[Congressional Record Volume 146, Number 104 (Friday, September 8, 2000)]
[Senate]
[Pages S8245-S8247]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                  MEDICARE PRESCRIPTION DRUG COVERAGE

  Mr. KENNEDY. Mr. President, senior citizens need a drug benefit under 
Medicare. They've earned it by a lifetime of hard work, and they 
deserve it. It is time for Congress to enact it. The clock is running 
out on this Congress, but it is not too late for the House and Senate 
to act.
  Al Gore and George Bush have proposed vastly different responses to 
this challenge. The Gore plan provides a solid benefit under existing 
Medicare. The Bush plan, by contrast, cannot pass the truth in labeling 
test. His plan is not Medicare--and it is not adequate. It is too 
little, too late. It puts senior citizens needing prescription drug 
coverage at the mercy of unreliable HMOs.
  And it is part of a proposal to privatize Medicare that will raise 
premiums and force the most vulnerable elderly to give up their family 
physician and join HMOs.
  Senior citizens need help now. Al Gore's plan provides prescription 
drug coverage under Medicare for every senior citizen in 2002--the 
earliest date such a program could realistically be implemented.
  Under the Bush plan, there is no Medicare coverage of prescription 
drugs for four years. Instead, Governor Bush proposes a block grant to 
states for low-income seniors only. Less than one-third of seniors 
would even be eligible. Only a minority of those who are eligible would 
participate. Senior citizens want Medicare, not welfare. Al Gore's plan 
recognizes that. George Bush's plan does not.

[[Page S8246]]

  On this chart, we see the differences between the two programs. This 
effectively, in under Vice President Gore, would go to the year 2002--a 
little over a year from where we are now. Under the Bush program, 
effectively it will go in 4 years after enactment. It would be a block 
grant that would go to the States to deal with those neediest among our 
poor. But it would effectively leave out 29 million Medicare 
recipients.
  Under the Gore program, you have guaranteed benefits. What does 
``guaranteed benefits'' mean? That means a senior goes into a doctor's 
office. The doctor says that you need XYZ drug. They could prescribe 
it, and the individual patient is going to be assured of it.
  Under the Bush program, under the HMO, which particular prescription 
drugs are going to be included? Just like it is under the HMO, to make 
a decision on what the premium is going to be, what the copayment is 
going to be, and what the deductible is going to be. There isn't a 
person today, including Governor Bush, who can tell what the benefit 
package would be for a senior under his program. They couldn't tell 
what the deductible, what the premium or what the copay would be. Under 
the Gore program, they could; and it is basically under the Medicare 
system.
  When Governor Bush says it is an ``immediate helping hand,'' that 
really can't pass the truth-in-labeling test. The claim is that it 
would help. The truth is, it is too little for too few.
  Seventy percent of the Medicare beneficiaries--more than 27 million--
would not be eligible for the block grant program.
  Effectively what we are saying is that under the program, 27 million 
will not be eligible under the block grant program. Even fewer would 
participate. Less than 20 percent of the eligible low-income seniors 
currently participate in the State-run Medicare premium assistance 
program, which is known as SLMB. That is where the States are basically 
helping and assisting through Medicare to offset the premiums for the 
lowest income. The States have shown a remarkable lack of interest in 
protecting the low-income seniors, and it is very little too late. They 
will do much better with regard to this program. This is a matter of 
very considerable concern.
  Again, the challenge is this ``immediate helping hand.'' We also say 
this can't pass the truth-in-labeling test. All 50 States must pass 
enabling or modifying legislation. We are going to have a different 
benefit package in each of the States under this particular program. 
Only 16 States currently have any drug insurance program at the 
existing time.
  If you look at the CHIP experience, which was enacted in August of 
1997, when the funding was already available to any of the States that 
went ahead and passed the law, it still took over 2 years for Texas to 
implement the CHIP program. We haven't even gotten the block grant 
money. It will have to be approved by the Congress in the future.
  As Governor Bush has pointed out, many States don't have the 
legislation. They meet biannually, and this will require enabling 
legislation in the States. Beyond that, the Governors have already 
rejected the block grant program. The Governors rejected the State 
block grant program. They did so in February of this year.

