[Congressional Record Volume 149, Number 168 (Wednesday, November 19, 2003)]
[House]
[Pages H11598-H11605]
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. HOOLEY of Oregon. Mr. Speaker, I offer a motion to instruct.
The SPEAKER pro tempore. The Clerk will report the motion.
The Clerk read as follows:
Ms. Hooley of Oregon 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.
The SPEAKER pro tempore. Pursuant to clause 7 of rule XXII, the
gentlewoman from Oregon (Ms. Hooley) and the gentleman from Florida
(Mr. Foley) each will control 30 minutes.
The Chair recognizes the gentlewoman from Oregon (Ms. Hooley).
{time} 1915
Ms. HOOLEY of Oregon. Mr. Speaker, I yield myself such time as I may
consume.
Mr. Speaker, I stand here in the well of the people's House today to
offer a motion to instruct the conferees of the Medicare prescription
drug bill to provide a much-needed payment update to physicians for the
next 2 years and eliminate provisions that would privatize Medicare.
Right now, as we speak, doctors are faced with the tough choices of
treating patients, old friends and new patients alike, or turning them
away since the reimbursements under the Medicare program have not kept
pace
[[Page H11599]]
with the costs of practicing medicine. This is not an argument about
the quality of health care; it is about the ability to receive health
care at all. This is a particular problem in rural areas like those
that make up part of my district in Oregon.
The decisions that we make on this bill will have a disproportionate
impact on the ability of millions of Americans to have access to health
care. We cannot enable more doctors to see more Medicare patients if we
continue cutting payments to doctors. If we do not act soon, there will
be another 4.5 percent reduction in reimbursements to physicians who
are treating those who count on their care the most, our seniors. That
4.5 percent cut represents a loss of $20 million to my State alone. The
overall costs are staggering, and the damage to the health of American
seniors will be as well.
For a State with historically low Medicare reimbursements like
Oregon, the impact is even greater. According to the AMA, the cost of
practicing medicine has gone up by more than one-third since 1991. Over
the same period of time, the rise in Medicare payments has been less
than 10 percent. Just last year, doctor payments were cut by 5.4
percent; and if we allow those further cuts to take effect, this would
be the fifth time in 12 years that rates have been cut. If cut, the
level would drop to nearly 8 percent below the 2001 level.
My doctors tell me their costs have not dropped by 8 percent, and I
suspect that doctors across the country would agree. It makes no sense
whatsoever to cut payments when the costs of practicing medicine are on
the rise. Doctors simply cannot afford to take more cuts. I am worried
whether we are going to have a Medicare system by the cuts we are
asking doctors to take. Already one-quarter of family physicians across
the Nation are saying they cannot accept any new Medicare patients. Who
knows how many more will choose to do the same in January when they are
told reimbursements have been slashed again.
As a Nation, we must provide our doctors with a 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 to payments for the next 2
years.
To fund the increases in payments to our doctors, this motion strikes
funding for privatization provisions in the underlying prescription
drug bill. The Centers for Medicare and Medicaid Services estimates
that under a privatized Medicare, premiums would skyrocket for seniors
who choose to stay in traditional Medicare. I am concerned that by
increasing the premiums of traditional Medicare many beneficiaries
would be forced into HMOs and other private plans.
This small, but critical, increase will give doctors nationwide the
wherewithal to continue treating seniors on Medicare, and it will give
Congress time to develop a permanent fix for 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 this Medicare physician
reimbursement formula which currently threatens to destabilize the
Medicare program. Seniors rely on their doctors and the medicines they
need to stay healthy. They have waited too long for a prescription drug
benefit in Medicare and relief from the high cost of prescription
drugs. 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 or paying their rent, electricity, or
buying food.
For 4 decades this Nation promised that Medicare would provide health
care for all seniors. Medicare ensures these hard-working older
Americans who have paid taxes and paid into the system that they have
health care coverage. I urge my colleagues to vote for this motion to
allow our constituents to continue to have access to high-quality care.
Mr. Speaker, I reserve the balance of my time.
Mr. FOLEY. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I am thrilled to be on the floor talking about Medicare
tonight and certainly thrilled I have a chance to answer some of the
comments made by the gentlewoman from Oregon (Ms. Hooley).
In my district in Florida, I have the fifth largest Medicare eligible
population of 435 congressional districts. This is not an issue I take
lightly. I would suggest some of our colleagues read the actual bill
because what they are asking us to do tonight in their amendment is
exactly why we are focused on some of the reforms in the very Medicare
package we are talking about.
A physician update, an increase in payment, is in the bill the House
Republicans have authored and sent to this floor and now is in
conference. There was a mention that there was a fee cut last year of
5.4 percent. I would like to correct the record. As a member of the
Committee on Ways and Means who fought to increase physician
reimbursement, not only did we eliminate the cut a year ago; we
actually increased by 1.5 percent in this bill. In Oregon we have a 1.5
percent update in 2004 and in 2005. We have a 5 percent bonus for those
working in rural Oregon to make certain that they are able to see the
patients because of the limited access and limited number of
physicians. So there is a 16 percent increase in the bill we are
talking about today.
Let me also take some exception when it is discussed about this FEHBP
competitive-style model for a minute. My district is typical of most
districts in the country. In fact, in Florida I represent eight
counties: Palm Beach County, St. Lucie, Okeechobee, Glades, Hendry,
Martin, and Charlotte. It goes from the east coast on the Atlantic to
the west, ending at the Gulf of Mexico. There is almost every
demographic mix one can imagine, people moving from the north and east
coast; and what they have said to me in town hall after town hall, I
want choices like Members of Congress have. They say they want choices
like we have in our health care delivery system, and I reach for my
wallet because I know somewhere in here is my Federal health benefit
plan; and I get a range of options to choose from, whether I want a
higher deductible, higher copayment, whether I want a fee-for-service
or PPO or a managed care plan.
