THE PLUS-CHOICE RELIABILITY ACT
(House of Representatives - May 25, 2000)

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[Pages H3859-H3860]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                    THE PLUS-CHOICE RELIABILITY ACT

  The SPEAKER pro tempore. Under a previous order of the House, the 
gentleman from Ohio (Mr. Brown) is recognized for 5 minutes.
  Mr. BROWN of Ohio. Mr. Speaker, on January 1, 1999, approximately 
400,000 Medicare beneficiaries were dropped unceremoniously by Medicare 
managed care plans. On January 1 the next year, 2000, 400,000 more were 
dropped unceremoniously by Medicare managed care plans. We can expect 
at least that much disruption again on January 1, 2001.
  By the way, fly-by-night coverage is just one of the shocks 
potentially awaiting plus-choice Medicare enrollees. Bait and switch. 
Supplemental benefits are another.
  All of us in this body have heard from Medicare beneficiaries who 
joined a plus-choice plan to gain access to prescription drug coverage 
or reduced cost sharing only to have those benefits cut back or 
stripped out just in time for the new year.
  Why is the plus-choice Medicare program failing seniors? Ask the 
Medicare managed care plans, and they will say it is because the 
Federal Government is underpaying them. Ask other experts and they will 
say it is because Medicare managed care plans overestimated their 
ability to operate more efficiently than traditional Medicare, refused 
to cross-subsidize between high and low reimbursement areas and 
underestimated the costs of providing supplemental benefits.
  Maybe the truth is in the middle, more likely. The specifics do not 
matter all that much. Most likely private managed care plans simply 
cannot serve two masters, the public interest and the corporate bottom 
line.
  Whatever is going on, the most expedient ways of responding to the 
program's failings are also the most irresponsible if our goal is to 
act in the best interest of Medicare beneficiaries. We could do 
nothing. We are pretty good at that here.
  Is it fiscally responsible to continue pouring public dollars into 
plus-choice plans? I would rather my tax dollars help finance health 
care coverage that is more predictable. Insurance that does not give 
one peace of mind is not good insurance. In Medicare's case, it is 
peace of mind for beneficiaries and their families alike. Health care 
coverage that is about as stable as a house of cards simply does not 
cut it.
  We could always pay managed care plans more, but if we do that 
without exacting a guarantee that these plans will provide stable 
benefits and continuous coverage, we are perpetuating the same double 
standard that protected the Medicare choice plan from the beginning.
  Somehow, managed care plans can cost Medicare more than the fee-for-
service program; can pick and choose which counties they will serve and 
which ones they will dump; can attract seniors on the promise of extra 
benefits, then eliminate those benefits, another cost-cutting strategy 
unavailable to the fee-for-service program, and still can be touted by 
many in this institution, including Republican leadership, as the long-
term solution for Medicare.
  How can Medicare privatization proposals be taken seriously when they 
feature the same private insurance companies and system that excluded 
half of all seniors in 1965 and treats them miserably 35 years later in 
the year 2000? I do not get it. When the traditional Medicare program 
spends more than expected, they tell us it is because public programs 
are big, bad and inefficient. When private managed care plans spend 
more than it is expected, it is because big, bad government was not 
paying them enough to begin with.
  In my view, private managed care plans do not belong in Medicare. 
They do not belong because they are unwilling; and frankly, they cannot 
prioritize the welfare of Medicare beneficiaries above the welfare of 
their business.

                              {time}  1615

  If we commit to paying managed care plans this year, then they will 
want even more next year. If we ask managed care plans to voluntarily 
commit to staying put and providing reliable benefits, they will tell 
us businesses require flexibility, and they do.
  But Medicare beneficiaries require consistency, stability, 
reliability. Private managed care plans cannot put many Medicare 
beneficiaries first. Yet, that is what Medicare must do in order to 
serve the public interest. If private Medicare managed care plans 
cannot serve the public interest, we should not pay them a dime.
  But regardless of my personal views on Plus Choice, the reality is, 
right now, millions of seniors depend on it. Policy makers have an 
obligation to try to make Plus Choice work. If we cannot make the Plus 
Choice program work, then we have an obligation to get rid of it.
  I am offering legislation today to try to make Plus Choice work. 
Under the Plus Choice Reliability Act, private

[[Page H3860]]

health plans would sign a contract to provide continuous service within 
a service area for 3 years. Health plans would agree not to terminate 
this coverage within the service area and would be required not to 
reduce their benefit package during that time period.
  Health plans would receive payments for enrollees equivalent to what 
Medicare would have spent had the enrollees stayed in-fee-for service, 
no more, no less.
  If we pay private health plans what it would cost fee-for-service to 
cover these individuals, and if private plans still cannot cover them 
and provide stable benefits or guarantee continuous coverage, as the 
fee-for-service program does, then it would be fiscally irresponsible 
and a breach of the public interest to permit these plans to stay in 
Medicare. It is as simple as that.
  I hope my colleagues will join me in promoting a Medicare Plus Choice 
option that actually provides continuity and stability, attributes that 
should be a given under our Medicare program.

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