[Congressional Record Volume 145, Number 128 (Tuesday, September 28, 1999)]
[Senate]
[Pages S11524-S11527]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




           SENIORS PRESCRIPTION INSURANCE COVERAGE EQUITY ACT

  Ms. SNOWE. Mr. President, I rise today, along with my distinguished 
colleague from Oregon, Senator Wyden, to discuss legislation we 
introduced in July concerning prescription drug coverage. The 
legislation is known as the Seniors Prescription Insurance Coverage 
Equity Act, or SPICE.
  We have come to the floor to address a number of questions that have 
been raised with respect to our legislation. We want to answer some of 
those questions so the Members of this body can be informed in terms of 
what our legislation is all about on this most critical issue.
  I am also pleased to announce Representatives Roukema and Pallone 
have introduced a companion bill to our legislation in the House of 
Representatives.
  I have always believed, as being part of the elective process, we 
have an obligation to serve the people by addressing the problems that 
are the most immediate and most critical. We are not here solely for 
the purpose of creating issues so our parties can run on those issues 
in the next election. Yet it seems all too often now Congress is only 
focusing on the difference between the two parties, the difference 
between Congress and the President, instead of focusing on how we can 
achieve a consensus on the most significant issues facing this country, 
where we can make a meaningful difference in the lives of our 
constituents. The people of this country rightfully expect us to 
legislate good public policy on those issues, to address problems 
facing this country.
  Yet, time and again, it seems the more critical issues we face in 
Congress and in this country are the ones that are the most polarized. 
Time and time

[[Page S11525]]

again, we fail to achieve a consensus on the key issues. The most 
notable, recently, of course, is the tax cut bill. While we might all 
have differences in terms of what kind of tax cut bill we should have 
or how much, there was no difference of opinion with the President or 
with Congress in terms of having a tax cut but, rather, what the size 
of that tax cut package should be. People say to me: Where is it going 
from here? I say: That is a good question.
  Inevitably, there will be another train wreck, and it doesn't have to 
be so. We ought to be able to demonstrate to the American people we are 
very serious about creating solutions, rather than issues, as a 
platform and a basis for the next election, which, by the way, is more 
than a year away. It is almost as if compromise has become a lost art.
  So here we are in September, approaching October, closer and closer 
to adjournment, and the only thing that will be falling faster than the 
leaves will be our legislative agenda and the public's faith. America 
expects us to build bridges and not to draw lines. So often 
bipartisanship has become a joke. It may well be within the beltway, 
but I can tell my colleagues, in the real world, it is no laughing 
matter.
  That is why Senator Wyden and I are taking the floor, not only to 
discuss our legislation but to urge the Members of the Senate and of 
the Congress, and the President, to come together on this most vital of 
issues to our Nation's citizens. That is why we are here, because we 
have introduced a bill that puts the interests of the American people 
over the best interests of politics, a bill that gives us a chance to 
show America's seniors and the American people that, yes, we can come 
together on an issue of great significance to our constituency.

  I believe that how a society treats its seniors speaks volumes. What 
does it say that while America is 4 or 5 months shy of its longest 
expansion ever in the history of this country, while this Nation enjoys 
an era of unprecedented wealth and prosperity and growth, a third of 
Medicare recipients still have no insurance coverage whatsoever on one 
of their most basic health needs, prescription drug coverage? What does 
it say, when seniors are cutting prescription medications out of their 
budgets and their lives simply because they cannot make ends meet; they 
cannot afford to pay for them?
  What does it say when the New England Journal of Medicine reports 
that poor elderly persons without Medicaid coverage spend about 50 
percent of their total income on out-of-pocket health care costs such 
as Medicare premiums and prescription drugs? It says: Wait until next 
year.
  Wait until next year? That may be good and may be acceptable in the 
world of sports and elections, but it is not acceptable when it comes 
to America's seniors and a matter of life and death. For them the 
status quo is a bitter pill to swallow.
  Our plan--the only bipartisan one, I might add, in the Senate--
represents a straightforward, comprehensive, responsible approach. It 
will appeal to anyone who wants seniors to have coverage, to have 
choice, to pay for it in a responsible fashion, to get it done this 
year, regardless of whether or not we have Medicare reform.
  How does it work? Instead of reinventing Medicare, because we know 
that is complicated and contentious, we created a program that builds 
on the existing medigap system, using the basis and the model of the 
Federal Employees Health Benefit Plan, the one that benefits Members of 
Congress and all Federal employees, and we have choice. So why 
shouldn't seniors have the same choices that are afforded Members of 
Congress and Federal employees with respect to their health insurance 
and to this prescription drug coverage?
  All Medicare-eligible individuals will have the option of purchasing 
this plan. It will be voluntary, a supplemental insurance program. It 
will be similar to medigap. We create a board that will disseminate the 
information on the choices available. Not only is this approach better 
for Medicare beneficiaries, but it keeps the costs down by encouraging 
competition because we have a potential pool of 39 million Medicare 
beneficiaries. All seniors will receive some premium support assistance 
on a sliding scale: 100 percent for those with incomes under 150 
percent of the poverty level and under, and then it phases out to 175 
percent and above to 25 percent, so at least at a minimum 25 percent 
premium support, and 100 percent for those under 50 percent of poverty 
level.
  Individuals will pay for the copayments and the deductibles. The 
policies will be the threshold standard developed by the board, which 
will include consumers and State representatives, insurance 
representatives, commissioners, designed with the seniors' needs in 
mind. There will be a number of choices based on the need and based on 
encouraging competition among a number of insurance companies across 
America because of the size of the pool.
  The question people ask the most about our plan is, Are you changing 
seniors' current Medicare program? No. SPICE will not be a part of 
Medicare. What is more, it is completely optional. Best of all, we pay 
for it with a reasonable and reliable funding mechanism that would not 
in any way affect the solvency of Medicare or dip into Social Security 
surpluses, which is a key issue, both on the Social Security and 
Medicare question.
  Senator Wyden and I, as members of the Budget Committee, last March 
offered an amendment to the budget resolution. At that time we had an 
amendment that allowed for the use of surpluses for the financing of a 
prescription drug program, predicated on the Senate Finance Committee 
and the House Ways and Means, to report out a Medicare reform 
package. This seemed a great way to create an incentive for Medicare 
reform and also a way of financing a prescription drug program, given 
that we will have projected surpluses of a trillion dollars over the 
next 10 years.