Seniors in my district are smart enough to know they are able to make
choices. The Democrats have been down the street burning AARP cards
this afternoon. Rather than engaging in constructive debate on how to
fix the most important plan for seniors in this country, they are
invoking memories of Jane Fonda burning things in city streets around
our country and screaming that AARP has sold them out.
A month ago AARP was, as I was told by some of my colleagues on the
other side of the aisle, the gold standard of senior lobbying
organizations, and I tend to agree. I meet with AARP in my district in
order to have a dialogue to see if we can meet some common ground and
common objective. So when AARP indicated that they were supporting our
Medicare bill, it was not only refreshing that we were engaged in a
bipartisan, constructive conversation, but we were actually modernizing
Medicare.
So to eliminate the competitive model in the Medicare plan we are
discussing undermines the very notion of what the gentlewoman from
Oregon (Ms. Hooley) is debating on the floor today. The update for
physicians is in the bill.
Let me also say another thing that is troubling me because I have
been somewhat perplexed by this insistence by the other side of the
aisle that the trouble with this bill is we do not get after those
nasty drug companies.
We do not just let our citizens run across the border and buy drugs
from Canada. I just finished a TV interview with one of my colleagues
talking about the cost of drugs in America and the cost of drugs in
Canada, but let me talk about a more critical concern of mine.
In my district in my county in Florida, the first case of anthrax
poisoning occurred in Palm Beach County, Florida, the death of a man
who worked for the National Inquirer because he contracted anthrax
through the mail that was sent to the National Inquirer.
Why do I bring that up and why do I raise the anthrax attacks and the
fear
[[Page H11600]]
it invoked in Florida? Because one of the concerns that we have all
indicated is we want cheaper prescription drug prices for our seniors,
but we wanted a protected chain of custody to make certain that the
drugs we are getting for our seniors are not tainted.
Let me read this headline from the National Journal Group American
Health Line. It says that Florida laws to prevent the sale of
counterfeit or diluted prescription drugs in the State are too weak,
according to a report issued Tuesday. The Miami Herald reports the
report found that as many as 55 of the 1,458 prescription drug
wholesalers licensed in Florida sell counterfeit or diluted medications
or treatments illegally imported into the United States. The Office of
the Attorney General said the questionable medicines for some
wholesalers have reached pharmacies, but the extent of the problem is
not known.
So I continue to hear these bottles of pills rattling on the other
side of the aisle saying just let us have our chance to be in the
debate, and we will get Americans cheaper drugs from Canada. Well, the
first person that dies from an anthrax-laced medication or the first
person that receives phony or altered cancer drugs and dies because
they did not receive the proper dosage, the first person who has a
catastrophic incident because somehow that cheaper drug that my
colleagues have suggested they will bring to our States has harmed a
citizen, I cannot wait to watch the rush for the exit by each of those
who have been rattling these pill bottles saying that was not my idea,
I certainly did not want any part of it.
So let us debate Medicare and let us debate it on the floor, not in
the AARP lobby, not in the newspapers, and not on TV, but for seniors
like my parents and in the memory of my grandmother, whose one wish was
that Social Security and Medicare would sustain her for her life. The
one check she would wait for was Social Security, and the one thing she
wanted more than ever was not to be a burden on her children or
grandchildren. She wanted to be self-sustaining. It is in her memory I
have worked 9 years on Medicare and want to make certain this proposal
works. So I reject this motion.
We will continue to have discussions on it, but the things that have
been raised in this motion today on H.R. 1 are just not accurate. They
just do not apply. If they read the bill, they will see that physicians
are getting compensated properly. They will see the competitive model
is not going to undermine Medicare. It has no effect on entitlement.
There is continued entitlement to defined benefits under current law.
There is continued access to traditional FFS Medicare through the fee-
for-service Medicare throughout the country, and all payments to plans,
including traditional fee-for-service Medicare based on the demographic
and health risks of employees. We have provisions in this bill that
deal with most of the problems raised.
Mr. Speaker, I reserve the balance of my time.
{time} 1930
Ms. HOOLEY of Oregon. Mr. Speaker, I yield 7 minutes to the gentleman
from Ohio (Mr. Brown).
Mr. BROWN of Ohio. Mr. Speaker, I thank the gentlewoman from Oregon
(Ms. Hooley) for yielding time and thank her for her leadership on this
Medicare issue and her leadership on health care issues generally.
Mr. Speaker, I heard my friend from Florida not once, not twice, not
three times, maybe not even four times, maybe five, six times say,
``You should just read the bill.'' That is the problem. As bad as the
Medicare bill is, the process is even worse. We would like to read the
bill. We cannot find it. The reason we cannot find the bill is the bill
was, first of all, written by the prescription drug companies, by the
insurance companies, in private, similar to how Vice President Cheney
wrote the energy bill, Vice President Cheney who still receives $3,000
a week from an oil company as part of his pay, but these bills have
been written in secret.
The prescription drug bill has been written by the insurance
industry, by the drug industry. At the conference committee when the
House and Senate were trying to work together to write a bill, no House
Democrats were allowed in the room. No House Democrats were allowed to
look at the bill, to discuss the bill, to debate the bill or to offer
amendments. When I hear my friend from Florida sort of gratuitously say
we should read the bill, we would like that opportunity.
The problem with this prescription drug issue, it is not really a
prescription drug bill. We could have passed a prescription drug bill,
take $400 billion and distributed it to seniors who need drug coverage.
We could have done that cooperatively, bipartisanly in a day or two,
but what this bill really is, it is a Medicare privatization bill. When
you think about this, and I have been a ranking Democrat on the
Subcommittee on Health for 4, 5, 6 years, I have been on that committee
for more years than that and watched sort of how the Republicans look
at this Medicare issue. They all say, my mom's on Medicare, my
grandfather's on Medicare, I like the program. Ultimately, when you
look at what Republicans do in Medicare and you look at the history of
the Republican Party with Medicare, the problem is they simply do not
like Medicare. You can say, well, that's not true.
