[Congressional Record Volume 149, Number 167 (Tuesday, November 18, 2003)]
[House]
[Pages H11493-H11500]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
MOTION TO INSTRUCT CONFEREES ON H.R. 1, MEDICARE PRESCRIPTION DRUG AND
MODERNIZATION ACT OF 2003
Ms. BERKLEY. Mr. Speaker, I offer a motion to instruct.
The SPEAKER pro tempore. The Clerk will report the motion.
The Clerk read as follows:
Ms. Berkley moves that the managers on the part of the
House at the conference on the disagreeing votes of the two
Houses on the Senate amendment to the bill H.R. 1 be
instructed as follows:
(1) To reject the provisions of subtitle C of title II of
the House bill.
(2) To reject the provisions of section 231 of the Senate
amendment.
(3) Within the scope of conference, to increase payments
for physician services by an amount equal to the amount of
savings attributable to the rejection of the aforementioned
provisions.
(4) To insist upon section 601 of the House bill.
Ms. BERKLEY (during the reading). Mr. Speaker, I ask unanimous
consent that the motion to instruct be considered as read and printed
in the Record.
The SPEAKER pro tempore. Is there objection to the request of the
gentlewoman from Nevada?
There was no objection.
The SPEAKER pro tempore. Pursuant to clause 7 of rule XXII, the
gentlewoman from Nevada (Ms. Berkley) and the gentlewoman from New
Mexico (Mrs. Wilson) each will control 30 minutes.
The Chair recognizes the gentlewoman from Nevada (Ms. Berkley).
General Leave
Ms. BERKLEY. Mr. Speaker, I ask unanimous consent that all Members
may have 5 legislative days within which to revise and extend their
remarks and include extraneous material on this motion to instruct.
The SPEAKER pro tempore. Is there objection to the request of the
gentlewoman from Nevada?
There was no objection.
Ms. BERKLEY. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I rise to offer a motion to instruct the conferees on
the Medicare Prescription Drug Bill to provide a much needed payment
update to physicians for the next 2 years.
I represent Las Vegas, which is home to the fastest growing seniors
population in the United States. In my community, we are facing a
health care crisis. The rapid growth of southern Nevada has put a
strain on the health care system, and many doctors face a tough choice
when it comes to treating Medicare patients because reimbursements are
not keeping up with the costs of practicing medicine. In addition to
staffing costs and utilities and rent, malpractice insurance for
doctors in my community has skyrocketed anywhere from 150 to 400
percent.
We rely on our doctors to treat more than 150,000 seniors under the
local Medicare system; but with the cost of doing business so high and
the demands for their services at a premium, in many instances our
doctors cannot afford to see new Medicare patients. We used to talk
about the quality of health care, but the situation is becoming so bad
that we are no longer talking about the level of treatment the patient
receives, but whether or not they will receive any treatment at all.
My community is struggling to attract enough medical professionals to
address the health care needs of our ever-expanding population. But how
can we expect more doctors to see more Medicare patients if we continue
to cut payments to doctors under Medicare? If we do not act soon, there
will be another 4.5 percent reduction in reimbursements to physicians
who are treating those who depend on their physicians' care the most,
our seniors.
If we allow this to happen, the result will be a loss of $17 million
in payments to physicians in my State of Nevada alone. The time is long
past due that we increase these payments which have limited medical
providers from expanding the number of patients receiving care. I have
heard from doctors in Las Vegas who say they want to treat Medicare
patients, but they are being forced to choose between taking on new
Medicare patients or keeping the lights on in their offices and their
practices solvent.
According to the AMA, since 1991 the cost of practicing medicine has
gone up by more than 33 percent, but payments have grown less than 10
percent. For years doctors have provided important tests for seniors
for cholesterol, depression, blood pressure, vision, and hearing
impairment without any reimbursements from Medicare.
Medicare reimbursements for primary care are inadequate, and in
January they will be too low for many doctors to continue to serve
Medicare patients. Just last year, doctors' payments were cut by 5.4
percent; and if we allow them to be cut once again, this will be the
fifth reduction since 1991 and would place doctors' reimbursements 8
percent below 2001 levels. It does not make any sense to be cutting
payments to doctors when the
[[Page H11494]]
costs of practicing medicine are on the rise.
Our doctors simply cannot afford to take any more cuts. Already one-
quarter of the family physicians across the Nation are saying they can
not accept any new Medicare patients. Who knows how many more will
choose to do the same in January when they are told their
reimbursements have been slashed once again?
As a Nation we must provide our doctors with the means to treat and
provide health care to our citizens. This motion would instruct the
conferees to protect the language in the House version of the
Prescription Drug Bill that would reverse the cut to our physicians
while providing a 1.5 percent increase in payments for the next 2
years. To fund the increase in payments to our doctors, this motion
strikes funding for privatization provisions in the Prescription Drug
Bill.
The Centers for Medicare and Medicaid Services estimated that under a
privatized Medicare, premiums would skyrocket for the seniors who
choose to stay in traditional Medicare. I am concerned that by
increasing the premiums of traditional Medicare, many patients would be
forced into HMOs and other private plans. This 1.5 percent increase
will give doctors nationwide enough to continue to treat seniors on
Medicare, and it will give Congress time to develop and permanently fix
this flawed system that shortchanges doctors and continues to restrict
the ability of seniors to access health care services.
I ask my colleagues to work with me to fix the Medicare physician
reimbursements formula which currently threatens to destabilize the
Medicare program. Seniors rely on their doctors and the medicines they
need to stay healthy. Seniors have waited too long for a prescription
drug benefit in Medicare and relief from high prescription drug costs.
We must work together for a drug benefit that prevents seniors from
risking their health by cutting pills in half or having to choose
between paying for medicine and paying for their rent, their
electricity or even the purchase of their food.
For 4 decades this Nation promised that Medicare would provide health
care for all seniors. It is a program that ensures these hardworking
older Americans who have paid taxes and have paid into the system will
have health care coverage.
