[Congressional Record Volume 148, Number 101 (Tuesday, July 23, 2002)]
[Senate]
[Pages S7194-S7199]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




   GREATER ACCESS TO AFFORDABLE PHARMACEUTICALS ACT OF 2001--Resumed

  The PRESIDING OFFICER. The clerk will report the bill.
  The assistant legislative clerk read as follows:

       A bill (S. 812) to amend the Federal Food, Drug and 
     Cosmetic Act to provide greater access to affordable 
     pharmaceuticals.

  Pending:

       Reid (for Dorgan) Amendment No. 4299, to permit commercial 
     importation of prescription drugs from Canada.
       Graham Amendment No. 4309, to amend title XVIII of the 
     Social Security Act to provide coverage of outpatient 
     prescription drugs under the medicare program.
       Hatch (for Grassley) Amendment No. 4310, to amend title 
     XVIII of the Social Security

[[Page S7195]]

     Act to provide for a medicare voluntary prescription drug 
     delivery program under the Medicare program, and to modernize 
     the Medicare program.

  The PRESIDING OFFICER. The Senator from Massachusetts is recognized.
  Mr. KENNEDY. Madam President, I point out to my friend from Oklahoma 
that there are no provisions in his bill that are going to require the 
insurance companies to provide more than two drugs in any therapeutic 
group in a formulary. There is none. What is beyond that is what the 
cost will be.
  In our bill, if the doctor recommends that a patient have a 
particular brand name drug that is not on the formulary, the patient 
can have it. We write in our bill how much that patient will pay, which 
is $40. But there is no such provision in the bill the Senator is 
talking about.
  The Senator cannot show in his bill what the premiums are, what the 
cost is for premiums, deductibles, or the copay. It is going to be what 
the insurance company wants to do. It is a blank check for the 
insurance companies. There is no provision in there that indicates what 
the costs will be. That is the big difference.
  Under the Graham proposal, which was spelled out in great detail last 
evening by Senator Graham and others, beneficiaries will be able to get 
that off-formulary drug, and the price will be $40.
  On page 29:

       Treatment of medically necessary nonformulary drugs will be 
     whatever is medically necessary.

  Madam President, I withhold the remainder of my time.
  Mr. NICKLES. Madam President, I believe under the unanimous consent 
request, we had Senator Gregg managing the time. Senator Grassley will 
manage the remainder of the time.
  Mr. KENNEDY. I yield 15 minutes to the Senator from Iowa.
  The PRESIDING OFFICER. The Senator from Iowa is recognized.
  Mr. HARKIN. Madam President, I was listening to the comments made by 
my friend from Oklahoma. It is too bad he wasn't here in 1965 because 
he could have joined the chorus of voices on that side of the aisle 
that argued against Medicare. He would have fit right in. If you read 
the debate, it is almost like listening to it again. So it is too bad 
my friend wasn't here in 1965. He could have led the charge against 
Medicare.
  Mr. NICKLES. Will the Senator yield?
  Mr. HARKIN. I only have 10 minutes.
  Mr. NICKLES. I was wondering why you were guessing what I might have 
done in 1965.
  Mr. HARKIN. I am just taking it from your approach here because you 
want to basically--what the Senator is saying is he wants to turn this 
over to the insurance companies. A lot of people wanted to do that in 
1965, to turn Medicare over to the insurance companies.
  Mr. NICKLES. If the Senator will yield further----
  Mr. HARKIN. I will yield when I get done.
  Mr. NICKLES. I would appreciate it, if my colleague is questioning my 
motives----
  Mr. HARKIN. The point is, the Senator from Oklahoma and other people 
on that side are saying turn it over to the insurance companies. He 
talks about rationing, but what the Republicans want to do is give 
private insurers a free ride, charge seniors whatever they want, and 
then they will be able to tell them what drugs they take. That is what 
the insurance companies do now anyway.
  Look at the debate on Medicare. Turn it over to the insurance 
companies. You can just go back to 1935 and look at the debate on 
Social Security. We have heard the same echoes all the time down 
through the years that we cannot do this. Well, it is time we do it. It 
is time we make good on the promise to 44 million Americans who rely on 
Medicare.
  The choice is very clear: You either do it under Medicare, which is 
proven and has a proven track record; it cuts out all of the middlemen 
in the middle ground and gets the drugs right to seniors, or you can go 
in the other direction and say we will do it through the insurance 
companies, which is exactly what the bill on the Republican side 
proposes to do.
  I know a little bit about this personally. My father was quite old 
when I was born. When I was in high school, my father was already in 
his late sixties, and he had worked just enough quarters to qualify for 
Social Security. He worked most of his life in coal mines, but during 
the war and right after the war he worked enough just to qualify for 
Social Security. But he would get sick every winter. We didn't have 
drug coverage. He would go to the hospital, and thank God for the 
Sisters of Mercy, who would take care of him and send him back home 
again. I happened to be in the military in 1965 when Medicare passed. I 
came home on leave and saw my father, and he had his Medicare card. 
Head held high, he could go in and be taken care of without relying on 
charity. But the one thing that was missing was prescription drugs.
  My father is long gone, but for others since that time, the one thing 
that is missing is prescription drugs. I have never been able to 
understand why it is that if you get sick and you go to the hospital, 
Medicare pays for all your drugs, but if you want to stay healthy, stay 
at home, Medicare won't pay for your drugs. That has never made sense 
to me. It seems to me you would want to get the drugs to the elderly to 
keep them as healthy as possible, to keep them at home, so they don't 
go to the hospital.

