S6784 CONGRESSIONAL RECORD — SENATE May 17, 1995

the prosecution has now had him plead

guilty.

The third person referred to was

Webb Hubbell. We know that case.

Webb Hubbell has pled guilty. It is a

sad day. He is a good friend. But it

was nothing that related to

Whitewater Development Corp., absolutely nothing that related to Madison

Guaranty, nothing whatsoever. Web

Hubbell pled guilty to overbilling his

clients; nothing to do with the RTC,

nothing to do with Whitewater; totally

irrelevant.

If we continue spreading this dragnet

out further, if we go after every person

that has ever had contact with Bill

Clinton or Hillary Clinton or James

McDougal or whatever, if they have

ever made a phone call to them, if they

have ever borrowed money or given

them a campaign contribution, Lord

only knows how long this investigation

is going to go. It will go beyond the

year 2000.

I just hope that our colleagues on the

Banking Committee will realize that

we must focus this investigation as it

relates to Whitewater and to its original mission.

Mr. President, I thank the distinguished Senator, ranking member, and

the distinguished chairman for yielding me this time.

I yield the floor.

Mr. SARBANES. Mr. President, I am

prepared to yield back time.

Mr. D’AMATO. Mr. President, we

yield back the remainder of our time.

The PRESIDING OFFICER. All time

having been yielded, the question is on

agreeing to the resolution.

On this question, the yeas and nays

have been ordered, and the clerk will

call the roll.

Mr. FORD. I announce that the Senator from Massachusetts [Mr. KENNEDY] is necessarily absent.

The legislative clerk called the roll.

The PRESIDING OFFICER (Mr.

SANTORUM). Are there any other Senators in the Chamber who desire to

vote?

The result was announced—yeas 96,

nays 3, as follows:

[Rollcall Vote No. 171 Leg.]

YEAS—96

Abraham

Akaka

Ashcroft

Baucus

Bennett

Biden

Bond

Boxer

Bradley

Breaux

Brown

Bryan

Bumpers

Burns

Byrd

Campbell

Chafee

Coats

Cochran

Cohen

Conrad

Coverdell

Craig

D’Amato

Daschle

DeWine

Dodd

Dole

Domenici

Dorgan

Exon

Faircloth

Feingold

Feinstein

Ford

Frist

Gorton

Graham

Gramm

Grams

Grassley

Gregg

Harkin

Hatch

Hatfield

Heflin

Helms

Hollings

Hutchison

Inhofe

Inouye

Jeffords

Johnston

Kassebaum

Kempthorne

Kerrey

Kerry

Kohl

Kyl

Lautenberg

Leahy

Levin

Lieberman

Lott

Lugar

Mack

McCain

McConnell

Mikulski

Moseley-Braun

Moynihan

Murkowski

Murray

Nickles

Nunn

Packwood

Pell

Pressler

Pryor

Reid

Robb

Rockefeller

Roth

Santorum

Sarbanes

Shelby

Simpson

Smith

Snowe

Specter

Stevens

Thomas

Thompson

Thurmond

Warner

Wellstone

NAYS—3

Bingaman Glenn Simon

NOT VOTING—1

Kennedy

So the resolution (S. Res. 120) was

agreed to.

Mr. D’AMATO. Mr. President, I move

to reconsider the vote by which the

resolution was agreed to.

Mr. SARBANES. I move to lay that

motion on the table.

The motion to lay on the table was

agreed to.

Mr. THURMOND addressed the Chair.

The PRESIDING OFFICER. The Senator from South Carolina.

Mr. THURMOND. Mr. President, I

ask unanimous consent to speak as in

morning business.

The PRESIDING OFFICER. Without

objection, it is so ordered.

Mr. THURMOND. I thank the Chair.

(The remarks of Mr. THURMOND pertaining to the introduction of S. 812 are

located in today’s RECORD under

‘‘Statements on Introduced Bills and

Joint Resolutions.’’)

Mr. DOLE addressed the Chair.

The PRESIDING OFFICER. The majority leader is recognized.

Mr. DOLE. Mr. President, it has been

our hope that we could work out some

agreement on H.R. 483, the so-called

Medicare Select bill. I know Senator

ROCKEFELLER has some concerns about

it. What we would like to do is bring

the bill up, and if anybody has amendments, they can offer the amendments

and see if we cannot complete action.

It is a program that expires on June 30.

I am not an expert on the program itself. I think Senators PACKWOOD and

CHAFEE will be happy to manage the

bill. I will not do that.

I would like to ask unanimous consent that we turn to the consideration

of H.R. 483, the Medicare Select bill,

but I am not going to make that request yet.

Is the Senator from West Virginia

prepared to object to that?

Mr. ROCKEFELLER. I am afraid I

will have to.

UNANIMOUS-CONSENT REQUEST

Mr. DOLE. Mr. President, I ask unanfimous consent that the Senate turn to

consideration H.R. 483 under the following time agreement: 1 hour on the

bill to be equally divided between the

chairman and ranking member of the

Finance Committee, with one amendment to be offered by Senator ROCKEFELLER relative to Medicare, 1 hour for

debate to be equally divided in the

usual form, and that no motion to

table be in order; further, that following disposition of the Rockefeller

amendment, the bill be advanced to

third reading and that final passage

occur without any intervening action

or debate.

The PRESIDING OFFICER. Is there

objection?

Mr. ROCKEFELLER. I do object.

The PRESIDING OFFICER. Objection is heard.

EXTENDED USE OF MEDICARE SELECTED POLICIES—MOTION TO

fPROCEED

Mr. DOLE. In light of the objection,

I move to proceed to the consideration

of H.R. 483.

The PRESIDING OFFICER. The

question is on the motion to proceed.

Is there debate on the motion?

Mr. ROCKEFELLER addressed the

Chair.

The PRESIDING OFFICER. The Senator from West Virginia.

Mr. ROCKEFELLER. Mr. President,

this is not one of the most broadly understood issues. But it is a very important one, Medicare Select. There are, I

guess, two issues that concern me.

One—and this is less important, but

nevertheless important to me—is the

area of process. I had written Senator

DOLE, the majority leader, a number of

months ago asking for a hearing on the

subject of Medicare Select. I was told

in a letter back from the majority

leader that we would have hearings on

Medicare, obviously, and that Medicare

Select would be a part of those hearings. The Finance Committee has not

had any hearings on Medicare Select

and, therefore, that constitutes a problem.

Second, there is a study on Medicare

Select which is going to be completed

by the end of the summer, and it is not

a frivolous study or a frivolous problem. It is a serious problem involving

seniors and Medicare supplementary

insurance. Currently, 15 States are participating in the 31⁄2-year experimental

Medicare Select Program. This bill

would expand Medicare Select to all 50

States for 5 years.

One of the States that has Medicare

Select is, in fact, the State of Florida.

I cosponsored legislation sponsored by

Senator GRAHAM that would temporarily expand Medicare Select for another year. So this is not just a question of those States that have Medicare

Select wanting to continue to expand

it, or to make it permanent, or whatever. We have genuine concerns.

There are other issues involved. One

of the conclusions of the preliminary

evaluation of this study which I have

been referring to, which will be completed at the end of the summer—and

that is why I hoped we could wait until

that time, this being the first year of a

2-year session—was that about half of

the savings in the form of cheaper

MediGap premiums for beneficiaries

came about as a result of discounting

payments to hospitals.

Now, theoretically, if seniors are

having their care actually managed,

the Medicare Program would realize

savings from the lower use of health

care services.
May 17, 1995 CONGRESSIONAL RECORD — SENATE S6785

If, in fact, the savings are merely the

result of hospital discounting arrangements, the Medicare Program is not

going to benefit at all financially.

Again, that is not an overwhelming

factor, but a very important factor in

view of the overall Medicare cuts we

are looking at this year.

