[Congressional Record Volume 149, Number 170 (Friday, November 21, 2003)]
[House]
[Pages H12247-H12297]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
CONFERENCE REPORT ON H.R. 1, MEDICARE PRESCRIPTION DRUG, IMPROVEMENT,
AND MODERNIZATION ACT OF 2003
Mr. THOMAS. Mr. Speaker, on behalf of seniors and taxpayers, pursuant
to House Resolution 463, I call up the conference report on the bill
(H.R. 1) to amend title XVIII of the Social Security Act to provide for
a voluntary program for prescription drug coverage under the Medicare
Program, to modernize the Medicare Program, to amend the Internal
Revenue Code of 1986 to allow a deduction to individuals for amounts
contributed to health savings security accounts and health savings
accounts, to provide for the disposition of unused health benefits in
cafeteria plans and flexible spending arrangements, and for other
purposes.
The Clerk read the title of the bill.
The SPEAKER pro tempore (Mr. Hastings of Washington). Pursuant to
House Resolution 463, the conference report is considered as having
been read.
(For conference report and statement, see proceedings of the House of
November 20, 2003, Book II at page 11877.)
The SPEAKER pro tempore. Pursuant to the order of the House of today,
the gentleman from California (Mr. Thomas) and the gentleman from New
York (Mr. Rangel) each will control 1 hour.
The Chair recognizes the gentleman from California (Mr. Thomas).
Mr. THOMAS. Mr. Speaker, I yield one-half of my time to the gentleman
from Louisiana (Mr. Tauzin), chairman of the Committee on Energy and
Commerce.
The SPEAKER pro tempore. Without objection, the gentleman from
Louisiana will control 30 minutes.
There was no objection.
Mr. THOMAS. Mr. Speaker, I yield myself such time as I may consume.
[[Page H12248]]
Mr. Speaker, I called up this bill for seniors and for taxpayers.
This evening you are going to hear some very harsh rhetoric. But what I
really want to do is remind everyone here that since Republicans became
the majority in this House in 1995, there has been a very positive and
remarkable change to Medicare. Probably most important has been the
introduction of preventive and wellness. For many years, it was
available to be added to Medicare, but it was not. It took the
Republican majority to add the testing and the education for diabetes,
for osteoporosis, for improved mammography, for colorectal cancer
screening, for prostate screening; and even today in this bill we
continue with cholesterol screening and physical exams.
Tonight, the Republican majority is going to add prescription drugs
to Medicare. We earnestly seek our friends across the aisle help in
doing this. The conference report before us is bipartisan. It is
bipartisan because of the House and the Senate structure. Tonight our
friends across the aisle have a chance to make it bipartisan in the
House. Our friends say that we are trying to destroy Medicare; but if
we are trying to destroy Medicare, why is the American Association of
Retired People supporting this proposal? Why is the AARP in favor of
this bill? You have heard some very harsh rhetoric from my friends
across the aisle describing their abandonment by the AARP. My friends,
the AARP has not abandoned you. You have abandoned seniors. AARP has
chosen to be with seniors, and they have chosen to be with us.
Fact: current Medicare cannot sustain itself financially. Question:
Why in the world would we then be adding a $400 billion expansion of
benefits under Medicare? Answer: today's medicine demands that we do
so. Yesterday's medicine was hospitals and doctors. Hospitals and
doctors still play a role, but prescription drugs play a central role.
We simply would not be doing justice to our seniors if we did not try
to add prescription drugs to Medicare.
But I also called this bill up for taxpayers, because if we add
prescription drugs to Medicare, we need to be able to tell our
taxpayers that we are also changing the funding structure of Medicare
as well.
{time} 2345
It cannot sustain itself, and we are adding an enormous new benefit.
It would be irresponsible of us to simply think all we need to do is
add prescription drugs. What we need to do is add prescription drugs,
modernize Medicare, and make sure that those people who pay taxes today
in the hopes of having a program tomorrow will be able to have one.
This bill protects low-income seniors. No one wants to place a
financial burden on those unable to pay. But, Mr. Speaker, it is
overdue to ask those who are financially well off enough to share.
We are hearing things from our friends across the aisle about how
horrendous the suggested financial burdens are. For example, in today's
voluntary, optional Part B Medicare, the premium is 75 cents on the
dollar paid for by the taxpayers, 25 cents on the dollar paid for by
the beneficiaries. This legislation is so radical, so extreme, that
what it does is it asks people who are making $100,000 a year in
retirement to pay 50 cents on the dollar and have the taxpayers pay 50
cents on the dollar. Ironically, that was the financial split when Part
B Medicare began. All we are asking is for those who have the
wherewithal to help share the financial burden. And where? There is an
opportunity to provide a modest copay, one of the most significant
factors in inhibiting overutilization. We ask those who are going to
have a prescription drug, $2 on a generic prescription, $5 on a brand
name. It will have a significant impact on utilization. It will also
show that we understand, we need to be sensitive to taxpayers. Today
they foot the bill, but tomorrow they also want a program. This bill is
really all about a fair deal. Modernize Medicare with prescription
drugs but put Medicare back on a sound financial basis as well.
We are going to hear a lot about what we are going to do for up to 40
million seniors in this legislation. Please understand with the modest
structural changes we are asking for, there are going to be 140 million
taxpayers who are going to be pleased as well.
This program cannot sustain itself. Add a new benefit and modernize
the program. Medicare is not a Democrat program; they do not own it.
Medicare is not a Republican program; we do not own it. It is a program
that is in need of modernization, prescription drugs and better
financing. The American people's Medicare, the seniors who receive the
benefits, and the taxpayers who foot the bill deserve H.R. 1.
Mr. Speaker, I reserve the balance of my time.
Mr. RANGEL. Mr. Speaker, I ask unanimous consent to turn one-half of
the time allotted to the distinguished gentleman from Michigan (Mr.
Dingell), a member of the Committee on Energy and Commerce, the dean of
the House of Representatives, the son of the author of the Medicare
bill, who was denied admission into the conference.
The SPEAKER pro tempore (Mr. Hastings of Washington). Is there
objection to the request of the gentleman from New York?
There was no objection.
Mr. RANGEL. Mr. Speaker, I yield myself such time as I may consume.
This must be a very important piece of legislation, Mr. Speaker. It
is 10 minutes to 12. When else would the majority bring out an
important piece of legislation but in the middle of the night?
But more importantly than that, tomorrow for many of us is a date
that many of us will never, never forget, at least those of us that
were old enough to know of and to love the late John F. Kennedy. Most
all of us will remember where we were or what we were doing on November
22. And I suggest to the Members that history will record what we do
this evening and what we do tomorrow. The arrogance that has been
displayed on this landmark piece of legislation defies description
tonight, but history will record it. The audacity for people to talk
about bipartisan here where for hundreds of years we inherited a House
of Representatives that whether one was a Republican or Democrat,
liberal or conservative, we could say in this House the people rule,
and we have enjoyed saying that. Where do the Republicans get the
audacity to say that when there is a conference, they would select the
willing coalition, that they could look at a person and because they
are a Democrat, appointed by the Speaker of this great House of
Representatives, they exclude them? And let me tell the Members
something else I am proud of, not just being a Member of this House,
but sitting on this side of the aisle and taking a look at the faces
and the backgrounds of the Members and where they come from, from the
rural areas, from the inner cities, from America. We do not have senior
citizens? We do not have a contribution to make? We can be excluded?
And then to have the audacity to come to this floor, even if it is in
the middle of the night, and call it bipartisan because you borrowed
two Democrats from the other side. That is shameful.
No, our citizens really will recall what we do tonight, what you have
done for AARP, what you have done for the pharmaceuticals, what you
have done for the private sector whom you have subsidized. The bill is
only 1,100 pages, but seniors know that they asked for some help for
prescription drugs. No, they did not ask for competition. They did not
ask for you to set up paper outfits. They did not ask for, at the end
of the day, that you try to run them out of business. And I am
suggesting to you, how would you know what you are going to hear on
this side when just common decency prevented you from allowing you to
follow the mandate that the Speaker set when he said that the House and
the Senate, Republicans and Democrats, please go to conference, and you
locked the door? One thing is clear. Seniors understand it better than
a whole lot of Members do because it may in the middle of the night,
but tomorrow they will be reading what we have done tonight.
Mr. Speaker, I yield the balance of my time to the gentleman from
California (Mr. Stark), who has worked hard for decades on this
legislation, and I ask unanimous consent that he be allowed to
administer the remainder of the time that has been allotted to me.
[[Page H12249]]
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from New York?
There was no objection.
Mr. THOMAS. Mr. Speaker, I yield the remainder of my time to the
gentlewoman from Connecticut (Mrs. Johnson), the chairperson of the
Health Subcommittee of the Committee on Ways and Means, and I ask
unanimous consent that she control the remainder of my time.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from California?
There was no objection.
Mrs. JOHNSON of Connecticut. Mr. Speaker, I yield 2\1/2\ minutes to
the gentlewoman from Washington (Ms. Dunn).
Ms. DUNN. Mr. Speaker, it is time to keep our promise and provide a
comprehensive and voluntary prescription drug benefit for all seniors.
Seniors cannot afford the frighteningly increasing cost of drugs any
longer. This bill will protect the poorest seniors by helping pay for
their drug costs immediately. By using the same principles already used
by private companies, this bill will lower drug costs for seniors by
passing along to them larger discounts from manufacturers.
As a result, over 775,000 Medicare beneficiaries in my State of
Washington will get access to the drugs they need at affordable prices.
The poorest seniors in Washington State, over 206,000 people living on
fixed incomes, will pay only nominal fees, and I am talking about $2 to
$5 for prescriptions, that is all, while qualifying for full assistance
on their premiums, their deductions, and their coverage.