  My friend from Oklahoma mentioned rationing. We hear rationing, 
rationing. I say to my friend, go to Iowa right now and talk to the 
low-income elderly in Iowa. Here is their rationing. They cannot pay 
for their prescription drugs.
  Mr. NICKLES. Will the Senator yield?
  Mr. HARKIN. They cut them in half, or they decide whether or not to 
pay their heating bills in the winter or take their drugs; and when 
they have to cut back on their drugs, they get sicker and sicker, and 
they go to the hospital, and of course then Medicare pays for all their 
drugs.
  Mr. NICKLES. Will the Senator yield?
  Mr. HARKIN. I said I will yield when I get through with my statement.
  So the Graham-Miller proposal is the one that does it through 
Medicare. It is the one on which seniors can rely, and it is rock 
solid.
  This is the proposal the Republicans have right here on this chart.
  For example, they say, under their plan, a senior with $1,000 in drug 
care costs still pays $913. That is 91 percent that they still have to 
pay. And 18 percent of seniors have drug costs of about $250. Under 
this, they would pay everything. Eighteen percent have drug costs of 
$1,000. Under the Republican proposal, they would pay 91 percent, $913. 
Seventeen percent of seniors have $2,000 in drug costs a year. Under 
the Republican proposal, they would pay $1,413, or 71 percent. Twenty-
three percent of seniors--about one out of four--have $4,000 a year in 
drug costs. Under the Republican bill, they would pay $2,688 out of 
pocket, or 67 percent. If they have $5,000 in drug costs, they are 
going to pay 74 percent out of pocket. What kind of insurance is that, 
where you are paying 91 percent, 71 percent, 67 percent, or 74 percent 
out of your own pocket? Would you buy insurance like that?
  Mr. NICKLES. Will the Senator yield?
  Mr. HARKIN. Would you buy any kind of insurance--say a homeowners 
policy, and if your house burned down, you would pay 91 percent? Or if 
your car gets wrecked and it has to be fixed up, you would pay 71 
percent of the fees. What kind of insurance proposal is that?
  It is nonsense, not insurance. It is just another rip-off for the 
drug companies. Again, this does not provide adequate coverage and it 
doesn't contain costs.
  Two weeks ago, I had a roundtable discussion in Iowa with insurers, 
business leaders, and consumers about drug costs. They were united in 
saying that not only are rising drug costs hurting seniors, they are a 
growing problem for employers trying to maintain affordable health 
insurance for workers. It is a problem for younger workers, feeling the 
pinch of higher health insurance premiums and cost sharing as a result. 
These Iowans were adamant, saying that any bill we pass has to have 
some new tools to hold down the rising drug prices.
  Only the Graham-Miller bill makes progress toward cost containment. 
It

