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104th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES

 1st Session                                                    104-157
_______________________________________________________________________


 
                        MEDICARE SELECT POLICIES

                                _______


                 June 22, 1995.--Ordered to be printed

_______________________________________________________________________


Mr. Bliley  , from the committee on conference, submitted the following

                           CONFERENCE REPORT

                        [To accompany H.R. 483]
      The committee of conference on the disagreeing votes of 
the two Houses on the amendment of the Senate to the bill (H.R. 
483), to amend title XVIII of the Social Security Act to permit 
medicare select policies to be offered in all States, and for 
other purposes, having met, after full and free conference, 
have agreed to recommend and do recommend to their respective 
Houses as follows:
      That the House recede from its disagreement to the 
amendment of the Senate and agree to the same with an amendment 
as follows:
      In lieu of the matter proposed to be inserted by the 
Senate amendment, insert the following:
SECTION 1. PERMITTING MEDICARE SELECT POLICIES TO BE OFFERED IN ALL 
                    STATES FOR AN EXTENDED PERIOD.

      Section 4358(c) of the Omnibus Budget Reconciliation Act 
of 1990, as amended by section 172(a) of the Social Security 
Act Amendments of 1994, is amended to read as follows:
      ``(c) Effective Date.--(1) The amendments made by this 
section shall only apply--
      ``(A) in 15 States (as determined by the Secretary of 
Health and Human Services) and such other States as elect such 
amendments to apply to them, and
      ``(B) subject to paragraph (2), during the 6\1/2\-year 
period beginning with 1992.
For purposes of this paragraph, the term `State' has the 
meaning given such term by section 210(h) of the Social 
Security Act (42 U.S.C. 410(h)).
      ``(2)(A) The Secretary of Health and Human Services shall 
conduct a study that compares the health care costs, quality of 
care, and access to services under medicare select policies 
with that under other medicare supplemental policies. The study 
shall be based on surveys of appropriate age-adjusted sample 
populations. The study shall be completed by June 30, 1997.
      ``(B) Not later than December 31, 1997, the Secretary 
shall determine, based on the results of the study under 
subparagraph (A), if any of the following findings are true:
      ``(i) The amendments made by this section have not 
resulted in savings of premium costs to those enrolled in 
medicare select policies (in comparison to their enrollment in 
medicare supplemental policies that are not medicare select 
policies and that provide comparable coverage).
      ``(ii) There have been significant additional 
expenditures under the medicare program as a result of such 
amendments.
      ``(iii) Access to and quality of care has been 
significantly diminished as a result of such amendments.
      ``(C) The amendments made by this section shall remain in 
effect beyond the 6\1/2\-year period described in paragraph 
(1)(B) unless the Secretary determines that any of the findings 
described in clause (i), (ii), or (iii) of subparagraph (B) are 
true.
      ``(3) The Comptroller General shall conduct a study to 
determine the extent to which individuals who are continuously 
covered under a medicare supplemental policy are subject to 
medical underwriting if they change the policy under which they 
are covered, and to identify options, if necessary, for 
modifying the medicare supplemental insurance market to make 
sure that continuously insured beneficiaries are able to switch 
plans without medical underwriting. By not later than June 30, 
1996, the Comptroller General shall submit to the Congress a 
report on the study. The report shall include a description of 
the potential impact on the cost and availability of medicare 
supplemental policies of each option identified in the 
study.''.
      And the Senate agree to the same.
                                   Tom Bliley,
                                   Michael Bilirakis,
                                   Dennis Hastert,
                                   Bill Archer,
                                   William Thomas,
                                   Nancy L. Johnson,
                                 Managers on the Part of the House.

                                   Bob Packwood,
                                   Bob Dole,
                                   Daniel Patrick Moynihan,
                                Managers on the Part of the Senate.
       JOINT EXPLANATORY STATEMENT OF THE COMMITTEE OF CONFERENCE

      The managers on the part of the House and the Senate at 
the conference on the disagreeing votes of the two Houses on 
the amendment of the Senate to the bill (H.R. 483) to amend 
title XVIII of the Social Security Act to permit Medicare 
select policies to be offered in all States, and for other 
purposes, submit the following joint statement to the House and 
the Senate in explanation of the effect of the action agreed 
upon by the managers and recommended in the accompanying 
conference report:
      The Senate amendment struck all of the House bill after 
the enacting clause and inserted a substitute text.
      The House recedes from its disagreement to the amendment 
of the Senate with an amendment that is a substitute for the 
House bill and the Senate amendment. The differences between 
the House bill, the Senate amendment, and the substitute agreed 
to in conference are noted below, except for clerical 
corrections, conforming changes made necessary by agreements 
reached by the conferees, and minor drafting and clerical 
changes.

          Extend Medicare Select to All States for Three Years

                              present law

      The Omnibus Reconciliation Act of 1990 (P.L. 101-508) 
established a demonstration project called Medicare Select 
under which insurers can market Medicare supplemental policies 
(called ``Medigap'' policies) that are the same as other 
Medigap policies except that supplemental benefits are paid 
only if services are provided through designated providers. The 
demonstration was limited to 15 states and expired December 31, 
1994. The demonstration was extended to June 30, 1995, in the 
Social Security Act Amendments of 1994 (P.L. 103-432).

                               house bill

      Medicare Select authority is extended to all states which 
wish to participate until June 30, 2000. The Secretary of 
Health and Human Services is to conduct a study of Medicare 
Select prior to 1998 to study cost, quality and access for 
Medicare Select compared to other Medigap policies. Medicare 
Select remains in effect unless the Secretary finds that 
Medicare Select has: (1) not resulted in savings of premium 
costs to beneficiaries compared to non-select Medigap policies; 
(2) resulted in significant additional expenditures for the 
Medicare program; or (3) resulted in diminished access and 
quality of care.

                            senate amendment

      Same as the House bill except the extension is until 
December 31, 1996. The Secretary is to complete the study by 
June 30, 1996. The General Accounting Office (GAO) is to 
conduct a study on Medigap insurance and report to Congress by 
June 10, 1996. The report is to include: (1) an analysis of 
whether there are problems in the current Medigap system for 
beneficiaries who wish to switch Medigap policies without 
medical underwriting or pre-existing condition exclusions; (2) 
options for modifying the Medigap market to address any 
problems identified; and (3) an analysis of the impact of each 
option on the cost and availability of Medigap insurance, with 
particular reference to problems with Medicare Select policies.
                          conference agreement

      The conference agreement adopts the Senate amendment with 
the following changes: (1) Medicare Select is extended to all 
States for three years (until June 30, 1998); and (2) the GAO 
study is clarified to require analysis of all types of Medigap 
insurance by removing specific reference to Medicare Select. 
Reference to pre-existing condition exclusions is also removed 
as they are already prohibited under current law for Medigap 
replacement policies.

                                   Tom Bliley,
                                   Michael Bilirakis,
                                   Dennis Hastert,
                                   Bill Archer,
                                   William Thomas,
                                   Nancy L. Johnson,
                                 Managers on the Part of the House.

                                   Bob Packwood,
                                   Bob Dole,
                                   Daniel Patrick Moynihan,
                                Managers on the Part of the Senate.