[Congressional Record Volume 148, Number 99 (Friday, July 19, 2002)]
[Senate]
[Pages S7099-S7100]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           PRESCRIPTION DRUGS

  Mrs. LINCOLN. Mr. President, in all the rhetoric and grandstanding 
about who has the best prescription drug plan, I truly do not want us 
to forget who we are trying to help.
  I cannot possibly forget the 436,000 Medicare beneficiaries in 
Arkansas who struggle every single day to pay for the prescription 
drugs to control blood pressure, their heart, and help them cope with 
chronic diseases.
  Yes, some seniors are eligible for Medicaid. Some have Medigap. But 
most of them fall through the cracks. In Arkansas, we don't have the 
tools that other States might have to help our seniors pay for their 
prescription drugs. Medicare+Choice has left our State. Medigap plans 
cost a lot more than the national average--almost 20 percent higher, to 
be exact, a year.
  Employer-sponsored retiree health plans are extremely rare. On top of 
that, 60 percent of our seniors live in rural areas. So how do our 
seniors afford their prescription drugs, which rise in cost absolutely 
every year? The sad fact is, they don't.
  The best way to combat this problem is add a prescription drug 
benefit to the Medicare Program. That is why I am so disappointed that 
neither of the Medicare prescription drug plans we will consider this 
next week seem to have the 60 votes they need to pass.
  I am disappointed we are at a standstill in the Senate, and I am 
disappointed we have been unable to forge a compromise in the Senate 
Finance Committee. As a member of that committee, I would prefer to be 
debating these plans in that committee. However, I understand that the 
urgency of the issue and the timing of the Senate schedule has brought 
us here today.
  In years past, I have been a cosponsor of Senator Bob Graham's 
Medicare prescription drug bill. My colleague from Florida has invested 
a tremendous amount of time and effort in designing a benefit that 
senior citizens desire. And he has done well. My constituents have told 
me how much they like the benefit package and the extra assistance for 
low-income beneficiaries. They like that the premium will be guaranteed 
at $25 a month and will not vary State by State or region by region. 
This is good because in States such as Arkansas, we usually--almost 
always--get the short end of the stick when that happens. They like 
that the benefit is stable and universal and that it does not have a 
gap in coverage and is straightforward and simple.

  Although I favor this plan, I did not cosponsor the bill this year in 
the hopes that I could help my colleagues on the Finance Committee 
forge a compromise that would work for seniors and that would have 
enough votes to pass the Senate. Unfortunately, that effort seems to 
have failed. I commend my chairman, Senator Baucus, for his efforts to 
try to shape a compromise between these two competing plans that we 
have before us today.
  I also thank my friend from Louisiana, Senator John Breaux. Senator 
Breaux, through serving on the National Bipartisan Commission on the 
Future of Medicare in 1997 and shaping the debate in Congress, has 
played a leading role in the national effort to improve the Medicare 
Program.
  I appreciate the many meetings we have had on this issue and hope we 
have the ability to continue to work in that bipartisan fashion, 
working to forge compromises as we move forward on the Senate floor, as 
well as in conference.
  I also want to recognize the tremendous amount of staff work that has 
been done, particularly and especially by my staff, Elizabeth 
MacDonald, all of the staff on the Finance Committee, as well as the 
Members who have had plans.
  However, despite the changes Senator Breaux, Senator Grassley, and 
others have made to the tripartisan bill, I believe the bill still 
fails to offer an acceptable model to deliver prescription drugs to 
seniors in rural States such as Arkansas.
  I cannot in good conscience vote for a plan that relies on the 
untried, untested delivery system laid out in the tripartisan plan. The 
private insurer model will require significant taxpayer subsidies to 
attract insurers into a drug-only insurance market, something we have 
never tried before. The insurance companies have told me they are 
hesitant to assume the risk for this type of plan unless they are 
heavily subsidized, and I do not think this is a proper use of our 
taxpayers' dollars. Nor can I support a plan that does not entitle 
seniors to any particular drug benefit but, rather, only a suggested 
benefit.
  Consider for a moment the story of Mrs. Mildred Owens of Havana, AR. 
Mildred is 70 years old, and she worked for 35 years before retiring 5 
years ago. Now widowed, Mildred receives about $830 a month in Social 
Security and about $125 a month in retirement.

[[Page S7100]]

  Mildred takes prescription drugs which cost about $200 a month. After 
paying her Medicare premium and drug expenses, she has spent well over 
27 percent of her income. She said that she and her two sisters, Evalee 
and Betty, who each make about $600 a month, do not even go to the 
doctor anymore because they cannot even afford the prescription drugs 
the doctor would prescribe. Sometimes Mildred and her sisters must rely 
on their children to help pay for some of their medications.
  If the tripartisan plan were law and if Mildred and her sisters asked 
me what their monthly premium was going to be and what their benefits 
would be for prescription drug coverage under Medicare, I would have to 
say to them, actually, I do not know; I cannot give you a specific; we 
will have to wait and see what actually happens in our area. Mildred 
may, in fact, end up paying a different premium for prescription drugs 
than her friends pay in California or Florida or New York or 
other States. Yet they both paid taxes into Medicare all of their lives 
and therefore should be entitled to the same Medicare benefit.

