[Congressional Record Volume 144, Number 146 (Wednesday, October 14, 1998)]
[Extensions of Remarks]
[Pages E2171-E2172]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




 100% ENROLLMENT OF LOWER INCOME MEDICARE BENEFICIARIES IN THE QMBY & 
                             SLMBY PROGRAMS

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                      Wednesday, October 14, 1998

  Mr. STARK. Mr. Speaker, I am pleased to join Representative McDermott 
in introducing legislation to ensure that 100 percent--or as close to 
100 percent as humanly possible--of low-income Medicare beneficiaries 
eligible for QMBy and SLMBy are enrolled in those programs. The bill 
provides for a data match between the IRS and HHS to detect low income 
Medicare beneficiaries and presumptively enroll them in the programs.
  We are introducing the bill in the last hours of the Congress so that 
the administration, seniors' groups, and others can study the issue 
over the adjournment period and make suggestions for improvements and 
changes for a new bill in the 106th Congress.
  In 1988, Congress enacted provisions to protect low-income Medicare 
beneficiaries from the financial distress of out-of-pocket health care 
costs. The protections were embodied in the Qualified Medicare 
Beneficiary (QMB) Program under which state Medicaid Programs pay 
Medicare premiums, deductibles and co-insurance for people with limited 
resources and with incomes of not more than 100 percent of the Federal 
poverty threshold, currently $691 per month for an individual. In 
subsequent years similar but more limited provisions were enacted for 
those with slightly higher incomes.
  Premium and other cost-sharing protections are critical to the well-
being of low-income Medicare beneficiaries. Medicare covers less than 
half of the total health spending of the elderly and is less generous 
than health plans typically offered by large employers. Health care 
spending for low-income beneficiaries who are also eligible for 
Medicaid is substantially higher--Medicare payments for them are 70 
percent higher than for those with higher incomes. Beneficiaries spend, 
on average, more than $2,500 out-of-pocket on Medicare premiums and 
cost-sharing, and on health services not included in the Medicare 
program. This is a third of the annual income of an individual living 
in poverty.
  Moreover, on average the health of low-income Medicare beneficiaries 
is substantially worse than that of the general Medicare population: 
Low-income beneficiaries are nearly twice as likely as those with 
higher income to self-report fair to poor health and nearly twice as 
likely to have used an emergency room in the past year; they are less 
likely to have a particular physician; and they are three times more 
likely to have needs for assistance due to functional impairments in 
activities such as dressing, eating and bathing.
  Despite the importance of financial protections and their promise of 
help to low-income beneficiaries, the current QMBy and SLMBy (Specified 
Low-Income Medicare Beneficiaries, with incomes up to 120 percent of 
poverty) benefits have failed to reach nearly four million eligible 
individuals. A recent Urban Institute report estimates that only 10 
percent of those eligible are participating in the SLMBy program and 
less than two-thirds of those eligible are enrolled for QMBy benefits.

[[Page E2172]]

  Complex enrollment processes, requirements to apply at welfare 
offices, lengthy delays in refunding premiums deducted from cash 
payments, and the lack of effective, coordinated outreach and problem-
solving systems have all been identified as issues that impede program 
effectiveness. Identifying and enrolling those entitled to benefits has 
been a significant challenge of the buy-in programs. Moreover, 
administration of the buy-in programs by different Medicaid systems of 
the 50 states and the District of Columbia make the benefit unevenly 
available across the country.
  The importance of the buy-in programs to low-income Medicare 
beneficiaries should not be underestimated. Because of their greater-
than-average health care costs, and because Medicare does not cover 
many services critical to older and disabled people, individuals 
eligible for buy-in programs can benefit greatly from the extra income 
they retain when they are relieved of cost-sharing responsibilities. 
The obvious and most important aspect of the buy-in programs is that 
they put income back into the pockets of low-income people who can use 
it to pay for food, clothing, shelter, un-reimbursed medical expenses 
and other necessities of life.
  Mr. Speaker, we look forward to public comment on the technical 
features of the bill, and hope it will have widespread support in the 
106th Congress.

                          ____________________