says the insurer has to offer him, if he wants 
out, another insurance package which gives him more conventional type 
of insurance availability, so that if he finds he is getting skinned or 
he does not like his service he has a way out of this plan.
  The proponents of this legislation have told nobody about these 
things and they have been somewhat dark secrets and it did not come up 
very well in the course of the hearings which were conducted in either 
committee, and we owe particular thanks to the gentleman from 
California [Mr. Stark] for bringing these matters to light, and we also 
owe particular thanks to the gentleman from California [Mr. Waxman] for 
having offered the amendment.
  The harsh fact of the matter is if you want to protect senior 
citizens from unscrupulous insurers, from exorbitant prices, from bait 
and switch, and if you want to see to it that they have decent 
treatment and they can get out of the onerous process of rapidly 
escalating costs where they are not offered the services, then you 
should go this route.
  That is, accept and adopt the amendment offered by the gentleman from 
California [Mr. Waxman] on behalf of himself, myself, and the gentleman 
from California [Mr. Stark].
  Mr. Chairman, having said these things, let me simply observe if you 
really want to protect the senior citizens, if you want to treat them 
fairly, the
 Waxman-Dingell-Stark amendment is the way that we should proceed, and 
to fail to do something different is unfair.

  Let us just talk about the home State of the distinguished 
gentlewoman from Connecticut. That is the State of Connecticut. It 
requires community rating of all Medigap policies. The Waxman 
substitute will simply protect that important public policy decision 
made by the State of Connecticut and will prevent the bill, under the 
authorship of the distinguished gentlewoman from Connecticut, from 
skinning a bunch of old folks in amongst other places the State of 
Connecticut where they may no longer be able to get community-rated 
policies. And so I urge my colleagues to adopt the amendment that has 
been offered by the distinguished gentleman from California. I have 
given Members good reason. They will be protecting the senior citizens 
from being skinned by unscrupulous bait and switch practices and 
enabling them to exit policies they have found to be oppressive and to 
assure that there will be policies available to them at the time they 
exit. Otherwise you will deny them those important rights.

                                              Consumers Union,

                                    Washington, DC, April 6, 1995.
       Dear Representative: We urge you to support the Dingell/
     Waxman amendment in the nature of substitute to H.R. 483, 
     which is expected to be considered by the House of 
     Representatives on Friday, April 7. Unlike H.R. 483, the 
     Dingell/Waxman amendment offers protections for the nation's 
     senior citizens.
       The Dingell/Waxman amendment would do the following:
       Limit the extension of Medicare Select to a five year 
     period, assuring that the program is evaluated thoroughly 
     before becoming permanent.
       Ban attained age rating for Medicare Select policies. 
     Attained age rating does not belong in health policies 
     designed for people 65 and over; it results in steep premium 
     increases as seniors grow older and have less income, making 
     medigap policies unaffordable for many. Medicare Select 
     policies are at a substantial competitive advantage in the 
     marketplace since, unlike traditional medigap policies, they 
     typically do not have to pay the Part A deductible. Banning 
     attained age rating for Medicare Select policies helps to 
     both level the playing field among medigap insurance policies 
     and provides a first step at protecting seniors against 
     unaffordable medigap premiums.
       Require Medicare Select companies to make available to 
     previous Medicare Select policyholders a traditional medigap 
     policy. In today's marketplace, there are no guarantees that 
     seniors with Select policies will have access to a 
     traditional policy in the future at a price they can afford. 
     Without this adjustment, many seniors could find themselves 
     locked into a Select policy when they feel they want and need 
     access to a broader choice of doctors and hospitals.
       Many Members have spoken recently of the need to provide 
     choice to seniors. Without the Dingell/Waxman amendment, many 
     seniors will face reduced choice: they will be priced out of 
     the medigap market or will find they have no choice but to 
     remain in a Select policy with limited choice of providers.
       We urge you to vote in favor of protecting the nation's 
     senior citizens by supporting the Dingell/Waxman amendment.
           Sincerely,
                                                     Gail Shearer,
                                Directory, Health Policy Analysis.

--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                  AFLAC Equalizer,    AARP--Prudential    Bankers Life and    Blue Cross of Calif.     Blue Shield of   
                                                American Family Life      Medicare          Casualty Co.         Medicare Select       Calif. Medicare  
                                                  Assurance Co. of    Supplement Plans  Medicare Supplements          Plans           Supplement Plans  
                   Coverage                         Columbus, GA     -----------------------------------------------------------------------------------
                                               ----------------------                                                                                   
                                                             Annual    Premiums do not    Age +      Annual     Age +      Annual     Age +      Annual 
                                                  Age +     premium      vary by age                premium               premium               premium 
--------------------------------------------------------------------------------------------------------------------------------------------------------
Plan A........................................  65-69        $643.50       $552         65           $565.41  65-69           $480  65-66           $720
                                                70-74         724.90                    70            642.21  70-74            540  67-69            852
                                                75-79         775.50                    75            750.10  75-79            600  70-74            936
                                                85+           809.60                    80+           888.76  80+              660  75-79          1,044
                                                                                                                                    80+            1,044
Plan B........................................  65-69         926.75        858         65            768.65                                            
                                                70-74       1,067.00                    70            907.74                                            
                                                75-79       1,175.35                    75          1,096.90                                            
                                                85+         1,263.35                    80+         1,340.83                                            
(1) Not offered                                                                                                                                         
(1) Not offered                                                                                                                                         
Plan C........................................  65-69       1,115.40        963         65            884.61                                            
                                                70-74       1,283.70                    70          1,045.74                                            
                                                75-79       1,426.70                    75          1,268.83                                            
                                                85+         1,541.65                    80+         1,565.01                                            
(1) Not offered                                                                                                                                         
(1) Not offered                                                                                                                                         
Plan D........................................                                                                                                          
(1) Not offered                                 930               65        809.23                                                                      
                                                                  70        970.36                                                                      
                                                                  75      1,194.32                                                                      
                                                                 80+      1,493.01                                                                      
(1) Not offered                                 65-66            960                                                                                    
                                                67-69          1,140                                                                                    
                                                70-74          1,284                                                                                    
                                                75-79          1,452                                                                                    
                                                80+            1,524                                                                                    


