[Congressional Record Volume 146, Number 131 (Wednesday, October 18, 2000)]
[Senate]
[Pages S10667-S10669]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
REFORM OF MEDICARE
Mr. BRYAN. Mr. President, I am now in my last days of serving the
people of the State of Nevada as a U.S. Senator. It is a role in which
I am proud and privileged to have had an opportunity to serve. I am
also very proud of the opportunity I have had to serve as a member of
the Finance Committee, the committee with jurisdiction over the
Medicare program.
Having said that, I am greatly troubled by this body's failure to
take action on several fronts as it relates to Medicare. I am
disappointed that we failed to act on Medicare coverage for
prescription drugs as well as the proposed payment changes in the so-
called BBA relief bill, a piece of legislation that deals with provider
payment enhancements to those services and companies that provide
service to Medicare patients.
The impact of Medicare over the past 35 years cannot be
overemphasized. Prior to enactment of Medicare in 1965, fewer than half
the seniors in America had any kind of health care coverage at all.
Today, as a result of Medicare's enactment, 99 percent do. As a result,
health care for the Nation's seniors has been improved and the burden
of health care costs for them has been greatly ameliorated. But a
Medicare program without prescription drug coverage does not meet the
promise we made to seniors in 1965.
In 1965, the Medicare program roughly paralleled what was available
in the private sector. Today, as all of us know, prescription drugs
play such a vital role, a greatly enhanced role in
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terms of our own Medicare treatment. We had a historic opportunity this
year to fulfill the promise of Medicare and to guarantee access to
comprehensive prescription drug coverage for Medicare beneficiaries.
Yet we have squandered it.
There is no legitimate reason for the Republican leadership to have
pushed meaningful prescription drug reform off for another year. The
Finance Committee has spent the last 2 years considering prescription
drugs. We have heard from experts on all sides of the issue. We have
talked to our constituents. Many of us have worked diligently to put
together legislation to provide a meaningful, comprehensive, affordable
benefit for all Medicare beneficiaries. Yet the Finance Committee did
not even hold a markup of a prescription drug benefit bill. By that I
mean, for those who are not familiar with legislative language, we did
not have the opportunity to vote on a Medicare bill in the Finance
Committee, move it from the committee, and debate it on the floor.
I consider it a great tragedy that could have made a difference in
the lives of our seniors. Our inaction will consign some 227,000
Medicare beneficiaries in my own State of Nevada and 39 million
beneficiaries nationally to yet another year of spending an ever-
increasing share of their fixed incomes on medically necessary drugs or
trying to stretch their prescriptions by taking them every other day
instead of every day or sharing them with spouses and friends or,
worse, even going without.
We will be voting on the conference report to accompany the
Agriculture appropriations bill this afternoon. The prescription drug
importation provision is included in the conference report. I was
pleased to join Senators Dorgan and Jeffords in their amendment in
July. I believe this amendment is an important measure that can be
helpful. There is no credible reason, no defensible basis that only
drug manufacturers should be allowed to reimport prescription drugs.
A well defined reimportation program could help to make drugs more
affordable for American consumers. The majority of our seniors are
often faced with the difficult choice of paying extremely high prices
at retail outlets or forgoing medically necessary prescription drugs
because they simply do not have the financial resources to pay for
them. However, the best designed reimportation provision is not a
sufficient answer to the millions of Medicare beneficiaries who lack
prescription drug coverage.
I hope my colleagues will not hide behind this provision when they
are asked by their constituents why the Senate didn't approve a
Medicare prescription drug benefit this year.
Moreover, the important provision has been altered by the Republican
leadership such that it is extremely questionable whether it will
actually meet the goal Senators Dorgan and Jeffords and others
desired--that of lowered prices.
One very basic problem with the provision is that a ``sunset'' date
was added so that the importation system would end 5 years after it
goes into effect. In order to assure the safety of the drugs being
imported, laboratory testing facilities would be required. Distribution
systems would also clearly be needed. I have serious doubts that the
private sector investment to carry out this program will materialize if
it is known that the program will only be in operation for 5 years. Why
spend the money to develop the infrastructure for such a short-lived
program? There is also a serious labeling problem that gives
manufacturers the ability to shut down the program.
