[Congressional Record Volume 146, Number 113 (Thursday, September 21, 2000)]
[House]
[Pages H7977-H7983]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
PRESCRIPTION DRUG COVERAGE
The SPEAKER pro tempore. Under the Speaker's announced policy of
January 6, 1999, the gentleman from Pennsylvania (Mr. Greenwood) is
recognized for 60 minutes as the designee of the majority leader.
Mr. GREENWOOD. Mr. Speaker, this evening, several of my colleagues
and I want to talk about prescription drug coverage. I want to talk
about one of the most important issues that this Congress is
deliberating upon and one that we believe there is a solution to and
particularly a bipartisan solution.
I want to begin by reading from a letter that I received from a
constituent of mine, a 70-year-old widow. She actually has some
prescription drug coverage, but it is a $500-per-year limit, and this
is what she writes: ``I am in pain daily, and I cannot correct the
problems because of financial difficulty. I have stopped taking
Prilosec, which cost $285 per month, Zoloft, which costs $100 per
month, Lossomax, which also costs $100 per month, Zanaz, which costs
$100 a month and Zocor, which costs over $100 a month. I need these
drugs filled monthly and simply cannot afford them.
I am also in need of a pain pill, Viox, approximately $89, and I have
not been able to purchase it. I have cried myself to sleep over this
dilemma.''
Mr. Speaker, those words touched my heart when I read that letter,
and that is why I have read it today, and I read it in many places
across this country. My constituent does not care whether Republicans
solve her problem or whether Democrats solve her problem or whether the
Congress solves her problem or whether the President solves her
problem. What she cares about is whether the pain goes away. What she
cares about is whether the glaucoma that is making her eyesight weak is
cured. What she cares about is whether she's depressed.
We have an opportunity now, right now, still this year, to put people
before politics and solve the problem of my constituent, and solve the
problem of elderly women and elderly men and disabled men, women and
children all over this country if we can provide a prescription drug
benefit.
{time} 1515
This House has passed a benefit. I just want to talk about how we got
here. In 1965 the Medicare program was created and it was a milestone
in American history. Prior to that time, if you became elderly and you
lost your health care, you lost your job, you retired. Unless you were
among the fortunate, you really were without and devastating illnesses
shortened life and certainly lessened the quality of life for many of
our elderly.
So the Congress, in 1965, did exactly the right thing, created the
Medicare program, a wonderful thing, a wonderful part of Americana. But
in those days, I do not think they even really gave serious
consideration to creating a prescription drug benefit. Why? Because
prescription drugs were not used nearly as frequently as they are
today, and also because they had just bitten off a pretty big piece, in
terms of the cost and the complexity of the program, to assure
hospitalization care, to assure doctors' visits were going to be paid
for. It was a huge accomplishment.
Now, in the 35 years that ensued between the creation of Medicare in
1965 and today, our constituents have told us, with increasing
frequency, with increasing poignancy, that they are making horrible
decisions between choosing to pay for the prescriptions that their
doctors tell them they must have and putting food on the table; between
taking the three or four pills that they are prescribed per day or
maybe only taking one because they are trying to stretch out their
medicines, which really is not in the interest of their health.
The Congress has not done anything. Congress has not done anything
for 35
[[Page H7978]]
years. Why not? Well, the fundamental reason is because Congress, in
most of those years, was spending money like mad and plunging this
Nation into what seemed like an irreversible dive into debt, adding
hundreds of billions of dollars to the national debt every year to the
point where the public debt was approaching $6 trillion. There was just
no way for Congress to seriously consider adding a new entitlement to
the Medicare program, no matter how important it was, when we did not
have any idea how we were going to pay for what we were already
spending here in Washington.
Well, that has changed now; and since 1995 there has been a big
change in this country. In 1997, we balanced the budget. In 1994, the
Congressional Budget Office predicted that this year, I think that the
deficit, the annual deficit that we would add to the national debt, was
going to be something in excess of I think $240 billion or something
like that. That was the projection. Today, because of the steps that we
took in 1995, in 1996, in 1997, we balanced the budget and, in fact,
this year, in 2000, we do not have a quarter of a trillion dollar
deficit; we have a quarter of a trillion dollar surplus.
Now, we took the next step, this fiscal year, we said and we will not
spend another penny of the Social Security revenues for anything else,
as Congress had done for years and years, except Social Security. We
locked it away, and we still have this surplus. We are paying down the
debt. We have surplus. We have given some tax relief where it was
needed and now we are in position to provide this benefit, and we can
do it.
I have something in my wallet. It is a prescription drug card. I take
a prescription for my cholesterol level, and when I go to the drugstore
to fill out my prescription I take this little card out of my wallet
and I give it to the pharmacist and the pharmacist gives me a
prescription, and I give the pharmacist a few dollars in copay for that
prescription. When my wife needs her prescriptions filled or my
children are sick, we do the same thing. I am a fortunate man. My
family is fortunate.
