[Congressional Record Volume 146, Number 122 (Wednesday, October 4, 2000)]
[Senate]
[Pages S9835-S9839]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           PRESCRIPTION DRUGS

  Mr. GRAMS. Mr. President, I come to the floor this evening to talk 
about an issue which has commanded a lot of attention lately in this 
body, an issue which has been a major concern of mine for a long time. 
That is, prescription drug coverage under our Medicare program.
  Prescription drugs, as we all know, are becoming an increasingly 
important, in fact, an essential component of our health care delivery 
system in the United States. Because of their increasing role in the 
improvement of health outcomes, I believe a newly designed Medicare 
would unquestionably include a prescription drug benefit. 
Unfortunately, Medicare is still operating under a 1965 model. Our 
seniors continue to lack this very essential coverage.
  Over a year ago I introduced the Medical Ensuring Prescription Drugs 
for Seniors Act, or MEDS, and this role would provide a prescription 
drug benefit for all Medicare-eligible beneficiaries, and on a 
volunteer basis. My plan would ensure that our neediest

[[Page S9836]]

seniors would get the assistance they need, when they need it, for as 
long as they need it. And MEDS, as most other plans that have been 
introduced in the Senate, is a comprehensive, Medicare-based approach 
and will take a few years to fully implement.
  Though I fully support MEDS and will fight for its passage, I believe 
our seniors need some relief now. To that end, I am supporting Senator 
Roth's bill, which would send Federal funds back to the States today in 
order to establish or improve our prescription drug coverage 
immediately for our seniors and those seniors who need that help and 
coverage now.
  I want to be clear, the only way that Congress will be able to 
address the prescription drug needs of our seniors this year is to pass 
the Roth proposal. We need to do it. Unfortunately, our friends on the 
other side of the aisle disagree with that view. They would rather work 
to push a massive Medicare-based plan which only seems to increase the 
burden on the majority of seniors through increased premiums, reduced 
benefits, and more bureaucracy; in other words, create a bigger and 
bigger government bureaucracy to handle this.
  I believe it is a backdoor tax increase on our seniors, which is both 
irresponsible, and it would be totally unacceptable, especially to 
those who really need the help in the coverage to afford prescriptions.
  The Democratic proposal, which Vice President Al Gore and others 
advocate, is frought with a lot of problems. First, his plan would take 
8 years to be fully implemented--8 years. The Roth bill would go into 
effect today. The Vice President's plan would take 8 years to phase in.
  You don't hear that when they talk about it, do you? But we all know 
that our seniors cannot afford to wait 8 years, especially the neediest 
of our seniors' population, to start realizing a prescription drug 
benefit under our Medicare program.
  This is a part of the plan that often goes unmentioned and one that 
needs to be highlighted. Either have a plan now that is immediate and 
provides help to our seniors today, or pass a plan that costs more, 
reduces benefits, and asks our seniors to wait 8 years to have it fully 
implemented under Medicare.
  The second problem with the proposal is that when it is fully phased 
in, it will put a new tax on our seniors because it asks for premiums 
of $600 a year in new additional premiums over and above what they are 
paying. Above and beyond the fact that many seniors would find that 
$600 to be cost prohibitive, statistics suggest that the average senior 
uses only about $675 in prescription drugs in a year. I am not a 
mathematician by profession, but I can tell you when the proposal only 
covers 50 percent of the costs of the prescription drugs to begin 
with--so, in other words, after paying your $600-a-year premium, you 
have to pay a 50-percent copay on all the drugs you consume, and I 
believe there is also a cap with it--it means that for the additional 
$600 premium, again a new tax on our seniors, the average senior would 
receive at best $37.50 in benefits.

