[Congressional Record Volume 141, Number 162 (Thursday, October 19, 1995)]
[Senate]
[Pages S15345-S15346]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. HELMS:
  S. 1343. A bill to amend title XVIII of the Social Security Act to 
provide that eligible organizations assure out-of-network access; to 
the Committee on Finance.
     out-of-network access legislation
  Mr. HELMS. Mr. President, three summers ago I had a close but 
fortunate encounter with some remarkable medical doctors in my home 
town of Raleigh. My heart surgery and the very effective subsequent 
rehabilitation made it clear that I had been cared for by some of the 
most capable people in the medical profession.
  I was free to choose the surgeon who performed the operation. Senior 
citizens enrolled in Medicare should have the same choice, and the bill 
I'm introducing today will enable senior citizens who join HMO's to 
preserve their right to choose their doctor.
  Mr. President most Americans, whether their health is insured by 
private firms or by Medicare, enjoy their freedom to decide which 
medical professional will provide their care and treatment. In 
reforming Medicare, Congress must make sure that senior citizens can 
choose their doctors and other medical providers.
  One of the many reasons for my having opposed the Clinton health plan 
was the well founded fear that the American people would have been 
denied their right to chose their medical care. The enormous 
bureaucracy of the Clinton plan made that apprehension a certainty--
which is why the American people rejected it.
  Now, Mr. President, the Senate is considering major reforms to save 
Medicare, and prevent its being pushed over the cliff. Medicare must be 
reformed before it goes bankrupt--otherwise the Medicare trust fund 
will be flat broke when the 21st century rolls around a few years 
hence.
  Americas's senior citizens depend on the health care coverage 
provided by the Medicare system, and those of us in Congress have a 
duty to make sure they will not be forced to give up their right to 
choose their doctors.
  It is vital to their future security that our senior citizens retain 
this right to choose. The power to choose will place citizens firmly in 
control of their health care. Their right to choose will encourage 
efficiency and cut costs without sacrificing quality care and 
treatment.
  Mr. President, all of us know full well that reform of the present 
Medicare System is imperative. The provisions of the legislation 
allowing senior citizens to join health maintenance organizations, and 
other types of managed care plans, will surely lower the costs of 
operating the vast Medicare System. And citizens who belong to a 
Medicare-supported HMO may gain coverage for prescription drugs, 
eyeglasses and hearing aids--coverages not presently provided by 
Medicare.
  Without some moderating legislation, however, senior citizens could 
very well find themselves locked into coverage that limits them to 
services provided by HMO-affiliated doctors, other professionals and 
hospitals. No longer would senior citizens have the freedom to choose 
their own doctor.
  So, Mr. President, these are the reasons why I am today introducing 
the Senior Citizens' Health Freedom Act to guarantee all Medicare-
eligible Americans who choose to enroll in an HMO the same freedom to 
choose their doctors that every member of Congress enjoys.
  As much as I support the Republican Medicare plan now under 
discussion, I cannot dismiss my reservations about the absence of 
doctor choice in the plan as it presently stands.
  Mr. President, consider if you will the predicament of a patient who 
requires heart surgery, and whose HMO will not approve the cardiologist 
with whom the senior has built up a longstanding relationship. Should 
the patient be required to wait for a year's time to change to a plan 
that will cover the cardiologist that the patient knows and trusts? My 
bill will enable women being treated for breast cancer to rest assured 
that they can continue to see the specialists familiar with them and 
their conditions. For this reason, more than a hundred patient advocacy 
groups have voiced their support for this bill.

  We must provide a safety valve to protect seniors who find themselves 
in that position. A point of service option would enable patients to 
see physicians and specialists inside and outside the managed care 
network. If senior citizens are satisfied with the care they receive 
within the network, they will feel no need to choose outside doctors 
and specialists. Without such options, however, these senior citizens 
will be locked into a rigid system which may or may not give them the 
health care they need from people they most trust to provide it.
  Mr. President, we heard from the CBO last February that a built-in 
point of service feature would not increase the cost of Medicare. In 
testimony before the Senate Budget Committee, CBO stated that ``the 
point of service option would permit Medicare enrollees to go to 
providers outside the HMO's panel when they wanted to, and yet it need 
not increase the benefit cost to HMO's or to * * * ''
  The fastest growing health insurance product is a managed care plan 
that includes the point of service feature. The marketplace has 
responded to patient's demand. Requiring HMO's to include point of 
service is not intrusive, but rather advances a developing trend. In 
fact, in 1993, 61 percent of all HMO's offered a point of service 
option.
  Building a point of service option into all health plans under 
Medicare will not interfere with the plan's ability to contain cost, 
nor will it limit their efforts to encourage providers and patients to 
use their health care resources wisely. It simply will ensure that 
health plans put the patient's interest first.
  Moreover, the actuarial firm of Milliman and Robertson concluded that 
depending on the terms of the plan and a reasonable cost sharing 
schedule, there would be no increase in cost to the HMO. In fact, there 
could actually be a savings.
  Mr. President, according to polls I have seen, patients are willing 
to pay a little more for the ability to go out of network to be assured 
of seeing the doctors of their choice. As many as 70 percent of 
Americans over 50 years old declared in one poll that they would be 
unwilling to join a Medicare managed plan that denied them the freedom 
to choose their own physicians.
  So the best incentive to get senior citizens to join HMO's is to make 
sure they can choose their own doctors.
  As we prepare to enact this historic revision of the Medicare 
Program, let us not overlook the steps that are necessary to protect 
the security of our senior citizens. Let us never deny them the right 
to take an active part in their health care and treatment.