We can only strengthen Medicare's future if we are able to ensure
access to the services that seniors need today. In this bill, we
increase payments to doctors and hospitals, especially in rural
communities, so that doctors will have some reason to stay in practice
and seniors will get access to health services that they need.
For Medicare HMOs this bill requires Medicare to account for military
retirees in the formula resulting in higher reimbursements in counties
with military facilities. To help every State, the Federal Government
will assume the drug costs for people eligible for both Medicare and
Medicaid. This is hugely important. It will help 82,000 beneficiaries
who qualify for both programs in my State with their drug costs, but
this bill will also save my State $500 million, half a billion dollars
over the next 8 years on drug coverage for its Medicaid population. In
all, Washington State will receive at least an additional $800 million
to serve our seniors.
Strengthening Medicare also means improving the quality of life for
every senior. For this reason, I am very happy that we are able to
provide preventative services to all seniors like a first-time initial
physical exam. For the first time, seniors will have access to
innovative treatments to deal with rheumatoid arthritis and other
diseases. Seniors also will profit from disease management care, which
means there will be coordination to help those seniors who suffer from
multiple serious illnesses.
Mr. Speaker, these treatments will allow seniors to receive
treatments in their homes, take the burden off physicians or hospitals,
and I will tell the Members for too long our parents and grandparents
have paid too much for the drugs they need. The time has come to
strengthen the Medicare program so that seniors can get the care that
they need and they deserve.
Mr. STARK. Mr. Speaker, I yield myself 2 minutes.
I first start by reminding the distinguished gentlewoman from
Washington that the Seattle Times said that one suspects that many
conservatives do not really care how the chips fall as long as they are
heavy enough to break the back of traditional Medicare. All this talk
about choice and updating or modernizing Medicare with market
competition is pure malarky. So it does appear that somebody from the
State of Washington understands what is going on here tonight.
But we are faced with a problem, and the Republican Party from the
very top of its leadership to the very bottom have been lying to us.
They have been lying to us about the war. They have been revising
history. They have been going back on their word to give us 3 days.
They have proven that we cannot trust them.
Just recently, the past few minutes, the chairman of the Committee on
Ways and Means indicated that they had attempted to put in preventative
measures. He seems to have forgotten that in 1995 he voted against
colon cancer testing. He voted against prostate cancer testing. He
voted against annual mammography. He voted against diabetes management.
He has voted more often to cut Medicare benefits than he can remember,
it appears.
So we are faced tonight with people who want to destroy Medicare.
They will lie to us. They will lie to seniors for the pure purpose of
their own messianic desires to destroy a system that will protect the
fragile seniors in this country.
Mr. Speaker, I reserve the balance of my time.
Mrs. JOHNSON of Connecticut. Mr. Speaker, I yield 2 minutes to the
gentleman from Pennsylvania (Mr. English).
Mr. ENGLISH. Mr. Speaker, I rise tonight without any messianic
pretensions to urge my colleagues to cast a vote for our seniors and
support improved health care by voting for this bipartisan Medicare
bill.
Mr. Speaker, today we have the best, and perhaps the last,
opportunity to provide America's seniors with a voluntary and
affordable prescription drug benefit as a part of Medicare. This is an
unprecedented expansion of an entitlement program that will make life
easier and health care better for many millions of Americans.
Mr. Speaker, I acknowledge this legislation is not perfect. There are
things I wanted to see included that are not in the bill.
{time} 0000
Yet, I am convinced that this is the best and most realistic
compromise Medicare bill that Congress has so far developed. There are
some here, I realize, who would make the perfect enemy of the good. But
when you strip away all of the rhetoric and the partisanship, it really
comes down to this: Do you support adding a prescription drug benefit
to Medicare, or not?
In my district in western Pennsylvania, we have a diverse population
of seniors. Some live on very low incomes and qualify for our State
prescription drug benefit, PACE. Others are happy with their own
private health plans, and some live in areas where there is only one
hospital within a reasonable driving range.
This bill helps all of these seniors by offering a benefit that wraps
around PACE, allows seniors to selectively participate in the Medicare
plan, and includes a number of provisions to ensure that rural health
facilities remain open and accessible.
Mr. Speaker, in 1965, our predecessors took the courageous and
compassionate step of creating this important program. Now we have the
best opportunity in years to build on their work by guaranteeing access
to lifesaving drugs for our seniors. It is time for Congress to put
people over politics and pass this Medicare bill.
I urge my colleagues to join AARP, America's doctors, America's
hospitals, and major health care providers and vote ``yes'' on
prescription drugs for our seniors.
Mr. STARK. Mr. Speaker, I am honored to yield 1\1/2\ minutes to the
gentleman from Michigan (Mr. Levin), who understands that the United
Steel Workers of America have said a vote for this measure is a vote to
destroy the stability and long-term viability of the Medicare system.
(Mr. LEVIN asked and was given permission to revise and extend his
remarks.)
Mr. LEVIN. Mr. Speaker, the key question: Why not add a prescription
drug benefit to Medicare like for physicians and hospital bills?
Because Republicans want to force seniors to get their drugs from
private insurance companies and HMOs, with no set premium, and
insurance companies would decide the benefits and could change them
every year.
So again, why not simply add a drug benefit directly to Medicare?
Because Republicans want to make sure the government has zero
involvement in lowering drug prices for consumers. Indeed, their bill
would prohibit Medicare from negotiating lower prices for drugs, and
the only thing the government could do would be to keep people
[[Page H12250]]
from buying cheaper drugs from Canada.
Again, why not simply add a drug benefit to Medicare? Because the
real Republican goal is to use a drug benefit as a vehicle for
fundamentally changing and undermining Medicare.
The President's Medicare administrator called Medicare a dumb system.
Under this bill, there would be a global cap on the size of the
Medicare program and a voucher to buy private health insurance instead
of getting regular Medicare, with the deck loaded against Medicare, $14
billion to HMOs.
Republican reforms are Medicare's destruction. Vote ``no'' on this
Republican bill.
Mrs. JOHNSON of Connecticut. Mr. Speaker, I yield myself 1 minute and
15 seconds.
I would remind the gentleman from Michigan that 28 percent of his
seniors will have no more costs than either $1 per generic or $2 per
generic or $3 for prescription and $5, and 35 percent of Michigan
seniors have incomes under 150 percent of poverty and will be totally
protected under this bill.
Mr. Speaker, I think as we proceed in this discussion, we ought to
remember that 38 States, 38 States provide Medicaid coverage for people
whose income is 74 percent of the national poverty income. So 38 States
are not even at 100 percent of poverty income. We cover people
completely, everything, except $1 per generic or $2, depending on
income, and $3 or $5 per prescription drug.
Do my colleagues understand that of the Medicare population, 57
percent are women? Mr. Speaker, 57 percent are women, and half of them,
half of those women will pay no more than $2 per generic or $5 per
prescription. They will have no other obligation, all the way up
through catastrophic. Half the women on Medicare. This is a giant
stride forward in women's health.
Mr. Speaker, I reserve the balance of my time.
Mr. STARK. Mr. Speaker, I am pleased to yield 1\1/2\ minutes to the
gentleman from Maryland (Mr. Cardin), who knows that all of the other
members of the Older Women's League understand that this bill was
supposed to modernize Medicare, not eviscerate it; and to deny basic
health services for those who need it most, to increase the profits of
the health care industry is criminal.
(Mr. CARDIN asked and was given permission to revise and extend his
remarks.)
Mr. CARDIN. Mr. Speaker, I am very disappointed. I had hoped that I
would have an opportunity to vote for a real prescription drug benefit
within the Medicare system, or at least I would be able to vote on a
bill that provides the foundation on which we could build a real
benefit within Medicare. Instead, this conference report provides no
guaranteed benefit whatsoever to our seniors for prescription drugs. It
uses what is known as ``actuarial equivalent'' which depends solely
upon private insurance companies.
We know what happened to Medicare+Choice with private insurance
companies. The eight that were operating in my State of Maryland are
all gone, leaving my seniors.
It has an ineffective mechanism to control prescription drug costs.
It denies the government the tools that every other industrial nation
in the world is using to bring down the cost of prescription medicines.
But worse than this, Mr. Speaker, it actually causes harm to our
seniors. The Congressional Budget Office has estimated that 2.7 million
retirees will lose their prescription drug benefits by the enactment of
this bill. Mr. Speaker, this is not a voluntary bill for those 2.7
million Americans; they have no choice. It cost-shifts costs on to our
seniors from basic Medicare because of premium support and triggers and
caps. We overpay HMOs, using money that could be available to help our
seniors. We make it more difficult for our seniors to get cancer
treatment by the changes that we make on the reimbursement for cancer
drugs.
So, Mr. Speaker, this bill does more harm than good. I support
providing our seniors with a meaningful prescription drug benefit
within the Medicare system that will strengthen Medicare. Therefore, I
must oppose this conference report and urge my colleagues to do the
same.
Mr. Speaker, I rise to express my disappointment with the conference
report on HR 1. For the past several years, I have worked toward
enactment of a prescription drug benefit for those who rely on the
Medicare program for their health care needs.
A meaningful Medicare prescription drug benefit must be affordable,
guaranteed, and available to all, it must contain an effective
mechanism to lower the cost of medicines and it must be built on a
sound structure that can be improved upon in future years.
I have carefully considered the legislation that is before us today,
and it fails each of these tests. This Congress has missed an
opportunity to enact far-reaching, bipartisan legislation that would
provide the help that millions of seniors need and deserve.
Some have criticized the Medicare program as outdated, inefficient, a
dinosaur. These members are ignoring Medicare's success in providing
universal, comprehensive coverage. They are ignoring Medicare's low
administrative costs--3%--relative to private insurers at 15 to 20
percent. They are ignoring Medicare's ability to cover a population
that has been shunned by private insurers for decades.
