[Congressional Record Volume 149, Number 96 (Thursday, June 26, 2003)]
[Senate]
[Pages S8686-S8709]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
PRESCRIPTION DRUG AND MEDICARE IMPROVEMENT ACT OF 2003--Continued
Mr. BAUCUS. Mr. President, will the Chair state the regular order?
The PRESIDENT pro tempore. The pending amendment numbered 1060, as
modified is the regular order.
Mr. BAUCUS. Mr. President, is that the Nickles-Feinstein amendment?
The PRESIDENT pro tempore. It is.
Mr. BAUCUS. Mr. President, I move to table the Nickles-Feinstein
amendment, and I ask for the yeas and nays.
The PRESIDENT pro tempore. Is there a sufficient second?
There is a sufficient second.
The question is on agreeing to the motion. The clerk will call the
roll.
The legislative clerk called the roll.
Mr. McCONNELL. I announce that the Senator from Oklahoma (Mr. Inhofe)
is necessarily absent.
Mr. REID. I announce that the Senator from Massachusetts (Mr. Kerry)
and the Senator from Connecticut (Mr. Lieberman) are necessarily
absent.
I further announce that, if present and voting, the Senator from
Massachusetts (Mr. Kerry) would vote ``yea.''
The PRESIDENT pro tempore. Are there any other Senators in the
Chamber desiring to vote?
The result was announced--yeas 38, nays 59, as follows:
[Rollcall Vote No. 261 Leg.]
YEAS--38
Akaka
Baucus
Bayh
Bingaman
Boxer
Breaux
Byrd
Cantwell
Clinton
Corzine
Daschle
Dorgan
Durbin
Edwards
Grassley
Harkin
Hollings
Inouye
Johnson
Kennedy
Lautenberg
Leahy
Levin
Lincoln
Mikulski
Miller
Murray
Nelson (FL)
Nelson (NE)
Pryor
Reed
Reid
Rockefeller
Sarbanes
Schumer
Snowe
Specter
Stabenow
NAYS--59
Alexander
Allard
Allen
Bennett
Biden
Bond
Brownback
Bunning
Burns
Campbell
Carper
Chafee
Chambliss
Cochran
Coleman
Collins
Conrad
Cornyn
Craig
Crapo
Dayton
DeWine
Dodd
Dole
Domenici
Ensign
Enzi
Feingold
Feinstein
Fitzgerald
Frist
Graham (FL)
Graham (SC)
Gregg
Hagel
Hatch
Hutchison
Jeffords
Kohl
Kyl
Landrieu
Lott
Lugar
McCain
McConnell
Murkowski
Nickles
Roberts
Santorum
Sessions
Shelby
Smith
Stevens
Sununu
Talent
Thomas
Voinovich
Warner
Wyden
NOT VOTING--3
Inhofe
Kerry
Lieberman
The motion was rejected.
Mr. BAUCUS. Mr. President, I suggest the absence of a quorum.
The PRESIDENT pro tempore. The clerk will call the roll.
The legislative clerk proceeded to call the roll.
Mr. GRASSLEY. Mr. President, I ask unanimous consent that the order
for the quorum call be rescinded.
The PRESIDENT pro tempore. Without objection, it is so ordered.
Mr. GRASSLEY. Mr. President, what is the business before the Senate?
The PRESIDENT pro tempore. Amendment No. 1060, as modified.
Mr. GRASSLEY. I urge adoption of the amendment.
The PRESIDENT pro tempore. Is there further debate?
Mr. BAUCUS. Mr. President, will the Chair identify the sponsors of
that amendment?
The PRESIDENT pro tempore. Senator Baucus for Senator Feinstein,
amendment No. 1060, Part B premium, subtitle (d).
Mr. BAUCUS. Mr. President, the Senate is ready to vote.
The PRESIDENT pro tempore. The question is on agreeing to the
amendment.
The amendment (No. 1060), as modified, was rejected.
Mr. BAUCUS. I move to reconsider the vote.
Mr. REID. I move to lay that motion on the table.
The motion to lay on the table was agreed to.
The PRESIDENT pro tempore. The Senator from Iowa.
Mr. GRASSLEY. Mr. President, I have a unanimous consent request to
correct a previous unanimous consent request. In a previous unanimous
consent request, I referred to amendment No. 990 when I meant to refer
to the previously adopted Murray amendment No. 961.
I ask unanimous consent to make that change.
I referred to the Kyl amendment No. 1128 when I meant to refer to Kyl
amendment No. 1121.
I also ask unanimous consent to make that change.
The PRESIDENT pro tempore. Is there objection? Without objection, it
is so ordered.
Mr. BAUCUS. Mr. President, I suggest the absence of a quorum.
The PRESIDENT pro tempore. The clerk will call the roll.
The legislative clerk proceeded to call the roll.
Mr. GRASSLEY. Mr. President, I ask unanimous consent that the order
for the quorum call be rescinded.
The PRESIDENT pro tempore. Without objection, it is so ordered.
Amendment No. 1133
Mr. GRASSLEY. Mr. President, I send an amendment to the desk.
The PRESIDENT pro tempore. The clerk will report.
The assistant legislative clerk read as follows:
The Senator from Iowa [Mr. Grassley] proposes an amendment
numbered 1133.
Mr. GRASSLEY. Mr. President, I ask unanimous consent that reading of
the amendment be dispensed with.
The PRESIDENT pro tempore. Without objection, it is so ordered.
(The amendment, No. 1133, is printed in today's Record under
``Amendments Submitted.'')
Mr. GRASSLEY. Mr. President, is there no discussion necessary on the
amendment?
The PRESIDENT pro tempore. Who seeks recognition?
The Senator from Texas.
Mrs. HUTCHISON. Mr. President, I would just like to say that we have
help for our teaching hospitals in the managers' amendment. It is not
much. But I am working with all of the managers, the ranking member as
well as the chairman, to try to increase funding for teaching
hospitals.
I want to point out our teaching hospitals must have the support that
is in this bill at a higher percentage if we are going to keep the
young physicians trained and if our country will keep the greatest
health care system in the world.
I thank the managers for helping me put that in the managers'
amendment.
[[Page S8687]]
The PRESIDENT pro tempore. The Senator from Pennsylvania.
Mr. SANTORUM. Mr. President, I oppose the managers' amendment because
of an amendment that is in the managers' amendment, the Corzine
amendment which provides three States the opportunity to basically opt
out of the Medicare Program for prescription drugs and have an
entitlement flow of funding going to the States for the States to
develop their own stand-alone drug benefit. As a result of that, States
like mine and two others will not have the advantage of an integrated
drug benefit which I fought very strongly for on this floor and which I
believe will also lead potentially to this unlimited entitlement flow
of funds to the States because of the way this language is drafted, the
potential for lots of mischief in respect to double dipping, inter-
government transfers, disproportionate share payments. We could be
opening a virtual Pandora's box. Yes. For my States and two others. But
I think, frankly, it is not good policy and does not do the kind of
improvement of the overall Medicare program which my State should
participate in as well as the other States represented here.
There is no Federal oversight by the Secretary of Health and Human
Services for this plan.
There are a host of other problems with this amendment. It is my
understanding that the managers gave a commitment that this amendment
be included in the package. And so to honor the chairman's commitment,
I will not object to this amendment nor call for a vote to strike the
amendment. But I, unfortunately, will have to vote against this bill.
The PRESIDENT pro tempore. Is there further debate?
Mr. GRASSLEY. I ask unanimous consent that the amendment be agreed
to.
The PRESIDENT pro tempore. Is there objection? Without objection, it
is so ordered.
The amendment (No. 1133) was agreed to.
Amendments En Bloc Withdrawn
Mr. GRASSLEY. Mr. President, I ask unanimous consent to withdraw the
pending amendments.
The PRESIDENT pro tempore. Without objection, it is so ordered.
The amendments (Nos. 953, 958, 934, 964, 965, 980, 979, 973, 986,
990, 977, 993, 962, 1004, 1019, 1020, 1021, 999, 954, 1037, 1039, 1051,
1012, 1061, 1075, 1076, 1077, 1024, 1073, 1088, 1089, 1090, 1091, 1110,
and 1041) were withdrawn.
Adult Day Care
Mr. BUNNING. Mr. President, during consideration of this bill in the
Finance Committee, I submitted language regarding adult day care which
I and my staff were told by Finance Committee staff was acceptable and
included in S. 1, the Prescription Drug and Medicare Improvement Act of
2003, as part of the base bill to be considered on the Senate floor. I
was very thankful for your consideration and approval of my language,
Chairman Grassley.
Mr. GRASSLEY. Yes, Senator Bunning, I remember your submitted
language regarding Adult Day Care.
Mr. BUNNING. After we voted to pass S. 1 out of the Finance
Committee, I have since learned that the adult day care language
accepted and made part of the bill is not the language I submitted at
all, but instead it is language based on a bill introduced by Senator
Santorum related to the same issue.
Mr. GRASSLEY. Yes, this is true, and I apologize for the inaccurate
information and misunderstanding provided to you and your staff from
the Finance Committee on this issue. The language included in the base
bill instead is based on Senator Santorum's bill.
Mr. BUNNING. While Senator Santorum's adult day care proposal and my
adult day care language are different, they both share the same goal of
providing services to those special and needy adults who require extra
attention and care. However, I have some differences with Senator
Santorum's proposal, and he has some differences with my proposed
language.
Mr. SANTORUM. Yes, we do share the same goal on this adult day care
issue, and we do have some fundamental differences with one another's
proposals and language on the matter.
Mr. GRASSLEY. Yes, that is my understanding, as well.
Mr. BUNNING. I am hopeful that once this bill gets to conference, we
and our staffs can work out our differences on this adult day care
issue and find a solution that is amenable to all of us. It is also my
understanding the current version of the House of Representative's
prescription drug benefit bill includes the adult day care language
which is identical to my language.
Mr. SANTORUM. I am willing to work on this matter further, and do
agree that since the Senate's and House of Representative's versions on
the adult day care language will be different, we will have to find a
solution to our differences on this important issue.
Mr. GRASSLEY. I will be happy to work with both of you and our staffs
to rectify this problem. Adult day care is an important issue, and
being that the Senate and House of Representatives will have different
language on this issue, it must be conferenced in a way to ensure that
all with interests in this matter, including interested provider and
senior organizations, are involved and approving of the final adult day
care language. I am looking forward to further working with both of you
on this matter.
Mr. BUNNING. Thank you, Mr. Chairman and Senator Santorum. I
appreciate both your willingness to revisit this matter and your
leadership on this important legislation for our seniors.
fee for service
Mr. FRIST. Mr. President, I believe in assuring the ability of
seniors who choose to do so to add their own funds on top of the
government contribution in order to participate in private fee-for-
service plans under Medicare. I also believe that private fee-for-
service plans should be able to provide an unmanaged form of the
subsidized prescription drug benefit.
Accordingly, I am committed to ensuring that the bill reported from
the conference committee that will consider S. 1 and H.R. 1
incorporates the functional equivalent of those provisions in H.R. 1
that permit private fee-for-service plans to provide the subsidized
prescription drug benefit as an unmanaged benefit whose premium amount,
just like the premium amount such plans charge for the core Medicare
benefit under current law, is not subject to governmental review or
approval.
Mr. GRASSLEY. I agree.
repeal of therapy caps
Mr. ENSIGN. Mr. President, I will withdraw my amendment to repeal the
arbitrary beneficiary caps on therapy. However, I would urge my
colleague from Iowa, the Chairman of the Finance Committee, to work in
conference to find a way to delay this law. As you know, the
beneficiary caps will have one of three results--beneficiaries will
either: (1) pay 100 percent out-of-their own pocket once the caps are
exceeded; (2) self-ration therapy care; or (3) forgo medically
necessary care altogether. Mr. President, I recognize that the Chairman
has been a voice to eliminate these caps and hope that a final Medicare
bill further delays implementation of them.
Mrs. LINCOLN. Mr. President, I would like the opportunity to join my
colleague from Nevada to speak in support of repealing the caps on
outpatient physical therapy, occupational therapy, and speech-language
pathology.
The current therapy cap discriminates against the most vulnerable of
Medicare beneficiaries. While the majority of enrollees will not exceed
an annual $1,590 limitation on rehabilitation services, approximately
13 percent of seniors and individuals with disabilities covered by
Medicare will be forced to pay for medically necessary services out of
pocket.
This is a particularly burdensome situation for beneficiaries living
in rural communities. Most likely to be harmed are beneficiaries who
have experienced a stroke or hip fracture or who have Parkinson's
disease or other conditions that require extensive rehabilitation
following injury or illness.
I urge the Chairman and Ranking Member of the Finance Committee to
work with me and my colleague, the Senator from Nevada, on repealing
this cap or at least suspending it for 1 or 2 years. My colleague and I
have sponsored legislation (S. 569) to permanently repeal this cap. Our
bill has
[[Page S8688]]
been cosponsored by 41 members of the Senate.
Again, I appreciate the opportunity to join my colleagues from Nevada
today. It is my sincere hope, Mr. President, that we will be able to
address the issue of the burdensome $1,590 cap on outpatient therapy
services.
Mr. GRASSLEY. I thank both the Senator from Nevada and the Senator
from Arkansas for their comments and for withdrawing the amendment. As
you may know, I asked CMS Administrator Scully at the Finance Committee
markup to further delay implementation of these beneficiary caps.
Unfortunately, as a result of the Senate Budget Resolution constraints,
I do not have Medicare dollars to repeal the beneficiary cap on therapy
services. I agree that this arbitrary limit does not make sense and
have sought to address this issue in the past. I will work in
conference to enact a therapy cap moratorium and appreciate your hard
work and passion on this issue.
Mr. ENSIGN. I appreciate the Chairman's leadership on this issue and
I thank my colleague for agreeing, at a minimum, to work toward another
moratorium on implementation of the therapy cap. I would also like to
thank the Senator from Arkansas for her words of support. Mr.
President, I yield the floor.
I ask unanimous consent that this full statement be included in the
Record as if read.
Mr. HATCH. Mr. President, I strongly support Senator Kyl's sense of
the Senate resolution to S. 1. His resolution asks Congress to rectify
problems with the formula that is used to update Medicare physician
reimbursement.
Due to flaws in this formula, payment rates for physicians and other
practitioners are predicted to fall by 4.2 percent in 2004. This cut in
physician compensation would be the fifth since 1991 including a 5.4
percent decrease in 2002. According to Medicare's own conservative
estimates, between the years 1991 and 2003, reductions for physicians
and other health professionals resulted in Medicare physician
reimbursement that equates to 14 percent below their actual practice
costs. The 2004 reduction would decrease Utah physician income by $13
million which translates to $3003 per physician in 2004. And this is in
addition to the $9 million decrease in reimbursement that Utah
physicians received in 2002. Furthermore, unless we correct this
formula, it is estimated that more cuts will occur in 2005, 2006, and
2007.
The Medicare Payment Advisory Commission, MedPAC, has stated that
these reimbursement reductions are the result of a problem with the
Sustained Growth Rate that is used as part of the calculation to adjust
rates each year. The SGR expenditure target is linked to gross domestic
product. Therefore, the formula may decrease Medicare reimbursement for
physicians and other practitioners when health care volume increases
outstrip increases in the gross domestic product. The problem is
magnified when gross domestic product decreases. Essentially, the
formula penalizes physicians for factors over which they have no
control.
It is true that as the population of our country ages, the volume of
Medicare health care services consumed increases. However, physicians
have no control over this and our Medicare system penalizes them
because of it. As a result, some physicians no longer take new Medicare
patients, some decline to participate in the Medicare program
altogether, and young people are considering other professions.
I would submit that as the baby-boomer generation ages and increasing
numbers of Americans become Medicare beneficiaries, we need physicians
and other health care providers more than ever. If anything, we should
be rewarding our physicians, not penalizing them.
An additional problem with the Sustained Growth Rate calculation is
that it does not account for many changes in health care that improve
quality but increase physician work also. The federal government
actively promotes new coverage decisions, quality improvement
activities and other initiatives that benefit patients but are not
taken into account by the Sustained Growth Rate calculation.
MedPAC's recommendation to Congress is that annual updates in
physician payments should reflect increases in the Medicare Economic
Index or MEI rather than the gross domestic product. Using the Medicare
Economic Index would eliminate the penalty that physicians and other
practitioners currently experience when the volume of health care
services increases due to factors that they are unable to control.
What we have before us is a flawed formula that is threatening the
health of Americans and the future of our country. Congress has
addressed this problem before, but it seems that we were only putting a
bandage over the wound; we never cured the disease that caused it. The
wound continues to fester and it will continue to do so until we cure
the problem. And the cure, it seems, is to revise the formula.
I for one, am tired of applying bandages to this wound. I believe
that it is time to address this problem directly and definitively. I
urge my colleagues to join with me in supporting this resolution and in
working to correct this problem.
Mr. FEINGOLD. Mr. President, I joined my colleague, the distinguished
Senator from Oregon, Mr. Smith, in offering an amendment to promote
better care for frail elderly and disabled. This amendment will allow
the Secretary of the Department of Health and Human Services to
designate health plans that disproportionately serve special needs
beneficiaries as specialized Medicare Advantage plans.
A number of States have successfully chosen to serve seniors and the
disabled by combining Medicare and Medicaid services through a waiver
approved by the Department of Health and Human Services that integrates
services under Medicare and Medicaid capitated financing arrangements.
These programs provide beneficiaries with a comprehensive benefit
package that combines the services traditionally provided by Medicare,
Medicaid, and home and community based waiver programs.
In my home State of Wisconsin, the Wisconsin Partnership Program is
one such success, a community-based program that has improved the
quality, access, and cost-effectiveness of the care delivered to its
beneficiaries. Perhaps most important to the beneficiaries, these
programs help the disabled and the frail elderly remain in their own
community, and avoid institutionalized care. Wisconsin is lucky to have
four such programs across our State: Elder Care and Community Living
Alliance of Dane County, Community Care for the Elderly of Milwaukee
County, and Community Health Partnership Eau Claire, Dunn, and Chippewa
Counties.
In order to qualify for these programs, a person must be Medicaid-
eligible, have physical disabilities or frailties of aging, and require
a level of care provided by nursing homes. Through programs such as the
Wisconsin Partnership Program, these frail elderly and disabled
beneficiaries are able to receive quality preventive care upfront,
which allows more beneficiaries to stay in their communities and
reduces the rate of hospitalization.
In Wisconsin, about 26 percent of all Medicaid recipients age 65 or
older are in nursing homes. This rate drops dramatically for those
enrolled in the Wisconsin Partnership Program, where only 5.9 percent
of recipients age 65 or older are in nursing homes.
While the Wisconsin Partnership Program is a success, we must ensure
that the Federal Government continues to support these State-based
solutions to our long-term care needs and other specialty managed care
programs that focus on frail, chronically ill seniors. Last year I
introduced the Frail Elderly Act of 2002, which promoted specialty
managed care programs and helped those already in existence to continue
to operate. This amendment will work to accomplish both goals by
providing a population-based designation that allows plans to be
recognized for specialization in services for special needs
beneficiaries. By establishing this specialized designation, we hope to
be able to more easily move specialized plans from demonstration status
to mainstream provider status, helping to promote a more effective way
of caring for the frail elderly and disabled.
