I

104TH CONGRESS

1ST SESSION H. R. 2152

To establish the Independent Commission on Medicare to make recommendations on how to best match the structure of the medicare program

with the funding made available for the program by Congress, to provide

for expedited consideration in Congress of the Commission’s recommendations, and to establish a default process for meeting congressional spending targets for the medicare program if Congress rejects the Commission’s recommendations.

IN THE HOUSE OF REPRESENTATIVES

AUGUST 1, 1995

Mr. ENGLISH of Pennsylvania (for himself, Mr. MCHALE, Mr. CLINGER, Mr.

WELDON of Pennsylvania, and Mr. STEARNS) introduced the following

bill; which was referred to the Committee on Ways and Means, and in

addition to the Committees on Commerce, Rules, and the Budget, for a

period to be subsequently determined by the Speaker, in each case for

consideration of such provisions as fall within the jurisdiction of the committee concerned

A BILL

To establish the Independent Commission on Medicare to

make recommendations on how to best match the structure of the medicare program with the funding made

available for the program by Congress, to provide for

expedited consideration in Congress of the Commission’s

recommendations, and to establish a default process for

meeting congressional spending targets for the medicare

program if Congress rejects the Commission’s recommendations.
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1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Commission to Save

5 Medicare Act of 1995’’.

6 TITLE I—INDEPENDENT

7 COMMISSION ON MEDICARE

8 SEC. 101. ESTABLISHMENT OF COMMISSION.

9 (a) IN GENERAL.—There is established a commission

10 to be known as the Independent Commission on Medicare

11 (in this Act referred to as the ‘‘Commission’’).

12 (b) MEMBERSHIP.—

13 (1) COMPOSITION.—The Commission shall be

14 composed of 7 members appointed by the President,

15 by and with the advice and consent of the Senate.

16 (2) CHAIR.—The President shall designate one

17 of the members to chair the Commission.

18 (3) QUALIFICATIONS.—The membership of the

19 Commission shall consist of individuals with national

20 recognition for expertise in fields related to health

21 care.

22 (c) TERMS.—

23 (1) IN GENERAL.—Except as provided in para24 graphs (2) and (3), each member of the Commission

25 shall be appointed for a term of 9 years.
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1 (2) TERMS OF INITIAL APPOINTMENT.—As des2 ignated by the President at the time of appointment,

3 of the members first appointed—

4 (A) 3 shall be appointed for a term of 3

5 years; and

6 (B) 3 shall be appointed for a term of 6

7 years.

8 (3) VACANCIES.—Any member appointed to fill

9 a vacancy occurring before the expiration of the

10 term for which the member’s predecessor was ap11 pointed shall be appointed only for the remainder of

12 that term. A vacancy in the Commission shall be

13 filled in the manner in which the original appoint14 ment was made.

15 (4) EXCLUSIVE EMPLOYMENT.—During the

16 term of appointment, members shall serve as em17 ployees of the Federal Government and shall hold no

18 other employment.

19 (5) COMPENSATION OF BOARD MEMBERS.—

20 Each member of the Commission (other than the

21 chair) shall receive an annual salary at the annual

22 rate payable from time to time for level IV of the

23 Executive Schedule. The chair of the Commission,

24 during the period of service as chair, shall receive an
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1 annual salary at the annual rate payable from time

2 to time for level III of the Executive Schedule.

3 (6) REMOVAL.—A member of the Commission

4 may be removed by the President only for neglect of

5 duty or malfeasance in office.

6 (d) MEETINGS.—Each meeting of the Commission

7 shall be open to the public, except that the Commission

8 may meet in executive session to address matters relating

9 to personnel and other internal matters of the Commission

10 unrelated to the duties specified in section 102.

11 (e) STAFF.—

12 (1) IN GENERAL.—The Commission shall ap13 point a Director, who shall be paid at a rate the

14 Commission considers appropriate. The Director

15 may appoint and fix the pay of such additional per16 sonnel as the Director (with the approval of the

17 Chair of the Commission) considers appropriate,

18 without regard to provisions of title 5, United States

19 Code, governing appointments in the competitive

20 service.

