[Congressional Record Volume 141, Number 109 (Friday, June 30, 1995)]
[House]
[Pages H6661-H6675]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


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

  Ms. PRYCE. Mr. Speaker, by direction of the Committee on Rules, I 
call up House Resolution 180 and ask for its immediate consideration.
  The Clerk read the resolution, as follows:

                              H. Res. 180

       Resolved, That, upon adoption of this resolution it shall 
     be in order to consider the conference report to accompany 
     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. All points of order 
     against the conference report and against its consideration 
     are waived. The conference report shall be debatable for one 
     hour equally divided and controlled by the chairman and 
     ranking minority member of the Committee on Commerce. The 
     previous question shall be considered as ordered on the 
     conference report to final adoption without intervening 
     motion. Upon the adoption of the conference report, Senate 
     Concurrent Resolution 19 shall be considered as agreed to.

  The SPEAKER pro tempore. The gentlewoman from Ohio [Mrs. Pryce] is 
recognized for 1 hour.
  Ms. PRYCE. Mr. Speaker, for the purposes of debate only, I yield the 
customary 30 minutes to the distinguished gentleman from California 
[Mr. Beilenson], pending which I yield myself such time as I may 
consume.
  During consideration of this resolution, all time yielded is for the 
purpose of debate only.
  Mr. Speaker, time is of the essence. Once again, that is the basic 
principle underlying our consideration of legislation to extend the 
Medicare Select Demonstration Program.
  In April, the Rules Committee reported a timely rule for H.R. 483. 
Today, we bring to the floor a rule making in order the conference 
report accompanying H.R. 483, with only hours to go before this 
valuable program is set to expire.
  In 1990, Congress created the 15-State demonstration Medicare Select 
Program to allow Medicare recipients the opportunity of purchasing a 
Medigap managed care option. The project in those states is set to 
expire today,June 30, and unless Congress takes prompt action to renew 
it, the insurance benefits of nearly half a million senior citizens 
covered by the Medicare Select Program would be in serious jeopardy.
  The conference agreement extends the Medicare Select Program for a 
period of 3 years. It also expands this option to seniors in all 50 
States, and puts it on track to finally becoming permanent if the 
Secretary of Health and Human Services certifies that the program has 
met certain conditions.
  In addition, the conference agreement clarifies that the definition 
of a State, for the purposes of this bill, includes the District of 
Columbia and the territories of the United States: Guam, Puerto Rico, 
the Virgin islands, and American Samoa.
  In order to expedite consideration of this conference agreement in 
the House, and to ensure that seniors will have uninterrupted coverage, 
the Committee on Rules has reported a straightforward and fair rule for 
this very necessary legislation.
  Specifically, the rule provides for 1 hour of general debate on the 
conference report, equally divided and controlled by the chairman and 
ranking minority member of the Committee on Commerce.
  The rule also stipulates that the previous question shall be 
considered as ordered on the conference report to final adoption 
without any intervening motion.
  Under the rule, all points of order against the conference report and 
its consideration are waived. While the Rules Committee generally 
prefers to avoid handing out such blanket waivers, this waiver and the 
rule itself are necessary because of a potential violation of clause 3 
of rule XXVIII (28), which prohibits the inclusion of matters in a 
conference report beyond the scope of matters committed to conference 
by either Chamber.
  A question has arisen as to the apparent lack of definition of the 
term State in either the House or Senate-passed bills. As I mentioned 
earlier in my statement, the conference report contains a definition of 
States which includes the District of Columbia and U.S. territories.
  The waiver granted in the rule is a precautionary step to ensure that 
passage of this critical legislation is not unnecessarily stalled by 
this particular provision or by any other unforeseen, yet potential 
violation contained in the conference report.
  Members might be interested to know, also that this rule fully 
complies with the 3-day availability requirement for conference 
reports, as the report was filed on June 22.
  Mr. Speaker, the conference agreement provides a reasonable balance 
to permit a very valuable, and successful program for our senior 
citizens to continue, while allowing us time to evaluate the program 
more closely before making it permanent.
  Our colleagues should keep in mind that the Medicare Select Program 
provides seniors with another viable option to receive affordable 
medical care. Premiums under the select option have resulted in savings 
as high as 37 percent over traditional Medigap policies. By giving 
older Americans more 

[[Page H6662]]
choices within Medigap, we give them the flexibility to choose plans 
which meet their own special or individual needs.
  In closing, I would remind our colleagues that the sponsors of this 
legislation have made it very clear that the House needs to act on this 
bill before leaving for the Fourth of July district work period. The 
Medicare Select Program is only hours away from expiring.
  More than 450,000 Medicare beneficiaries will be impacted if the 
Medicare Select Program is not renewed. The Senate adopted the 
conference report on June 26. This rule will enable the House do to its 
part for our senior citizens.
  Mr. Speaker, House Resolution 180 is a fair, balanced, and 
responsible rule. It was approved unanimously by the Rules Committee 
last night, and I urge my colleagues on both sides of the aisle to give 
it their full support.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BEILENSON. Mr. Speaker, I thank the gentlewoman from Ohio for 
yielding time to me. I yield myself such time as I may consume.
  Mr. Speaker, we support the rule which, as my colleague and friend on 
the Committee on Rules has pointed out, waives all points of order 
against the conference report and is necessary because the conferees 
added new material not included in the House or the Senate bill.
  The addition is minor. That is why we agreed unanimously last night 
to this rule for the conference report.
  The legislation we are about to consider under this rule would expand 
the availability of an experimental Medigap Program, known as Medicare 
Select, from 15 States to the rest of the country. The Medicare Select 
Program makes available to senior citizens a managed care insurance 
policy to fill in the gaps of Medicare coverage. It differs from other 
Medigap policies that require senior citizens to participate in the 
insurer's selected network of health care providers in order to receive 
payment for Medicare's cost sharing amounts.
  There have been a number of substantial concerns raised about the 
operation of Medicare Select Programs. In its initial estimate of the 
bill, CBO noted that a preliminary study of this program by the Health 
Care Financing Administration found very little management of care by 
the insurers and no measurable cost savings to Medicare.
  In addition, preliminary data for a subsequent study indicate that 
Medicare costs have actually gone up in eight of the States where these 
programs now operate. Many of us had hoped that we would be able to 
postpone final consideration of the bill until results of the 
subsequent study are available to the Congress sometime this fall. We 
would be in a better position to evaluate the usefulness and cost of 
this alternative program to the elderly who choose to participate in 
it. Nonetheless, we understand that the proponents of this legislation 
feel it is important to complete consideration as soon as possible to 
ensure that the beneficiaries currently enrolled in the program do not 
lose their coverage.

                              {time}  1100

  In addition, Mr. Speaker, the conference report extends the 
authorization for the program for only 3 rather than the 5 years 
included in the original House and Senate bills. It also allows the 
Secretary of HHS to discontinue the program at the end of 5 years, if 
it is determined that the program results in higher premium costs to 
beneficiaries or increased costs to the Medicare Program itself.
  This issue of cost is, Mr. Speaker, of course one of the real major 
and regular concerns about Medicare Select. Our colleagues will fully 
discuss all of this during the debate on the conference report.
  We have absolutely no objection to the rule reported by the Committee 
on Rules last evening for consideration of this conference report. We 
urge our colleagues to approve the rule so we may proceed with 
consideration of H.R. 483 today.
  Mr. Speaker, I yield such time as he may consume to the distinguished 
gentleman from Michigan [Mr. Dingell].
  (Mr. DINGELL asked and was given permission to revise and extend his 
remarks.)
  Mr. DINGELL. Mr. Speaker, this is a bad rule, it is a bad bill, it is 
bad legislation, it has been handled poorly, it is going to hurt the 
American people, it is going to raise the cost of Medicare, and it is 
going to be generally bad for the economy, the country, and the budget. 
Having said, that, Mr. Speaker, it is probably OK to proceed.
  I would urge my colleagues to vote this rule down. I would urge them 
with equal vigor and diligence to vote down the legislation. The bill 
is being pushed more rapidly than information is available, and more 
rapidly than the committee or the House is being permitted to gather 
the facts about what the legislation does.
  Initial information shows that Medicare has had its costs increased 
17 percent on the average in States in which this Medicare Select 
Program has been made available. What that means is that senior 
citizens are getting less for more, and the Medicare system is getting 
billed more for less. This is a wonderful giveaway to the health 
insurance companies. It is being crafted in a fashion which defies good 
explanation.
  The rule is needed today because the Republican leadership pushed 
this bill through the House without adequate thought, and then rushed 
it to a conference which did not deserve that honorable title between 
the House and Senate. We had a conferees meeting, which was scheduled 
for 5 p.m. one day last week. It was over at 5:01 p.m. Only yesterday 
did the Republican leadership become aware of the fact that they had a 
number of significant scope violations in a two-page bill.
  Clearly slovenly legislation, slovenly legislative process is before 
this body. The issues presented in the statement of managers and in the 
offers passed back and forth between the House and Senate were 
presented as merely technical, but they were in fact highly 
substantive, and they will, for example, try to make gifts through 
these devices to the health insurance industry.
  The result of this action is also to assure that the study which 
should take place to find out what is really going to happen under this 
Medicare Select Program will be so crafted as to make it very difficult 
to in fact obtain the necessary facts that the Congress ought to have, 
to know whether we ought to continue to extend this outrage, or whether 
in fact we ought to terminate it, as we indeed should.
  The scope of the bill was expanded so that insurance companies can 
sell highly questionable policies not only in 50 States but in the 
territories and in the District of Columbia as well. I am certain that 
there are a number of guileless, unsuspecting elderly consumers in 
these locations that can be plucked for further advantage and further 
economic benefit to the health insurance industry.
  Of course, the health insurance industry will profit mightily from 
this further largesse by this Congress under the Republican leadership 
at the expense of the taxpayers, at the expense of the budget, and at 
the expense of Medicare recipients.
  The subjects of the GAO study in the bill was changed, so it will be 
more difficult for us to get GAO to present us with options for 
modifying the MediGap market, and therefore, to be sure that the 
seniors who switch out of these Medicare select policies can do so in a 
way where they can get back into a decent package of insurance.
  Understand, this is insurance which does not go on a level basis, it 
starts at about $870 a year, if one is 65, but by the time one has 
reached 85, it is going to cost $2,300 or $2,400. Nobody is telling the 
senior citizens about that at all. Of course, the process here has been 
crafted so as to proceed with such blinding speed that no one will see 
that the senior citizens, the Medicare trust fund, the American people, 
are going to get skinned by this outrage.
  Mr. Speaker, I urge my colleagues to vote against the rule. I urge 
them to vote against the bill. I predict that if this bill passes and 
is signed into law, we are going to find that Medicare is going to cost 
the taxpayers and the trust fund about an additional 17 percent. I tell 
the Members, they should put that in their book. They are going to have 
a chance to remember that when we review this legislation.
  Ms. PRYCE. Mr. Speaker, I yield 1 minute to the distinguished 
gentleman from California [Mr. Thomas], chairman of the Subcommittee on 
Health of the Committee on Ways and Means.

[[Page H6663]]

  Mr. THOMAS. Mr. Speaker, I had not planned to speak, but I do want to 
put the statements of the gentleman from Michigan in context. He was 
one of the 14 who voted against the bill originally. There were 408 
Members who supported it.
  Mr. Speaker, on April 4 he sent out a Dear Colleague letter that 
said, ``Why the rush to bring H.R. 483 to the floor this week?'' He 
just in the well stated, ``Why the rush on moving forward with this 
legislation?'' June 30, today, is the expiration date for this program. 
I would think that is why the rush argument has been laid to rest.
  As far as scope is concerned, we said it was going to be available to 
50 States. The majority on the other side of the aisle, in their 
wisdom, decided to contest that; since the 50 States was extending it 
to the District of Columbia and Puerto Rico, as according to the Social 
Security Act, they were going to argue that was out of scope, so we 
simply went to the Committee on Rules to make sure that we could 
include the District of Columbia and Puerto Rico in the scope.
  As to the GAO study, I think the gentleman from Michigan [Mr. 
Dingell] knows that we do not need legislation to get a GAO study. A 
Member just has to ask.
  Mr. BEILENSON. Mr. Speaker, I yield 2 minutes to the gentleman from 
Maine [Mr. Baldacci].
  Mr. BALDACCI. Mr. Speaker, it is the height of hypocrisy for the 
majority party to pat themselves on the back for restoring the Medicare 
Select Program, when just hours ago they cut $270 billion from Medicare 
to help pay for tax breaks for the wealthy.
  The Medicare Select Program is a good program. It is a program that 
pays the cost for sharing of Medicare beneficiaries if they go into a 
selected list of providers, but the Medicare Select Program is a 
supplemental program, and after today, it has nothing to supplement.
  Medicare select is a worthwhile program, but this worthy program 
cannot begin to make up for the damage of the massive Medicare cuts 
made earlier. Medicare select is supposed to be the frosting on the 
Medicare cake, not the entire cake. A diet of frosting only is bound to 
make the stomachs of America's seniors upset. I know that is how I feel 
today.


