[Congressional Record Volume 144, Number 29 (Tuesday, March 17, 1998)]
[Senate]
[Pages S2127-S2135]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. MOYNIHAN (for himself, Mr. Kennedy, Mr. Daschle, Mrs. 
        Boxer, Mr. Dodd, Mr. Durbin, Mr. Glenn, Mr. Harkin, Mr. Kerry, 
        Mr. Lautenberg, Ms. Moseley-Braun, Mr. Rockefeller, and Mr. 
        Torricelli):
  S. 1789. A bill to amend title XVIII of the Social Security Act and 
the Employee Retirement Income Security Act of 1974 to improve access 
to health insurance and medicare benefits for individuals ages 55 to 65 
to be fully funded through premiums and anti-fraud provision, and for 
other purposes; to the Committee on finance.


                 the medicare early access act of 1998

  Mr. MOYNIHAN. Mr. President, I rise to introduce a bill to provide 
access to health insurance for individuals between the ages of 55-65. 
These individuals are too young for Medicare, not poor enough to 
qualify for Medicaid, and in many cases, are forced into early 
retirement or pushed out of their jobs in corporate downsizing.
  The ``Medicare Early Access Act'' is based on the President's three-
part initiative announced on January 6, 1998. The bill is a targeted, 
self-financing proposal to give older Americans under 65 new options to 
obtain health insurance coverage. Many of these Americans have worked 
hard all their lives, but, through no fault of their own, find 
themselves uninsured just as they are entering the years when the risk 
of serious illness is increasing. This legislation attempts to bridge 
the gap in coverage between years when persons are in the labor and the 
age--(65) when they become eligible for Medicare.
  The bill has three parts: (1) It enables persons between ages 62 and 
64 to buy into Medicare by paying a full premium; (2) it provides 
displaced workers over age 55 access to Medicare by offering a similar 
Medicare buy-in option; and (3) it extends COBRA coverage to persons 55 
and over whose employers withdraw retiree health benefits. A more 
detailed description of the proposal is attached.


                                THE COST

  The program is self-financing and is largely paid for by premiums 
from the beneficiaries themselves. The financing of the program is 
carefully walled off from the Medicare Part A and Part B Trust Funds, 
to ensure that it will not adversely impact the existing program.
  There is a modest cost to the buy-in proposal for 62-65 year-olds 
because participants would pay the premium in two parts: most of the 
cost would be paid by the individual up front; a smaller amount would 
be paid after they turn 65 years old. Medicare would in effect ``loan'' 
participants the second part of the premium until they reach 65, when 
they would make small monthly payments in addition to their regular 
Medicare Part B premium. That ``loan'' accounts for most of the 
Medicare costs of the legislation, and is fully offset by a separate 
savings from a separate bill to reduce Medicare waste, fraud and 
overpayment that I am also introducing at this time.
  The CBO analysis of this bill found no impact on the Medicare Part A 
or Part B Trust Funds. The net cost of the two bills is virtually 
zero--an average of about $60 million per year. CBO also predicted that 
about 410,000 individuals would participate (or 33 percent more than 
first estimated by the Administration). Finally, CBO estimated that the 
post-65 premium that people ages 62-65 would pay would be only $10 per 
month per year--$6 per month, or $72 less per year, than the 
Administration estimated.
  Mr. President, the problem of health insurance for the near elderly 
is getting worse. Congress should act now to provide valuable coverage 
for these individuals.
  Mr. President, I ask unanimous consent that the full text and summary 
of the bill be printed in the Record.
  There being no objection, the items were ordered to be printed in the 
Record, as follows:

                                S. 1789

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Medicare 
     Early Access Act of 1998''.
       (b) Table of Contents.--

Sec. 1. Short title; table of contents.

TITLE I--ACCESS TO MEDICARE BENEFITS FOR INDIVIDUALS 62-TO-65 YEARS OF 
                                  AGE

Sec. 101. Access to medicare benefits for individuals 62-to-65 years of 
              age.

 ``Part D--Purchase of Medicare Benefits by Certain Individuals Age 62-
                           to-65 Years of Age

``Sec. 1859. Program benefits; eligibility.
``Sec. 1859A. Enrollment process; coverage.
``Sec. 1859B. Premiums.
``Sec. 1859C. Payment of premiums.
``Sec. 1859D. Medicare Early Access Trust Fund.
``Sec. 1859E. Oversight and accountability.
``Sec. 1859F. Administration and miscellaneous.

 TITLE II--ACCESS TO MEDICARE BENEFITS FOR DISPLACED WORKERS 55-TO-62 
                              YEARS OF AGE

Sec. 201. Access to medicare benefits for displaced workers 55-to-62 
              years of age.

             TITLE III--COBRA PROTECTION FOR EARLY RETIREES

 Subtitle A--Amendments to the Employee Retirement Income Security Act 
                                of 1974

Sec. 301. COBRA continuation benefits for certain retired workers who 
              lose retiree health coverage.

        Subtitle B--Amendments to the Public Health Service Act

Sec. 311. COBRA continuation benefits for certain retired workers who 
              lose retiree health coverage.

      Subtitle C--Amendments to the Internal Revenue Code of 1986

Sec. 321. COBRA continuation benefits for certain retired workers who 
              lose retiree health coverage.

                          TITLE IV--FINANCING

Sec. 401. Reference to financing provisions.
TITLE I--ACCESS TO MEDICARE BENEFITS FOR INDIVIDUALS 62-TO-65 YEARS OF 
                                  AGE

     SEC. 101. ACCESS TO MEDICARE BENEFITS FOR INDIVIDUALS 62-TO-
                   65 YEARS OF AGE.

       (a) In General.--Title XVIII of the Social Security Act is 
     amended--
       (1) by redesignating section 1859 and part D as section 
     1858 and part E, respectively; and
       (2) by inserting after such section the following new part:

 ``Part D--Purchase of Medicare Benefits by Certain Individuals Age 62-
                           to-65 Years of Age

     ``SEC. 1859. PROGRAM BENEFITS; ELIGIBILITY.

       ``(a) Entitlement to Medicare Benefits For Enrolled 
     Individuals.--
       ``(1) In general.--An individual enrolled under this part 
     is entitled to the same benefits under this title as an 
     individual entitled to benefits under part A and enrolled 
     under part B.
       ``(2) Definitions.--For purposes of this part:
       ``(A) Federal or state cobra continuation provision.--The 
     term `Federal or State COBRA continuation provision' has the 
     meaning given the term `COBRA continuation provision' in 
     section 2791(d)(4) of the Public Health Service Act and 
     includes a comparable State program, as determined by the 
     Secretary.
       ``(B) Federal health insurance program defined.--The term 
     `Federal health insurance program' means any of the 
     following:
       ``(i) Medicare.--Part A or part B of this title (other than 
     by reason of this part).
       ``(ii) Medicaid.--A State plan under title XIX.
       ``(iii) FEHBP.--The Federal employees health benefit 
     program under chapter 89 of title 5, United States Code.
       ``(iv) TRICARE.--The TRICARE program (as defined in section 
     1072(7) of title 10, United States Code).
       ``(v) Active duty military.--Health benefits under title 
     10, United States Code, to an individual as a member of the 
     uniformed services of the United States.

[[Page S2128]]

       ``(C) Group health plan.--The term `group health plan' has 
     the meaning given such term in section 2791(a)(1) of the 
     Public Health Service Act.
       ``(b) Eligibility of Individuals Age 62-to-65 Years of 
     Age.--
       ``(1) In general.--Subject to paragraph (2), an individual 
     who meets the following requirements with respect to a month 
     is eligible to enroll under this part with respect to such 
     month:
       ``(A) Age.--As of the last day of the month, the individual 
     has attained 62 years of age, but has not attained 65 years 
     of age.
       ``(B) Medicare eligibility (but for age).--The individual 
     would be eligible for benefits under part A or part B for the 
     month if the individual were 65 years of age.
       ``(C) Not eligible for coverage under group health plans or 
     federal health insurance programs.--The individual is not 
     eligible for benefits or coverage under a Federal health 
     insurance program (as defined in subsection (a)(2)(B)) or 
     under a group health plan (other than such eligibility merely 
     through a Federal or State COBRA continuation provision) as 
     of the last day of the month involved.
       ``(2) Limitation on eligibility if terminated enrollment.--
     If an individual described in paragraph (1) enrolls under 
     this part and coverage of the individual is terminated under 
     section 1859A(d) (other than because of age), the individual 
     is not again eligible to enroll under this subsection unless 
     the following requirements are met:
       ``(A) New coverage under group health plan or federal 
     health insurance program.--After the date of termination of 
     coverage under such section, the individual obtains coverage 
     under a group health plan or under a Federal health insurance 
     program.
       ``(B) Subsequent loss of new coverage.--The individual 
     subsequently loses eligibility for the coverage described in 
     subparagraph (A) and exhausts any eligibility the individual 
     may subsequently have for coverage under a Federal or State 
     COBRA continuation provision.
       ``(3) Change in health plan eligibility does not affect 
     coverage.--In the case of an individual who is eligible for 
     and enrolls under this part under this subsection, the 
     individual's continued entitlement to benefits under this 
     part shall not be affected by the individual's subsequent 
     eligibility for benefits or coverage described in paragraph 
     (1)(C), or entitlement to such benefits or coverage.

     ``SEC. 1859A. ENROLLMENT PROCESS; COVERAGE.

