[Congressional Record Volume 141, Number 79 (Friday, May 12, 1995)]
[House]
[Pages H4907-H4911]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
MEDICARE
The SPEAKER pro tempore (Mr. Fox of Pennsylvania). Under the
Speaker's announced policy of January 4, 1995, the gentleman from New
Jersey [Mr. Pallone] is recognized for 60 minutes as the designee of
the minority leader.
Mr. PALLONE. Mr. Speaker, I would like to spend my time today talking
about Medicare. In light of what some of the previous speakers said
today, I would point out that I am not really interested in the issue
of whether or not we call the changes that the Republicans have talked
about in their budget as cuts or modifications or whatever. I am
satisfied to call them changes.
The bottom line is, the Republicans in their budget proposals, both
in the Senate as well as in this House, have suggested some major
changes that are going to have major impacts on the Medicare program.
Some of the previous speakers suggested today that perhaps seniors are
not worried about it or that perhaps Democrats are making them worried
unnecessarily.
Let me tell you the reality is seniors are worried, and they are not
worried because of anything that the Democrats have said to them. They
are worried because they hear that some of these changes that are
coming in the proposed Republican budget are going to have a major
impact on Medicare, on Medicaid, which is also of importance to
seniors, as well as on Social Security, which as you know was
previously said to be off the table.
I guess I was a little concerned when I heard the previous speaker,
the gentleman from Georgia [Mr. Kingston], mention his mom. I guess it
is that we are getting close to Mother's Day now. Different speakers
talked about their moms. The gentleman from Georgia specifically said
that in his case his mother or his family, I guess, was not really that
worried about the Federal Government and Federal programs, that he felt
that it was increasingly important for us to sort of not depend on
Federal programs or forget about these Federal programs.
The bottom line is, when you talk about these three Federal programs
that I mentioned, Medicare, Medicaid, and Social Security, these are
Federal programs that a lot of people in this country do depend on.
They are watching very carefully, in my opinion, what we do here in the
next few weeks or the next few months that might impact on those
programs.
If I could just use my own mom for an example, and I do not usually
do that but, since it has already been stated by some of the others,
she called me up just a couple of days ago and she was very worried.
She just turned 65 a few weeks ago, is now eligible for Medicare for
the first time, relied on the fact that when she became of age that she
was going to have the benefits of Medicare. And now all of a sudden,
when she first feels that she can take advantage of the program that
she and my dad have been paying into all these years, realizes that
there may be some major changes and she will not be able to benefit
from what she expected in the program.
This is of major concern to seniors. This is not something that is
abstract. This is something that the average person is concerned about.
In my district, when we held a number of forums for senior citizens
during the April 3 weeks that were in the district, when we were not
voting in Washington, I heard over and over again from senior citizens
in my district, which is not a very poor district. I consider my
congressional district very
much the average. I have some wealthy seniors. I have poor seniors and
most of my seniors are simply middle class. But they are very scared.
When they hear about the changes in Medicare that might make them have
to pay more out of their pocket for a copayment or a higher deductible
before they get benefits or changes that might limit their options in
terms of whether or not they go to a particular doctor or hospital,
these are things they are concerned about.
When they hear about Medicaid changes that might impact their ability
to get long-term care, they are very concerned. And they are
particularly concerned about what they consider a broken promise on the
part of the Republicans when the budget, when the House Republican
budget proposals talk about a change in the Consumer Price Index that
will actually lower the COLA. Seniors worry about that COLA, that cost-
of-living adjustment.
Mr. Speaker, many of them budget, and their budget depends on every
dollar that they receive on a monthly basis from Social Security. And
when you talk about changing the Consumer Price Index so that the
amount of the COLA is reduced, that extra few dollars a month or
annually that they receive makes a big difference to them.
What I wanted to do today was to basically go through some of the
suggested changes that are being discussed by the Republicans in the
budget that affect Medicare. I think many have heard the last few days
that the Senate Republican plan would pare about $250 billion from
projected spending on Medicare and that the House plan ups that ante,
if you will, to $270 billion.