I urge my colleagues to vote for this motion to allow our
constituents to continue to choose what doctors they see, what
hospitals they are treated in, and to continue to access the highest
quality of care.
Mr. Speaker, I reserve the balance of my time.
Mrs. WILSON of New Mexico. Mr. Speaker, I yield myself such time as I
may consume.
Mr. Speaker, it is a little bit hard for me to understand why we are
going to vote on this motion to instruct or why my colleague from
Nevada has offered it, because the conference committee on the Medicare
bill has already agreed that we are not going to have the provisions in
there that she is worried about that we are going to adjust the
physician payments.
In fact, the American Medical Association has written to us asking us
to strongly oppose the Berkley motion to instruct and urges the
conference to pass the pending Medicare conference report. So, in fact,
I think the problem that the gentlewoman has addressed or has
identified here has already been addressed in the conference report to
the satisfaction of physicians nationwide. Perhaps to explain this a
little bit more fully we will turn to a physician.
Mr. Speaker, I yield 3 minutes to the gentleman from Texas (Mr.
Burgess), who is an OB-GYN and he has worked very hard on issues
related to health care.
Mr. BURGESS. Mr. Speaker, I thank the gentlewoman from New Mexico
(Mrs. Wilson) for yielding me time.
Mr. Speaker, I confess to being a little bit mystified as to why we
are here tonight with a motion to instruct conferees when the
conference report appears to have been decided; but I am just a simple
country doctor, and I do not always understand the ways of Congress.
But the motion to instruct as I understand it would strip out
important competitive provisions in the Medicare conference report and
redirect funds allegedly towards reimbursement of physicians. The
conference committee has reportedly included a provision that will
provide physicians with positive updates in 2004 and 2005. That is not
a permanent solution. It does provide Congress with the time it needs
to make long-term substantive changes to the Medicare physician payment
formula. It will also ensure that Medicare beneficiaries continue to
access high-quality health care.
That is why the American Medical Association, the American
Osteopathic Association, and the Alliance of Specialty Medicine all
strongly support the House Medicare bill.
I am aware the supporters of the motion are attempting to portray
this as a choice between HMOs or doctors; and this is false and the
authors know it is false. However, do not take my word for it. Listen
to what the AMA has to say about this motion: ``Simply attempting to
transfer dollars from patients to physicians through some ambiguous,
unspecified mechanism, as is intended under the motion to instruct,
would not change the flawed Medicare payment formula and thus would not
ensure long-term access for Medicare patients.''
As mentioned before, the House bill increased reimbursements for
physicians and is supported by the physician community. It also
provides seniors with more choices under Medicare and attempts to make
some long-term competitive reforms so that Medicare is available and on
sound financial footing for generations to come.
Mr. Speaker, Medicare spends $247 billion a year as it stands. The
gentlewoman that offered the motion to instruct is from Nevada and, of
course, Nevada has had a serious problem with liability in recent
years. In fact, a study by Kessler in 1996 showed that with two
diagnostic codes, $50 billion a year could be saved in Medicare if we
did not have to bear the costs of defensive medicine in this country.
That $50 billion would more than fund the $40 billion a year with which
we are seeking to add a prescription drug benefit.
The House-passed Medicare bill does not ever require that Medicare
beneficiaries leave traditional Medicare. I might add that we will have
a new out-patient drug prescription drug benefit available to
beneficiaries. Anyone who says otherwise either does not understand the
legislation or does not care to talk about the facts.
This is an irrelevant motion introduced only to score political
points. I urge Members to recognize it for what it is and to vote
against the motion.
Ms. BERKLEY. Mr. Speaker, I yield 10 minutes to the gentleman from
Ohio (Mr. Brown).
Mr. BROWN of Ohio. Mr. Speaker, I thank the gentlewoman from Nevada
(Ms. Berkley) for her leadership on health care issues and for her
advocacy on behalf of seniors, especially in Nevada, and around the
country.
Mr. Speaker, I normally when speaking on the House floor do not quote
from a television show, but I would like to start this evening with
several of my colleagues. The gentlewoman from Ohio (Mrs. Capps), the
gentleman from Rhode Island (Mr. Kennedy) and maybe some others, maybe
the gentleman from New Jersey (Mr. Pallone) and the gentleman from
Massachusetts (Mr. Delahunt) are going to speak on this too.
I am quoting from Al Hunt on ``Capital Gang.'' If you have seen that
show, those people watching, you know he does something called the
``Outrage of the Week.'' He says: ``Now for the outrages of the week.
The American Association of Retired Persons, the largest lobby for the
elderly, is on the verge of selling out many seniors on the Medicare
bill.'' This is a commentator saying this, not me. ``The legislation as
it now stands would deny 4 million retirees coverage they currently
get, would give sweeping new powers to HMOs over the traditional one
for Medicare,'' basically a $12 billion pay-off to the insurance
companies, ``and would gut a measure approved by both Houses to
facilitate importation of cheaper prescription drugs from Canada,''
from countries that charge two and three and four times what the drug
companies do in this country.
``The AARP Washington lobbyists apparently care more about their own
influence than what they can do for struggling seniors.''
[[Page H11495]]
Mr. Speaker, we should not be surprised by this. Let me share some
comments, some articles written about AARP which most of us in
Washington know is one of the largest insurance companies in the
country.
In Newsday 3 years ago, ``Critics say AARP, which formally unveiled
its new headquarters building in downtown Washington last month, has
softened its earlier militancy because it is preoccupied with its
profit-making enterprise, including $100 million in earnings from the
sale of insurance.''
{time} 2200
The Denver Post wrote not too long ago, ``AARP receives more than
$100 million in revenue from health insurers.''
