[Congressional Record Volume 146, Number 41 (Wednesday, April 5, 2000)]
[Senate]
[Pages S2145-S2156]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
FISCAL YEAR 2001 BUDGET--Resumed
Pending:
Hutchison/Ashcroft amendment No. 2914, to express the sense
of the Senate to provide for relief from the marriage penalty
tax.
Robb amendment No. 2915 (to amendment No. 2914), to
condition Senate consideration of any tax cut reconciliation
legislation on previous enactment of legislation to provide
an outpatient prescription drug benefit under the Medicare
program that is consistent with Medicare reform.
The PRESIDENT pro tempore. Who yields time?
Mr. LAUTENBERG. Mr. President, I yield 5 minutes to the Senator from
Minnesota.
The PRESIDENT pro tempore. The Senator from Minnesota is recognized.
Mr. WELLSTONE. Mr. President, I thank my colleague from New Jersey.
Let me first of all commend Senator Robb of Virginia. I think what he
has done out here on the floor of the Senate is very important for our
country, and not just for senior citizens. He submitted an amendment
that would make it out of order for the Senate to consider a
reconciliation bill that spends on-budget surplus on tax cuts unless
Congress has already enacted legislation establishing an outpatient
Medicare prescription drug benefit.
I come here to the floor of the Senate to congratulate Senator Robb
and to speak for senior citizens in Minnesota.
If we are about legislation that is important to people's lives, if
we want to be here to represent the people in our States, there is no
more important amendment for us to pass. This isn't where the rubber
meets the road, but it is all about the general direction for the
Senate, and the direction Senator Robb's amendment calls is to make
sure we make a commitment to funding prescription drug coverage for
senior citizens in this country.
In the State of Minnesota, on the basis of hearings I have attended,
on the basis of conversations and meetings--some of them incredibly
heartfelt and incredibly painful--with elderly citizens in my State,
there is no more important thing we can do than to pass this amendment
and to once and for all cover prescription drug benefits for senior
citizens.
First of all, in the State of Minnesota, because of a very unfair
and, I argue, even discriminatory Medicare reimbursement to our
managed-care plans and to our seniors, we have in our State only one-
third of senior citizens
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receiving any kind of prescription drug coverage at all. Two-thirds of
the senior citizens in Minnesota don't have any coverage whatsoever. I
think in the country it is about one-third. But in our State it is an
acute problem; it is a problem of crisis proportion.
Second of all, as a result of that, it is not uncommon to meet
seniors who, even when the doctor gives them a prescription, can't fill
the prescription because they don't have the money, or they cut the
pills into thirds or into halves, all of which is dangerous. I have met
all of those senior citizens. I have been in these conversations with
senior citizens about this. It is not uncommon to meet people who spend
$300 or $400 a month to meet their prescription drug costs and at the
same time their total monthly income is $1,000--all the while, in the
pharmaceutical industry, the costs have gone up 17 percent a year over
the past couple of years, and they are projected to go up again. The
pharmaceutical industry rakes in record--I argue exorbitant, I argue
obscene--profits.
But for today, what is so important about the Robb amendment is that
if we want to do something to really make a difference in the lives of
people we represent, we must expand Medicare and provide this coverage.
My colleagues on the Republican side want to go forward with tax
cuts, many of which go to higher income people least in need. They seem
to believe it is not an appropriate role for Government or the Senate
to provide prescription drug coverage as a part of what Medicare is all
about.
I think the vast majority of people in the country believe that when
it comes to certain pressing issues of their lives, there is a positive
role Government can play. This is a perfect example to make sure people
do not go without the very prescription drugs they need, which is so
essential to their health. That is what is so important about this
amendment.
When my Republican colleagues say they want to limit this to low-
income senior citizens, I just want to say what has made Medicare and
Social Security work is that it is a universal coverage program. It
commands broad support. This is about building on Medicare. This isn't
going back to means-tested programs which quite often become poor
programs.
Just because a senior citizen in Minnesota or Virginia or
Massachusetts has an income of $17,000 a year or $18,000 a year, it
does not mean he or she or both of them are not in need of some help so
they can purchase the prescription drugs that are so important to their
health.
This is a very important amendment. I am tired of the Minnesotans
having to go to Canada to purchase prescription drugs they can afford.
I am tired of the Minnesota Senior Federation, which is a courageous,
gutsy grassroots organization, having to raise Cain over and over and
over again about the fact that so many senior citizens are not able to
afford the prescription drugs they need for their health.
``All politics,'' Tip O'Neill said, ``is local.'' I argue all
politics is also personal. Having been the child of parents, both of
whom have passed away with Parkinson's disease, I know what drugs such
as L-Dopa and Sinemet cost.
There is no more important thing we can do if we want to get real, if
we want to respond to what our constituents need, than to pass this
Robb amendment.
I thank the Senator from Virginia for his leadership. I yield the
floor.
Mr. REID. The Senator from North Dakota is allotted 5 minutes.
Mr. DORGAN. Mr. President, this budget is brought to the floor as
part of an annual ritual. The ritual in the Senate is to debate budget
priorities. It is about making choices.
One hundred years from now we will all be gone. We will not be
around, but historians can look back at this day, and by evaluating
what we viewed to be important and what we wanted to spend money on,
they can evaluate what our priorities were. Did we feel health care was
a priority? Was education a priority? Were tax cuts a priority?
Let's look at the choices. This budget is brought to the floor
suggesting that a significant priority is to provide tax cuts, the
benefit of which go largely to upper-income folks in this country. The
Senator from Virginia, Mr. Robb, offers a different set of priorities.
He says: Let's not have these tax cut proposals move forward until and
unless there is a prescription drug benefit added to the Medicare
program.
I happen to think we ought not have tax cuts until we have made a
significant payment toward reducing the Federal debt. I also believe,
with the Senator from Virginia, that we ought to have a benefit for
prescription drugs in the Medicare program.
That is what this debate is about--it is about making choices. What
are the right choices? I have held hearings in six States with the
Democratic Policy Committee on the issue of prescription drugs and
Medicare. Let me tell Members about choices senior citizens are making.
The Senator from Virginia suggests we are about to make the wrong
choice unless we adopt his amendment. I agree with him. Let's make the
right choice.
Let me describe the choices senior citizens are making. At a hearing
in Dickinson, ND, Dr. James Baumgartner told me of a patient of his on
Medicare who had surgery for breast cancer. He told her about the
prescription drug she would have to take to reduce the chances of
recurrence of breast cancer. She said: Doctor, I can't do that. I don't
have the money to buy those prescription drugs. I'm just going to have
to take my chances.
That is a choice. Not a good choice, but a forced choice because
there is no coverage for prescription drugs in Medicare.
How about the choice of buying food? At another hearing in Illinois,
a woman told me that where she goes to the grocery store, the pharmacy
counter is at the back end of the store. She must go to the rear of the
store to buy her prescription drugs, first, because only then will this
older woman know how much money she has left for food. She must buy her
prescription drugs first because only then will she know what she can
afford to pay for her food.
That is a choice she had to make.
At another hearing, a fellow told me that he pays $2,400 for
medicine. He is living on a fixed income in retirement. He said: I eat
spaghetti sometimes 8 and 9 days in a row because I can't afford
anything else, and still be able to pay for my prescription medicine.
That is a choice. Not a good one but a choice.
Or transplant recipients at a hearing in Illinois. We had two people
with heart transplants and one with a double lung transplant. One of
them said her prescription drugs costs $24,000 a year.
That person could probably make a choice of having the rejection of
her transplants, but that is not much of a choice either, is it?
Or the woman in New York at the hearing I held. Connie, from Rye
Brook, NY, has no prescription drug coverage and is forced to pay out-
of-pocket costs she cannot afford. She said: I cut the pill in half and
take half the dosage so it lasts twice as long.
That, too, is a choice. Not a good choice.
All over the country, senior citizens are having to make these
choices. They are not good choices because we don't have a prescription
drug benefit in the Medicare program.
Senator Robb from Virginia has said in his amendment that we ought to
make it a priority to do the right thing. He is dead right. We have a
responsibility to add a prescription drug benefit to this Medicare
program. This is the time and the place to make that choice. This vote
will determine what that choice is going to be.
I yield the floor.
Mr. REID. Mr. President, I yield 1 minute to the Senator from
Virginia. Following his statement, I yield 5 minutes off of our 45
minutes, or whatever time is remaining, to Senator Kennedy from
Massachusetts, and then 5 minutes on the bill for a total of 10 minutes
to Senator Kennedy.
The PRESIDING OFFICER. The Senator from Virginia.
Mr. ROBB. Mr. President, I first thank the Senator from Minnesota and
the Senator from North Dakota for their statements.
The bottom line is this particular provision in the resolution before
the Senate locks in as a matter of law a permanent tax cut that would
gobble up all but 2 percent of the on-budget
[[Page S2147]]
surplus that is available. No matter how much we talk about the desire
to do something in terms of prescription drugs for seniors, after the
stories we hear about choosing between food and medicine, the bottom
line is we lock in a tax cut and we take all the money that would
otherwise be available. Notwithstanding the expressed good intentions,
it just won't work.
