[Congressional Record Volume 147, Number 81 (Tuesday, June 12, 2001)]
[House]
[Pages H3032-H3038]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                   HEALTH CARE AND PRESCRIPTION DRUGS

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 3, 2001, the gentlewoman from Ohio (Mrs. Jones) is recognized 
for 60 minutes as the designee of the minority leader.
  Mrs. JONES of Ohio. Mr. Speaker, on behalf of my colleagues, we wish 
to discuss the whole issue of health care this evening. Particularly we 
are going to be discussing the issue of prescription drugs.
  We anticipate that, over the next few years, prescription drug use 
will increase with age along with the prevalence of chronic and acute 
health problems. Over 13 million Medicare beneficiaries have no drug 
coverage whatsoever, and over three in five beneficiaries have 
undependable drug coverage.
  The Federal Health Insurance Program that covers 40 million elderly 
and disabled Americans does not cover outpatient prescription drugs. 
Ten million Medicare beneficiaries have no drug coverage at all.
  According to HCFA, the national spending on drugs has tripled in the 
last decade, and it is expected to more than double between 2000 and 
2010 from an estimated $172 billion to $366 billion.
  Medicare beneficiaries account for 14 percent of the United States 
population, but 43 percent of the Nation's total drug expenditures. 
Medicaid provides drug coverage for 12 percent of the Medicaid 
population, generally those with very low income. Only half of all the 
Medicare beneficiaries with incomes below the Federal poverty line are 
covered by Medicaid.
  In 1998, Medicaid spent on average $893 per elderly beneficiary for 
pharmaceuticals. Medicare HMOs assisted 15 percent of all beneficiaries 
with their drug costs in 1998, although the share dropped to about 10 
percent in 2001. Virtually all Medicare beneficiaries use 
pharmaceuticals on a regular basis and fill an average of 22 
prescriptions per year.
  In 2001, the average annual out-of-pocket spending for drugs among 
Medicare beneficiaries is estimated to be about $858, with 27 percent 
of beneficiaries expected to spend more than $1,000. Medigap provides 
prescription drug benefits to approximately only 10 percent of all the 
Medicare beneficiaries.
  I listed all of these prescription drugs statistics particularly to 
focus in on the fact that, across this country, there are senior 
citizens and others who are in a dilemma without having any type of 
prescription drug benefit.
  Mr. Speaker, I would like to kind of engage in a colloquy with the 
gentlewoman from Florida (Mrs. Thurman), who has been very active in 
the forefront on the issue of prescription drug benefits.
  Mr. Speaker, I yield to the gentlewoman from Florida (Mrs. Thurman) 
to discuss what she has been seeing that has occurred in the State of 
Florida on this issue.
  Mrs. THURMAN. Mr. Speaker, if one can imagine, in Florida a high 
percentage of our seniors are in the Medicare program because we have a 
very high senior population. You know what I have found is interesting 
over the last couple of years, we have had this issue on the table. 
This issue is being talked about. It has been massaged. It has been 
looked at. We have tried to bring it to the forefront of any debate 
that has happened in this Congress because of exactly what the 
gentlewoman has put in her remarks, what is happening out there.
  I think that any of us that has had any kind of work done, that one 
of the first issues that we have to look at is how do we make sure that 
the people in this country are getting the same medicines at the same 
cost as other countries. I do not want to hear, well, it is about 
research, because we hear it is about marketing research, and we have 
all seen the ads.
  So we did, a couple of years ago, just a kind of analysis of what was 
happening in our State and in my district in particular, in the Fifth 
District, and

[[Page H3033]]