                                                                                                                                                        
[[Page H4391]]
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                  AFLAC Equalizer,    AARP--Prudential    Bankers Life and    Blue Cross of Calif.     Blue Shield of   
                                                American Family Life      Medicare          Casualty Co.         Medicare Select       Calif. Medicare  
                                                  Assurance Co. of    Supplement Plans  Medicare Supplements          Plans           Supplement Plans  
                   Coverage                         Columbus, GA     -----------------------------------------------------------------------------------
                                               ----------------------                                                                                   
                                                             Annual    Premiums do not    Age +      Annual     Age +      Annual     Age +      Annual 
                                                  Age +     premium      vary by age                premium               premium               premium 
--------------------------------------------------------------------------------------------------------------------------------------------------------
Plan E........................................                                                                                                          
(1) Not offered                                 957               65        892.57      65-69         \1\780                                            
                                                                  70      1,061.01      70-74       \1\1,080                                            
                                                                  75      1,289.77      75-79       \1\1,260                                            
                                                                 80+      1,590.86      80+         \1\1,380                                            
(1) Not offered                                                                                                                                         
Plan F........................................  65-69       1,316.15      1,161         65          1,220.61                                            
                                                70-74       1,507.00                    70          1,483.08                                            
                                                75-79       1,663.75                    75          1,808.06                                            
                                                85+         1,783.65                    80+         2,213.11                                            
(1) Not offered                                 65-66          1,044                                                                                    
                                                67-69          1,248                                                                                    
                                                70-74          1,392                                                                                    
                                                75-79          1,572                                                                                    
                                                80+            1,642                                                                                    
Plan G........................................  65-69       1,218.25      1,104         65          1,111.41                                            
                                                70-74       1,417.35                    70          1,368.86                                            
                                                75-79       1,584.00                    75          1,693.51                                            
                                                85+         1,715.45                    80+         2,107.40                                            
(1) Not offered                                                                                                                                         
(1) Not offered                                                                                                                                         
Plan H........................................                                                                                                          
(1) Not offered                                 1,212             65      1,778.49                                                                      
                                                                  70      2,115.47                                                                      
                                                                  75      2,555.43                                                                      
                                                                 80+      3,116.16                                                                      
(1) Not offered                                 65-66          1,224                                                                                    
                                                67-69          1,452                                                                                    
                                                70-74          1,608                                                                                    
                                                75-79          1,788                                                                                    
                                                80+            1,896                                                                                    
Plan I........................................                                                                                                          
(1) Not offered                                 1,377             65      2,576.81      65-69       \2\1,620  65-66          1,440                      
                                                                  70      3,071.87      70-74       \2\1,920  67-69          1,692                      
                                                                  75      3,704.70      75-79       \2\2,220  70-74          1,860                      
                                                                 80+      4,505.31      80+         \2\2,340  75-79          2,088                      
                                                                                                              80+            2,208                      
Plan J........................................                                                                                                          
(1) Not offered                                 1,764                                                                                                   
(1) Not offered                                                                                                                                         
(1) Not offered                                                                                                                                         
(1) Not offered                                                                                                                                         
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\Prudent Buyer Plan. Added skilled nursing facility days. Part B deductible not covered.                                                              
\2\Platinum Plan, no drug limit. Increased skilled nursing facility days. No Part B deductible.                                                         
Senior World Magazine, May 1994.                                                                                                                        