CBO, in fact, scored the expansion of

the Medicare Select Program as budget

neutral, not as saving or costing Medicare, but budget neutral. They said it

does not cost and it does not save the

Medicare Program any dollars at all.

Now, my colleagues and friends on

the other side talk about expanding

choice and restructuring Medicare by

getting more seniors into managed

care in general. Yet Medicare Select,

one of the managed care options already available under the Medicare

Program in at least 15 States, does not

save the Medicare Program money.

So far, therefore, claims from the

other side on the so-called magic of the

marketplace does not seem to be doing

anything to save costs for Medicare.

That is the point I am trying to make.

Many people believe that managed care

is not going to save the amount of

money that some people think it is because the elements of managed care

are not enough. There is the cost of

technology and more people getting

older faster—that number is increasing

very fast.

The Consumers Union testified before

the House Commerce Health Subcommittee that:

Lawmakers should not make permanent a

managed care form of insurance to plug gaps

in Medicare coverage because of very serious

questions about the supplemental’s plan deceptive pricing practices and its effectiveness at holding down health care costs. We

should not make this program permanent

and expand it to other States until we know

that it is really a good deal for the customers.

That is all I am saying. I am simply

requesting that the study which will be

ready by the end of the summer, which

is already in progress, which has already issued a beginning report, be allowed to be completed, that we see if,

in fact, it is good for consumers, before

we take any further steps.

Consumers Union has raised concerns

that because of insurance underwriting

practices, seniors may be locked into

Medicare Select managed care policies

and be unable to purchase another

MediGap policy.

We looked at MediGap 5 years ago, in

1990. We passed legislation on MediGap.

It was very good legislation and it cut

down on abuses and consumer confusion. Seniors, for the most part, do

have Medicare supplemental policies.

Sometimes they use it to help pay part

of their premiums. Sometimes they use

it to get more services that Medicare

does not offer. But it is very, very important.

HCFA, the Health Care Financing

Administration, has voiced a concern

about a lack of quality assurance requirements for Medicare Select managed products.

Medicare HMO’s are required to have

an active quality assurance committee

headed by a physician that gathers and

analyzes data and works for continuous

quality improvement. That is important. There is no comparable requirement for Medicare Select managed care

products.

Medicare HMO’s are required to provide data on such indicators as waiting

times for appointments in urgent care,

telephone access to HMO, both during

and after hours. There is no comparable requirement for Medicare Select managed care products.

Understand, I am not condemning

Medicare Select. Fifteen States are

using it. Some of those States want it

to be made permanent. Some are less

happy about it, but this bill is a major

expansion. Therefore, it is something

that we need to look at closely.

To go from 15 to 50 without the benefit of at least the study Congress ordered so that we could make an orderly

decision about this, just does not seem

to me to make sense. It is for that reason that I am here talking, hoping that

we can do something about it.

If Medicare Select managed care is to

be made permanent as a Medicare option, beneficiaries should be guaranteed the same level of assurance on issues of quality, issues of access, and,

for example, grievance rights, as they

have already in other Medicare managed care options. That seems sensible.

Do the 15 have it? Do all of them have

it? Do none of them have it? We need

to know.

A preliminary analysis of the Medicare Select experiment that was completed last year by the Research Triangle Institute concluded that from

Medicare’s perspective, unless Medicare Select reduces use or directs use

to providers that cost Medicare less

money, it offers little benefit to Medicare.

The preliminary case study also indicates:

Aggressive case management and restriction of networks to the more efficient providers in the communities are rare. Thus, it

appears unlikely that Medicare Select will

result in claims cost savings for HCFA.

Now, Mr. President, I do not think

that these concerns mean that we

should end the Medicare Select Program. I want to be very certain on

that. I think that experimentation—

State experimentation—is tremendously important. I believe in it.

However, I do think that several serious issues have been raised about the

Medicare Select Program, and as a result I have grave reservations about extending this program to all 50 States—

that would be 35 more States—in 5

years.

Instead, to avoid any potential disruption in those States that currently

are participating in the Medicare Select experiment, we ought to extend

their programs so that they do not

have to stop enrolling new people on

June 30, 1995.

Now, that is an important point to

make. We have a drop dead date we are

facing rather quickly. They cannot

take new enrollees unless we extend

the current States that have the programs, which I am very much for

doing, so that we can learn more from

those programs.

I would sincerely hope that before expanding it beyond those States that

now have it, we take a much closer

look at the Medicare Select Program

in the committee of jurisdiction, which

is the Finance Committee.

Then I go back again to the process

question. I asked the majority leader

by letter if he would hold hearings on

this subject. He answered me earlier,

some months ago, that we would hold

general Medicare hearings in the Finance Committee, and Medicare Select

would be part of those hearings.

They have not been part of those

hearings. They have not been even

mentioned in these hearings. That is

important to me because I think that

process and the knowledge that one

gains from that is tremendously important.

I find it somewhat disturbing that

my friends on the other side of the

aisle who want to cut Medicare by $256

billion to balance the budget and pay

for tax cuts, and who talk on a daily

basis about restructuring Medicare,

will not even take the time to consider

a final evaluation of the Medicare Select Program. Congress mandated that

this study be done. This was not somebody’s whim. It was a congressionally

mandated study. The Federal Government has already paid for this study to

be done. But my colleagues are apparently not willing to wait a couple of

months to consider the results of that

congressionally mandated study.

In some ways it seems to me that we

are here more because the Senate is

looking for something to do. I do not

think this is the right way to handle

the problem of the Medicare Select

Program. This came up suddenly and

here we are with it.

I want to make it very clear why I

have objected to the idea of the Senate

simply rubberstamping a bill passed by

the other body. There is absolutely no

reason for us to be using up the time of

the Senate on this at this time. If the

majority leader would simply give the

committee of jurisdiction the chance

to review the legislation and the study

through something as basic as a hearing or a partial hearing or a subcommittee hearing, then we could

work out a course of action based on a

responsible process and careful thought

about the substance which I have

raised, which is very much in question.

The Senate should, I think, not acquiesce to a cavalier way of doing business, and that is what concerns me.

The majority leader wants the Senate to rubberstamp a bill that would

turn a limited demonstration program,

called Medicare Select, into an openended national program. I am very concerned about an attempt to pass legislation affecting the Medicare Program
S6786 CONGRESSIONAL RECORD — SENATE May 17, 1995

without having it carefully considered

by anyone in the Senate.

I ask my colleagues, who are not

present on the floor with the exception

of the distinguished Presiding Officer,

how many of them can really tell me

much about the Medicare Select Program? How many could give me one

short paragraph on what the Medicare

Select Program is? I would daresay it

is probably six people; probably six

people. And here we are at a moment

when there is not much else to do,

awaiting the budget resolution, but

with some time to kill, and we are

about to expand into a national program something which is being experimented with locally, by the States.

If anything is clear these days, the

Senate should know what it is doing

when it changes Medicare. We are

about to enter into a major debate on

Medicare as it concerns the budget resolution. So anything that has the word

Medicare in it, we ought to be precise,

knowledgeable, and informed rather

than having an hour’s discussion and

then a vote of some sort, affecting profoundly what happens in this country.

Medicare affects 33 million people—36

million to 37 million people when you

add on end-stage renal disease and the

disabled, as well as those over 65. It has

enormous consequences. It has enormous consequences.

As we learned during the MediGap

debates, it is very hard, often, for seniors to resist buying policies which are

constantly offered to them. That was

what the MediGap legislation was

about. It was to discipline this proliferation of policies to ensure folks

could not prey on seniors who could

not necessarily understand all the

small print, or even read the small

print in the policy. So this is about

protecting seniors; about not misleading seniors; about making sure that

seniors get the quality assurances that

are verbally offered to them by those

who would sell Medicare Select.