But every American in this country needs to have one of these. Every
American, particularly the elderly, I mean I have one prescription, but
my 70-year-old widowed constituent has numerous prescriptions,
obviously, and she does not have one of these, except that it is good
for $500 for the whole year. Mine is good all year around. The bill,
the legislation we passed in this House earlier this year, would make
sure every American senior and every disabled Social Security
beneficiary has a card just like this to take to the drugstore to
provide for their drugs. That is what we are going to talk about this
evening.
Mr. Speaker, I am going to next yield the gentleman from Pennsylvania
(Mr. Sherwood), my distinguished colleague.
Mr. SHERWOOD. Mr. Speaker, I am very grateful to my colleague, the
gentleman from Pennsylvania (Mr. Greenwood), for arranging this
opportunity to discuss the importance of making prescription drug
coverage available to all older Americans. I see it as really vital to
the health and well-being of seniors throughout the Commonwealth of
Pennsylvania and all across the country, and that is why I voted for
the Medicare Prescription 2000 Act, H.R. 4680 when it passed the House
in June of this year.
In Pennsylvania, we are very fortunate to have the PACE program and
the PACE Net program, which is available for low-income seniors. I am a
strong supporter of the PACE program, which was enacted in 1984 by the
Pennsylvania legislature and is administered by the Department of
Aging. I know just how vital the PACE program is to those Pennsylvania
seniors who qualify, but I also recognize that there are many
individuals who have exorbitant prescription drug bills and limited
incomes and are not covered by PACE.
For that reason, I supported H.R. 4680, which helps States with
pharmacy assistance programs and allows them to expand coverage to more
seniors.
For instance, PACE today, the State pays $205 million for people of
low income. Then the State has $131 million annually for low- to
moderate-income people. Now, PACE tomorrow, with the addition of the
money for our prescription bill, would mean that the Federal Government
would pay that $205 million that PACE was picking up for Pennsylvania's
poor and low income.
So the State then would have $336 to spend for low- and moderate-
income. So what would happen, the Federal Government would take over
the prescriptions for the very limited-income Pennsylvanians, and the
Pennsylvania program then could be a great help to the middle class.
New Federal subsidies would allow governors to expand popular State
pharmacy assistance programs to the middle class. The Republican
Congress can really take credit for creating these subsidies. The bill
we passed in the House allows States flexibility to take advantage of
these new Federal subsidies.
Speaker Hastert wrote to Governor Ridge to advise him that there
would be a seamless transition to all seniors and the disabled to this
new pharmaceutical assistance program. Our delegation is working
closely with the leadership to assure that all Pennsylvania seniors
have access to affordable, voluntary prescription drug benefit.
All the costs incurred by the PACE program, for those under 135
percent of poverty, would be picked up by the Federal Government under
our new plan. Any costs incurred after $6,000 are picked up by the
Federal Government. States are completely off the hook for the big
expense and the low-income people. For beneficiaries of 135 percent to
150 percent of poverty, there is a partial subsidy and it allows States
like Pennsylvania, New Jersey and Connecticut to greatly expand their
coverage to the middle class.
This new Federal benefit goes into effect in 2003, giving our
governors the time necessary to make any changes to their State
programs. The bipartisan bill transfers financial liability for the
millions of dually eligible beneficiaries from medicaid to Medicare,
giving the governors $22.8 billion, that is billion with a ``B'' in
additional funds to expand drug coverage.
The substitute bill sought to keep prescription drug coverage as a
financial responsibility of the Medicaid program for which States must
fund half the cost. Nothing in our bill 4680 prevents the States from
funding senior access to any pharmacy. This is a cost already incurred
by State pharmacy assistance programs.
My colleagues and I are totally committed to enacting a Medicare
prescription drug benefit program which will allow seniors to take full
advantage of a subsidized plan to hold down drug prices. The folks in
this country that pay the most for a prescription are the ones that go
in and buy it on their own without having the benefit of being in any
plan. So that card that my colleague, the gentleman from Pennsylvania
(Mr. Greenwood), held up a few minutes ago, if we all had access to
that, that means that all prescription drugs to seniors would most
probably be reduced in price from 25 to 40 percent. That, in addition
to these subsidized benefits is real progress for our seniors.
Prescription drugs for seniors is far too an important issue to be
playing partisan politics with. We owe it to our seniors to have a plan
which is voluntary, affordable and available.
My colleagues and I are totally committed, before we go home this
year, to having such a plan enacted.
Mr. GREENWOOD. Mr. Speaker, the gentleman from Pennsylvania (Mr.
Sherwood) has made a really important point here on the floor of the
House with regard to our State of Pennsylvania. If we take the
legislation that we passed and match it to our current program, our
PACE program, which by the way is the best program in the whole
country, there are, I think, 300,000 low-income seniors in Pennsylvania
who receive almost virtually cost free drugs under the PACE program
financed by our lottery, the PACE Net program elevates the standard, so
with some copay even more middle-class Americans, Pennsylvanians, I
should say, get the benefit.
And the legislature, because the State of Pennsylvania also has a
surplus, has just proposed even raising the levels higher to reach into
the middle class. So by the time we take this Federal legislation that
we have passed here and relieve the State of Pennsylvania, our State,
of the burden of the lowest income and then you add all of those new
State dollars and the existing lottery dollars to that, we will have
[[Page H7979]]
virtually cost free or certainly no premiums, no copays, no deductibles
for a very significant portion, well up into the middle class, in
Pennsylvania, and so it makes these benefits completely affordable to
every one of our constituents.