21 (2) EXPERTS AND CONSULTANTS.—The Com22 mission may procure temporary and intermittent

23 services under section 3109(b) of title 5, United

24 States Code.
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1 (3) STAFF OF FEDERAL AGENCIES.—Upon re2 quest of the Director, the head of any Federal de3 partment or agency may detail, on a reimbursable

4 basis, any of the personnel of that department or

5 agency to the Commission to assist it in carrying out

6 its duties under this Act.

7 (f) POWERS.—

8 (1) HEARINGS AND SESSIONS.—The Commis9 sion may, for the purpose of carrying out its duties

10 under this Act, hold hearings, sit and act at times

11 and places, take testimony, and receive evidence as

12 the Commission considers appropriate. The Commis13 sion may administer oaths or affirmations to wit14 nesses appearing before it.

15 (2) POWERS OF MEMBERS AND AGENTS.—Any

16 member or agent of the Commission may, if author17 ized by the Commission, take any action which the

18 Commission is authorized to take by this section.

19 (3) OBTAINING OFFICIAL DATA.—The Commis20 sion may secure directly from any department or

21 agency of the United States information necessary

22 to enable it to carry out this Act. Upon request of

23 the Chair of the Commission, the head of that de24 partment or agency shall furnish that information to

25 the Commission.
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1 (4) GIFTS, BEQUESTS, AND DEVISES.—The

2 Commission may accept, use, and dispose of gifts,

3 bequests, or devises of services or property, both real

4 and personal, for the purpose of aiding or facilitat5 ing the work of the Commission. Gifts, bequests, or

6 devises of money and proceeds from sales of other

7 property received as gifts, bequests, or devises shall

8 be deposited in the Treasury and shall be available

9 for disbursement upon order of the Chair of the

10 Commission.

11 (5) MAILS.—The Commission may use the

12 United States mails in the same manner and under

13 the same conditions as other departments and agen14 cies of the United States.

15 (6) ADMINISTRATIVE SUPPORT SERVICES.—

16 Upon the request of the Commission, the Adminis17 trator of General Services shall provide to the Com18 mission, on a reimbursable basis, the administrative

19 support services necessary for the Commission to

20 carry out its duties under this Act.

21 SEC. 102. DUTIES OF THE COMMISSION.

22 (a) IN GENERAL.—The Commission shall—

23 (1) transmit to Congress and the President

24 during December of each year (beginning with 1995)
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1 a report on the aspects of the Medicare program

2 specified in subsection (b); and

3 (2) transmit to Congress during July of each

4 year (beginning with 1996) a report containing spe5 cific recommendations on the matters specified in

6 subsection (c).

7 (b) ASPECTS OF MEDICARE.—

8 (1) IN GENERAL.—The report transmitted pur9 suant to subsection (a)(1) during December of a

10 year shall include information on the following:

11 (A) The total outlays made under the med12 icare program for each of the 10 most recently

13 completed fiscal years.

14 (B) Projections of the outlays under such

15 program for the fiscal year beginning on Octo16 ber 1 of the next calendar year and each of the

17 4 succeeding fiscal years, on an aggregate and

18 a per capita basis.

19 (C) Projections of the actuarial value of

20 the package of benefits provided to medicare

21 beneficiaries for each of the fiscal years speci22 fied in subparagraph (B), on an aggregate and

23 a per capita basis.

24 (D) A comparison of each of the projec25 tions made under subparagraph (B) for a fiscal
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1 year with the projections made for the year

2 under subparagraph (C).

3 (E) The health status of medicare bene4 ficiaries, the access of beneficiaries to health

5 services covered under the medicare program,

6 and the utilization of such services by bene7 ficiaries.

8 (F) Methods to improve the methodologies

9 used to determine the payments made under

10 the medicare program to or on behalf of medi11 care beneficiaries (including the use of risk ad12 justment in the determination of the amount of

13 such payments) and methods to encourage effi14 ciency and cost-effectiveness in the delivery of

15 health care services.

16 (G) Such other matters as the Commission

17 determines to be appropriate.