Newsday wrote, ``Critics suggest that AARP's substantial profits from
the sales of insurance policies, drug company advertising,''--no
surprise there either considering they sold out to the drug industry on
this one,--``drug company advertising in its magazines, and investment
schemes conflict with its interests on behalf of seniors. AARP
President William Novelli acknowledged complaints from members that
AARP has been too timid in the political battles to defend Medicare and
Social Security. He conceded that AARP has pulled its punches since
right-wing groups and Members of Congress criticized it.''
Capital News Service wrote, ``AARP's pharmacy service,''--its
connection to the drug industry, think about that,--``is part of its
insurance sales operation which generated $101 million in revenue last
year, 17 percent of the organization's total budget.'' No wonder they
are there for this bill that enhances the profits of the drug industry,
$150 billion it enhances their profits and gives a $12 billion blank
check to the HMOs in this country.
Milwaukee Journal says, ``AARP receives millions of dollars from
UnitedHealthcare, a national health insurance firm based in
Minnesota.''
Now, Mr. Speaker, in the last minute or two before yielding to my
friends, I want to mention that Mr. Novelli, who is the head of AARP,
who did the negotiations, these tough-minded negotiations with the drug
companies and the insurance companies, Mr. Novelli wrote the preface to
Newt Gingrich's book on how to reform Medicare.
Newt Gingrich is the guy that first thing after Medicare passed in
1965, only 12 Republicans voted for it. Bob Dole voted no. Donald
Rumsfeld voted no. Strom Thurmond voted no. All kinds of Republicans
voted no. In those days, Republicans did not like Medicare. They say
they do now, but then Newt Gingrich, when the Republicans finally took
control of the House in 1995, the first thing Newt Gingrich did was cut
$250 billion from Medicare to do what? Guess. To pay for a tax cut for
the richest people in the country. Same old story.
Mr. Novelli has decided he is buying in. The head of AARP writes the
preface to Newt Gingrich's book on how to privatize Medicare, the same
Newt Gingrich that said: If I have my way, Medicare's going to wither
on the vine. The same Newt Gingrich that said that.
Mr. Novelli writes, ``Newt's ideas,'' and they are on a first-name
basis obviously as much time as they spent together trying to dismantle
Medicare, ``Newt's ideas are influencing how we at AARP are thinking
about our national role in health promotion and disease prevention and
in our advocating for system change.'' If only his 40 million members
knew that he was in league with Newt Gingrich to try to privatize
Medicare; that he, Mr. Novelli, was in league with the drug industry
which will gain $150 billion, billion with a B, that is twice what we
are spending in Iraq, $150 billion to the drug industry and a $12
billion insurance payout to the insurance companies. That is like 1,000
times more than Halliburton is still paying Dick Cheney, the Vice
President of the United States.
These things are pretty incredible, Mr. Speaker, when we think about
the money that AARP is going to make from this bill. They are going to
get in line behind the drug companies and the insurance companies with
their hand out.
Mrs. CAPPS. Mr. Speaker, will the gentleman yield?
Mr. BROWN of Ohio. I yield to the gentlewoman from California.
Mrs. CAPPS. Mr. Speaker, I thank my friend the gentleman from Ohio
(Mr. Brown) for yielding to me.
I want, first of all, to acknowledge this motion to instruct
conferees and thank my colleague from Nevada. It is very appropriate
that this motion be submitted at this time as we are aware that the
conferees on the Medicare modernization bill are meeting, but some news
has been trickling out, even though to my knowledge there are Members
only on one side of the aisle attending that conference report from the
House of Representatives, and so it is just bits and pieces of news
that come.
I am thankful that my colleague from Ohio mentioned the fact that
AARP has endorsed this legislation which we really have not seen yet,
but they must know some things about it, and I just want to say to my
colleague that I sent Mr. Novelli a letter today resigning my
membership, withdrawing my membership from AARP. I remember so clearly
members from the organization from the Washington office coming to my
office to tell me in very strong language this summer about the four
principles that they were high bound must be in a prescription
medication bill, a Medicare modernization bill, including defined
benefits, including no means testing, including other standards, all of
which are fast disappearing from the legislation as it is being
prepared to bring to the floor for a conference vote before we adjourn
here.
As this discussion goes on, I cannot get out of my mind the faces of
the seniors in my district, several meetings over the past several
weeks that I have had with them, seniors who signed up for
Medicare+Choice, that partnership between the private sector, the HMOs,
the insurance companies and Medicare, a volunteer program, voluntary
program that they signed up for to help pay their prescription
medications. In my congressional district which is, a lot of parts of
it are rural, one after another of these HMOs after raising their
premiums, after raising their copays, have left. In parts of my
district, there is no choice for seniors but straight Medicare or
medigap programs, and in other areas, there is one program just hanging
on by a thread.
So the high cap program, the part of Medicare that provides a
voluntary counseling service, had gathered seniors together to explain
to them why they got this letter from the HMOs saying that they were
going to withdraw from the area, not serve them any longer, confuse
seniors in their eighties, many of them with health conditions. They
were frightened. They were frustrated, and they do not want this
legislation. They know very well what happens when we begin the
process, which this bill most certainly will do, to take us into
privatizing of Medicare, exactly what the former speaker, Mr. Gingrich,
had in mind when he became Speaker of the House in the last decade.
This bill, the House bill and the Senate bill which are now being
reconciled, are trying to impose an untried and really unnecessary
privatization scheme. Medicare works. The piece that needs to be
modernized is the prescription benefit. Privatizing Medicare will,
contrary to what someone from the other side of the aisle said, will
not give seniors that backup, because it will force and by bribing the
HMOs, by putting money up front to the HMOs, which this motion to
instruct seeks to remove, by bribing the HMOs to come into an area, the
folks who are left with Medicare, straight Medicare will be the older
and the sicker seniors, because those HMOs will raise their rates. They
will raise their premiums, they will cherry pick, and only the sick
seniors, the old seniors who have the highest costs will be left with
straight Medicare. That is not a choice and that is going to happen. It
will be happening before the end of this decade if this bill is passed
and goes into effect.
