[Congressional Record (Bound Edition), Volume 147 (2001), Part 16]
[Extensions of Remarks]
[Pages 22091-22092]
[From the U.S. Government Publishing Office, www.gpo.gov]



      INTRODUCTION OF THE MEDICARE+CHOICE CONSUMER PROTECTION ACT

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                       Thursday, November 8, 2001

  Mr. STARK. Mr. Speaker, I rise with a group of colleagues to 
introduce the Medicare+Choice Consumer Protection Act of 2001. Congress 
should enact this bill immediately to ensure overdue protections for 
Medicare+Choice enrollees who are seeing increasing costs, decreasing 
benefits, and fewer options to obtain affordable supplemental coverage 
for Medicare.
  The Medicare+Choice program is an option that many seniors appreciate 
and it is an option that should remain viable in Medicare. 
Unfortunately, the problem of plan pullouts, benefit reductions, and 
cost increases, will never be solved by continuing to pour more money 
into HMOs. Even if their demands for ever higher payments are met, they 
will change yearly--just as our benefits do in the Federal Employee 
Health Benefits Program. This is because--unlike the rest of Medicare--
these plans are private companies that make annual changes to their 
benefit offerings based on costs and other business decisions. The 
bottom line is that they are in business to make money. That's 
understandable, but it undermines program stability, and confuses 
beneficiaries.
  The bill I am introducing today, along with a group of colleagues 
including Reps. Gephardt, Rangel, Dingell, Waxman, Brown, Kleczka, 
Cardin, Thurman and Tierney, will help senior citizens and other 
beneficiaries deal with the everchanging world of Medicare+Choice.
  It doesn't heap any new money on the HMO industry.
  Instead, it extends important consumer protection standards to 
Medicare beneficiaries who find themselves in a plan that no longer 
meets their needs. There are three major components to the bill:

[[Page 22092]]