we found out that, for the most part, life-sustaining drugs, not just 
fun drugs or something that was not life-sustaining, but drugs that 
seniors had to take actually were costing overall about 125 percent 
more than they were in actual programs like Medicare+Choice or 
prescription drug benefit under some Medigap programs or whatever.
  Now, also, then, we went a little bit further; and we said, well, let 
us look at other countries and what is happening. We looked at our 
border countries like Mexico and Canada. Then of course when we started 
looking at that, and the information started coming up to the seniors 
in this country, guess what happened? They decided that they needed to 
go over the border to buy their medicines because they could get them 
at half of what we were paying for them in the United States.
  Then we went a little bit closer in, and we found the same kind of 
thing happening in the European nations where they, too, were getting 
medicines for a lower cost.
  Mrs. JONES of Ohio. Mr. Speaker, the gentleman from Ohio (Mr. Brown) 
in Lorain took two or three busloads of seniors up to Canada because 
they were able to purchase their prescriptions at a significantly lower 
cost than they were able to have purchased them in the United States.
  Mrs. THURMAN. Mr. Speaker, saying that, we had the same thing 
happening up in Vermont, in Maine, where they also went up on bus 
trips.
  What is interesting is the States have recognized the potential 
problem or the problem they are having, and State legislatures were 
getting a lot of pressure put on them to change their laws and, in 
fact, did in some of these legislatures say that the pharmaceutical 
companies could not charge more than what they were paying for or what 
they were getting in Canada or their border state, which was, quite 
frankly, something that I think that a lot of Americans need to know 
about because we could do that here.
  In fact, there is a piece of legislation this year, the Allen bill, 
and there are several of us that are on that, that actually would say 
that.
  We need to look at the cost and what it is costing Americans as to 
what it is costing not only our border states, but other countries 
around us. We think we could save about 40 percent of the cost without 
doing any benefit, without costing one dime from the Federal 
Government. I mean, you would not even have to put out a charge there. 
All you would have to do is say we think that if you can sell it for 
this amount over here, then why should not we be given the same benefit 
in this country. Well, and that is just one thing.
  Now we have another issue going on that actually we have had some 
U.S. Senators that have introduced it, along with the gentleman from 
Ohio (Mr. Brown), who the gentlewoman from Ohio (Mrs. Jones) mentioned, 
who took the lead in this; and it was based on what I call stacking, 
which was actually a part of a program, one of the news programs at 
night was talking about. I just thought this is crazy. I mean, here we 
are again watching the same thing over and over and over again.
  We have this thing called patents, and patent laws protect the name 
brand medicine for about 20 years. Then the patents are let go; and, as 
we know, then we get what is called a generic drug, which by the way 
costs a lot less. The gentlewoman from Ohio mentioned the difference, I 
believe.
  Mrs. JONES of Ohio. I did, Mr. Speaker.
  Mrs. THURMAN. Mr. Speaker, maybe the gentlewoman can tell me those 
numbers again, but how many people have dropped off Medicare+Choice 
programs that no longer had prescription drugs where they did before. 
Is it twelve?
  Mrs. JONES of Ohio. Mr. Speaker, over 13 million Medicare 
beneficiaries have no drug coverage. Over three out of five 
beneficiaries have undependable drug coverage. Right.
  Mrs. THURMAN. Mr. Speaker, so now what is happening, and what I found 
in some of this work that I have been doing, is that in some of these 
Medicare+Choice programs, not only are they dropping a lot of their 
prescription drug coverage, but in some cases they will only cover 
generic drugs.

                              {time}  1915

  Mrs. JONES of Ohio. And if the drug they need is not at the status of 
being a generic drug, then these people are really in a dilemma.
  Mrs. THURMAN. They have no coverage now.
  Mrs. JONES of Ohio. At all.
  Mrs. THURMAN. So what happened is, all of a sudden now there is this 
information coming out to us that drug companies, or pharmaceutical 
companies, are able to extend their patents, I cannot even believe why, 
would extend the patents probably somewhere around 2 to 3 years, 
creating the idea that then the generic drug never becomes available 
for that long. And that also causes a problem because we could cut or 
look at the cost.
  Mrs. JONES of Ohio. The interesting thing is, and I think that 
everyone on our side of the aisle wants to be clear that we are not 
trying to bankrupt any of the drug companies. We thank them for the 
research that they have done in this particular area.
  Mrs. THURMAN. Absolutely.
  Mrs. JONES of Ohio. And the advancement in medicine that has been 
made. But the reality of it is that there are people across our country 
that cannot afford to purchase the drugs at the costs that are 
currently set; and we really need an opportunity to spread the wealth, 
to allow those who are unable to afford that high cost to participate 
as well.
  The gentlewoman was talking about the studies that were done in the 
State of Florida. We did a study in my congressional district; and 
there was one drug, that I wish I could remember the name as I stand 
here right now, that seniors were paying 1,000 over the cost if they 
were in a favored status plan.
  Mrs. THURMAN. It actually is a hormone, and it actually was something 
that sometimes we need to keep ourselves in balance.
  Mrs. JONES of Ohio. Correct.
  Mrs. THURMAN. A lot of people understand that. Even our husbands 
would understand that on occasion.
  Mrs. JONES of Ohio. Absolutely.
  Mrs. THURMAN. And that was one of those issues that in fact raised 
the level of it, and it causes a lot of problems for some people.
  But on this generic thing, I think there is something else that needs 
to be remembered. This is not just about seniors at this point. This is 
families. This is children. This is young, this is middle-aged, and 
this is the older generation. Everybody benefits when we have a generic 
drug. And the numbers that we looked at were that it actually could 
save about $71 billion for this whole group of folks, whether it was 
families or whatever. Think about $71 billion.
  Mrs. JONES of Ohio. And the thing that is so important is that we 
have as a Nation now developed our health care in a delivery system 
where we can engage in preventive health care. And if we could engage 
in preventive health care with certain prescription drugs, then we 
could really save ourselves dollars on the other end of the lifeline. 
We need to be able to provide the necessary prescription drug benefit 
to people at an early age, to keep them from getting themselves in 
harm's way.
  One of the prevalent conditions that exists across the country is the 
whole issue of diabetes and trying to reach diabetes at an early age so 
individuals do not develop to the level where they have to take 
insulin, which is much more costly than watching your diet and taking 
some type of prescription. That would be significant in all families.
  Let us even take a look at the gentleman from Illinois (Mr. Davis), 
our colleague, who was talking earlier about the whole issue of 
prostate cancer and having the ability to do the diagnosis, the 
preventive care, the type of prescription drugs to be able to arrest 
that situation early on and to give advice and counsel. That would be 
significant.
  Mrs. THURMAN. The gentlewoman brings up an excellent point, and it is 
a point that needs to be talked about even more. As we just did the tax 
bill, and we are watching all these dollars kind of go out there right 
now, which legitimately we all agree there should have been a tax bill, 
we just think it should have been a little more reasonable.
  Mrs. JONES of Ohio. And to allow for prescription drug benefits.