What does all this mean? What do these cuts or changes or
modifications mean? How do the Republicans propose to go about
implementing that? What does it mean for the average person?
Well, we heard today, or at least I heard for the first time today
that there was some detailed recommendations, about three dozen
recommendations that were made on the House side by Republicans on the
House Committee on the Budget to slow the growth of Federal Medicare
cost; in other words,
[[Page H4908]] to implement these so-called cuts or changes. And those
proposals, I understand, have been put forward by a task force from
some of the Republican Members, which was made available today, that
was actually sent to the chairman of my Subcommittee on Health and
Environment of the Committee on Commerce.
I would like to go through some of those proposals by reference to an
article that was in the New York Times today that sort of summarized
some of them. If I could read from the New York Times article, it says
that Republicans on the House Committee on the Budget recommended three
dozen ways to slow the growth of federal Medicare costs. They include
higher premium deductibles and copayment for beneficiaries and strong
new incentives for them to join health maintenance organizations--we
call them HMO's--which provide comprehensive care in return for a fixed
monthly fee.
The gentleman from Ohio [Mr. Kasich], the chairman of the Committee
on the Budget, said the Republican proposals would expand health care
choices for the elderly. But a Mr. Corey, who is the director of
Federal affairs for the AARP, the American Association of Retired
Persons, said the Republicans were creating a coercive environment in
which Medicare beneficiaries will be herded into managed care and out
of traditional fee-for-service arrangements.
Under one of the leading options, Medicare beneficiaries would
receive Federal vouchers worth a fixed amount, around $5,100 a year, to
enroll in an HMO or other private health plan. They would have to use
their own money to make up the difference if the cost exceeded the
amount of vouchers, but they could keep most of the savings if they
chose less expensive plans.
Now, this voucher proposal is just one of the proposals that has been
put forth by Republicans on the House Committee on the Budget to try to
cut back, if you will, on Medicare.
I would like to go through some of this and some of the others that
are mentioned. When you talk about a voucher worth $5,100 to enroll in
an HMO or other private health care plan, again, you have to make up
your own money for the difference.
One of the things that a lot of seniors are worried about is that
right now Medicare is largely a fee-for-service program, which means
that you can go out to the doctor of your choice or to the hospital of
your choice, if you happen to live in an area where there are a number
of hospitals, and that doctor or hospital performs a service and then
they send a bill and Medicare pays for it on what we call a
fee-for-service basis. The idea is choice. You have your own choice of
doctors.
Seniors traditionally had their choice of doctors both when they were
working and now as part of the Medicare Program. In many parts of the
country, including my own, the seniors do not feel that the HMO's or
managed care systems are as good or do not include some of the
physicians or hospitals that they may want to go to. But now all of a
sudden under this proposal, if it is implemented, they would not have a
choice. They basically get a voucher for $5,100 and they can find an
HMO that will take them, or they can find another private health plan
that operates on the traditional fee-for-service basis.
But think about it a minute. Most of these managed care systems or
other private health care plans that operate on a fee-for-service basis
are not going to be particularly interested in someone who is older,
who might have disabilities, who might have some previous condition
that is going to make them a high risk individual. How likely is it
that they are going to be able to find a plan that satisfies them for
that $5,100?
Ultimately, many of them are going to have to basically take that
additional money out of their pocket if they have it to pay for a plan.
And I have to tell you, and I think most people understand that a lot
of seniors simply do not have the money. So this idea of the voucher is
a serious change, that is being talked about, that would have a major
implication and for many seniors might result in them not having health
care at all.
The next proposal that comes from the Republicans on the Committee on
the Budget, and again reading now from the New York Times summary, the
Republicans also recommend a stiff financial penalty for new Medicare
beneficiaries who refuse to join HMO's. Beginning in 1999, all new
enrollees choosing Medicare fee for service would pay a premium $20
higher than that of current Medicare beneficiaries one of the
Republican recommendations says. The premium is now $46 a month.
So basically what they are saying is that if you enter, for example--
this is not until 1999, but I will use my mom as an example again; she
just entered the system within the last month. But let us say she was
entering in 1999. If she basically decides that she does not want to go
to an HMO or managed care system that limits the doctors or the
hospitals, then she has to pay more to continue in a fee-for-service
system out of her own pocket.