       ``(a) In General.--An individual may enroll in the program 
     established under this part only in such manner and form as 
     may be prescribed by regulations, and only during an 
     enrollment period prescribed by the Secretary consistent with 
     the provisions of this section. Such regulations shall 
     provide a process under which--
       ``(1) individuals eligible to enroll as of a month are 
     permitted to pre-enroll during a prior month within an 
     enrollment period described in subsection (b); and
       ``(2) each individual seeking to enroll under section 
     1859(b) is notified, before enrolling, of the deferred 
     monthly premium amount the individual will be liable for 
     under section 1859C(b) upon attaining 65 years of age as 
     determined under section 1859B(c)(3).
       ``(b) Enrollment Periods.--
       ``(1) Individuals 62-to-65 years of age.--In the case of 
     individuals eligible to enroll under this part under section 
     1859(b)--
       ``(A) Initial enrollment period.--If the individual is 
     eligible to enroll under such section for July 1999, the 
     enrollment period shall begin on May 1, 1999, and shall end 
     on August 31, 1999. Any such enrollment before July 1, 1999, 
     is conditioned upon compliance with the conditions of 
     eligibility for July 1999.
       ``(B) Subsequent periods.--If the individual is eligible to 
     enroll under such section for a month after July 1999, the 
     enrollment period shall begin on the first day of the second 
     month before the month in which the individual first is 
     eligible to so enroll and shall end four months later. Any 
     such enrollment before the first day of the third month of 
     such enrollment period is conditioned upon compliance with 
     the conditions of eligibility for such third month.
       ``(2) Authority to correct for government errors.--The 
     provisions of section 1837(h) apply with respect to 
     enrollment under this part in the same manner as they apply 
     to enrollment under part B.
       ``(c) Date Coverage Begins.--
       ``(1) In general.--The period during which an individual is 
     entitled to benefits under this part shall begin as follows, 
     but in no case earlier than July 1, 1999:
       ``(A) In the case of an individual who enrolls (including 
     pre-enrolls) before the month in which the individual 
     satisfies eligibility for enrollment under section 1859, the 
     first day of such month of eligibility.
       ``(B) In the case of an individual who enrolls during or 
     after the month in which the individual first satisfies 
     eligibility for enrollment under such section, the first day 
     of the following month.
       ``(2) Authority to provide for partial months of 
     coverage.--Under regulations, the Secretary may, in the 
     Secretary's discretion, provide for coverage periods that 
     include portions of a month in order to avoid lapses of 
     coverage.
       ``(3) Limitation on payments.--No payments may be made 
     under this title with respect to the expenses of an 
     individual enrolled under this part unless such expenses were 
     incurred by such individual during a period which, with 
     respect to the individual, is a coverage period under this 
     section.
       ``(d) Termination of Coverage.--
       ``(1) In general.--An individual's coverage period under 
     this part shall continue until the individual's enrollment 
     has been terminated at the earliest of the following:
       ``(A) General provisions.--
       ``(i) Notice.--The individual files notice (in a form and 
     manner prescribed by the Secretary) that the individual no 
     longer wishes to participate in the insurance program under 
     this part.
       ``(ii) Nonpayment of premiums.--The individual fails to 
     make payment of premiums required for enrollment under this 
     part.
       ``(iii) Medicare eligibility.--The individual becomes 
     entitled to benefits under part A or enrolled under part B 
     (other than by reason of this part).
       ``(B) Termination based on age.--The individual attains 65 
     years of age.
       ``(2) Effective date of termination.--
       ``(A) Notice.--The termination of a coverage period under 
     paragraph (1)(A)(i) shall take effect at the close of the 
     month following for which the notice is filed.
       ``(B) Nonpayment of premium.--The termination of a coverage 
     period under paragraph (1)(A)(ii) shall take effect on a date 
     determined under regulations, which may be determined so as 
     to provide a grace period in which overdue premiums may be 
     paid and coverage continued. The grace period determined 
     under the preceding sentence shall not exceed 60 days; except 
     that it may be extended for an additional 30 days in any case 
     where the Secretary determines that there was good cause for 
     failure to pay the overdue premiums within such 60-day 
     period.
       ``(C) Age or medicare eligibility.--The termination of a 
     coverage period under paragraph (1)(A)(iii) or (1)(B) shall 
     take effect as of the first day of the month in which the 
     individual attains 65 years of age or becomes entitled to 
     benefits under part A or enrolled for benefits under part B 
     (other than by reason of this part).

     ``SEC. 1859B. PREMIUMS.

       ``(a) Amount of Monthly Premiums.--
       ``(1) Base monthly premiums.--The Secretary shall, during 
     September of each year (beginning with 1998), determine the 
     following premium rates which shall apply with respect to 
     coverage provided under this title for any month in the 
     succeeding year:
       ``(A) Base monthly premium for individuals 62 years of age 
     or older.--A base monthly premium for individuals 62 years of 
     age or older, equal to \1/12\ of the base annual premium rate 
     computed under subsection (b) for each premium area.
       ``(2) Deferred monthly premiums for individuals 62 years of 
     age or older.--The Secretary shall, during September of each 
     year (beginning with 1998), determine under subsection (c) 
     the amount of deferred monthly premiums that shall apply with 
     respect to individuals who first obtain coverage under this 
     part under section 1859(b) in the succeeding year.
       ``(3) Establishment of premium areas.--For purposes of this 
     part, the term `premium area' means such an area as the 
     Secretary shall specify to carry out this part. The Secretary 
     from time to time may change the boundaries of such premium 
     areas. The Secretary shall seek to minimize the number of 
     such areas specified under this paragraph.
       ``(b) Base Annual Premium for Individuals 62 Years of Age 
     or Older.--
       ``(1) National, per capita average.--The Secretary shall 
     estimate the average, annual per capita amount that would be 
     payable under this title with respect to individuals residing 
     in the United States who meet the requirement of section 
     1859(b)(1)(A) as if all such individuals were eligible for 
     (and enrolled) under this title during the entire year (and 
     assuming that section 1862(b)(2)(A)(i) did not apply).
       ``(2) Geographic adjustment.--The Secretary shall adjust 
     the amount determined under paragraph (1) for each premium 
     area (specified under subsection (a)(3)) in order to take 
     into account such factors as the Secretary deems appropriate 
     and shall limit the maximum premium under this paragraph in a 
     premium area to assure participation in all areas throughout 
     the United States.
       ``(3) Base annual premium.--The base annual premium under 
     this subsection for months in a year for individuals 62 years 
     of age or older residing in a premium area is equal to the 
     average, annual per capita amount estimated under paragraph 
     (1) for the year, adjusted for such area under paragraph (2).
       ``(c) Deferred Premium Rate for Individuals 62 Years of Age 
     or Older.--The deferred premium rate for individuals with a 
     group of individuals who obtain coverage under section 
     1859(b) in a year shall be computed by the Secretary as 
     follows:
       ``(1) Estimation of national, per capita annual average 
     expenditures for enrollment group.--The Secretary shall 
     estimate the average, per capita annual amount that will be 
     paid under this part for individuals in such group during the 
     period of enrollment under section 1859(b). In making such 
     estimate for coverage beginning in a year before 2003, the 
     Secretary may base such estimate on the average, per capita 
     amount that would be payable if the program had been in 
     operation over a previous period of at least 4 years.
       ``(2) Difference between estimated expenditures and 
     estimated premiums.--

[[Page S2129]]

     Based on the characteristics of individuals in such group, 
     the Secretary shall estimate during the period of coverage of 
     the group under this part under section 1859(b) the amount by 
     which--
       ``(A) the amount estimated under paragraph (1); exceeds
       ``(B) the average, annual per capita amount of premiums 
     that will be payable for months during the year under section 
     1859C(a) for individuals in such group (including premiums 
     that would be payable if there were no terminations in 
     enrollment under clause (i) or (ii) of section 
     1859A(d)(1)(A)).
       ``(3) Actuarial computation of deferred monthly premium 
     rates.--The Secretary shall determine deferred monthly 
     premium rates for individuals in such group in a manner so 
     that--
       ``(A) the estimated actuarial value of such premiums 
     payable under section 1859C(b), is equal to
       ``(B) the estimated actuarial present value of the 
     differences described in paragraph (2).

     Such rate shall be computed for each individual in the group 
     in a manner so that the rate is based on the number of months 
     between the first month of coverage based on enrollment under 
     section 1859(b) and the month in which the individual attains 
     65 years of age.
       ``(4) Determinants of actuarial present values.--The 
     actuarial present values described in paragraph (3) shall 
     reflect--
       ``(A) the estimated probabilities of survival at ages 62 
     through 84 for individuals enrolled during the year; and
       ``(B) the estimated effective average interest rates that 
     would be earned on investments held in the trust funds under 
     this title during the period in question.

     ``SEC. 1859C. PAYMENT OF PREMIUMS.

