[Congressional Record Volume 150, Number 21 (Wednesday, February 25, 2004)]
[Senate]
[Pages S1592-S1593]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. AKAKA:
  S. 2122. A bill to amend part C of title XVIII of the Social Security 
Act to prohibit the comparative cost adjustment (CCA) program from 
operating in the State of Hawaii; to the Committee on Finance.
  Mr. AKAKA. Mr. President, I rise today to introduce legislation to 
prohibit the comparative cost adjustment program, which is commonly 
known as premium support, from operating in Hawaii.
  The Medicare Prescription Drug Improvement and Modernization Act of 
2003 included the creation of premium support demonstration programs in 
select metropolitan statistical areas starting in 2010. In these 
demonstration programs, seniors would be provided with a defined 
contribution payment for Medicare Part B rather than a defined benefit. 
Seniors would receive a set minimum payment to be used towards 
enrolling in either traditional fee-for-service Medicare or a managed 
care plan. Seniors that choose options that are more expensive than the 
defined premium would have to pay the difference themselves.
  Many of the older and less healthier seniors stay in the traditional 
fee-for-service Medicare rather than enrolling in Medicare managed care 
programs. The defined contribution premium will likely not be able to 
cover the entire cost of their fee-for-service premium. So, they may 
not be able to afford to stay in the traditional Medicare program and 
will be forced to enroll in lowest-cost health maintenance 
organization, HMO, or preferred provider organization, PPO, in their 
community. Seniors deserve to have their right to choose whether to 
remain in traditional Medicare or enroll in a managed care program 
based on their health care needs and not be forced into managed care 
programs because they are not able to pay the increased premium 
required for traditional Medicare.
  Now, seniors across the country pay the same premium for Medicare 
Part B services. After the implementation of the premium support 
demonstration programs, this will not be the case. Not only are there 
likely to be wide variations in Medicare Part B premium rates for 
beneficiaries across the country, but there will even be differences 
among seniors within the same State. This is unjust. Seniors that 
receive the same benefits should be paying the same premium in an 
entitlement program such as Medicare.
  Proponents of the premium support plan believe that this will help 
control Medicare costs and save money. However, this proposal will only 
work if more of the costs are shifted to seniors who will have to pay 
higher premiums or have their benefits reduced.
  It is my hope that these demonstration projects are never implemented 
in any state. My legislation would ensure that the residents of Hawaii 
are protected from having this demonstration program impair their 
Medicare Part B choices. I am pleased that several of my colleagues 
have also introduced

[[Page S1593]]

legislation to protect seniors in their states from the premium support 
demonstration projects.
  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. 2122

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

     SECTION 1. PROHIBITION ON OPERATION OF MEDICARE COMPARATIVE 
                   COST ADJUSTMENT (CCA) PROGRAM IN HAWAII.

       (a) In General.--Section 1860C-1(b) of the Social Security 
     Act, as added by section 241 of the Medicare Prescription 
     Drug, Improvement, and Modernization Act of 2003 (Public Law 
     108-173), is amended by adding at the end the following:
       ``(3) No cca areas within hawaii.--A CCA area shall not 
     include an MSA any portion of which is within the State of 
     Hawaii.''.
       (b) Effective Date.--The amendment made by this section 
     shall take effect as if included in the enactment of the 
     Medicare Prescription Drug, Improvement, and Modernization 
     Act of 2003 (Public Law 108-173).
                                 ______