[Congressional Record Volume 144, Number 10 (Wednesday, February 11, 1998)]
[Extensions of Remarks]
[Pages E133-E134]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                  AARP REFUTES MAILINGS ON KYL-ARCHER

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                      Wednesday, February 11, 1998

  Mr. STARK. Mr. Speaker, for offices receiving mail on the Kyl-Archer 
bill to let any doctor at any time bill any Medicare patients as much 
as the doctor wants, the following article from the February, 1998 AARP 
Bulletin will provide a useful insert-answer.

[[Page E134]]

  The AARP article shows that a number of groups have been trying to 
scare seniors into contributing to a phony cause.

                  [From the AARP Bulletin, Feb. 1998]

     AARP Answers `Scare Campaign' on Medicare Private Contracting

                   (By Elliot Carlson and Don McLeod)

       Medicare beneficiaries are being flooded with 
     misinformation about their right to enter into private 
     contracts with their doctors.
       As examples, observers cite reports in some newspapers and 
     magazines stating that, because of the 1997 Balanced Budget 
     Act (BBA), doctors will be barred from treating older 
     patients on a private basis.
       ``What we have here,'' says AARP legislative director John 
     Rother, `is a concerted scare campaign aimed at misleading 
     Medicare beneficiaries into believing that they have lost the 
     freedom to choose their own doctors and seek the care they 
     need.''
       That's false, Rother says. Rather than weakening an 
     enrollee's right to contract privately with doctors, he adds, 
     the recently enacted BBA actually expands that right. Prior 
     to passage of that law last fall, Medicare beneficiaries and 
     doctors were not permitted to contract privately for services 
     Medicare covered, such as office visits.
       Any doctor treating a Medicare patient had to file a claim 
     with Medicare and was limited in how much he or she could 
     charge a beneficiary.
       The BBA liberalizes these provisions. For the first time, 
     effective Jan. 1, 1998, the law allows doctors to contract 
     privately with Medicare enrollees for services that are 
     already covered by Medicare.
       But no sooner was the BBA enacted, Rother points out, than 
     some groups started misinterpreting it--telling people 
     incorrectly that the new law, rather than expanding enrollee 
     rights, had taken them away.
       One group, he notes, has been writing beneficiaries, quite 
     erroneously, that if they pay a doctor out of their own 
     pocket for a treatment not covered by Medicare, then their 
     doctor will be barred from treating Medicare patients for two 
     years.
       Not so. Patients always could--and still can--privately buy 
     services not covered by Medicare, such as prescription drugs, 
     eyeglasses and hearing aids. ``Beneficiaries have always been 
     able to pay out of their own pocket for services not covered 
     by Medicare without penalty to themselves or their 
     physicians,'' says Nancy-Ann DeParle, administrator of the 
     Health Care Financing Administration, which runs Medicare. 
     ``The new Balanced Budget Act doesn't change that.''
       And you always could--and still can--pay for extra medical 
     tests you want without you or your doctor being penalized, 
     even if your doctor disagrees about the need.
       A case in point is mammograms. Under the law Medicare pays 
     for one mammogram per year. If you have a history of breast 
     cancer in your family and your doctor deems it advisable, 
     Medicare will pay for a second test.
       Even if you aren't a high-risk case for breast cancer but 
     you simply want a second test, you can go ahead and pay for 
     it on your own without penalty to you or your doctor.
       But the 1997 BBA does change some things. As noted above, 
     it allows doctors for the first time to contract privately 
     with Medicare enrollees for services that are already covered 
     by Medicare.
       This change stems from a bill advanced last June by Sen. 
     Jon Kyl, R-Ariz., who said the change was needed to allow 
     ``those 9 percent of the physicians who do not treat Medicare 
     patients to continue to treat their patients [after patients 
     turn 65] as they always have.'' In the waning hours of the 
     debate on this proposal, House-Senate conferees modified the 
     Kyl provision and incorporated a number of enrollee 
     protections.
       A key protection requires doctors to disclose contract 
     terms. Thus, the doctor and Medicare patient must both sign a 
     contract in which the patient agrees not to file a claim with 
     Medicare. The patient also agrees to pay 100 percent of 
     whatever amount the doctor charges. The contract must 
     disclose that Medicare will pay no portion of the cost of the 
     service. Nor will the enrollee's medigap policy.
       Also, the new provision is limited to doctors who agree, in 
     an affidavit, to forgo all payment from Medicare for two 
     years--a clause that has turned out to be controversial. 
     Critics argue that the ``two-year ban'' makes it very hard 
     for doctors to take advantage of the Kyl provision. And, they 
     add, it could discourage doctors from taking new Medicare 
     patients.
       Such concerns don't stand up to close examination, says 
     Tricia Smith, coordinator of AARP's legislative health team. 
     ``There is good reason for the two-year exclusion.'' For 
     starters, ``the provision is a real protection for Medicare 
     patients,'' she says. ``It's intended to prevent doctors from 
     picking and choosing patients based on income and severity of 
     illness.
       ``Also,'' Smith adds, ``it seeks to protect Medicare 
     against fraud.''
       In the wake of the controversy over private contracting, 
     Senator Kyl is advocating a new bill that would go well 
     beyond the intent of his original proposal. Not only is he 
     seeking to eliminate the two-year ban, but he also wants to 
     allow doctors to contract privately with low-income patients 
     and those in managed care. And he wants to let doctors pick 
     and choose what services they will contract for.
       The legislation is supported by the American Medical 
     Association (AMA), which has opposed Medicare's limits on 
     balance billing--the extra amount doctors can charge 
     beneficiaries over and above Medicare's payment.
       But AARP, along with the New York-based Medicare Rights 
     Center and some other consumer groups, strongly opposes the 
     Kyl legislation. The American College of Physicians has 
     raised serious questions about it.
       ``These proposed changes could open up Medicare to even 
     more fraud and abuse than we see now,'' says AARP's Smith. 
     ``Medicare would have a very hard time identifying which 
     services were paid for privately. Thus, doctors could double-
     bill and collect from both beneficiaries and Medicare.''
       Critics, AARP among them, also worry about the danger that 
     private contracting could create a ``two-tiered system''--one 
     for better-off enrollees who could afford high-priced doctors 
     and another for all other enrollees.
       Finally, AARP and other critics worry about the ability of 
     doctors to charge any price for services rendered and the 
     Medicare enrollee being held responsible to pay 100 percent 
     of the bill.
       ``When a beneficiary agrees to a private contract, he or 
     she is liable for 100 percent of what the doctor chooses to 
     charge for the service,'' Smith observes. ``When 
     beneficiaries discover that and recognize that their medigap 
     policy won't cover the costs, they may find that the out-of-
     pocket costs will be unmanageable.''

     

                          ____________________