       ``(a) Payment of Base Monthly Premium.--
       ``(1) In general.--The Secretary shall provide for payment 
     and collection of the base monthly premium, determined under 
     section 1859B(a)(1) for the age (and age cohort, if 
     applicable) of the individual involved and the premium area 
     in which the individual principally resides, in the same 
     manner as for payment of monthly premiums under section 1840, 
     except that, for purposes of applying this section, any 
     reference in such section to the Federal Supplementary 
     Medical Insurance Trust Fund is deemed a reference to the 
     Trust Fund established under section 1859D.
       ``(2) Period of payment.--In the case of an individual who 
     participates in the program established by this title, the 
     base monthly premium shall be payable for the period 
     commencing with the first month of the individual's coverage 
     period and ending with the month in which the individual's 
     coverage under this title terminates.
       ``(b) Payment of Deferred Premium for Individuals Covered 
     After Attaining Age 62.--
       ``(1) Rate of payment.--
       ``(A) In general.--In the case of an individual who is 
     covered under this part for a month pursuant to an enrollment 
     under section 1859(b), subject to subparagraph (B), the 
     individual is liable for payment of a deferred premium in 
     each month during the period described in paragraph (2) in an 
     amount equal to the full deferred monthly premium rate 
     determined for the individual under section 1859B(c).
       ``(B) Special rules for those who disenroll early.--
       ``(i) In general.--If such an individual's enrollment under 
     such section is terminated under clause (i) or (ii) of 
     section 1859A(d)(1)(A), subject to clause (ii), the amount of 
     the deferred premium otherwise established under this 
     paragraph shall be pro-rated to reflect the number of months 
     of coverage under this part under such enrollment compared to 
     the maximum number of months of coverage that the individual 
     would have had if the enrollment were not so terminated.
       ``(ii) Rounding to 12-month minimum coverage periods.--In 
     applying clause (i), the number of months of coverage (if not 
     a multiple of 12) shall be rounded to the next highest 
     multiple of 12 months, except that in no case shall this 
     clause result in a number of months of coverage exceeding the 
     maximum number of months of coverage that the individual 
     would have had if the enrollment were not so terminated.
       ``(2) Period of payment.--The period described in this 
     paragraph for an individual is the period beginning with the 
     first month in which the individual has attained 65 years of 
     age and ending with the month before the month in which the 
     individual attains 85 years of age.
       ``(3) Collection.--In the case of an individual who is 
     liable for a premium under this subsection, the amount of the 
     premium shall be collected in the same manner as the premium 
     for enrollment under such part is collected under section 
     1840, except that any reference in such section to the 
     Federal Supplementary Medical Insurance Trust Fund is deemed 
     to be a reference to the Medicare Early Access Trust Fund 
     established under section 1859D.
       ``(c) Application of Certain Provisions.--The provisions of 
     section 1840 (other than subsection (h)) shall apply to 
     premiums collected under this section in the same manner as 
     they apply to premiums collected under part B, except that 
     any reference in such section to the Federal Supplementary 
     Medical Insurance Trust Fund is deemed a reference to the 
     Trust Fund established under section 1859D.

     ``SEC. 1859D. MEDICARE EARLY ACCESS TRUST FUND.

       ``(a) Establishment of Trust Fund.--
       ``(1) In general.--There is hereby created on the books of 
     the Treasury of the United States a trust fund to be known as 
     the `Medicare Early Access Trust Fund' (in this section 
     referred to as the `Trust Fund'). The Trust Fund shall 
     consist of such gifts and bequests as may be made as provided 
     in section 201(i)(1) and such amounts as may be deposited in, 
     or appropriated to, such fund as provided in this title.
       ``(2) Premiums.--Premiums collected under section 1859B 
     shall be transferred to the Trust Fund.
       ``(3) Transfer of savings from new fraud and abuse 
     initiatives.--
       ``(A) In general.--There is hereby transferred to the Trust 
     Fund from the Federal Hospital Insurance Trust Fund and from 
     the Federal Supplementary Medical Insurance Trust Fund 
     amounts equivalent to the amounts (specified under 
     subparagraph (B)) of the reductions in expenditures under 
     such respective trust fund as may be attributable to the 
     enactment of the Medicare Fraud and Overpayment Act of 1998.
       ``(B) Use of cbo estimates.--For each fiscal year during 
     the 10-fiscal-year period beginning with fiscal year 1999, 
     the amounts under subparagraph (A) shall be the amounts 
     described in such subparagraph as determined by the 
     Congressional Budget Office at the time of, and in connection 
     with, the enactment of the Medicare Early Access Act of 1998. 
     For subsequent fiscal years, the amounts under subparagraph 
     (A) shall be the amount determined under this subparagraph 
     for the previous fiscal year increased by the same percentage 
     as the percentage increase in aggregate expenditures under 
     this title from the second previous fiscal year to the 
     previous fiscal year.
       ``(b) Incorporation of Provisions.--
       ``(1) In general.--Subject to paragraph (2), subsections 
     (b) through (i) of section 1841 shall apply with respect to 
     the Trust Fund and this title in the same manner as they 
     apply with respect to the Federal Supplementary Medical 
     Insurance Trust Fund and part B, respectively.
       ``(2) Miscellaneous references.--In applying provisions of 
     section 1841 under paragraph (1)--
       ``(A) any reference in such section to `this part' is 
     construed to refer to this part D;
       ``(B) any reference in section 1841(h) to section 1840(d) 
     and in section 1841(i) to sections 1840(b)(1) and 1842(g) are 
     deemed references to comparable authority exercised under 
     this part; and
       ``(C) payments may be made under section 1841(g) to the 
     Trust Funds under sections 1817 and 1841 as reimbursement to 
     such funds for payments they made for benefits provided under 
     this part.

     ``SEC. 1859E. OVERSIGHT AND ACCOUNTABILITY.

       ``(a) Through Annual Reports of Trustees.--The Board of 
     Trustees of the Medicare Early Access Trust Fund under 
     section 1859D(b)(1) shall report on an annual basis to 
     Congress concerning the status of the Trust Fund and the need 
     for adjustments in the program under this part to maintain 
     financial solvency of the program under this part.
       ``(b) Periodic GAO Reports.--The Comptroller General of the 
     United States shall periodically submit to Congress reports 
     on the adequacy of the financing of coverage provided under 
     this part. The Comptroller General shall include in such 
     report such recommendations for adjustments in such financing 
     and coverage as the Comptroller General deems appropriate in 
     order to maintain financial solvency of the program under 
     this part.

     ``SEC. 1859F. ADMINISTRATION AND MISCELLANEOUS.

       ``(a) Treatment for Purposes of Title.--Except as otherwise 
     provided in this part--
       ``(1) individuals enrolled under this part shall be treated 
     for purposes of this title as though the individual were 
     entitled to benefits under part A and enrolled under part B; 
     and
       ``(2) benefits described in section 1859 shall be payable 
     under this title to such individuals in the same manner as if 
     such individuals were so entitled and enrolled.
       ``(b) Not Treated As Medicare Program for Purposes of 
     Medicaid Program.--For purposes of applying title XIX 
     (including the provision of medicare cost-sharing assistance 
     under such title), an individual who is enrolled under this 
     part shall not be treated as being entitled to benefits under 
     this title.
       ``(c) Not Treated As Medicare Program for Purposes of COBRA 
     Continuation Provisions.--In applying a COBRA continuation 
     provision (as defined in section 2791(d)(4) of the Public 
     Health Service Act), any reference to an entitlement to 
     benefits under this title shall not be construed to include 
     entitlement to benefits under this title pursuant to the 
     operation of this part.''.
       (b) Conforming Amendments to Social Security Act 
     Provisions.--
       (1) Section 201(i)(1) of the Social Security Act (42 U.S.C. 
     401(i)(1)) is amended by striking ``or the Federal 
     Supplementary Medical Insurance Trust Fund'' and inserting 
     ``the Federal Supplementary Medical Insurance Trust Fund, and 
     the Medicare Early Access Trust Fund''.
       (2) Section 201(g)(1)(A) of such Act (42 U.S.C. 
     401(g)(1)(A)) is amended by striking `` and the Federal 
     Supplementary Medical Insurance Trust Fund established by 
     title

[[Page S2130]]

     XVIII'' and inserting ``, the Federal Supplementary Medical 
     Insurance Trust Fund, and the Medicare Early Access Trust 
     Fund established by title XVIII''.
       (3) Section 1820(i) of such Act (42 U.S.C. 1395i-4(i)) is 
     amended by striking ``part D'' and inserting ``part E''.
       (4) Part C of title XVIII of such Act is amended--
       (A) in section 1851(a)(2)(B) (42 U.S.C. 1395w-21(a)(2)(B)), 
     by striking `` 1859(b)(3)'' and inserting ``1858(b)(3);
       (B) in section 1851(a)(2)(C) (42 U.S.C. 1395w-21(a)(2)(C)), 
     by striking ``1859(b)(2)'' and inserting ``1858(b)(2)'';
       (C) in section 1852(a)(1) (42 U.S.C. 1395w-22(a)(1)), by 
     striking `` 1859(b)(3)'' and inserting ``1858(b)(3);
       (D) in section 1852(a)(3)(B)(ii) (42 U.S.C. 1395w-
     22(a)(3)(B)(ii)), by striking ``1859(b)(2)(B)'' and inserting 
     ``1858(b)(2)(B)'';
       (E) in section 1853(a)(1)(A) (42 U.S.C. 1395w-23(a)(1)(A)), 
     by striking ``1859(e)(4)'' and inserting ``1858(e)(4)''; and
       (F) in section 1853(a)(3)(D) (42 U.S.C. 1395w-23(a)(3)(D)), 
     by striking ``1859(e)(4)'' and inserting ``1858(e)(4)''.
       (5) Section 1853(c) of such Act (42 U.S.C. 1395w-23(c)) is 
     amended--
       (A) in paragraph (1), by striking ``or (7)'' and inserting 
     ``, (7), or (8)'', and
       (B) by adding at the end the following:
       ``(8) Adjustment for early access.--In applying this 
     subsection with respect to individuals entitled to benefits 
     under part D, the Secretary shall provide for an appropriate 
     adjustment in the Medicare+Choice capitation rate as may be 
     appropriate to reflect differences between the population 
     served under such part and the population under parts A and 
     B.''.
       (c) Other Conforming Amendments.--
       (1) Section 138(b)(4) of the Internal Revenue Code of 1986 
     is amended by striking ``1859(b)(3)'' and inserting 
     ``1858(b)(3)''.
       (2)(A) Section 602(2)(D)(ii) of the Employee Retirement 
     Income Security Act of 1974 (29 U.S.C. 1162(2)) is amended by 
     inserting ``(not including an individual who is so entitled 
     pursuant to enrollment under section 1859A)'' after ``Social 
     Security Act''.
       (B) Section 2202(2)(D)(ii) of the Public Health Service Act 
     (42 U.S.C. 300bb-2(2)(D)(ii)) is amended by inserting ``(not 
     including an individual who is so entitled pursuant to 
     enrollment under section 1859A)'' after ``Social Security 
     Act''.
       (C) Section 4980B(f)(2)(B)(i)(V) of the Internal Revenue 
     Code of 1986 is amended by inserting ``(not including an 
     individual who is so entitled pursuant to enrollment under 
     section 1859A)'' after ``Social Security Act''.
 TITLE II--ACCESS TO MEDICARE BENEFITS FOR DISPLACED WORKERS 55-TO-62 
                              YEARS OF AGE

     SEC. 201. ACCESS TO MEDICARE BENEFITS FOR DISPLACED WORKERS 
                   55-TO-62 YEARS OF AGE.