Mr. President I also want to point out that this amendment does not
change payments, does not change administrative rules, and therefore
doe not have a fiscal effect.
Fundamental long-term care reform is vital to any health care reform
that
[[Page S8689]]
Congress may consider. As part of these reforms, we must support State
and local efforts to encourage care for the most vulnerable
populations. We must provide our seniors and disabled with real
choices. They are entitled to the opportunity to continue to live in
the homes and communities that they helped build and sustain. I urge my
colleagues to support this amendment that will help provide a measure
of support for the most frail elderly and disabled to allow them to
stay in their own homes.
Mr. President, I ask unanimous consent that two letters of support
for this amendment, from the Community Health Partnership and Elder
Care of Dane County be printed in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:
Community
Health Partnership, inc.,
Eau Claire, WI, June 26, 2003.
Hon. Russell Feingold,
U.S. Senate,
Washington, DC.
Dear Senator Feingold: I am writing to express my support
for the amendment you will be offering with Senator Gordon
Smith to create a designation for Medicare Advantage plans
that target special needs beneficiaries. Community Health
Partnership, Inc. (CHP) is one of four Wisconsin Partnership
Program demonstration sites that has developed innovative
models of care specifically for frail seniors and people with
physical disabilities that would benefit from a specialty
designation.
The Wisconsin Partnership Program (WPP) is an integrated
program of acute and long-term care services designed to
improve access to needed care, reduce fragmentation of care
across providers and settings, and help people remain
independent in the community, while achieving cost savings.
The target populations for WPP include both elderly and
physically disabled individuals who meet nursing home level
of care criteria. CHP serves both populations in a 3 county,
rural area. Participants must be Medicaid eligible or dually
eligible for Medicare and Medicaid services. A hallmark of
this program is the use of an inter-disciplinary care team
comprised of a physician, nurse practitioner and social
worker that help coordinate beneficiaries' care across all
health care settings. The WPP also participates in the
Medicare/Medicaid Integration Program, a demonstration to
test strategies for integrating Medicare and Medicaid
services. The goal of this program is to create a seamless
system of care for beneficiaries and to reduce costs related
to duplication of services and administrative functions
across programs.
Like a number of other specialty Medicare+Choice programs,
the WPP currently operates under demonstration authority,
which expires at the end of next year. And, like virtually
all Medicare demonstration programs, there is no mechanism
for transitioning from demonstration status into the
mainstream of Medicare. I understand that The Medicare
Prescription Drug and Reform Act of 2003 begins to address
this problem by establishing a special designation for
specialized Medicare Advantage plans that exclusively serve
special needs beneficiaries. Your amendment would allow the
Secretary also to designate as specialized Medicare Advantage
plans those that disproportionately serve special needs
beneficiaries.
The expansion of the specialized Medicare Advantage
designation would provide CHP and other WPP members
additional flexibility in expanding our unique program to
other beneficiary groups such as those who are eligible for
Medicare, but not Medicaid and ``pre-duals''--those who are
at risk of spending down to Medicaid based on health status
and/or income limitations. Targeting healthy beneficiaries
before they become frail or disabled would reduce long-run
Medicare and Medicaid costs by preventing or delaying health
care decline and the need for costly medical or long-term
care services. Your amendment also would offer CHP a
mechanism to serve non-special needs beneficiaries as a
strategy for expanding our membership under a mainstream
model or reducing our risk through a more representative
cross-section of Medicare beneficiaries in West Central
Wisconsin.
Your compassion for seniors, disabled and other special
needs beneficiaries has been evident since you served as the
Chair of the Senate Aging Committee in the State of
Wisconsin. The amendment you are offering to the Senate
Medicare bill only provides further evidence that you
continue to be hard at work on behalf of Wisconsin's most
vulnerable populations. Thank you for all of your work on
behalf of Wisconsin's seniors.
Sincerely,
Karen A. Bullock,
CEO.
____
Elder Care of Dane County,
Madison, WI, June 24, 2003.
Hon. Russell Feingold,
U.S. Senate,
Washington, DC
Dear Senator Feingold: I am writing to express my support
for the amendment you will be offering with Senator Gordon
Smith to create a designation for Medicare Advantage plans
that target special needs beneficiaries. Elder Care of Dane
County is one of four Wisconsin Partnership Program
demonstration sites that has developed innovative models of
care specifically for frail seniors and people with physical
disabilities that would benefit from a specialty designation.
The Wisconsin Partnership Program (WWP) is an integrated
program of acute and long-term care services designed to
improve access to needed care, reduce fragmentation of care
across providers and settings, and help people remain
independent in the community, while achieving cost savings.
The target populations for WWP include both elderly and
physically disabled individuals who meet nursing home level
of care criteria. Elder Care Partnership serves frail elderly
beneficiaries. Participants must be Medicaid eligible or
dually eligible for Medicare and Medicaid services. A
hallmark of this program is the use of an inter-disciplinary
care team comprised of a physician, nurse practitioner and
social worker that help coordinate beneficiaries' care across
all health care settings. The WWP also participates in the
Medicare/Medicaid Integration Program, a demonstration to
test strategies for integrating Medicare and Medicaid
services. The goal of this program is to create a seamless
system of care for beneficiaries and to reduce costs related
to duplication of services and administrative functions
across programs.
Like a number of other speciality Medicare+Choice programs,
the WWP currently operates under demonstration authority,
which expires at the end of next year. And, like virtually
all Medicare demonstration programs, there is no mechanism
for transitioning from demonstration status into the
mainstream of Medicare. I understand that The Medicare
Prescription Drug and Reform Act of 2003 begins to address
this problem by establishing a special designation for
specialized Medicare Advantage plans that exclusively serve
special needs beneficiaries. Your amendment would allow the
Secretary also to designate as specialized Medicare Advantage
plans those that disproportionately serve special needs
beneficiaries.
The expansion of the specialized Medicare Advantage
designation would provide Elder Care and other WWP members
additional flexibility in expanding our unique program to
other beneficiary groups such as those who are eligible for
Medicare, but not Medicaid and ``pre-duals''--those who are
at risk of spending down to Medicaid based on health status
and/or income limitations. Targeting healthy beneficiaries
before they become frail or disabled would reduce long-run
Medicare and Medicaid costs by preventing or delaying health
care decline and the need for costly medical or long-term
care services. Your amendment also would offer Elder Care a
mechanism to serve non-special needs beneficiaries as a
strategy for expanding our membership under a mainstream
model or reducing our risk through a more representative
cross-section of Medicare beneficiaries in Madison.
Your compassion for seniors, disabled and other special
needs beneficiaries has been evident since you served as the
Chair of the Senate Aging Committee in the State of
Wisconsin. The amendment you are offering to the Senate
Medicare bill only provides further evidence that you
continue to be hard at work on behalf of Wisconsin's most
vulnerable populations. Thank you for all of your work on
behalf of Wisconsin's seniors.
Sincerely,
Karen Musser,
CEO.
Mr. HATCH. Mr. President, I rise to speak on the Gregg-Schumer
amendment which was adopted last week. This amendment was based on a
piece of legislation, S. 1225, the Greater Access to Affordable
Pharmaceuticals Act of 2003, reported by the HELP Committee on June
11th.
I want to take this opportunity to explain why I cast the lone vote
against this amendment. It is my hope that when my colleagues consider
my explanation that they may be open to making additional changes to
this very important amendment as the process moves forward.
Let me start by commending Senators Gregg, Schumer, McCain, and
Kennedy for their work in developing this provision which I believe is
a significant improvement on legislation that was adopted by the Senate
last Congress, S. 812.
The Gregg-Schumer amendment relates to a complex and often admittedly
confusing law I coauthored with my friend, Representative Henry Waxman
of California in 1984 the Drug Price Competition and Patent Term
Restoration Act.
I chaired a hearing of the Senate Judiciary Committee in May of 2001
that helped document some abuses that were occurring in the law. Since
our last hearing on this issue, much has happened.
Both the Federal Trade Commission and the Food and Drug
Administration played a constructive role in attempting to end several
mechanisms by which some research-based and generic
[[Page S8690]]
drug firms were attempting to game the system put in place by the 1984
and subsequent court decisions to avoid competition in the marketplace.
The FTC succeeded in achieving several widely-publicized consent
decrees with a variety of offending firms under the existing antitrust
statutes.
In addition, the FTC conducted an exhaustive survey and study of how
certain provisions of the 1984 Waxman-Hatch Act affected competition in
the pharmaceutical industry.
The FTC study contained two major recommendations. The first
addressed the use of the statutory 30-month stay granted by the 1984
law in situations where patents are challenged by generic competitors.
The FTC recommended that the law:
Permit only one automatic 30-month stay per drug product
per ANDA to resolve patent infringement disputes over patent
listed . . . prior to the filing date of the generic
applicant's ANDA.
This was precisely the position that I suggested in testimony before
the HELP Committee on May 8, 2002 and argued for last year during the
Senate debate on the Edwards-Collins substitute amendment to the
McCain-Schumer legislation.
I would note that the 30-month stay provision in the McCain-Schumer
bill last year, S. 812, and in the Edwards-Collins substitute, were
both at variance with this central recommendation of the FTC report.
The second major FTC recommendation responds to those situations in
which R&D and generic firms were entering into agreements not to impede
generic competition. The FTC recommended that Congress:
Pass legislation to require brand-name and first generic
companies applicants to provide copies of certain agreements
to the Federal Trade Commission.
Senator Leahy, working very closely with the FTC, developed
legislation, the Drug Competition Act, S. 946, that squarely addressed
this second recommendation.
During the 107th Congress, I worked with Senator Leahy on refining
that bill. I supported it in committee, and worked with him to pass it
through the Senate late last year. I supported his efforts to have it
attached to the Medicare vehicle earlier this week. I expect that the
108th Congress will adopt this measure.
The FTC study served an important purpose of cataloging the facts
surrounding certain abuses of the 1984 act. In formulating public
policy, the facts should matter and a legislative or regulatory
response should be tailored to fit the problem.
Unfortunately, the timing of the issuance of FTC study did not allow
the report to get the attention it deserved by the Senate. The FTC
report was published only one day before the Senate adopted S. 812, the
Greater Access to Affordable Pharmaceuticals Act of 2003, last July
31st.
The GAAP Act, developed by Senators McCain and Schumer, was
substantially altered by the Edwards-Collins substitute, with active
involvement of Senator Kennedy.
While there is no question my colleagues were motivated by their goal
of making drugs more affordable for seniors and all Americans, and
despite the fact that it garnered 78 votes in the Senate, there were
significant shortcomings in the bill.
Let me briefly review a few of the most troublesome provisions of the
Edwards-Collins substitute to S. 812. The proposed legislation would
have created for the first time a private right of action in the
Federal Food, Drug, and Cosmetic Act. The last thing the already
overburdened FDA staff needs is a bunch of trial lawyers bringing the
agency to a screeching halt by second-guessing its judgment calls.
The bill that passed last year would have resulted in the waiver of
patent rights apparently against even third parties--if pioneer drug
firms did not file its patents with the FDA and, if challenged by a
generic drug applicant, pursue expensive litigation within tight time
frames.
In sharp contrast to the FTC recommendation, S. 812 basically made
any patents listed with the FDA after a month from the date the pioneer
drug application was approved by the FDA ineligible for the 30-month
stay. In most cases, this is at least four years earlier than what I
and the FTC recommended--freezing the Orange Book to patents listed
before a generic drug application was filed.
The American Intellectual Property Law Association opposed S. 812.
The patent-dependent biotech industry worked against the bill. The
Patent and Trademark Office found that ``S. 812 would forfeit
unnecessarily the core right of patent holders--the right to exclude
others from practicing the inventions for the entire patent term. After
years of research and development and significant investment, the
patent right is extinguished for the mere failure to satisfy an
administrative task or respond in a timely manner.''
Here is what the July 18, 2002 Statement of Administration Policy
said about the Edwards-Collins-McCain-Schumer legislation:
. . . the Administration opposes S. 812 in its current form
because it will not provide lower drug prices. S. 812 would
unnecessarily encourage litigation around the initial
approval of new drugs and would complicate the process of
filing and protecting patents on new drugs. The resulting
higher costs and delays in making new drugs available will
reduce access to new breakthrough drugs. Moreover, the new
cause of action is not necessary to address patent process
abuses. Clearly, the bill would benefit from consideration by
the Senate's experts on Hatch-Waxman law on the Judiciary
Committee, the proper committee of jurisdiction for this
bill.
While S. 812 passed by a very wide margin, it was certainly not
without its critics.
Comes now S. 1225. This bill emerged from the HELP Committee. Once
again, it is entitled the Greater Access to Affordable Pharmaceuticals
Act. Once again, it is cosponsored by Senators McCain, Schumer, and
Kennedy.
Due in large part to the leadership of Chairman Gregg, there are
significant changes in the bill compared with last year's legislation.
While I have significant concerns over certain aspects of S. 1225 as
adopted in its amended form on June 19, 2003, I must acknowledge
Chairman Gregg and Majority Leader Frist for their roles in working
with the cosponsors of last year's bill to make substantial
improvements in the legislation.
Likewise, I commend Senators Schumer, McCain and Kennedy for
abandoning many of the troublesome features of a bill that garnered 78
votes last Congress.
I can only believe that the factual presentation, analysis, and
recommendations contained in the FTC report and subsequent public
notice and comment process surrounding the recently-issued FDA final
rule on patent listings and the application of the statutory 30-month
stay both played a constructive role in helping to form the basis of
the Gregg-Schumer legislation.
It is appropriate to recognize the efforts of the Bush administration
for tackling the problem of multiple, successive 30-months stays
through rulemaking. Secretary Thompson, Commissioner McClellan, and FDA
Chief Counsel Dan Troy, should be saluted for their roles in so
promptly completing a rulemaking regarding patent listing that
generally embraced the one-and-only-one 30-month stay policy
recommended in the FTC Report. Chairman Muris and the FTC staff deserve
credit for a report that helped shape a more carefully targeted policy
response.
There can be no doubt that this year's vehicle, S. 1225, is superior
to S. 812. This new Gregg-Schumer bill, S. 1225, embraces exactly the
type of one-and-only-one 30-month stay policy that I suggested to the
HELP Committee last May, argued for on the floor last July, and was
ultimately recommended by the FTC.
The Gregg-Schumer legislation, S. 1225 in the form adopted by the
Senate, also addresses some problems that the FDA rule perhaps did not
resolve satisfactorily. As FDA Chief Counsel Dan Troy stated at the
June 17th Judiciary Committee hearing:
We tried as best we could to cut down on all opportunities
for gaming. We did not succeed in cutting down all
opportunities for gaming, because nothing, no legislation is
so good, no rule could be so good as to cut down all
opportunities for gaming, because there are unforeseen
circumstances and unintended consequences.
I think Mr. Troy is correct about the nature of the inherent
limitations of regulatory and legislative fixes for complex problems
where there are powerful incentives to game the system to gain
financial advantage. We need to
[[Page S8691]]
keep this in mind as we analyze further the amendment the Senate
adopted last week.
As I stated at the June 17th hearing, it was unfortunate that the PTO
was unable to present a witness. Admittedly, the invitation was issued
on short notice. I have asked PTO for its formal comments on the Gregg-
Schumer amendment. I would also be interested in the PTOs comments on
whatever language the House adopts. We would also be wise to hear from
the Office of the United States Trade Representative if USTR finds that
the legislation raises any concerns for international trade and
intellectual property under the TRIPS provisions.
It is my understanding that FDA and FTC staff provided a great deal
of what is known as ``technical assistance'' on the Gregg-Schumer
amendment, a good deal of it between the markup on June 11th and the
time the amendment was offered on June 19th. I am not aware whether PTO
or USTR were consulted.
PTO and USTR should understand that this is a fast moving train, so
they should be prepared to give us any comments they may have in short
order. President Bush and the congressional leadership have made it
plain that they expect the conference report on the Medicare bill to be
completed as soon as possible.
One special area of concern to me as Chairman of the Judiciary
Committee is that one provision of the amendment overwhelmingly adopted
by the Senate raises significant issues with respect to civil justice
policy, including a constitutional concern. Specifically, proposed
section 271(e)(5) of title 35, would make the failure of a patentee to
file a patent infringement action within a specified time frame
sufficient to establish ``an actual controversy'' for the purpose of
establishing subject matter jurisdiction for a declaratory judgement
action by a generic drug firm challenging a patent.
Whether the Congress can, or should, by statute grant subject matter
jurisdiction for a declaratory judgment based on the failure to bring a
suit raises some interesting questions, particularly in light of manner
in which the U.S. Courts of Appeals, including the Federal Circuit,
have developed and applied the ``reasonable apprehension'' test. At our
June 17th hearing, DOJ did not present the Judiciary Committee with its
final opinion on the matter but Mr. Sheldon Bradshaw, Deputy Assistant
Attorney General, Office of Legal Counsel, noted, ``that the actual
case of controversy requirement is constitutionally compelled rather
than statutorily required. And as a result, Congress can't simply
create a case or controversy by statute but the plaintiffs must
establish the constitutional requirement for bringing the case.'' The
committee has received a spirited correspondence that takes differing
views on the case or controversy provision of the Gregg-Schumer
amendment.
I have requested the Department of Justice for its formal views on
this language. At this point, I think it premature to embrace this
language. It is my understanding that the bill that the House will take
up does not contain the controversial case or controversy language. I
stand prepared to work with the sponsors of the amendment, DOJ and
others on this important issue.
Yet another improvement of S. 1225 over the bill adopted by the
Senate last year relates to the manner in which the 180-day rule is
addressed. In short, I am pleased that the policy embraced last year,
the rolling exclusivity policy, was replaced in favor of a ``use it or
lose it'' approach. I have long stated a preference for the consumer
friendlier ``use it or lose it'' rule over the too open-ended rolling
exclusivity.
The Waxman-Hatch law provides an incentive for generic firms to
challenge patents. To encourage generic competitors to pursue patent
challenges in a vigorous fashion, the 1984 law provided 180 days of
marketing exclusivity in situations where a generic drug firm could
show the pioneer's patents were invalidated or not infringed. For many
years it was thought, as intended, that this valuable 180-day period of
exclusive marketing would be granted to the first generic firm to
successfully invalidate or invent around the pioneer's patents.
FDA regulations issued in 1994 required that the first generic
applicant had to defend successfully against a patent claim made by a
brand name company to receive the 180-day exclusivity. In a 1998 D.C.
Circuit case, Mova v. Shalala, the court construed the plain language
of the statute to strike down the successful defense requirement. As a
result FDA now makes 180-day exclusivity decisions by applying the
literal words of the statute. This results in a system that rewards
first filers, not necessarily successful challengers.
The Gregg-Schumer amendment retains the preference for first filers.
I believe that re-instating the successful defense requirement may
prove preferable than intentionally sanctioning a first filer regime.
Frankly, I am uncertain of the policy justification for S. 1225's
retention of granting the 180-day reward to the first filer rather than
the first successful defendant. I believe that there is a lot to be
said for giving the reward to the actual winner in court or the first
not to be sued, not just the first one to enter the Parklawn Building
with an application.