[[Page S7196]]

includes a bipartisan plan that will close the loopholes that have 
allowed drug companies to block lower cost generics from coming on the 
market. It addresses the issue of the 30-month rollover that they get 
all the time. The bill on that side doesn't do that. It is crucial 
because generic drugs cost a fraction of what the name brand equivalent 
costs, and they are just as safe and effective. But only the Graham-
Miller bill addresses that issue of bringing generics on the market and 
providing for that competition with brand names.
  The Graham-Miller bill has the Stabenow amendment, which will allow 
States to provide the discounts they get through Medicaid to others in 
the State, including seniors.
  There is also the important Dorgan amendment, which says drugs could 
be reimported from Canada by pharmacists. If you want to know how 
important this is, talk to my friend Marie, a 67-year-old retired nurse 
from Council Bluff. She dedicated 43 years of her life to helping 
others. She told me she is lucky compared to her friends because she is 
only on three medications. She recently got an advertisement from a 
drug company in Canada that would sell her drugs to her for less. She 
did some research and got a prescription from her doctor. She is saving 
over $80 a month right now.

  She has a friend who takes tamoxifen, an anticancer drug for breast 
cancer. She tried buying her tamoxifen from the Canadian company. In 
the United States, it cost her $319 for a 3-month supply. It cost her 
$37 from Canada.
  The problem with that is that individuals are doing that, and they 
are leaving out their local pharmacists. It is vitally important for 
the elderly to have communication and a relationship with their local 
pharmacist to make sure they are taking the right drugs and the right 
dose.
  While I think it is fine for seniors to get their drugs from Canada 
reimported, we have to make sure local pharmacists can do the same 
thing. Let them reimport the drugs from Canada at that same price. The 
Republican bill does not do that, but the Graham-Miller bill does.
  Today we have a chance to pass a bill that will contain costs, that 
will provide affordable and reliable prescription drug coverage without 
gaping holes. We have the chance to make sure we bring generics on the 
market sooner to provide competition and to let our pharmacists 
reimport drugs from Canada at a cheaper price for our consumers.
  All of that is in the Graham-Miller-Kennedy amendment, not in the 
Grassley-Breaux-Jeffords, et al, amendment. If you want good coverage, 
if you want to close the loopholes, vote for the Graham-Miller bill and 
not the fake substitute on the other side.
  The PRESIDING OFFICER (Mrs. Clinton). The Senator's time has expired.
  Who yields time? The Senator from Iowa.
  Mr. GRASSLEY. Madam President, I yield 1 minute to the Senator from 
Oklahoma, and then I would like to immediately yield 9 minutes to the 
Senator from Louisiana.
  The PRESIDING OFFICER. Is there objection?
  Mr. KENNEDY. Madam President, I do not intend to object. If the 
Senator from Oklahoma should be provocative, which for a moment or two 
he might be, I hope I can yield a moment to the Senator from Iowa just 
to be quiet, calm and reserved, and then go to the 9 minutes for 
Senator Breaux.
  The PRESIDING OFFICER. The provocation standard is recognized. The 
Senator from Oklahoma.
  Mr. KENNEDY. Do we have that understanding?
  Mr. GRASSLEY. I agree.
  The PRESIDING OFFICER. The Senator from Oklahoma is recognized.
  Mr. NICKLES. Madam President, people are entitled to their own 
opinion, but they are not entitled to their own facts. The tripartisan 
bill--and I will let Senator Grassley and Senator Breaux and others 
defend it--says for people with incomes less than 150 percent of 
poverty, the Federal Government, or this new plan, will pick up 95 
percent of the drug--95 percent.
  Under the Democrat proposal, if you do not have the Government-chosen 
plan or prescription drug, you get zero. Zero. Not 9 percent, not 50 
percent.
  The chart the Senator from Iowa has is incorrect. Under the basic 