                             general leave

  Ms. PRYCE. Mr. Speaker, I ask unanimous consent that all Members may 
have 5 legislative days in which to revise and extend their remarks on 
this legislation.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentlewoman from Ohio?
  There was no objection.
  Ms. PRYCE. Mr. Speaker, I reserve the balance of my time.
  Mr. BEILENSON. Mr. Speaker, I yield such time as he may consume to 
the gentleman from California [Mr. Stark], the ranking member of the 
subcommittee.
  Mr. STARK. Mr. Speaker, I thank the distinguished gentleman for 
yielding time to me.
  Mr. Speaker, I rise in hopeless opposition to a rule that was crafted 
in the dead of night, and I rise to warn the American public. The 
gentleman from Michigan [Mr. Dingell], who spoke a few minutes ago, was 
absolutely correct. This is terribly flawed legislation. This bill 
destroys a fairly good idea.
  This bill has been introduced and written by former operatives of the 
health insurance industry. It deregulates supplemental insurance, and 
provides an opportunity for the worst shylocks in the health insurance 
industry to steal from the Medicare system and from our seniors.
  Sitting right over there is a man who, within the past year, has 
received hundreds of thousands of dollars from the health insurance 
industry. He is a Republican Committee on Ways and Means staff person 
who drafted this bill for the health insurance industry.
  Mr. Speaker, they are entitled to get payback for the huge 
contributions they made to the Speaker's campaign funds. That is OK. We 
know that goes on. However, I am telling the Members, Mr. Speaker, that 
what has happened here presages doom. If this kind of sloppily drafted 
legislation is how the Republicans think they are going to find a way 
to cut $270 billion out of Medicare, they would save everybody a lot of 
time by just moving to eliminate Medicare, because they will do it 
through stupidity, lack of experience, urgency to provide help to the 
people who have feathered their campaign nests, and with complete 
disregard for the seniors.
  Mr. Speaker, the seniors who sign up for this in States where it is 
not regulated, and it is regulated in those States, it is regulated by 
no one except the good conscience of the insurance companies. Companies 
like Prudential, who have stolen billions of dollars from seniors, 
companies that are under indictment or have pled guilty and paid $300 
million, $400 million in fines are the same companies who are going to 
take care of our parents, and indeed ourselves, under this plan. Do not 
buy into that.
  Mr. Speaker, this is just a precursor of the Republican plan to 
destroy Medicare. We will hear about it after the recess. We will hear 
about taking $270 billion out of the most popular program, the most 
efficient insurance program in the country. It is being done at the 
behest of the health insurance companies by the Republicans. Members 
should vote against this rule in protest, and Members should vote 
against the bill.
  Mr. BEILENSON. Mr. Speaker, I yield such time as he may consume to 
the gentleman from Texas [Mr. Gene Green].
  (Mr. GENE GREEN of Texas asked and was given permission to revise and 
extend his remarks.)
  Mr. GENE GREEN of Texas. Mr. Speaker, I thank my colleague, the 
gentleman from California, for yielding me this time.
  Mr. Speaker, I voted for the Medicare Select bill as it first came 
up, and now I intend to support the conference committee report. But I 
have some concern about it, in light of the big picture. That is what 
we need to look at today on this House floor. I hope the American 
people are looking at it, particularly those people who are senior 
citizens.
  Mr. Speaker, the budget resolution was passed yesterday, planning 
$270 billion in cuts in Medicare, and at the same time providing tax 
cuts of $245 billion. I do not think it makes sense that today, the 
very next day, we have a conference committee report on Medicare 
Select, which supplements the same Medicare Program that was cut 
yesterday.
  Those of us who support the HMO concept and managed care, still 
support the individual making that decision. However, with what 
happened yesterday and what will happen over the next few years, we 
will see that freedom of choice for our seniors and future seniors 
limited. It has not happened yet, but we are setting the stage for it, 
as we stand here.
  I represent the city of Houston in Harris County. We have 286,000 
seniors who receive over $1.5 billion in Medicare payments. A $270 
billion cut nationally over the next few years will impact those 
seniors. Mr. Speaker, the Republicans seem to not understand that 
health care costs are going up, and they are going up because we are an 
aging population. To cut those seniors, the growth, as they say, will 
force them to go into more managed care and into Medicare Select like 
we are seeing today.
  We are voting on the conference committee report that offers seniors 
hopefully the goal of more coverage under the HMO and more expansion, 
but the secret of the HMO concept for seniors is freedom of choice, 
their freedom of choice to go into it, not somebody in Washington, a 
bureaucrat or even their elected Members of Congress saying, ``You have 
to go to a Medicare Select plan.''
  Mr. Speaker, let me repeat what we are talking about today. We will 
see over the next few years senior citizens being forced into the 
Medicare Select or other HMO programs, removing that freedom of choice 
as part of the way to save that $270 billion. That is what people need 
to understand. That is the fear I hear from my constituents at home.
  Mr. Speaker, last Monday I was with a hundred senior citizens in the 
city of Houston. Some of them were in the Medicare Select or the HMO 
that is offered by a number of private contractors. Some of them were 
happy with it. However, they wanted to make sure it was their choice, 
not the choice of the U.S. Congress or that of some bureaucrat. We 
promised Medicare in 1965. 

[[Page H6664]]
Frankly, if we waited for the Republican majority to provide for 
Medicare back then, it would not be here today.
                              {time}  1115

  I guess what I am concerned about is the forced cuts, Mr. Speaker, 
particularly in the budget bill passed yesterday with the change in the 
Consumer Price Index, and again in light of what is happening today 
with this bill.
  We will see the Consumer Price Index readjusted to where the cost of 
living increases in Social Security will be reduced. That reduction, 
with the increase in Medicare expenditures, will cost senior citizens 
who are now receiving it, and again those who are growing into it, 
those 60-year-olds, those 55-year-olds who are looking forward to be 
able to have some type of security and having medical care when they 
are over 65.
  I like the idea of Medicare select, Mr. Speaker, but I do not like 
the idea when we encompass everything together with the cuts we will 
see and the forced choices those people are going to have to make. I 
think that is what we need to be concerned about. I would hope over the 
Fourth of July recess and over the next couple of months and even over 
the next few years, because this will not happen today or tomorrow or 
next week, but it will surely happen with the budget vote yesterday to 
cut $270 billion out of the growth of Medicare.
  Mr. Speaker, I hope that all of our Members remember that, when we 
vote for this bill.
  Ms. PRYCE. Mr. Speaker, I yield 2 minutes to the distinguished 
gentlewoman from Connecticut [Mrs. Johnson].
  Mrs. JOHNSON of Connecticut. Mr. Speaker, I just want to thank the 
preceding speaker for his support of Medicare select. There were 408 
Members of this House that voted for it. I hope every one of those 408 
Members will vote for it again, because this is an entirely voluntary 
alternative for our seniors. In the States where it has been available, 
it has offered them more care at a lower cost and been well-regulated 
by both the State and the industry and some Federal rules.
  I also want to point out that as we reform Medicare, as we assure 
that Medicare will be there for our seniors and provide the quality of 
care that we have depended on Medicare for, we will over the next 7 
years increase spending per senior in America from $4,800 on average to 
$6,700 on average. That is a one-third increase, a very solid increase 
in the face of declining costs in the health care sector. Our seniors 
are going to be well cared for.
  While change is hard, if it is made with concern and in a responsible 
way, we can increase the money that we make available for senior care 
per capita throughout this Nation in an honorable way and one that 
supports the needs of retirees in this great Nation of ours.
  Mr. BEILENSON. Mr. Speaker, I yield 3 minutes to the gentleman from 
North Dakota [Mr. Pomeroy].
  Mr. POMEROY. Mr. Speaker, it has been a contentious, partisan week in 
the House of Representatives, and much of the division has involved the 
Medicare Program. The budget passed by this House yesterday on a 
largely partisan vote imposes cuts of $284 billion that will be 
devastating to the program.
  That will definitely mean higher out-of-pocket costs for seniors and 
less choice. I feel bad about that issue this morning and bad about the 
way the House resolved it and anxious about how those cuts will 
actually be put in place as we deal with the legislation that is before 
us.
  It is sometimes difficult, then, to get on to other issues where 
there is in essence no partisan division, where it is a pretty clear 
and simple little bill that ought not have some of the rancor from 
earlier debates spilling over into it, but that is not precisely the 
case with the Medicare select extension before us today.
  It passed the first time in the House of Representatives 408 to 14, 
most Democrats, most Republicans joining together in a rather unusual 
show of bipartisan support for a program. Why did that vote occur? 
Because I think the Members recognized that a program such as this, a 
voluntary way for seniors to opt for an insurance program that is going 
to give them a premium discount, that has had a successful run in the 
15 States that have been allowed to run the Medicare Select Program, 
ought to be extended to the 50 States, ought to be given a 3-year 
extension so that the marketing of this program can begin in earnest.
  I know something about this program. I was the insurance commissioner 
in North Dakota at the time it passed. I lobbied HHS to get North 
Dakota into the program because I believed in it. Ten thousand North 
Dakotans participate in this program. They get a monthly savings in 
premium amounting to 17 percent below those buying the Blue Cross/Blue 
Shield Medicare supplement that is not Med select.
  Medicare select saves money. It negotiates discounts from the 
hospital and passes it on to the senior citizen. It also passes on any 
managed-care savings experienced in claims payment to the senior 
citizen purchasing the insurance policy.
  What is wrong with this? Is this some sort of diabolical plot by the 
evil insurance industry? Certainly not. Certainly not. It is a simple 
little program, it works well, and we ought not take some of the bad 
feeling we have about some of the other discussions going on around 
here and bring it to this little issue. Medicare select should be 
passed. This House passed it once before, 408 to 14, and I trust we 
will again this morning.
  Mr. BEILENSON. Mr. Speaker, I yield 7 minutes to the gentleman from 
Rhode Island [Mr. Kennedy].
  Mr. KENNEDY of Rhode Island. Mr. Speaker, I was among those who voted 
against it when it came to the floor last time, and I want to correct 
something that my colleague was talking about in terms of leaving it up 
to the States.
  Maybe it was good for North Dakota, and I am sure my colleague, when 
he was an insurance commissioner, looked out for the consumers, but I 
can tell you the problem with having 50 different select plans, 50 
different select plans regulated by 50 different States. It means that 
seniors in one State, like in my State of Rhode Island, if they have 
their Medicare Select MediGap plan and they go over to Massachusetts, 
it is a different plan. That, to me, does not sound like the proper 
approach to take to this when we are talking about needing 
comprehensive savings.
  In addition, I just want to talk a little bit about this so-called 
increased choice. Under the guise of giving seniors increased choice, 
Congress is about to pass legislation that will in fact box them in. 
Yes, one more plan will now be available, but it is a narrow one and it 
is difficult, leaving many seniors in a potentially very risky 
situation. More choice do not simply mean better choices. For seniors 
who are considering the Medicare select policy, keep one thing in mind: 
This plan could be hazardous to your health.
  When Medicare select came before us the last time, I supported an 
alternative that addressed the serious flaws in Medicare select. This 
amendment would have ended the problems with price rising with age, 
lowered the barriers that make it difficult and risky and dangerous for 
seniors to switch, and would have limited the extension until we know 
that this is a really good idea, because the jury is still out.
  Let me just add, what this does it, it puts it into the insurance 
companies' hands and allows them to come up with the rating system. I 
have seen these Medicare select plans, because in my State I represent 
the fourth most elderly district in this country, and the senior 
citizens in my State are worried about this because they know better 
than we do what is coming down the road.
  It means that they are going to be able to age-rate you. What does 
that mean? That means when you get older, they are going to be able to 
jack up the premiums, and because you are locked into this plan now, 
you are locked in for life.
  You try to switch, and guess what: You are going to be paying all 
those preexisting condition prices, because another insurance company 
is not going to want to pick up because you may have had asthma, you 
may have had some kind of visiting nurse care you might have needed, 
and new plans are not going to want to touch you. 

[[Page H6665]]
Why? Because they are not going to make money off of you. Because if 
you are sick, insurance companies do not want to cover you. That is why 
we have Government, because Government is going to regulate the private 
sector when it comes to insurance, to make sure that the private sector 
does not run roughshod over the senior citizens and take advantage of 
them.
  Believe me, if you do not think they are going to do it, you have got 
another think coming, because these HMO plans are all about making 
money, and they do not make money off people who are sick. They do not 
make money off senior citizens.
  Be careful, Members. Be careful when you vote for the select plan, 
because the Republicans did not allow enough time for us to do a proper 
study of this and now they want to open it up to all the States under 
the guise of new choice.
  What is that new choice? It is a bait-and-switch routine. It says new 
choice. We do not want to face the tough choices, so we will let this 
private marketplace reduce your benefits. That is what we are saying.
  We are squeezing the Medicare budget. We are seeing it on the floor 
of this House. We are squeezing Medicaid. We are cutting the senior 
citizens Medicare Program. The gentleman from Ohio [Mr. Kasich], the 
chairman of the Committee on the Budget, says we are not, that we are 
only reducing the rate of growth, but make no mistake about it, there 
is going to be less money in Medicare.
  What is going to happen? There is not going to be enough money to go 
around, so the MediGap select policies, that is, the supplemental 
insurance that allows senior citizens to cover what Medicare will not 
cover, if Medicare does not have as much money as they had before, you 
better believe they are going to have to have more in the way of 
supplemental insurance to bridge the gap. Congress is passing this 
Medicare select because the Republicans are just about to pass all 
these cuts to Medicare.
  Mr. Speaker, this idea that this is going to save
   you money, this is really tricky. If you join the HMO plan, you are 
not paying as much, so who would not want to buy into that?