Before Medicare was enacted, there was little private interest in
covering elderly and disabled Americans. And there is still little
private interest in doing so. That is why in my own state of Maryland,
several hundred thousand seniors who once had the choice of eight
Medicare HMOs, now have no HMO options available to them. As the
options dwindled between 1998 and 2002, the remaining plans quadrupled
their premiums, slashed their drug coverage and eliminated extra
benefits. By 2003, the M+C HMO penetration rate in Maryland was zero
percent. Nationwide, since 1997, more than 2.4 million seniors have
been abandoned by private insurance plans, even though the plans were
paid at 119 percent of fee-for-service Medicare costs.
This conference report changes the name ``Medicare+Choice'' to
``MedicareAdvantage,'' and adds $20 billion in subsidies to private
plans, boosting their payments to equal more than 125 percent of the
amount paid for traditional Medicare. But it cannot create private
interest in the senior market. We have tried that and failed.
To be successful, a drug benefit must be within basic Medicare and
based on a sound structure that can be improved over time. Only a
benefit that is based on a solid foundation will give seniors the
stability they need and deserve. Rather, this bill relies solely on the
willingness of private insurance companies to offer the benefit. In the
Ways and Means Committee, I fought for a fallback within Medicare that
would be available to every beneficiary in the country. It would have a
set premium, deductible, and copays that would always be there
regardless of where seniors live and what plans enter their region. If
the private sector offered a superior, more efficient plan, seniors
would choose the private plan. But if the private plan never
materialized, or if it offered a premium that was unaffordable,
Medicare would be there for them. In rejecting my amendment, and
choosing a ``fallback'' that could come and go from year-to-year, the
conferees bypassed the opportunity to continue Medicare's promise of
universally available health care for all seniors.
Ask your constituents if they want a choice of more private plans.
They do not. They want a choice of hospitals and doctors, and they want
stability, reliability, and real help with paying their prescription
drug costs.
This conference report lets them down. It offers seniors an
inadequate benefit. The President and the Republican leadership say
that this plan gives seniors the same benefits enjoyed by Members of
Congress and federal employees. That is untrue for several reasons.
First, the benefit packages are nearly mirror images of one another. In
most FEHBP plans, federal employees receive 80% coverage for
prescription drugs. A federal employee with annual drug costs of
$5,000, would pay about $1,000 out-of-pocket. But under this
legislation, seniors with annual drug costs of $5,000 would have to pay
$4,020 out-of-pocket.
Second, the Medicare drug benefit has a wide coverage gap that will
leave many of our seniors paying premiums for several months when they
are receiving no benefits. There is no plan approved by OPM that would
require federal employees to continue paying premiums when we are
receiving no benefits. Seniors should not have to do that either.
Third, under this bill, seniors who want to remain in traditional
Medicare would have to enroll in a stand-alone drug plan to get
prescription drug benefits, but there is no such plan in the under-65
market. The conference report does not guarantee them what their
premium will be; only that a private company will offer them an
actuarially equivalent benefit that can change from year to year. It is
a level of uncertainty that our senior should not have to face.
Our seniors now know the details of this bill. They are calculating
their prescription drug costs at kitchen tables across the country
tonight. They are calling Congress to say how
[[Page H12251]]
disappointed they are at the inadequate benefits this bill provides,
and they are urging us to vote no.
Rather than providing relief to our seniors, this bill shifts
additional costs from government onto their backs. Although the drug
benefit premium is estimated at $35, the conference report gives
insurers license to charge much more. The Medicare Part B deductible
will increase by ten percent in 2005 and then by program costs each
year.
Some of my colleagues have tried for years to curtail Medicare
spending by hundreds of billions of dollars, usually in the form of
targeted provider cuts. But our hospitals, doctors, nursing homes and
rehabilitation providers need fair reimbursement, and Congress has
usually answered the call. In addition, these members have found
difficult to argue the need for drastic cost containment given that
Part A Medicare solvency is now the third longest in the history of the
program. So the conferees have taken a surreptitious approach, adding a
provision that was not in the House or Senate-passed bills. They
created a new definition of insolvency that caps Medicare's use of
general revenues at 45 percent of total Medicare costs and would force
government to cut benefits or raise payroll taxes if this limit is
exceeded. By triggering an increase in payroll taxes, which
disproportionately affect lower-income Americans, this provision shifts
the burden of Medicare away from those most able to support it to those
who are least able, further jeopardizing Medicare's long-term
stability.
Because we are limited to $400 billion in this bill, it would make
sense to use every instrument possible to get the best price for
prescription medicines. But the conference report contains an
inadequate mechanism to lower the price of drugs, which have escalated
steadily over the past few years, and show no signs of decreasing. This
bill specifically prohibits the Secretary of HHS from using the federal
government's purchasing power to negotiate lower drug prices, a tool
that has been used effectively in nearly every other industrialized
nation in the world. Instead, it relies on pharmaceutical benefit
managers, which have had mixed results in past years.
I had hoped that this bill would improve health care for seniors.
Unfortunately, the provisions affecting oncology drug reimbursement
will do just the opposite for cancer patients and reduce their ability
to get needed cancer care. The final bill still contains severe cuts to
cancer care providers, nearly $1 billion annually. If this bill becomes
law, many cancer centers will close, others will sharply reduce their
staffs, and others will be forced to turn away patients.
The Ways and Means Committee and the Energy and Commerce Committee
have examined this issue carefully. We recognize that the current
payment system for cancer care needs to be fixed. Medicare over-
reimburses for the drugs themselves, while it under-reimburses for the
services that oncologists provide. I support appropriate reimbursement
for cancer drugs, but we cannot make cuts of this magnitude without
simultaneously paying oncologists fairly for the care they render. To
do so will endanger the lives of cancer patients.
Finally I cannot support a conference report that harms currently
covered retirees. I remain concerned about the impact of this bill on
retirees with employer-sponsored drug coverage. Because of the
inadequate reimbursements to retiree health plans, CBO estimates that
2.7 million retirees are expected to lose their benefits. The bill also
encourages employers to drop the coverage they now provide by excluding
private plan spending from counting toward the catastrophic limit.
Because of provisions written into the bill, most seniors with retiree
coverage and high drug costs will never reach the point at which
Medicare resumes coverage. The authors of this bill say that the
benefit they're devised is voluntary, but for those seniors who lose
their private retiree health coverage, this plan won't be optional, it
will be the only game in town.
Tonight's vote caps several years' efforts to provide Medicare
beneficiaries with desperately needed prescription drug coverage.
Unfortunately, the conferees have produced a bill that won't result in
better health care for our seniors, a more efficient Medicare program,
or fiscal responsibility. It will eventually do more harm than good to
Medicare, and to those who depend on it for their health care needs. I
support providing our senior a meaningful prescription drug benefit
within the Medicare system that will strengthen Medicare. Therefore I
must oppose this conference report and urge my colleagues to do the
same.
Mrs. JOHNSON of Connecticut. Mr. Speaker, I yield myself 15 seconds.
Mr. Speaker, if the gentleman will note and other Members will note,
and the listening public will note, on pages 49 to 53 of the bill,
which is all on the Internet, they will see that there is what we call
a hard fall-back. That is, if private plans do not offer prescription
drugs to our seniors, the government will. The seniors will be
guaranteed a drug plan; that is in the statute.
Mr. Speaker, I yield 2 minutes to the gentleman from Arizona (Mr.
Hayworth).
Mr. HAYWORTH. Mr. Speaker, I thank my good friend, the chairwoman of
the Subcommittee on Health of our full committee, for yielding me this
time.
It has been interesting to listen to the debate thus far this
evening. In fact, it evokes memories of an earlier time when I first
arrived in this Chamber and, much to my surprise, heard all of these
horror stories about what might happen to senior Americans and how
schoolchildren might be starved and all sorts of villainy and
demonizations that had no basis in fact.
Mr. Speaker, good people can disagree, but it is important to take a
look at what we are doing with this legislation. The first thing we are
doing is actually strengthening Medicare and preparing it for the 21st
century, for the influx of more seniors, demographically what we will
see in the 21st century, in just a few short years. And what we are
also doing is updating Medicare for the 21st century to reflect changes
in medicine. Prescription drugs are the first line of defense for
America's seniors. This legislation recognizes that reality and moves
to cover it. But moreover, Mr. Speaker, we first reach out to those
seniors most in need, and we provide for all seniors next year
immediate discounts, with our discount drug cards. Very, very
important.
Now, we have heard a lot of wailing and gnashing of teeth about the
endorsement of this plan by the AARP. I think rather than tearing up
cards or engaging in personal attacks on those who may serve very
competently in that association, it might be good to actually listen to
the words of our seniors who belong, the millions of seniors who depend
on prescription drugs and believe in the AARP. And they readily admit,
as all of us would admit, this legislation may not be perfect, but it
is a good place to start. We all know, on both sides of the aisle,
change comes incrementally. Let us adopt this legislation for America's
seniors and for future seniors.
Mr. STARK. Mr. Speaker, I yield 1\1/2\ minutes to the gentleman from
Wisconsin (Mr. Kleczka), who agrees with the Arizona Daily Star from
Tucson that by doing nothing to address the cost of medicines and by
raising payments to private HMOs that want to compete with Medicare,
the bill dooms the Medicare program to major problems down the road.
Mr. KLECZKA. Mr. Speaker, the gentleman from Arizona who just spoke
advised us to listen to our seniors; and many of us, I say to my
colleagues, are doing just that with our vote today. Here is a senior
from my district who advises me to oppose this bill, and they just
canceled their AARP membership this morning.
What is going on here? This bill started out as a drug bill for
senior citizens and, all of a sudden, we find the bill before us has
over $100 billion for special interests in this country, and the calls
we are getting to support the bill are from those special interests.
They are saying, here is 200,000 specialty physicians; support the
bill. Here, a big fat letter. And not once do they mention Medicare
drugs for seniors. They are worried about their own pocket. Letter
after letter in my office and on my fax machine are from special
interests who have lobbyists in town urging Members to vote for this
bill because they are getting something out of it: more money. And none
of them are saying, and also the senior provision is good.
