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104th Congress                                             Rept. 104-79
                        HOUSE OF REPRESENTATIVES

 1st Session                                                     Part 2
_______________________________________________________________________


 
                  EXTENSION OF MEDICARE SELECT POLICIES

                                _______


                 April 6, 1995.--Ordered to be printed

_______________________________________________________________________


  Mr. Bliley, from the Committee on Commerce, submitted the following

                              R E P O R T

                             together with

                     SEPARATE AND ADDITIONAL VIEWS

                        [To accompany H.R. 483]

      [Including cost estimate of the Congressional Budget Office]
    The Committee on Commerce, to whom was referred 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 considered the same, report 
favorably thereon with an amendment and recommend that the bill 
as amended do pass.
                                CONTENTS

                                                                   Page

Purpose and summary..............................................     2
Background and need..............................................     2
Hearings.........................................................     4
Committee consideration..........................................     4
Rollcall votes...................................................     4
Committee oversight findings.....................................     6
Committee on Government Reform and Oversight.....................     7
Committee cost estimates.........................................     7
Congressional Budget Office estimates............................     7
Inflationary impact statement....................................     8
Section-by-section analysis and discussion.......................     8
Changes in existing law made by the bill, as reported............     8
Separate and additional views....................................     9

    The amendment is as follows:
    Strike out all after the enacting clause and insert in lieu 
there-of the following:
SECTION 1. EXTENDING MEDICARE SELECT POLICIES TO ALL STATES FOR AN 
                    ADDITIONAL 5-YEAR 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--
          (1) by inserting ``and those other States that elect them to 
        apply'' after ``15 States (as determined by the Secretary of 
        Health and Human Services)'', and
          (2) by striking ''3\1/2\-year'' and inserting ``8\1/2\-
        year''.
                          Purpose and Summary

    The purpose of H.R. 483, as amended, is to extend authority 
for a demonstration program under which insurers can market a 
Medigap product, know as Medicare Select. H.R. 483 extends 
authority for this program for five years and permits Medicare 
Select policies to be marketed and sold in all 50 states.

                  Background and Need for Legislation

                            Medigap Policies

    The majority of beneficiaries age 65 or older have some 
health insurance coverage in addition to Medicare. Such 
coverage can be obtained through current or former employers, 
unions, the Medicaid Program, or through the purchase of 
individual policies, known as Medigap or Medicare supplemental 
policies; about half of the beneficiaries with additional 
coverage purchase Medigap policies.
    Medigap policies are designed to fill in specific gaps in 
the Medicare benefits structure. These policies typically offer 
coverage for Medicare's deductibles and coinsurance and may pay 
for some services not covered by Medicare. Prior to 1980, 
Medigap policies were governed only by State insurance 
regulations and not by Federal law. Congressional concern over 
marketing abuses of Medigap policies led to the enactment of 
voluntary Federal minimum standards developed by the National 
Association of Insurance Commissioners (NAIC) for Medigap 
policies. The Omnibus Budget Reconciliation Act of 1990 (OBRA 
1990) included provisions that established mandatory standards 
for Medigap policies in order to prevent the sale of 
duplicative policies and to provide consumers with 
understandable choices. The implementing regulations for those 
plans limited the number of different types of Medigap plans 
that can be sold in a State to no more than 10 standard benefit 
plans. One of the 10 standard plans (known as Plan A) provides 
a core benefits package which covers Medicare Parts A and B 
coinsurance and blood products. The other nine plans (B through 
J) include the core package plus the Part A deductible and 
additional benefits, such as prescription drugs and preventive 
medical care. Not all 10 plans are available in all states. 
Massachusetts, Minnesota, and Wisconsin have received waivers 
from the requirement that their plans correspond to the 10 
model plans because these States already had acceptable 
programs in place that restricted the number and types of plans 
that could be offered.

