[Congressional Record Volume 148, Number 102 (Wednesday, July 24, 2002)]
[Senate]
[Pages S7292-S7299]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
GREATER ACCESS TO AFFORDABLE PHARMACEUTICALS ACT OF 2001--Continued
Mr. ROCKEFELLER. Mr. President, understanding the gravity of the
moment, I do not want to leave a very important piece of legislation.
Before I say a word, I would like to add Senator Zell Miller as a
cosponsor to the amendment and I ask unanimous consent.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. ROCKEFELLER. Mr. President, as I look at the situation, we have a
whole lot of meetings going on around this Capitol--conference
committees on trade, conference committees on prescription drugs. We
have a generic drug bill. That is the underlying bill here with a
prescription drug amendment attached to it. We have a Federal matching
Medicaid amendment which I am offering. There is so much going on on
health but there is so little that is going on on health, and it
perturbs me.
Senator Durbin, when he was talking, pointed out the importance of
Medicaid to hospitals, nursing homes, and others. It makes it extremely
important for me to note that in the State I represent, 80 percent of
our hospitals are losing money. They are mostly rural hospitals, and
most of them depend upon Medicaid and Medicare in combination, usually
at 85, 80, sometimes 75 percent of their total reimbursement of
everything that they do. That is the nature of the State I represent.
So many others are like that. It is the nature of part of the State
that the Presiding Officer represents.
So the question of are we doing Medicaid and reimbursing States so
they can keep their health facilities open and Medicaid available to
their people is a profoundly important matter. But we treat it as if it
were not.
We are trying our best to come to an agreement on prescription drugs.
There is no particular compromise in sight at the moment. We had two
votes yesterday. Both failed. The American people ask us: What are you
doing about health care for our people? My people ask, What are you
doing about health care for our people? What am I to answer? What am I
to tell them?
I can refer, if I want, to the catastrophic health bill experience of
a number of us, where we had a terrific bill that the House turned down
three times, the Senate refused to turn down three times. But the point
was that we finally had to yield, and there was no catastrophic health
care bill.
Then we had something called the Pepper Commission where we came up
with a very good solution for both long term and acute care, and it
went nowhere. It was declared dead on arrival, and those who so
declared it were correct. Nothing happened.
Then we had the very large health care experience of the early 1990s
when everything got very politicized. The result was twofold: One, that
we passed nothing on that health care bill; and, two, everybody
retreated inside their shells. Nobody seemed to want to take up health
care, and health care became something that somehow, either politically
or for whatever reason--because it was complex--people did not want to
undertake.
Senator Jack Danforth and I, and now Senator Frist and I, started
something called the alliance for health reform. The whole idea was to
get those who did not serve on the Finance Committee more acquainted
with the intricacies and difficulties of what is a very difficult
problem; that is, all the acronyms and complexities associated with
health care. Now there are a lot more people who know a lot more about
health care, and we are still not getting anything done.
Now we are talking about the Federal matching adjustment for Medicaid
to our most vulnerable people, to people to whom, we go to our
Jefferson and Jackson Day Dinners, when we appeal and bring out emotion
and speak emotionally, and then when we come up here, we do nothing to
help them.
I put this amendment on the floor with endless cosponsors. I am
looking at Susan Collins, a good Republican from Maine, and there she
stands, perhaps ready to speak, and she and seven other Republicans are
cosponsors of this amendment. Senator Zell Miller just became a
cosponsor. So we have, I don't know, 35, 40 sponsors.
I come to two conclusions. No 1, I think this amendment is going to
pass and that there may be those who are not coming to this floor to
speak against it because they do not want to because they know their
Governors feel so passionately about it. Whether they be Republican,
Democratic, or Independent, Governors are absolutely passionate about
passing this amendment. But they cannot do it. We have to do it for
them.
We are not doing universal health care. We haven't done anything on
prescription drugs yet. We have not done a generic drug bill yet. We
have not done anything about importation. We passed a bill--the White
House said they do
[[Page S7293]]
not want to implement it--about bringing drugs in from Canada, produced
here, at a lower cost.
So we are talking, debating, having compromises, having caucuses, and
we are not accomplishing anything. Here is an amendment in which we can
do something real for the people in our States who need it. They are
not just children, but that is a very basic part of it. It is also
reimbursement for hospital facilities. It is reimbursement for skilled
nursing facilities, for nursing homes. And they need it more than ever
because Medicaid is the one program in government, other than the
Veterans Administration, which does have prescription drugs. It does
have prescription drugs.
As the Presiding Officer has said so many times so eloquently as the
leader of this fight, the cost of prescription drugs has been going up
in a terrifying manner in these last several years. Who bears the brunt
of that? Medicaid. Medicaid bears the brunt of it. And here we are
trying to do something which the States cannot do for themselves, which
we can do for them, which they are unanimously--Republicans, Democrats
and Independent--on record unanimously wanting.
I stand here on the floor accompanied only by a distinguished Senator
from Maine and the distinguished Presiding Officer. I find this
perplexing and troubling. Are we risk averse? Have we become risk
averse? That is a health care term. Maybe it ought to be a Senate term.
Have we become afraid of doing things which require tough votes?
As the Senator from Illinois said, this is a very easy process.
People put legislation forward, it goes through committees or doesn't
go through committees, it comes to the floor, doesn't come to the
floor, but if it comes to the floor, then you have a chance to vote on
it. If people want to filibuster it, then you can file a cloture
motion, you wait 2 days, and you get a vote on it. People have to
eventually vote up or down, or else, as the Senator from Illinois said,
they should not be in this profession.
I conclude with a sense of awe and tremendous anger, I would say to
the Presiding Officer. I started out my career in public life--which I
never intended to enter and which my parents were not fond of as a
career. They were not pleased as I entered it as a career.
I went to a little coal mining community in the State of West
Virginia which was nothing but people who had no health insurance, who
wanted to work but had no job, who wanted to go to school but had no
bus. They had one 1-room school through the sixth grade, 1 through 6,
lined up row by row, just in a row.
