104th Congress: Democratic Perspectives 103rd-107th
Congress Committee Activity The Medicare Select program is an interesting experiment designed to learn whether elderly individuals may want to participate in restricted health care networks and, if so, to determine whether such networks can deliver cheaper Medicare supplemental products.
Currently, the program is set up as a time-limited demonstration program in only 15 states. Because it is set to expire in June of this year, we have no objection to and might even favor a timely extension of the demonstration in those states now participating. Some of us, however, have reservations about extending the program to all 50 states for the five years provided in the Committee-reported bill. With so little useful information yet available on the demonstration program, the permanent extension and expansion in the Ways and Means Committee's reported version is even more troublesome.
While we have a number of questions about the approach taken in Committee, the two most serious concerns are reflected in amendments offered in the Committee and defeated by Republican majorities.
First, we are concerned about the increased use of `attained age rating,' a practice permitting regular rate increases based solely on a policyholder's age. An amendment was offered to ban this practice because it results in deceptive pricing practices, interferes with meaningful comparisons of products, and destabilizes the marketplace. The proliferation of Medicare Select products that compete on the basis of this kind of rating is a distressing trend that will hurt elderly people. With their defeat of this amendment, Republicans have endorsed that trend.
Second, we are concerned that as Medicare Select insurers achieve deeper penetration into the marketplace, more and more elderly people who are ill-served by restricted networks will find themselves lacking choices and unable to obtain affordable alternative coverage. We therefore supported an amendment by Representative Ganske to correct this inequity by establishing a mechanism whereby policyholders who wanted or needed to opt out of a restricted network arrangement could obtain alternative fee-for-service coverage on a basis comparable to that which they would have enjoyed had they first signed up for a fee-for-service plan. Regrettably, all but two Republicans, Messrs. Ganske and Coburn, voted against providing this choice to the elderly.
As Republican proposals to achieve savings in the Medicare programs through managed care or privatization are advanced, we are concerned that meaningful choice for beneficiaries may not be adequately protected. While the Medicare Select program deals only with a portion of an elderly person's medical bills, we view with alarm the Republicans' rejection of measures to stabilize the marketplace and protect beneficiaries. In short, defeat of these amendments presages a willingness to compromise quality of care and choice for elderly Americans when the Congress takes up a reconciliation bill later this spring.
As Democrats, we remain committed to strong consumer protections for elderly people purchasing Medicare supplemental policies, and we strongly oppose changes in the Medicare program itself that would undermine meaningful consumer choice.
John D. Dingell.
Henry A. Waxman.
Edward J. Markey.
Ron Wyden.
John Bryant.
Thomas J. Manton.
Edolphus Towns.
Gerry E. Studds.
Frank Pallone, Jr.
Sherrod Brown.
Elizabeth Furse.
Peter Deutsch.
Bobby L. Rush.
Anna G. Eshoo.
Ron Klink.
Bart Stupak.
I had hoped that the legislation before the Committee could have been improved before consideration on the floor of the House. I am concerned with the serious health problem that diabetes continues to be in America. Diabetes is our fourth leading cause of death, affecting 14 million Americans and costing our nation over $100 billion annually. I had offered an amendment to improve H.R. 483 by requiring insurers offering a Medicare Select product to include, as part of their core benefits package, coverage of two of the most important disease-management tools available to people with diabetes: outpatient self-management training and blood testing strips. Unfortunately, the Committee defeated this amendment on a party line vote.
Contrary to what most people believe, insulin is not a cure for diabetes; it only helps those with diabetes properly manage their disease. If people with diabetes don't have the necessary tools and training to manage their disease, the results are costly--often fatal--complications: blindness, heart disease, leg and other extremity amputations, and stroke. The only way we can help reduce the burden of diabetes, and these costly complications, is to empower people with diabetes to manage their disease. That is the essence of what my amendment was about: reducing complications and saving money for a limited number of people with diabetes.
While the problem of access to these important tools is not limited strictly to managed care environments, a soon-to-be-released study by a major university substantiates that the needs of people with diabetes are not being met by current managed care arrangements, resulting in more complications. According to the National Diabetes Research Coalition, an organization of leading endocrinologists and other scientists active in diabetes research, 10% reduction in complications will save a staggering $5 billion. Expanding access to self-management tools would have benefited everyone by reducing the long-term health care costs resulting from diabetes.
I was pleased that my amendment had the full support of the American Diabetes Association, and colleagues on the Committee stated their support for the goals of my amendment. I look forward to working with them in the upcoming months to ensure that all people with diabetes have access to these critical self-management tools.
Elizabeth Furse.
104th Congress: Democratic Perspectives
103rd-107th
Congress Committee Activity