This is a matter of priorities.
I am delighted to yield to the distinguished Senator from
Massachusetts.
The PRESIDING OFFICER. The Senator from Massachusetts.
Mr. KENNEDY. Mr. President, I express appreciation to Senator Robb
for his leadership in bringing the Senate to where we are this morning
with an opportunity to vote at 11 o'clock on whether we will put the
seniors in this country ahead of an unwise tax cut at this time.
A budget is about national priorities. This amendment says to the
American people that prescription drug coverage under Medicare is as
high a priority for the Senate as it is for the American people. This
amendment says health care for the elderly is more important than tax
cuts for the wealthy.
Without this amendment, this Republican budget resolution has its
priorities backwards. It says the first priority is tax cuts.
Yesterday, my friend and colleague, the distinguished chairman of the
Senate Budget Committee, and I engaged in a discussion of this point. I
asked the chairman if there was any guarantee in the budget
instructions that we will have prescription drugs on the floor by
September 31, which is effectively the last week of Congress. This is
what my honorable friend said: No, there is no guarantee.
He went on to say that under the resolution a prescription drug bill
could be brought to the floor without a budget point of order being
lodged against it after September 1.
That is an empty promise. Such a bill would still be subject to a
filibuster. It would still require 60 votes to even get to the floor if
any Senator objected to its consideration. It would still have to be
called up by the majority leader or offered as an amendment if there
was a suitable vehicle. If by some miracle it did get to the floor, an
unlimited number of amendments could be offered, and it would still be
subject to a number of restrictions that I will discuss in a moment.
Compare that to the tax bill. It is required to be reported by the
Senate Finance Committee no later than September 22--not permitted,
required. It cannot be filibustered under Senate rules. Debate is
limited, in terms of the total hours, to 50 hours. It requires only 50
votes to pass.
Of course, we know the majority party is absolutely committed to pass
a tax bill, but this budget resolution makes it abundantly clear there
is no similar commitment to Medicare drug coverage. It is that plain
and simple. There are two different standards, make no mistake about
it--one standard for the tax, and an entirely different one for
prescription drugs. I daresay the one on the prescription drugs is
illustrated by the language of the resolution itself. It says that, in
the Senate, the budgetary limits may be adjusted and allocated and may
be revised by legislation reported by the Committee on Finance to
provide a prescription drug benefit. ``May be'' is optional. That is
different from where it says the Senate Finance Committee shall report
to the Senate on the tax bill.
So we have not only the requirements that it ``may be'' rather than
``shall'' with regard to prescription drugs, but we have the whole
procedure in the Senate that will permit filibusters in bringing it up,
in debating it on the floor of the Senate. It will require 60 votes to
be able to get to a final resolution as compared to 50 votes for the
tax bill. That is dramatically different.
What we are saying with the Robb amendment is let us pass the
prescription drug bill first and then consider the tax cut afterwards.
In the remaining time, I want to mention one additional item. This
particular prescription drug proposal, as I mentioned, is a 3-year
proposal, even if they are able to jump through the hoops that I have
mentioned. Let's say we are able to consider the bill; let's say we are
able to get the majority leader to call it up. It is very difficult to
get any measure that we can amend, as we have seen over the course of
this time, but let's say we get the majority leader to call it up. And
let's say we have the 60 votes to get cloture. It is only for 3 years.
Beyond that, you only get a continuation of that program if we find the
solvency of the Medicare fund, and there is going to be a complete
revamping of the Medicare program without using any general funds in
order to stabilize the Medicare system. Here we find, again, the
conditions that have to be realized before we are able to extend it.
The tax cut is permanent. Do we understand? The tax cut is permanent.
It is virtually automatic. Once this bill passes, there will be a
requirement that the tax bill be on the floor of the Senate in
September. But this prescription drug proposal has to jump through all
the hoops for the first 3 years, and even if we jump through the hoops
for the first 3 years, we have to go back through the hoops over the
remaining 2 years. It is not permanent as is the tax bill.
Finally, I want to once again review about whom we are talking and
what the costs are in terms of the prescription drugs. Yesterday I
tried to point out, as has been mentioned here, a third of American
seniors do not have any coverage and another third are losing it
dramatically. In the last 3 years, we have seen a 25-percent drop in
coverage. If you take the drops in 1998 and 1999, it shows it is going
right on down, and the costs of Medigap are going through the ceiling.
The HMOs are setting limits that make it difficult if not virtually
impossible for senior citizens to get the protections they earned.
Who are these senior citizens? Look at this chart here and we see
what the income is for senior citizens, the retirees, the men and women
who fought in the World Wars, brought this country out of the
Depression, and have made it the great Nation it is. Mr. President, 57
percent of them have incomes below $15,000; 21 percent below $25,000.
That is almost 80 percent of our senior citizens, those with incomes
below $25,000. Then it continues on with only 7 percent at $50,000 or
over. Many would say that is just middle income. Certainly, if you have
some children at school, $50,000 is considered to be middle income. We
are talking about individuals who are hard pressed. These are men and
women who made the country and now are dependent upon these
prescription drugs in order to be able to survive.
Finally, we see in this chart what it is costing these elderly
citizens. For so many of the moderate-income beneficiaries, typical
drug costs versus their income--when you look at about 150 percent of
poverty, that is almost the median income for senior citizens in this
country. Look at this chart of what it costs for these routine
illnesses and sicknesses of our elderly people. Every elderly person
either is in danger of, or fears, or has osteoporosis and heart
trouble, high blood pressure, irregular heartbeat----
The PRESIDING OFFICER. The time of the Senator has expired.
Mr. REID. Mr. President, I yield the Senator from Massachusetts 2
minutes off of the bill.
Mr. KENNEDY. High blood pressure, heart disease. This is the typical
cost in 1 year. This is the percent of their income they are paying: 20
percent, 26 percent, 31 percent, 40 percent, 240 percent of their
income.
This is just for prescription drugs. This is not for any other
medical expenses. That is more than they are spending, in many
instances, for their rent, their food, their clothing, and their other
necessities.
As we see this issue, there is nothing more important--preserving our
Social Security and preserving Medicare--than prescription drug
protection for senior citizens. I believe we ought to be able to shape
a program that will be universal, that will have the catastrophic as
well as the basic, and that will be affordable for individuals as well
as the Federal Government.
What we are saying is let's debate that issue. Let's have an
opportunity for the Senate to take action on that issue prior to the
time we go to these massive tax breaks. That is what this Robb
amendment is all about, putting our seniors first. I hope our
colleagues will join in supporting it.
The PRESIDING OFFICER. The Senator from Nevada.
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Mr. REID. Mr. President, I ask unanimous consent the time this
morning that has been charged to the resolution, which I think is about
7 minutes, not be counted to the 45 minutes of time on the side of the
minority.
The PRESIDING OFFICER. Is there objection? Without objection, it is
so ordered.
Mr. REID. Mr. President, I yield 7 minutes to the Senator from
Massachusetts.
The PRESIDING OFFICER. The Senator from Massachusetts.
Mr. KERRY. Mr. President, I applaud my colleague from Massachusetts
for his tremendous leadership on this subject and for having just
pointed out the realities of the situation we find ourselves in on the
floor of the Senate. It is hard for anybody, rationally, to think about
the problems our seniors face in this country and then measure those
problems against what the Republican majority is presenting the country
in its budget resolution.
I do not understand the rationale. I do not understand how they can
come to the floor prepared to guarantee the wealthiest Americans are
going to get an extraordinary tax cut. That is absolutely cast in
stone. That is going to happen. They saw to it in this budget
resolution that there is a certainty as to the tax cut. But at the same
time they saw to it that there is no certainty with respect to senior
citizens having an opportunity that we take care of their needs for
prescription drugs. Their budget pays lipservice to the critical issue
of helping seniors afford medications that are prescribed by their
doctors.
If you measure this, the budget resolution provides a tax cut of over
$150 billion over 5 years. Those tax cuts will require we pay $18
billion more in interest payments. So when you add the interest
payments to the tax cuts themselves, you have virtually the amount of
the entire non-Social Security surplus that is going to be taken off
the table and given back. But what is extraordinary is their focus.
Here is a major problem. There is not one of us, as Senators, who does
not go home to our States and find countless numbers of citizens come
to us and say: I cannot afford to buy drugs. I have to choose between
paying rent or food and buying the prescription drugs I need to be
healthy.
We have citizens who are piling into buses going to Mexico and Canada
to buy drugs, and yet ``our'' fixation, the fixation of the majority is
to absolutely guarantee that the wealthiest people in America who have
done the best over the last 15 to 20 years are absolutely going to get
a tax cut, but the neediest people in America who need help with
prescription drugs, who are paying thousands of dollars a year and are
on a fixed income and cannot afford it, have no guarantee in this
budget that they are going to have the Senate produce a prescription
drug benefit.
There is some lipservice to $40 billion, but as my colleague from
Massachusetts pointed out, there is no guarantee we are ever going to
see legislation.