               DESCRIPTION OF THE MEDICARE SELECT PROGRAM

    OBRA 1990 established a demonstration project under which 
insurers could market a Medigap product known as Medicare 
Select. These policies closely resemble other Medigap policies; 
however, Medicare select policies only pay in full if the 
covered services are provided by health professionals and 
facilities designated by the insurer. These are commonly known 
as preferred provider networks.
    Select policies do not affect the obligation of Medicare to 
pay its portion of the bill. However, the amount, if any, of 
supplemental benefits paid or co-insurance/deductible paid 
depends on whether the beneficiary uses a preferred provider. 
Beneficiaries who obtain covered services through one of the 
network's preferred providers will generally have their 
benefits paid in full. Under OBRA 1990, the Select plan is also 
required to pay full benefits for emergency and urgent-out-of-
area care provided by non-network providers. In all other 
cases, supplemental benefits and co-insurance/deductible will 
not be paid, or will not be paid in full, if a beneficiary uses 
a non-network provider.
    Select policies do not remove a beneficiary's freedom to 
choose any fee-for-service provider. If a beneficiary is 
unhappy with a Medicare Select provider for any reason, he can 
go to any provider and Medicare will pay if it is a covered 
service; however, the beneficiary is liable for the deductible 
and coinsurance.
    An insurer marketing a select policy is required under OBRA 
1990 to demonstrate the its network of providers offers 
sufficient access to subscribers and that it has an on-going 
quality assurance program. It must also provide full and 
documented disclosure, at the time of enrollment, of: network 
restrictions; provisions for out-of-area and emergency coverage 
and availability; and cost of Medigap policies without the 
network restrictions.
    In addition, Medicare Select policies are governed by the 
same types of regulations imposed on Medigap policies 
concerning: limitations on pre-exiting conditions; loss ratios; 
portability; guaranteed renewal, and open enrollment.
    OBRA 1990 also includes significant penalties for Select 
plans that: restrict the use of medically necessary services; 
charge excessive premiums; expel an enrollee except for non-
payment of premiums; or withhold required explanations or fail 
to obtain required acknowledgements at the time of enrollment.
    OBRA 1990 limited the demonstration project to three years 
and to 15 States. The following are Medicare Select 
demonstration States: Alabama, Arizona, California, Florida, 
Illinois, Indiana, Kentucky, Massachusetts, Minnesota, 
Missouri, North Dakota, Ohio, Texas, Washington, and Wisconsin. 
The program was extended for an additional six months at the 
end of the 103d Congress in P.L. 103-432.
    As of October 1994, approximately 450,000 beneficiaries 
were enrolled in Medicare Select; while the majority are 
covered through Blue Cross/Blue Shield plans, approximately 50 
companies offer Medicare Select products. In August 1994, 
Consumer Reports rated the top Medigap insurers nationwide. 
Eight out of the top rated 15 Medigap plans were Medicare 
Select.
    OBRA 1990 required the Secretary of the Department of 
Health and Human Services (HHS) to conduct an evaluation of the 
Medicare Select demonstration program and to submit the results 
to Congress by January 1, 1995; HHS is not expected to submit 
the report until the end of this year. For this reason, the 
Committee decided not to extend the program on a permanent 
basis as proposed in the introduced version of H.R. 483. 
Instead, while the Committee reported bill extends the program 
to all 50 States, its authority is only extended for a period 
of 5 additional years.
    Current authority for the program expires in June 1995. 
Failure to extend the authority for the program would result in 
the inability of insurers to enroll new beneficiaries in 
Medicare Select programs as of July 1995, although they could 
continue to serve current enrollees. This would lead to higher 
premiums for enrollees and the potential withdrawal of insurers 
from the market.