It is unquestionably and undeniably wrong that American citizens pay
the highest prices for prescription drugs--particularly when many of
these drugs are developed on American soil, by American companies who
are receiving enormous tax breaks, patent protections and the benefit
of billions of NIH research dollars.
I have been hoping to offer a germane amendment to the Foreign Sales
Corporation (FSC) legislation that would deny the export tax benefit to
pharmaceutical manufacturers charging Americans at least 100 percent
more than they charge foreign consumers for the same drug. This
amendment, if I get the chance to offer it, and if approved, would have
one of two positive effects for the American consumer and taxpayer:
either, the price of prescription drugs would decrease, or if the
manufacturer chooses to continue to exploit American consumers, at
least the taxpayer would not be providing a tax benefit for doing so.
The prices of prescription drugs could also be lowered through the
simple measure of providing more information to purchasers of
prescription drugs. I introduced the Consumer Awareness of Market-Based
Drug Prices Act of 2000 because purchasers today do not have any
meaningful price information--and there is no way competition can work
without information on prices. I believe in the free market, but we
have to let it work. The availability of real market-based price
information is critical to the ability of employers and insurers to
negotiate lower prices for their employees and enrollees.
Under the current law, that information is denied to those who
purchase prescription drugs on behalf of either their insureds or those
who are part of their employee group.
Not only does the lack of price information keep prices artificially
high, but it affects the Federal budget. Drug manufacturers have been
able to manipulate the average wholesale price, which is a meaningless
statistic, but it results in billions of dollars of Medicare
overpayments.
My legislation would simply require the Secretary of HHS to make
available to the public the market-based information on drug prices
that she currently collects: the average manufacturer price for each
drug, and the best price available in the market. These prices are
already collected to implement the Medicaid prescription drug rebate
system--so no new bureaucracy or administrative structures would be
necessary. Legislation is necessary, however, because the Secretary is
statutorily prohibited from disclosing this information.
Our legislation would simply lift that prohibition and make that
information available.
A reimportation provision without the loopholes and the sunset
provision could help to lower prices. There are also other ways to
lower prices--by requiring manufacturers to treat American patients
fairly if they want to receive generous tax benefits, and by disclosing
prices--but we also must add an affordable, voluntary prescription drug
benefit to the Medicare program. Anything less is an empty promise to
our seniors who often go without much-needed drugs, or pay astronomical
prices for them.
Earlier this year, I introduced the Medicare Outpatient Drug Act.
Like the Vice President's proposal, this bill would provide
prescription drugs as a defined, comprehensive and integral component
of the Medicare program to ensure it is available and affordable for
all beneficiaries.
The drug benefit must be a part of the Medicare program--if it is
not, there is no guarantee to our seniors and those Medicare
beneficiaries with disabilities that it will be available, no guarantee
that is will be affordable, no guarantee that it will provide
catastrophic protection, and no guarantee that it will be around the
following year.
Only Medicare can ensure that it is guaranteed to be there, that it
is affordable, that there is catastrophic protection, and that it will
be there year after year.
The Democrats offer Medicare beneficiaries choices: the Medicare
benefit is a voluntary one. If a person has drug coverage through an
employer or some other source, he or she can keep that coverage. The
beneficiary can choose to receive the drug benefit as a part of the
traditional fee-for-service program, or through a managed care plan.
So there are three choices that are available here: either not to
accept it, or to have either a fee-for-service program, or a managed
care program.
The GOP proposal, in Congress, and as promoted by Governor Bush,
gives the choices to the insurers. The insurer can choose whether or
not to offer prescription drug coverage--there is no requirement. The
insurer can choose the level of the deductible, and the amount of the
coinsurance the beneficiary must pay for each prescription. The insurer
can choose whether or not to offer catastrophic coverage. The insurer
can choose to limit those drugs
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that are covered to a select few--either by limiting the diseases that
qualify for treatment, or by limiting the number of prescriptions that
may be filled each month. The insurer can choose to keep the benefit
the same from year to year, or the insurer can choose to change the
benefit each year or to discontinue coverage.
The Democrats have tried to pass a bill this year that would provide
choices for beneficiaries, while our colleagues on the other side of
the aisle have advocated a bill that would provide choices for
insurers.
Given the cost of a prescription drug benefit, it is critical that we
spend those federal dollars in a way that will ensure that the benefit
and the choices are going to the Medicare beneficiaries--not to the
insurers.