------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                    Golden State Mutual  Life Investors Inc.     Med-Care Plus         Medico Life,       Mutual of Omaha,    National Home Life Assurance    Physicians Mutual 
                                       Life, Medicare       Co., Medicare       Bankers Multiple   Medicare supplement  Medicare supplement     Co., Medicare supplement       Inc. Co., total  
                                      supplement plans       supplements         Line Ins. Co.,         insurance              plans                    insurance                senior care    
                                   ------------------------------------------       Medicare      ----------------------------------------------------------------------------------------------
             Coverage                                                             supplements                                                                                                   
                                                Annual               Annual  ---------------------             Annual               Annual               Annual                          Annual 
                                      Age +    premium     Age +    premium               Annual     Age +    premium     Age +    premium     Age +    premium                Age +    premium 
                                                                                Age +    premium                                                                                                
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Plan A............................  65-69       $447.27  65          $543.60  65          $519.70  65          $627.15  65          $684.37                 Male     Female  65-89       $518.10
                                    70-74        630.63  70           712.80  70           590.18  66-69        661.05  70           852.07  65          $419.40    $371.40                     
                                    75           930.99  75           865.60  75           689.45  70-72        721.90  79         1,062.67  66-70        539.40     479.40                     
                                                         80+          916.80  80+          816.87  73-75        766.35  80+        1,141.14  71-75        599.40     539.40                     
                                                                                                   76-79        793.30                       76+          659.40     575.40                     
                                                                                                   80+          816.70                                                                          
Plan B............................  65-69        531.80  65           808.80  65           720.43                                                                                               
                                    70-74        749.81  70         1,062.00  70           850.79                                                                                               
                                    75         1,106.92  75         1,274.40  75         1,027.96                                                                                               
                                                         80+        1,365.60  80+        1,256.61                                                                                               
(1)Not offered                                                                                                                                                                                  
(1)Not offered                                     Male  Female                                                                                                                                 
                                    65           719.40  647.40                                                                                                                                 
                                    66-70      1,007.40  839.40                                                                                                                                 
                                    71-75      1,079.40  947.40                                                                                                                                 
                                    76+        1,199.40  995.40                                                                                                                                 
(1)Not offered                                                                                                                                                                                  
Plan C............................                                                                                                                                                              
(1)Not offered                      65           945.60  65           834.54  65         1,123.20  65         1,157.21                                                                          
                                    70         1,240.80  70           986.61  66-69      1,189.90  70         1,440.82                                                                          
                                    75         1,489.20  75         1,197.04  70-72      1,310.40  79         1,796.96                                                                          
                                    80+        1,596.00  80+        1,476.42  73-75      1,411.05  80+        1,929.72                                                                          
                                                                              76-79      1,491.75                                                                                               
                                                                              80+        1,583.05                                                                                               
(2)Not offered                      65-89        873.10                                                                                                                                         
                                    70-79        977.68                                                                                                                                         
                                    80-84      1,070.41                                                                                                                                         
Plan D............................                                                                                                                                                              
(1)Not offered                      65           924.00  65           759.81                                                                                                                    
                                    70         1,213.20  70           911.12                                                                                                                    
                                    75         1,455.60  75         1,121.45                                                                                                                    
                                    80+        1,560.00  80+        1,401.92                                                                                                                    
(1)Not offered                                                                                                                                                                                  
(1)Not offered                                                                                                                                                                                  
(2)Not offered                                                                                                                                                                                  
(1)Not offered                                                                                                                                                                                  
Plan E............................                                                                                                                                                              
(1)Not offered                      65           966.00  65           833.34                                                                                                                    
                                    70         1,267.20  70           990.65                                                                                                                    
                                    75         1,521.60  75         1,204.35                                                                                                                    
                                    80+        1,629.60  80+        1,485.37                                                                                                                    
(1)Not offered                                                                                                                                                                                  
(1)Not offered                                                                                                                                                                                  
(2)Not offered                                                                                                                                                                                  
(1)Not offered                                                                                                                                                                                  
Plan F............................                                                                                                                                                              
(1)Not offered                      65         1,089.60  65         1,220.61  65         1,372.45  65         1,294.02                                                                          
                                    70         1,430.40  70         1,483.08  66-69      1,452.00  70         1,611.17                                                                          
                                    75         1,716.00  75         1,808.06  70-72      1,597.05  75         2,009.59                                                                          
                                    80+        1,838.40  80+        2,213.11  73-75      1,714.05  80+        2,157.95                                                                          
                                                                              76-79      1,806.50                                                                                               
                                                                              80+        1,908.30                                                                                               
(2)Not offered                      65-69      1,208.79                                                                                                                                         
                                    70-79      1,286.56                                                                                                                                         
                                    80-89      1,371.59                                                                                                                                         
Plan G............................                                                                                                                                                              
(1)Not offered                      65         1,039.20  65         1,111.41                                                                                                                    
                                    70         1,364.40  70         1,368.86                                                                                                                    
                                    75         1,598.40  75         1,693.51                                                                                                                    
                                    80+        1,754.40  80+        2,107.40                                                                                                                    
(1)Data unavailable                                                                                                                                                                             
(1)Not offered                                     Male  Female                                                                                                                                 
                                    65           947.40  827.40                                                                                                                                 
                                    66-70      1,307.40  1,079.40                                                                                                                               
                                    71-75      1,415.40  1,199.40                                                                                                                               
                                    76+        1,547.40  1,307.40                                                                                                                               
(1)Not offered                                                                                                                                                                                  
Plan H............................                                                                                                                                                              
(1)Not offered                      65         1,296.00  65         1,660.57                                                                                                                    
                                    70         1,700.40  70         1,975.29                                                                                                                    
                                    75         2,040.00  75         2,385.91                                                                                                                    
                                    80+        2,185.20  80+        2,909.65                                                                                                                    
(1)Not offered                                                                                                                                                                                  
(1)Not offered                                                                                                                                                                                  
(2)Not offered                                                                                                                                                                                  
(1)Not offered                                                                                                                                                                                  
Plan I............................                                                                                                                                                              
(1)Not offered                      65         1,519.20  65         2,410.45                                                                                                                    
                                    70         1,993.20  70         2,873.54                                                                                                                    
                                    75         2,391.60  75         3,465.68                                                                                                                    
                                    80+        2,563.20  80+        4,214.58                                                                                                                    
(1)Not offered                      65         1,876.21                                                                                                                                         
                                    70         1,955.93                                                                                                                                         
                                    79         2,439.68                                                                                                                                         
                                    80+        2,619.71                                                                                                                                         
(2)Not offered                                                                                                                                                                                  
(1)Not offered                                                                                                                                                                                  
Plan J............................                                                                                                                                                              
(1)Not offered                      65         2,235.60                                                                                                                                         
                                    70         2,935.20                                                                                                                                         
                                    75         3,522.00                                                                                                                                         
                                    80+        3,772.80                                                                                                                                         
(1)Not offered                                                                                                                                                                                  
(1)Not offered                                                                                                                                                                                  
(1)Not offered                                                                                                                                                                                  
(2)Not offered                      65-69      1,858.45                                                                                                                                         
                                    70-79      2,000.02                                                                                                                                         
                                    80-89      2,153.80                                                                                                                                         
                                                                                                                                                                                                