                                Hearings

    The Subcommittee on Health and Environment held an 
oversight hearing on February 15, 1995 on Medicare Select and 
Medicare Managed Care Issues. Witnesses included the sponsors 
of H.R. 483: Honorable Nancy Johnson and Honorable Earl 
Pomeroy.
    Testimony was also heard from the following individuals: 
Dr. Bruce Vladeck, Administrator, Health Care Financing 
Administration; Honorable William Gradison, President, Health 
Insurance Association of America; Mr. Gordon Sprenger, 
Executive Officer, Allina Health System; Ms. Karen Ignagni, 
President, Group Health Association of America; Ms. Debbie Ahl, 
Executive Vice President, Olympic Health Management Systems, 
Inc.; Mr. David Bradford, Chief Operating Officer, Family 
Health Plan Cooperative; Ms. Mary Nell Lehnhard, Senior Vice 
President, Blue Cross/Blue Shield Association; Keven Cronin, 
National Association of Insurance Commissioners; Ms. Bonnie 
Burns, Senior Health Insurance Specialist, California Health 
Insurance Counseling Association; and Ms. Gail Shearer, 
Director, Health Policy Analysis, Consumer's Union.

                        Committee Consideration

    On March 22, 1995, the Subcommittee on Health and 
Environment met in open markup session and ordered the bill, 
H.R. 483, as amended, reported to the Full Committee by a voice 
vote, a quorum being present.
    Chairman Bilirakis offered an amendment in the nature of a 
substitute, which was approved by voice vote.
    An amendment to the amendment in the nature of a substitute 
was offered by Mr. Waxman but was not approved by the 
Subcommittee. The amendment offered by Mr. Waxman would have 
banned attained age rating for Medicare Select policies. The 
Waxman amendment was defeated by rollcall vote of nine ayes to 
thirteen nays.
    On April 3, 1995, the Full Committee met in open markup 
session and ordered H.R. 483, as amended, reported to the House 
by a voice vote, a quorum being present.

                             Rollcall Votes

    Pursuant to clause 2(l)(2)(B) of rule XI of the Rules of 
the House of Representatives, following are listed the recorded 
votes on the motion to report H.R. 483 and on amendments 
offered to the measure, including the names of those Members 
voting for and against.
      COMMITTEE ON COMMERCE--104TH CONGRESS--ROLLCALL VOTE NO. 38

    Bill: H.R. 483, Extension of Medicare Select Program.
    Amendment: Amendment by Mr. Ganske re: access at time of 
disenrollment.
    Disposition: Not Agreed To, by a rollcall vote of 19 ayes 
to 22 nays.

----------------------------------------------------------------------------------------------------------------
     Representative          Aye       Nay     Present        Representative          Aye       Nay     Present 
----------------------------------------------------------------------------------------------------------------
Mr. Bliley..............  ........        X   .........  Mr. Dingell.............        X   ........  .........
Mr. Moorhead............  ........        X   .........  Mr. Waxman..............        X   ........  .........
Mr. Fields..............  ........  ........  .........  Mr. Markey..............        X   ........  .........
Mr. Oxley...............  ........        X   .........  Mr. Tauzin..............  ........  ........  .........
Mr. Bilirakis...........  ........        X   .........  Mr. Wyden...............        X   ........  .........
Mr. Schaefer............  ........        X   .........  Mr. Hall................        X   ........  .........
Mr. Barton..............  ........        X   .........  Mr. Bryant..............        X   ........  .........
Mr. Hastert.............  ........        X   .........  Mr. Boucher.............  ........        X   .........
Mr. Upton...............  ........        X   .........  Mr. Manton..............        X   ........  .........
Mr. Stearns.............  ........        X   .........  Mr. Towns...............        X   ........  .........
Mr. Paxon...............  ........        X   .........  Mr. Studds..............        X   ........  .........
Mr. Gillmor.............  ........        X   .........  Mr. Pallone.............        X   ........  .........
Mr. Franks..............  ........        X   .........  Mr. Brown...............        X   ........  .........
Mr. Klug................  ........        X   .........  Mrs. Lincoln............  ........  ........  .........
Mr. Greenwood...........  ........        X   .........  Mr. Gordon..............        X   ........  .........
Mr. Crapo...............  ........  ........  .........  Ms. Furse...............        X   ........  .........
Mr. Cox.................  ........        X   .........  Mr. Deutsch.............        X   ........  .........
Mr. Burr................  ........        X   .........  Mr. Rush................  ........  ........  .........
Mr. Bilbray.............  ........        X   .........  Ms. Eshoo...............        X   ........  .........
Mr. Whitfield...........  ........        X   .........  Mr. Klink...............        X   ........  .........
Mr. Ganske..............        X   ........  .........  Mr. Stupak..............        X   ........  .........
Mr. Frisa...............  ........        X   .........  ........................  ........  ........  .........
Mr. Norwood.............  ........        X   .........  ........................  ........  ........  .........
Mr. White...............  ........        X   .........  ........................  ........  ........  .........
Mr. Coburn..............        X   ........  .........  ........................  ........  ........  .........
----------------------------------------------------------------------------------------------------------------