The amendment places a high premium on being a first filer. At our
hearing last week, FTC Chairman Muris characterized the rush to be a
first filer as ``the shantytown problem of people in line to file.''
FDA Chief Counsel Troy described that ``. . . right now, there are
sometimes limousines, sometimes vans, sometimes cars, sometimes even
tents in the Metro North parking lot that come days, weeks, and in some
cases even months in advance of a particular date. Why we should reward
someone because they camp out longer in the parking lot is a good
question?''
I am concerned that the language that passed the Senate could allow
some unintended and, in fact, counterproductive, results. Changes in
current law with respect to the court decision and commercial marketing
triggering mechanisms for the 180-day exclusivity provision demand
careful attention and analysis. The amendment does not appear to adopt
all the FTC recommendations in this area.
Other questions should be raised. What if, for example, the generic
applicant that successfully challenges the validity of the patent is
not also a first filer? Why should such a non-first filing but
successful invalidity challenger not be granted the 180 days
exclusivity? Stated another way, why should the first filer--or in
Chairman Muris' ``shantytown'' situation, a whole group of first-day,
exclusivity-sharing, first-filers, gain while the actual successful
challenger waits out the 180-days? I am not sure that such an outcome
is fair or even rational. Moreover, such a system may not result in the
most efficient or aggressive pursuit of patent challenges.
One thing is for sure: You can expect a lot more first filers to
appear at the door of the FDA building on the first day that successful
drugs become eligible for patent challenges. As I pointed out at the
Judiciary Committee hearing, some have already suggested that the first
to file system might result in an increase in willful infringement
cases. In fact, there was a decision last month by a Federal court in
Chicago that ruled against a generic firm which filed a generic drug
challenge before obtaining the opinion of outside counsel on either
non-infringement or invalidity.
Another type of potential problem could arise, and frankly I am not
certain how it can be avoided, if a non-first filing generic drug
challenger wins a court decision on grounds of non-infringement. Unless
I am wrong in my understanding of the Gregg-Schumer amendment, a
generic challenger that prevailed on a non-infringement theory would
have to wait for the 180-days granted the first filer, or a group of
first-day, first-filers, to expire before the non-infringing firm could
enter the market. Such an outcome only hurts consumers by needlessly
delaying introduction of the non-infringing generic product for 180
days.
Unlike a determination of patent invalidity, a finding of non-
infringement does not accrue to third parties. It is important to
understand that there are two ways for a generic firm patent challenger
to be awarded the 180-day exclusivity under the law. First, the generic
challenger can show that the pioneer's patent is invalid. And second,
the generic challenger can demonstrate
[[Page S8692]]
that its product will not infringe a pioneer's patent.
These are two very different theories. Al Engelberg, a highly
successful and highly respected attorney engaged by generic drug firms
to attack pioneer patents, has made the following observation about the
difference between invalidity and non-infringement challenges:
In cases involving an assertion of non-infringement, an
adjudication in favor of one challenger is of no immediate
benefit to any other challenger and does not lead to multi-
source competition. Each case involving non-infringement is
decided on the specific facts related to that challenger's
product and provides no direct benefit to any other
challenger. In contrast, a judgment of patent invalidity or
enforceability creates an estoppel against any subsequent
attempt to enforce the patent against any party. The drafters
of the 180-day exclusivity provision failed to consider this
important distinction.
As one of the drafters of the 1984 law, I must accept a measure of
responsibility for this problem. It is not clear, however, that S. 1225
has addressed this issue in a satisfactory fashion. The language
adopted in the Gregg-Schumer amendment does not appear to solve the
problem created by the 1998 Mova decision that effectively eliminated
the successful defense requirement.
Frankly, I think we need further thought on how best to address the
implications of the distinction between invalidity and non-infringement
claims in the context of Hatch-Waxman patent challenges and 180-day
exclusivity awards. Specifically, I question the appropriateness of
continuing to group together patent invalidity and patent non-
infringement challenges, particularly in light of the fact that the
latter may in practice extend longer than the purported 180-day award.
From what I know now, there are strong arguments to prefer the
reinstatement of the successful defense requirement over the
establishment of a new system based on first filing.
Let me close by once again commending Senators Gregg, Schumer,
McCain, and Kennedy for all their hard work in reaching the compromise
amendment that was so overwhelmingly adopted by the Senate. The Gregg-
Schumer amendment represents significant improvement over the
legislation passed by the Senate last year. I am pleased that the
amendment adopts the one-and-only-one 30-month stay policy that I, and
the FTC, advocated last year.
I am also pleased that the Senate has adopted Senator Leahy's Drug
Competition Act, which also addressed a major recommendation of the
FTC. I have worked with Senator Leahy to perfect and pass this measure.
As a co-author of the 1984 Drug Price Competition and Patent Term
Restoration Act, I support efforts to bring affordable and innovative
drugs to the American public. While I support the spirit and much of
the letter of the Gregg-Schumer amendment, for the reasons I have set
forth, I was unable to fully support this measure at this time.
Mr. BUNNING. Mr. President, during consideration of S. 1, an
amendment was introduced by Senators Santorum and Schumer dealing with
payments to the Medicare+Choice program. This amendment would have
increased payments to the M+C plans over the next 2 years, to make sure
they are still viable when the MedicareAdvantage program takes effect
in 2006.
I realize the amendment was withdrawn because of the lack of funding
in the Senate bill, but it is still an important issue I would like to
lend my support to.
The Medicare+Choice program already provides a good prescription drug
benefit to many seniors across the county, and gives these seniors
another option to the Medicare fee-for-service program.
Unfortunately, many Medicare+Choice plans are pulling out of the
program because their reimbursement levels are too low. This is leaving
many seniors scrambling for a new Medicare+Choice plan or having to go
back into fee-for-service Medicare which doesn't offer them the same
types of benefits as their old M+C plan.
In fact, it seems like every year, more and more Medicare+Choice
plans leave the market.
I am concerned if we do not provide these plans with enough funding
over the next two years while the MedicareAdvantage program is being
implemented, these M+C plans will continue to leave the program and
more seniors will be left in the lurch.
This isn't fair to our seniors.
I had hoped we could provide some additional funding for the
Medicare+Choice plans over the next 2 years so the plans currently in
the program will remain and we might actually attract new plans to
other areas that have not been served.
In Kentucky, we have a limited number of Medicare+Choice plans. In
fact, only seniors in certain counties in Northern Kentucky and around
Louisville have access to these plans. With higher payments to
Medicare+Choice plans, we might actually get some more plans to come
into our state and cover more counties.
We shouldn't give up on the Medicare+Choice plans, or the seniors
enrolled in them. I hope this is an issue we can resolve during the
conference with the House, and I commend Senators Santorum and Schumer
for bringing this issue before the Senate.
Mr. LEAHY. Mr. President, I am pleased that late last night the
Senate again supported lowering drug prices and maintaining a fair
generic drug approval process by adding the Drug Competition Act of the
Prescription Drug and Medicare Improvement Act of 2003, S. 1. Last
November, the Drug Competition Act passed the Senate by unanimous
consent. On Monday, Senator Grassley and I, along with Senators
Cantwell, Durbin, Feingold, Kohl, and Schumer, offered our bill as an
amendment to the larger Medicare bill. 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 they 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 versions.
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
practice that hurts American families, particularly senior citizens, by
denying them access to low-cost generic drugs, and further inflating
medical costs.
Last July, the Federal Trade Commission released to 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 manufactures 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 commonsense 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-
[[Page S8693]]
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 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 cost 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 am pleased that my colleagues have recognized that it fits
well within the framework of the Prescription Drug and Medicare
Improvement Act of 2003. It is a good complement to the larger bill and
does nothing to disrupt the bill's balance. I sincerely hope that this
commonsense legislation is a part of any final agreement with the House
on the larger Medicare prescription drug bill.
(At the request of Mr. Daschle, the following statement was ordered
to be printed in the Record.)
Mr. KERRY. Mr. President, I wish to express my enthusiastic
support for the amendment Senators Schumer and Santorum offered to
increase funding for the Medicare+Choice Program in 2004 and 2005. This
amendment addresses a critically important issue that has far-reaching
implications affecting the health care benefits of millions of low-
income and minority seniors. I am pleased to be a cosponsor of this
amendment to ensure that this urgently needed funding increase is
included in the Medicare bill.
I believe we must take bold action to address the fact that Congress
has not provided adequate funding for the health care of Medicare
beneficiaries who select HMOs and other private sector health plans. In
many parts of Massachusetts, and in other parts of the country, funding
for Medicare+Choice plans has been limited to annual increases of only
2 percent in most years since 1998. These increase are inadequate at a
time when health care costs are rising by 8 to 10 percent annually.
This level of inadequate funding is unfair to the 170,000 Medicare
beneficiaries in Massachusetts who have selected private health plan
options. I am a strong supporter of the wonderful health plans we have
in Massachusetts--Harvard, Tufts, Blue Cross/Blue Shield, and Fallon
Community Health Plan. We must step up to the plate to help these
plans--nonprofit plans in my State--in their time of need.
The Schumer-Santorum-Kerry amendment takes important steps to address
this problem. By providing funding now to stabilize existing private
health plan options for Medicare beneficiaries, we can help ensure that
the proposed Medicare Advantage Program will be successful in the
future. Our amendment lays the groundwork for successful long-term
efforts to provide beneficiaries with high-quality health care choices.
As the Senate continues to debate changes in Medicare, it is
important for us to remember that, for more than 4.5 million Medicare
beneficiaries across America, Medicare+Choice is an essential program
that provides high-quality, comprehensive, affordable coverage that is
not always available, or affordable under the Medicare fee-for-service
program. These seniors and disabled Americans have voluntarily chosen
to receive their health coverage through Medicare HMOs and other
private sector plans because they recognize the value they offer.
Seniors in Massachusetts have come to rely on the high-quality health
care they receive through their Medicare+Choice plans. Prescription
drugs coverage, disease management services, physician exams, vision
benefits, and hearing aids are examples of the additional benefits that
are routinely offered by their Medicare+Choice plans.
These additional benefits are valued by all seniors, but they are
particularly important to low-income seniors who cannot afford other
Medicare supplementary plans that might provide them such benefits but
at a greater cost.
As the Medicare debate moves forward, it is important for Congress to
remember that Medicare+Choice serves as a vital safety net for many of
our Nation's most vulnerable seniors. For millions of beneficiaries who
cannot afford to purchase a Medigap policy, Medicare+Choice is their
only hope for obtaining comprehensive health coverage.
The Schumer-Santorum-Kerry amendment focuses on protecting this
important option for seniors who have nowhere else to turn for the
quality health coverage they need. I urge my colleagues to support the
additional funding that is urgently needed to strengthen the
Medicare+Choice Program for seniors. This should be among our highest
priorities in this year's Medicare debate.
Mr. CARPER. Mr. President, when I ran for the U.S. Senate, I promised
Delawareans that I would work in a bipartisan fashion to provide a
Medicare prescription drug benefit for our Nation's seniors. I pledged
that I would seek consensus around what is right with competing
Republican and Democratic plans. Along with my Democratic colleagues, I
would support voluntary coverage that is available and affordable for
all seniors. Along with my Republican colleagues, I would support
choice and competition to constrain costs. And to the extent we found
ourselves constrained by limited resources, I would seek to provide the
greatest assistance to those with the greatest needs.
The bill before us today achieves some of that vision. It is
bipartisan. It will provide a benefit available to all seniors on a
voluntary basis. It will harness market forces to strengthen the
integrity of the Medicare Program for the future. And it will provide
comprehensive health security to our most vulnerable, low-income
seniors.
Still, the bill we have before us today is not everything I would
have hoped for. The overriding priority of the current majority here in
Congress has been to make dramatic reductions in Federal revenues
without corresponding reductions in Federal spending. As a result,
there is insufficient money in the budget under which we are currently
operating to provide the kind of comprehensive coverage that all
seniors--not just low-income seniors--truly deserve. This is an
unfortunate choice of priorities, I think, but it is the choice that
this President and this Congress have made.
Unfortunately, the consequences of the majority's misguided
priorities are evident in this legislation. When Medicare was created,
the idea was to provide seniors with health coverage that was similar
to the coverage available to most working Americans through their
employers. This is what seniors expect when we say that we are
providing them with a Medicare prescription drug benefit. However, the
majority has only set aside for this bill about half of what it would
take, according to the Congressional Budget Office, to provide seniors
a benefit comparable to standard employer-provided coverage. Thus,
there is a very noticeable gap in this bill's coverage, reflective of a
substantial hole in our Nation's budget.
When seniors reach $4,500 in prescription drug costs, the coverage in
this bill gives out. It does not kick back in until total spending
reaches $5,800. It is widely acknowledged that this makes no sense. It
makes no sense from an insurance perspective. It certainly is not
reflective of the standard either in private employer-provided coverage
or in the coverage provided to those of us who are fortunate enough to
serve as Members of Congress. Nobody likes this gap in coverage.
Nobody, so far as I can tell, defends it. However, because the root of
problem is the majority's failure to set aside sufficient resources for
this program, efforts to deal with the problem have only created new
and potentially more serious difficulties.
For example, the authors of this legislation have attempted to narrow
the coverage gap by not allowing employer contributions to count
towards the calculation of seniors' out-of-pocket
[[Page S8694]]
spending in the gap. To see how this works, we need to understand how
the coverage gap works. Once seniors reach $4,500 in total drug costs,
they fall into the coverage gap. They then have to spend a certain
amount of their own money--in the final bill reported out of the
Finance Committee it is $1,300--before their coverage resumes, or they
get out of the coverage gap.
The effect of not allowing seniors to count payments made by their
retiree health plans toward this out-of-pocket requirement is to ensure
that seniors will remain in the gap longer and fewer will get out of
it. This allows the level of spending at which the gap ends to be set
at a lower level than would otherwise be possible for the same
budgetary cost. The problem with this, however, is that it also
provides an unintended incentive for employers to drop or scale back
their retiree drug coverage.
Thankfully, contributions from State prescription drug plans, like
our Delaware Pharmacy Assistance Program, count toward the out-of-
pocket requirement, which should encourage States to ``stay in the
game.'' Employers, though, are effectively barred from wrapping their
coverage around Medicare in the way that would be most beneficial for
their retirees, which would be by filing Medicare's coverage gap.
In the course of our consideration of this legislation here on the
floor of the Senate, I have urged my colleagues to address these
shortcomings in the bill, even if that means reconsidering the
majority's budget plan and the resource allocation for this program. I
supported an amendment by Senator Boxer to eliminate the gap in
coverage. And I cosponsored an amendment offered by Senator Rockefeller
to allow employer-provided coverage to wrap around the Medicare benefit
and thus to eliminate the incentive for employers to drop coverage for
their retirees.
The majority has made clear, however, that they are unwilling to
reorder their priorities or to emplore the possibility of finding the
necessary resources elsewhere in the budget to fix what they
acknowledge are shortcomings in this legislation. Thus, the rest of us
are left to choose between a prescription drug benefit that provides
some, but not all, of the assistance that seniors deserve, or no
prescription drug benefit at all.
Congress has been debating this issue for more than a decade. In many
ways, it has been debating the issue since Medicare was first created
back in 1965. I ran for the Senate in part because I was frustrated at
the inability or unwillingness of the parties in Washington to come
together to do what they could to solve problems and get things done. I
am unwilling to walk away from the table this year with nothing for
Delaware's seniors. They have waited too long and the need is too
great.
In light of the budgetary priorities of the Republican majority, I am
also very concerned about our future prospects. Should we let the
present opportunity pass us by? I am concerned that if we do not act to
get started with prescription drug coverage this year, even the limited
resources that now remain may go out the door for other purposes--most
likely another round of top-heavy, upper bracket tax cuts.
This is a first step. It is a downpayment. Just as I pledged when I
ran for the Senate to work in a bipartisan fashion to get results, I
pledge today to continue to work to build on these results. I continue
to believe that we should provide our seniors with quality coverage
without caps or gaps. I will work to ensure that filling the gap of
coverage that exists in the present bill is given greater priority in
future budgets than it was in this year's Republican budget. I also
believe that it is a mistake to shun rather than welcome employer
efforts to wrap around the new Medicare benefit, and I will work to
rectify that mistake as we move toward implementation of this program
over the next few years.
Mr. President, it is often said that politics is the art of the
possible. The bounds of the possible are a bit narrower now than they
need, thanks to our Republican friends. But, as the ranking member of
the Budget Committee has said, this may be the best bill that could be
written under the constraints of the Republican budget. For that
reason, I commend the authors of this legislation--Chairman Grassley
and Senator Baucus, among others--for their work. I urge my colleagues
to support this compromise as an important, if limited, first step
toward addressing what clearly is a pressing priority, not just for our
elderly population, but for our Nation as a whole.
Mr. JEFFORDS. Mr. President, as we debate the Prescription Drug and
Medicare Improvement Plan of 2003, I would like to take a few minutes
today to speak in support of the overall bill, but I would also like to
highlight several provisions in the bill that are of particular
importance to me and my State of Vermont.
Over the last several days, we have focused much of our discussion on
the aspects of this bill related to prescription drugs and the Medicare
Advantage Program. These are clearly among the most important
provisions of this bill and these issues warrant the attention and
debate they are receiving. I especially appreciate the close
relationship this bill has to last year's tripartisan effort--which
effectively is the parent of the current bill Last year, my friends--
Senators Grassley, Snowe, Hatch, and Breaux--and I set out to design a
bill that provided a prescription drug benefit along with other
improvements, what we called ``enhancements,'' to the basic operations
of the Medicare Program. The tripartisan bill was good legislation--
something all of its original cosponsors were very proud to work on
together.
This year, I am pleased to say that the Grassley-Baucus bill is even
better than our effort from last year, and I commend Chairman Grassley
and Ranking Member Baucus for their leadership and initiative in
bringing it to the Senate floor.
One of the most important reasons that the Prescription Drug and
Medicare Improvement Act is stronger than the tripartisan plan from
last year is because it includes provisions that begin to resolve
longstanding inequities in payments to rural doctors, hospitals, and
other provisions. This problem can be stated simply. Rural health care
providers are paid less than providers in more densely populated areas
for the same exact services. Earlier this year, I joined with my
colleagues, Senators Hatch, Grassley, Lincoln, and Bingaman, in
introducing the legislation that addressed geographic inequities for
physician services by changes to the physician reimbursement formulas.
As many of our colleagues are aware, Senator Grassley fought to
include these rural provisions in the recent tax bill that was signed
by the President. And although I strongly disagreed with enacting
further tax cuts, I was doubly disappointed to see the rural health
provisions stripped out in the conference with the House. These unfair
geographic differences in reimbursement rates have gone on far too
long, and I am especially pleased to see reimbursement issues for rural
providers getting the attention they deserve--including the commitment
from the President to my friend from Iowa pledging his support for
rural health relief as part of the effort we have underway. I am,
therefore, very pleased to see that these provisions are included in
the chairman's mark and are now part of this bill.
I am also glad that Chairman Grassley and Ranking Member Baucus have
worked with me to address another inequity in the system. Critical
access hospitals provide care in the most remote regions of my State of
Vermont and all other rural States. These hospitals are small, yet
serve as critical resources to their communities. The managers have
agreed to include a provision in their amendment that will make a
technical correction to current law, allowing hospitals like the Mt.