  But in the event we don't have a reform package--and I hope we do 
work on it because it is critically important and we should not be 
deferring this issue, but given the fact that we might not, and given 
the precarious state of the projected surpluses, Senator Wyden and I 
decided to offer another alternative of financing a prescription drug 
program when the budget came up.
  We offered an amendment based on the President's proposal to increase 
the tobacco tax by 55 cents and also accelerate the scheduled tax 
increase of 15 cents on tobacco. Even though we were defeated on a 
budgetary point of order that required 60 votes, we got 54 votes. We 
had a majority of support for financing a prescription drug program 
through tobacco tax revenues. It makes good policy sense. Columbia 
University did a study in 1995, and it showed, in that year alone, 
smoking-related illnesses cost the Medicare program $25 billion or 14 
percent of the total expenditures of the Medicare program. There is no 
reason whatsoever to think those costs have diminished at all. So we 
think this is a reasonable, logical way to finance a prescription drug 
program.
  People may have differences and say: We don't want to raise any kind 
of tax, even if it is a tobacco tax. But I urge my colleagues that 
there are other alternatives. We have to have funding. It isn't 
responsible to introduce a prescription drug program and have no 
financing mechanism. What we don't want to do with the SPICE program is 
to add layers of bureaucracy. We are minimizing bureaucracy by creating 
a board that will maximize oversight. But HCFA will not be presenting 
this program. We will not affect current Medicare benefits, and we 
won't be affecting the solvency of the program.
  I urge the Members of the Senate to give careful consideration to the 
legislation we are offering. It is critically important. We have the 
luxury, so to speak, of deferring issues, but our seniors in this 
country--certainly in the State of Maine--don't have the luxury of 
deferring their well-being. A third of Medicare enrollees have nothing, 
not to mention the patchwork quilt involved in the coverage for all the 
other seniors.
  Now, if you think it is acceptable for 15 million enrollees in the 
Medicare program not to have any coverage whatsoever, then fine. But if 
you are truly concerned about the fact that 15 million Americans have 
nothing, then I urge you to consider this legislation.
  Some of our opponents have said, well, the lack of prescription drug 
coverage isn't a crisis; it is a mirage. They

[[Page S11526]]