They fed me; they took care of me; we worked together; we developed
community programs. They had something called the dollar-an-hour
program in West Virginia. You went out and you worked and you cleaned
up the roads--men for the most part, at that point--and you got $1 an
hour. Glory be, you got 8 hours a day. Any health insurance? Of course
not. Nobody had health insurance. No one had health insurance.
That seared my soul then, and it sears me today, and it sears me as I
talk now, as we sit here and avoid a chance to vote on something with
which we can immediately help our States and our people. Are we only to
legislate on Afghanistan or broad national concepts or are we here to
help people? Is there something wrong, in fact, about actually doing
something which would help people?
Some people say it would because it would cost money. Then why was it
they put this in the emergency supplemental? They put the Medicaid
match formula in the emergency supplemental because it was considered
that important to the country. And now here we are, 9 months later, 10
months later--whatever it is--and we have done absolutely nothing. This
Senator is tired of it. This Senator is very pleased to note that, with
eight Republican cosponsors and a whole lot of people waiting to vote
for this, there is a cloture motion being filled out, and we are going
to vote on this, and we are going to show the people of our States that
we care about our children and our families, our prescription drug
programs, and that we are not risk averse. We are quite capable, yes,
of helping people when it comes to health care. We have not shown that
very much in recent years. We are going to show it this time.
I yield the floor.
The PRESIDING OFFICER (Ms. Stabenow). The Senator from Maine.
Ms. COLLINS. Madam President, I share the concern of the Senator from
West Virginia that we should not delay action on this important matter.
Support for our proposal is growing with each hour. I am excited
about that. This proposal offers real relief to our State governments
that are struggling with budget shortfalls. But, most importantly, it
offers the promise that low-income families who depend on Medicaid will
not face a cutoff of some of their important benefits.
The Senator from West Virginia raises a very good point. There are
health care providers in my State, as well as his, rural hospitals in
particular, that are struggling to make ends meet. The threat of
Medicaid cuts imposed by States trying to balance their budgets during
this very difficult fiscal time poses a threat to their ability to
continue to provide quality care.
That is why we have the support of so many health care provider
groups.
I am going to read from some of letters that we have received that
endorse our proposal. In some cases, the letters speak to earlier
legislation that I introduced along with my friend and colleague,
Senator Ben Nelson of Nebraska. But, as I said earlier, we have pooled
our efforts because we want to get relief to the States as fast as
possible.
Let me tell you what our visiting nurses say about the importance of
providing this relief.
This is a letter that I will read from the Visiting Nurse
Associations of America. It is signed by the president, Carolyn Markey.
She writes:
On behalf of the Visiting Nurse Associations of America
(VNAA), I would like to express our strong support for you
and Senator Ben Nelson's proposed legislation that would
provide temporary fiscal relief to states for Medicaid-
covered health care services. VNAA is the national membership
association for non-profit, community-based Visiting Nurse
Agencies (VNAs), which collectively care for approximately
50% of all Medicaid home health patients each year.
VNAA is concerned that approximately one-half of the states
across the nation have had to cut their FY 2002 Medicaid
budgets in order to avoid a budget crisis. We fear that the
majority of states will implement additional cost-containment
measures, including reducing benefits, increasing beneficiary
cost-sharing and further reducing Medicaid reimbursement to
health care providers.
On average, Medicaid already reimburses providers
significantly less than the cost of care.
That is an important point. There are already reimbursement levels
that aren't covering the cost of providing this essential care.
The letter goes on to say:
VNAA's 2001 data shows that, collectively, VNAs are
incurring an average $565 loss per Medicaid patient, with an
annual loss of $148,500. VNAs' mission is to provide care to
all eligible persons regardless of their condition or ability
to pay. Because of this mission, VNAs will attempt to
continue to admit all eligible Medicaid beneficiaries, but
subsidizing Medicaid will force VNAs to cut other social
service programs that are funded through charity
contributions, such as Meals on Wheels and preventive health
clinics.
Your legislation is sorely needed at this time. It would
help states maintain eligibility and program levels in order
for low-income families, children, seniors and persons with
disabilities to continue to receive the health care they
need. It will also prevent the exodus of some providers from
Medicaid participation, and prevent other providers from
having to cut vital community-based social services.
Those are the stakes. The stakes are high.
I ask unanimous consent to have the full text of the letter from
Carolyn Markey, the president of the Visiting Nurse Associations of
America, printed in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:
Visiting Nurse Associations
of America,
Washington, DC, May 29, 2002.
Hon. Susan M. Collins,
Russell Senate Office Building,
Washington, DC.
Dear Senator Collins: On behalf of the Visiting Nurse
Associations of America (VNAA), I would like to express our
strong support for your and Senator Ben Nelson's proposed
legislation that would provide temporary fiscal relief to
states for Medicaid-covered health care services. VNAA is the
national membership association for non-profit, community-
based Visiting Nurse
[[Page S7294]]
Agencies (VNAs), which collectively care for approximately
50% of all Medicaid home health patients each year.
VNAA is concerned that approximately one-half of the states
across the nation have had to cut their FY 2002 Medicaid
budgets in order to avoid a budget crisis. We fear that the
majority of states will implement additional cost-containment
measures, including reducing benefits, increasing beneficiary
cost-sharing and further reducing Medicaid reimbursement to
health care providers.
On average, Medicaid already reimburses providers
significantly less than the cost of care. VNAA's 2001 data
shows that, collectively, VNAs are incurring an average $565
loss per Medicaid patient, with an annual loss of $148,500.
VNAs' mission is to provide care to all eligible persons
regardless of their condition or ability to pay. Because of
this mission, VNAs will attempt to continue to admit all
eligible Medicaid beneficiaries, but subsidizing Medicaid
will force VNAs to cut other social service programs that are
funded through charity contributions, such as Meals on Wheels
and preventive health clinics.