  But let me warn you, in policies that have already been issued under 
this Medicare select policy, once you are in the plan, it does not bar 
them from jacking the rates up on you. Now you are stuck because you 
are in the plan. You have signed your rights away as a consumer.
  And guess what? Let's say your doctor leaves the plan and you want to 
go back to your doctor. Forget it. Under Medicare select you cannot do 
that, because if your doctor is not on the list of approved doctors, 
you are not going to get that doctor. Let's say you want to switch and 
follow your doctor. You cannot do that.
  Then as far as the prices, initially you have got a lower price, but 
like I said earlier, they will jack the price up on you once you get 
older. Once you get older, they are going to be able to age-rate you.
  Mr. Speaker, insurance commissioners in the various States may be 
able to look after the senior citizens, but I just think it is a really 
terrible approach. It is the kind of approach we have been taking to 
everything, give it back to the States, but on health care I think we 
are making a big mistake when we are trying to have a patchwork quilt.
  It is going to be a spot, State-by-State approach to this problem, 
and I do not think it is the right way to go. We need comprehensive 
health care reform that regulates the insurance companies on the 
national level, because in a small State like mine in Rhode Island, 
these insurance companies are going to be able to run roughshod over us 
and we are not going to have a leg to stand on.
  My State is a million people. Do you think we are going to be able to 
stand up to those insurance companies and say, ``Hey, what you're doing 
is wrong''? Forget it. We cannot do it. We have got insurance companies 
in our State who are already threatening to say, ``We're not going to 
write your automobile insurance anymore.'' I do not want that to happen 
to health care and it should not happen to health care.
  Mr. BEILENSON. Mr. Speaker, I yield 2 minutes to the gentleman from 
Michigan [Mr. Dingell].
  Mr. DINGELL. Mr. Speaker, I rise to direct a question to the manager 
of the rule. I note that in the last words in the rule, it says, ``Upon 
the adoption of the conference report, Senate Concurrent Resolution 19 
shall be considered as agreed to.''
  To what are we agreeing in this rule? Can anybody help me to know 
what is in Senate Concurrent Resolution 19? I think this is an 
important matter, because the Senate would not have passed a concurrent 
resolution on it unless it were important, but we are being asked to 
agree to this.
  To what are we being called upon to agree? Is this something that was 
considered in the 1-minute conference which we had between 5:00 and 
5:01, or was it some matter which was not considered, which now must be 
considered and added to the proceedings of this body?

                              {time}  1130

  Mr. DINGELL. Mr. Speaker, can the gentleman from Virginia [Mr. 
Bliley], my good friend, tell me what momentous Senate concurrent 
resolution we are adopting in the rule and why we could not consider it 
out in the open and have everyone know what we are doing here?
  Mr. BLILEY. Mr. Speaker, will the gentleman yield?
  Mr. DINGELL. I yield to the gentleman from Virginia.
  Mr. BLILEY. Mr. Speaker, I would say to the gentleman from Michigan 
[Mr. Dingell] that it is right out in the open. That the Senate 
resolution merely conformed the title to what we are doing.
  Mr. DINGELL. Mr. Speaker, I would ask the gentleman, is that because 
we were sloppy in the House or because the Senate was sloppy or because 
the conference was sloppy in the processing of legislation? I 
understand that the title is to be changed so that it no longer refers 
to an amendment to the Social Security Act, but it refers now to an 
amendment to OBRA; is that correct?
  Mr. BLILEY. Mr. Speaker, if the gentleman will continue to yield, it 
is not the proper duty for us to question what the motives of the 
Senate were for doing what they do. But I did point out that the 
resolution does conform the title to the bill. That is done all the 
time.
  Mr. DINGELL. With great respect for my colleague, what this shows is 
this is stupid legislation, further done with great speed and limited 
wisdom.
  Ms. PRYCE. Mr. Speaker, I continue to reserve my time.
  Mr. BEILENSON. Mr. Speaker, I yield 2 minutes to the gentleman from 
California [Mr. Fazio].
  Mr. FAZIO of California. Mr. Speaker, I had not intended to speak on 
this, but I felt at this point that I would want to comment. The 
gentleman from Rhode Island [Mr. Kennedy] raises what I think are 
generally concerns about the entire way the health insurance industry 
is regulated in this country and the problem with adverse selection and 
other factors that really can work against the interest of working 
people and seniors generally. There is not doubt that this body needs 
to address unfair insurance practices and the overall problems of our 
patchwork health care systems. Furthermore, I do not believe that 
debate over this measure should be mistaken for the broader debate that 
needs to take place over protecting and improving on our Medicare 
system. What is important to keep in mind is that this program has been 
a positive if small step, toward providing more MediGap options for 
seniors who can get additional benefits at no more cost.
  Therefore, Mr. Speaker, I rise in support not only of this rule, but 
of expanding this effort to experiment with health maintenance 
organizations and other forms of managed care in all 50 states.
  While all of the data on this program is not conclusive, in my state 
of California, this demonstration project appears to be working. 
Seniors have the choice of opting for managed care MediGap programs or 
they can stick with a more traditional fee-for-service type MediGap 
Program. It is their choice.
  There is a high rate of consumer satisfaction with these plans. Last 
year Consumer Reports Magazine rated the top 15 MediGap insureres 
nationwide. Eight
 of them were from the Medicare 

[[Page H6666]]
Select Program. And while we need more analysis, there are strong 
indications that the program could eventually keep costs down.

  I must emphasize that this is not a carte blanche extension. Medicare 
select cannot become permanent if the Secretary of Health and Human 
Services determines that it costs the Government money, that it did not 
save beneficiaries money, and did not provide quality health care. And 
I think it is the responsibility of both sides of the aisle to make 
sure that all three of those criteria are met and that we back the 
Health and Human Services Secretary if she or any of her successors 
determine that we have failed to meet this criteria.
  Mr. Speaker, I would hope that this Congress, while supporting this 
today, will pay attention to the data that results from these further 
experimentations. Medicare select is an important test case for the 
Medicare system.
  Mr. BLILEY. Mr. Speaker, I rise in support of the rule waiving points 
of order on the Medicare select conference report.
  The Medicare select program provides Medicare beneficiaries with a 
cost effective alternative to typical MediGap policies. It gives 
seniors the option of purchasing a MediGap policy for hundreds of 
dollars less than the typical policy. Hundreds of thousands of Medicare 
beneficiaries benefit from these policies.
  Medicare select policies, however, are sold through a demonstration 
authority which expires tonight at midnight. This conference report 
will extend the program and allow all States to participate in this 
excellent program which provides less costly MediGap policies to our 
Nation's elderly.
  At this late date, however, our colleagues on the other side of the 
aisle were attempting to delay the continuation of this program by 
raising the most obscure and nitpicking objections based on scope 
violations. There are no real scope problems in this conference report. 
However, the Democrats in their effort to stop this program were 
resorting to technical nitpicking.
  And who will be the individuals hurt if this program is stopped? The 
hundreds of thousands of elderly who have purchased these policies. I 
ask you to support this rule so that we can proceed to the 
consideration of the conference report. A vote for this rule is a vote 
for our Nation's Medicare beneficiaries, who can then gain the benefits 
of these innovative MediGap policies which provide high quality care at 
an affordable price.
  Mr. BILIRAKIS. Mr. Speaker, I rise in support of the rule on the 
conference report on Medicare Select. I come to the floor with a strong 
feeling of deja vu. When I appeared on the floor to speak in favor of 
passage of H.R. 483 earlier this spring, I indicated how important the 
Medicare Select Program was and how the fate of half a million 
beneficiaries rested on the action taken by the House.
  The road to this point, in my view has been unnecessarily long. If it 
were not for the action on the other side of the aisle, we would not be 
here at the 11th hour seeking passage of a rule to bring this 2 page 
conference report to the House floor. We have delayed long enough.
  Medicare Select is a very simple program. It 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 1 of 11 options currently available.
  I urge my colleagues to pass this rule so that we can enact this 
legislation swiftly. Our senior citizens deserve no less.
  Mr. BEILENSON. Mr. Speaker, I have no further requests for time, and 
I yield back the balance of my time.
  Ms. PRYCE. Mr. Speaker, I have no further requests for time, I yield 
back the balance of my time, and I move the previous question on the 
resolution.
  The previous question was ordered.
  The resolution was agreed to.
  A motion to reconsider was laid on the table.
  Mr. BLILEY. Mr. Speaker, I call up the conference report 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.
  The Clerk read the title of the bill.
  The SPEAKER pro tempore (Mr. Hastert). Pursuant to the rule, the 
conference report is considered as having been read.
  (For conference report and statement, see proceedings of the House of 
Thursday, June 22, 1995, at page H6256.)
  The SPEAKER pro tempore. 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].


                             general leave

  Mr. BLILEY. Mr. Speaker, I ask unanimous consent that all Members may 
have 5 legislative days in which to revise and extend their remarks on 
the conference report to accompany H.R. 483.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Virginia?
  There was no objection.
  Mr. BLILEY. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I urge my colleagues to join me in supporting the 
conference report to extend the Medicare Select Program. The conference 
report provides for a 3-year extension of the program. The report 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 (1) Medicare 
select has not resulted in savings to Medicare Select enrollees, (2) it 
has led to significant expenditures in the Medicare program, or (3) 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 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. Speaker, I urge my colleagues to join me in supporting this 
conference report.
  Mr. Speaker, I reserve the balance of my time.
  Mr. DINGELL. Mr. Speaker, I ask unanimous consent that my time be 
equally divided between myself and the gentleman from California [Mr. 
Stark], a member of the Committee on Ways and Means, and that he be 
permitted to control that time.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Michigan?
  There was no objection.
  Mr. DINGELL. Mr. Speaker, I yield myself 4\1/2\ minutes.
  (Mr. DINGELL asked and was given permission to revise and extend his 
remarks.)
  Mr. DINGELL. Mr. Speaker, the agreement we are voting on today 
extends the Medicare select demonstration program to all 50 States for 
a 7\1/2\-year period beginning in 1992.
  It does so with no appreciation of the consequences of this. Although 
many support this program, I believe that because Medicare cuts 
required by the Republican budget in the amount of some $270 billion 
are so drastic, and 

[[Page H6667]]
will require such fundamental reductions in the Medicare program, it is 
impossible to pass any Medicare legislation, including Medicare select 
without taking those reductions into account.
  In addition, Mr. Speaker, as many of my colleagues know, we argued in 
the committee that we should await the results of the State evaluations 
before expanding this program to all 50 States. It has come to my 
attention that the preliminary results of this evaluation are now in, 
but they have not been made available by the handlers of the 
legislation.
  Those results indicate that Medicare select is significantly 
associated with Medicare cost increases in 8 of 12 select States. Let 
me repeat that. Medicare select is associated with cost increases in
 8 of 12 States.

  Furthermore, the cost increase is 17.5 percent. The cost increase is 
17.5 percent. That is not fiscal responsibility.
  Now, while I know these results will not be final until next month, 
we should clearly examine the results before passing an expansion to 
all 50 States. How can we possibly extend a program that has the 
potential of increasing Medicare costs in all of the 50 States, as it 
has in the States in which it is now used by the amount of 17.5 
percent?
  This leads one to the unfortunate conclusion that my Republican 
colleagues are willing to cut back on benefits to Social Security 
recipients and to Medicare recipients, but that they are not willing to 
lock up a program which is going to increase costs to the Medicare 
system and to increase profits to the insurance companies.
  Mr. Speaker, I therefore urge that we vote ``no'' on the conference 
agreement on H.R. 483, and that we reconsider these changes in the 
light of evaluation results and in the context of budget 
reconciliation. Then we can more fully examine the entire Medicare 
Program, which is going to be examined in extenso in connection with 
reconciliation, because we are going to have Republican cuts in 
Medicare recipients, and we should include the Medicare cost increases 
which will result in the additional beneficiary out-of-pocket costs 
that will occur under this program, along with increased utilization 
and limitations on the beneficiaries' choice of providers as indicated 
in the preliminary report.
  Let me remind my colleagues that Medicare select has had some 
peculiar consequences. It has not been the unmixed blessing which the 
proponents would have us believe. First of all, it has raised costs, 
but it has done some other things which have significant impact on 
recipients.
  It first of all starts out low and goes up. The average premium cost 
at the beginning is around $870 a year. But by the time the recipient 
has reached the age of 85, it has risen, lo and behold, to something 
like $2,300 a year.
  Now, during that time he is locked in because any preexisting 
conditions which he had during the time or before he got on Medicare 
select, he cannot carry over and have treated in any new package. So if 
a person joins this Medicare Select Program, he is locked in. He cannot 
get out because he cannot get treatment for new conditions.
  Those new conditions are carefully walled out by preexisting 
condition clauses in any new insurance policy. So he pays more and more 
and more and he cannot get out. If his doctor moves or his hospital 
closes or some condition requires him to want to go to a particular 
person, doctor, or facility for treatment and they are not included in 
this HMO, that individual cannot go.
  This is Medicare select all right. It is selected for the benefit of 
the insurance companies who are going to make lots of money. And they 
are going to make it, in part, off the Medicare trust fund and they are 
going to make it in part off of the poor little guy who is dependent on 
Medicare for providing his benefits.
                              {time}  1145

  They are going to skin the public, and everybody is going to act with 
great surprise when we find the new returns and the new information 
show us that we have in fact cost ourselves a lot more money; we have 
in fact denied Social Security and Medicare recipients benefits; and we 
have benefited the health insurance industry; and we have left 
ourselves in a situation where we all of a sudden find that Medicare 
has cost a lot more.
  I urge my colleagues, vote this down. Let us consider it in a more 
temperate fashion, and let us consider it when we can have a look at 
all of the things, including the cuts in Medicare benefits which are 
coming to the Medicare recipients courtesy of my good friends and 
colleagues on the Republican side of the aisle.
  Mr. BLILEY. Mr. Speaker, I yield 2 minutes to the gentleman from 
Texas [Mr. Archer], the chairman of the Committee on Ways and Means.
  Mr. ARCHER. Mr. Speaker, I thank the gentleman for yielding and 
compliment him on his good work on this bill.
  It is a good conference agreement that deserves the support of every 
Member of this House. The Medicare Select Program expires today if we 
do nothing.
  Early in the session, we heard from Members who opposed this program, 
that there is no need to rush, that we are moving too quickly, and yet 
here we are only hours away from the program expiring and over 450 
thousand seniors are still uncertain as to their fate under this 
important program.
  The Senate has already passed the conference report by unanimous 
consent. The 408 Members of the House who voted in favor of extending 
the Medicare Select Program earlier in this session should support this 
conference report and send it to the President for his signature 
tonight. It is a simple, noncontroversial bill which extends to seniors 
across the country the opportunity to choose at their option a Medigap 
program that has proven highly successful, high quality, and cost 
effective, and contrary to comments that were made earlier a few 
minutes ago, the
 CBO scores this as revenue neutral to the Medicare Fund, and the 
opponents of this know that.

