[Congressional Record Volume 147, Number 147 (Tuesday, October 30, 2001)]
[Senate]
[Pages S11213-S11214]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. NELSON of Florida:
  S. 1592. A bill to amend title XI of the Social Security Act to 
prohibit Federal funds from being used to provide payments under a 
Federal health care program to any health care provider who charges a 
membership or any other extraneous or incidental fee to a patient as a 
prerequisite for the provision of an item or services to the patient; 
to the Committee on Finance.
  Mr. NELSON of Florida. Mr. President, I am pleased to introduce the 
Medicare Equal Access to Care Act. I am jointed by my colleagues 
Senators Durbin and Edwards. This legislation is designed to address a 
disturbing development which may make it harder for some seniors to 
have access to Medicare.
  I have recently become aware of a practice, an early example if which 
took place in Florida, in which doctors assess their existing patients 
a $1,500 membership fee in order to receive continued care. In some 
States, these fees have been as high as $20,000. By charging these 
extraneous and unwarranted dues, the doctors can shrink their practice, 
yet maintain their profits. Another version of this arrangement is to 
require that patients seek and pay for non-Medicare covered services 
from their doctors as a condition for joining or remaining in the 
practice. Tragically, the patients who can't afford these large sums 
for the privilege of medical care or who choose not to purchase non-
Medicare covered services are simply told to find another doctor. In 
areas where there is already a shortage of doctors, this practice could 
severely hamper Medicare beneficiaries' access to health care.
  Then, in addition to membership fees the doctors bill Medicare for 
the cost of the covered services they provide.
  Were Medicare a private insurance company, this practice would not be 
allowed. Private health insurance companies do not permit their 
providers to charge an ``access fee'' as a condition to being accepted 
as a patient. The Federal Government, the American taxpayers, should 
not hold its providers to a looser standard, thereby supporting a 
distasteful division of Medicare beneficiaries into haves and have-
nots. This situation is unacceptable.

[[Page S11214]]

  The Medicare Equal Access to Care Act bill will put a damper on such 
agreements. This legislation is simple: it will prevent any federal 
health program, like Medicare, from reimbursing doctors who charge 
their patients membership fees, as defined by the Secretary of Health 
and Human Services, or who require that their patients purchase non-
Medicare.
  I want to emphasize that this legislation does not interfere with the 
right of the doctor and patient to enter into private arrangements. A 
doctor may forego Medicare reimbursement and charge patients a 
membership fee of any amount, and patients have the choice of whether 
to accept that condition. Likewise, a doctor is free to charge a 
patient for any service that is not reimbursed under Medicare.
  Though they present a carefully crafted loophole, these arrangements 
violate the intent and spirit of the Balanced Billing Act.
  Clearly, our health care system is not working for patients. 
Additionally it's not working for doctors, if they must resort to these 
types of practices. Also, hundreds of thousands of our nation's seniors 
have been informed that their managed care company will be withdrawing 
from the Membership program. We need to adequately reimburse doctors, 
to provide the incentive to continue to participate in the 
Medicare+Choice program. Just as we don't want Medicare beneficiaries 
to be told their HMO is unavailable, we don't want them to be told 
their doctor is unavailable, unless they pay a fee. These are among 
these reasons that Congress needs to complete and pass a Patient's Bill 
of Rights and send it to the President. But in the meantime, we must 
protect our seniors and ensure that their access to Medicare is not 
subject to hurdles and conditions.
  I look forward to working with my colleagues to pass the Medicare 
Equal Access to Care Act.
  I ask unanimous consent that the text of the Bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1592

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Equal Access to Care Act''.

     SEC. 2. LIMITATION ON PAYMENTS TO PROVIDERS UNDER A FEDERAL 
                   HEALTH CARE PROGRAM.

       (a) In General.--Title XI of the Social Security Act (42 
     U.S.C. 1301 et seq.) is amended by inserting after section 
     1128F the following new section:

     ``SEC. 1128G. LIMITATION ON PAYMENTS TO PROVIDERS UNDER A 
                   FEDERAL HEALTH CARE PROGRAM.

       ``(a) In General.--No Federal funds shall be used to 
     provide payments under a Federal health care program to any 
     physician (as defined in section 1861(r)), practitioner (as 
     described in section 1842(b)(18)(C)), or other individual who 
     charges a membership fee or any other extraneous or 
     incidental fee to a patient, or requires a patient to 
     purchase an item or service, as a prerequisite for the 
     provision of an item or service to the patient.
       ``(b) Federal Health Care Program Defined.--In this 
     section, the term `Federal health care program' has the 
     meaning given that term under section 1128B(f) except that, 
     for purposes of this section, such term includes the health 
     insurance program under chapter 89 of title 5, United States 
     Code.''.
       (b) Effective Date.--The amendment made by subsection (a) 
     applies to payments made on or after the date of enactment of 
     this Act.
                                 ______