[Congressional Record Volume 143, Number 143 (Wednesday, October 22, 1997)]
[Extensions of Remarks]
[Pages E2048-E2049]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




     INTRODUCTION OF LEGISLATION TO REPEAL ``LOCK-IN'' OF MEDICARE 
                  BENEFICIARIES IN MANAGED CARE PLANS

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                      Wednesday, October 22, 1997

  Mr. STARK. Mr. Speaker, I am today introducing legislation to repeal 
a provision in the Balanced Budget Act of 1997 that would ``lock'' 
Medicare beneficiaries into a managed care plan. My bill would continue 
the present policy which permits continuous open enrollment--and 
disenrollment--in HMO's by Medicare beneficiaries.
  The BBA provides that in 2002 Medicare beneficiaries have half a year 
to get out of a Medicare+Choice plan that they have enrolled in. In 
2003 and forever thereafter, they have only 3 months each year to 
decide to disenroll.
  Mr. Speaker, many HMO's do a good job making people happy while they 
are healthy. Like fire engines at the Fourth of July parade, they look 
good and make people feel safe. The test comes when there is a fire--or 
in the case of an HMO, when a person gets sick. There is strong 
evidence that many HMO's do not do well when a person becomes ill, 
particularly when one faces a chronic illness or disability and needs 
rehabilitation. Today under Medicare, an HMO enrollee who finds they 
need help and the HMO is not delivering can on a month-by-month basis 
leave and seek care in another HMO or in the fee-for-service sector.
  Beginning in 2002, that right will end.
  There are good policy reasons for limiting the enrollment and 
disenrollment of people in HMO's. For example, coordinating periods of 
open enrollment provides a wonderful chance to compare plans and to 
encourage more competitive pricing of HMO products as they compete for 
business during an annual open enrollment period. Further, a bad HMO 
can make a huge profit by encouraging the disenrollment of people once 
they become sick and it makes financial sense for Medicare to limit 
this opportunity for gaming.
  Mr. Speaker, these good reasons are overridden in my mind by the 
danger that lock-in creates for people who become seriously ill and who 
needs treatment that an HMO may refuse to provide. There are good 
economic

[[Page E2049]]

reasons for Medicare to limit disenrollment--but those economic reasons 
are going to kill some of our seniors and disabled. Thus, I support 
repeal of the BBA lock-in.
  We simply do not know enough about quality of care in HMO's to 
justify a lock-in. Perhaps some day when there are much better 
measurements of outcomes and quality we could put a limit on the timing 
of enrollment and disenrollment. But that time is not here yet, and I 
fear the proposed lock-in will be deadly.
  Friends of the managed care movement should support this amendment, 
because it will remove a fear that many Medicare beneficiaries will 
have of joining an HMO and then being stuck in it for most of a year. 
If there is continuous open enrollment and disenrollment, more people 
are likely to try managed care without the fear of being stuck in a 
nonresponsive bureaucracy or assigned to a quack of a gatekeeper.
  Mr. Speaker, I do not expect this legislation to move in the 105th 
Congress--but as we get closer to 2002 and the lock in of 
beneficiaries, I expect that the interest will grow dramatically. I 
urge my colleagues to support this legislation in the months to come.

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