  My thanks to all the members of the Committee on Ways and Means and 
Committee on Commerce who have made this legislation possible. I 
particularly cite the outstanding work of two members of my own 
Committee on Ways and Means, the gentleman from California [Mr. Thomas] 
and the gentlewoman from Connecticut [Mrs. Johnson]. It was their 
energy and commitment that brought us to this point today.
  Mr. Speaker, this is a worthy proposal. I urge an ``aye'' vote on the 
conference report.
  Mr. STARK. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, this conference report legislation seeks to extend and 
expand the capricious demonstration program which will endanger the 
Medicare program and its beneficiaries.
  Basically it is a license for the insurance companies to steal.
  Medicare is the finest health care program in the county. There is no 
insurance plan in the country that offers more beneficiary choice. It 
is valued because we in Congress have worked long and hard to make it 
so.
  Today by forcing a premature expansion of this demonstration program, 
the Republicans in Congress are turning their backs on this great 
tradition. Republicans are putting the interests of private insurance 
companies ahead of the Medicare program, not only in this bill, but in 
their budget bill which seeks to cut $270 billion out of the Medicare 
program, and they are ignoring the beneficiaries who rely upon it for 
their health care security.
  This bill, as I have said before, is written by a Republican Ways and 
Means staff member who, within the past year, was receiving hundreds of 
thousands of dollars from the health insurance industry. Talk about big 
time sellout to private interests, this bill takes the cake.
  Medicare select will be presented as a program without problems, just 
another choice for the seniors to elect. The facts are quite different.
  At the time of the committee action on this bill, only a very 
preliminary evaluation of the Medicare Select Program had been 
concluded. That preliminary analysis found as follows:

       There is little coordination or management of care by 
     organizations offering Medicare Select. The network formed by 
     insurance companies were initially organized to increase 
     Medicare market share at network hospitals rather than to 
     minimize utilization.

  Since the time of the committee action, a more complete evaluation of 


[[Page H6668]]
Medicare select has been conducted, and before my Republican friends 
dismiss the report as some partisan document, I would like to remind 
them that this report was commissioned by a Republican administration, 
and the researchers who conducted the study were selected by that 
Republican administration. The study has been ongoing
 for well over 2 years. I will enter the study in the Record, and it is 
important to note here that in the study it talks about costs and 
utilization findings to date. The study says:

       We were surprised to find Medicare Select is significantly 
     associated with Medicare cost increases in 8 of the 12 select 
     States: Alabama, Arizona, Florida, Indiana, Kentucky, 
     Minnesota, Texas, and Wisconsin. For the eight States 
     indicating positive impacts on Medicare program costs, the 
     average impact is 17.5 percent. The estimates vary from 7\1/
     2\ percent in Minnesota to a 57-percent cost increase in 
     Indiana. However, only the Indiana estimate is much more than 
     20 percent. The results indicate that the cost increases 
     substantially reflect increases in inpatient hospital 
     utilization. These estimates are unusually robust.

  That is the understatement of the day, 17.5 percent increase on the 
Medicare trust fund, in addition to cutting $270 billion out. As I have 
said before, you would save the taxpayers a lot of money if you just 
introduced a resolution to eliminate Medicare tomorrow, let the 
Republicans vote for it. That is basically what they intend to do. Let 
the public see their true colors.
  Given the findings and the fact that the Congressional Budget Office 
found that this study raises serious questions about the operation of 
the Medicare Select Program, why are the Republicans rushing forward to 
extend and expand this demonstration project, particularly when they 
are trying to reduce Medicare expenditures? Are they that cavalier 
about the report's conclusion? For months congressional Democrats and 
the administration have called for a limited extension of the program 
in order that the assessment of the demonstration could be completed 
and necessary adjustments made based upon its findings. Republicans 
have only marched forward faster.
  Why? Whose interests are the Republicans responding to in this 
intemperate bill? Why are we trying to reduce costs under Medicare, and 
this program at the same time is moving in exactly the wrong direction?
  Halting the expansion of this demonstration program is the only 
prudent action for us to take.
  Proponents of this bill have made the claim if we do not extend it 
beneficiaries will be harmed. That is wrong. It is absolutely not the 
truth. Everyone
 should understand there is no current participant in the Medicare 
select plan who will lose coverage if we do not extend the program 
today. Certainly, additional beneficiaries will be prohibited from 
enrolling after today, but current enrollees would be allowed to 
continue in the plans.

  By voting ``no'' today, the program evaluation will be allowed to be 
completed without corrupting Medicare.
  And, third, voting ``no'' today will confirm our responsibility for 
the fiscal integrity of Medicare by blocking a premature expansion of 
this program.
  How can any of us explain to our constituents a vote to expand a 
program from 15 to 50 States that has just been found to raise costs to 
the Federal Government by tens of millions of dollars? That is fiscal 
irresponsibility at its highest.
  For those who ignore the evidence and vote to expand this program 
today, before adjustments can be made to it, you are in effect voting 
to increase Medicare's costs by $800 for each beneficiary who ends up 
in one of these plans. That is not fair to the seniors.
  Finally, what does the Medicare beneficiary get who is in the 
Medicare select plan? Access to a very limited network of doctors and 
hospitals. You prevent them from getting the ability to switch out of 
the Medicare select plan and back into a reasonable MediGap program. 
You deny them their choice of medical independence.
  In my home State of California, the Medigap plan will cost them an 
extra $3,360 in premiums.
  For the fiscal integrity of the Medicare trust fund and the 
protection of beneficiaries, you must vote ``no'' on the conference 
report to H.R. 483.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BLILEY. Mr. Speaker, I yield such time as he may consume to the 
gentleman from Florida [Mr. Bilirakis], the chairman of the Health and 
Environment Subcommittee.
  (Mr. BILIRAKIS asked and was given permission to revise and extend 
his remarks.)
  Mr. BILIRAKIS. Mr. Speaker, I rise in strong support of the 
conference report on H.R. 483, legislation to extend and expand the 
Medicare Select Program.
  The Omnibus Reconciliation Act of 1990 was established by a 
Democratic Congress, under which insurers could market an additional 
Medigap product, an additional Medigap choice, known as Medicare 
select. Medicare select policies 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 
through June 30, 1995, in the Social Security Act Amendments of 1994.
  The conference report on Medicare select provides that:
  First, Medicare select is extended to all 50 States for a 3-year 
period. The Secretary is required to conduct a study comparing Medicare 
select policies with other Medigap policies in terms of cost, quality, 
and access. Further, it provides that Medicare select will remain in 
effect unless the Secretary determines, based on the results of the 
study, that Medicare select has: First, not resulted in savings of 
premium costs to beneficiaries compared to non-select Medigap policies; 
second, resulted in significant additional expenditures for the 
Medicare Program; or third, resulted in diminished access and quality 
of care.
  Second, GAO is required to conduct a study by June 30, 1996 to 
determine the extent to which individuals who are continuously covered 
under Medigap policies are subject to medical underwriting if they 
switch plans and to identify options, if necessary, for modifying the 
Medigap market to address this issue.
  Select policies do not affect the obligation of Medicare to pay its 
portion of the bill. Beneficiaries who obtain covered services through 
one of the network's preferred providers will generally have their 
benefits paid in full. Under OBRA 1990, the select plan is also 
required to pay full benefits for emergency and urgent-out-of-area care 
provided by non-network providers.
  Select policies do not remove a beneficiary's freedom to choose any 
fee-for-service provider.
 If a beneficiary is unhappy with a Medicare select provider for any 
reason, that person may opt out at any time to get off the plan and 
pick up any other Medigap policy, or he can remain in the plan and go 
to any provider, and Medicare will pay if it is a covered service. 
However, in that case, the beneficiary may be liable for a deductible 
and coinsurance.

  An insurer marketing a select policy is required under OBRA 1990 to 
demonstrate that its network of providers offers sufficient access to 
subscribers and that it has an ongoing quality assurance program. It 
must also provide full and documented disclosure, at the time of 
enrollment, of: network restrictions; provisions for out-of-area and 
emergency coverage and availability; and cost of Medigap policies 
without the network restrictions.
  In addition, Medicare select policies are governed by the same types 
of regulations imposed on Medigap policies concerning: limitations on 
preexisting conditions; loss ratios; portability; guaranteed renewal, 
and open enrollment.
  OBRA 1990 also included significant penalties for Select plans that: 
Restrict the use of medically necessary services; charge excessive 
premiums; expel an enrollee except for nonpayment of premiums; or 
withhold required explanations or fail to obtain required 
acknowledgements at the time of enrollment.
  The following are Medicare select demonstration States: Alabama, 
Arizona, California, Florida, Illinois, Indiana, Kentucky, 
Massachusetts, Minnesota, Missouri, North Dakota, Ohio, Texas, 
Washington, and Wisconsin.
  As of October 1994, approximately 450,000 beneficiaries were enrolled 
in Medicare select; while the majority are covered through Blue Cross/
Blue Shield plans, approximately 50 companies offer Medicare select 
products.

[[Page H6669]]

  Current authority for the program expires in June 1995. Failure to 
extend the authority for the program would result in the inability of 
insurers to enroll new beneficiaries in Medicare Select Programs as of 
July 1995, although they could continue to serve current enrollees. 
This would lead to higher premiums for enrollees and the potential 
withdrawal of insurers from the market.
  Is that what we want? It seems to me that none of our people want 
that. The gentleman from California has stated that Medicare select 
plans are not adequately regulated and has told us how terrible the 
plans are. Well, that is his opinion. Here are the facts:
  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 ten 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.

