[Congressional Record Volume 149, Number 94 (Tuesday, June 24, 2003)]
[Senate]
[Pages S8429-S8431]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
PRESCRIPTION DRUG AND MEDICARE IMPROVEMENT ACT OF 2003--Continued
Mr. FRIST. Mr. President, as we bring this very busy day to a close,
I wish to reflect on where we are with this very historic bill that
will provide prescription drugs and, at the same time, strengthen and
improve Medicare for our seniors and individuals with disabilities.
It is a historic week in many ways, but primarily because we will
accomplish something that many thought would be impossible even a
couple of months ago that will benefit America's seniors; historic
because during this week, both Houses will likely pass the first major
reform of Medicare in the almost 40 years of that program's existence.
Thanks to the strong leadership of President Bush, as well as the
bipartisan support of this body, I am optimistic that by the end of
this week, we will have added a $400 billion prescription drug benefit
for our deserving seniors for their health care security. And indeed,
it has been a long time in coming. A lot of us have talked about it,
have known we should move in that direction, and now after a lot of
participation we will be able to deliver on that for which we have all
worked so hard. Both parties have promised action in the past.
America's seniors have demanded it. Indeed, America's seniors deserve
it.
As part of this current legislation, not a lot has been said on this
particular aspect of it, so I do want to mention it. Within 8 months or
9 months after the President signs the final product of our
discussions, when he signs this bill, seniors will have access to a
prescription drug card that will provide immediate savings for them.
This is an important interim move that allows us to say to seniors:
Help is, indeed, on the way.
During this period of time of a year and a half or a couple years
while they have that prescription drug card, we will be constructing
the appropriate infrastructure to provide that prescription drug
benefit for that population that wishes to stay in traditional Medicare
or that population that wishes to take advantage of a new, transformed
type of Medicare that will allow continuous, ongoing quality care in a
more seamless fashion, a fashion that will involve preventive medicine
and chronic disease management, as well as prescription drugs.
The great aspect about what we are doing, at the same time we are
offering this new benefit of prescription drugs, which our seniors
deserve, is that we are modernizing the Medicare Program, strengthening
it, improving it in a way that can be sustained long term, and
hopefully there will even be some cost savings in the future, but at
the same time I am absolutely positively sure that the quality of care
will be better. I say that because of this focus on preventive
medicine, chronic disease management, and overall disease management
which is simply not provided in traditional Medicare.
I wish to list a couple of principles.
First, individual choice versus a one-size-fits-all system. Seniors,
for the first time, will be given an opportunity to choose the health
care coverage which will best meet their individual needs. It is very
different from the one-size-fits-all type program that is provided
today.
Second, private sector competition versus Government price setting.
Private insurers--I mention private insurers and private plans because
we hear a lot today from certain think tanks that not very much is new
in this bill. There is not very much reform, there is not very much
modernization.
My simple response to them is, yes, there is a new entitlement in
terms of this drug benefit, but it is going to be delivered 100 percent
through the private sector, through private plans. Yes, regulated by
Government, but the entities, the mechanisms of delivering these
prescription drugs, whether it is in a freestanding plan or part of the
traditional Medicare+Choice or part of a new PPO system, are 100
percent competitively bid with market-based principles.
That allows us to step back and say: Yes, there is something new that
over the long haul, if carried out well, if appropriately structured,
will allow seniors to have better value, a higher quality of care for
the same input, the same amount of money that is spent.
So this market-based competition is important and, I would argue, is
very important to the long-term sustainability of the program because
of this huge demographic shift of the doubling of the number of
seniors.
Third, innovation versus bureaucratic delays. The participation of
private health plans in Medicare will help ensure up-to-date coverage.
Because Medicare is so rigid, it takes a long time for Medicare to
incorporate innovation, new technology, new and better ways of doing
things. When you have Government bureaucrats making the decisions or
politicians or political figures deciding what is covered and what is
not, it simply takes a longer time than occurs in the more responsive
private sector.
Four, long-term savings versus spiraling costs. There is a lot of
debate in this Chamber, but I would argue, consistent with what the
Medicare actuaries tell us, that the most efficient private plans today
have the potential for beating Medicare costs by as much as 2.3
percent. Compounded over time, that can result in significant cost
savings to the program. Thus, for the same input of dollars, you will
have better output, better care delivered, and better quality of care.