       If Congress decides to expand the prescription drug 
     coverage for seniors, it should not shift that 
     responsibility, or its costs, to the States.

  That is exactly what this program does. Here are the Governors, in a 
bipartisan way, indicating that they didn't want to take the new 
administration on and the bureaucracy of trying to administer this 
program. They didn't want the responsibility, and they didn't want to 
have to put out any of the costs as well. It is a very clear indication 
that the Governors are not interested in this program, to have it 
implemented with regard to the States. The Gore plan provides the 
guaranteed benefits. The Bush plan leaves the benefits and premiums up 
to the HMOs.
  We are out on the floor of the Senate trying to get a Patients' Bill 
of Rights up to try to make sure the HMOs are going to be responsive to 
the health care needs of our people in this country and do what is 
necessary for them as identified by the doctors and trained 
professionals. Here we are having a whole new program that is going to 
be effectively administered by the HMOs.
  Under the Gore plan, there is no deductible. The Government pays for 
50 percent, up to $2,000, and rising to $5,000. Premiums are limited to 
the cost of the services--not the profits of the HMOs. The Government 
and beneficiaries each pay half of the premium. There is a $4,000 limit 
on the out-of-pocket costs.
  It seems to me we have this dramatic difference in these approaches 
between the two programs. Under the Gore proposal, this will be a 
prompt help for senior citizens, just 1 year after enactment; under 
Governor Bush's proposal, it will take 4 years after enactment to be 
put in place in the 50 different States, it will rely upon the HMOs, 
and it will take care of less than a third of the needs of our senior 
citizens.
  We have a guaranteed benefit program. They have no guaranteed benefit 
program. We will not hear any Republican able to identify what 
prescription drugs are going to be guaranteed to the seniors of this 
country. Under the Gore proposal, whatever the doctor says is going to 
be necessary will be guaranteed. We have guaranteed access to the 
needed drugs. The doctor decides.
  Mr. President, I think there is a dramatic contrast and difference.
  Look at the cost under the different proposals. We find with a 25-
percent premium payment under the Medicare actuaries, they have 
indicated there will be a rise in the premiums anywhere from 35 to 45 
percent. It was because of those findings, which have been 
substantiated by the Senate Finance Committee, that the basic Gore 
program has indicated there has to be a support of at least 50 percent 
of the premium in order to make sure it will be universal. It is 
voluntary. But with this kind of a 50-percent premium offset, the best 
estimate is, according to the Senate Finance Committee hearings, there 
will be virtually a universal appeal for that. With 25 percent of 
premium, according to the Finance Committee hearings, they believe the 
increase in the cost of the premiums will rise from 35 to 45 percent.
  In conclusion, we have the Federal budget commitment of $253 billion 
under Vice President Gore; it is $158 billion under Governor Bush. The 
Federal contribution to beneficiary premiums is 50 percent under Vice 
President Gore; under Bush, it is 25 percent.
  I say to the editorial writers, read the Senate Finance Committee and 
the House Ways and Means Committee. Find out, in the questions and 
answers at those hearings, whether anyone believes with a 25-percent 
offset in premium--without knowing what the premium is going to be, 
because the premium is going to be established by the HMO--whether the 
overall costs in terms of prescription drugs is not going to increase 
anywhere from 35 to 42 percent. The proportion of our seniors 
participating in the drug coverage is virtually 100 percent; in the 
Bush program, less than half.
  I think it is important to have an understanding of what is before 
the Congress in the Senate. We still have time to take action. We are 
interested in taking action. We ought to be able to develop a 
bipartisan effort to try to deal with the principal concerns of our 
senior citizens. We all know that if Medicare were being passed today 
rather than in 1965, a prescription drug benefit would be included. The 
guarantee in 1965 to our senior citizens was: Work hard, contribute 
into the Medicare system, and your health care needs will be attended 
to. We are not attending to the needs of our senior citizens. Every day 
that goes by without a prescription drug benefit, we are violating that 
commitment to our senior citizens, and that is wrong.
  We have in the last 4\1/2\ weeks the opportunity to take meaningful 
steps to address that critical need for our senior citizens. We should 
not fail them. That is what I think is a fundamental responsibility we 
have in the Senate.

