[Congressional Record Volume 149, Number 168 (Wednesday, November 19, 2003)]
[House]
[Pages H11634-H11640]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




        MEDICARE PRESCRIPTION DRUG AND MODERNIZATION ACT OF 2003

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 7, 2003, the gentleman from Georgia (Mr. Gingrey) is recognized 
for 60 minutes as the designee of the majority leader.
  Mr. GINGREY. Mr. Speaker, I want to thank my colleagues on this side 
of the aisle for joining with me tonight in discussing over the next 
hour one of the most important issues to come before this great body, 
this United States House of Representatives, probably in the history of 
the Congress, and I am talking about, Mr. Speaker, the impending 
passage of the bipartisan Medicare Prescription Drug and Modernization 
Act of 2003.
  Mr. Speaker, Medicare is a good program. Medicare had done a lot of 
things since its inception, of course, when it was first put into place 
almost 40 years ago, but it is not perfect. Medicare, although it is a 
good program, is not perfect. Two of the main problems, Mr. Speaker, 
with Medicare are these: number 1, it has never had a prescription drug 
benefit. Yes, it covers

[[Page H11635]]

hospital expenses. Yes, it covers major surgery and, certainly, it 
allows some time to be spent in a skilled nursing home if that is 
necessary. But it has never had any emphasis on preventive therapy 
which, of course, is what prescription drugs is all about.
  Now, maybe back in 1965, when I was a freshman in medical school, we 
were not prescribing as many drugs. There were not as many lifesaving 
drugs on the market. In fact, back then, there was a penicillin 
antibiotic if you had an infection. There was a heart medication called 
digitalis if your heart was not beating properly. There was maybe 
codeine if you had a bad headache. But there were not the lifesaving 
drugs that are available to us today in the 21st century.
  Medicare also does not do anything about preventive care, and there 
is no catastrophic coverage, Mr. Speaker. Under part A of Medicare, 
after a patient has expended a certain number of days in the hospital 
for a covered illness, then everything is out-of-pocket, and the same 
is true for an extended stay in a nursing home. That is why so many of 
our seniors find themselves in their twilight years having to go on 
Medicaid, having to become literally wards of the State because of this 
lack of catastrophic coverage.
  So, Mr. Speaker, the main two problems have finally been addressed in 
the Medicare Prescription Drug and Modernization Act. We are finally 
going to deliver on a promise to our seniors and include under Medicare 
a prescription drug benefit, and also make sure that our seniors have 
an opportunity to get the preventive care and disease management they 
need.
  Mr. Speaker, not covering for a prescription and covering for major 
surgery is really akin to having a service contract on your car that 
covers to have the transmission replaced, but not to have the oil 
changed. It makes absolutely no sense. So finally, Mr. Speaker, we have 
come to the point in the history of Medicare where we have got to 
change, we have got to bring it into the 21st century.
  Other people, Members of Congress, the health coverage that we have, 
has a strong emphasis on prevention and wellness and, in the long run, 
this is less expensive. Certainly, managed care understands that, that 
it is in their best interest to keep people healthy. When we think 
about it, so many of us; in fact, most of our citizens who are on that 
type of plan, including probably all Members of Congress, they are used 
to that preventive care. They have that catastrophic coverage. And, all 
of a sudden, they turn 65, and Medicare becomes primary, and if they 
cannot afford, or if they do not have an employer-provided health 
benefit for a retiree or a very expensive maybe Medigap plan and they 
are just relying on Medicare, then they have gone from a coverage that 
gave them protection, that gave them catastrophic protection and, all 
of a sudden, at age 65 and beyond, they do not have that anymore, and 
that makes no sense at all.
  The point is, Mr. Speaker, that we have not modernized Medicare, and 
that is what we are going to do here within the next couple of days in 
this 108th Congress. I am very proud, as a Member and as a physician 
Member, to be a part of this historic time in our Congress.
  I am, as I say, very pleased that members of my caucus are here with 
us tonight in this late hour, but they understand the importance of 
this issue, and they understand the need to make sure that the public 
and, hopefully, some are watching tonight, especially our seniors, have 
an opportunity to see exactly what we are going to do for them with 
this passage of this historic piece of legislation.
  At this time, Mr. Speaker, I yield to the gentleman from South 
Carolina (Mr. Wilson), just across the border from my home State of 
Georgia, my good friend and colleague.