Let us do a little bit of history. When Congress passed the
legislation to create Medicare, President Johnson signed the bill in
July of 1965 creating this program that now insures 39 million
Americans. At that moment, half of American seniors had no health
insurance. The other half did, but it was clearly a big problem. Lyndon
Johnson signed this bill. The fact is only 13 Republicans in the whole
House of Representatives supported the bill to create Medicare. Gerald
Ford, a Member of the House, opposed it. Bob Michel, the Republican
leader, opposed it. John Rhodes, another Republican leader, opposed it.
Bob Dole opposed it. Senator Strom Thurmond opposed it. Donald Rumsfeld
voted against the creation of Medicare. They simply did not like the
idea of a government program. They wanted to continue to let these
seniors be out in the market, be in the private market. If they could
get insurance good; if they could not, that was just too bad. They
should have thought of that and made more money or whatever the reason.
Nothing much happened to change Medicare except it worked, from 1965
until 1995. Then the first time Republicans had a chance, the first
time Republicans were in the majority in 1995, right out of the box
Newt Gingrich tried to privatize Medicare. He tried to cut $250 billion
from Medicare to pay for a tax break for the most privileged people in
society, just like they do now. He immediately tried to privatize
Medicare. Fortunately, President Clinton stopped that. Fortunately,
other Members of this Congress stood up and fought it and stopped it.
Speaker Gingrich, in 1995, bragging in a meeting of the American
Conservative Union, said, We don't get rid of Medicare right away. We
don't think it's politically smart. We think the right way is to go
through a transition, but we know it's going to wither on the vine.
That is what Speaker Gingrich wanted to do. He wanted to privatize it.
Bob Dole, then a Senator, then a Presidential candidate, Bob Dole
bragged that he was in the arena trying to fight Medicare, trying to
fight its creation 30 years earlier.
It is pretty clear that Republicans in 1965 voted against the
creation of Medicare, including one future President, one future
Presidential candidate and other leading Republicans. Then in 1995,
when they had a chance, they immediately tried to privatize Medicare
and cut its funding. In fact, AARP president Bill Novelli, who has
gotten sort of famous this week in his sellout to the drug companies
and the insurance interests, Bill Novelli wrote the preface in Newt
Gingrich's health care book, his health care privatization book. He
called Newt a big-idea person. The Republican majority has continued to
rally behind Newt Gingrich's call for Medicare privatization. John
Linder told the House Rules Committee last year that Medicare was a
Soviet-style program. Dick Armey, majority leader of the House of
Representatives last year, said, in a free society we wouldn't want to
have Medicare. Former Congressman Rick Santorum says the traditional
Medicare program has to be phased out. And Bill Thomas, working with
the drug industry and the insurance industry in writing this Medicare
privatization bill, told a reporter, to those who say that this bill
would end Medicare as we know it, our answer is, we certainly hope so.
[[Page H11601]]
The conference bill does that. It would end Medicare as we know it,
because Republicans would rather throw money at a private failure
rather than continue support for a public success.
Mr. Speaker, Medicare has worked for seniors in this country. We need
to add a prescription drug benefit inside Medicare, not turn this
program over to the insurance interests who are getting a $20 billion
taxpayer gift once this bill is signed into law if it passes, and we do
not want to turn this program over to the drug industry who will profit
140 billion additional dollars under this bill.
Mr. Speaker, my Republican friends, it is an honest debate. They
simply do not like Medicare. They do not believe there should be a
government program called Medicare. They think the insurance industry
and the drug industry ought to do this. That is their view. Mr.
Speaker, I hope that enough Members rally around because it is clear
that seniors in this country want to protect Medicare. They do not want
it privatized. They want a public health system that works for
everybody and treats everybody the same.
Mr. FOLEY. Mr. Speaker, I yield myself such time as I may consume.
It is indeed appropriate that there be a doctor in the House sitting
in the well presiding as we discuss this important project, a doctor
who happens to be a Republican. The notion that we want to destroy
Medicare is patently false. It is interesting, I am on the Committee on
Ways and Means, so this is something we deal with quite frequently, how
many letters I get urging us to increase the fee payments to
Medicare+Choice organizations, Blue Cross and Blue Shield of New
Jersey, Blue Cross and Blue Shield of Florida. From my colleagues on
the other side of the aisle who somehow find those Medicare+Choice,
which are popular with their constituents, we should increase
reimbursements to those plans. But if they listened to the argument
they just made about privatization, then those Medicare+Choice panels
would not even operate. They would not even exist.
So it seems like there is a number of Members here that seem to trust
the private health insurance industry when it suits the political goals
of allowing their constituents to have access to prescription drugs, to
eyeglasses, to other remedial services, that is okay. That is not
really privatization. That is kind of a sort of an experiment, I guess.
But that is in fact what is happening today. There are managed care
plans that President Clinton supported and endorsed and increased
funding for, community health care organizations, a number of things
that we have done in our communities to make certain health care is
delivered.
We know they are losing the debate when they have to bring up Newt
Gingrich on the floor and rather than talk about substantive debate
here, many of us have read the bill numerous times because we had it on
the floor, we all had a vote, I think nine Democrats joined us in
supporting that bill. I know it was not in its entirety. I am sure
there are some new additions, some new conference report language, some
different things, but we are not talking about whole new territory
here, we are not going over new ground. But I would caution when we
start accusing the entirety of the Republican Party as being opposed to
Medicare that that is somewhat of a hurtful statement to this Member
because I take seriously the responsibility I have representing
seniors, I take seriously the fact that my parents are on Medicare,
enrolled in Medicare, my father is suffering today with cancer who is
being treated by great physicians in Palm Beach County who are being
reimbursed by Medicare, who seem to be not only caring for him, but
obviously thrilled with their work and happy with the reimbursements
being offered.