That is what is going on here. The seniors who call us are against
the bill. The special interests who, in a campaign period can give us
$10,000 in campaign contributions, are encouraging us to vote for the
bill. Who do you think is going to win at the end of the day, huh? The
seniors do not got a PAC. They do not give us $5,000 a crack, $10,000 a
crack. That is what is happening, I say to my colleagues. And let us
not forget it.
Mrs. JOHNSON of Connecticut. Mr. Speaker, I yield myself 15 seconds.
I do not consider the AARP a special interest group, or the Coalition
to Ensure Patient Access a special interest
[[Page H12252]]
group, or the Alzheimer's Association a special interest group, or the
Kidney Cancer Association a special interest group.
Mr. KLECZKA. The Hospital Association, the American Medical
Association, that is who I am talking about.
Mrs. JOHNSON of Connecticut. Mr. Speaker, it is my time.
Mr. KLECZKA. Let us not kid a kidder; we know who they are.
The SPEAKER pro tempore (Mr. Hastings of Washington). The gentleman
will suspend. The gentlewoman from Connecticut has the time.
Mrs. JOHNSON of Connecticut. The Mental Health Association of Central
Florida, the Larry King Cardiac Foundation, the Latino Coalition.
Mr. Speaker, I yield 1 minute to the gentleman from Georgia (Mr.
Gingrey).
Mr. GINGREY. Mr. Speaker, I rise tonight in support of the House-
Senate Medicare agreement. For those of us who had hoped that this bill
would contain more reforms or greater cost constraints, I agree. We did
not accomplish all that we had hoped. But as a physician, I realize the
medical reality of the bill, a medical reality that the prescription
drug benefit itself is fiscally responsible and a potential cost-saver
for Medicare.
By providing a prescription drug benefit, providers will be able to
take the necessary preventive action to potentially stave off or treat
an illness in an earlier stage, making it easier to control the cost of
treatment.
{time} 0015
The medical reality is that prescription medication can help seniors
live longer, healthier lives, while saving a tremendous amount of money
on treatment by avoiding costlier options.
Although I hope the future will bring about more changes and
modernization to Medicare, the Medicare agreement will be a great
start. And I urge my colleagues to take this fiscally responsible step
and pass the Medicare conference report.
Mr. STARK. Mr. Speaker, I yield for the purpose of making a unanimous
request to the gentleman from Minnesota (Mr. Oberstar).
(Mr. OBERSTAR asked and was given permission to revise and extend his
remarks.)
Mr. OBERSTAR. Mr. Speaker, I rise in opposition to the conference
report.
Mr. STARK. Mr. Speaker, I yield 1\1/2\ minutes to the gentleman from
Georgia (Mr. Lewis).
Mr. LEWIS of Georgia. Mr. Speaker, I stand in strong opposition to
H.R. 1. I believe in Medicare, I believe that Medicare is a sacred
trust between the Federal Government and the American people. I believe
with all my heart, with all my soul, and with all my being that
Medicare must have a dependable, affordable, and strong prescription
drug benefit. And that is why I cannot support this bill.
Mr. Speaker, 38 years ago the Republicans did not like Medicare and
they do not like it now. Republican Speaker Newt Gingrich gleefully
stated that he wanted to see Medicare wither on the vine. Mr. Speaker,
my colleagues, Newt Gingrich is back, and his fingerprints are all over
this bill.
If this bill is passed, it would be a dagger in the heart of Medicare
as we know it. This bill is an attempt by the Republican party to
privatize Medicare. I stand against privatizing Medicare, and I stand
against this bill.
Medicare is a sacred trust. It is a covenant with our seniors. Let us
not breach this trust. Let us not violate this covenant. We must do
what is right.
I urge my colleagues to vote against this unreliable bill, vote for
the seniors, vote for those that are in need. Vote against this bill.
Mrs. JOHNSON of Connecticut. Mr. Speaker, I reserve the balance of my
time.
Mr. STARK. Mr. Speaker, I yield 1\1/2\ minutes to the distinguished
gentleman from Massachusetts (Mr. Neal), who agrees with the Boston
Globe that this experiment needs to be stopped before the Republicans
in Congress damage a program that has served the elderly well for 38
years.
Mr. NEAL of Massachusetts. Mr. Speaker, it is not always an easy task
to agree with the Boston Globe.
Mr. Speaker, I thank the gentleman from California (Mr. Stark). Well,
here we are again in the dark of night, whether it is doing Trade
Promotion Authority or whether it is doing tax cuts, or whether it is
doing the privatization of Medicare, we do it in the dark of night.
Only could the gentleman from California (Mr. Thomas), the chairman
of the Committee on Ways and Means, talk about the crisis that
confronts Medicare after they led the charge to rip $2 trillion out of
the Federal budget over the next 10 years. Tonight we are children of
Roosevelt on this side and Johnson, and let us not forget it. When you
hear them talk about their newfound affinity for Medicare, recall that
it was Dole and Michael and Rumsfeld and Ford who voted against the
establishment of Medicare.
And I want to say something to my colleagues on the democratic side
tonight who are tempted by what is about to happen. You mark my words,
we are going to be back here in a year, and the next step is Social
Security. That is where they are headed. Medicare is an amendment to
the Social Security Act. America is a more egalitarian society today
because it was our party who stood against the forces of privilege.
They are the ones that said no.
Turn down this privatization of Medicare.
Mrs. JOHNSON of Connecticut. Mr. Speaker, I yield 1 minute to my
colleague, the gentleman from Pennsylvania (Mr. Peterson).
Mr. PETERSON of Pennsylvania. Mr. Speaker, I want to congratulate
those that have worked on this very complicated bill. I was pleased
this morning to receive from the Governor of Pennsylvania, Governor
Rendell, an endorsement of this plan. Why would a democrat governor
from Pennsylvania support his plan? His people were here and reviewed
it.
This allows states like Pennsylvania and 20 other states who have
pharmacy plans to wrap around and make a really comprehensive pharmacy
program for their state with a state effort and the Federal effort.
Now, those of you who come from rural America better think seriously
about voting against this bill. Rural health care has been fighting for
its life. This is a lifeline that will for once and forever help
stabilize Medicare payments. In rural America what good does a pharmacy
program do if you do not have a doctor in a hospital and a home health
care agency for him or her to work in?
This program does more to help rural health care than has ever been
done. The urban areas of this country have had Medicare Plus Plus while
rural America has had Medicare Minus Minus. An unfair system. And this
bill does more to equalize that. It also preserves cancer care that has
been under threat. And it brings health savings accounts that will be
an offering to our businesses more seriously considering about walking
away from health care because they cannot afford the current plan.
Commonwealth of Pennsylvania,
Office of the Governor,
Harrisburg, PA, November 21, 2003.
Hon. John Peterson,
Cannon Building,
Washington, DC.
Dear Representative Peterson: I am writing to thank you for
your efforts to develop provisions in the Medicare
Prescription Drug bill to allow PACE to continue to be the
primary source of drug benefits for qualifying seniors in
Pennsylvania. As of early 2004, we expect approximately
325,000 Pennsylvania seniors to be in the PACE program, and
we owe it to all of them to ensure the program on which they
rely continues to work for them.
As the Medicare drug benefit legislation had been in
development, our goals have been to ensure seniors in the
PACE program would be able to benefit from the new federal
benefit without experiencing any changes in the way they
obtain prescription drugs and without being forced through a
bureaucratic process along the way. Federal legislation must
allow for a seamless transition for PACE beneficiaries while
at the same time allowing PACE to expand its prescription
drug program and services to more of our seniors.
I am informed that the language in the Medicare drug
benefit bill achieves our major goals relating to the PACE
program. This is good news for our constituents and I
appreciate very much all the hard work you and others in the
Pennsylvania delegation did to make this happen.
Should the legislation ultimately be enacted, I look
forward to working with you and Secretary Thompson to make
sure the PACE-related provisions are implemented as we all
believe they should be.
[[Page H12253]]
Thank you again for your efforts on behalf of
Pennsylvania's seniors.
Sincerely,
Edward G. Rendell,
Governor.
Mr. STARK. Mr. Speaker, I yield 15 seconds to the gentleman from
Pennsylvania (Mr. Doyle).
Mr. DOYLE. Mr. Speaker, I just spoke with the Governor's office
earlier this evening. I was aware of this letter that was sent out to
four Republicans. Governor Rendell does not endorse this program. He
does not support this program. And I just want that to be reflected in
the Record.
Mr. STARK. Mr. Speaker, I yield 1\1/2\ minutes to the gentleman from
Texas (Mr. Sandlin) who agrees with the Houston Chronicle, the
Republicans are interested only in the illusion of providing a popular
benefit, a Republican driven bill to, quote, improve Medicare is
impossible.
Mr. SANDLIN. Mr. Speaker, we have heard a lot of pretty words from
the Republicans tonight, but every one on both sides of the aisle knows
that this bill is nothing but a sham, a charade, a shameless trick on
America's seniors.
America's seniors need help right now and yet the bill advanced by
the Republicans does not even take effect until 2006. No coverage in
2003, no coverage in 2004, no coverage in 2005, and who knows what will
happen in 2006.
Our seniors cannot afford prescription drugs, and in the face of that
challenge, the Republicans have presented a bill that requires seniors
to pay out of their pockets over $4,000 of the first $5,000 spent on
drugs. That is no benefit at all.
Now, have the Republicans done anything to reduce the cost of drugs?
No. The HMOs and the pharmaceutical companies will not let them do it.
And this bill that is supposed to make drugs more affordable, there is
no control over the prices charged by the pharmaceutical companies.
Their greed is what got us in this situation in the first place. Do you
think that philanthropy has suddenly invaded the boardroom of the
pharmaceutical companies. Is that what you think?