Why is it that there is an absolute certainty as to the tax cut, an
absolute guarantee that people who have done the best are going to be
helped but people who are the most needy are not going to be helped?
The Senate ought to be committed to addressing the importance of
working families receiving this kind of help.
Why is that so important? It ought to be obvious to every Member of
the Senate. When Medicare was created in 1965, the biggest cost concern
for patients was a long stay in the hospital. Today, particularly
because of the wonders of modern medicine and the biotechnology
revolution, patients who once needed surgery now can take drugs;
patients who once needed extensive stays in hospitals are now able to
take wonder drugs of the modern age to lower cholesterol, lower blood
pressure, stabilize weak hearts, and do extraordinary things, but they
cost a lot of money.
There has been a remarkable cost-shifting process. It used to be that
if one went to the hospital to have an operation and stayed in the
hospital, insurance took care of the stay. But now the hospital stay
and the long period of convalescence has been supplanted by the miracle
drug, and the cost has shifted from the insurance to the individual,
and most of these individuals are not able to afford it.
Take, for instance, a highly effective drug for hypertension. Sixty
percent of the people over the age of 65 have hypertension. The fact
is, highly effective drugs to control this typically cost about $40 a
month. They greatly reduce the potential of stroke. A stroke,
obviously, requires rehab time in hospitals and a variety of in-house
costs and services to the medical system. If we can prevent that from
happening, we save the system money. But if that cost shifting is to
the individual who is on a fixed income, they get stuck with the
problem.
Prescription drug expenditures in the United States--and I ask my
colleagues to focus on this--have grown at nearly double-digit rates
almost every year since 1980, with seniors' drug prices growing at four
times the rate of inflation.
In 1997, prescription drug expenditures had the highest growth rate
of all health and human services and supplies. There was a 14.1-percent
growth in those costs versus the overall health care expenditure cost
that rose at only 4.8 percent--14.1 percent for prescription drugs;
health care costs were generally 4 percent.
A lot of us will support the increase in the NIH funding because we
want to continue this revolution, but the fact is, it does not do a lot
of good to put on the shelf drugs from the laboratory that are
completely inaccessible to the average American who needs them because
they simply cannot afford them.
We are missing a historic opportunity in the Senate in terms of our
legislating process. The fact is, we have an opportunity to provide 14
million senior citizens, who lack prescription drug coverage, with that
coverage. That is, one-third of all Medicare beneficiaries have no
prescription drug coverage at all.
Three-fifths of all Medicare beneficiaries lack dependable coverage,
and one-quarter of all Medicare beneficiaries have retiree drug
coverage from their former employer, but the number of firms offering
that coverage has declined by 25 percent over the last 4 years.
In our state of Massachusetts, there are 982,934 Medicare
beneficiaries. 45% of these seniors lack prescription drug coverage.
55% of these seniors have some form of coverage--but, the form that
coverage takes is often capped, costly, inadequate or all of the above.
Prescription drugs are the largest out-of-pocket health care cost for
seniors in Massachusetts and throughout the country. More than 85% of
Medicare beneficiaries take at least one prescription medicine, and the
average beneficiary fills 18 prescriptions per year. The average annual
prescription drug cost for Medicare beneficiaries will reach $1,100
this year. Even beneficiaries with some drug coverage incur high out-
of-pocket spending, an average of $700 per year. Increasing costs
coupled with the lack of coverage force 1 out of 8 seniors in our
country to choose between buying food and medicine.
Unless we act, we can only expect these numbers to increase.
Americans aged 85 and older represent the fastest growing segment of
the population, with expected growth from 4 million people today to 19
million people by 2050. We cannot afford to allow this problem to
continue.
Medicare was enacted in 1965 as a promise to the American people
that, in exchange for their years of hard work and service to our
country, their health care would be protected in their golden years.
Mr. President, it is past time we deliver on that promise.
My hope is that we will adopt the Robb amendment. I congratulate the
Senator from Virginia for bringing this amendment to the floor. It
requires that we find some methodology by which we will guarantee that
Congress will pass a prescription drug program. It seems to me it is as
imperative we do that as give a tax cut, considering the fact that the
Federal tax burden is the lowest it has been in 20 years. Let's get our
priorities straight and do what is correct.
I thank the Chair.
The PRESIDING OFFICER (Mr. L. Chafee). The Senator from Colorado.
Mr. ALLARD. Mr. President, I ask unanimous consent that the scheduled
votes for 11 a.m. today now begin at 10:45 a.m., under the same terms
as previously agreed to, and that at 10:45 a.m., the majority manager
be recognized to make a point of order and then
[[Page S2149]]
yield an additional 4 minutes to the minority side from the majority's
time.
Mr. REID. It is my understanding that will give the minority 25
minutes remaining.
The PRESIDING OFFICER. The Senator is correct.
Mr. REID. This has been checked with Senator Lautenberg, and we on
the minority side agree to this unanimous consent request.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. ALLARD. Mr. President, I yield 15 minutes to the Senator from
Tennessee.
The PRESIDING OFFICER. The Senator from Tennessee.
Mr. FRIST. Mr. President, I rise to address the underlying amendment
offered by the Senator from Virginia and his colleagues which links our
efforts to provide affordable access to outpatient prescription drugs
for seniors to the issue of tax relief. I believe this amendment is
unnecessary.
One of the highest priorities in the Republican-sponsored budget is
to provide outpatient prescription drug coverage for Medicare
beneficiaries, something in which I, as a physician who has taken care
of thousands of Medicare beneficiaries--individuals with disabilities
and seniors--and my colleagues strongly believe is critical to the
health care security of these beneficiaries. They need and deserve
affordable access to prescription drugs, and that is an important part
of our agenda.
We reduce the tax burden on hard-working Americans who today are
being taxed more than at any time in the peacetime history of this
country.
I simply cannot and will not support any amendment that pits these
two goals, which are inherent and integral parts of this budget,
against one another. It is unnecessary, and it is irresponsible. We can
do both in our budget and we provide the means to do so.
It is a fascinating time in our history in terms of the evolution of
health care. We are almost where we were in the early 1960s in our
discussion of prescription drug coverage. Before Medicare, we did not
have coverage for hospitals and physician services. In the early 1960s,
we had the opportunity to shape health care security for seniors, and
later for individuals with disabilities, in a way that has been very
beneficial. I say that as a health care provider who has been on the
frontline.
In large part as a product of the tremendous research and development
and the discovery of new drugs, and the application of those drugs in
recent years, it is time that we in this Congress address Medicare for
seniors in a modernized way. ``In a modernized way'' means that we must
bring prescription drugs into Medicare in an integrated fashion to
deliver a full set of comprehensive benefits to beneficiaries. That is
why in this budget we address modernizing Medicare and setting aside
$40 billion to strengthen the program and include an outpatient
prescription drug benefit.
But something we do that is critical, that is not being addressed by
these freestanding drug bills that are being proposed--both in the
House and in the Senate--is that we link that inclusion of prescription
drug coverage to the overall modernization of the Medicare system.
Although this is a budget discussion, it is not just a matter of only
dollars and cents. We are talking about health care security for our
seniors. The physician, the hospital, the health care facility, and the
prescription drugs all must be a part of one seamless health care
delivery program.
As good as Medicare is today, it is not as good as most people think
it is, for lots of different reasons.
No. 1, it is a fragmented system. We have a Part A trust fund and a
Part B trust fund. We have outpatient care and we have inpatient care.
It is incomplete. The benefit package is outdated. There is even very
little in the way of preventive services as part of Medicare today,
services that seniors desperately need.
Preventative care, which is in private health care plans, has
proliferated. We all know how important it is. Yet there is almost none
of that in Medicare today.
Many people think Medicare is going to take care of our seniors later
in their lives. It is a fact, of every dollar that is spent for a
senior's health care, if you put it all together, only 53 cents is paid
for by Medicare. The other 47 cents, that is paid for by that senior or
that individual with the disability who has to reach out, scrape
around, get another insurance policy, pay out of pocket, or ask for
free care in order to cover health care expenses. We can do better.
Thus, we are absolutely committed to the principle of, yes, including
prescription drugs into the system, but doing it in such a way that we
can improve and modernize Medicare as the whole, to be a seamless
system in the provision of high-quality care for our seniors.
I believe it is irresponsible--when you have a Medicare program that
is threatened in terms of long-term solvency, when you look at deficits
in cash-flow, when you look at the huge demographic shift that will be
occurring with the baby boomers coming through the system, with a
doubling of the number of seniors over the next 30 years, and a
lessening of the people who are paying into the system--it is
irresponsible, unless you address the overall health care system, to
take a benefit, a very expensive benefit, and simply set it on top of a
system that cannot be sustained long term. It is deceptive. It is just
not right. Our seniors deserve better.
Thus, instead of trying to link tax relief to improving health care
for our seniors, what we Republicans believe--expressed in this
budget--is that the appropriate linkage is providing prescription drugs
in an affordable way, but linking it inextricably to the modernization
of the overall Medicare system. That is the most prudent, short-term
and long-term approach to guarantee health care security for our
seniors.