[[Page H3034]]

  Mrs. THURMAN. Right, and the fact of the matter is that within that 
there is also the situation we are in now with Medicare and dollars 
that we have available and what is going to happen in 10 years from now 
when the baby boomers come in and we have this huge exploding price. 
Well, one of the ways, and the gentlewoman is exactly right, that we 
can look at the expenses is by prevention.
  Well, this is what happens under Medicare. If a person is ill, an 
elderly person, and we have heard the stories.
  Mrs. JONES of Ohio. Over and over.
  Mrs. THURMAN. People would cry if they heard some of the letters I 
have gotten as we have started talking about this: wives saying I 
cannot take my medicine any more because my husband needs it more; or I 
can only take it half the time. Guess what happens? These folks end up 
in the hospital. They end up in the hospital; and now we have Medicare, 
which, in fact, as the gentlewoman pointed out, pays for inpatient 
medicines. So they pay for the inpatient medicine. So we get the person 
healthy, or as healthy as we can.
  Mrs. JONES of Ohio. Under the circumstances.
  Mrs. THURMAN. Under the circumstances. And we kind of get them out 
there; and then we say, okay, now, go home. They go home and they have 
their prescription drug from their doctor, and they go to the pharmacy 
and all of a sudden we have got them in balance now. They are feeling a 
little better. They go to the pharmacy and what happens? The first 
thing that happens is they are standing there, and they may be looking 
at a $300 bill, a $200 bill, an $800 bill, going, I cannot afford this. 
They buy what they can, they work with the pharmacist, they cut them in 
half, and 3 or 4 months later, guess what happens? They end up back in 
the hospital. And Medicare is paying for that.
  Mrs. JONES of Ohio. I cannot forget that, in the course of my 
decision to come to Congress, I was engaged in a town hall meeting; and 
one of the people in the audience says, Well, why don't you buy every 
constituent in your district a pill cutter? I said, do what? Buy them a 
pill cutter, and then they could cut up the pills that they have and it 
would extend over a longer period of time. I said, Sir, the real reason 
I won't buy one is I am not a pharmacist or a doctor. And how can I 
tell a constituent of mine how much medicine to take and when they 
should take it? That is why we license doctors to prescribe and why we 
license pharmacists to dispense on the prescriptions.
  I could not believe it. But the reality is that we do have people 
across this country who have gotten pill cutters and started thinking 
that they can self-prescribe by saying, well, instead of taking one 
pill today, I will cut it in three and take it three times in a day and 
really not understanding how different prescriptions interplay with one 
another and the impact they can have on their health long term.
  We have been joined by our colleague, the gentleman from New Jersey 
(Mr. Pallone), who is actually our leader on this particular issue.
  Mr. Speaker, can I get a ruling from the Chair as to how I would now 
turn this time over to the gentleman from New Jersey (Mr. Pallone) so I 
will not cause us to lose this time, please.
  The SPEAKER pro tempore (Mr. Grucci). On the designation of the 
minority leader, the balance of the pending hour is reallocated to the 
gentleman from New Jersey (Mr. Pallone).
  Mrs. JONES of Ohio. As I leave, Mr. Speaker, I would like to say that 
it has been wonderful to have an opportunity to engage in a colloquy 
with my colleague, the gentlewoman from Florida (Mrs. Thurman). She has 
been a leader in this area.
  Mr. PALLONE. Mr. Speaker, I want to thank my colleague from Ohio, and 
I apologize that I came here late; but I am so glad the gentlewoman 
took the time so we did not lose it.
  The dialogue that the two gentlewomen were having was really 
excellent. I know she has to leave; but I want to continue on, if I 
could, with my colleague from Florida on this generic issue, because I 
think it is so crucial, but I do thank the gentlewoman.
  Mrs. JONES of Ohio. I thank the gentleman very much.