                              {time}  2200

  Mr. WILSON of South Carolina. Mr. Speaker, it is an honor to be here 
tonight. I would like to thank my colleague, the gentleman from Georgia 
(Mr. Gingrey), for his leadership in helping to present the truth about 
the prescription drug plan which is before Congress this week.
  I want our colleagues to know that it means so much to me that we 
have a physician such as the gentleman from Georgia (Mr. Gingrey) here 
who has a background of working for quality health care for persons in 
Georgia and the southeastern part of the United States. And he has got 
a background of knowing what is needed for our citizens. And it just 
means a lot to have his leadership tonight.
  Additionally, I am happy to be here because of the support of AARP of 
the plan which is before us at this time. I am a member of AARP. I am 
proud of their promotion of the best health plan that they feel can be 
produced, and that is the bill before us this week.
  Additionally, I want to congratulate the gentleman from California 
(Chairman Thomas) of the Committee on Ways and Means who has worked so 
hard to try to balance interests and come up with a bill which is 
beneficial to the people of the United States. As we are quite familiar 
with the providing of prescription drugs, there are other features in 
the bill that I find very helpful. And I want to relate three of them 
tonight because I think they are going to have meaning to persons of 
all ages and particularly for younger people, for persons middle-aged, 
and, indeed, beneficial for persons who are AARP members.
  The first point I would like to bring out is that this bill provides 
for health savings accounts. This is a provision which in the past has 
been known as medical savings accounts. This has been a provision which 
the gentleman from Illinois (Speaker Hastert) here has been a primary 
proponent of because it provides new incentives for individuals to put 
money aside for health care.
  The H.R. 1 provisions provide that health savings accounts can 
provide for people to put, say, up to $1,000. If they have a deductible 
on their policy of $1,000 they can place $1,000 into an account which 
can be used to pay all qualified medical expenses. The contributions, 
earnings, and distributions are all tax free. These accounts are 
portable from job to job and into retirement. And, indeed, when persons 
pass away, the money that is left over will be passed on through their 
estate to their loved ones and their family members. Individuals, 
employers, and family members can all make contributions.
  This is a revolutionary effort on behalf of all Americans, both 
seniors and nonseniors. Because of the health savings accounts, less 
money will be spent by the taxpayer. And Americans can plan their 
futures and plan their ability to provide for better health. These 
plans will allow seniors to have more control over their health care 
options.
  Other features that I find very helpful in the bill that is before us 
are to provide for preventative care. The newly enrolled beneficiaries 
will be covered for a physical. And this I think is so beneficial. I 
know every time that I have had a health insurance plan, the first 
question I have after we sign up, unfortunately, is do we have a 
provision for a physical. And I found out that we did not in my law 
practice. So it was really very disappointing to me because I believe 
that if you can have a physical and you can have the normal test, that 
this will be beneficial to planning your health care.
  Additionally, cardiovascular screening, blood tests including 
cholesterol will be included in the testing provisions. And then 
another very important effort will be made for diabetes screening for 
at-risk beneficiaries. This is particularly appropriate to consider 
today because November is American Diabetes Month. And I know that in 
the southeastern part of the United States, that we, unfortunately rank 
very high with the number of persons who suffer from diabetes.
  These benefits do not have deductibles or co-pays so those with 
limited resources can access the benefits. These screenings will catch 
treatable, manageable conditions that would otherwise result in severe 
health consequences and cost the Medicare program an immense amount of 
money. But the main feature is it will help people live longer healthy 
and fulfilling lives.
  Another and final point that I want to bring out that had not 
received extraordinary attention is reform of the average wholesale 
price, the AWP, which needs to be reformed. And, additionally, the 
provision of oncology services. These are cancer treatments

[[Page H11636]]