The amount that they are talking about here, $20 higher than that of
the current beneficiaries, which is now $46 a month, is significant.
But I would maintain that as time goes on, that differential between
what the senior is going to be charged if they enter the managed care
system versus the fee-for-service system will grow. And the greatest
fear that many of the seniors have in my district, the greatest fear
that they have is that ultimately, if they are given a choice, which is
not really a choice, between a managed care HMO and a fee-for-service
system, that if the cost of the fee for service becomes so prohibitive
that they cannot pay for it, they are essentially forced into an HMO or
managed care system. That is what we are talking about here with this
second Republican recommendation.
Ultimately the cost of the fee-for-service system would be so
expensive that seniors would be forced into an HMO where they would
not, given the choice, have their choice of doctors or even hospitals
in many cases.
The third proposal that comes from the House Republican budget group
task force is they would reduce payments to doctors and hospitals,
especially teaching hospitals and those that serve large numbers of
low-income patients. Well, this is what I would call a reduction in the
reimbursement rate. Many of you know that in terms of Medicare, a rate
is established to pay for doctors or hospitals by Medicare, and that is
what they get reimbursed for the different services that are provided.
Some people and some of you, my own seniors, have said to me: So
what, the doctors get a lot of money. The hospitals make too much
money. So you reduce their reimbursement rate. What do I care, maybe it
is good.
The bottom line is maybe it is not good, because many hospitals,
particularly those who have a high number of seniors, as is the case
with my district in New Jersey, are basically dependent on Medicare
reimbursement and are just basically managing with the budget they
have, because they have so many senior citizens or they have so many
poor people.
If you reduce the reimbursement rate to hospitals, some hospitals
will simply close. Others will not be able to provide the level of
service or the quality of service that they are providing now. What
happens if you reduce the reimbursement rate to doctors? Some may say
``So what, the doctors make too much money''. The reality is that
doctors do not have to take Medicare patients. If the reimbursement
rate becomes significantly lower or does not increase as much as it
should to keep up with inflation, then a lot of doctors will just say
``I'm not going to take Medicare patients.'' Seniors have already
complained to me about how, in many cases, they cannot find a doctor
who will take Medicare. If more doctors do not take Medicare, fewer
doctors are going to be available to senior citizens.
``The fourth thing that was recommended by the Republicans on the
House Committee on the Budget,'' and again I am reading from the New
York Times article, ``was to double the amount that beneficiaries must
pay for doctors' services before Medicare coverage begins. This is the
deductible.''
The annual deductible, now $100, would be raised to $200 and then
increased automatically to keep pace with the growth of the program.
The deductible has been raised only three times in the 30-year history
of Medicare.
[[Page H4909]] Here we get to the real nub of the question. This
option increased the deductible. Of course, everyone knows what that
means. The deductible goes up, the senior has to pay more out of pocket
before they are actually able to take advantage of Medicare. It may
sound nice, but most or many seniors simply cannot afford it. What they
will do is they will simply forego care, because they know that that
care will be less than the deductible that they have to pay out, the
last thing in the world that we could possibly want.
The fifth thing that was mentioned by this Republican Committee on
the Budget, or by Members recommending how to deal with Medicare, is to
``increase the monthly $46 premium by $5 in each of the next 4 years,
and then by $6 in 2000 and in each of the following 2 years.'' I assume
that what we are talking about here probably is the part B premium that
seniors pay for doctors, so again, we are talking about an increased
amount of money out of seniors' pockets if they can afford it.
There are two more options that I wanted to talk about today that
have been suggested by the Republicans on the Committee on the Budget
to deal with these changes they have suggested in Medicare. This next
one says that ``They would charge higher premiums for beneficiaries
with incomes exceeding $70,000 a year. The premium would more than
triple, to $164 a month for individuals with more than $95,000 a year,
and couples with more than $115,000.''
Here we are talking about means testing. I think many of you know
that historically, and certainly when the Medicare program was started
under President Lyndon Johnson, that Medicare was not going to be
income-based. You paid into it. When you reached the age of 65, you
took advantage of it. It did not matter what your income was, it was
not meant to be a welfare program. It was for all senior citizens.