  Considering the enormous financial burden this is going to place on 
an already ailing Medicare system, I am not sure the American people 
are going to want to assume what will inevitably be a new tax liability 
and at the same time risk the collapse of Medicare in order to prop up 
a plan that delivers only pennies a year in prescription drug benefits.
  Because it is a bit politically distasteful, supporters of this plan 
and similar measures fail to mention the cost of these proposals. They 
make it sound as if this is going to provide Medicare prescription drug 
coverage to all seniors at no cost. That is the way they always like to 
present a lot of these plans, that somehow it is free. I don't know of 
many seniors out there who believe they are going to get something for 
nothing. When was the last time they had a free lunch? They know that. 
Our seniors are smarter than that, but yet they are being told these 
are things we can provide free.
  The bill supported by the Vice President and a number of my 
colleagues will cost nearly $250 billion over the next 10 years. Aside 
from having to raid either the Social Security or Medicare trust funds 
to pay for it--and that is how they pay for it. They are going to take 
money from an ailing trust fund and try to shift it into expanding new 
benefits and saying nobody has to pay for it but they are basically 
robbing from Peter to pay Paul and weakening an already weak system.
  An equally troubling fact is that it does nothing to modernize the 
Medicare program at all. It is basically just putting a Band-Aid over 
an old system that has problems; again, trying to bring in a 1965 model 
and adapt it to the year 2000. When the Medicare Commission actually 
made these proposals, President Clinton pulled the plug. He did not 
even consider what this panel was recommending. But thanks to Senators 
Frist and Breaux, they are introducing this plan which makes sense, and 
that is to overhaul, to reform Medicare, and to make sure prescription 
drugs are an important part of that. But the Roth bill would be that 
stopgap in order to provide coverage today for our seniors until we can 
have a real Medicare reform package.
  In the absence of these important reforms, this plan offered by the 
Vice President is nothing more than a prescription for disaster. The 
funding comes out of the Social Security surplus, which, by the way, 
the Vice President claims to wall off for only Social Security and only 
Medicare, but while they are doing that they are trying to expand these 
services and say it is going to cost nothing. It is a free lunch, a 
free ride. Nobody believes that can happen. Especially our seniors know 
that there is no free lunch. Adding new demands on Medicare through the 
Social Security surplus without reforming the program, again, will only 
put Medicare further at risk than what it is today.
  Finally, their proposal provides no flexibility in terms of being 
able to opt in or opt out of their program. Again, our proposal is 
voluntary. If it benefits you, you can get into it. If it doesn't 
benefit you, don't; keep your own coverage as you have it today. But 
you have a choice.

  Again, these big government programs, the first thing they want to 
eliminate is choice for the consumer, and in this case for our seniors. 
You only have one shot under the Vice President's plan to get in and 
that is it. Seniors, as they age into Medicare, need to make a 
determination whether they want to get in and save a few dollars a year 
at best, into a system that is going to cost them at least $600 a year 
in more taxes. If they take it and change their mind, it is simply too 
late; they are stuck. They are either in or they are out.
  I am happy and proud to have been one of the first to introduce a 
prescription drug plan in the Senate, and I am hopeful that by having 
done so, my commitment to this issue and our Nation's seniors is 
underscored. But, most importantly, I want to ensure that any effort we 
undertake in Congress will actually help to provide assistance to those 
who truly need it and provide it sooner rather than later; not with a 
plan where we are going to try to solve the problems for 6 or 10 
percent of the population, but the way they try to solve it is to 
mandate 100 percent of Americans get involved in their big new 
bureaucracy for prescription drugs. Importantly, too, my plan does not 
use the Social Security surplus which I have also secured in a lockbox.
  I reiterate, I believe our seniors deserve a prescription drug plan 
that is truly voluntary, one that will not jeopardize the future of 
Medicare, and one which will not place on the backs of taxpayers any 
additional burdens or liabilities. Instead, I am hopeful the Senate can 
pass legislation immediately returning the money to the States to 
provide relief while strengthening Medicare and implementing the long-
term comprehensive benefit that does not result in a new tax on our 
seniors. We have an historic opportunity to help our Nation's seniors. 
I believe we should act now, this year.
  Mr. President, I yield the floor.
  Mr. GRAHAM. Mr. President, will the Senator yield for a question?
  Mr. GRAMS. Yes.
  Mr. GRAHAM. I say to my colleague, I am concerned that several of 
your criticisms sound to me as if they are really criticisms against 
Medicare, as opposed to the idea of prescription drugs being offered 
through Medicare. For instance, did you just say that you