Amazingly, this bill prohibits, makes it illegal, against the law for
the government to negotiate for lower prices with a pharmaceutical
companies. They supply the product, they set the price, the seniors
foot the bill, that is a sweet deal for them. And can the seniors save
money by getting drugs from Canada or Mexico? Oh, no, the Republicans
in this bill that was written by the pharmaceutical companies say no.
And that is the way it is.
Finally, Mr. Speaker, the Republicans have the audacity to support a
plan that lines the pockets of HMOs by taking $10 billion out of cancer
treatment, leaving America's seniors both broke and dying. If this bill
passes, it passes on the back of the America's seniors. The Republicans
will have to answer. They can run in the middle of the night, but they
cannot hide.
Mrs. JOHNSON of Connecticut. Mr. Speaker, I reserve the balance of my
time.
Mr. STARK. Mr. Speaker, I yield 1\1/2\ minutes to the gentlewoman
from Ohio (Mrs. Jones), who is a woman who agrees with Al Hunt, who
wrote in the Wall Street Journal that this is an open rip-off by HMOs.
There is a reason most Americans and, virtually all who have endured
serious medical issues, despise HMOs. They are, with few exceptions,
vultures.
(Mrs. JONES of Ohio asked and was given permission to revise and
extend her remarks, and include extraneous material.)
Mrs. JONES of Ohio. Mr. Speaker, I am proud to have had the
opportunity to serve my first year on the Committee on Ways and Means.
And I think it is important for America to know that, finally, we had
an African American male on the Committee on Ways and Means who rose to
ranking member, who rose to representation on the conference committee,
and he was excluded from being part of the willing coalition.
I say to people across America, particularly the African Americans in
this country, you were not at the table, your interests were not
represented. Let me, in addition, say that since we have two Houses in
this Congress, the House of Representatives and the Senate, that the
House was not represented on the Democratic side in this report.
But let me address another issue. And I have got a written statement
that I will submit for the Record. Everybody keeps saying about AARP
and how renowned they should be. But they do not talk about that in the
last 4 years AARP made $608 million in insurance-related expenses, 30
percent of its income. They do not talk about that AARP had a 10-year
Medigap contract with some company and the business is now worth $3.7
billion. They do not talk about that AARP made $10.8 million last year
by selling its member list to insurance companies. And they do not talk
about the fact that AARP spends $7 million in support of this
legislation. Talk about a conflict of interest. If there ever was one,
it is right there. So I say to you, we are going to ruin neighborhood
drug companies. We are not drug pharmacies. Do not vote for this bill.
This bill is not in the interest of senior citizens.
Mr. Speaker, I rise in opposition and with great disapproval of the
Medicare conference agreement. The republican leadership in the House
of Representatives has excluded Democratic Members from the
negotiations and has written a Medicare bill that bows to major drug
companies and prevents Medicare from negotiating better prices. This
agreement masquerades as an attempt to add a long-overdue prescription
drug benefit, but this is really a Trojan horse designed to dismantle
Medicare, as we know it.
This agreement is flawed in countless ways. Its concentration on
privatization is misguided at best and devastating. This is a special
interest giveaway to the insurance companies with provisions including
a $12 billion slush fund to bribe HMO's and PPO's to participate, all
at the expense of taxpayers and the elderly alike. The agreement leaves
a substantial number of the 6.4 million low-income Medicare
beneficiaries who are also eligible for Medicaid worse off by requiring
them to pay higher co-payments for prescription drugs than they pay
today. This agreement also prevents Medicaid from filling in the gaps
of this new, limited benefit. This bill squanders $6 billion needed for
coverage on tax breaks for the wealthy which in fact creates an
unprecedented tax loophole that would undermine existing employer
coverage and adds to the ever-growing number of uninsured. These funds
should be used to prevent employers from dropping coverage or to
improve the drug benefit. Even worse, this bill would force some low-
income seniors who have modest savings to impoverish themselves in
order to take advantage of the extra help allegedly available in this
bill. A disproportionate share of African American Medicare recipients
are disabled. The cut-off points chosen in this conference agreement
will pigenhole African Americans into what is referred to as the
``donut'' on paying for the drug benefit. This will unreasonably hurt
African American Medicare recipients, many of whom have chronic
ailments. We are forcing our seniors to choose among purchasing food,
prescription drugs or paying for a roof over their heads.
In closing, please let me inform America that this bill does not
address the needs of our citizens. This bill would manufacture a crisis
when an arbitrary cap on general revenue funding is reached, which
would trigger a fast-track process for consideration of legislation to
radically cut Medicare, including benefit cuts, payment cuts for
hospitals, nursing homes, home health providers and increased cost
sharing. Without hesitation, Congress provided $87 billion to rebuild
Iraq; is it too much to provide the appropriate funding needed to give
our Nation's seniors what they deserve--an affordable and guaranteed
medicare drug benefit?
Mr. Speaker, I represent 206,000 constituents in my district who are
65 and older and are below the federal poverty level. The same
constituents I promised that I would vote for a Medicare prescription
drug bill that would be affordable with reasonable premiums and
deductibles that are designed to significantly reduce the price of
prescription drugs; a meaningful medicare prescription drug bill that
would be defined, provide guaranteed benefits, there would be
absolutely no gaps; no separate privatized plan; and most important, I
repeatedly told my constituents that I would support a Medicare
prescription drug bill that would be available to all seniors and
disabled Americans. The results of the Medicare conference agreement is
not what I expected. Dear colleagues, I ask that you join me and vote
against this measure.
[[Page H12254]]
[From USA Today, Nov. 21, 2003]
AARP Accused of Conflict of Interest
(By Jim Drinkard and William M. Welch)
Washington.--AARP, the nation's leading lobbying force for
retirees, has a major conflict of interest in its backing for
a new Medicare prescription drug plan, opponents charge.
The organization receives millions of dollars a year in
royalties for insurance marketed under its name. It stands to
reap a windfall from the plan, which would pump $400 billion
into a new drug benefit and open Medicare to private
insurance competition.
AARP's annual reports show it has received about $608
million in insurance-related income over the four most recent
years for which data are available. That's 30% of its total
income, roughly equal to what it collects in membership dues.
``It's almost unimaginable that they wouldn't stand to
gain'' if the new benefit is passed, says David Himmelstein
of Harvard Medical School. He is a proponent of national
health insurance.
Much of AARP's insurance business is in policies that pay
costs not covered by Medicare--so-called Medigap insurance.
UnitedHealth Group signed a 10-year contract with AARP in
1998 to provide health coverage to its 35 million members.
The business was worth $3.7 billion last year to the
insurance company.
``The same folks who are in the Medigap market would want
to get into this, and the best route in is through the AARP
membership list,'' Himmelstein says.
AARP also collects millions of dollars a year from
insurance and drug companies that advertise in the magazine
it mails to members. It also makes money--$10.8 million last
year--by selling its members list to insurance companies.
From its earliest roots in the 1950s, AARP has been closely
tied to the insurance business. It grew out of a retired
teachers group that sought to provide health insurance to its
members. ``They have always had this commercial identity,''
says Jonathan Oberlander, a political scientist at the
University of North Carolina who has studied the politics of
Medicare.
The breadth of AARP's business activities--which include
not only insurance but credit cards, travel packages and
prescription drugs--has drawn unwanted attention before. In
1995, Sen. Alan Simpson, R-Wyo., convened hearings that
alleged the group was abusing its non-profit status. AARP was
forced to pay back taxes on its earnings from those
commercial ventures. and the group has faced periodic
questioning about whether its business interests at times
overshadow the interests of its members.
Simpson, now retired from the Senate, remains one of the
group's sharpest critics. ``If there was a sublime definition
of conflict of interest, it would be AARP from morning to
night,'' he says.
AARP is tax exempt and officially non-partisan. ``We made
public policy decisions without regard to business
considerations,'' says the group's policy director, John
Rother. Spokesman Steve Hahn says some of its Medigap
policies and mail-order pharmaceutical sales are likely to be
hurt by passage of the Medicare bill because it will increase
competition.
Democrats in Congress seemed stunned this week when AARP
announced it would support the Republican-drafted Medicare
compromise and pour $7 million into a TV ad campaign urging
passage.
Senate Minority Leader Tom Daschle, D-S.D., and House
Minority Leader Nancy Pelosi, D-Calif., say the legislation
would sell out the interests of senior citizens. It
``undermines Medicare and serves the agendas of big drug and
insurance companies,'' they wrote in a letter to AARP head
William Novelli. They asked Novelli to pledge not to profit
from any program that might be created.
Rep. Pete Stark, D-Calif., called the legislation a
``special-interest boondoggle'' that will split AARP's
leaders from its grass roots. On Thursday, a message board on
the group's Web site was peppered with angry postings from
members, including 839 new missives under the title, ``AARP
sellout.''
For a decade, AARP has been a sleeping giant. The
organization felt burned after its support for a catastrophic
insurance benefit in 1988 backfired with seniors and had to
be repealed. It had since been reluctant to take positions on
hot political issues. Its membership is evenly divided among
Democrats, Republicans and independents, making it hard to
take sides in policy fights.
But when the group does decide to engage, its clout is
unmatched. ``They are the most important and well-organized
association in Washington,'' says James Thurber, who teaches
lobbying at American University in Washington.
Mrs. JOHNSON of Connecticut. Mr. Speaker, I yield 1 minute to my
colleague, the gentlewoman from Florida (Ms. Ginny Brown-Waite), who
has experience legislating in the area of health care reform.
Ms. GINNY BROWN-WAITE of Florida. Mr. Speaker, I am one of those
Republicans who grew up very poor. My dad was a Democrat. And I
remember asking him why he was a Democrat, and he said because the
Democrats protect the poor.