Your legislation is sorely needed at this time. It would
help states maintain eligibility and program levels in order
for low-income families, children, seniors and persons with
disabilities to continue to receive the health care they
need. It will also prevent the exodus of some providers from
Medicaid participation, and prevent other providers from
having to cut vital community-based social services.
Thank you for all you do for the nation's most vulnerable
populations.
Sincerely,
Carolyn Markey,
President and CEO.
Ms. COLLINS. Madam President, I see the Senator from New York is in
the Chamber. If he would like to speak on this issue at this point, I
would be happy to yield.
The PRESIDING OFFICER. The Senator from New York.
Mr. SCHUMER. Madam President, I thank my colleague from Maine, and I
thank her for her leadership on this bill.
I thank the Senator from West Virginia for his sponsorship of this
important legislation. He has done a great job on every aspect of this
proposal. I want to once again clarify for the record the help he has
been not only on this issue, not only on adding prescription drugs to
Medicare, but on generic drugs as well. We all owe the Senator from
West Virginia a debt of gratitude for the great work he has done on the
generic drug issue.
This is an extremely important amendment that I am proud to support.
My State, as so many of the States, is in fiscal trouble. We have found
great difficulty in doing what we have to do. Our State tends to be a
generous State in terms of health care benefits. Programs enacted
throughout the years make our Medicaid benefit generous. We have gone
beyond Medicaid. We tried to help a little bit on prescription drugs
with the Epic Program, as I know 17 other States have done a little bit
here and there. We tried to help in a whole variety of ways.
During times of prosperity, we do quite well. But, obviously, the
attacks of September 11, which cost us dearly in terms of life, and
then secondarily in terms of dollars, as well as the downturn in the
financial markets, which probably hit our State harder than any other,
have caused real problems. If there was ever a time that this amendment
was appropriate for New York, it is now.
I think the amendment is appropriate to all of our States. Not only
are they all under fiscal strains--my State may be under greater strain
than others--but we all know that Medicaid spending is probably the
fastest growing part of most State budgets. It is certainly mine.
I would add one other point about New York. Our localities will get
help, if this aid passes, because we are one of the few States where we
ask the localities to pay half of the non-Federal share of Medicaid. In
other words, we are 50-25-25. A city such as New York that is
straining--our budget deficit is about $4 billion in the next fiscal
year, it is estimated, and some estimates go as high as $5 billion--
would also get a real shot in the arm. Our communities upstate are
hurting because of the poor economy--Buffalo, Albany, Rochester,
Binghamton, and Utica are all hurting and need the help as well.
Certainly, the amendment is needed from a fiscal point of view.
Certainly, it helps the Medicaid Program meet the promise that was made
early on in terms of its help. It is appropriate that it be added to
this bill.
If you ask the States the No. 1 cause of their fiscal problems, most
of them would say it is Medicaid. Then, if you ask the head of Medicaid
in each State what the No. 1 reason is for costs going up, that person
would say prescription drugs. In fact, Medicaid drug costs nationally
have increased 18 percent every year for the past 3 years. That is
something that cannot keep going on.
Our States are now faced with terrible choices--either go more deeply
into debt or cut benefits to the most vulnerable. That is something we
really do not want to do.
I support the amendment. It would be a tremendous shot in the arm for
New York. It would be a tremendous shot in the arm to all State
governments. And it is the right thing to do.
The cost is large. I believe it is something like $8 billion. But the
benefits are larger still.
Every time any part of America has a child who doesn't get the
appropriate coverage, it sets him back or her back--it sometimes sets
the family back in ways from which they never recover. The fact that
our country has decided to say health care for everyone is important--
and not say because you have no money you should get no health care--is
one aspect that makes us a great country. The fact that today we are
saying that during this time of crisis, the Federal Government will
step up to the plate and fulfill its role is really important.
Let me go over the numbers for New York.
In fiscal year 2002, if the Rockefeller-Collins-Nelson amendment were
adopted, we would receive, in terms of our Medicaid help, $244 million.
This is the temporary FMAP increase. In 2003, we would receive $553.8
million. That means, for the total of the 18 months--the second half of
2002 and all of 2003--it would be $797.8 million.
In terms of temporary grants, we would get an additional--these are
available through 2004--an additional $461 million.
That is $1.2 billion. That is real help. That is not just a nice
little bauble around the edges. And it could not come at a more
appropriate, needed time in my State.
So I say to my colleagues, you all have your problems in your States.
We have our problems in New York. Let's unite. This amendment is a
bipartisan amendment. Let's unite and adopt it.
Let's make sure that our poor people get the medical help they need.
And let us say to the States that during these extremely difficult
times--as I say, made doubly difficult in New York because we were the
epicenter of the 9/11 attacks--we are not going to punish you because
of your generosity in helping the poor attain some modicum of health
care.
So I am proud to support the amendment. Again, I compliment my
colleague from West Virginia, who has been such a leader on this issue,
as on so many others. I thank my colleague from Maine as well.
I look forward to quickly adopting this amendment as part of our base
bill which, as you know, I am proud is the bill that Senator McCain and
I introduced in terms of generic drugs.
Madam President, I yield the floor and suggest the absence of a
quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The assistant legislative clerk proceeded to call the roll.
Ms. COLLINS. Madam President, I ask unanimous consent the order for
the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Ms. COLLINS. Madam President, the National Partnership for Women and
Families has issued a statement today endorsing the amendment I have
offered with Senators Rockefeller, Ben Nelson, and Gordon Smith. It
includes some very important information that helps us better
understand why this debate is so important.
The National Partnership cites the National Governors Association's
May report that over 40 States are facing budget shortfalls totaling
$40 to $50 billion overall.
Since Medicaid makes up, on average, 20 percent of State spending, it
is often the first place that States look to make cuts. So our
amendment would provide $9 billion in total fiscal relief that would
help sustain critical State Medicaid Programs and bolster the States'
ability to keep providing vital social services to those most in need.
