[Congressional Record Volume 151, Number 158 (Monday, December 12, 2005)]
[Senate]
[Page S13453]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. NELSON of Florida:
  S. 2080. A bill to amend title XVIII of the Social Security Act to 
prohibit physicians and other health care practitioners from charging a 
membership or other incidental fee (or requiring purchase of other 
items or services) as a prerequisite for the provision of an item or 
service to a medicare beneficiary; to the Committee on Finance.
  Mr. NELSON of Florida. Mr. President, I rise today to introduce the 
Equal Access to Medicare Act of 2005 to combat the growing practice of 
health care often called ``concierge'' medicine. As my colleagues may 
recall I introduced similar legislation in the past two sessions of 
Congress to deal with the growing problem of doctors shutting down 
their practices and opening new ones, only accepting those patients 
willing to pay a membership fee. These fees range from $60 to $15,000 
annually. By charging these extraneous and unwarranted dues or 
requiring patients to purchase non-Medicare covered services, doctors 
can shrink their practices, maintain a high profit margin, and continue 
billing Medicare, all on the backs of low and middle-income 
beneficiaries.
  This is a dangerous model that causes significant disparities in the 
care available to Medicare beneficiaries. A doctor receiving Medicare 
reimbursement should not be allowed to turn away Medicare beneficiaries 
who cannot or choose not to pay membership fees or fees for other non-
Medicare covered services. My bill simply prevents Medicare from 
providing payments to doctors who charge their patients membership fees 
or any other incidental or extraneous fees, or who require the purchase 
of non-Medicare covered services as a condition for the provision of 
Medicare covered services.
  Since the introduction of this bill in 2001, the practice has been 
expanding with versions in many States. According to a recent GAO 
report, the number of physicians practicing concierge medicine has 
increased by more than 10 times in the past 5 years. As an increasing 
number of Medicare beneficiaries voice their concerns, it is time for 
Congress to act. Should this practice proliferate, a doctor shortage 
for low and middle-income Medicare beneficiaries is likely, 
exacerbating an already ailing health care marketplace.
  I must emphasize that this bill does not interfere with the ability 
of doctors to limit the size of their practices or to be adequately 
compensated; it simply applies the same standard private insurance 
companies apply to their providers--that doctors may not select 
patients based upon willingness or ability to pay an entrance fee.
  I hope my colleagues will join me in helping Medicare keep its 
promise of accessibility to seniors who have paid a lifetime of 
``premiums.''
  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. 2080

       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 Medicare Act 
     of 2005''.

     SEC. 2. PROHIBITION OF INCIDENTAL FEES AND REQUIRED PURCHASE 
                   OF NONCOVERED ITEMS OR SERVICES UNDER MEDICARE.

       (a) In General.--Section 1842 of the Social Security Act 
     (42 U.S.C. 1395u) is amended by adding at the end the 
     following new subsection:
       ``(u) Prohibition of Incidental Fees or Requiring Purchase 
     of Noncovered Items or Services.--
       ``(1) In general.--A physician, practitioner (as described 
     in subsection (b)(18)(C)), or other individual may not--
       ``(A) charge a membership fee or any other incidental fee 
     to a medicare beneficiary (as defined in section 
     1802(b)(5)(A)); or
       ``(B) require a medicare beneficiary (as so defined) to 
     purchase a noncovered item or service as a prerequisite for 
     the provision of a covered item or service to the beneficiary 
     under this title.
       ``(2) Construction.--Nothing in this subsection shall be 
     construed to apply the prohibition under paragraph (1) to a 
     physician, practitioner, or other individual described in 
     such subsection who does not accept any funds under this 
     title.''.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply to membership fees and other charges made, or 
     purchases of items and services required, on or after the 
     date of enactment of this Act.
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