[Congressional Record Volume 148, Number 52 (Wednesday, May 1, 2002)]
[Senate]
[Pages S3606-S3607]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           PRESCRIPTION DRUGS

  Mrs. LINCOLN. Madam President, as in morning business, I will talk a 
little bit about an issue that I think is probably the most paramount 
issue in the State of Arkansas and also probably the most paramount 
issue across this great Nation, and that is the issue of the Medicare 
coverage of prescription drugs for our elderly. We have debated this 
issue for quite some time. I advocated that Congress add a universal 
voluntary prescription drug benefit to Medicare when I first started 
campaigning for the Senate in 1998. Five years later, we still have not 
passed a plan. We have to begin moving forward on this initiative, as I 
look across the great State of Arkansas and recognize the number of 
elderly in my State who would benefit from such a plan.
  More importantly, we also have to look at how we as a government, in 
the economics of today, would benefit from a prescription drug plan for 
our elderly. If we do not want to do it for the quality of life for our 
elderly relatives, our grandparents, our parents, and all of those we 
love and adore, we should at least want to do it for the economics of 
this country because we know, without a doubt, particularly in rural 
America, that in providing a prescription drug package we are going to 
save dollars down the road because we prevent those elderly, when they 
are on a prescription drug, from having to have the more costly acute 
hospitalization or nursing care, or perhaps some of the more expensive 
home health care which they might need if we can simply keep them on a 
prescription drug plan that they so drastically need.
  Both structure and costs of the benefit have been the main issues 
holding us up, but we have to move beyond those difficulties and those 
problems that we have in structuring cost.

  I think back to last summer and some of the other members of the 
Senate Finance Committee with whom I was working. We were moving 
forward on coming together with a good compromise and working through 
the details of what we could see as being a beneficial plan for 
everyone in this country. Then, unfortunately, the events of 9-11 
occurred. We, in the Congress, obviously, have had a great deal to deal 
with since then. We have talked about homeland security, our airport 
security, our national security, and the foreign affairs that come 
along with all of the issues we have dealt with since 9-11.
  I do sincerely believe that now is the time we must remember what are 
the most important issues with which we have to deal on the homefront, 
particularly before we conclude this Congress. We must begin now with a 
prescription drug package if we clearly intend to come up with 
something by the end of this session, and I think we must look 
earnestly, not only at what we can afford but, more importantly, how we 
can get the biggest bang for that buck and how we can be assured that 
the majority of the elderly, particularly those who are in the greatest 
need, will receive a benefit package. Seniors need this now more than 
ever. We have to enact that benefit which is adequately funded and 
guaranteed to be universal, affordable, and accessible.
  We have looked at some of the plans that have come out recently, and, 
unfortunately, they do fall very far short of what our seniors need. 
Much of the money has gone into some of the private areas that actually 
present me with great concern. Medicare+Choice, for instance, the last 
three Medicare+Choice plans in Arkansas were pulled out the end of 
December of last year. Not a single one of those three plans offered a 
prescription drug package. Medigap in Arkansas is disproportionately 
higher in cost than it is nationwide. So it does not provide the 
service, it does not provide the safety net, it does not provide the 
benefits that Arkansans need, and it comes at an exceptionally high 
price.
  We have to look at putting competition in, but we have to make sure 
it is a benefit package that is going to work for all areas of this 
great country. We want to continue to work on this. Rural beneficiaries 
in my State are more likely to have poor health and lower incomes than 
seniors living in urban areas. They also use more prescription drugs.