[[Page S9837]]

felt it was inappropriate that there be a premium charged for the 
prescription medication benefit?
  Mr. GRAMS. To answer the Senator from Florida, I am not opposed to a 
surcharge or a prescription charge but a charge that is going to assume 
a new $600-per-year additional tax or cost on our seniors while 
providing very little in benefit that would overcome that cost.
  Mr. GRAHAM. So you are opposed to the principle of a shared cost 
program between beneficiaries and the Federal Government in delivering 
Medicare; is that correct?
  Mr. GRAMS. That is not true. The Senator from Florida is inaccurate 
because in my own plan, my MEDS program is a copay and also has 
deductibles built in depending on wages or income. It is worked through 
Medicare and through the HCFA program.
  So, no, I do not oppose a shared responsibility or liability but one 
that is a benefit to seniors, and not one that drains their pocketbooks 
for little or no benefit.
  Mr. GRAHAM. No. 1, you understand, of course, that Part B of Medicare 
requires, first, a voluntary election to participate and then, second, 
a monthly premium which today is approximately $45?
  Mr. GRAMS. Correct.
  Mr. GRAHAM. You also understand the Vice President's plan would 
require a second voluntary election to participate in prescription 
drugs, and the monthly fee would be $25, or $300 a year, not $600 a 
year? Is that correct?
  Mr. GRAMS. But his plan is not voluntary. You can voluntarily get in, 
but when you do not get in, you can't reapply. That is my 
understanding.
  Mr. GRAHAM. No. 2, do you understand Part B of Medicare--I am talking 
about Medicare as it existed for 35 years--requires the exact same 
election process as the Vice President's plan would require for 
prescription drugs? He is doing nothing beyond what we have done for 35 
years in Part B of Medicare; that is, the physicians and outpatient 
services. Do you agree with that?
  Mr. GRAMS. My understanding is that in order to be a part of the Vice 
President's plan of receiving prescription drug coverage, one must pay 
a $50 premium per month, or new tax, in order to be involved in the 
system. You have one choice, one chance to get in or you are left out. 
So you are putting pressure on seniors at whatever age. Then, when you 
average in what an average senior consumes today in prescription drugs, 
it is very little if any benefit at all.
  Mr. GRAHAM. No. 1, it is $25 a month or $300 a year. No. 2, it is a 
voluntary election, exactly the same way that you had a voluntary 
election for Part B for 35 years.
  No. 3, you understand that the plan of the Vice President is a 
universal plan like all the rest of Medicare; over 39 million Americans 
who are eligible for Medicare are eligible to make the voluntary 
election to participate in the prescription drug benefit?
  Mr. GRAMS. So you are saying the President's plan, when fully phased 
in, will be only $25 per month or are you talking about the initial 
plan with the coverage available with the caps and coverage?
  Mr. GRAHAM. I am talking about the plan that will be in effect in the 
year 2002 when we adopt this plan. It will be a voluntary plan. It will 
be a plan which will be affordable. It will not only give you the 
benefit of access to 50-percent coverage of your immediate prescription 
medication cost, but it will also give you, after you pay $4,000, a 
stop loss, a catastrophic intercept which says, beyond that point, the 
Federal Government will pay all of your prescription drug bills.
  That is, in my opinion, the most important part of this plan because 
the fear of many seniors, and the thing they see as the potential 
threat to not only their health but their economic security, is that 
they are going to fall into a serious illness where suddenly their 
prescription drug costs are not $20 or $30 a month but are $800 or 
$1,000 a month.
  The Vice President's plan assures that after you have paid $4,000, 
then you will have a stop loss against any further payments. Don't you 
think that is a pretty significant security for America's seniors?
