[Congressional Record Volume 148, Number 83 (Thursday, June 20, 2002)]
[Senate]
[Pages S5792-S5794]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
PRESCRIPTION DRUGS
Mr. GRAHAM. Mr. President, since its creation in 1965, the Medicare
Program has helped millions of the Nation's elderly and disabled when
they were in desperate need, after they had become sick enough to
require a physician's assistance or hospitalization. Thirty-seven years
after its creation, it is time for change.
A prescription drug benefit is the most fundamental reform we can
make to the Medicare Program. Why? If we want to truly reform Medicare,
we must change its basic approach from one that is oriented toward
intervention after sickness to one that focuses on maintaining wellness
and the highest quality of life. This prevention approach will require
in almost every instance a significant use of prescription drugs.
An example of how the use of prescription drugs has changed medicine
was made by Dr. Howard Forman, a congressional fellow in my office, who
is a doctor and professor at the Yale Medical School. Dr. Forman
remarked to me that none of his students had ever seen ulcer surgery.
Why? Because we now give patients prescription drugs to care for this
ailment which previously was dealt with through surgery. This is just
one of many examples of where modern medicine has fundamentally been
altered by prescription drugs; notably, by improving the quality of
people's lives, ending the need for many surgeries and long recovery
periods.
A side benefit of this change would be that the cost to the Medicare
Program could be lowered by utilizing these expensive but less
expensive prescription procedures as opposed to traditional surgery.
The prescription drug legislation I am sponsoring, with my friends,
Senator Zell Miller of Georgia and Senator Ted Kennedy of
Massachusetts, would improve the Medicare Program and give seniors a
real, a meaningful, a sustainable drug benefit. With a $25 monthly
premium, no deductible, and a simple copayment of $10 for generic
drugs, $40 for medically necessary, standard brand name drugs, and $60
for other brand name drugs, and a maximum of $4,000 in out-of-pocket
expenses, our plan would give seniors the universal, affordable,
accessible, and comprehensive drug coverage which they want and need.
Our plan would help 80-year-old Freda Moss of Tampa, FL. She has no
prescription drug coverage. Today, she pays nearly $8,000 a year for
the drugs she needs to keep her healthy. This does not include a new
prescription for Actos, an oral diabetes drug that costs $143.68 every
month. Freda has not had this prescription filled because it is so
expensive.
Under the Graham-Miller-Kennedy plan, she would pay just over
$2,900--saving $5,100 each year. Under the House Republican plan,
Freda's drug costs would be at least $4,220 a year. Why would the House
plan cost Freda $1,320 more per year?
There are many reasons, including a higher monthly premium and a $250
deductible. But the single biggest reason is the ``donut.''
What is the donut, Mr. President? We are all familiar with donuts.
They are round; they taste good; often, they have powdered sugar on
them; they are tasty at the edges. But when you get into the middle,
there is nothing there. That describes the benefit structure of the
House Republican plan.
Let's look at how this plan would have affected Freda and her
husband, Coleman. After having paid a $250 annual deductible, Freda and
her husband would pay 20 percent of the cost of each specific
prescription up to $1,000. From $1,001 to $2,000, she would pay 50
percent of each prescription. And then she hits the hole in the donut.
Freda is on her own until she reaches the catastrophic limit of $4,900
in total drug costs.
While she is struggling through this hole in the middle of the donut,
she would be responsible for continuing to pay her monthly premiums of
about $34, for which she would receive nothing, no benefit.
Mr. President, there is no comparable donut in private health care
plans. The kind of plan which probably covered Freda and Coleman before
she came on to Medicare did not have this approach; it has, as we do,
continuous protection. One of the things our older citizens want is
certainty and security. Our plan gives them that.
The House Republican plan converts them into guinea pigs,
experimenting with untested health care policies and a ``gotcha'' of an
unexpected hole in the middle of their benefit--a hole which runs from
$2,001 all the way to $4,900 of expenditures. We are not going to make
39 million senior Americans into laboratory experiments.
