[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.
____________________