Now we are talking, under this proposal, of turning Medicare
basically into an income-based program, I will call it a welfare
program, and basically reneging on the contract that was made with
those Americans, that was made 30 years ago by the President then and
this Congress, that this was not going to be an income-based program.
Some may say ``So what? Changing times, we have to change the reality
of things.'' Let me assure you that in those States, and I will use my
State as an example, which have a very high cost of living, some of
these income categories that are being used, for example, $70,000 a
year, I would maintain that as time goes on we will see that level be
reduced. If it is now 70, it will go to 60, then to 50, then to 30.
Think about people who live in States where the cost of living is
very high. These arbitrary numbers that are going to be used, in my
opinion, are going to make a lot of people who can really ill afford
it, based on this means testing plan, have to pay out of their pocket
more money for their health care, when they happen to be senior
citizens. It goes against the contract that was made with seniors by
this original enacting legislation, and ultimately, I think it will
have more and more impact on middle-class seniors.
The last thing, and there are many others, I am only citing 6 but I
think there are something like 35 recommendations that were put forward
by these 4 members of the Committee on the Budget in the letter they
sent to the chairman of my Subcommittee on Health and Commerce, but the
seventh and last one that I want to mention says ``They will charge
patients for a portion of the cost of home health care provided to
elderly people residing in their homes. Republicans said such a change
would discourage overuse of home health services.''
Again, one of the most serious problems we face now is the need for
long-term care for seniors. I think everyone knows that if you can
provide seniors with home-based health care, where someone comes into
the home to help them get out of bed, to help them clean up, or to help
them with the various disabilities that they have, that is a very
cheap, preventive way of dealing with health care problems that face
the elderly, much better than having to go to the hospital and the
costs entailed with a hospital, or a nursing home, or other kinds of
institutions.
Why in the world would we want to discourage home health care or
build in an extra charge for home health care? All that is going to do
is discourage seniors from using home health care, or not use it at all
if they cannot afford it, and the ultimate cost of that is that people
become institutionalized and it costs even more money to the Federal
Government.
Mr. Speaker, the point I am trying to make here today is very simple.
Whether we call it a cut, whether we call it a modification, whatever
we call it, of the changes that are being discussed by the House
Republicans on the Committee on the Budget, and they are going to be
coming before this Congress, this House, next week, they are major
changes in the Medicare Program. They have a direct impact on seniors.
The bottom line is that they are probably going to result in a lot
more money that seniors are going to have to pay out of their pocket,
and if they cannot afford it, which many cannot, they are simply not
going to have the quality and level of services, or in some cases, may
not have any health care at all.
I do not think, Mr. Speaker, that the costs of balancing the budget
should be so heavily forced on the elderly within this country. We all
know that we have to balance the budget, and I certainly advocate that,
but this budget, this budget resolution that is being proposed depends
too much on hurting and making it more difficult for seniors,
particularly with regard to their health care needs. That is not the
way to go about balancing the budget.
Mr. Speaker, I wanted to talk a little bit about some of the Medicaid
cuts and respond a little bit to some of the statements that were made
about President Clinton's health care proposal.
Mr. Speaker, I talked initially about the Medicare program. I want to
also talk a little bit about the Medicaid cuts or changes that are
being discussed. Before I do that, though, I want just to take 5
minutes or less to just give some statements that have been made by
some of the associations that deal with senior citizens about what
these Medicare and Medicaid cuts or changes are going to mean for the
elderly.
I just want to highlight a few of these things, because sometimes I
feel if I make a statement, maybe some people will believe it, but it
comes from some of the associations that represent senior citizens,
perhaps it will be more believable.
The American Association of Retired Persons, which, of course, has
been, I guess, the leading opponent of some of these changes, they have
said that Medicare was hardly discussed in the last election, and there
was certainly no mandate from the electorate to change the system. I
think that is obvious. This is not something that was part of any
political discussion that I know of in terms of anyone running for
office last year.