Under our plan, Freda would pay no deductible, receiving coverage
from her first prescription. She would pay a simple copay for each
prescription. There are no donut holes. Instead of gaps, we give
American seniors a plan that mirrors the copay system that they had in
their working lives.
Mr. President, as my colleague, Senator Miller, says with such
conviction and passion: This is the year for action, not just talk, on
prescription drugs.
I don't want to go back to Tampa, FL, and tell Freda we had a very
strong debate about this issue. I want to tell Freda she can start
going to the drugstore and from her first prescription begin to get
real assistance. We all will come to the floor this week, and in the
following weeks, to remind our colleagues about the importance of
passing a prescription drug benefit before the August recess, and to
have that benefit in law before the end of this session of Congress.
The ACTING PRESIDENT pro tempore. The Senator from Georgia is
recognized.
Mr. MILLER. Mr. President, I, too, rise to talk about prescription
drugs and the struggle our seniors face every day.
Since April, I have been coming down to this Chamber on a regular
basis to speak about the urgency of passing a prescription drug benefit
before the August recess. I have spoken about how we have kept our
seniors waiting in line for years and how we have bumped them time and
time again to debate other issues--other important issues but other
issues.
Our majority leader, Senator Daschle, has said we will bring up
prescription drugs on the Senate floor before the August recess. I and
many others are very grateful.
As of today, we now have three bills in Congress to add a
prescription drug benefit to Medicare--two in the House and one in the
Senate--the one I am a cosponsor of, along with Senator Graham of
Florida, Senator Kennedy, Senator Daschle, and about 28 other Senators.
This issue is now where it should be; it is front and center. It has
more momentum today than it has had in all the years we have been
talking about it. Our seniors have finally reached the front of the
line. Now it is time to get down to business and have a real debate on
the details of these proposals.
Make no mistake about it, there are real differences among them.
Let's debate those differences. If we can, let's find some common
ground. And then let's get something passed because if we fail to do
something now, if we just criticize each other's bills for the sake of
criticizing, and dig in our heels and refuse to compromise and work
something out, our seniors are never going to let us forget it come
November.
After years of wandering in the wilderness, our seniors are now
inside of the promised land. Both political parties have brought them
there and have given them a glimpse. We cannot send them away to wander
in the desert for
[[Page S5793]]
another election cycle or who knows how many more years.
I urge my colleagues to let us have a healthy debate on these bills.
Let us point out the strengths and weaknesses of each proposal, but
never lose sight of the big picture, as Senator Graham just said at the
end of his remarks.
This should not be viewed as just an issue for the next election
campaign. I urge my colleagues not to look at it in that way. Our goal
should be to pass a prescription drug benefit. I will work hard to see
that the bill we pass in the Senate offers real help for our seniors,
especially for our neediest seniors.
As Senator Kennedy said so eloquently last week: The state of a
family's health should not be determined by the size of a family's
wealth.
One way to help our seniors, including the neediest, with
prescription drugs is to pass a bill that has no gap in coverage and
that places a reasonable cap on out-of-pocket expenses.
The Graham-Miller-Kennedy bill offers just that. There is no gap in
coverage, and the out-of-pocket maximum is set at $4,000 a year. After
$4,000, Medicare would pick up 100 percent of the cost of prescriptions
under our bill. But the House Republican bill provides no coverage from
the time a senior's total drug costs reach $2,000 to the time they
reach $4,900. That is that ``hole in the donut'' Senator Graham was
talking about that is so obvious.
Who will it hurt the most? The ones who can afford it the least--the
low-income seniors. To add insult to injury, the House bill requires
seniors to continue paying monthly premiums during this gap, even
though they are not receiving a single penny of benefit. Even the
neediest seniors would have to pay these premiums during this gap. That
is not right; that is just plain unacceptable.