that we will provide in the bill for reimbursements to physicians in 
services to patients. And this has particularly been enhanced in the 
last several days because of concern that there may be a reduction in 
reimbursements and services to patients.
  I know firsthand how important this is and that one of our sons at 
the age of 17 was diagnosed with malignant thyroid cancer. But thanks 
to his treatment at the Lexington Medical Center, the detection by Dr. 
Butch Bledsoe, the surgery by Dr. Dan Davis, the pathology reports by 
Dr. John Carter, and the subsequent treatment by Dr. Tripp Jones, our 
son is in full remission. In fact, he was able to graduate from the 
Naval Academy, and he is following in the footsteps of the gentleman 
from Georgia (Dr. Gingrey). He is in his third year of medical school 
at Uniformed Services University here at Bethesda, Maryland. So we know 
firsthand that by getting proper cancer treatment in our family that 
people can recover and live full lives.
  The bill will provide fixes to a flawed system that is costing 
America's seniors in prescription drugs, but the oncologist and other 
practitioners are covered by the reform with assistance with practice 
expenses.
  Additionally, a final point, the average sales price, ASP, will be 
calculated at a rate that will be welcomed by the health community, 
including the much-appreciated oncologists and other specialists.
  As I conclude tonight, I want to say a message as always: God bless 
our troops. We will not forget the sneak attack of September the 11th 
on our innocent civilians in New York, Pennsylvania, and Washington.
  Mr. GINGREY. Mr. Speaker, I thank the gentleman from South Carolina 
(Mr. Wilson). I especially am grateful for him sharing that very 
personal anecdotal information with us about his son.
  Mr. Speaker, what the gentleman from South Carolina (Mr. Wilson) is 
talking about is so true, that medications that are available today we 
did not have in 1965. God forbid maybe if his son had had that leukemia 
in 1965, he would not be alive today. I know my mom who was suffering 
from cancer several years ago would not be alive today if it were not 
for the chemotherapy that basically completely put her cancer in 
remission.
  Just imagine now, just imagine someone that is in their late 60s or 
maybe even mid-70s that has no insurance coverage for prescriptions who 
comes down with cancer that could very well be successfully treated if 
only they could afford, if only they could afford to take a very 
expensive medication that would cure that cancer, put that cancer in 
remission, and let them continue to live and enjoy life. So that is why 
it is so important in this 21st century that we finally have a coverage 
for prescription drugs.
  It gives me a lot of pleasure at this point, Mr. Speaker, to yield 
time to the gentleman from Georgia (Mr. Burns), my colleague and friend 
from the 12th Congressional District.
  Mr. BURNS. Mr. Speaker, it is a historic time. It is a historic time 
to be in Congress. We are at the brink of passing landmark legislation 
that is long overdue in our country. This week, just in a day or two or 
three, we are going to take up on this floor H.R. 1, the Medicare 
Reform Modernization Act, including a prescription drug benefit for our 
seniors. This is an important and historic vote that we have to come 
together now and complete the promise that we have made to America.
  I committed to the 12th district of Georgia that I would preserve and 
protect and improve Medicare. H.R. 1 does that. I committed that I 
would work hard to ensure that our seniors receive a prescription drug 
benefit that will improve their quality of life, that will allow them 
to live full and complete lives that are free from pain and free from 
suffering. H.R. 1 will do that.
  As my colleagues have both pointed out, for the first time in the 
history of Medicare, we will begin to shift from treatment from acute 
care to prevention to utilizing those drugs, the wonder drugs that we 
have now in the 21st century to ensure that our seniors can live full 
lives.
  It is a tragedy that in today's Medicare world someone with diabetes 
cannot receive the prescription of insulin which would prevent them 
from losing a limb or having to be subjected to painful dialysis. It is 
a tragedy that under today's Medicare those with heart conditions 
cannot receive the medications they deserve, but yet have to be 
patients for bypass surgery or other invasive practices. This bill 
provides our seniors with the coverage that they need to ensure their 
future.
  There are many provisions in the bill that are positive for America's 
seniors. It is a bipartisan bill. It is a conference report that has 
come through the fire. This House acted originally on our version, the 
Senate on theirs; and now we come together. I think if you look at the 
contents of this bill, the naysayers will sit there and pick it apart; 
but if you look at the total package, it is good for America. Medicine 
has changed dramatically since 1965. It is time for Medicare to change 
so that it can provide the medical services to our seniors.
  The things that I want to point out in this bill relate to the fact 
that our low-income seniors who have the greatest need receive the 
greatest benefit. These individuals will no longer have to choose 
between their prescription drugs and food or utilities or roof over 
their head. They will be given essentially 100 percent coverage, and 
that ensures that they will live full and complete lives. So those at 
the low-income levels of our society will benefit the most. Those who 
have tremendous medical needs, prescription drug needs, catastrophic 
drug costs they will also receive significant support. I think if you 
look at this bill, those two areas alone suggest we need to deliver the 
prescription Medicare bill for our seniors.
  Implementation is critical. And I appreciate the discount card that 
is going to be available in April of 2004. And I certainly appreciate 
the fact that our low-income seniors will receive immediately $600 
worth of prescription drug assistance per year. And then in 2006, the 
full prescription drug plan will be available.
  I come from a district, the 12th in Georgia, with many rural 
hospitals. This bill is a strong statement in support of rural 
hospitals. It extends the standardized base payment rate for our rural 
hospitals. For all of those hospitals in cities of less than a million, 
it ensures that they immediately get an increase in the 
disproportionate share payments that they are entitled to. And I think 
if you look at the rural health care component in this bill, you find 
that it is second to none that has ever been a part of our Congress.
  Another very significant component of this bill that I think too many 
people overlook, there is a fear that for some reason employers would 
abandon their retirees. Just 2 days ago, we had a press conference here 
in the Capitol where we met with the employer coalition representatives 
of over 60 U.S. companies that have worked hand in hand with the 
Congress to be able to ensure that these companies will not abandon 
their retiree health plans but would stay in the game, that would 
continue to provide the medical coverage for retirees, the prescription 
drug coverage for retirees that their retirees have earned through a 
lifetime of service.

                              {time}  2215

  So if we look at the employer coalition over 60 companies and their 
commitment to their employees and their commitment to their retirees 
and their willingness to work with Congress, H.R. 1 provides the 
incentive for these employers to stay in the game.
  Certainly I had an opportunity in the summer and early fall to meet 
with representatives of the AARP, American Association of Retired 
Persons. Again, I am a member. My wife is a member, and I met with them 
in the 12th district, and I was talking with them and we were comparing 
the House and Senate version of the bill, and we were talking about the 
changes we needed to make and the compromises and the coming together; 
and I committed to them that when this bill came out of conference that 
it would be a bill that they could support and that together the 
Congress and AARP would work for the passage of this bill, and indeed, 
that is what has happened. I am glad and proud of the fact that we were 
able to work effectively with AARP to ensure that seniors in America 
receive the health care coverage that they deserve.
  Lastly, Mr. Speaker, I want to point out the most significant 
component of

[[Page H11637]]