  That is one of the reasons I am here today. This is an extremely 
powerful issue in America and across rural America. We are only as 
strong as our weakest link. If rural America happens to be that weak 
link now, we must address those problems. Putting a plan into place 
that only gets at the problems of the urban areas or the highly 
populated areas is not going to work because it will continue draining 
the overall system in rural areas.
  In Arkansas, 60 percent of seniors live in rural areas. I am 
extremely concerned about the limited prescription drug coverage 
available to them. Only 14 percent of Arkansas employers offer retiree 
health insurance. Only 2 percent of rural Arkansans are enrolled in 
managed care, which goes to show one size does not fit all. We have to 
come up with a comprehensive plan that has enough flexibility that we 
can make it fit all regions of this great Nation, but that we can do so 
in a way that is cost effective and cost efficient.
  Medicare+Choice plans do not work in our rural States anymore, and 
Medigap coverage is out of reach for most seniors.
  This is an essential issue with which we have to deal. We must come 
together. We must come up with a compromise. We must come up with a 
sound policy that will not only provide the quality of life we want for 
our loved ones but also a huge part of stabilizing our economy in this 
great country in a time when health care has blown completely out of 
proportion.
  The PRESIDING OFFICER. The Senator from Florida.
  Mr. NELSON of Florida. I ask unanimous consent to be recognized in 
morning business.
  Mr. REID. If my friend from Florida would withhold for a minute, we 
are near the time where the majority leader will come to the floor. It 
should be

[[Page S3607]]

another 10 minutes. Is that adequate time for the Senator?
  I ask unanimous consent the Senator from Florida be recognized for up 
to 10 minutes to speak as in morning business.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. NELSON of Florida. Madam President, I compliment the Senator from 
Arkansas for her excellent statement about health care. As the Senator 
pointed out the need for a prescription drug benefit to modernize 
Medicare, it reminded me of an unbelievable story. I don't know that it 
is fact, but it sounded pretty solid.
  The White House is floating a plan that someone on home health care 
would have to have a copay through Medicare in order to get that 
service. Certainly in our part of the country, home health care is an 
alternative to the more expensive care of a nursing home, and clearly 
it is a lot more expensive being in a hospital. And home health care, 
despite the expense, is clearly a lot better quality of life for the 
senior citizen than being in a nursing home or in a hospital if they 
can be medically treated appropriately and successfully in home health 
care.
  The Senator talked so eloquently about medical care in the State of 
Arkansas. Would it not be devastating to senior citizens to have a 
copay on home health care that they now do not have under Medicare?
  Mrs. LINCOLN. In some areas, it has gotten difficult even finding 
home health care that will serve rural areas. Certainly for myself, 
with aging parents who are at home and independent, home health care is 
essential.
  If the question is whether or not they will serve and whether or not 
those individuals can afford or are able to provide a copay, it will be 
devastating.
  In my home State of Arkansas, 49 percent of the people have an 
adjusted gross income of $20,000 or less. We are a snapshot of what the 
rest of the Nation is going to be like. Florida has a lot of retirees 
and elderly, but for us as a percentage of our population, we rank in 
the top three. We are clearly a snapshot of where the rest of the 
country is going to be in terms of the percentage of our elderly 
population and the lack of services. Because we are rural, we have that 
lack of services.
  Even the urban areas will be without the services if we do not look 
at Medicare reform and we do not start now looking at the ways we can 
make health care delivery more affordable. Prescription drugs is the 
most reasonable place to start. We have the technology, we have the 
development of pharmaceuticals that can help provide that quality of 
life, and we have home health care out there that can help keep down 
the costs of acute hospitalization, acute care in nursing homes, and 
other areas.
  Making it cost prohibitive does not increase the availability or the 
accessibility of health care. We can keep our loved ones in their homes 
and cared for at a reasonable cost, the Senator is exactly right.
  It is so important to recognize we need to start now. We are so 
underprepared as a nation as to what will happen in the next 15 to 20 
years when the baby boomers hit 65 and we have no geriatricians, no 
physicians, and a nursing shortage. The State of Massachusetts lost 25 
or 26 nursing homes last year, all of which were 85 percent or better 
occupied.
  We are not preparing ourselves for what will happen with our 
population, which is going to increase phenomenally in the aged 
category. Home health care and providing it in a way that is cost 
effective is absolutely essential. The Senator from Florida knows, and 
I am with him without a doubt, we have to make sure we focus on this 
issue. We need to do it sooner rather than later.
  Mr. NELSON of Florida. It is amazing to me where they come up with 
the ideas from the administration to get savings out of Medicare, 
particularly when they start talking about making senior citizens pay 
copays on home health care, which is an activity that is desirable and 
saves money in the long run by giving seniors an alternative to the 
hospital and nursing homes that are so much more expensive.

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