``Medicare cuts would mean that over the next 5 years, older
Americans would pay at least $2,000 more out of pocket than they would
pay under current law, and over the next 7 years they would pay $3,489
more out of pocket. The total number of Medicaid beneficiaries who
would use long-term care services could reach $1.7 million in the year
2000.'' That is from the AARP.
The National Council of Senior Citizens says ``The levels of the cuts
in Medicare contemplated by the Senate and House Budget Committees will
not just devastate the finances of millions of older citizens, but more
importantly, they will devastate the hopes for a secure and healthy old
age for all Americans.''
The Older Women's League says:
We receive hundreds of letters from women who are already
forced to choose between paying for food and rent and buying
much needed medicine that is not covered by their Medicare.
Substantial cuts in Medicare will literally take food out of
the mouths of these older women.
I could not agree with that more. When I have my forums in my
district, the overwhelming majority of the seniors who show up are
women. Most of the people that are particularly scared are women. Many
of them are just making ends meet. If you talk about additional
deductibles or copayments or out-of-pocket expenses, they are
[[Page H4910]] making choices between food and rent and needed medical
care.
Last, Mr. Speaker, and I mention it because I happen to be a Roman
Catholic, the Catholic Health Association says that ``Budget cuts of
such magnitude in Medicare and Medicaid would attack the very fiber of
these programs, and in fact, decimate them.'' As I think many know,
Catholic Charities is one of many nonprofits that provides medical care
to people who do not otherwise have it, and anyone who has visited a
Catholic Charities knows that a lot of the people, really significant
numbers of the people that are serviced by them are senior citizens, as
well as children.
I would like to now go into Medicaid, which I guess has not gotten as
much attention as the proposed changes in Medicare, but the Medicaid
program, which is the program for poor people in this country, mostly
people who are receiving some sort of welfare of assistance, is also
severely cut, some would say more severely challenged, in terms of the
amount of money that is going to be available over their next few years
than Medicare under this Republican budget proposal.
A lot of people think that Medicaid is just, you know, a program for
people under 65, and that somehow seniors do not take advantage of
Medicaid because they are covered by Medicare. The reality is that for
many seniors who do not have the assets to pay for long-term health
care, if they are poor enough, or if they become poor because they have
to spend money on health care, Medicaid ends up financing much of their
long-term care, particularly nursing home care, as well as home health
care, because that is not provided or covered by Medicare.
The cuts in Medicaid will also severely impact seniors who need long-
term care. I don't think anybody needs to be reminded of the nursing
home crisis we have in this country. Again, if you significantly cut
back on the amount of money that is available, I would argue that the
quality of care is certainly going to decrease.
Medicaid is basically a combined Federal-State health insurance
program, primarily for poor women and children, the blind, and the
disabled. It is the largest provider of long-term care coverage for the
elderly and the disabled. Two-thirds of the costs of the Medicaid
Program go to provide both acute and long-term care to the blind, the
disabled, and the elderly.
Most Medicaid beneficiaries are children, and children have the
lowest rate of health insurance in the country. so therefore, being
without Medicaid insurance among children would be catastrophic. The
cuts proposed in the Medicaid Program are massive. They are
substantially larger than the total annual Federal costs of the
Medicaid Program. The elderly and disabled will bear the brunt of these
cuts, because that is where most of the money is spent.
Many senior citizens who have spent their life savings on long-term
care are enrolled in the Medicaid Program, which assures that their
long-term care can continue. With the proposed Medicaid cuts, these
seniors will either be forced out of absolutely vital long-term care,
or their families will have to pick up the costs of maintaining care.
These cuts amount to a huge hidden tax increase on the families of
those who need or may need long-term care.
Where are we shifting these costs? We are shifting these costs to the
families that have to care, in many cases, for the elderly. We are
going to shift these costs to the States, because some States will
decide that they cannot let people just go without health care,
particularly seniors, so they will have to kick in their tax dollars,
ultimately resulting in higher costs and taxes on the State level, or
ultimately, also, the burden goes to the local communities and the
local property taxpayers. Because Medicaid costs are shared with the
States, cuts of the magnitude that are being talked about here will
force States to bear even larger Medicaid costs, leading to substantial
increases in State taxes. If States are unable to meet that, people
will lose coverage. The uninsurance rate, particularly among children,
will explode, forcing up costs for everyone else. Cost shifting will
get much worse.