The current Medicare system is a sickness model. I am hopeful that
the party on the other side of the aisle comes back to the roots of
Claude Pepper from Florida and Lyndon Johnson who would have recognized
a fabulous program but one that needs to reflect today's technologies.
In our bill we have wellness incentives to look for dietetic
screenings to see if we can prolong the life of someone suffering from
diabetes. Medicare today will reimburse to amputate your limb, they
will watch you go blind, they will put you on dialysis, but we will not
reimburse a dietician to come in and see if we can properly construct a
diet to minimize the onset of the disease. That is a plan that they
want to sit here and defend? New technologies that can indicate a
cancer in the body early and detect it and cause, hopefully, the cure
of that cancer. Cardiovascular screening that I have worked on with
Senator Bob Graham from Florida.
This Medicare bill we are bringing to the floor has a lot more to
offer than some of the criticism would indicate. But I still have to
snicker when I see a group of people standing outside of AARP burning
cards. It harkens back to an earlier day. I just somewhat humorously
look at how quickly they turn on that organization whom they held in
such high esteem up to 48 hours ago and now is being vilified here on
the floor. We are happy AARP weighed in. They said it was a first step.
They did not say this was a panacea, nor did any Member of this body
ever suggest that this is the last thing we will ever do on Medicare.
We will learn as we go along, we will add, we will try and increase the
opportunities for preventive health care, we will increase
reimbursement to hospitals in every Members' district, a bill that I
authored. We are doing the drug discount card, another provision that I
authored that will be in this bill. I think we are on the right track.
Mr. Speaker, I reserve the balance of my time.
Ms. HOOLEY of Oregon. Mr. Speaker, I yield myself such time as I may
consume.
Just a reminder, I think that everybody on the floor of the House,
all Members from both the Republican and Democratic Party, would be
happy to see those changes, that in fact they would not pay for
amputation of a leg or an arm and would pay for diabetes treatment
along the way.
Mr. Speaker, I yield 5 minutes to the gentleman from New Jersey (Mr.
Pallone) who has been working on health care issues the entire time he
has been in Congress.
Mr. PALLONE. Mr. Speaker, I want to thank the gentlewoman for
yielding me the time and her remarks.
I listened to what the gentleman from Florida said, and I have to
say, I know he is well-intentioned. I certainly do not mean to imply
that he is not well-intentioned, but the problem is that the ideology
of the Republicans is getting in the way of what works practically. I
am afraid that the ideology, even though they may not intend it,
ultimately, will destroy Medicare.
The gentleman from Florida talked about Lyndon Johnson and the
origins of Medicare. I do not want to go through all that again, but we
must remember that the reason that President Johnson and the Democrats
primarily put Medicare into place in the sixties was because the
private market did not work. Seniors were not able to go out and get
insurance in the private market, and so that is why the government had
to set up a program to insure the senior citizens. That is the bottom
line. Practically speaking, I do not really have an ideology. I do not
care if it is a government program versus a private program, but the
bottom line is that the government program, the Medicare program, works
and it works because you have this large pool that all the seniors are
members of, and the private market has essentially told us in many
cases that they are not going to provide the type of health insurance
that many of the Republicans have talked about.
The gentleman says that Democrats are against HMOs. I do not have a
problem with HMOs and managed care. He mentioned my home State of New
Jersey. Sure, lots of seniors sign up for HMOs in New Jersey. But the
problem is that the HMOs have increasingly dropped the seniors.
Something like 80,000 to 100,000 New Jersey seniors in the last few
years have been dropped by HMOs. All we are saying, as Democrats, is we
do not want seniors to be forced into managed care, forced into HMOs in
order to get a drug benefit. That is what the gentleman is doing. That
is what the Republicans are doing with this bill. Essentially, the only
way practically speaking that you are going to be able to get a drug
benefit is if you join an HMO, and then you lose your choice of
doctors. That is not fair.
[[Page H11602]]
If you really cared about Medicare, and you wanted to just expand it
and include a prescription drug benefit to deal with preventive care,
then all you have to do is what the Democrats have said all along, add
the drug benefit to traditional Medicare. We have talked about that. We
have said just like you have part B now for your doctor bills, where
you pay about a $50 a month premium, you have a $100 deductible for
your first doctor's visit and after that the Federal Government pays 80
percent of the cost and you pay 20 percent up to a certain amount when
the Federal Government pays the whole thing. We advocated and we voted
on a substitute to this awful Republican bill. We had a Democratic
substitute that did exactly the same. You paid $25 a month, the first
$100 deductible on your drug bills you have to pay, and after that 80
percent is paid for by the Federal Government, 20 percent by you, up to
a certain amount, and then the Federal Government pays 100 percent. If
you really liked traditional Medicare and wanted to keep it going the
way it is, then you would not have any problem doing just that. Take
whatever pot of money you have and add a prescription drug benefit to
traditional Medicare. But that is not what you do. The Republicans
basically want to privatize, and they force people to go into an HMO to
get the drug benefit.
{time} 1945
The gentlewoman's motion here is very simple. Basically, she is
saying do not give extra money to the HMOs and the private insurers
because we know that they cannot compete with the regular Medicare
program. Do not give them the windfall and extra money in order to make
them participate in this plan. Take that money and give it, as she
said, to the doctors to increase their reimbursement rate. Whether we
give it to the doctors or whomever we give it to, the bottom line is
that we should not be giving windfall dollars to HMOs and private
insurers so that they have extra money to compete with the traditional
Medicare fee-for-service.