Ascutney Hospital in Windsor, VT, to expand access to psychiatric and
rehabilitative services to the most vulnerable citizens in that
community.
I would also like to speak today in support of a provision in this
bill that establishes Medicare demonstration programs to improve health
care quality. I heard my friend from Montana speak yesterday about
quality and geographic disparities, and I know how committed he is to
improving the quality of services delivered under Medicare. Earlier in
this Congress, I was pleased that Senators Frist, Beaux, and Gregg
joined me in introducing S. 1148, the Medicare Quality Improvement Act.
I want to thank Chairman
[[Page S8695]]
Grassley and Ranking Member Baucus for including this provision in this
bill.
I became concerned about the issue of health care quality after
reading the work of Dr. Jack Wennberg of Dartmouth, which has shown
that higher levels of Medicare spending do not lead to better health
outcomes. Let me repeat this finding. Higher levels of Medicine
spending do not lead to better health outcomes. Instead, spending tends
to vary by region--generally reflecting the availability of physicians
and hospitals--rather than the health or needs of the population.
I have followed Dr. Wennberg's work for a very long time. One of his
early studies looked at rates of surgical procedures at Vermont
hospitals. He found that communities in Vermont that had many more
medical procedures were not necessarily healthier. I saw how this
result led Vermont health care providers to join with the business
community in achieving high quality, supportable outcomes. I also saw
how our State government used this effort to improve health care across
our State. Today, I am happy to say that Vermonters enjoy some of the
highest quality health care in the United States, at a cost that is
among the lowest in the country.
As we prepare to vote for the bill before us, I think it is
critically important for us to consider some of the lessons learned
from Vermont. Some of my colleagues have expressed concern about the
costs of the bill before us. Others have expressed concern that the
bill does not go far enough. The quality demonstration program in this
bill will give us some of the answers we need to these funding
questions.
The need for these demonstrations is critical. RAND Health published
a study today in the New England Journal of Medicine that describes the
problems with overuse and underuse of needed medical care services in
the United States. The RAND study will make it clear that every
American is at risk--not only for failing to receive needed medical
care, but also for receiving care that is not needed and may even be
harmful. This is a problem that belongs to each and every one of us,
and we must find ways to fix it.
The legislation before us closes a significant gap in the health
benefit package available to our Nation's seniors. However, providing
coverage for health care services is not enough. We must do a better
job of ensuring that people are getting the care they need, and also
that they need the care they get.
In closing, I would like to urge my colleagues from both sides of the
aisle to support this bill as we move forward. This bill will establish
a drug benefit that is universal, comprehensive, affordable, and
sustainable. This bill restores necessary and long-needed fairness to
our physicians and providers in rural areas. And, the bill will improve
the quality of care offered under Medicare.
Mr. DORGAN. Mr. President, over the last 2 weeks the Senate has
debated the most significant changes to the Medicare Program since it
was created in 1965. Today, we passed this legislation by a 76 to 21
vote, and I would like to take a few minutes to explain why I supported
this bill.
This bill will, for the first time, provide the option of modest
prescription drug coverage for nearly 39 million Medicare
beneficiaries, including about 103,000 beneficiaries in North Dakota.
It is also intended to give Medicare beneficiaries more choices of
health plans. And it takes significant steps towards equalizing the
Medicare payments that rural health care providers receive, compared to
their urban counterparts.
There is no question that, if Medicare were being created today, it
would include prescription drug coverage. Prescription medicines are a
vital part of modern medicine. Last year alone, pharmaceutical
companies introduced 26 new prescription medicines into the
marketplace. But these advancements in medicine mean little if
Americans cannot afford to access them. That is especially true for
senior citizens who have reached their declining income years.
For years now, Congress has been debating proposals to add a
prescription drug benefit to Medicare. Unfortunately, however, in past
years we have not been able to reach agreement on just how to do this.
With each passing year, older Americans continue to struggle to pay for
their medicine. In North Dakota, about 48,000 Medicare beneficiaries
have no prescription drug coverage, and many more have limited drug
coverage. I hear from North Dakota seniors regularly who tell me that
they have to choose between taking the medicines their doctor
prescribed for them and other necessities such as food and heat.
These older North Dakotans say that they want and need Medicare drug
coverage, and they want and need it now. If Congress doesn't enact
legislation this year, chances are that several more years will go by
before there is another serious opportunity to consider this issue. In
other words, we could pass the legislation before the Senate today or
we could do nothing for yet another year. In my judgment, doing nothing
is not an option.
The prescription drug benefit in this bill is not as helpful to
seniors as I would like or as generous as I think Medicare
beneficiaries deserve--but it is a start.
Frankly, I think our budget priorities have been wrong. If I had my
way, Congress would have reduced the size of the tax cuts for the very
wealthy and instead set aside more money for improving and modernizing
Medicare. During the Senate's debate earlier this year on the budget, I
offered an amendment to set aside a total of $620 billion over the next
10 years for a Medicare prescription drug benefit. This is the amount
of funding I felt was needed to provide a more generous and reliable
benefit. Unfortunately, the majority in the Senate rejected my
amendment, so we are limited to a package of just $400 billion over 10
years. When you consider that Medicare beneficiaries are projected to
spend $1.8 trillion on prescription drugs over the next 10 years, it is
impossible to develop a robust benefit within the $400 billion budget
constraint, in my judgment.
The benefit provided for in this legislation is better than that
which President Bush proposed in several key respects. Most
importantly, this bill will not force seniors to leave the traditional
Medicare Program--and the doctors they depend on--in order to get the
prescription drug coverage they also need. I could not support a bill
that coerces seniors out of the traditional Medicare Program that
virtually all of North Dakota's Medicare beneficiaries rely on.
In addition, this bill provides extra assistance above the basic drug
benefit for those older or disabled beneficiaries who have low incomes
or very high drug expenses. Medicare beneficiaries with incomes below
about $14,400 for individuals and $19,400 for couples--about 40 percent
of North Dakota's beneficiaries--would qualify for extra assistance.
And those with the highest drug costs--totaling more than about
$5,800--would qualify for the catastrophic drug coverage. About 7
percent of North Dakota Medicare beneficiaries would reach this
threshold.
Despite these improvements over the President's proposal, there are
other concerns that I worked to address during the Senate's debate. In
some instances, we were able to make changes to address these concerns,
and in other cases, those efforts were rejected. In those instances
where concerns still exist, I intend to continue working to fix them in
conference with the House of Representatives.
For instance, as I have already mentioned, I am concerned that this
coverage is not as generous as it should be, and in fact, there are
some holes in the coverage. Under this benefit, seniors will have to
reach a $275 deductible before their Medicare drug coverage starts. In
addition, seniors whose drug expenses reach $4,500 will have to pay 100
percent of their drug costs between $4,501 and $5,800. Then, when their
drug spending reaches $5,800, the catastrophic drug coverage will kick
in and Medicare will pay 90 percent of their drug expenses after that.
This means that there could be periods--in some cases as much as 3
months--when Medicare beneficiaries will have paid a premium for drug
coverage but will be getting no benefit.
That makes no sense to me. No other insurance plans that I am aware
of include such gaps in coverage. I supported various amendments on the
Senate floor to close these coverage gaps or at least ensure that
seniors
[[Page S8696]]
don't have to pay premiums for the periods when they aren't receiving
coverage. Regrettably, however, those efforts were rejected.
I am also concerned that rural Medicare beneficiaries may not receive
a benefit that is as stable or as generous as other beneficiaries
receive. This bill envisions that seniors will basically have two
options for receiving drug coverage. First, this bill creates a new
Medicare Advantage Program through which beneficiaries could choose to
get their drug coverage, as well as the rest of their medical care,
through an HMO or a PPO. Frankly, however, I am very skeptical that
HMOs or PPOs will want to serve rural areas, and even if they do, I
don't think most North Dakota beneficiaries will want to leave the
traditional Medicare Program.
Those seniors who want to remain in the traditional Medicare Program
will be able to do so and get their prescription drug coverage through
private ``drug only'' insurance plans. Budget experts estimate that
Medicare beneficiaries who sign up for these drug-only plans will pay
an average monthly premium of about $35. However, this is only an
estimate, and the actual premium that seniors pay could vary
substantially from area to area. That is already the case in the
current Medicare HMO program--for instance, a Medicare HMO with drug
coverage currently charges $99 per month in Connecticut and only $16 a
month in Florida. I am worried that it would be rural seniors who would
pay the highest premiums, even though they paid the same Medicare
payroll taxes as other beneficiaries.
To address this concern, I supported an amendment by Senator Daschle
that would have limited the variation in premiums to only 10 percent
above the national average, no matter where beneficiaries live. In
other words, insurance companies could charge beneficiaries a lower
premium but they couldn't charge them more than 10 percent above the
national average. Unfortunately, however, Senator Daschle's amendment
was rejected.
In areas where there are not at least two private drug-only plans
offered to Medicare beneficiaries in any given year, Medicare would
step in and ensure that there is a ``fallback'' plan available. This is
a vital guarantee for beneficiaries in rural States like North Dakota
where I believe it is unlikely that there will be two stable drug-only
plans available. But even with this fallback plan, seniors could still
be bounced back and forth between different plans, depending on how
private plans move in and out of an area.
I supported an amendment that would have addressed this concern by
allowing all Medicare beneficiaries to choose the fallback option, no
matter how many private plans are available where they live. When that
amendment failed, I cosponsored an amendment with Senator Conrad that
would at least allow seniors who have the fallback option to remain in
that plan for 2 years, not just 1 year. That amendment was also
rejected.
Even though this bill doesn't require Medicare beneficiaries to leave
traditional Medicare, I know there are some concerns that Medicare
beneficiaries will be getting their drug coverage through private
plans. I, too, would strongly have preferred that all seniors be able
to choose from a Medicare-administered benefit.
However, let me say this if I felt that by structuring the drug
coverage the way it is in this bill, we were undermining the entire
underlying Medicare Program, I would not support it. Medicare has been
a wonderful success, and in our efforts to modernize it, we should
exercise extreme caution not to undermine it. However, virtually all of
the major Medicare prescription drug proposals would have used a
private entity in some way to provide the drug benefit. Indeed, the
traditional Medicare Program currently contracts with private insurance
companies to pay the millions of Medicare claims that come in each
year. Furthermore, the Congressional Budget Office estimates that only
1 to 2 percent more beneficiaries will choose the new Medicare
Advantage option, so it seems clear that the vast majority of seniors
will continue to rely on the traditional Medicare Program for the bulk
of their medical care.
One area where we had some success in improving the bill during the
Senate's debate is in the area of reducing drug costs. This bill relies
largely on private insurance companies to negotiate lower drug prices.
However, we have seen from prior experience that insurance companies
have not been able to keep drug spending from increasing by nearly
double digits every year 9.7 percent in 2002, 17 percent in 2001, 18.8
percent in 2000, and 16 percent in 1999.
To help put downward pressure on drug prices, I offered an amendment
that was passed by the Senate by a 62-to-28 vote to allow for the
reimportation of lower-priced, FDA-approved medicines from Canada. As
many North Dakotans know first hand, the same FDA-approved prescription
drug that costs $1 in the United States costs only 62 cents in Canada,
even though it is the exact same drug, in the same bottle, made by the
same manufacturer.
It is not my intention with this amendment to require Americans to go
to Canada in order to get lower drug prices. Rather, by allowing U.S.
licensed pharmacists and drug distributors to do the importing for
them, Americans can stay at home, and by breaking the monopoly that the
drug companies currently have on drug pricing in this country, we will
force a repricing of drugs here in the United States.
I also supported an amendment that will help to make more affordable
generic drugs more readily available. Generic drugs are safe,
effective, and lower priced alternatives to heavily advertised brand-
name prescription drugs. Unfortunately, however, some of the big brand-
name drug companies use loopholes in the patent laws to keep generic
drugs off the market for longer than intended. This amendment, which
passed the Senate by a 94-to-1 vote, will close these loopholes and
thereby speed consumers' access to generic medicines.
I am also pleased that this bill improves Medicare's coverage of
preventive services, especially by including a provision that I
authored to provide for a cholesterol screening benefit for Medicare
beneficiaries. I have felt for a long time that Medicare needs to do a
better job of preventing disease, rather than just paying to treat it.
In the case of cholesterol screening in particular, high cholesterol is
one of the major, changeable risk factors for heart attacks, stroke and
other cardiovascular diseases. Yet when Americans turn 65 and enter the
Medicare Program, their coverage for cholesterol screening stops unless
they already have cardiovascular disease. That makes no sense, and I am
glad the Senate has taken steps to provide this coverage.
Finally, I am very happy that this bill includes a range of
provisions that will make Medicare reimbursement more fair and
equitable for our rural hospitals, physicians, and other health care
providers. It is simply not right that Medicare has historically
reimbursed urban health care providers at a much higher rate than their
urban counterparts. This inequity in Medicare reimbursement has very
real consequences for hospitals and clinics in rural States like ours.
They have to reduce services, have greater difficulty recruiting staff,
are less able to make capital improvements, struggle to give their
patients access to the latest innovations in medical care, and in same
instances, they even have to close.
I have been fighting for a long time to correct this inequity. In
fact, some of the provisions in this bill are similar to legislation
that I introduced in the Senate earlier this year, and I am glad they
have been included in this bill.
I know there will be some who feel that this bill should have been
rejected by the Senate because it relies too heavily on private plans
and others because it does not place enough emphasis on enrolling
seniors in private plans. Others will feel that the Medicare benefit is
not generous enough, and some feel its coverage is too liberal. I agree
that this legislation isn't perfect--far from it, in fact. In the
coming months and years, I will continue working to improve it. But it
is a start in the right direction, and that is why I have supported it.
The House of Representatives is also expected to pass its version of
Medicare legislation this week. The House and the Senate will now need
to have a conference committee to work out the differences between the
two bills. I
[[Page S8697]]
have some serious concerns about the House-passed bill. I hope these
concerns and the concerns that I have with the Senate bill can be
resolved in the final bill, so that we can send a bill to the President
for his signature this year.
Mr. SARBANES. Mr. President, I rise today to speak on S. 1, the
Prescription Drug and Medicare Improvement Act of 2003. I applaud my
colleagues in working toward enactment of legislation to provide
prescription drug coverage under Medicare. However, I am deeply
concerned that the bill before us today would not ensure an affordable,
guaranteed benefit that would cover seniors' outpatient prescription
drug expenses.
Under this legislation, the Secretary of the Department of Health and
Human Services would temporarily issue prescription drug discount cards
for seniors until the drug benefit begins in 2006. At that time, all
Medicare beneficiaries would receive a standard prescription drug
benefit whether they remained in traditional fee-for-service or in a
private plan. For a $275 deductible and an estimated $35 per month, 50
percent of a beneficiary's drug costs would be covered up to $4,500. A
beneficiary would receive no coverage for drug costs between $4,501 and
$5,800, though they are still responsible for paying the monthly
premium during this coverage gap. Furthermore, any assistance provided
by employer-sponsored plans or third parties on behalf of the
beneficiary does not count toward the out-of-pocket costs. After drug
expenses reach $5,801, the plan would cover 90% of drug expenses.
The bill creates a new Medicare Advantage program, which would
replace Medicare+Choice, and create a new agency, the Center for
Medicare Choices, CMC, with authority parallel to the existing Centers
for Medicare and Medicaid Services. The CMC would administer the
Medicare Advantage program and the prescription drug plans. The drug
plans would be administered through private plans, but when no private
plans exist, the government would provide a fallback plan for seniors
in fee-for-service. However, if a new private plan decides to enter an
area, beneficiaries would again be forced to receive their coverage
through that plan.
If this sounds terribly confusing, it is. One hundred Senators and
their staffs found it difficult to work through this bill and
understand exactly how the benefit would work. Seniors who don't sign
up as soon as they are eligible are subject to a penalty similar to the
penalty imposed on those who delay enrollment in Part B. It is unfair
to expect seniors and their families to work through this web to make
an informed decision.
The complexity of this drug plan is only one of numerous flaws with
this bill. S. 1 does not provide a national fixed premium. The bill
sets out an estimate of a $35 monthly premium, but there is no
guarantee for seniors that they will not have to pay much more than
that estimate.
The bill has the serious potential to cause a number of retirees to
lose existing employer-sponsored prescription drug coverage. CBO
estimates that as many as 37 percent of Medicare beneficiaries would
lose existing coverage. This is an unacceptable consequence of
legislation that is supposed to make life easier for seniors. This
serious deficiency is the number one concern of constituents who have
called into my office about this bill.
The bill before us leaves a large gap in coverage and forces seniors
to continue premium coverage during that gap period. Seniors may have
to face months without any assistance, waiting to reach the limit where
catastrophic coverage begins. The seniors who fall into this coverage
gap are among the most ill, with severe chronic conditions and
prescription needs. It is difficult to support legislation that would
cease coverage for prescription drugs for seniors at the very time when
it is needed most.
Finally, because this proposal relies on private plans to deliver the
drug benefit, seniors could be forced to shift from plan-to-plan, year-
to-year as they did when Medicare+Choice HMOs pulled out of the
Medicare program a few years ago. In my own State of Maryland,
insurance companies left the Medicare program, abandoning more than
100,000 seniors.
This legislation makes our Nation's seniors the subject of an
experiment to which none of us should be willing to subject our parents
and grandparents. We don't know what the benefit is under this bill. We
don't know how much it will cost. We don't know how private plans will
participate and make a profit. We don't know how many seniors would
lose existing coverage. What we know is we are prepared to spend
approximately $400 billion over 10 years to create an inadequate drug
benefit, a new bureaucracy, and subsidies for private insurance
companies.
With modest additional resources, we could have closed the coverage
gaps in this bill. Amendments offered by my colleagues to provide
stability for seniors, move up the start date of the drug benefit,
eliminate beneficiary premiums during the coverage gap period, and
improve a variety of shortcomings have been defeated. We have lost so
many opportunities to make this bill something all Medicare
beneficiaries can support. I am hopeful that in the future we can
improve upon this and create a system that is easier for seniors to
understand, more affordable, and more reliable than what is offered
today.
I want to highlight one amendment that would have provided Medicare
beneficiaries with a substantial, reliable and straight-forward
prescription drug benefit. I cosponsored and voted for this amendment
offered by my colleague from Illinois, Senator Durbin. His alternative
would have provided a Medicare-delivered drug benefit that allows the
Secretary of HHS to employ negotiating strategies used by the VA and
other government entities to bring down drug prices. Under Senator
Durbin's plan, seniors would have no deductible, pay only 30 percent of
costs until reaching the catastrophic limit, and face no coverage gap.
In addition, employer contributions would count toward out-of-pocket
limits so there would be much less risk of employers dropping retiree
coverage. This was the proposal we should be working from today, but
unfortunately the Durbin alternative was defeated by a vote of 56 to
39.
Those opposed to providing a richer benefit argue we don't have the
money. The selective amnesia of these so-called fiscal conservatives is
baffling. Not too long ago, this body passed a tax cut that primarily
benefited the wealthiest Americans. Where was their sense of fiscal
responsibility then? As my colleagues Senators Durbin and Harkin noted
yesterday, this is about priorities. I'm sure others have raised this
very good point as well. We can risk greater budget deficits to give
huge tax cuts to Americans who are already prospering, but we cannot
provide the necessary resources for millions of Medicare beneficiaries
to get an affordable, reliable drug benefit that they can understand?