plan, if you have an income above 150 percent of poverty--in other 
words, above $20,000 for a couple--the Federal Government picks up half 
the prescription drug cost up to $3,450--half, 50 percent--and you 
choose your drug, not the Government choosing the drug. There is a big 
basic difference in this plan. You get to choose the drugs, not the 
Federal Government.
  The PRESIDING OFFICER. The Senator from Iowa.
  Mr. HARKIN. Madam President, I ask for 1 minute to respond.
  Mr. KENNEDY. I yield 1 minute.
  The PRESIDING OFFICER. The Senator from Iowa.
  Mr. HARKIN. Madam President, I heard the Senator from Oklahoma. Talk 
about a Harry Houdini magic trick and trying to pull a funny curtain 
over issues. If you are below 150 percent of poverty, then it picks up 
95 percent, but what he is not telling you is there is an assets test.
  Take someone in Iowa who has an automobile worth $4,500. We need cars 
in Iowa. We do not have mass transportation. If you have a $4,500 car, 
you are not eligible for less than 150 percent of poverty. That is the 
assets test. If you have a burial plot worth $1,500, then you are out 
of the 150-percent poverty test; $2,000 worth of furniture, you are 
out. They are not telling you that. Have him stand up and tell you 
about the assets test and tell my elderly in Iowa, many who are below 
150 percent of poverty, that they cannot have a $4,500 car, that they 
cannot have a $1,500 burial plot, that they cannot even have $2,000 
worth of furniture in their house. If they do, they do not qualify. Go 
ahead and tell them that.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Louisiana.
  Mr. WELLSTONE. Madam President, with my colleague's indulgence, I ask 
unanimous consent that I follow the Senator from Louisiana for 5 
minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. BREAUX. I thank the Chair. Madam President, I thank my colleague 
for yielding me time.
  On this amendment, on the argument in which the two colleagues were 
engaged, there is already an assets test for Medicare. The assets test 
is part of the concept of delivering health care in this country. If 
someone has low income but has assets--a house in Florida, a large bank 
account, investments in stock--those assets are always considered to 
determine whether a person is eligible for Medicaid. We have all 
supported that. It is not new.
  The purpose of my taking the limited time that I have is not to 
criticize the other approach because our approach cannot be good just 
because the others are deficient. The tripartisan plan should be able 
to stand on what it stands for, not because the Graham plan is 
deficient in any particular area. So I am not going to spend my time 
talking about any perceived deficiencies in their plan but rather 
explain what we have presented to the Senate.
  Legislating is the art of the possible. It is not trying to get 
something done that cannot happen. There are a number of proposals 
trying out how we are going to do what everybody thinks we should do, 
and that is an attempt to provide some reform to Medicare and at the 
same time do what we should have done in 1965, and that is to cover 
prescription drugs under Medicare.
  Prescription drugs today are equally as important as a hospital bed 
was in 1965. Mostly that is on what Medicare tried to focus. It should 
cover prescription drugs, we all agree. There are various proposals as 
to how we should do that, ranging from $150 billion over 10 years, the 
Hagel proposal from the Republican side; the House has a plan for about 
$350 billion which includes provider givebacks; the Graham proposal is 
$594 billion dollars; our proposal is Medicare reform and a 
prescription drug plan that is about $370 billion, which I think fits 
between the various proposals.
  Every one of us should remember from where the money is coming. The 
money on any plan is coming from the Social Security trust fund. Our 
plan, the Graham plan, the Hagel plan--all of it is taking the money 
for the people today out of the trust fund for Social Security for our 
children and our