(1)Phone 1-213-731-1131 for                                                                                                                                                                     
 specific details on coverages.                                                                                                                                                                 
(1)Six month waiting period for                                                                                                                                                                 
 medical conditions occurring                                                                                                                                                                   
 within 6 months prior to                                                                                                                                                                       
 effective date of coverage. If                                                                                                                                                                 
 policy replaces previous                                                                                                                                                                       
 supplement insurance, credit for                                                                                                                                                               
 pre-existing condition limitation                                                                                                                                                              
 is applied. Phone 1-800-229-6565                                                                                                                                                               
 for specific details.                                                                                                                                                                          
(1)Preferred Provider plan. No                                                                                                                                                                  
 balance billing. All network                                                                                                                                                                   
 providers accept assignment.                                                                                                                                                                   
 Automatic claims filing when                                                                                                                                                                   
 using network providers. Rates                                                                                                                                                                 
 vary by zip code. Rates shown are                                                                                                                                                              
 for zip code areas 918-925. Phone                                                                                                                                                              
 619-747-7712 for specific details                                                                                                                                                              
 on coverage and network                                                                                                                                                                        
 providers.                                                                                                                                                                                     
(1)Rates vary by geographical                                                                                                                                                                   
 areas. Rates shown are for the                                                                                                                                                                 
 San Diego area. No pre-existing                                                                                                                                                                
 medical condition limitation.                                                                                                                                                                  
 Phone 1-800-228-6080 for                                                                                                                                                                       
 specifics on coverages and                                                                                                                                                                     
 current rates for geographical                                                                                                                                                                 
 areas.                                                                                                                                                                                         
(1)Rates vary by zip code. Rates                                                                                                                                                                
 shown are for zip code areas 900-                                                                                                                                                              
 931. No waiting period for pre-                                                                                                                                                                
 existing conditions for Plans A,                                                                                                                                                               
 C or F. Phone 1-800-228-7669 or 1-                                                                                                                                                             
 402-342-7600 for details and                                                                                                                                                                   
 coverage specifics. Automated                                                                                                                                                                  
 claims processing feature.                                                                                                                                                                     
(2)6 months waiting period for pre-                                                                                                                                                             
 existing medical conditions                                                                                                                                                                    
 occurring within six months prior                                                                                                                                                              
 to effective date of coverage.                                                                                                                                                                 
 Phone 1-800-356-6271 for                                                                                                                                                                       
 specifics on details and                                                                                                                                                                       
 coverages.                                                                                                                                                                                     
(1)Special savings if husband-wife                                                                                                                                                              
 plans selected. No waiting period                                                                                                                                                              
 for pre-existing conditions.                                                                                                                                                                   
 Rates vary by zip code areas.                                                                                                                                                                  
 Rates shown are for zip code                                                                                                                                                                   
 92128. Phone 1-800-325-6300 for                                                                                                                                                                
 specifics and coverages.                                                                                                                                                                       
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Senior World Magazine, May 1994.                                                                                                                                                                


[[Page H4392]]

