[Congressional Record (Bound Edition), Volume 159 (2013), Part 1]
[House]
[Pages 1333-1334]
[From the U.S. Government Publishing Office, www.gpo.gov]




                              {time}  1040
                 PUERTO RICO MEDICARE PART B EQUITY ACT

  The SPEAKER pro tempore. The Chair recognizes the gentleman from 
Puerto Rico (Mr. Pierluisi) for 5 minutes.
  Mr. PIERLUISI. Mr. Speaker, today I'm introducing a modified version 
of bipartisan legislation I introduced last Congress. The bill would 
amend a provision in Federal law that applies only to Puerto Rico and 
that has harmed thousands of Medicare beneficiaries on the island. My 
legislation would eliminate this problem for future beneficiaries and 
provide appropriate financial relief to current beneficiaries who have 
been adversely affected. Senator Schumer is introducing a companion 
bill, and I want to thank him for his support on this issue.
  Most individuals become eligible to enroll in Medicare part A, which 
covers inpatient hospital care, when they turn 65. In every State and 
territory except Puerto Rico, individuals enrolled in part A are 
automatically enrolled in part B, which covers doctors' services and 
outpatient hospital care and requires the payment of a monthly premium. 
Individuals can opt out of part B if they don't want it. In Puerto 
Rico, by contrast, individuals enrolled in part A are not automatically 
enrolled in part B but, rather, must opt in to receive this coverage.
  The problem with the opt-in requirement is that the law requires 
individuals to elect part B coverage within a 7-month initial 
enrollment period or to pay a penalty to the Federal Government. The 
penalty is substantial--a 10 percent increase in the monthly part B 
premium for every year of delayed enrollment. It is also permanent, 
lasting as long as the individual has part B, which can be decades.
  Over the years, the responsible Federal agencies have done a poor job 
informing beneficiaries in Puerto Rico about the opt-in requirement and 
the consequences of late enrollment. Therefore, many of my constituents 
fail to realize they lack Part B until they get sick and need to visit 
a doctor, by which point significant time may have elapsed. To 
illustrate the repercussions, consider the standard Medicare Part B 
monthly premium of $105. An individual who enrolls 2 years late must 
pay a 20 percent surcharge--an additional $21 per month. Over 1 year, 
that is $252. Over 20 years, it is $5,000.
  The combination of the opt-in requirement and inadequate beneficiary 
education in Puerto Rico has led to consequences that are both severe 
and predictable. Puerto Rico has the lowest part B participation rate 
in the country--81 percent compared to the national average of 92 
percent. There are least 130,000 island residents enrolled in

[[Page 1334]]

part A but not part B. Without this coverage, beneficiaries have 
limited access to doctors' services and outpatient hospital care. If 
these individuals do eventually enroll in part B, as most will, the 7-
month window will have closed and they will be required to pay a 
lifetime penalty.
  Moreover, there are at least 53,000 seniors or disabled individuals 
in Puerto Rico who are already paying a lifetime penalty for enrolling 
late in part B. Each year, in fact, island residents pay a total of 
over $7 million in late fees. This is profoundly unfair. Through no 
fault of their own, my constituents are required to forfeit money to 
the Federal Government they should be using to meet their basic needs 
and support their families.
  On the administrative front, I have worked hard with Senator Schumer 
to ensure that the relevant Federal agencies improve the educational 
materials provided to Puerto Rico beneficiaries, and I am pleased they 
have taken positive steps in response to our demands. But the only true 
solution to this problem is legislative.
  My bill would do three things:
  First, it would amend Federal law so that, going forward, 
beneficiaries in Puerto Rico are treated like their counterparts in 
every other jurisdiction, automatically enrolled in part B with the 
option to opt out of coverage;
  Second, to ease the burden on those who enrolled late in part B, 
usually with no understanding of the consequences of that choice, the 
bill would reduce the monthly penalty they are required to pay by 85 
percent;
  Finally, to address those beneficiaries who are enrolled in part A 
but not B and who will pay a late penalty whenever they do enroll, the 
bill would authorize a special period during which those individuals 
could enroll in part B and pay a monthly surcharge that is 85 percent 
less than the penalty they would be subject to under current law.
  I look forward to working with my colleagues in both the House and 
the Senate to enact this much-needed bill into law.
  I should also mention that I was impressed with the State of the 
Union delivered by President Obama last evening, and I particularly 
support his call for democracy in America. But I remind, respectfully, 
both the President and all Americans that Puerto Rico has a status that 
is undemocratic. There are 3.7 million American citizens living in 
Puerto Rico who lack the most basic voting rights in a democracy. They 
cannot vote for the President, and they do not have voting 
representation in Congress. They have rejected this status, and the 
least that this Congress should do is give Puerto Rico the choice of 
joining the Union as a State or be treated as a sovereign nation.

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