label our bill, and other bills for prescription drug coverage, a 
``solution in search of a problem.'' They use words such as 
``misguided,'' ``regressive,'' ``unnecessary,'' and ``fictitious.'' 
They say our claims about seniors having to choose between drug 
coverage and filling their cupboards are simply not true.
  Ask the seniors in my State and all across this country who have 
written to us and said they are cutting their pills in half, or cutting 
dosages, or skipping dosages, and not simply filling prescriptions when 
they get them from the doctor because they are unable to pay for them. 
That is the bottom line. It will be a big surprise to older Americans 
if you say it is not a problem.
  Mr. President, I yield to my colleague, Senator Wyden from Oregon, 10 
minutes.
  The PRESIDING OFFICER. The Senator from Oregon.
  Mr. WYDEN. Mr. President, it has been a pleasure to listen to my 
colleague from Maine. I think she has said it superbly. It has been a 
pleasure to be working with her over the last few months. The reality 
is that nothing important in the Congress gets done unless it is 
bipartisan. It is just that simple.
  What Senator Snowe and I have said repeatedly is that we want to get 
beyond some of the squabbling that goes on in Washington, DC, and 
really come together as a Congress, across the political aisle, and get 
prescription drug coverage added to the Medicare program.
  I think it is especially important now to hear from the Nation's 
senior citizens. For the last few months, we have been hearing from all 
of these beltway experts. Some of them, as Senator Snowe mentioned, 
have actually said seniors don't need these benefits. They say, well, 
this isn't a very serious problem, in spite of the fact that we have 
more than 20 percent of the Nation's elderly spending $1,000 a year out 
of pocket on their prescription medicine. We have some of these self-
styled experts in Washington, DC, going to conferences and programs and 
saying seniors really don't need this coverage.
  So what we want to do is take this debate about prescription drug 
coverage and the need to assist seniors out of the beltway, get it out 
beyond Washington, DC, and start hearing from seniors and their 
families.
  Maybe some of these experts have good coverage and that is why they 
don't think it is important to cover the needs of seniors. Maybe they 
are not talking to their parents. But I can tell you, the seniors who 
come out to town meetings in Maine and Oregon are saying they can't 
afford prescription medicine and, very often, they will leave an order 
that has been phoned in by their physician at a pharmacy because they 
can't afford to pick it up. They are told to take three pills as part 
of their program to recover, but they start off taking two; they can't 
afford that; and then they take one; and eventually they get much 
sicker and end up needing much more expensive care.
  So we want to make sure in the days ahead, in our effort to pass a 
bipartisan prescription drug bill, that the Senate and the Congress 
hear from the Nation's older people. We would like to say today that we 
hope senior citizens and their families across this country who want to 
see the Congress pass a bipartisan bill to add prescription drug 
coverage--we hope those seniors and their families, just as this chart 
next to me indicates, will send copies of their bills to their Senator 
and their Member of Congress.
  Right next to me is a chart showing how simple it is for seniors and 
their families to make sure their voices aren't drowned out by some of 
these experts saying we don't need prescription drug coverage as part 
of Medicare. Just as this chart shows, a simple note to a Member of 
Congress, a Member of this body, can help us forge a bipartisan 
coalition and actually get this done. We hope when we hear from seniors 
and their families, they will support the SPICE legislation. But what 
is really important is that the Congress hear from those older people 
and their families.
  We think ours is a good bill. For example, under our legislation, 
seniors will have the bargaining power and the clout in the marketplace 
the way the big health maintenance organizations have, so we can keep 
the costs of prescription drugs down.
  A lot of our colleagues, both in the Senate and in the House, are 
touting studies about how seniors spend a lot more when they walk into 
a pharmacy for their prescription drugs than would a big buyer such as 
a health maintenance organization. That is true. Seniors get hit by a 
double whammy: They can't afford prescription drug coverage. Yet when 
they walk into a pharmacy, they subsidize those big buyers, the 
purchasers through a health maintenance organization who get a 
discount.
  Well, Senator Snowe and I think that if a health plan is good enough 
for Members of Congress and their families and that health plan uses 
marketplace forces to hold costs down, let's use a model such as that 
to serve the needs of older people. We are not reinventing the wheel. 
We are not having the Federal Government take over health care. We are 
using a system that Members of Congress and their families know well, a 
system that ensures that seniors will be in a position to hold down the 
costs of their medicine as well as be able to obtain coverage.
  I am very pleased to have a chance to work with Senator Snowe and to 
spend a few minutes discussing issues with her. I think the big 
challenge is to get this issue out of the beltway and to work in a 
bipartisan fashion. Senator Snowe and I have been trying to do that in 
the Budget Committee. There are some who want to make this a political 
issue for the 2000 campaign. We are not naive. We recognize that.
  Certainly if there were no good ideas to tackle this problem, it 
would be an issue that would come up in the campaign. However, Senator 
Snowe and I think because more than half of the Senate has already 
voted for the funding plan that we propose, because we are relying on a 
model we know works for Members of Congress and their families, we 
shouldn't wait another 2 years for another election to act. We think 
the time to act is now.
  I will address my colleague by way of saying, Senator, what strikes 
me as missing is the voice of seniors and their families. We have heard 
from all the experts in Washington, DC. What has been missing is the 
voices of seniors and their families. I want them to start sending in 
their bills and telling Members what they think about the crushing 
costs of prescription medicine.
  Perhaps the Senator could comment.
  Ms. SNOWE. Will the Senator yield?
  Mr. WYDEN. I am happy to yield to the Senator.
  Ms. SNOWE. Mr. President, I commend Senator Wyden for his idea on 
having seniors in this country send their prescription drug bills to 
the Members of the Senate and to their Representatives. It is 
absolutely critical for people to understand the significance of this 
issue in the daily lives of our seniors.
  Doesn't the Senator find it somewhat remarkable there are some in 
Washington saying there is no crisis among our Nation's seniors when it 
comes to prescription drug coverage, that this is a fictitious problem? 
My seniors are telling me: We cannot afford to pay for our prescription 
drug bills.
  I met with a senior recently who said she is reducing the number of 
pills she takes every day because she cannot afford to fill the entire 
prescription. So she tries to make it last longer. That is a real 
story. It is happening all across America.
  I find it somewhat amazing people are suggesting it is not a problem. 
On average, the seniors will spend $642 a year on drugs. That is on 
average. Prescription drug access in America, for most seniors, is out 
of reach. I think we have to impress upon Members of this body, 
Congress, and the President, this is an issue we all need to come 
together on, to work out now, not 2 years from now.
  People say: After the election. The election is a year from November. 
Then it will be another year, at the minimum, before we can get 
anything passed. That is 2 years.
  The American seniors cannot defer their health, their well-being. In 
many instances, it is the difference between life and death. Much 
sicker seniors are being discharged from hospitals today than ever 
before. That is why prescription medication becomes all the more 
compelling and urgent in helping our seniors.