                              {time}  1200

  Mr. BLILEY. Mr. Speaker, I yield 1 minute to the gentleman from 
California [Mr. Bilbray], a member of the committee.
  Mr. BILBRAY. Mr. Speaker, I have to stand in support of the proposal, 
and I just want to point out to my colleague from California there is a 
100,000 Californian seniors that want that choice. I have a stack, I 
have stacks of comments coming from my seniors in my district saying 
how it is nice to be able to have options that Washington is not 
mandating on seniors, that seniors are allowed to be treated as 
dignified individuals. This program was something that has worked, is 
continuing to work, in our State, and to restrict it not only from the 
rest of the country, but to allow it to die, is not a vote in support 
of seniors and their dignity, but actually a support to replace the 
dignity of seniors' choices with big centralized Federal control 
systems, and I think the problem is some of our colleagues are so 
wedded to command and control, big, centralized government that they 
are willing to sacrifice our seniors' ability to have the dignity of 
having their choice to choose something that serves them, and I think 
that we need to start treating our seniors with the dignity they earned 
over the years.
  Mr. DINGELL. Mr. Speaker, I yield 5 minutes to the distinguished 
gentleman from California [Mr. Waxman].
  Mr. WAXMAN. Mr. Speaker, I rise in opposition to the adoption of the 
conference report on H.R. 483, a bill to permit Medicare select 
policies to be offered in all States.
  Let me state that I oppose adoption of this conference report 
reluctantly. We have underway in a limited number of States, including 
my own State of California, a demonstration project to study the value 
and effects of Medicare select policies. I favor letting that 
demonstration continue. I favor continuing to offer Medicare select 
policies where they are currently being tested under the demonstration.
  But I have grave concerns about expanding Medicare select to all 
States. At the time this bill passed the House I raised these concerns 
and suggested the prudent course would be to wait and receive the 
evaluation of the demonstration that was underway. We did not.
  Now, before the conference was concluded, HCFA provided us with some 
preliminary information that the evaluation was finding. And that 
information should give pause to any prudent legislator. They found 
that Medicare select was significantly associated with cost increases 
in spending in the Medicare program itself in 8 of the 12 States where 
select policies were offered.
  Surely, on a day when the Republicans in this House passed over the 
nearly unanimous objection of the Democrats a budget which slashes 
Medicare spending by $270 billion over the next 7 years, it is folly to 
pass legislation which threatens to increase the cost to the public of 
Medicare so that more private insurance companies can reap profits on 
their Medicare select policies.
  It is only prudent to stop this expansion of Medicare select until we 
can be sure that they are not adding to expenditures in the Medicare 
Program.
  We might also pause and consider the irony of the actions we have 
taken today. Let's think about why we need MediGap and Medicare select 
policies in the first place.
  We need these policies for one simple reason: Medicare requires 
people to pay a lot of money out-of-pocket when they get sick. Most 
Medicare beneficiaries are so frightened by the amounts they have to 
pay if they get sick that they spend hundreds of dollars to buy MediGap 
protection.
  And yet, as a result of the Republican budget this House adopted 
today, 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. And if they just can't afford a Medigap 
policy any more--they will live in fear of having to pay a lot of out-
of-pocket costs.
  Some 4 million seniors under this Republican budget may find that 
they can't even afford to pay the higher premium to keep Medicare Part 
B protection at all. Once Medicaid is an under-financed block grant 
program--which is what the Republican budget makes it--seniors can 
forget about any assurance of help from Medicaid to pay their Medicare 
premiums.
  Remember, who the typical person is who relies on Medicare. Most 
Medicare beneficiaries have modest incomes of $25,000 or less. Nearly a 
third of them depend on Social Security for almost all of their income. 
And now they are going to find that this Republican budget means that 
half of their Social Security COLA is being eaten up by increased 
premiums and cost-sharing in Medicare.
  We ought to be talking today about how to make Medicare better--about 
how to help people who can't afford the prescription drugs they need, 
who fear ending up in a nursing home that they can't afford.
  Instead this House adopted a Republican budget that slashes the 
Federal commitment to Medicare and Medicaid. And we now are about to 
adopt a conference report which extends a program which might be 
costing Medicare money instead of saving it.
  This is not responsible legislating. This is not putting the 
interests of Medicare and Medicaid beneficiaries first.
  I urge rejection of the conference report.
  Mr. BLILEY. Mr. Speaker, I yield such time as she may consume to the 
gentlewoman from Connecticut [Mrs. Johnson], the principal author of 
this legislation.
  Mrs. JOHNSON of Connecticut. Mr. Speaker, I thank the gentleman from 
Virginia [Mr. Bliley] for his leadership and hard work on getting this 
program before us for final action.
  Mr. Speaker, I am very pleased to rise today in support of this final 
agreement to extend and expand Medicare select. This is the right kind 
of health plan choice for us to make available to all seniors in 
America at this time. Medicare select is a Medigap policy. That is it 
is just insurance covering costs and services that Medicare does not. 
The difference is the Medicare select enrollees get their care from a 
preferred provider organization, but they are still Medicare 
beneficiaries. Medicare will cover health care costs for them even if 
they go outside the network. By staying within the network 
beneficiaries make the best use of their coverage because the health 
plan picks up most or all of their out-of-pocket costs.
  Medicare select is not, and I repeat, not, an HMO risk contracting 
plan. Such plans require beneficiaries to get their care entirely 
within the network or Medicare will not pay. With select, seniors in 
America have that choice to be part of an integrated system of care, 
but still go outside that system if they want to and if they choose to. 
Medicare covers their charges outside that network.
  It is very important that, as we carry forward this debate and as we 
give seniors choices in America, they understand clearly what their 
choices are, 

[[Page H6670]]
and so I want to make clear that my esteemed colleague from Michigan is 
not quite correct when he says that seniors would be locked into these 
programs. With due respect, in fact he is wrong. Any senior in this 
program, any Medicare Select System, can go outside that system and, as 
a Medicare beneficiary, can receive care under Medicare terms, but in 
addition any senior in a Medicare Select Program can change plans. They 
can drop this MediGap policy and pick up another MediGap policy, and in 
every single State in America there are MediGap policies on the market 
that have no exclusion for preexisting conditions that do not block any 
seniors out. In sum, in fact, the idea that any senior is locked into a 
Medicare select choice is simply not accurate, and that is important 
for seniors to know.
  Medicare select also saves beneficiaries money. We know that seniors 
on fixed incomes have a tough time in this environment, and Medicare 
select saves them up to 38 percent premium costs.
  Medicare select is not a Government program. It is an insurance 
program, and, as such, it is regulated at both the Federal and State 
levels. It operates around the Medicare Program, and in those States 
where it has been expanded, it is saving dollars.
  In California with select the cost of medical services per admission 
is 20 percent lower than for nonnetwork providers. The average length 
of stay in a hospital is 73 percent lower than for nonnetwork 
providers, attesting to the management of care, the integration of 
care, and only one-third as many enrollees are ever admitted to a 
hospital from these integrated care systems, a great advantage for the 
elderly. A Washington State Medicare Select Plan operator has reported 
that Medicare select policies cost 13 percent less than the traditional 
insurance policy. Even after adjusting for demographic factors the 
plans realized a 5-percent savings to the Medicare Program.
  Now those figures are about real experience. How does that real 
experience line up with some of the comments that my colleagues have 
made about the preliminary conclusions of the report that we, as 
Members of Congress, asked HCFA to do so that we can understand the 
strengths of this program and the weaknesses more fully?
  This is basically how it boils out. That report is reporting very 
preliminary data. The researchers themselves say the results are 
inconclusive, but listen to what they say about those areas in which 
they have seen costs increase. The researchers suggest that under these 
managed care entities, that is the Medicare select plans, and I quote 
from the report, new patient screening has detected a large backlog of 
formerly undiagnosed and untreated problems. This has meant that new 
patients have unexpectedly large, albeit short-term requirements for 
medicare treatment. In other words, Medicare select plans are offering 
seniors far more careful, comprehensive analysis of their health care 
problems, and, yes, short term it costs more, and many of these plans 
that this report, this study, is reporting have only been in place 3 
months, so we have only been through the high cost analysis and the 
early treatments.
  In one of the States where the program has been in place since 1992, 
and they have 4 years of cost data, they are seeing significant 
savings. I ask, ``Isn't that just what we want? Don't we want early 
intervention? Don't we want prevention? Don't we want that backlog, the 
formerly undiagnosed and untreated problems, dealt with for seniors in 
America? And most importantly, don't we want seniors to have the 
choice, the voluntary choice, of that quality health plan?'' I, for 
one, do, and my constituents want this choice as well.
  As a State that does not have a demonstration project, I get letters 
daily saying when are we going to have that choice. I urge my 
colleagues to adopt this conference report and to help us take the 
first step toward giving seniors in America better choices for their 
health care.
  Mr. STARK. Mr. Speaker, I yield 3 minutes to the gentleman from 
Maryland [Mr. Cardin].
  Mr. CARDIN. Mr. Speaker, I thank my colleague for yielding me this 
time.
  Mr. Speaker, I support Medicare select and will vote for the 
conference report to extend this program to all 50 States. If it is 
properly structured, it can provide more competition, choice and cost 
savings. However I must tell my colleagues I am concerned that the 
study that was commissioned by HCFA shows that there might be increased 
costs associated with Medicare Select Programs in at least eight States 
which currently have the program. But what primarily concerns me: It 
seems like this Congress is acting or making decisions on what appears 
to be facts. When we look at the information we may be acting on what 
we believe to be correct rather than what the facts show.
                              {time}  1215

  Congress is taking as fact that Medicare select extends managed care 
into the MediGap marketplace and it will save money. Yet when we look 
at the study, that may not be in fact the case unless the Medicare 
select program is properly structured. Is this a preview of what will 
happen when we get to the budget debate?
  In the near future we are going to be called upon to act on 
legislation to cut the Medicare program by $270 billion. Are we going 
to make these decisions on fact or beliefs? There are very limited ways 
in which we can reduce the Medicare program by $270 billion. We are 
going to be calling upon our beneficiaries to pay more, higher copays 
and deductibles, putting more pressure on the Medicare select program.
  We are going to be asking our seniors who already as a class pay the 
highest amount of out-of-pocket costs, on average 21 percent of their 
income is used for out-of-pocket costs. If we are going to be talking 
about $27 billion in Medicare cuts, we are going to be asking our 
seniors to pay more in copays and deductibles. Will we be acting on our 
beliefs or on facts?
  I am very concerned about that, Mr. Speaker, and concerned that we 
will not be looking at what impact those types of cuts will have on our 
seniors. I am worried that we are going to have to cut benefits. The 
Medicare program already does not cover prescription drugs and very 
little benefits for long-term care, really no catastrophic care. Yet we 
are going to be asked to make cuts in the program that could very well 
take away benefits from our seniors on the belief that that may be 
acceptable. I want to act upon fact.
  We already have inadequate reimbursement levels and cost shifting 
within the Medicare system, causing in many areas our seniors to be 
jeopardized from receiving quality care. Are we going to be asked to 
make additional cuts that could very well cause more cost shifting and 
less adequate care to our seniors on the belief that that can be 
absorbed? I want to act upon facts.
  The consequences of our actions will dramatically affect our Nation's 
seniors and their health care. It is imperative that we make these 
changes based upon the best data available, not just data that we 
choose to believe.
  I hope in the future when we act upon Medicare that we do it upon the 
facts.
  Mr. BLILEY. Mr. Speaker, may I inquire how much time remains?
  The SPEAKER pro tempore. The gentleman from Virginia [Mr. Bliley] has 
13 minutes remaining, the gentleman from Michigan [Mr. Dingell] has 
4\1/2\ minutes remaining, and the gentleman from California [Mr. Stark] 
has 5 minutes remaining.
  Mr. BLILEY. Mr. Speaker, I yield such time as he may consume to the 
gentleman from California [Mr. Thomas].
  Mr. THOMAS. Mr. Speaker, I thank the gentleman for yielding time to 
me. As chairman of the House subcommittee of the Committee on Ways and 
Means, we have looked at this over a period of time.
  As a member of the conference committee, we produced a conference 
report. I am a little confused by the gentleman from Maryland's 
statement that we would want to base a decision as to whether or not we 
would go forward with the program on a permanent basis on facts rather 
than just assumptions or desires or wishes or hopes.
  I can only assume that the gentleman from Maryland did not read the 
conference report, because I would join him, if, in fact, we were 
talking about creating a permanent program without a basis of analysis 
of a pilot program.

[[Page H6671]]

  Despite what may have been from any of the speakers who are in 
opposition to this, all this does is continue a program until the 
Secretary determines that, in fact, there are savings, that this is a 
better program. If the Secretary of Health and Human Services, after a 
3-year study, says that this is not saving money, it is not a better 
program, the program ends. If she finds it does, it goes forward.
  So, first of all, the conference report says, we are going to take 
this pilot program that is in 15 States, make it available to 50 
States, but not on a permanent basis. We are going to examine the 
results after 3 years. And then we will make a determination as to 
whether or not it is to be permanent.
  We heard talk about a study over here. As a matter of fact, on the 
earlier pilot program, there was supposed to be a study reported to 
Congress in January. Six months later, it still has not issued a 
report. What they are talking about is a preliminary finding which was 
leaked by this administration.
  We had the head of the Health Care Financing Administration in front 
of the subcommittee in which we said, you know, this seems to be a 
politically charged issue. We have folks who are taking extreme 
positions and making statements not based upon fact for whatever reason 
they choose to do so, and I am concerned about the political 
atmosphere.
  So, Mr. Valdeck, please make sure that your operation does not 
prematurely leak information which may not have been fully evaluated 
about this program.
  Mr. Valdeck in front of the Health Subcommittee said, you bet; we 
will make sure this information does not come out until it has been 
analyzed and properly understood and presented. Lo and behold, several 
weeks ago, initially on the Senate side and now we have heard 
statements read here that are supposedly flat-out statements of fact 
that this study shows that there are higher costs. In fact, that is not 
the case.
  Mr. Valdeck apparently was so embarrassed by this that he wrote me a 
personal note saying that he was embarrassed that the study had gotten 
out prematurely, that it has not been vetted. They have not done the 
proper correlations in the study. Somebody is very interested in 
killing this modest little proposal.
  Let us go back and remember what this is. Currently there are 10 
programs available to seniors to augment their Medicare program. They 
are called MediGap. They are insurance programs that fill in where 
Medicare does not offer as complete a package as people would want. 
What we are doing is talking about adding one more, an 11th to the 10 
that are already there, fully monitored by Health and Human Services. 
In fact, you have got to explain exactly what you are doing. You have 
to pass a standardized examination to
 make sure that you are doing what everybody else is doing. There are 
categories that have to be met. The seniors are fully protected and 
they have a choice.

