[Congressional Record Volume 148, Number 101 (Tuesday, July 23, 2002)]
[Senate]
[Pages S7199-S7218]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
GREATER ACCESS TO AFFORDABLE PHARMACEUTICALS ACT OF 2001--Continued
The PRESIDING OFFICER. The Senator from Montana.
Mr. BAUCUS. Mr. President, what is the parliamentary situation? What
is pending?
Amendments Nos. 4309 and 4310
The PRESIDING OFFICER. Under the previous order, there will now be 30
minutes for debate, to be equally divided between the Senator from
Massachusetts, Mr. Kennedy, and the Senator from New Hampshire, Mr.
Gregg.
The Senator from Montana is recognized.
Mr. BAUCUS. Mr. President, on behalf of Senator Kennedy, whom I do
not see in the Chamber yet, I yield myself 4 minutes.
The PRESIDING OFFICER. The Senator from Montana.
Mr. BAUCUS. Mr. President, I am going to vote for the Graham-Miller
amendment because it is, to my mind, the best proposal before us. It
will provide affordable prescription drug coverage throughout the
country. I think that is the best policy.
But it now appears there may not be enough votes for that amendment.
The same, I might add, is also true of the Grassley amendment, which
embodies the so-called tripartisan approach.
If that turns out to be the case, we will be at a stalemate. At that
point, we will have to decide whether there is some way to resolve our
remaining differences so we can write a prescription drug bill that can
pass.
With that in mind, I would like to briefly discuss the three key
remaining differences.
The first, and probably most significant, is referred to as the
delivery model. That may sound like some kind of technical jargon, but
it is actually a very important matter and will determine whether we
are passing some theoretical, pie-in-the-sky prescription drug benefit
that works on paper but fails out in the real world or whether we are
passing one that will really get prescription drugs to seniors at
affordable prices.
There are two approaches.
Under the Graham-Miller approach, prescription drugs will simply be
added to the existing Medicare Program, with some new incentives for
efficient administration.
Under the Grassley approach, in contrast, prescription drugs will be
provided through a new, market-based system that relies on private
insurance companies.
People may ask: Why not try something new? What is wrong with a new
market-based system?
Simply this: The new system is untested and may leave seniors without
adequate coverage, especially in rural States such as my State of
Montana.
Let me explain. Montana seniors, like those living in other rural
areas, lack the rich retiree coverage options their urban counterparts
enjoy. There just are not as many large companies offering benefits to
retired workers in my State of Montana as there are in other parts of
the country.
We also do not have any Medicare+Choice plans offering free or low-
cost drugs to beneficiaries as in places such as Florida or some other
parts of the country. In addition, our Medigap rates are higher than
the national average and Medicaid coverage is lower.
On top of all that, we have been burned in the past by the promises
of competition and efficiency. Rural areas often get the short end of
the stick when we deregulate and leave people at the complete mercy of
market forces that favor highly-populated areas. Consider airline
deregulation, managed care, and energy deregulation, to name a few.
I don't want to overstate the case. I'm not saying that a new
approach is absolutely unworkable. But I am not willing to buy a pig in
a poke. I want a reasonable assurance that a private insurance model
will work.
I know that many other Senators share my concern. How can we address
this concern? Is there another way, another idea? There may be.
In essence, we would shift to a new, market-oriented system but do it
gradually, with plenty of safeguards to make sure that it really works,
especially in rural areas and other underserved areas.
The resulting system might not be quite as efficient as some would
like but in exchange, it is more stable than it otherwise would be
under the private model.
The second key difference, between the two main proposals, is how
much to spend on a prescription drug benefit. Clearly, we are talking
about a big investment of government dollars, and even at the amounts
we are considering here, we won't buy a benefit that will meet seniors'
expectations.
[[Page S7200]]
The proposals that include a so-called doughnut, or coverage gap,
give pause for concern, simply because during some parts of the year,
seniors would not receive any assistance. I don't want to belabor the
point, as I know many others have talked about this problem over the
past few days.
To my mind, the Graham-Miller bill is right about on target, and I
hope that those who support the Grassley approach can, in the spirit of
compromise, agree to devote some further resources to helping our
seniors.
The final key difference involves what is referred to as ``Medicare
reform.'' That means making additional changes to the Medicare system,
beyond those necessary to provide a prescription drug benefit.
With due respect to the proponents of reform, I believe that we
should keep our eye on the ball. We have limited resources. Many of the
reforms are untested and, in some cases, risky. We will have other
opportunities to consider broader changes to the Medicare program.
In light of this, I suggest that we defer the debate about additional
reforms until a later date, and concentrate on prescription drug
coverage.
Those are the key differences. Delivery model, spending, and other
reforms.
Are they significant? They certainly are.
Can they be resolved? If we roll up our sleeves and put the interests
of seniors ahead of politics or theory, we will get it done.
I yield the floor and encourage my colleagues in the next several
days to work to find a compromise that gets the large vote and protects
our seniors.
The PRESIDING OFFICER. The Senator from Iowa.
Mr. GRASSLEY. Mr. President, I yield 3 minutes to the Senator from
Maine.
The PRESIDING OFFICER. Without objection, it is so ordered.
Ms. SNOWE. Mr. President, the moment is at hand when the Senate will
determine the fate of prescription drug coverage for our Nation's
seniors. I hope we will not allow a 60-vote threshold to stand between
us and the possibility of passing a meaningful benefit for our Nation's
seniors. That would be doing a tremendous disservice to those seniors
who desperately need prescription drug coverage. I hope we will avoid
the procedural gymnastics and do what is right.
The tripartisan plan is the only plan that has across-the-aisle
political support. We worked on this endeavor for more than a year. I
hope Members of the Senate will give it serious consideration.
The facts speak for themselves on the tripartisan plan. Our plan is
permanent. It does not sunset as the Graham proposal that sunsets after
2010. The language is right in the legislation. We have never, ever
added a temporary benefit to the Medicare Program in its 37-year
history, and we should not start now. It is providing a false hope to
seniors who need this type of coverage. They should not have to beat
the clock when it comes to their own health care. I guess you had
better not get sick after 2010 because that benefit will expire.
The tripartisan plan is universal, applying to seniors no matter
where they live in America, with the lowest premium offered of any bill
either in the House or the Senate, thanks to a 75-percent Federal
subsidy, which is higher than what Federal employees get under their
health care coverage. Our opponents' plan not only creates a higher
premium, but they also increase the prices of prescription drugs. That
is not our projection; it is the projection of the Congressional Budget
Office that estimates it could be anywhere as high as 15 percent, but
at least 8 percent, in driving up the cost of prescription drugs.
It is also estimated under the tripartisan plan that 99 percent of
seniors will participate, and 80 percent of those who do will never
reach our benefit limit of $3,450.
I remind Members that we have a catastrophic benefit of $3,700 to
protect people's out-of-pocket costs that are very high. Seniors in our
plan will pay less on copayments, less on copayments under our plan for
39 out of the top 50 prescribed drugs for seniors. And we cover all
drugs--brand name, generics--unlike the plan offered by the Senator
from Florida, Mr. Graham who leaves out most of the brand name
prescriptions. In fact, only 10 percent of the brand name drugs will be
covered under that legislation. Under the tripartisan plan, seniors
will have access to all drugs.
I ask unanimous consent for an additional minute.
The PRESIDING OFFICER. Without objection, it is so ordered.
Ms. SNOWE. That is an important feature because by excluding most of
the brand names from coverage, that means you are denying seniors
access to the most innovative and cutting-edge therapies available.
That is not the kind of coverage we want to provide because that is a
huge gap in coverage.
Finally, I hope we will not allow this issue to die today here on the
floor. I appeal to my colleagues to do everything they can to prevent
killing this legislation. We need to get something done. These votes
today are going to be very important in determining who wants the
politics or who wants the issue.
We want progress. The best way to get progress on this most vital
issue to our Nation's seniors is by supporting the tripartisan plan
that has bipartisan support in the Senate.
I hope Members of this body will support this plan that will do more
to help our Nation's seniors in providing them a much-deserved
prescription drug benefit.
I yield the floor.
Mr. LEAHY. Mr. President, in recent days the Senate has begun to
consider a number of proposals designed to help Americans afford their
needed prescription drugs, not the least of which is to create a
Medicare prescription drug benefit. This is an important debate, and
one that has been a long time in coming to the floor of the Senate. Now
we have the opportunity to not just talk about creating a Medicare drug
benefit but to prove to our Nation's seniors and disabled that we stand
by our word. The amendment offered by Senators Graham, Miller, and
others is the best proposal before us, and it is one that I urge my
colleagues to support.
I am pleased to be an original cosponsor of this piece of legislation
because it is the only one that would create a new, voluntary
prescription drug benefit within the Medicare Program that all
beneficiaries would be eligible for. Under the Graham-Miller proposal,
Medicare beneficiaries will receive assistance starting from the moment
they buy their first prescription drug. There is no deductible and
there is no gap in coverage, ensuring that no senior will be left
stranded without the drugs they need. Beneficiaries would be
responsible for copayments of $10 for generic drugs and $40 for
medically necessary preferred brand name drugs until they have reached
$4,000 of out-of-pocket spending, at which point Medicare pays all
expenses. This bill provides low-income seniors and those with
disabilities with extra assistance by covering the premiums and copays
for those living below 135 percent of poverty, and giving premium
assistance to those between 135 and 150 percent of poverty. In my State
of Vermont, 28,000 of our 87,000 Medicare beneficiaries have incomes
less than 150 percent of poverty and thus will qualify for this extra
assistance available under the Graham-Miller proposal.
This amendment will help our seniors get the drugs they need, no
matter where they live, what their income, or how sick they are. I urge
my colleagues to support this important measure that will put
affordable prescription drugs within the grasp of some of our most
vulnerable Americans.
Mr. AKAKA. Mr. President, I rise today as a cosponsor of the Graham-
Miller-Kennedy amendment that would establish a guaranteed Medicare
prescription drug benefit for all seniors.
Approximately 19 million seniors in the United States have little or
no prescription drug coverage. Prescription drugs are the largest out-
of-pocket health care cost for seniors. Many who cannot afford drug
coverage often do not take the drugs their doctors prescribe, and one
in eight senior citizens is sometimes forced to choose between buying
food and buying medicine. While numerous seniors live on modest fixed
incomes, prescription drug costs have increased by more than 10 percent
a year since 1995. Medicare needs a voluntary prescription drug benefit
so
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seniors have the same protection against the high cost of prescription
drugs as they have for hospital care.
The Graham-Miller-Kennedy amendment is the most comprehensive
Medicare prescription drug benefit proposed in the Senate thus far. It
provides coverage to all seniors regardless of their health or income.
In Hawaii, 159,000 senior citizens and disabled Medicare beneficiaries
would be eligible for coverage under the Outpatient Prescription Drug
Act, 41,000 low-income seniors in Hawaii would qualify for additional
assistance under the plan.
Affordable premiums and copayments are key components of the Graham-
Miller-Kennedy plan. For example, if a senior spends $4,000 on
prescription drugs, she would reach the catastrophic limit and all
additional drug expenses would be covered under this proposal. Seniors
will not lose their current employer retirement coverage and will not
have to rely on the public benefits provided by the plan. There also
would not be a asset test required for participation in the Graham-
Miller-Kennedy program.
The competing amendment proposed by the Senator from Iowa is well
intended, but the Grassley amendment would not provide adequate
coverage for seniors. The Grassley amendment would result in 26,000
seniors in Hawaii losing their existing retirement coverage, 47,000
seniors and disabled Medicare beneficiaries in Hawaii would fall into
the benefit hole and would have to continue paying premiums and paying
higher drug costs while not receiving any benefits. The Grassley
amendment would also include a means test to qualify for additional
assistance that would prevent seniors with assets greater than $4,000
from qualifying for additional assistance.
Today, the Senate has a historic opportunity to provide seniors with
the missing piece of health care coverage that is urgently needed. We
must ensure that all seniors are provided with an affordable and
comprehensive prescription drug benefit for all seniors. I urge my
colleagues to support the plan which does this, the Medicare Outpatient
Prescription Drug Act.
Mr. VOINVICH. Mr. President, I rise to speak in favor of the
tripartisan prescription drug proposal before the Senate. I applaud the
efforts of Senators Grassley, Breaux, Hatch, Snowe, and Jeffords, in
developing this legislation.
Their work is the culmination of a year's effort to bridge the gap
between the Medicare of 1965 and the Medicare for today and the future.
As my colleagues know, when Medicare was enacted in 1965, Congress made
a commitment to our Nation's seniors and disabled to provide for their
health security. Unfortunately, that security is on shaky ground
because Medicare has not kept up with the evolving nature of health
care. The delivery of health care has vaulted ahead so dramatically 37
years after the inception of Medicare, that this system which was once
sufficient is now anticipated and ineffective.
For example, conditions that used to require surgery or inpatient
care can now be treated on an outpatient basis with prescription drugs.
It is time for Medicare to reflect the realities of today's health care
delivery system. The vast majority of my colleagues will agree when I
say providing prescription drug coverage through Medicare is the next
logical step towards modernizing the program. The best way to deliver
such a benefit, however, is a point on which a number of my colleagues
on the other side of the aisle disagree. My colleagues from the Finance
Committee have found a solution that is a good compromise and is result
that can be agreed to by both Democrats and Republicans. In fact, I
would venture to say that the tripartisan proposal has the support of a
majority of Senators.
Unfortunately, a simple majority will not suffice. As my colleagues
know, we are working under the fiscal year 2002 budget resolution,
which set aside $300 billion for a prescription drug benefit. Because
we never voted on a fiscal year 2003 budget resolution, the first time
the Senate has not done so since 1974, we have no choice but to stay
within the parameters of 2002 funding levels. The fact of the matter is
we have stacked the deck against passing any sort of meaningful benefit
that costs over $300 billion, regardless of whether the majority of
Senators support the proposal.
Regardless, the bar has been raised to pass prescription drug
coverage, which clearly indicates that any bill that passes through
this body will have to be bipartisan in nature--or tripartisan in this
case. The tripartisan bill is the only measure we have before the
Senate that bridges both parties and is a benefit that can pass.
We cannot delay any further. Each year we delay means another year
our Nation's seniors will be forced to do without. already we have
heard too often of seniors that have had to choose between food and
prescription drugs. I, for one, am ready to go to my constituents in
Ohio and say we were able to move past partisanship and provide real
security for their health. The tripartisan proposal does that. We must
act now, and we must act responsibly.
It is vital that we pass a prescription drug benefit this year, and
it is vital that we pass one that is fiscally responsible. Ideally, the
Federal Government would able to pay for every pill ever needed for
every senior. Unfortunately, we live in the real world and are subject
to limited resources. I would like to take a few moments to shed some
light on our Government's current fiscal condition. Last year, the
Congressional budget Office predicted a unified budget surplus of
$313billion or fiscal year 2002. As my colleagues know, this rosy
budgetary picture is no longer the case. Recent budget projections show
that the Federal Government is in much worse fiscal condition than we
thought. These new projections show that the Federal Government will
spend the entire Social Security surplus in both the current fiscal
year and in fiscal year 2003 and we will be borrowing $52 billion this
year and $194 billion in 2003.
With this in mind, it is imperative that we act not only to provide
Medicare benefits for today's beneficiaries, but also for the baby
boomers who will arrive in 2011. If we do not act responsibly in
providing a benefit, we will end up writing IOUs not only for Social
Security, but for this benefit as well. The tripartisan proposal
strikes a balance between providing seniors and the disabled access to
needed prescription drugs today and doing so in a fiscally sensible way
that will allow benefits to extend to future generations.
I cannot say the same for the Graham-Miller bill. Top the best of my
knowledge,I cannot definitively state what the Graham-Miller bill will
cost. My colleagues on the other side claim that their bill will cost
$450 billion over 6 years. Then, after 6 years, as their bill is
currently written, the benefit would sunset.
However, let us make the assumption that the Graham-Miller bill
passed and their benefit did not sunset. What would that mean for the
American people? I have a sneaking suspicion that $450 billion will
somehow become $800 billion or as much as $1 trillion over 10 years.