  Mr. WAXMAN. Mr. Chairman, do I get to close on the debate?
  The CHAIRMAN. The gentleman from Virginia [Mr. Bliley] has the right 
to close.
  Mr. WAXMAN. Mr. Chairman, I yield myself such time as I may consume.
  Mr. Chairman, if I might on our side conclude the debate, I would say 
this is an important consumer protection effort. As we go down the road 
of Medicare select, going from 15 States to 50, I worry about what it 
is going to mean for consumers who may well be taken advantage of by 
insurance companies that will be able to raise their rates after they 
get older and, more likely, sick. I agree that it would be viable for 
us to do this for all Medigap policies, and I hope at some point we 
will be able to reach all Medigap policies. But this is what is before 
us now and it would be improper under the rules and nongermane to offer 
an amendment to all Medigap policies.
  But when we come to the closed panel and the fact that consumers will 
want a choice beyond that, this is the appropriate place and I think it 
is appropriate to do what Democrats and Republicans recommended out of 
the Committee on Commerce, and to put that 5-year sunset in place.
  This amendment is supported by the Consumers Union, which has played 
a very active role in advising people about the dangers for consumers, 
that consumers can be taken advantage of. And it says in this 
amendment, according to the Consumers Union, the statement which I 
would like to put in the Record, many seniors will face reduced choice, 
they will be priced out of the Medigap market, or they will find that 
they have no choice but to remain in a select policy with limited 
choice of providers.
  That is our fear. We think Medicare select policies can survive and 
function well and we want to encourage them, but we want consumer 
protections built in. I urge support of the amendment.
  Mr. Chairman, I yield back the balance of my time.
  Mr. BLILEY. Mr. Chairman, I yield myself 30 seconds just to say that 
one of the problems--and I know the intentions of the gentleman who 
offered this and I respect him intensely--is that you have an 
unintended consequence. That is, if you mandate these things on one 
Medigap policy and they are not mandated on the others, you will have 
the effect of killing the program because the premiums will be higher.
  Mr. Chairman, to close debate on our side, I yield such time as she 
may consume to the gentlewoman from Connecticut [Mrs. Johnson].
  Mrs. JOHNSON of Connecticut. Mr. Chairman, I thank the gentleman for 
yielding time to me.
  Mr. Chairman, I rise in opposition to the amendment, but I am pleased 
that the underlying bill has broad bipartisan support. We are joined 
together in wanting to make available to seniors a lower-cost, high-
quality Medigap insurance policy.
  The amendment, however, jeopardizes that choice for seniors because 
if the amendment passes, it will require Medicare select plans to offer 
a benefit that no other Medigap policy is required to offer, and by 
doing that you will force the price of Medicare select policies up, you 
will kill the savings that seniors now enjoy by buying Medicare select 
policies. So you will effectively eliminate a choice that has been very 
good for seniors, very helpful to them in a tough world, saves them 
$300 a year, and offers them prescription drugs and broader coverage 
than other Medigap plans could offer them.
  We would do ourselves and we would do the seniors of America a great 
disservice if under the guise of reform we denied them alone any access 
to participate in, on a voluntary basis, a managed care plan. Medicare 
is a fee-for-service system. Medicare also has a very tight, closed 
panel HMO component. The only access seniors have to participate in 
integrated systems of care is through the Medicare select plan.
  If today under the guise of reform we force those plans to offer a 
benefit that no other Medigap policy in the market has to offer, we put 
that plan at a competitive disadvantage that will kill it, and we will 
deny to seniors the most cost-effective, high-quality plan in the 
market.
  I urge a ``no'' vote on the substitute and a yes vote on the bill.
  Mrs. COLLINS of Illinois. Mr. Chairman, I rise in support of the 
substitute offered by Congressmen Dingell and Waxman to H.R. 483, the 
Expanded Use of Medicare Select Policies Act. This bill would expand 
the Medicare select demonstration program that currently exists in my 
State of Illinois and 14 other States to all 50 States and extend these 
programs until June 2000 and beyond unless the Secretary of Health and 
Human Services determines otherwise.
  Under this program, senior citizens on Medicare are allowed to buy 
private MediGap insurance policies through managed-care providers to 
supplement what Medicare does not cover.
  I rise in support of the substitute because it would establish 
important consumer protection safeguards for senior citizens for 
MediGap insurance. Specifically, the substitute would ban attained age 
rating for Medicare select policies. Attained age rating hurts senior 
citizens when they are at their most vulnerable. As they grow older and 
have less income, attained age rating causes seniors' premiums to rise 
sharply, make MediGap insurance increasingly unaffordable for many 
senior citizens on limited incomes. It is critically important to many 
senior citizens in my district that attained age rating is eliminated.
  The substitute would also limit the extension of Medicare select to a 
5-year period, to ensure that we provide ample opportunity to review 
the program before it is established permanently.
  Mr. Chairman, I would also like this opportunity to express concerns 
that I have about the reason that H.R. 483 is being pushed through the 
House at this time. Based on the drastic cuts that I have seen made to 
programs during the Republicans' first 100 days, it is crystal clear to 
me that draconian cuts to Medicare are ahead. There is already 
discussion about turning Medicare into block grants for the States and 
based on what happened to the Federal school lunch and breakfast 
programs in the House of Representatives, I know that block grant is a 
code word for cutting, slashing, and eliminating.
  Let me just urge my colleagues who intend to support this bill to not 
use H.R. 483 as the first thread with which to unravel the entire 
Medicare system. I have far too many senior citizens in my district who 
depend on Medicare and would be devastated by any cuts to the program 
to allow it to be destroyed.
  Mr. BLILEY. Mr. Chairman, I yield back the balance of our time.
  The CHAIRMAN. The question is on the amendment in the nature of a 
substitute offered by the gentleman from California [Mr. Waxman].
  The question was taken; and the Chairman announced that the noes 
appeared to have it.