[[Page S7295]]
Let's look at whom this benefits.
Medicaid provides health insurance to approximately 40 million low-
income Americans, including 21 million children and young adults, 11
million elderly and disabled individuals, and 8.6 million adults in
families, most of whom are single mothers. That is the population that
is hurt when Medicaid budgets are slashed. That is the most vulnerable
of populations. They need our help.
The States need our help in order to maintain vital health care
services for those 40 million low-income Americans. Without this
critical safety net, millions of women and their families would be left
with no health insurance at all.
So that is why we must act. And we must act before more time elapses
and more States are forced to cut their Medicaid budgets. Time is of
the essence.
I urge my colleagues to join with us in supporting this absolutely
critical bipartisan proposal.
Madam President, I yield the floor and suggest the absence of a
quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The assistant legislative clerk proceeded to call the roll.
Mr. NELSON of Nebraska. Madam President, I ask unanimous consent the
order for the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. NELSON of Nebraska. Madam President, the proposal that is before
the body today, to enhance the partnership between the Federal
Government and the States with regard to Medicaid and with regard to
welfare reform and social services that are so critical to the most
vulnerable in our society, is a very important piece of legislation.
It merits our total support, not because it is just about money but
because it is about doing the right thing to continue the gains and not
see a spiral downwards back to welfare for those who have been able to
make it to the workforce. It is for those who are teetering on the
brink who would, if their eligibility for Medicaid were taken away, be
unable to support themselves and/or their families. It is for the
seniors who need, so much today, the kind of support the Medicaid
Program provides when they are in nursing homes.
So it is about people. That is what it is truly about. It is about
doing the right thing. It is continuing the relationship and the
partnership that has been developed between our Governors, our State
legislatures, and our Federal Government. It is an important
partnership that must be maintained.
It is also important that we recognize it is a temporary fix. It is
not a permanent solution. No one is expecting that kind of a permanent
solution today, given the temporary, and hopefully only temporary,
nature of the downturn in the economy. But it is essential we do
something soon because of the plight of the States and the experience
they have in terms of not being able to meet all of their obligations
as they move forward on these programs.
The truth of the matter is, we can work together with the States as
we have in the past. Many of our colleagues here, as you know, are
former Governors. You may be able to take us out of the Governor's
office, but you cannot take the experiences we have gained in that
position away from us simply because we have changed our titles or we
have new responsibilities.
It is important, also, that we recognize that the States, in making
these tough decisions, will have to make them on the basis of how they
balance their budgets because all but a handful have to balance their
budgets and can't have deficit spending. So they either balance their
budgets with major cuts or with tax hikes or with a combination.
In any event, most of the States have made the cuts they believe they
can make, up until this point, without affecting Medicaid. But as their
budgets continue to flow with red ink, now they are looking at these
social programs for the necessary cuts. They have cut education. They
have cut many of the other essential programs. Now they are faced with
cutting this program.
So if we wait until they have made the cuts, there will be the
casualties of those who are not able to have the benefits--the elderly,
the young people, those who in our society today are reliant on the
availability of these programs.
We have asked people to work their way out of welfare, to join the
workforce. We have created at the State level, with welfare reform at
the Federal level, the opportunity for people to transition out of the
levels of poverty and welfare, with the opportunity to join the
workforce. We have done it with transitional benefits that are
comprised of child care, some Medicaid continuing coverage, so these
individuals and their families have the capacity to leave the welfare
rolls to join the workforce.
If we pull back on these and other programs like it, they will
teeter, and it is very likely that they will fall back into the welfare
situation. While already experiencing higher unemployment levels than
we have experienced over the last 10 years, we see that the growing
population of Medicaid is putting more pressure on Medicaid
expenditures at the State level.
I remember looking at the growth of Medicaid and the opportunities
that were there to try to reform it and to make it so it worked not to
create incentives for unemployment but opportunities for employment and
incentives for joining the workforce. But when you see it today and you
see the growth in this program, you recognize that something must be
done in order to stem that growing tide.
The truth is, we can and we should do this. There will be some who
will say we don't have an obligation, a further obligation to the
States. But it is not about just from one government to another; it is
about to the people of the United States who have the need for these
very important benefits. Those are the people we need to be supporting.
In supporting them, we work through the States in our partnership.
That is the opportunity we have. I hope if there are some who have a
different, opposing point of view, they will come down to the floor and
explain why they don't think we ought to support this Federal Medicaid
assistance program on a temporary basis to permit the States to
continue to support the kinds of programs that are important to the
most vulnerable of our population. I hope they will come to the Chamber
so we have the opportunity for a full debate and so, if there are
opposing views, we will be able to respond to them rather than speak to
an empty Chamber. That is not what this should be about. If there is to
be spirited debate, I hope we will have that begin in the near future.
I yield the floor.
The PRESIDING OFFICER. The Senator from Nevada.
Mr. REID. Madam President, I would like to direct a question through
the Chair to my friend from West Virginia, the author of the amendment.
I was here about an hour and a half ago. I ask the Senator from West
Virginia if anyone has spoken against the merits of his amendment.
Mr. ROCKEFELLER. I say to the Senator from Nevada, I am not sure, but
I believe Senators have been here discussing it favorably for 2 to 2\1/
2\ hours. Not a single Senator has come to the floor opposing this
amendment.
Mr. REID. I say to my friends, whoever opposes this amendment, I
don't know where they are. We were told by one of the sponsors of the
amendment, the distinguished Senator from Oregon, Mr. Smith, that he
didn't oppose it, but he, on information and belief, understood that
the senior Senator from Texas opposed the amendment. I would hope that
my friend from Texas, if that, in fact, is the case, would come here
and defend his position. I will say that if that isn't the case, that I
will ask for the yeas and nays and move forward on the amendment. It is
just simply not fair.