I know that the gentleman from Pennsylvania (Mr. Sherwood) shares
that.
{time} 1530
Mr. Speaker, I yield to the gentleman from Pennsylvania (Mr.
Sherwood).
Mr. SHERWOOD. Mr. Speaker, I think what is so important about H.R.
4680 is that it is a flexible plan so that it fits with what we have in
Pennsylvania. Because as the gentleman said, we have this wonderful
PACE program, when the Federal Government picks up the part of the
program that PACE has handled, then Pennsylvania, as I described
before, has all of this extra money to make PACE a wraparound program
so that it comes up into the middle class.
I have so many constituents that have worked hard all their lives and
they have done everything right, and they own their home, and they have
saved just a little money, and they have their Social Security benefit.
If nothing catastrophic comes along, they can get through their golden
years pretty well. But they all live in fear of a catastrophic illness
or catastrophic prescription drug cost, which would drain down their
resources and lose their nest egg or force them to sell their home to
pay these bills.
This is a program that removes that fear for senior citizens. By
supplementing the PACE program, it takes care of a great deal more of
their prescription costs, and it also puts an absolute cap on the top,
so that no senior should have to worry about losing their home because
of the very high cost of prescription drugs.
The other thing it does is akin to a group purchasing power. As I
said before, people who pay the most are the people who walk up and buy
their pharmaceuticals cold turkey and pay with their own money. Anybody
that is a member of a buying plan buys them at a reduced rate.
We have heard in the discussion that pharmaceuticals sometimes cost
less in other countries than they cost here. That is a very involved
discussion, but we need to pull the costs down here. One way that H.R.
4680 will do that is by the group purchasing power. If we take all
pharmaceutical costs and reduce them by 25 to 40 percent before the
government has to step in and pick up their share, then the
government's money, your money, goes a lot further.
So this plan has some very good points to it. It is voluntary. If one
has a plan through one's former employer or through one's union that is
superior, one does not have to leave it. One can stay with that and not
be charged anything because they voluntarily did not get in the plan.
If this is a better plan than someone has, one can join it. If one is
low-income, it will take care of all of their prescription costs. If
one is middle-income, it will take care of a great many more of them
than they have ever had the opportunity to do before, and it will have
a level above which they have no responsibility.
Mr. Speaker, I think that the merging of our plan and PACE and
PACENET in Pennsylvania would take very good care of our citizens. I am
very proud to be associated with it.
Mr. GREENWOOD. Mr. Speaker, I thank the gentleman. The fact is that
two out of three of our elderly, as the gentleman mentioned, already
have some kind of coverage. Some, as we have mentioned, have coverage
through the PACE program. Others who are so low-income that they
qualify for Medicaid get their drugs through the Medicaid program. Some
have a fee-for-service Medicare program, and then they buy a Medigap
insurance that in many cases provides prescription drugs; and others
have a Medicare HMO, we call it Medicare+Choice, and they get their
Medicare benefits through an HMO and many of those HMOs have been
providing a prescription drug benefit.
The problem, as the gentleman well knows, because he has had me to
his district to visit his district and to discuss this problem and its
solution, the problem is that the Medicare+Choice programs have been
ratcheting back their benefits. They have been providing, they used to
provide relatively generous prescription drug benefits, but they are
pulling back. They are pulling back because they feel that the
Congress, frankly, and the administration has not been providing
sufficient funds to pay for the full health care benefits of today's
seniors in managed care Medicare.
So then the gentleman and I understood that both in my district and
in his district and throughout Pennsylvania and throughout the country,
many of these plans announced, just in July, that they were going to
leave areas.
Mr. SHERWOOD. Mr. Speaker, there is a very serious problem in my
district in northeastern Pennsylvania. It is inequitable. The formula
was set years ago, and then it has grown over the years; and it is now
that the HMO Plus Choice plans in my most rural counties are reimbursed
at the rural national rate, and that is approximately $400 a month, and
in the larger cities, the rate is over $700 a month.
So what it boils down to is that my rural constituents are going to
be denied a benefit under Medicare that people that live in more urban
areas have the benefit of. So this is a basic unfairness in the system.
I have written HCFA, and I have written the President to try and solve
this problem, and my colleague and I have a bill together to try and
solve it, and there are some other bills coming out; but that is very
important that we make sure that problem is solved before we go home by
election time. Because it is basically unfair that a senior that lives
in Bradford County, Pennsylvania, should not be able to get the same
benefit under Medicare that a senior who lives in Philadelphia County
in Pennsylvania, or in Washington, D.C., or Houston, Texas, or Miami,
Florida.
So I have a great many people in my district that receive these
notices. I think there are approximately 30,000 people in my
congressional district that were informed in July that their
Medicare+Choice provider would cease to do business under the plan on
the first of January.
Now, we have asked those Medicare+Choice providers to reconsider, to
wait until we can do something, and I have written to the administrator
of HCFA to ask that that date be moved out so that it can be solved.