What I am hearing here tonight says the Democrats do not care about
the poor. They do not care about the little old lady whose income is
about $11,000, who only has Social Security, who cannot get
prescription drugs today. That is the wrong message to be sending if
they hope to be the savior of the poor and the drowntrodden.
I also teach health care. One of the things that I teach in my class
are statistics. And the statistics are that the African American
community and the Hispanic community pass away at a much earlier age
from heart attacks, from coronary artery problems, and you know what?
These are the prescription drugs that will be available under this
prescription drug plan. How can they go back home and say that they are
protecting the poor and the down-trodden? These are the same, the poor
and the down-trodden, these are the people that are going to benefit
from this prescription drug plan. I fully support it. It is a good bill
for everyone.
Mr. Speaker, I rise today in support of the Bipartisan Medicare
Prescription Drug, Improvement, and Modernization Act because it
finally provides the much needed prescription drug relief seniors have
asking for, offers help to our rural hospitals and our nation's
doctors, and begins the real modernization and reform of a Medicare
program in dire need.
Throughout my public service, I have heard a persistent question from
my seniors how are you going to help us with the cost of prescription
drugs? With the passage of this bill, I feel that I can finally begin
to answer that question.
For the first time in history, we are going to provide all 40 million
seniors and disabled Americans with prescription drug coverage.
It gives me great comfort to know that in 2006, with this
Prescription Drug Plan, drug costs for seniors could be cut almost in
half. And as early as next year, senior will begin to save an estimated
25 percent on prescription drugs with their Medicare prescription drug
card. In the first year we expect seniors to save an estimated $365.
As a member of the Speaker's Prescription Drug Task Force, this is
something we fought for, and this is something we got.
In addition, we are giving Americans more control over their health
care by creating Health Savings Accounts, where they can contribute up
to $2,500 a year into these tax-free accounts and citizens 55 years or
older are permitted to make ``catch up'' payments. These accounts can
be used for future medical expenses and may prove to be an additional
much needed asset to our aging population.
Mr. Speaker, I would also like to bring to the attention of my
colleagues a very important component to this bill. As we are all
aware, in 2004, the prescription drug discount card in Medicare will
offer seniors up to 25 percent off their drug costs and provide low-
income seniors, those with incomes of less than 135 percent of poverty
into account, a $600 subsidy on top of the discount card. That's great
savings, especially for wealthier seniors.
But what if you have an income of over 135 percent of poverty and
you're disqualified from receiving the cash subsidy? Currently,
hundreds of thousands of seniors in this country are provided discount
cards from the prescription drug companies that offer significant
savings on medications that a particular company produces. The income-
restrictions on these cards are in some cases up to 300 percent of
poverty. This means virtually all seniors in my district are eligible
for this savings, which in many cases equals up to 80 percent off the
retail cost of the drug. For example, Mr. Speaker, Eli Lilly makes
Prozac; and if one of my 5th district seniors needs assistance with the
cost of that drug, they can sign up to receive a card from Eli Lilly
that entitles them to receive a 30-day supply of any Eli Lilly product
for just $12. If, due to the new Medicare discount card, these
important voluntary programs were discontinued, many of our Nation's
seniors would end up paying higher prices. My constituent would end up
paying over $75 for the same Prozac he or she is now receiving for only
$12. Just as there was a fear this benefit would cause employers to
drop coverage once it became available, I was concerned that the drug
card would cause drug manufacturers to discontinue their cards.
Mr. Speaker, working with you, Majority Leader DeLay, Majority Whip
Blunt and many of my other colleagues in this House, I took the lead
and fought to protect seniors who are benefiting from the current
prescription drug cards.
Now, on page 64 of the report language addendum and addressing
section 1860D-31 of Conference agreement; Section 105 of House bill;
Section 111 of Senate Bill reads:
Seniors currently benefit from prescription drug assistance
programs offered by pharmaceutical companies. Conferees
intend that these programs continue to be offered until the
full implementation of the prescription
[[Page H12255]]
drug benefit. Nothing in this conference report shall be
interpreted as encouraging the discontinuation or diminution
of these benefits.
Additionally, I have secured several letters from drug manufacturers
in this country indicating their commitment to continuing to offer
these worthwhile and necessary card programs, copies of which I'd like
to insert into the Record.
Mr. Speaker, I simply want to bring this to the attention of my
colleagues on both sides of the aisle and especially to the seniors in
my district. Neither conference staff nor most of the members of this
body were aware of this glitch in the proposal and I am very proud of
the work we were able to do together.
In closing, Mr. Speaker, friends, colleagues, the citizens of the 5th
Congressional District of Florida elected me to this seat because they
believed my voice would be heard and that I would stand with them in
making a prescription drug benefit in Medicare a reality. It simply has
been too long that our Nation's seniors have had to choose between
life-saving drugs and food and this is unacceptable.
No one in this chamber believes that this bill is perfect, including
myself, but I believe this bill is a good beginning and it signifies
progress in our efforts to provide all of our constituents with the
best, safest, and most affordable health care the world has to offer.
In the months and years ahead, it is my hope and my promise that I will
continue to work with Democrats and Republicans, to continue to make
progress in our ongoing battle to improve health care for all
Americans, including additional protections for retirees currently
receiving health care benefits and addressing the rising costs of
prescription drugs.
But tonight we have a choice to make--to take a step forward or to
accept the status quo. Instead of concentrating on the weaknesses of
this proposal, we must each embrace its strengths and dedicate
ourselves to the next step forward. Accordingly, I urge my colleagues
to vote in favor of the Prescription Drug and Medicare Modernization
Act.
Mr. STARK. Mr. Speaker, I am delighted to yield 2 minutes to the
minority whip, the gentleman from Maryland (Mr. Hoyer).
Mr. HOYER. Mr. Speaker, this Medicare conference report is, sadly, a
missed opportunity. I was here in 1983. Ronald Reagan, Tip O'Neill, and
Bob Michael joined together to save Social Security. They came
together, President Reagan, Speaker O'Neill, and Minority Leader
Michael and said, we need to have a bill that has bipartisan support
and will get the job done.
{time} 0030
It did.
The Republicans rejected that model. Most Members of this body on
both sides of the aisle recognize that it is long past time that we
provide for our seniors and give them a prescription drug program; but
it is not this bill that they expected, a feeble benefit that forces
them to pay 80 percent of their costs.
I will tell the gentlewoman from Florida (Ms. Ginny Brown-Waite) her
dad was right. He was a Democrat because this party has historically
and now believes that we should have done better by our seniors. Even
the conservative Heritage Foundation, which is against this bill
because they want to see Medicare done away with, says this, ``The
politically engineered premiums and deductibles, coupled with the odd
combination of `donut holes' or gaps in drug coverage, are likely to be
unpopular with seniors.''
The Heritage Foundation said that. Not Steny Hoyer, not Democrats.
Even Dick Armey, the immediate past leader of our party wrote in the
Wall Street Journal on Friday that this conference report is ``bad news
for seniors.''
Your majority leader just past said that. Now, he wants to do away
with Medicare. He does not believe we ought to have Medicare. He
nevertheless says this is bad news for seniors. Because it is bad news
for seniors, we ought to vote against this bad bill.
Mrs. JOHNSON of Connecticut. Mr. Speaker, I yield myself 10 seconds.
I remind the gentleman from Maryland (Mr. Hoyer) that of his 713,000
seniors, 31 percent will get total drug coverage under this bill.
Mr. Speaker, I yield 2 minutes to the gentleman from Illinois (Mr.
Weller), a member of the Committee on Ways and Means.
(Mr. WELLER asked and was given permission to revise and extend his
remarks.)
Mr. WELLER. Mr. Speaker, this is historic legislation tonight. Again,
we make another positive step forward in modernizing Medicare, a
process we have been working on every year the nine years that I have
served in the House of Representatives.
I am proud that a majority of House Republicans voted in favor of
Medicare when it was created. I am proud a majority of this House, who
is the majority, continues to work to modernize and improve Medicare
for our seniors.
This legislation that came out of bipartisan work, it is endorsed by
the AARP, a trusted organization that represents millions of American
seniors. And in the case of Illinois, my home State, 1.7 million
seniors benefit in the State of Illinois. They benefit because they
will have for the first time ever prescription drug coverage that is
voluntary, it is affordable, and it is universal, available for every
senior citizen. It will be immediately available.
In fact, within 6 months of this legislation becoming law, seniors
will have a prescription drug card immediately this coming year
allowing them to see up to a 25 percent savings; and 2 years later,
2006, every senior again will have the opportunity to see up to a 75
percent savings on prescription drugs. They choose to enroll in a
prescription drug plan available through this modernization of
Medicare. In fact, at a cost of about $1 a day, they can see a 75
percent savings, up to a 75 percent savings. And if they are low
income, they will pay little or no premium. This is a good plan. That
is why it has bipartisan support.
I want to salute Senator Breaux and Senator Baucus for working with
Republicans to come up with a bipartisan plan.
I would also note that hospitals and community health centers do
benefit because when you modernize Medicare, you also fix the
reimbursements. In communities that I represent, almost all of our
hospitals, I think every one of them, is a not-for-profit. They
struggle, both the hospitals and community health centers. Some call
them special interests, but they get big improvements back for
Illinois, $400 million in additional reimbursements as a result of this
legislation.
Mr. STARK. Mr. Speaker, the Republicans can lock out two of the
leading Democratic legislators from their conference committee, but
just to show you that we are bigger than all that, we will turn the
other cheek. I yield 2 minutes to the gentleman from Indiana (Mr.
Burton).
Mr. BURTON of Indiana. Mr. Speaker, first of all, I want to make it
clear, I am a Republican and I am very proud to be a Republican.
However, there are problems with this bill that make it impossible for
me to vote for it.