  (1) Eliminate the Medicare+Choice lock-in scheduled to begin going 
into effect in January 2002.
  (2) Extend the existing Medigap protections that apply to people 
whose Medicare+Choice plan withdraws from the program to anyone whose 
Medicare+Choice plan changes benefits or whose doctor or hospital 
leaves the plan.
  (3) Prohibit Medicare+Choice plans from charging higher cost-sharing 
for a service than Medicare charges in the fee-for-service program. 
This provision is crafted to continue to allow reasonable flat-dollar 
copayments.
  The bill is endorsed by a host of senior and consumer advocacy 
organizations including: the National Committee to Preserve Social 
Security and Medicare, Alliance for Retired Americans, National Council 
on the Aging, Families USA, The Medicare Rights Center, California 
Congress of Seniors, and California Health Advocates. They've endorsed 
it because the three components are each important consumer protection 
improvements for beneficiaries in Medicare+Choice plans.
  Eliminating the lock-in means that no one will be forced to stay in a 
health plan that doesn't meet their needs. When seniors get marketing 
material from an HMO and choose to join, they don't know what illnesses 
will befall them or what injuries may occur. If they picked a plan that 
suddenly doesn't meet their specific needs, they need to be able to get 
out. The lock-in prohibits that flexibility. Especially with the 
volatility of the Medicare+Choice marketplace over the past several 
years, it is important that seniors know that if they test an HMO and 
don't like it, they'll be able to leave and choose a Medicare option 
that better suits them. This is a provision that is agreed upon and 
strongly supported by both consumer advocates and the managed care 
industry.
  Under current law, if your Medicare+Choice plan leaves your community 
or withdraws from Medicare all together, you can move into a select 
category of Medigap plans (A, B, C and F) without any individual health 
underwriting. This protection is obviously important because it makes 
more affordable Medigap options available to people who through no 
fault of their own can no longer remain members of the Medicare+Choice 
plan in which they had been enrolled.
  Unfortunately, these protections do not extend to seniors whose plans 
make drastic changes, but stop short of completely withdrawing from the 
program. Many Medicare beneficiaries are getting letters from their 
HMOs describing changes to their plan for next year that are so 
dramatic that the plan no longer meets their financial needs, health 
needs--or both.
  In my district, PacifiCare is pulling out of some parts of the 
county, but remaining in others. In the areas where they remain, they 
have instituted a new $400 hospital deductible for each covered 
admission (up from $100 last year), a new $50 copayment for dialysis 
where there had been none, and increased Medicare-covered inpatient 
injectible medication cost-sharing from $30 to $250 or the full cost of 
the drug, whichever is less. By any standard, these are dramatic 
increases. HealthNet, which also serves my district, will now have a 
hospital deductible of $750, and they have dropped all coverage of 
prescription drugs,, while more than doubling their premium from $30 to 
$85 a month.
  These changes may well affect the ability of current enrollees to 
afford to continue in the plan--and certainly could impact their 
ability to get needed care. It is very likely that a Medigap 
supplemental policy might make better sense for these beneficiaries. 
Therefore, it is critical to extend the current Medigap protections for 
when a plan terminates Medicare participation to participants of plans 
that have made changes to their benefits like those described above.
  Those same protections need to apply if a patient's doctor or 
hospital discontinues participation in the Medicare+Choice plan as 
well. There have never been any lock-in provisions for providers that 
require that they continue with a Medicare+Choice plan for the full 
contract year. Again, it is beyond a patient's control if their doctor 
or hospital withdraws from their HMO. They need to have the option to 
follow that doctor--and that likely means being able to join a Medigap 
supplemental plan and return to traditional fee-for-service Medicare.
  The third provision of the bill may be the most important. I am truly 
shocked by the level of gamesmanship going on with the cost-sharing 
proposals being put forth by many HMOs in their Medicare+Choice plan 
outlines this year. I believe that the Secretary has the latitude in 
current law to prohibit many of these schemes from being put in place--
and I encourage him to make ample use of that power. But, I think we 
need a change in law that makes it perfectly clear that Medicare+Choice 
plans cannot charge patients more for a service than the patient would 
face under the Medicare fee-for-service program.
  Medicare+Choice guarantees beneficiaries the same benefits they get 
from Medicare--plus more. If a Medicare HMO is charging $50 for 
dialysis services that a patient needs to stay alive and those same 
costs would be approximately $23 in fee-for-service Medicare, that is 
not meeting Medicare's level of benefit coverage. I can't understand 
why we would want to allow that. If Medicare covers home health care 
with no cost-sharing, why should we allow Medicare+Choice plans to 
diminish the value of that benefit by charging cost-sharing? The same 
is true with durable medical equipment, and the list goes on and on.
  On top of being unfair, the ability to charge higher cost-sharing for 
services like DME, home health, and dialysis perpetuates the cherry 
picking and risk avoidance that is well-documented in the Medicare HMO 
program. It has the obvious unfair consequence of allowing 
Medicare+Choice plans to avoid patients that know they will need those 
services. Patients with specific health needs read the benefit package 
carefully to see what is covered before they enroll. They won't even 
apply for the plan if their needed services are too costly or not 
covered at all. That keeps the Medicare+Choice plans from enrolling 
costly patients. They've already won at delaying risk adjustment which 
would help solve that problem. We shouldn't let them begin to use cost-
sharing as another mechanism to avoid risk.
  These are common sense protections that would help beneficiaries feel 
more confident about their choices. Proponents of the Medicare+Choice 
program should support enactment of this legislation because it will 
reduce the uncertainty and fear factor that makes beneficiaries 
understandably skeptical about the Medicare+Choice program in the first 
place.
  The bottom line is that the Medicare+Choice Consumer Protection Act 
is a simple, incremental bill that will help protect Medicare 
beneficiaries who choose to enroll in a Medicare+Choice option. We've 
made this option available to seniors, and I think it is our 
responsibility to assure that they don't lose other options in Medicare 
because they've taken us up on the offer. I urge all of my colleagues 
to join us in enacting this small, but important bill this year.

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