  It is not mandated. You choose. We are simply saying instead of 10 
choices, we are going to offer 11 choices.
  You would think that we are reinventing the wheel by offering seniors 
11 choices rather than 10. All we are doing is saying that the 11th 
choice is of a kind of health care delivery service that more and more 
Americans find saving them money. That is what this is all about. These 
fellows over here who used to be the chairmen of the Health 
Subcommittee and Ways and Means, and the gentleman from California [Mr. 
Waxman] who spoke earlier was the chairman of the Health Subcommittee 
of Commerce, and the gentleman from Michigan was the chairman of 
Commerce, they are used to bottling up reform and change, especially 
the kind that had the private sector driving down costs in health care.
  They are kind of frustrated because with this new majority, different 
people are in charge. We want to try these new ideas, fully protected 
with studies by the Secretary making a determination as to whether it 
goes forward or not.
  So I understand their frustration. But in trying to deal with this 
frustration of being a new minority, you really ought to rely on facts 
rather than the kind of fear mongering and conjuring up of seniors 
deserted by their Government when you talk about the Medicare select 
program.
  The gentleman from North Dakota was absolutely right. This is a 
modest little program. We think it will save money. Four hundred eight 
Members of Congress, both Democrat and Republican, voted for this the 
first time around; 14 voted against it. We have high hopes that the 
same 408 and perhaps some of the 14 who voted against this might join 
in in sending it to the President today so that on this last day of the 
pilot program the President will sign this bill so that the seniors 
will not be fearful that this option will not be available to them.
  We are going to pass it today. I have high hopes the President will 
sign it tonight and then we will move on to more fundamental real 
reform where seniors will see that more choices will be available to 
them and that their Medicare dollar expenses will be covered by an 
ever-increasing amount from the Federal Government.
  Those are the facts.
  Mr. STARK. Mr. Speaker, I yield 2 minutes to the distinguished 
gentleman from Montana [Mr. Williams].
  Mr. WILLIAMS. Mr. Speaker, I thank the gentleman for yielding time to 
me.
  The Medicare Select Program as a model deserves support, and it 
should be renewed. In fact, we should expand the model, but we should 
keep it as a model until we know how well in fact it is going to work 
and what the difficulties in it are. And we already have reports that 
tell us there are difficulties in it.
  So, yes, we would like to see the program continued, but that is not 
what is going on here. This is a full-scale expansion of the program. 
We are not certain it works that well. And they want to put it, the 
Republicans do, in every State in this country. Now, why? and why 
today?
  Because yesterday the Republicans voted to cut Medicare. I know they 
say they did not cut Medicare but, my senior citizen friends, inflation 
is going to continue in health care; right? Of course. And new people 
are going to come into the system, of course. Are they going to receive 
the same services that today's senior citizens receive on Medicare? No, 
because the Republicans are going to cut close to $300 billion out of 
what is needed to meet current services. So do not let them tell you 
they are not cutting the program.
  This proposal being brought to the floor today is a duck and cover 
for yesterday's action of cutting close to $300 billion.
  There is a second reason that they are expanding this program and 
that is because the lobbyists, including the health care insurance 
lobbyists, are in full throat and are writing legislation for the 
Republican leadership.
  I chaired one of the subcommittees along with the gentlemen from 
California Mr. Stark and Mr. Waxman, that tried to reform national 
health care last time. And I learned something, I learned a lot, as 
chairman of that committee, as we passed out health care reform bills 
last Congress.
  But I learned one thing that I will never forget and that is, you can 
trust some of the health care insurance industry some of the time, but 
you cannot trust all of them all of the time. This country has to keep 
one eye on the insurance company, and this bill takes both Federal eyes 
off of the health care insurance industry. And senior citizens will rue 
the day we did it.
  Mr. BLILEY. Mr. Speaker, do I have the right to close?
  The SPEAKER pro tempore. The gentleman from Virginia [Mr. Bliley] has 
the right to close.
  Mr. BLILEY. Mr. Speaker, I reserve the balance of my time.
  Mr. DINGELL. Mr. Speaker, how much time do we now have remaining?
  The SPEAKER pro tempore. The gentleman from Michigan [Mr. Dingell] 
has 4\1/2\ minutes remaining, the gentleman from Virginia [Mr. Bliley] 
has 7 minutes remaining, and the gentleman from California [Mr. Stark] 
has 3 minutes remaining.
  Mr. DINGELL. Mr. Speaker, I yield 2 minutes to the distinguished 
gentleman from Michigan [Mr. Kildee].
                              {time}  1230

  Mr. KILDEE. Mr. Speaker, I thank the gentleman for yielding time to 
me.
  Mr. Speaker, I am deeply concerned about Medicare this year. First of 
all, 

[[Page H6672]]
we know that the Republican budget will cut Medicare by $270 billion 
over the next 7 years. That certainly has to be taken into 
consideration in the context of this bill. This bill, while it may have 
some merit, the plan may have some merit, I do not think we should be 
expanding it as this bill would propose. The bill does allow insurance 
companies to sell insurance policies to seniors that limit their 
choice, and they may be locked into those choices.
  Basically, Mr. Speaker, I fear that this year, this 104th Congress, 
we may see a series of things that will be weakening Medicare. First of 
all, this program itself is a pilot program. We should look at it more. 
One study indicates that it increases the cost about 17\1/2\ percent 
per beneficiary in 8 of the 12 States, and in only 1 State was there 
some possible cost savings.
  However, put that in context again with what I mentioned in the 
beginning, that we are cutting $270 billion from Medicare. We have to 
cast this bill in that context. We are using that cut from Medicare to 
pay for a tax cut for our very rich.
  Mr. Speaker, in my district, I do not see people asking for that tax 
cut, and especially, I think they do not want to take money from 
Medicare to pay for that tax cut. My mother died last year at age 84. 
In her life, both her mental health, her peace of mind, and her 
physical health was better served because of a good Medicare Program. 
We should approach this very, very carefully. Do not rob the account 
and do not expand this program without experience.
  Mr. STARK. Mr. Speaker, I yield 1 minute to the distinguished 
gentleman from Washington [Mr. McDermott].
  (Mr. McDERMOTT asked and was given permission to revise and extend 
his remarks.)
  Mr. McDERMOTT. Mr. Speaker, this is a perfect example of the triumph 
of ideology over American pragmatism. The Republicans say they are 
going to save the fund. First they take $86 billion out by a tax break. 
Then they take another $280 billion out by the cuts they are going to 
make. Then their solution is to pick a solution that does not work.
  There was a study done by the Research Triangle Institute which says 
it spends 17\1/2\ percent more for select than it does in the system we 
have today, which means they are going to spend it down quicker. The 
real result of their efforts is to get rid of Medicare. They want to 
break the system 17 percent faster by putting people into select. That 
is not a solution. It simply makes the problem worse. Everyone should 
understand it and vote ``no.''
  Mr. DINGELL. Mr. Speaker, I yield myself the balance of my time.
  The SPEAKER pro tempore. The gentleman from Michigan [Mr. Dingell] is 
recognized for 2\1/2\ minutes.
  Mr. DINGELL. Mr. Speaker, hurry, hurry, hurry. Let us get this bill 
through. Let us get it through before the facts are in. Let us get it 
in before it shows that this package for Medicare Select is in fact 
going to cost Medicare or the taxpayers more.
  Hurry, hurry, hurry. Let us get it through before it shows that the 
senior citizen recipients of Medicare are not going to get the option 
to move from policy to policy on their health insurance packages which 
would supplement their Medicare policies; and hurry, hurry, hurry, 
before it comes out that a policy which costs about $870 is going to go 
up to something like about $2,300 by the time you get to 85, if you buy 
it for $870 at age 67. Mr. Speaker, let us get this thing through 
before the people find out what we are about. That is what my 
Republican colleagues are saying. That is what is at issue today.
  What is good legislative practice and good legislation? It requires 
that we should wait and find out what the facts are. The information is 
already out. Medicare select is costing on the average 17\1/2\ percent 
more. That means that Medicare select is going to cost the Medicare 
trust fund 17\1/2\ percent more. It is going to trap senior citizens in 
policies on supplemental benefits that will not be able to be carried 
to new insurers because of preexisting conditions. Costs are going to 
go up.
  Senior citizens are not going to know this at the time that their 
good-hearted insurance salesman comes around to peddle them this 
wonderful new Medicare Select. The taxpayers are not going to know that 
this is in fact going to cause the Medicare trust fund to go broke 
faster.
  Hurry, hurry, hurry. Pass this thing before anybody finds out what is 
going on. Do it in a conference which takes less than 1 minute by the 
clock, and then have to be rescued by the Committee on Rules because 
such a poor job of legislation was done. Mr. Speaker, this is the way 
we are legislating today.
  I would urge Members to vote this outrage down and let us proceed 
more cautiously. Let us protect the public. Let us see to it that 
senior citizens, the Medicare trust fund, and the American people get 
decent treatment here from this Congress today.
  Mr. STARK. Mr. Speaker, I yield myself the balance of my time.
  The SPEAKER pro tempore. The gentleman from California [Mr. Stark] is 
recognized for 2 minutes.
  (Mr. STARK asked and was given permission to revise and extend his 
remarks, and include extraneous matter.)
  Mr. STARK. Mr. Speaker, the reason to vote no on this bill is to give 
the Congress time to perfect the necessary structures and regulations 
for Medicare Select to work. Indeed, it does work in California. The 
trouble is, there is only one insurance company, Blue Cross, who has 
been importuning Members to support it, because the insurance 
commissioner will not allow it.
  The corporation commissioner does, giving Blue Cross a monopoly. That 
is not fair in California, either. If it is good in California, let us 
let other insurance companies sell it. Somebody brought up the good 
name of the Consumers Union. They did in fact mention some of these 
policies. However, let me summarize Consumers Union's recommendations 
to the Subcommittee on Health of the Committee on Ways and Means in 
February of this year.
  Consumers Union stated that:

       Congress should study the impact of further negotiated 
     discounts . . . before rushing to extend the Medicare Select 
     program. . . . Research done to date indicates that the 
     Medicare Select . . . has not achieved its goals. It has 
     resulted in a marketplace in which premium pricing games 
     distort the true cost of the policy. It has not achieved cost 
     savings, but merely shifts costs to other consumers. Few 
     insurers and few consumers have participated. In many States, 
     regulation of this product has fallen between the cracks of 
     different regulatory agencies--is it insurance or managed 
     care?--leaving consumers without the protections they need. 
     Congress should not expand the program and make it permanent, 
     but should take steps now to fix what is broken, and what is 
     broken is the pricing structure, the need for open 
     enrollment, and await further study results before locking 
     the program into place. With respect to Medicare Select, 
     Consumers Union would urge you to proceed with caution.

  I would join with the distinguished gentleman from Michigan [Mr. 
Dingell] and others, and urge Members to vote ``no'' to protect the 
consumers, to protect the Medicare trust fund which the Republicans are 
going to dismantle and destroy, $1 billion here, $1 billion there, $84 
billion to rich seniors, $270 billion to pay the tax cuts to the very 
richest in this country. Do not let them destroy Medicare any further. 
Vote ``no.''
 Summary of Consumers Union Testimony on Medicare Select, February 10, 
                                  1995

       Medicare Select is a cross between traditional Medicare 
     supplement policies (``medigap'') and HMO's. We urge caution 
     when it comes to expanding Medicare Select or making it 
     permanent because of the following major problems:
       Pricing games: Medicare Select policies often offer cheaper 
     premiums to begin with. But because of a system of so-called 
     ``attained age'' pricing that many policies use, premiums 
     will rise steeply as the policyholder gets older. Congress 
     should not lock-in or expand a program which perpetuates this 
     deceptive pricing practice.
       Illusory Cost Savings: Medicare Select premiums are often 
     low, but at a cost to other Americans. Insurance companies 
     that write Medicare Select policies typically don't pay the 
     deductible to the hospital that other medigap policies are 
     designed to pay. But the hospital still has to cover its 
     costs. The result: it shifts the cost to other patients--and 
     their insurers.
       The Medigap Maze: The whole idea behind the OBRA medigap 
     reforms was to allow consumers to make kitchen table 
     comparisons among plans. But the Medicare Select program 
     doesn't forward that goal. Medicare Select adds a layer of 
     confusion by forcing consumers to balance initially lower 
     premiums against restricted freedom of choice of doctor or 
     hospital.
       We believe that it is premature to expand or make permanent 
     the Medicare Select program. Preliminary analysis of the 
     program 