It has been said tonight that 35 million AARP members cannot be
wrong, but I am telling you AARP does not speak for all seniors. And
when the seniors find out what is in this bill, that most of them
initially are going to pay about $4,000 of the first $5,000 they are
going to spend on pharmaceuticals, they are going to be so angry it is
going to be like 1988 all over again.
Now, I want to talk a little bit about the pharmaceutical industry.
There is nothing in here that allows our government to negotiate the
prices with the pharmaceutical industry. We pay the highest prices in
the world for pharmaceuticals. We pay seven, eight, nine, 10 times as
much for Tamoxifen, a woman who has breast cancer and has to have it,
than they do in Canada; and yet there is no provision in this bill for
negotiation.
You say we have a 25 percent discount card. Twenty-five percent of
what? If the pharmaceutical industry has these high prices and you
knock 25 percent off, they are still a hell of a lot higher than they
are in Canada or Germany, and yet we cannot reimport. Why? It does not
make sense.
Do we believe in free trade? We have NAFTA. You can import everything
back and forth across the borders, but not pharmaceuticals because it
is not safe. Yet when we talk to the Canadians, and I had four hearings
on it, they could not find one case where there was a problem. This is
not a safety issue. The problem is profit and price.
I want to tell you something. It has been said that for too long
seniors have paid too much. They have been paying too much. But we are
not doing anything in this bill to lower the price of pharmaceutical
products.
Now, I want to say to my colleagues also there is $70 billion in this
bill, a
[[Page H12256]]
pay-off to Big Business to keep their employees and their former
employees covered under this plan.
I want to tell you something. As a businessman, they are going to
look down the road and they are going to say, hey, Congress changes
from time to time and they are going to start dumping their employees
on the Federal plan. And when they do, those retirees are going to be
so angry at us, you are not going to believe it.
Mrs. JOHNSON of Connecticut. Mr. Speaker, I yield for the purpose of
making a unanimous consent request to the gentleman from Florida (Mr.
Young).
(Mr. YOUNG of Florida asked and was given permission to revise and
extend his remarks.)
Mr. YOUNG of Florida. Mr. Speaker, as one who represents the largest
groups of senior citizens, older Americans who are on Medicare and
Social Security, I rise in support of this bill.
Mr. Speaker, I rise in support of H.R. 1, The Medicare Prescription
Drug, Improvement, and Modernization Act of 2003. This is the most
important and comprehensive improvement to the Medicare program since
it was established 38 years ago.
For the first time, Medicare will provide prescription drug coverage
for 40 million older Americans. It will provide lifesaving help for the
millions of seniors who today forgo taking prescription drugs because
they have no coverage and cannot afford them. It will allow seniors to
take their full dose of medicine as prescribed rather than cut them in
half or skip days to make the supply last longer. And it will eliminate
the heart wrenching decisions many seniors must make over whether to
buy food or prescription medicine, because they cannot afford both.
One of the reasons Americans are healthier and living longer is that
prescription medication is available to control many chronic diseases
such as high blood pressure, cholesterol, and diabetes. Unfortunately,
these medicines are oftentimes not available to those living on fixed
incomes. This legislation changes that by creating a tiered benefit
program that provides prescription drug coverage for everyone eligible
for Medicare. Yet it still allows those who receive prescription drug
coverage through their employers or other health benefit plans to elect
to retain that coverage.
Because of the complexity of bringing the new Part D prescription
benefits on line, those benefits will not take effect until 2006. In
the interim, however, Medicare beneficiaries will be eligible beginning
next April to receive a Medicare-approved drug discount card. Seniors
will take this card to their local pharmacy to receive discounts of 10
to 25 percent off their prescription medicine. This will provide
immediate savings to seniors while preparations are underway to launch
the full Medicare prescription drug program in 2006.
Once implemented, seniors electing prescription drug coverage will
pay a monthly premium of $35. Following a $250 deductible, they will
receive federal coverage for 75 percent of the costs of their
prescription drugs up to $2,250. For each prescription filled, there
will be a $2 co-payment for generic drugs and a $5 co-payment for brand
name drugs. If a senior incurs catastrophic drug costs, exceeding
$3,600 in out-of-pocket costs, Medicare will cover 95 percent of drug
costs over that amount.
For those on small fixed, limited incomes (below $12,123 for
individuals and $16,362 for couples), they will pay no deductible and
no premium and there will be no gap in coverage between the initial
coverage limit of $2,200 and the catastrophic coverage threshold of
$3,600. For those with incomes between those levels and 150 percent of
the federal poverty level ($13,470 for individuals and $18,180 for
couples), the premiums and deductibles will increase on a sliding
scale.
In addition, it is estimated that this legislation will drive down
the price of prescription medication by as much as 20 percent, to yield
further savings for seniors. It also sets in place new federal laws
that will allow drug manufacturers to bring to market quicker, more
affordable generic drugs.
In addition to the new prescription drug coverage, this legislation
will improve the quality of care for seniors in a variety of other
ways. Most notably, it provides coverage for the first time for
important new preventative benefits. Beginning in 2005, all newly
enrolled Medicare beneficiaries will be covered for an initial physical
examination. All beneficiaries will be covered for cardiovascular and
screening blood tests and those at risk will be covered for a diabetes
screen. These new benefits will allow for the screening of patients to
catch many illnesses and conditions early, allowing them to be treated
and managed in a way that improves their health and quality of life
while at the same time lowering medical costs to individuals and the
program by preventing later serious health consequences.
Finally, this legislation will ensure that Medicare payments for
physician and hospital services keep pace with inflation so that we do
not lose health care providers who are available to care for the
growing population older Americans. It also seeks to stabilize the
reimbursement rates and drug coverage for cancer patients, who have
faced increasing problems with the reduction in Medicare payments for
these services over the past few years.
Mr. Speaker, as the representative of one of the largest populations
of Medicare recipients in this Congress, I know first hand the life-
line that this program provides for seniors. My highest priority in the
development of this legislation was to ensure that we do nothing to
diminish or endanger the health care coverage it provides. We have done
a good job in seeing that just the opposite is true. With its
enactment, H.R. 1 will provide expanded benefits and will ensure that
these benefits are more affordable and more available to all.
H.R. 1 also responds to the three major concerns I have heard from my
constituents throughout the development of this legislation. First, it
guarantees access to the traditional Medicare program, services, and
benefits that they currently receive. It will, however, allow those who
are interested to consider new Medicare-approved plans where drug
coverage is integrated into broader medical coverage or lower cost
managed care plans offering expanded benefits.
Second, H.R. 1 maintains the full Federal commitment and backing of
the Medicare program. Some were concerned that the final legislation
would in some way privatize the delivery of these health care benefits.
That is not the case in this bill.
Third, H.R. 1 does not in any way encourage employers or private
health care plans to drop current employees or beneficiaries from their
health care or prescription drug plans. Instead, it provides a number
of important incentives for employers and private health care plans to
retain employees and beneficiaries in their health care plans and
allows the new Medicare benefits to supplement the benefits they
already receive privately.
Addressing these concerns is one of the many reasons the American
Association of Retired Persons has endorsed H.R. 1. In a statement
earlier this week, AARP said, ``AARP believe that millions of older
Americans and their families will be helped by this legislation . . .
The bill represents an historic breakthrough and important milestone in
the nation's commitment to strengthen and expand health security for
its citizens at a time when it is sorely needed. The bill will provide
prescription drug coverage at little cost to those who need it most:
People with low incomes, including those who depend on Social Security
for all or most of their income. It will provide substantial relief for
those with very high drug costs, and will provide modest relief for
millions more. It also provides a substantial increase in protections
for retiree benefits and maintains fairness by upholding the health
benefit protections of the Age Discrimination and Employment Act.''
Mr. Speaker, the historic legislation before us today provides long
overdue reforms to the Medicare program. It provides for the first time
prescription drug coverage for older Americans. For those seniors
currently unable to afford their medicines, it provides important new
access to many preventive drugs. It also provides access for them to
treat serious conditions before they worsen and require emergency room
or hospital care.
This legislation also improves Medicare coverage for preventative
health care including physicals and cardiovascular health and diabetes
screening tests. This too will improve the quality of medical care our
seniors receive and will forestall many serious and costly medical
problems.
Finally, this legislation modernizes the Medicare program to provide
21st Century solutions to give seniors more health care choices. It
also will bring market forces to bear to ensure that they receive
better medical care at more affordable and competitive prices.
This is the culmination of a six year legislative effort that
included the consideration of three separate prescription drug bills in
the House. Our colleagues in the House and Senate have taken a hard
look at the problems facing older Americans who receive their care
through Medicare and have agreed upon a thoughtful and comprehensive
approach. Certainly we will identify problems that will need correcting
as the next step in implementing this complex program begins. For our
seniors, however, this legislation fulfills a promise to give them
access to prescription drug coverage for the first time through the
Medicare program. It is a good response to a long overdue problem and I
urge support for its final passage.
Mrs. JOHNSON of Connecticut. Mr. Speaker, how much time remains on
each side?
The SPEAKER pro tempore (Mr. Hastings of Washington). The gentlewoman
from Connecticut (Mrs. Johnson) has 9\1/2\ minutes remaining. The
[[Page H12257]]
gentleman from California (Mr. Stark) has 8 minutes remaining.
Mrs. JOHNSON of Connecticut. Mr. Speaker, I yield myself 30 seconds.
I would like to note that the 25 percent discount means you pay 25
percent less. And once the subsidies go into effect, you pay 75 percent
less, and half the Medicare recipients are women and half of those
women will be covered totally. So this is a big, powerful prescription
drug bill that will help half the women on Medicare by providing all of
their drug coverage.
Mr. Speaker, I yield 2 minutes to the gentleman from Iowa (Mr.
Nussle), chairman of the Committee on the Budget.
Mr. NUSSLE. Mr. Speaker, I thank the gentlewoman for yielding me time
and for her leadership on this issue, as well as the chairman of the
Committee on Ways and Means.