It just seems to me that if we are

about to talk about a $256 billion cut in

Medicare, we really ought to know

what we are talking about when we do

anything about Medicare, much less

add on a new program, whether it costs

or not.

Just yesterday Dr. June O’Neal, who

is the new head of CBO, the

Congression Budget Office, and whom I

had not seen before, testified before the

Finance Committee that quality—hear

this, ‘‘The quality will suffer under the

Medicare Program if we enact Medicare cuts of $256 billion.’’

She said that seniors will have to pay

more to get the same level of quality

that they are currently receiving under

Medicare. And I think this is a very serious consequence. In fact, by the year

2002, I think they will be paying $900

more per year and I think on an aggregate basis they will be paying close to

$3,500 more between now and the year

2002. When you consider the fact that

only a very tiny proportion of Medicare

recipients have incomes of higher than

$50,000 a year and that the enormous

majority of them are way down at

$15,000 or $10,000 or below, in that area,

something like that becomes an enormous consideration. An additional

$3,500? They already spend over 20 percent of their income on health care.

In fact, we had an interesting

minidebate yesterday on whether or

not the cuts in Medicare will in fact

cut Social Security for seniors. Of

course, if that were to be the case, that

would be a kind of third-rail item on

the American scene because cutting

into Social Security is something we

have all decided not to do. We came up

with the judgment, not so much during

the hearing but after the hearing, that

because of the increases in premiums,

et cetera, in copayments, seniors will

have to pay for more costs for Medicare, that in effect their COLA increases under Social Security in many

cases will be wiped out entirely.

Will seniors see that as a cut in Social Security? I think it is quite possible they will. Because it is interesting—I would not have guessed this, I

say to the Presiding Officer—that Social Security and Medicare are looked

upon, in many ways, as the same by

the people of this country and by the

seniors of this country. That whereas

we said before ‘‘Do not cut Social Security,’’ people look upon Medicare as the

same sort of a sacred contract, so to

speak, that the American Government

and the American people have with

each other, and not another incidental

program.

So I think this is a very serious problem. The Health Care Finance Administration, HCFA, has voiced a concern

about lack of Medicare Select quality

assurance requirements. HCFA is not a

radical organization. It is a big organization, 4,000 people, who in fact are

very expert. Nobody knows they exist

but they do, and they do all kinds of

complicated work. They are expressing

concern about Medicare Select quality

assurance requirements, that they do

not exist in this legislation and they do

exist for other managed care options.

As I said, Medicare HMO’s are required

by law to have active quality assurance

committees.

So I think there is lot at question

here, and I just hope we could work

this out. I had suggested a variety of

alternatives, options; that we could

take the States that now have Medicare and extend those for a year and a

half or 2 years. Some people say if you

extend it for a year, that does not really give the managed care company that

is interested in looking at Medicare

much incentive to move ahead. It

sounds like a year-by-year basis.

Maybe we could do it for longer than

that. Maybe we could add on some

more States, add on four or five more

States and allow that to happen.

But to take the entire country and

open it up to Medicare Select when a

study which has already raised questions is still out there and questions

have been raised by health care experts

in HCFA about insurance problems,

plus the fact that it is Medicare, which

is probably the most sensitive subject

that could be discussed on the floor of

this Chamber, we ought to be careful.

That is why I am not for going ahead

at the present time with expanding

this the way the majority leader seems

to want to do.

I will have more comments. But I do

not see anybody at this point who

wishes to say anything. So I yield the

floor and note the absence of a quorum.

The PRESIDING OFFICER. The

clerk will call the roll.

The assistant legislative clerk proceeded to call the roll.

Mr. ROCKEFELLER. Mr. President, I

ask unanimous consent that the order

for the quorum call be rescinded.

The PRESIDING OFFICER. Without

objection, it is so ordered.

Mr. ROCKEFELLER. Mr. President, I

note the presence of the distinguished

Senator from Rhode Island on the

floor. I know he wants to speak. I will

not take long. I talked a moment ago

about the concerns of the consumer

groups and the Medicare Select Program. One of their concerns is called

attained age rating. Just as insurance

companies charge older people more for

insurance in the under 65 market,

MediGap insurers charge older seniors

more for their MediGap policies as they

grow older. In the under 65 market, insurers claim that age rating is a sound

business practice because older people

use more health care services and because older people are better off financially than those who are 20 years old

or younger. This argument does not

work at all for those who are over 65

years old. In that important market,

85-year-olds are generally, as I hope we

all know, a lot poorer than 65-yearolds.

Another question that has been

raised is the so-called one time open

enrollment period. When we worked in

the Finance Committee—I know the

Senator from Rhode Island worked

very hard on that also—on the

MediGap legislation in 1990, we required insurers to have a one-time, 6-

month open enrollment period when

seniors first turned 65 so that they

would have 6 months to simply enroll.

During this 6-month period, an insurer

under the MediGap Program is not allowed to deny insurance to any senior

based upon their health status. That is

an enormous statement in the health

insurance industry. It is an enormous

statement. They are not allowed during those first 6 months to make any

health status judgments and thus say

no to people. Consumer groups have

raised a concern that if seniors sign up

with a Medicare Select managed care

product and decide that they do not

like that product, they may be unable

to buy a MediGap policy later because

the open enrollment period would have

gone by, especially, of course, if their

health status is poor.

I want to just add those things.

I yield the floor.
May 17, 1995 CONGRESSIONAL RECORD — SENATE S6787

Mr. CHAFEE addressed the Chair.

The PRESIDING OFFICER. The Senator from Rhode Island.

PRIVILEGE OF THE FLOOR

Mr. CHAFEE. Mr. President, I know

the distinguished Senator from North

Carolina is waiting to give a brief

statement, and then I would like to

speak. Let me discuss it with the Senator from Oregon.

But meanwhile, I ask unanimous consent that privileges of the floor be

granted to a member of my staff, Douglas Guerdat during today.

The PRESIDING OFFICER. Without

objection, it is so ordered.

Mr. CHAFEE. Thank you.

Mr. HELMS addressed the Chair.

The PRESIDING OFFICER. The Senator from North Carolina.

Mr. HELMS. I thank the Chair.

(The remarks of Mr. HELMS pertaining to the submission of S. Con. Res. 14

are located in today’s RECORD under

Submission of Concurrent and Senate

Resolutions.)

Mr. PACKWOOD addressed the Chair.

The PRESIDING OFFICER. The Senator from Oregon.

Mr. PACKWOOD. Mr. President, let

me make a few comments on the socalled Medicare Select policies and explain first what they are.

Medicare does not cover all medical

expenses. So a popular policy that is

sold in this country is called MediGap.

You can buy it. It is voluntary. You do

not have to buy it. You can buy it. It

basically fills in the holes that Medicare does not cover. There are different

kinds of MediGap policies. You can get

some that are more expansive and with

more coverage than others and they

cost a bit more. But I emphasize they

are voluntary.

Medicare Select is a particular form

of MediGap policy. It is one of the most

popular policies that are around. It is

about 40 percent less expensive than

other policies. It exists now in 15

States. You have to have Federal permission to sell it. The authority to

issue these policies expires on June 30

of this year.

The House has passed a bill—let me

check my figures—I think 408 to 14, to

extend Medicare Select to the rest of

the Nation. This is hardly a partisan

issue with that kind of a vote. And if

we, frankly, get a vote on it in the Senate, it is going to pass probably 80–20 or

90–10, unless I am mistaken. So do not

let anybody be of the impression this a

Republican-Democrat issue. This has

overwhelming support.

The National Association of Insurance Commissioners is one group that

supports it, and they monitor complaints about insurance policies

throughout the Nation. There are

about 500,000 people enrolled in just

these 15 States in Medicare Select, and

of those 500,000 policies, in 1994, all of

the insurance commissioners in those

15 States had 9 complaints—9—in comparison with 967 complaints against

other types of MediGap policies,

nonselect MediGap policies.

