[Congressional Record (Bound Edition), Volume 145 (1999), Part 1]
[Extensions of Remarks]
[Page 338]
[From the U.S. Government Publishing Office, www.gpo.gov]



        INTRODUCTION OF THE MEDICARE HMO IMPROVEMENT ACT OF 1999

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                           HON. SAM GEJDENSON

                             of connecticut

                    in the house of representatives

                       Wednesday, January 6, 1999

  Mr. GEJDENSON. Mr. Speaker, I rise today to introduce the Medicare 
HMO Improvement Act of 1999.
  By the end of 1998, over 8,000 senior citizens in my district--and 
over 13,000 throughout Connecticut--received perhaps the most 
frightening news any American can get. Their Medicare HMO's informed 
them that they are terminating their health insurance by the end of the 
year. Some of these seniors were recruited only months before through 
aggressive company marketing campaigns.
  Insurers came to the Federal Government in the early 1980's and said 
``We're private industry, we can run Medicare better than you can while 
giving more services to seniors. Give us a chance.'' Well, we gave them 
a chance and they let our seniors down. The companies thought they 
could just jump in and jump out of my district, and others around the 
country, without regard to the health and well-being of the seniors 
that they had signed up just months ago. Across our Nation, Medicare 
HMO's have terminated health insurance for nearly 440,000 seniors. That 
is not acceptable. That is not a responsible way to operate a business 
whose primary purpose is to ensure people's health.
  The termination announcements sent shock waves through Tolland, 
Windham and New London counties. At a public meeting I hosted with 
Senator Chris Dodd in September 1998 following the announcement that 
7,000 seniors would lose their coverage by year's end, 400 seniors 
gathered to hear about their options for the future. The tension, 
anxiety and desperation of my constituents pervaded the room. One of my 
constituents, whose wife had recently had a stroke, was so upset about 
losing health insurance that after asking a question, he had a heart 
attack. That man, Frederick Kral, died on the way to the hospital.
  Under the current system, Medicare HMO's can act with impunity. 
There's no accountability, no responsibility. Profits are all that 
matter. Patients and quality health care are secondary. This is just 
wrong.
  My legislation--the Medicare HMO Improvement Act of 1999--will inject 
some accountability into the Medicare HMO system. It will change the 
contract term from 1 year to 3 years. This change is designed to 
discourage HMO's from making short-term promises to seniors only to 
terminate coverage a year later when they don't make quite as much 
money as they hoped. It gives the Secretary of Health and Human 
Services (HHS) authority to enjoin contract terminations for up to one 
year if public health will be seriously threatened, insurance coverage 
will be compromised, or the Governor of the state affected requests 
that the Secretary exercise this authority.
  Moreover, my legislation is designed to discourage HMO's from 
``cherry picking'' between regions within a State by offering coverage 
only in those areas with the highest reimbursement rates. It 
accomplishes this goal by requiring the Secretary of HHS to terminate 
all contracts a Medicare HMO has for a metropolitan statistical area 
(MSA) if that HMO terminates coverage in any portion of the MSA in that 
state. I selected the MSA as the geographical unit because it is 
already used in the law and should discourage ``cherry picking'' 
without reducing coverage on a state-wide basis. Finally, if a company 
terminates coverage and a beneficiary is currently receiving treatment, 
this bill requires the HMO to provide 90 days of coverage to allow the 
patient to continue to receive such treatment. This will ensure that 
patients under active treatment will have a few additional months to 
make the transition to another doctor or health plan.
  Mr. Speaker, what Medicare HMO's did in my district--and what they 
are doing across the country--is unreasonable and irresponsible. The 
Medicare HMO Improvement Act is a reasonable approach which will 
provide badly needed protection to older Americans. I invite my 
colleagues to join me as co-sponsors.

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