       (a) Eligibility.--Section 1859 of the Social Security Act, 
     as inserted by section 101(a)(2), is amended by adding at the 
     end the following new subsection:
       ``(c) Displaced Workers and Spouses.--
       ``(1) Displaced workers.--Subject to paragraph (3), an 
     individual who meets the following requirements with respect 
     to a month is eligible to enroll under this part with respect 
     to such month:
       ``(A) Age.--As of the last day of the month, the individual 
     has attained 55 years of age, but has not attained 62 years 
     of age.
       ``(B) Medicare eligibility (but for age).--The individual 
     would be eligible for benefits under part A or part B for the 
     month if the individual were 65 years of age.
       ``(C) Loss of employment-based coverage.--
       ``(i) Eligible for unemployment compensation.--The 
     individual meets the requirements relating to period of 
     covered employment and conditions of separation from 
     employment to be eligible for unemployment compensation (as 
     defined in section 85(b) of the Internal Revenue Code of 
     1986), based on a separation from employment occurring on or 
     after January 1, 1998. The previous sentence shall not be 
     construed as requiring the individual to be receiving such 
     unemployment compensation.
       ``(ii) Loss of employment-based coverage.--Immediately 
     before the time of such separation of employment, the 
     individual was covered under a group health plan on the basis 
     of such employment, and, because of such loss, is no longer 
     eligible for coverage under such plan (including such 
     eligibility based on the application of a Federal or State 
     COBRA continuation provision) as of the last day of the month 
     involved.
       ``(iii) Previous creditable coverage for at least 1 year.--
     As of the date on which the individual loses coverage 
     described in clause (ii), the aggregate of the periods of 
     creditable coverage (as determined under section 2701(c) of 
     the Public Health Service Act) is 12 months or longer.
       ``(D) Exhaustion of available cobra continuation 
     benefits.--
       ``(i) In general.--In the case of an individual described 
     in clause (ii) for a month described in clause (iii)--

       ``(I) the individual (or spouse) elected coverage described 
     in clause (ii); and
       ``(II) the individual (or spouse) has continued such 
     coverage for all months described in clause (iii) in which 
     the individual (or spouse) is eligible for such coverage.

       ``(ii) Individuals to whom cobra continuation coverage made 
     available.--An individual described in this clause is an 
     individual--

       ``(I) who was offered coverage under a Federal or State 
     COBRA continuation provision at the time of loss of coverage 
     eligibility described in subparagraph (C)(ii); or
       ``(II) whose spouse was offered such coverage in a manner 
     that permitted coverage of the individual at such time.

       ``(iii) Months of possible cobra continuation coverage.--A 
     month described in this clause is a month for which an 
     individual described in clause (ii) could have had coverage 
     described in such clause as of the last day of the month if 
     the individual (or the spouse of the individual, as the case 
     may be) had elected such coverage on a timely basis.
       ``(E) Not eligible for coverage under federal health 
     insurance program or group health plans.--The individual is 
     not eligible for benefits or coverage under a Federal health 
     insurance program or under a group health plan (whether on 
     the basis of the individual's employment or employment of the 
     individual's spouse) as of the last day of the month 
     involved.
       ``(2) Spouse of displaced worker.--Subject to paragraph 
     (3), an individual who meets the following requirements with 
     respect to a month is eligible to enroll under this part with 
     respect to such month:
       ``(A) Age.--As of the last day of the month, the individual 
     has not attained 62 years of age.
       ``(B) Married to displaced worker.--The individual is the 
     spouse of an individual at the time the individual enrolls 
     under this part under paragraph (1) and loses coverage 
     described in paragraph (1)(C)(ii) because the individual's 
     spouse lost such coverage.
       ``(C) Medicare eligibility (but for age); exhaustion of any 
     cobra continuation coverage; and not eligible for coverage 
     under federal health insurance program or group health 
     plan.--The individual meets the requirements of subparagraphs 
     (B), (D), and (E) of paragraph (1).
       ``(3) Change in health plan eligibility affects continued 
     eligibility.--For provision that terminates enrollment under 
     this section in the case of an individual who becomes 
     eligible for coverage under a group health plan or under a 
     Federal health insurance program, see section 1859A(d)(1)(C).
       ``(4) Reenrollment permitted.--Nothing in this subsection 
     shall be construed as preventing an individual who, after 
     enrolling under this subsection, terminates such enrollment 
     from subsequently reenrolling under this subsection if the 
     individual is eligible to enroll under this subsection at 
     that time.''.
       (b) Enrollment.--Section 1859A of such Act, as so inserted, 
     is amended--
       (1) in subsection (a), by striking ``and'' at the end of 
     paragraph (1), by striking the period at the end of paragraph 
     (2) and inserting ``; and'', and by adding at the end the 
     following new paragraph:
       ``(3) individuals whose coverage under this part would 
     terminate because of subsection (d)(1)(B)(ii) are provided 
     notice and an opportunity to continue enrollment in 
     accordance with section 1859E(c)(1).'';
       (2) in subsection (b), by inserting after Notwithstanding 
     any other provision of law, (1) the following:
       ``(2) Displaced workers and spouses.--In the case of 
     individuals eligible to enroll under this part under section 
     1859(c), the following rules apply:
       ``(A) Initial enrollment period.--If the individual is 
     first eligible to enroll under such section for July 1999, 
     the enrollment period shall begin on May 1, 1999, and shall 
     end on August 31, 1999. Any such enrollment before July 1, 
     1999, is conditioned upon compliance with the conditions of 
     eligibility for July 1999.
       ``(B) Subsequent periods.--If the individual is eligible to 
     enroll under such section for a month after July 1999, the 
     enrollment period based on such eligibility shall begin on 
     the first day of the second month before the month in which 
     the individual first is eligible to so enroll (or reenroll) 
     and shall end four months later.'';
       (3) in subsection (d)(1), by amending subparagraph (B) to 
     read as follows:
       ``(B) Termination based on age.--
       ``(i) At age 65.--Subject to clause (ii), the individual 
     attains 65 years of age.
       ``(ii) At age 62 for displaced workers and spouses.--In the 
     case of an individual enrolled under this part pursuant to 
     section 1859(c), subject to subsection (a)(1), the individual 
     attains 62 years of age.'';
       (4) in subsection (d)(1), by adding at the end the 
     following new subparagraph:
       ``(C) Obtaining access to employment-based coverage or 
     federal health insurance program for individuals under 62 
     years of age.--In the case of an individual who has not 
     attained 62 years of age, the individual is covered (or 
     eligible for coverage) as a participant or beneficiary under 
     a group health plan or under a Federal health insurance 
     program.'';
       (5) in subsection (d)(2), by amending subparagraph (C) to 
     read as follows:
       ``(C) Age or medicare eligibility.--
       ``(i) In general.--The termination of a coverage period 
     under paragraph (1)(A)(iii) or (1)(B)(i) shall take effect as 
     of the first day of the month in which the individual attains 
     65 years of age or becomes entitled to benefits under part A 
     or enrolled for benefits under part B.
       ``(ii) Displaced workers.--The termination of a coverage 
     period under paragraph (1)(B)(ii) shall take effect as of the 
     first day of the month in which the individual attains

[[Page S2131]]

