[Congressional Record Volume 141, Number 88 (Thursday, May 25, 1995)]
[House]
[Pages H5577-H5581]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




    APPOINTMENT OF CONFEREES ON H.R. 483, MEDICARE SELECT EXPANSION

  Mr. BLILEY. Mr. Speaker, I ask unanimous consent to take from the 
[[Page H5578]] Speaker's table 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 a Senate amendment 
thereto, disagree to the Senate amendment, and request a conference 
with the Senate thereon.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Virginia?
  There was no objection.


               Motion to Instruct Offered by Mr. DOGGETT

  Mr. DOGGETT. Mr. Speaker, I offer a motion.
  The Clerk read as follows:

       Mr. Doggett moves that the managers on the part of the 
     House at the conference on the disagreeing votes of the two 
     Houses on the Senate amendment to the House bill, H.R. 483, 
     be instructed to resolve the difference between the House's 
     8\1/2\-year program and the Senate's 5-year program of 
     medicare select policies, within the scope of the conference, 
     in light of the changes in Medicare--the program that 
     medicare select policies supplement--to increase beneficiary 
     cost-sharing and to limit choice of provider as contemplated 
     in this year's budget process.

  The SPEAKER pro tempore. The gentleman from Texas [Mr. Doggett] will 
be recognized for 30 minutes, and the gentleman from Virginia [Mr. 
Bliley] will be recognized for 30 minutes.
  The Chair recognizes the gentleman from Texas [Mr. Doggett].
  Mr. DOGGETT. Mr. Speaker, this Medicare Select bill does not take 
into consideration the tremendous changes that are going to be made in 
Medicare under the budget resolution which was approved in this House, 
unfortunately, within the last week. This Medicare Select legislation 
does not take into consideration the fact that though no Member of the 
majority has come forward to tell the American people, they are 
proposing a doubling of the deductible for those on Medicare. They are 
proposing to increase, to add new charges if a senior citizen needs to 
go to a lab as a result of the doctor's orders. They are proposing new 
charges for home health care. They are proposing that even if one has 
the audacity as an American senior to say, ``I want the doctor that I 
have always had, and I would like to stay with my own doctor, the 
doctor of my choice,'' that will be an extra $20 a month.
  All of these things need to be considered by the conferees. That is 
what this motion is designed to do.
  Mr. Speaker, I would like to emphasize what the effect of this 
Medicare Select will be, unless we have these conferees instructed to 
consider this increase that has been proposed in the budget resolution 
increasing out-of-pocket costs to seniors, where we are going to end 
up. Many American seniors right now are just barely able to make a go 
of it. They have to make, in my district, from some of the people that 
I have talked with, individual seniors, they have to make a decision 
between whether or not they will have enough food on the table or 
whether they will have to pay the prescription bill that is not covered 
by Medicare at present.
  With regard to those seniors, to now load them up with additional 
out-of-pocket costs, charging them to see their own doctor, doubling 
their deductible, increasing their premiums year after year, those are 
the changes that have been proposed by one of the secret task forces. 
Those are the changes that, when it came to the floor of this Congress, 
after all the debate on the budget measure, not one Member was willing 
to come forward and fess up to the fact that those changes are there, 
that they are being made in the Medicare Program.
  Of course, no consideration has been given in this Medicare Select 
bill, which is not a bad idea to have Medicare Select, it just does not 
solve the problem if we load onto American seniors all of those 
additional charges.
  What we are trying to do, Mr. Speaker, through this instruction is to 
see that the conferees consider these really drastic changes. It 
increased out-of-pocket charges, which so many American seniors are 
going to have more of every year unless the conferees give adequate 
consideration to this.
  Mr. DINGELL. Mr. Speaker, will the gentleman yield?
  Mr. DOGGETT. Mr. Speaker, I yield such time as he may consume to the 
gentleman from Michigan [Mr. Dingell], the distinguished ranking member 
of the Committee on Commerce, to add a word or two at this point.
  Mr. DINGELL. Mr. Speaker, the Congress is considering legislation of 
great importance to the American people. The bill before us and the 
matter on which the conference will commence between the House and 
Senate is the so-called Medicare Select Program.