  Mrs. THURMAN. I appreciate the dialogue too; it was great.
  Mr. PALLONE. I noticed that my colleagues were talking about what I 
call the GAAP bill, Greater Access to Affordable Pharmaceuticals Act, 
or GAAP. I think it is important, and I want to kind of give my New 
Jersey perspective on this, because I agree with the gentlewoman 
completely when she said that the greater use of generics is certainly 
a way to address the affordability issue.
  We have been talking in our health care task force and amongst 
Democrats about trying to put together a Medicare prescription drug 
benefit, and we have certain principles that we want to be universal: 
everybody should have it, should be voluntary, and it should be 
affordable. Because if it is not affordable, it is not much use to 
anybody. I agree with my colleague that in many ways, and I am not 
saying the two of us, but I think a lot of our colleagues have not paid 
enough attention to the whole issue of how generics and more widespread 
use of generics could really address that affordability issue in a 
major way.
  Now, I say the New Jersey perspective because I have been kind of 
outraged by the fact that in my State, as the gentlewoman knows, there 
are a number of the brand-name drug companies, and I am very happy they 
are in my State, and we have a lot of people employed by them, but many 
of them over the years have approached me and other colleagues to try 
to put in these patent extensions. I have refused to sponsor patent 
extensions because I think it is wrong. I think what it effectively 
does is it postpones the day when the generics come to market, and it 
keeps the price artificially high using these brand names that have 
actually expired even under the law.
  These things usually do not pass as stand-alone bills, as my 
colleague knows. They usually get stuck into some omnibus 
appropriations bill at the end of the session or some reconciliation or 
something else, and nobody even knows what they are voting on because 
it is a little paragraph somewhere in a bill that is 2 feet high on the 
desk. So that is something that has to stop, and the GAAP bill tries to 
address that.
  The other thing we get is this whole issue of trying to change the 
patent. In other words, I will give an example. This is one of their 
favorite tactics that we get from some of the brand-name companies, and 
the gentlewoman may have already mentioned this, and I apologize.
  Mrs. THURMAN. I did not.
  Mr. PALLONE. They make essentially insignificant changes to the 
product, and they get a new patent just as the original patent is set 
to expire; and then they go on for years with essentially the same 
patent.
  Mrs. THURMAN. And if the gentleman will yield, one of the things they 
do is they might change the label or how the medicine is configured; 
they might change the color. Now, they might have a problem with some 
of their medicines, because they do an awful lot of advertising on some 
called the purple pill. And there are a lot of folks out there that 
know the purple pill, so if they changed it to pink, I am not sure how 
many more they could sell. But that is the idea of what is going on out 
there.
  It is not about the chemical makeup of this medicine; it is about 
just changing the label or color or whatever, but something that has 
nothing to do with the makeup of the medication at all.
  Mr. PALLONE. And the way the current law reads, and I do not think it 
was really intended that way, but it has been basically utilized in the 
wrong way, that once that presentation is made with this new patent, 
for 30 months the generic cannot come to market. That is 30 months. We 
are talking about 2\1/2\ years, which is incredible; and we correct 
that in the bill that we talked about. In the GAAP bill we correct 
that.
  Mrs. THURMAN. Yes. And we also correct a somewhat curious operation 
where they have actually kind of been involved or engaged with some 
generic companies where they actually have bought out or have actually 
delayed the generic drug coming to the market as well, and that is 
another area that we are trying to address in this piece of 
legislation.