     62 years of age, unless the individual has enrolled under 
     this part pursuant to section 1859(b) and section 
     1859E(c)(1).''; and
       (6) in subsection (d)(2), by adding at the end the 
     following new subparagraph:
       ``(D) Access to coverage.--The termination of a coverage 
     period under paragraph (1)(C) shall take effect on the date 
     on which the individual is eligible to begin a period of 
     creditable coverage (as defined in section 2701(c) of the 
     Public Health Service Act) under a group health plan or under 
     a Federal health insurance program.''.
       (c) Premiums.--Section 1859B of such Act, as so inserted, 
     is amended--
       (1) in subsection (a)(1), by adding at the end the 
     following:
       ``(B) Base monthly premium for individuals under 62 years 
     of age.--A base monthly premium for individuals under 62 
     years of age, equal to \1/12\ of the base annual premium rate 
     computed under subsection (d)(3) for each premium area and 
     age cohort.''; and
       (2) by adding at the end the following new subsection:
       ``(d) Base Monthly Premium for Individuals Under 62 Years 
     of Age.--
       ``(1) National, per capita average for age groups.--
       ``(A) Estimate of amount.--The Secretary shall estimate the 
     average, annual per capita amount that would be payable under 
     this title with respect to individuals residing in the United 
     States who meet the requirement of section 1859(c)(1)(A) 
     within each of the age cohorts established under subparagraph 
     (B) as if all such individuals within such cohort were 
     eligible for (and enrolled) under this title during the 
     entire year (and assuming that section 1862(b)(2)(A)(i) did 
     not apply).
       ``(B) Age cohorts.--For purposes of subparagraph (A), the 
     Secretary shall establish separate age cohorts in 5 year age 
     increments for individuals who have not attained 60 years of 
     ages and a separate cohort for individuals who have attained 
     60 years of age.
       ``(2) Geographic adjustment.--The Secretary shall adjust 
     the amount determined under paragraph (1)(A) for each premium 
     area (specified under subsection (a)(3)) in the same manner 
     and to the same extent as the Secretary provides for 
     adjustments under subsection (b)(2).
       ``(3) Base annual premium.--The base annual premium under 
     this subsection for months in a year for individuals in an 
     age cohort under paragraph (1)(B) in a premium area is equal 
     to 165 percent of the average, annual per capita amount 
     estimated under paragraph (1) for the age cohort and year, 
     adjusted for such area under paragraph (2).
       ``(4) Pro-ration of premiums to reflect coverage during a 
     part of a month.--If the Secretary provides for coverage of 
     portions of a month under section 1859A(c)(2), the Secretary 
     shall pro-rate the premiums attributable to such coverage 
     under this section to reflect the portion of the month so 
     covered.''.
       (d) Administrative Provisions.--Section 1859F of such Act, 
     as so inserted, is amended by adding at the end the 
     following:
       ``(d) Additional Administrative Provisions.--
       ``(1) Process for continued enrollment of displaced workers 
     who attain 62 years of age.--The Secretary shall provide a 
     process for the continuation of enrollment of individuals 
     whose enrollment under section 1859(c) would be terminated 
     upon attaining 62 years of age. Under such process such 
     individuals shall be provided appropriate and timely notice 
     before the date of such termination and of the requirement to 
     enroll under this part pursuant to section 1859(b) in order 
     to continue entitlement to benefits under this title after 
     attaining 62 years of age.
       ``(2) Arrangements with states for determinations relating 
     to unemployment compensation eligibility.--The Secretary may 
     provide for appropriate arrangements with States for the 
     determination of whether individuals in the State meet or 
     would meet the requirements of section 1859(c)(1)(C)(i).''.``
       (e) Conforming Amendment to Heading to Part.--The heading 
     of part D of title XVIII of the Social Security Act, as so 
     inserted, is amended by striking ``62'' and inserting ``55''.
             TITLE III--COBRA PROTECTION FOR EARLY RETIREES
 Subtitle A--Amendments to the Employee Retirement Income Security Act 
                                of 1974

     SEC. 301. COBRA CONTINUATION BENEFITS FOR CERTAIN RETIRED 
                   WORKERS WHO LOSE RETIREE HEALTH COVERAGE.

       (a) Establishment of New Qualifying Event.--
       (1) In general.--Section 603 of the Employee Retirement 
     Income Security Act of 1974 (29 U.S.C. 1163) is amended by 
     inserting after paragraph (6) the following new paragraph:
       ``(7) The termination or substantial reduction in benefits 
     (as defined in section 607(7)) of group health plan coverage 
     as a result of plan changes or termination in the case of a 
     covered employee who is a qualified retiree.''.
       (2) Qualified retiree; qualified beneficiary; and 
     substantial reduction defined.--Section 607 of such Act (29 
     U.S.C. 1167) is amended--
       (A) in paragraph (3)--
       (i) in subparagraph (A), by inserting ``except as otherwise 
     provided in this paragraph,'' after ``means,''; and
       (ii) by adding at the end the following new subparagraph:
       ``(D) Special rule for qualifying retirees and 
     dependents.--In the case of a qualifying event described in 
     section 603(7), the term `qualified beneficiary' means a 
     qualified retiree and any other individual who, on the day 
     before such qualifying event, is a beneficiary under the plan 
     on the basis of the individual's relationship to such 
     qualified retiree.''; and
       (B) by adding at the end the following new paragraphs:
       ``(6) Qualified retiree.--The term `qualified retiree' 
     means, with respect to a qualifying event described in 
     section 603(7), a covered employee who, at the time of the 
     event--
       ``(A) has attained 55 years of age; and
       ``(B) was receiving group health coverage under the plan by 
     reason of the retirement of the covered employee.
       ``(7) Substantial reduction.--The term `substantial 
     reduction'--
       ``(A) means, as determined under regulations of the 
     Secretary and with respect to a qualified beneficiary, a 
     reduction in the average actuarial value of benefits under 
     the plan (through reduction or elimination of benefits, an 
     increase in premiums, deductibles, copayments, and 
     coinsurance, or any combination thereof), since the date of 
     commencement of coverage of the beneficiary by reason of the 
     retirement of the covered employee (or, if later, January 6, 
     1998), in an amount equal to at least 50 percent of the total 
     average actuarial value of the benefits under the plan as of 
     such date (taking into account an appropriate adjustment to 
     permit comparison of values over time); and
       ``(B) includes an increase in premiums required to an 
     amount that exceeds the premium level described in the fourth 
     sentence of section 602(3).
       (b) Duration of Coverage Through Age 65.--Section 602(2)(A) 
     of such Act (29 U.S.C. 1162(2)(A)) is amended--
       (1) in clause (ii), by inserting ``or 603(7)'' after 
     ``603(6)'';
       (2) in clause (iv), by striking ``or 603(6)'' and inserting 
     ``, 603(6), or 603(7)'';
       (3) by redesignating clause (iv) as clause (vi);
       (4) by redesignating clause (v) as clause (iv) and by 
     moving such clause to immediately follow clause (iii); and
       (5) by inserting after such clause (iv) the following new 
     clause:
       ``(v) Special rule for certain dependents in case of 
     termination or substantial reduction of retiree health 
     coverage.--In the case of a qualifying event described in 
     section 603(7), in the case of a qualified beneficiary 
     described in section 607(3)(D) who is not the qualified 
     retiree or spouse of such retiree, the later of--

       ``(I) the date that is 36 months after the earlier of the 
     date the qualified retiree becomes entitled to benefits under 
     title XVIII of the Social Security Act, or the date of the 
     death of the qualified retiree; or
       ``(II) the date that is 36 months after the date of the 
     qualifying event.''.

       (c) Type of Coverage in Case of Termination or Substantial 
     Reduction of Retiree Health Coverage.--Section 602(1) of such 
     Act (29 U.S.C. 1162(1)) is amended--
       (1) by striking ``The coverage'' and inserting the 
     following:
       ``(A) In general.--Except as provided in subparagraph (B), 
     the coverage''; and
       (2) by adding at the end the following:
       ``(B) Certain retirees.--In the case of a qualifying event 
     described in section 603(7), in applying the first sentence 
     of subparagraph (A) and the fourth sentence of paragraph (3), 
     the coverage offered that is the most prevalent coverage 
     option (as determined under regulations of the Secretary) 
     continued under the group health plan (or, if none, under the 
     most prevalent other plan offered by the same plan sponsor) 
     shall be treated as the coverage described in such sentence, 
     or (at the option of the plan and qualified beneficiary) such 
     other coverage option as may be offered and elected by the 
     qualified beneficiary involved.''.
       (d) Increased Level of Premiums Permitted.--Section 602(3) 
     of such Act (29 U.S.C. 1162(3)) is amended by adding at the 
     end the following new sentence: ``In the case of an 
     individual provided continuation coverage by reason of a 
     qualifying event described in section 603(7), any reference 
     in subparagraph (A) of this paragraph to `102 percent of the 
     applicable premium' is deemed a reference to `125 percent of 
     the applicable premium for employed individuals (and their 
     dependents, if applicable) for the coverage option referred 
     to in paragraph (1)(B)'.''.
       (e) Notice.--Section 606(a) of such Act (29 U.S.C. 1166) is 
     amended--
       (1) in paragraph (4)(A), by striking ``or (6)'' and 
     inserting ``(6), or (7)''; and
       (2) by adding at the end the following:

     ``The notice under paragraph (4) in the case of a qualifying 
     event described in section 603(7) shall be provided at least 
     90 days before the date of the qualifying event.''.
       (f) Effective Dates.--
       (1) In general.--The amendments made by this section (other 
     than subsection (e)(2)) shall apply to qualifying events 
     occurring on or after January 6, 1998. In the case of a 
     qualifying event occurring on or after such date and before 
     the date of the enactment of this Act, such event shall be 
     deemed (for purposes of such amendments) to have occurred on 
     the date of the enactment of this Act.
       (2) Advance notice of terminations and reductions.--The 
     amendment made by subsection (e)(2) shall apply to qualifying 
     events occurring after the date of the enactment of this Act, 
     except that in no case shall notice

[[Page S2132]]

     be required under such amendment before such date.
        Subtitle B--Amendments to the Public Health Service Act

     SEC. 311. COBRA CONTINUATION BENEFITS FOR CERTAIN RETIRED 
                   WORKERS WHO LOSE RETIREE HEALTH COVERAGE.