  Mr. Speaker, the bills for which we are appointing conferees expand 
the Medicare Select Demonstration Program.
  And although many support this program, I believe that because the 
Medicare cuts required by the Republican budget are so drastic and will 
require such fundamental reductions in the Medicare Program, it is 
irresponsible to pass any Medicare legislation, including extending 
Medicare Select, without taking these reductions into account.
  Medicare Select is a preferred-provider managed care plan that pays 
cost sharing for Medicare beneficiaries if they go to a selected list 
of providers. It will not pay for cost sharing if beneficiaries go to 
providers outside the selected list.
  Both the House and the Senate bills expand Medicare Select to all 50 
States, the Senate bill makes it an 8\1/2\-year program, the House bill 
a 5-year program.
  Therefore, I move that the managers on the part of the House at the 
conference on H.R. 483 be instructed to resolve the differences between 
the House and Senate bills--taking into account the impact of the 
budget proposal, including Medicare Select cost increases that may 
result from increased beneficiary out-of-pocket costs and limitations 
on beneficiaries' choice of providers.
  As Democrats, we should remain committed to protecting seniors from 
cuts that will drastically affect the Medicare Program and, more 
importantly, from increasing their out-of-pocket health care costs.
  The Republican budget proposal adds $3,500 to the out-of-pocket 
health care costs of each and every senior citizen over 7 years.
  This translates to a back-door raid on Social Security. By 2002, 
nearly 50 percent of every senior citizen's cost-of-living adjustment 
in Social Security will go to pay for the increased cost in Medicare.
  We cannot let that happen.
  We should also preserve seniors' traditional right to choose their 
own health care and their own doctors.
  The Republican's budget proposal will have serious consequences for 
every aspect of the Medicare Program, including Medicare Select. 
Therefore, we must act to protect all seniors and take these critical 
issues into account.
  I urge all Members to support the motion to instruct.
  Mr. BLILEY. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise in opposition to the motion to instruct 
conferees. Presently, we will be going to a conference with the other 
body on a bill which extends the Medicare Select Program in the 
Medicare Program. Medicare Select is a particular type of MediGap 
policy which allows seniors to choose a Medicare benefits package 
modeled on a preferred provider delivery system of health care. The 
Medicare Select policy allows seniors to buy a less expensive MediGap 
insurance policy which wraps around the traditional Medicare benefit. 
It represents the new wave of innovative managed care delivery options 
that the private sector is currently using to hold down the rise in 
health care costs. Let us remember that for those elderly who choose a 
MediGap policy it is one of 11 options currently available.
  This conference needs only to resolve the difference between the two 
bills on two elements--the length of the extension of the program, and 
whether or not a GAO study will be done. Those are the only outstanding 
issues.
  But this motion to instruct is attempting to tie the extension of the 
Medicare Select Program to the recently passed House budget resolution. 
The House budget resolution is only binding on authorizing committees 
in terms of meeting aggregate budget numbers in entitlements and other 
programs. In terms of Medicare, it is the authorizing committees which 
will determine the policies that will meet budget targets. That is a 
process that will occur months from now in budget reconciliation. 
Therefore, at this point [[Page H5579]] in time it is impossible to 
determine the effect of a future event on a current conference. 
Therefore, this motion to instruct seems to be based on a belief by my 
Democratic colleagues in their ability to use crystal balls and 
psychics to devine the future.
  I urge my colleagues to use the conference to resolve our differences 
quickly so that medicare select can be extended before its June 30 
sunset date. If we do not, the only losers will be the hundreds of 
thousands of Medicare recipients who are currently in this program.
  Mr. Speaker, I reserve the balance of my time.
  Mr. DOGGETT. Mr. Speaker, I yield myself 30 seconds to respond.
  Mr. Speaker, it is easy to talk about billions and jillions and 
resolutions that are going to come. However, when we are talking about 
the future, I am concerned about the future of just one person like 
Henrietta Carter in Austin, TX, who writes me of a friend who she says 
just cannot afford health insurance now, ``so she suffers a lot, 
because Medicare doesn't take care of her doctor visits and she has 
nothing to help with medication. She fell and cut a large gash in her 
leg but refused to go to the doctor because she was afraid she couldn't 
pay. There are days we know she is hurting, but she just keeps on.'' 