If my colleagues feel that there needs to be competition and that
HMOs should be out there as an option, or other private insurance
options should be out there, then let them compete in a traditional
way. Do not give them all this extra money and say, Here is some extra
money, so you come into the market, because then we do not have fair
competition. We do not have fair competition at all. We are giving them
extra money, and what we are going to ultimately do is to make it
impossible for people to stay in traditional Medicare.
The thing that really bothers me the most is that they keep
mentioning on the Republican side all the different groups that support
this Republican Medicare bill. They mention AARP, they mention the AMA,
they mention the drug companies, PhARMA or whatever. The reason that
all these different groups support this bill is because they are all
getting a piece of the action. In other words, the doctors are getting
an increased reimbursement rate, so of course they think it is a great
bill. AARP is an insurance company. They are going to sell insurance,
so they think it is a great idea. And the drug companies love it
because they have a clause in here that says that the Secretary of
Health and Human Services, the Medicare administrator, cannot negotiate
price reductions, so they are happy because they can continue to charge
higher price, increasing prices.
So all these different special interest groups, they are all very
happy; but the Medicare recipient, the senior, is the one that suffers
because they are not being given an adequate benefit. Not only are you
telling them that they have to join an HMO, but they are going to have
to pay more out in their out-of-pocket in order to get any kind of drug
benefit.
If we look at the way this thing is structured, the deductible is
$275, not $100. 275. The cost sharing, basically the Federal Government
pays 75 percent of the cost but only up to $2,200 a year. After that
there is a doughnut hole and the senior has to pay out of pocket up to
$5,044. So what we are going to see here with these seniors is there is
no set premium. So the HMO is going to come in and say they are going
to charge them, who knows, $75 a month, $80 a month. The sky is the
limit. There is no set premium; 275 deductible, between $2,200 and
$5,000 out of pocket. They get nothing from the Federal Government.
There is no reason for anybody to sign up for this thing because they
are not getting a benefit. They have to lose their choice of doctors.
They get a lousy benefit that is not even worth having. Meanwhile, all
the special interests, the HMOs, get all this windfall in terms of
dollars.
Mr. GEORGE MILLER of California. Mr. Speaker, will the gentleman
yield?
Mr. PALLONE. I yield to the gentleman from California.
Mr. GEORGE MILLER of California. Mr. Speaker, the gentleman is
correct here. Assuming the $35 premium, in fact, out of the first
$5,000 of benefit, they have to pay $4,020 out of pocket.
Mr. PALLONE. Absolutely.
Mr. GEORGE MILLER of California. Mr. Speaker, I guess maybe some
people in America think that is a drug benefit, but that is not going
to provide. Out of the first $5,000, they pay $4,020 out of their
pocket and they get $1,000 in benefit.
Mr. PALLONE. Right. Reclaiming my time, Mr. Speaker, that is assuming
that the benefit is $35.
Mr. GEORGE MILLER of California. That is assuming it is $35, but
nothing in the law requires it to be $35.
Mr. PALLONE. Absolutely not.
Mr. FOLEY. Mr. Speaker, I reserve the balance of my time.
Ms. HOOLEY of Oregon. Mr. Speaker, I yield 4 minutes to the gentleman
from Florida (Mr. Hastings).
Mr. HASTINGS of Florida. Mr. Speaker, I thank the distinguished
gentlewoman from Oregon for yielding me this time, and I appreciate her
so very much for her bringing this motion.
It is most regrettable that we are in this dispute in the manner that
we are because in many respects it comes from a lack of communication
between the two respective sides.
Mr. Speaker, it gives me great pleasure to support the gentlewoman
from Oregon's (Ms. Hooley) measure.
Since 1965 Medicare has been a vital instrument in ensuring quality
health care to America's elderly and disabled. Like my friend from
Florida, my mother is on Medicare, and like my friend from Florida, my
mother is desperately ill. The real truth of the matter is if it were
not for Medicare, I would not be able to sustain my mother's present
care.
Medicare's 40 million beneficiaries use thousands of different health
care products and services furnished by over 1 million providers in
hundreds of markets nationwide. However, today a great number of people
in this House seek to dismantle Medicare with a fool's gold of a bill
titled the Medicare Prescription Drug and Modernization Act.
Despite my Democratic colleague's best efforts to make this an
inclusive and comprehensive process, one that addresses the real
concerns of America's seniors and disabled, we are shut out from
negotiations. My friend on the other side from Florida, and he is my
friend, may have seen this bill. But I serve on the Committee on Rules.
We have not met on it for it has not been filed, and we will not see it
until maybe an hour before we go to the Committee on Rules on this
measure.
The bill does not ensure affordable prescription drugs because of the
arbitrary budget cap pushed by the administration. H.R. 1 has high
deductibles and does not guarantee an affordable premium. In addition,
the Medicare Prescription Drug and Modernization Act creates large
coverage gaps with many seniors being required to pay high premiums
even when they do not receive benefits. Let me tell the Members about
one guy that is from Myakka City, Florida, Mr. Coldao, a Vietnam
veteran-turned-farmer who cannot afford health coverage and now faces
losing the little that he has because drug companies flee rural areas
in search of bigger profits.
Approving this bill may not guarantee a destitute future for those of
us that are Members of Congress, but it will guarantee a destitute
future for those seniors who do not and have not served in this body.
Mr. Speaker, simply put, this bill should be wrapped around a toilet
paper holder and stuck in one of the Capitol's bathrooms. It is that
bad. It is poison for this country. It stinks.
And now I want to tell my friend about this AARP. I am a member of
that organization until yesterday. And
[[Page H11603]]
I did not go to AARP and burn my card. I sent to its director notice
that I resigned, and let me tell the gentleman why. Because I never
received a mumbling word from anybody at AARP asking me, one of the 35
million members, what I think about this particular measure. I did not
receive a questionnaire from them, and I ask my friend from Florida,
are all seniors being treated equally under the Republican plan that he
has seen and Democrats have not? What are the effects on Medicaid in
the State of Florida and in the State of Oregon and this Nation as it
pertains to the poor? And most importantly, here come the baby boomers.