The principles of prescription drug coverage are, in my mind, pretty
simple. I think all of us must recognize that a new drug benefit should
not be modeled on Medicare's traditional, out-of-date delivery model.
We need a new model. The President's plan does not change the system at
all, but instead places more financial burdens on an already fragile
program, while at the same time placing Medicare beneficiaries' health
at risk.
No. 2, such a benefit should be voluntary. Most would agree on both
sides of the aisle including the President that it must be accessible
to all. At the same time, we should not do anything that forces people
into HMOs. We should not do anything that forces seniors today, who
already have prescription drug coverage, to give up what they have. We
should not force seniors today, who are already paying a certain amount
for prescription drug coverage, to pay more than what they pay today.
The third principle is--this is important--something we have the
responsibility to address in the short-term and the long-term; that is,
that price controls in prescription drugs will not work. They will
destroy the opportunity to develop that new drug, that new
prescription, that new agent that can be lifesaving, that can treat
illness and prevent disease. Price controls will wipe out drug
innovation.
I believe those three principles must be a part of the drug package
that we assimilate into a modernized Medicare system. Thus, the long-
term goal--again, this linkage in this amendment of tax relief, or
holding one hostage for the other--is not the right thing to do for our
Medicare beneficiaries.
For the 35 million seniors and 5 million individuals with
disabilities who are out there, why hold them hostage? Why not go to
the underlying budget proposal, which I believe has the more
responsible link; and that is, yes, prescription drug coverage--it has
to be there--it is health care security but linking it to
modernization, reform of our Medicare system. That should be our long-
term goal.
Prescription drug coverage should be brought into the system
alongside physician services, hospital services, facilities services,
medical devices where you can consider them all, not as some
freestanding plan saying drugs are over there. Those drugs are just as
important as that surgical knife that I once wielded. We need a
seamless system, a coordinated care approach.
On this issue, again, we are talking about the budget. But it is
important for all of our colleagues to understand
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this linkage that I believe is so important of bringing prescription
drugs in, because it is this whole range of tools that physicians and
health care providers need in order to guarantee affordable high-
quality care.
Now is not the time to institutionalize freestanding plans which
result in further fragmentation. If we pass a freestanding plan, it is
likely to result in further fragmentation of the system when we need
seamless, coordinated care.
We have moved today, in the year 2000, towards disease management and
coordinated delivery of health care. We no longer operate under a model
where a surgical procedure is performed and then the patient is sent to
another doctor to treat the headache, and to another doctor to give a
device or a pacemaker. We want that seamless management. That is why
prescription drugs must be made a part of the overall, comprehensive
reform of our Medicare system.
Less than 10 years ago, the Medicare trustees estimated that the
Medicare Part A Trust Fund, otherwise known as the Hospital Insurance
Trust Fund, would be insolvent in 1999. Since then, the Trustees'
solvency estimates of the Part A Trust Fund have fluctuated
tremendously. As little as five years ago the Part A Trust Fund was
expected to be depleted by 2002. In 1996 and 1997, insolvency was
estimated in the year 2001, in 1998, it was projected for 2008, in 1999
for 2015, and in the year 2000, Medicare bankruptcy is projected for
2023. It might seem strange that insolvency dates could fluctuate so
dramatically--a 21-year range--over a 5-year period. The reason for
this is simple. The Medicare Trustees' reports are estimates--estimates
based on assumptions regarding growth in expenditures in the Medicare
program, economy, life expectancy, and the like, which are continually
changing. Therefore, any interpretation of these reports must be made
with the understanding that as early as the following year, program
insolvency estimates may look dramatically different. History has shown
us as much.
Equally important, the definition of ``solvency'' itself calls for
further examination. The historic concept of Medicare's solvency is one
that has been partially and inappropriately borrowed from Social
Security and has never fully reflected the fiscal integrity of the
Medicare program. Solvency in Medicare is not the same as solvency in
Social Security. The Social Security Trust Funds are funded exclusively
through payroll taxes, so it is relatively easy to determine when
Social Security expenditures are projected to exceed income.
Medicare, however, is funded by a combination of payroll taxes,
general revenue, and beneficiary premiums, divided between two separate
trust funds--Part A and Part B. Additionally, the ratio of these
revenue streams has changed over time such that a greater portion of
Medicare expenses is now paid by general revenues through the Part B
Trust Fund, and a relatively smaller portion is paid by payroll taxes
and beneficiary premiums--than was originally intended when the program
was first enacted. The payroll tax supporting the Social Security Trust
Funds is limited both by its rate and the wage base on which that rate
is applied. Medicare's funding has an unlimited taxable wage base and
therefore no limit on the maximum tax. The Part A Trust Fund is funded
by a payroll tax of 1.45 percent on all earnings in covered employment
and 2.9 percent for the self employed. In sum, the sources of funding
for the Medicare program are numerous, unlimited and divided among
trust funds, making the true test for program solvency much more
complicated than Social Security.
Today, almost equal numbers of seniors and disabled, about 39 million
total, are enrolled in both Parts A and B of the program. Part B
spending represents nearly 40 percent of total program expenditures and
that number will increase significantly, reaching 50 percent by 2020,
as Part B spending continues to grow at twice the rate of Part A. So
why is it that only 60 percent of program spending--the Part A Trust
Fund only--is used to determine the financial health of Medicare as a
whole?
Actually, the notion of Part A ``solvency'', or rather
``insolvency'', has been used as political leverage to shift more
Medicare financing to Part B and draw on general revenues. This not
only fundamentally alters the way the Part A Trust Fund is financed by
moving away from payroll financing toward a formal commitment of future
general fund revenues, but also sends a false sense of security to the
American public regarding the true financial health of the program.
An example, in is the Balanced Budget Act of 1997, where Congress
passed legislation that shifted a major portion of home health
expenditures--approximately $80 billion--from Part A to Part B. By
doing so, the fiction of Part A Trust Fund ``solvency'' was extended
from 2002 to 2008. However, this shift increased the draw on general
revenues tremendously. Worse, it continued to mask the financial
instability of the program and made it easier to allow fiscal
imbalances to go unnoticed.
In addition, although insolvency dates are often used to determine
when the Part A Trust Fund can no longer sustain the program, there is
another important element that must not be overlooked--that is trust
fund assets. Long before the insolvency date is reached, the Part A
Trust Fund must draw upon its assets to continue to fund the program.
These assets are really a claim on the Treasury. When the trust fund
runs a cash deficit, like the Part A Trust Fund has been doing since
1992, these securities are redeemed to pay for program costs. For
instance, this year the Medicare Trustees Report indicates that the
Part A Trust Fund will remain solvent until 2023. This only occurs,
however, because securities are redeemed in order to pay for program
costs, beginning in 2015. The reality is in 2015, the Part A Trust Fund
will begin a deficit again where program expenditures will exceed
income. To redeem the securities necessary to keep the program solvent
until 2023, the government as a whole must come up with the cash by
either increasing taxes, reducing spending or borrowing from the
public. This is all in light of the fact that any small shift in the
economy, program expenditures or health care costs could greatly affect
not only the date in which the program falls into a cash deficit, but
also when insolvency is reached.
The Congressional Budget Office reports that Medicare spending will
grow at an annual average rate of 7.1 percent over the next 10 years.
The Medicare Trustees report highlights the 38 percent growth in the
Part B trust fund over the past 5 years, with these growth rates
expected to continue and even increase. Clearly, addressing
the financial health of the Medicare program by looking at
approximately one-half of the total program expenditures is not only
misleading, but also a misrepresentation of the programs financial
viability--to our nation's Medicare beneficiaries and the public at
large.
Even the Medicare Trustees acknowledge that future operations of the
Part A Trust Fund will be very sensitive to future economic,
demographic, and health cost trends and could differ substantially from
2023 insolvency projections estimated this year. Medicare has never had
a trust fund balance at the beginning of any year that could cover much
more than one year's worth of expenditures. In 1996, the program was
able to fund a little more than one year's worth of expenditures, the
highest ratio yet, but in 1983 the Part A Trust Fund would have only
been able to fund one-fifth of Medicare program expenditures--and in
1999 only 92%.
You see, we can continue to kid ourselves into believing that
Medicare is financially stable. We can address only a fraction of the
program and shift numbers until the program looks solvent on paper. But
the truth is the Medicare program is in great financial trouble and
fast approaching a financial crisis. Without addressing Medicare's
fundamental programmatic and financial problems, combined with the huge
demographic shift of baby boomers in a decade, Medicare will go
bankrupt at the expense of Americans who need and deserve quality,
affordable health care. As we continue to discuss the addition of a new
entitlement to Medicare--outpatient prescription drugs--I urge my
colleagues to carefully consider the fragile financial condition the
program is in.
