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Kidney disease
medioare.
86 Stat. 1463.
42 USC 426.
50 Stat, 307.
45 USC 228a.

of the course in which he is so enrolled or until the first day of
the third month beginning after such time, whichever first

occurs)."
Sec. 3. Séction 226(e) of the Social Security Act is amended

(1) by inserting "ar would be fully or currently insured if his
service as an employee (as defined in the Railroad Retirement Act
of 1937) after December 31, 1936, were included in the term
'employment' as defined in this Act” after "(as such terms are
defined in section 214 of this Act)” in 2(A) thereof;

(2) by inserting “or an annuity under the Railroad Retirement Act of 1937" after “monthly insurance benefits under title II of this Act” in 2(B) thereof;

(3) by inserting “or would be fully or currently insured if his service as an employee (as defined in the Railroad Retirement Act of 1937) after December 31, 1936, were included in the term 'employment' as defined in this Act” after "fully or currently insured” in 2(C) thereof; and

(4) by inserting "or an annuity under the Railroad Retirement Act of 1937" after “monthly insurance benefits under title II of

this Act” in 2(D) thereof. SEC. 4. (a) The provisions of this Act, except the provisions of section 1, shall be effective as of the date the corresponding provisions of Public Law 92-603 are effective. The provisions of clauses (xi) and (xii), which are added by section 1 of this Act, shall be effective as follows: clause (xi) shall be effective with respect to calendar years after 1971 for annuities accruing after December 1972; and clause (xii) shall bc effective as of the date the delayed retirement provision of Public Law 92-603 is effective.

(b) Any child (1) whose entitlement to an annuity under section 5(c) of the Railroad Retirement Act was terminated by reason of his adoption prior to the enactment of this Act, and (2) who, except for such adoption, would be entitled to an annuity under such section for a month after the month in which this Act is enacted, may, upon filing application for an annuity under the Railroad Retirement Act after the date of enactment of this Act, become reentitled to such annuity; except that no child shaH, by reason of the enactment of this Act, become reentitled to such annuity for any month prior to the effective date of the relevant amendments made by this Act to section 5(1) (1) (ii) of the Railroad Retirement Act.

Approved July 6, 1973,

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LEG IS LAT IVE HISTORY:

HOUSE REPORT No. 93-222 (Comm. on Interstate and Foreign commere).
SENATE REPORT No, 93-215 (Comm. on Labor and Publio Welfare).
CONGRESS IONAL RECORD, Vol. 119 (1973):

May 31, oonsidered and passed House,
June 15, oonsidered and passed Senate, amended,
June 21, House oonourred in Senate amendments,

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Mr. HATHAWAY, from the Committee on Labor and Public Welfare and

on behalf of the Committee on Finance, submitted the following

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The Committee on Labor and Public Welfare and the Committee on Finance, to which was referred the bill (H.R. 7357) to amend section 5(1) (1) of the Railroad Retirement Act of 1937 to simplify administration of the act; and to amend section 226(e) of the Social Security Act to extend kidney disease medicare coverage to railroad employees, their spouses, and their dependent children; and for other purposes, having considered the same, report favorably thereon and recommend that the bill do pass with amendments.

The committee amendment is in the nature of a substitute. The committee accepted the provisions of H.R. 7357, but added one amendment, which together with the provisions of H.R. 7357 were consolidated into the committee substitute. The new provision added by the committee was recommended to it by the Railroad Retirement Board. This amendment is technical in nature and conforms to the provision of present law which permits the Railroad Retirement Board to disregard postretirement earnings in computing the Social Security guaranty rate.

PURPOSE OF THE BILL The bill has three major purposes: (1) to simplify administration of the social security minimum guaranty provision contained in section 3(e) of the Railroad Retirement Act; (2) to liberalize the eligibility conditions for children's benefits under the Railroad Retirement Act to conform with the liberalizations provided in such benefits under the Social Security Act by Public Law 92–603, approved October 30, 1972; and (3) to extend kidney disease medicare coverage to railroad employees, their spouses, and their dependent children on the same basis as such coverage is now provided for persons insured under the Social Security Act.