  More than 900,000 senior citizens lost their Medicare under HMOs this 
year. Yes, 900,000 senior citizen lost their Medicare HMO coverage this 
year. Yet that is going to be the pillars on which this program is 
going to be built after 4 years; 934,000 Medicare beneficiaries lost 
their HMO coverage this year. Approximately 30 percent of beneficiaries 
live in areas with no HMOs.
  In vast areas of the country, there are virtually no HMOs at all. We 
have

[[Page S8247]]

seen them leaving in droves, including the States of Connecticut and my 
own State of Massachusetts. It has been true in the State of Maryland. 
There is one HMO left in the State of Maryland. Now we have 30 percent 
of all beneficiaries living in areas with no HMOs.
  Private insurance premiums will increase 10 to 30 percent this year. 
This is the principal concern. In the first 4 years, 29 million senior 
citizen otherwise eligible under Medicare will not be able to 
participate in the Bush program. After that, it will be built upon the 
HMOs without a defined benefit package, without any indication of what 
the premiums, copays, or deductibles are going to be.
  The alternative is a very impressive and significant downpayment in 
the commitment of this country to building on Medicare. I know there 
are many--and probably most--who are opposed to building on Medicare, 
who are against the Medicare system in any event. One doesn't have to 
be a rocket scientist to understand that. But we believe the Medicare 
system has worked and is working. It has to be strengthened, it has to 
be improved. There are many features in terms of health care that it 
doesn't cover. It don't cover the eye care, dental care, or foot care 
that it should. It doesn't do the prescription drug coverage, which is 
life and death. That is the major opening.
  We find under the Bush plan the benefits provided are guaranteed to 
not be adequate. The Bush program allocates $100 billion less to 
prescription drug coverage than the Gore plan over 10 years. The reason 
for this large gap is obvious. The Bush approach allocates too much of 
the surplus to tax breaks for the wealthy, and too little is left to 
help our senior citizens.
  Under the Bush plan, the Government contributes 25 percent of the 
cost of prescription drug premiums--half as much as under the Gore 
program. In the entire history of Medicare, citizens have never been 
asked to pay such a high proportion of the cost of any benefit. They 
have never been asked to pay such a high proportion of the cost of any 
benefit. The nonpartisan Congressional Budget Office has estimated 
under the similar Republican plan passed by the House of 
Representatives, benefits would be so inadequate, costs so high, that 
more than half of the senior citizens who need help the most will not 
be able to participate. Any prescription drug benefit that leaves out 
more than 6 million of our senior citizens who need the protection the 
most is not a serious plan to help senior citizens.
  Perhaps the worst aspect of the Bush plan is that it makes 
prescription drugs available to senior citizens only if they also 
accept the extreme changes in Medicare that would dramatically raise 
premiums for their doctors and hospital bills and coerce the most 
vulnerable seniors to join HMOs. That is not the kind of Medicare 
coverage and it is not the kind of prescription drug benefit the 
American people want.
  Under Bush's vision of Medicare reform, the premiums paid by senior 
citizens for conventional Medicare could increase by as much as 47 
percent in the first year and continue to grow over time, according to 
the nonpartisan Medicare actuaries. The elderly would face an 
unacceptable choice between premiums they can afford and giving up 
their family doctor by joining an HMO.
  Senior citizens already have the right to choose between conventional 
Medicare and private insurance that offers additional benefits. The 
difference between what seniors have today and what George W. Bush is 
proposing is not the difference between choice and bureaucracy, it is 
the difference between choice and coercion, driven by the right-wing 
Republican agenda to undermine Medicare by privatizing it. On this 
ground alone it deserves rejection. We don't have to destroy Medicare 
in order to save it.

  There is still time this year for Congress to enact a genuine 
prescription drug benefit under Medicare. Al Gore and the 
administration have presented a strong proposal. Let's work together to 
enact it. The American people are waiting for our answer.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from New Hampshire.

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