The final point I will close with is regulatory relief versus the
redtape of bureaucracy that is so characteristic of our Medicare system
today. In this bill, there are several rulemaking and regulatory relief
changes for health care providers that will allow them to focus on what
they should be doing; that is, providing that clinical care, that
patient care, instead of filling out paperwork or spending a lot of
time on redtape activity.
A recent study by Price Waterhouse estimated that for every hour in
the emergency room, there are about 30 minutes of paperwork required by
emergency personnel. There is just no reason for that today, and this
bill helps address that regulatory relief.
So a new benefit, individual choice, market-based competition, rapid
assimilation of new technology, as well as new medicines, long-term
savings, relief from this red tape, health security for seniors, that
is what this bill is all about.
vote explanation
Mr. BROWNBACK. Mr. President, I regret that due to a previously
scheduled White House event celebrating Black Music History Month, I
was unable to cast a vote on Amendment No. 1002 offered by my friend,
Mr. Lautenberg. I would like the Record to reflect that had I been
present, I would have voted against the amendment.
Mr. JOHNSON. Mr. President, as we move forward with debate on
Medicare prescription drugs, it is important to recognize that this
bill does very little to address the unrestrained costs of prescription
drugs. I find it disconcerting that as we are discussing one of the
most major public program expansions of all time, we have neglected to
have a real discussion about how to ensure that taxpayers get the
[[Page S8430]]
most bang for their buck in this program, and that seniors who will
have significant cost sharing responsibilities have as minimal a burden
as possible.
For many years, I have been a strong advocate for implementing
reforms to reduce prescription drug costs for consumers in this
country. I believe one way to do that is through increasing consumers'
access to approved, safe and affordable generic prescription drugs.
Last week the Senate passed an amendment that would accomplish this
very goal. I was pleased to see that the Gregg-Schumer-McCain-Kennedy
amendment passed the Senate with wide bipartisan support and I want to
thank my colleagues for their dedication and hard work on this issue.
This represents one encouraging step towards leveling the playing field
and ensuring that prescription drug costs under this program are indeed
reasonable.
The generics amendment, which I have cosponsored along with many of
my colleagues will allow generic drug companies to compete with brand-
name manufactures by clearing the major obstacles that delay generic
drug approval. The act levels the playing field for generic drug makers
to better compete against large, brand-name manufacturers, and it
represents a bold step in putting consumer health and savings first.
The legislation seeks to bolster the Hatch-Waxman Act passed in 1984,
which promoted the growth of the generic drug industry. Loopholes in
the patent laws, which benefited brand-name drug manufacturers,
prohibited the bill from ever realizing its full potential.
Efforts to promote the value of generic drugs are competing with some
powerful forces, such as direct-to-consumer advertising and the
unwillingness of many doctors to prescribe generic drugs more
regularly. However, I believe this amendment, along with greater public
education efforts directed at consumers and doctors about the
effectiveness of safe and approved generic drugs, will go a long way
towards improving greater access and utilization of generic
prescription drugs.
I will continue to fight for lower prescription drug costs and will
oppose any efforts that would deny generic drugs equal access into the
market. With the enactment of this amendment, we are one major step
closer to achieving this goal and I hope the House will follow suit and
make similar provisions a part of shier Medicare prescription drug
legislation. Passage of the generics amendment paved the way, but we
must not stop here. We must continue the discussion and debate on the
cost containment of prescription drugs under this program and I urge my
colleagues to support all amendments that work towards that goal.
Mr. SMITH. Mr. President, I would like to join my distinguished
colleague from Iowa as a cosponsor of the ``Money Follows the Person
Amendment'' to the Prescription Drug and Medicare Improvement Act of
2003.
This amendment would authorize the 2004 ``Money Follows the Person''
initiative in Medicaid, a part of the President's New Freedom
Initiative to integrate people with disabilities into the communities
where they live.
This amendment would create a 5-year program to help States move
people with disabilities out of institutional settings and into their
communities. For example, under this legislation, Oregon's effort to
help an individual move out of an institutional care facility and into
a community home would be 100 percent federally funded for 1 year.
After that first year, the Federal Government would pay its usual rate.
Under the provisions of this amendment, States like Oregon can take
advantage of $350 million dollars of Federal assistance for 5 years for
a total of $1.75 billion.
This amendment is important to the disabled community for several
reasons. First, by supporting States' efforts to help Americans who
have been needlessly placed in institutional settings move into
community settings, this amendment will help States increase access to
home and community-based support for people with disabilities.