BACKGROUND

. Section 3(e) of the Railroad Retirement Act contains what is generally referred to as the social security minimum guaranty provision. This provision guarantees that the combined monthly railroad retirement benefits which an individual and a dependent deriving benefits from him will receive under the Railroad Retirement Act and the Social Security Act (based on the individual's earnings record) would be no less than 110 percent of the amount which would have been payable to that family under the Social Security Act on the basis of the individual's combined railroad and nonrailroad earnings if his railroad service after 1936 had been covered under the Social Security Act. The implementation of this provision had become more and more difficult with each amendment to the Social Security Act since 1965, and, therefore, certain technical amendments to section 3(e) of the Railroad Retirement Act were proposed in 1972 for the purpose of simplifying the administration of the guaranty provision. These amendments were enacted on October 4, 1972, as Public Law 92–460.

One of the amendments enacted by Public Law 92460 added clauses (ix) and (x) to section 3(e) of the Railroad Retirement Act. These clauses were added in order to relieve the Railroad Retirement Board of the burden of policing an employee's earnings record after his annuity had been awarded and of making recomputations to determine whether the guaranty provision would, in light of any such earnings, provide a higher benefit to the employee than the regular railroad retirement annuity formula. Since inclusion of the latest social security earnings generally did not result in an increase in the amount payable under the guaranty provision and since it is a rare case where inclusion of such earnings would result in an employee's annuity previously paid at the rate provided by the regular railroad retirement formula being transferred to the guaranty provision rate, clauses (ix) and (x) permit the Board to disregard the employee's earnings after retirement in computing his "average monthly wage”. These provisions fully accomplished their intended purpose at the time of their enactment because under the then existing law the amounts of any benefits payable to an employee under the guaranty provision were related to the amount of his average monthly wage. Shortly thereafter, however, the Social Security Act was amended by Public Law 92–603 (approved October 30, 1972) to provide special minimum primary insurance amounts (section 215(a) (3) of that Act) and so-called "increment month" increases (section 202 (w) of that Act), neither of which were related to the employee's average monthly wage. Therefore, clauses (ix) and (x) of section 3(e) cannot, under present law, be applied in making guaranty provisions computations as to the amount of a retired employee's special primary insurance amount or increment increases, thereby defeating the purpose of those clauses to a significant extent. The provisions of section 1 of the bill would remedy this situa.. tion so as to fully effectuate the original purpose of the clauses in question.

When technical amendments were originally proposed in 1972 to simplify the administration of the guaranty provision of section 3(e) of the Railroad Retirement Act, several provisions were included, the enactment of which was contingent upon the enactment of H.R. 1, which was then being considered by the 92d Congress. Since it was believed that H.R. 1 would not be enacted in 1972, those provisions were deleted before the technical amendments of 1972 were enacted as Public Law 92460. Subsequently, however, H.R. 1 was enacted, on October 30, 1972, as Public Law 92-603 and, therefore, the aforementioned provisions which were deleted from the 1972 Railroad Retirement Act technical amendments are included in this bill. The costs resulting from these provisions, together with the costs and savings from the technical amendments previously enacted in 1972 and additional financial interchange gains because of the enactment of Public Law 92–603, balance out, so that no financial burden to the railroad retirement system would result therefrom.