  Mr. GRAMS. I disagree with the Vice President--if I may reclaim my 
time--and I will tell you why. Because, as you said, when it goes into 
effect in 2002, it is not fully implemented for 6 to 8 years. You might 
start off with a low payment, but it escalates to $50-a-month premiums 
fully implemented, and it does provide you have to pay 50 percent, up 
to $4,000.
  To compare that with my MEDS plan, we have a $25 copay per month, 
$300 per year. We do not have a cap for people below 135 percent of 
poverty. So they will get any amount of drugs for $300 a year compared 
to the President's $4,000. For some who are on the edge of poverty, 
they do not have the $4,000, I say to the Senator, to pay for this.
  Mr. GRAHAM. As you understand, all of the plans provide for no 
payment for persons who are above the Medicaid eligibility limit but 
generally below 175 percent of poverty, which means approximately 
$14,000 or $15,000. They would pay no premium. They would pay no 
copayments. They would have no deductibles. For those people, the Vice 
President's plan would be fully available without any charges.
  What we are talking about in both plans is the people who are above 
175 percent of poverty. What percentage subsidization would you provide 
for persons over 175 percent of poverty?
  Mr. GRAMS. Not to belabor this debate, and it is good we are talking 
about it because the American people need to hear it, but over that 
amount of money you are talking about, we would still have a $25 copay, 
the $150 deductible, and then no cap at all on coverage. If you were at 
that income level, you would probably pay, at most, $175 per month for 
the whole year or $175 per month per year.
  Mr. GRAHAM. So you pay $175 a month, is your premium.
  Mr. GRAMS. If you are going to have the $25 copay and $125 a month 
deductible.
  Mr. GRAHAM. If I had been there last night--and I know the rules of 
the first debate precluded having a chart--I would have loved to have 
had a chart and asked Governor Bush to fill in the blanks. Since we do 
not have Governor Bush here but you are advocating the first phase of 
his plan, let me ask you about a few of the blanks on his chart.
  What would be your coverage for persons over 175 percent of poverty? 
What percentage of their prescription drug costs would you cover?
  Mr. GRAMS. I am not here to try to defend or put words in----
  Mr. GRAHAM. I am trying to get the facts.
  Mr. GRAMS. I am trying to defend the plan I have offered, and that is 
my MEDS program.
  Mr. GRAHAM. Let me ask about your plan. For persons over 175 percent 
of poverty, what percentage of the prescription drug expenses would you 
have the plan cover as opposed to that for which the individual would 
be responsible?
  Mr. GRAMS. It would cover 100 percent of everything over a $25 copay 
and a $150-a-month deductible for those who are in that income level or 
above.
  Mr. GRAHAM. So it would be a $150 monthly deductible and a $25 copay?
  Mr. GRAMS. Yes----
  Mr. GRAHAM. Is that copay per prescription filled?
  Mr. GRAMS. For the month, yes.
  Mr. GRAHAM. I thought $150 a month was the deductible. There is a 
copay beyond that?
  Mr. GRAMS. Yes.
  Mr. GRAHAM. How is that calculated?
  Mr. GRAMS. Twenty-five dollars of the prescription.
  Mr. GRAHAM. The plan would pay 25 percent----
  Mr. GRAMS. That is the deductible. The individual would pay 25 
percent of the cost of the prescription, and then if they were at an 
income level you are talking about, it would be a $150 deductible with 
no caps or limits for the year; not the $4,000 you are talking about.
  Mr. GRAHAM. What do you estimate to be the cost of that plan that has 
a $150 deductible and $25 copay?
  Mr. GRAMS. We have tried, but we have not had it scored yet and have 
not been able to get the numbers, but some of the projections we have 
say it will be under $40 billion a year, not the 258 or 253 the Vice 
President is talking about.
  Mr. GRAHAM. How can you offer a more generous plan by having the 
beneficiary pay only 25 percent as opposed