      committee on commerce--104th congress--rollcall vote no. 39

    Bill: H.R. 483, Extension of Medicare Select Program.
    Amendment: Amendment by Mr. Waxman re: limiting attained 
age rating.
    Disposition: Not Agreed To, by a roll callvote of 17 ayes 
to 21 nays.

----------------------------------------------------------------------------------------------------------------
     Representative          Aye       Nay     Present        Representative          Aye       Nay     Present 
----------------------------------------------------------------------------------------------------------------
Mr. Bliley..............  ........        X   .........  Mr. Dingell.............        X   ........  .........
Mr. Moorhead............  ........        X   .........  Mr. Waxman..............        X   ........  .........
Mr. Fields..............  ........  ........  .........  Mr. Markey..............        X   ........  .........
Mr. Oxley...............  ........        X   .........  Mr. Tauzin..............  ........  ........  .........
Mr. Bilirakis...........  ........        X   .........  Mr. Wyden...............        X   ........  .........
Mr. Schaefer............  ........  ........  .........  Mr. Hall................        X   ........  .........
Mr. Barton..............  ........        X   .........  Mr. Bryant..............        X   ........  .........
Mr. Hastert.............  ........        X   .........  Mr. Boucher.............        X   ........  .........
Mr. Upton...............  ........        X   .........  Mr. Manton..............        X   ........  .........
Mr. Stearns.............  ........        X   .........  Mr. Towns...............        X   ........  .........
Mr. Paxon...............  ........        X   .........  Mr. Studds..............  ........  ........  .........
Mr. Gillmor.............  ........        X   .........  Mr. Pallone.............        X   ........  .........
Mr. Klug................  ........        X   .........  Mr. Brown...............        X   ........  .........
Mr. Franks..............  ........        X   .........  Mrs. Lincoln............  ........  ........  .........
Mr. Greenwood...........  ........        X   .........  Mr. Gordon..............        X   ........  .........
Mr. Crapo...............  ........        X   .........  Ms. Furse...............        X   ........  .........
Mr. Cox.................  ........        X   .........  Mr. Deutsch.............        X   ........  .........
Mr. Burr................  ........        X   .........  Mr. Rush................  ........  ........  .........
Mr. Bilbray.............  ........        X   .........  Ms. Eshoo...............        X   ........  .........
Mr. Whitfield...........  ........        X   .........  Mr. Klink...............        X   ........  .........
Mr. Ganske..............  ........  ........  .........  Mr. Stupak..............        X   ........  .........
Mr. Frisa...............  ........        X   .........  ........................  ........  ........  .........
Mr. Norwood.............  ........  ........  .........  ........................  ........  ........  .........
Mr. White...............  ........  ........  .........  ........................  ........  ........  .........
Mr. Coburn..............  ........  ........  .........  ........................  ........  ........  .........
----------------------------------------------------------------------------------------------------------------

      committee on commerce--104th congress--rollcall vote No. 40

    Bill: H.R. 483, Extension of Medicare Select Program.
    Amendment: Amendment by Ms. Furse re: inclusion of diabetes 
outpatient self-management training services.
    Disposition: Not Agreed To, by a rollcall vote of 17 ayes 
to 22 nays.