I believe there is consensus among many of us here this morning--much
of which has been heard over the last twenty four hours--to include an
outpatient prescription drug benefit in the
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Medicare program this year. I agree completely. More than ever, as a
physician, I understand the need to ensure our nation's seniors and
individuals with disabilities have access to life-saving drugs. But I
also believe that we all have a responsibility to ensure that Medicare
is viable and can be sustained with any new benefit that is added. I
want to be able to guarantee my fellow Tennesseans and every Medicare
beneficiary health care security. This is not an easy task--and it is
tempting to avoid the difficult discussions and decisions that must be
made to address the overall programmatic and financial health of
Medicare. But we owe it to our grandmothers and grandfathers, our
children and even ourselves to be responsible in developing an
outpatient prescription drug benefit to ensure Medicare will be
available now and well into the future.
I thank the chairman for bringing forth a budget that sets aside
funding specifically for Medicare and outpatient prescription drugs.
And again I reiterate that the amendment put forth by Senator Robb and
his Democratic colleagues is unnecessary. The Republican-supported
budget resolution sets aside $40 billion over the next 5 years for
Medicare and the inclusion of an outpatient prescription drug benefit.
In addition, it also provides relief to hard-working Americans who are
being taxed at the highest rate in the peacetime history of this
country. Both are high priorities--they are not mutually exclusive. We
should not be pitting the health of our nation's Medicare beneficiaries
against tax relief. It is unfair and it is irresponsible to do so. Both
are critical to this budget and can be done--and we will continue to
work hard to reach these important goals.
Mr. President, how much time do I have remaining?
The PRESIDING OFFICER. All the majority's time has expired.
The Senator from Nevada has 25 minutes.
Mr. FRIST. May I yield myself 3 more minutes?
Mr. REID. As long as we vote at 10:48.
Mr. FRIST. I yield myself 3 more minutes.
The PRESIDING OFFICER. The Senator has no more time to yield.
The Senator from Nevada.
Mr. REID. I say to my friend from Tennessee, we have 5 speakers to
take up our time. We have no more time. If he wants to extend the time
to vote, that is fine with me. That would be 10:48.
Mr. DOMENICI. Mr. President, I have 10 minutes left on the bill?
The PRESIDING OFFICER. There is no time remaining on the majority
side.
The vote is set for 10:45.
Mr. REID. I yield 5 minutes to the Senator from Louisiana.
Mr. BREAUX. I thank the Senator from Nevada for yielding me 5
minutes.
It is interesting to hear discussion and debate in the Congress on
the question of prescription drugs for seniors and the Medicare
program. There is no one in this Congress I know who is going to come
to the floor of the Senate and say: I am opposed to giving seniors
prescription drugs. That is not the issue. I think there is almost
unanimous agreement by everyone in the Congress that prescription drugs
today are as important as a hospital bed was in 1965 when the Medicare
program was first established.
In that period of time, Members of Congress said: We have to pay for
seniors' hospital stays, and we have to pay for their doctors'
treatment. But at that time, prescription drugs was not that big of a
deal in the sense of being something that helped people, in fact, stay
out of hospitals and be cured of what ailed them in medical terms.
Today, it is quite different. Today, prescription drugs keep people
out of hospitals as well as cure them from diseases that formerly were
thought to be incurable. The question today is not whether Medicare,
which serves almost 40 million seniors, should cover prescription
drugs. The answer is, of course, it should. The question is, How do we
go about doing it and when do we do it? That is what the subject of
this debate is all about.
There are some on the Democratic side who make the point with the
Robb amendment today that we should add prescription drugs to Medicare
before we do tax cuts that are excessive. Excessive tax cuts? What is
excessive? One hundred fifty billion over 10 years? How about $25
billion over 10 years? Is that excessive? The point made by many of my
Democratic colleagues is, do prescription drugs before you do excessive
tax cuts.
On the other hand, Republican colleagues take the approach, let's do
prescription drugs but make sure we do reform of the program at the
same time. In other words, don't put the cart before the horse, as so
many of my Republican colleagues have said.
I share the concern that just adding prescription drugs to a program
that last year spent $7 billion more than we took in is certainly not
helping the solvency of the Medicare plan. Does it make people feel
good about adding prescription drugs? Yes? But does it do anything to
fix a program that spent $7 billion more than it took in? It doesn't do
that at all. In fact, it makes it more difficult for the program to
provide the benefits that are necessary for our seniors.
The latest analysis by the Medicare trustees says the program is OK
until the year 2023. Tell that to the nursing homes. Tell them it is
all right that they are being cut and put into bankruptcy and put out
of business. Tell the rural hospitals of America the program is in
great shape, when many of them, in fact, do not get enough money to
stay open and treat the Medicare patients we are talking about. Tell
the home nursing facilities that are going bankrupt and being put out
of business: The program is fine; don't worry.
The truth is, the trustees looked only at Part A. They did not look
at Part B, which is growing at almost 40 percent annually and is
expected to increase even further.
It is absolutely clear that we make a serious mistake if we do one
without the other. As Senator Moynihan, ranking Democrat on the Finance
Committee said:
Medicare reform is the price you must pay for adding
prescription drugs to the program.
That makes a lot of sense. If we do the dessert before we do the
spinach, no one is going to be around to eat the spinach. We are all
going to issue a press release and say: We added prescription drugs;
isn't that a great thing?
It is the right thing to do, if we do it in the context of reforming
the program and taking it out of the 1960s and bringing it into the
21st century.
Some say: Just add more money to the program and we will fix it. I
have drawn the analogy that it is like adding more gasoline to a 1965
automobile. It is still going to run like an old car.
The fundamental problem we have is to reform the program, the
delivery system. We cannot continue to micromanage Medicare with
133,000 pages of regulations, three times more than the IRS, where
every time someone wants to do something differently, they have to come
to Washington and get an act of Congress to add a treatment or to
subtract a treatment.
I conclude by saying, yes, I am for prescription drugs. Yes, we agree
on the amount that needs to be spent. But, yes, we should also do it in
the context of reforming the program.
Mr. REID. Mr. President, I yield 10 minutes to the Senator from
Montana.
The PRESIDING OFFICER. The Senator from Montana.
Mr. BAUCUS. Mr. President, I will make a few points about the budget
resolution.
First of all, I am quite concerned that the budget fails to set the
right priorities. At least when we listen to the American people as to
what their priorities are, this budget resolution before us does not
fit, does not manage.
Once again, this budget resolution emphasizes massive tax cuts at the
expense of most everything else. I don't think that is where most
Americans are. It might not be readily apparent that this budget
resolution emphasizes massive tax cuts. For example, last year's budget
provided for a tax cut of $792 billion. This year's provides for a tax
cut of only $150 billion. So at first glance, one might say the tax cut
this year is a lot less than one-fifth of the one proposed last year
and the one that was rejected last year. But that is only at first
glance. One has to compare not apples with oranges but apples with
apples.
Last year's budget was based on 10-year projections; this year's is
based on 5-year projections. So if you compare apples with apples, by
looking at the 5-year projections, you see that last
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year's budget resolution would have cut taxes by $156 billion, almost
precisely the same as this year's budget resolution. In other words, it
is the same big tax cut, when extended out 10 years as opposed to five.
In fact, 98 percent of the projected on-budget surpluses in this budget
resolution would be used for tax cuts. But the authors of the
resolution fiddled with the accounting periods to make it look a little
bit smaller.
I don't buy it. I think that is wrong. We should assume that a tax
cut that has virtually the same effect over 5 years also would have
virtually the same effect over 10 years. Therefore, it is the same old,
excessive, unpopular, proposal in a new flashy suit, the one the
American people rejected last year. Once they know what is in this
budget resolution, I am sure they will have the same feeling; that is,
not be in favor of it. It is the wrong priority. In other words, this
is a tax cut of about $800 billion over 10 years which will make
impossible other popular American priorities.
Don't get me wrong. I believe there is room for a reasonable tax cut.
I think most Americans think there is room for a reasonable tax cut.
But it should be targeted and it should be one that provides relief to
working families, people who really need the help. The budget
resolution must leave room for other national priorities.
In particular, we must take this wonderful opportunity we have to
reduce the national debt. I don't know how many times we are going to
have this opportunity again. We have it today with a very prosperous
economy and with large projected budget surpluses. We should take
advantage of this opportunity that we have during this year, and the
next couple of years, to dramatically reduce our approximately $7
trillion national debt. That should be a higher priority. It is not a
high priority in this budget resolution.
The budget resolution should also clearly provide for full
prescription drug coverage, as the Robb amendment would do.
Prescription drugs are more effective than ever before in maintaining
health. They are also much more expensive, leaving many seniors with a
choice of either buying groceries or paying for prescriptions.
I have seen it, Mr. President. I have worked at a drugstore, and I
have seen seniors faced with this choice. It is a very unhappy sight.
Our elderly need help now. We have heard comments from Senators who
say, shouldn't prescription drug coverage be folded into general
Medicare reform? Ideally, it should be, but we have to do the best we
can with what we have. I say it is important because seniors need help
now. We can't wait for an abstraction of help in the future. We need it
now. Clearly, we should enact prescription drug benefits this year.
While seniors make up 12 percent of our Nation's population, they
account for only about 30 percent of all prescription drug spending.