This is on top of the estimated $3.6 trillion it will cost the Federal
Government to provide basic Medicare services for seniors and the
disabled. As I see it, under the Graham-Miller bill, the American
people get stuck between choosing cyanide and hemlock.
Senator Grassley and the others in the tripartisan group have put
before the Senate a proposal that would cost $370 billion as scored by
CBO. The natural question that I think the American people would like
to know is what does $370 billion buy? In my opinion, $370 billion
provides a real prescription drug benefit that is affordable to both
the beneficiaries and the Federal Government.
Under the tripartisan proposal, premiums would be $24 a month, an
amount that is lower than the Graham-Miller bill. After a $250
deductible, the Government would cover half of all prescription drug
costs up to $3,450.
Now, my colleagues on the other side of the aisle will claim that the
so-called doughnut hole after $3,450 will be the financial ruin of
every senior. The truth is that the vast majority of seniors, 80
percent, would never even hit that hole. Moreover, the hole exists only
until the beneficiary accrues another $250 in costs, at which time the
government would pay for 90 percent of all remaining drug costs.
While this benefit will greatly help seniors throughout the Nation,
there are still some seniors for whom the $24 per month premium and
additional
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cost-sharing is still too high. For those individuals, the tripartisan
bill provides protections that will allow access to prescription drugs.
For those seniors under 135 percent of poverty, the tripartisan plan
would provide a full subsidy for monthly premiums. In addition, the
Government would cover 95 percent of their prescription drug costs to
the initial benefit limit and 100 percent above the stop-loss limit.
And for those seniors between 135 and 150 percent of the poverty level,
the tripartisan proposal would provide assistance with their monthly
premiums on a sliding scale. In addition, these individuals would pay
no more than 50 percent of their drug costs once the $250 deductible
has been reached.
When we talk about dollars being spent, we should also point out to
seniors that they will receive more bang for their buck under the
tripartisan proposal. Seniors will not just receive direct assistance
from the government to cover their prescription drug bills. Rather,
under the tripartisan plan, competing pharmaceutical delivery plans
will be forced to provide the best value on prescription drug prices in
order to attract beneficiaries to their respective plans. To the
advantage of both Medicare beneficiaries and the Federal Government,
this competition will decrease the price of prescription drugs and
permit all parties to stretch their dollars further. For example, the
same dollar that today would buy one day's dose of Lipitor, might
purchase 2 days' worth of the drug when competing plans vie for
consumers as they would under the tripartisan plan.
This body has been playing this political posturing game for too
long. I am tired of explaining partisanship as the excuse for why this
body has not passed a prescription drug benefit and has forced the
least of our brothers and sisters to choose between food and
prescription drugs. I am pleased that the Senate will have the
opportunity to show the American people, especially our Nation's
seniors and disabled, whether we are serious about enacting legislation
to provide a prescription drug benefit this year.
The tripartisan bill has support from both sides of the aisle. The
House has passed their measure. The President is ready and willing to
sign a bill into law this year. The burden is squarely on the Senate's
shoulders. All eyes are on us. I am confident that we will have more
than 50 votes in favor of the tripartisan plan. I hope that those that
are considering voting against this proposal have a very good reason
for not supporting it, because the people in their State will be asking
them the question: Why didn't you support a plan that gets the job done
in a fiscally responsible way.
So while seniors wait for a prescription drug benefit, I will
continue to work to educate seniors about generic drugs. I have been
working on this issue for some time, providing funds at the Food and
Drug Administration for consumer education and working with other non-
profits to educate our seniors about the availability and efficacy of
generics.
In the meantime, I urge my colleagues to waive the budget point of
order on the tripartisan amendment so that Medicare can move forward
into the 21st century and so that seniors and the disabled are able to
have access to affordable prescription drugs.
Ms. COLLINS. Mr. President, as an original cosponsor of the
tripartisan 21st Century Medicare Act, I rise in support of this
amendment to make affordable prescription drug coverage available to
all of our Nation's seniors.
Prescription drugs are as important to a Medicare beneficiaries'
health today as a hospital bed was in 1965, when the program was
created, and I have long been a supporter of providing a prescription
drug benefit as part of our efforts to strengthen Medicare. With recent
advances in research, prescription drugs can literally be a life-line
for patients whose drug regimen protects them from becoming sicker and
reduces the need to treat serious illness through hospitalization and
surgery. Soaring prescription drug costs, however, have placed a
tremendous financial burden on the millions of Medicare beneficiaries
who must pay for these drugs out of their pockets.
More and more, I am hearing disturbing accounts of older Americans
who are running up huge, high-interest credit card bills to buy
medicine they otherwise couldn't afford. Even more alarming are the
accounts of patients who are either skipping doses to stretch out their
pill supplies or being forced to choose between paying the bills or
buying the prescription drugs that keep them healthy. It is therefore
critical that we bring Medicare into line with most private sector
insurance plans and expand the program to include prescription drugs.
The tripartisan plan that is before us today will provide an
affordable and sustainable prescription drug benefit that will be
available to all seniors. Moreover, unlike the alternative bill, our
plan will make the drug benefit a permanent part of Medicare and is
fully funded at $370 billion over 10 years.
Under the tripartisan bill, all seniors will have the choice of at
least two prescription drug plans, regardless of where they live. This
will enable them to select the kind of prescription drug coverage that
they need. Moreover, the coverage under these plans will be
comprehensive. Seniors will have access to every drug, from the
simplest generic to the most advanced, innovative therapy.
Our plan is also affordable and has the lowest monthly premium--$24--
of any of the comprehensive prescription drug proposals that are on the
table. Not only does our plan offer a lower premium, but it also offers
lower copays for most drugs than the amendment proposed by the Senator
from Florida. As the senior Senator from Maine pointed out on the floor
the other day, seniors will pay more for most of the top 50 drugs under
the Democrats' bill than they will under the tripartisan plan. For
example, the copayment for Glucophage, which is used in the treatment
of Type 2 diabetes, would be $40 under the Graham-Kennedy bill, and
only $31 under the tripartisan plan.
In fact, our plan is such a good deal that the Congressional Budget
Office tells us that just about everyone will take it. According to the
CBO, 93 percent of seniors will enroll in our program, while 6 percent
will elect to retain their current prescription drug coverage. This
means that 99 percent of all seniors will have prescription drug
coverage once our plan is implemented.
No one should have to choose between paying their bills and buying
their pills. That is why our bill provides additional subsidies to low-
income seniors. For example, the 10 million seniors nationwide,
including 65,000 Mainers, with incomes below 135 percent of poverty
will have 98 percent of their prescription drug costs covered by
Medicare with no monthly premiums and no gap in coverage.
In addition, these low-income seniors will not be subject to any
deductible, and they will pay an average copayment of just $1 and $2
for each prescription. This is comparable to the copays required under
Maine's Medicaid Program, which requires beneficiaries to pay $2 for
each generic drug and $3 for each brand name drug.
The 10,000 Maine seniors with incomes between 135 percent and 150
percent of poverty will also receive generous subsidies under our plan.
All seniors with incomes below 150 percent of poverty will be exempt
from the benefit limit. As a consequence, 80 percent of Medicare
beneficiaries will never experience any gap in coverage under our plan.
Seniors with incomes below 150 percent of poverty will also receive a
subsidy that lowers their monthly premiums to anywhere between zero and
$24 a month, based on a sliding scale according to income.
My biggest concern about the amendment offered by my colleague from
Florida is the cost. My understanding is that this plan will cost
anywhere between $600 billion and $1 trillion over the next ten years.
This is simply too heavy a financial burden for both current and future
generations to shoulder, particularly given our mounting Federal
deficit.
Moreover, despite its tremendous cost, the alternative plan promises
only temporary help, not a permanent solution. Their plan sunsets after
6 years, and makes no provision for a drug benefit after 2010. In other
words, their plan ends just as the tidal wave of baby boomers is
preparing to retire.
The tripartisan plan also includes other improvements to the Medicare
Program that are not included in the Graham-Kennedy proposal. The
current
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Medicare benefit package, which was established in 1965, now differs
dramatically from the benefits offered under most private health plans.
Our bill would provide a new, enhanced fee-for-service option for
Medicare beneficiaries that more closely mirrors private health plans.
For example, it would cover more preventive services than traditional
Medicare at little or no cost. It would also provide protection against
catastrophic medical costs for those seniors with serious health
problems. The traditional Medicare Program provides no such
catastrophic protection.
No one would be forced to enter this new plan. It is simply another
option. If seniors want to stay in the traditional Medicare Program,
that is fine, and they will still be eligible for the new prescription
drug coverage.
Access to affordable prescription drugs is perhaps the most important
issue facing our Nation's seniors today. It is therefore my hope that
the Senate will stop playing politics so that we can pass a meaningful
Medicare prescription drug bill this year. The 21st Century Medicare
Act is the only legislation before the Senate that has not just
bipartisan, but tripartisan support. Moreover, it has the support of 12
of the 21 members of the Senate Finance Committee, which has
jurisdiction over Medicare. That is not to say that I think the
tripartisan plan is perfect. I do not, for example, like the copayments
imposed on home health care in the new fee-for-service option, and I
would, of course, prefer a plan that had no gaps in coverage.
The tripartisan plan does, however, provide a major improvement in
coverage, and I believe that it is the only proposal that gives our
seniors any real hope of getting an affordable Medicare prescription
drug benefit this year.
Since the cost of providing a meaningful drug benefit will only
increase as time passes, it is all the more important that we act now.
I therefore urge all of my colleagues to join me in supporting this
tripartisan amendment.
Mr. REED. Mr. President, I would like to take a few minutes before we
vote later today on the Graham amendment and the Grassley amendment to
describe some of the grave concerns I have with the tripartisan
amendment sponsored by Senators Grassley, Jeffords and Breaux.
The tripartisan Senate bill offers the following ``benefits'' to
seniors: an expected monthly premium of $24; a beneficiary must cover
the first $250 in drug costs; then half of his or her drug costs are
covered between $251 and $3,450; at that point the beneficiary is then
responsible for all drug expenses between $3,451-$5,300;
Moreover, the plan claims to offer assistance for low-income
beneficiaries. What is not mentioned is that a strict asset test would
prevent 40 percent of low-income seniors from even qualifying for this
subsidy. A car, a wedding ring, or a burial plot over a certain value
would render a beneficiary completely ineligible.
The purpose of insurance is to provide protection against certain
costs. The kind of insurance some of my colleagues in the Senate have
proposed would leave those seniors and persons with disabilities
holding the bag when their drug expenditures are highest. Under the
tripartisan plan, beneficiaries could still be required to pay
thousands of dollars in drug expenditures.
This proposal would create a serious lapse in what is supposed to be
a safety net for our most vulnerable citizens, only paying a quarter of
an average Rhode Islander's prescription drug costs.
When a person breaks an arm, Medicare pays for the whole cast, not
half. A prescription drug benefit should pay for all of your benefits.
There are other nonprescription-drug-related provisions contained in
the tripartisan bill that are also of great concern, particularly Title
II, the ``Option for Enhanced Medicare Benefits'' section. To me, the
provisions outlined in this section of the bill are a direct affront on
the Medicare Program as we know it. It seeks to create a new Medicare
option that combines both Part A and Part B with a combined premium.
Under this option, a beneficiary would pay more upfront, out-of-
pocket costs, such as a $10 co-payment for the first five home health
visits and $60 per day for the first 100 days in a skilled nursing
facility. In return, the beneficiary would pay nothing for preventive
health services such as mammography and cancer screening and would
receive protection against catastrophic health care costs.
This new Medicare benefit option would reverse the universal nature
of our current program by creating a new line of services for those who
can pay more. During the Balanced Budget Act debate of 1997, I fought
against the addition of copayments for home health and other essential
services because they threaten the access of low-income beneficiaries
to those services.
This new enhanced benefit option would create a two-tiered system of
the haves and the have-nots. Since there is no premium assistance for
low-income beneficiaries who may wish to enroll in the enhanced benefit
option, only more wealthy beneficiaries would be able to afford it. And
since it requires beneficiaries to pay a greater share of their upfront
costs, it would divert healthier, younger beneficiaries from the
traditional program. This adverse selection would ultimately result in
higher costs for those who remain in the traditional Part A and Part B
program.
The sponsors and supporters of the tripartisan Senate bill have
argued that even though our Nation's most vulnerable citizens deserve a
Medicare prescription drug benefit they can depend on, the proposal
offered by Senators Graham, Miller, and Kennedy is simply too
expensive. I would like to take a moment to highlight for my colleagues
a recent report by the Center on Budget and Policy Priorities that I
believe adds an important perspective to that point of debate.
The report compared the cost of last year's tax cuts with the costs
of two prescription drug proposals for the Medicare population. The
estimated 10-year cost of the first plan being roughly $350 billion and
the second $700 billion for the same period. The report found that when
the tax cut is fully in effect, the cost of the tax cut for just the
top 1 percent of the population would exceed the entire difference in
cost between the two prescription drug proposals.
I voted against the President's tax cut because I felt that it failed
to leave room for critical immediate needs such as a prescription drug
benefit, nor did it allow us to adequately address the long-term
solvency of Social Security and Medicare.
Once Congress enacts a Medicare prescription benefit, it will be
difficult to modify or significantly alter it. If we are going to enact
a benefit, we must pass a solid, reliable benefit that will continue to
meet the needs of Medicare beneficiaries in years to come. And if
resources are the issue, many Members have already stated clearly that
there is a way to address that issue, either through the reserve fund
set aside in last year's budget or by other means.
The PRESIDING OFFICER. The Senator from Florida.
Mr. GRAHAM. Mr. President, I yield myself 4 minutes, after I ask
unanimous consent that Senator Dayton be added as a cosponsor of this
amendment.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. GRAHAM. Mr. President, I rise to respond to criticisms raised
about the availability and cost of drugs under the Democratic proposal.
The minority leader has distributed a memo in which he cites selected
provisions of our bill to come to a false conclusion about the access
seniors would have to prescription drugs. I want to set the record
straight.
Under the Democratic proposal, all medically necessary drugs would be
available to our seniors at a rate of no more than $40 per prescription
for the year 2005--all medically necessary drugs, not just the drugs
that are on the preferred list.
The sections of the amendment Senator Lott chose to omit make clear
that every senior would have access to any drug that is medically
necessary for that senior. Seniors are further protected because the
Medicare Program would assure that the definition of a class of drugs
is clinically appropriate. To the contrary, the Republican bill allows
the drug HMOs to define the classes of drugs and, further, on page 32
of their amendment, clarifies that not all drugs within a class would
have to be covered.
[[Page S7204]]
Senator Lott may want to take a closer look at the Republican
language given his concerns in this area.
Under the Democratic proposal, seniors will know in advance exactly
how much they will pay for any drug. In 2005, they will never pay more
than $10 for a generic and $40 for a medically necessary brand name
drug.
Under the Republican plan, there is no way of knowing how much a
senior would pay for a specific drug because there is no defined
benefit in the Republican plan. Who makes the decisions? The drug HMOs
make the decision. They choose how much the beneficiaries will pay,
what the deductibles will be, and how much they will pay for each
prescription in coinsurance. It could be 50 percent, which is what
their charts say. It could be 80 percent. It will be determined not by
the seniors, not by Medicare, but by the drug HMO.
I urge my colleagues to consider carefully the differences between
the Democratic and Republican bills. Our bill uses the Medicare
Program, a tried and true delivery system, to provide prescription
drugs to our seniors. The Republican bill privatizes Medicare and
requires seniors to get their drugs from a drug HMO--if they can find
one in their State.
Our bill assures that seniors in rural America are guaranteed the
same benefits provided to senior Americans elsewhere in this country.
The Republican bill abandons rural Americans. Our bill gives seniors an
affordable drug benefit and guaranteed prices. The Republican bill lets
private insurers decide what drugs are covered and how much seniors
will pay for each prescription.
Our bill uses every taxpayer dollar, every dollar paid by the
beneficiary in monthly premiums to lower the cost of prescription drugs
for seniors. The Republican bill uses taxpayer dollars and premium
dollars to lure uneager private insurers into a market for which today
there is no private insurance being offered.
Our bill is a bill for seniors. The Republican bill is a bill for
drug companies and private insurers. The differences between the bills
will make a very real difference in the ability of our seniors to
afford the prescription drugs they need, and enjoy the improved health
that those drugs will bring.