       (a) Establishment of New Qualifying Event.--
       (1) In general.--Section 2203 of the Public Health Service 
     Act (42 U.S.C. 300bb-3) is amended by inserting after 
     paragraph (5) the following new paragraph:
       ``(6) The termination or substantial reduction in benefits 
     (as defined in section 2208(6)) of group health plan coverage 
     as a result of plan changes or termination in the case of a 
     covered employee who is a qualified retiree.''.
       (2) Qualified retiree; qualified beneficiary; and 
     substantial reduction defined.--Section 2208 of such Act (42 
     U.S.C. 300bb-8) is amended--
       (A) in paragraph (3)--
       (i) in subparagraph (A), by inserting ``except as otherwise 
     provided in this paragraph,'' after ``means,''; and
       (ii) by adding at the end the following new subparagraph:
       ``(C) Special rule for qualifying retirees and 
     dependents.--In the case of a qualifying event described in 
     section 2203(6), the term `qualified beneficiary' means a 
     qualified retiree and any other individual who, on the day 
     before such qualifying event, is a beneficiary under the plan 
     on the basis of the individual's relationship to such 
     qualified retiree.''; and
       (B) by adding at the end the following new paragraphs:
       ``(5) Qualified retiree.--The term `qualified retiree' 
     means, with respect to a qualifying event described in 
     section 2203(6), a covered employee who, at the time of the 
     event--
       ``(A) has attained 55 years of age; and
       ``(B) was receiving group health coverage under the plan by 
     reason of the retirement of the covered employee.
       ``(6) Substantial reduction.--The term `substantial 
     reduction'--
       ``(A) means, as determined under regulations of the 
     Secretary of Labor and with respect to a qualified 
     beneficiary, a reduction in the average actuarial value of 
     benefits under the plan (through reduction or elimination of 
     benefits, an increase in premiums, deductibles, copayments, 
     and coinsurance, or any combination thereof), since the date 
     of commencement of coverage of the beneficiary by reason of 
     the retirement of the covered employee (or, if later, January 
     6, 1998), in an amount equal to at least 50 percent of the 
     total average actuarial value of the benefits under the plan 
     as of such date (taking into account an appropriate 
     adjustment to permit comparison of values over time); and
       ``(B) includes an increase in premiums required to an 
     amount that exceeds the premium level described in the fourth 
     sentence of section 2202(3).
       (b) Duration of Coverage Through Age 65.--Section 
     2202(2)(A) of such Act (42 U.S.C. 300bb-2(2)(A)) is amended--
       (1) by redesignating clause (iii) as clause (iv); and
       (2) by inserting after clause (ii) the following new 
     clause:
       ``(iii) Special rule for certain dependents in case of 
     termination or substantial reduction of retiree health 
     coverage.--In the case of a qualifying event described in 
     section 2203(6), in the case of a qualified beneficiary 
     described in section 2208(3)(C) who is not the qualified 
     retiree or spouse of such retiree, the later of--

       ``(I) the date that is 36 months after the earlier of the 
     date the qualified retiree becomes entitled to benefits under 
     title XVIII of the Social Security Act, or the date of the 
     death of the qualified retiree; or
       ``(II) the date that is 36 months after the date of the 
     qualifying event.''.

       (c) Type of Coverage in Case of Termination or Substantial 
     Reduction of Retiree Health Coverage.--Section 2202(1) of 
     such Act (42 U.S.C. 300bb-2(1)) is amended--
       (1) by striking ``The coverage'' and inserting the 
     following:
       ``(A) In general.--Except as provided in subparagraph (B), 
     the coverage''; and
       (2) by adding at the end the following:
       ``(B) Certain retirees.--In the case of a qualifying event 
     described in section 2203(6), in applying the first sentence 
     of subparagraph (A) and the fourth sentence of paragraph (3), 
     the coverage offered that is the most prevalent coverage 
     option (as determined under regulations of the Secretary of 
     Labor) continued under the group health plan (or, if none, 
     under the most prevalent other plan offered by the same plan 
     sponsor) shall be treated as the coverage described in such 
     sentence, or (at the option of the plan and qualified 
     beneficiary) such other coverage option as may be offered and 
     elected by the qualified beneficiary involved.''.
       (d) Increased Level of Premiums Permitted.--Section 2202(3) 
     of such Act (42 U.S.C. 300bb-2(3)) is amended by adding at 
     the end the following new sentence: ``In the case of an 
     individual provided continuation coverage by reason of a 
     qualifying event described in section 2203(6), any reference 
     in subparagraph (A) of this paragraph to `102 percent of the 
     applicable premium' is deemed a reference to `125 percent of 
     the applicable premium for employed individuals (and their 
     dependents, if applicable) for the coverage option referred 
     to in paragraph (1)(B)'.''.
       (e) Notice.--Section 2206(a) of such Act (42 U.S.C. 300bb-
     6(a)) is amended--
       (1) in paragraph (4)(A), by striking ``or (4)'' and 
     inserting ``(4), or (6)''; and
       (2) by adding at the end the following:

     ``The notice under paragraph (4) in the case of a qualifying 
     event described in section 2203(6) shall be provided at least 
     90 days before the date of the qualifying event.''.
       (f) Effective Dates.--
       (1) In general.--The amendments made by this section (other 
     than subsection (e)(2)) shall apply to qualifying events 
     occurring on or after January 6, 1998. In the case of a 
     qualifying event occurring on or after such date and before 
     the date of the enactment of this Act, such event shall be 
     deemed (for purposes of such amendments) to have occurred on 
     the date of the enactment of this Act.
       (2) Advance notice of terminations and reductions.--The 
     amendment made by subsection (e)(2) shall apply to qualifying 
     events occurring after the date of the enactment of this Act, 
     except that in no case shall notice be required under such 
     amendment before such date.
      Subtitle C--Amendments to the Internal Revenue Code of 1986

     SEC. 321. COBRA CONTINUATION BENEFITS FOR CERTAIN RETIRED 
                   WORKERS WHO LOSE RETIREE HEALTH COVERAGE.

       (a) Establishment of New Qualifying Event.--
       (1) In general.--Section 4980B(f)(3) of the Internal 
     Revenue Code of 1986 is amended by inserting after 
     subparagraph (F) the following new subparagraph:
       ``(G) The termination or substantial reduction in benefits 
     (as defined in subsection (g)(6)) of group health plan 
     coverage as a result of plan changes or termination in the 
     case of a covered employee who is a qualified retiree.''.
       (2) Qualified retiree; qualified beneficiary; and 
     substantial reduction defined.--Section 4980B(g) of such Code 
     is amended--
       (A) in paragraph (1)--
       (i) in subparagraph (A), by inserting ``except as otherwise 
     provided in this paragraph,'' after ``means,''; and
       (ii) by adding at the end the following new subparagraph:
       ``(E) Special rule for qualifying retirees and 
     dependents.--In the case of a qualifying event described in 
     subsection (f)(3)(G), the term `qualified beneficiary' means 
     a qualified retiree and any other individual who, on the day 
     before such qualifying event, is a beneficiary under the plan 
     on the basis of the individual's relationship to such 
     qualified retiree.''; and
       (B) by adding at the end the following new paragraphs:
       ``(5) Qualified retiree.--The term `qualified retiree' 
     means, with respect to a qualifying event described in 
     subsection (f)(3)(G), a covered employee who, at the time of 
     the event--
       ``(A) has attained 55 years of age; and
       ``(B) was receiving group health coverage under the plan by 
     reason of the retirement of the covered employee.
       ``(6) Substantial reduction.--The term `substantial 
     reduction'--
       ``(A) means, as determined under regulations of the 
     Secretary of Labor and with respect to a qualified 
     beneficiary, a reduction in the average actuarial value of 
     benefits under the plan (through reduction or elimination of 
     benefits, an increase in premiums, deductibles, copayments, 
     and coinsurance, or any combination thereof), since the date 
     of commencement of coverage of the beneficiary by reason of 
     the retirement of the covered employee (or, if later, January 
     6, 1998), in an amount equal to at least 50 percent of the 
     total average actuarial value of the benefits under the plan 
     as of such date (taking into account an appropriate 
     adjustment to permit comparison of values over time); and
       ``(B) includes an increase in premiums required to an 
     amount that exceeds the premium level described in the fourth 
     sentence of subsection (f)(2)(C).
       (b) Duration of Coverage Through Age 65.--Section 
     4980B(f)(2)(B)(i) of such Code is amended--
       (1) in subclause (II), by inserting ``or (3)(G)'' after 
     ``(3)(F)'';
       (2) in subclause (IV), by striking ``or (3)(F)'' and 
     inserting ``, (3)(F), or (3)(G)'';
       (3) by redesignating subclause (IV) as subclause (VI);
       (4) by redesignating subclause (V) as subclause (IV) and by 
     moving such clause to immediately follow subclause (III); and
       (5) by inserting after such subclause (IV) the following 
     new subclause:

       ``(V) Special rule for certain dependents in case of 
     termination or substantial reduction of retiree health 
     coverage.--In the case of a qualifying event described in 
     paragraph (3)(G), in the case of a qualified beneficiary 
     described in subsection (g)(1)(E) who is not the qualified 
     retiree or spouse of such retiree, the later of--

       ``(a) the date that is 36 months after the earlier of the 
     date the qualified retiree becomes entitled to benefits under 
     title XVIII of the Social Security Act, or the date of the 
     death of the qualified retiree; or
       ``(b) the date that is 36 months after the date of the 
     qualifying event.''.
       (c) Type of Coverage in Case of Termination or Substantial 
     Reduction of Retiree Health Coverage.--Section 4980B(f)(2)(A) 
     of such Code is amended--
       (1) by striking ``The coverage'' and inserting the 
     following:

[[Page S2133]]

