[Public Papers of the Presidents of the United States: WILLIAM J. CLINTON (2000, Book II)]
[October 10, 2000]
[Pages 2113-2114]
[From the U.S. Government Publishing Office www.gpo.gov]



Letter to Congressional Leaders on Health Care Legislation
October 10, 2000

Dear Mr. Speaker:  (Dear Mr. Leader:)
    I am writing to express my serious concerns that the Congressional 
Republican Leadership is preparing to pass unjustifiably large Medicare 
health maintenance organization (HMO) payment increases while preventing 
passage of a strong Patients' Bill of Rights. Managed care reform in the 
106th Congress should focus on patient protections, not on excessive 
payments to managed care plans. Moreover, these reimbursement increases 
are effectively diverting resources from critically important health 
care priorities.
    This past weekend marked the 1-year anniversary of the 
overwhelmingly bipartisan passage of the Norwood-Dingell Patients' Bill 
of Rights.

[[Page 2114]]

Despite the bipartisan majority supporting this bill in the Senate, 
parliamentary and political tactics have blocked an up-or-down vote on 
this long-overdue legislation.
    At least as disconcerting is that Congress is proposing to dedicate 
$25 to $53 billion in increased payments to managed care--without a 
sound policy basis. The Congress is currently contemplating dedicating 
40 to 55 percent of their total investment in provider payments and 
beneficiary services to increase managed care payments--over twice the 
amount they plan to spend on hospitals and over five times the amount 
that they plan to spend on beneficiaries. The Congress is proposing this 
investment despite studies showing that Medicare managed care plans are 
overpaid by nearly $1,000 per enrollee and that their payment rates have 
grown faster under the Balanced Budget Act than the payment rates for 
traditional Medicare.
    It is important to note that increased payments provide no guarantee 
that Medicare HMOs will stop dropping benefits or abandoning seniors' 
communities altogether. It is clear that increasing payments to managed 
care plans did not work this year--we invested an additional $1.4 
billion in Medicare+Choice, yet watched nearly 1 million seniors and 
people with disabilities lose access to plans. Without explicit 
accountability provisions, it will not work next year either.
    The unwarranted managed care payment increases would deprive funding 
for initiatives that would have real effects on peoples' lives, such as: 
restoring State options to insure vulnerable legal immigrants; fully 
funding the Ricky Ray Relief Fund; providing health insurance to 
children with disabilities; funding grants to integrate people with 
disabilities into the community; improving nursing home quality; 
eliminating Medicare preventive services cost sharing; targeting dollars 
to vulnerable hospitals; assuring adequate payments to teaching 
hospitals and home health agencies; and funding other critical health 
priorities. These high-priority initiatives are outlined in additional 
detail in the attached document.
    These initiatives represent our highest health priorities. In 
contrast, Congress is increasing reimbursement to managed care plans at 
a time when Medicare managed care plans are about to receive billions of 
dollars in increased Medicare payments, which are linked to increases in 
fee-for-service payments to hospitals, nursing homes, and other 
providers.
    It is long past time that we work together in a bipartisan fashion 
to respond to the Nation's highest health care priorities. It is 
irresponsible to provide excessively high reimbursement rates for HMOs 
without ensuring that they are accountable through the Patients' Bill of 
Rights and through commitments to provide stable and reliable services 
to Medicare beneficiaries. I urge you to produce more balanced 
legislation that puts Medicare beneficiaries and the Nation's taxpayers 
first.
        Sincerely,

                                                      William J. Clinton

Note: Letters were sent to J. Dennis Hastert, Speaker of the House of 
Representatives, and Trent Lott, Senate majority leader. An original was 
not available for verification of the content of this letter.