II 

109TH CONGRESS 

1ST SESSION S. 1589 

To amend title XVIII of the Social Security Act to provide for reductions 

in the medicare part B premium through elimination of certain overpayments to Medicare Advantage organizations. 

IN THE SENATE OF THE UNITED STATES 

JULY 29, 2005 

Mr. BINGAMAN (for himself, Mr. ROCKEFELLER, Mr. FEINGOLD, Mr. 

CORZINE, Mr. KOHL, Ms. MIKULSKI, Mr. DURBIN, and Mr. HARKIN) introduced the following bill; which was read twice and referred to the Committee on Finance 

A BILL 

To amend title XVIII of the Social Security Act to provide 

for reductions in the medicare part B premium through 

elimination of certain overpayments to Medicare Advantage organizations. 

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 ‘‘Affordability in Medi5 care Premiums Act of 2005’’. 
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1 SEC. 2. REDUCTION OF MEDICARE PART B PREMIUM FOR 

2 INDIVIDUALS NOT ENROLLED IN A MEDI3 CARE ADVANTAGE PLAN. 

4 Section 1839(a) of the Social Security Act (42 U.S.C. 

5 1395r(a)) is amended— 

6 (1) in paragraph (3), in the first sentence, by 

7 striking ‘‘The Secretary’’ and inserting ‘‘Subject to 

8 paragraph (5), the Secretary’’; and 

9 (2) by adding at the end the following new 

10 paragraph: 

11 ‘‘(5)(A) For each year (beginning with 2006), the 

12 Secretary shall reduce the monthly premium rate deter13 mined under paragraph (3) for each month in the year 

14 for individuals who are not enrolled in a Medicare Advan15 tage plan (including such individuals subject to an in16 creased premium under subsection (b) or (i)) so that the 

17 aggregate amount of such reductions in the year is equal 

18 to the aggregate amount of reduced expenditures from the 

19 Federal Supplementary Medicare Insurance Trust Fund 

20 that the Secretary estimates would result in the year if 

21 the annual Medicare+Choice capitation rate for the year 

22 was equal to the amount specified under subparagraph 

23 (D) of section 1853(c)(1), and not subparagraph (A), (B), 

24 or (C) of such section. 

25 ‘‘(B) In order to carry out subsections (a)(1) and 

26 (b)(1) of section 1840, the Secretary shall transmit to the 
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1 Commissioner of Social Security and the Railroad Retire2 ment Board by the beginning of each year (beginning with 

3 2006), such information determined appropriate by the 

4 Secretary, in consultation with the Commissioner of Social 

5 Security and the Railroad Retirement Board, regarding 

6 the amount of the monthly premium rate determined 

7 under paragraph (3) for individuals after the application 

8 of subparagraph (A).’’. 

9 SEC. 3. FUNDING REDUCTIONS IN THE MEDICARE PART B 

10 PREMIUM THROUGH REDUCTIONS IN PAY11 MENTS TO MEDICARE ADVANTAGE ORGANI12 ZATIONS. 

13 Section 1839(a) of the Social Security Act (42 U.S.C. 

14 1395r(a)), as amended by section 2, is amended— 

15 (1) in paragraph (3), in the first sentence, by 

16 striking ‘‘paragraph (5)’’ and inserting ‘‘paragraphs 

17 (5) and (6)’’; and 

18 (2) by adding at the end the following new 

19 paragraph: 

20 ‘‘(6) For each year (beginning with 2006), the Sec21 retary shall reduce the monthly premium rate determined 

22 under paragraph (3) for each month in the year for each 

23 individual enrolled under this part (including such an indi24 vidual subject to an increased premium under subsection 
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1 (b) or (i)) so that the aggregate amount of such reductions 

2 in the year is equal to an amount equal to— 

3 ‘‘(A) the aggregate amount of reduced expendi4 tures from the Federal Supplementary Medicare In5 surance Trust Fund in the year that the Secretary 

6 estimates will result from the provisions of, and the 

7 amendments made by, sections 4 and 5 of the Af8 fordability in Medicare Premiums Act of 2005; 

9 minus 

10 ‘‘(B) the aggregate amount of reductions in the 

11 monthly premium rate in the year pursuant to para12 graph (5)(A).’’. 

13 SEC. 4. APPLICATION OF RISK ADJUSTMENT REFLECTING 

14 CHARACTERISTICS FOR THE ENTIRE MEDI15 CARE POPULATION IN PAYMENTS TO MEDI16 CARE ADVANTAGE ORGANIZATIONS. 

17 Effective January 1, 2006, in applying risk adjust18 ment factors to payments to organizations under section 

19 1853 of the Social Security Act (42 U.S.C. 1395w–23), 

20 the Secretary of Health and Human Services shall ensure 

21 that payments to such organizations are adjusted based 

22 on such factors to ensure that the health status of the 

23 enrollee is reflected in such adjusted payments, including 

24 adjusting for the difference between the health status of 

25 the enrollee and individuals enrolled under the original 
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1 medicare fee-for-service program under parts A and B of 

2 title XVIII of such Act. Payments to such organizations 

3 must, in aggregate, reflect such differences. 

4 SEC. 5. ELIMINATION OF MA REGIONAL PLAN STABILIZA5 TION FUND (SLUSH FUND). 

6 (a) IN GENERAL.—Subsection (e) of section 1858 of 

7 the Social Security Act (42 U.S.C. 1395w–27a) is re8 pealed. 

9 (b) CONFORMING AMENDMENT.—Section 1858(f)(1) 

10 of the Social Security Act (42 U.S.C. 1395w–27a(f)(1)) 

11 is amended by striking ‘‘subject to subsection (e),’’. 

12 (c) EFFECTIVE DATE.—The amendments made by 

13 this section shall take effect as if included in the enact14 ment of section 221(c) of the Medicare Prescription Drug, 

15 Improvement, and Modernization Act of 2003 (Public Law 

16 108–173; 117 Stat. 2181). 

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