[Congressional Record (Bound Edition), Volume 158 (2012), Part 10]
[Extensions of Remarks]
[Page 14488]
[From the U.S. Government Publishing Office, www.gpo.gov]




   INTRODUCTION OF THE MEDICARE SECONDARY PAYER AND LATE ENROLLMENT 
                      PENALTY FAMILY FAIRNESS ACT

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                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                     Wednesday, September 19, 2012

  Mr. STARK. Mr. Speaker, I rise to introduce the Medicare Secondary 
Payer and Late Enrollment Penalty Family Fairness Act. Today, the 
Social Security Act uses different definitions of familial 
relationships for purposes of Medicare secondary payer rules and late 
enrollment penalty protections. Beneficiaries over age 65 are subject 
to a more restrictive definition than younger beneficiaries who are 
eligible for Medicare due to disability. My legislation fixes that 
anomaly by creating a uniform definition so that Medicare beneficiaries 
of all ages are treated equally. I would like to thank my constituent 
Joseph Goleman for bringing this problem to my attention.
  Medicare's secondary payer rules generally allow an individual to 
maintain employer-sponsored coverage after they've obtained Medicare 
eligibility and forgo joining Medicare Part B (and therefore having to 
pay the Part B monthly premium) as long as they maintain such coverage. 
In these instances, their employer-sponsored coverage remains their 
primary coverage, and Medicare Part A is their secondary coverage. Very 
importantly, the law also protects people in this situation who then 
transition to Medicare Part B when they lose that employer-sponsored 
coverage. The law shields these beneficiaries from the late enrollment 
penalty because they've maintained consistent coverage and therefore 
carry no adverse risk for Medicare. This is a key benefit as the late 
enrollment penalty is a substantial financial hit.
  These rules exist because they are a win for beneficiaries with 
access to employer-sponsored coverage and a win for taxpayers. 
Beneficiaries gain because employer-sponsored coverage usually has 
lower cost sharing than Medicare and typically has lower deductibles as 
well. Plus, taxpayers win because Medicare isn't responsible for many 
new health costs for these individuals because they are being primarily 
covered by their employer's plan.
  For people who become eligible for Medicare based on disability, the 
current law provides that these Medicare Secondary Payer and Late 
Enrollment Penalty rules apply to the beneficiary and his or her 
``family member.'' For people who become eligible for Medicare by 
reason of turning 65, these protections only apply to the beneficiary 
or their ``spouse.''
  The practical impact of these different definitions of familial 
relationships is that a person eligible for Medicare based on 
disability is protected from late enrollment penalties when covered by 
a same sex spouse on his or her employer plan. However, a person 
eligible for Medicare because they've turned 65 is not.
  I learned of this problem after I received a constituent inquiry in 
my Fremont, California office. Joseph Coleman is a 34-year-old person 
with a disability and is enrolled in Medicare on that basis. After 
becoming enrolled in Medicare, he learned that he could obtain spousal 
coverage and thereby avoid having to pay the Part B premium. He was 
also rightly informed that he'd be eligible to rejoin Medicare Part B--
without paying a penalty--if that spousal coverage changed.
  Imagine Joseph's surprise, anger, and fear when he went to exercise 
that right to rejoin Medicare Part B and he was told by a local Social 
Security office in our community, that that right didn't extend to him 
because he was in a same-sex marriage. Instead, he would be subject to 
a significant late enrollment penalty, which made Medicare Part B 
coverage entirely unaffordable for him.
  Thankfully, Joseph reached out to me. My staff quickly discovered 
that he was, in fact, guaranteed the protection to rejoin Medicare 
without penalty. After several go 'rounds with the local Social 
Security office by my staff and Medicare's Region 9 staff, we were able 
to get Joseph the benefits to which he was due. However, it is clear to 
me that because there are two different standards in the law, mistakes 
are made and people are likely losing benefits to which they are 
entitled under current law. This certainly would have been the case 
with Joseph if I hadn't intervened.
  Regardless of your position on same-sex marriage, revising the law to 
have a standard definition using ``family member'' for the Medicare 
secondary payer rules and the late enrollment penalty protection simply 
makes financial sense for Medicare. By converting to the term ``family 
member,'' we steer clear of stepping into any debate over the Defense 
of Marriage Act. While I oppose that law and would strongly support its 
repeal, that's not the fight we're waging today.
  The simple goal of this bill is to right a wrong, which was brought 
to my attention by a constituent. If left unchanged, not only does the 
law treat Medicare beneficiaries in identical situations differently, 
it obviously results in confusion for those who enforce the law. I am 
sure more people than Joseph Coleman have been wrongly denied benefits 
based on misinterpretation of the convoluted law--potentially accented 
by personal prejudices.
  I urge my colleagues to join with me in support of this small bill 
that affects few people, but simply clarifies the law. It will mean the 
difference between people obtaining quality, affordable coverage 
through Medicare Parts A&B, or being left behind.

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