That is the kind of individual I am concerned about.
  Mr. Speaker, I yield 2 minutes to the distinguished gentleman from 
West Viriginia [Mr. Wise].
  Mr. WISE. Mr. Speaker, I thank the gentleman for yielding time to me.
  Mr. Speaker, I, too, would raise the name of a constituent from my 
district, Martha Haircrow, from Charleston, who talked recently about 
the medical problems she is having and the great concern that she has 
about Medicare to meet that challenge. The argument here is that this 
is a narrow bill. It simply deals with medicare select. The irony of 
that is, let us take a look at the alphabet, 26 letters. However, if we 
take two letters out and fool around with them, we can greatly change 
the complexion of the alphabet. Therefore, we ought to be looking at 
Medicare and what is going to be happening to it in toto.
  I understand why some do not want to do it. It has 300 billion 
dollars' worth of cuts that were mandated in the budget resolution that 
passed out of this House that many of the people on the other side of 
the aisle supported. It is $3,500 more of out-of-pocket expenses. The 
part B premium, that is the monthly premium that seniors pay every 
month, will shoot up sharply as a result of these budget cuts, the 
Medicare cuts.
  The irony to this, of course, is that at a time when Medicare part B 
premiums will be going up, the same budget resolution mandated a change 
in the cost-of-living adjustment so that the monthly cost-of-living 
adjustment that seniors receive will be going down; less money coming 
in, more money being paid out of pocket. It is a sure prescription for 
real problems to every senior citizen.
  There will be more copayments, there will be more deductibles paid 
out of pocket, more cost increases, no assurance that some of the 
programs that many of us pushed for last year in restructuring 
Medicare, such as outpatient prescription medications, the beginnings 
of long-term care, that they will be dealt with. Therefore, what is 
going to happen is that there will be a bit here done and a bit there 
done, but avoiding the entire picture.
  Mr. Speaker, I do not see how we can legislate Medicare select in a 
vacuum. Indeed, if medicare select is going to be the wave of the 
future for Medicare, then we have to have all of the Medicare cuts that 
this body approved and that the Republican leadership supported and 
pushed through. They have to be on the table as well.
  Mr. BLILEY. Mr. Speaker, I yield myself 30 seconds just to point out 
that this program is not a new program. It has been in 15 States. It 
serves 450,000 people. Last year, of all of those 450,000 people, there 
were but 9 complaints.
  Mr. Speaker, I yield 4 minutes to the gentleman from California [Mr. 
Thomas], chairman of the Subcommittee on Social Security of the 
Committee on Ways and Means.
  Mr. THOMAS. Mr. Speaker, I thank the gentleman for yielding time to 
me.
  Mr. Speaker, if anybody tuned in and listened to the arguments on the 
other side of the aisle, they would think that this was a free for all 
debating here on any subject that any Member wanted to speak on. In 
fact, that is not the case. What is in front of us is a motion to 
instruct conferees. The House passed 408 to 14 a measure to extend 
Medicare Select. Medicare Select is a so-called MediGap. It is one of 
those insurance policies available to folk to create a whole package 
around part A and part B Medicare. There are currently 10 MediGap 
insurance type policies that have been approved by the Department of 
Health and Human Services. Medicare select is simply an 11th offering.
  It says, instead of the traditional structure, you may go out into a 
network to get this wrap-around health care package. That is all it is. 
That is all it ever was. That is all it is ever going to be. It is 
simply the 11th, the addition to 10 other small programs.
  What the minority is trying to do, Mr. Speaker, is argue the entire 
Medicare issue on their motion to instruct. What a bizarre motion to 
instruct. It says that ``will be instructed to resolve the differences 
between the House 8\1/2\ year extension and the Senate 5-year extension 
of Medicare Select policies.'' Eight and one-half years, 5 years? The 
House bill that was passed said extend it for 5 years. The Senate bill 
that was passed said extend it for 18 months. Extension in the 
unabridged dictionary right over here says ``An additional period of 
time from the current time;'' adding time, an extension. Where in the 
world the Democrats got 8\1/2\ years and 5 years as extensions is 
beyond me.

