[Congressional Record Volume 141, Number 153 (Thursday, September 28, 1995)]
[House]
[Pages H9646-H9647]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




      INTRODUCTION OF H.R. 2350, THE PATIENT CHOICE AND ACCESS ACT

  The SPEAKER pro tempore. Under a previous order of the House, the 
gentleman from Oklahoma [Mr. Coburn] is recognize for 5 minutes.
  Mr. COBURN. Mr. Speaker, as Congress begins its consideration of 
reforming Medicare, I want to bring to the attention of my colleagues, 
perhaps the most important component of the Medicare reform debate. 
What must we do to ensure the quality of care that Medicare patients 
will receive after changes are made to the program?
  While all of us in Congress are deeply concerned about the solvency 
of the Medicare trust fund, we must be equally concerned that the 
changes made to this program do not adversely affect the availability 
of health care to the elderly. As a practicing physician, I have spoken 
with my patients; and as a Member of Congress, I also have heard from 
thousands of my constituents. Their message is a clear one. Any 
Medicare reform proposal must guarantee patient choice and access 
quality. It must not result in a decline in the quality of care 
Medicare patients now receive.

  For the last several months, I have been working closely with the 
patient access to Specialty Care Coalition, a group of 115 patient, 
senior citizen, physician, and nonphysician organizations, dedicated to 
the principle that patients must be able to access the providers of 
their own choice. This week, I introduced H.R. 2350, the Patient Choice 
and Access Act, a bill to provide protection to beneficiaries enrolled 
in the Medicare Program. Throughout the process of crafting a Medicare 
reform bill, I have been urging the House leadership to include my 
patient protection provisions.
  The cornerstone of the current Medicare law is choice of health care 
provider. Presently, there is a belief that the Federal Government can 
save money by enrolling seniors into managed care deliver systems. And 
I agree how such changes can produce dramatic Federal savings, I am not 
opposed to the concept of managed care or a gatekeeper model. Instead, 
I want to make sure that quality of care for seniors is preserved, 
should most of the elderly population be moved into managed care. In 
addition, I have deep concerns about how these proposed changes in 
Medicare may affect my rural constituents.
  Today, many major changes are taking place in the way people purchase 
health insurance and receive medical care. The pressures to reduce 
health spending continues to be intense, and health plans and providers 
have become more aggressive in their cost containment activities. While 
many health plans have developed a number of effective techniques to 
achieve economy and maintain quality of care, others have not always 
achieved that balance. Since Medicare is a federally funded program, we 
should make sure that these tax dollars are returned to Medicare 
enrollees in the form of appropriate patient care.
  After changes are made to Medicare, many existing and new products 
will be offered to the Medicare population. Our most vulnerable 
population will be flung into a fiercely competitive marketplace, where 
access to appropriated medical services may take a back seat. I believe 
that in this rapidly changing environment, Medicare patients must be 
given basic rights and effective protection against the potential that 
these new markets may inappropriately restrict access to medically 
necessary health care services.
  My legislative proposal addresses these concerns, and it puts the 
patient first, not the doctor, not the insurance company, but the 
patient. My bill is designed to improve and enhance health care to our 
country's senior citizens. It will not add to the cost of the Medicare 
Program. Under my legislation, all patients will have the option to 
seek the out-of-network treatment they desire no matter what health 
care plan they select.
  True freedom of choice for patients can only be achieved by making 
out-of-network medically necessary treatment and services available for 
all health care plans. Real health care security is the freedom for 
patients to choose their own primary and specialty care provider, and 
then to continue to access these same caregivers. All patients should 
have the option, at an additional copayment known in advance, to seek 
the out-of-network treatment they desire. This point-of-service feature 
should be built into every health care plan, and not just offered as an 
option at the time of enrollment.
  Patinets, especially seniors, are acting with less than perfect 
information about their health status at the time of enrollment. In 
reality, patients are unable to assess their health care needs, until 
they actually get sick or need specialty care. Consequently, the 
broadest possible patient protection is to build choice of health care 
provider into every health care plan.
  The most effective check against abuses in this changing marketplace 
is the patient's power to go outside the network established by the 
health plan and obtain medical services. Health plans that provide good 
service to their enrollees will not be troubled by this requirement. 
Only health plans that fail to meet the needs of their subscribers will 
be affected.

  Making out-of-network treatment and services available for enrollees 
in all health care plans provides a very good quality assurance check. 
It ensures that all health care plans provide seniors with the health 
care they need and deserve. If a Medicare enrollee is not satisfied 
with care, he or she could pursue other treatment for a reasonable, but 
not cost-prohibitive price.
  Today, the fastest growing health insurance product is a managed care 
plan with the availability of out-of-network coverage. Patients have 
been demanding this freedom to choose, and the marketplace has 
responded. Requiring this type of plan for any senior is not intrusive, 
but rather advances a developing trend.
  Building a point-of-service feature into all health plans under 
Medicare will not affect any health plan's ability to be aggressive in 
their cost-containment activities, nor will it limit their efforts to 
encourage providers and patients to use health care resources wisely. 
It will simply put pressure on health plans to keep the patient's 
welfare uppermost on their agenda, ahead of dividends and the bottom 
line.

[[Page H 9647]]

  The managed care industry has consistently claimed that a point-of-
service feature in all health plans would greatly increase the cost of 
doing business. This assertion is simply not true. The point-of-service 
feature is not costly. According to a cost-impact study released this 
year by the actuarial firm of Milliman and Robertson, Inc., at the 
request of the Patient Access to Specialty Care Coalition, a point-of-
service feature built into all managed care plans would place no 
financial burden on these plans.
  Moreover, in testimony before the Congress this year, the 
Congressional Budget Office stated that requiring a point-of-service 
feature would not add to the Federal Government's cost of the Medicare 
Program. Instead, the cost is covered by patients, who expect to bear 
some additional expense for this point-of-service feature. This cost, 
however, is not great, and it is a simple actuarial calculation 
to determine a reasonable copayment. My legislation calls for the 
managed care plan to share with its potential enrollees the cost 
schedule for going out of network.

  My legislation contains additional provisions to ensure that patients 
receive the full range of health care services to which they are 
entitled. It assures access to specialty care, and provides Medicare 
patients with an enrollee information checklist so they can have 
adequate and important information to compare the quality of all health 
care plans offered to seniors. Also, it includes several Medicare 
patient rights provisions, and a streamlined rapid appeals process 
within a health care plan, when there has been a denial of care. 
Finally, my bill places a ban on provider financial incentive schemes 
which result in the withholding of care or a denial of a referral.
  My legislation does not include any provider protection and is not an 
any-willing-provider bill. Any-willing-provider provisions deal with 
the contractual relationships between health plans and providers of 
medical services. The focus of my bill is on patient choice and the 
health care rights of Medicare enrollees.
  Mr. Speaker, H.R. 2350, the Patient Choice and Access Act of 1995, 
offers Medicare enrollees real choice and real patient protection. It 
will give the Medicare patient effective protection against the 
potential for restricting access to medically necessary health care 
services. Finally, it will provide a quality assurance check on all 
health care plans to make sure that they are providing the full range 
of health care services to their enrollees.
  I urge my colleagues in the Congress to cosponsor this bill, and to 
join with me in my efforts to include these provisions in a Medicare 
reform proposal. Only if this patient component is included in Medicare 
reform legislation can we be able to say that we have worked to achieve 
quality health care and Medicare enrollees protection, and preserved 
patient freedom of choice in selecting health care providers.

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