this bill and that is a choice, a choice. If a senior is happy with 
their current Medicare, they can continue receiving that benefit as it 
currently exists. If they would like a drug benefit coverage with that, 
they are welcome to accept that benefit, but they are not required to 
do so. It is their choice. If they choose to take Medicare advantage 
where they receive screening, where they receive supportive preventive 
care, that is the individual Medicare recipient's choice. We have 
preserved Medicare, Mr. Speaker. We have protected Medicare, Mr. 
Speaker. We have enhanced Medicare, Mr. Speaker.
  If my good colleague and friend from Georgia would be willing, I 
would like to maybe pose a question or two and get his input on this 
bill, if he is willing to engage in a colloquy.
  Mr. GINGREY. Absolutely.
  Mr. BURNS. Mr. Speaker, I think one of the things that the gentleman 
can help the Nation understand, as a physician, how do you compare the 
current physician reimbursement policies under Medicare with the 
proposals that are in this new modernization act?
  Mr. GINGREY. I am so glad that the gentleman asked that question, and 
I have actually been speaking on the floor of this House for the last 
month on a weekly basis talking about that very thing that the 
gentleman speaks of.
  Physicians have been suffering severely over the last several years. 
They have taken deep cuts in Medicare payments, and the projected cuts 
for the next 2 years were 4.5 percent, 4.5 percent less per year in 
Medicare reimbursement at a time when their practice expenses, 
especially the cost of malpractice premiums, are literally going 
through the roof; and the answer to my colleague's question is that 
under this bill, physicians not only in the next 2 years will not 
suffer that 4.5 percent cut, but in fact, they will have a 1.5 percent 
increase.
  Mr. BURNS. That is a large swing. We are talking a 10 percent, 11 
percent swing over the next 2 years.
  Mr. GINGREY. Mr. Speaker, that is correct.
  Mr. BURNS. I think one of the things we need to understand is that 
our physicians need to be willing to accept new Medicare patients, and 
we need to make sure that health care is available as well as access to 
help our seniors, and H.R. 1 provides that capability.
  The gentleman was a part of the employer coalition conference when we 
talked about the employers being a part of this solution. What was your 
impression and what incentives do you see for employers to stay 
engaged, to continue to provide their retirees with the benefits that 
were really committed to them while they were working for their 
organizations?
  Mr. GINGREY. Another great question, and I am sure the gentleman from 
the 12th, from southeast Georgia, as he has had town hall meetings in 
his district all the way from Augusta to Savannah, is hearing the same 
concerns that I have been hearing. In fact, these were the major 
concerns and have been the major concerns of the AARP, and that is, 
what happens to these retirees who have had a great health insurance 
plan after their retirement that includes a very generous prescription 
drug benefit from their employer. There was this great fear, has been a 
great fear, that all of the sudden employers may, since there is an 
opportunity, an option under Medicare, drop their plans; and so we have 
made sure that we incentivize employers to keep those plans, to keep 
providing for those men and women who in some instances have worked 40 
years for the company, very loyally working for the company. This 
Medicare Modernization and Prescription Drug Act actually gives 28 
percent, 28 percent of coverage up to $5,000 per individual to 
employers, a tax-free supplement to incentivize them not to drop those 
plans. The AARP and its 35 million seniors are quite happy with that, 
and I think we have solved that problem.
  Mr. BURNS. Mr. Speaker, I think we need to recognize that we need to 
keep our employers in the game. We need to keep them involved in 
supporting their retirees, and certainly this provision in H.R. 1 does 
that.
  The last question deals with our low-income seniors and really all 
seniors. What does my colleague see as the level of health care that 
they will receive under H.R. 1, this modernization act, compared to 
traditional Medicare that has been around some 40-plus, almost 40 years 
now?
  Mr. GINGREY. As the gentleman said at the beginning of his remarks, 
the most important part of this legislation is that it helps our 
needier seniors. It gives them probably the greatest benefit.
  Most of our seniors who are not low income, yes, they get significant 
help with this bill, particularly in regard to catastrophic coverage 
when they get above $3,600 out of pocket in any 1 year, but the point 
the gentleman is making is such a good one. It is so important for the 
public to understand, and that is that we are taking care of our 
neediest seniors first. If they have an income, an individual, of less 
than $12,000 give or take a few dollars per year or a couple at the 
$16,000 income level per year, then they pay nothing for their 
deductible. They do not pay a copay. They do not have to pay those 
monthly premiums. All of that is taken care of, and they are only 
liable for maybe a dollar for a generic drug or $3 for a brand-name 
medication or, if they are above 135 percent of the Federal poverty 
level, that goes to $2, $5. So minimum, and that is where the emphasis 
is, as the gentleman from the 12th is pointing out, on our most needy 
seniors.

  Mr. BURNS. Mr. Speaker, I think if we look at this bill and we look 
at all aspects of the bill, it is a good bill. Never let the perfect 
get in the way of the good. This is a solid bill that needs to be 
passed in Congress.
  I think one of the components of the bill that my good friend and 
colleague from South Carolina (Mr. Wilson) pointed out was the health 
savings account. What a revolutionary opportunity for Americans and for 
families to support tax free the health care costs, their own and then 
perhaps their parents; and if I look at that single provision alone, it 
is a tremendous advantage to America.
  I would like to thank my colleague, the gentleman from Georgia (Mr. 
Gingrey), for his leadership. I am delighted to have the opportunity to 
serve in Congress with two physicians in our freshman class who 
understand health care and who understand the challenges of our 
seniors.
  Mr. Speaker, as this conference report comes to the floor later this 
week, I think it is time for action. It is time for us to stand up for 
America and to stand up for America's seniors, to pass this bill and to 
ensure that our seniors receive the Medicare coverage they deserve, the 
prescription benefits that they deserve and need desperately but also 
preserve this system for my children and my grandchildren and for 
America.
  Mr. GINGREY. Mr. Speaker, I thank the gentleman from Georgia for 
those very, very timely and accurate comments in regard to this bill. 
In fact, the gentleman from Georgia mentioned the health savings 
account, and I think that is one of the many parts of this bill that is 
so good. It is something that we have waited for a long time to have 
what we might call a universal health savings account opportunity.
  Mr. Speaker, at this point, I would like to yield to my colleague and 
friend, the gentleman from Indiana (Mr. Chocola), who is a small 
businessman and understands this issue just about as good as anybody 
that I have discussed it with.
  Mr. CHOCOLA. Mr. Speaker, I thank the gentleman for yielding, and I 
thank him for his leadership in bringing us to together tonight to 
really discuss what has been pointed out, I think, as one of the 
historic bills we will consider in our career, no matter how long we 
serve in this body and have the privilege of representing the people in 
our home districts.
  We have had a lot of talk about all the provisions that are in this 
bill and how important they are, and certainly the prescription drug 
provision is very important in the basis of this bill, and I join my 
colleagues in saying it is about time that we live up to the promises 
that we have made to our seniors and really live up to our 
responsibility to deliver the prescription drug benefit under Medicare 
that they deserve.
  Really, what I would like to do tonight is focus on another provision 
of the bill that I think is equally important and really has an impact 
on every single working family in our country.