                              {time}  1020

  But that is what they say here.
  In addition, to make this motion germane, they say the scope of the 
conference, but what they really want to do is talk about the large 
program of Medicare. They do not offer specific proposals to fix 
Medicare that the trustees of the trust fund said is going broke in 7 
years. No. They do not offer constructive alternatives. They stand up 
and complain. What a whimpering group the Democrats have been reduced 
to in this House.
  Where are your ideas? Where are your alternative proposals to what we 
are offering? This is a simple motion to instruct conferees about 
extending a program that is currently in 15 States, very high success 
rate, to allow any of the 50 States to participate in the program. For 
how long? 5 years.
  And guess what? After that 5-year period, the Secretary of Health and 
Human Services has to come to the Congress and say that this program 
has not resulted in savings, that those enrolled in Medicare Select 
policies are not provided with comparable coverage, and if that is the 
case, we do away with it. But if they are provided with comparable 
coverage, if it does provide savings, then we are going to go ahead and 
continue the program.
  That is what this debate is about. A bill that passed 408 to 14 and 
by unanimous vote in the Senate, are we going to extend this modest 
little program?
  I want Members to listen to this side of the aisle during this debate 
on what is supposed to be a motion to instruct. They are going to throw 
all kinds of garbage to scare the seniors about what is going to happen 
to the Medicare Program. I will tell you what is going to happen. If we 
listen to them and do nothing, the Medicare Program is going to go 
bankrupt.
  Mr. Speaker, Republicans as the majority are going to offer 
constructive alternatives which will not only make sure that the 
program does not go bankrupt but it creates real choice in today's 
health care market like a modest little program called Medicare Select.
  When we listen to the stories over here, it is going to be about 
making political hay, not about the program that the House and the 
Senate are going to reconcile their differences over to give seniors 
one small additional choice in the arsenal of making sure they have 
adequate health care protection.
  Mr. DOGGETT. Mr. Speaker, I yield myself 20 seconds.
  Mr. Speaker, when we talk about whimpering, this is a picture of what 
Republicans have told us and told American seniors they are going to do 
on the floor of this House. It is a total blank. That is whimpering. 
Had it not been for reporters, had it not been for the American 
Association of Retired [[Page H5580]] Persons exploring these secret 
task force memos, we would not know a thing.
  Mr. Speaker, I yield 3 minutes to the distinguished gentleman from 
California [Mr. Waxman].
  (Mr. WAXMAN asked and was given permission to revise and extend his 
remarks.)
  Mr. WAXMAN. Mr. Speaker, I am almost amused when I hear our 
colleagues on the other side of the aisle say, ``Don't let the 
Democrats frighten the elderly.'' Then they go talk about how the trust 
fund is going to go bankrupt and they are going to save Medicare.
  The fact of the matter is when you look at the extent of the budget 
cuts that they are proposing in Medicare, it is far beyond anything to 
deal with the trust fund. It is going to devastate the Medicare 
Program.
  That relates to the issue that is before us today. We need to focus 
on why we have MediGap policies and the Medicare Select policies.
  We need these for one simple reason. Medicare requires people to pay 
a lot of money out of pocket right now when they get sick and use 
services. Most Medicare beneficiaries are so frightened by the amounts 
they will have to pay if they get sick that they take out a 
supplemental insurance policy to protect themselves.
  Yet in this budget resolution that was adopted by my Republican 
colleagues in the House last week, people on Medicare are going to have 
to pay a lot more money than they already do out of their own pockets. 
Their MediGap premiums are going to soar, whether they try to economize 
by using Medicare Select or not, or if they decide they cannot afford 
the premium for a supplemental policy any longer, they are going to run 
the liability of having to pay very high cost-sharing amounts.
  Medicare is not a program giving a lot of wealthy people a free ride, 
contrary to what some of our Republican friends try to use as a 
characterization. Most Medicare beneficiaries have modest incomes of 
$25,000 a year or less. They already pay a hefty deductible of $716 if 
they have to go to a hospital. They pay a part B premium to get 
coverage for physician services which is already $550 a year. They have 
a $100 deductible and coinsurance on these services.