[[Page H3035]]

  Let me ask the gentleman a question, because I do not have this 
information, and I wish the gentlewoman from Ohio (Mrs. Jones) was back 
here, because one of the things we did not talk about that I think is 
also very important, and certainly the gentleman and I have looked at 
this and the research, but this whole issue of the profits. Because one 
of the things that the American people are being told at this time and 
have been told, and by the way through rather large marketing of 
political statements to the tune of about $30 million in this last 
campaign to try to persuade people to believe, that there were things 
that ought not to happen in a benefit plan. And I quite frankly was 
offended in some of the tactics that were taken in scaring people as to 
what might have happened.
  But when we look at the profits and we start to do the breakdown, and 
I think Forbes came out with this, and I do not have it with me; but 
they were like four or five top parts, like profits or whatever. But, 
anyway, they had like three or four columns; and the pharmaceutical 
companies were top in every one of them in terms of profits, and then 
in the fourth column it was oil and gas.

                              {time}  1930

  So it was kind of ironic to me that here we are looking at issues, 
and I know in my home State and I think in all of our home States, is a 
life-or-death situation for many people. I do not know if the gentleman 
has those numbers.
  Mr. PALLONE. Mr. Speaker, I do not have them with me, but in the last 
6 months we have seen a lot of stocks tumble, generally in Internet and 
other areas. The drug stocks have stayed pretty good, primarily because 
they are making record profits. We are capitalists in America. And we 
do not have a problem with people making money, but they are making 
money at the expense of these seniors who cannot afford to pay for 
these prescription drugs. And as the gentlewoman says, it is a life-or-
death situation.
  During the course of the last Presidential campaign, as well as 
congressional races, we saw the current President, as well as many of 
our Republican colleagues, run on a platform that they were going to 
address prescription drugs and have some kind of benefit. We are not 
seeing it.
  At one point, the President said that he wanted to do a low-income 
benefit. We are not sure if that is what he ultimately will say that he 
wants the Congress to do. At this point, I wish he would do anything. 
The idea of doing a low-income benefit is not what I am hearing from my 
constituents. The people that are coming to me are not the people that 
are eligible for Medicaid, but the people in the middle-income bracket 
that do not have a benefit because the HMO does not provide it, or they 
want to buy some Medigap which does not cover it. They are going 
without. They are doing as the gentlewoman from Ohio and the 
gentlewoman from Florida said, they are cutting back or taking half a 
pill or just not getting any pill.
  I agree with the gentlewoman that generics is one way to address 
this, but we need a benefit package. We have to say that everyone that 
is covered by Medicare, regardless of income, gets a prescription drug 
benefit. We figure out how to do it and whether there is going to be a 
co-pay and what the catastrophic is. I do not see that happening with 
the Republican leadership. I do not see any movement in that direction.
  Mrs. THURMAN. Mr. Speaker, the only movement that we have seen or has 
been talked about is the $157 billion that would be used, as suggested, 
for low-income seniors. In Florida, we already have a Medicaid medical-
needy program for those in that position. The gentleman is correct, it 
is in the middle and at the high. The issue there as well, and quite 
frankly an issue I have with the entire Medicare situation, some people 
have it because they have Medicare Choice, but we are seeing Medicare 
Choice programs are pulling out, and then these folks have no 
prescription drug benefit.
  But at the same time, if an individual is a fee-for-service Medicare 
beneficiary, they have paid in exactly the same thing on a tax on 
earnings to provide for Medicare, and the money that goes into HMO 
Medicare Choices are nothing more than the tax dollars which have been 
put in there and then given to the Medicare Choice programs to provide 
this.
  So you have a very unbalanced Medicare beneficiary program going on 
where some get it and some do not. Some are getting pulled out, and 
they have nothing to replace it with. When you look at the Medigap 
programs, and we have all heard and seen, and certainly from the 
stories we hear from our constituents, Mr. Speaker, they might pay 
$1,800 a year, but they might only get $1,000 in benefits. That is part 
of what is going on out there.
  When we started looking at this last year, we said it has to be a 
Medicare benefit. It cannot be through some private benefit because we 
had all of the insurance companies, or at least many of them come and 
say, guess what, we are not going to provide this. On top of that, you 
dilute the buying power of the Federal Government for a benefit 
package. And that is where a lot of discussion is going on right now in 
the health care caucus that we have been talking about in trying to 
come up with some alternatives. Those are some issues that we are all 
trying to wraparound and figure out what to do with them here; but the 
gentleman's State has a better start.
  When I talked about the medical needy or the Helping Hand Up, quite 
frankly, part of that plan was to give back to the governors.
  Mr. PALLONE. Mr. Speaker, that is a block grant.
  As the gentlewoman says, every one of these proposals that the Bush 
administration comes up with, the people that they are supposed to help 
say they are not going to work.
  My own State, Mr. Speaker, if an individual is eligible for Medicaid 
and is very low income, they usually get their drugs. There are 
problems, I am not saying it is easy, but generally they have access. 
Because we have casinos, there is revenue that is generated by the 
casinos that goes to the State, and we use that to finance a lower 
income prescription drug benefit that is above the people eligible for 
Medicaid.

  Right now I think that is maybe as high as, for a family of 2, maybe 
up to $19,000 or $20,000 annually; and that is very good because you 
only have to pay $5, I think, for each prescription.
  Mrs. THURMAN. Mr. Speaker, if the gentleman would yield, who does 
this?
  Mr. PALLONE. Mr. Speaker, the State does with the casino revenue 
funds. That has been going on for awhile, but that does not cover the 
majority of seniors or the majority of middle-income seniors. Those are 
the people I hear from. New Jersey has a high cost of living. When one 
talks about $16,000, $17,000, $18,000, $19,000, one cannot live on it 
in most cases.
  As the gentlewoman said, we have heard two things from the 
Republicans. One is the Bush proposal which is the Helping Hand. I have 
in front of me, he says that the measure establishes block grants for 
States to provide prescription coverage for some low-income seniors. 
His plan limits full prescription coverage to Medicare beneficiaries 
with incomes up to 35 percent above the poverty level, up to $11,600 
for individuals and $15,700 for couples. That is below what New Jersey 
is already offering with the casino revenue. We would not benefit at 
all, and that is obviously why in our State nobody is in favor of this.
  Mr. Speaker, the other thing that we are getting was this idea about 
the Republican proposal last session which is the drugs-only policy. In 
other words, rather than have prescription drugs as a benefit under 
Medicare for everyone, which the gentlewoman and I propose, and the 
Democrats propose, they would just give a certain amount of money and 
you go out with a voucher and buy a drugs-only policy. But as the 
gentlewoman said, no insurance company says they are going to write it.
  Mr. Speaker, I know in Nevada they actually did that about a year 
ago. For 6 months they could not get anybody to write it. Then somebody 
wrote it, but I do not think that they covered even 100 people. It was 
a total failure.
  So these approaches, it is almost like let us do whatever we can not 
to guarantee this under Medicare because Medicare is somehow evil or 
government. I do not have any patience for people who get into the 
ideology of whether it has to be government run or not. The only thing 
I care about is whether it works practically. I do not care about the 
ideology myself.