Baby boomers, get ready. Get ready to go bust under this plan.
Mr. FOLEY. Mr. Speaker, I yield myself such time as I may consume.
Of course I respect very much my colleague from Florida, and I
appreciate his words tonight. I do want to at least add that at the
current program we have on Medicare, just to correct any record, there
is zero prescription drug coverage in Medicare. So for the very seniors
they are talking about tonight, the veterans they are talking about
tonight, citizens watching us tonight, they have zero coverage from
Medicare for prescription drugs. Yes, there is a $275 deductible, and
there is a monthly premium. The average American spends about $2,000 on
drug costs annually. Under our plan they will probably save anywhere
from $900 to $1,100 that will now be provided through Medicare to them.
So anyone who is spending money on drugs today with this bill will have
a benefit.
The drug discount card that I authored along with Senator Hagel that
is now part of this global bill includes for low-income families a $600
credit much like their ATM card that they can use at drug stores to not
only achieve a discount off the retail price of the pharmaceutical but
also have money to purchase and back up that purchase.
So, yes, I am pleased with the progress we are making. I am pleased
that we have things in this bill to provide new remedies for situations
for ailing seniors, and I am encouraged by the fact that we have been
able to increase reimbursements to hospitals, increase reimbursements
to physicians. We are able to do some of the diagnostic tests necessary
to improve and enhance the quality of life. So I feel very comfortable,
as we continue the debate, that more changes probably can be made if we
deal in a constructive fashion.
Mr. PALLONE. Mr. Speaker, will the gentleman yield?
Mr. FOLEY. I yield to the gentleman from New Jersey.
Mr. PALLONE. Mr. Speaker, again I have not seen the bill because it
has not been given to the Democrats, but my understanding is that the
Medicare program that the gentleman has talked about, the comprehensive
program, is not effective until the year 2006.
Could the gentleman explain to me, if it is true that all these
problems are out there and all these changes need to be made to
Medicare, why the Republicans are going to wait until the year 2006 to
have this program kick in?
Mr. FOLEY. Mr. Speaker, reclaiming my time, actually 6 months from
enactment, we will start with a discount card that will provide an
immediate $600 in the plan. A number of the wellness provisions we are
talking about will become instantaneous, the increase to physicians,
the increase to hospitals, the increase to managed care.
Mr. PALLONE. But generally, Mr. Speaker, it does not kick in until
2006.
Mr. FOLEY. Mr. Speaker, reclaiming my time, there will be a number of
things that will take place up until 2006. The big fundamental
prescription drug will be 2006, the gentleman is correct. Because we
have to get plans up and running. We have to implement the delivery
system. We have to get plans concurrent. We have to do the
pharmacology. So there are a number of things that will require some
time.
Mr. PALLONE. Mr. Speaker, the gentleman does not think that could be
done by next year?
Mr. FOLEY. Maybe. That may be possible as we move forward. With some
cooperation, we may be able to actually expedite the time frame. That
is this gentleman's wish. The sooner, the better. But within 6 months
of enactment, we will have the first phase of this. We will have a
number of the components already implemented. As to the prescription
drug plan, I think our leadership will move more quickly than 2006.
Mr. Speaker, I reserve the balance of my time.
Ms. HOOLEY of Oregon. Mr. Speaker, I yield 3\1/2\ minutes to the
gentlewoman from California (Ms. Lee).
Ms. LEE. Mr. Speaker, I thank my colleague for yielding me this time
and also for this motion to instruct and for her tremendous leadership
on this issue.
This bill of course we have yet to see but have heard a lot about
what will essentially privatize Medicare. Not only will the bill begin
to dismantle a program that has worked for over 30 years; it does
fatten the pockets of the pharmaceutical and the private insurance
industry donors, leaves over 9 million rural Medicare beneficiaries
with no access to affordable prescription drugs, and really does pit
seniors one against the other based on their income through means
testing.
I hope we say no to this Republican bill. Under this bill,
Republicans have eliminated Federal Medicaid funding to fill in the
gaps in the Medicare drug benefit, disproportionately affecting rural
beneficiaries who are 20 percent more likely to have incomes below 150
percent of poverty level. This means that up to 1.7 million
beneficiaries could have their current drug coverage reduced.
Under this bill new, untested private insurers are authorized to
provide a prescription drug benefit. Under this bill Republicans cap
Medicare spending for the traditional programs and also for private
plans, of course shifting the greater risk and cost to our senior
citizens. It does not make any sense to provide a $12 billion slush
fund to keep private insurers in Medicare, which is really
anticompetitive. It is costly and it is unfair to seniors.
{time} 2000
Also, as I understand it, under this bill, Republicans leave seniors
who spend between $2,200 and $3,500 for prescription drugs without any
cost assistance or sharing for Medicare. And again, not having seen the
bill, but from what we hear, under this bill, and of course the
administration and the Republican leadership have weakened all of the
measures to control the costs of these drugs; policies to promote
access to generic drugs and reimportation of U.S.-made drugs which, of
course, we passed in this House, those provisions have either been
watered down or just totally disregarded.
To put it simply, a senior who receives $2,200 worth of drugs in a
year will pay about $420 in premiums, $275 deductibles, and $481, which
is about 25 percent of drug costs from $276 to $2,200. So the total
cost is somewhere between $1,700 and $2,200 in drugs.
Also, with this gap or what we call the ``doughnut hole,'' the
Republicans have left that in this bill, of course. Seniors whose drug
costs fall above $2,200 and $3,500 will pay 100 percent of the cost.
Seniors with $3,500 in annual drug costs will pay too much.