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grandchildren. That is from where it is coming.
  I can say I want $1 trillion, but from where is it coming? We have to 
be realistic in these economic times to recognize there is not a whole 
lot of money floating around that we can do with what we think is 
appropriate without doing grave damage to the Social Security trust 
fund for our children and our grandchildren.
  What we have tried to do in the tripartisan approach is to figure out 
what is a good drug delivery system and what is an affordable price. I 
mentioned the price we have is about $370 billion, which includes about 
$30 billion for reforming Medicare, which desperately needs reforming.
  The model we have used is to ask: What has worked? One approach that 
has worked is the health care plan I have as a Senator--it is a pretty 
good plan; we wrote it--as do about 9 million other Federal employees. 
It is contained in the Federal Employees Health Benefits Plan that we 
get every year. We get to choose our drug plan or our health plan. We 
have private contractors come in and say: This is what we can offer to 
provide you health care at this price.
  What we have tried to do in the tripartisan plan is say let's combine 
the best of what Government can do with the best of what the private 
sector can do. Some of my colleagues on this side of the aisle would 
say the private sector should do everything--keep the Government out of 
it. Some on my side of the aisle will say we need to have a Government-
run program because nothing else is going to work.
  The truth is, the best of what both can do needs to be combined, and 
that is exactly what the tripartisan plan has attempted to do. We 
combine the best of what Government can do, i.e., helping to raise the 
money to pay for it; No. 2, supervising it to make sure nobody in the 
private sector tries to scam it; to have Government controls and 
Government approvals over all segments of participation, and then what 
the private sector can do is bring about innovation and bring about 
competition to help keep costs down. So that is the proposal we have 
before the Senate.
  Some have said that is not going to work because the big insurance 
companies are somehow going to try to rip off the beneficiaries in this 
country. Well, there are insurance companies right now that provide 
Medicare to beneficiaries, which is supervised by the Federal 
Government. Blue Cross and Aetna regularly provide all of the benefits, 
the hospitals and doctor coverage, under a contract with the Federal 
Government.
  What we are saying is have the same type of delivery system for 
prescription drugs but have the plans have some of the risks. We are 
talking about Blue Cross and Blue Shield, Aetna and Merck-Medco, 
national operations that are big boys in this business. Under the 
Graham plan, they say we are going to have a management contract with 
them, but if they overshoot their costs and their costs are more than 
they say they are going to be, the taxpayer is going to pay the 
difference. The difference in our plan says these guys are big players 
and if they say they can provide prescription drugs for $100 per 
beneficiary, and it ends up costing $102, they are going to have to 
assume the risk. They are going to have to eat their mistake, not the 
taxpayers of this country.
  Why is that important? It is important because if they know they are 
on the hook for some of the risk, they are going to have an incentive 
to negotiate the best possible price with the pharmaceutical companies 
in order to make sure the price they say they can do it for is, in 
fact, that price or even less. They will then have an incentive.
  What kind of an incentive does a provider have if they know when they 
bid costs more than that, the taxpayer is going to pick up the cost? 
That is exactly what the other approach does and why I think the 
approach, by saying these companies should have some of the risk, not 
all of it, but they ought to have enough risk to make sure they 
negotiate and compete, and that is one of the differences in our plan.
  All of this is done under the supervision of the Health and Human 
Services Secretary to make sure the plans they present do not try to 
scam the beneficiaries, do not try to cherry-pick only the healthiest. 
The Government can do that, and in our plan the Government does that.
  One of the other concerns I have had is that people have said it is 
not going to work in rural areas; Medicare+Choice does not work in 
rural areas. And that is true. One of the reasons is that 
Medicare+Choice has to do a lot more than just provide prescription 
drugs. They have to have a hospital in a rural area, doctors, emergency 
rooms, ambulance services, all the things that are necessary to create 
a health care system in a rural area. As the Presiding Officer knows, 
that is a very difficult challenge.