This is something our seniors know very well, and the seniors who
have contacted my office today in response to my removing myself from
AARP are thankful that we are speaking up because they know that this
is something that will not benefit them.
Mrs. WILSON of New Mexico. Mr. Speaker, I yield myself such time as I
may consume.
I think all of us agree that Medicare is one of the most successful
health
[[Page H11496]]
care programs in the history of this country, and I think all of us
have a right to be proud of what we are about to accomplish here
because we have been elected to make a difference. All of us come here
to make a difference on things that matter to the people that we serve,
and a large number of national organizations, including the AARP and
the American Medical Association, the hospital association, have all
endorsed what we are about to accomplish.
I am very pleased to welcome this evening the other doctor from the
State of Georgia (Mr. Gingrey) to explain further what this bill is
going to do for Americans.
Mr. Speaker, I yield 3\1/2\ minutes to the gentleman from Georgia
(Mr. Gingrey).
Mr. GINGREY. Mr. Speaker, I thank the gentlewoman from New Mexico for
yielding time to me.
Mr. Speaker, there they go again. They do not like the message so
they start trashing, trashing the messenger, and in this case, the
messenger just happens to be 35 million seniors who are members of the
AARP. Excuse me, 35 million less one. The gentlewoman from California
just told us that she resigned.
This is a solution, Mr. Speaker, in desperate need of a problem. The
motion to instruct conferees, like so many that the minority has
offered before, serves no useful purpose in this debate. They are
simply political tools used in a desperate attempt to divert attention
away from the fact that the Republican House will in a matter of days
deliver, it will deliver on its commitment to providing seniors with
access to meaningful, affordable and comprehensive prescription drug
coverage.
Mr. Speaker, I support properly reimbursing physicians. The House
bill did that and so does the bipartisan Medicare conference agreement
which is why it is supported by a number of medical societies,
including the American Medical Association.
Listen to what they say: ``The American Medical Association strongly
supports passage of the Medicare prescription drug conference report,
which currently includes historic and critical provisions for improving
choice and access for Medicare seniors and disabled patients. In
addition,'' Mr. Speaker, ``in addition, the conference report would
halt 2 years of impending Medicare payment cuts to physicians and other
health professionals and replace them with payment increases of at
least 1.5 percent per year. Because the Medicare conference report
includes these critical provisions for improving choice and access, the
AMA strongly opposes the Berkley motion to instruct and urges Congress
to pass the pending Medicare conference report before they adjourn.''
If the gentlewoman from Nevada is serious about wanting to help our
Nation's providers, our physician providers, and I trust that she is, I
would urge her to reconsider her opposition to medical liability reform
legislation such as H.R. 5, the HEALTH Act, the tort reform bill, a
bill that was strongly supported by both the AMA and the Nevada Medical
Association. The other body has not acted yet, so the gentlewoman will
have yet another chance to truly support physician providers.
Mr. Speaker, I strongly support the bipartisan Medicare conference
agreement, and we will soon consider this on the House floor. This
motion to instruct no longer serves any purpose. Indeed, the provisions
related to Medicare competition that the gentlewoman references in her
motion are not even part of the final conference committee agreement.
I urge my colleagues to join me in rejecting this motion to instruct
and supporting the final Medicare conference agreement.
Ms. BERKLEY. Mr. Speaker, I yield 5 minutes to the gentleman from
Rhode Island (Mr. Kennedy).
Mr. KENNEDY of Rhode Island. Mr. Speaker, I want to thank the
gentlewoman from Nevada for offering this motion, and I reject those
who would call it political.
Yes, believe it or not, we are in a political body, and yes, believe
it or not, we live in a democracy where we are Representatives of the
people, and we represent those folks the best we can. The gentlewoman
from Nevada is doing her job in highlighting the fact that the
Republican conference report on the Medicare bill is a sham.
If this was about prescription drug coverage, we would have it all
done. There is no disagreement from anyone about the fact that
prescription drug coverage ought to be passed. We are talking about
$400 of prescription drug coverage for seniors. It would be done
tonight. We could have it on the President's desk. There would not be
one person against it other than those who are dead set against any
kind of Medicare improvement whatsoever.
The problem the gentlewoman has accurately identified is that this
premium support plan that is essentially part of their reform is
untenable. It is untenable because the nature of senior citizens, their
high risk of needing health care, is such that, guess what, we needed
the Medicare program because when we relied on the private sector, the
private sector was not there.
{time} 2215
That is why we have the Medicare program, for those who do not
understand what we are talking about tonight. We have the Medicare
program because when left to the private sector, they did not cover
seniors because they were too high risk.
So what do the Republicans propose? They propose going back to the
days before we passed Medicare, where we left the seniors' health care
to private insurers. Now, what are private insurers going to do? Guess
what, they are going to have to figure out a way to make a profit. How
do you make a profit with risk insurance when you have someone as high
risk as a senior citizen? Well, if you are smart about your insurance
practices, you try to avoid the risk. That is the whole nature of
insurance, to avoid risk.
I hope I am not telling anyone anything new, but that is the nature
of insurance. So you avoid risk, and that means avoid the sickest
seniors. Avoid the seniors who will cost the most. And there will be no
argument from the other side on this because it flies in the face of
the for-profit nature of the HMO companies that they are about to turn
our Medicare system over to.
So you avoid all the seniors that are costing you, you take the
seniors that do not require much health care and you want to sign them
up. And then what do you do? What happens to all those seniors that are
not signed up? Oh, you propose to leave them in the traditional
Medicare program, but will increase the premiums of part B on the
traditional Medicare program to cover the increased cost that the
Medicare program will incur. And the Republicans put a provision in the
Medicare program saying that if it should exceed certain cost
guidelines, then we will have to come back to Congress to figure out
what to do.