18 (2) ACTUARIAL VALUE DEFINED.—For pur19 poses of projecting the actuarial value of the pack20 age of benefits provided to medicare beneficiaries

21 under paragraph (1)(C), the Commission shall deter22 mine actuarial value by measuring the costs of re23 sources used to provide health care services covered

24 under the medicare program and adjusting such

25 costs to take into account—
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1 (A) inflation in the costs of health care

2 services and all costs generally;

3 (B) demographic changes in the population

4 of beneficiaries, including population growth,

5 age distribution, health status, and access to

6 care;

7 (C) changes in the mix and intensity of

8 services provided to beneficiaries and the sites

9 at which services are furnished;

10 (D) scientific and technological advances;

11 (E) the quality of care provided, including

12 the effect on quality of the overutilization of

13 services and other factors;

14 (F) other factors affecting the demand of

15 beneficiaries for services; and

16 (G) such other factors as the Commission

17 considers appropriate.

18 (c) RECOMMENDATIONS ON CONTROLLING OUT19 LAYS.—The report transmitted to Congress pursuant to

20 subsection (a)(2) during July of a year shall include spe21 cific recommendations on changes in the medicare pro22 gram, including changes in eligibility, benefits (including

23 the mode of delivery of such benefits), cost-sharing, or

24 payments made to or on behalf of beneficiaries, sufficient

25 to ensure that total outlays for the program for the fiscal
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1 year beginning on the following October 1 do not exceed

2 the limit established for that fiscal year under section 201,

3 except that such recommendations may not include

4 changes relating to the payment of payroll taxes for fi5 nancing the program.

6 SEC. 103. EXPEDITED CONGRESSIONAL CONSIDERATION

7 OF RECOMMENDATIONS.

8 (a) IN GENERAL.—The recommendations submitted

9 by the Commission under section 102(c) for a fiscal year

10 shall take effect if a joint resolution (described in sub11 section (b)) approving such recommendations is enacted,

12 in accordance with the provisions of subsection (c), before

13 the first day of the fiscal year.

14 (b) JOINT RESOLUTION OF APPROVAL.—A joint res15 olution described in this paragraph means only a joint res16 olution which is introduced within the 10-day period be17 ginning on the date on which the Commission submits rec18 ommendations under section 102(c) and—

19 (1) which does not have a preamble;

20 (2) the matter after the resolving clause of

21 which is as follows: ‘‘That Congress approves the

22 recommendations of the Independent Commission on

23 Medicare concerning methods to control outlays

24 under the medicare program for fiscal year

25 llll, as submitted by the Commission on
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1 lllllll.’’, the first blank space being filled

2 in with the appropriate fiscal year and the second

3 blank space being filled in with the appropriate date;

4 and

5 (3) the title of which is as follows: ‘‘Joint reso6 lution approving recommendations of the Independ7 ent Commission on Medicare concerning methods to

8 control outlays under the medicare program for fis9 cal year llll, as submitted by the Commission

10 on lllllll.’’, the first blank space being

11 filled in with the appropriate fiscal year and the sec12 ond blank space being filled in with the appropriate

13 date.

14 (c) PROCEDURES FOR CONSIDERATION OF RESOLU15 TION OF APPROVAL.—Subject to subsection (d), the provi16 sions of section 2908 (other than subsection (a)) of the

17 Defense Base Closure and Realignment Act of 1990 shall

18 apply to the consideration of a joint resolution described

19 in subsection (b) in the same manner as such provisions

20 apply to a joint resolution described in section 2908(a)

21 of such Act.

22 (d) SPECIAL RULES.—For purposes of applying sub23 section (c) with respect to such provisions—

24 (1) any reference to the Committee on Armed

25 Services of the House of Representatives shall be
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1 deemed a reference to an appropriate committee of

2 the House of Representatives (specified by the

3 Speaker of the House of Representatives at the time

4 of submission of recommendations under subsection

5 (c)) and any reference to the Committee on Armed

6 Services of the Senate shall be deemed a reference

7 to an appropriate committee of the Senate (specified

8 by the majority leader of the Senate at the time of

9 submission of recommendations by the Commission

10 under section 102(c)); and

11 (2) any reference to the date on which the

12 President transmits a report shall be deemed a ref13 erence to the date on which the Commission submits

14 recommendations under section 102(c).