  If only prescription drugs are being delivered, that infrastructure 
is not needed. The only thing that is needed is a doctor to write a 
prescription and a drugstore to fill it, or a mailbox if one chooses to 
do it by mail order. The entire infrastructure is not needed as it is 
under Medicare+Choice.
  What we say in the bill very clearly is that every administrator 
shall, consistent with the requirements, approve at least two contracts 
to offer a Medicare prescription drug plan in an area. What that means 
is that every person, even in the most rural part of America, has to 
have at least two people or two companies offering prescription drugs 
to the people in that area. If only one bids, the Government can make 
the assumption of the risk even greater until one gets at least two 
plans to compete. If one ends up with only one, the Government will be 
the one that provides the other alternative.
  So rural areas are protected. Can't we tighten that up? I am 
certainly willing to try and do it. I think we state very clearly that 
every part of the country has to have at least two plans offered to 
them on a competitive basis. That is what the law would be. The 
Government has to make sure that there are two plans, and if someone 
does not get two plans, then the Government will come in and offer the 
prescription drugs to the people in the area.
  Under the Federal Employees Health Benefits Plan, pick the most rural 
part of New York or the most rural part of Montana and there is a 
Federal employee who probably works in one of those counties that has 
Federal health insurance. They get it in the most rural part of this 
country, under a system that utilizes private contractors to provide 
it. They get their prescription drugs under the Federal Employees 
Health Benefits Plan.
  The other part is that people have said there is too much flexibility 
in our plan. Every plan that everybody gets, including mine, has 
flexibility of choice. We can pick the plan that is actuarially 
equivalent and pick the one that makes the most sense for us.
  How much time do I have remaining?
  The PRESIDING OFFICER. The Senator has used 9 minutes.
  Mr. BREAUX. I would conclude by saying I think we have offered 
something that is possible, that is doable and that we can actually 
adopt. I think that is a good suggestion this body ought to take under 
consideration.
  The PRESIDING OFFICER. The Senator from Minnesota.
  Mr. WELLSTONE. Madam President, Eli Lilly has a discount card. It is 
called Lilly Answers. The card is supposed to give low-income seniors a 
30-day supply of any Lilly drug for a $12 fee. Sounds like a great 
deal, but when one reads the fine print, it turns out that a lot of 
drugs are excluded.
  Noland Decks from Winona sent me this letter about his sister:

       I am writing to relate to you the prescription medicine 
     situation for my sister, Hazel Decks, who has Parkinson's 
     disease. Her income is such that she has qualified for the 
     Lilly Answers program which is supposed to give her a one 
     month supply of Permax for $12. When I approached the 
     pharmacy to get her prescription refilled, I was informed 
     that Eli Lilly has chosen to exclude this medication from the 
     program, in spite of the fact that the bottle says it is 
     manufactured by Lilly. I contacted Lilly and could find no 
     one who would explain why. I now believe that they will not 
     allow it because it is too expensive. The 30 day supply costs 
     Hazel $375.

  For Parkinson's medication. I had two parents with Parkinson's 
disease.

       Her Social Security check is $479 a month.

  I give this example because in 5 minutes I cannot even begin to cover 
the ground, but there are about three or four thoughts that come to 
mind as we come close to a vote. First, I do not think, based upon what 
we have seen in the last month or two, anybody any longer would believe 
that the Arthur

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Andersens of this world should be writing any kind of reform 
legislation when it comes to securities reform, when it comes to 
protecting investors and consumers. I do not believe that hardly 
anybody in the Senate would argue that when it comes to a clean air 
bill or a clean water bill that environmental polluters should write 
that legislation.
  So it is, I do not believe that the pharmaceutical companies ought to 
be writing a prescription drug benefit plan. I think it is a mistake.
  What are the differences? I will not go through all the numbers. 
Everybody has heard the numbers. To me, the differences are as follows: 
In the Graham-Kennedy-Miller plan, at least there is a defined benefit. 
Does it sound familiar, a ``defined benefit''? Not defined 
contribution. Senior citizens' prescription drug coverage is part of 
Medicare. It is a defined benefit. They know what they are going to be 
eligible for and they are going to have the coverage.
  The competing proposal basically has the Federal Government farming 
out a subsidy to private health insurance plans, Medicare managed-care 
plans, and basically saying we hope to give enough of a subsidy that 
they then will provide the benefit. It is a suggested benefit. It is 
not a defined benefit. There is no security for senior citizens with 
this alternative.
  For my own part, I will go one step further. When there is too high a 
deductible or there is a doughnut hole where a lot of seniors are 
worried about what they are going to do about these expenses as they 
run up $2,000, $3,000, $4,000 a month, that is the other big issue. We 
do not want to have a huge gap where people get no coverage, and that 
is exactly what is in the competing proposal.
  Finally, I say to all of my colleagues, which is a different point, 
but I get a chance to say this, I want to see us do better on discounts 
and cost containment. I want to see us for sure support the Schumer-
McCain amendment on generic drugs. I want to make sure this 
reimportation from Canada actually is put into effect--it looks like 
the administration does not want to--because of the huge discount for 
senior citizens and other seniors as well. I would personally like to 
see the Federal Government become a bargaining agent for 40 million 
Medicare recipients, and in the Graham-Kennedy-Miller bill there is 
allowance for the different managers around the country, benefit 
managers to do that work getting discounts. I want to see the States 
building on the Stabenow amendment and see States able to recoup some 
of the savings they get from exacting a discount for people with no 
coverage now and adding that on to medical assistance.