I urge my colleagues to support the Graham-Miller-Kennedy Medicare
prescription drug benefit. In the event that none of the proposals that
will be voted on this afternoon garner the necessary votes to move
forward, I urge my colleagues to roll up their sleeves and begin work
immediately on a proposal that can be adopted this year.
The outcomes of the votes today should not be viewed as a trumpet of
defeat, but as an even more urgent call to find a proposal this year,
in 2002, that will bring our seniors the drugs they need, the drugs
that we have promised, the drugs a compassionate America will provide
to this, our greatest generation.
The PRESIDING OFFICER. Who yields time?
The Senator from Iowa.
Mr. GRASSLEY. Mr. President, I yield 3 minutes to the Senator from
Louisiana.
Mr. BREAUX. Mr. President, I thank the distinguished Senator and say
how much I have enjoyed working with him on the tripartisan group.
The Senate will be faced, in a few moments, with an interesting
proposition. We will have Graham legislation that will not get the
requisite number of votes to proceed. And we will be faced with the
tripartisan proposal to see if we have an opportunity to proceed with
that legislation. That will be the second and final vote, I take it,
today on this issue. At least, I think it will be.
I don't think the Senate and this Congress can go back this year and
tell our constituents that we didn't do prescription drugs because it
is the other party's fault. I don't think the Republicans can say they
didn't bring back prescription drugs because it is the Democratic
Party's fault, and I don't think we will get very far saying we didn't
have a prescription drug plan because the Republicans would not support
ours. I think the seniors are wising up and know that this blame game
is no longer going to help them one bit. You cannot take an excuse to
the drugstore and buy prescription drugs. What the seniors need is both
sides to come together and create a program that would work. Our
tripartisan bill is somewhere between the two versions that I have
described--the Hagel bill at $150 billion, and the Graham bill at about
$594 billion. All of that comes out of the Social Security trust fund
money. We have tried to be responsible in how much we can spend to make
sure we have a sufficient number of votes to actually pass something
and also create a delivery system that can work.
What we have suggested is that for people in the Medicare Program,
just like those of us in the Federal Employees Health Benefits Plan--
the program that we have drug coverage under and all of our insurance--
that private companies compete for the right to sell us that coverage.
They compete for the right to sell us prescription drugs. The company
that can do it the cheapest is the one, in most cases, from which we
purchase the plan. That is what we are suggesting.
We are also suggesting that these companies are big people, big
players. There are PBMs like Merck-Medco or Aetna or Blue Cross. These
companies are used to assuming risk. That is their business. Why should
we say we are going to get companies to deliver the product, but if
they underestimate how much it is going to cost, the taxpayers are
going to cover their loss? Our bill says if these companies bid $100 to
provide prescription drugs for seniors, and it costs them $102, then
that is their responsibility. That is the risk they have to assume. Why
should the taxpayers say: Look, we don't care how much it actually
costs, the taxpayer will pick up the difference no matter what.
Regarding rural areas, our legislation says there will be at least
two competing plans in every area of the United States. The Government
will ensure that there are at least two competing plans. It is not like
an HMO. Here you had to have a hospital and doctors and emergency
rooms. The only thing you need to deliver drugs in a rural area is a
drugstore to have the prescription filled and a doctor to write the
prescription. We guarantee that every part of the country will have at
least two competing plans.
What do we do if neither side has 60 votes? Do we give up? I suggest
we try to find common ground. I think we can do that and we will
continue to work in that regard.
The PRESIDING OFFICER. Who yields time?
Mr. KENNEDY. Mr. President, how much time remains on each side?
The PRESIDING OFFICER. The minority has 5 minutes 45 seconds. The
majority has 4 minutes 45 seconds.
Mr. GRASSLEY. Mr. President, I yield 3 minutes to the Senator from
Utah.
Mr. HATCH. Mr. President, just a few years ago, when President
Clinton was President, he was asking for a drug benefit program of $168
billion. Last year, the Democrats wanted a $311 billion program. This
year it is $600 billion. Frankly, I think it is a lot more than that
because they have written in a sunset provision that actually helps to
reduce the cost of that program, but also makes the program temporary.
I have to say that some of the things I find objectionable about the
Graham approach is that the bill sets up a Government formulary that
allows only two drugs for each illness. Because of that, it means that
literally dozens of drugs that may be prescribed by doctors will have
to be purchased by the patients themselves.
I might also add that it means a situation of price controls without
question. Countries that set price controls on prescription drugs have
been unable to duplicate the success of the United States in developing
new pharmaceuticals.
Our tripartisan plan provides a permanent benefit, not a temporary
one like Graham-Miller does. It gives beneficiaries choice in Medicare
coverage, drug coverage, and options to select any prescription they
want. It is affordable. Our plan costs $370 billion over 10 years. The
Graham plan costs $600 billion over 10 years. Our plan, in addition,
includes Medicare reforms. The Graham-Miller plan does not. Our plan is
not run by the Government, but by the private sector, and it depends on
private competition. It trusts seniors to make their own decisions and
choices. The Graham-Miller bill does not. Ours is affordable, it
creates competition, and there are no price controls on drugs. We take
care of the
[[Page S7205]]
poorest of the poor and we do it within reasonable budgetary limits.
Mr. President, I yield back the remainder of my time.
Mr. KENNEDY. Mr. President, I yield 4 minutes to the Senator from
Georgia.
The PRESIDING OFFICER. The Senator from Georgia is recognized.
Mr. MILLER. Mr. President, first I want to quickly make a point about
a matter that has been raised on the provision in the Graham-Miller-
Kennedy bill that says we take a second look at this legislation after
a few years. That is not a weakness. It is one of its strengths, and it
is nothing new. That is what we did with welfare reform, and that is
what we did with the farm bill.
I submit to the Chair, if we had that provision in the original
Medicare bill, we probably would have had a prescription drug benefit
years ago.
Back in April, right after the Easter recess, I came to the Senate
floor and talked about the urgency of passing a prescription drug bill.
I spoke then of my 88-year-old Uncle Hoyle who lives next door to me in
the mountains of North Georgia. He has been like a father to me in many
ways. Once a very strong mountain man, Uncle Hoyle now suffers from
diabetes, prostate cancer, recently had angioplasty, and also suffers
from a kidney infection. Although he still makes a great garden--and I
had tomatoes and corn out of it this last week--that once strong body
is growing frail. I cannot get Uncle Hoyle, or millions like him, off
my mind.
Many--too many--refuse to see these elderly waiting, waiting for
someone, anyone, to knock on that screen door and say, as John Prine
sings: ``Hello in there.''
The elderly are waiting for something else, too. They are waiting for
us to do something about their health needs. So far, they have waited
in vain, each day growing older, growing weaker. Now it comes down to
us on this July afternoon 2002.
If we do not do something, you know who we are going to be like? If
we do not do something, we are going to be like those who pass by that
man in the ditch on the side of the road in that Biblical story of the
Good Samaritan: Passed him by, tried not to look at him, refused to
help him. We will be no better than they were and should be remembered
in the same negative way.
We must come to the aid of our seniors by adding a meaningful
prescription drug benefit to Medicare. The Graham-Miller-Kennedy bill
would do just that. I believe and, more importantly, the AARP believes
that our bill offers the best value for seniors. We deliver our
prescription drug benefit through the tried and tested Medicare system.
We provide extra help for our neediest seniors. We guarantee coverage
24 hours a day in every corner of this country, including that tiny
rural town that the Presiding Officer knows, where I and my Uncle Hoyle
live.
Remember what FDR once said: Try something; if it doesn't work, try
something else. But for God's sake, try something. That is what I am
trying to say. I want Uncle Hoyle and all those millions like him in
this land of plenty who played by the rules, raised their families, and
worked hard to have some hope and dignity in their twilight years.
Is that really too much to ask? Mr. President, I do not think so.
I yield the floor.
The PRESIDING OFFICER. Who yields time? The Senator from Nevada.
Mr. REID. Mr. President, I ask unanimous consent that the Senator
from Iowa be granted 3 additional minutes and the Senator from
Massachusetts, the manager of the bill, be given 3 additional minutes
prior to the vote.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. GRASSLEY. Mr. President, I yield myself such time as I might
consume.
The PRESIDING OFFICER. The Senator from Iowa is recognized.
Mr. GRASSLEY. Mr. President, soon we will cast what could be our
final votes on a new Medicare prescription drug benefit. I am deeply
disappointed with the process that brought us to this point, a process
that ignored the good bipartisan will on the Finance Committee in favor
of politics and partisanship that has seemed to dominate the debate on
the floor of the Senate.
However, I continue to believe that our bill, the Tripartisan 21st
Century Medicare Act, represents the broadest and best approach to
providing prescription drug coverage.
Our work on this bill over the course of a full year involved fine
Senators from every party. I have never been prouder to work in a
bipartisan manner than with my colleagues Senator Hatch, Senator
Breaux, Senator Snowe, and Senator Jeffords on probably the most
important change in Medicare in the 37-year history of that
legislation.
Together the five of us, bipartisan or tripartisan, whatever one
wishes to call it, consulted stakeholders of all political persuasions
and the Congressional Budget Office as we developed our policies over
the last year. At every step of the way, we faced tradeoffs and made
compromises, all in the spirit of cooperation, with the common goal of
getting something done that could actually work without breaking the
Medicare bank.
Our bill reflects the best of what good bipartisan cooperation can
do. It offers seniors affordable coverage on a permanent basis. It does
not sunset, and it does not take brand name drugs away from our
seniors. It improves and enhances other unfair aspects of the Medicare
Program, and it does it all on a voluntary basis. It does so at a total
cost that reasonable people from both parties should be able to
support--$370 billion over 10 years.
I urge my colleagues to remember that anything that comes to the
floor on a purely partisan basis, such as the Graham-Kennedy bill
before us right now, is destined to failure, and I remind everyone
again that nothing ever passes this body on a partisan basis alone.
Around here, it takes bipartisanship to make things happen, and
apparently the Democrat leadership is not interested in making things
happen for our senior citizens.
Our bill is built on a bipartisan foundation. Had it been given a
chance to be debated in the Senate Finance Committee, it could no doubt
have been improved further still, but we were denied that chance all
because the other side did not want real debate. They wanted a real
issue instead.
I urge my colleagues, especially those on the other side of the
aisle, to listen closely when Senators claim to care about
bipartisanship. Our bill is the only bipartisan prescription bill in
all of Washington, DC, this year. It deserves consideration of the full
Finance Committee, but since we have been denied that right by the
Democratic leadership, it deserves your vote today.
The bill, other than the tripartisan bill before us, is without a
doubt a program for big Government. Rather than allow prescription drug
plans to design cost savings and innovative benefits that best suit
seniors' needs, the Graham-Kennedy bill requires Federal bureaucrats to
set up 10 regional drug formularies, basically deciding which
prescription drugs seniors can and cannot access.
Under Graham-Kennedy, plans would not compete with one another. It
would not be allowed to deviate from a regional drug formula, thus
restricting seniors' choices. Plans would be further restricted from
offering more than two brand name drugs in a therapeutic class.
This approach puts control squarely in the hands of bureaucrats in
Government, and we know from experience that exclusive Government
control over medicine has not worked well. The Government has lagged
many years behind the private sector in covering immunizations,
physicals, mammograms, and other preventive care in Medicare.
By contrast, the Tripartisan 21st Century Medicare Act approach puts
control in the hands of our senior citizens. The bill guarantees
multiple plans will compete in each region of the country, giving
seniors a choice to pick the plan that best suits their needs and the
right to get out of plans that do not meet their needs.
The tripartisan bill also does not restrict plans from offering more
drug choices and better overall drug coverage. Under the tripartisan
bill, private plans compete for seniors, not Government bureaucrats.
What if the specific drug a senior relies on is not on the regional
Government formulary? The Graham-Kennedy bill forces seniors to go
through multiple layers of bureaucratic red tape to convince the
Government to give them the drugs that their doctors think they need.
[[Page S7206]]
The tripartisan bill lets seniors and their doctors decide what drugs
they should receive.
Take your choice. We have it within the next 5 minutes. I hope you
will vote for the tripartisan plan.
The PRESIDING OFFICER. The Senator from Massachusetts.
Mr. KENNEDY. Will the Chair let me know when there are 15 seconds
remaining?
The PRESIDING OFFICER. The Chair will so advise the Senator.
Mr. KENNEDY. Mr. President, this vote is one of the most important
any of us will ever cast. It is a vote about our national character and
national priorities.
It is a vote about the quality of our society. But most of all it is
a vote about senior citizens and disabled Americans and their right to
live in dignity.
Medicare is a solemn promise between Government and the individual.
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 doctors 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.
Today, we have the opportunity and the duty to mend the broken
promise of Medicare. It is time to pass a Medicare prescription drug
benefit. It is time for Congress to listen to the American people
instead of the powerful special interests.
When I first came to the Senate, I was privileged to participate in
the debates that led to Medicare's passage. Then, as now, there were
two plans before us. One plan was the solid, dependable, comprehensive
Medicare program that became law. The other was little more than a
political fig leaf for the elections. One plan was supported by all the
organizations representing senior citizens and working families. The
other plan was supported only by the powerful special interests. That
is the same situation we face today.
Senators Graham, Miller, and I have offered a solid, affordable
Medicare prescription drug benefit that offers senior citizens and
disabled Medicare beneficiaries the protection they need at a price
they can afford. There is no deductible, there are no gaps, there are
no loopholes. The benefit and the premium are both guaranteed in the
law itself. Low income senior citizens get special assistance.
But the other side has taken a different approach. Their plan is not
affordable, not adequate, and not Medicare.
Under their plan, benefits are so inadequate that senior citizens
will still be forced to choose between food on the table and the
medicines they need to survive. There is a high deductible and a large
coverage gap. Whether the senior citizen has large drug needs or more
modest ones, the program only pays a small fraction of the cost of
needed medicine--leaving the elderly to shoulder the rest or go
without.
Special help for the low income elderly is conditioned on a cruel and
intrusive assets test.
Instead of guaranteeing benefits for senior citizens, their program
provides subsidies for insurance companies--and allows them to set the
premium and determine the benefits that the elderly can receive.
And to reduce the cost of their plan, they have set it up in such a
way that it actually encourages employers to drop the good retirement
coverage that more than ten million senior citizens now enjoy.
According to the Congressional Budget Office, under the Republican
plan one-third of these retirees--three and one-half million--would
actually lose the good coverage they have today and be forced into the
inferior Republican plan.
From the AARP to the Leadership Council of Aging Organizations to the
National Committee to Preserve Social Security and Medicare, virtually
every organization representing senior citizens and the disabled
supports our amendment. Not a single legitimate organization of senior
citizens or the disabled supports their proposal.
We are proud that our Democratic leader brought this matter to the
floor of the Senate. This is the time for us to act.
The PRESIDING OFFICER. The Senator from Massachusetts has 15 seconds
remaining.
Mr. KENNEDY. 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.
Every single member of this body has a good prescription drug
benefit. Let's do the same for the American citizens. That is what our
program does.
The PRESIDING OFFICER. Who yields time?
Mr. KENNEDY. I think the time has expired.
The PRESIDING OFFICER. The Senator from Iowa has 45 seconds.
Mr. GRASSLEY. Mr. President, I yield back the remainder of our time.
Mr. President, I make a point of order that the Graham amendment, No.
4309, violates section 302(f) of the Budget Act.
The PRESIDING OFFICER. The Senator from Massachusetts.
Mr. KENNEDY. Mr. President, pursuant to section 904 of the
Congressional Budget Act of 1974, I move to waive the applicable
sections of that act for purposes of the pending amendment, and I ask
for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There appears to be a sufficient second.
The question is on agreeing to the motion. The clerk will call the
roll.
The assistant legislative clerk called the roll.
Mr. NICKLES. I announce that the Senator from North Carolina (Mr.
Helms) is necessarily absent.
The PRESIDING OFFICER (Mr. Carper). Are there any other Senators in
the Chamber desiring to vote?
The result was announced--yeas 52, nays 47, as follows:
[Rollcall Vote No. 186 Leg.]