[[Page H3036]]

  Mrs. THURMAN. Mr. Speaker, I think that the governors got together. I 
believe this is what happened.
  Mr. PALLONE. Mr. Speaker, the gentlewoman is correct.
  Mrs. THURMAN. And they talked about it. One of the things that they 
do not want to do is they do not want to be in the position of taking 
over the Medicare program. They already are involved in the Medicaid 
program, plus whatever programs they have within their own States, and 
they do not want this responsibility.
  Then they have to pick and choose. They have to make that 
determination. Quite frankly, that is a very bipartisan group of folks 
out there. That is Democrats, Republicans, Independents, making that 
decision not to have the Federal Government abrogate to the States our 
responsibility which is Medicare.
  Mr. PALLONE. Mr. Speaker, that is an important point. The problem 
with the block grant, if you use my State, you can write into this 
language that would not allow this, but there is the danger that you 
send the block grant to the State and they use the money to fund the 
program already there. You can try to avoid that through legislation, 
but it is always going to be a problem. If there is not enough money, 
they use it for the existing program and do not expand it to include 
anybody else.
  Mrs. THURMAN. Mr. Speaker, at the Federal Government we are already 
participating with the Medicaid program.
  Mr. Speaker, somebody gave me a note to tell me what those three 
subtitles were on the profits. I will go back to that. Number one, 
return on revenue. Number one, return on assets. Number two, return to 
the shareholder equity. That is what they were actually in the last 
look in the last time. I thought that was pretty interesting.
  And I agree with the gentleman from New Jersey (Mr. Pallone). I give 
the gentleman a lot of credit because I know he has a lot of 
pharmaceuticals, and the gentleman is bucking those people at home who 
do provide jobs. So I give the gentleman a lot of credit for standing 
up on principle and on an issue that he believes in. The gentleman has 
done a tremendous amount of work. It is not easy, especially when one 
looks at the dollars spent on things like Flo, and some of the ads 
attacking us because we have this belief that people ought to have a 
Medicare prescription drug benefit. But it is important.
  Mr. PALLONE. Mr. Speaker, the gentlewoman is correct that so much 
money has been spent, and of course New Jersey does have a lot of the 
brand name drug companies. But if you talk to people on the street in 
my State, their attitude is not any different. They do not have any 
better access or ability to purchase the drugs than anybody else; so 
the problems are the same wherever you are.

  Mrs. THURMAN. Mr. Speaker, here is another issue, and this hits 
everybody. This is not just a Medicare patient, this is now starting to 
hit families, working men and women across this country. I actually got 
the first taste of it about a year ago when a major corporation came in 
to talk to me about this. They were talking about health care costs 
going up. I said, Tell me what that means. They said, Well, our 
prescription drug benefit is going up so high and the cost of the drugs 
are getting so high that we have a couple of choices now. We can either 
reduce the benefits of a prescription drug, or we can no longer or we 
will not be able to actually do coverage of other areas of health care.
  Mr. Speaker, if a business had a plan where they were given some 
dental or they might have been given some mental health or they might 
have had for their child an ear examination or a woman might have had a 
pap smear, mammography every year, now they are changing those plans to 
meet the needs in the prescription drug part of it, and they are now 
cutting back on the other benefits of these plans. It is all because of 
one area within health care that is really pushing this up.
  That worries me because here we are talking about all of the 
uninsured, the 44 million people that are uninsured. We are trying to 
find ways in this Congress to actually make it easier and beneficial to 
employers to provide health care. Then once they get into it, and what 
people are looking for in a plan is not going to be available to them 
because of one cost over here. So it could just eventually escalate.
  The same thing is happening in the hospital system. They do have some 
reimbursement for Medicare within the hospital setting, but in some of 
these other insurance companies as they cut and are not available, 
there is nothing we can do about it. Their costs are starting to go up. 
So then it is a domino effect. If you have to do this, what are you 
going to do about nurses, what do you do about the shortages we are 
having? There are all of these domino effects to the health care 
system.
  Mr. Speaker, I do not think that any of us want to see the 
pharmaceutical companies go out of business. My husband had a kidney 
transplant in 1995-1996. If the medicines like immunosuppressant drugs 
were not available, transplants might not be as easily done because 
this medicine works as an anti-rejection.

