[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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