[Congressional Record (Bound Edition), Volume 151 (2005), Part 20]
[Senate]
[Pages 27923-27924]
[From the U.S. Government Publishing Office, www.gpo.gov]




          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      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

[[Page 27924]]

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.
                                 ______
                                 
      By Mr. SUNUNU (for himself, Mr. Leahy, Mr. Craig, Mr. Rockfeller, 
        Ms. Mukowski, Mr. Kennedy, Mr. Levin, Mr. Durbin, Ms. Stabenow, 
        and Mr. Salazar):
  S. 2082. A bill to amend the USA PATRIOT Act to extend the sunset of 
certain provisions of that Act and the lone wolf provision of the 
Intelligence Reform and Terrorism Prevention Act of 2004 to March 31, 
2006; to the Committee on the Judiciary.
  Mr. LEAHY. Mr. President, On a September morning 4 years ago nearly 
3,000 lives were lost on American soil, and our lives as Americans 
changed in an instant. In the aftermath of the 9/11 attacks, Congress 
moved swiftly to pass anti-terrorism legislation. The fires were still 
smoldering at Ground Zero in New York City when the USA PATRIOT Act 
became law on October 30, 2001, just 6 weeks after the attacks.
  Many of us here in the Senate today worked together in a spirit of 
bipartisan unity and resolve to craft a bill that we had hoped would 
make us safer as a nation. Freedom and security are always in tension 
in our society, and especially so in those somber weeks after the 
attacks, and we tried our best to strike the right balance.
  One of the fruits of that bipartisanship was the PATRIOT Act's sunset 
provisions. These key provisions set an expiration date of December 31, 
2005, on certain government powers that had great potential to affect 
the civil liberties of the American people. Republican House Majority 
Leader Dick Armey and I insisted on these sunsets to ensure that 
Congress would revisit the PATRIOT Act within a few years and consider 
refinements to protect the rights and liberties of all Americans more 
effectively, and we prevailed.
  Sadly, the Bush administration and the Republican congressional 
leadership have squandered key opportunities to improve the PATRIOT 
Act. The House-Senate conference report filed last week by Republican 
lawmakers falls short of what the American people expect and deserve 
from us. The bipartisan Senate bill, which the Senate Judiciary 
Committee and then the Senate adopted unanimously, struck a far better 
balance.
  The reauthorization of the PATRIOT Act must have the confidence of 
the American people. The Congress should not rush ahead to enact flawed 
legislation to meet a deadline that is within our power to extend. We 
owe it to the American people to get this right.
  The way forward to a sensible and workable bipartisan bill is clear. 
Today I am pleased to join with Senator Sununu and others to introduce 
a bill to extend the sunsets on the expiring PATRIOT Act powers until 
March 31, 2006. Our bill also extends for three months the so-called 
``lone wolf'' FISA surveillance authority, which Congress enacted last 
year as part the Intelligence Reform and Terrorism Prevention Act.
  The deadline that Congress imposed to ensure oversight and 
accountability should not now become a barrier to achieving bipartisan 
compromise and the best bill we can forge together. This is a vital 
debate, and these are vital issues to all Americans. If a brief 
extension is needed to produce a better bill that will better serve all 
of our citizens, then by all means, let us give ourselves that time. 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. 2082

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. EXTENSION OF SUNSET OF CERTAIN PROVISIONS OF THE 
                   USA PATRIOT ACT AND THE LONE WOLF PROVISION OF 
                   THE INTELLIGENCE REFORM AND TERRORISM 
                   PREVENTION ACT OF 2004.

       Section 224(a) of the Uniting and Strengthening America by 
     Providing Appropriate Tools Required to Intercept and 
     Obstruct Terrorism (USA PATRIOT ACT) Act of 2001 (Public Law 
     107-56; 115 Stat. 295) is amended by striking ``December 31, 
     2005'' and inserting ``March 31, 2006''.

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