I have long been a strong supporter of providing older Americans and
disabled individuals who rely on Medicare an affordable, comprehensive,
reliable and voluntary prescription drug benefit. However, I want to
ensure we do so in a way that does not worsen the situation in which
many seniors find themselves as they face rapidly rising drug costs. As
we consider proposals to expand our Nation's major health entitlement
programs, it is appropriate to follow a guiding principle in the
practice of medicine--do no harm. Our seniors deserve a drug benefit
that is a real improvement, not a complex experiment that may cause
more trouble than it's worth. We must not enact a law intended to help
that might eventually harm millions. The American people deserve
better.
Mrs. BOXER. Mr. President, for over 35 years, Medicare has been a
savior for our seniors citizens. It has helped pay their doctor bills,
their hospital bills, and their home health bills.
But it has not paid for their prescription drug bills, and millions
of seniors across the country have been waiting a long time for the day
when prescription drug coverage is offered through Medicare. That day
is getting closer.
I am supporting--and the Senate will soon pass--a Medicare
prescription drug benefit.
Let me tell you why this is important. In California, four million
people are enrolled in Medicare. Every day, far too many of them are
forced into the difficult choice of paying for their prescriptions or
putting food on the table.
[[Page S8698]]
I want to tell you a few of their stories.
I recently heard from a California woman who told me she struggles to
survive on $950 a month income. She cannot, she says, afford all of her
prescription drugs. She is, unfortunately, all too typical.
A constituent from San Marcos, CA told me that her annual costs for
prescription drugs this year will top $10,000.
Another constituent from Indio, CA told me that she has made five
trips to Mexico over the last several years to purchase her
prescriptions. She drives all day long to Mexico in order to purchase
affordable heart medication. She wanted me to remind my colleagues that
``thousands of seniors are forced to do this.''
A retired physician from Marina Del Rey told me that a pill he takes
for his heart disease has gone up 600 percent from $15 per month to
$85.
These seniors--all of our seniors--need and deserve to have Medicare
help pay for their prescription drugs. We need to end this situation
where seniors are cutting their pills in half or forgoing their
medications altogether or skipping meals in order to pay for their
prescription drugs. That is unacceptable.
Today, we are making a prescription drug benefit a part of Medicare.
And that is why I am supporting this bill--because, at long last, it
puts a Medicare prescription drug benefit on the books.
But, this bill is wanting. It has problems. And I have voted for
amendment after amendment to fix those problems.
I offered an amendment to close the benefit shutdown. Under this
bill, even when seniors have paid and continue to pay premiums,
Medicare stops covering prescription drugs, forcing seniors to pay the
entire cost. When that failed, I offered an amendment to ensure that
seniors with cancer would never have their benefit stopped.
I supported an amendment by Senator Stabenow to ensure that all
seniors could get prescription drug coverage from Medicare itself--the
tried and proven system--rather than from a private insurance company.
I supported an amendment by Senator Graham to stop charging seniors
premiums when they are not getting any benefits.
I supported an amendment by Senator Lautenberg to start this benefit
next year not 2 and a half years from now.
I supported an amendment by Senator Dodd to encourage employers not
to drop their retiree health coverage so seniors who have good coverage
can keep it. And the Levin amendment, which I also supported, would
have ensured that if employers did drop such coverage, Medicare would
be there to provide prescription drugs.
I supported an amendment by Senator Dorgan to reduce the premiums
that beneficiaries must pay each month. And I supported an amendment by
Senator Daschle to limit the disparities in premiums so that seniors in
different parts of the country are not paying different premiums for
the same benefit.
These amendments would have made the Medicare drug benefit a better
drug benefit for seniors. Unfortunately, none of them passed.
But we should not--and I will not--stop trying to make it the best
benefit it can be.
The good news is that Medicare will soon, for the first time ever,
cover prescription drugs. The better news will be when we fix the
problems with this bill and improve the coverage for our seniors. I
look forward to the day when enough of my colleagues will join me in
that effort.
Finally, let me say that I hope the conference report on this bill--
the final version of the bill before it goes to the President--does not
come back to the Senate in a way that would provide even less help to
seniors or in a way that would undermine the entire Medicare program.
Ms. MIKULSKI. Mr. President, senior citizens are facing a crisis--a
crisis in affording health care and a crisis in affording prescription
drugs.
I have been in communities all over Maryland. Listening to seniors
who are desperate. Listening to their families in the diners--who want
to help their parents, yet face stresses of their own. Listening to the
employers in the boardrooms--who want to help their retirees, but can
no longer afford to.
Here is what they tell me. They say: We need a prescription drug
benefit in Medicare. We need a safety net for seniors and families.
Congress must enact a Medicare prescription drug benefit, and must do
it now.
I absolutely agree. It is time Congress made Medicare prescription
drug coverage a national priority.
For so many years, Congress has talked about prescription drugs and
Medicare. Talk, talk, talk. You can't talk yourself out of high
cholesterol; you need Lipitor. You can't talk your way out of diabetes;
you need insulin.
The problem with the Senate is--when all gets said and done--more
gets said than gets done. Finally--the Congress is acting.
Here are my principles. These principles are the yardstick by which I
measure any proposal.
The benefit must be for seniors, not for insurance companies. That
means the cornerstone must be Medicare. This bill does that. It does
not force seniors to give up the Medicare they love to get the drugs
they need.
It must help the majority of Marylanders. I work for Marylanders. So
I did the numbers--570,000 Marylanders are on Medicare. According to
Johns Hopkins, 68 percent of these seniors would benefit from this
legislation. That means 394,000 would benefit from this bill.
It must be voluntary. And the answer is, yes, this bill is voluntary.
No one should be coerced or forced into a private program or forced to
give up coverage they currently have.
It must be affordable. I am not so sure. I am concerned about the
significant deductible--$275 a year and the hefty premiums--almost $400
a year. It also has a coverage gap. Once you spend $4,500 a year--you
get no help until you spend $5,800. This will cost too much. That is
why I supported the Durbin amendment, which would have provided a
better benefit at less cost to seniors.
It must be accessible. It must be available to all seniors,
regardless of where they live. This bill does that.
It must be meaningful. It must cover the kind of drugs your doctor
says you need, not what an insurance executive thinks you should get.
This bill does that by creating a medical necessity override. This
means your doctor has the final say on which drugs you get, not an
insurance company. I feel pretty good about that.
I tried to improve the bill. I voted for amendments to improve the
bill. For example: For the Durbin substitute which would have created a
stronger, more comprehensive benefit at a lower cost to seniors.
For an amendment to get rid of the coverage gap. This would guarantee
that seniors would have continuous coverage for their prescription drug
costs.
For an amendment to provide seniors with a guaranteed prescription
plan that is under Medicare. This would allow seniors to stay in a
prescription drug plan that is operated by Medicare and not have to
move in and out of private plans and a Medicare fallback plan that is
only available when the private plans leave the market.
For amendments to protect the benefits of retirees who already have
drug coverage. These amendments would help employers to continue to be
able to offer quality health care to their retirees.
For an amendment to implement the drug benefit next year--instead of
waiting until 2006 to start these benefits.
I am sorry all these amendments failed on party line votes.
This legislation is a beginning. It is something we can build on.
What it comes down to for me is--will it help the majority of seniors
in Maryland? The answer is, yes; it will help over 394,000 people. For
people who spend at least $1,110 a year on prescription drugs--it will
help. For someone who is facing a catastrophic disease like cancer and
has very high drug costs--it will help. So I will vote for this bill.
It is not the bill I want. Yet we can't let the perfect be the enemy of
the good. We can't do nothing--as seniors struggle to pay for the drugs
they need.
But let me be very clear, this is as far as I will go. If this bill
comes back from conference and it is a benefit for insurance
companies--say goodbye to my vote. If it increases costs for seniors,
say goodbye to my vote. If it cuts benefits, say goodbye to my vote.
[[Page S8699]]
So I will vote for this legislation tonight because I don't want to
say goodbye to this opportunity to provide a Medicare prescription drug
benefit for seniors.
Mr. HOLLINGS. Mr. President, I rise today in opposition to the
Prescription Drug and Medicare Improvement Act of 2003.
The Senate has spent the last 2 weeks debating how to help our
Nation's senior citizens afford their prescription drugs. The Kaiser
Family Foundation estimates that average annual out-of-pocket drug
spending for Medicare beneficiaries grew from $644 3 years ago to $999
this year and will reach $1,454 by the time this bill takes effect in
2006. As a result, 25 percent of seniors without drug coverage declined
to fill a prescription and 27 percent of seniors without drug coverage
skipped doses to make their prescriptions last longer. This is
unacceptable. These citizens deserve affordable, comprehensive, and
reliable drug coverage. Unfortunately, the legislation now before us
fails to provide sufficient coverage.
From the outset this proposal will confuse seniors. Enrollees in
private plans better not get too comfortable because their plans could
be gone in 2 years if the HMOs find them unprofitable just like they
have with Medicare+Choice in my state of South Carolina. The same goes
for enrollees in fallback plans. They will be kicked out of their plan
in as early as a year if enough private plans enter their area. This
volatile system could force seniors to move in between three separate
plans, with three separate formularies, in 3 years. This bill should
create a sense of stability in the system and reduce the confusion over
coverage. That is why I supported first the Stabenow amendment and then
the Lincoln-Conrad amendment, which would have extended the
availability of fallback plans to ensure that seniors will have access
to stable drug coverage.
Senior citizens will need to hire an accountant just to comprehend
the benefits available to them under this legislation. Once seniors
select their Medicare drug plan, they will have to maneuver a maze of
premiums, deductibles and copayments for benefits that contain huge
gaps in coverage. On top of their premiums, which will vary from region
to region and plan to plan, seniors will get no help for the first $275
of their drug costs, pay half of costs from $276 to $4,500, pay all the
costs from $4,501 to at least $5,813, and then pay a tenth of costs
above $5,288. With a breakeven point of $1,115, many healthier Medicare
beneficiaries will opt not to participate. With a coverage gap of
$1,302, many of the sickest patients will still have to continue paying
premiums even though they may have to resort to rationing their care
until they can spend their way out of the ``doughnut.''
Once again, the Senate defeated a number of amendments that I
supported that would have brought much needed simplicity and fairness
to the bill including the Boxer amendment, which would have closed the
coverage gap for all seniors, and the Daschle amendment, which would
have limited the regional variation among premiums to 110 percent of
the national average. Finally, we chose to provide $13 billion in new
subsidies to PPOs and HMOs instead of using that money to reduce
premiums or fill in the coverage gap for cancer or Alzheimer's
patients. All in all, the bill provides Medicare beneficiaries with a
benefit valued at about $1,000 less than the drug coverage available to
Federal employees.
This is a plan only Washington could dream up. It should come as no
surprise that the authors of this convoluted mess and their friends in
the White House have decided to wait until after the 2004 election
before allowing Medicare beneficiaries to see what they are in for.
I should also note that this Nation is more than $6.6 trillion in
debt. This bill is part of budget resolution and economic plan that
will run up an average deficit of $600 billion a year for the next 10
years. Make no mistake about it, we will borrow every red cent to pay
for this program. And what do we get in return? Massive subsidies for
HMOs, spotty drug coverage for senior citizens, and a lack of attention
to the factors driving the rapid increase of health care costs in this
country. If we are going to borrow from future generations to pay for
this benefit, we should get it right.
Now that we have disposed of all amendments and final passage appears
imminent, I have concluded taxpayers and Medicare beneficiaries would
be better served if we go back to the drawing board. We should come
back with a proposal with affordable premiums and cost sharing
requirements with no gaps in coverage that is administered in a manner
that gives seniors the same sense of security they receive under the
current Medicare program. I have heard many of my colleagues say this
is an important first step and it is important that we get something on
the books. Nonsense. Thirty months will pass before the first
beneficiary receives coverage. That was enough time to draft and ratify
the Constitution. It was enough time to complete the Manhattan Project.
Thirty months should be more than enough time for us to create a real,
meaningful prescription drug benefit for our senior citizens.
I hope this body will have the wisdom to vote no and do this right.
Mr. FEINGOLD. Mr. President, I will vote for passage of the Medicare
prescription drug bill that has been debated over the past several
weeks.
I do so, however, with great reservations about many of the
provisions in the bill.
I am voting for this measure for two principal reasons.
First, I believe that we owe our seniors a Medicare prescription drug
benefit. I believe such a benefit is long overdue for our Nation's
seniors. For years we have promised them we would give them the crucial
help they need with their skyrocketing prescription drug costs. And I
believe that it is finally time to deliver on that promise.
It has taken Congress too many years to act on this pressing need. We
have been debating for years about the best way to provide this
benefit, and I am afraid that if we do not take the opportunity in
front of us today, it will take us even longer to provide seniors the
help they deserve. Our seniors cannot wait any longer.
The costs of prescription drugs are soaring, and the financial toll
they take on our seniors means that too often seniors must choose
between eating and taking the medication that will help them live
productive, healthy lives. Our seniors should not have to make that
choice. They contributed to the Medicare system over their lifetimes.
That system, which is supposed to provide health care to all seniors,
needs to be able to help them obtain the prescription drugs they need
to preserve their health.
The second reason I am voting for this benefit is that it takes a big
step in addressing what I see as one of the biggest flaws of the
current Medicare system--the geographic inequities within the Medicare
reimbursement system. We need to end Medicare's continued
discrimination against Wisconsin's seniors. As I have previously
discussed on this floor, Wisconsin seniors already receive the short
end of the stick when it comes to Medicare. Wisconsinites pay the same
payroll taxes to Medicare as all American workers do, but receive fewer
benefits in return. Instead, Wisconsinites' Medicare dollars are used
to subsidize higher reimbursements in other parts of the country.
Wisconsin Medicare beneficiaries receive on average $4,318 in
Medicare benefits per year, the eighth lowest in the country. By
contrast, beneficiaries in the State with the greatest per capita
reimbursement receive $7,209. This distribution of Medicare dollars
among the 50 States is grossly unfair to Wisconsin. I thank the
leadership of the Finance Committee for including provisions to begin
to address this inequity in this prescription drug bill. But I know
that we still have more to do to reverse the Medicare discrimination
against States like Wisconsin.
I am pleased that key provisions have been accepted that greatly
improve this bill. The Senate adopted the Gregg-Schumer-McCain-Kennedy
amendment, which I was proud to cosponsor and support, which will bring
more competition to the prescription drug market by preventing
pharmaceutical companies from blocking generic drugs from entering the
market. This amendment is one of the only provisions that will help to
bring cost savings to seniors.
[[Page S8700]]
By adopting Senator Dorgan's amendment relating to the reimportation
of prescription drugs from Canada, the Senate will help seniors obtain
affordable prescription drugs. This legislation helps both consumers
who buy prescription drugs and businesses which sell them. I supported
this provision, both in its earlier legislative form and in this
amendment, because it is the right thing to do. Our seniors and other
Americans in need of affordable prescription drugs deserve no less.
I also supported Senator Enzi's amendment, which passed
overwhelmingly, that will make sure that community pharmacies, like the
ones in my home State of Wisconsin, can still operate within this new
prescription drug program. Smaller pharmacies will be protected from
being shut out by larger pharmacies through this amendment, and that
means helping seniors to access the prescription drugs they need in
their own communities.
I also worked with Senator Allard on an amendment to provide
regulatory relief for home health care providers that the Senate
adopted. Our amendment enables home health care providers to spend more
time with patients and less time on paperwork. This is particularly
important at a time when some home health care providers are leaving
the home health industry because of burdensome paperwork requirements.
And I am pleased that an amendment I offered to bring some clarity to
the Medicare Program for our seniors was adopted. The Medicare Program
is already full of bureaucratic red tape, often creating barriers for
seniors looking for basic information about their health care options.
This prescription drug benefit is the biggest expansion of the Medicare
Program since its inception in 1965. We are adding an entire new part
to the program, and we need to help guide our seniors through it.
My amendment is simple. It establishes a Medicare Beneficiary
Advocate Office within the Department of Health and Human Services,
with the sole function of providing clear information to all Medicare
beneficiaries. The office will serve as a one-stop information source
on all of Medicare for our seniors.
This new office will provide a toll-free phone number, a regularly
updated website and regional publications that will give our seniors
all of the information they need to make informed health care
decisions.
That is the good news. But as I said earlier, I have many
reservations about this bill. This is not the bill I would have
proposed.
This bill does not go far enough to deliver on our promise to give
seniors a meaningful prescription drug benefit. It fails to provide any
assistance after a senior's prescription drug costs total $3,450, until
they spend another $1,850 on prescription drugs, or $5,300 total. And
it adds insult to injury by making beneficiaries continue to pay a
premium even during the time they receive no benefit.
I am also troubled that this bill does not provide clear, uniform
benefits and premiums for all seniors. Many aspects of the benefits
provided in the bill remain uncertain, and will continue to remain
uncertain after the plan goes into effect. Under this bill, the
premiums are not defined. The premiums for the Medicare prescription
drug plan will be dictated by the private insurers who will offer the
plans. The only thing we know for sure is that the Congressional Budget
Office estimates that the national average for premiums will be $35.
However, those premiums may vary dramatically. Just look at Medicare
HMO premiums. Medicare HMO premiums in Connecticut are $99, but in
Florida they are only $16.
Who will offer the plans is also uncertain. There is no guarantee
that plans will be offered in regions where there may not be enough
profit. History again shows us that private companies do not always
find rural and smaller urban areas profitable enough to move in. All
too often, private companies that do move into less desirable Medicare
markets end up deciding to leave the region, leaving Medicare
beneficiaries scrambling to figure out where they will turn for
coverage.
Furthermore, my understanding is that this plan only offers a
guaranteed Medicare-administered plan, or ``fallback plan,'' if there
are less than two private plans in a region. This means that, if only
one private plan offers a prescription drug benefit in the region that
includes Almena, WI, a Medicare beneficiary living in Almena may
instead choose the Medicare-administered fallback plan. While on the
fallback plan, my Almena constituent would become familiar with the
medications that are included in their formulary and the cost of their
premiums. If a second private plan subsequently decides to move into
that region, my understanding is that my constituent will be dropped
from the Medicare fallback plan, and forced to join one of the private
plans even if those plans have higher premiums, or do not include their
prescriptions in their formularies.
Further, my Almena constituent can be forced to leave the plan that
he or she has come to know, if that plan leaves the region. This leads
to instability and uncertainty for seniors.
Benefits are also uncertain under this proposal. Again, benefit
packages will be determined by the private insurers who offer the
plans. And we can assume, from experience with the Medicare+Choice
Program, that the benefits will vary widely. I am concerned about what
this may mean for States like my home State of Wisconsin, States that
have had a difficult time attracting and keeping private Medicare
plans. Some Medicare prescription drug plans may be able to offer more
brand name drugs at a lower cost to beneficiaries, while others in less
profitable areas may limit the amount of brand name drugs they can
offer at affordable rates.
I fear that as with Medicare HMOs, Wisconsin seniors may be faced
with little choice with Medicare prescription drug plans.