  The point is, we do not know yet what private plans might offer in 
different regions of the country. We do not know what their benefits 
would be. We do not know if private plans would want to participate. We 
do not know how much they would charge for it. And there is absolutely 
no guarantee that seniors would be able to depend on the same plan or 
benefit structure from year to year. These are just too many unknowns, 
and for seniors, nothing is more frightening than the unknown.
  Why do we want to force our parents and grandparents into an untested 
delivery system that is unlike any other system in American health care 
as we know it?
  Why should seniors in rural Arkansas, who are older and sicker and 
more likely to use prescription drugs, be in the dark about what their 
premiums will be until the Federal Government entices the private 
insurers to compete in their area of the country?
  Why should we risk forcing them to pay higher premiums than those in 
urban areas?
  Show me where it has worked. I ask my colleagues: Show me a study, 
show me a demonstration project. If the sponsors of the tripartisan 
plan are so confident that their delivery model will work, then I 
propose a compromise that could garner the 60 votes needed to pass a 
Medicare prescription drug plan.
  Let's put a demonstration project in the home State of the bill's 
chief architects and use the Graham delivery model in Arkansas and the 
rest of the country so that we can be assured of what we are going to 
get until we know what works. Let's see if this untested delivery model 
works in a few States before we take it nationwide and put everyone at 
risk.
  Why subject our seniors to a vast social experiment? Why should we 
subsidize private insurance companies when we should instead empower 
our seniors with the ability to afford the prescription drugs they 
need?
  I am also concerned that the tripartisan bill has a gap in coverage, 
albeit a much smaller one than originally proposed. How can I tell 
seniors in my State that they will not receive any coverage for their 
drug costs between $3,451 and $5,300?
  Although the tripartisan plan says it only contains a gap of $250, in 
reality it is actually a gap of $1,850 because the first threshold 
includes the combined expenditures of seniors and the Government, while 
the second only refers to the senior's out-of-pocket expenses.
  How can I explain to Mildred Owens that no other American but 
Medicare beneficiaries will have this gap in coverage? Members of 
Congress and Federal employees do not face a gap in prescription drug 
coverage, nor do non-Federal retirees or employees. This gap in 
coverage for seniors who use more prescription drugs than any other 
population group in our country is not only unfair, it is simply 
unreasonable.
  Further, this gap in coverage is opposed by the AARP, which counts 
about 350,000 Arkansans in their nationwide membership. AARP has 
surveyed their membership on the value of a prescription drug benefit 
and has identified five characteristics that any prescription drug 
benefit must include in order to attract the enrollees it needs. One of 
those characteristics is a benefit that does not expose beneficiaries 
to a gap in insurance coverage.
  Mr. President, I ask unanimous consent to print a letter from the 
Arkansas AARP State chapter in the Record that shows how the 
tripartisan bill fails to meet the kitchen-table test that their 
Members will likely use when determining if the drug benefit is a good 
buy.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:


                                                         AARP,

                                    Washington, DC, July 12, 2002.
     Hon. Blanche L. Lincoln,
     U.S. Senate,
     Washington, DC.
       Dear Senator Lincoln: Medicare beneficiaries cannot wait 
     any longer for protection against the increasing cost of 
     prescription drugs. The 439,000 Medicare beneficiaries in 
     Arkansas need an affordable prescription drug benefit enacted 
     into law this year.
       Currently, about 13 million Medicare beneficiaries 
     nationwide lack prescription drug coverage for the entire 
     year and about 16 million lack coverage for some point during 
     the year. State pharmacy assistance programs often provide 
     some prescription drug benefits to low to moderate-income 
     beneficiaries. However, as you know, Arkansas does not even 
     have such a program to help meet the needs of low-income 
     beneficiaries in the state.
       The prescription drug legislation recently passed by the 
     House of Representatives begins to move the Medicare program 
     one step closer to providing millions of older Americans and 
     people with disabilities with some help against the rising 
     costs of prescription drugs. But more needs to be done.
       We know from our membership that they will assess the value 
     of a prescription drug benefit by adding up the premium, 
     coinsurance and deductible to determine if it is a good buy. 
     We believe that in order for a voluntary Medicare 
     prescription drug benefit to pass this ``kitchen table test'' 
     and attract enough enrollee it should:
       Provide an affordable benefit as a permanent part of 
     Medicare's benefit package;
       Keep the monthly premium to no more than $35;
       Ensure reasonable and stable cost-sharing for 
     beneficiaries;
       Ensure that there are no gaps in coverage that leave 
     beneficiaries vulnerable;
       Be voluntary and available to all beneficiaries no matter 
     where they live;
       Help to bring down the soaring costs of prescription drugs; 
     and
       Protect low-income beneficiaries.
       It is critical that the Senate pass a Medicare prescription 
     drug bill this month that meets these goals. The 205,000 AARP 
     households in Arkansas are counting on your support for a 
     prescription drug benefit at least as good as the Graham-
     Miller proposal.
       If you have any questions please call one of us or have 
     your staff call David Certner, Director of our Federal 
     Affairs Department, at (202) 434-3750.
           Sincerely,
     William D. Novelli,
       Executive Director and CEO.
     Cecil Malone,
       AARP Arkansas State President.
     Maria Reynolds-Diaz,
       AARP Arkansas State Director.

  Mrs. LINCOLN. Mr. President, I am also hopeful that a compromise on 
the Medicare prescription drug benefit is imminent. I am ever 
optimistic that we can all agree on a good basic solution at the end of 
the day. We must not fall into the trap of all talk and no action once 
again. For the almost 4 years I have served in the Senate, I have 
continually gone home to my State of Arkansas, talked to seniors across 
our great State, and assured them that the Senate would act on a 
prescription drug package.
  I can no longer in good faith continue to simply talk about the 
benefit that is so needed. Our parents and our grandparents are 
depending on us. It would be a national tragedy to let them all down.
  We have talked and talked about it for years. Let us act this year 
and in this session. Let us not adjourn until we pass a Medicare 
prescription drug benefit that is meaningful and affordable for all 
seniors across this great country, no matter where they live.

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