I look forward to debating this provision, and many others, when we
take up prescription drugs in the next few weeks. I urge my colleagues
in both Houses and in both parties to keep the big picture in mind. Our
duty to seniors is not just to debate a bill, it is to pass a bill.
The final product won't be perfect. It won't include everything that
I want, and it won't include everything that some of my colleagues may
want. But it will be better than what our seniors have now. And what
our seniors have now is nothing.
The ACTING PRESIDENT pro tempore. The Senator from Massachusetts is
recognized.
Mr. KENNEDY. Mr. President, first of all, I want to commend our
colleagues, Senator Miller and Senator Graham, for their leadership in
this area, which is of such enormous importance and consequence to
people in my State of Massachusetts and across the country.
I hope the American people are going to pay close attention to these
presentations that are made today by both of these leaders, as well as
my friend from Michigan, Debbie Stabenow, as they continue to help the
American people understand what is really at stake.
Medicare is a solemn promise between the government and the American
people and between the generations. It says ``Play by the rules,
contribute to the system during your working years, and you will be
guaranteed health security in your retirement years.'' Because of
Medicare, the elderly have long had insurance for their hospital bills
and doctor bills. But the promise of health security at the core of
Medicare is broken every day because Medicare does not cover the
soaring price of prescription drugs.
Too many elderly citizens must choose between food on the table and
the medicine their doctors prescribe. Too many elderly are taking half
the drugs their doctors prescribe--or none at all--because they can't
afford them. The average senior citizen has an income of $15,000 and
prescription drug costs of $2,100. Some must pay much more.
I want to pick up on the issue of comparing the different bills.
Hopefully, as we come to debate these issues and questions, we will
begin to understand the importance of the differences in the Democratic
and Republican bills. They are enormously different.
The administration's first bill did not even pass the laugh test, and
the bill that is being considered now by the Republicans in the House
of Representatives does not pass the truth-in-advertising test. The
administration allocated $190 billion. Senior citizens are going to
spend $1.8 trillion for prescription drugs. So they get about 10 cents
on the dollar to assist them, and there are still a lot of gimmicks
they have to go through to get even that.
Listen to the Republican proposal. The House Republicans have a
proposal that says: If you have an income below 150 percent of poverty,
you are not going to have to worry about your premiums, copayments, or
deductibles. Doesn't that sound reasonable for low-income people?
Except there is an assets test which the Miller-Graham proposal does
not have.
This is basically a hoax on the low-income people. To qualify for
low-income subsidies under the Republican plan a senior cannot have
$2,000 in savings. They cannot have $2,000 in furniture or property,
they cannot have a car that is worth $4,500 or a burial plot that is
worth $1,500. Any one of these assets disqualifies one from the
Republican plan. Do they mention that? No. Do you read about it? No. Is
it there? Yes. Effectively this writes off, writes out millions of low-
income seniors.
This group of seniors is seeing a fraud perpetrated on them. The
Miller-Graham bill has rejected that concept. If we in the Senate are
going to be true to our word, we will reject it, too. This will be an
important battle.
The second group of seniors is those with moderate incomes who are
going to pay the $420 annual premium and the additional $250
deductible. We know they are going to get very little in return. They
will pay up to $670 in premiums and deductibles before they are going
to get any assistance at all. Those with prescription drug spending of
$250 or less will pay $670 and receive no benefit. Seniors who have
drug costs between $250 and $1,000 annually will spend up to $820 in
annual costs but only receive up to $600 in benefits. Those seniors
with prescription drug costs falling between $1,000 and $2,000 a
year will pay premiums, deductibles, and copayments totaling up to
$1,320 in return for benefits of up to only $1,100. Seniors ought to
know just what help the Republicans are offering in their proposal.
Finally there is the last group, individuals who still have a very
modest income, but have prescription drug costs over $2,000. They are
going to fall into the hole, as Senator Graham has pointed out. They
will get no assistance for their drug costs once they reach $2,000.