I think we have to understand that the Medicaid Program has basically
brought primary and preventive care to people who would not otherwise
get health care, and without the Medicaid Program, or with some of the
changes that are being proposed, we are going to see a lot of people
who are poor simply not getting coverage.
Mr. WISE. Mr. Speaker, will the gentleman yield?
Mr. PALLONE. I am happy to yield to the gentleman from West Virginia.
Mr. WISE. I just want to thank the gentleman, not only for the
special order, but making the point on Medicaid, because so much is
focused, and rightly so, on the cuts in Medicare, which is basically
health care for the senior citizen. Medicaid, 50 percent of Medicaid
dollars go to senior citizens, basically for nursing homes.
I do not think that a lot of people appreciate the fact that there is
no nursing home care under Medicare. Medicare does not provide for the
long-term nursing home care that so many families require, so they have
to turn, instead, middle-income families, turn instead to Medicaid.
{time} 1430
The average family, this was a few years ago, but the statistic was
that if somebody had to pay the cost out of pocket of a nursing home
for their loved one, the average family would be impoverished in 13
weeks.
Medicaid is what has kept many, many middle-income families able
first to meet the responsibility to their loved one and at the same
time to avoid bankruptcy.
Cutting back on this program, as well, goes right at the heart of not
only providing health care but I think also middle-income families.
Mr. PALLONE. I appreciate what the gentleman from West Virginia said
and it is very true.
The average cost of a nursing home now, the last I looked, was
something like $30,000 to $40,000 a year, at least in my area. It might
be less elsewhere. How many middle-income people can afford that?
Essentially what they do as you described is that they will pay
private maybe for a year or two, depending on how much money they have,
and then will go on Medicaid because they won't have any money left.
They will end up being in a nursing home paid for by Medicaid a lot
longer than that year or two that they happen to be paying out of their
pocket.
I don't particularly like that spend-down system that exists right
now, but the bottom line is it depends heavily on Medicaid.
From the information that I actually had here before me, the bottom
line is that most of the Medicaid dollars actually are going to pay for
programs like that for the elderly.
We are talking about middle-income people, if you will, that become
impoverished because of the cost of nursing home care. I appreciate
those comments.
The last thing that I wanted to talk about today, and again this is
partially in response to some of my Republican colleagues who spoke
earlier today, and were somewhat critical, I thought, of President
Clinton and his response to the issue of changes in Medicare that have
been proposed by the Republicans on the budget committees.
The reason that I have to take issue with some of the statements that
were made is because the President's position has been very clear for
several years now. It is essentially that changes in Medicare and any
savings that could be achieved in Medicare costs basically should only
be made in the context of an overall health care reform.
I totally agree with that premise that the President has put forth.
The idea is, and he basically expounded on it the last year or two when
he put forth his health care reform proposals, is that in the overall
context of health care reform, we could probably save some money on
Medicare costs, but at the same time we would expand Medicare to
provide more services.
The President actually talked about expanding Medicare to cover
prescription drugs, to cover certain long-term care in certain
circumstances.
His idea was not to cut or modify Medicare and take that money and
use it for other things. His idea was that the Medicare dollars that
are saved would be used to expand Medicare, particularly for
preventative services like
[[Page H4911]] prescription drugs, like long-term care for the elderly,
and to try to basically save some money as part of the overall reform
that he was making for all Americans.
I think it is very, very unfair for some of the Republicans to
suggest that somehow the President is not being responsive on the
Medicare issue. He has been, he was, and when he was, he did not
receive
cooperation from the Republicans.
I just wanted to highlight that if I could by a letter that was sent
to Speaker Gingrich I believe last week from Leon Panetta, the Chief of
Staff for President Clinton, and just to read a couple of paragraphs if
I could:
Last year, the President spoke directly to the nation about
the need to reform our health care system and made clear that
further federal health savings needed to take place in the
context of serious health care reform. In December 1994, the
President wrote the Congressional leadership and made clear
that he would work with Republicans to control Health care
spending in the context of serious health care reform. The
President repeated this offer in his 1995 State of the Union
speech.