       ``(i) In general.--Except as provided in clause (ii), the 
     coverage''; and
       (2) by adding at the end the following:
       ``(ii) Certain retirees.--In the case of a qualifying event 
     described in paragraph (3)(G), in applying the first sentence 
     of clause (i) and the fourth sentence of subparagraph (C), 
     the coverage offered that is the most prevalent coverage 
     option (as determined under regulations of the Secretary of 
     Labor) continued under the group health plan (or, if none, 
     under the most prevalent other plan offered by the same plan 
     sponsor) shall be treated as the coverage described in such 
     sentence, or (at the option of the plan and qualified 
     beneficiary) such other coverage option as may be offered and 
     elected by the qualified beneficiary involved.''.
       (d) Increased Level of Premiums Permitted.--Section 
     4980B(f)(2)(C) of such Code is amended by adding at the end 
     the following new sentence: ``In the case of an individual 
     provided continuation coverage by reason of a qualifying 
     event described in paragraph (3)(G), any reference in clause 
     (i) of this subparagraph to `102 percent of the applicable 
     premium' is deemed a reference to `125 percent of the 
     applicable premium for employed individuals (and their 
     dependents, if applicable) for the coverage option referred 
     to in subparagraph (A)(ii)'.''.
       (e) Notice.--Section 4980B(f)(6) of such Code is amended--
       (1) in subparagraph (D)(i), by striking ``or (F)'' and 
     inserting ``(F), or (G)''; and
       (2) by adding at the end the following:

     ``The notice under subparagraph (D)(i) in the case of a 
     qualifying event described in paragraph (3)(G) shall be 
     provided at least 90 days before the date of the qualifying 
     event.''.
       (f) Effective Dates.--
       (1) In general.--The amendments made by this section (other 
     than subsection (e)(2)) shall apply to qualifying events 
     occurring on or after January 6, 1998. In the case of a 
     qualifying event occurring on or after such date and before 
     the date of the enactment of this Act, such event shall be 
     deemed (for purposes of such amendments) to have occurred on 
     the date of the enactment of this Act.
       (2) Advance notice of terminations and reductions.--The 
     amendment made by subsection (e)(2) shall apply to qualifying 
     events occurring after the date of the enactment of this Act, 
     except that in no case shall notice be required under such 
     amendment before such date.
                          TITLE IV--FINANCING

     SEC. 401. REFERENCE TO FINANCING PROVISIONS.

       Any increase in payments under the medicare program under 
     title XVIII of the Social Security Act that results from the 
     enactment of this Act shall be offset by reductions in 
     payments under such program pursuant to the anti-fraud and 
     anti-abuse provisions enacted as part of the Medicare Fraud 
     and Overpayment Act of 1998.
                                                                    ____


                   MEDICARE EARLY ACCESS ACT OF 1998


  A BILL DESIGNED TO PROVIDE AMERICANS 55 TO 65 NEW HEALTH INSURANCE 
                                OPTIONS

                               Background

       Americans ages 55 to 65 face special problems of access to 
     and affordability of health insurance. They face greater 
     risks of health problems and are twice as likely to have 
     heart disease, strokes, or cancer as people aged 45 to 54. As 
     people approach 65, many retire or shift to part-time work or 
     self-employment as a bridge to retirement, sometimes 
     involuntarily. Displaced workers aged 55 to 65 are much less 
     likely than younger workers to be re-employed or re-insured 
     through a new employer. As a result, more of them rely on the 
     individual health insurance market. Without the benefits of 
     having their costs averaged with younger people, as with 
     employer-based insurance, these people often face high 
     premiums.
  Such access problems will increase, due to two trends: declines in 
retiree health coverage and the aging of the baby boom generation. 
Recently, businesses have cut back on offering health coverage to pre-
65-year-old retirees; only 40 percent of large firms now do so. In 
several small but notable cases, businesses have dropped retirees' 
health benefits after workers have retired. These ``broken promise'' 
retirees lack access to employer continuation coverage and could have 
problems finding affordable individual insurance. Finally, the number 
of people 55 to 65 years old will rise from 22 million to 35 million by 
2010 -- or by 60 percent.

                                Summary

       This bill creates three important health insurance choices 
     for certain people ages 55 to 65:
       1. People ages 62 to 65 without access to group insurance 
     could buy into Medicare;
       2. Workers ages 55 and older and their spouses who lose 
     their health insurance when their firm closes or they are 
     laid off could buy into Medicare; and
       3. Retirees ages 55 and older whose employers drop their 
     retiree health coverage after they have retired could buy 
     into the employer's health plan through ``COBRA'' coverage.
       Participants would pay premiums to cover almost the entire 
     costs of coverage. Any shortfall would be paid for by 
     policies to reduce Medicare fraud and overpayments, proposed 
     in a companion bill called the Medicare Anti-Fraud and 
     Overpayment Act of 1998.
       The Medicare buy-in would be completely walled off from the 
     Medicare Trust Funds, to ensure that it does not in any way 
     affect current beneficiaries.

Title I. Access to Medicare Benefits for Individuals 62-to-65 Years of 
                                  Age

       The centerpiece of this initiative is the Medicare buy-in 
     for people ages 62 to 65.
       Eligibility: People ages 62 to 65 who do not have access to 
     employer sponsored or federal health insurance may 
     participate.
       Premium Payments: Participants would pay two separate 
     premiums--one before age 65 and one between age 65 and 85:
       Base premium: The base premium would be paid monthly 
     between enrollment and when the participant turns age 65. It 
     is the part of the full premium that represents what Medicare 
     would pay on average for all people in this age group. CBO 
     estimates that this would be about $300 per month. It would 
     be adjusted for geographic variation, but the maximum premium 
     would be limited to ensure participation in all areas of the 
     country.
       Deferred premium: The deferred premium would be paid 
     monthly beginning at age 65 until the beneficiary turns age 
     85. It is the part of the premium that covers the extra costs 
     for participants who are sicker than average. Participants 
     will be told before they enroll what their deferred premium 
     will be. CBO estimates that this would be about $10 per month 
     per year of participation.
       This two-part payment plan acts like a mortgage: it makes 
     the up-front premium affordable but requires participants to 
     pay back the Medicare ``loan'' with interest. It also ensures 
     that in the long-run, this buy-in is self-financing.
       Enrollment: Eligible people can enroll within two months of 
     either turning 62 or losing access to employer-based or 
     federal insurance.
       Applicability of Medicare Rules: Services covered and cost 
     sharing would be, for paying participants, the same as those 
     of Medicare beneficiaries. Participants would have the choice 
     of fee-for-service or managed care. No Medicaid assistance 
     would be offered to participants for premiums or cost 
     sharing. Medigap policy protections would apply, but the open 
     enrollment provision remains at age 65.
       Disenrollment: People could stop buying into Medicare at 
     any time. People who disenroll would pay the deferred premium 
     as though they had been enrolled for a full year (e.g., a 
     person who buys in for 3 months in 1999 would pay the 
     deferred premium as though they participated for 12 months). 
     This is intended to act as a disincentive for temporary 
     enrollment.

 Title II. Access to Medicare Benefits for Displaced Workers 55-to-62 
                              Years of Age

       In addition to people ages 62 to 65, a targeted group of 55 
     to 61 year olds could buy into Medicare. The Medicare buy-in 
     would be the same as above, with the following exceptions.
       Eligibility: People would be eligible if they are between 
     ages 55 and 61 and: (1) lost their job because their firm 
     closed, downsized, or moved, or their position was eliminated 
     (defined as being eligible for unemployment insurance) after 
     January 6, 1998; (2) had health insurance through their 
     previous job for at least one year (certified through the 
     process created under HIPAA to guarantee continuation 
     coverage); and (3) do not have access to employer sponsored, 
     COBRA, or federal health insurance. Spouses of these eligible 
     people may also buy into Medicare.
       Premium Payments: Participants would pay one, 
     geographically adjusted premium, with no Medicare ``loan''. 
     This premium represents what Medicare would pay on average 
     for all people in this age group plus an add-on (65 percent 
     of the age average) to compensate for some of the extra costs 
     of participants who may be sicker than average. These 
     premiums would be about $400 per month.
       Disenrollment: Like people ages 62 to 65, eligible 
     displaced workers and their spouses must enroll in the buy-in 
     within 63 days of becoming eligible. Participants continue to 
     pay premiums until they voluntarily disenroll, gain access to 
     federal or employer-based insurance or turn 62 and become 
     eligible for the more general Medicare buy-in. Once they 
     disenroll, they may only re-enroll if they meet all the 
     eligibility rules again.

           Title III. Retiree Health Benefits Protection Act

       The bill would also help retirees and their dependents 
     whose former employer unexpectedly drops their retiree health 
     insurance, leaving them uncovered and with few places to 
     turn.
       Eligibility: People ages 55 to 65 and their dependents who 
     were receiving retiree health coverage but whose coverage was 
     terminated or substantially reduced (benefits' value reduced 
     by half or premiums increased to a level above 125 percent of 
     the applicable premium) would qualify them for ``COBRA'' 
     continuation coverage.
       Premium Payments: Participants would pay 125 percent of the 
     applicable premium. This premium is higher than what most 
     other COBRA participants pay (102 percent) to help offset the 
     additional costs of participants.
       Enrollment: Participants would enroll through their former 
     employer, following the same rules as other COBRA eligibles.
       Disenrollment: Retirees would be eligible until they turn 
     65 years-old.