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to the Vice President's 50 percent and yet have such a lower cost?
  Mr. GRAMS. Because what we are trying to do is target those who need 
the help, and that is about 6 or maybe 10 percent of the population. 
What the Vice President is doing and what you are talking about is 
bringing 100 percent of Americans under a new national program where 
the Government is going to be the purchaser and the dispenser of these 
prescriptions. I reject that type of a plan.
  Mr. GRAHAM. Mr. President, I will conclude these questions by going 
back to my first assertion. We are not talking about prescription drugs 
through Medicare; we are talking about an assault against the basic 
principles of Medicare itself. That is a universal program, not a 
program limited by class to only the poor and near poor of America: 
That is a voluntary program. That is a shared cost program between the 
beneficiary and the Federal Government. That is a comprehensive program 
that covers all of the necessary health care for older Americans. And, 
as I believe the Senator stated in his introductory comments, nobody 
would develop Medicare today, in 2000, without having a prescription 
drug benefit.
  When you attack all those principles that are the foundation of 
Medicare, what you are really doing is attacking one of the programs 
which has made the greatest contribution to lifting 39 million 
Americans into levels of respect and security and well-being of any 
program that the Federal Government has ever developed. The American 
people need to hear that this debate is not just about prescription 
drugs; it is about a frontal assault against Medicare. If this 
philosophy prevails, that is where the battleground will be.
  I thank the Chair.
  Mr. GRAMS. Reclaiming my time, not to leave the impression that by 
any means this is an assault on Medicare, because the plan I have 
proposed and outlined is handled and complemented through Medicare. I 
know they like to always say the Republicans are making an assault 
against Medicare and somehow we want to end the program of providing 
this help and assistance to millions of seniors across the country. 
That is simply not true.
  This plan does nothing to make an assault on Medicare or the benefits 
it provides today, but it also does not turn a prescription drug 
program into a national prescription drug program run and handled by 
the Government, and that is basically my belief of what is outlined 
here.
  We will work to preserve and strengthen Medicare, and that includes 
adding an affordable prescription drug plan that will take care of the 
neediest of the seniors in our society today.
  Thank you very much, Mr. President. I yield the floor.
  The PRESIDING OFFICER. The Senator from Iowa.
  Mr. HARKIN. I want to get engaged in that discussion. I guess we will 
have time for that later. But the fact is, I think the Senator from 
Florida is correct. What we are seeing here, really, is a continuation 
of Newt Gingrich's philosophy that Medicare should wither on the vine. 
We all remember that. That was this ``Contract on America.'' That was 
Newt Gingrich's philosophy. I think we see it further taking place here 
today.
  The Senator from Minnesota, I think, is basically going down that 
same path that Governor Bush is. Basically, what they have envisioned 
is a prescription drug program where, basically, if you are poor, you 
are on welfare, and you get it. If you are rich, you don't need it, and 
you pay for your own or you can belong to your own insurance plan and 
pay for it, or maybe you have an employer-sponsored program. But if you 
are the middle class, and you are in that middle group, you are paying 
the bill for both of them. You are paying for the tax breaks for the 
wealthy, and you are paying for the welfare benefits for the poor so 
they can get their prescription drugs. But you, in the middle class, 
don't get anything. If you do, in fact, get in this program, you will 
be paying and paying and paying and paying.
  The Republicans have never liked Medicare. They did not like it when 
it came in, and they have never liked it since. So they just keep 
coming up with these kinds of programs that sound nice, but basically 
it is designed to unravel Medicare and let it wither on the vine.
  Mr. President, I want to take to the floor today again to speak about 
the lack of due process in the Senate regarding judgeships, and 
especially the nomination of Bonnie Campbell for a position on the 
Eighth Circuit Court of Appeals.
  Her nomination has now been pending for 216 days. Yesterday, the 
Senate voted through four judges. Three of them were nominated and 
acted on in July; one was nominated in May. Bonnie Campbell was 
nominated in March. Yet those got through, but they are holding up 
Bonnie Campbell. Why?
  Maybe it is because she has been the Director of the Violence Against 
Women Office in the Justice Department for the last 5 years; that 
office which has implemented the Violence Against Women Act, which, by 
all accounts, has done an outstanding job.
  Maybe my colleagues on the other side of the aisle do not want any 
woman that is qualified to be an appeals court judge. Maybe that is why 
they are holding it up. Maybe it is because she has done such a good 
job of implementing the Violence Against Women Act.
  Maybe they are holding her up because they think there are enough 
women on the circuit court. Of 148 circuit judges, only 33 are women; 
22 percent. But maybe my colleagues on the Republican side think that 
is enough women to have on the circuit court.
  I have said time and time again--and I will say it every day that we 
are in session--that Bonnie Campbell is not being treated fairly, not 
being accorded, I think, the courtesy the Senate ought to afford 
someone who is well qualified.
  All the paperwork is done. All the background checks are done. She is 
supported by Senator Grassley, a Republican, and by me, a Democrat from 
her home State. That may rarely happen around here. So Bonnie Campbell 
is not being treated fairly.
  Senator Hatch, the other day, said, well, the President made some 
recess appointments in August, and that didn't set too well with some 
Senators. But what has that got to do with Bonnie Campbell? Maybe they 
don't like the way President Clinton combs his hair, but that has 
nothing to do with Bonnie Campbell being a judge on the circuit court.
  Is Senator Hatch really making the argument that because President 
Clinton made some recess appointments that he didn't like, so that 
gives him an adequate excuse and reason to hold up Bonnie Campbell? I 
find that an interesting argument and an interesting position to take.