We passed this in the Senate 5 years

ago. We were awaiting a report. The report was due in January. It is not going

to be out until next January now. It is

late. It is not going to come.

And again, Medicare Select has overwhelming support. I am going to read

just a list of the groups that support

expanding this to the 50 States: The

American Group Practice Association,

the American Hospital Association, the

American Managed Care and Review

Association, the Association of Public

Pension and Welfare Plans, Blue Cross

and Blue Shield Association, California

Association of Hospitals and Health

Systems, the Federation of American

Health Systems, the Group Health Association of America, the Health Insurance Association of America, the Medical Group Management Association,

the National Association of Insurance

Commissioners, the National Conference of State Legislatures, and the

National Governors’ Association.

Now, Mr. President, you are not

going to get a much better group than

that in terms of breadth and philosophical support. Our problem is that

this apparently is going to face an objection to coming up and apparently a

filibuster. I have no question but what

the filibuster is going to be broken and

going to be broken overwhelmingly. We

will get the 60 votes. But one of the

problems the leader faces, of course, is

that once we are on to a bill and once

cloture has been invoked, you cannot

go to anything else. You can pull it

down. And he would like to get onto

the budget bill.

I say again, this is the middle of

May. The authority for these programs

runs out next month. This Congress

goes on recess in about 10 days. And so

unless we act now, these people who

like these policies, to which there is almost no complaint, will be faced with

rising premiums because they cannot

be sold to anyone else.

So I hope that the leader will be successful in bringing this bill up, that we

would have a short debate. I will be

happy to agree to a time limit on

amendments or a time limit on the bill

and get to final passage. I will emphasize again it passed 408 to 14 in the

House of Representatives.

I thank the Chair.

Mr. CHAFEE addressed the Chair.

The PRESIDING OFFICER (Mr.

GREGG). The Senator from Rhode Island.

Mr. CHAFEE. Mr. President, I see the

distinguished Senator from West Virginia in the Chamber. I would be glad

to pose him some questions if he is

available to respond.

As the chairman of our committee

just pointed out, we are talking about

Medicare Select. But what is Medicare

Select, anyway?

Medicare Select is the name of a type

of MediGap policy. It is something that

seniors can buy to cover their Medicare

deductibles and copayments.

Medicare Select is a type of MediGap

policy that permits managed care; that

is, a managed care MediGap policy.

That is what it is.

What was the problem in getting this

plan started and why the restrictions?

Why could not the insurance companies offer Medicare Select if they wanted to? Because when MediGap legislation was originally passed in the House

of Representatives, there were some

objections to Medicare Select. A Representative from California did not believe in managed care. Consequently

seniors were not able to have these

plans.

Well, finally, after patiently working

at this several years ago in late

evening sessions, we arranged that

there would be 15 States that could try

this and see how it worked out. And so

15 States have done it, and as the

chairman of our committee pointed

out, it has worked very well. The trouble is that the option of these 15 States

to offer this policy ends June 30; which

is what—a month and a half from now.

As the chairman pointed out, there is

now a danger that we cannot extend

Medicare Select because of having to

deal with the budget, and so forth, and

then all these people who have these

MediGap policies—and, indeed, it is a

MediGap policy—will not be able to

buy it or renew it.

Indeed, there is question about enrollments right now: Should a senior

enroll in a MediGap policy that has

this managed care plan or should I not?

What happens if the plan is going to

disappear?

Our point is not only should we extend Medicare Select but should we

also make it permanent.

But what about the rest of the

States? Why should not seniors in

other States have this option? In my

State, for example, why should not my

citizens have the option of buying a

MediGap policy that is $25 to $27 less

per month, depending on the situation,

than they are paying for other

MediGap policies?

Mr. ROCKEFELLER. Will the Senator yield?

Mr. CHAFEE. Let me just finish. The

Senator is objecting to that. What I

find puzzling is the Senator, a distinguished member of the Finance Committee, has twice voted in the Senate

Finance Committee and twice on the

floor to pass a permanent 50-State extension of legislation that is before us.

What has changed?

Mr. ROCKEFELLER. What has

changed, I say to the distinguished

Senator from Rhode Island, is that I

had correspondence with the majority

leader of the Senate, a letter that I ask

unanimous consent to have printed in

the RECORD, and also the majority

leader’s response to this Senator.

There being no objection, the letters

were ordered to be printed in the

RECORD, as follows:
S6788 CONGRESSIONAL RECORD — SENATE May 17, 1995

U.S. SENATE,

Washington, DC. March 21, 1995.

Hon. ROBERT DOLE,

U.S. Senate,

Washington, DC.

DEAR SENATOR DOLE: As ranking member

of the Finance Subcommittee on Medicare,

Long-Term Care, and Health Insurance that

you chair, I would like to propose a hearing

on the Medicare SELECT program for oversight and an education on its results so far.

As you know, Congress approved a 3-year,

15-state Medicare SELECT demonstration

project as part of the Omnibus Reconciliation Act of 1990. Medicare SELECT offers

seniors less expensive Medigap premiums in

exchange for receiving their health care

services from a selected network of health

care providers. Under current law, Medicare

SELECT’s authorization—which was extended temporarily last October—is due to

expire on June 30, 1995, unless Congress takes

further action.

Personally, I would support extending this

program for another six months to maintain

program continuity, with a strong interest

in avoiding the program’s disruption while

allowing Finance Committee members an opportunity to fully examine the knowledge

available so far on the SELECT demonstration. A temporary extension would give the

Subcommittee an opportunity to have a full

hearing on the Medicare SELECT program

that would include results of a formal evaluation of the demonstration project.

It is my understanding that preliminary

results of an evaluation study that is being

performed by Research Triangle Institute

will be ready by the end of the summer. Information that will be available includes

data gathered from insurer and beneficiary

surveys, as well as claims analyses that will

examine the impact of SELECT enrollment

on the use and costs of Medicare services.

Therefore, I believe it would not be appropriate or prudent to extend this program on

a permanent basis to all 50 states until Finance Committee members have the most

up-to-date information on which to base future legislative action.

Thank you in advance for your attention

to this matter, and I hope to work with you

on this issue. Mary Ella Payne is the contact

on my staff.

Sincerely,

JOHN D. ROCKEFELLER IV.

U.S. SENATE,

OFFICE OF THE MAJORITY LEADER,

Washington, DC. April 3, 1995.

Hon. JOHN D. ROCKEFELLER IV,

U.S. Senate,

Washington, DC.

DEAR JAY: Thank you for your letter regarding the Medicare Select Program. I

agree with you that this issue deserves careful consideration, particularly if Congress

intends to extend the program permanently.

I know that the Chairman plans to hold extensive hearings at the full committee level

on the Medicare program—it’s costs, it’s benefits, and what changes need to be made to

improve it. I have been assured by the Chairman that through this process we will take a

close look at Medicare Select, as we will all

parts of the Medicare program.

The Committee will obviously have its

work cut out for it this year. I look forward

to working with you as we debate some very

important and complex issues.

Sincerely,

BOB DOLE.

Mr. ROCKEFELLER. I wrote the majority leader on March 21, and I said

this problem is going to be coming up.

We know there is a deadline. I am fully

aware of that. He wrote back on April

3, and he told me, ‘‘I agree with you

that this issue deserves careful consideration, particularly if Congress intends to extend the program permanently. I know that the chairman,’’

that being Senator PACKWOOD, ‘‘plans

to hold extensive hearings at the full

committee level on the Medicare Program.’’ And, ‘‘We will take a close look

at Medicare Select, as we will all parts

of the Medicare Program.’’

What I would say to my friend from

Rhode Island is that we have not done

that. In the meantime, Congress mandated a study to be done, and the study

is in the process of being done. The

study has also already raised several

questions. Other groups raised other

questions about quality, about being

able to buy other medigap policies. So

there are a number of questions that

needed to be answered. I wished to do

all of this somewhat earlier, and I was

given the promise that we would do

this somewhat earlier. It is just that

the promise was not fulfilled.