Mr. Speaker, this is really the beginning of the end of Medicare as
we know it. This is an attempt really to dismantle Medicare. We cannot
allow that. We must stand up for our constituents. We must stand up for
our senior citizens and provide a prescription drug benefit which is
helpful, not which is harmful. This bill is not comprehensive, I guess.
I mean we have not seen it, but from what we hear, it is terrible and
it is very incomplete.
So I think we need to be honest with our senior citizens. It does
privatize Medicare. It does begin to dismantle Medicare. It is much too
costly for our senior citizens to buy drugs which are already too
expensive.
Mr. FOLEY. Mr. Speaker, I yield myself such time as I may consume.
It is almost comical on the floor for people who claim they have
never seen this bill, they know every aspect of it and can criticize it
with great flourish and abundance.
We just heard about the rural health care network, and I absolutely
represent a lot of rural communities. Mr. Speaker, $30 billion
additionally to fund rural health. Standardized amount for payments. A
labor share to help with the labor index in rural communities. The
disproportionate share program is increased in our bill. Low-
[[Page H11604]]
volume hospitals receive additional payments based on their discharges.
Critical-access hospitals have additional benefits. A wage index.
Graduate medical education programs. Sole-community hospitals qualify
based on some data.
These are all incorporated in this new Medicare reform proposal that
will benefit constituents in the gentlewoman from California's
district.
Bonus payments for physician, an increased 5 percent add-on if you
are in the rural component. Clinics pay separately for professional
services. Rural health care clinics, federally qualified. Low-volume
rural ambulance, targets higher payments for ambulances in rural
communities. Home health care adds an additional 5 percent.
So these are all funded by our program, including community health
centers.
Now, it came up about the $2,200, the doughnut that they continue to
describe. The median recipient on Medicare uses approximately $2,000
annually in drug utilization costs. That is why we came up with the
$2,200 to cover the majority of Americans. After $3,600 of drug
expenditures, we then pick up 95 percent of the tab for the
catastrophically ill.
Now, what the Democrats fail to continue to mention, and I wish they
would put their price tag alongside their lofty ideas, is to give drugs
to every senior in an unlimited amount without payment, without
copayment, without deductible, would be about $900 billion, almost $1
trillion. Please, somebody on the other side, advise me where that
money comes from, and I will be willing to listen to their proposal.
But in the abstract and failing to offer concrete solutions, they
criticize a bill that has been worked on by the Committee on Ways and
Means. They should contact some of their Democratic colleagues who
serve on the committee with me. They are probably not happy with every
aspect of the bill, but they have seen it. We have debated it. We have
discussed it. This bill has been around for about 4\1/2\ years, no
shocks, no nuances, no changes. It has all been part of the debate.
Yes, they may object to portions of it, but to claim that somehow we
just popped this bill up in the middle of the night belies the 4\1/2\
years I have been on the committee working on this and shows little of
the knowledge of the very important components that provide relief to a
number of their constituents, Democrat, Republican, and Independent
alike.
Mr. Speaker, I reserve the balance of my time.
Ms. HOOLEY of Oregon. Mr. Speaker, I yield 3 minutes to the gentleman
from California (Mr. George Miller).
Mr. GEORGE MILLER of California. Mr. Speaker, I thank the gentlewoman
for offering this motion and for yielding me this time.
I just want to say, following up what my colleague, the gentleman
from Florida (Mr. Hastings) said, and that is that unfortunately, we
now see people who are offering themselves as so-called honest brokers
who set up thresholds and tests as to whether this would be a good bill
for senior citizens; whether or not this would provide the kind of drug
benefit that senior citizens should have and that they need to match
the cost of the drugs that they now have to pay the prices that they
have to pay, we now see that that organization, AARP, was in the bag
all of the time. They were not there representing their members, they
were not there representing senior citizens; they were there
representing themselves as an insurance company. Now, we see that under
the provisions of the bill, they stand to do billions of dollars in
business. They do about $100 million in business now, selling Medigap
insurance policies, but now they want to get into the pharmaceutical
business.
So they were not an objective observer of this process. They were not
there as guardians; they were there as special interests with a special
seat at the table. So special that the Republican administration gave
them a number of contracts over the last couple of years from the
Department of Labor and other agencies in this Federal Government, and
now all of a sudden we find out they took a dive on the bill. They did
not talk to their Members and say, what should we do. The beltway
lobbyists, speaking from their own interests, made a decision to
support this bill to the extent now that all day long we have been
watching on the news as people have been turning in their membership in
AARP, people have been resigning from the organization. I have a letter
here from their legislative chairman in Raleigh, North Carolina who
says that he is resigning because they were never asked about this. And
the fact that they would support a bill as they understand it with the
level of benefits, with the privatization of Medicare, they want out.
They are resigning. That was supposedly the honest broker that was
going between the sides and discussing the merits of this program.
This bill is one thing and one thing only: it is to provide
protection to the big pharmaceutical industry. This bill does nothing
about price. You can have your discount cards, but it is discounted off
an inflated price, and it specifically prohibits the Secretary of
Health and Human Services from negotiating price. When asked about why
this is in the provision in a meeting today, one of the authors of the
bill said because that is the way big PhRMA wanted it. Well, big PhRMA
got their way and Mr. Middle America, they got hosed in this operation.
We cannot negotiate like Wal-Mart. We cannot negotiate like Costo. We
cannot negotiate like the Veterans' Administration. No. They get to set
the price and then somehow we are going to give you a discount off an
inflated price. So they did not do anything about price there; all they
did was protect the profits of the pharmaceutical industry, and if the
seniors get a benefit, they will be lucky. Out of the first $5,000,
they will pay $4,000. That is not the benefit that the AARP should be
fighting for.
Mr. FOLEY. Mr. Speaker, I yield myself such time as I may consume.