YEAS--52
Akaka
Baucus
Bayh
Biden
Bingaman
Boxer
Breaux
Byrd
Cantwell
Carnahan
Carper
Cleland
Clinton
Conrad
Corzine
Daschle
Dayton
Dodd
Dorgan
Durbin
Edwards
Feingold
Feinstein
Fitzgerald
Graham
Harkin
Hollings
Inouye
Jeffords
Johnson
Kennedy
Kerry
Kohl
Landrieu
Leahy
Levin
Lieberman
Lincoln
Mikulski
Miller
Murray
Nelson (FL)
Nelson (NE)
Reed
Reid
Rockefeller
Sarbanes
Schumer
Stabenow
Torricelli
Wellstone
Wyden
NAYS--47
Allard
Allen
Bennett
Bond
Brownback
Bunning
Burns
Campbell
Chafee
Cochran
Collins
Craig
Crapo
DeWine
Domenici
Ensign
Enzi
Frist
Gramm
Grassley
Gregg
Hagel
Hatch
Hutchinson
Hutchison
Inhofe
Kyl
Lott
Lugar
McCain
McConnell
Murkowski
Nickles
Roberts
Santorum
Sessions
Shelby
Smith (NH)
Smith (OR)
Snowe
Specter
Stevens
Thomas
Thompson
Thurmond
Voinovich
Warner
NOT VOTING--1
Helms
The PRESIDING OFFICER. On this vote, the yeas are 52, the nays are
47. Three-fifths of the Senators duly chosen and sworn not having voted
in the affirmative, the motion is rejected. Under the previous order,
the amendment is withdrawn.
Vote On Amendment No. 4310
The PRESIDING OFFICER. The question now occurs on the Grassley
amendment No. 4310.
The majority leader.
Mr. DASCHLE. Mr. President, I make a point of order that the pending
amendment violates section 302(f) of the Congressional Budget Act of
1974.
The PRESIDING OFFICER. The Senator from Iowa.
Mr. GRASSLEY. Mr. President, pursuant to section 904 of the Budget
Act, I move to waive the point of order for the pending amendment and
ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There appears to be.
The question is on agreeing to the motion. The clerk will call the
roll.
The legislative clerk called the roll.
Mr. NICKLES. I announce that the Senator from North Carolina (Mr.
Helms) is necessarily absent.
[[Page S7207]]
The PRESIDING OFFICER. Are there any other Senators in the Chamber
desiring to vote?
The yeas and nays resulted--yeas 48, nays 51, as follows:
[Rollcall Vote No. 187 Leg.]
YEAS--48
Allard
Allen
Bennett
Bond
Breaux
Brownback
Bunning
Burns
Campbell
Cochran
Collins
Craig
Crapo
DeWine
Domenici
Ensign
Enzi
Fitzgerald
Frist
Gramm
Grassley
Gregg
Hatch
Hutchinson
Hutchison
Inhofe
Jeffords
Kyl
Landrieu
Lott
McCain
McConnell
Murkowski
Nickles
Roberts
Santorum
Sessions
Shelby
Smith (NH)
Smith (OR)
Snowe
Specter
Stevens
Thomas
Thompson
Thurmond
Voinovich
Warner
NAYS--51
Akaka
Baucus
Bayh
Biden
Bingaman
Boxer
Byrd
Cantwell
Carnahan
Carper
Chafee
Cleland
Clinton
Conrad
Corzine
Daschle
Dayton
Dodd
Dorgan
Durbin
Edwards
Feingold
Feinstein
Graham
Hagel
Harkin
Hollings
Inouye
Johnson
Kennedy
Kerry
Kohl
Leahy
Levin
Lieberman
Lincoln
Lugar
Mikulski
Miller
Murray
Nelson (FL)
Nelson (NE)
Reed
Reid
Rockefeller
Sarbanes
Schumer
Stabenow
Torricelli
Wellstone
Wyden
NOT VOTING--1
Helms
The PRESIDING OFFICER. On this vote, the yeas are 48, the nays are
51. Three-fifths of the Senators duly chosen and sworn not having voted
in the affirmative, the motion is rejected. Under the previous order,
the amendment is withdrawn.
Mr. DASCHLE. Mr. President, I move to reconsider the vote.
Mr. GRAMM. I move to lay that motion on the table.
The motion to lay on the table was agreed to.
Mr. DASCHLE. Mr. President, I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The legislative clerk proceeded to call the roll.
Mr. ENSIGN. Mr. President, I ask unanimous consent that the order for
the quorum call be rescinded.
The PRESIDING OFFICER (Mr. Corzine). Is there objection?
Mr. REID. Mr. President, I object.
The PRESIDING OFFICER. The objection is heard.
Mr. REID. Mr. President, I ask unanimous consent that the order for
the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. REID. Mr. President, I ask unanimous consent that when the Senate
considers the Hagel amendment, it be considered under the following
time limitations: During today's session there be 90 minutes under the
control of Senator Hagel or his designee and 30 minutes under the
control of Senator Kennedy or his designee; that upon the use or
yielding back of the time, the amendment be set aside to recur when the
Senate resumes consideration on Wednesday, July 24; and there be
additional time of 120 minutes prior to the vote in relation to the
amendment controlled as follows: 60 minutes under the control of
Senator Hagel or his designee and Senator Kennedy or his designee; that
upon the use of the time, the Senate vote in relation to the amendment.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. REID. Mr. President, before Senator Hagel begins the debate, we
hope to get from the House today the supplemental appropriations bill.
After Senator Hagel and Senator Kennedy finish debate time today, we
will begin the debate on the supplemental appropriation.
Based on the unanimous consent agreement just entered, I have the
authority of the majority leader to announce there will be no more
rollcall votes tonight.
I have been asked we have a consent request on the supplemental. The
time, of course, is not running against the Senator's amendment.
Senator Hagel has been his usual courteous self. He has been very
patient in waiting for us to write this agreement. We have known his
was going to be the next amendment for some time, and it is unfortunate
it has taken so long to get to where we are.
Mr. President, I ask unanimous consent that at the conclusion of the
Hagel amendment debate today, and notwithstanding receipt of the
conference report to accompany H.R. 4775, the supplemental
appropriations bill, there be 2 hours 40 minutes for debate with
respect to the conference report, with the time divided as follows: 60
minutes each for the chairman and ranking member of the committee; 30
minutes under the control of Senator Wellstone, and 10 minutes under
the control of Senator Reid of Nevada or his designee; that on
Wednesday, July 24, the Senate proceed to the consideration of the
conference report at 10:30 a.m. with the time until 11 a.m. equally
divided and controlled by Senators Byrd and Stevens or their designee;
that at 11 a.m., without further action or debate, the Senate vote on
adoption of the conference report.
The PRESIDING OFFICER. Without objection, it is so ordered.
The Senator from Nebraska.
Amendment No. 4315 to Amendment No. 4299
(Purpose: To provide medicare beneficiaries with a drug discount card
that ensures access to affordable outpatient prescription drugs)
Mr. HAGEL. Mr. President, I call up amendment No. 4315, which is at
the desk.
The PRESIDING OFFICER. The clerk will report.
The legislative clerk read as follows:
The Senator from Nebraska [Mr. Hagel], for himself, Mr.
Ensign, Mr. Lugar, Mr. Gramm, Mr. Inhofe, and Mr. Gregg,
proposes an amendment numbered 4315 to amendment No. 4299.
Mr. HAGEL. I ask unanimous consent reading of the amendment be
dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
(The amendment is printed in today's Record under ``Text of
Amendments.'')
Mr. HAGEL. Mr. President, we have spent 4 days debating and voting on
two Medicare prescription drug proposals, the Graham-Miller-Kennedy
bill and the so-called tripartisan bill. I have worked with Senators
Ensign, Lugar, Phil Gramm, Inhofe, Santorum, and Gregg to introduce
relevant, straightforward, realistic legislation to add a prescription
drug benefit to our Medicare Program.
Our legislation would create a permanent Medicare prescription drug
program that would be available to all Medicare beneficiaries beginning
January 1, 2004. We keep it affordable to both beneficiaries and
taxpayers. We do it without creating a new Federal Government
bureaucracy. The program is not perfect. None of the Medicare
prescription drug bills we have considered have been perfect.
This bill accomplishes a very important goal. This bill gives seniors
the peace of mind that comes with knowing they have security from
extremely high drug costs, catastrophic costs that ruin families.
Why are we engaged in this debate?
Medicare was created, as we all know, in 1965--and it is a 1965
model. Preventive health care, like diet, lifestyle, and exercise, was
not emphasized in 1965. Prescription drugs were not as widely
prescribed or used. Research had not developed the kind of lifestyles
and life expectancies and quality of life we now enjoy--prescription
drugs, pharmaceutical research, being the core of that development.
Seniors needed protection, in 1965, from high hospital costs for
inpatient services, and we gave them that protection. It came through
Medicare Part A hospital insurance.
In 2000, the average American spent $435 a year on prescription
drugs. Today, Medicare beneficiaries need protection from unlimited
out-of-pocket prescription drug costs.
John C. Rother, policy director of AARP, was quoted today in the New
York Times as saying:
Another possibility is for Medicare to provide catastrophic
coverage for prescription drug expenses over a certain
threshold, perhaps $4,000 to $6,000 a year, with no premium.
This could be combined with additional help for low-income
beneficiaries and a government-authorized drug discount card.
So reported the New York Times today as a quote from Mr. Rother, the
policy director of AARP. What Mr. Rother states is exactly what this
bill does.
How would this program work? There are two major components to our
bill. First, all participating beneficiaries
[[Page S7208]]
would be protected from unlimited out-of-pocket drug expenses through a
cap on their private expenditures. The annual out-of-pocket limit would
depend on their income. That would go as follows: For annual income
levels below 200 percent of poverty, the annual expense would be no
more than $1,500. That is a little more than a $100-a-month cap on out-
of-pocket expenses. For those with annual income levels 200 percent to
400 percent of poverty, it would be capped at $3,500--no more,
regardless of the need. For those incomes between 400 percent and 600
percent of poverty, out-of-pocket expenses would be capped at $5,500--
no more. And for those who wanted to subscribe--this is a voluntary
program, open to all Medicare beneficiaries--with incomes above 600
percent of poverty, their out-of-pocket expenses would be capped at 20
percent of their income.
Again, to give some relevancy to help understand those numbers, the
2002 Federal poverty level is $8,860 for an individual and $11,940 per
couple. Beneficiaries with the lowest incomes would have their out-of-
pocket expenses on prescription drugs limited, as I said, to about $100
a month. And almost half of all Medicare beneficiaries live on incomes
lower than 200 percent of poverty.
The second part of our program would be that every beneficiary would
be able to choose to enroll or not to enroll in a discount drug card
program, giving them access to privately negotiated discounts on
prescription drugs.
Who would administer this program? The Secretary of Health and Human
Services would administer the program through the Centers for Medicare
and Medicaid Services, CMMS. The Secretary would negotiate with private
companies to deliver the benefits. What that means is no new Federal
bureaucracy, no new Government program to administer these benefits.
I would like to point out that two-thirds of all seniors already have
some type of private prescription drug coverage that they like and want
to keep. Seniors would not be forced to drop supplemental coverage, and
employers would be encouraged to retain and even improve existing
coverage under our plan.
Our bill would allow employer-sponsored plans--all employer-sponsored
plans: Medicare supplemental plans, Medicare+Choice plans--
pharmaceutical benefit managers--PBMs--pharmacists, and even States
working with private companies to deliver the benefits.
By structuring our program this way, we do not create an expensive
and new, expansive Government bureaucracy or the subsequent redtape
that follows. We would use the market system in place.
These private market tools, such as consumer choice and competition
to control costs without limiting innovation, are critical to the
future development and innovation of prescription drugs.
How would seniors participate? Seniors would enroll with an approved
provider and pay an annual fee of $25, which would be waived for
beneficiaries with incomes less than 200 percent of poverty,
individuals with incomes of less than $17,720. Once beneficiaries had
met their out-of-pocket limit on prescription drug expenses, they would
pay a small copayment of no more than 10 percent of the cost of each
prescription drug. Seniors would not have to pay monthly premiums for
deductibles.
When would the program start? Our program would take effect January
1, 2004. Other bills that were considered would not have taken effect
until 2005 or even later. And our benefit is permanent; we do not
sunset the program.
Why do we structure the program this way? Any realistic Medicare
prescription drug proposal must not only be affordable for seniors, but
it must also be affordable to the taxpayers, future generations of
Americans who are going to have to pay for this program. Why is that
important? It is very important because if we begin a program and
obligate and commit the next generations of Americans to this program,
then we owe them. We have a responsibility of giving them all the facts
and structuring a program that is accountable and responsible.
Let's examine something carefully. Projected Federal deficits now are
seen for at least the next 2 years and probably longer. So as opposed
to a couple of years ago when we looked out onto the horizon and saw
surpluses as far as the eye could see, we are now in a different
dynamic, a different environment. No one really knows how long we will
be in deficit, so any new Federal program and entitlement that is
added, someone must pay for that.
We are not operating under a new budget resolution, so, as of October
1, we will no longer be subject to budget caps. The two previous
prescription drug bills we debated did not attain the 60 votes needed
today in order to overcome a point of order raised because both
violated the budget resolution cap of spending no more than $300
billion over the next 10 years. That was an important point. Both of
the bills we debated that did not attain those 60 votes needed were in
excess of the $300 billion cap that the Budget Committee of the Senate,
this Senate, this body, voted for last year. But after October 1, there
are no caps because we are not operating under a budget.
Finally, the underlying Medicare Program is still in danger of
becoming insolvent. Let me pass on an interesting number. When Medicare
was passed in 1965, Part A hospital costs for 1990 were projected to be
$9 billion. In 1990, Medicare Part A actually spent $67 billion.
So from the projection, in 1965, out 25 years, as to how much
Medicare Part A would cost, all the actuaries said then--all the smart
people, all the medical care people--we would be spending, including
inflation, and the rates of increase in costs--all the dynamics that
are part of health care--$9 billion in 1990 when, in fact, we spent $67
billion in 1990.
We should pay attention to this number. I do not know of a Federal
program--especially entitlement programs--that did not go far beyond
any projections, partly because we always, for the political benefit,
understate the numbers. But the numbers I have just recited are real
numbers.
We ask, why should we be concerned about costs? I see a lot of young
people sitting in the galleries. You better be concerned about some
costs. You better be very concerned about what we do on prescription
drugs because if we do not pay attention, and we are not concerned and
enact an accountable, responsible, affordable program, I do not know
how you are going to afford it--because you are going to pay for it.
You will be paying for my prescription drug costs.
So we must act in a responsible, accountable way. Each of us who has
the high privilege of serving in this body is but a passing, fleeting
steward of your interests and the interests of this country. That is
our highest responsibility.
According to a preliminary actuarial analysis--we are getting CBO
scores on our amendment--our proposal would cost less than $200 billion
over the next 10 years. In fact, the numbers are coming in at around
$160 billion. That stays within the $300 billion budget resolution that
this body, this Senate, voted for last year. The Congressional Budget
Office will give us those exact numbers by the end of the day.
We have a tremendous opportunity to pass a responsible bill, to
provide all Medicare beneficiaries with a permanent prescription drug
benefit that would start January 1, 2004. We have that now within our
grasp.
The debate we have had over the last 4 days has been good debate,
relevant debate, important debate. All sides, all perspectives have had
an opportunity to lay this out, as we should, as we are embarking upon
this great new entitlement program. And we need this program. Make no
mistake, this program is necessary. We need to deal with this issue.
This amendment that we offer today is not perfect. However, what we
offer today is a real-world solution to a real-world problem.
Our amendment will give beneficiaries the protection they need most.
And we focus on those who need it most, those who are without
prescription drug insurance, those who are at the bottom of the social-
economic ladder, those who have to make hard choices about their lives.
We can do this. We must do this. But it must be in a way that is
accountable and responsible.
As the New York Times editorial phrased it this morning:
The most important short-term priority should be the needs
of the fairly narrow, and politically uninfluential, band of
Americans
[[Page S7209]]
who have very low incomes and very high drug prices.
They have said it accurately. They have stated it correctly. They
have focused on those who need it most. This amendment does that.