It is important to understand, as we begin this debate, who is going
to be helped and who is not going to be helped. The Republican program
fails to explain that either to their membership or to the American
public.
In each of these areas, the Miller-Graham bill rejects those
artificial barriers and assists each and every citizen all the way
through. That is a major difference. This is one of the important
differences we ought to recognize.
Here's another important difference. Rather than the safe, dependable
Medicare system that senior citizens understand, the Republican plan is
run through private insurance companies--pharmaceutical HMOs. They are
allowed to set premiums at whatever the traffic will bear. And there is
no guarantee that benefits will actually be available if private
insurance companies decide they don't want to participate. Senior
citizens have seen what has happened to HMOs in the regular Medicare
program--cutbacks in benefits, withdrawal of services. They don't need
that for lifesaving prescription drug coverage.
And to complete this dishonor roll of the Republican plan, it does
not even start until 2005. The Republican prescription for senior
citizens: take two aspirin and call the pharmacy in two and a half
years.
Senior citizens and their children and their grandchildren understand
that affordable, comprehensive prescription drug coverage under
Medicare should be a priority. Let's listen to their voices instead of
those of the powerful special interests. Let's pass a Medicare
prescription drug benefit worthy of the name.
The ACTING PRESIDENT pro tempore. The Senator from Michigan.
Ms. STABENOW. Mr. President, I rise today to join my colleagues in
supporting the Graham-Miller-Kennedy bill of which I am very pleased to
be a
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cosponsor, which will provide a voluntary comprehensive Medicare
prescription drug benefit. This is long overdue.
I also rise today to express great concern about what is being done
in the House of Representatives. We know that in the end we need to
come together with a bipartisan bill. We welcome that and want to work
with our colleagues, but it has to be something real, it has to be
something that provides more than 20 percent of the cost of
prescription drugs--only 20 percent help--leaving our seniors to pay 80
percent and, in some cases more, for their prescriptions. It is just
not good enough.
I wish to share some portions of a letter I received yesterday from
the Kroger Company of Michigan that was written to me concerning the
legislation that is being drafted and passed by our Republican
colleagues in the House. It says:
Dear Senator Stabenow: As president of the Michigan Kroger
stores, I am writing to advise you that our stores oppose the
Thomas-Tauzin medicare bill.
The Republican bill in the House.
Passage of this bill will hurt Michigan senior citizens by
confining their freedom in choosing generic over brand name
medications and restricting their pharmacy choices.
Furthermore, the viability of community pharmacies is of
significant concern, especially in rural areas where
inadequate reimbursement rates could force many community
pharmacies out of business, further restricting seniors'
choices.
There is great concern not only from the senior groups, those that
represent consumers in our country. I appreciate the president of
Kroger expressing great concern about this as well. We can do better.
The question is, To whom are we going to listen?
I am asking, as are my colleagues, that we listen to not only seniors
but businessowners and others who are experiencing an explosion in the
prices of prescription drugs, and that we act and do so now. It is long
overdue.
A few weeks ago, I invited people to come to my Web site. We have set
up the prescription drug people's lobby in Michigan. We are tying it to
a Web site that has been set up nationally, fairdrugprices.org, and I
have been asking people to share their concerns, their experiences with
the high prescription drug prices we are seeing across the country.
Once again, I wish to share a story from one of those citizens in
Michigan who has signed up to be a part of our prescription drug
people's lobby.
This is from Molly A. Moons, who is 44 years old in Pontiac, MI. She
says:
Senior citizens are not the only people suffering from the
high cost of prescription drugs. I am the sole employee of a
small business and not eligible for any health care plans
that cover the cost of prescription drugs. I have four
prescriptions that need filling each month, and the cost is
in excess of $300 a month--a real financial burden. At the
invitation of some senior citizen friends, I was invited to
take a ``drug run'' to Canada.
Mr. President, a number of us have done this to demonstrate the
differences in prices.