Well, guess what is going to happen then? At that point you will say,
well, we are going to have to dismantle Medicare because, guess what,
it just is not working. Well, you are setting it up not to work. You
are underfunding it. And if my colleagues do not believe anything I am
saying, just understand this. Who is in favor of this bill? The
pharmaceutical industry. Why are they in favor of this bill? Because it
does not do what needs to be done to take on the pharmaceutical
industry and say you need to give in this matter.
Thirty percent profit rates for the pharmaceutical industries are too
much when our seniors are barely able to make it buying the
prescription drugs they need and affording them the health and other
things they might need in terms of housing and food and the like. The
pharmaceutical companies like the Republican bill.
Who else likes the Republican bill? Guess what, the insurance
companies like the Republican bill. And as the gentleman from Texas
(Mr. DeLay) has said before, and the gentleman from California (Mr.
Thomas), the chairman of the committee, and so we do not misunderstand
their intentions, because they said it very clearly, and here is the
chairman of the committee: ``To those who say that the House bill ends
Medicare as we know it, our answer is: we certainly hope so.''
Well, my friends, if senior citizens are comfortable with the fact
that the future of Medicare is in the hands of those who believe in the
private sector, then so be it.
Mrs. WILSON of New Mexico. Mr. Speaker, I yield myself such time as I
may consume.
[[Page H11497]]
Sometimes I feel here like we are looking through the looking glass,
like in the Alice in Wonderland book. Sometimes things people say do
not make any sense to me at all. I do not understand how can people say
we have underfunded, when we are just about to add $400 billion in new
benefits to Medicare.
When Medicare was started back in 1965, medicine was only 1 percent
of the cost of health care. We did not have the miracle medicines that
we have today. Cancer, the diagnosis of cancer in 1965, was a death
sentence. Today, people survive it because of medicine. And yet we have
a system under Medicare that will pay for a diabetic to go into the
hospital and have their foot amputated but will not pay $29.95 a month
for the Glucophage to control blood sugar.
That is why so many seniors in New Mexico have opted for something
called Medicare+Choice, because that is the only thing in Medicare that
has given them something of a prescription drug benefit. Now, this is
my card as a Member of Congress. I am actually a member of an HMO, like
a whole lot of New Mexicans. It is very common in New Mexico. Forty
percent of seniors in New Mexico take advantage of these kinds of plans
because it has given them some choice and some options, when Medicare
has not given them that choice before.
What we are adding to Medicare this week is a guaranteed benefit not
just for people who are fortunate enough to live in Albuquerque, New
Mexico, but for everybody else who has not had that opportunity: a
guaranteed benefit under Medicare to add prescription drugs. That
reduces the cost of medicine for everybody, and that gives people
choices and options.
I think people want choices. If you are in Santa Rosa, New Mexico,
maybe you want to get your prescription drugs by mail order. My family,
we like to get it at the pharmacy, at the Journal Center at Loveless,
just because that is convenient for us; but seniors should have those
choices.
The other thing I think is important to seniors is that this is
voluntary. If there is a senior, and I know a lot of veterans who are
already covered by the VA or folks who have earned their health
benefits through employment and they have great retiree plans, they do
not have to sign up for this if they do not want to. But for those who
do not have that coverage now, they will have the opportunity to get
prescription drugs through Medicare.
Now, why does all this matter? I mean, we talk here about deductibles
and donuts and all these kind of things; but I had somebody call my
office recently, her name is Bertha Griego, and she is a wonderful lady
who is 74 years old. She has lived all her life in New Mexico, and she
talks with affection about the 1929 Model T her dad had driving around
the dirt roads of New Mexico. She is a wonderful lady. And like most of
our parents and grandparents, she has a growing list of ailments. Some
of them are serious; some of them are just annoying. But prescription
drugs have allowed her to live a relatively healthy life in her senior
years.
Last year, she paid $1,700 for the whole year just in copayments for
her medicine. She is on a fixed income. Her husband, Robert, also has
medical bills; and he gets Social Security. He has a small pension. All
together they earn about $16,000 a year. Well, when you pay the
groceries and the light bill and the heating bill, the checking account
gets a little short by the end of the month. And that happened
recently.
Mrs. Griego ran out of money in the checking account 7 days before
the next check came in. She also ran out of Lovexil, which is a
medicine she takes for her thyroid problem. The pharmacist told her if
she did not buy her medicine in the next 7 days, she would get a little
groggy and tired in the meantime. And that is what happened. But Mrs.
Griego could not get her pills until she had her check.
In New Mexico, 52 percent of seniors are low income, including Bertha
and Robert. When we pass this legislation, and we get this program in
place, Bertha and Robert will not have to wait for the next Social
Security check to come in to buy their medicine. And that is why this
matters. That is why we have a responsibility to do what we can with
what we have from where we are and start making a difference for the
problems that affect the people we care so much about.
Mr. Speaker, I reserve the balance of my time.
Ms. BERKLEY. Mr. Speaker, I yield 30 seconds to the gentleman from
Rhode Island (Mr. Kennedy).
Mr. KENNEDY of Rhode Island. Mr. Speaker, I thank the gentlewoman for
yielding me this time, just a couple of seconds to respond to the
gentlewoman from New Mexico.
The fact of her being so passionate about seniors I do not question
whatsoever, but if she was truly interested in helping those low-income
people, then how come her votes and those of her colleagues repeatedly
have cut the very programs on behalf of the people that she says she is
trying to help? Instead, her party votes to cut taxes for the richest 1
percent of our population, those with incomes over $350,000, by nearly
$2 trillion. And two-thirds of that goes to the wealthiest 1 percent.
And I might add that when they are done with this Medicare bill, they
are going to give all the money they cut; they are going to add to
special interest money for those with HMOs and those with
pharmaceutical interests. And do not take my word for it; just look at
the Wall Street Journal. The HMOs and the pharmaceutical companies are
jumping up and down thanking the gentlewoman from New Mexico for giving
them a gift.