Mr. President, I am grateful for an opportunity to propose this
amendment and debate it. We will have a vote on it tomorrow. I know a
number of my colleagues wish to speak on this amendment.
So I yield the floor to my cosponsor on this amendment, who has
worked long, hard, diligently, and understands the issue as well as
anyone in the Senate. I am very proud we have teamed up, along with a
number of our other colleagues, to present something we think is
important for our country that is workable, doable, and responsible.
I yield the floor.
The PRESIDING OFFICER. The Senator from Nevada.
Mr. ENSIGN. Mr. President, I thank the co-author of this amendment,
the Senator from Nebraska, for the great work he has done; and, by the
way, that both of our staffs have done in coming up with an amendment
that we think is fiscally responsible and that meets the needs of those
seniors who need it the most.
We have heard a lot of examples during the House debate, and during
the Senate debate, about those seniors who are having to choose between
paying rent and paying for prescription drugs, or paying their food
bills and being able to pay their drug bills. We have heard about a lot
of heartbreaking stories. Those are real stories that are out there. We
have those stories in my home State of Nevada. We get letters from
those people all the time.
I got an e-mail a few weeks ago from a lady who sent this e-mail at
11:20 p.m. West Coast Time. She was up thinking--and probably looking
through her medical bills--and just crying out for help, asking if I
would be willing to take a moral stand to help seniors who need the
help the most? Our amendment does exactly that. It helps those seniors
who need help the most.
But this morning, I was also thinking about our responsibility to our
children and the next generation of young people coming up who are
going to be working for a living and paying taxes.
Will Medicare and Social Security be there for them? Will this
country be there for them? Somebody has to pay for all of these
programs that we are talking about.
People have not wanted to means test Medicare and Social Security
because they believed that they have earned this benefit, that they
have paid in for this benefit.
Realistically speaking, this new prescription drug benefit would not
been earned by anybody that is going to get it, at least early on.
Frankly, it is a straight giveaway to seniors. It is taking it out of
the pocket of younger people who are paying into the system now and
putting it into the pocket of older people who, while they were working
and paying taxes, paid for a Medicare program that did not have a
prescription drug benefit
All of us feel a great responsibility to our parents and our
grandparents, to take care of them in their golden years. But we must
do this in a way that does not put such a burden on young people in our
society that they cannot prosper.
Why should their tax rates have to be so high just because we in the
Senate wanted to get reelected, so we voted for things that just kept
spending these young people's money? Ultimately, they will have no
choice but to pay high taxes because politicians pay attention to the
senior citizens because senior citizens vote. We need to pay strict
attention to what we are doing here and whose money we are doing it
with.
Once we add a benefit to Medicare, we will not be cutting that
benefit in the future. So whatever we do, we better do in a fiscally
responsible fashion.
Senator Hagel and the rest of the team that has put this amendment
together believes that we have done exactly that: We have provided help
to those seniors who need it, but we have done it in a fiscally
responsible manner.
I want to talk a little bit about the amendment and how it works.
Senator Hagel has covered some of this, but I want to reemphasize a
couple points and to use a chart for those who need to see it. I am
kind of a visual learner and need a chart to understand things
sometimes, to actually be able to see the numbers on a piece of paper
so I can put them in my head.
The way our bill works, first of all, is that we cap--this is
catastrophic coverage--we cap the amount of out-of-pocket, expenses a
senior citizen is going to have to pay. We do that based on income. The
people who are have the lowest income get the most help. It goes up
from there based on your income level. That seems to make sense if you
think about it. Should a person like Ross Perot, who would qualify for
this benefit, get the same help as somebody who makes $15, $16, $17,000
a year--a senior citizen? Should they get the same level of help? I
think most people would say they should not get the same level of help.
Our bill says that if you are lower income, you are going to get more
help. It also says that the sicker you are, the more help you get
because those seniors who are very sick or who have a chronic condition
such as heart disease, diabetes--and we will talk about a few examples
later--pay much more per year in prescription drug costs and our plan
limits their out-of-pocket spending. Those are the people our bill
actually helps more than the leading Democrat proposal or the so-called
tripartisan proposal.
For people who make $17,720 or less a year, up to 200 percent of
poverty and below, we cap their out-of-pocket expenses at $1,500. This
is a little over half of the seniors in this country. If you make
between $17,721 and $35,440 per year, your out-of-pocket expenses are
capped at $3,500, and it scales up from there.
Once again, our program is completely voluntary. I have heard that in
1987 the Senate passed, and actually enacted into law in 1988, a
catastrophic drug benefit plan. We hear people--and I am not sure if
they were referring to our plan or not--saying seniors opposed the 1988
plan so much, that they repealed it the next year. They were not
opposed to it because of the catastrophic coverage, they were opposed
to it because one, they were forced to join; and, two, their Medicare
premiums went up. Ours is a voluntary program, and it only has an
annual enrollment fee of $25 per year. That is strictly to take care of
administrative costs. We figure about $25 per year is what is necessary
to handle these costs per enrollee.
When you pay that fee and sign up for the program, you will get a
drug discount card. You will be able to sign up for various plans in
the area, and pharmaceutical benefit managers will have a list of
pharmacies that are participating. They will have a formulary or a list
of drugs that are offered. You will go through those, and you will say:
I have this disease, or, I like that particular formulary; maybe I will
get together with some of my fellow seniors or I will get together with
my doctor and say, Which one of these plans do you recommend? Then you
will sign up for that plan that best meets your needs. It is the
competition between the plans and the volume buying that will allow the
average senior to save somewhere between 25 and 40 percent on the drugs
they buy with this drug discount card.
Right upfront, they save 25 to 40 percent. Then, we cap their out-of-
pocket expenses. So it is a two-pronged approach. We believe that
because the senior pays initially out of pocket--about $100, $120 a
month for the low-income seniors--that they will shop for their drugs
and take advantage of the lower prices that are being offered as a
result of competition between the participating entities.
I want to give a couple of real-life examples of those cases we
always hear about--those cases that tug at our heartstrings.
James is a 68-year-old man who has an income of about $16,000 per
year. He is being treated for diabetes. These are the various
medications he is taking: Glucophage, Glyburide, Neurontin, Protonix,
Lescol, and Zoloft. He has monthly prescription drug costs of $478.04,
and a yearly cost of $5,736.48--so James is paying out of his own
pocket over $5,700 right now. Medicare doesn't cover anything.
To compare the various plans, first of all, under the Graham-Miller
plan, James' out-of-pocket expenses would
[[Page S7210]]
be $2,940.00. Under the tripartisan plan, he would pay $2,341.65. Under
the Hagel-Ensign plan, he would pay $1,923.65. So for the low- to
moderate-income person who has a serious disease, the Hagel-Ensign plan
gives that person more help than any of the other bills. And example
after example has been heard on this floor about has been this type of
a case.
If you don't like this one, we will give you the next one. Doris is a
75-year-old and has an income of around $17,000 a year. She suffers
from diabetes, hypertension, and high cholesterol, which is not unusual
for a senior. Her medications are Lipitor, Glucophage, Insulin,
Coumadin, and Monopril, for a total cost of $304.03 a month, and
$4,648.36 a year.
Once again, here is how Doris would fare under the various plans
Under the Graham-Miller plan, the leading Democrat plan, she would pay
$2,220.00 a year out of pocket; under the tripartisan plan, she would
pay $2,086.36 a year; and, under our plan, she would pay $1,714.84 a
year. Once again, this person does better under the Hagel-Ensign plan
more so than either of the other two plans which were voted on and
failed to get the 60-vote point of order.
To reemphasize, the plan we have all worked on together, including
Senator Gramm of Texas, provides a Medicare prescription drug benefit
in a much more fiscally responsible way and takes into account future
generations.
There is a third example I want to talk about. Betty, who is a 66-
year-old, has an income of $15,500 per year. She is being treated for
breast cancer. She is still receiving low-dose radiation therapy with
Nolvadex. Her medication profile is as follows: Morphine, Paxil,
Dexamethasone, Aciphex, Trimethobenzamide, and Nolvadex--monthly total
of $668.33 and $8,019.96 per year.
These are three real-life cases from Nevada. The names have been
changed to protect their privacy.
Betty's medications, under the three different proposals, once again:
Under the Graham-Miller plan, the leading Democrat plan, she would pay
$3,180.00 out-of-pocket expense; under the tripartisan plan, $2,570.00;
and under the Hagel-Ensign plan, $2,152.00 out-of-pocket expense.
The person who is the sickest, who is moderate to low income, is the
person our plan benefits more than any of the other plans. That is why
we think our plan is superior, because when we hear about people, when
they go on the talk shows, when they talk in front of seniors groups,
when we are hearing all these horror stories, these last three examples
are the type of people about whom they are talking.
So if my colleagues really want to help those seniors who need it the
most, they should support our plan. The other thing is--and I will
conclude with this--that we have had two other plans voted down today.
The two plans that were voted down, because they did not get the 60-
vote point of order, are pretty much dispensed with at this point.
Senators should ask themselves if they want to get a bill done this
year. If they do, this is your best chance of doing it.
If we pass this plan in a bipartisan fashion, lay aside the
politics--and we said we are going to put seniors ahead of politics,
and ahead of being a Republican, or ahead of being a Democrat--we can
pass a plan now. We should put seniors ahead of a political issue in
this November's election. This Hagel-Ensign bill is the bill that
offers that opportunity for people.
So I encourage my colleagues to support our bill. It will be voted on
tomorrow. We have a great chance and a great opportunity for the
American people, and especially for those seniors and disabled people
who are on Medicare, to really get the help that they need.
Mr. President, I ask unanimous consent to add Senator Allard as a
cosponsor of amendment No. 4315.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. ENSIGN. I yield the floor.
The PRESIDING OFFICER. The Senator from New York is recognized.
Mr. SCHUMER. Mr. President, I am not going to speak very long, but I
know my colleagues, the Senator from Nebraska and the Senator from
Nevada, put forward their plan. I thought I would make a few points in
regard to it. I commend them for their effort. They are trying to do
something that is extremely difficult. They are trying to be both
responsible in a plan in terms of how much they will provide, in terms
of helping people who need help, but at the same time, they are trying
to be as fiscally, I guess they would say responsible--I would say as
minimal as possible. I would say, yes, if you just look at the plan and
say which one should cost the least, the Hagel-Ensign plan is there.
If you look at all the other things we do in the budget and then say
we don't have any money for this, repeal of the estate tax comes to
mind, which I believe both of my colleagues have supported--and most
have supported--and ask if it is an either/or proposition if you want
to be fiscally responsible, which would people choose? A more generous
plan. I think that cost us $600 billion in the President's budget to
make that permanent. Putting together a generous plan and not repealing
the estate tax, or repealing the estate tax and having this minimal
plan, my guess is that 80 or 90 percent of the American people would
reject the plan put forward by my colleagues from Nebraska and Nevada.
I guess if I had to think of the rubric of the plan, they are trying
to be compassionate conservatives. It is a hard thing to do, a
difficult thing to do. I respect their real effort to do it.
If my colleagues think this is a generous or adequate plan, it
clearly is not. In fact, some have argued that this would be a step
backward. That is not Chuck Schumer, Democrat of New York, but it is
AARP. I will read some excerpts from the AARP letter on this plan sent
to Senator Hagel on July 23. I ask unanimous consent that it be printed
in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:
Dear Senator Hagel: Enacting a comprehensive prescription
drug benefit in Medicare this year remains the top priority
for AARP. Our members are counting on the Senate to pass a
meaningful drug benefit that is available and affordable to
all beneficiaries. Our members were promised in the last
election that a comprehensive drug benefit would be a
priority, and we are counting on you to make good on that
promise this year.
We appreciate the intent of your bill, S. 2736, the
``Medicare Rx Drug Discount and Security Act of 2002,'' to
provide a prescription drug discount card and stop-loss
protection to Medicare beneficiaries. However, in addition to
our substantive objections, we are concerned that by offering
this scaled-back proposal today, you would effectively derail
bipartisan discussion and compromise on more meaningful
comprehensive approaches. We believe Congress should focus
its efforts on enactment of a more comprehensive drug benefit
this year.
In addition to the timing of your proposal, AARP has
concerns about the approach taken in your bill, including:
Catastrophic coverage--While AARP has not opposed income-
relating premiums, income-relating the Medicare benefit
changes the nature of the program. This would set an
extremely dangerous precedent in Medicare. Further, the stop-
loss levels set in the bill do not provide enough protection
for lower income beneficiaries. A low-income couple could
spend 25 percent of their income just for drugs before this
plan offered assistance. Thirdly, there are a number of
issues involved in using tax returns to determine program
eligibility levels, and we believe other options should be
explored.
Discount card--While AARP supports the use of a discount
card program as a building block for a Medicare prescription
drug benefit, your proposal lacks the necessary
specifications to guaranty the level of discount, what level
of discount would be passed to beneficiaries, and the degree
of consumer protections required of plans.
Given these concerns, AARP opposes your amendment. We
remain fully committed to developing a comprehensive drug
benefit for all Medicare beneficiaries and we look forward to
working with you on legislation that our members can support.
Sincerely,
William D. Novelli,
Executive Director and CEO.
Mr. SCHUMER. Let me quote from the letter to Senator Hagel:
Our members are counting on the Senate to pass a meaningful
drug benefit that is available and affordable to all
beneficiaries.
AARP goes on to say that while they appreciate the intent of S.
2736--this is their quote--they are
. . . concerned that by offering this scaled-back proposal
today, you would effectively derail bipartisan discussion and
compromise on more meaningful, comprehensive approaches.
That is exactly the problem. I think when seniors from one end of
this country to the other hear the exact specifics of the Hagel plan,
they are going
[[Page S7211]]
to be shocked. I think they even probably think that the most generous
of the plans--the Graham-Miller-Kennedy plan--doesn't go far enough in
terms of help that they need. To hear this one--and I will get into
some of the details--I think they would say: Gee whiz, what the heck
did they do? If we went home and said we passed a prescription drug
benefit and passed the Hagel-Ensign bill, most of our constituents
would say--correctly--no, you didn't, and don't you claim that you did
because you are not helping the vast majority of people who desperately
need the help.
I will go on with the AARP letter. They are worried about the
catastrophic nature of the Hagel-Ensign bill. Quoting them:
While AARP has not opposed income-relating premiums,
income-relating the Medicare benefit changes the nature of
the problem. This would set up an extremely dangerous
precedent in Medicare.
That is exactly right. Anybody who thinks this bill is helping
middle-class people hasn't read it. The vast majority of our
constituents who struggle with the cost of drugs, who may be making
$20,000 or $25,000 and paying a couple thousand dollars--not $6,000,
but $2,000--are left out in the cold by this bill. They are far more
typical than the examples my good colleague from Nevada has brought up
in his chart.
So to think that this is comprehensive, to think that it covers most,
is wrong. We do have a choice. It is a value choice. How much are we
willing to spend to help people? You cannot have it both ways. You
cannot say we are passing a comprehensive prescription drug benefit and
not spend the money for it. These drugs are wonderful, but they are
expensive, and you cannot avoid that conundrum. You have to decide
which side of the fence you are on.
With some regret, and I say it in admiration for their bold essay,
the Hagel-Ensign amendment says we are on the side not of providing
broad, comprehensive coverage but, rather, doing a little bit. And,
again, as I said, put into the context of all the other things we spend
money on, put in the context of the desire on the other side to
continue with tax cuts, which takes their budget and puts it in a
warped and pretzel-like way, it is not what the American people want.
So I am going to conclude with this quote:
Given these concerns, AARP opposes your amendment. We
remain fully committed to developing a comprehensive drug
benefit for all Medicare beneficiaries, and we look forward
to working with you on legislation that our members can
support.
What AARP said to my colleagues I say as well. Let me just go over
some of these things. This is the Hagel bill. Senior citizens with an
income of $9,000--in parts of my State, that is not enough to pay rent,
we would make that senior citizen with a $9,000 income pay $1,500
before the benefit outlined in the Hagel-Ensign bill--before they got
any help at all. Now, is that fair? Is that right? Even taking the
basic philosophy of Hagel-Ensign--and I disagree with it, but I respect
it, helping the very poor who need the help--when you have a $9,000
income in most parts of America, you cannot afford to pay $1,500 in
prescription drugs. You will never get there. That will be 17 percent
of somebody's income. That is wrong.