[[Page H6673]]
     indicates that so far it has not been successful in reducing costs or 
     even attracting substantial interest from insurers or 
     consumers. We recommend that Congress:
       Require ALL states to do what several states have already 
     done: community rate their medigap market to eliminate the 
     hazardous pricing structure used by many Medicare Select 
     plans (and level the playing field among all insurers). 
     Alternatively, condition a state's ability to participate in 
     Medicare Select to a statewide requirement of community 
     rating for the medigap market.
       Require a six month open enrollment period for all 
     consumers who were previously enrolled in Medicare Select. 
     (Currently, in many cases, they are not eligible if their 
     Medicare Select insurer does not offer a traditional policy.)
       Limit the extension of Medicare Select to a two-year time 
     period that would allow for analysis of cost savings and 
     quality control. Such a study is currently underway at HCFA. 
     Postpone expansion of the program to additional states until 
     the studies are complete and regulatory adjustments can be 
     put in place.
       Consumers Union\1\ appreciates the opportunity to present 
     our views on the issue of Medicare Select. We have spent 
     several years monitoring the medigap market and working to 
     improve protections for seniors who buy medigap policies. We 
     worked in support of this Subcommittee's efforts to fix the 
     problems in this marketplace, efforts that culminated in the 
     historic enactment of OBRA-90 medigap reforms. These reforms 
     made it much easier for consumers to comparison-shop among 
     so-called medigap policies, which are designed to fill in the 
     gaps in coverage left by Medicare. We continue to believe 
     that these reforms serve as a valuable model for future 
     legislation in areas such as long-term care insurance and 
     regulation of a supplemental market in future health reform.
     Footnotes at end of article.
---------------------------------------------------------------------------
       This testimony addresses one aspect of the Medicare 
     supplement insurance market--Medicare Select. Medicare Select 
     is a cross between traditional Medicare supplement (or 
     medigap) policies and HMO's. In return for initially cheaper 
     premiums, consumers agree to obtain care within a designated 
     network of doctors--in order to be reimbursed for the costs 
     covered by the policy. (Medicare still provides coverage, 
     regardless of whether the provider is in the Select network.)
       We believe that there are several problems with Medicare 
     Select. In the big picture, Medicare Select represents a 
     diversion from the tough issue of reining in Medicare costs--
     through managed care or other steps. Pressing questions that 
     this Subcommittee must address include: to what extent do 
     HMO's--which limit seniors freedom of choice of doctor--truly 
     save costs (or merely select the healthy risks)? Is there 
     adequate quality assurance in Medicare risk contracts? Is 
     there sufficient ability for consumers who do not feel well-
     served by Medicare HMO's to pick up traditional Medicare/
     medigap coverage? Is it possible--and fair to seniors--to 
     ratchet down the Medicare budget without achieving cost 
     control in the private insurance sector (in the context of 
     overall health care reform)?
       There are several major problems with the Medicare Select 
     market and we urge caution when it comes to making Medicare 
     Select a permanent program:
       Pricing games: Medicare Select policies often offer cheaper 
     premiums to begin with. But because of a system of so-called 
     ``attained age'' pricing that many policies use, premiums 
     will rise steeply as the policyholder gets older. Congress 
     should not lock-in or expand a program which perpetuates this 
     deceptive pricing practice.
       Illusory Cost Savings: Medicare Select premiums are often 
     low, but at a cost to other Americans. Insurance companies 
     that write Medicare Select policies typically don't pay the 
     deductible to the hospital that other medigap policies are 
     designed to pay. But the hospital still has to cover its 
     costs.
      The result: it shifts the cost to other patients--and their 
     insurers.
       The Medigap Maze: The whole idea behind the OBRA-90 medigap 
     reforms was to allow consumers to make kitchen table 
     comparisons among plans. But the Medicare Select program 
     doesn't forward that goal. Medicare Select adds a layer of 
     confusion by forcing consumers to balance initially lower 
     premiums against restricted freedom of choice of doctor or 
     hospital.

                       Summary of Recommendations

       We believe that it is premature to expand or make permanent 
     the Medicare Select program because of these problems and 
     others described below. Preliminary analysis of the program 
     indicates that so far it has not been successful in reducing 
     costs or even attracting substantial interest from insurers 
     or consumers. We recommend that Congress:
       Require ALL states to do what several states have already 
     done: community rate their medigap market to eliminate the 
     hazardous pricing structure used by many Medicare Select 
     plans (and level the playing field among all insurers). 
     Alternatively, condition a state's ability to participate in 
     Medicare Select to a state-wide requirement of community 
     rating for the medigap market.
       Require a six-month open enrollment period for all 
     consumers who were previously enrolled in Medicare Select.
       Limit the extension of Medicare Select to a two-year time 
     period that would allow for study and analysis (that is 
     currently under way by HCFA) of cost savings (vs. cost 
     shifting) and quality control. Postpone expansion of the 
     program to additional states until the studies are complete 
     and regulatory adjustments can be put in place.
       We elaborate on our concerns and recommendations below.

                 Analysis of the Medicare Select Market


                             pricing games

       Medicare Select policies often use an ``attained age'' 
     pricing structure, which Consumer Reports says is ``hazardous 
     to policyholders.'' Various letters and comments regarding 
     Medicare Select have noted that Consumer Reports found that 
     eight of the top 15 Medigap products were Medicare Select. 
     But this tells only part of the story. Five of the eight 
     policies mentioned use an attained-age pricing structure. 
     Consumer Reports stated that:
       Attained-age policies are hazardous to policyholders. By 
     age 75, 80, or 85, a policyholder may find that coverage has 
     become unaffordable--just when the onset of poor health could 
     make it impossible to buy a new, less expensive policy. Take, 
     for example, an attained-age Plan F offered by New York Life 
     and an issue-age Plan F offered by United American. For 
     someone age 65, the New York Life policy is about $114 a year 
     cheaper. But by age 80, the buyer of the New York Life policy 
     would have spent a total of $5,000 more than the buyer of the 
     United American policy.\2\
       The attained-age pricing structure allows companies to bait 
     consumers with low
      premiums in early years, and then trap them with high 
     increases in later years. Standardization of the medigap 
     market resulted in price conscious consumers, with the 
     effect of facilitating a trend away from community-rated 
     policies and toward attained-age rated policies. The 
     percent of Blue Cross-Blue Shield affiliates, for example, 
     that sell attained-age policies grew from 31 percent in 
     1990 to 55 percent in 1993.
       Ten states have recognized this market dynamic and have 
     taken steps to protect consumer either by requiring community 
     rating for this market or by banning attained-age rating. 
     These are Arkansas, Connecticut, Florida, Georgia, Idaho, 
     Maine, Massachusetts, Minnesota, New York, and Washington. 
     Four of these states--Florida, Massachusetts, Minnesota and 
     Washington--are part of the Medicare Select demonstration 
     program.\3\
       Recommendation: Require ALL states to do what several 
     states have already done: community rate their medigap market 
     to eliminate the hazardous pricing structure used by many 
     Medicare Select plans (and level the playing field among all 
     insurers). Alternatively, condition a state's ability to 
     participate in Medicare Select to a state-wide requirement of 
     community rating for the medigap market.


                         illusory cost savings

       The purpose of Medicare Select was to cut health care costs 
     through coordinated care networks that increase the use of 
     utilization review and management controls, often through 
     PPO's. It was expected that enrollees would be restricted to 
     a subset of providers. But the experience shows that often 
     there is no restriction of providers. There is little 
     coordination or management of care in Select plans.\4\
       Medicare Select premiums may be low for the wrong reasons--
     because these policies shift costs to others by not covering 
     all the costs that traditional medigap policies must cover. 
     Medicare Select companies often negotiate with providers to 
     eliminate the payment of Part A deductibles. Insurers have 
     indicated that the discounts of the Part A deductible by 
     participating hospitals is the most significant source of 
     premium savings available in Medicare supplements.\5\ This 
     means that hospitals get less reimbursement from Medicare 
     Select carriers. It does not mean that the hospital's costs 
     are lower, so cost shifting to other patients (and their 
     insurers) is inevitable.
       Before extending Medicare Select to additional states (or 
     for a substantial time period), we urge you to study further 
     why Medicare Select premiums are often low. Are they cutting 
     premiums for their policyholders merely by shifting costs to 
     other payers? Another issue of concern to us is whether the 
     Medicare Select markets in each state are truly competitive. 
     We understand that in California, for example, there is only 
     one key
      Medicare Select carrier (Blue Cross).\6\ A study prepared 
     for HCFA found that three-fourths of Medicare Select 
     enrollees have policies from affiliates of three Blue 
     Cross and Blue Shield plans (in Alabama, California and 
     Minnesota), hardly an indication of a truly competitive 
     marketplace.\7\ We urge you to study the level of 
     competition in this marketplace, recognizing of course 
     that traditional medigap policies do compete with medicare 
     Select policies.
       Recommendation: Limit the extension of Medicare Select to a 
     two-year time period that would allow for study and analysis 
     (that is currently underway by HCFA) of cost savings (vs. 
     cost shifting) and quality control. Postpone expansion of the 
     program to additional states until the studies are complete 
     and regulatory adjustments can be put in place.


                              medigap maze

       A key goal of the medigap reform legislation that was 
     included in OBRA-`90 was to provide true consumer choice of 
     medigap 

[[Page H6674]]
     policy by standardizing policies, thereby simplifying the choice. In 
     light of the minimal role the Medicare Select products have 
     made in this marketplace, we question whether the expanded 
     complexity offers consumers significant benefits. Consumers 
     (in Medicare Select states) must decide between Medicare 
     only, Medicare risk plans, Medicare cost plans, health care 
     prepayment plans, medicare Select plans, and traditional 
     Medicare supplement policies. They can't even consider which 
     of 10 standard packages to consider until they have made this 
     choice.
       Furthermore, insurers have indicated that the 10 standard 
     medigap plans are appropriate for fee-for-service 
     (traditional) medigap policies, but not for network Medicare 
     Select products.\8\ If Medicare Select necessitates an 
     additional one or more standard policies, then simplicity is 
     further undercut.


                      need to await study results

       Medicare Select was included in OBRA-90 medigap reform 
     legislation as a demonstration program. Medicare Select was 
     established with the hope of achieving goals such as reducing 
     health care costs (both for the Medicare program and 
     consumers) and reducing the paperwork burden on consumers 
     (since Medicare Select plans relieve consumers of the 
     paperwork burden inherent in filing claims). It should not be 
     made permanent until studies of its effectiveness have been 
     completed. The preliminary report (February 1994) paints a 
     picture of Medicare Select that is hardly complimentary. A 
     tiny percent of people eligible have enrolled; a small 
     fraction of insurers participate; cost savings appear to be 
     superficial only and may be cost-shifting in disguise; the 
     market is highly concentrated; Medicare Select regulation 
     often falls between the cracks in state regulatory 
     departments.
       Some specific findings that should set off alarms to put on 
     the brakes--not rush ahead with a permanent expansion--
     include:
       Some states (e.g., Arizona) have found that market response 
     has been poor and that beneficiaries tend to migrate back to 
     traditional plans.\9\
       Several states that were selected for the program could not 
     get it off the ground and dropped out.\10\ Others have had no 
     applications for select plans.\11\
       When studied by RTI, only 2.5 percent of eligible Medicare 
     enrollees selected Medicare Select policies, and most of 
     these ``rolled over'' from prestandardization products. It 
     appears that consumers are not, in general, attracted to 
     Medicare Select policies.\12\
       Nor are insurers attracted to the Medicare Select product: 
     only ten percent of HMOs and medigap insurers in Select sates 
     offer Medicare Select policies, with even interest in some 
     states.\13\
       Recommendation: Congress should delay expanding and making 
     permanent the Medicare Select program until further study 
     results are available. It should not be made permanent 
     without fixing the elements that are broken.


                            Regulatory Gaps

       Medicare Select is fraught with questions about regulatory 
     authority. It is not unusual for a state's insurance 
     department to regulate fee-for-service medigap coverage, but 
     another state department (e.g, Department of Public Health or 
     Department of Corporations) to regulate Select products. It 
     is very possible that Medicare Select policies get lost in 
     the regulatory cracks where authority for traditional 
     insurance and HMO's is split. This confusion has even led to 
     approval of plans (as Select) that deviate from the OBRA '90 
     standard plan designs.\14\
       Medicare Select consumers need regulatory protection. For 
     example, consumers switching out of Medicare Select need 
     protection. Consumers who choose a Medicare Select option 
     must use providers in the designated network in order to get 
     medigap coverage. The NAIC model regulation provided 
     protection to consumers who elect Medicare Select but then 
     wish to change to traditional medigap policy. Companies were 
     required to offer such consumers a policy with similar 
     benefits, without underwriting. But this provision has a 
     loophole--consumers have no assurance of such an offer if the 
     Medicare Select company does not offer a traditional (``fee-
     for-service'') medigap policy.
       In the event that Congress decides to end the Medicare 
     Select program, either now
      or in the future, then consumers who have Select policies 
     when the program is ended will need protection. Without 
     new entrants in their pool, their premiums (in closed 
     blocks of business) would spiral upwards. They will need 
     the protection from such an open enrollment period.
       Recommendation: Congress should require that all 
     policyholders who wish to switch out of Medicare Select be 
     eligible for an open enrollment period (regardless of which 
     company they select) in order to protect them against being 
     locked into a Medicare Select plan that they do not like.\15\ 
     This protection would actually help to promote the Medicare 
     Select option because consumers would have a safety valve if 
     they are dissatisfied. If Congress chooses to end the 
     Medicare Select program, insurers should be required to 
     extend an open enrollment period to Medicare Select 
     policyholders. We urge the Congress to study carefully the 
     regulatory experience and analyze where regulatory authority 
     for Medicare Select is best housed.


                does medicare select compromise quality?

       Medicare Select policies keep premiums low by negotiating 
     lower reimbursement schedules with providers (mostly 
     hospital), providing discounts to policyholders. On average 
     Medicare pays doctors and hospitals about 59 percent of what 
     private insurers pay for the same services. If (in the 
     future) Medicare Select coverage is negotiated downward 
     (e.g., providing Select policies with Part B discounts also), 
     providers will get even less. At some point, the cumulative 
     impact of lower reimbursement has got to have an impact on 
     quality of care that patients receive. This could occur when 
     providers withdraw from providing services to consumers, or 
     when they cut corners (such as patient time) due to the lower 
     reimbursement levels.
       Recommendation: Congress should study the impact of further 
     negotiated discounts for providers before rushing to extend 
     the Medicare Select program.
       In conclusion, research done to date indicates that the 
     Medicare Select demonstration program has not achieved its 
     goals. It has resulted in a marketplace in which premium 
     pricing games distort the true cost of the policy. It has not 
     achieved cost savings, but merely shifts costs to other 
     consumers. Few insurers and few consumers have participated. 
     In many states, regulation of this product has fallen between 
     the cracks of different regulatory agencies (is it insurance 
     or managed care?), leaving consumers without the protections 
     they need. Congress should not expand the program and make it 
     permanent, but should take steps now to fix what is broken 
     (the pricing structure, the need for open enrollment) and 
     await further study results before locking the program into 
     place. With respect to Medicare Select, we urge you to 
     proceed with caution.
       Thank you for considering our views.