I should say also that a number of

questions have been raised which have

somewhat changed the atmosphere in

the last several months. Before the

Senator came to the floor, I talked

about questions which had been raised

by a number of groups—pricing games,

medigap availability, illusory costs,

and things of that sort. The Senator

from West Virginia wants to be sure.

Mr. CHAFEE. Well, the Senator from

West Virginia may wish to be assured,

but I do not know how far we have to

go. The National Association of Insurance Commissioners supports the extension of this program. We just had

the list of those who were supporting

Medicare Select read by the chairman

of our committee. You can go on and

on and find reasons not to do something.

But we are really in a very, very difficult situation here. This program expires in 30 days from now or 45 days

from now. It seems to me we ought to

get on and extend it, and not only extend it but let the other States in on it.

Some mention was made about the

Consumers Union’s concerns about

Medicare Select. But the fact of the

matter is the Consumers Union’s problems that were raised apply to all

medigap policies, not focused in on

Medicare Select.

Mr. ROCKEFELLER. Will the Senator yield?

Mr. CHAFEE. Yes.

Mr. ROCKEFELLER. Mr. President,

obviously, we need to work this out.

The time problem is not, in fact, a constraint on those States which currently have Medicare Select because I

already said I would be perfectly happy

to go ahead and extend them.

The question is: How can we, looking

at some of these complaints about not

being able to change MediGap policies,

discrimination of various sorts, how

can we arrive at some kind of compromise which gives consumer protection for these Medicare beneficiaries

that would choose Medicare Select?

How can we give them some kind of

consumer protection over and above

what is contemplated in the law that

the Senator from Rhode Island wants

to get passed right away?

Would the Senator be willing to discuss those matters, if not publicly, privately?

Mr. CHAFEE. Mr. President, the Senator says we have to wrestle with these

problems. Who says there is a problem?

Let me just touch on one matter that

the Senator raised, and that is the socalled attained-age rating, with a suggestion that Medicare Select, this type

of managed care policy, MediGap policy, has this attained-age rating.

Well, the fact is that the attainedage rating is permitted under current

MediGap law. It is not restricted. The

attained age is not something peculiar

to Medicare Select. That is permitted

under the current MediGap law.

And so while it is true that most

medigap policies and most Medicare

Select policies do not use the attainedage method, I do not see why you focus

in and say that is something peculiar

to MediGap or Medicare Select, because it is not.

Mr. ROCKEFELLER. The Senator

from West Virginia did not say it was

peculiar, but I said it was a problem as

far as the Medicare extension is concerned. Whether it applies to more

medigap policies is not, at the moment, of concern to me. I want to make

sure that, in Medicare Select, we can.

HCFA has concerns about quality

and concerns about access. They are

not a frivolous organization.

I just think we have a chance to try

to find an accommodation, hopefully in

a quorum call, in which we could address some of the consumer concerns

and perhaps also accommodate the

Senator from Rhode Island, the majority leader, and the Senator from Oregon in the process, since I am, obviously, very well aware of where the

votes are in the situation. I just want

to do the best I can to build in

consumer protection for a program

which is young, which is actually only

in 14 States, and is not at all in all 50

States.

Mr. CHAFEE. Mr. President, I do not

concede that there are all these problems or that there are these problems.

It seems to me what the Senator from

West Virginia is doing is applying a

higher standard to the Medicare Select,

these managed care MediGap policies,

than he is to the regular MediGap policies. I do not think that is fair. I do not

think it is fair to say, ‘‘No, in Medicare

Select, you cannot have attained age,’’

whereas it is permitted in the other

MediGap policies.

The suggestion here is that we ought

to have hearings on this. Well, I cannot

speak for what the majority leader

said, but all I do know is that the Senate has passed a permanent extension

of this proposal twice in the past 4

years. It was included in every major

health reform proposal last year, including Senator Mitchell’s, Senator
May 17, 1995 CONGRESSIONAL RECORD — SENATE S6789

DOLE’s and Senator PACKWOOD’s bill,

and in the mainstream coalition bill.

All of them had Medicare Select in

them. So it is not that we are coming

up against some unknown item here

that we better be terribly cautious of.

As I say, it has been out in these

States. In 15 States, it is authorized. I

cannot challenge the Senator’s information when he says it is actually in

practice, I believe he said, in 14 States.

All I know is that I think it is a good

option that is less expensive and that

we ought to give all the citizens a

chance at it. And the citizens from my

State would like a chance at this. If

they do not want to use it, that is their

business. But if they have a right to

choose a MediGap policy that is less

expensive than the current ones, I

think they ought to have it and not be

prevented from doing so because this

Congress refuses to extend Medicare

Select to all the States.

Again, no one is more thoughtful and

compassionate in this Senate than the

Senator from West Virginia, so I am

not sure why he takes this particular

position. Because, as we mentioned before, this passed in the House 408 to 14.

You could hardly get a motherhood

resolution passed by that amount.

Mr. ROCKEFELLER. If the Senator

will yield, I think one could practically

rewrite the Constitution in the House

of Representatives by that vote in the

current climate.

If the Senator would further yield, he

talked about standards being higher for

Medicare Select than for other

medigap things. I think high standards

are important and I know the Senator

from Rhode Island does, too. I want to

see the Senator from Rhode Island and

his State be able to have this program

if that is what the State and the Senator wants.

I think the time crisis that the Senator refers to can be handled in 60 seconds. That can be changed in 60 seconds.

My point is that for 2 months I have

suggested extending the program to

the 14 States with the program already

in effect. What I am really suggesting

now is that we first look at the evaluation of the program before we open the

door to all the other States. What I am

really suggesting is that, if we could

perhaps suggest the absence of a

quorum, we could work something out

on this.

Mr. CHAFEE. Mr. President, our

staff asked the Health Care Financing

Administration [HCFA] for suggested

changes. Any problems? What do you

think we ought to do? They did not

have any. They had no suggestions for

us.

Maybe the Senator from West Virginia can find, what we cannot find,

any documented quality problem with

this program. Now, some beneficiary

somewhere may object, I am sure they

have, just like they have objected to a

host of other medigap policies.

But, as I say, this has received a favorable report by the Consumers Union

and by Consumers Report magazine

and by the State insurance commissioners.

So, I do not have anything particular

to offer. I would be glad to talk with

the Senator from West Virginia. Whatever ideas we have, we would have to

transmit them. Obviously, I would

have to speak to the chairman of the

Finance Committee, whom I do not see

on the floor here.

Mr. ROCKEFELLER addressed the

Chair.

The PRESIDING OFFICER. The Senator from West Virginia.

Mr. ROCKEFELLER. The Senator

from Rhode Island made mention of no

particular problems being raised by

HCFA. I think that raises, therefore,

this very important point. Because, in

fact, Donna Shalala has written to the

Honorable BILL ARCHER, chairman of

the Committee on Ways and Means, on

March 7 of this year.

And one paragraph says:

The case study portion of the Medicare Select evaluation has already raised a number

of questions about the Medicare Select demonstration.

That is from HCFA.

As managed care options under Medicare

are expanded, we want to ensure that our

beneficiaries are guaranteed choice and appropriate consumer protections.

That is precisely what the Senator

from West Virginia was asking for.

Donna Shalala goes on:

In addition, many of the select plans consist solely of discounting arrangements to

hospitals.

The Senator from West Virginia mentioned that at the beginning.

Donna Shalala goes on:

We would be concerned if the discounting

arrangements under Medicare Select were to

be expanded to Medicare supplementary insurance part B services. Discounting arrangements, particularly for part B services,

may spur providers to compensate for lost

revenues through increased service volume.