But we have to get enough funding to the rural areas that people who
live in rural areas have the same benefits under Medicare as people who
live in urban areas.
Mr. Speaker, it goes back to something that was said earlier. Seniors
do not care whether the Congress solves it or the President solves it,
and they do not care whether it is prescription drug prices or HMO Plus
Choice. It is all health care; it is all health care costs. We need to
continue to work to make health care more available and more affordable
for seniors.
This plan, H.R. 4680, goes a long way towards that. But we will have
to complement that with some legislation like the gentleman's which
will solve or help to solve the flight of the Medicare+Choice
providers.
Mr. GREENWOOD. Mr. Speaker, if I may, the legislation is ours. I
serve on the Subcommittee on Health of the Committee on Commerce, and
it was the gentleman who came to me and said this is a real problem in
my area; this is a real serious matter, and we put our heads together
and we wrote that legislation.
The fact of the matter is, and I do not think the gentleman is even
aware of this, but it is my expectation that on Tuesday of next week,
yours and mine, will be taken up by the Committee on Commerce, by the
full committee, will be part of a comprehensive bill to try to restore
a variety of payments, probably $21 billion into the Medicare program
to help our hospitals, to help our nursing care facilities, to provide
better benefits for home health care, as well as to expand the
likelihood that these HMOs will be able to stay in place and continue
to offer that benefit.
So I am cautiously optimistic. I am actually very optimistic that, as
the gentleman says, we will do that. We recognize the problem in your
area and in mine and throughout the country, and we will hopefully
report that legislation from committee on Tuesday. It will pass this
House of Representatives, it will be signed by the President, and we
will have made a real difference.
[[Page H7980]]
Mr. Speaker, it is my fervent hope that those health insurance plans,
those HMOs that provide the Medicare+Choice benefit all over the
country, once that is done, will be able to reverse the decision that
they made, that they announced in July, because they have to do it in
July, according to law, we require them to make that announcement; but
they will be able to reverse this judgment and continue to provide
service, good quality health care for our seniors in the gentleman's
district and mine.
Mr. SHERWOOD. Mr. Speaker, that is very good news, and I thank the
gentleman for continuing to work that bill with the Committee on
Commerce, because I have made the pledge to my seniors that I will do
everything in my power to get the HMO plus choice providers to stay in
our area.
That is one of the big problems. Health care in rural areas is short
of money, short of resources; and I have worked with local hospitals to
fund the blend and to do all of the things that they need to do to
remain viable, that is, to keep our medical institutions strong. This
bill would help keep a service to our older Americans that live in
rural areas that they deserve. I think we will have to be flexible in
that, and we will have to make sure that there are enough resources
there that the program works.
Mr. Speaker, I think there has been nothing since I came to Congress
that has been as hard for me to get my arms around as health care has
been. Being a businessperson all of my life, I always thought that I
could understand any program and put it together very quickly. Well,
our health care system is very, very complicated. The rules that
administer it under HCFA have grown over a period of time, and some of
them need changing. This is one that certainly needs changing, and I
thank the gentleman for his efforts; and we will be glad to push that
bill through.
Mr. GREENWOOD. Mr. Speaker, I thank the gentleman from Pennsylvania
for participating in this special order this afternoon and for all of
his hard work on behalf of his seniors in his district. He must be
known for that one thing in his district, because he sure talks about
it here in the whole of the House.
We are joined tonight by another of our colleagues who wants to
participate, fortunately, in our special order, the gentleman from
Tennessee (Mr. Bryant). And I yield to him at this time.
Mr. BRYANT. Mr. Speaker, I thank the gentleman from Pennsylvania who
certainly has taken the lead in this very important legislation in the
House and has been there from day one to get it started and to
participate and lead us down the road, and as we pass this bipartisan
bill out of the House, has been a consistent proponent of it, a
spokesman, a worthy advocate of this bill. Certainly the background and
the experience he brings to this House on this issue and coming from a
State like Pennsylvania, which has an outstanding program, certainly
cannot be lessened in any degree and must certainly be valued.
Several months ago, the gentleman from Illinois (Mr. Hastert), the
Speaker of the House, appointed a task force of House Republicans to
study this issue of prescription drugs and Medicare. Along with the
gentleman from Pennsylvania (Mr. Greenwood), I was privileged to serve
on that task force; and we worked very diligently over a long period of
time with the Committee on Ways and Means and the Committee on
Commerce, the two primary committees that have jurisdiction over this
issue, and brought forth under the Speaker's very direct, hands-on
leadership, a bill that ended up being a bipartisan bill in the sense
that it had both Democrat and Republican support. It had more
Republicans than Democrats, quite honestly; but there was support from
both sides of the aisle, although now, that party, the Democrat Party,
has their own separate bill that is very different, that is the
President's, the administration's bill that is very different than
ours; and I will talk about that more in a minute.
But the Speaker's task force was charged with developing a fair and
responsible plan to help seniors and disabled Americans with their drug
expenses. We started with a set of principles that the Speaker gave us.