  Mr. Speaker, if they really get sick, they can exhaust their coverage 
entirely. On top of that, they have no coverage for prescription drugs, 
and only Medicaid to rely on if they have to go into a nursing home. It 
is no wonder they end up paying on the average something like $840 in 
premiums for MediGap coverage.
  What is the answer of my Republican colleagues? To ask them to pay 
more. The AARP has estimated the average Medicare beneficiary will pay 
something like $3,500 more out of pocket over the next 7 years if the 
changes in the House budget, the requirements that the Republicans are 
looking at, go into effect.
  Mr. Speaker, I want to insert my full statement in the Record, but I 
wanted to take this time to point out that what really is going on is 
what people are now paying is only a small portion of what they are 
going to have to pay if the Republican budget goes through.
  Mr. Speaker, as the House goes to conference with the Senate to 
determine the period during which Medicare Select products can be 
marketed, it is important to focus on why we have MediGap policies, and 
Medicare Select policies.
  We need these policies for one simple reason: Medicare requires 
people to pay a lot of money out-of-pocket when they get sick and use 
services. Most Medicare beneficiaries are so frightened by the amounts 
they will have to pay if they get sick that they take out a 
supplemental insurance policy to protect themselves.
  And yet, in the budget resolution my Republican colleagues passed in 
the House last week, people on Medicare are going to have to pay a lot 
more.
  Their MediGap premiums will soar--whether they try to economize by 
using Medicare Select or not--or, if they decide they cannot afford the 
premium for a supplemental policy any longer, they will risk liability 
for very high cost-sharing amounts.
  Medicare is not a program giving a lot of wealthy people a free ride. 
Most Medicare beneficiaries have modest incomes of $25,000 or less. 
They already pay a hefty deductible of $716 if they have to go into the 
hospital. They pay a part B premium to get coverage for physician 
services which is nearly $550 a year. They have a $100 deductible and 
coinsurance on those services.
  If they get really sick, they can exhaust their coverage entirely. 
And on top of all that, they have no coverage for prescription drugs, 
and only Medicaid to rely on if they have to go into a nursing home.
  It is no wonder they end up paying on the average something like $840 
in premiums for MediGap coverage.
  And what is the answer of my Republican colleagues? To ask them to 
pay more. The AARP has estimated that the average Medicare beneficiary 
will pay something like $3,500 more out of pocket over these next 7 
years if the changes this House budget requires go into effect.
  People who try to protect themselves with MediGap insurance will find 
that their MediGap premiums are going to skyrocket. That is going to 
take money out of the pockets of Medicare beneficiaries just as surely 
as a tax increase.
  And people who decide to get their coverage through a Medicare Select 
policy will find they are faced by very large cost-sharing obligations 
if they choose a physician that is not covered by their plan. 
Exercising their right to choose a physician is going to be an 
expensive one.
  Every Medicare beneficiary is going to have to pay more cost-sharing 
or higher MediGap premiums, whatever their economic circumstances. Even 
if they are struggling along with just their Social Security check to 
support them.
  And the poorest of our elderly will suffer the most. Today, Medicaid 
pays their premium for Medicare, and helps them pay their cost-sharing. 
But once Medicaid is gone, and we have capped the Federal dollars we 
spend on that program, that help will not be there any longer.
  And let me also note something else that will not be there once 
Medicaid becomes a block grant--the assurance of nursing home care for 
those who need it and cannot afford it. Once again, the middle-class 
American family is going to have to struggle with paying $35,000 or 
$40,000 a year for their elderly parent's nursing home care.
  This budget is bad for you if you are old or you are sick. Medicare 
and Medicaid coverage will be less--and it is not enough today. A more 
expensive Medicare Select or other MediGap policy will not be an 
answer.
  This bill on which the House goes into conference today is of minor 
significance in the light of the changes the budget resolution will 
mean for the Medicare Program. And that is the issue that should be on 
the minds of our House conferees as they meet with our colleagues in 
the Senate.
  Mr. BLILEY. Mr. Speaker, might I inquire who has the right to close?