[[Page S 15346]]

  We can save Medicare. We can extend its benefits while lowering the 
towering costs that beset us today. And with the legislation I 
introduce today, we can also preserve a basic American freedom to 
choose.
  Mr. President, I ask unanimous consent that the list of patient 
advocacy groups supporting this bill be printed in the Record.
  There being no objection, the list was ordered to be printed in the 
Record, as follows:

Organizations Supporting Patient Access to Specialized Medical Services 
                        Under Health Care Reform

       Allergy and Asthma Network Mothers of Asthmatics, Inc.
       American Academy of Allergy and Immunology.
       American Academy of Child and Adolescent Pyschiatry.
       American Academy of Dermatology.
       American Academy of Facial Plastic and Reconstructive 
     Surgery.
       American Academy of Neurology.
       American Academy of Ophthalmology.
       American Academy of Orthopaedic Surgeons.
       American Academy of Otolaryngology-Head and Neck Surgery.
       American Academy of Pain Medicine.
       American Academy of Physical Medicine & Rehabilitation.
       American Association for Hand Surgery
       American Association for the Study of Headache
       American Association of Clinical Endocrinologist.
       American Association of Clinical Urologists.
       American Association of Hip and Knee Surgeons.
       American Association of Neurological Surgeons.
       American College of Cardiology.
       American College of Foot and Ankle Surgeons.
       American College of Gastroenterology.
       American College of Nuclear Physicians.
       American College of Obstetricians & Gynecologists.
       American College of Osteopathic Surgeons.
       American College of Radiation Oncology.
       American College of Radiology.
       American College of Rheumatology.
       American Diabetes Association.
       American EEG Society.
       American Gastroenterological Association.
       American Lung Association.
       American Orthopedic Society for Sports Medicine.
       American Pain Society.
       American Pediatric Medical Association.
       American Psychiatric Association.
       American Sleep Disorders Association.
       American Society for Dermatologic Surgery.
       American Society for Gastrointestinal Endoscopy.
       American Society for Surgery of the Hand.
       American Society for Anesthesiologists.
       American Society for Cataract and Refractive Surgery.
       American Society for Clinical Pathologists.
       American Society for Dermatology.
       American Society for Echocardiography.
       American Society for General Surgeons.
       American Society for Hematology.
       American Society for Nephrology.
       American Society for Pediatric Nephrology.
       American Society for Plastic and Reconstructive Surgeons, 
     Inc.
       American Society for Transplant Physicians.
       American Thoracic Society.
       American Urological Association.
       Amputee Coalition of America.
       Arthritis Foundation.
       Arthroscopy Association of North America.
       Association of Subspecialty Professors.
       Asthma & Allergy Foundation of America.
       California Access to Specialty Care Coalition.
       California Congress of Dermatological Societies.
       Congress of Neurological Surgeons.
       Cooley's Anemia Foundation.
       Cystic Fibrosis Foundation.
       Eye Bank Association of America.
       Federated Ambulatory Surgery Association.
       Joint Council of Allergy and Immunology.
       Lupus Foundation of America, Inc.
       National Association for the Advancement of Orthotics and 
     Prosthetics.
       National Association of Epilepsy Centers.
       National Association of Medical Directors of Respiratory 
     Care.
       National Foundation for Ectodermal Dysplasias.
       National Hemophilia Foundation.
       National Kidney Foundation.
       National Multiple Sclerosis Society.
       National Osteoporosis Foundation.
       National Psoriasis Foundation.
       Orthopaedic Trauma Association.
       Pediatric Orthopedic Society of North America.
       Pediatrix Medical Group? Neonatology and Pediatric 
     Intensive Care Specialists.
       Renal Physicians Association.
       Scoliosis Research Society.
       Society for Vascular Surgery.
       Society of Cardiovascular & Interventional Radiology.
       Society of Gynecologic Oncologists.
       Society of Nuclear Medicine.
       Society of Thoracic Surgeons.
       The Alexander Graham Bell Association for the Deaf, Inc.
       The American Society of Derma- tophathology.
       The Endocrine Society.
       The Paget Foundation For Paget's Disease of Bone and 
     Related Disorders.
       The TMJ Association, Ltd.
       National Committee to Preserve Social Security and 
     Medicare.
                                 ______