We have an order in effect that as soon as this amendment is
completed, we would move to something that Senator Gregg or someone he
designates would offer. And then following that we have a Democratic
amendment in order. We should move through those. I hope that if there
are people other than the distinguished Senator from Texas who oppose
this amendment or the Senator from Texas, that they would come to the
floor and explain themselves.
I will say that I am getting the feeling that this is one of those
kinds of
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stealth oppositions we get around here a lot of times. People know this
is a good amendment, supported by the Governors of the States,
supported by people in the States who are desperate for dollars. States
are suffering. I think there are people who would like to come and
oppose this, but they really don't quite know why. So they just stay
away hoping it will go away.
It is not going to go away. If I come back here again and there is no
one within a reasonable period of time who has voiced any opposition to
the amendment or there is no one on the floor speaking against it, I
will ask for the yeas and nays and move on to something else.
The PRESIDING OFFICER. The Senator from Nebraska.
Mr. NELSON of Nebraska. Madam President, the National Governors
Association has written a letter, dated July 24--very current--to the
minority and majority leaders of the Senate strongly urging support for
the Rockefeller-Collins-Nelson-Smith compromise.
I ask unanimous consent to print it in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:
National Governors
Association,
Washington, DC, July 24, 2002.
Hon. Thomas A. Daschle,
Majority Leader, U.S. Senate, The Capitol, Washington, DC.
Hon. Trent Lott,
Minority Leader, U.S. Senate, The Capitol, Washington, DC.
Dear Senator Daschle and Senator Lott: The nation's
Governors strongly support the Rockefeller-Collins-Nelson-
Smith compromise state fiscal relief legislation. We urge its
consideration as an amendment to S. 812 on the Senate floor
and its swift passage into law.
The legislation to temporarily increase the federal share
of the Medicaid program as well as provide a temporary block
grant to states will assist during the current fiscal crisis
so that states will not be forced to make deep cuts in
health, social services, and even education programs. It will
thus ensure that low-income vulnerable families are protected
from drastic cuts in these key programs.
One of the major contributors to the rising state Medicaid
costs is prescription drug expenses. Immediate Federal
assistance with these costs would provide real fiscal relief
to the states. We urge timely Senate action on the
Rockefeller-Collins-Nelson-Smith amendment.
We would very much appreciate your support and we look
forward to working with you to ensure that meaningful state
fiscal relief legislation is enacted.
Sincerely,
Paul E. Patton,
Governor.
Dirk Kempthorne,
Governor.
____
Mr. NELSON of Nebraska. I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The assistant legislative clerk proceeded to call the roll.
Mr. WYDEN. Madam President, I ask unanimous consent that the order
for the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. WYDEN. Madam President, the Senator from West Virginia, in my
view, has outlined a very important position with respect to a critical
health issue for the States. I commend him for his outstanding work. It
is going to make a difference in Oregon and across the country.
I ask unanimous consent to speak for up to 10 minutes as in morning
business.
The PRESIDING OFFICER. Without objection, it is so ordered.
(The remarks of Mr. WYDEN are printed in today's Record under
``Morning Business.'')
Mr. WYDEN. Madam President, I am a strong supporter of the
Rockefeller amendment which will make a huge difference for our States
at a time when the situation is truly dire with respect to health care.
So I thank my colleague. When we get to a vote on the Rockefeller
amendment--I know Senator Nelson of Nebraska has done excellent work on
this as well--I hope the amendment will pass with a resounding
majority.
I yield the floor.
Mr. ROCKEFELLER. Madam President, I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The bill clerk proceeded to call the roll.
Mr. GREGG. Madam President, I ask unanimous consent that the order
for the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. GREGG. Madam President, I wanted to speak on a couple of issues.
First is the underlying effort here to pass major legislation in the
area of assisting senior citizens, specifically, with the cost of their
prescription drugs.
I think we all understand very well that there has been a fundamental
shift in the way medicine is practiced in our country, and it has been
a positive shift. That shift is that we have gone from a society which
had basically as its first line of defense for significant health
concerns an invasive medical procedure using a scalpel, to a society
which has as its first line of defense for major medical concerns the
use of pharmaceuticals. This has been a revolution, a biotech
revolution.
As a result, it is not so much that pharmaceuticals have become more
expensive--but not outrageously so, with respect to inflation and other
costs--but they have become so much more aggressively utilized. As a
result, senior citizens and all citizenry that have medical concerns
are finding that they are more often than not going down to the
pharmacy and purchasing a pill in order to address a physical ailment
versus going into the hospital and receiving some sort of remedial
medical care that might involve an operation or some sort of therapy
within the physical confines of a hospital. So utilization has gone up
dramatically in the area of pharmaceuticals. This is a change in the
way we practice medicine as a country.
The practical effect of that is that all Americans, but seniors
especially because as a practical fact, as people begin to get older,
they have more health needs in most instances.
Seniors are finding themselves more and more put into the situation
of having to purchase pharmaceutical goods, which are adding up, and
because there is more significant utilization, they are expensive and
sometimes unaffordable, especially to low-and middle-income seniors. So
we as a Congress and the President are attempting to address this
through passing some sort of a package that will give senior citizens
the opportunity to take some of the pressure off of the cost of this
new need to use prescription drugs.
The goal, in my opinion, should be basically twofold: One, to assure
that low- and moderate-income seniors--especially low-income seniors--
who find it virtually impossible to fit into their budgets, which are
usually very constricted, the cost of pharmaceuticals, to allow those
individuals to receive assistance as they have to purchase these
medications; second, to address the situation where a senior who has
reasonable income and reasonable wealth confronts a catastrophic
situation where simply the cost of medication exceeds even their
capacity to pay for it. Those should be our two primary goals as we put
together this package of relief for senior citizens, in my opinion.
Also, there are a lot of secondary goals. Secondary goals should be--
and it is fairly significant--that we do not undermine the ability of
our society to bring new drugs to the market.
