[Congressional Record Volume 141, Number 103 (Thursday, June 22, 1995)]
[House]
[Pages H6256-H6257]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


        CONFERENCE REPORT ON H.R. 483, MEDICARE SELECT POLICIES

  Mr. BILIRAKIS submitted the following conference report and statement 
on 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:
                  Conference Report (H. Rept. 104-157)

       The committee of conference on the disagreeing votes of the 
     two Houses on the amendment of the Senate to 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, having met, after full and free 
     conference, have agreed to recommend and do recommend to 
     their respective Houses as follows:
       That the House recede from its disagreement to the 
     amendment of the Senate and agree to the same with an 
     amendment as follows:
       In lieu of the matter proposed to be inserted by the Senate 
     amendment, insert the following:

[[Page H 6257]]

     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 6\1/2\-year 
     period beginning with 1992.

     For purposes of this paragraph, the term `State' has the 
     meaning given such term by section 210(h) of the Social 
     Security Act (42 U.S.C. 410(h)).
       ``(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 medicare supplemental 
     policies. The study shall be based on surveys of appropriate 
     age-adjusted sample populations. The study shall be completed 
     by June 30, 1997.
       ``(B) Not later than December 31, 1997, the Secretary shall 
     determine, based on the results of the study under 
     subparagraph (A), if any of the following findings are true:
       ``(i) The amendments made by this section have not resulted 
     in savings of premium costs to those enrolled 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.
       ``(iii) Access to and quality of care has been 
     significantly diminished as a result of such amendments.
       ``(C) The amendments made by this section shall remain in 
     effect beyond the 6\1/2\-year period described in paragraph 
     (1)(B) unless the Secretary determines that any of the 
     findings described in clause (i), (ii), or (iii) of 
     subparagraph (B) are true.
       ``(3) The Comptroller General shall conduct a study to 
     determine the extent to which individuals who are 
     continuously covered under a medicare supplemental policy are 
     subject to medical underwriting if they change the policy 
     under which they are covered, and to identify options, if 
     necessary, for modifying the medicare supplemental insurance 
     market to make sure that continuously insured beneficiaries 
     are able to switch plans without medical underwriting. By not 
     later than June 30, 1996, the Comptroller General shall 
     submit to the Congress as report on the study. The report 
     shall include a description of the potential impact on the 
     cost and availability of medicare supplemental policies of 
     each option identified in the study.''.

       And the Senate agree to the same.

     Tom Bliley,
     Michael Bilirakis,
     Dennis Hastert,
     Bill Archer,
     William Thomas,
     Nancy L. Johnson,
                                Managers on the Part of the House.

     Bob Packwood,
     Bob Dole,
     Daniel Patrick Moynihan,
                               Managers on the Part of the Senate.
       JOINT EXPLANATORY STATEMENT OF THE COMMITTEE OF CONFERENCE

       The managers on the part of the House and the Senate at the 
     conference on the disagreeing votes of the two Houses on the 
     amendment of the Senate to 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, 
     submit the following joint statement to the House and the 
     Senate in explanation of the effect of the action agreed upon 
     by the managers and recommended in the accompanying 
     conference report:
       The Senate amendment struck all of the House bill after the 
     enacting clause and inserted a substitute text.
       The House recedes from its disagreement to the amendment of 
     the Senate with an amendment that is a substitute for the 
     House bill and the Senate amendment. The differences between 
     the House bill, the Senate amendment, and the substitute 
     agreed to in conference are noted below, except for clerical 
     corrections, conforming changes made necessary by agreements 
     reached by the conferees, and minor drafting and clerical 
     changes.

          Extend Medicare Select to All States for Three Years


                              present law

       The Omnibus Reconciliation Act of 1990 (P.L. 101-508) 
     established a demonstration project called Medicare Select 
     under which insurers can market Medicare supplemental 
     policies (called ``Medigap'' policies) that are the same as 
     other Medigap policies except that supplemental benefits are 
     paid only if services are provided through designated 
     providers. The demonstration was limited to 15 states and 
     expired December 31, 1994. The demonstration was extended to 
     June 30, 1995, in the Social Security Act Amendments of 1994 
     (P.L. 103-432).


                               house bill

       Medicare Select authority is extended to all states which 
     wish to participate until June 30, 2000. The Secretary of 
     Health and Human Services is to conduct a study of Medicare 
     Select prior to 1998 to study cost, quality and access for 
     Medicare Select compared to other Medigap policies. Medicare 
     Select remains in effect unless the Secretary finds that 
     Medicare Select has: (1) not resulted in savings of premium 
     costs to beneficiaries compared to non-select Medigap 
     policies; (2) resulted in significant additional expenditures 
     for the Medicare program; or (3) resulted in diminished 
     access and quality of care.


                            senate amendment

       Same as the House bill except the extension is until 
     December 31, 1996. The Secretary is to complete the study by 
     June 30, 1996. The General Accounting Office (GAO) is to 
     conduct a study on Medigap insurance and report to Congress 
     by June 10, 1996. The report is to include: (1) an analysis 
     of whether there are problems in the current Medigap system 
     for beneficiaries who wish to switch Medigap policies without 
     medical underwriting or pre-existing condition exclusions; 
     (2) options for modifying the Medigap market to address any 
     problems identified; and (3) an analysis of the impact of 
     each option on the cost and availability of Medigap 
     insurance, with particular reference to problems with 
     Medicare Select policies.
                          conference agreement

       The conference agreement adopts the Senate amendment with 
     the following changes: (1) Medicare Select is extended to all 
     States for three years (until June 30, 1998); and (2) the GAO 
     study is clarified to require analysis of all types of 
     Medigap insurance by removing specific reference to Medicare 
     Select. Reference to pre-existing condition exclusions is 
     also removed as they are already prohibited under current law 
     for Medigap replacement policies.

     Tom Bliley,
     Michael Bilirakis,
     Dennis Hastert,
     Bill Archer,
     William Thomas,
     Nancy L. Johnson,
                                Managers on the Part of the House.

     Bob Packwood,
     Bob Dole,
     Daniel Patrick Moynihan,
                               Managers on the Part of the Senate.
     

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