These ladies were all widows/retirees on fixed incomes that
were having trouble paying for their medications, so I joined
them to buy our prescriptions in Canada.
. . . I am able to get a 3-month supply of medication for
what it costs me for a 1-month supply in the United States.
A 3-month supply in Canada for a 1-month supply in the United States.
I find that shameful.
While I believe that everyone has a right to make a
profitable living, the gouging of the pharmaceutical
companies is sickening. Additionally, the loopholes that
these companies use to keep drugs from generic manufacturers
are also criminal. Please help make this stop.
I thank Molly Moons for sharing her story as a small businessowner
and sharing her concern about the senior citizens who were on that bus
going to Canada. Shame on us. She is right, ``I find it shameful,'' and
it is shameful. We are saying we can do something about it. We can do
something about it by passing the Graham-Miller-Kennedy bill that will
provide a comprehensive Medicare prescription drug benefit, and we can
further do it by passing other legislation to lower prices through
expanded use of generics, opening the border to Canada and other
policies that will lower prices. We can do that, and we need to do
that.
Why has this not been done? Why has this not happened? We have been
talking about it. I talked about it as a Member of the House of
Representatives. We tried to pass something then. Colleagues of mine
have talked about it. Presidential candidates have talked about it. As
the Senator from Georgia said earlier, it is time to stop talking about
it and get something done.
Why has that not happened? Unfortunately, we have seen too much
influence and too many voices trying to stop this, and not enough of
the people's voice in this process, which is what we are trying to do
right now.
We have a Web site that I have invited people to go to that is called
fairdrugprices.org. We are inviting people to sign a petition to urge
Congress to act right now, to urge Congress to pass a comprehensive
Medicare prescription drug benefit, and to pass other efforts to lower
prices. We urge people to go to this Web site and share their story. We
will share those stories on the floor of the Senate.
Why is that important? It is important because, according to our
numbers, there are about six drug company lobbyists for every Member of
the Senate. Their voice is being heard. This is about making the
people's voice heard through their Representatives and their Senators.
Unfortunately, there are other ways in which voices are heard. I
found it unfortunate that yesterday, while in the midst of debating a
Medicare bill, which has been viewed by colleagues and quoted in the
paper from House Republican staff as being a bill they are very
concerned about having reflect the needs of the drug companies, but at
the same time we do not have the concerns of our seniors and our
families being voiced as a part of that process, that last evening
there was a major fundraiser. Our colleagues on the other side of the
aisle and the House of Representatives had a major Republican
fundraiser and we saw a number of pharmaceutical companies playing a
major role.
We saw Glaxo Smith Klein, according to the newspaper, contributing
about $250,000 to that fundraising effort; PHRMA, which is the trade
organization for the companies, contributing about $250,000 to that
fundraiser; Pfizer, about $100,000, and other companies as well. So
there are those that are not only here as lobbyists but contributing
dollars to fundraisers, certainly wanting to make their voice heard.
The PRESIDING OFFICER (Mr. Miller). The Senator's time has expired.
Ms. STABENOW. Mr. President, I ask unanimous consent for 2 additional
minutes.
The PRESIDING OFFICER. Without objection, it is so ordered.
Ms. STABENOW. In conclusion, we know the lobbyists' voices are heard
on this issue, the drug companies' voices are heard in a multitude of
ways. Now is the time for the people's voice to be heard on this
subject, and I urge those who are watching today to get involved
through fairdrugprices.org, by showing support for a bill that will be
brought up in July and will be voted on in this Senate to provide real
help for seniors and those with disabilities in our country.
We will bring forward other legislation to lower prices for everyone,
for the small businessowner, the manufacturer in Michigan, the farmer,
those who are paying high prices through their insurance premium or at
the pharmaceutical counter. The time has come to act. We know what to
do. Now it is time to do it.
The PRESIDING OFFICER. The Senator from Pennsylvania.
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