  The SPEAKER pro tempore (Mr. Shays). The gentleman from Texas [Mr. 
Doggett] has the right to open and also the right to close.
  Mr. BLILEY. Mr. Speaker, I yield 5 minutes to the gentleman from 
Florida [Mr. Bilirakis], the 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. Speaker, I rise in opposition to the motion to 
instruct the conferees with regard to the conference on the Medicare 
Select Program. The instruction is virtually incomprehensible. It 
states that the conferees must resolve the differences between the two 
bills in light of changes in Medicare contemplated in this year's 
budget process.
  Medicare Select is a very simple program: It is simply a 
demonstration project for a preferred provider network under MediGap 
policies, the private insurance policies that are designed to fill in 
specific gaps in the Medicare benefits structure such as deductibles, 
copayments, and services not covered by the Medicare Program. It is 
just another MediGap option available to Medicare beneficiaries. The 
authority for the Medicare Select Program is due to expire at the end 
of June. The extension of this program has absolutely nothing to do 
with the budget process we are currently engaged in. In fact, the 
program is not designed to, nor has it, reduced Medicare costs to the 
Federal Government. It merely is of help to the seniors.
  This motion to instruct is asking the conferees to consider the 
Medicare Select Programs in light of this year's budget process. This 
effort makes no sense since: First, it is imperative that the 
conference on Medicare Select be completed before the end of June when 
the authority for the program expires; second, the budget resolution 
which [[Page H5581]] just passed the House has a September reporting 
date for the committees of jurisdiction to act on Medicare; and third, 
the budget resolution must be conferenced with the Senate budget 
resolution, which has not yet been passed.
  It seems that the real purpose of this motion to instruct is to once 
again try to steer us away from the seriousness of the task ahead of 
us: To ensure that the Medicare Program is preserved for current and 
future beneficiaries. I should not have to remind Members that the 
trustees for the Medicare hospital insurance and supplementary medical 
insurance trust funds are facing significant financial problems in both 
the short term and the long term.
  Under the best estimates of the trustees, the hospital insurance 
trust fund will be exhausted by 2002. In short, the hospital insurance 
side of the program will not be able to pay its bills because of 
exploding part A expenditures. Part A is described by the trustees as a 
program ``severely out of financial balance.''
  Not only is the HI trust fund financially out of balance, but 
spending growth by the supplementary medical insurance [SMI] trust fund 
is also a concern because the SMI rate of growth is unsustainable. SMI 
cost growth directly affects Medicare beneficiary part B premiums as 
well as general revenues from which the largest share of SMI costs are 
financed.
  In 1995, premiums paid by enrollees will finance only about 28 
percent of annual costs, according to the 1995 trustees' report. Over 
the next decade, the contribution from general revenues to the SMI 
trust fund will increase from $46 billion in 1995 to $151 billion in 
2004, for an average annual growth rate of over 14 percent.
  We are deeply concerned about the future of the Medicare Program. We 
strongly believe any solution to this crisis must be addressed in a 
bipartisan manner and we are disappointed by the administration's 
repeated refusal to join this effort. We are particularly alarmed that 
the President is ignoring the strongest possible warnings from the very 
individuals he appointed to safeguard the Medicare Program since 4 of 6 
trustees are administration officials.
  The end result of this instruction will be to put in jeopardy the 
MediGap policies of the 450,000 Medicare beneficiaries currently 
enrolled in Medicare Select plans. This program is very popular among 
senior citizens with good reason. In August 1994, Consumer Reports 
rated the top MediGap insurers nationwide. Eight out of ten of the top 
rated 15 MediGap plans were Medicare Select plans. During our Health 
Subcommittee hearing on Medicare Select, the National Association of 
Insurance Commissioners 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.
  This instruction is simply a dilatory tactic and should be rejected. 
Members should think seriously before they cast a vote eliminating the 
Medicare Select Program.
  Mr. DOGGETT. Mr. Speaker, I yield 2 minutes to the gentleman from 
California [Mr. Stark], the ranking member of the Subcommittee on 
Health and Environment of the Committee on Ways and Means, a Member of 
this house who has worked long and hard to try to protect our Medicare 
beneficiaries.


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