As a society, we have basically become the creators of most of the
major new pharmaceuticals that are created in this world, and that is
because we have a vibrant research capability going on in this country
and a vibrant commercialization of goods and products which are created
within that research market. It is important that we not kill the goose
that is laying the lifesaving drug, as I said earlier, and that we
allow the entrepreneurs in our society, who are research scientists for
the most part, to evolve a capability of continuing to bring to market
drugs which save people's lives and benefit people and make their lives
better, and that we not in the process of developing a package of drug
benefits end up creating an atmosphere which works against the bringing
to market of new pharmaceutical drugs. That should be a subsidiary
effort as we move forward to address the question of a drug benefit for
senior citizens.
In that context, we are now working aggressively to try to pull
together a
[[Page S7297]]
package. We have had three major votes on different drug packages. We
had the Democratic proposal which, regrettably, was, in my opinion,
fundamentally flawed because it did not meet the conditions I have laid
out.
First, it was extraordinarily expensive, and I should have mentioned
that as a fourth line of consideration, which is that as we put this
benefit package in place for seniors, we should not have it created in
such a way that it transfers a huge new cost on to working Americans,
especially young Americans with young families, who are trying to make
ends meet, who have other issues, such as education, housing, the day-
to-day costs of raising a family.
We should not make the cost of this major new drug benefit so high
that the tax burden to pay for it--which will fall on working Americans
for the most part will significantly disadvantage working Americans in
their ability to live a good life.
This new drug benefit is not like the Medicare proposals under which
we presently work. There is no premium in most instances. Some have
premiums, most do not. There is also no earned benefit--in other words,
over the years people paying into the Part A insurance fund and
building up a fund. In this instance, seniors are going to simply
receive this benefit without it having been paid for through building
it up over the years, paying through Part A. It is essentially going to
be a tax. To pay for this drug benefit, there is going to be a tax
levied on working Americans, especially young Americans, to assist
senior citizens with the issue of how they pay for drugs.
We have to be very careful in putting this package together that we
do not end up putting such a huge burden on young working Americans
that it makes it very difficult for them to raise their families.
As I mentioned, there have been three votes on this issue in the
Senate in the last few days. The first was on the Democratic plan. The
Democratic plan failed in a number of areas.
One, it was extraordinarily expensive. It would have passed $600
billion--and that was the estimate. We all know estimates end up being
low. For example, when Medicare was originally passed in the 1960s, it
was estimated in 1990 to cost $9 billion. Medicare in 1990 cost about
$70 billion. It was off by almost 1,000 percent. We know the $600
billion pricetag attached to the Democratic package is a pricetag which
is probably low. Even if it were accurate, it is a huge pricetag to
pass on to working Americans, younger Americans, and far more than we
should put on the backs of the working American who is trying to raise
that young family. It is far too high a burden on those individuals.
It is disproportionate in the way it deals with the intergenerational
issues in benefiting dramatically, in terms of dollars spent, senior
citizens at the expense of young Americans who are trying to raise a
family. It exceeded the budget allocation by $300 billion, by 100
percent. There was $300 billion budgeted. This was a $600 billion
package, which is far too expensive.
Also, it undermined the marketplace. It was a public program, which
in and of itself is an undermining of the marketplace, but it was a
public program which had an incredibly regressive element to it. It
essentially said that you could only, for a certain ailment--let's take
arthritis--purchase one type of drug for that ailment, one. There are
probably 20 different drugs on the market to address arthritis. Why
would you limit the ability of a senior to only purchase one and have
it covered by insurance? It is a foolish idea from the standpoint that
doctors may not want to prescribe that one drug, and it may not be
medically a good idea, plus it is just not conducive to creating a
marketplace which is going to bring more pharmaceuticals on to the
market so seniors have more choices and that we drive down the prices
of pharmaceuticals generally because we have competition.
It is truly a regressive idea from the standpoint of health care and
from the standpoint of how you develop a strong and vibrant market for
producing pharmaceuticals. That bill, in my opinion, was fundamentally
flawed. Plus, of course, it had the little gimmick in it--rather large
actually--that it was not a permanent benefit. It lapsed after 5 years.
It would not exist anymore. I do not know what was going to happen
then. It would be gone and who knew what was going to happen.
It was a black hole or a cliff proposal where everybody gets a
benefit for 5 years and suddenly they look down and there is no more
benefit and they have to step off the cliff into the abyss, not knowing
what is going to happen. It was a poorly constructed idea and it failed
because it did not get 60 votes.
The second idea that came through was the tripartisan proposal.
Again, it is a fairly expensive proposal, $370 billion, but
significantly less than the Democratic proposal, but much more
reasonable in the way it approached the issue. It opened the
marketplace. It gave seniors options as to what pharmaceuticals they
could use.
Senator Snowe was talking about how many more pharmaceuticals it
covered than the Democratic proposal, dramatically more. I am not sure
of the numbers. In any event, the specific numbers were that it covered
far more specific pharmaceutical products, and made those available
to seniors, than the Democratic plan--dramatically more.
In addition, it had language which significantly protected the low-
income senior. It gave them basically a 90-percent subsidy and had
positive catastrophic language.
That also failed to get 60 votes.
The third vote we had was on the Hagel-Ensign proposal, which is an
idea I am attracted to, although I also voted for the tripartisan plan.
It says what I have been saying. You take low-income seniors and
protect them. You give them the ability to buy the pharmaceutical, you
give them support to do that and it does not wipe out their income. The
plan was very progressive in this way.
You say to seniors, who are in the general population, who are not
low-income seniors: If you have a serious illness which throws you into
a high-cost pharmaceutical situation, and you are spending a dramatic
amount of your basic wealth, your income, your assets on
pharmaceuticals, the Government will come in and pick it up. There was
a catastrophic cap which the Government picked up.