Now, my friend from Nevada took one side of the line. I am going to
take the other side of the line. He used a $17,000 example. Let's say
you go to $18,000 in income. Nobody is rich on $18,000, whether you
live in Nebraska, Nevada, or in Manhattan. It is harder in Manhattan
than anywhere else. Your standard of living is different with the same
income level there.
Listen to this: A senior making $18,000 would have to pay $3,500
before they receive any help. That is not the kind of benefit the
American people are asking for whether they be senior citizens or
younger people with parents. That is 20 percent of their income. If
your income is $18,000, you pay $3,500 first? What they would say in
New York is: Forget about it. What they would say to the rest of the
country is: Please go back and try to do a little better.
Even a senior citizen with an income of $35,000--once you are at
$35,000 and you are a senior citizen, hopefully your kids are out of
the house and you are not doing that badly, although, again, in parts
of New York, $35,000 does not stretch too far when you have an average
rental payment of $1,000 a month or $800 a month. That eats a lot of
it, and then you take taxes and other expenses. That person would have
to pay $5,500, 16 percent of their income, before they got any help.
My guess is that 98 percent of all senior citizens at that level of
income--hardly a very high level--would not qualify for this program at
all. The number who pay that huge amount for prescription drugs--and
that is the amount they would need before the program begins--is small.
I would not call this insurance. I would not call it Medicare. If it
would become law, poor senior citizens would still be choosing between
food on the table and the medicines they need to survive. That senior
citizen who is making $9,000 and paying $1,500 for their much-needed
prescription drugs is still choosing between food on the table and
medicine.
Middle-class senior citizens who are willing to pay a little more in
copayments and monthly payments would not get a benefit that they would
find worthwhile at all. It would not affect most of them.
To all of my colleagues, this bill is more fiscally tight, stingier,
if you will, than the House Republican bill. It is more inadequate than
either of the two bills voted for in the Senate. I do not know a single
organization of the elderly or the disabled that supports it, and I do
not believe it deserves the support of the Senate.
The fight for a real Medicare prescription drug benefit does not end
today. In fact, I argue that we made some progress today. Fifty-two
votes for the Graham-Miller-Kennedy bill is a lot of progress, and, in
fact, should we adjust the Budget Act next year, that 52 votes might be
adequate to actually pass the bill. Once we forget these notions of
spending money on things that virtually nobody wants, except a small
rarefied few, we will be able to do it.
We made progress today. I am not despairing. I compliment the Senator
from Georgia, as well as the Senator from Florida and the Senator from
Massachusetts, who will be here shortly, for putting together a
proposal that I think does much more of both: It is still fiscally
within our means but really is broad and comprehensive and deals with
people's needs.
To vote for Hagel-Ensign I think would be a cop-out. In fact, the
argument was made by my friends--again, I salute the sincerity of their
effort; I really do. This is an honest proposal and I thank them for
that, but they admitted themselves: We will not do much after this.
I would rather go back to the drawing board and try to pass something
that far better meets the American people's needs, such as the bill
proffered by the Senators from Florida, Georgia, and Massachusetts. I
urge my colleagues to defeat this amendment, and let's keep working on
this issue until we get it right.
I yield the floor.
The PRESIDING OFFICER (Mr. Miller). The Senator from Texas is
recognized.
Mr. GRAMM. Mr. President, I am not going to get into an argument with
our dear friend from New York. I will say, I think in New York if you
make $9,000 a year, you qualify for Medicaid. So you are completely
covered.
I also have to say, if we are going to take the approach the Senator
from New York takes, and that is ``how much are they willing to spend
to help you,'' then we get into a debate not about what works, not
about what is feasible, not about what we can afford, but who is
willing to spend more money?
In truth, we have already been in that debate. I want to show my
colleagues this, because this is frightening to me.
In 1999, just before he left office, President Clinton proposed a
comprehensive drug benefit--let me start earlier. We had, through a
legislative act of Congress, a bipartisan commission appointed with
Senator Breaux as chairman. I was on that commission. Part of what we
did is we put together a proposal to modernize Medicare through the use
of competitive marketplace forces.
For example, if you have a cane with four little legs on it and you
buy it
[[Page S7212]]
through Medicare, the average Medicare cost is $40. The VA, which has
never been thought of as the world's most efficient buyer, buys it for
$15. The Breaux commission put together a proposal to modernize
Medicare and to use some of those savings to help people get coverage
for pharmaceuticals, and the way they got it was opting into a more
cost-effective system.
That proposal actually saved money because reforms in Medicare save
more money than providing the pharmaceuticals cost within this more
competitive environment.
President Clinton, who had us all down to the White House, looked us
in the eye and said: Don't let this process fail because of you. I was
one of the members of this commission. President Clinton looked us
right in the eye and said: Don't let it fail because of you. And then
all four of his appointees voted no at the last minute. We needed 11
out of the 17 to make a recommendation to Congress, and we only got 10.
At that point, incredibly, providing pharmaceuticals not only did not
cost money, it was part of a reform program where the savings we would
have gotten with Medicare reform would have paid for the pharmaceutical
benefit.
That is where the debate started, and we failed to act because of one
vote on the bipartisan commission, when all four of the President's
appointees voted no. In fact, they had a press conference at the White
House denouncing the plan before we had the vote.
At that point, at the end of his administration, President Clinton
said: We can have a comprehensive benefit for $168 billion. That was in
1999 just as President Clinton was ending his term.
Then Congress in 2000 had a proposal. Former Senator Robb from
Virginia was the author of that proposal, and it cost $242 billion. If
you went back and looked at that debate, everybody who was for that
plan said: We can solve this problem. If you will just give us $242
billion, we can solve the problem.
Then you will remember the budget debate we had last year, the Baucus
amendment. I could quote 20 Democrat Senators who said: We can provide
all the benefits we need for $311 billion.
I could quote Senator Baucus, I could quote the distinguished
majority leader, but it is never fair using people's words against
them. I do not do it, but I could.
In the budget debate last year, $311 billion would have done
everything we wanted to do. This year in the budget we said: No, that
is not enough. That is being tight fisted with the elderly. We do not
want $311 billion. In the budget we said $500 billion. The budget did
not pass, but that is what the budget had.
Now we come to the floor with a proposal that says: We cannot spend
$500 billion; that is being tight fisted with our seniors. How dare we
to have thought of $311 billion? What was wrong with Senator Robb's
tightness at $242 billion? Was Bill Clinton a person who did not love
the elderly at $168 billion? What a heartless man he was. Today, we
said: No, it is going to take $600 billion--not $311 billion but $600
billion.
Mr. SCHUMER. Will my colleague yield?
Mr. GRAMM. Let me finish this point, and I will be happy to yield.
Mr. SCHUMER. I thank the Senator.
Mr. GRAMM. The $600 billion would not pay for a real program. It
starts in 2005. It ends in 2010. So if one does not live until 2005,
they get no benefits; if they live past 2010, they get no benefits--and
it still cost $600 billion.
Now, where do we think we are going? Where does all of this end? We
are asking people to look and see who cares the most. And you can
measure that by how much money they are willing to spend.
Where does this end? Will it not go on forever? I am going to yield
to the Senator, but let me make this point to sort of bring it
together.
Forget this red in the chart. That was about this bill that I was
talking about when I made the chart. Just look at the yellow on this
chart. I want to try to impress this one figure on people's minds.
Today, Medicare, which has an unfunded liability in present value terms
of $17 trillion--when you discount it above the present value of the
revenues we are going to collect, today it is taking 2 percent of the
economy. If we do not pass any drug benefit and we just leave Medicare
as it is, by 2030 it is going to take 4 percent of the economy. Today
the payroll tax for Medicare and Social Security is 15.3 percent. If
left unchanged, meaning we do not cut it and we do not increase it, the
payroll tax will have to more than double by 2030 to over 30 cents out
of every dollar earned by every worker to pay for Social Security and
Medicare. That is without a prescription drug benefit.
Some people estimate that if the bill had been adopted that we
sustained a point of order against today, this would go not from 2
percent of the economy to 4 percent but from 2 percent to 6 percent. We
would literally be looking at over 40 cents out of every dollar earned
by every worker to pay for Social Security and Medicare.
I understand all of these people who want these benefits are writing
these letters saying we do not love them enough--that $170 billion is
not enough. They say these people who want to spend $600 billion love
us more. Of course, they are going to love us even more next year with
$900 billion. There will be lots of love next year.
The point is, does anybody care if young workers 28 years from today
are paying 40 cents out of every dollar they earn on Medicare and
Social Security? How much love can we afford? That, I think, is a
critical point.
So I beg my colleagues, let us not get in the business where we
measure a program simply by how much it costs.
Others I am sure want to speak, but I am going to talk about how this
program gets you a lot for every dollar you spend. I am happy to yield.
Mr. SCHUMER. I thank my colleague.
First, our colleague from Texas has been on the floor a whole lot
lately on all of the various issues which we have been debating. He has
always been a great warrior and a great debater, but since he announced
his retirement, he is a happier warrior. Every argument he makes, he
has a twinkle in his eye. I compliment him for that. It is a pleasure
to listen to him, as much as I disagree with him. I do not know if this
would happen to the rest of us if we also announced we would not be
here, we would be much happier in our arguments, but I want to make
three points and ask them to form the question.
First, I ask my colleague from Texas if he knew that the Medicare
level in New York is $599, which is $7,200 a year. I ask him if he knew
that.
Mr. GRAMM. If I were from New York, I would be trying to change that.
Mr. SCHUMER. Well, we will, maybe with the help of the Senator from
Texas. In any case, that person in the example does not qualify.
The second question I ask my colleague is this. I like his chart. It
sort of fits my argument because that last number is $600 billion. As I
understand it, if we did not make the estate tax repeal permanent,
something my colleague from Texas has fought very long and hard over,
that would be about $670 billion, as I understand it. That is how much
it would cost over the same 10-year period. So we are not talking about
the ability of the Government to pay this; we are talking about size of
government. That is one of the great debates we have. But it is not
that my colleague says we cannot afford it; rather, he is using it for
different purposes.
At least to me, when I go from one end of my State to the other, the
number of people who ask for estate tax repeal is much smaller than the
number who ask for a comprehensive prescription drug plan for Medicare.
So I ask my colleague, aside from the ideological and philosophical
argument about size of government and all of that--on which we have had
nice debates on both the floor and in our various committees that we
share--but certainly within the contemplation of my good friend from
Texas, if we did not take that money for estate tax reduction, we could
put it into this program; am I right about that? This is a simple value
choice.
Mr. GRAMM. I am going to answer that point. Was there a third point?
Mr. SCHUMER. Yes. The third point is this: When we compared the
programs, the $168 billion, the $242 billion, and the $311 billion,
that was apples and oranges, as I understand it. The benefit I remember
from the Robb program that my friend from Texas pointed out did not
have the same level of benefit, the same generosity of benefit, as the
plan proffered by the Senators
[[Page S7213]]
from Florida, Georgia, and Massachusetts. So we are really comparing
apples and oranges.
It is not that anybody thought the original plans did everything, it
was just the amount of money they were willing to spend, and in fact,
as I recall it, the Robb plan was sort of objective because people
thought for the amount of money it cost compared to the amount of
benefit, it was not quite worth it, at least in political terms, using
politics in the finer sense in terms of people's value choices.
Those are my three questions to my colleague, and I welcome the
answers he will give with the same twinkle in his eye.
Mr. GRAMM. Let me begin with No. 3 first. We are comparing apples and
apples. In 2001, in the political bidding war we were in then, $311
billion represented a sufficient number of apples to engage
successfully in the bidding contest. Today, it is $600 billion and
heading up. My point is that, beginning with the chairman of the
Finance Committee and the majority leader, we had Members saying last
year that $311 billion would provide a wonderful program. The problem
is, this year it is $600 billion, and that is a wonderful program. And
it is not apples and oranges, it is a lot more apples.
Secondly, I think where my colleague is leading on the death tax
thing is kind of a circular argument. If you are willing to take away
people's money, the only limit you get as to how much you can spend on
Medicare or anything else is the amount of money that can be extracted
without destroying the productivity of society.
The point I had made earlier was that you are already committed under
the existing program to take 30 cents out of every dollar everybody
earns to pay for Social Security and Medicare. If you adopted your
program, by some estimates you would be paying 40 cents out of every
dollar that people earn, and the question is: Is that something that
the economy can bear, and is that fair to young people?
In terms of the death tax, we have a very different view of the death
tax. Nobody in my family ever paid any death tax, and nobody ever
bequeathed anybody anything because they did not have anything. But
when somebody works a lifetime to build up a farm or a family business,
the view of the Senator is that that belongs to the Government and my
view is it belongs to the people who build it up. They build it up for
their family, and it is not right for us to force their family to sell
off their business or sell off their farm or sell off their life's work
to give the Government 55 cents out of every dollar they earn.
It is a perfectly legitimate position to say they ought to have to do
that, but it is not something of which I am supportive. I think it is
fundamentally wrong.
There are other people who want to speak.
Mr. SCHUMER. I am not yielding but thanking him for the answers.
Mr. GRAMM. Let me also say one thing that has happened about which I
am worried. Many of my Democrat colleagues, knowing that this tax cut
that we adopted is temporary--because of this quirk in the budget,
unless something changes it goes away in 10 years--almost seem
determined to spend and spend and spend until we have to take the tax
cut away.
I remind my colleagues, throughout American history the highest
sustainable tax rate that we have been able to sustain over long
periods of time was taking 19 cents, on average, of every dollar
created in the economy. When we adopted the tax cut last year, the
Government was taking 22 cents out of every dollar produced in the
economy. That was a record high that only had one year higher. That was
1944 at the peek of the war effort. I hope people do not believe we
should go back to a 22-percent tax burden.
The final point I make, the Senator acts as if death taxes would pay
for Medicare. We all know Medicare is funded by payroll taxes. If you
are working in some factory somewhere--I don't imagine you are watching
this debate, but if you are and say you are taking a coffee break and
this is the only thing they have on in the factory--don't think that
some rich guy is going to be forced to sell off his farm to pay for
your Medicare. You are going to have to pay for it with higher payroll
taxes. Don't be confused.
Now, I have talked longer than I had intended. Let me make a couple
of points. First, I read a quote, from John C. Rother, policy director
of AARP. In recognizing that the two big plans would be defeated, he
said: Another possibility is for Medicare to provide catastrophic
coverage for prescription drug expenses over a certain threshold.
And he notes also that we could have a Government-authorized discount
card.
Now, let me make my points about this bill and stop. First, I had
virtually nothing to do with writing this bill. Two Senators have been
principal authors of it. I recognized, in simply looking at it, that it
was the best plan around. They came up with it.
Why is it the best plan around? First, it is within budget. Now, it
is hardly some insignificant amount of money. Somewhere between $140
and $170 billion is what this costs. That is a lot of money.
What it does is provides the most help to people who fall into two
categories: A, you don't have very much income; and B, you have high
drug bills. I submit those are the people who need the help the most.
The problem with the other two proposals--let me make my criticism
bipartisan--the problem with the other two proposals is that they spend
80 percent of their money helping people who don't need help. When you
take the view that the Government ought to have a program that pays at
least 25 percent of the drug bill for Bill Gates and Ross Perot--that
it is not a universal program unless they are covered--you are going to
end up spending huge amounts of money paying for people who don't need
the help. You end up paying for the roughly two-thirds of people who
already have health insurance for pharmaceuticals, because you
substitute the taxpayer for the private insurance policy they already
have as part of their retirement program.
The point I am trying to make is you are spending 80 cents on people
who either almost have the benefit or don't need it to get 20 cents on
the target to people who do need it.
The advantage of the Hagel-Ensign bill is that it puts every dollar
on the target. This is what it says. Again, you can spend more money;
God knows you can spend more money. But just listen to what it does.
Let me take a retired couple. If their income is $23,000, they would
have to pay roughly $100 a month in drug bills themselves, but at
slightly above $100 a month this program kicks in and they get full
payment except, possibly, a very small, little copayment per
prescription.
