[Congressional Record Volume 143, Number 93 (Friday, June 27, 1997)]
[Senate]
[Pages S6778-S6779]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                       WHAT IS RIGHT FOR MEDICARE

 Mr. DORGAN. Mr. President, earlier this week, the Senate voted 
on a reconciliation bill that will make some of the most significant 
changes in the 30-year history of the Medicare Program, and I want to 
explain to my colleagues and constituents why I opposed the Senate's 
bill.
  I opposed the bill with some regret, because, for the most part, it 
reflects the bipartisan budget agreement, which I have supported. For 
example, I voted for the bipartisan budget resolution earlier this 
month. That plan requires the Congress to pass legislation to cut the 
deficit by just over $200 billion over the next 5 years, with about 
$115 billion of that deficit reduction to come from slowing down the 
rate of growth of Medicare. So I am not unwilling to vote for 
restraining Medicare spending in order to reduce the deficit.
  We must put this country on track toward a balanced budget while 
ensuring the health and stability of the Medicare Program. Doing so 
requires that we limit the rate of growth of the Medicare Program. The 
Medicare Program has been growing at a rate of about 10 percent a year, 
a rate of growth that the country cannot sustain, especially once the 
baby boomer generation begins retiring and putting additional financial 
stress on the program.
  I had hoped to support the Senate's bill. In fact, the bill includes 
many items I have supported for a long time, including expanding 
Medicare's coverage for preventive benefits, expanding the health plan 
options available to seniors in North Dakota and across the country, 
and other changes to improve access to health care in rural areas and 
strengthen our ability to fight fraud and abuse in the program. I voted 
for a substitute Medicare package offered by Senator Reed that included 
these provisions but did not include the more controversial provisions 
found in the Senate bill. Most notably, the Reed substitute, like the 
Senate bill, would have extended the life of the Medicare trust fund 
for 10 more years, but would have done so without asking Medicare 
beneficiaries to pay significantly more for their health care and 
without knocking a number of seniors out of the Medicare Program.
  Unfortunately, in several extremely important areas, this bill did 
not abide by the bipartisan budget agreement achieved during months of 
negotiations this spring. The Senate bill abandoned this approach by 
including several provisions that will result in significantly higher 
out-of-pocket health care expenses for our Nation's older Americans.
  The Senate bill included two significant structural changes--an 
increase in the Medicare eligibility age from 65 to 67 and a means test 
for the Medicare part B premium paid by upper income older Americans. I 
voted to strike these provisions from the Senate bill because I think 
it is inappropriate to make these kinds of central changes to the 
Medicare Program on the spending side of the budget ledger in order to 
make room for larger tax cuts on the tax side of the ledger. It is my 
view that changes made to Medicare should be made for the purpose of 
strengthening the program--not to provide room for tax cuts, the bulk 
of which will go to upper income earners in this country. Let's keep 
Medicare healthy and our older Americans healthy as well.
  Why in this bill was it proposed that we ask seniors who make more 
than $50,000 to pay higher prices for their Medicare policies so that 
investors who make $500,000 or more could be given tax cuts? There is 
no denying a direct connection when the Medicare changes were proposed 
in the context of reconciliation legislation that includes tax cuts. In 
this reconciliation process, the act of achieving Medicare savings was 
intertwined with the desire for tax cuts on the revenue side.
  There are some signs of reasonableness in this bill. For example, I 
support this bill's creation of a national, bipartisan commission 
charged with making recommendations to Congress on the long-term 
changes necessary to ensuring the extended solvency of the Medicare 
program. On the advice of this Commission we should confront the 
demographic changes facing our country over the next 30 to 40 years as 
the baby boomers retire and our Nation grays. The commission will have 
one year to study and report its recommendations to Congress. Let's 
hope that this process will ultimately result in a solid package of 
changes that the Congress will act on quickly.
  With this package of recommendations on long-term solvency I am 
willing to consider basic structural changes to the program, including 
means testing and/or increasing the eligibility age if the following 
conditions are met.
  First, if we consider increasing the eligibility age, we must be able 
to respond to the needs of the retirees between the ages of 65 and 67 
who will still need affordable insurance coverage. The Senate bill does 
not consider this issue. It simply proposes to leave these folks 
uninsured. Already, the number of retirees with employer-provided 
health insurance has dropped 14 percent in the six years between 1988 
to 1994, and every indication is that this trend would be exacerbated 
by raising the Medicare eligibility age. Most low- or even middle-
income seniors in their mid-sixties will never be able to afford the 
premiums that will be assessed by the health insurance industry to 
cover people of that age.
  Now, I voted in support of increasing the Social Security retirement 
age in 1983, as part of a plan to extend the solvency of the Social 
Security program well into the next century. But I do not agree with 
those who compare the increase in the eligibility age for Medicare to 
increasing the Social Security retirement age to 67. Under Social 
Security, seniors who need or choose to retire before age 67 will still 
have the option to do so, at a reduced benefit level. The ramifications 
are very different for increasing the Medicare eligibility age. Under 
the Senate bill, these seniors will not have an option for getting 
Medicare benefits before they turn 67 and many of them will become 
uninsured.
  If we raise the Medicare eligibility age from 65 to 67, we must 
provide some means to guarantee the availability of affordable 
insurance coverage for the citizens in that age group. One of the 
issues the Medicare commission created by this bill is charged with 
studying is whether it is feasible to allow retirees who have not yet 
reached the eligibility age for Medicare to buy into the program. This 
idea deserves consideration before we act to increase the eligibility 
age.
  With respect to means testing or income relating, as it is called in 
the Senate bill, I am willing to support means testing for Medicare, 
but again, only after careful consideration of the ramifications for 
the entire Medicare program and for the purpose of extending the 
solvency of Medicare, not as

[[Page S6779]]

part of a reconciliation bill that is designed to cut spending for the 
purpose of accommodating additional tax cuts.
  One of the reasons that Medicare has such widespread support is 
because it provides health insurance coverage for virtually all older 
Americans. If through means testing we create an incentive for 
wealthier, healthier people to drop out of the program because they can 
get a better deal outside of Medicare, then we ought to at least 
understand and consider the ramifications of that.
  There are other things about the Senate bill that create substantial 
new burdens on low- and moderate-income older Americans. Under this 
bill, seniors will be asked to pay significant new out-of-pocket costs. 
In North Dakota, 70 percent of our senior citizens have incomes under 
$15,000, and on average, they spend $2,500 for prescription drugs and 
other health care expenses not covered by Medicare or supplemental 
insurance. Many of these folks simply cannot afford to pay much more.
  I am concerned about the new $5 co-payment for home health visits. I 
voted to eliminate this new cost from the Senate bill. While $5 may not 
seem like a lot of money to many of us, a lot of the seniors who rely 
on home health care cannot afford this extra expense and might be 
forced to enter a hospital or nursing home at significantly greater 
cost to the Medicare and Medicaid programs.
  This bill also erodes the protections that currently exist in 
Medicare which limit the amount doctors can charge Medicare 
beneficiaries above and beyond the Medicare-approved amount. This bill 
results in millions of dollars in new out-of-pocket costs.
  The conferees on this bill have an opportunity to address these 
concerns and to drop troubling provisions from the bill, such as the 
means testing of the Medicare premium, the increase in the Medicare 
eligibility age, and the new home health care co-payment. Eliminating 
these provisions from the final bill would still lengthen the solvency 
of the Medicare program for 10 more years, and I hope the conference 
committee will take this action.

                          ____________________