[[Page H11638]]

Not only does it impact retirees, not only does it impact Medicare 
recipients, but it impacts every single family in this country, and as 
the gentleman from Georgia pointed out, that is health savings 
accounts; and the reason I want to talk about this is because ever 
since the day I decided to run for Congress, every single conversation 
that I have had about health care in America has revolved around the 
following conversation.
  Basically, health care reform is the most important and complicated 
domestic issue that we face as a Congress, and the only way that we are 
going to see true health care transformation in this country is to have 
individual ownership and control of health care coverage; and the only 
way that we are going to have individual ownership and control of 
health care coverage is to have what we used to call medical savings 
accounts, but now we call health savings accounts, because it rewards 
people for shopping for their health care services on economic, not an 
emotional, basis, and it is an opportunity for people to build wealth 
over a period of their life, over the course of their career, and they 
can use that wealth to cover their retiree health care needs.
  I used to be a small business owner, as the gentleman from Georgia 
pointed out, and we had about 1,300 employees. We provided very 
generous health care benefits for our employees, but every year it was 
harder and harder and harder to be able to keep those benefits in place 
at a reasonable cost to the company and reasonable cost to the 
employees; but every single day I saw the magic of ownership in 
accounts like profit sharing plan accounts, like a 401(k) plan. People 
that live paycheck to paycheck did not have bank accounts, took 100 
percent personal responsibility in those accounts because they knew it 
was their money, and if it was managed well, it would benefit their 
retirements and their family.
  I thought every day as I watched the magic of that ownership, why can 
we not apply these same principles to health care coverage in America, 
and that is exactly what health savings accounts do. As an employer 
would it not be great if we could establish a system that says that the 
employer can contribute and the individual can contribute on a tax-free 
basis into an account that covers a high-deductible policy?
  Mr. Speaker, for those that are not familiar with what health savings 
accounts are, basically they are a high-deductible health care policy, 
and the high-deductible portion of that policy is owned by the 
beneficiary of that policy. They make the decisions on what medical 
services they are going to buy. They make the decisions on how much 
they are going to pay for those medical services; and if they are good 
shoppers and they are relatively healthy, and certainly our experience 
in our company, I do not think it was too different than most 
experiences, in that the 80/20 rule applies. Eighty percent of the 
people are pretty healthy, and they do not really need expensive health 
care coverage. Twenty percent of the people do encounter health care 
needs, and they will be covered by the catastrophic portion of their 
coverage; but for the 80 percent, they will be able to shop wisely and 
save money.
  That is in their account on a year-by-year basis. That money will 
grow tax free year over year and grow into an asset that they can 
utilize in their retirement to purchase qualified health care needs.