    Companion Bill: Medicare Anti-Fraud and Overpayment Act of 1998

       This bill improves the financial integrity of Medicare and 
     helps fund the Medicare

[[Page S2134]]

     buy-in. It does this through a series of policies, including:
       Eliminating Excessive Medicare Reimbursement for Drugs. A 
     recent report by the HHS Inspector General found that 
     Medicare currently pays hundreds of millions of dollars more 
     for 22 of the most common and costly drugs than would be paid 
     if market prices were used. For more than one-third of these 
     drugs, Medicare pays more than double the actual acquisition 
     costs, and in one case, pays as high as ten times the amount. 
     This proposal would ensure that Medicare payments are 
     provider's actual acquisition cost of the drug without mark-
     ups.
       Eliminating Overpayments for Epogen. A 1997 HHS Inspector 
     General report found that Medicare overpays for Epogen (a 
     drug used for kidney dialysis patients). This policy would 
     change Medicare reimbursement to reflect current market 
     prices (from $10 per 1,000 units administered to $9).
       Eliminating Abuse of Medicare's Outpatient Mental Health 
     Benefits. The HHS Inspector General has found abuses in 
     Medicare's outpatient mental health benefit--specifically, 
     that Medicare is sometimes billed for services in inpatient 
     or residential settings. This proposal would eliminate this 
     abuse by requiring that these services are only provided in 
     the appropriate treatment setting.
       Ensuring Medicare Does Not Pay For Claims Owed By Private 
     Insurers. Too often, Medicare pays claims that are owed by 
     private insurers because Medicare has no way of knowing the 
     private insurer is the primary payer. This proposal would 
     require insurers to report any Medicare beneficiaries they 
     cover. Also, Medicare would be allowed to recoup double the 
     amount owed by insurers who purposely let Medicare pay claims 
     that they should have paid, and impose fines for failure to 
     report no-fault or liability settlements for which Medicare 
     should have been reimbursed.
       Enabling Medicare to Negotiate Single, Simplified Payments 
     for Certain Routine Surgical Procedures. This proposal would 
     expand HCFA's current ``Centers of Excellence'' demonstration 
     that enables Medicare to pay for hospital and physician 
     services for certain high-cost surgical procedures through a 
     single negotiated payment. This lets Medicare receive volume 
     discounts and, in return, enables hospitals to increase their 
     market share, gain clinical expertise, and improve quality.
       Deleting Civil Monetary Penalty Provision that Weakens 
     Ability to Reduce Fraud and Abuse. HIPAA limited the standard 
     used in imposing civil monetary penalties regarding false 
     Medicare claims. It limited the duty on providers to exercise 
     reasonable diligence to submit true and accurate claims. This 
     provision would repeal this weakening of the standard.
       Deleting the Exceptions from Anti-Kickback Statute for 
     Certain Managed Care Arrangements. Current law makes an 
     exception from the anti-kickback rules for any arrangement 
     where a medical provider is at ``substantial financial risk'' 
     whether through a ``withhold, capitation, incentive pool, per 
     diem payment, or any other risk arrangement.'' Because of the 
     difficulty of defining this exception, this provision may be 
     serving as a loophole to get around the anti-kickback 
     provisions. This provision would eliminate the exception.
       Parenteral Nutrition Reform. According to the Office of the 
     Inspector General, there is an overpayment for these 
     services. This proposal would pay for these products at 
     actual acquisition cost and add a requirement that the 
     Secretary provides for administrative costs and sets 
     standards for the quality of delivery of parenteral 
     nutrition.

  Mr. KENNEDY. Mr. President, too many Americans nearing age 65 face a 
crisis in health care. They are too young for Medicare, but too old for 
affordable private coverage. Many of them face serious health problems 
that threaten to destroy the savings of a lifetime and prevent them 
from finding or keeping a job. Many are victims of corporate down-
sizing or a company's decision to cancel the health insurance 
protection they relied on. No American nearing retirement can be 
confident that the health insurance they have today will protect them 
until they are 65 and are eligible for Medicare.
  Three million Americans aged 55 to 64 have no health insurance today. 
The consequences are often tragic. As a group, they are in relatively 
poor health, and their condition is more likely to worsen the longer 
they remain uninsured. They have little or no savings to protect 
against the cost of serious illness. Often, they are unable to afford 
the routine care that can prevent minor health problems from turning 
into serious disabilities or even life-threatening illness.
  The number of uninsured is growing every day. Between 1991 and 1995, 
the number of workers whose employers promise them benefits if they 
retire early dropped twelve percent. Barely a third of all workers now 
have such a promise. In recent years, many who have counted on an 
employer's commitment found themselves with only a broken promise. 
Their coverage was canceled after they retired.
  The plight of older workers who lose their jobs through layoffs or 
downsizing is also grim. It is hard to find a new job at age 55 or 60--
and even harder to find a job that provides health insurance. For these 
older Americans left out and left behind through no fault of their own 
after decades of hard work, it is time to provide a helping hand.
  And finally, significant numbers of retired workers and their 
families have found themselves left high and dry when their employers 
cut back their coverage or canceled it altogether.
  The legislation we are introducing today is a lifeline for millions 
of these Americans. It provides a bridge to help them through the years 
before they qualify for full Medicare eligibility. It is a constructive 
next step toward the day when every American will be guaranteed the 
fundamental right to health care. It will impose no additional burden 
on Medicare, because it is fully paid for by premiums from the 
beneficiaries themselves.
  I commend Senator Moynihan and Senator Daschle and our other co-
sponsors for their leadership on this issue. I especially commend the 
President for his initiation of this national debate by including this 
proposal in his budget. When this legislation becomes law, millions of 
older families will have him to thank.
  The opponents of this constructive step are already waging a campaign 
of disinformation against the program. They claim that it will somehow 
harm Medicare--even though that is not true. They say we should wait 
for the Medicare Advisory Commission to report--but older uninsured 
Americans have waited too long for the help they need. They say that 
this is just another entitlement program--ignoring the fact that it 
will be paid for in full--and primarily by the participants themselves. 
They say it is another attempt to inject government into the health 
care system--even though it simply gives uninsured older Americans 
better access to the health care they need through the most successful 
health program ever enacted.
  The opponents of this proposal will do everything they can to keep 
the program from coming to the floor of the House and Senate for a full 
and fair debate. They have a lot of power in Congress. But they don't 
have the President on their side. They don't have the vast majority of 
Democrats in Congress on their side. And most of all, they do not have 
the American people on their side.
  We intend to do all we can to bring this issue to the floor of the 
Senate early this year. There will be a vote, and, if necessary, there 
will be many votes. Despite the opposition of the Republican 
Leadership, this Congress has already taken a major step to expand 
health insurance coverage for American children. This can also be the 
Congress that extends help to older Americans who need health care. The 
American people want us to act, and I am confident that Congress will 
respond.
  Mr. DASCHLE. Mr. President, today I join my colleagues in introducing 
the Medicare Early Access Act. The bill offers new coverage options for 
a population that faces significant problems finding affordable 
insurance, individuals between age 55 and 65, the age at which they 
become eligible for Medicare.
  It is not easy to be without health insurance between the ages of 55 
and 65. You are twice as likely as someone just 10 years younger to 
experience heart disease, cancer, or other significant health problems.
  And it is not easy to find health insurance when you're between 55 
and 65. Prices for coverage often are unaffordable. For those with 
serious health problems, finding coverage can be impossible.
  There are 2.9 million individuals ages 55 to 65 without health 
insurance. Some individuals in this age group lose their employer-based 
health insurance when their spouse becomes eligible for Medicare. Many 
lose their coverage because their company downsizes or their plant 
closes. Still, others lose insurance when promised retiree health 
coverage is dropped unexpectedly.
  A little over 3 years ago, 1,200 former employees of the John Morrell 
meatpacking plant in Sioux Falls, South Dakota, received letters in the 
mail telling them their retiree health

[[Page S2135]]

benefits would be canceled in a matter of weeks. These were men and 
women who had worked for 20, 30, even 40 years at the Morrell plant.
  The company did not give them retiree health benefits out of the 
goodness of their hearts. The Morrell workers earned those benefits. 
They took smaller pay increases and made other sacrifices while they 
were still working so they could have some measure of security when 
they retired.
  The letters telling the Morrell retirees that their former company 
was canceling their health benefits was just the first of many shocks. 
An additional shock came when those Morrell employees under 65 were 
forced to buy exorbitant private health insurance--an extremely 
difficult purchase on a retiree's pension.
  To address these concerns, I introduced legislation, S. 1307, the 
Retiree Health Benefits Protection act of 1997. S. 1307 would require 
companies to keep the promises they make to their retirees and their 
families.
  I am pleased that the President, Senator Moynihan, and Representative 
Stark have incorporated a key piece of that bill in the Medicare Early 
Access Act. This provision would allow retirees between ages 55 and 65 
to buy into their former employer's health plan if the employer cancels 
or substantially reduces promised benefits. Retirees and their spouses 
would remain eligible until they turn 65 and become eligible for 
Medicare.
  The Medicare Early Access Act includes two additional important 
provisions for individuals ages 55 to 65. First, it would allow people 
between the ages of 62 and 65 who do not have access to group coverage 
to buy into the Medicare program. Second, it would offer access to 
Medicare for workers between the ages of 55 and 65, and their spouses, 
when their employer downsizes or their plant shuts down.
  Some have questioned whether this program will hurt the current 
Medicare program. Let me emphasize that the proposal will pay for 
itself. All workers and retirees who buy into Medicare under our plan 
would pay premiums out of their own pockets. Any additional costs would 
be paid through savings from Medicare anti-fraud and abuse measures. 
Because the bill is self-financing, it does not in any way threaten 
Medicare's solvency or its future. It is responsible proposal that pays 
for itself.
  Mr. President, there are hundreds of thousands of Americans who could 
benefit from this bill. It is my hope that we can engage in productive 
debate over the next few weeks and find a way to fill these gaps in 
health insurance coverage, instead of making excuses about why we are 
waiting to help these individuals.

                          ____________________