He wanted a plan that was a voluntary plan, a universal plan that was
available to everyone and affordable, and affordable, to all of the
beneficiaries. He wanted to give seniors meaningful protection, some
real protection and bargaining power, the ability to use the numbers,
the bulk in purchasing, to achieve lower prescription drug prices, and
he wanted to make sure that we preserved and protected all Medicare
benefits that seniors currently have.
Finally, the Speaker wanted an insurance-based, public-private
partnership that set us on a path toward a stronger, a more modern
Medicare, and which would extend the life of the program for my baby
boomer generation, and beyond that even.
{time} 1545
Coming up with a good plan that fits all of these guidelines and
principles that the Speaker laid out was a very tall order. The
bipartisan Medicare Prescription RX 2000 legislation, in my view, does
follow these guidelines, and I believe it is the right approach.
First, our plan provides prescription drug coverage that is
affordable. Seniors in my district and across the State of Tennessee
that I represent have been writing and calling me asking for help with
their high drug costs. We will help more people get prescription drug
coverage at lower cost by creating, through this plan, the power of
group purchasing, group buying, without price fixing and without
government control, something we really, really do not want in this
process.
For the first time, Medicare beneficiaries will no longer have to pay
the highest prices for prescription drugs if we effectively use this
bulk purchasing power. Under this proposal, seniors will have access to
the same discounts that the rest of the insured population presently
enjoys.
An analyst for the Lewin Group concluded after studying this private
market-based insurance policy, they concluded that it could reduce
consumer prescription drug costs by as much as 39 percent, 39 percent.
That is 39 cents on every dollar.
Also, our proposed bipartisan plan strengthens Medicare so that we
can protect seniors against out-of-pocket costs that are very high,
that threaten the beneficiaries' health and their financial security.
In other words, sometimes people have such high drug costs that they
literally, seniors do, literally have to sell their home, they have to
exhaust their lifelong savings to pay these drug costs. This should not
be.
Our plan sets forth a monetary ceiling beyond which Medicare would
come back in and pay 100 percent of the drug cost of these high cost
expenses over that ceiling.
Second, our plan is available to all Medicare beneficiaries. Our
public-private partnership ensures that drug coverage is available to
everybody who needs it, by managing risk and lowering premiums. The
plan calls for the government to share in insuring the sickest seniors,
those that have those extraordinarily high drug costs, thereby making
the risk more manageable for the insurers and lowering the premiums for
every other beneficiary, which is something that will be very
attractive to our senior citizens.
We protect the most vulnerable citizens by providing the 100 percent
Federal assistance for the low-income beneficiaries. In other words,
those seniors that cannot afford to pay these premiums at the lower end
get their premium subsidized 100 percent by the government under our
plan.
Thirdly, our plan is voluntary and provides seniors the right to
choose the coverage that best suits their needs. Beneficiaries would be
able to choose from several competing drug plans. Also, because the
drug benefit is 100 percent voluntary, it preserves the beneficiaries'
right to keep the coverage they already have.
I cannot tell my colleagues how many times I go home and I start
talking about this, this plan, and somebody stands up and says, listen,
I do not want the government taking away the present drug benefit I
have. I am retired. I like the plan I have got. I do not want this one-
shoe-fits-all type government response that you are talking about.
I tell them, well, that is not what we are talking about here. Our
plan is voluntary. If one likes what one has, then one can keep that.
But if one is among
[[Page H7981]]
those 35 percent of American seniors who do not have any drug coverage,
this is certainly a good solution for one.
I could go on and talk about this. I think I have adequately covered
what I wanted to cover about this plan. I could talk about the
President's plan and how it is a good start and it moves us along the
right direction, but it lacks so many of the good parts of our plan,
that our plan is superior. But we believe that if the White House has a
sincere interest in providing a prescription drug benefit to senior
citizens, that they will be willing to begin to work with us and we, as
a Congress, work with them, a commitment that we made a long time ago,
and we can come up with a plan that I think that will be beneficial to
our senior citizens.
But right now I do not think we sense that willingness, or I am not
sure how I would put that, but maybe it is an election year. I do not
know.
Mr. GREENWOOD. Mr. Speaker, it certainly is an election year. I think
the thing some of us find so discouraging is we have a tendency
sometimes to take our eye off the ball and remember that these are real
people out there.
I read a letter from a real constituent who, in her letter, said she
cries herself to sleep because she cannot afford the medicines. That
story is repeated all over this country. The wealthiest country in the
world, the most powerful Nation in history, and we have our
grandmothers who are making these painful decisions, and they are
suffering from arthritis. They are suffering from all kinds of health
problems because they do not have access to these prescriptions.
Now, we did pass a bill. It happens to be the gentleman from
Tennessee (Mr. Bryant) and I are Republicans, but the bill is a
bipartisan bill. It had both bipartisan sponsors as well as both
Republicans and Democrats that voted for it. It is, I believe, the only
comprehensive prescription drug add-on for Medicare that the Congress
has ever passed. It is our bill, and we passed it, and that is
terrific.
Now, we happen to like our plan better than some of the other bills,
and that is what one would expect in a democracy where one has the
lively debate of issues and different points of views and philosophies.