Ms. BERKLEY. Mr. Speaker, I yield 3 minutes to the gentleman from New
Jersey (Mr. Pallone).
Mr. PALLONE. Mr. Speaker, I have a great deal of respect for the
gentlewoman from New Mexico, and also the gentleman from Georgia, but I
have to say I feel like I am listening to Alice in Wonderland when I
listen to what the two of them are saying about this Medicare
conference report that we are about to vote on in a few days.
The gentlewoman said that Medicare is very successful, and she
pointed out that we are adding $400 billion to the program. But I would
ask a very simple question: If it is so successful, why do we not just
add it as a drug benefit and give the seniors the $400 billion for
their prescription drugs?
That is what the Democrats proposed. We said, right now you have part
B where you pay so much, I think it is about $50 a month for your
doctor's care, a $100 deductible, 80 percent of the cost paid for by
the Federal Government, and 20 percent copay. That is what the
Democrats proposed. We said, do the same thing with prescription drugs:
have the seniors pay $25 for a premium, a $100 deductible, 80 percent
of the cost paid for by the Federal Government, 20 percent copay up to
a certain amount, and then it becomes catastrophic. But that is not
what the Republicans did.
The reason that the gentlewoman from Las Vegas is proposing this
motion is because she does not want to give money to the HMOs. She does
not want to force seniors to have to go to an HMO to get their
prescription drugs. She says, let us give this money in this case to
the doctors or let us give it to the seniors in some way so they
benefit from it.
I totally agree with the gentlewoman that we need to provide
prescription drug coverage and preventive care for seniors, but then
why are the Republicans giving away money to the HMOs? Why are they
forcing seniors to go to an HMO to get their prescription drug
coverage? Sure, if someone wants to join an HMO, like in my State, some
people do get their drug coverage, I have no problem with that; and I
know the gentlewoman does not. But this forces the seniors into the
HMO. My colleagues are saying they have to join an HMO in order to get
the prescription drug coverage. And that is not fair. That is not
choice. That is not voluntary.
Now, the gentleman from Georgia, said, well, we are providing with
this Medicare agreement meaningful, affordable, and comprehensive
coverage. That is simply not the case. First of all, seniors are being
forced into an HMO. The Republicans are privatizing Medicare in the
long run. But think about this benefit that you are giving the senior
citizens. First of all, we do not even know what the premium is, so it
may not be affordable at all. There is no set premium. We know that the
deductible is $275, not $100, like it is for part B. And then there is,
in fact, as the gentlewoman mentioned, this huge donut hole when you do
not get any
[[Page H11498]]
coverage at all. So the seniors in the long run are going to be paying
more out, in my opinion, than they are going to get back.
Now, yes, this is a voluntary program. But what good is it if nobody
sees fit to sign up for it because they will be forced into an HMO or
they will have to pay so much money out of pocket that they do not get
a meaningful, affordable, or comprehensive benefit the way the
gentleman from Georgia described? None of that is the case here.
Finally, why can we not have real competition? Let us have the
Medicare administrator negotiate price reduction. That is not in this
bill either.
{time} 2230
Mrs. WILSON of New Mexico. Mr. Speaker, I yield myself such time as I
may consume.
Mr. Speaker, this bill does not force anybody to join an HMO, but
seniors have the right to choose to get their medicine from managed
care if they want to. Or if they want to, they can choose a stand-alone
prescription drug plan or they can have it integrated with a fee-for-
service plan that works for them.
People choose different ways to get their health care. My family has
made our choice, and we are comfortable with why we make those choices
for a lot of reasons, but we should have enough variety in this new
system so we do not have a one-size-fits-all system, and that seniors
have the right to choose, whether it is a stand-alone prescription drug
program, a mail order program, added to fee-for-service, or rolled into
a managed care plan, if that is what citizens want, that is what we
have tried to do.
I have to say, in the end, this program is being supported by a
pretty broad array of organizations who see it for what it is, a very
good step towards providing prescription drugs to seniors in this
country.
Mr. Speaker, I reserve the balance of my time.
Ms. BERKLEY. Mr. Speaker, I yield 1 minute to the gentlewoman from
California (Ms. Woolsey).
Ms. WOOLSEY. Mr. Speaker, I thank the gentlewoman for yielding me
this time.
Mr. Speaker, I would like the gentleman from Georgia to know he is
going to have to continue doing the math and subtraction because the
gentlewoman from California (Mrs. Capps) is not alone in resigning her
membership today. I resigned mine, and I also circulated a letter here
on the House floor, and within 30 minutes I had over 50 Members sign a
letter to Mr. Novelli saying they were resigning their membership
because of his change in his positions with AARP determining that it is
more important to protect their insurance industry and their own
insurance company than protecting the membership of AARP.
I want Members to know each time one of us announces that we have
resigned and our constituents hear of it, we get calls back saying oh,
I am resigning, too. I want to tell Members when the seniors in this
country catch on to what the other side of the aisle are doing to them,
they are going to want to resign.
Mrs. WILSON of New Mexico. Mr. Speaker, I yield myself such time as I
may consume.
Mr. Speaker, I am not old enough to join AARP, but since they have
become such a big part of this debate, I want to read what they have
said. It is not an unqualified endorsement. I have never seen the
perfect bill yet in this job, but it is a pretty good bill. I think the
AARP came to that conclusion. I would like to enter their statement
into the Record, but maybe reading some parts will explain where they
are coming from. It is dated November 17, 2003, AARP endorses Medicare
prescription drug bill, and this is directly from them.
``AARP today announced its strong endorsement of the prescription
drug bill offered by the conference committee and will work vigorously
for its passage.
``AARP believes that millions of older Americans and their families
will be helped by this legislation. Though far from perfect, the bill
represents an historic breakthrough, an important milestone in the
Nation's commitment to strengthen and expand health security for its
citizens at a time when it is sorely needed.