And I am concerned that the uncertainty in this bill regarding
monthly premiums, the possible differences in benefits packages and the
stability of private plans that will deliver these benefits may lead to
more inequity for Wisconsin seniors.
I was disappointed that Senator Durbin's amendment, the MediSAVE Act,
was not adopted in the Senate. Senator Durbin's amendment, which I
strongly supported, would have fixed most of the errors that exist in
this bill. The MediSAVE Act would have made this benefit one that would
truly help all seniors with all of their prescription drug benefit.
Senator Durbin's proposal offered a meaningful, enhanced prescription
drug benefit that would have covered all seniors regardless of whether
their prescription drug costs are high, low, or somewhere in between.
The MediSAVE Act not only put forth cost controls so that taxpayers
as well as seniors could save money, but it also would have given
seniors certainty. Seniors would have known exactly what their premiums
and benefits were and would have the certainty of knowing that a
Medicare-administered prescription drug benefit would be available to
them, no matter what private plans were offered to them. Most
importantly, the MediSAVE Act provided the certainty that a senior
would have assistance with their prescription drug costs year-round and
would never be caught in the so-called ``donut hole'' of coverage that
this bill provides.
I am voting for this bill because something, some help for our
seniors with their pressing prescription drug costs, is better than
nothing. I will support this legislation with the intention of working
with my colleagues over the next 2 years to improve this bill and
finally deliver on our promise to give seniors a meaningful
prescription drug benefit under Medicare.
Mr. JEFFORDS. Mr. President, this bill is a landmark piece of
legislation the most significant modernization of the Medicare Program
since its inception in 1965. Its passage by the Senate is a major
accomplishment on the path toward enacting a prescription drug benefit
for our Nation's seniors. It is the result of years of bipartisan, I
might even say tripartisan, effort and it puts in place many long-
sought changes. It has many significant features for the citizens of my
home State of Vermont. It provides a sustainable, universal, and
comprehensive prescription drug benefit. It guarantees access to
traditional Medicare for all beneficiaries. It allows Medicare
beneficiaries to participate, if they choose, in new systems of care
that better reflect today's dynamic health care environment. The bill
recognizes the high cost of providing quality care in rural settings
and closes the reimbursement
[[Page S8701]]
gap between rural providers and their urban counterparts. Finally, it
contains a provision that will allow us to better understand how to
provide quality health care--not care driven by using more and more
resources, but instead one based on ensuring quality patient outcomes.
Over the past 2 weeks, I have applauded the work of my colleagues who
have labored over this bill. Today, I have the pleasure of
congratulating them on their success and thanking them for their
efforts.
I have worked for more than 3 years with my good friends, Chairman
Grassley and Senators Snowe, Breaux, and Hatch. In many meetings over
many months, we delved into the details of what came to be called the
Tripartisan Bill. This has been one of the finest experiences of my
many years in Congress. I am very proud to have been a part of that
group and that our efforts led the way to our success today.
I especially want to salute the efforts of Senator Baucus and Senator
Kennedy without whose hard work and commitment to working through an
agreement we would not have accomplished this remarkable victory, and
they deserve our accolades.
A bill such as this is the result of great effort on the part of many
different people who are not elected to this body, but upon whom we all
rely. I would like to recognize the staff members who have worked so
hard on this bill and deserve much of the credit for its successful
passage.
On Senator Grassley's staff: Ted Tottman, Linda Fishman, Colin
Roskey, Mark Hayes, Jennifer Bell, and Leah Kegler, and on Senator
Baucus' staff Jeff Forbes, Liz Fowler, Jon Blum, Pat Bousliman, Kate
Kirschgraber, and Andrea Cohen deserve considerable recognition for
their tireless efforts. Catherine Finley, Tom Geier, and Carolyn Holmes
from my friend Senator Snowe's staff; Patricia DeLoatche and Trecia
Knight of Senator Hatch's office; and most especially Senator Breaux's
legislative director Sarah Walters deserve enormous credit for this
bill. Finally, we would not be claiming a victory today if it were not
for the contributions of Senator Kennedy's staff, especially, David
Nexon and Michael Meyers.
On my own staff, I particularly want to recognize the contributions
of Paul Harrington during the last Congress, and most especially the
work of Sean Donohue who took up that effort on the tripartisan bill
and who has continued to see it through to today's success, with the
recent assistance of Daniel Crimmins, our Robert Wood Johnson Health
Policy Fellow. Each and all have worked tirelessly to gather the input,
analyze the issues, and build a consensus toward achieving this final
product.
Mr. LEVIN. Mr. President, I support making a prescription drug
benefit available to seniors. Most Members of the Senate do. However,
there are honest disagreements about how to get it done and whether the
bill before us will strengthen or weaken Medicare.
My principles are simple. The benefit should be voluntary,
guaranteed, universal, and affordable.
Perhaps my greatest concern with the bill before us is the effect its
passage is likely to have on retirees who currently have prescription
drug coverage provided by their former employers. Many retirees
currently enjoy good prescription drug coverage from their former
employer. However, the Congressional Budget Office has indicated that
if we adopt the legislation before us approximately 37 percent of
retirees who are currently receiving prescription drug coverage from
their former employers will lose that coverage. Specifically, on June
12, the Director of the Congressional Budget Office, CBO, Mr. Douglas
Holtz-Eakin, who previously served for 18 months as chief economist for
President Bush's Council of Economic Advisers, testified at a Finance
Committee markup that 37 percent of retirees would be dropped from
their former employers coverage. At that same markup, the Administrator
of HHS' Center of Medicare and Medicaid Services, CMS, Mr. Tom Scully,
stated that for current retirees ``who have employer-sponsored
insurance, our estimate is consistent with 37 percent having their
coverage dropped.'' During the debate so far, amendments to strengthen
incentives for employers to maintain their prescription drug coverage
for their retirees have failed.
Also very troubling is what I call the yo-yo effect. To participate
in the proposed plan, a senior in any service area where two or more
private plans are offered, no matter what the premium, would only have
the option of purchasing private insurance. The reason is that only if
there are not two private plans offered in the region is the so-called
Medicare fallback plan available. So let's assume that there are two
plans offered in 2006 in a particular service area and a senior opts
in. Assume further that in 2008, one of the two insurance companies
pulls out of the service area and the so-called Medicare fallback plan
is then available. So the senior opts for the Medicare fallback plan.
However, if two private plans become available a later time, say 2009,
the Medicare fallback plan is no longer available to the senior and she
would then be required to again enroll in one of the private plans to
retain coverage. This yo-yo effect could be repeated forcing seniors to
deal again and again with different programs with different costs and
different benefits and lots of paperwork. This is totally unacceptable.
Seniors want stability and continuity in their Medicare Program. They
want a program on which they can trust and rely.
In addition, the legislation we are considering has a large gap in
the prescription drug coverage. Once a senior's total drug spending
reaches $4,500 for the year, she will have to pay 100 percent of the
cost of their prescriptions until her total drug spending reaches
$5,800. This has come to be called the donut hole. This coverage gap
will leave many seniors to pay the full cost of prescriptions at a time
when they most need assistance. I know of no other insurance program
that is so unfairly structured in that way. There is a gaping hole in
coverage but no gap in the requirement to pay premiums. That obligation
continues even during the period that benefits are halted.
The bill before the Senate also has an unspecified premium that could
fluctuate from service area to service area as well as from year to
year. Premium amounts are left up to the insurance companies. I believe
there should be a cap on those premiums. The effort to adopt one
failed.
Adding a prescription drug benefit to Medicare is one of the most
important things Congress can do this or any other year. We spend more
on prescription drugs than we do on hospital costs. Members of Congress
have been promising for years that we would pass a Medicare
prescription drug benefit for seniors. The only way to assure that the
benefit will be available reliably and without complications to our
seniors is to make it a guaranteed part of Medicare. The bill before us
falls short of that. We should at least do no harm. When CBO estimated
37 percent of seniors currently receiving a prescription drug benefit
from their former employer are going to lose the benefit because of
this legislation, that is real harm.
I hope the major flaws of this bill are somehow corrected in
conference so I can vote for a conference report. But I cannot vote for
the version before us.
Ms. COLLINS. Mr. President, I was pleased to join my colleagues,
Senators Boxer, Coleman, Landrieu, Kohl & Murray in offering an
amendment to authorize a Medicare demonstration project on pancreatic
islet cell transplantation to help advance this tremendously important
research that holds the promise of a cure for more than 1 million
Americans with Type 1 or juvenile diabetes.
As the founder and cochair of the Senate Diabetes Caucus, I have
learned a great deal about this serious disease and the difficulties
and heartbreak that it causes for so many Americans and their families
as they await a cure. Earlier this week, I had the privilege of
chairing a hearing featuring young delegates from the Juvenile Diabetes
Research Foundation's Children's Congress who had traveled to
Washington from every State in the country to tell Congress what it is
like to have diabetes, just how serious it is, and how important it is
that we find a cure.
Diabetes is a devastating, lifelong condition that affects people of
every age, race, and nationality. It is the
[[Page S8702]]
leading cause of kidney failure, blindness in adults, and amputations
not related to injury. Moreover, a study released by the American
Diabetes Association earlier this year estimates that diabetes cost the
Nation $132 billion last year and that health spending for people with
diabetes is almost double what it would be if they did not have
diabetes.
The burden of diabetes is particularly heavy for people with juvenile
diabetes. Juvenile diabetes is the second most common chronic disease
affecting children. Moreover, it is one that they never outgrow.
In individuals with juvenile diabetes, the body's immune system
attacks the pancreas and destroys the islet cells that produce insulin.
While the discovery of insulin was a landmark breakthrough in the
treatment of people with diabetes, it is not a cure, and people with
juvenile diabetes face the constant threat of developing life-
threatening complications as well as a drastic reduction in their
quality of life.
Thankfully, there is good news for people with diabetes. We have seen
some tremendous breakthroughs in diabetes research in recent years, and
I am convinced that diabetes is a disease that can be cured and will be
cured.
I am encouraged by the development of the Edmonton Protocol, an
experimental treatment developed at the University of Alberta involving
the transplantation of insulin-producing pancreatic islet cells, which
has been hailed as the most important advance in diabetes research
since the discovery of insulin in 1921. Of the 257 patients who have
been treated using variations of the Edmonton Protocol, all have seen a
reversal of their life-disabling hypoglycemia, and 80 percent have
maintained normal glucose levels without insulin shots for more than 1
year. Amazingly, many of the transplant recipients have even reported a
reversal of some of their complications, such as improved vision and
less pain from neuropathy.
Earlier this year, I joined with my colleague from Washington,
Senator Patty Murray, as well as my colleague and cochair of the Senate
Diabetes Caucus, Senator John Breaux, in introducing the Pancreatic
Islet Cell Transplantation Act of 2003, which will help to advance this
significant research that holds the promise of a cure for the more than
1 million Americans with juvenile diabetes. The amendment we are
introducing today is based on one of the provisions of that bill, which
currently has 43 Senate cosponsors.
Diabetes is the most common cause of kidney failure, accounting for
40 percent of new cases, and a significant percentage of individuals
with Type 1 diabetes will experience kidney failure and become
Medicare-eligible before they are 65. Medicare currently covers both
kidney transplants and simultaneous pancreas-kidney transplants for
these individuals. To help Medicare decide whether it should cover
pancreatic islet cell transplants, the amendment authorizes a 5-year
demonstration project to test the efficacy of pancreatic islet cell
transplantation for individuals with Type 1 diabetes who are eligible
for Medicare because they have end-stage renal disease, ESRD.
The cost of this demonstration would not be high. The Health
Strategies Consultancy LLC, a highly regarded independent health policy
firm, estimates that the net Federal cost of the proposal would be
about $6.2 million in 2004 and about $84 million over 10 years.
The cost of the demonstration project is low because the number of
islet cell transplants that could be performed is limited. Islet cells
are extracted from a donated pancreas, and the number of pancreas
donors is extremely small when compared to the number of Medicare
beneficiaries who could benefit from islet cell transplants. In 2002,
there were 1,875 pancreas donations, but there were over 27,000
Medicare beneficiaries who have diabetes as the primary cause of their
end-stage renal disease and who might potentially benefit from islet
cell transplants.
The Health Strategies' cost estimate does not include the financial
benefits that would accrue to Medicare for the reduced medical care
costs that would occur for beneficiaries who receive islet cell
transplants and, as a result, suffer fewer diabetes-related
complications such as kidney failure, heart disease, blindness and
amputation. Since diabetes currently accounts for one out of every four
Medicare dollars, I believe that this amendment actually holds much
promise for reducing Medicare spending in the future.
I understand this demonstration project has been included in the
Medicare prescription drug legislation that is being considered by the
House. I hope that the Senate demonstrates similar wisdom, and I urge
all of my colleagues to support it.
Mr. KOHL. Mr. President, I rise to oppose S. 1, the Prescription Drug
and Medicare Improvement Act. This bill is good for drug companies,
insurance companies, and people who make TV ads for politicians--but it
is not good for Wisconsin seniors.
I know that many of my colleagues will vote for this legislation and
that it will pass the Senate. I know that many of my colleagues believe
that this is a first step, if an imperfect one. I would like to agree
with them. I would like to vote for a bipartisan compromise that
delivers even a part of the drug benefit our seniors rightly demand.
But this is not that bill. This is, instead, an empty promise of
straightforward help for seniors struggling with crippling drug costs.
When they figure out the details--when they see the costs--when they
understand the limited benefit provided--when they work through the
complicated formulas determining whether they ought to sign up--when
they see the drug industry continue to raise their prices and reap
record profits--they will--rightly, rightly--revolt.
I warn my colleagues, this is no bird in the hand--it is a vulture.
And I cannot support it.
I cannot support a so-called benefit that asks many seniors, for
months at a time, to pay premiums but receive absolutely no help with
their drug costs. I cannot support a ``benefit'' that could cause up to
37 percent of retirees to lose their retiree health plans, leaving
their former employees worse off than before we passed this bill. And I
cannot support a ``benefit'' which is denied to low-income seniors
eligible for both Medicaid and Medicare. A ``benefit'' of no benefit
for seniors above average drug costs, for seniors with decent retiree
plans, for seniors who are poor.
I also cannot support a plan that neither I nor anyone in this body
can explain because its details depend on the vagaries of a private
market that doesn't exist yet. Under this system, seniors could be
forced into a different plan, pay a different premium, and have
different medicines covered every year. Insurance companies can come in
and out, leaving seniors lost and confused in a maze of paperwork and
choices every year. And we know that for those insurance companies that
do participate, premiums are sure to increase because there is no
limitation on premiums in this law.
I also cannot support a plan that relies so heavily on the private
sector to offer something they have never been willing to offer before.
Drug-only plans are virtually nonexistent in today's marketplace. And
the Medicare+Choice experiment, which also uses private insurance
companies, has not worked in Wisconsin and in many other States. I
cannot support a plan that has to pay insurance companies huge
subsidies in order to offer a drug benefit. Not only is there no
guarantee that they will participate; but precious Medicare dollars
that could be used to pay directly for medicines are wasted, funneled
to a drug industry that, last I checked, was not in need of a Federal
handout. Even worse, this plan does not take advantage of the potential
for controlling drug costs by utilizing the purchasing power of the
millions of Medicare beneficiaries.
I do not want to point out that aside from the Medicare drug benefit,
there are several provisions that I strongly in this bill. I am very
pleased that the bill includes long-needed reforms that will finally
take a strong step toward fixing the distorted Medicare system we have
today--a system that penalizes Wisconsin health care providers by
paying them less than other States, and a system that penalizes
Wisconsin seniors by offering them fewer benefits than seniors in other
States enjoy. Not only is this unfair for people in the Medicare
system; it also increases costs for Wisconsin businesses, employees,
and families, who pay higher costs
[[Page S8703]]
to make up the Medicare shortfall. The bill before us changes many of
Medicare's payment systems, especially for rural areas, and goes a long
way toward making Medicare fair for seniors and providers, no matter
where they live.
I am also pleased that the bill includes provisions to make generic
drugs more available to all Americans. It will close loopholes in our
current law that keep generics off the market and keep drug prices too
high for too long. The CBO estimates that this provision will save
Americans $60 billion over 10 years.
I hope, but don't expect, that these two important provisions will
survive the upcoming conference with the House of Representatives. And
while I continue to hope that the conference will come back with a
better Medicare drug benefit, I regret that it is unlikely to be the
case. The House bill is in many ways even worse than the Senate bill
before us.
Mr. President, I regret that none of the amendments that I supported
during this debate prevailed. These amendments would have greatly
improved this bill and provided a real prescription drug benefit to
seniors--a benefit we could all have been proud of. Instead, this bill
is an empty promise to seniors and the disabled on Medicare. This is
not the kind of plan they have been asking for or have a right to
expect. We could and should have done better. But at minimum, we could
and should be able to hold our work here to the standard set in the
Hippocratic Oath: do no harm. And we have failed.
I yield the floor.
Ms. COLLINS. Mr. President, I want to thank the chairman of the
Finance Committee for including provisions in S. 1 that will provide a
measure of relief to rural health care providers, and in particular to
home health agencies serving patients in rural areas. I am concerned,
however, that the underlying bill does not go quite far enough and have
filed an amendment with Senator Bond to increase the rural add-on
payment for home health agencies to 10 percent. This was the amount of
the payment prior to its expiration on April 1, and I believe it is the
amount that is necessary to ensure that Medicare patients in rural
areas continue to have access to the home health services that they
need.
Home health has become an increasingly important part of our health
care system. The kinds of highly skilled--and often technically
complex--services that our Nation's home health agencies provide have
enabled millions of our most frail and vulnerable older persons to
avoid hospitals and nursing homes and stay just where they want to be--
in the comfort and security of their own homes.
Surveys have shown that the delivery of home health services in rural
areas can be as much as 12 to 15 percent more costly because of the
extra travel time required to cover long distances between patients,
higher transportation expenses, and other factors. Because of the
longer travel times, rural caregivers are unable to make as many visits
in a day as their urban counterparts. Saundra Scott-Adams, the
executive director of the Visiting Nurses of Aroostook in Aroostook
County, ME, where I am from, tells me her agency covers 6,600 square
miles with a population of only 72,000. Her costs are understandably
much higher than the average agency due to the long distances her staff
must drive to see clients. And, her staff is not able to see as many
patients.
Agencies in rural areas are also frequently smaller than their urban
counterparts, which means that their relative costs are higher due to
smaller scale operations. Smaller agencies with fewer patients and
fewer visits mean that fixed costs, particularly those associated with
meeting regulatory requirements, are spread over a smaller number of
patients and visits, increasing overall per-patient and per-visit
costs.
Moreover, in many rural areas, home health agencies are the primary
caregivers for homebound beneficiaries with limited access to
transportation. These rural patients often require more time and care
than their urban counterparts, and are understandably more expensive
for agencies to serve. If the rural add-on payment is not reinstated,
agencies may be forced to make decisions not to accept rural patients
with greater care needs, and access will suffer further.
The loss of the rural add-on has already caused many agencies to
reduce their service areas. Some are eliminating services altogether in
remote areas. There are some counties in Montana, for example, that
have no home health services. And agencies in my home State of Maine
have had to eliminate delivery of services to some of our outlying
islands.