But what troubles me, frankly, is that what tends to happen, because
it is an election year, is people say, well, let us take a look at
their bill and see how many holes we can punch in. Let us take a look
at their bill and see how many holes we can punch in that. Then we can
use it in the campaign and see who gets elected to President over this
issue and see who gets elected the majority in Congress over this issue
and see how many Republicans and Democrats we can knock out of office
over this issue. That is pretty cynical, and it does not do the issue
justice.
I still believe that if President Clinton wants to, that we can sit
down and we can find the common ground and we can split our differences
and we can take the best issues, the best ideas from each side and at
least solve a good portion of this problem in this year and, if we do
not solve it all to everyone's liking this year, to continue that next
year. But we ought not to lose this rare opportunity.
We are finally one Chamber, the House of Representatives has passed
the first bill to provide this prescription drug benefit.
Mr. BRYANT. Mr. Speaker, will the gentleman yield?
Mr. GREENWOOD. I yield to the gentleman from Tennessee.
Mr. BRYANT. Mr. Speaker, let me echo what the gentleman from
Pennsylvania is saying. I was a late baby. My mother is actually 93
years old and will be 94 her next birthday. The medical technology is
great. A couple of years ago, she had a pacemaker put in, I think,
about age 91 or 92, and she is rolling strong again. She has to take
medication as a result of that, and, fortunately, for her, it is not
too expensive, and she can pay for that.
But I think about all those other folks out there who are not as
fortunate as we are as a family that have these kinds of prescription
drug benefits that they really need or even higher costs that they have
to incur and literally in some cases have to pick between paying other
bills and having their medication filled.
As the gentleman from Pennsylvania (Mr. Greenwood) pointed out, this
is the first Congress that has passed this type of bill. Here we are
literally within reach of getting a bill that can help so many people
and yet, unfortunately, it seems like the politics are out there
involved in it. It is going to happen at some point, but it needs to
happen now, this year, and not be politicked to death.
I see the gentleman from North Carolina (Mr. Burr) is here to talk a
little bit about that. He is another expert on that subject. I am going
to quit talking now and yield back to the gentleman from Pennsylvania
(Mr. Greenwood) and thank him for what he is doing today and thank both
of these gentleman for the work they have done on this very worthwhile
project.
Mr. GREENWOOD. Mr. Speaker, I thank the gentleman from Tennessee (Mr.
Bryant) for his contribution and his very great work in the committee.
We are joined now by the gentleman from North Carolina (Mr. Burr),
another colleague of mine from the Subcommittee on Health and
Environment of the Committee on Commerce, who really does work very
hard day and night on this issue.
Mr. Speaker, it is a pleasure to yield to the gentleman from North
Carolina (Mr. Burr).
Mr. BURR of North Carolina. Mr. Speaker, I thank the gentleman from
Pennsylvania (Mr. Greenwood) for yielding to me.
The gentleman and I have done this numerous times. We did it when it
was not popular to get out and talk about the expansion of a benefit.
But because both of us worked 2\1/2\ years on reforming the Food and
Drug Administration, we understood from that process just how many
people in America were relying on the research and development that not
only public entities but private companies were doing.
We understood the great advances we had made in the last 30 years in
this country in treatment of disease, prevention of disease, through
the use of pharmaceuticals that did not exist in the 1960s when we
created Medicare.
It is not hard for me to believe that, when Medicare was created,
Republicans and Democrats, neither one perceived that prescription drug
coverage was a benefit that should be encompassed in it. But we have
also seen through the evolution of Medicare that today the Health Care
Financing Administration is, in fact, the wrong agency for us to look
to to administer a new drug benefit.
I think that is why many of us took on the great challenge of, one,
being the first to talk about expansion of a drug benefit for seniors,
but to, two, do it in a way that addressed what we saw the problems in
the delivery system, that we needed a new entity whose sole job it was
to administer this benefit to the 37 million Americans, those seniors,
the disabled who qualified for Medicare benefits.
It is a shame that it is an election year. If this was not a
Presidential election year, we would have a drug benefit, not only
passed in the House of Representatives, it would be passed in the
Senate, it would be signed today by any President in the White House.
But the sheer realities of the year 2000 is it is a Presidential
election year. The gentleman and I have been faced with that before.
But because it is a Presidential election year, it means that politics
do come into health care.
At a time where we know in America that the senior population over
the next 10 to 15 years will double, will move from 37 million to 72
million seniors in this country, all with the same challenges about how
do I pay for prescription drugs, at a time that the mapping of the
Human Genome project will be finished, we will be able to treat
diseases that were chronic or terminal up to that point, we never had a
cure for, and that in many cases those pharmaceuticals will now give us
the ability to treat and in some cases hopefully cure, but it does no
good if people cannot pay for it.
This is the first real opportunity that we have had to present a plan
that is market based, that subsidizes those most at risk, that is
designed in a way that the majority of seniors would want to
participate out of their pocket to be part of, and for those that
cannot, that they receive a government subsidy; and that it provides
them the choice that they look for in any health care plan that they
might look for when we created Medicare+Choice as
[[Page H7982]]
an option for seniors who had an insurance-based option, many of which
are in Pennsylvania with the gentleman from Pennsylvania (Mr.