                              {time}  2230

  Mr. Speaker, I do not think there is anything we can do that would be 
more responsible as Members of Congress than to free the American 
people to have wealth for their health care retirement needs. Certainly 
Medicare is a very important provision. It has been a great law in this 
country and has covered many people in a very responsible way. As this 
whole debate goes on this week, we will all recognize that since 1965 
health care in America has changed, and we need to change Medicare to 
reflect that change. And we certainly need to provide a prescription 
drug benefit for our Medicare recipients. But would it not be great if 
we could provide every single American working family the opportunity 
to build wealth and be able to be free to have a substantial account in 
the bank, to be able to have the flexibility to have the health care 
services they desire, no matter what those are, when they retire?
  So, Mr. Speaker, I think it is so important that we do not forget how 
important this provision is. And as we talk about how do we lower 
health care costs in America, just think of this: When is the last time 
you changed the oil in a rental car? If we do not own it, we do not 
take care of it. If we own our health care coverage, we have every 
incentive to take care of ourselves. We are rewarded for having health 
prevention and we are rewarded for buying our health care costs on an 
economic basis.
  And there are two examples to show how powerful that is. Three years 
ago, I had LASIK surgery. And 3 years ago, I paid $3,000 to have that 
LASIK surgery so I could see. Today, you can probably go for 30 to 40 
percent less to have that same surgery. The only difference in that 
medical procedure is that it is not covered by insurance. It is paid 
for by people out of their own pocket. They shop, and economic and 
market forces have driven that cost down. The same thing with elective 
surgery. People who have plastic surgery, those costs have risen slower 
than the cost of inflation.
  So, Mr. Speaker, it is possible to bring health care costs down in 
America. It is possible to live up to our responsibility to our 
seniors. It is possible to give every American family the freedom and 
the flexibility to have the wealth to take care of their retirement 
health care needs if we pass this bill. So I join with my colleagues 
here tonight to encourage every Member of this body to pass H.R. 1 and 
live up to our responsibilities to the American people.
  Mr. GINGREY. Mr. Speaker, I thank the gentleman from Indiana. I think 
this is such an important aspect of this bill and I appreciate his 
discussing that with us.
  Mr. Speaker, there are probably 40 million people in this great 
country of ours who have no health insurance at all, and 60 percent of 
them, maybe more than 60 percent, have jobs. They are not unemployed. 
Maybe they work for a small shop of five to 10 to 15 people and that 
employer just cannot go out in the marketplace and get a volume 
discount, so they just cannot afford it. It is a benefit they cannot 
afford.
  This health savings account will give these employees that are 
working but do not have the opportunity for group health insurance to 
put up to $5,000, up to $5,000 a year, Mr. Speaker, tax deferred and 
will have an opportunity for that account to grow, as the gentleman 
from Indiana so vividly pointed out.
  I want to shift gears, Mr. Speaker, for just a minute. We have heard 
a lot of discussion tonight during this time about the AARP and how 
very supportive they are of this Medicare Modernization and 
Prescription Drug Act, this bipartisan conference committee report. Let 
me just read a letter, Mr. Speaker, from the President of AARP, Mr. 
William Novelli, and here is what Mr. Novelli says about this bill.
  ``Some people are surprised by AARP's support of the Medicare 
prescription drug legislation now before Congress. They shouldn't be. 
Our decision is not based on political calculation or allegiance to 
rigid ideology, but solely on what this will mean for our members and 
the health of all older Americans.
  ``There are many reasons for our endorsement. First, this 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. Second, it will provide 
substantial relief for those with very high drug costs and will provide 
modest relief for millions more.
  ``Finally, we are pleased to see a substantial increase in 
protections for retiree benefits. That fairness is maintained by 
upholding the health benefit protections of the Age Discrimination and 
Employment Act.
  ``On July 14, in a letter to congressional leadership, we outlined 
our concerns and our expectations for a bill that we could support. 
Among them was our opposition to what is commonly known as ``premium 
support,'' a new structure requiring traditional Medicare to compete 
against private plans, which could very likely result in

[[Page H11639]]

higher out-of-pocket costs for those who choose to stay in traditional 
Medicare.
  ``As a result of negotiations, this was scaled back to a 
demonstration project that is very limited in scope that doesn't begin 
until 2010, that exempts low-income beneficiaries and limits any 
premium increases. This will not,'' and I repeat, Mr. Speaker, ``this 
will not jeopardize traditional Medicare'' as we know it.
  ``Of real concern to our members and millions of older and disabled 
Americans was the prospect that by gaining a Medicare benefit, they 
might lose their current employer-retiree coverage.'' We talked about 
that earlier. ``We said that the final agreement should provide 
adequate incentives for employers to maintain their current plans. The 
proposed legislation includes an unprecedented $88 billion in subsidies 
to ensure that people who have good private coverage do not lose it.
  ``This bill is not perfect, but millions of Americans cannot wait for 
perfect. They need help now. And, finally, help is on the way.
  ``This is an issue too important to be held hostage to the status 
quo. As the late civil rights leader Whitney Young once said, `We have 
no permanent friends or enemies, just permanent interests.' Our 
interests are what is best for our members and for all older Americans.