                               footnotes

     \1\Consumers Union is a nonprofit membership organization 
     chartered in 1936 under the laws of the State of New York to 
     provide consumers with information, education and counsel 
     about goods, services, health, and personal finance; and to 
     initiate and cooperate with individual and group efforts to 
     maintain and enhance the quality of life for consumers. 
     Consumers Union's income is solely derived from the sale of 
     Consumer Reports, its other publications and from 
     noncommercial contributions, grants and fees. In addition to 
     reports on Consumers' Union's own product testing, Consumer 
     Reports with approximately 5 million paid circulation, 
     regularly, carries articles on health, product safety, 
     marketplace economics and legislative, judicial and 
     regulatory actions which affect consumer welfare. Consumers 
     Union's publications carry no advertising and receive no 
     commercial support.
     \2\``Filling the Gaps in Medicare,'' Consumer Reports, August 
     1994, p. 526.
     \3\It is premature to evaluate the impact of the combination 
     of Medicare select and community rating, since two states 
     (Massachusetts and Washington) are new to Medicare select and 
     since community rating requirements are fairly recent.
     \4\``Evaluation of the Medicare SELECT Amendments--Case Study 
     Report, RTI Project No. 32U-5531, prepared for Office of 
     Demonstrations and Evaluations, Health Care Financing 
     Administration, U.S. Department of Health and Human Services, 
     February 10, 1994, RTI, p. XX-3.
     \5\RTI, p. xi.
     \6\Three other plans: Foundation Health Plans; National Med; 
     and Omni Health Plan have been approved but had minimal 
     enrollment, that totals less than 500. [RTI, p. IV-17]
     \7\p. ix.
     \8\RTI, p. xiii.
     \9\RTI, p. III-6.
     \10\E.g., Oregon and Michigan. RTI, p. XV-1.
     \11\E.g., Illinois. RTI, p. XV-3.
     \12\RTI, p. ix.
     \13\RTI, p. ix.
     \14\See, for example, RTI, p. IV-9, IV-10.
     \15\In Florida, Select insurers are required to offer at 
     least a basic Plan A in a non-Select form, providing partial 
     protection for people who wish to switch out of Select plans. 
     One side-effect: this provision makes it infeasible for HMO's 
     to offer SELECT plans.

  Mr. BLILEY. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, this has been an interesting debate. It has been about a 
lot of things, it has been about almost everything except the 
underlying legislation. We have talked about the budget, we have talked 
about Medicare in general we have been told ``why the rush?'' The 
gentleman who poses the question knows full well why we are acting 
today. This is a demonstration project that expires today, if we do not 
act. That is why we are here. That is why I urge it to be passed. I am 
sure that it will be.
  We have also heard about the fact that it might cost more. That is 
interesting, Mr. Speaker, because when this bill was first passed 
several years ago, a study was supposed to be done. It was supposed to 
be available in January, but of course the administration advised us 
that it would not be ready and it would not be ready for months, so 
they could not provide it to the authorizing committees as the 
legislation was being crafted.
  However, just a few weeks ago, Mr. Speaker, mysteriously, part of the 
information, not the full report, was leaked, not to the committees of 
jurisdiction, but to a Member of the other body who is opposed to the 
legislation. I find that rather curious. Needless to say, this is not 
the usual method the administration uses to provide committees of 
jurisdiction with important information.
  Mr. Speaker, time is wasting. We need to get on with this program. 
Let 

[[Page H6675]]
me finally end this by saying, No. 1, the study that is required before 
this program expires in 3 years requires the Secretary to discontinue 
the program if it is found that Medicare select: has not resulted in 
savings of premium costs to beneficiaries compared to non-select 
MediGap policies;
  Second, they cannot extend it if it shows that it has resulted in 
significant additional expenditures for the program; or
  Third, it cannot be extended if it results in the diminished access 
in quality of care. There are plenty of safeguards to ensure that 
beneficiaries are well protected. I urge my colleagues to join me in 
supporting the conference report.
  Mrs. COLLINS of Illinois. Mr. Speaker, I rise in opposition to the 
conference report on H.R. 483, the Expanded Use of Medicare Select 
Policies Act. While I recognize the role that the Medicare select 
demonstration program that currently exists in my State of Illinois and 
14 other States plays, I am concerned that this legislation is being 
used as a cover for the draconian $270 billion in Medicare cuts 
included in the budget resolution conference report that passed this 
body yesterday.
  Under the Medicare Select Program, senior citizens on Medicare are 
allowed to buy private MediGap insurance policies through managed-care 
providers to supplement what Medicare does not cover. An important 
objective, but following what happened here yesterday with the GOP 
budget plan, Medicare select could easily become the only health care 
option for seniors, as Medicare is gutted, services are curtailed, and 
older folks have to pick up the pieces through private plans. The end 
result will be less access to services and higher out-of-pocket costs.
  It is crystal clear to anyone watching the actions of the majority 
party in the 104th Congress that devastating changes to Medicare are 
ahead. There is rampant GOP discussions ongoing about turning Medicare 
into block grants for the States and based on what happened in the 
House welfare reform legislation to the Federal School Lunch and 
Breakfast Programs, I know that ``block grant'' is a code word for 
cutting, slashing, and eliminating.
  Let's not fool anyone Mr. Speaker, H.R. 483 is one of the first 
threads 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 crippled by Republican cuts to the program to allow it to be 
treated as it has by the Speaker and his cronies.
  I urge my colleagues to vote ``no'' on this conference report and 
reject the Republicans' attempts to balance the budget on the backs of 
seniors and then hand them the check when the bill comes due.
  Mr. Speaker, I yield back the balance of my time and I move the 
previous question.
  The SPEAKER pro tempore. Pursuant to House Resolution 180, the 
previous question is ordered.
  The question is on the conference report.
  Mr. DINGELL. Mr. Speaker, on that I demand the yeas and nays.
  The SPEAKER pro tempore. Under the rule, the yeas and nays are 
ordered.
  The yeas and nays were ordered.
  The vote was taken by electronic device, and there were--yeas 350, 
nays 68, not voting 16, as follows:
                             [Roll No. 467]

                               YEAS--350

     Ackerman
     Allard
     Andrews
     Archer
     Armey
     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
     Bonilla
     Bono
     Brewster
     Browder
     Brown (CA)
     Brown (OH)
     Brownback
     Bryant (TN)
     Bunn
     Bunning
     Burr
     Burton
     Buyer
     Callahan
     Calvert
     Camp
     Canady
     Cardin
     Castle
     Chabot
     Chambliss
     Chapman
     Chenoweth
     Christensen
     Chrysler
     Clayton
     Clinger
     Coble
     Collins (GA)
     Combest
     Condit
     Cooley
     Costello
     Cox
     Cramer
     Crane
     Crapo
     Cremeans
     Cubin
     Cunningham
     Danner
     Davis
     de la Garza
     Deal
     DeLauro
     DeLay
     Deutsch
     Diaz-Balart
     Dickey
     Dicks
     Dixon
     Doggett
     Dooley
     Doolittle
     Dornan
     Doyle
     Dreier
     Duncan
     Dunn
     Durbin
     Edwards
     Ehlers
     Ehrlich
     Emerson
     Engel
     English
     Ensign
     Eshoo
     Everett
     Ewing
     Farr
     Fawell
     Fazio
     Flake
     Flanagan
     Foley
     Forbes
     Fowler
     Fox
     Franks (CT)
     Franks (NJ)
     Frelinghuysen
     Frisa
     Frost
     Funderburk
     Furse
     Ganske
     Gejdenson
     Gekas
     Gephardt
     Geren
     Gilchrest
     Gillmor
     Gilman
     Goodlatte
     Goodling
     Gordon
     Goss
     Graham
     Green
     Greenwood
     Gunderson
     Gutierrez
     Gutknecht
     Hall (OH)
     Hall (TX)
     Hamilton
     Hancock
     Hansen
     Harman
     Hastert
     Hastings (WA)
     Hayes
     Hayworth
     Hefley
     Hefner
     Heineman
     Herger
     Hilleary
     Hobson
     Hoekstra
     Hoke
     Holden
     Horn
     Hostettler
     Houghton
     Hoyer
     Hunter
     Hutchinson
     Hyde
     Inglis
     Istook
     Jackson-Lee
     Jacobs
     Johnson (CT)
     Johnson (SD)
     Johnson, E. B.
     Johnson, Sam
     Johnston
     Jones
     Kaptur
     Kasich
     Kelly
     Kennedy (MA)
     Kennelly
     Kim
     King
     Kingston
     Kleczka
     Klug
     Knollenberg
     Kolbe
     LaHood
     Lantos
     Largent
     Latham
     LaTourette
     Laughlin
     Lazio
     Leach
     Levin
     Lewis (CA)
     Lewis (KY)
     Lightfoot
     Lincoln
     Linder
     Lipinski
     Livingston
     LoBiondo
     Lofgren
     Longley
     Lowey
     Lucas
     Luther
     Maloney
     Manzullo
     Martini
     Mascara
     Matsui
     McCarthy
     McCollum
     McCrery
     McDade
     McHale
     McHugh
     McInnis
     McIntosh
     McKeon
     McNulty
     Meehan
     Menendez
     Metcalf
     Meyers
     Mfume
     Mica
     Miller (FL)
     Mineta
     Minge
     Molinari
     Mollohan
     Montgomery
     Moorhead
     Moran
     Morella
     Myers
     Myrick
     Neal
     Nethercutt
     Neumann
     Ney
     Nussle
     Oberstar
     Obey
     Ortiz
     Orton
     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
     Reed
     Regula
     Richardson
     Riggs
     Rivers
     Roberts
     Roemer
     Rogers
     Rohrabacher
     Ros-Lehtinen
     Rose
     Roth
     Roukema
     Roybal-Allard
     Royce
     Sabo
     Salmon
     Sanford
     Sawyer
     Saxton
     Scarborough
     Schaefer
     Schiff
     Schumer
     Scott
     Seastrand
     Sensenbrenner
     Serrano
     Shadegg
     Shaw
     Shays
     Shuster
     Sisisky
     Skeen
     Skelton
     Smith (MI)
     Smith (NJ)
     Smith (TX)
     Smith (WA)
     Solomon
     Souder
     Spence
     Spratt
     Stearns
     Stockman
     Stump
     Talent
     Tanner
     Tate
     Tauzin
     Taylor (MS)
     Taylor (NC)
     Tejeda
     Thomas
     Thornberry
     Thornton
     Thurman
     Tiahrt
     Torkildsen
     Traficant
     Upton
     Vento
     Volkmer
     Vucanovich
     Waldholtz
     Walker
     Wamp
     Ward
     Weldon (FL)
     Weldon (PA)
     Weller
     White
     Whitfield
     Wicker
     Wilson
     Wise
     Wolf
     Woolsey
     Wynn
     Young (FL)
     Zeliff
     Zimmer

                                NAYS--68

     Abercrombie
     Bonior
     Borski
     Brown (FL)
     Clay
     Clyburn
     Coleman
     Collins (IL)
     Collins (MI)
     Conyers
     Coyne
     DeFazio
     Dingell
     Evans
     Fattah
     Fields (LA)
     Filner
     Foglietta
     Ford
     Frank (MA)
     Gibbons
     Gonzalez
     Hastings (FL)
     Hilliard
     Hinchey
     Jefferson
     Kanjorski
     Kennedy (RI)
     Kildee
     Klink
     LaFalce
     Lewis (GA)
     Manton
     Markey
     Martinez
     McDermott
     Meek
     Miller (CA)
     Mink
     Murtha
     Nadler
     Olver
     Owens
     Payne (NJ)
     Pelosi
     Rangel
     Rush
     Sanders
     Schroeder
     Skaggs
     Slaughter
     Stark
     Stokes
     Studds
     Stupak
     Thompson
     Torres
     Torricelli
     Towns
     Tucker
     Velazquez
     Visclosky
     Waters
     Watt (NC)
     Waxman
     Williams
     Wyden
     Yates

                             NOT VOTING--16

     Boehner
     Boucher
     Bryant (TX)
     Clement
     Coburn
     Dellums
     Fields (TX)
     Gallegly
     McKinney
     Moakley
     Norwood
     Reynolds
     Stenholm
     Walsh
     Watts (OK)
     Young (AK)

                              {time}  1303

  The Clerk announced the following pair:
  On this vote:

       Mr. Watts of Oklahoma for, with Mr. Dellums against.

  Mr. MARTINEZ changed his vote from ``yea'' to ``nay.''
  Mr. KING, Mr. BERMAN, Ms. RIVERS, and Mrs. MALONEY changed their vote 
from ``nay'' to ``yea.''
  So the conference report was agreed to.
  The result of the vote was announced as above recorded.
  A motion to reconsider was laid on the table.
  

                          ____________________