Twelve percent of our population are seniors, but they account for 30
percent of all drug spending. And while about a third of seniors lack
drug coverage overall, that number increases to nearly 50 percent in
rural areas. Thirty percent of Americans do not have coverage for
prescription drugs, overall, in America. In rural America, it is closer
to 50 percent.
In Montana, there is very little employer-provided coverage.
Medigap--the program which is insurance coverage to pay for the
difference between Medicare and the cost--coverage is much too
expensive in America, particularly in Montana, and there is no Medicare
managed care in Montana. That is right. Until January of this year, my
State of Montana had only one Medicare HMO, providing quality care and
drug coverage to about 2,600 seniors in Billings, MT. But now that plan
has pulled out, leaving those seniors without a drug benefit. So we
have no managed care Medicare program in Montana because it is too
expensive. We don't have the population to provide it. Our seniors are
being left out in the cold. In my mind, providing seniors with a
prescription drug benefit is a top priority, and it should be part of
this budget resolution.
I also want to make a point about the so-called marriage penalty. I
support the Hutchison amendment. I agree that, as that amendment says,
we should pass legislation which begins to reduce the marriage penalty.
But I would like to add a word of caution.
Listening to some of the debate here, it almost sounds as if the
majority is for marriage and that anyone who questions their proposal
is against marriage. Nothing could be further from the truth. Marriage
is a great institution; I am all for it. It is one of the most
wonderful institutions devised by the human race. But the proposal
before us and the challenge before us is not quite as simple as some
might like it to be. After all, the so-called marriage penalty is not
something that was intentionally cooked up to penalize married people
and reward sinners. Rather, it is an unintended offshoot of some very
difficult, complex decisions that have to be made about our tax system,
such as how to tax individuals compared with married couples, which is
not an easy question to answer, and how to tax married couples who have
a different distribution of income between spouses. Sometimes that is
difficult to do.
We have wrestled with this problem since virtually the inception of
the Tax Code. The current system, which sets the ``break points''--that
is, 15 percent, 21 percent, 28 percent--and the various brackets for
individuals at about 60 percent of those for couples filing joint
returns, was established in 1969 in the tax reform bill signed by
President Nixon. So the basic concept we have was enacted in 1969,
again, and signed in by President Nixon.
It was set in response to a very legitimate concern at that time.
That concern was that previous rates were unfair to individuals. So the
current system, where we have to correct the mistake that was biased
against individuals, now is the one we are dealing with to make sure
marrieds are treated fairly as well.
There is no easy, pat solution to this problem that doesn't create
additional problems. For example, it is mathematically impossible to
have a neutral marriage tax--or it is neutral to all married couples if
at the same time we want a progressive tax system--and we do--and if at
the same time we want all married couples who have the same total
married income to be taxed equally, as we do. It is mathematically
impossible to accomplish those objectives altogether. I could insert
proof of that into the Record. That is to say, when you try to adjust
the rates, you are going to cause inequities elsewhere, as to what the
taxes might be on marrieds versus individuals. It is not an easy thing
to do.
In fact, the bill reported by the Finance Committee does not
eliminate the marriage penalty; it merely reduces the penalty. At the
same time, over half of the total relief the bill reported out by the
Finance Committee goes to married couples who don't pay any marriage
penalty today whatsoever.
This bill is somewhat a marriage penalty relief bill, but the
Democratic alternative proposed by the Finance Committee, particularly
by our ranking member, Senator Moynihan, is a better approach. Why?
First of all, it is less costly and much more targeted. It targets
every dollar to the couples who actually are facing a marriage penalty.
In other words, it is more targeted, in my judgment, and more
responsible.
The PRESIDING OFFICER. The Senator's time has expired.
Mr. BAUCUS. Might I have 1 more minute?
Mr. LAUTENBERG. The time is already allocated. I am sorry. We owe our
friends on the other side a couple minutes.
Mr. BAUCUS. Apropos the discussion we just had about 15 minutes ago.
Mr. LAUTENBERG. We had a good advantage of time here, so if the
Senator might wrap it up.
Mr. BAUCUS. How about 30 seconds?
Mr. LAUTENBERG. OK.
Mr. BAUCUS. To sum up, the budget resolution before us does not
reflect the priorities of the American people. That is clear. The
American people do not want 98 percent of the surplus to be allocated
to tax cuts. I daresay the majority of Americans want a large part of
it targeted to debt relief, paying off the national debt, something
targeted for a marriage penalty, something targeted for prescription
drugs, and just to do things right, not make a political statement.
I thank my colleagues and yield the floor.
[[Page S2153]]
Mr. LAUTENBERG. Mr. President, I yield 4\1/2\ minutes to the Senator
from Oregon.
The PRESIDING OFFICER. The Senator from Oregon is recognized.
Mr. WYDEN. Mr. President, budgets aren't just about charts and graphs
and cold figures on a sheet of paper. Budgets are about the hopes and
aspirations of the American people and our core values. In my view, if
the Senate passes the Robb amendment this morning, it will send a
message to the millions of senior citizens and families across this
country that their hope of prescription drug coverage under Medicare is
a priority for the Senate.
If the Senate passes the Robb amendment, it will be a chance to build
on the progress that was made on the prescription drug issue in the
Budget Committee. I particularly thank my colleagues, Senator Snowe and
Senator Smith. In the Budget Committee, we were able to lock in a hard
figure of $40 billion to start this prescription drug program.
Just as important, in the Budget Committee, there is a stipulation
that if the Finance Committee doesn't act on the prescription drug
issue on or about September 1 of this year, it is possible for any
Member of this Senate, without points of order, to come directly to the
floor. So we have been able to register our commitment behind the
urgency of prescription drug coverage for older people.
The Robb amendment recognizes that the revolution in modern health
care has bypassed the Medicare program. Every major private sector
player in the health care field understands that pharmaceuticals are
essential because they help to keep people well. Medicare Part A, on
the other hand, will pay thousands of dollars for senior citizens'
hospital bills, but Medicare Part B will not pay for outpatient
prescription drug coverage to help older people stay well.
So that is why this is so important to the American people, and the
Robb amendment says to all of those senior citizens who are breaking
their pills in half because they can't afford their medicine or taking
two pills when they ought to be taking three, who ought to be taking a
drug such as Lipitor to deal with cholesterol and blood pressure and
can't afford it, we have heard that, we understand how important this
coverage is to older people.
If we pass the Robb amendment, it will not be possible for Members of
this body to get to the end of the session and then say, gee, there
just wasn't time to deal with this issue that is so important to
seniors and families.
This amendment is critical to the hopes and aspirations of the
American people. They are asking that prescription drug coverage be
added to this program.
I yield the floor.
Ms. MIKULSKI. Mr. President, I rise on an issue of critical
importance to seniors in Maryland and across the United States. That
issue is the need for Medicare coverage of prescription drugs.
``Honor your father and mother'' is not only a good commandment to
live by, it is a good public policy to govern by. It should be a
priority not only in the federal law books, but in the federal
checkbook. And I believe that providing a Medicare drug benefit is a
perfect way of honoring our fathers and mothers. That is why I'm proud
to stand in support of Senator Robb's amendment, which says that a
Medicare drug benefit is more important than tax cuts.
The Medicare Program has been a tremendous success story. It has
reduced poverty among the elderly by almost two-thirds since it was
created in 1965. But the world has changed in the last 35 years. In
1965, people feared the costs of hospitalization. One major illness,
which years ago often resulted in a hospital stay of several weeks or
even months, could bankrupt many families. Today, people fear the costs
of chronic care. They need help with the costs of prescription drugs
that control chronic conditions and keep people out of the hospital.
Many of these life-saving medicines are the result of American medical
science and breakthroughs made in this country. I feel very strongly
that all Americans should have access to those breakthroughs. We must
act now to ensure that they do.
In my home state of Maryland, almost 560,000 seniors rely on
Medicare. That number is likely to increase to more than 1 million
people by the year 2025. Unfortunately, 3 in every 4 of those seniors
does not have decent, dependable private sector drug coverage today. At
least one-third don't have any drug coverage at all, and their options
for getting coverage are limited. Joining a Medicare HMO is an option
for some, but not for seniors in the 17 rural counties of my state. And
the other alternative, which is buying a Medigap policy, is expensive.
The monthly premium for a policy with drug benefits averages about $136
nationwide, which means that Medigap policies are out of reach for
many.
One of the most important things I do as a United States Senator is
listen to the people and the stories of their lives. And the problems
people are having getting the drugs they need is something I've heard a
lot about lately. In the last 6 months, I've gotten more than 200
letters and literally thousands of telephone calls from seniors and
their families about the hardships that the high cost of prescription
drugs and lack of insurance coverage are causing them. For example, an
84 year old woman from the Eastern Shore who is blind and has diabetes
told me that she takes 11 medicines every day and is spending $275 of
her $800 monthly income on prescription drugs. The son of a 91 year old
woman wrote me to say that his mother spends one-third of her income on
her medications, and often takes her daily medicine every other day to
make it last longer. This is simply unacceptable. Prescription
medicines are now an essential part of modern medicine, and are an
essential thread that must be woven into the safety net for seniors.