                              {time}  1945

  I can tell you how thankful I am that I have my husband, and I am 
thankful for the research they have done. But we cannot just hang that 
out, because there are so many things going on out there that just have 
not been proven to us, at least have not been proven to me that in fact 
they could not give a little to our constituents who do not have the 
opportunity to have a prescription drug benefit at this point.
  Mr. PALLONE. I want to pick up on the gentlewoman's point there about 
how as the prescription drug part of health insurance, as the cost 
continues to rise, and you have, as you say, either cutbacks in other 
areas or just costs that make it prohibitive for employers to cover 
their employees, that is the crux of the problem. We had as a 
percentage of the population fewer people that were uninsured a few 
years ago than we do now, mainly because the primary way that people 
were insured historically in this country was through their employer, 
on the job. And when you create a situation where those employers can 
no longer cover their employees, that is where the crisis comes with 
the uninsured. Again, I do not want to look at it ideologically. In my 
view I would love to have everybody covered by their employer and not 
have to have any Federal program. But we know that the problem now 
again is not people who are on Medicaid or people who are low income, 
who are not working because they are disabled or they cannot find a 
job, the problem is for people who are working. The uninsured, that 45 
million people, they are almost all people that are working.
  Again I say, I have been as strong an advocate as the gentlewoman of 
expanding some of these Federal programs to the uninsured, as most of 
the Democrats have. We initiated the CHIP program for kids, which 
basically gives money to the States so that they can insure children, 
and we have advocated as Democrats that we would like to see CHIP 
expanded to the parents so that the parents who are working do not just 
enroll their kids but can enroll themselves. Again, we have had the 
Republican leadership and the President, I would not say oppose it 
completely, but certainly not been supportive. They have granted 
waivers to certain States in a minimal way to do it, but most States do 
not have waivers. What we really need is a program that covers 
everybody who is eligible for the CHIP program, be they a parent or 
even a single person. I do not think they should have to be a parent 
either. I think even a single person who is in that situation.
  Again, I do not advocate that because I think that the government 
should run health care or because I want a government program to 
provide insurance, but simply because the employers cannot do it 
anymore. That is why we have had this shift to so many people who do 
not have health insurance.
  I agree with the gentlewoman that the drug companies, to the extent 
that they are making these big profits, they are contributing to the 
inability of employers to pay for health insurance or to make a 
significant enough contribution to make it so that employees can take 
advantage of it.
  Mrs. THURMAN. That is what we are hearing at home. It really is kind 
of sad.
  I think maybe we should jump over just to one other issue quickly 
because I think we might even have an opportunity either this week or 
next week to

[[Page H3037]]

look at something also that has been on a lot of people's minds and 
that is the Patients' Bill of Rights, another issue that has been 
around since about 1999, 1998, that quite frankly passed this House in 
a present form that we could take up today, pass it and move it over to 
the Senate with a very similar piece of legislation and we could be 
putting the Patients' Bill of Rights on the President's desk. However, 
once again, and I heard some stuff today that I need to check out, but 
some of the things that are going to be stuck in this, like maybe some 
MSA stuff and some other areas that are going to make it kind of bog 
down again. This is such a critical issue in so many ways.
  One of the stories that I always tell and actually came from one of 
the editors of my newspapers who said, tell me about the Patients' Bill 
of Rights. We said, well, this would give the opportunity for children 
to go to their pediatricians and women to go to their obstetricians and 
all of these abilities for us to have a little bit of choice in our 
programs and who the doctor might be. But I think the underlying issue 
is somebody taking the responsibility of a mistake being made, because 
quite frankly when you have to take responsibility, less mistakes are 
made. I honestly believe that that is what this issue is really all 
about.
  One of my editors was telling me about a young woman that his 
daughter was going to school with. What happened was she went in for a 
breast exam, had a lump, and the doctor asked to have a mammogram done. 
They said, no, that she is too young, that she is not going to have 
breast cancer and on and on. The doctor said, no, you need to do this.

