[Congressional Record Volume 144, Number 138 (Tuesday, October 6, 1998)]
[Senate]
[Page S11531]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




         MEDICARE HMO BENEFICIARY EMERGENCY RELIEF ACT OF 1998

  Mr. DODD. Mr. President, last week, close to 400,000 older Americans 
and individuals with disabilities, representing some 300 counties and 
18 States across this Nation, were notified by their Medicare health 
maintenance organizations that as of January 1, 1999, their insurers 
would be terminating their health coverage.
  In my State of Connecticut, we were notified on Friday around 6 
o'clock that 6,000 seniors would see their HMO, Oxford Health Plan, 
leave their communities. When added to earlier withdrawals from the 
market by other HMOs in Connecticut, this announcement means that more 
than 12,000 Connecticut Medicare beneficiaries will lose their present 
HMO providers.
  One can only imagine the anxiety of seniors reading of the 
announcement in their newspapers or hearing on television that their 
HMO would not be there for them on January 1 and having no one to turn 
to, no one to ask questions of, with offices closed for the weekend. 
Even the Health Care Financing Administration, which regulates these 
HMOs, had not yet received the news.
  Only three weeks earlier, two other HMOs in Connecticut notified 
their customers that they would be backing out of New London, Windham, 
and Tolland Counties, jeopardizing affordable Medicare coverage for 
about 6,000 seniors.
  The precipitous withdrawal of managed care organizations from 
Medicare is a growing problem. Unless action is taken, on January 1, 
1999 thousands of seniors will find themselves at forced to leave 
established relationships with their doctors and without affordable 
health care coverage.
  I am fearful that with Congress adjourning later this week or early 
next week, and being out of session for the bulk of October, November, 
December, it may not be until January that we will again have the 
opportunity to do something about this.
  I am going to be calling on the leadership today to enact an 
emergency piece of legislation, which I will be introducing today, to 
put a moratorium on HMOs leaving the Medicare market while we are not 
in session. This legislation will give us some time to see if we can't 
sort out this mess and prevent thousands more seniors from finding 
themselves without HMO coverage on January 1, 1999, a matter of weeks.
  My hope is that the leadership will find some time to consider this 
and adopt it before we leave, hopefully on a bipartisan basis, to stop 
this serious problem we are seeing in my State and 17 other States 
around the country.
  Mr. President, last Friday I also introduced legislation that deals 
with the broader issues underlying the recent withdrawals of Medicare 
HMOs from certain communities. Because it takes a comprehensive 
approach, I do not expect that this bill would be adopted before we 
leave. However, I would hope that for now we can at least agree on a 
narrowly defined moratorium which would at least give us time to find 
solutions to the larger problem.
  Mr. President, I would like to briefly outline for my colleagues the 
provisions of the legislation I introduced last week. Specifically, the 
legislation would not allow a flat termination of coverage if there are 
other less drastic options available. In the case of the withdrawals of 
two HMOs in eastern Connecticut, after causing considerable distress to 
seniors with an announcement that they were leaving, the companies re-
evaluated their positions in the face of strong pressure from the 
community, and said ``Well, maybe there are some other options we 
hadn't considered.'' This legislation will require they consider those 
other options first--before creating anxiety among our seniors.
  Secondly, the legislation will stipulate that if a company maintains 
there are no other options but ending coverage, they must demonstrate 
that. In addition, the HMO would then be responsible for notifying 
consumers of what alternative coverage is available.
  The legislation also requires that HMOs commit to serving seniors for 
more than just a year. Right now, HMOs are only required to contract on 
an annual basis. We would require them to make a 3-year commitment. It 
is important to keep in mind that we are talking about companies that 
have made the careful determination that it is in their financial 
interest to enter the Medicare market. These are companies that have 
extensively recruited seniors and convinced them to leave long-standing 
relationships with their health care providers to join their HMO and 
then, with very precipitous announcements, as we have seen in the last 
several weeks, they have left those communities.
  Mr. President, this is a serious, serious problem that is going to 
get worse, in my view, if we don't take some steps. We passed similar 
legislation a number of years ago dealing with plant closings. We 
finally decided that having a company announce precipitously it is 
leaving, disrupting communities, disrupting the lives of their 
employees, is unwise and that we ought to adopt legislation that 
requires at least some advance notice so that communities and people 
can try to rearrange their lives.
  I am suggesting parallel legislation to deal with Medicare HMOs. Here 
it is so important, particularly for our older Americans or disabled 
Americans, many of them living alone, who don't have the financial 
resources to hire lawyers and read through all of the morass of 
paperwork when it comes to finding a new HMO, that they be given 
adequate notice and provided with clear information about their 
options.
  We are hopeful we can build some support for the idea of considering 
all options, having more advanced notice, and extending the contract 
term. If you are going to go out and try to entice people to sign up, 
it seems to me you have an obligation to stick with them for a while. 
Certainly just to make a decision that you are going to pull out of the 
area, with minimal notice, I think is wrong.

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