If the 10 percent rural add-on payment is not restored, it will only
put more pressure on rural home health agencies that are already
operating on very narrow margins and could force more of these agencies
to close. Many home health agencies operating in rural areas are the
only home health providers in a vast geographic area. If any of these
agencies are forced to close, the Medicare patients in that region will
lose complete access to home care.
There is strong support in the Senate for restoring the rural add-on.
Earlier this month, 55 Senators joined me in sending a letter to the
chair and ranking member of the senate Finance Committee urging that
they extend the 10 per cent rural add-on for home health agencies, and
I ask unanimous consent that this letter be printed in the Record.
The chairman of the Finance Committee and his staff have been working
with us to try to accommodate my amendment, and I am very appreciative
of their efforts. I am hopeful that we will be able to work this out so
that we will be able to ensure that Medicare patients in rural areas
continue to have access to the home health services that they need.
There being no objection, the material was ordered to be printed in
the Record, as follows:
U.S. Senate,
Washington, DC, June 5, 2003.
Hon. Charles E. Grassley, Chairman,
Hon. Max Baucus, Ranking Member,
Senate Committee on Finance, Dirksen Senate Office Building,
Washington, DC.
Dear Senators Grassley and Baucus: Home health has become
an increasingly important part of our health care system. The
kinds of highly skilled and often technically complex
services that our nation's home health agencies provide have
enabled millions of our most frail and vulnerable older
persons to avoid hospitals and nursing homes and stay just
where they want to be--in the comfort and security of their
own homes.
By the late 1990s, home health was the fastest growing
component of Medicare spending. The rapid growth in home
health spending understandably prompted the Congress and the
Administration--as part of the Balanced Budget Act of 1997--
to initiate changes that were intended to slow this growth in
spending and make the program more cost-effective and
efficient. These measures however, produced cuts in home
health spending far beyond what Congress intended. Home
health spending dropped to $10 billion in FY 2002, nearly
half the 1997 amount, and it is clear that the savings goals
set for home health in the Balanced Budget Act have not only
been met, but far surpassed.
According to the Congressional Budget Office (CBO), the
post-Balanced Budget Act reductions in home health spending
totaled more than $72 billion between fiscal years 1998 and
2002. This is over four times the $16 billion that the CBO
originally estimated for that time period and is a clear
indication that the Medicare home health cutbacks have been
far deeper than Congress intended.
As a consequence of these cutbacks, over 3,400 home health
agencies nationwide have either closed or stopped serving
Medicare beneficiaries. Moreover, the number of Medicare
patients receiving home health care nationwide has dropped by
1.3 million--more than one-third. Which points to the central
and most critical issue--cuts of this magnitude simply cannot
be sustained without ultimately affecting patient care.
On October 1, 2002, home health agencies received an
additional across-the-board cut in Medicare home health
payments, and the Centers for Medicare & Medicaid Services
has dramatically reduced projections for home health spending
under the Medicare program over the next ten years. We are
concerned that any further cuts in payments for home
health services simply cannot be sustained without
affecting patient care, particularly for those Medicare
beneficiaries with complex care requirements.
As you begin consideration of a Medicare modernization
package, we urge that you avoid any further cuts in payments
for home health services and preserve the full market basket
update for payments for home health services for 2004. In
addition, we urge that you extend the 10 percent add-on
payment for home health services in rural areas that expired
on April 1, 2003. Surveys have shown that the delivery of
home health services in rural areas can be as much as 12 to
15 percent more costly because of the extra travel time
required to cover long distances between patients, higher
transportation expenses, and
[[Page S8704]]
other factors. Extension of this add-on payment will
therefore help to ensure that Medicare patients in rural
areas continue to have access to the home health services
they need.
Thank you for your consideration, and we look forward to
working with you to ensure that elderly and disabled
Americans continue to have access to quality home health
services.
Sincerely,
Susan M. Collins; Christopher S. Bond; Wayne Allard;
Gordon Smith; Robert F. Bennett; Richard Lugar; Jack
Reed; Russell D. Feingold; Patty Murray; John W.
Warner; James Talent; Carl Levin.
Charles Schumer; Chuck Hagel; Barbara Mikulski; Jon
Corzine; Tim Johnson; Patrick Leahy; Herb Kohl; Mary
Landrieu; Evan Bayh; Dianne Feinstein; Hillary Rodham
Clinton; Maria Cantwell; Frank Lautenberg; Ron Wyden;
John Kerry; Ben Nelson; Debbie Stabenow; Mark Dayton;
Ben Nighthorse Campbell; Mike DeWine.
Arlen Specter; George Voinovich; James Jeffords; Bill
Nelson; Saxby Chambliss; Conrad Burns; Christopher
Dodd; Joseph Lieberman; Blanche L. Lincoln; Larry
Craig; Paul Sarbanes; Lincoln Chafee; Mike Crapo;
Richard Durbin; Barbara Boxer.
Tom Harkin; Pat Roberts; Jim Bunning; Ted Kennedy; Sam
Brownback; Byron Dorgan; Thad Cochran; and Richard
Shelby.
Mr. DODD. Mr. President, I rise today to speak in support of S. 1,
the Prescription Drug and Medicare Improvement Act of 2003. However, I
do so with great trepidation. While I intend to vote for the bill that
is presently before the Senate, I believe that drastic changes are
still necessary to make the benefit created by this legislation one
that meets the needs of our senior citizens.
I am also deeply concerned that Members on the other side of the
aisle--as well as those in the House of Representatives, and the
administration--will attempt to move this bill in a destructive
direction during conference. Let me reiterate what I said in an earlier
statement on this issue: we must not approve any Medicare reform
measure that would force seniors to join private plans in order to
receive a more generous prescription drug benefit. Such a measure would
signal an end to the Medicare Program as we know it and should be
rejected out of hand. I urge my colleagues to protect the Medicare that
our seniors have come to rely on, and I urge the President not to sign
any bill that privatizes Medicare. If such changes are made, I will not
hesitate to oppose the conference report.
Given these concerns, it is reasonable to ask why I am supporting
this bill. The answer is quite simple--seniors in my home State of
Connecticut and across the country have been waiting far too long for a
prescription drug benefit under Medicare. And it is time that we in
Congress heard them.
Over the past month I had the opportunity to convene a series of
forums on senior health care in Connecticut in an attempt to frame the
scope of this debate. At these forums I heard from my constituents on
many matters regarding their health care. But the present lack of
coverage for prescription drugs under the Medicare program was by far
the issue raised most often.
At these forums I heard from seniors who literally could not afford
to fill prescriptions called for by their doctors. I heard from elderly
Medicare beneficiaries forced to choose between purchasing groceries or
filling their prescriptions. I heard from seniors who were forced to
skip dosages of their medicines in an attempt to stretch their limited
supplies of needed medicines. I heard from Medicare beneficiaries
requiring more than 10 prescribed medicines a day unable to afford even
half of these prescriptions. Clearly, what I heard from hundreds of
Connecticut's more than 500,000 Medicare beneficiaries is their grave
concern over the present lack of a prescription drug benefit under the
Medicare Program.
I believe that the legislation about to be approved by this body
offers an answer to those concerns. It is not the most complete answer,
but it is a start--based on which we can improve in the future. It is a
start because it will make so many seniors better off than they are
today. And that should be our ultimate goal as legislators--to make
people's lives better. Often this must be done incrementally, in steps.
This bill is a positive first step.
What do I mean when I say that it will make people better off? In
Connecticut, one-third of all Medicare beneficiaries have incomes below
160 percent of poverty. For many of these seniors, drug costs can be
crippling. They are forced to choose between putting food on the table,
and buying the medicines that they need to live healthy lives. With the
passage of this bill, these seniors will no longer have to make this
choice. The new Medicare prescription drug benefit will cover most, if
not all, of their drug costs. I congratulate Senator Grassley and
Senator Baucus, and other members of the Senate Finance Committee for
including in this bill such a generous benefit for those low-income
seniors.
This legislation is not as clear cut for those seniors who have
incomes above 160 percent of poverty. However, I believe that the
majority will be helped by passage of this bill. The break even for
this benefit--the point where an individual is better off with the
benefit rather than just paying for all prescription drugs our of their
own pocket--is about $1,100 in total annual drug costs. The average
Medicare beneficiary spends approximately $2,300 on prescription
medicines today. That number will undoubtedly be higher when this new
benefit goes into effect in 2006. With the benefit created by this
bill, that average beneficiary will realize nearly $600 in savings. The
savings will be even greater for the 11 percent of beneficiaries who
spend more than $5,000 per year on prescription drugs. These are the
seniors facing the most sever health problems, and most in need of
financial assistance. That is what this bill provides--even if it is
not to the extent that many of us would have liked.
I am voting for this bill because so many seniors in Connecticut and
throughout the country stand to benefit. However, no bill is perfect
and S. 1 clearly still leaves much room for improvement even as it
moves toward final Senate passage. I am particularly disheartened that,
despite numerous attempts over the past 2 weeks, we have failed to
address concerns over the present bill's lack of adequate provisions to
ensure that those companies presently providing their retirees with
prescription drug coverage receive adequate Federal support for their
laudable efforts. While the creation of a prescription drug benefit
under the Medicare program is laudable, it should not come at the price
of displacing the employer-based benefits that so many seniors have
come to rely on.
Additionally, I remain concerned that the gap in coverage in the
present bill, the so-called donut hole, will leave many Medicare
beneficiaries facing high prescription drug costs with no assistance at
the very time when it is most needed. Over the past 2 weeks, I have
both offered and supported amendments designed to provide assistance to
those with prescription drug costs within the hole, especially those
with lower incomes who can least afford any gap in coverage, that have
failed to win support by the Senate. Failure to close this gap, in my
view, constitutes a glaring failure, one that I hope can be reversed as
this bill moves into conference.
I also am concerned that S. 1 fails to adequately protect Medicare
beneficiaries form the very understandable confusion and uncertainty
that may surround them just as they begin to navigate the intricacies
of a brand-new program. Specifically, if enacted the underlying bill
will require Medicare beneficiaries choosing a prescription drug plan
to stay with that plan for a minimum of 1 year. With the enactment of
such broad and weeping changes to the Medicare program, I am fearful
that many Medicare beneficiaries will face great uncertainty trying to
find the best plan to meet their particular needs. For this reason, I
offered an amendment to S. 1 that would have simply granted Medicare
beneficiaries navigating this new benefit for the very first time the
ability to switch plans as they seek to determine which plan fits their
particular health care needs in the first 2 years of the bill's
benefit. Unfortunately, this amendment was not agreed to and I remain
concerned that without its protections, senior Medicare beneficiaries
will be unfairly locked into plans that do not meet their needs.
Mr. President, I am pleased that S. 1 represents a significant
departure from
[[Page S8705]]
previous plans supported by the administration that would have required
Medicare beneficiaries to leave the traditional fee-for-service
Medicare Program in order to receive coverage for their prescribed
medicines. Such a move would be unconscionable as 89 percent of all
Medicare beneficiaries today are in the traditional program. To force
these beneficiaries to leave their present system of coverage, and most
likely the doctor that they have come to know and trust, would not only
create great disruption, it would also for the first time since the
program's inception create a tiered benefit system under Medicare that
would more greatly reward those who choose to join a private preferred
provider organization, PPO, or health maintenance organization, HMO.
And while I am pleased that the bill before us soundly rejects a
tiered benefit system, I am deeply concerned that the plan presently
taking shape in the House of Representatives appears to rely on such a
flawed plan. As I said earlier, such a measure should be soundly
rejected.
So it is with great caution that we come to the final moments of
debate on this important issue. Medicare's nearly 41 million
beneficiaries clearly need assistance in affording their needed
medicines. The result of our efforts over the past 2 weeks, and more
important, the result of the coming conference committee on this
legislation will greatly determine to what extent we assist our
Nation's Medicare beneficiaries to afford their needed medicines.
Clearly, a great opportunity is presently before us. As the
underlying bill moves to conference committee. I look forward to
working with my colleagues to ensure that we seize this opportunity by
strengthening the underlying bill. With passage of the bill presently
before us, we now face a choice. We can insist on the good start that
we have made here with passage of S. 1, and work to strengthen its
provisions. Or, conversely, we can accede to the House legislation that
in my view unfairly jeopardizes the traditional Medicare Program by
tilting the system in favor of risky privatization schemes and against
seniors.
I ask my colleagues to join with me in working to ensure that any
Medicare prescription drug legislation passed by this Congress is at
least as strong as the bill we are about to vote on. A tilt toward the
House-drafted language would signify not a strengthening of Medicare,
but rather a weakening of this vital program's foundation and must be
avoided at all costs.
Nearly 38 years ago on July 9, 1965, this body passed the legislation
creating the Federal Medicare Program sending it to a conference
committee with the House. On that day, President Lyndon Baines Johnson
remarked, ``This is a great day for older Americans. And it is a great
day for America. For we have proved, once again, that the vitality of
our democracy can shape the oldest of our values to the needs and
obligations of today.'' Nearly four decades later, we are on the cusp
of a similar challenge. Let us move Medicare toward the future without
threatening its proven ability to provide for the health and well being
of this Nation's senior citizens.
Mr. COLEMAN. Mr. President, I am proud to mark this extraordinary day
by coming to the floor of the Senate to celebrate the imminent passage
of a prescription drug benefit for Medicare. This is a triumph not for
a party or a President, but for America's seniors and their families.
This is an incredibly hopeful day for all Americans who long for a
national government that can get things done for people.
Thirty-eight years ago Congress voted to create a health care program
that would be the primary source of health insurance for this Nation's
seniors. Most people would agree that this program has served us well
for almost four decades. However, the practice of medicine has changed.
Drug therapies, medical devices, and human genome research all hold
great hope for breaking through physical limitations that hinder many
seniors' ability to enjoy the later years of life.
The question we now ask is what level of care are we going to provide
our seniors and is the current system equipped to provide the type of
care our seniors need and deserve.
The benefits provided under Medicare, considered generous at its
inception in 1965, pale in comparison to those enjoyed by Federal
employees and most workers in the private sector today. A recent report
submitted by the Joint Economic Committee found that Medicare has the
least generous benefit package among leading forms of insurance.
Medicare covers 56 percent of total health care expenses, while typical
employment-based health insurance covers 70 percent.
Seniors need prescription drug coverage. Seniors need better access
to preventative care and disease management. Seniors need more choices
in their health care options than they have today. Without updating, it
may take years to add this kind of care to the current program--after
all, it has taken over 30 years to add a prescription drug benefit.
The Prescription Drug and Medicare Improvement bill is a step toward
meeting the needs of this Nation's seniors.
This bill provides a solid drug benefit that will provide assistance
to every senior struggling to pay for prescription drugs as well as the
security of knowing they are covered for unforeseen drug expenses.
Under this plan, the average senior's annual drug costs will be
reduced by 53 percent each year. That amounts to $1,677 each year back
in the pocket of our seniors. And seniors with the greatest needs will
receive additional assistance through increased cost-sharing, and
reduced or waived monthly premiums and deductible.
Equally important, this plan provides seniors with the security of
knowing that they are covered in the event something happens and they
find themselves facing exorbitant drug costs. At $3,700 in out of
pocket drug costs, stop-loss coverage kicks in and the senior is only
responsible for 10 percent of costs beyond this amount.
This bill is also about expanding options for this generation and
future generations of seniors. The incremental improvements to the
Medicare program have largely been the result of legislative action
over the last 40 years. The legislative process, however, is not a
quick process, and it is simply not possible to keep the program
current in the first parcel environment we currently live.
The Medicare Advantage program included in this bill offers seniors
the choice of receiving their health care benefits in a Preferred
Provider Organization, PPO, the same type of health plan enjoyed by
many families.
Under this health care option--not mandate--seniors will have
increased access to the latest advances in care such as desire
management and better preventive screenings. Additionally, seniors who
chose this option will also have a lower deductible for inpatient and
hospital care than those in traditional Medicare.
This bill lays the foundation for a Medicare program that is better
able to respond to an evolving health care system by harnessing the
efficiencies of the health care market, while preserving traditional
Medicare for those seniors who are satisfied with their current
coverage.
This bill is about expanding options for seniors so our parents and
grandparents have access to the type of care best suited for them.
Is this bill everything everyone wants? Of course not. Are there
decisions still to be made as it is implemented and we see how it
actually works in the marketplace? Certainly. But this bill says we are
not going to let the lack of perfection stop us from doing real good
for people as soon and as effectively as we practically can.
I would be remiss if I didn't express my appreciation to Senators
Grassley and Baucus for their leadership in including many provisions
in this bill to strengthen rural health care.
The availability of health care in rural areas in Minnesota is
absolutely critical to the stability and viability of many communities.
The provisions in this bill to improve payments to hospitals in rural
areas and reduce the geographic disparity in physician payments are
critical to ensuring that these hospitals that threat not only seniors,
but entire communities continued to receive care.
I am pleased that we did not allow perfect to be the enemy of good as
we considered this package.
This is a substantial and dependable benefit for America's seniors.
Again,
[[Page S8706]]
it's not everything everyone wants. There are still decisions to be
made as it is implemented and we monitor how it works in the
marketplace. But today we are delivering on a promise to provide
quality care to our seniors.
I am hopeful that with bipartisan support this landmark legislation
will pass the Senate and the House of Representatives by the July 4th
holiday. When it does, there may not be any fireworks and parades but
millions of seniors will be able to declare their independence from
worrying about getting the prescription drugs they need to live a
quality life.
Mr. BIDEN. Mr. President, after many years of preparation and
deliberation, and following weeks of debate and discussion on the floor
this year and last, we in the Senate are about to vote on a bill
providing some prescription drug benefits for Medicare beneficiaries
that is widely expected to pass.
Seniors have been demanding prescription drug coverage for many years
now. They need it and they deserve it, and I believe what we should be
passing here today is a bill that will bring the American people the
type of prescription drug benefit they have been seeking--one that is
easy to understand and use, one that covers a substantial portion of
all their costs, and one that is affordable.
But to the many Medicare beneficiaries who will read the details of
this bill and say, ``there isn't much in here for me and it will cost
me more than I am now paying for drugs,'' I would say: I hear you. This
bill is not enough, not nearly enough.
I have a lot of concerns about this bill. There is no uniformity from
region to region in the benefit package or beneficiary payments.
Seniors in the East could be paying far higher premiums than their
relatives in the Midwest.
The drug plan relies on private insurance companies to provide a type
of insurance policy that they have already said they are unwilling to
sell. I am skeptical that these private plans will stay, and that could
mean seniors will have no stability in their coverage. The bill does
allow traditional Medicare to step in and fill the gap but seniors
might have to move back to a private drug plan if new ones come to the
region.
There is also a gap in coverage which I think is unfair and will
surprise a lot of people.
Finally, the bill falls short in its efforts to induce employers not
to abandon their retiree prescription drug coverage, a situation that
too many retirees have already faced in recent years.
In summary, I view this bill not as a situation where we would say
that the glass is half full and half empty; to my thinking, the glass
is only about one-quarter full. In 2003, prescription drugs are as
important in medical care as surgery; consequently, it seems logical to
me that if Medicare pays for the bulk of the cost of a heart bypass
operation for all beneficiaries, it should similarly pay the bulk of
the cost of the drugs used to lower the cholesterol, and which would
prevent the need for the bypass operation, for all beneficiaries. This
bill does not achieve that commonsense goal. Not even close.