                             recorded vote

  Mr. WAXMAN. Mr. Chairman, I demand a recorded vote.
  A recorded vote was ordered.
  The vote was taken by electronic device, and there were--ayes 175, 
noes 246, not voting 13, as follows:
                             [Roll No. 301]

                               AYES--175

     Abercrombie
     Andrews
     Baesler
     Baldacci
     Barcia
     Barrett (WI)
     Becerra
     Beilenson
     Bentsen
     Berman
     Bonior
     Borski
     Brewster
     Brown (FL)
     Brown (OH)
     Bryant (TX)
     Cardin
     Clay
     Clayton
     Clement
     Clyburn
     Coleman
     Collins (IL)
     Condit
     Conyers
     Costello
     Coyne
     Danner
     de la Garza
     DeFazio
     DeLauro
     Dellums
     Deutsch
     Dicks
     Dingell
     Dixon
     Doggett
     Dooley
     Doyle
     Durbin
     Edwards
     Engel
     Eshoo
     Evans
     Farr
     Fattah
     Fazio
     Fields (LA)
     Filner
     Flake
     Foglietta
     Ford
     Frank (MA)
     Furse
     Gejdenson
     Gephardt
     Gibbons
     Gonzalez
     Gordon
     Green
     Gutierrez
     Hall (OH)
     Hall (TX)
     Hamilton
     Hastings (FL)
     Hayes
     Hefner
     Hilliard
     Hinchey
     Holden
     Hoyer
     Jackson-Lee
     Jefferson
     Johnson (SD)
     Johnson, E. B.
     Johnston
     Kanjorski
     Kaptur
     Kennedy (MA)
     Kennedy (RI)
     Kildee
     Kleczka
     Klink
     LaFalce
     Lantos
     Levin
     Lewis (GA)
     Lincoln
     Lipinski
     Lofgren
     Lowey
     Luther
     Maloney
     Manton
     Markey
     Martinez
     Mascara
     Matsui
     McCarthy
     McDermott
     McHale
     McKinney
     McNulty
     Meehan
     Meek
     Menendez
     Mfume
     Miller (CA)
     Mineta
     Mink
     Moakley
     Mollohan
     Montgomery
     Moran
     Murtha
     Nadler
     Neal
     Oberstar
     Obey
     Olver
     Ortiz
     Orton
     Owens
     Pallone
     Pastor
     Payne (NJ)
     Poshard
     Rahall
     Rangel
     Reed
     Richardson
     Rivers
     Roemer
     Roybal-Allard
     Rush
     Sanders
     Sawyer
     Schroeder
     Schumer
     Scott
     Serrano
     Skaggs
     Slaughter
     Spratt
     Stark
     Stenholm
     Stokes
     Studds
     Stupak
     Tauzin
     Taylor (MS)
     Tejeda
     Thompson
     Thornton
     Thurman
     Torres
     [[Page H4393]] Torricelli
     Towns
     Traficant
     Tucker
     Velazquez
     Vento
     Visclosky
     Volkmer
     Ward
     Waters
     Watt (NC)
     Waxman
     Williams
     Wilson
     Wise
     Woolsey
     Wyden
     Wynn
     Yates

                               NOES--246

     Allard
     Archer
     Armey
     Bachus
     Baker (CA)
     Baker (LA)
     Ballenger
     Barr
     Barrett (NE)
     Bartlett
     Barton
     Bass
     Bateman
     Bereuter
     Bevill
     Bilbray
     Bilirakis
     Bishop
     Bliley
     Blute
     Boehlert
     Boehner
     Bonilla
     Bono
     Boucher
     Browder
     Brownback
     Bryant (TN)
     Bunn
     Bunning
     Burr
     Burton
     Buyer
     Callahan
     Calvert
     Camp
     Canady
     Castle
     Chabot
     Chenoweth
     Christensen
     Chrysler
     Clinger
     Coble
     Coburn
     Collins (GA)
     Combest
     Cooley
     Cox
     Cramer
     Crane
     Crapo
     Cremeans
     Cubin
     Cunningham
     Davis
     Deal
     DeLay
     Diaz-Balart
     Doolittle
     Dornan
     Dreier
     Duncan
     Dunn
     Ehlers
     Ehrlich
     Emerson
     English
     Ensign
     Everett
     Ewing
     Fawell
     Fields (TX)
     Flanagan
     Foley
     Forbes
     Fowler
     Fox
     Franks (CT)
     Franks (NJ)
     Frelinghuysen
     Frisa
     Funderburk
     Gallegly
     Ganske
     Gekas
     Geren
     Gilchrest
     Gillmor
     Gilman
     Goodlatte
     Goodling
     Goss
     Graham
     Greenwood
     Gunderson
     Gutknecht
     Hancock
     Hansen
     Harman
     Hastert
     Hastings (WA)
     Hayworth
     Hefley
     Heineman
     Herger
     Hilleary
     Hobson
     Hoekstra
     Hoke
     Horn
     Hostettler
     Houghton
     Hunter
     Hutchinson
     Hyde
     Inglis
     Istook
     Jacobs
     Johnson (CT)
     Johnson, Sam
     Jones
     Kasich
     Kelly
     Kennelly
     Kim
     King
     Kingston
     Klug
     Knollenberg
     LaHood
     Largent
     Latham
     LaTourette
     Laughlin
     Lazio
     Leach
     Lewis (CA)
     Lewis (KY)
     Lightfoot
     Linder
     Livingston
     LoBiondo
     Longley
     Lucas
     Manzullo
     Martini
     McCollum
     McCrery
     McDade
     McHugh
     McInnis
     McIntosh
     McKeon
     Metcalf
     Meyers
     Mica
     Miller (FL)
     Minge
     Molinari
     Moorhead
     Morella
     Myers
     Myrick
     Nethercutt
     Neumann
     Ney
     Norwood
     Nussle
     Oxley
     Packard
     Parker
     Paxon
     Payne (VA)
     Peterson (FL)
     Peterson (MN)
     Petri
     Pombo
     Pomeroy
     Porter
     Portman
     Pryce
     Quillen
     Quinn
     Radanovich
     Ramstad
     Regula
     Riggs
     Roberts
     Rogers
     Rohrabacher
     Ros-Lehtinen
     Roth
     Roukema
     Royce
     Sabo
     Salmon
     Sanford
     Saxton
     Scarborough
     Schaefer
     Schiff
     Seastrand
     Sensenbrenner
     Shadegg
     Shaw
     Shays
     Sisisky
     Skeen
     Skelton
     Smith (MI)
     Smith (NJ)
     Smith (TX)
     Smith (WA)
     Solomon
     Souder
     Spence
     Stearns
     Stockman
     Stump
     Talent
     Tanner
     Tate
     Taylor (NC)
     Thomas
     Thornberry
     Tiahrt
     Torkildsen
     Upton
     Vucanovich
     Waldholtz
     Walker
     Walsh
     Wamp
     Watts (OK)
     Weldon (FL)
     Weldon (PA)
     Weller
     White
     Whitfield
     Wicker
     Wolf
     Young (AK)
     Young (FL)
     Zeliff
     Zimmer