Again, this was built in, as I understood it, in a progressive way so
higher income people had to spend more than middle- and moderate-income
people had to spend. It was very progressive in a thoughtful way. This
idea made a lot of sense and got a very good vote. In fact, it got as
high a vote as any other proposal that came to the floor. I hope from
this idea we can evolve a package that can work effectively.
That is basically where we stand today. We have now had three major
packages. None have passed because the sequence of events that are set
up is that the Democratic leadership refused to take these bills
through committee and created a situation where we could not pass them
on the floor because they all required 60 votes.
Had Hagel-Ensign, for example, come out to the floor after having
gone through the committee, with the vote it got on this floor it would
have passed the Senate, and we would now have in place a drug benefit.
It would not have been subject to a budget point of order because it
was under $300 billion--just barely, $294 billion. That was not allowed
to happen because of the way this whole exercise was set up, which is
unfortunate.
Where do we go from here? It is my hope we will reach some sort of
consensus on a catastrophic package, a package that takes care of low-
income seniors and makes sure they have adequate coverage, that takes
care of people who have a huge impact on their assets through a
catastrophic event, and allows seniors who have moderate income, if
they wish, to purchase the insurance if they want to cover the
difference through some sort of Medigap insurance. This, to me, is a
logical way of resolving this issue.
Independent of all that, however, we have had other amendments
dealing with this bill. One of them is the amendment which we presently
have before us which is a $9 billion bailout for the States--some
States, not all States. States such as mine, which do not happen to
meet the formula because we have been very frugal in the way we have
managed our Medicaid accounts and, as a result, have kept our
reimbursement at 50 percent, do not benefit a whole lot from this
proposal.
[[Page S7298]]
For States which have been less effective in their ability to deal with
Medicaid, this bill basically is a $9 billion bailout. Is the $9
billion offset? No, it will simply be a vote by the Senate which says
we are going to spend another $9 billion on Medicaid to assist the
States.
First off, this is the wrong place to bring forth this amendment.
This bill started out as a generic drug bill. It has moved on to an
all-inclusive drug bill debate, but it has always been a bill that has
been debated in the context of Medicare and drug initiatives, and this
is a Medicaid bailout, which is totally separate from the underlying
issue of what we discussed in these other bills. This amendment should
have gone through committee and should have been brought out here as a
committee bill versus being brought out here separately.
Secondly, it sets a very dangerous precedent in that it waters down
the FMAP formula even on a temporary basis. The purpose and fairness of
the formula will be eroded over time. Around here, temporary changes
rarely turn out to be temporary, although they claim it is temporary.
This amendment sets a precedent, and if it is passed, any State that
ever faces an FMAP decrease in the future will lobby Congress to
override the formula. Instead of an automatic process based on a fair
formula, future FMAP rates will become a political fight in Congress,
which is exactly what this exercise is.
It is basically an attempt to use the fact that a number of States
believe they need more money and to pull enough people together from
those States so there are enough to vote for this $9 billion bailout.
It is called logroll. It is working very effectively on this amendment,
I am afraid, which is too bad.
This is totally fiscally irresponsible. Such a process as this
disrupts the whole process and will not likely produce a program that
benefits those who need it most but, rather, States that have been most
ineffective in managing their Medicaid accounts.
FMAP rates are not designed to change according to short-term
economic developments. Although FMAPs are based on State per capita
income levels and other economic indicators, they have not typically
risen at all and with short-term economic trends. If State logic
suggests raising FMAP now, then it would also apply to lowering them in
times of economic boom.
If we had followed such a course after 9 years of economic recovery,
current FMAP rates would be much lower than they are today. Such
cyclical movements are contrary to the intent of Medicaid statutes and
in the long term would serve the interests neither of the States nor
the Federal Government to pursue this action.
States have other options to making Medicaid benefits more secure.
States can take steps to make their benefits more efficient, enabling
more persons to be covered with the same or lower costs using the
health insurance flexibility and accountability initiatives unveiled in
August 2001. The HIFAI demonstration is designed to help States reduce
the number of uninsured through innovative and cost-effective
approaches using Medicaid and CHIP funds. The initiative emphasizes
private insurance options rather than public program expansions. To
date, HHS has approved HIFAI demonstrations in Arizona and California,
and it could approve more if more States are willing to be aggressive.
The simple fact is what we have is an effort by a large number of
States that have had problems with their Medicaid accounts for a
variety of reasons to basically raid the Federal Treasury to the tune
of $9 billion. I guess they are probably going to have enough votes to
do that because they have structured this formula so that enough States
are going to pick up money from it that is significant. But I have to
ask the question, Why are we not offsetting this $9 billion? Why are we
just coming out and saying let's take another $9 billion hit on the
Federal Treasury, in which we do not happen to have any money right
now, and add that to the deficit? It makes very little sense from the
standpoint of fiscal policy.
Fifty States have the power to energize this type of support for $9
billion. I would think they would have the power to go find money to
offset it somewhere, but unfortunately they are not doing that in this
amendment. It is an unfortunate, in my opinion, effort to raid the
Treasury, as a result of which we will not only get bad policy but we
will get a significant increase in Federal debt.
I yield the floor and make a point of order that a quorum is not
present.
The PRESIDING OFFICER (Mr. MILLER). The Senator from West Virginia.
Mr. ROCKEFELLER. Am I correct in understanding that the distinguished
Senator raised a point of order?
Mr. GREGG. No, I have not raised a point of order.
The PRESIDING OFFICER. He did not.
The Senator from Nebraska.
Mr. NELSON of Nebraska. Mr. President, the distinguished Senator from
New Hampshire raised a number of very important questions regarding
this FMAP proposal to expand the support that the Federal Government is
providing to the States as part of the partnership that has existed for
many years.
I think it would be very difficult to go back and tell our partners
that we are unable to or we should not increase the amount of the
Federal match because we did not follow the procedures that some people
in the Senate believed we ought to follow. Inside baseball is not going
to make those friends who are on the outside experiencing some major
financial challenges very happy. They may not be very happy at all with
that kind of an explanation.
