[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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