15 SEC. 104. NO TERMINATION OF COMMISSION.

16 Section 14(a)(2)(B) of the Federal Advisory Commit17 tee Act (5 U.S.C. App.; relating to the termination of advi18 sory committees) shall not apply to the Commission.

19 TITLE II—CONTROLLING OUT20 LAYS UNDER MEDICARE PRO21 GRAM

22 SEC. 201. ESTABLISHMENT OF ANNUAL LIMITS ON OUT23 LAYS.

24 Not later than April 15 of each year (beginning with

25 1996), Congress shall in the concurrent resolution on the
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1 budget for the fiscal year beginning on the following Octo2 ber 1 establish a limit on total outlays to be made under

3 the medicare program for the fiscal year.

4 SEC. 202. ENFORCEMENT OF LIMITS THROUGH SEQUES5 TRATION.

6 (a) IN GENERAL.—Part C of the Balanced Budget

7 and Emergency Deficit Control Act of 1985 (2 U.S.C. 900

8 et seq.) is amended by inserting after section 252 the fol9 lowing new section:

10 ‘‘SEC. 252A. SEQUESTRATION WITH RESPECT TO MEDICARE.

11 ‘‘(a) SEQUESTRATION.—If, with respect to a fiscal

12 year (beginning with fiscal year 1997), Congress has not

13 enacted a joint resolution under section 103(b) of the

14 Commission to Save Medicare Act of 1995 before the first

15 day of the fiscal year, there shall be a sequestration to

16 eliminate any budgetary excess in the medicare program

17 as described in subsection (b).

18 ‘‘(b) ELIMINATING A BUDGETARY EXCESS.—

19 ‘‘(1) IN GENERAL.—Outlays under the medicare

20 program shall be reduced during a fiscal year as

21 provided by paragraph (2), as necessary to eliminate

22 any amount by which estimated outlays under the

23 program in the year exceed the limit for such out24 lays established for the year by Congress pursuant
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1 to section 201 of the Commission to Save Medicare

2 Act of 1995.

3 ‘‘(2) REDUCTIONS DESCRIBED.—In carrying

4 out paragraph (1), the President shall—

5 ‘‘(A) reduce payments made under the

6 medicare program by a uniform percentage suf7 ficient to reduce 50 percent of the amount de8 scribed in paragraph (1); and

9 ‘‘(B) increase premiums, deductibles,

10 copayments, and coinsurance required to be

11 paid under the program by a uniform percent12 age sufficient to reduce 50 percent of the

13 amount described in paragraph (1).

14 ‘‘(c) PART-YEAR APPROPRIATIONS AND OMB ESTI15 MATES.—Paragraphs (4) and (7) of section 251(a) shall

16 apply to sequestration of amounts under this section in

17 the same manner as those paragraphs apply to discre18 tionary appropriations and sequestrations under that sec19 tion.

20 ‘‘(d) COORDINATION WITH OTHER SEQUESTRA21 TION.—

22 ‘‘(1) IN GENERAL.—Reductions under sub23 section (b) for a fiscal year shall supersede any re24 duction otherwise made under section 252 or 253.
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1 ‘‘(2) REPORTS.—On the dates specified in sec2 tion 254(a), OMB and CBO shall issue preview, up3 date, and final reports on medicare sequestration

4 under this section. Such reports shall specify—

5 ‘‘(A) the estimated amount described in

6 subsection (b)(1) for the fiscal year;

7 ‘‘(B) the estimated uniform percentage de8 scribed in subsection (b)(2)(A) of the fiscal

9 year; and

10 ‘‘(C) the estimated uniform percentage de11 scribed in subsection (b)(2)(B) of the fiscal

12 year.

13 ‘‘(3) RULES FOR APPLICATION OF REDUC14 TIONS.—The provisions of section 256(d) shall apply

15 to reductions under this section.’’.

16 (b) CLERICAL AMENDMENT.—The table of contents

17 for part C of the Balanced Budget and Emergency Deficit

18 Control Act of 1985 (2 U.S.C. 900 et seq.) is amended

19 by inserting after the item relating to section 252 the fol20 lowing:

‘‘Sec. 252A. Sequestration with respect to medicare.’’.

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