Consequently, we are concerned that such an

expansion would lead to increased utilization

of part B services rather than contribute to

the efficiency of the part B program through

managed care.

Then she says:

We would, therefore, oppose such a change.

There is honest and open debate on

this matter. I am still willing to talk

with the Senator from Rhode Island. I

think we can work something out.

Again, I, unfortunately, can count the

votes, but the Senator would like to

have some consumer protection in this,

and I think the Secretary of HHS

would, too. I think, frankly, George

Mitchell, in his bill, had open enrollment and major insurance reforms, and

the Senator from Rhode Island knows

that well.

The Mitchell bill, in fact, did not propose to make Medicare Select permanent in the absence of coordinated open

enrollment.

So I think there is room to work

something out here, Mr. President, because I think everybody is talking with

good will on both sides on this matter.

Mr. CHAFEE addressed the Chair.

The PRESIDING OFFICER. The Senator from Rhode Island.

Mr. CHAFEE. Mr. President, the

problem here is—I know the Senator is

concerned about this—but the points

he raises affect not Medicare Select

but affect the whole MediGap range. In

other words, when he says he is interested in open enrollment, there is no

open enrollment now in the MediGap

policies. He is saying he wants it for

Medicare Select. But that means you

want it presumably for all of MediGap.

Now, that is a very big separate issue

that can come up any time. You do not

have to tag it on to a Medicare Select

policy which, as I say, is just one of a

whole series of medigap policies.

If the Senator wants to do that, that

is changing the rules for the whole series of policies that are issued under

medigap.

Mr. ROCKEFELLER. Will the Senator yield?

Mr. CHAFEE. I will make one other

point, if I might, and that is, as you recall, when I said my staff spoke to the

Health Care Financing Administration,

what I said was they asked for suggested changes and none came back. In

the letter the Senator quoted from Secretary Shalala, he mentioned somewhere in there concerns about expansion into the part B plan. We do not do

that. There is no expansion into that in

this Medicare Select.

So I will be glad to talk with the

Senator. If he would like, we can suggest the absence of a quorum and have

a little chat here.

Mr. ROCKEFELLER. The Senator

from West Virginia would like to do

that, but if I might add one more

thing, that is, the Senator is right

about part B, and the Senator from

West Virginia just got carried away

and read too much of a paragraph,

which was a mistake on the part of the

Senator from West Virginia.

Donna Shalala, on the other hand, is

referring to the Medicare Select evaluation. She is referring to the Medicare

Select evaluation in this letter which

she wrote back on March 7, which

should have been available to all of us.

Bruce Vladeck, in his testimony on

February 15 in front of the House Committee on Energy and Commerce,

raised a major concern with the adequacy of beneficiary protections under

Medicare Select.

If that is not HCFA speaking, I do

not know what is. Bruce Vladeck said:

There is no requirement for States to review the actual operations of the Select

plans once they are approved to assure that

quality and access standards are being met.

He does not like that. He is worried

about that, and he says:

We feel strongly that beneficiaries should

not have to worry about the quality and access provisions on their Medicare choices.

We look forward to working with the subcommittee * * *

And then Bruce Vladeck, the head of

HCFA, said:
S6790 CONGRESSIONAL RECORD — SENATE May 17, 1995

Our second concern is whether Medicare

Select will make any contribution to increasing the efficiency of the Medicare program.

I think that goes off into another

area. It is the consumer protection

area, I say to my friend from Rhode Island, which concerns me the most.

I might suggest the absence of a

quorum in order for some conversation

to go on.

I suggest the absence of a quorum.

The PRESIDING OFFICER. The

clerk will call the roll.

The legislative clerk proceeded to

call the roll.

Mr. KENNEDY. Mr. President, I ask

unanimous consent that the order for

the quorum call be rescinded.

The PRESIDING OFFICER. Without

objection, it is so ordered.

Mr. KENNEDY. Mr. President, the

Medicare Select is a demonstration

program. Evaluation will not be completed until December 1995. While the

demonstration program technically expires on June 30, the regulations governing the program clearly state that

insurers must continue their coverage

of current enrollees, even if no extension is approved.

There is no overwhelming urgency to

pass this legislation. I do favor a temporary extension, and I am prepared to

support such an extension today. But I

have a number of concerns about permanent extension of the Medicare Select Program.

First, extension of Medicare Select

should be considered in the context of

a whole range of managed care options

we might wish to make available to

Medicare beneficiaries. There is a great

deal of interest on both sides of the

aisle in expanding choice. The administration is working on development of a

PPO option. Before we make the Medicare Select Program permanent, we

should understand its impact and balance it against other options.

Second, Medicare Select raises significant concerns about beneficiary

protections. HHS has stated concerns

about quality oversight. Most important, Medicare Select requires enrollees to receive their care from a limited

set of providers. This may be perfectly

acceptable to younger, healthier, enrollees. As beneficiaries age and become sicker, however, they may find

themselves dissatisfied with providers

in the select network. They can find

themselves permanently locked out of

regular MediGap coverage, with no

ability to buy a policy to protect themselves from the costs that Medicare

does not cover.

This seems to me to be an excessive

denial of choice that we should not enshrine in permanent legislation without more consideration.

These concerns have been raised by

Consumers Union and other consumer

advocates. Consumers Union, Families

USA, and the National Council of Senior Citizens all are on record as opposing this legislation. These concerns are

serious and they deserve to be addressed.

We must always be especially concerned about the frailest and the most

vulnerable elderly. We want to provide

options that improve the choices available, not limit them. We want to provide benefits and services that seniors

need, not deprive them of necessary

care. We should move with great care

in considering a measure that might

have that affect.

It is not my intention to terminate

the Medicare Select demonstration or

put it out of business. I would be willing to support the short-term extension of the program or a permanent

program if these concerns are considered and addressed.

It is ironic that this particular Medicare issue should surface just a day before we are to consider a budget resolution which would strike a mighty blow

at the integrity of the Medicare Program as a whole and at the retirement

security of senior citizens it was designed to secure.

This budget plan proposes to break

America’s compact with the elderly,

and all to pay for an undeserved and

unneeded tax cut for the wealthiest

Americans.

The cuts in Medicare are unprecedented: $256 billion over the next 7

years. By the time the plan is fully

phased in, the average senior is likely

to pay $900 more a year in Medicare

premium and out-of-pocket costs.

An elderly couple would have to pay

$1,800 and, over the life of the budget,

would face $6,400 in additional costs.

Part B premiums, which are deducted

right out of the Social Security check,

will rise to almost $100 a month at a

cost of an additional $1,700 over the life

of the budget plan.

The typical senior needing home

health services will have to pay an additional $1,200 per year. Someone sick

enough to use the full home care benefit will have to pay $3,200. The fundamental unfairness of this proposal

leaps out from a few simple facts.

Because of gaps in Medicare, senior

citizens already pay too much for the

health care they need. The average senior pays an astounding one-fifth of

their total pretax income to purchase

health care, more than they paid before

Medicare was even enacted. Lower income older seniors pay even more.

Medicare does not cover prescription

drugs. Its coverage of home health care

and nursing home care is limited. Unlike virtually all private insurance

policies, it does not have a cap on outof-pocket costs. It does not cover eye

care or foot care or dental care.

Yet this budget plan heaps additional

medical costs on every senior citizen,

while the Republican tax bill that has

already passed the House, gives a tax

cut of $20,000 to people making more

than $350,000 a year.

I ask any of our colleagues to travel

to any senior citizens’ home in their

State and have a visit with retirees.

Ask the retirees by a show of hands

how many pay $50 a month or more for

prescription drugs. Anywhere from 25

percent to 50 percent of the hands will

go up in the air. Ask them how many

pay $25 a month or more for prescription drugs, and the spontaneous groan

in the audience will be enormous. It is

an expression that they are astounded

that we do not understand that they

are paying at least $25 a month or more

and now 80 percent to 90 percent of the

hands go into the air.

