[Congressional Record (Bound Edition), Volume 146 (2000), Part 17]
[Extensions of Remarks]
[Pages 25781-25782]
[From the U.S. Government Publishing Office, www.gpo.gov]



MOTION TO INSTRUCT CONFEREES ON H.R. 4577, DEPARTMENTS OF LABOR, HEALTH 
AND HUMAN SERVICES, AND EDUCATION, AND RELATED AGENCIES APPROPRIATIONS 
                               ACT, 2001

                                 ______
                                 

                               speech of

                        HON. BENJAMIN A. GILMAN

                              of new york

                    in the house of representatives

                        Sunday, October 29, 2000

  Mr. GILMAN. Mr. Speaker, I support the motion to instruct on 
Medicare+Choice being offered by the gentleman from New Jersey.
  This motion will allow Medicare+Choice organizations to offer 
Medicare+Choice plans under Part C of Title XVIII for a minimum 
contract period of three years and to maintain the benefits specified 
under the contract for the three years.
  At the time the Medicare+Choice Program was being developed, it 
seemed like a revolutionary concept that would greatly expand services 
available under Medicare, while keeping overall costs down. 
Regrettably, for far too many seniors, Medicare+Choice has become a 
false choice and a cruel joke.
  In theory, Medicare+Choice sounded like a good program. Private 
health maintenance organizations (HMOs) would enter into contracts with 
the Health Care Financing Administration to provide services to seniors 
who signed up for membership. These services were included in various 
benefit plans, the content of which varied with the premium price. The 
higher the premium, the more services it offered. It bears noting 
however, that many of the benefits packages initially came with little 
or no premium cost to the individual senior. Moreover, many of these 
plans offered extensive benefits for such little cost, including 
prescription drug coverage. It sounded too good to be true. As history 
would show, this was precisely the case.
  Within the first year, many of the HMOs recognized that providing 
health coverage for seniors, especially prescription drug benefits, was 
a highly expensive matter. Once the books were balanced, it became 
apparent that the cost of providing these services was not being offset 
by the per patient reimbursement being offered by HCFA. Being creatures 
of profit, the various HMOs began to take one of two courses of action. 
They either received permission to drastically raise their premium 
rates, as much as 1,500 percent in some cases, or they conveyed their 
intent to HCFA to withdraw their services from areas which they deemed 
to be unprofitable, usually surburban and rural counties.
  My region, the 20th Congressional District of southeastern New York 
has been devastated by this process. When the Medicare+Choice Program 
was started, there were approximately six HMOs for seniors in my 
district to choose from. Today, none remain in Sullivan County, two 
small plans exist in Orange County and the remaining plans in Rockland 
and Westchester Counties have sharply raised their premiums.
  This is inexcusable. Our seniors deserve to be able to sign up for a 
plan with the knowledge and comfort that it will not be ripped out

[[Page 25782]]

from under them after a year's time. The current system simply presents 
seniors with false hopes.
  The fault for this situation lies with: HCFA, for not offering 
reasonable floor reimbursement rates, the HMOs, for seeking 
unreasonably high profits above patient care, and with the Congress, 
for failing to attach any punitive measures to HMOs that pull out of 
certain counties when they arbitrarily decide they will not meet their 
projected profit margin.
  Mr. Pallone's motion is a good first step toward solving this problem 
even though it represents the bare minimum of what the Congress should 
do to address this crisis. Last year, the Congress sent $1.4 billion in 
additional funds to HMOs so that they would remain in the 
Medicare+Choice Program. Yet no accountability provisions were 
attached. The result was further pullouts this year. The House did the 
same thing last week with the Balanced Budget Act (BBA) giveback 
legislation that was incorporated into the tax bill; additional funds 
for HMOs with no strings attached. I predict this latest action will 
meet with the same results.
  For the sake of those seniors who have been left out in the cold by 
their Medicare+Choice providers, I urge my colleagues to vote for this 
motion, and restore some common sense and basic accountability to this 
broken program.

                          ____________________