lamarsmith.house.gov

Lamar Smith
Contact: Brad Bennett 202-225-4236


Seniors Need Choices

Washington, Oct 28 -

Medicare was created in 1965 as a program to provide comprehensive health care coverage for older Americans. Thirty-seven years later, the nationwide health insurance program covers 40 million American seniors and disabled persons. It provides broad coverage for the costs of many health services.

Since the early 1980s, Medicare beneficiaries have been able to enroll in health maintenance organizations (HMOs) so that beneficiaries get all of their Medicare services through the HMO. The HMO assumes the risk for paying for covered services, and in turn, Medicare makes a predetermined fixed monthly payment to the plan for each enrollee no matter what amount of resources are used.

Enrollment in HMOs offered Medicare patients some options, but not nearly as many as are available to a majority of American workers. To address this deficiency in choice, Congress passed legislation, in 1997, that established a new program, Medicare+Choice.

Medicare+Choice allows private plans to offer beneficiaries a wide range of options, similar to what is available in the private sector today. It includes important protections for patients and providers, as well as requirements for quality assessment and improvement. Today, 14 percent of Medicare beneficiaries obtain services through these plans.

Medicare + Choice provides better care and additional benefits and improved cost sharing for beneficiaries. Seniors need the additional benefits and lower costs that Medicare + Choice plans provide, but those very options have been declining each year.

I supported legislation in the House this year that stabilizes the Medicare + Choice program for the next two years. And it implements a more competitive program in 2005. This will result in more choices to ensure the maximum benefits at the lowest cost for seniors.

The new Medicare Modernization bill stabilizes Medicare+Choice by creating a new competitive structure for M+C plans to assure that seniors will have dependable choices, premium savings and early access to the various medical service and treatment innovations that are commonly available to the private sector first.

Medicare has been helpful for millions of Americans but there is room for improvement. The fact is seniors need the peace of mind that they have adequate medical coverage should a catastrophic illness hit.

To be fair and responsible, we must give senior citizens more power to choose what`s best for them. That means an affordable and voluntary prescription drug benefit, a stronger Medicare+Choice program, and lower overall health care costs.