What has been the cost of the prescription drugs over recent years? They

have been rising at more than double,

sometimes even triple, the Consumer

Price Index.

Look also at the profits of the major

pharmaceutical companies. It is an interesting fact that they are some of the

most profitable companies in America,

while at the same time the cost of prescription drugs, which are absolutely

essential in order to relieve suffering

or to even live life in many instances,

is going right up through the roof.

Now, that is a real issue for the seniors. That is an issue that we ought to

be debating out here this afternoon.

That is an issue of prime concern to

every senior citizen.

I daresay, if any Member of the Senate went to a group of senior citizens

and asked them this afternoon, ‘‘What

do they want the U.S. Senate to be focusing on? The issue of prescription

drugs or Medicare Select?’’ Ninety-nine

percent would say, ‘‘Look after the

problems that we are facing with prescription drugs.’’ ‘‘Look after the problems we are facing in terms of dental

care and eye care.’’ Look around the

room and count the number of senior

citizens who are wearing glasses. Look

around the room at the numbers who

need help and assistance with dental

care. Look around the room at the

number of seniors who need the care of

a podiatrist.

Our seniors think the U.S. Senate

ought to be focusing on Medicare here

this afternoon. But we should not focus

solely on Medicare Select, until we

have a full and complete evaluation of

that program, which has the potential

of some very important adverse effects,

as well as some potentially beneficial

effects.

We ought to insist that we have all of

the facts before we move forward on a

program that will unquestionably

mean enormous profits to some companies and industries. It will perhaps give

at least the appearance of security to

some of our senior citizens for a period

of time, but that security will be illusory unless it is carefully crafted and

there are built-in kinds of protections

which are not evidenced in the proposal

that we are reviewing or considering

this afternoon.

It is interesting, Mr. President, to

compare the generous benefits that the

authors of the Senate resolution enjoy

under our Federal Employees Health

Benefit Program plan available to

every Member of Congress to the less

adequate benefits provided for Medicare.

We are going to find out that while

the measure we will be debating here in
May 17, 1995 CONGRESSIONAL RECORD — SENATE S6791

the U.S. Senate cuts back on protections for our senior citizens, we sure

are not cutting back on the protections

for any of the Members in the U.S. Senate. That is an interesting irony.

We heard so much in the early part of

the year about how we will make sure

that every law that we pass in the Congress is going to be applicable to the

Members of Congress. Remember those

speeches? We heard them from morning

until eveningtime here in the Senate.

And it is right that we do that. But

how interesting that we do not say we

are going to provide for the American

people all the benefits that we have

here in the U.S. Senate.

If we wanted to, we could give to the

American people the kind of health

benefits that we have, by extending the

Federal Employees Health Benefit Program. Many of us have supported this

in the past; many of us fought last year

to try to make this available. FEHBP

affects 10 million Americans. We have

40 million Americans who do not have

health care coverage, and 16 million of

those who are children. We could do

very well if we just provided the extension of the Federal Employees Health

Benefit Program to all Americans. But,

again, we are not debating that issue

here. We are not involved in that debate here on the floor of the U.S. Senate.

We are talking about the Medicare

Select issue, a very narrow, very defined issue. We will be debating, tomorrow, and perhaps the day after tomorrow, and for a series of tomorrows, the

proposed cuts that are coming in Medicare, in the budget proposal, that will

not be utilized for health care reform

as we tried to do last year. We tried to

provide some prescription drug benefit.

We tried to provide some home care.

We tried to provide some communitybased care. We tried to provide some

additional protections for our elderly.

But no, this year we are going to go

ahead and cut the Medicare Program to

set aside a little kitty of $170 billion

that can be used someday in the future

for tax cuts for the rich. Take benefits

away from the seniors in the Medicare

Program, raise their copayments, raise

their premiums, raise their

deductibles, raise all of their costs so

that we can put over here a little saving account that can be drawn down to

allow tax cuts for the wealthiest individuals.

That is what we will be debating.

And it is also amazing to me that we

will have a time constraint on this

issue that is going to affect the quality

of life for our senior citizens in such a

dramatic way. We do not have that

time restraint this afternoon, when we

are debating Medicare Select, but we

will have it when that budget bill is

called up.

It is important that we put some of

these measures into proportion. This

issue, Medicare Select, is being pressed

this afternoon. We are on the eve of

what will be a very important debate,

not only here on the floor of the U.S.

Senate but across this countryside;

whether or not we want to say to our

senior citizens we are going to cut your

benefits so we can use those savings,

those cuts, those resources that we

have captured from you to give a tax

cut to the wealthiest individuals.

Maybe that is what the election was

about last November. It certainly was

not about that in my State of Massachusetts. People will say, out here on

the Senate floor: They voted for

change. Is this the kind of change that

the people voted for, Mr. President,

$256 billion in Medicare cuts so we can

provide $170 billion for tax reductions

for the wealthiest individuals? Is that

what the election was about last fall?

I do not believe so. And I think that

is why all of us are seeing, in our own

States, that those who are paying increasing attention to what we are debating and what we are acting on, are

going to be so concerned by this particular budget proposal.

Sure we have to get some savings in

Medicare. Sure we have to have some

reductions in expenditures. But what

we did last year, when we proposed

comprehensive health care reform, was

to try to bring about the kinds of

changes that over the long term are

going to provide important quality

health protections for our senior citizens, and second, to get a handle on

health care costs. We need to get a

handle not only on Medicare and Medicaid costs but also on the total health

care system, since Medicare costs are

only 15 percent of total national health

expenditures. The notion that we can

deal with escalating health care costs

by cutting Medicare alone, shows a

fundamental lack of understanding of

the basic elements of the health care

debate.

Medicare provides no coverage at all

for outpatient prescription drugs, but

they are fully covered under the most

popular plan in the Federal Employees

Health Benefit Program. The combined

deductible for doctor and hospital services under the average Blue Cross and

Blue Shield plan is $350; for Medicare

the combined deductible is $816. Blue

Cross and Blue Shield covers unlimited

hospital days with no copayments;

under Medicare, seniors face $179 per

day copayments after 60 days; $358

after 90 days. After 150 days Medicare

pays nothing at all.

Compare the differences between

what our seniors are facing and what

the Members of the U.S. Senate are

facing. Medicare covers a few preventive services but does not cover

screenings for heart disease, for prostate cancer, for other cancer tests—all

FEHBP benefits. Dental services are

covered for Members of Congress. We

have them for Members of Congress—

not for the Medicare recipients. Members of Congress are protected against

skyrocketing out-of-pocket costs by a

cap on their total liability. There is no

cap on how much a senior citizen has

to pay for Medicare copayments on

deductibles.

Members of Congress earn $133,600 a

year. The average senior’s income is

$17,750. For the limited Medicare benefits seniors receive they pay $46.10 a

month, but for their comprehensive insurance coverage Members of Congress

will pay a grand total of $44.05 a

month. Seniors actually pay $2 more

out of incomes about an eighth as

large.

Is that something for our seniors to

hear about as we are going to be considering a program that is going to cut

their programs even more—and yet not

affecting the Members of Congress at

all? We have had this debate, some of

us, for a number of years. Let us just

give to the American people what we

give to the Members of Congress. But

we are not doing that, not with Medicare. We are being told to go ahead and

provide additional burdens on the senior citizens that are not being asked of

the Members of Congress.

No wonder people wonder what this is

about. Is this the change that we voted

for? I would love to ask a group of citizens in any State, is this the change

you voted for last November? For further cuts on the Medicare benefits, increasing copayments, increasing

deductibles to the tune of $256 billion,

taking $170 billion of it and reserving it

over here for tax cuts? Is that what the

American people wanted as the change?