Thanks to the leadership of Senator Daschle, Senate Democrats have
come together to agree on basic principles that should serve as a
blueprint for action. We have agreed that a Medicare drug benefit
should be:
1. Voluntary: Medicare beneficiaries who now have dependable,
affordable prescription drug coverage should be able to stick with what
they've got.
2. Accessible: A hallmark of Medicare is that all beneficiaries have
access to dependable health care. The same should hold true of a
prescription drug benefit.
3. Meaningful: A Medicare drug benefit should make a difference in
the lives of seniors by helping protect them from excessive out-of-
pocket costs.
4. Affordable: The benefit should be affordable both for
beneficiaries and for the Medicare program. Medicare should contribute
enough toward the prescription drug premium to make it affordable and
attractive for all beneficiaries and to ensure the viability of the
benefit. Low-income beneficiaries should receive extra help with
prescription drug premiums and cost sharing.
This amendment simply says that we must provide a Medicare
prescription drug benefit before we provide tax cuts. And I think that
shows that we've got our priorities in the right order. The
constituents who have written and called me to ask why they or their
parents can't get the medicines they need don't want to hear about a
tax cut. They want to hear that Medicare covers prescription drugs.
That's why I will continue to fight to make access to prescription
medicines a reality for seniors in Maryland and across the nation, and
why I urge my colleagues to join me in support of Senator Robb's
amendment. Thank you.
Mr. SARBANES. Mr. President, I rise in support of the pending Robb
amendment to prevent the Majority from spending almost all of the non-
Social Security surplus on tax breaks instead of prescription drug
coverage for senior citizens.
Ensuring that older Americans have access to prescription drugs
should be one of our top priorities, but the Majority is clearly more
interested in enacting deep and unwarranted tax cuts. The Majority's FY
2001 Budget Resolution includes a deadline for consideration of their
tax cut plan, but no date is set for establishing a prescription drug
benefit. With this amendment, we would clarify that funding a
prescription drug benefit for Medicare beneficiaries will be given a
higher priority than tax cuts that primarily benefit the wealthy.
Prescription medication is now essential to quality medical care, but
many senior citizens cannot afford the
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medicine they need because Medicare does not cover the cost of
prescription drugs. When Medicare was created, it was modeled after a
health care delivery system focused on inpatient hospital care. Today,
drugs are as important as a hospital bed was in 1965, but over 13
million seniors have absolutely no assistance covering the cost of
prescription medication. Medicare must be updated to include a
prescription drug benefit.
Seniors need prescription drug coverage more than the average citizen
because they generally live on fixed incomes and suffer from chronic
diseases requiring drug therapy. To make matters worse, the cost of
prescription drugs has been rising dramatically over the past few
years. In addition, older Americans without any prescription drug
coverage pay significantly more than HMOs, insurance companies, Federal
health programs, and other favored customers for the same
pharmaceuticals.
Currently, seniors can obtain some coverage for drugs by joining
Medicare HMOs. But, these HMOs are not available in many parts of the
country, particularly in the rural areas. Moreover, Medicare HMOs are
sharply cutting back on the drug benefits they offer.
Medicare beneficiaries may also purchase drug coverage through
Medigap insurance policies. However, these plans are extremely
expensive and generally provide inadequate coverage. In addition, for
most Medigap plans, the premiums substantially increase with age. Thus,
just as beneficiaries need drug coverage the most and are least able to
afford it, this drug coverage is priced out of reach. This cost burden
particularly affects women who make up 73 percent of people over age
85.
Employer-sponsored retiree health plans generally offer adequate drug
coverage. However, only about one quarter of Medicare beneficiaries
have access to such plans. In addition, health care coverage for
retirees is declining dramatically. According to a recent study, only
23 percent of Maryland firms now offer retiree health insurance.
During the Budget Committee's mark-up of the Majority's budget
resolution, I supported an amendment to make $40 billion available for
a prescription drug benefit. This amendment, which was adopted, will
hopefully inspire action on this issue during the remaining months of
this Congress. But, in the meantime, we must ensure that there will be
funds available for this benefit by preventing the Majority's
unreasonable tax cut plan from consuming the entire on-budget surplus
first.
I urge my colleagues to take this opportunity to address one of the
most widespread problems facing older Americans today by guaranteeing
our seniors access to prescription medications instead of squandering
the on-budget surplus on excessive tax cuts.
Mr. ROCKEFELLER. Mr. President, I rise in strong support of Senator
Robb's amendment to insist that tax cuts do not take priority over
ensuring that tens of millions of seniors receive affordable outpatient
prescription drug coverage.
This is a commonsense amendment about priorities. If we have hundreds
of billions of dollars in the next several years to spend on tax
reductions that will primarily benefit the wealthiest Americans--and
that's what my Republican colleagues are saying when they voted for
$250 billion over 5 years in tax cuts for some married people just last
week--then we should certainly enact a meaningful Medicare out-patient
drug benefit first. It's important to note that when it comes to tax
cuts for married people, the Republican proposal doesn't even focus on
eliminating the marriage penalty, but rather, gives large bonuses to
only certain upper-income married couples. The cost of the Senate
Finance marriage bonus proposal explodes in the out years. And yet,
when it comes to finding a way to offer Medicare beneficiaries a
prescription drug benefit there are all kinds of ifs and conditions.
Senator Robb is right to say let's do first things first. I urge my
colleagues to vote for his amendment that makes a statement about our
order of priority. I know too many West Virginia seniors who too
frequently go without food, or heat, or other necessities because they
are forced to make the terrible choice between the drugs they need and
other necessities of life. This is just plain wrong. We should provide
all Medicare beneficiaries with a health care benefit that meets their
needs. It is ludicrous that the Medicare program doesn't currently
offer this critical component of health care today. We should change
that, and we have the resources to do it this year. We have the
resources if we don't fritter them away by picking favored
constituencies for special tax breaks.
Let's look at the facts about how the Republican budget treats tax
cuts and how it treats the real hope of many Americans that we will
find a way to provide a Medicare outpatient prescription drug benefit.
The Republican budget's statement of purpose is to provide $150 billion
in tax cuts over 5 years. It provides the money to the Senate Finance
Committee to do it. It is a certainty. It will have the protection of
reconciliation.
The Republican budget resolution on Medicare prescription drugs does
nothing more than suspend existing budget rules to allow for a Medicare
drug benefit should the Senate meet its moral responsibility to provide
one. It doesn't say do it. It says you can do it. It includes only a
$20 billion placeholder to finance a drug benefit. Most people agree
that won't be sufficient to offer a decent drug benefit to all Medicare
beneficiaries. Moreover, the Republican budget resolution puts a 3-year
time limit on a possible Medicare drug benefit--with absolutely no
guarantee that the benefit would be continued after 2005. The
Republican budget resolution also conditions 2004 and 2005 funding of a
possible Medicare drug benefit on Medicare reform. Congress clearly has
not reached any consensus on how to approach Medicare reform.
Mr. President, we have a unique window of opportunity to do something
good for millions of seniors and disabled Americans. I strongly urge my
colleagues to do what is right and vote for the Robb amendment to
provide prescription drug coverage to Medicare.
Mr. LAUTENBERG. Mr. President, I support the Robb second-degree
amendment to help ensure that Congress acts this year to provide a real
prescription drug benefit for seniors.
Mr. President, prescription drugs are a vital part of health care in
this country. In fact, senior citizens spend more of their own money on
prescription drugs than on any other health care item. If Medicare were
enacted today, it would be unthinkable to create a benefit package that
did not include prescription drugs.
The resolution before us claims to provide $40 billion for a drug
benefit through a reserve fund for Medicare. But there are no
reconciliation instructions to make sure that the Congress actually
acts--unlike the tax breaks, which the Finance Committee is required to
produce.
Mr. President, this amendment ensures that Congress really will act
on prescription drugs, by requiring that such legislation be enacted
before we take up any tax cut. This makes sure that we keep our
priorities straight. And that we won't give tax breaks for the wealthy
a higher priority than life-saving drugs for seniors.
Why is it so important that we move on prescription drug legislation
this year? Unfortunately, three of every four Medicare beneficiaries
lack decent, dependable coverage for prescription drugs. At least a
third of those people have no drug coverage at all.
And we're not talking about wealthy people here. Fifty-four percent
of the people on Medicare without drug coverage earn about $17,000 a
year. Most of those people can't afford to pay the high premiums for
Medigap coverage.
We just can't justify a health care system that forces elderly
Americans to choose between paying for food and paying for medicine.
And that's what's happening today.
Unfortunately, Congress thus far has failed to act to address the
need for prescription drugs. And I'm afraid that if we don't force the
issue forward, it will continue to languish.
Mr. President, let me be clear. I support targeted tax cuts focused
on the real needs of middle class families. But I'm not for moving
forward use drain projected surpluses until we've provided seniors with
the drugs that could preserve their health, or even save their lives.
In my view, before we approve any of these tax cuts, we should do
first
[[Page S2155]]
things first, and pass legislation to provide prescription drugs to
seniors. It's simply a question of priorities.