Now, our colleague from New York said a huge number of seniors, 80
percent I think he said, would reject this program. I don't believe it.
My mama's drug bill is $400 a month. She does not want help in 2005.
She does not know if she will be alive in 2005. She wants help now.
The advantage of this program is that it provides help right now.
What it would mean in her case is she would have to pay a little over
$100 a month and now she is paying $400 a month.
Now, if your income goes up, then the deductible goes up. For
example, if you are making $46,000 a year, your deductible is $3,500.
If you are retired, most retirees who make $46,000 a year own their own
home. What this bill says is, if your expenses on pharmaceuticals get
up really high, the Government is going to come in and help you. If you
make $69,000, you have to spend $5,500 to get the payment by the
Government. So it is tied to your income.
And for Bill Gates and people who are very wealthy, they have to
spend 20 percent of their income on pharmaceuticals. Bill Gates will
never get a benefit and he shouldn't. He doesn't need it, and he
doesn't want it. He might not even take it.
That is not the only help you get, by the way, because immediately
this program would let private companies contract through Medicare to
represent Medicare beneficiaries in negotiating for their
pharmaceuticals. So each of these companies would compete in buying the
drugs you buy. You would buy from whoever could sell them to you the
cheapest, and it is estimated that they would save you somewhere
between 25 percent and 40 percent of the cost of your drug bill.
In my mama's case, this would mean spending much less than $400 a
month--
[[Page S7214]]
it is estimated that these companies, because they have more buying
power, would get the best price. She goes to the same pharmacy because
it is the one convenient to her house. These companies could go all
over the country to find her drugs and buy them the cheapest. They
could save her $100 on average just simply by being competitive.
Remember I told you about the cane with four legs on it--Dr. Frist,
you have seen them--lots of people have them in hospitals. Medicare
pays $40 for that cane on average. The VA buys that cane for $15
because they go out and engage in competitive bidding. These companies
would do the same thing. Then, anything above $100 per month, the
Federal Government would pay.
If you said to my mother and anybody else's mother: Would you rather
have the Government pay the whole thing? The answer would be yes. She
would rather the Government pay the whole thing. But the point is, this
is a reasonable, responsible program that would help real people.
Finally, Senator Ensign has presented three or four times--you can
never do it enough--cases of people who have real high drug bills, and
remarkably he has shown that his program is cheaper for them than these
very expensive programs. Before somebody runs down here to the floor to
answer me and says: How is it possible? We spend $600 billion and
Senator Ensign spends $170 billion and you are saying it is cheaper?
You are saying it is cheaper under Senator Ensign's program. How can
that be when he doesn't spend as much money?
The answer is very simple. He doesn't cover everybody. If you do not
have high pharmaceutical bills--and in any given year a substantial
number of seniors do not--and if you do not have moderate income, he
helps you get competitive purchase of your drugs, which saves you
between 25 percent and 40 percent. But the Government does not pay if
you do not fall in this category of people. You don't get help under
those circumstances.
Now you say everybody should get help. The point is, this bill helps
the people who need the help the most. This is a good proposal.
I remind my colleagues, we are at an impasse here. There are some
people already talking about spending more money to break the logjam.
The logical thing to do now, if we want to act this year, is to take
this proposal and adopt it. That will help people who need the help
most and help them now. Then we can come back next year. We can look at
the budget situation, we can see where we are, and in the process we
can supplement this if we want to.
Let me give you one example because Senator Ensign has done it better
than I could possibly do it. This is somebody who lives in Nevada. He
calls her Betty Smith. She is 66 years old. She has an income of
$15,000 per year. She is being treated for a whole bunch of things.
Her drug bill is $8,000 a year. My mother's drug bill is $4,600 a
year and, thank God, she doesn't have these kinds of problems. So it is
easy to believe an $8,000 bill.
Here is the point. Look at the Hagel-Ensign bill under exactly this
situation. Your income is $15,500 and you are being treated for breast
cancer and you are taking all these drugs and you have a $8,000 bill,
so you are spending over half of your income on drugs. This is
literally somebody. We all talk about this cliche of people being
forced to choose between medicine and food. I hope her children are
helping her. If they aren't, they ought to be. But she would
literally--if she didn't have any children, didn't have anybody helping
her--she would literally be choosing between eating and drugs.
Now, here are the three bills. Two of them we voted on, and one we
are about to vote on. The point that Senator Ensign has made is that
under the bill that costs $600 billion and covers everybody, this lady
would have to pay $3,180 a year. Under the tripartisan bill, she would
have to pay $2,570 a year. But under the Hagel-Ensign bill, she would
pay $2,152. In other words, for a lady who is very sick and who has a
very moderate income, she would be better off under this plan.
But for people who say how is that possible when it only spends $170
billion, the way it is possible is it is focused to help exactly people
like this lady. It does not take the view that we have to provide the
Government program for everybody. It just helps people who need the
help. And it provides this system of competitive purchase for
everybody.
So, I urge my colleagues, do not get into this business about saying
this cannot be as good as that because that costs so much more money.
Some of the best things in life are not necessarily the most expensive.
Remember, we are going to have to pay for it. Not ``we'' being Members
of the Senate. We are not going to pay for it. We don't pay for
anything. We are going to be covered by the Government insurance
program when we get out of here. But that blue collar worker on that
assembly line is going to have to pay for it.
I congratulate my colleagues. This bill ought to be adopted. There is
a budget point of order against it but not because it is over budget.
It is because we wrote in the budget that the bill had to come out of
the Finance Committee. The Finance Committee refused to report a bill,
so no bill could come out of the Finance Committee. So every bill had a
budget point of order. If it had gone through the Finance Committee, no
point of order would have lied against this bill. However, if the
Graham-Kennedy bill had gone through the Finance Committee, two points
of order would still have lied against the it, a section 302 and a
section 311 point of order, as well as the tripartisan bill.
But this bill is not subject to a point of order because it spends
too much money. It is subject to a point of order because the Finance
Committee was not allowed to do its job.
So I hope people will look at this and decide we can help a lot of
people, and we can do it right now. The purchasing discounts would
start immediately. We do not have to wait until 2005. And this is
something we can afford. We could come back and do more next year if we
had the money.
I appreciate my colleagues listening, and I commend this program to
them.
I yield the floor.
The PRESIDING OFFICER. Who yields time?
Mr. BROWNBACK. Mr. President, I ask the sponsor of the amendment to
yield to me 10 minutes to debate the issue.
Mr. HAGEL. I yield to the Senator from Kansas 10 minutes off our
time, Mr. President.
Mr. NELSON of Florida. Might I inquire of the Chair how much time is
remaining on this side?
The PRESIDING OFFICER. Sixteen and a half minutes.
Mr. NELSON of Florida. Mr. President, I would like to be recognized
at the appropriate time.
The PRESIDING OFFICER. The Senator from Kansas is recognized.
Mr. BROWNBACK. Mr. President, I thank my colleague from Nebraska for
allowing me the time and for his proposal. I think it is an outstanding
proposal and one that we can do and one that we can afford and one that
can provide benefits to some people who really need this help and need
it now. It is something I think we could build on in the future.
Remember now, we are talking about a group of people who do not have
pharmaceutical benefits and need them, people with low income but above
Medicaid; low income, and this is taking a big portion of their income.
They have to have these pharmaceutical drug benefits. They need it.
Here is a proposal where we can do it.
If I can just make an observation at the outset: This process cries
to go back to the Finance Committee and come out of the Finance
Committee. This has not been taken through the Finance Committee. It
clearly should have been. This is the largest--this will be the largest
new entitlement program that I will have voted on since I have been in
the Congress, either the House or the Senate, by far. I think at the
end of the day, when the dollars are tallied up, you are looking at a
multitrillion-dollar program because once we start a benefit, we do not
stop it. This is something that we will start, and will do, and it is
going to continue for a number of years. It is something we need to do.
But if you are going to start, at the end of the day, a trillion-
dollar program in all probability, you need to take it through the
right process. It needs to come through the committee that looks at the
numbers and figures out how to pay for it.
[[Page S7215]]
To just pass a benefit and say we are going to do it, and we will
figure out how to pay for it after the bills come due, is the height of
irresponsibility on our part.
I have two charts. I do not want to overburden everyone with lines on
a chart, but I want to point out, this is where we are today with these
various proposals. This black line represents the total income for
Medicare. I call this chart ``The Great Medicare Accounting Scandal''
because I do not think we are accounting for the real cost of these
programs.
We are being critical of people--and rightfully so--in corporate
America for not accounting for real costs and for sliding things around
saying: Well, OK, we will capitalize this, but it should have been a
direct expenditure and expense. We are criticizing them--and rightfully
so--for doing that.
What are we doing here? What are we doing here on our accounting? The
black line is the amount of money we have coming into Medicare. The red
line is the Graham-Kennedy benefit proposal. You can see, in year 1 of
the benefit, in the year 2005, the expenditures are more than the
income we have coming in from Medicare. In the first year out of the
box, you are spending more money than you have coming in in Medicare.
That does not count the accumulation that you are going to have up
until 2010, when the program, theoretically, ends. But, of course, it
does not.
We do not terminate benefit programs. It is going to continue past
2010, into 2011, which is the first year the baby boomers start
retiring. So you have this group of soon-to-be seniors--72 million baby
boomers--in America. Count myself amongst them. That is kind of the big
lump in the python coming through, the pig in the python, in the
demographic charts in the United States, starting in 2011, where the
program is supposed to end in 2010. Of course, it isn't going to
happen.
On this chart, where would this red line be in the year 2011, when
you start getting this large group of retirees coming into the system?
It is going to be much higher and be an accounting scandal for us.
So how are you going to pay for this? You are either going to cut
benefits, which I do not think we are going to do, you are going to
raise payroll taxes, which I would think would be the wrong thing to
do--we already load so much on people working in the system--or are you
going to try to take this from somewhere else in the system, or raise
the deficit? Probably you are going to do all of those things, other
than cutting benefits. But we are not talking about that in this system
right now.
Look here, on this chart, at the various other proposals that we
have.
The purple line shows the total expenditures today, without a
benefit. The Hagel-Ensign proposal is shown by the green line.
Of the proposals that are coming forward--and I think we need to have
a prescription drug benefit--this is the most responsible one that we
can handle and that we can do. And we, clearly, should do something.
The process cries out for us, right now, to do something now and not
just to have something for campaigns. Here is the Democrat proposal.
Here is the Republican proposal. But you cannot take those as
prescription drugs. That is not income to you. You cannot eat promises.
That is what we have sitting out there now. And that is where it seems
the debate is heading, unless we can take it back to the Finance
Committee and have a legitimate process, one where we would come out
with a benefit that people can afford and need to have today.
This one has been a very disappointing discussion, to me, in the
sense that there is a clear compromise that sits out there that is
available to do, and we could cobble together different proposals of
any of these bills and figure out how to make it work, and get a
bipartisan proposal that we would all support, that would include a
prescription drug benefit.
That sits out there to be had. That can take place. Instead, we are
just saying, no, we are going to take it through this different
process. We are going to bypass the Finance Committee on the most
expensive entitlement program that I will have voted on as a Member of
this body. We are going to bypass the normal process. We will just have
a political debate on it that I do not think is edifying for the body
and is not the right way to go.
On the particular proposal, the Hagel-Ensign proposal, of which I am
pleased to support, I also note that it is supported by AARP. Unlike my
colleague from New York, who said the AARP does not support it, in
today's New York Times, John Rother, policy director of AARP, said
this:
Another possibility is for Medicare to provide catastrophic
coverage for prescription drug expenses over a certain
threshold, perhaps $4,000 to $6,000 a year, with no premium.
This could be combined with additional help for low-income
beneficiaries and a government-authorized drug discount card.
That is not my speech supporting Hagel-Ensign. That is from the
policy director of AARP in the New York Times today. He is saying:
Look, you have the parties. Each have a proposal. They are at a
standoff on this proposal. What could we get done so we can move this
forward for the benefit of seniors in America? And he describes the
Hagel-Ensign proposal. That is what we should do.
That is the type of proposal we need to move forward. It would be an
appropriate proposal for us to move forward, so we can provide a
benefit, we can get it done now, and provide it to people who need it
now. They do not need promises. They need action by us. And they could
have the action. This is something we need to do, and we need to do it
this way today.
This chart shows the various lines depicting where the assets in the
proposals go. You can see the current projected Medicare trust fund
assets, and also the projected Medicare trust fund assets under Graham-
Kennedy. You can see where we are taking this proposal. This line is
going south, fast, if you get a benefit that you cannot afford.
I ask a rhetorical question of all my colleagues: Would we rather
encounter the first wave of baby boomer retirees with $660 billion in
the Medicare trust fund or would we rather encounter retirees having
spent all but $250 billion? That is what these lines point out.
We know we have the baby boomer generation hitting in 2011. They
start jumping into the retirement pool in 2011. We want to face them
with some money built up at that point in time and still have a
prescription drug benefit like what is in Hagel-Ensign, or even the
tripartisan bill. We can get there with more assets in the bank and
still provide today a prescription drug benefit for those who need it
today. And they need it today.
I really think we should set our Republican and Democrat caps aside
and say we can provide this to people who need it today. For the 27
percent of the public who do not have a prescription drug benefit of
some type, who are in a low-income category, who need this, we provide
a discount drug card or discount card, such as in the Hagel-Ensign
proposal. We do that today and still save some money for when the baby
boomers start retiring in 2011.
I hope we will all look at that and say that is the right thing to
do, to provide that benefit. It is the responsible thing to do. And as
we look to our future, it is the right thing for workers coming up in
this system so that they are not stuck with this huge lug on their
shoulders when the baby boomers retire.
The PRESIDING OFFICER. The Senator has spoken for 10 minutes.
Mr. BROWNBACK. Thank you, Mr. President, very much. And I thank my
colleague from Nebraska for yielding time to me.
The PRESIDING OFFICER. The Senator from Florida.
Mr. NELSON of Florida. Mr. President, I rise to speak in opposition
to the amendment. I want the Senator from Nebraska to know of my
personal affection and respect for him. There are certain people in a
body to whom you just naturally gravitate and you naturally like, and
he is certainly one of them.
I rise in opposition, not because he does not have an excellent,
substantive proposal, but I would offer my objection as has been
articulated by the AARP today in a letter to Senator Hagel in which
they state:
In addition to our substantive objections, we are concerned that by
offering this scaled-back proposal today, you would effectively derail
bipartisan discussion and compromise on more meaningful comprehensive
approaches.
[[Page S7216]]
That is what I want to discuss today. What this Nation is begging for
is a comprehensive approach, not a piecemeal approach. What the senior
citizens of this Nation are yearning for is that we modernize Medicare
to provide a prescription drug benefit.
If any of us were designing a Medicare system, which is a health
insurance system for senior citizens, funded by the Federal Government,
if we were devising it today in the year 2002 instead of the year 1965,
when it was enacted, would we include prescription drug benefits? The
answer to that is, obviously, yes.
Medicare was set up in 1965 when the condition of health care was
centered around acute care in hospitals. But with the miracles of
modern medicine, with the advent of prescription drugs that can
increase the quality of our lives, that can take care of chronic
ailments and that, indeed, add to what we would say, in the street
vernacular, is preventive maintenance, then, clearly, if we were
designing a health insurance system funded by the Federal Government
for senior citizens today it would clearly include prescription drugs.
That is the question that is before this body. But because of the
rules of the Senate, we have to get 60 votes in order to pass anything
here which, with competing plans, makes it very difficult.
Although I think the Senator from Nebraska has some excellent ideas,
it is injected in this debate at the wrong time because in the words of
the AARP, as articulated in their letter today:
We are concerned that by offering this scaled-back proposal
today, you would effectively derail bipartisan discussion and
compromise on more meaningful, comprehensive approaches.
We have to keep trying. We have just been unable to get the 60 votes
on two different substantive approaches to prescription drugs in the
votes that occurred earlier today. We have to keep trying to forge a
compromise. The compromise is not this scaled-down version.
I wish to speak about the substantive alternatives that are here. One
of the alternatives, as suggested by what has been voted out of the
other body, the House of Representatives, utilizes the private sector
and private sector insurance companies in which they offer the
prescription drug benefit.
