[Congressional Record Volume 144, Number 133 (Tuesday, September 29, 1998)]
[Extensions of Remarks]
[Page E1845]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

[[Page E1845]]



        INTRODUCTION OF THE MEDICARE HMO IMPROVEMENT ACT OF 1998

                                 ______
                                 

                           HON. SAM GEJDENSON

                             of connecticut

                    in the house of representatives

                      Tuesday, September 29, 1998

  Mr. GEJDENSON. Mr. Speaker, I rise today to introduce the Medicare 
HMO Improvement Act of 1998.
  Earlier this month, nearly 8,000 seniors in my district received 
perhaps the most frightening news any American can get. Their Medicare 
HMOs informed them that they are terminating their health insurance by 
the end of the year. Some of these seniors were recruited only months 
before through aggressive company marketing campaigns.
  Insurers came to the federal government and said ``We're private 
industry, we can run Medicare better than you can while giving more 
services to seniors. Give us a chance.'' Well, we gave them a chance 
and they let our seniors down. They thought they could just jump in and 
jump out of my district without regard to the health and well-being of 
the seniors that they had signed up just months ago. This is not 
acceptable. That is not a responsible way to do business.
  The termination announcements sent shock waves through Tolland, 
Windham and New London counties. At a public meeting that I hosted with 
Senator Chris Dodd to discuss this action, 400 seniors gathered to hear 
about their options for the future. The tension and desperation of my 
constituents was evident as they vented their frustration and anxiety. 
One of my constituents, whose wife had recently had a stroke, was so 
upset about what losing health insurance would mean to him and his wife 
that after asking a question he had a heart attack. That man, Frederick 
Kral, died on the way to the hospital.
  Under the current system, Medicare HMOs can act with impunity. There 
is no accountability, no responsibility. Profits are all that matter. 
Patients and quality health care are secondary. This is just wrong.
  My legislation will inject some accountability into the Medicare HMO 
system. It will change the contract term from one year to three years. 
This change is designed to discourage HMOs from making short-term 
promises to seniors only to terminate coverage a year later when they 
don't make quite as much money as they hoped. It gives the Secretary of 
Health and Human Services (HHS) authority to enjoin contract 
terminations for up to one year if public health will be seriously 
threatened, insurance coverage will be compromised, or the Governor of 
the state affected requests that the Secretary exercise this authority.
  Moreover, my legislation is designed to discourage HMOs from ``cherry 
picking'' between regions within a state by offering coverage only in 
those areas with the highest reimbursement rates. It accomplishes this 
goal by requiring the Secretary of HHS to terminate all contracts a 
Medicare HMO has for a metropolitan statistical area (MSA) if that HMO 
terminates coverage in any portion of that MSA in that state. I 
selected the MSA as the geographical unit because it is already used in 
the law and should discourage ``cherry picking'' without reducing 
coverage on a state-wide basis. Finally, if a company terminates 
coverage and a beneficiary is currently undergoing treatment, this bill 
requires the HMO to provide 90 days of coverage to allow the patient to 
continue to receive such treatment. This will ensure that patients 
under active treatment will have a few additional months to make the 
transition to another doctor or health plan.
  Mr. Speaker, what Medicare HMOs did in my district--and are doing in 
others across the country--is unreasonable and irresponsible. The 
Medicare HMO Improvement Act is a reasonable approach which will 
provide badly needed protection to older Americans.

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