  I have heard that there was a news report that came out today that 
some of the Senators on the other side had some problems with her 
views. Now, this is sort of general. I don't know what those problems 
are. But that is why we vote. If some Senator on the other side does 
not believe Bonnie Campbell is qualified or should not be a Federal 
judge in a circuit court, bring her name out, let's debate it. These 
are debatable positions. Let's talk about it. And then let's have the 
vote.
  If someone feels they can't vote for her, that is their right and 
their obligation. But we did not even have that. We do not even have 
her name on the floor so we can debate it because the Judiciary 
Committee has bottled it up.
  Then I was told her name came in too late. It came in just this year. 
I heard that again. That is also in the news reports today, that 
somehow this vacancy occurred a year ago, but her name did not come 
down until March.
  So I did a little research.
  In 1992, when President Bush--that is the father of Governor Bush--
was President in 1992, and the Senate was in Democratic hands, we had 
13, 14 judges nominated; 9 had hearings; 9 were referred; and 9 were 
confirmed--all in 1992. Every judge who had a hearing got referred, got 
acted on, and got confirmed.
  Now, that was OK in 1992, I guess, when there was a Republican 
President and a Democratic Senate. But I guess it is not OK when we 
have a Democratic President and a Republican Senate.
  Here we are. This chart shows this year, we have had seven nominees, 
including Bonnie Campbell. We have had two hearings; we have had one 
referred; one confirmed--one out of seven. So this kind of story I am 
hearing, that her nomination came in too late, is

[[Page S9839]]

just pure malarkey. This is just another smokescreen.
  Circuit judges. They say: Well, it's a circuit court. There's an 
election coming up. We might win it, so we want to save that position 
so we can get one of our Republican friends in there.
  Well, again, in 1992, circuit nominees, we had nine: six were acted 
on in July and August, two in September, and one in October. Yet in the 
year 2000, we had one acted on this summer, and we are in the closing 
days of October. No action.
  So, again, it is not fair. It is not right. It is not becoming of the 
dignity and the constitutional role of the Senate to advise and consent 
on these judges.
  Thirty-three women out of 148 circuit judges; 22 percent--I guess my 
friends on the other side think that is fine. I do not think it is 
fine.
  Again, everything has been done. All of the paperwork has been in, 
and here she sits.

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