``The bill will provide prescription drug coverage at little cost to
those who need it most: People with low incomes, including those who
depend on Social Security for all or most of their income. It will
provide substantial relief for those with very high drug costs, and
will provide modest relief for millions more. It also provides a
substantial increase in protections for retiree benefits and maintains
fairness by upholding the health benefit protections of the Age
Discrimination and Employment Act.
``AARP is pleased by the improvements made to the conference report
in recent days. A new structure called ``premium support'' which
required competition between traditional Medicare and private plans was
downsized to a limited test starting in 2010, which has significant
protections for those in traditional Medicare. The government will
provide coverage in areas where private plans fail to offer coverage.
The integrity of Medicare will be protected.
``An unprecedented $88 billion will encourage employers to maintain
existing health retiree benefits. The legislation will help speed
generic drugs to market and add important new preventive and chronic
care management services. Finally, this legislation protects poor
seniors from future soaring prescription drug costs.
``AARP is launching a national grassroots, advertising and
information campaign this week to explain the legislation and urge
bipartisan support for its passage.''
Sometimes we get the kind of lukewarm endorsement around here that
Members just pull a sentence or two of. This is not one of them. This
is unqualified support from an organization that is not known for
supporting Republican provisions in bills, frankly. And I think we got
to this point because we put aside partisanship and politics and
focused on making a difference for the people that we came here to
serve.
I think we have a right to be proud of what this body and this
Congress as a whole is about to achieve this week. I welcome and
commend the AARP for setting aside its traditional focus on sometimes
which party Members are in and focusing on policy and not on politics.
AARP Endorses Medicare Prescription Drug Bill
AARP today announced its strong endorsement of the
prescription drug bill offered by the conference committee
and will work vigorously for its passage.
AARP believes that millions of older Americans and their
families will be helped by this legislation. Though far from
perfect, the bill represents a historic breakthrough and
important milestone in the nation's commitment to strengthen
and expand health security for its citizens at a time when it
is sorely needed.
The bill will provide prescription drug coverage at little
cost to those who need it most: people with low incomes,
including those who depend on Social Security for all or most
of their income. It will provide substantial relief for those
with very high drug costs, and will provide modest relief for
millions more. It also provides a substantial increase in
protections for retiree benefits and maintains fairness by
upholding the health benefit protections of the Age
Discrimination and Employment Act.
AARP is pleased by the improvements made to the conference
report in recent days. A new structure called ``premium
support'' which required competition between traditional
Medicare and private plans was downsized to a limited test
starting in 2010, which has significant protections for those
in traditional Medicare. The government will provide coverage
in areas where private plans fail to offer coverage. The
integrity of Medicare will be protected.
An unprecedented $88 billion will encourage employers to
maintain existing health retiree benefits. The legislation
will help speed generic drugs to market and add important new
preventive and chronic care management services. Finally,
this legislation protects poor seniors from future soaring
prescription drug costs.
AARP is launching a national grassroots, advertising and
information campaign this week to explain the legislation and
urge bipartisan support for its passage.
Mr. Speaker, I reserve the balance of my time.
Ms. BERKLEY. Mr. Speaker, I yield myself such time as I may consume.
I am absolutely astounded by the continued nonsensical talk about
bipartisanship when the Democrats were not even allowed in the room
when the decisions were made, when consumer groups were excluded, when
there was absolutely no interaction of bipartisanship on this bill, and
I dare say that we have not even seen the legislation yet in its
completed form because it has
[[Page H11499]]
yet to come from the House leadership so all of us can review this. So
this bipartisan discussion is nonsense.
Mr. Speaker, I yield 2 minutes to the gentleman from Oregon (Mr.
DeFazio) to enlighten all of us.
Mr. DeFAZIO. Mr. Speaker, the gentlewoman from New Mexico (Mrs.
Wilson) mentioned the VA. I assume she is aware as a veteran that the
VA negotiates on behalf of all of America's veterans, and they have
negotiated prices and the extortionate cost of pharmaceuticals of about
60 percent. That is how we can afford to give them very inexpensive
medications with a very small copayment.
Those are similar to the reductions in Canada, about 50-60 percent,
but the Republicans have prohibited in this legislation that the
government should negotiate on behalf of the 40 million people in
Medicare any reduction in the price of pharmaceuticals at the behest of
the pharmaceutical industry. This bill also prohibits the importation
of drugs from Canada. They say, no, it does not do that, we are going
to give the authority of the Secretary of HHS to reimport the drugs,
but guess what he has already said, he will not do it because they are
not safe. But, in fact, arguably drugs, U.S. manufactured, FDA-approved
drugs are safer when they come back from Canada because their supply
chain is left corrupt in Canada because it is controlled by the
government and because they negotiate 50-60 percent reductions in the
price.
The gentlewoman talks about competition. Guess what, the insurance
industry who the gentlewoman wants to subsidize with $20 billion is
exempt from antitrust law. They can throw out any senior at any time.
We may get a 1-year plan from a company, but it is like every other
form of insurance in America today, file one claim, next year you are
back in the Medicare fee-for-service plan where the premiums have gone
up because the industry has cherry picked people out until they need
the service. They will give them a service grudgingly until the end of
year until they can cut them off.
The people in my district know HMOs, they know them really well. The
HMOs pulled out. They said we are not making enough money in southern
Oregon, we are pulling out of southern Oregon, and they did. Now, there
are no options. So we are going to put people back into the plans and
the graces of the private insurance industry, after giving them a $20
billion subsidy without subjecting them to antitrust law and exempting
them from any negotiation by the government to reduce the price of
pharmaceuticals. This is a giveaway to the pharmaceutical industry,
plain and simple.
Mrs. WILSON of New Mexico. Mr. Speaker, I yield myself such time as I
may consume.
Mr. Speaker, it is true the VA does negotiate very hard to get low
costs for veterans in their system; and the reason and the way they do
that is the same way we are going to see under these new plans because
it is kind of like when Americans go down to Costco or Price Club, when
buying in bulk, consumers are going to get a better price.