  ``In the coming days, we will do all we can to help the American 
people understand how important this legislation is to them and to 
convince Members of Congress to work in a bipartisan,'' absolutely a 
bipartisan ``fashion to pass it now.'' William Novelli, President of 
the American Association of Retired Persons.
  Mr. Speaker, at this time I would like to yield to my colleague and 
good friend from the great State of Alabama. Our districts butt up 
against each other at the State line, and I know that the people that 
he represents in his district in Alabama have the same needs, life 
experiences, and concerns that my folks do in the 11th District of 
Georgia.
  So it gives me a great deal of pleasure at this time, and I thank the 
gentleman from Alabama (Mr. Rogers) for joining us tonight.
  Mr. ROGERS of Alabama. Mr. Speaker, I thank my good friend and 
colleague, the gentleman from Georgia, for yielding to me.
  Mr. Speaker, it has been said that good things come to those who 
wait, but when it comes to our seniors' health, waiting is a luxury we 
can no longer afford. Year after year we hear the cries for help: Drug 
costs are skyrocketing, family budgets are stretched, doctors' visits 
go unfulfilled. Mr. Speaker, the prognosis is clear: Seniors need our 
help.
  In my home State of Alabama, seniors now pay nearly $1,300 per year 
for prescription drugs. These costs are expected to rise just as 
seniors' dependency on lifesaving prescription drugs continues to grow. 
But rising drug costs are not the only symptoms. Alabama's seniors and 
doctors suffer from unfair rural health care penalties as well. Rural 
doctors, for example, are being squeezed by health care costs. They are 
finding it more and more difficult to continue providing service to our 
seniors. This is because Medicare simply has not reimbursed rural 
health doctors at fair and reasonable rates. As a consequence, we are 
experiencing a crisis in rural health care. The most highly-qualified 
doctors are forced to move out and younger doctors are choosing not to 
move in.
  Mr. Speaker, America's seniors sent us here to get the job done. The 
bipartisan plan to strengthen Medicare with a prescription drug benefit 
helps seniors right where they need it, in their pockets. This 
legislation provides record increases for rural health care, it gives 
seniors more choices and more options, and, most importantly, it 
provides a drug benefit that is completely optional while allowing 
seniors to stay in Medicare's traditional fee-for-service system.
  Doctors in rural areas, like mine in Alabama, would have a greater 
incentive to continue providing care. Seniors would subsequently 
benefit from more health care options and more doctors. Most 
importantly, seniors would get an immediate discount on their 
prescriptions. A Medicare-endorsed prescription drug card would be 
available within 6 months of the passage of this bill and provide 
savings up to 25 percent on seniors' prescriptions. And the best part, 
every senior who receives Medicare is eligible for these instant 
savings, which typically number in the hundreds or even thousands of 
dollars every single year.
  There are also safeguards for our most vulnerable Americans. For 
certain low-income seniors, a $600 annual credit would appear on their 
drug card. This helps ensure that our poorest seniors receive access to 
the best possible care, no matter their income.
  Mr. Speaker, this bill is not just about today, it is about our 
future, for our near retirees and for our children. It is not perfect, 
but it is a great start.
  I know many of my colleagues here share my enthusiasm for this 
bipartisan bill, but the chorus of support for its passage is not 
limited to those in this Chamber. In fact, the AARP has formally 
blessed this bill with their ``Good Housekeeping Seal of Approval.'' 
AARP and its 35 million members have committed to helping ensure 
passage of this historic legislation.
  To quote AARP President James Parkel from a statement earlier today, 
``The bill represents an historic breakthrough, and an important 
milestone in the Nation's commitment to strengthen and expand health 
security for current and future beneficiaries.''
  So let us get the job done. I urge my colleagues on both sides of the 
aisle to come together to improve the health of our seniors. We all 
need to support this bipartisan proposal to create a new prescription 
drug benefit under Medicare and help improve the lives of our seniors 
for generations to come.
  I thank the gentleman from Georgia, Mr. Speaker.
  Mr. GINGREY. Mr. Speaker, I thank the gentleman from Alabama, and 
before I introduce the last member of our team tonight, I would like to 
read a letter from the President of the American Medical Association, 
and he says:
  ``Dear Mr. Speaker, the American Medical Association is proud to 
support the Medicare Prescription Drug and Modernization Act of 2003 
conference report. Congress listened to America's patients and the 
physicians who serve them.
  ``The AMA gave Congress a set of principles for a sound prescription 
drug policy. We asked that the pharmaceutical drug benefit be fully 
funded as a separate new part of the Medicare program and provide for 
adequate accounting so that drug program expenditures can be tracked 
separately from all other expenditures. We asked that it be targeted to 
reduce hardship for those with low incomes and those with catastrophic 
costs and that patients be offered a choice of insurance options. The 
conference report meets all of these requirements.
  ``We asked for help with the drastic 4.5 percent physician payment 
cuts that physicians and other health care providers will face 
beginning in less than 2 months. We said that cuts in Medicare payments 
jeopardize access to medical care not only for seniors but also for 
military retirees and their dependents. The conference report provides 
a 2-year increase in payments for 2004 and 2005 of at least 1.5 percent 
each year,'' not, Mr. Speaker, a 4.5 percent cut. ``It also provides a 
mechanism to begin correcting the flawed payment formula in an effort 
to stabilize those payments over time.
  ``We asked for relief from regulatory burdens imposed on physicians 
and other health care providers when dealing with the Centers for 
Medicare and Medicaid Services, CMS. Using many components of the AMA 
model bill, the conference report guarantees physicians certain due 
process rights in Medicare appeals and targets education dollars 
promote.
  ``We asked important flexibility and assistance in moving toward 
electronic prescribing technology. The conference report provides 
incentive grants to small, rural, and low-volume practices instead of 
mandating that all providers use electronic prescribing technologies in 
a short time frame. It also provides for `safe harbors' for group 
practices and others in an effort to make these technologies more 
widely available.''

                              {time}  2245

  ``We asked to retain the coding system that makes sense for American 
physicians, not to move to a new, untested system. The conference 
report

[[Page H11640]]