Second, by assisting the movement of people who are not best served
by an institution into a community care facility, this amendment gives
them the freedom to make choices. Too often, Americans with
disabilities are unable to take advantage of opportunities others take
for granted--to choose where they want to live, when to visit family
and friends, and to be active members of their communities.
Finally, this amendment would help States comply with the Americans
with Disabilities Act. As my colleagues in the Senate are well aware,
we are nearing the 13th anniversary of the Americans with Disabilities
Act and of the Olmstead Supreme Court decision. That decision ruled
that needless institutionalization of Americans with disabilities
constitutes discrimination under the Americans with Disabilities Act.
I urge my colleagues on both sides of the aisle to support this
important amendment and to support the freedom of choice for Americans
with disabilities.
Amendment No. 974
Mr. LEAHY. Mr. President, last November, the Drug Competition Act
passed the Senate by unanimous consent. This morning, I am proud to
join Senator Grassley, along with Senators Cantwell, Durbin, Feingold,
Kohl, and Schumer in offering our bill as an amendment to the
Prescription Drug and Medicare Improvement Act of 2003, S. 1, I hope
that in this Congress it is actually enacted into law as part of the
larger effort to improve the health care of millions of Americans.
Prescription drug prices are rapidly increasing, and are a source of
considerable concern to many Americans, especially senior citizens and
families. Generic drug prices can be as much as 80 percent lower than
the comparable brand-name version.
While the Drug Competition Act is small in terms of length, it is
large in terms of impact. It will ensure that law enforcement agencies
can take quick and decisive action against companies that are driven
more by greed than by good sense. It gives the Federal Trade Commission
and the Justice Department access to information about secret deals
between drug companies that keep generic drugs off the market. This is
a practice that hurts American families, particularly senior citizens,
by denying them access to low-cost generic drugs, and further inflating
medical costs.
Last fall, the Federal Trade Commission released a comprehensive
report on barriers to the entry of generic drugs into the
pharmaceutical marketplace. The FTC had two recommendations to improve
the current situation and to close the loopholes in the law that allow
drug manufacturers to manipulate the timing of generics' introduction
to the market. One of those recommendations was simply to enact our
bill, as the most effective solution to the problem of ``sweetheart''
deals between brand name and generic drug manufacturers that keep
generic drugs off the market, thus depriving consumers of the benefits
of quality drugs at lower prices. Indeed, at a hearing just yesterday
in the Judiciary Committee, Chairman Timothy Muris of the FTC praised
the Drug Competition Act in his testimony, and urged its passage. In
short, this bill enjoys the unqualified endorsement of the current FTC,
which follows on the support by the Clinton administration's FTC during
the initial stages of our formulation of this bill. We can all have
every confidence in the common sense approach that our bill takes to
ensuring that our law enforcement agencies have the information they
need to take quick action, if necessary, to protect consumers from drug
companies that abuse the law.
Under current law, the first generic manufacturer that gets
permission to sell a generic drug before the patent on the brand-name
drug expires enjoys protection from competition for 180 days--a head
start on other generic companies. That was a good idea--but the
unfortunate loophole exploited by a few is that secret deals can be
made that allow the manufacturer of the generic drug to claim the 180-
day grace period--to block other generic drugs from entering the
market--while, at the same time, getting paid by the brand-name
manufacturer not to sell the generic drug.
Our legislation closes this loophole for those who want to cheat the
public but keeps the system the same for companies engaged in true
competition. I think it is important for Congress not to overreact and
throw out
[[Page S8431]]
the good with the bad. Most generic companies want to take advantage of
this 180-day provision and deliver quality generic drugs at much lower
costs for consumers. We should not eliminate the incentive for them.
Instead, we should let the FTC and Justice look at every deal that
could lead to abuse, so that only the deals that are consistent with
the intent of that law will be allowed to stand. The Drug Competition
Act accomplishes precisely that goal, and helps ensure effective and
timely access to generic pharmaceuticals that can lower the cost of
prescription drugs for seniors, for families, and for all of us.
The effects of this amendment will only benefit the effort to bring
quality health care at lower costs to more of our citizens. The Drug
Competition Act enjoyed the unqualified support of the Senate last
year, and I hope my colleagues will recognize that it fits well within
the framework of the Prescription Drug and Medicare Improvement Act of
2003. It will do nothing to disrupt the balance struck in the larger
bill, while aiding the ultimate goal of that legislation. I urge all
Senators to embrace this effort on behalf of Medicare recipients, and
of all Americans.
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