I think it is important to remember how the Medicaid Program
developed, as well as some of the social benefits programs that are
also included as part of this bill. If the Chair remembers--and I know
he does as a former Governor from Georgia--this was a big part of his
budget. He probably was surprised, as I was, on the day we took office
and put our budgets together to find out what a big piece of the pie
this Medicaid Program amounted to as part of the budget. If the Chair
remembers what happened, as I am sure he does, as do all former
Governors, and I believe all of our colleagues do, this came about
because of a Federal mandate. The Federal Government said we are going
to have a Federal Medicaid Program and the States are going to be
parties to it and the Federal Government is going to decide how much
the Federal Government contributes to it, and the Federal Government is
always going to be able to raise or lower the amount of the Federal
match on the basis of a formula that has been established. The States,
as the junior partners, have to go along with whatever the Federal
Government proposes.
It was a mandate--not an unfunded mandate but an underfunded Federal
mandate.
The States generally made innovative challenges, but I know the
distinguished former Governor of Georgia will recall when States came
to the Federal Government and said, we would like to make some changes
to the program, you had to get a waiver and come back to Washington and
ask, will you please allow us to make these innovative changes that our
distinguished colleague from the Northeast was talking about that have
been made in some areas. Many proposed innovative changes were denied.
It has been essentially a Federal program where the States have been
the junior partner. In this situation, all we are saying is, instead of
reducing the amount of the Federal match over the next 19 months, as it
has been scheduled to be reduced in various States, we are going to
hold that constant. In addition, we are going to add 1 percent to the
State in the Federal match, so for 18 months we will help the States so
they do not have to take away benefits from the most needy and most
vulnerable in our society today.
It is recognizing we have a partnership. This was part of the
stimulus package worked on this last year. It just did not survive into
the ultimate stimulus package that was passed earlier this year. Last
year and this year, when the stimulus package was being discussed,
there was little talk about offsets. Now, when it is convenient to talk
of offsets, in getting in a direction the way this is heading, we talk
of assets. There is not anyone in this body not in favor of offsets,
unless the whole discussion of offsets is designed to set this off the
tracks so we can get it passed.
It seems to me what we have to do is recognize how the program began,
how
[[Page S7299]]
it works, and what assistance this plan we are proposing today--how it
will help the States and why it is necessary to help the States deal
with our citizens, citizens of the United States of America who happen
to reside in the various States.
It seems to me we do have a responsibility, that we can meet that
responsibility, and, yes, I would love to have offsets, but I want to
make sure the search for offsets is not what gets this off the track.
I yield the floor and suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The assistant legislative clerk proceeded to call the roll.
Mr. WELLSTONE. 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. WELLSTONE. Mr. President, I ask unanimous consent I be allowed to
speak for 10 minutes as in morning business.
The PRESIDING OFFICER. Without objection, it is so ordered.
(The remarks of Mr. WELLSTONE are printed in today's Record under
``Morning Business.'')
Mr. WELLSTONE. I yield the floor and suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The assistant legislative clerk proceeded to call the roll.
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, what is the matter before the Senate?
The PRESIDING OFFICER. The pending question is the Rockefeller
second-degree amendment.
Cloture Motion
Mr. REID. Mr. President, I send a cloture motion to the desk.
The PRESIDING OFFICER. The cloture motion having been presented under
rule XXII, the Chair directs the clerk to read the motion.
The legislative clerk read as follows:
Cloture Motion
We, the undersigned Senators, in accordance with the
provisions of Rule XXII of the Standing Rules of the Senate,
do hereby move to bring to a close the debate on the
Rockefeller and others amendment No. 4316.
John D. Rockefeller IV, E. Benjamin Nelson of Nebraska,
John Edwards, Paul Wellstone, Harry Reid, John F.
Kerry, Blanche L. Lincoln, Richard J. Durbin, Jack
Reed, Edward M. Kennedy, Susan Collins, Daniel K.
Inouye, Patrick Leahy, Tom Daschle, Debbie Stabenow,
Charles Schumer, Ron Wyden.
Mr. REID. Mr. President, I have been advised that Senators Grassley
and Gramm wish to come to the floor and speak on the Rockefeller
amendment. I am also advised that one of the Senators is going to raise
a point of order, which we will attempt to waive. But we need them here
to do that. I am sure they will be here soon.
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. REID. Madam President, I ask unanimous consent the order for the
quorum call be rescinded.
The PRESIDING OFFICER (Ms. Cantwell). Without objection, it is so
ordered.
Mr. REID. Madam President, it is my understanding we now are on the
Rockefeller amendment. Is that right?
The PRESIDING OFFICER. The Senator is correct.
The Senator from Texas.
Mr. GRAMM. Under section 205 of H. Con. Res. 290, I raise a point of
order against the emergency designation of section (c) of the pending
amendment, No. 4316.
Mr. REID. Madam President, I move to waive section 205 of the Budget
Act. I ask for the yeas and nays.
The PRESIDING OFFICER. The motion is pending.
Is there a sufficient second? There is a sufficient second.
The yeas and nays were ordered.
Mr. REID. Madam President, I have spoken to Senator Gramm. He and
others wish to speak. This is a debatable motion. We will set some
time. Senator Gramm has graciously acknowledged he doesn't want to
speak too long since we already have a cloture motion filed. But we
will shortly determine how much time will be needed and will debate
this in the morning and vote sometime in the morning.
Hopefully, while we are waiting on the unanimous consent agreement to
get the legislative branch appropriations bill, which also kicks in the
fact that prior to next Wednesday--or on next Wednesday I should say,
we will start debating the DOD appropriations bill.
So we have a lot to do in the next few days. This will move us down
the road.
I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The assistant legislative clerk proceeded to call the roll.
Mr. WARNER. Madam President, I ask unanimous consent that the order
for the quorum call be rescinded.
The PRESIDING OFFICER (Ms. Cantwell). Without objection, it is so
ordered.
____________________