----------------------------------------------------------------------------------------------------------------
     Representative          Aye       Nay     Present        Representative          Aye       Nay     Present 
----------------------------------------------------------------------------------------------------------------
Mr. Bliley..............  ........        X   .........  Mr. Dingell.............        X   ........  .........
Mr. Moorhead............  ........        X   .........  Mr. Waxman..............        X   ........  .........
Mr. Fields..............  ........  ........  .........  Mr. Markey..............        X   ........  .........
Mr. Oxley...............  ........        X   .........  Mr. Tauzin..............  ........  ........  .........
Mr. Bilirakis...........  ........        X   .........  Mr. Wyden...............        X   ........  .........
Mr. Schaefer............  ........  ........  .........  Mr. Hall................        X   ........  .........
Mr. Barton..............  ........        X   .........  Mr. Byrant..............        X   ........  .........
Mr. Hastert.............  ........        X   .........  Mr. Boucher.............        X   ........  .........
Mr. Upton...............  ........        X   .........  Mr. Manton..............        X   ........  .........
Mr. Stearns.............  ........        X   .........  Mr. Towns...............        X   ........  .........
Mr. Paxon...............  ........        X   .........  Mr. Studds..............  ........  ........  .........
Mr. Gillmor.............  ........        X   .........  Mr. Pallone.............        X   ........  .........
Mr. Klug................  ........        X   .........  Mr. Brown...............        X   ........  .........
Mr. Franks..............  ........        X   .........  Mrs. Lincoln............  ........  ........  .........
Mr. Greenwood...........  ........        X   .........  Mr. Gordon..............        X   ........  .........
Mr. Crapo...............  ........  ........  .........  Mr. Furse...............        X   ........  .........
Mr. Cox.................  ........        X   .........  Mr. Deutsch.............        X   ........  .........
Mr. Burr................  ........        X   .........  Mr. Rush................  ........  ........  .........
Mr. Bilbray.............  ........        X   .........  Ms. Eshoo...............        X   ........  .........
Mr. Whitfield...........  ........        X   .........  Mr. Klink...............        X   ........  .........
Mr. Ganske..............  ........        X   .........  Mr. Stupak..............        X   ........  .........
Mr. Frisa...............  ........        X   .........  ........................  ........  ........  .........
Mr. Norwood.............  ........        X   .........  ........................  ........  ........  .........
Mr. White...............  ........        X   .........  ........................  ........  ........  .........
Mr. Coburn..............  ........        X   .........  ........................  ........  ........  .........
----------------------------------------------------------------------------------------------------------------

           committee on commerce--104th congress--voice votes

    Bill: H.R. 483, Extension of Medicare Select Program.
    Motion: Motion by Mr. Bilirakis to order H.R. 483 reported 
to the House, as amended.
    Disposition: Agreed To, by a voice vote, a quorum being 
present.

                      Committee Oversight Findings

    Pursuant to clause 2(l)(3)(A) of rule XI of the Rules of 
the House of Representatives, that Subcommittee on Health and 
Environment held an oversight hearing and made findings that 
are reflected in this report.

              Committee on Government Reform and Oversight

    Pursuant to clause 2(l)(3)(D) of rule XI of the Rules of 
the House of Representatives, no oversight findings have been 
submitted to the Committee by the Committee on Government 
Reform and Oversight.

                        Committee Cost Estimate

    In compliance with clause 7(a) of rule XIII of the Rules of 
the House of Representatives, the Committee adopts as its own 
the cost estimate prepared by the Directive of the 
Congressional Budget Office pursuant to Section 403 of the 
Congressional Budget Act of 1974.