The President has long stated that making significant cuts
in Medicare and Medicaid outside the context of health care
reform will not work. Such dramatic cuts could lead to less
coverage and lower quality, much higher costs to poor and
middle income Medicare recipients who cannot afford them, a
coercive Medicare program, and cost-shifting that could lead
to a hidden tax on the health premiums of average Americans.
That is why it is essential to deal with the Medicare Trust
Fund in the context of health care reform that protects the
integrity of the program, expands not reduces coverage, and
protects choice as well as quality and affordability.
I could not agree more with what the President suggests, that
whenever changes we make and whatever costs are saved in Medicare have
to be looked at in the context of overall health care reform.
Incidentally and importantly for me because I happen to live in the
State of New Jersey and represent part of New Jersey, there was an
editorial in the Star Ledger, New Jersey's largest daily, on May 3 that
basically criticized the Republican budget proposals and was critical
of the fact that the Republicans did not want to deal with Medicare in
the context of overall health care reform.
Mr. Speaker, if I could just read parts of this because I think it is
so telling in terms of the debate we are about to engage in:
The editorial is entitled, ``Messin' With Medicare.'' About halfway
down it says:
The Republicans say President Clinton wants to hold
Medicare reform ``hostage'' to a broader plan for national
health care reform.
Which would be the wise thing to do.
You can't mess with Medicare without affecting other parts
of health care and spending, certainly not in New Jersey
where Medicare spends $5.2 billion a year on 1.1 million
beneficiaries, ninth highest in both categories. Consider the
proposal to raise the age of eligibility for Medicare to 70
so the program can save about five years on each persons'
medical bills.
I did not even mention that. That is another option, I suppose, that
you just raise the age before you get Medicare benefits.
That means shifting some of the $5.2 billion to employer-
paid health plans to cover all the years Medicare doesn't. If
not, retirees will either have to pay their own way or go
without coverage and care as they enter the stage of life
when they are likely to need both most. Think of how many
would come of age for Medicare just in time for the program
to pay the consequences of years of government neglect of
problems they've had since they were young but which went
untreated for lack of health care insurance.
Hospitals and doctors can treat them during those years and
try to recover their own cost by dropping it into everybody
else's bill.
If I could just interject. What the Star Ledger editorial is saying,
that if you make these changes, cost shiftings are going to occur
essentially for everyone else in the private sector.
Private insurance is switching to managed care. Health
maintenance organizations and other insurance plans send
their members to the doctors and hospitals which give big
discounts, discounts that leave no margin to cover what
Medicare does not.
Shifting senior citizens into managed care is another
reform proposal. The HMOs say they can do more for less
because they hunt for discounts and manage how many tests and
procedures and hospitalizations are ordered.
If the U.S. government doesn't have enough muscle to force
prices down through Medicare, it's hard to imagine a private
plan that would at least not without cutting benefits
drastically.
We face the prospect that Washington may give seniors the
``choice'' of switching to ill-defined managed care or
staying with traditional Medicare at an increased out-of-
pocket cost too onerous to make it a real choice.
That is really what my seniors are most afraid of which is, are they
going to be given the option of some kind of managed care system which
basically is ill-defined and which does not provide the coverage that
they need, or, which is more likely, they are going to be staying in
Medicare and paying more and more out of their own pocket in order to
continue as part of the program.
Of course that really begs the ultimate question, which is, if you
are not in a position because you are too poor or lower middle class
that you simply can't pay those additional out-of-pocket costs that are
the consequence of these Republicans proposals, you are going to go
without medical care or preventative care, get sicker and not be cared
for. That, I think, is the ultimate result of these Republican
proposals.
I hope that as we go into the debate over the next week or so that
this comes out and that the American public is able to realize what
these changes, if you will, in the Medicare program that the
Republicans are talking about really mean. I think the changes are
major and I think we have to do whatever we can in this House to
prevent them from becoming law.
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