  They did not get it. Six months later she went back, the same thing, 
did not get it. Finally she came home for Thanksgiving or something, 
her parents said, we really need to get you to this doctor. They went, 
they did a check on it and in fact it was cancerous. It was my 
understanding that she may not live because of this. That was someone's 
responsibility. The doctor made the decision and somebody denied that 
care.
  Now, what really strikes me, though, is if the doctors do that under 
liability as we know today, they would have to be held accountable and 
in many cases they become the ones who are held accountable for a 
decision that they made to have it done but somebody else told them no.
  Mr. PALLONE. Because they were told that if they have so many tests 
or if they have too many costs, then they are going to not be part of 
the plan and they will not be able to practice medicine essentially. It 
is very sad.
  Mrs. THURMAN. Hopefully we will have a good, clean bill and a good, 
clean debate on this floor.
  Mr. PALLONE. I wanted to point out, and the gentlewoman said it 
earlier on, but I want to reiterate it, and again I am being very 
partisan, but I have been very frustrated because if there was one 
health care issue that during the course of the presidential campaign 
the current President, then candidate George W. Bush, said was that he 
wanted to pass a Patients' Bill of Rights and even mentioned how in the 
State of Texas that they had a Patients' Bill of Rights. He forgot to 
mention that he did not sign it and he let it become law, but we will 
forget about that for the time being. The bottom line is that the first 
thing that many of us did who supported a Patients' Bill of Rights, the 
first day we were here in session in January, on a bipartisan basis, 
there were just as many Republicans as Democrats, put in the bipartisan 
Patients' Bill of Rights, exactly the same as the Texas law, and said, 
``Okay, here is the bill. Let's get it going. Let's get it signed.''
  The gentleman from Michigan (Mr. Dingell) took the lead on the 
Democratic side, the gentleman from Iowa (Mr. Ganske) on the Republican 
side. I guess I am not supposed to mention the other body, but I will 
say it was bipartisan in the other body as well. Six months have passed 
almost and what has happened? Nothing. I understand that the other body 
is going to take this up because of the change in the party, Democrats 
are now in control in the other body and they supposedly are going to 
take this up, but we should not have to wait for a party change for 
that to happen.
  And what is wrong with doing it here in the House of Representatives? 
As you said, this bill, the Ganske-Dingell bill, is almost exactly the 
same as what passed overwhelmingly here in the last session with almost 
every Democrat and I think about a third of the Republicans, and the 
President now says, ``Well, I don't like it too much. I may want to 
change which court you sue in.'' He has got a couple of things. In my 
opinion, they are relatively minor. I honestly believe that if you took 
the proponents of the two parties on this issue and you sat them down 
in the well here tonight, they would be able to iron out their 
differences in an hour and we could bring the bill up tomorrow. The 
President is really dragging his feet on this and the Republican 
leadership is dragging their feet because they do not want it to be 
brought up because they know if it does as last year, it will be passed 
overwhelmingly.
  I hear, though, that there is a movement on, and I will not get into 
too many details but some of the Republicans on the Committee on Ways 
and Means, the gentlewoman's committee, to try to come up with an 
alternative bill that is a lot weaker, that actually does not cover 
everybody, covers a smaller group, not everybody or does not even 
provide some of the basic protections. I would hate to see any watering 
down in that respect, because we clearly have a majority here that 
wants a strong, real Patients' Bill of Rights. We need to keep 
everybody's feet to the fire and say, ``That's a bill that's going to 
get out of here.''
  Mrs. THURMAN. We talked about this a couple of weeks ago. I actually 
went back and looked at the vote. The vote was overwhelming. Not only 
on top of the vote being overwhelmingly bipartisan, also instructions 
to the conferees, because remembering that the House passed it, the 
Senate passed it, it was in conference, but it was never allowed to get 
out. The President at that time, Mr. Clinton, was ready to sign the 
bill. They could never come to agreement. It was all over this issue of 
responsibility, which I find extremely interesting because any other 
mention of any other issue, they keep telling that we need to take 
personal responsibility. Why would you not expect an HMO to take 
personal responsibility for decisions they make any different than you 
would ask an individual to take personal responsibility?
  So here it is, 2001, potentially we will have this opportunity. I 
would hope that our colleagues who supported the Dingell-Ganske-Norwood 
bill would be in favor of also getting this done in a prompt time and 
let us get it to the President and then he can make the decision as to 
what he wants to do. I am not trying to do that, I am just trying to 
make sure that in fact the people that we represent are given the 
options that they have been asking for since 1998. Because, quite 
frankly, we have done a lot of other things for the hospitals, we have 
done it for managed care in this last go-around, we have worked on some 
of the issues, the money issues, we have tried to be fair and balanced 
in all of the kind of revenue bills we have done, the appropriations, 
the revenue bills we have done over the last couple of years when money 
was cut out of Medicare, to kind of pump that back up. They all got 
some of it. Now we are just saying, ``Okay, let's be responsible and 
let's do the right thing for the people.''
  Mr. PALLONE. I will be honest with the gentlewoman, I am totally 
convinced that anything that comes to the floor somehow procedurally, 
the majority's will will prevail and we will be able to get a good 
bill. Even if the Republican leadership comes with a bad bill to the 
floor, we will do amendments, we will do substitutes, we will do 
whatever and we will be able to overcome it and come up with a good 
bill. I am just afraid we never see it. That I think is again the 
special interest, the health insurance industry, which unfortunately 
does not want to see the changes that this bill does. Basically what 
the bill does, if you want to sum it up in maybe one or two sentences, 
is it says that decisions about what kind of medical care you are going 
to get, what is medically necessary, are made not by the insurance 
company but by the physician and the patient. They do not want that. 
The second thing is that if you are denied, as you mentioned, that you 
have a legitimate way to express your grievance, either through an 
independent,

[[Page H3038]]

 outside board or to go to court, and they do not want that, either. 
Naturally the insurance companies are going to oppose this and they are 
going to try to do whatever they can to prevent it from coming up here 
in a fashion that we really can vote as a majority for what we think is 
good for the country. But we will just keep speaking out as we have 
until we see something come forward that we know is good for the 
American people.
  Mrs. THURMAN. I have enjoyed this. I hope some people have been 
listening. We certainly would love to hear their comments or their 
stories or issues that make a difference in people's lives, because I 
think it is important that we hear from the real people out there that 
have to deal under the laws that we either pass or do not pass in some 
cases.
  Mr. PALLONE. I agree. I want to thank the gentlewoman for being here 
tonight as she has so many times. I think all we are really trying to 
do is what is right for the average American. These health care issues 
are really crying out for a solution. It is not pie in the sky, it is 
real, day-to-day lives that people are living and it impacts on their 
lives.

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