Greenwood). We did not limit it to one company. We did not say it could
only be offered by the Federal Government.
The American people have been very specific. One size fits all does
not work in health care. Drug benefits should be no different. We
should supply seniors affordability, choice, access. The sooner we can
do that, the better they can plan for those later years. But, more
importantly, long term, the gentleman from Pennsylvania and I both know
the less expensive health care is going to be to us, because what we
have been treating or what we have been operating on today might just
be a prescription drug in the future.
Heart disease because of high blood pressure is controllable with
pharmaceuticals today. Bypass surgery could be a thing of the past with
a noninvasive procedure or with pharmaceutical treatment in the future.
We will never experience this unless this body, this institution, the
government moves forward with a prescription drug benefit plan that
allows seniors access, choice, and affordability.
Mr. Speaker, I would appreciate the observations of the gentleman
from Pennsylvania (Mr. Greenwood) on that.
{time} 1600
Mr. GREENWOOD. The point that I was thinking about making right now
is that this conversation almost always turns towards the senior
beneficiary of Medicare, and the gentleman has frequently in his
remarks cojoined the fact that there are seniors and there is the
disabled population that in fact are eligible for Social Security. And
what is important to remember, when we think about that disabled
community, that disabled community includes those who have very serious
physical disabilities, frequently because of complicated and
debilitating illnesses; and these are people who are under the age of
65.
We forget about the fact they do not have prescription drug benefits
either. And they are less likely to have prescription drug benefits
coming from a an employer, because they are less likely because of
their disability, obviously, to have worked for an employer long enough
to have had a prescription drug benefit that carries into the years
when they cannot work and they are on disability. So this is another
group of people who certainly need this benefit and they need it soon.
And some of those, a good number of those, their disability is the
result of a mental health issue, and of course the treatment of mental
illness is more and more pharmaceutical. There are more drugs coming on
to the market all of the time that can help with these serious
debilitating mental illnesses and in fact help those folks get back
into the workforce. So our ability to provide a prescription drug
benefit that also provides the benefit to the disabled population as
well as the senior population is an important component of what we did
pass in this House, and I commend the gentleman for remembering to
remember that Medicare applies to the disabled as well as to the
elderly.
Mr. BURR of North Carolina. I know the gentleman from Pennsylvania
remembers that it would have been easier with a limited pot of money to
say let us take care of seniors. Those other ones who might be
ancillary groups, they do not fall into the same category. There was
that strong argument from Members, but also that sense of
responsibility that we had that we cannot leave anybody behind.
This was the most inclusive piece of legislation on prescription
drugs to be debated in this institution ever. The only regret that I
have is that it did not yet move past the House of Representatives;
that we have not had the engagement of our friends at the other end of
Pennsylvania Avenue, who talk about prescription drugs; but we have
done something on prescription drugs.
We have done something that works. It expands the coverage and it
provides the benefit. It means that those seniors who have had to make
crucial decisions between rent and drugs, food and drugs, will not have
to do it because of limited incomes. It means that we have looked at
that disabled population. We have not excluded them. In many cases
seniors have more employment opportunities than those who are in that
disabled category, but we did not leave them behind. We included them
because we knew the importance of medication but, more importantly, the
importance of taking medication on a regular basis; not just when you
can afford it, but on a regular basis. Because we know that those
individuals, more than most, need that regular routine and that they
cannot go with interruption based upon their cash flow, their lack of
work that week, their lack of income that month. That safety net was
provided for them, as it was for seniors.
I cannot imagine another issue that this institution could take up
where we so clearly had enough vision to look down the road and see the
demographic change that was happening, where we knew that the senior
population will, in fact, double; where the institution did not use
that vision to prepare for that future. If we miss this opportunity,
how in the world will we design a benefit program that is right for my
mother and that is affordable for my children when we are talking about
twice as many people and having to learn how to find the right program
then?
The smart thing for us to do, even though the gentleman and I know
that we will not do it this calendar year, is to come back in January,
to reintroduce this bill, and to make a commitment to whoever is on the
other end of Pennsylvania Avenue that we are going to pass it and that
we want to work with them.
Unlike a lot of talk about prescription drugs in this town, for those
of us that have worked on it now since January, we have always said our
door is open; we want to talk. It is just nobody has ever knocked. And
when we have left it open, no one has ever shown up.
Mr. GREENWOOD. If I can reclaim time for a moment, the thing that is
ironic is that, as we have said, in the history of the Congress,
certainly in the last 35-year history of Medicare, it is only the one
bill the gentleman and I helped to author that has passed in the House.
Now, there has been plenty of talk for 35 years from politicians on
the stump running for this House and the Senate and the presidency.
They have all talked about this issue. But when it came to sitting
down, as we did, and saying how would we actually write this; what
would the words be that we would choose to put in the bill; what would
the provisions look like; how would we pay for it; how would it be
flexible; how would we be able to make it affordable to the lower-
income and still be affordable to the taxpayers; how does it reach into
the middle class; how would we take care of the catastrophic end of
things; how do we make sure it is appropriate for the disabled
population as well; how do we make sure that by offering this we do not
create a disincentive for employers to continue to provide the benefit;
how would we do that, we grappled with all of those questions, as the
gentleman knows, and we had to make decisions.