Or did they believe in what we have as

Members of the U.S. Senate, and what

more than 9 million other Americans

have, the Federal employees? Surely

they were thinking when they voted,

‘‘OK, if it is good enough for the Members of Congress it ought to be good

enough for all Americans, young and

old alike?’’

This debate is going to be important

in these next several days. I hope and

urge our seniors to watch this debate

and listen carefully. Listen carefully to

those who are making recommendations to cut Medicare. Listen to their

responses to the challenges about equity to our seniors.

This President has indicated he will

listen. He will listen to proposals to

cut Medicare if they are about total

health care reform. This means that we

are going to do something for our seniors that is going to enhance the quality of health care in such areas as prevention, home care, and communitybased systems. It means making a difference by reducing deductibles or

making payments for pharmaceuticals

so seniors will not be distressed every

time they take much-needed prescription drugs; so they do not need to decide whether they can afford to go

down and get that prescription for $50,

$75, $100 per month, when they do not

have enough food on their table or heat

in their home? We will have the chance

to debate that. We welcome the opportunity to do so.

The authors of the budget resolution

do not seem to understand how limited

the incomes of senior citizens are. Because of their budget, millions of senior citizens will be forced to go without
S6792 CONGRESSIONAL RECORD — SENATE May 17, 1995

the health care they need. Millions

more will have to choose between food

on the table, adequate heat in the winter, paying the rent, or medical care.

This budget resolution is cruel. It is

unjust. Senior citizens have earned

their Medicare payments. They have

paid for them, and they deserve them.

Medicare cuts in this resolution

harm more than senior citizens. These

proposals will strike a body blow to the

quality of American medicine by damaging hospitals and other health care

institutions that depend upon Medicare. These institutions provide essential care for Americans of all ages, not

just senior citizens. And progress in

medical research and training of health

professionals depends upon their financial stability. The academic health

centers, the public hospitals, and the

rural hospitals will bear especially

heavy burdens. As representatives of

the academic health centers that are

the guarantors of excellence in health

care in America said of this budget,

‘‘Every American’s quality of life will

suffer as a result,’’ because there will

be less funding to support the best

health professional education and

training to the young people of this

country, and there will be a diminution

in support for the research that is associated with the great medical centers

in this country.

In addition, massive Medicare cuts

will inevitably impose a hidden tax on

workers and businesses, who will face

increased costs and higher insurance

premiums as physicians and hospitals

shift even more costs to the

nonelderly. According to the recent

statistics, Medicare now pays only 68

percent of what the private sector pays

for comparable physician services; for

hospital care, the figure is 69 percent.

The proposed Republican cuts will

widen this already ominous gap.

The impact of these cuts on local

communities will be astounding. In my

State of Massachusetts we have 123

hospitals. Historically, one of the best

and most efficient hospitals has in

Barnstable County, not far from my

home on Cape Cod. But it has had increasing difficulty serving its patients

in recent years. What changed? The

doctors have not changed. The nurses

have not changed. The ability to get

the good kind of equipment has not

changed. The training that they went

through has not changed. What has

changed? The percentage of Medicare

beneficiaries being attended to in that

hospital changed.

In my State of Massachusetts, any

hospital that gets close to 55 and 67

percent Medicare is headed for bankruptcy because of the reimbursement

rates. What are we doing? Do you know

what happens? Hospitals must cut back

on the nurses; they cut back on their

outreach programs in the community

to work with children; they cut back

on their training programs; they cut

back, as much as they regret it, on the

quality of care people get—not just for

the elderly people, but for all the people being served.

What happens locally? Communities

raise local taxes to try to assist hospitals, or they appeal to the State

house and try to get additional resources. They try to get the revenues

from someplace. Either localities accept a decline in health care quality or

they have to raise additional resources

locally or at the State level. Maybe

some other States are experiencing

generous surpluses, but you are not

going to find many that are in our region of the country.

Financial cutbacks that have occurred in the past have made it difficult for hospitals to provide the excellent services they are used to providing, and the kinds of cutbacks being

discussed by the Republicans now will

only exacerbate this problem.

The right way to slow Medicare cost

growth is in the context of a broad

health reform program that will slow

health inflation and in the economy as

a whole. That is the way to bring Federal health care costs under control

without cutting benefits or shifting

costs to the working families.

In the context of a broad reform, the

special needs of the academic health

centers, the rural hospitals, and innercity hospitals can also be addressed.

Unilateral Medicare cuts alone, by contrast, could destroy the availability

and the quality of care for the young

and old alike.

The President said that he is willing

to work for a bipartisan reform of the

health care system, but our friends on

the other side have said no. The only

bipartisan shift they seem to be interested in is the kind that says, ‘‘Join us

in slashing Medicare.’’ That is not the

kind of bipartisanship the American

people want.

The authors of the budget resolution

claim to protect Social Security while

making draconian cuts in Medicare.

But the distinction is a false one because Medicare is part of Social Security. Like Social Security, it is a compact between the Government and the

people that says, ‘‘Pay into the trust

fund during your working years and we

will guarantee decent health care in

your old age.’’ This Republican budget

breaks that compact.

As the ceremonies on V–E Day this

past week remind us, today’s senior

citizens have stood by America in war

and in peace, and America must stand

by them now. The senior citizens have

worked hard. They brought us out of

the Depression. They fought in the Second World War. Their sons fought in

the Korean war, and the Vietnam War.

They have sacrificed greatly to advance the interests of their children.

They played by the rules.

If this country is the great country

that all of us believe that it is, it is

really a tribute to the senior citizens.

They have contributed to Medicare.

They have earned their Medicare benefits. And they deserve to have them.

This Republican budget proposes to

take those benefits away, and it should

be rejected.

Mr. President, I suggest the absence

of a quorum.

The PRESIDING OFFICER. The

clerk will call the roll.

The bill clerk proceeded to call the

roll.

Mr. SPECTER. Mr. President, I ask

unanimous consent that the order for

the quorum call be rescinded.

The PRESIDING OFFICER. Without

objection, it is so ordered.

THE UNITED STATES EMBASSY IN

fISRAEL

Mr. SPECTER. Mr. President, I have

sought recognition this afternoon to

respond to those who have raised an

issue about the current efforts to have

the United States Embassy moved to

Jerusalem, the capital of Israel, instead of its current location in Tel

Aviv.

There have been some suggestions

that we are motivated for political purposes in 1995 to raise this issue. The

history of these efforts conclusively refutes that contention. A bill was introduced on October 1, 1983, S. 2031, cosponsored at that time by 50 United

States Senators, which sought to have

the United States Embassy and the residence of the American Ambassador to

Israel hereafter be located in the city

of Jerusalem.

That resolution was referred to committee and was not called for a vote,

but it was later noted that in addition

to the 50 U.S. Senators, there were 227

Members of the House of Representatives who joined in endorsing that

transfer of the U.S. Embassy from Tel

Aviv to Jerusalem.

Then on March 26, 1990, Senate Concurrent Resolution 106 was introduced,

which called for the recognition of Jerusalem as the capital of Israel, and

that resolution was passed in the Senate by a voice vote.

Then, following those actions, on

February 24, 1995, a letter was sent to

Secretary of State Warren Christopher

signed by 92 U.S. Senators evidencing

strong bipartisan support, again calling for the moving of the U.S. Embassy

from Tel Aviv to Jerusalem.

Mr. President, I was an original cosponsor of S. 2031 which was introduced

back on October 31, 1983; supported

Senate Concurrent Resolution 106 back

in 1990; and joined in the letter of February 24, 1995, evidencing my consistent support for this program.

Recently, the Prime Minister of Israel, Yitzhak Rabin, was in Washington, and the issue was raised as to

whether or not action by the Congress

of the United States in calling for the

removal of the Embassy from Tel Aviv

to Jerusalem would be an impediment

to the peace process which is ongoing

at the present time because obviously

we do not wish to interfere with the

peace process. At that time, Prime

Minister Rabin responded that it was a