[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.
____________________