But we need to start somewhere. This is the first step in gradually
moving the health plan that covers nearly 40 million seniors and
disabled individuals into the 21st century. And it is, very frankly,
the best that we can expect to pass this Congress and that the
President will sign.
There are some good provisions in this bill. All Medicare
beneficiaries will have access to a prescription drug plan. Individuals
with low incomes, below 160 percent of Federal poverty level, will have
access to prescription drug coverage at very little cost. Those with
very high prescription drug expenses, in the many thousands of dollars,
will have stop-loss protection to help protect them against
catastrophic drug costs. And no one is forced to abandon the
traditional Medicare Program for their basic health care, with which
they are so familiar, in order to obtain prescription drug coverage.
During the Senate deliberation on this bill, I have voted for
amendments that would improve the prescription drug coverage and
decrease the cost to beneficiaries. Almost all of these amendments were
not adopted, mostly with the rationale that there was not enough money.
I do not feel constrained by some arbitrary $400 billion cost limit on
this bill. I never agreed to such a limit. In fact, my sense of values
tells me that prescription drug benefits are a high priority, and I
would be willing to spend more than $400 billion for a good
prescription drug plan, while cutting budget items of lower priority,
such as tax cuts for the very wealthy.
In the end, I decided to vote for this bill, despite its severe
limitations. Given the many past years of fruitless discussions on this
matter, I feel it is critical to put something into law now that can
serve as a starting point for development of a true prescription drug
plan. But that is not to say that I will accept any lesser of a bill,
and my colleagues should not count on my continued support, if the
final version of this bill that comes out of negotiations with the
House of Representatives undercuts the Medicare Program or moves toward
reducing protections for beneficiaries.
We also need to remember, this bill comes with a warning to all of
us: the public is a lot smarter than they are sometimes given credit
for, and if we do not work diligently to improve what we have begun,
they will rightly take out their anger on us. We need to ensure that
this bill is the first step, not the last step.
Mr. GRASSLEY. Mr. President, parliamentary inquiry. Are we now ready
for third reading?
The PRESIDENT pro tempore. The question is on agreeing to the
committee amendment in the nature of a substitute, as amended.
The committee amendment in the nature of a substitute, as amended,
was agreed to.
The PRESIDENT pro tempore. The question is on engrossment and third
reading of the bill.
The bill was ordered to be engrossed for a third reading and was read
the third time.
Mr. GRASSLEY. Mr. President, I ask unanimous consent that following
passage of S. 1, the bill be held at the desk; further, when the Senate
receives from the House the companion measure to S. 1 the Senate
proceed to its consideration, all after the enacting clause be
stricken, and the text of S. 1 as passed be inserted in lieu thereof;
the bill then be read a third time and passed with the motion to
reconsider laid upon the table; further, that the Senate then insist on
its amendments and request a conference with the House, and the Chair
be authorized to appoint conferees with a ratio of 5 to 4; finally,
with that action, I ask unanimous consent that passage of S. 1 be
vitiated and the bill be placed back on the calendar.
The PRESIDENT pro tempore. Without objection, it is so ordered.
Mr. BAUCUS. Mr. President, I want to take a few moments to return to
the basics of what this bill is all about. Let's keep our eyes on the
ball.
We are working here to make a meaningful improvement in health care
for seniors. We are working to bring prescription drug coverage to
Medicare beneficiaries.
Too many seniors do without drug coverage. The Congressional Budget
Office reports that roughly a quarter of Medicare beneficiaries have no
drug coverage. Ten million people. They have to pay all of their drug
costs out of their own pockets. They pay full price.
Lack of coverage means poorer health. Seniors who get along without
drug coverage get fewer of the healing benefits that prescription drugs
provide. CBO reports that when seniors do not have drug coverage, they
fill about a quarter fewer prescriptions, on average, than do those who
have coverage.
But whether seniors have coverage or not, they still need a
significant amount of prescription drugs. CBO says that in 1999,
Medicare beneficiaries who had coverage filled an average of 32
prescriptions a year. Those without coverage still filled an average of
25 prescriptions a year.
These prescriptions cost seniors a good deal of money. The average
Medicare beneficiary spends about $2,500 a year on prescription drugs.
That's a big number--especially as the median income for all elderly
households in 2001 was less than $19,000.
Those costs are rising fast. CBO projects that the average Medicare
beneficiary's drug costs will rise at a
[[Page S8707]]
rate of more than 10 percent a year over the next decade. That is far
faster than the cost of living. That means that without this
legislation, seniors will need to devote larger and larger shares of
their income to paying prescription drug bills.
So we are here to try to make prescription drugs more affordable for
seniors. And we are here to extend coverage to the roughly 10 million
seniors who have no prescription drug coverage at all.
We are here to try to end seniors' painful choice between filling
prescriptions and buying food. Seniors should not have to choose among
the necessities to maintain their health. We are here to do something
about that today.
Let me review what this bill would do.
This bill would make available prescription drug insurance to all
seniors.
This bill would ensure that 44 percent of Medicare beneficiaries--
those with the lowest incomes--would have truly affordable prescription
drug coverage with minimal out-of-pocket costs. For these lower-income
seniors, with incomes up to 160 percent of the poverty level,
copayments would never exceed 20 percent of the cost of drugs.
Let me take some examples. Let's look at what this bill would do for
beneficiaries with what will likely be average drug spending of $3,155
in 2006.
For seniors with average drug expenses, even with higher incomes,
this bill would save them $1,677. That is a 40 percent savings in out-
of-pocket costs.
The savings would be greater for lower income seniors. For an
individual making $14,000 or a couple making $19,000 a year, with
average drug spending, they would save $2,842. That is a 90 percent
savings in out-of-pocket costs.
For an individual making $12,000 or couple making $16,000 a year with
average drug spending, they would save $2,842 in out-of-pocket costs.
That would be a savings of 96 percent in out-of-pocket costs.
This bill would thus ensure that those who have been least able to
receive the healing benefits of prescription drugs would now be able to
do so. Millions of people would have a better quality of life. Lives
would be saved.
This bill would create a strong Government fallback. Seniors would
have access to at least two private plans for a prescription drug
benefit, or the Government would provide a standard fallback plan. If
there is not true competition, then traditional Medicare would provide
a fallback.
The Department of Health and Human Services would continue to oversee
these plans. The plans would operate within tightly controlled limits.
This bill includes strong consumer protections.
And this bill does not tilt the playing field. This bill does not
make private plans a better deal than traditional Medicare.
This bill would make a nearly $400 billion expansion of a major
entitlement program. This is a historic opportunity to make a
fundamental change for the better for millions of Americans.
In so doing, this bill would finally do something that the
overwhelming majority of industrialized nations have already done.
This is a broad compromise. This is not a bill of the left or a bill
of the right. This is a weaving together of approaches, in the finest
American tradition.
This is a historic opportunity. Let us finally seize that
opportunity, and improve health care for our seniors. Let us finally
seize the opportunity, and bring prescription drug coverage to all.
Mr. GRASSLEY. Mr. President, we are about to take a historical vote.
Since 1965, Medicare hasn't covered prescription drugs. Now, 38 years
later, we're changing that--on a strong bipartisan basis.
Because of this bill, on January 1, 2004, seniors across America will
have immediate help with prescription drug costs. Moreover, on January
1, 2006, seniors will have access to affordable, comprehensive drug
coverage as a permanent part of Medicare.
No longer will seniors have to make hard choices when it comes to
paying for prescription drugs.
This bill also strengthens and improves Medicare, giving seniors more
choices and better benefits than they have today.
At the same time, it brings long overdue Medicare equity to the
people of Iowa and to other rural States.
We are on the verge of a major victory.
I urge my colleagues to support S. 1.
Mr. BAUCUS. Mr. President, we are about to vote. I want to thank all
Senators for their tremendous patience. It is not an easy task. I
particularly thank the chairman of the committee but also all Senators.
Second, I thank the staff who have not had any sleep in the last two
or three weeks. I don't know how they are still standing. A lot of
people have been working on this bill. My thanks. I know I speak for
all the Senators in thanking all the staff that worked so hard to help
achieve this end.
The PRESIDENT pro tempore. The bill having been read the third time,
the question is, shall it pass?
Mr. HOLLINGS. Mr. President, I ask for the yeas and nays.
The PRESIDENT pro tempore. Is there a sufficient second?
There is a sufficient second. The clerk will call the roll.
The legislative clerk called the roll.
Mr. McCONNELL. I announce that the Senator from Oklahoma (Mr. Inhofe)
is necessarily absent.
Mr. REID. I announce that the Senator from Massachusetts (Mr. Kerry)
and the Senator from Connecticut (Mr. Lieberman) are necessarily
absent.
I further announce that, if present and voting, the Senator from
Massachusetts (Mr. Kerry) would vote ``nay''.
The PRESIDENT pro tempore. Are there any other Senators in the
Chamber desiring to vote?
The result was announced--yeas 76, nays 21, as follows:
[Rollcall Vote No. 262 Leg.]
YEAS--76
Akaka
Alexander
Allen
Baucus
Bayh
Bennett
Biden
Bingaman
Bond
Boxer
Breaux
Brownback
Bunning
Burns
Campbell
Cantwell
Carper
Chafee
Chambliss
Cochran
Coleman
Collins
Conrad
Corzine
Craig
Crapo
Daschle
Dayton
DeWine
Dodd
Dole
Domenici
Dorgan
Durbin
Enzi
Feingold
Feinstein
Fitzgerald
Frist
Grassley
Hagel
Hatch
Hutchison
Inouye
Jeffords
Johnson
Kennedy
Kyl
Landrieu
Lautenberg
Leahy
Lincoln
Lugar
McConnell
Mikulski
Miller
Murkowski
Murray
Nelson (FL)
Nelson (NE)
Pryor
Reid
Roberts
Schumer
Sessions
Shelby
Smith
Snowe
Specter
Stabenow
Stevens
Talent
Thomas
Voinovich
Warner
Wyden
NAYS--21
Allard
Byrd
Clinton
Cornyn
Edwards
Ensign
Graham (FL)
Graham (SC)
Gregg
Harkin
Hollings
Kohl
Levin
Lott
McCain
Nickles
Reed
Rockefeller
Santorum
Sarbanes
Sununu
NOT VOTING--3
Inhofe
Kerry
Lieberman
The bill (S. 1), as amended, was passed.
(The bill will be printed in a future edition of the Record.)
The PRESIDENT pro tempore. Without objection, the title amendment is
agreed to.
The title was amended so as to read: ``A bill to amend title XVIII of
the Social Security Act to provide for a voluntary prescription drug
benefit under the medicare program and to strengthen and improve the
medicare program, and for other purposes.''.
Mr. GRASSLEY. Mr. President, I move to reconsider the vote.
The PRESIDENT pro tempore. The Chair, in my capacity as a Senator
from the State of Alaska, moves to lay that motion on the table.
The motion to lay on the table was agreed to.
Mr. INHOFE. Mr. President, because of urgent business back in my
State of Oklahoma, I will be unable to be in attendance to vote on S.
1. It makes no difference, however, because I would have voted against
it.
Last week, I addressed this Chamber regarding S. 1, the Prescription
Drug and Medicare Improvement Act. At that time, I said I could not
support the legislation in its current form and expressed my hope that
it could be improved on the floor. Unfortunately, that has not
occurred. I am restating my opposition to this legislation.
This is simply another Federal entitlement program designed to
balloon past expected costs of $400 billion. For
[[Page S8708]]
example, in the past, Medicare expenses have soared nearly five times
the projected costs. I remember that well because I remember in 1965
when it was passed. This trend will only escalate if we continue to add
unfunded obligations without ensuring the long-term solvency of the
entire program.
We must examine the necessity of such obligations prior to placing
the burden on the backs of the future taxpayers. And is a full
prescription drug benefit necessary? Currently, 76 percent of seniors
already have some form of prescription drug coverage. A recent Zogby
poll found that three-fourths of seniors thought the coverage offered
under this plan would be no better than what they currently have. In
fact, less than one-half would even purchase the option if given the
choice. However, with the passage of S. 1, those individuals may not be
given that choice. CBO estimates that one-third of Medicare
beneficiaries with employer-sponsored coverage will lose those benefits
once the bill takes effect. Seniors who currently have private coverage
that they like will be forced to buy the Government-sponsored benefit
simply because it is the only thing that will be available.
There is something wrong with that picture. The Government should not
be replacing coverage that already exists. However, this legislation
opens the door for continued Government intervention. With the
inclusion of the fallback provision, this benefit has the potential to
become fully federalized if private plans do not surface. Once again,
we are placing more and more expense at the door of the taxpayers, our
children, and our grandchildren.
I am concerned about the effect this bill could have on the future of
the entire Medicare Program. I have worked with my colleagues to
support improvements to this legislation. I and many of my colleagues
have signed letters to both Senator Frist and President Bush outlining
the principles that need to be included in the final version of this
bill. I also cosponsored an amendment with Senators Ensign, Hagel, and
Lott to provide a more reasonable prescription drug benefit that does
not create a massive entitlement program. I believe the House of
Representatives is on the right track with this issue.
I am hopeful that with the passage of S. 1, the conferees will work
to see that the final legislation adheres to the principles stated in
the letters to President Bush and Senator Frist and the proposal
supported by the House. At that time, I will look forward to supporting
this legislation.
The PRESIDENT pro tempore. The majority leader.
Mr. FRIST. Mr. President, for years Congress has debated providing
prescription drug coverage to seniors and how to strengthen and improve
the Medicare Program. Tonight we have acted. Tonight America is one
step closer to being a more caring society for millions of seniors and
individuals with disabilities. Tonight seniors and individuals with
disabilities, through this bill, will get relief from high prescription
drug costs and outdated, often inadequate medical care. Tonight we are
one step closer to providing real health care security to seniors all
across the Nation.
We stand on the shoulders of many in this body and in the House of
Representatives who have labored mightily to improve the Medicare
Program. We have reached this point of success because of the
commitment of the leadership in the House as well as the Senate. Above
all, we are indebted to the bold leadership of the President of the
United States without whom we would not be transforming or improving
the system.
Indeed, the bill we have just passed is nothing less than historic.
By dramatically expanding opportunities for private sector innovation,
it offers genuine reform that will dramatically improve the quality of
health care for all seniors. At the same time, the legislation
preserves traditional Medicare so that those who wish can remain in
traditional Medicare and keep exactly what they have today.
This bill combines the best of the public and private sectors and
positions Medicare to evolve with the medical treatments of the future.
It is entirely voluntary.
I am very pleased by the overwhelming majority of this body who
tonight voted to move this legislation towards a more competitive
private model but a partnership between the public and private sector.
I am also pleased that the amendment maintained the balance that has
been so important in what I set out a few weeks ago, to be a truly
bipartisan effort. The bill devotes increased resources and expands
opportunities within the traditional Medicare Program for chronic care
coordination, for disease management, for preventive care.
As many people have stated, it is not a perfect bill, but we will
continue to move this legislation forward now to conference once, later
in the evening or in the hours of the morning, after the House passes
its legislation, we will have the opportunity to make the private
sector provisions more flexible, indeed more competitive, and more like
the Federal Employees Health Benefits Plan. All of us in this body are
familiar with the impressive record of that plan, the Federal employees
plan. Every Member of Congress and over 8 million other Federal workers
and retirees enjoy the ability to choose the plan that best suits their
medical needs.
Indeed, as we go through conference and once the bill is signed by
the President of the United States, all seniors will have that same
opportunity to voluntarily choose the plan that best meets their
medical needs.
I look forward to working with my colleagues on both sides of the
aisle to improve this legislation and to make sure that it does not
inadvertently displace good private health care coverage that exists
today--options that are available to millions of Medicare
beneficiaries, including employer-sponsored health coverage.
Compromise and debate are the cornerstone of this great democratic
system of government. I commend my colleagues for their admirable show
of bipartisan spirit. Thanks to the leadership of our colleagues in the
Senate and the commitment of President Bush, America's seniors will
finally receive the health coverage they need and the security they
deserve.
I want to take a brief moment to thank all of my colleagues for their
hard work and dedication over the last several weeks. It has been about
3 months ago that I set out that we would address Medicare for these 2
weeks--the 2 weeks prior to the July 4 recess. Many people said we were
trying to do too much in too short a period of time. Others said it is
something that has been debated for weeks and months, and indeed years,
and there is no way we can finish it before July 4.
Yet through the hard work of our colleagues--again, on both sides of
the aisle--we have fulfilled that vision. Again, it is a first step, a
step that will be improved in that conference before us. Nevertheless,
we succeeded in what we set out to do with the legislation that is
built upon the work of many Members of the Senate, as well as the House
of Representatives and, in particular, the members of the Senate
Finance Committee. I do want to thank especially Senators Hatch,
Nickles, Lott, Snowe, Kyl, Thomas, Santorum, Smith, Bunning, and Breaux
for their hard work and leadership.
In particular, of course, I thank Chairman Grassley and Senator
Baucus, the managers, who for the last 2 weeks have so capably managed
the bill on the floor. Their cooperation and their leadership has been
invaluable. Without it, we would not be here so close to the finish
line.
I would like to recognize all of the staff who have contributed to
this effort:
First, I would like to thank my chief of staff, Lee Rawls: my policy
director, Eric Ueland; and my health policy director, Dean Rosen. Paul
Jacobson, Bob Stevenson, Nick Smith, Bill Hoagland, and Amy Holmes of
my Leadership office also made important contributions. I also would
like to recognize the other members of my health team who worked so
hard to help make possible the passage of this legislation: Elizabeth
Scanlon, Craig Burton, Susan Goelzer, Shana Christrup, Allison Winnike,
and Jennifer Romans.
The Majority Whip's staff deserves special recognition, especially
Kyle Simmons, Michael Solon, and Amy Swonger, for the long hours they
put in and for the guidance they provided to our Finance Committee
Chairman and our entire Republican leadership team.
[[Page S8709]]
As I have said, passage of this legislation was made possible in the
United States Senate because of the genuine spirit of bipartisan
cooperation. Both the Republican and Democratic staff of the Senate
Finance Committee worked incredibly hard, long hours these past several
weeks and months. Their expertise, support, and stamina has been
invaluable.
I would like to thank Kolan Davis, Ted Totman, Linda Fishman, Colin
Roskey, Leah Kegler, Mark Hayes, Jennifer Bell, and Alicia Ziemiecki of
Chairman Grassley's staff.
And I would also like to thank Jeffrey Forbes, Elizabeth Fowler, Bill
Dauster, John Blum, Pat Bousilman, Kate Kirchgraber, and Andrea Cohen
of Senator Baucus' staff for their contributions.
Hazen Marshall, Stacey Hughes, and Megan Hauck of the Senate Budget
Committee staff are also commended for their efforts.
Thank you to you all.
I look forward to working with Chairman Grassley and our colleagues
in the House of Representatives to produce a conference report that can
pass both Houses and be signed by the President in a timely manner
later this year.
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. FRIST. Mr. President, I ask unanimous consent that the order for
the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
____________________