                             NOT VOTING--13

     Ackerman
     Brown (CA)
     Chambliss
     Chapman
     Collins (MI)
     Dickey
     Frost
     Kolbe
     Pelosi
     Pickett
     Reynolds
     Rose
     Shuster

                              {time}  180

  The Clerk announced the following pair:
  On this vote:

       Ms. Pelosi for, with Mr. Chambliss against.

  Mr. GREENWOOD and Mr. BISHOP changed their vote from ``aye'' to 
``no.''
  Messrs. Martinez, Tauzin, Williams, and Meehan changed their vote 
from ``no'' to ``aye.''
  So the amendment in the nature of a substitute was rejected.
  The result of the vote was announced as above recorded.
  The CHAIRMAN. The question is on the amendment in the nature of a 
substitute made in order as original text.
  The amendment in the nature of a substitute made in order as original 
text was agreed to.
  The CHAIRMAN. Under the rule, the Committee rises.
  Accordingly the Committee rose; and the Speaker pro tempore [Mr. 
Hobson] having assumed the chair, Mr. Bonilla, Chairman of the 
Committee of the Whole House on the State of the Union, reported that 
that Committee, having had under consideration the bill (H.R. 483) to 
amend title XVIII of the Social Security Act to permit Medicare select 
policies to be offered in all States, and for other purposes, pursuant 
to House Resolution 130, reported the bill back to the House with an 
amendment adopted by the Committee of the Whole.
  The SPEAKER pro tempore. Under the rule, the previous question is 
ordered.
  The question is on the amendment.
  The amendment was agreed to.
  The SPEAKER pro tempore. The question is the engrossment and third 
reading of the bill.
  The bill was ordered to be engrossed and read a third time, and was 
read the third time.
  The SPEAKER pro tempore. The question is on the passage of the bill.
  The question was taken, and the Speaker pro tempore announced that 
the ayes appeared to have it.


                             recorded vote

  Mrs. JOHNSON of Connecticut. Mr. Speaker, I demand a recorded vote.
  A recorded vote was ordered
  The vote was taken by electronic device, and there were--ayes 408, 
noes 14, not voting 12, as follows:

                             [Roll No. 302]