I had a little bit of experience as the elected insurance
commissioner of Florida for 6 years before coming here. I point out
that you can get some glimpse of the enthusiasm of insurance companies
to offer this prescription drug benefit if you look to the States.
For example, 4 years ago, the State of Nevada passed a prescription
drug benefit. It was to be offered by private insurance companies.
Within 2 years after the passage of that law, not one insurance company
had come forth to offer that prescription drug benefit.
On the basis of that experience, that is certainly not what we want
to be offering to senior citizens of our country on something that is
so important to them, a benefit that would be illusory, that would not
be there. That is why we ought, in whatever compromise we strike, to
come closer to the Graham-Miller approach, which is a substantial
reworking of Medicare, and the prescription drug benefit becomes a part
of Medicare. Then it is my hope, once we can find that illusive
consensus, we can go on and add additional improvements.
The health care providers of this country are hurting because they
are not getting reimbursed for their Medicare procedures at a rate that
is commensurate with what they should be reimbursed. One of the items
we are going to discuss--and hopefully we would be able to take this
base bill and amend it--is an increase of those Medicare reimbursements
so that we are taking care of the Medicare beneficiaries, the senior
citizens, and we are also helping those who are providing the services,
the health care providers, by increasing their Medicare reimbursement.
When we do that, I hope we will also look at some of the practices
that because doctors are getting squeezed, in large part squeezed by
insurance companies, sometimes regular insurance companies, some called
HMOs, which are insurance companies, and because doctors are getting
squeezed, they are trying to find ways to keep their income up.
Lo and behold, down in my State of Florida, there is a group of
doctors now saying to all of their patients: We are not going to see
you anymore unless you pay us an entrance fee of $1,500 per patient per
year. But by the way, we still want to take your Medicare
reimbursement.
That is simply the beginning of the end for Medicare, because the
logical extension of that is that only those who are wealthy enough to
afford that entrance fee--in the case of Florida, $3,000 per year per
couple--are going to get the access to the doctor they want, that
doctor who is being reimbursed by the Federal Government for the
services performed for those senior citizens.
That is wrong. It should be changed. It ought to be illegal and yet
the Department of HHS has said it is not illegal. So we are going to
have to change the law so that a doctor cannot receive reimbursement
from Medicare if they are saying to those patients: I will not see you
unless you pay me $1,500 a year as an entrance fee into concierge care.
I hope we strike the major compromise, that it is closer to the
Graham-Miller bill, that we address Medicare reimbursements because the
doctors and other health care providers need it, and that we add the
amendment I just talked about which would prevent doctors from limiting
patients to seeing them unless they pay an entrance fee while at the
same time getting their Medicare reimbursement.
I thank the Chair and yield the floor.
The PRESIDING OFFICER. The Senator from Nebraska.
Mr. HAGEL. Mr. President, could the Chair tell me how much time this
side has remaining?
The PRESIDING OFFICER. Twelve minutes fifty seconds.
Mr. HAGEL. And how much time does the other side have remaining?
The PRESIDING OFFICER. Five minutes fifty-seven seconds.
Mr. HAGEL. I thank the Chair.
Mr. President, I allocate 5 minutes of our remaining time to the
Senator from Oklahoma.
Mr. INHOFE. Mr. President, I know time is now precious and we are
down to a few minutes. I will skip a lot of things I was going to say
since there has been a lot of redundancy.
My good friend from New York was on the floor and was talking about
the relative significance of the inheritance tax and how it wasn't
really all that meaningful. I am sure the occupant of the chair would
agree because he was one of the rare Democrats who stood up and said we
should repeal that unfair tax on money that has already been spent.
Also, with the farm crisis we have had out West in my State, I have yet
to find one person out there who wasn't more concerned about losing his
farm because of the very unfair death tax than even the farm bill. But
that is not what we are here to talk about.
I think something the Senator from Texas, Mr. Gramm, said has to be
repeated over and over; that is, this Hagel-Ensign bill is a lot less
expensive and does a better job, but there is one major reason. We have
a saying out in Oklahoma that ``if it ain't broke, don't fix it.'' That
is exactly what the situation is.
We have a lot of people who don't need additional coverage now. If
they don't need it, why provide it? Why get into some very large
program?
Now, we have had two programs that have been rejected today. The
first would not do for seniors what it said it would do, and it would
have cost a lot more than we can afford, and it would not have included
a lot of the drugs the seniors need. That program, as well as costing
too much and not covering enough medications, would sunset in 2010.
That means in 2010, people who have been relying on the Medicare
prescription drug benefit would have had their coverage taken away. We
know better than that.
I remember one of the best speeches that should be required reading
for all young people, called ``A Rendezvous With Destiny,'' by Ronald
Reagan. He said:
The closest thing to immortality on the face of this earth
is a Government benefit or program once started.
We all know that is the way it would work out and we would end up
with some very large, spiraling cost program that we could not get rid
of. It is not responsible, reasonable, and it is
[[Page S7217]]
not the best we can do for seniors. I am glad it did not pass.
Then we were given a chance to consider a second option, the
tripartisan plan. I thought it was too expensive, but I supported it.
It is very much like what the House passed. It is something we can go
to conference on and have something effective come out of it. Once a
person's drug costs reach a higher fixed limit, the Government would
have paid 90 percent of the additional cost. Many colleagues supported
it, as I did; but it was defeated.
Now we have a chance to give seniors a real prescription drug
benefit. This legislation is a responsible, long-term, comprehensive
plan which truly takes into account the needs and the situation of
individual seniors. Several fellow cosponsors have already spoken to
the specifics of the plan, such as low premiums, low overall costs on
catastrophic coverage. I will tell you what it means to the people who
sent us here.
Senator Gramm talked about some individuals without identifying them.
I will identify the people. The Hendersons are from Okmulgee County, a
short distance from where I live in Oklahoma. I told them I was going
to use their case. They wrote me to tell me about their struggle with
prescription drugs. They had a unique problem--one was a heart problem
and one was a cancer problem. The Hendersons have a yearly household
income of $24,000 and they spend $9,000 of that on prescription drugs
in a single year. The Hendersons' income falls between the 200 percent
and 400 percent above the national poverty level. That national poverty
level for couples is $11,940 a year.
Under our bill, an out-of-pocket limit on the cost of prescription
drugs for people with a similar income to the Hendersons is set at
$3,500. If they were between 100 and 200 percent of poverty, that would
come down to $1,500. But in the case of the Hendersons, they would have
to pay that maximum, and then a copay of 10 percent of the cost of
these drugs. Calculate that out. While the remaining cost of the
Hendersons' drugs is $5,500, their copays would be no more than $550,
and under this bill the Hendersons would pay a total of $4,050 a year
for prescription drugs, when they are now paying $9,000 a year. This
bill cuts their drug costs by more than half.
The Hendersons, under the Democrat plan, would have faced uncertainty
on three fronts: First of all, uncertainty about which drugs were
covered, since only two drugs in each therapeutic class would be
covered; secondly, uncertainty about how much the prescriptions would
cost since the $10, $40, and $60 copayments in the plan were virtually
done away with through amendments; and, three, uncertainty about how
long their benefits would last even if it didn't sunset. They would not
know this. Uncertainty is there.
I believe the Hagel plan is real assistance, and I strongly support
it. I believe this is the alternative that is left and the most
responsible one.
I thank the Chair.
The PRESIDING OFFICER (Ms. Cantwell). The Senator from Michigan is
recognized.
Ms. STABENOW. Madam President, I yield myself 4 minutes.
Madam President, first of all, I want to speak to my colleague from
Oklahoma. My mother grew up in Oklahoma, and I have a great affinity
for that State. I have a lot of relatives there.
But I was quite surprised to hear the comment that ``if it ain't
broke, don't fix it,'' when we are referring to Medicare. When we look
at the Medicare system and the inability to cover prescription drugs
for our seniors, when we look at the explosion in the price of the
prescription drugs, I would say it is very tough to find a system that
is more broken than our inability today to provide low-cost
prescription drugs, whether it be through Medicare or whether it be a
small business or a farmer trying to get coverage for their family.
This system is broken. That is why we are here. It needs to be fixed.
I rise in opposition to the Hagel amendment. I appreciate the desire
of my colleagues to find an alternative, but I certainly am concerned
that this does not begin to address what it is that seniors in this
country are needing or asking them to do. There seems to have been a
lot of confusion about where AARP is regarding this issue. So I will
read a letter sent to the author of the amendment on July 23--today--
which says:
Dear Senator Hagel: Enacting a comprehensive prescription
drug benefit in Medicare this year remains the top priority
for AARP. Our members are counting on the Senate to pass a
meaningful drug benefit that is available and affordable to
all beneficiaries. Our members were promised in the last
election that a comprehensive drug benefit would be a
priority, and we are counting on you to make good on that
promise this year.
We appreciate the intent of your bill, S. 2736, the
``Medicare Rx Drug Discount and Security Act of 2002,'' to
provide a prescription drug discount card and stop-loss
protection to Medicare beneficiaries. However, in addition to
our substantive objections, we are concerned that by offering
this scaled-back proposal today, you would effectively derail
bipartisan discussion and compromise on more meaningful
comprehensive approaches. We believe Congress should focus
its efforts on enactment of a more comprehensive drug benefit
this year.
In addition to the timing of your proposal, AARP has
concerns about the approach taken in your bill, including:
Catastrophic coverage--While AARP has not opposed income-
relating premiums, income-relating the Medicare benefit
changes the nature of the program. This would set an
extremely dangerous precedent in Medicare. Further, the stop-
loss levels set in the bill do not provide enough protection
for lower income beneficiaries. A low-income couple could
spend 25 percent of their income just for drugs before this
plan offered assistance. Thirdly, there are a number of
issues involved in using tax returns to determine program
eligibility levels, and we believe other options should be
explored.
Discount card--While AARP supports the use of a discount
card program as a building block for a Medicare prescription
drug benefit, your proposal lacks the necessary
specifications to guaranty the level of discount, what level
of discount would be passed to beneficiaries, and the degree
to consumer protections required of plans.
Given these concerns, AARP opposes your amendment. We
remain fully committed to developing a comprehensive drug
benefit for all Medicare beneficiaries and we look forward to
working with you on legislation that our members can support.
This is signed by the executive director and CEO of AARP. I simply
wanted to enter that into the Record to make it clear that AARP joins
us in opposition to the amendment.
The PRESIDING OFFICER. The Senator from Oklahoma.
Mr. HAGEL. Madam President, I ask unanimous consent that Senators
Frist and Nickles be added as cosponsors of amendment No. 4315. I yield
the remainder of our time to the distinguished Senator from Tennessee.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. FRIST. Madam President, how much time remains on our side?
The PRESIDING OFFICER. Six minutes twenty-four seconds.
Mr. FRIST. And the time on the other side?
The PRESIDING OFFICER. One minute.
Mr. FRIST. Madam President, will you notify me when I have 1 minute
remaining.
I rise in support of the Hagel-Ensign Medicare Prescription Drug
Discount and Security Act of 2002. I do so after a long day of debate,
discussion, and votes on bills which attempt to reach out with
affordable prescription drug coverage for our seniors.
Over the course of the day's debate, we have touched upon what
matters most to seniors. That is what I want to address in the next 3
or 4 minutes.
What do seniors who are listening today--38 million Medicare
potential recipients who are seniors today and another 5 or 6 million
individuals with disabilities--what do they want regarding prescription
drug coverage? I think it is three things. The first issue is that
seniors want security. They want peace of mind. When you are 65, 70,
75, 80 years of age, the most frightening thought is that in those
final years of your life you develop something--whether it is heart
disease, chronic lung disease, emphysema, or lymphoma--and all of a
sudden you face high prescription drug costs which are skyrocketing. We
know this is an issue--we have been talking about that all week long.
In essence, paying for prescription drugs bankrupts you in terms of
what you can afford and, even worse than that, what your children may
be able to afford. The beauty of this particular bill is that it
addresses that peace of mind, that security.
The second issue I hear as I talk to seniors as I travel around
Tennessee,
[[Page S7218]]
and it has been discussed a lot on the floor today, is that, with
regard to prescription drugs, seniors want help now. They listen to the
debate, and both of the bills discussed earlier today have some very
good, substantive issues to them, are comprehensive, and each have
pluses and minuses. But the defect that both bills have that the Hagel-
Ensign bill does not have is this bill takes effect, in essence, right
now. That is what seniors want.
Seniors who are listening may think: Why talk about a bill taking
place in 2006 or 2005? I do not even know if I am going to be around 3
or 2 years from now. What they really want is help now. Those who need
it want it now. The message they tell me is to do it now. Again, the
Hagel-Ensign bill takes effect next year, not 2 years and not 3 years
from now.
The third factor this bill does is it addresses prescription drugs in
a responsible way. We are not in a world today or in a country today
where you can just throw unlimited money and say it will be taken care
of by the next generation or by my family 5 years from now. This is
especially true when we have a doubling of the number of seniors, the
demographic change, the move of the baby boomers coming online in 2008
and 2010. Seniors tell me, whatever you do, do it responsibly. Do it in
a way that is just not over a 3-year period, 4-year period and it
disappears, you take the benefit away or raise taxes exorbitantly. Do
it in a way that can be sustained over time. Do it responsibly.
That is what the Hagel-Ensign bill does. One of the most beautiful
aspects of this bill is that we can do it now, and we can do it
responsibly. We talk big figures. The dollar figure was $160 billion.
It is a lot of money, but it is not the $800 billion or the $1 trillion
or even the $370 billion of the tripartisan plan. It takes effect now,
giving peace of mind in capping how much money a senior is going to
have to pay out of pocket if there is a catastrophe or if a senior
develops a disease which requires the miracle medications that are out
there today, and it does it in a responsible way.
How does the bill work? We have been through the details. The first
issue I mentioned was peace of mind, security, and savings. Instead of
what seniors are doing now--going to a pharmacy, placing a prescription
on the table, and paying a retail price that nobody in this body, most
employer-sponsored plans do not have to--they will be able to go in to
a pharmacy with a card that they put on the table and take advantage of
mass negotiations.
The PRESIDING OFFICER. The Senator has 1 minute remaining.
Mr. FRIST. I thank the Chair.
Madam President, seniors can take this card in and get discounts,
resulting in savings to seniors right now.
Catastrophic coverage gives security, peace of mind. Using
marketplace tools is important as we look ahead because it takes
advantage of the marketplace in negotiating discounts that are not
available today.
Madam President, I close with the statement that I believe the Hagel-
Ensign bill brings to a head much of the discussion today in that it
reaches out and gives seniors the security they want. It does it now.
It does it in a way that is responsible. It is affordable for seniors,
affordable for taxpayers, and is permanent.
Madam President, I yield the floor.
Ms. STABENOW. Madam President, can you give us an indication of the
time remaining to each side?
The PRESIDING OFFICER. The Senator from Michigan controls 1 minute.
The Senator from Nebraska controls 5 seconds.
Ms. STABENOW. Does the Senator from Nebraska wish to take his 5
seconds?
Mr. HAGEL. I want the Senator from Michigan to have my 5 seconds.
Ms. STABENOW. I was looking forward to what the Senator might say in
5 seconds.
Mr. HAGEL. Madam President, the Senator from Michigan has a more
difficult case to make. She needs more time.
The PRESIDING OFFICER. The Senator from Michigan.
Ms. STABENOW. Madam President, I will simply say in closing that
AARP, representing seniors, and other senior organizations across this
country do not believe this, in fact, is a good deal. There is no
question they want action now, but it has to be real and meaningful.
Discount cards are available now. In many cases, they do not work at
all or they are very limited. It is important we be responsible.
I would argue there is a broader responsibility in the Senate. When
we debate whether or not the tax cut geared to the wealthiest
individuals in the country will be extended another 10 years, we are
debating an amount of money that is more than four times any
comprehensive Medicare plan that we will have before us.
This is a question of priorities. It is a question of what we
believe, as Americans, should be our values and how we act on those in
terms of our priorities, and I argue that doing the right thing with
the real Medicare benefit is what our seniors are asking for and it is
what they deserve. I urge my colleagues to vote no on the Hagel
amendment.
The PRESIDING OFFICER. All time has expired.
The Senator from West Virginia.
____________________