I would just ask Members who are so comfortable with the insurance
provided to them through Blue Cross Blue Shield, it is a PPO, it is
made out to me, it is a government-wide benefit plan that has a retail
pharmacy carrier; it has a mail order if I want; there is a customer
service number; I can use it at most hospitals for admission and
medical doctors. But surprisingly, it is not the Federal Government, it
is Blue Cross and Blue Shield. So if this is so onerous and a disaster
waiting to happen, then maybe my colleagues ought to turn in their
card. I think they probably would not go without the coverage, and that
is what my constituents have been asking for: give me what you have.
Let me have choices. Let me have options. Let me decide for myself.
Now, they may be outraged at AARP, but up until last week they were
always throwing it in our faces that this was the legitimate group that
negotiated for seniors, and now all of a sudden they have racked up
this alleged racketeering, mob-style pharmaceutical alliance with big
PhRMA. It is just interesting, when they change their viewpoint and
decide to support something we are doing, this is evil incarnate. A
week ago they were the gold standard of senior care and consideration;
today we are going to burn our cards.
So I ask my colleagues to be the judge: is it politics, or is it
process? Is it results, or is it claiming credit? As a Member of the
Committee on Ways and Means, yes, there is a lot more I would like to
do to this bill. But part of the process I have learned is compromise,
negotiation, and meaningful steps forward to make results achievable
for citizens, the people that pay our salary that send us to work.
When I go home after reviewing this bill and looking at its contents,
I know in my heart I can look at seniors, whether they live in Lake
Worth, Port St. Lucie, Punta Gorda, Okeechobee; whether they are
wealthy or poor, whatever their ethnic background, whatever their
family composition, that I will be able to look them in the eye and
say, this is a better program than it was last month and last year.
Mr. Speaker, with that I know the hour is late, and I sincerely
appreciate, as I have worked with the gentlewoman from Oregon on a
number of issues, and we care deeply about health care; we share common
objectives and common goals. But I think the characterization of this
bill is overstated in its demagoguery. I think if we look at what is
being provided and the full range of services, people should come
[[Page H11605]]
away from this bill knowing this is an important, critical first step
to providing prescription drug coverage for our seniors. Today, at this
hour, seniors have absolutely zero coverage by the Federal Government
for prescription drugs.
If there is any indication that what we are about to embark on by
those who suggest this is not a benefit, then they have not read the
calculation. Just do the math along with me. From $3,600 to $5,000, the
example used by the gentleman from California, if you spent $5,000, you
are only paying $900; well, do the math. From $3,600 to $5,000 is
$1,400. Your obligation is a 5 percent copay of that. So it does not
take rocket science to figure out that is $70. That means you have
$1,330 of a benefit there alone. If you take the front end, if you take
the front end and you look at the deductible and the $2,200 amount, you
are talking about roughly $900 to $1,100. So if you add those two
together, there is about $2,430 of benefit for a person that spends
$5,000, not counting the $600 and the discount card, plus the discounts
achieved. So if we reflect on all of those numbers and you hear these
numbers thrown around, get out a calculator, we will supply the
numbers. It is not that difficult.
My final statement will be to those who say our seniors do not
understand enough of what they are doing to be able to figure these new
processes or new bills out. Well, do my colleagues know what? The
generation I am talking about managed their way through the depression,
they survived World War II, they taught us how to ride our bikes and
drive our cars. They raised us. They fought wars. They have been able
to succeed in life on their own without the Federal Government dumbing
them down and acting like they cannot make choices.
The Medicare bill we are about to bring to this floor represents
significant, important, fundamental change. It represents increasing
opportunity to gain wellness care. It represents prescription drug
coverage for the first time in this Nation's history.
The Congress was controlled by the Democrats in 1965, when Medicare
was introduced, to 1995 when the Republicans took over and, in that
span of time, no prescription drugs were added. So I ask the basic
question. I have been working on it since I came to Congress in 1995.
We finally have a product on the floor in 2003, a lot later than I
would have liked to, but under our majority, with President Bush and
the Senate majority in Republican hands, we are about to embark on a
wellness Medicare program for the 21st century.
{time} 2015
So I appreciate the time of the gentlewoman from Oregon (Ms. Hooley),
and I appreciate the House's indulgence.
Mr. Speaker, I yield back the balance of my time.
Ms. HOOLEY of Oregon. Mr. Speaker, I yield myself such time as I may
consume.
Mr. Speaker, the gentleman from Florida (Mr. Foley) and I have worked
on many issues together. I guess I would like to offer today to work on
another issue. Oregon happens to be a very low reimbursement State
because we have been very efficient in our health care. I am glad that
Florida has a high reimbursement rate. I would just like to be there
with them. And our State, because it is a low reimbursement State, I
have areas in my district where doctors are filled. Because they lose
money every time they take a Medicare patient, they do not want to take
anymore. It is not because they do not want to provide the service; it
is that they cannot afford to do it. They cannot afford to have 100
percent of their clients Medicare clients because, again, of the
reimbursement level.
I urge my colleagues to vote for this motion to direct the millions
that the House bill uses for privatization to improving Medicare
payments for physicians. Physicians cannot deliver 21st-century
medicine to our seniors with payment rates that do not cover the cost
of their care.
My motion would address the concerns of doctors across the country
and ensure that they are able to treat Medicare patients. Instead of
putting the Medicare system in jeopardy through risky and untested
privatization schemes, we should protect our constituents' access to
care.
I urge my colleagues to support our doctors and their patients and to
vote ``yes'' on the motion to instruct.
Mr. Speaker, I yield back the balance of my time.
The SPEAKER pro tempore (Mr. Hensarling). 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 Oregon (Ms. Hooley).
The question was taken; and the Speaker pro tempore announced that
the ayes appeared to have it.
Ms. HOOLEY of Oregon. 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 and the
Chair's prior announcement, further proceedings on this motion will be
postponed.
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