We put those decisions into a document and we said, now, can we get
218 votes out of 435 Members of the House to pass it. That meant we had
to talk to various constituencies within the House to make sure that it
worked in the Northeast, and that it worked in the Southwest, and it
worked in the Southeast and the Northwest, and across the country. We
had to do that. But when we did that, we had a document and, of course,
no good deed going unpunished, we become subject to criticism. Because
now people had an actual document instead of just words, and they could
take that document, and they could look at it, and they could criticize
this aspect or that aspect.
I think that that is what has happened, to a large extent; and I
think that is unfortunate, that having put something together for the
first time in history and getting it to pass the House, that we have
become subject to some criticism about all of that. The hard part for
us is that right now the President does not have a proposal. We do not
have a bill from the President that says on paper, a document that
thick, this is how I would answer all those questions about making sure
that it is affordable and making sure that it meets all of these needs.
We do
[[Page H7983]]
not have that. So we have a real document against just rhetoric, and it
is making for an unbalanced debate.
I think if we can get the Members at the other end of this building,
as well as the gentleman at the other end of Pennsylvania Avenue in the
White House, to in fact give us some documents, we would have the basis
about which we could sit in a room and combine them and merge them and
work out the differences, as we do regularly and is our job.
I yield to the gentleman from North Carolina.
Mr. BURR of North Carolina. As the gentleman from Pennsylvania knows,
it is one thing to talk about catastrophic coverage, which is the
ability to look at the senior population and say the one thing that we
can do is put the Federal Government where it should have been in
health care, the safety net, and assure our seniors that if they ever
spend out of pocket a certain amount of money in a given year that they
will never be exposed for any more than a fixed amount, catastrophic
coverage, a limit. It is one thing to talk about it; it is another
thing to put it on paper and to pass the test of the Congressional
Budget Office or the Office of Management and Budget and have that
number scored. But we did it. We did it and we lived within the
framework of the available money, and we provided a stop loss for
seniors of $6,000.
The President had a bunch of pieces of a plan, and he said he would
like to incorporate stop loss or catastrophic loss, but the fact is
that he could never do it in a way that he could put it on paper and
have that paper scored because of the way he proposed designing the
original plan, which was no choice, which got very little discount from
the current price of pharmaceuticals in the marketplace.
The Congressional Budget Office looked at our approach and said that
because we had competition, because we had provided seniors and the
disabled choice in the plans that they could choose from, we will
achieve at least a 25 percent discount across the board for things that
are insurance-based purchased and for things that are purchased out of
pocket, a 25 percent savings just by creating choice that the
administration does not get with their proposal.
Mr. GREENWOOD. And if I may, that is before we even apply the Federal
contribution to the actual price of the item. So that 75 is cut in
half. And, of course, we pay 100 percent of the remainder for the low-
income and for middle-class folks, a half. So now we are talking about
going from paying 100 percent of retail price to paying 37\1/2\ percent
of retail price. It is almost a two-thirds reduction in the cost of the
pharmaceutical product to the average American.
Mr. BURR of North Carolina. If there existed truth in advertising on
this we would have stars all across this plan because it provides at
every level what seniors want.
Before the gentleman mentioned employers, I had written the word
employers on a piece of paper up here because that was one of the
biggest challenges that our whole task force had. There is a segment of
America, a large percentage of America that are seniors today that are
currently provided prescription drugs as a benefit of their retirement.
As we see prices go up 11 or 12 percent a year, the question we have to
look out and ask is how long will they continue to offer that benefit.
Because they are not obligated to, it is just a commitment that they
made when individuals retired.
We found a way to incorporate into our plan that those employers that
provide that benefit, once those individuals reached that stop-loss
amount, they would be covered under the Federal stop loss, a great
incentive for employers to continue to provide that first dollar
coverage for the millions of seniors that are currently under their
health plans. We found the approach to keep the employer engaged.
We found a way to incorporate the catastrophic or the stop loss into
their plan without dislocating them, which made our plan totally
voluntary to every eligible person regardless of where they currently
had their coverage, if they did. They could stick with that and still
utilize that stop-loss protection of the national plan.
Clearly, we spent a lot of time on that, making sure that we got it
right. But the fact that it was voluntary, the fact that for those that
chose to participate there was choice, the fact that everybody, whether
they were in their employer plan or chose one of the accredited plans
by that new entity that ran the prescription drug benefit, all of them
benefited from an annual stop-loss amount that protected every senior
and made sure that they could not lose everything that they had
accumulated because they had run into a health care problem that
required unusual pharmaceutical costs.
Mr. GREENWOOD. I believe our time has just about elapsed. I want to
thank the gentleman from North Carolina for his participation, as well
as my other colleagues from around the country.
This clearly is, if not the number one issue in America, certainly
ought to be. There is still time to resolve this issue. All we need to
do is to work with the House and the Senate and the President together
and, in fact, we can all be proud of meeting a need that just cries out
to be met; and we think we have made a good start.
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