                               AYES--408

     Allard
     Andrews
     Archer
     Bachus
     Baesler
     Baker (CA)
     Baker (LA)
     Baldacci
     Ballenger
     Barcia
     Barr
     Barrett (NE)
     Barrett (WI)
     Bartlett
     Barton
     Bass
     Bateman
     Becerra
     Beilenson
     Bentsen
     Bereuter
     Berman
     Bevill
     Bilbray
     Bilirakis
     Bishop
     Bliley
     Blute
     Boehlert
     Boehner
     Bonilla
     Bonior
     Bono
     Borski
     Boucher
     Brewster
     Browder
     Brown (FL)
     Brown (OH)
     Brownback
     Bryant (TN)
     Bryant (TX)
     Bunn
     Bunning
     Burr
     Burton
     Buyer
     Callahan
     Calvert
     Camp
     Canady
     Cardin
     Castle
     Chabot
     Chambliss
     Chenoweth
     Christensen
     Chrysler
     Clay
     Clayton
     Clement
     Clinger
     Clyburn
     Coble
     Coburn
     Coleman
     Collins (GA)
     Collins (IL)
     Collins (MI)
     Combest
     Condit
     Cooley
     Costello
     Cox
     Coyne
     Cramer
     Crane
     Crapo
     Cremeans
     Cubin
     Cunningham
     Danner
     Davis
     de la Garza
     Deal
     DeFazio
     DeLauro
     DeLay
     Deutsch
     Diaz-Balart
     Dicks
     Dixon
     Doggett
     Dooley
     Doolittle
     Dornan
     Doyle
     Dreier
     Duncan
     Dunn
     Durbin
     Edwards
     Ehlers
     Ehrlich
     Emerson
     Engel
     English
     Ensign
     Eshoo
     Evans
     Everett
     Farr
     Fawell
     Fazio
     Fields (LA)
     Fields (TX)
     Filner
     Flake
     Flanagan
     Foglietta
     Foley
     Forbes
     Ford
     Fowler
     Fox
     Frank (MA)
     Franks (CT)
     Franks (NJ)
     Frelinghuysen
     Frisa
     Funderburk
     Furse
     Gallegly
     Ganske
     Gejdenson
     Gekas
     Gephardt
     Geren
     Gibbons
     Gilchrest
     Gillmor
     Gilman
     Goodlatte
     Goodling
     Gordon
     Goss
     Graham
     Green
     Greenwood
     Gunderson
     Gutierrez
     Gutknecht
     Hall (OH)
     Hall (TX)
     Hamilton
     Hancock
     Hansen
     Harman
     Hastert
     Hastings (FL)
     Hastings (WA)
     Hayes
     Hayworth
     Hefley
     Hefner
     Heineman
     Herger
     Hilleary
     Hilliard
     Hinchey
     Hobson
     Hoekstra
     Hoke
     Holden
     Horn
     Hostettler
     Houghton
     Hoyer
     Hunter
     Hutchinson
     Hyde
     Inglis
     Istook
     Jackson-Lee
     Jacobs
     Jefferson
     Johnson (CT)
     Johnson (SD)
     Johnson, E. B.
     Johnson, Sam
     Jones
     Kanjorski
     Kaptur
     Kasich
     Kelly
     Kennedy (MA)
     Kennelly
     Kildee
     Kim
     King
     Kingston
     Kleczka
     Klink
     Klug
     Knollenberg
     LaFalce
     LaHood
     Lantos
     Largent
     Latham
     LaTourette
     Laughlin
     Lazio
     Leach
     Levin
     Lewis (CA)
     Lewis (GA)
     Lewis (KY)
     Lightfoot
     Lincoln
     Linder
     Lipinski
     Livingston
     LoBiondo
     Lofgren
     Longley
     Lowey
     Lucas
     Luther
     Maloney
     Manton
     Manzullo
     Markey
     Martinez
     Martini
     Mascara
     Matsui
     McCarthy
     McCollum
     McCrery
     McDade
     McHale
     McHugh
     McInnis
     McIntosh
     McKeon
     McKinney
     McNulty
     Meehan
     Meek
     Menendez
     Metcalf
     Meyers
     Mfume
     Mica
     Miller (CA)
     Miller (FL)
     Mineta
     Minge
     Moakley
     Molinari
     Mollohan
     Montgomery
     Moorhead
     Moran
     Morella
     Murtha
     Myers
     Myrick
     Nadler
     Neal
     Nethercutt
     Neumann
     Ney
     Norwood
     Nussle
     Oberstar
     Obey
     Olver
     Ortiz
     Orton
     Owens
     Oxley
     Packard
     Pallone
     Parker
     Pastor
     Paxon
     Payne (VA)
     Peterson (FL)
     Peterson (MN)
     Petri
     Pickett
     Pombo
     Pomeroy
     Porter
     Portman
     Poshard
     Pryce
     Quillen
     Quinn
     Radanovich
     Rahall
     Ramstad
     Rangel
     Reed
     Regula
     Richardson
     Riggs
     Rivers
     Roberts
     Roemer
     Rogers
     Rohrabacher
     Ros-Lehtinen
     Rose
     Roth
     Roukema
     Roybal-Allard
     Royce
     Rush
     Sabo
     Salmon
     Sanders
     Sanford
     Sawyer
     Saxton
     Scarborough
     Schaefer
     Schiff
     Schroeder
     Schumer
     Scott
     Seastrand
     Sensenbrenner
     Serrano
     Shadegg
     Shaw
     Shays
     Sisisky
     Skaggs
     Skeen
     Skelton
     Slaughter
     Smith (MI)
     Smith (NJ)
     Smith (TX)
     Smith (WA)
     Solomon
     Souder
     Spence
     [[Page H4394]] Spratt
     Stearns
     Stenholm
     Stockman
     Stokes
     Studds
     Stump
     Talent
     Tanner
     Tate
     Tauzin
     Taylor (MS)
     Taylor (NC)
     Tejeda
     Thomas
     Thompson
     Thornberry
     Thornton
     Thurman
     Tiahrt
     Torkildsen
     Torres
     Torricelli
     Towns
     Traficant
     Tucker
     Upton
     Velazquez
     Vento
     Visclosky
     Volkmer
     Vucanovich
     Waldholtz
     Walker
     Walsh
     Wamp
     Ward
     Watts (OK)
     Waxman
     Weldon (FL)
     Weldon (PA)
     Weller
     White
     Whitfield
     Wicker
     Williams
     Wilson
     Wise
     Wolf
     Woolsey
     Wyden
     Wynn
     Yates
     Young (AK)
     Young (FL)
     Zeliff
     Zimmer

                                NOES--14

     Abercrombie
     Conyers
     Dellums
     Dingell
     Fattah
     Gonzalez
     Johnston
     Kennedy (RI)
     McDermott
     Mink
     Stark
     Stupak
     Waters
     Watt (NC)

                             NOT VOTING--12

     Ackerman
     Armey
     Brown (CA)
     Chapman
     Dickey
     Ewing
     Frost
     Kolbe
     Payne (NJ)
     Pelosi
     Reynolds
     Shuster

                              {time}  1826

  So the bill was passed.
  The result of the vote was announced as above recorded.
  A motion to reconsider was laid on the table.
  

                          ____________________