                  Congressional Budget Office Estimate

    Pursuant to clause 2(l)(3)(C) of rule XI of the Rules of 
the House of Representatives, following is the cost estimate 
provided by the Congressional Budget Office pursuant to section 
403 of the Congressional Budget Act of 1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                     Washington, DC, April 4, 1995.
Hon. Thomas J. Bliley, Jr.,
Chairman, Committee on Commerce,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
reviewed H.R. 483, a bill to permit Medicare Select policies to 
be offered in all states, as ordered reported by the House 
Committee on Commerce on April 3, 1995. CBO estimates that 
enactment of H.R. 483 would not significantly affect the 
federal budget or the budgets of state and local governments. 
Pay-as-you-go procedures would apply because the bill could 
affect direct spending. The estimated change in direct 
spending, however, is not significant.
    Medicare Select policies are Medicare supplemental health 
insurance policies allowed under a demonstration program that 
Congress initiated in section 4358 of the Omnibus Budget 
Reconciliation Act of 1990. The program was limited to 15 
states and was to run for three years beginning on January 1, 
1992. The demonstration was extended for six months in section 
172 of the Social Security Act Amendments of 1994. This bill 
would extend the program for five years and make it available 
to the entire country. This bill is similar to H.R. 483, as 
ordered reported by the House Committee on Ways and Means on 
March 8, 1995; the earlier version, however, would make the 
Medicare Select program permanent.
    Except for Medicare Select policies, issuers of Medicare 
supplemental policies are not allowed to offer benefits that 
differ depending on the provider selected by the beneficiary. 
Under Medicare Select policies, insurers can, in effect, set up 
Medicare Preferred Provider Organizations (PPOs). If PPOs are 
successful in managing care, they can reduce Medicare costs, 
because Medicare pays for most of the cost of the services 
covered under the supplemental policies. The preliminary 
evaluation of the demonstration conducted under contract to the 
Health Care Financing Administration (HCFA), however, has found 
very little management of care by the insurers and no cost 
savings to Medicare. On the other hand, Medicare costs could 
rise if enactment of this bill caused additional Medicare 
beneficiaries to purchase coverage that reduced their 
copayments and thus diminished their economic incentives to 
seek cost-efficient care. The preliminary evaluation of the 
demonstration found that few additional beneficiaries purchase 
Medicare supplemental policies. Because this bill could result 
in either costs or savings, and there is little evidence of 
either, CBO estimates that this bill would have no significant 
effect on the federal budget.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Scott 
Harrison.
            Sincerely,
                                              James L. Blum
                                             (For June E. O'Neill).

                     Inflationary Impact Statement

    Pursuant to clause 2(l)(4) of rule XI of the Rules of the 
House of Representatives, the Committee finds that the bill 
would have no inflationary impact.

             Section-by-Section Analysis of the Legislation

  section 1. extending medicare select policies to all states for an 
                        additional 5-year period

    Section 1 amends the Omnibus Budget Reconciliation Act of 
1990 to permit Medicare Select policies to be sold and marketed 
in all 50 states and extends authority for the program for a 
period of 5 additional years.

         Changes in Existing Law Made by the Bill, as Reported

    In compliance with clause 3 of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italics, existing law in which no change 
is proposed is shown in roman):

     SECTION 4358 OF THE OMNIBUS BUDGET RECONCILIATION ACT OF 1990

SEC. 4358. MEDICARE SELECT POLICIES.

    (a) * * *
          * * * * * * *
    (c) Effective Date.--The amendments made by this section 
shall only apply in 15 States (as determined by the Secretary 
of Health and Human Services) and those other States that elect 
them to apply and only during the [3\1/2\-year] 8\1/2\-year 
period beginning with 1992.
          * * * * * * *
                     SEPARATE AND ADDITIONAL VIEWS

    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.
                ADDITIONAL VIEWS OF HON. ELIZABETH FURSE

    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.