[[Page S11527]]

  Mr. WYDEN. We know new prescriptions are right on the forefront of 
preventive medicine. What is exciting about the new medicines is they 
help to lower blood pressure and they can be helpful in dealing with a 
wide variety of health concerns, including cholesterol and other 
problems seniors have.

  Could the Senator tell Members a little bit about how the model SPICE 
benefit was devised? It seems to me the Senator is trying to focus on 
wellness, holding costs down, and making prescriptions affordable.
  Ms. SNOWE. The Senator raises an important question about the choices 
that would be available to seniors by creating this board. We look at 
the needs of seniors. What are the prescription drugs seniors most use? 
What is most available? What is out there already for insurance 
coverage? Where are the gaps? This board will have the ability to 
devise a number of plans across the board and make it available to 
seniors. Then they can make decisions as to whether or not that plan is 
tailored to their needs, similar to what Members of Congress get.
  Members of Congress can avail themselves to an array of plans that 
provide for prescription drug coverage. The seniors in America should 
have the same choices. We want them to have choices and to avail 
themselves, as Senator Wyden indicated, to the state-of-the-art, 
advanced developments in prescription drugs and medications.
  We did not rely on Government programs, a big bureaucracy of price 
controls in order to achieve prescription drug coverage because there 
are bills out there in the House and the Senate that will either 
control the price of drugs or create a huge Government bureaucracy or 
impinge on the Medicare Program that already has significant financial 
problems.
  Could the Senator tell Members how our bill will help seniors without 
relying on Government price controls but at the same time giving them 
the ability to have access to the most advanced prescription drug 
coverage in America?
  Mr. WYDEN. I appreciate my colleague's question. We use marketplace 
forces. We use a dose of free enterprise, how our Federal employee 
health plan works.
  What troubles me is a lot of those other bills focus on an approach 
of Government purchasing the medicine, but that will shift the costs 
onto a lot of other people.
  I am very fearful that under some of those approaches, particularly 
the ones in the House, because Medicare essentially would control 
prices, they will shift the costs. What will happen is an African 
American woman who is 27, maybe single with a couple of children, will 
end up with a higher prescription drug bill because that person will 
end up seeing the costs shifted when prices are controlled just for the 
Medicare Program.
  I think we ought to use marketplace forces, competitive principles. 
That is what our legislation does. It will prevent cost shifting and 
help to hold down costs for all Americans.
  I yield the floor.
  Ms. SNOWE. Mr. President, I compliment my colleague, Senator Wyden, 
for the comments he made. It is critically important to understand the 
differences in our approach as compared to others for controlling the 
price of drugs which will have an impact on the developments that have 
occurred in prescription drugs in America.
  Most importantly, Senator Wyden and I have come together on an 
approach we think is reasonable both from a fiscal standpoint as well 
as from a policy standpoint. We are allowing competition; we are 
allowing choice. We don't create a bureaucracy; we don't affect 
Medicare. We provide a financing mechanism.
  It truly is a reasonable solution to a crisis that is facing 
America's seniors. I encourage my colleagues to take a very close look 
at this bipartisan proposal, the only one that has been introduced in 
the Senate, to talk to Members to see if we can come together so we can 
address this issue this year in this Congress.
  I yield the floor.

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