I am also deeply troubled by the way the majority leadership is
allocating federal dollars in the ``BBA-relief'' bill. While members of
the Finance Committee have not been allowed to participate in the
development of this package, I understand that about $10 billion out of
a total of $28 billion is to go to Medicare HMOs over the first 5
years. That is over one-third of the money in this package, when only
16 percent of Medicare beneficiaries are enrolled in Medicare HMOs.
The HMOs tell us that they need this level of funding to
``stabilize'' the market, and that without it they will have to
withdraw from the program, or reduce benefits. But we know from the
General Accounting Office that we are already overpaying the HMOs--by
nearly $1,000 per enrollee.
And yet, our colleagues on the other side of the aisle are not
requiring any accountability on the part of the managed care plans in
exchange for this huge influx of funding. They don't require them to
stay in the market, and they don't require them to commit to a benefit
package.
Managed care plans should be provided a reasonable portion of the
funds in this package. But the majority has provided funds for HMOs at
the expense of reducing beneficiary cost-sharing for preventive
benefits and outpatient visits, at the expense of expanding health
options for legal immigrants, at the expense of patients with Lou
Gehrig's disease, at the expense of uninsured children, and at the
expense of persons with Alzheimer's disease.
This is too great an expense.
I have a letter signed by 23 senior groups opposing this large
payment of funds to Medicare+Choice HMOs.
I ask unanimous consent that this letter be printed in the Record.
There being no objection, the letter was ordered to be printed in the
Record, as follows:
Leadership Council
of Aging Organizations,
Washington, DC, October 18, 2000.
Hon. Richard H. Bryan,
U.S. Senate,
Washington, DC.
Dear Senator Bryan: The undersigned organizations oppose
the large payment of funds to Medicare+Choice HMOs rather
than using these dollars to help Medicare beneficiaries in
the proposed Medicare Balanced Budget Act (BBA). The pending
leadership proposal reportedly spends about $10 billion on
HMOs and only a small fraction on America's seniors.
The proposed restoration of funds to HMOs is out of balance
with the rest of the bill. Currently less than 16 percent of
beneficiaries are enrolled in HMOs, yet one-third of the
funds go to these entities. The increase in funds is of
particular concern since HMOs are not being held accountable
for their participation in Medicare. The plans have not
committed to maintaining their benefits or to staying in the
program for any length of time. Additionally, the proposed
increase flies in the face of the fact that independent
experts, such as the General Accounting Office, have found
that these plans currently are paid too much.
Earlier in the year, Congress's budget resolution committed
to spending $40 billion on a new Medicare prescription drug
benefit. This has not been done. And now rather than spend
this $40 billion on direct beneficiary improvements,
Republican leaders are proposing only a small fraction of the
original amount promised for beneficiaries.
There are many other senior concerns that are being
shortchanged by this legislation including those that relate
to quality of care. The bill would not provide sufficient
funding to address a number of serious problems Medicare
beneficiaries and their families currently face. The
priorities related to the balance of payments in this bill
must be changed to assure that the group that Medicare is
supposed to serve--America's seniors--receive their fair
share of the funds.
Sincerely,
AFSCME Retirees.
American Association for International Aging.
American Federation of Teachers Program on Retirement and
Retirees.
Association for Gerontology and Human Development in
Historically Black Colleges and Universities.
Association of Jewish Aging Services.
Eldercare America.
Families USA.
Meals on Wheels Association of America.
National Academy of Elder Law Attorneys.
National Association of Area Agencies on Aging.
National Association of Foster Grandparent Program
Directors.
National Association of Nutrition and Aging Services
Programs.
National Association of Retired and Senior Volunteer
Program Directors.
National Association of Retired Federal Employees.
National Association of Senior Companion Project Directors.
National Association of State Units on Aging.
National Caucus and Center on Black Aged.
National Committee to Preserve Social Security and
Medicare.
National Council of Senior Citizens.
National Council on the Aging.
National Senior Citizens Law Center.
National Senior Service Corps Directors Associations.
OWL.
Mr. BRYAN. Mr. President, finally, let me conclude by saying that the
administration has indicated the President may veto this legislation
because of the heavy tilt toward managed care plans, the lack of
accountability, and the lack of provisions that would directly help
Medicare beneficiaries--our intended audience. I would support that
veto.
I thank the Presiding Officer. I yield the floor.
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