In 1965, when the medicare program was established, persons age 65 and over who were insured under the Railroad Retirement Act were: provided the same hospital insurance and supplemental medical insur-. ance benefits as persons insured under the Social Security Act. Again, when medicare coverage was extended in 1972 by Public Law 92-603, to disabled individuals under age 65, such coverage was accorded disabled railroad retirement beneficiaries on the same basis as to disabled social security beneficiaries. Public Law 92–603, however, also provided medicare coverage for certain individuals covered under the Social Security Act who need treatment for kidney disease, but, through an oversight, this provision failed to extend such benefits to individuals covered under the Railroad Retirement Act. This bill would correct that oversight. This provision was considered by the Committee on Finance, which has jurisdiction over the Social Security Act, and that committee submitted the following letter for inclusion in this report:

U.S. SENATE,
COMMITTEE ON FINANCE,

Washington, D.C., June 7, 1973.
Hon. HARRISON A. WILLIAMS,
Chairman, Committee on Labor and Public Welfare, U.S. Senate,

Washington, D.C. DEAR MR. CHAIRMAN:On June 1, H.R. 7357, a bill affecting persons covered under the Railroad Retirement Act, was referred jointly to the Committee on Finance and the Committee on Labor and Public Welfare. On June 5, the Committee on Labor and Public Welfare ordered the bill favorably reported with an amendment striking everything after the enacting clause and adding instead a committee substitute. The committee amendment, like the House bill contains an amendment to the Social Security Act, which is within the jurisdiction of the Committee on Finance.

Last year, as part of Public Law 92–603, the Congress agreed to cover under Medicare all those persons who are fully or currently insured under social security, and their dependents, if they are medically determined to have chronic renal disease which necessitates kidney dialysis or implantation. This coverage begins with the third month after the course of dialysis is initiated, and it terminates 12 months after implantation or 12 months after dialysis is terminated. Under the amendment, the Secretary of Health, Education, and \Velfare is authorized to limit reimbursement for implantation and dialysis procedures to centers which meet requirements he prescribes, including

III.

requirements for a minimal utilization rate and for a medical review board to screen the appropriateness of the patient for the procedure. The new coverage becomes effective June 1, 1973.

With the exception of this new provision, the Medicare law applies equally to social security beneficiaries and railroad retirement beneficiaries. However, last year's provision extending Medicare coverage to persons needing kidney implantation or dialysis omitted any reference to railroad retirement beneficiaries. H.R. 7357 would correct this omission by extending the new provision to persons under the railroad retirement program.

On June 6, 1973, the Committee on Finance met in executive session and agreed to favorably report this provision.

I would appreciate it if you would include this letter in the joint committee report that will be filed on H.R. 7357. With every good wish, I am Sincerely,

CHAIRMAN.

REPORTS OF EXECUTIVE DEPARTMENTS AND AGENCIES The report of the agency concerned with this bill is set forth in the appendix to this report. The bill was initiated by the Railroad Retirement Board and is supported by railroad management (Association of American Railroads) and railroad labor (Congress of Railway Unions and Railway Labor Executives' Association).

GENERAL EXPLANATION OF THE BILL (1) Under present law the Railroad Retirement Board must take into account an employee's earnings in and after the year of retirement for some purposes in computing the amount of the benefit which would be payable to him under the social security minimum guaranty provision contained in section 3(e). of the Railroad Retirement Act and must disregard such earnings for other purposes in making the same computation. The amendments made by the bill would require the Board to disregard such earnings for all purposes in making the guaranty provision computation as to the amount of the benefit which would be payable to an employee thereunder. (Section 1.)

(2) Some eligibility conditions for benefits under the Social Security Act were liberalized by certain provisions in Public Law 92603. Thus, a child's survivor benefit will continue after his adoption by anyone (in general, an adopted child's benefit entitlement previously continued only if he was adopted by a close relative); a-survivor benefit will be paid to a child for a disability which began before age 22, instead of before age 18; a student child will continue to receive benefits after age 22 in some cases; and a dependent grandchild will be treated as a child of his grandparent. This bill would make the same liberalizations for annuities payable under the Railroad Retirement Act. The enactment of these provisions would also simplify administration of the guaranty provision of section 3(e) of the act. In computing annuity amounts payable under this provision, the Railroad Retirement Board is required to include certain spouses and children even if such persons could not themselves qualify for railroad retire

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