  Colleagues, what is going on is there are quite a few Senators in 
good faith--I don't assume bad faith--who do not believe there is a 
major government role here. They do not believe this ought to be part 
of Medicare. They are not quite sure they believe in Medicare, though 
it has been an enormously successful program. We should extend 
prescription drug benefits to Medicare and make it a clear, defined 
benefit that is affordable for senior citizens. That is the right thing 
to do.
  I yield the floor.
  Mr. FRIST. Madam President, how much time do I have?
  The PRESIDING OFFICER. The Senator from Tennessee has 5 minutes and 
40 seconds.
  Mr. FRIST. And the other side?
  The PRESIDING OFFICER. Three minutes 55 seconds.
  Mr. FRIST. I yield myself 3 minutes.
  Madam President, soon we will vote on one of the most important 
matters facing the Nation--whether to provide within Medicare a 
prescription drug benefit. In order to strengthen Medicare, we must 
include affordable prescription drug coverage as part of the package. 
Too many seniors today find prescription drugs unaffordable. The high 
cost of prescription drugs serves as a barrier between seniors and the 
health care security they deserve--which this body has promised them.
  There is only one proposal that accomplishes the goal of modernizing 
Medicare and including a prescription drug benefit within Medicare: 
that is the tripartisan bill. Senator Snowe, a Republican, Breaux, a 
Democrat, Jeffords, an Independent, Hatch, a Republican, Grassley, a 
Republican, Collins, a Republican, and Landrieu, a Democrat, 
collectively have sponsored this bill which reduces the cost of 
prescription drugs and provides a stable and sustainable prescription 
drug benefit. The word ``sustainable'' is critical.
  The tripartisan bill provides low-income seniors and those with 
initially high drug costs special additional coverage in order to give 
them security. It expands and improves Medicare benefits under the 
traditional Medicare fee-for-service program that seniors and 
individuals with disabilities are comfortable with and understand 
today. It begins the critical element of instilling competition as we 
seek to add a new benefit--which means prudent decisionmaking will be 
made. The tripartisan bill is designed to be permanent, sustainable, 
affordable and responsible. Even though the cost--$370 billion--goes 
beyond what was intended in the initial budget, I believe it is a 
reasonable first step.
  In closing, the tripartisan bill is not perfect, but it is clearly 
more responsible than the alternative bill. Many think $370 billion, 
the cost of this bill, is high. And it is high, especially since it is 
not coupled with as much reform as I think will be required to 
ultimately strengthen Medicare. Additionally, the bill lacks some of 
the necessary reforms that are needed to make Medicare truly 
sustainable--considering that the number of seniors will double in the 
next 30 years. Finally, the bill is not immediate, but neither is the 
alternative bill.
  The time to help seniors is now. We must act now, act responsibly, 
and implement a plan that can be sustained. I will support the 
tripartisan bill because it provides the best and only real opportunity 
for progress this year on this important issue.
  I reserve the remainder of my time.
  The PRESIDING OFFICER. Who yields time?
  The Senator from North Carolina.
  Mr. EDWARDS. Madam President, I yield myself 3\1/2\ minutes.
  This debate taking place in the Senate is about people's lives. We 
have senior citizens who desperately need a prescription drug benefit. 
This is what they want. They want one that is affordable and reliable. 
It is no more complicated than that.
  The Graham-Miller bill meets that criteria. Unfortunately, the bill 
from the other side does not for at least two major reasons. It turns 
the prescription drug benefit over to private insurance companies. The 
insurance companies themselves have said this will not work. It will 
not work because they are in the business of making a profit. They will 
only go to the markets where it is profitable. That means there will be 
millions of senior citizens around this country with no access to a 
prescription drug benefit.
  Second, it has an enormous gap in coverage. For those who have $400 a 
month in prescription drug costs, there will be 3 or 4 months toward 
the end of the year where they will get no coverage at all, no help for 
their prescription drugs, although every month they are writing a 
premium check. That makes no sense. Those problems are taking care of 
in the Graham-Miller bill.
  In addition, we have to bring the cost of prescriptions under 
control. That is why, no matter what, we have to pass the underlying 
bill that gets generics in the marketplace, stops the frivolous use of 
patents to keep generics out of the marketplace so we can have 
competition and bring down the cost of prescription drugs for everyone.
  Second, to allow, in a safe fashion approved by the FDA, for drugs 
from Canada at lower cost to be brought into the United States so folks 
can buy at a lower cost.
  Third, to allow States to make prescription drugs available to the 
uninsured at the same cost of those of us with health insurance and 
those in the Medicaid Program pay, to make the same cost available to 
them that is available to everyone else so they are not taken advantage 
of.
  Those things will help make this prescription drug benefit 
affordable.
  Last, in addition to all of that, this has to be considered in the 
context of a responsible fiscal budget, in order to get this country 
back on the path to fiscal discipline. In January of 2001, there was a 
$5.6 trillion projected surplus; $5 trillion of it is gone. Why? The 
biggest single reason is because of a tax cut proposed by the President 
that