removed language that would have imposed new, regulatory burdens in 
payment coding systems that physicians use every day. Moving physicians 
from some 7,000 codes to some 170,000 codes could only mean less time 
spent with patients.
  ``We ask that geographic disparities in payments between rural and 
urban areas be diminished. The conferees worked out a compromise to 
increase payments in this regard and to thoroughly study patient access 
to physicians, as well as retention and attraction of physicians to 
scarcity areas.
  ``The status quo is unacceptable to patients and their physicians. 
The Medicare conference agreement includes numerous provisions that 
will improve seniors' access to medical services. We worked closely 
with Congress to do the right thing for American's seniors, and 
Congress heard us. We pledge to wholeheartedly support the Medicare 
Prescription Drug and Modernization Act. Sincerely, Michael D. Maves,'' 
president of the American Medical Association.
  Mr. Speaker, I think this is a perfect segue into the introduction of 
my colleague from Texas who not only is my freshman colleague in this 
Congress, but he also is my colleague as a physician and further as a 
specialist in obstetrics and gynecology. I yield to the gentleman from 
Texas (Mr. Burgess).
  Mr. BURGESS. Mr. Speaker, unlike the gentleman from Georgia, I was 
not involved in medicine when Medicare was passed back in 1965. It was 
a good program that was passed to help seniors with their surgery costs 
and their medical costs if they were hospitalized, but there was an 
important omission; and now this Congress almost 40 years later, almost 
4 decades later, stands on the brink of correcting that deficiency that 
started in 1965.
  Seniors to this day have no comprehensive drug benefit, an omission 
from the original Medicare passed in 1965. On a daily basis, I saw how 
this impacted my patients. I would have patients who could not afford 
the medications that I prescribed, patients who would split pills or 
take a smaller dose. Medicare would cover the cost of the doctor visit, 
but because of this hole that was left in the program, which could only 
be classified as a typical government approach, they would often be 
unable to follow my recommended course of treatment if prescription 
drugs were involved due to a lack of coverage.
  This President and this Republican Congress have had the courage to 
stand up and do what is right by correcting this oversight by helping 
millions of American seniors pay for their prescription drugs. This 
bill gives seniors purchasing power to meet their prescription drug 
needs and cover their health costs.
  The prescription drug discount card will reduce the cost of 
prescription drugs by as much as 25 percent. With the additional 
subsidy placed on for low-income seniors, this benefit alone will cover 
drug costs for nearly half the seniors enrolled in Medicare with 
minimal financial participation on the part of the beneficiary. 
Additionally, the bill would authorize consumer-based accounts 
dedicated to their holder's health and well-being.
  We have heard a lot about health savings accounts this evening during 
the course of this hour, and I would underscore the importance of 
health savings accounts. This is not an arbitrary concept. This is not 
just an idea that someone has had; this is, in fact, a reality that has 
been in existence for the last 5 years. The Archer Medical Savings 
Accounts were passed in 1996 or 1997. I had a medical savings account 
until coming to Congress and have seen firsthand how you can have real 
wealth grow in an interest-bearing tax-free account dedicated to your 
health care needs. Health savings accounts allow individuals and 
families to put their money in tax free, allow it to grow tax free, and 
be withdrawn tax free to cover medical costs. These accounts will give 
younger Americans the ability to save for future medical expenses, and 
give older Americans the ability to soften the financial strain of 
costly procedures or even long-term care insurance. By shifting 
Medicare to a more consumer-focused program, we improve health 
outcomes, give purchasing power and make the program more accountable 
to the American taxpayer.
  There have been those who criticize this ground-breaking program 
before Congress as an attempt to privatize. Mr. Speaker, which 
President actually privatized Medicare? In fact, it was Lyndon Johnson. 
The private market has been intimately involved in Medicare since day 
one. When President Johnson signed Medicare into law in 1965, he was 
asking hundreds of thousands of doctors and their private practices and 
their private hospitals to participate in a government program. The 
program then depended on the private market to provide a network of 
doctors to care for seniors, and the program today depends upon that 
same private market to provide that care.
  Because the delivery of health care is so much more complex today 
than it was back in 1965 with the complex array of specialty providers, 
physician networks, insurance companies, pharmaceutical benefit 
managers and mail order pharmacies, it would be irresponsible of the 
U.S. Congress to not rely on this same network that provides care every 
day to millions of Americans as we look to reform how Medicare covers 
America's seniors.
  As for the claim that seniors will be forced into HMOs, nothing could 
be further from the truth. We have heard over and over how health 
savings accounts will impact the health of Americans in the future. The 
truth is that under this bill, seniors will have more options to meet 
their health care needs than they currently have. Under this proposal, 
seniors would certainly have the option to receive care through an HMO. 
Some seniors prefer that type of care, but they would also have the 
option to receive their care through a preferred provider organization 
or, if they like fee-for-service Medicare, they can stay right where 
they are. The bill provides choices available to seniors; it does not 
limit them.
  Our work is far from done with this bill. More work needs to be done 
to infuse more market-based principles into this government-run 
program. More work will need to be done to improve the program so it 
focuses not just on covering as many Americans as possible, but 
actually improving their health with attention to the detail of health 
maintenance.

  Congress will remain accountable and engaged. Medicare is a program 
that will need continual supervision over the years to ensure it 
remains a viable program. We will continue our oversight on Medicare 
for future generations. This Medicare bill is the future of health care 
for our Nation.
  Mr. GINGREY. Mr. Speaker, I thank the gentleman from Texas (Mr. 
Burgess) and the other Members for joining us tonight. An hour goes by 
very quickly. I think we need about three to really talk about 
everything that we need to talk about.
  In conclusion, let me say that we proudly support this Medicare 
Modernization and Prescription Drug Act of 2003. We talk about 
compassionate conservatism, and that is a pledge upon which our 43rd 
President ran, and he promised that we would deliver. And some pun 
intended, I might add as an OB-GYN, but the President promised, and 
this leadership promised, this Republican Congress promised that we 
would deliver. Finally, at long last we have overcome a lot of 
obstructionism to get to the day that we are going to deliver to 
American seniors, and they deserve it.
  It is compassionate because there are people in this society who 
through absolutely no fault of their own need our help, and that is 
what compassionate conservatism is all about. Mr. Speaker, I say this 
is its finest hour. Let us get this bill passed with support from both 
sides of the aisle and make this truly a bipartisan success for our 
seniors.

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