So, Mr. President, I congratulate my colleague, Senator Robb, for his
leadership on this issue, and I urge support of his amendment.
The PRESIDING OFFICER. The Senator from New Jersey.
Mr. LAUTENBERG. Mr. President, parliamentary inquiry: How much time
remains?
The PRESIDING OFFICER. Four and one-half minutes.
Mr. LAUTENBERG. I will take a minute and a half, and then yield to my
colleague on the Republican side.
Very simply, I fully support this Robb second-degree amendment. We
want to be sure that Congress acts this year to provide a real
prescription drug benefit for seniors. Senator Robb offered an
amendment that very specifically does that. The only problem we have
that I am concerned about is there are no reconciliation instructions.
That doesn't ensure that Congress will act to put this very important
benefit in place.
Having graduated to that status of senior citizen, I can tell you
this: When I talk to people in that group, the most important and
worrisome thing they have in front of them is whether or not they are
going to be able to afford the drugs, not only to keep them healthy but
also to provide a decent lifestyle.
I commend the Senator from Virginia for having developed this
amendment because he knows this is the most critical issue right now
affecting the senior citizens beyond having to preserve Social Security
and Medicare.
I yield the time remaining to my friend from New Mexico.
The PRESIDING OFFICER. The Senator from New Mexico.
Mr. DOMENICI. I thank Senator Lautenberg. I yield myself 2 minutes
and yield the remainder of the time to the Senator from Texas. We have
3\1/2\ minutes. Is that correct?
The PRESIDING OFFICER. The only time left is under the control of----
Mr. DOMENICI. He yielded his time. What is the ruling of the Chair?
Do we have time or not?
The PRESIDING OFFICER. The Senator from New Jersey has yielded to the
Senator from New Mexico.
Mr. DOMENICI. Mr. President, I will be very brief.
This amendment has very little to do with Medicare. The budget
resolution takes care of Medicare, thanks to a bipartisan
understanding.
I call to the attention of millions of newly married couples and all
of the married couples who are filing tax returns this year that this
amendment says you can't have the marriage tax penalty that Senator
Hutchison recommends on the floor of the Senate, for the adoption of
this amendment in the name of not having any tax cuts knocks out the
marriage tax penalty provision. I don't think that is what Americans
want.
Speaking about what Americans want, they want us to get rid of the
marriage tax penalty and get rid of it quick. If you adopt this
amendment, that is gone. All of Senator Hutchison's work in trying to
get us to vote on this is out the window because we will have decided
that is not in order. The Senator's amendment will not be in order.
Reconciliation cannot include her marriage tax penalty. That is the
issue.
I believe the Senate will overwhelmingly support Senator Hutchison
and deny Senator Robb because there is already Medicare in this budget
resolution--$40 billion worth. Democrats crowed on how good it is and
all of a sudden went to the White House and invented a new thing.
We have taken care of Medicare in this budget resolution.
I yield the remainder of my time to the Senator from Texas.
The PRESIDING OFFICER. The Senator from Texas.
Mrs. HUTCHISON. Mr. President, the Senator from New Mexico is
absolutely right. We are going to take care of Medicare. We are going
to have reform that includes prescription drugs of some kind. But we
are saying a good idea is in the wrong place, and it is going to
absolutely eliminate the ability for us to correct a huge inequity in
the Tax Code. This is not a tax cut. It is a tax correction. Twenty-one
million American couples pay an average of $1,400 extra just because
they got married. A policeman and a schoolteacher get married and owe
$1,000 more in taxes. This is wrong.
We must go on record saying that we are not going to tolerate it for
one more minute. The Robb amendment eliminates our ability to do that.
We cannot allow the Robb amendment to vitiate all the efforts that we
have made to correct the marriage penalty tax in this country. We will
deal with prescription drugs. We will deal with Medicare. We are
committed to doing that, and we are committed to doing it in this
budget.
Thank you, Mr. President.
I urge rejection of the Robb amendment and the passage of the
Hutchison-Ashcroft amendment.
The PRESIDING OFFICER. The Senator from New Mexico.
Mr. DOMENICI. Mr. President, the Robb amendment is not germane to the
provisions of the budget resolution. I therefore raise a point of order
against the amendment under section 305 (b)(2) of the Budget Act.
The PRESIDING OFFICER. The Senator from Virginia.
Mr. ROBB. Mr. President, pursuant to section 904 of the Congressional
Budget Act of 1974, I move to waive the applicable sections of that act
for the pending amendment, and ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There is a sufficient second.
The question is on agreeing to the motion to waive the Congressional
Budget Act in relation to amendment No. 2915 to amendment No. 2914. The
clerk will call the roll.
The assistant legislative clerk called the roll.
The PRESIDING OFFICER (Mr. Hutchinson). Are there any other Senators
in the Chamber who desire to vote?
The yeas and nays resulted--yeas 51, nays 49, as follows:
[Rollcall Vote No. 52 Leg.]
YEAS--51
Abraham
Akaka
Baucus
Bayh
Biden
Bingaman
Boxer
Breaux
Bryan
Burns
Byrd
Chafee, L.
Cleland
Conrad
Daschle
DeWine
Dodd
Dorgan
Durbin
Edwards
Feingold
Feinstein
Fitzgerald
Graham
Harkin
Hollings
Inouye
Johnson
Kennedy
Kerrey
Kerry
Kohl
Landrieu
Lautenberg
Leahy
Levin
Lieberman
Lincoln
Mikulski
Moynihan
Murray
Reed
Reid
Robb
Rockefeller
Sarbanes
Schumer
Specter
Torricelli
Wellstone
Wyden
NAYS--49
Allard
Ashcroft
Bennett
Bond
Brownback
Bunning
Campbell
Cochran
Collins
Coverdell
Craig
Crapo
Domenici
Enzi
Frist
Gorton
Gramm
Grams
Grassley
Gregg
Hagel
Hatch
Helms
Hutchinson
Hutchison
Inhofe
Jeffords
Kyl
Lott
Lugar
Mack
McCain
McConnell
Murkowski
Nickles
Roberts
Roth
Santorum
Sessions
Shelby
Smith (NH)
Smith (OR)
Snowe
Stevens
Thomas
Thompson
Thurmond
Voinovich
Warner
The PRESIDING OFFICER. On this vote, the yeas are 51, the nays are
49. Three-fifths of the Senators duly chosen and sworn not having voted
in the affirmative, the motion is rejected. The point of order is
sustained, and the amendment falls.
Mr. DOMENICI. Mr. President, I ask unanimous consent that the next
vote in this series be limited to 10 minutes.
The PRESIDING OFFICER. Without objection, it is so ordered.
Vote on Amendment No. 2914
The PRESIDING OFFICER. The question is on agreeing to amendment No.
2914.
Mrs. HUTCHISON. Mr. President, I ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There is a sufficient second. The clerk will call the roll.
The legislative clerk called the roll.
The result was announced--yeas 99, nays 1, as follows:
[Rollcall Vote No. 53 Leg.]
YEAS--99
Abraham
Akaka
Allard
Ashcroft
Baucus
Bayh
Bennett
Biden
Bingaman
Bond
Boxer
Breaux
Brownback
Bryan
Bunning
Burns
Byrd
Campbell
Chafee, L.
Cleland
Cochran
Collins
Conrad
Coverdell
Craig
Crapo
Daschle
DeWine
Dodd
Domenici
[[Page S2156]]
Dorgan
Durbin
Edwards
Enzi
Feingold
Feinstein
Fitzgerald
Frist
Gorton
Graham
Gramm
Grams
Grassley
Gregg
Hagel
Harkin
Hatch
Helms
Hollings
Hutchinson
Hutchison
Inhofe
Inouye
Jeffords
Johnson
Kennedy
Kerrey
Kerry
Kohl
Kyl
Landrieu
Lautenberg
Leahy
Levin
Lieberman
Lincoln
Lott
Lugar
Mack
McCain
McConnell
Mikulski
Moynihan
Murkowski
Murray
Nickles
Reed
Reid
Robb
Roberts
Rockefeller
Roth
Santorum
Sarbanes
Schumer
Sessions
Shelby
Smith (NH)
Smith (OR)
Snowe
Specter
Stevens
Thomas
Thompson
Thurmond
Torricelli
Warner
Wellstone
Wyden
NAYS--1
Voinovich
The amendment (No. 2914) was agreed to.
Mr. DOMENICI. Mr. President, I ask unanimous consent that Senators
Abraham and Levin be recognized as in morning business for up to 10
minutes to discuss a resolution relating to the NCAA tournament and
that that time be counted towards the remaining time on the budget.
The PRESIDING OFFICER. Without objection, it is so ordered.
The Senator from Michigan.
Mr. DOMENICI. Before the Senator proceeds, on the next amendment,
Senator Bingaman's amendment, I ask unanimous consent that the last 2
minutes we have on our hour be reserved out of our overall time on that
amendment.
Mr. DASCHLE. Mr. President, I object.
The PRESIDING OFFICER. Objection is heard.
The Senator from Michigan.
____________________