[[Page S7199]]

has now been passed and signed into law.
  To get this country back on the path to fiscal discipline, which it 
so desperately needs to be able to afford a prescription drug benefit, 
we ought to do at least three things; First, we ought to have pay-as-
you-go rules apply in this Congress; Second, we ought to follow 
spending caps; Third, we ought to do something about the top layer of 
the tax cut for the 1 percent of Americans, the highest earning, 
richest people in America, scheduled to go into effect in the year 
2004, to ask them to give up that tax cut in order to help their fellow 
Americans, in order to help us get back on the path to fiscal 
discipline and operate this Federal Government and this Federal budget 
in a responsible way.
  The American people want us to do all these things. Give them a real 
prescription drug benefit, one that is affordable, one that is 
reliable, one they know they can depend on to bring down the cost of 
prescription drugs and find a way to pay for it.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Iowa.
  Mr. GRASSLEY. I yield myself such time as I may consume of the 
remaining 2 minutes and 40 seconds.
  First, I am happy to hear the Senator from North Carolina mention the 
prescription drug program has to be within the context of a fiscally 
sound budget process. I agree with that. But I think that is very much 
an argument for a piece of legislation that is permanent as the 
tripartisan plan is, as opposed to a sunsetted provision coming from 
the other side of the aisle that is $370 billion as opposed to $595 
billion, the latter being the figure from the other side of the aisle. 
Just basically getting more for your money in the sense that CBO has 
scored the tripartisan program as the only program that brings down 
drug prices because of competition and the efficiency with which they 
are delivered as opposed to the program on the other side of the aisle 
that is very much a partisan plan as opposed to our bipartisan plan 
that drives up the price of drugs according to the CBO, which is our 
nonpartisan scoring arm.
  Also, for the benefit of the Senator from Massachusetts who is still 
here and my colleague from the State of Iowa who is not here, I go back 
to the assets test. I think they think they have something. But the 
point of the matter is, they do not. We have heard these repeated 
objections to the assets test for low-income benefits in our bill as if 
it is something new. That is a red herring. There has been an assets 
test for low-income Medicare populations since 1987, and I happen to 
know that these programs passed by overwhelming margins--under the 
qualified Medicare beneficiary program as one example, as a specified 
Medicare beneficiary program as a second--and these programs have 
passed overwhelmingly with the support of my Democrat friends on the 
other side of the aisle.
  I think that is injecting an argument into the program that is not 
legitimate. Current law excludes from the test the home and property it 
is on, a car that is necessary. I can also say it happened to be in the 
1999 Clinton Medicare bill--that included an assets test as well.
  The PRESIDING OFFICER. The time of the Senator has expired.

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