[Congressional Record (Bound Edition), Volume 145 (1999), Part 11]
[Extensions of Remarks]
[Page 15373]
[From the U.S. Government Publishing Office, www.gpo.gov]




               PRESERVING HEALTH CARE CHOICES FOR SENIORS

                                 ______
                                 

                         HON. MICHAEL BILIRAKIS

                               of florida

                    in the house of representatives

                         Thursday, July 1, 1999

  Mr. BILIRAKIS. Mr. Speaker, today, I am proud to introduce 
legislation that will help millions of Medicare beneficiaries whose 
health coverage is in jeopardy. My Florida colleague, Peter Deutsch, 
has joined me in sponsoring this bipartisan measure. Our bill--the 
``Medicare+Choice Risk Adjustment Amendments of 1999''--will help to 
preserve and expand health care choices for seniors who participate in 
Medicare managed care plans.
  The Medicare+Choice program was created as part of the 1997 Balanced 
Budget Act to increase health care options for Medicare beneficiaries. 
While the majority of beneficiaries remain in traditional fee-for-
service Medicare, enrollment in managed care plans has grown rapidly in 
recent years. Many seniors now depend on the additional benefits (such 
as prescription drug coverage) available through plans under the 
Medicare+Choice program. However, a serious crisis threatens this vital 
program.
  Last year, nearly 100 Medicare managed care plans did not renew their 
Medicare contracts or reduced their geographic areas of service. This 
year, many more plans have announced their intent to leave the 
Medicare+Choice program, raising serious concerns about its continued 
availability as an option for Medicare beneficiaries. Many plans cite 
inadequate reimbursement as a major factor in their decision.
  Unless Congress takes action to correct this problem, the 
consequences will be devastating for Medicare beneficiaries, especially 
low-income seniors. Many will lose the option of participating in a 
Medicare managed care plan altogether. Others will face increased out-
of-pocket costs or a reduction in benefits.
  This situation is largely due to a decision by the Health Care 
Financing Administration (HCFA) to disregard the intent of Congress in 
establishing the Medicare+Choice program. The 1997 Balanced Budget Act 
required HCFA to establish a process for ``adjusting'' Medicare+Choice 
payments based on the likelihood or the ``risk'' that enrollees will 
use health care services.
  Congress anticipated that this new ``risk adjustment'' process would 
provide Medicare+Choice plans with higher payments for patients who are 
chronically ill and lower payments for those who are generally healthy. 
We did not intend to decrease overall Medicare+Choice spending through 
this process. Instead, we were simply trying to make sure that 
Medicare+Choice funds would be distributed based on the health status 
of Medicare+Choice enrollees.
  However, HCFA has completely disregarded the intent of Congress on 
this critical issue. The agency is using its authority to establish a 
``risk adjustment'' process as an excuse to try to impose deep spending 
cuts in the Medicare+Choice program. HCFA's ill-advised decision 
threatens to seriously underfund the Medicare+Choice program. Estimates 
indicate as much as $11 billion may be drained from Medicare+Choice 
over the next five years, if HCFA is allowed to go forward with its 
plan.
  At the time the 1997 Balanced Budget Act was considered, the 
Congressional Budget Office (CBO) estimated no savings from the risk 
adjuster. CBO's analysis assumed that the risk adjuster would simply 
shift funds within Medicare+Choice. By contrast, HCFA's approach would 
drain billions of dollars from the program.
  The ``Medicare+Choice Risk Adjustment Amendments of 1999'' would 
address this problem in two ways. First, it would require HCFA to 
implement its risk adjustment process on a budget neutral basis--as 
Congress intended. Second, the bill would repeal a provision of current 
law that automatically requires the annual increase in Medicare fee-
for-service payments.
  Millions of seniors rely on Medicare+Choice for greater flexibility 
in meeting their health care needs. My legislation will help to 
stabilize this vital program and guarantee continued health care 
choices for Medicare beneficiaries. I urge my colleagues to join me in 
protecting seniors' health care choices by cosponsoring the 
``Medicare+Choice Risk Adjustment Amendments of 1999.''

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