Mr. DeFAZIO. Mr. Speaker, will the gentlewoman yield?
Mrs. WILSON of New Mexico. I yield to the gentleman from Oregon.
Mr. DeFAZIO. Mr. Speaker, I would ask the gentlewoman just to
clarify, is the VA part of the government and are we prohibiting the
rest of the government from negotiating on behalf of seniors?
Mrs. WILSON of New Mexico. Mr. Speaker, reclaiming my time, I would
be happy to answer the gentleman's question in my own way here.
The VA does negotiate low prices because they have the leverage of
having a lot of people who use the medicine. That is the same concept
we are applying here, that there are large groups of people who can get
a better price and get lower costs because they do it together. There
is a group rate, just like we do if we go into Denny's with a large
party, diners get a group rate and a lower cost.
The estimates are that the cost of medicine will go down between 15-
25 percent, and we do not say that there has to be a Medicaid price.
The companies can negotiate a low price, as low as they can get, and we
give them leverage to do so. I think that is the way to go. And I think
that guaranteed benefit is the way to go in this program.
Mr. Speaker, in closing, we are about this week to pass historic
legislation that has been a long time in coming. This House has passed
Medicare prescription drug bills twice before, but this is the first
time that the Senate has also passed something and we can meet together
in the middle. Contrary to the protestations by some of my colleagues,
there actually were Democrats in the room, Senator Baucus and Senator
Breaux have both signed onto this approach, and without their support,
we would not be passing this bill. I think that is important.
I think it is important to set some of those partisan things aside
and try to get things done, recognizing that it is not perfect, but we
are getting something done for the people who need it. It is voluntary.
It gives people choices. It gives the most help to those who are low
income and those who have high medicine costs because they are very
sick. For the first time in Medicare, we are going to really focus on
chronic disease management so that we improve the quality of life of
seniors in addition to extending the length of life.
The biggest problem in Medicare today is that not enough seniors can
afford life-saving medicine. We need to add this prescription drug
benefit to Medicare.
I told Members about a lady in my district and there is another one I
met who is a great grandmother. Her name is Ella May Naser. She is
older than Medicare. She is about to be 98 years old, and she is still
sharp as a tack. She is on her own now, but in August of every year she
has to change her health care plan from one Medicare+Choice system to
another because she only gets about $685 a month, and at some point the
prescription drug benefit runs out in her plans. She has one medicine
to control her high blood pressure, another to prevent degenerative
bone disease, and another one for glaucoma. She has family that helps
her sort all of these things out and try to make sure that her plans
cover what she needs because they know she will stop taking her
medicine if she does not have the money to pay for it.
This plan will help people like her. That is why we are doing this.
That is why we have to set aside the little differences in order to
accomplish the big things that people send us here to do.
Mr. Speaker, I yield back the balance of my time.
Ms. BERKLEY. Mr. Speaker, I yield 45 seconds to the gentleman from
Massachusetts (Mr. Delahunt).
Mr. DELAHUNT. Mr. Speaker, I think it is important that we note as a
matter of record that where the gentlewoman from New Mexico (Mrs.
Wilson) indicated there were two Democrats that were present at the
conference, and the gentlewoman I understand served on that conference.
The gentlewoman is aware that the gentleman from New York (Mr. Rangel),
the gentleman from Michigan (Mr. Dingell), and the gentleman from
Arkansas (Mr. Berry) were appointed by the leadership to serve in that
conference and were denied access.
{time} 2245
There was no input from the Democratic Party in this House into this
particular conference.
Ms. BERKLEY. Mr. Speaker, I yield myself the balance of my time.
I have always believed in providing a prescription medication benefit
under the Medicare system. It makes no sense to me that we have a
Medicare system that allows seniors to see a doctor, the doctor
prescribes the least expensive, most cost-effective way of dealing with
illness, which is prescription medication. Many of the seniors in my
district and throughout the United States cannot afford the
prescription medication that the doctor prescribes. Being a doctor's
wife and having a stepdaughter who is a third-year medical student, I
do not need to be lectured by the other side of how the effect of these
Medicare reimbursements are affecting doctors because I know firsthand
and personal what it is doing. I know that the doctors are suffering
and that there is a real crisis in health care and that our doctors
need to be appropriately reimbursed for the Medicare patients that they
see.
But what I am opposed to is privatizing the Medicare system, and
[[Page H11500]]
that is what this legislation does. Make no mistake about it, this
legislation, rather than being a prescription drug plan, rather than
being a Medicare reimbursement plan for doctors, what this is is the
first step in privatizing Medicare, and that would be a disaster for
our seniors.
I urge my colleagues to vote for this motion. My motion addresses the
concern of the doctors across the country and ensures that Medicare
patients can have access to their doctors by providing these doctors
with a 1.5 percent increase in physician payments over the next 2
years. I ask my colleagues to protect our citizens and not have them
investing in risky and untested privatization schemes and to put the
necessary funding in the prescription drug bill to fairly reimburse our
doctors who administer the necessary care to Medicare patients. Instead
of putting the Medicare system in jeopardy, we should protect our
constituents' access to care. This motion fixes this problem for
another 2 years, but I implore my colleagues that in the future we must
work together to address a permanent fix for the formula.
I urge my colleagues to support our doctors and their patients and
vote ``yes'' on this motion to instruct.
Mr. Speaker, I yield back the balance of my time.
The SPEAKER pro tempore (Mr. Rogers of Alabama). Without objection,
the previous question is ordered on the motion to instruct.
There was no objection.
The SPEAKER pro tempore. The question is on the motion to instruct
offered by the gentlewoman from Nevada (Ms. Berkley).
The question was taken; and the Speaker pro tempore announced that
the ayes appeared to have it.
Ms. BERKLEY. Mr. Speaker, on that I demand the yeas and nays.
The yeas and nays were ordered.
The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further
proceedings on this motion will be postponed.
____________________