Mr. Speaker, America has got a big decision tonight and seniors have
been waiting a long time. The previous gentleman said that seniors when
they wake up tomorrow, if this passes, will find out they still have to
pay a little bit of money. Some will not have to pay at all, but
seniors will really be mad if they wake up tomorrow morning and find
out that we failed yet again.
Four budgets in a row we have had the pleasure of putting into our
budget plan a prescription drug benefit. This year is the first time we
have been able to get it to this point, a conference report; and that
is because the President of the United States has provided the
leadership to get us to this point.
In Iowa we have been waiting for 20 years for fairness when it comes
to reimbursement. We have been waiting for 20 years when it comes to
the difficulty of recruiting physicians and other health care
providers. We have been waiting 20 years to stop the cost shifting to
the private side of health care that drives up the cost for small
business people and farmers. We have been waiting for 20 years for
seniors to have prevention and drug benefits and basic services.
Tonight we have the opportunity to solve so many of these problems.
It is not perfect, as many people have said; but it is on the road
toward making Medicare a fiscally responsible, sound and a very
beneficial program for seniors. And it is fiscally responsible. I know
there are Members who are suggesting that somehow this may not be
perfectly fiscally responsible. Let me ask you the question, If we do
nothing tonight, is Medicare going bankrupt? Wake up if you want to
talk about fiscal responsibility. We are seeing a program go bankrupt
before our very eyes. Doing nothing is not an option.
It is fiscally responsible to fix a program that we know is going
bankrupt, to fix a program that would have a prescription drug benefit
if it were created today, to fix a program that is not paying the bills
in rural America and keeping doctors and health care professionals
located there to provide quality health care.
Vote for this bill because it is fiscally responsible. We have been
waiting long enough. Seniors deserve our answer tonight.
Mr. STARK. Mr. Speaker, I yield myself 15 seconds.
I remind the gentlewoman from Connecticut (Mrs. Johnson) that the
seniors do not need to be misrepresented. I will not call it lying, but
nowhere in that bill does it mention any percentage that they will save
on the drug discount. You cannot find it in the bill because it is not
in there. So do not tell the seniors something that is not true. It is
not respectful.
Mr. Speaker, I yield 45 seconds to the gentleman from Illinois (Mr.
Emanuel).
Mr. EMANUEL. Mr. Speaker, I rise in opposition to this conference
report.
The conferees have three opportunities in this bill to lower the
price of prescription drugs. They could have opened the markets and
allowed prescription drugs to compete and allowed competition and
choices to bring prices down. They passed.
They could have allowed Tommy Thompson to lower prices and create a
Medicare Sam's Club, a right enjoyed by private companies and
businesses everywhere in this country. They took a pass.
They could have included meaningful provisions for generics to get to
market to create competition. They took a pass.
This box of Zocor, a cholesterol drug, was purchased in Germany for
$41. Here in the United States it cost $90. It went up 10 percent the
last year. It is going up another 10 percent this year.
The only immediate benefit that comes out of this bill is the
political benefit that its supporters are expecting in 2004. The
elderly, on the other hand, will have to wait until 2006. Hopefully,
they can survive 2 years while the politicians take their victory lap.
Mrs. JOHNSON of Connecticut. Mr. Speaker, I yield 2\1/2\ minutes to
the gentleman from Ohio (Mr. Portman), a member of the committee.
Mr. PORTMAN. Mr. Speaker, I thank the gentlewoman for yielding me
time, and I thank her for her leadership as chair of the Subcommittee
on Health, as well as the gentleman from California (Mr. Thomas), in
getting us to this point.
This is not the first time we have had a Medicare prescription drug
bill on the floor, but I think we have the best one. I think it is a
great program that has been misdescribed tonight by a number of the
speakers, and I just wanted to clarify a few things.
First of all, it is voluntary. People have come to the floor and
talked about this is a mandate and people will be forced to get off
their existing plans and get on this plan and so on. It is voluntary.
If seniors do not choose to take up the prescription drug plans, they
do not have to. Those who have looked at it, the Department of Health
and Human Services, Special Budget Office, nonpartisan analysts think
most seniors will, 90-some percent.
Second, I have heard people talk about the fact that, gee, some
people have employer plans already. Let me give some statistics. In
1993, 40-some percent of employers provided coverage for their
retirees. In 2002 it was 27 percent. It is happening. It is bleeding.
People are not providing retiree benefits as they used to.
What I love about this bill is it goes the other way. It puts $88
billion into helping people be able to stay with their employer plans.
EBRI, which is a nonpartisan group that is called the Employee
Benefit Research Institute, has studied this this week. Their analysis
is that 2 percent, 2 percent of seniors will migrate from their
existing retiree plans because their employers no longer offer it, into
this. If this does not get passed, it will be greater than 2 percent.
So those who have said this will result in a problem, I think it is
just the opposite.
We are beginning to stop what is happening anyway. I think that is a
good part of the plan.
People have talked about how puny the benefit is. Well, I have to
tell you, over 35 percent of the American seniors, one figure says 38
percent, let us say over 35 percent of Americans who are seniors, who
are low income, meaning they are less than 150 percent of poverty,
their income, are going to be able to get prescription drug coverage
with no premium, no deductible, no share. All they will do is pay a
nominal co-pay, $5, $3.
{time} 0045
That is over 35 percent of our seniors, represented by all of us.
Some of us in this House have districts where that number will be as
high as 60 percent. So a puny benefit, I do not know where that comes
from.
For other seniors that additional, let us say, 65 percent of seniors
more than half of their drug costs, some say as high as 70 percent,
more than half of their drug costs for the average senior, that is no
average senior, but average senior costs for drugs will be covered,
more than half of the drug cost.
This is why the AARP supports this. This is why the AARP is standing
up for their seniors. Some people on my side of the aisle think it is
too generous. People on the other side of the aisle ought to look at
this plan, at what it is, not the politics, but the substance. It is a
good plan, and I hope people on both sides of the aisle tonight will
support it.
Mr. STARK. Mr. Speaker, I yield myself such time as I may consume.
There they go again. I do not think they understand their own bill.
Between 135 percent and 150 percent of poverty, there is a 15 percent
copay, and regardless of what my colleague says, there are many, many
poor seniors are going to pay more under this
[[Page H12258]]
bill than they do now, but it is sad that the people who wrote the bill
do not know what they are talking about.
Mr. Speaker, I yield 45 seconds to the gentleman from Arkansas (Mr.
Ross), the distinguished member of our caucus who is in the
pharmaceutical business.
Mr. ROSS. Mr. Speaker, as the owner of a small town family pharmacy
and a wife who is a pharmacist, I see seniors who cannot afford their
medicine. So I came here to help our seniors with the high cost of
prescription drugs. This bill does not do that.
This morning we must decide whether to decide with the big drug
manufacturers or side with America's seniors. In 2001, the gentlewoman
from Missouri (Mrs. Emerson) and I sponsored a bipartisan bill that
would truly modernize Medicare to include medicine for our seniors, and
the Republican leadership refused to give us a hearing or a vote on
that issue, and now 2 years later the Republicans offer us a bill that
does what? That says the Federal Government shall be prohibited from
negotiating with the big drug manufacturers to bring down the high cost
of medicine and provide seniors $1,080 worth of help on a $5,100 drug
bill.
Have my colleagues ever heard of Medicare fraud? This is Medicare
fraud.
Mrs. JOHNSON of Connecticut. Mr. Speaker, I would like to inquire as
to the time remaining.
The SPEAKER pro tempore (Mr. Hastings of Washington). The gentlewoman
from Connecticut (Mrs. Johnson) has 4\1/2\ minutes remaining. The
gentleman from California (Mr. Stark) has 6 minutes remaining.
Mrs. JOHNSON of Connecticut. Mr. Speaker, I reserve the balance of my
time.
Mr. STARK. Mr. Speaker, I yield 45 seconds to the distinguished
gentleman from New York (Mr. Crowley).
(Mr. CROWLEY asked and was given permission to revise and extend his
remarks.)
Mr. CROWLEY. Mr. Speaker, I thank the gentleman for the time.
Mr. Speaker, let me see if I got this straight. In 1965, with a
Democratic President, a Democratic House and a Democratic Senate the
Medicare program was founded. Am I to believe today with a Republican
President, a Republican House and a Republican Senate that somehow you
all are going to save a program you did not support in the first place?
We have an expression in New York and all around this country, give me
a break. You are not about saving Medicare or Social Security. You are
about dismantling it, and in 40 years, when I look at my children and
they ask me where were you when they tried to dismantle Medicare, I
will look them in the eye and I will be able to tell them that I voted
against the dismantling of this great program.
I will vote against this, and I will vote against any chance that you
may bring up to this floor to dismantle Social Security as well.
Mr. Speaker, I rise to support Medicare and oppose the incredibly
offensive bill before us tonight. Medicare was created nearly 40 years
ago to protect the health of seniors. And today, sadly, Members of this
Congress are seeking to destroy the very program that has been so
helpful to so many. In its place, Republicans claim they are inserting
a new, better, and expanded program. But the reality is that this is
not a bill about providing drug coverage under Medicare.
This is a bill about giving billions of dollars to insurance
companies and drug companies. This is a bill about killing the Medicare
program that seniors have depended on for generations.
Seniors in my district want and deserve prescription drug coverage.
This could not be more true, as far too many of them are struggling
without it. But I have yet to hear from a senior in my district who is
asking for a $17 billion slush fund to be created for private insurance
companies. Not one senior has talked to me about making sure that big
drug companies are able to protect their massive profits. Not one of
them has asked me for a prescription drug benefit where they have to
pay $4,000 out of their first $5,000 in prescription drug costs. Not
one of them has asked for a bill that would force seniors out of
Medicare and push them into HMOs. And yet that is exactly what
Republicans are giving them with this bill.
This bill seeks to help drug companies and insurance companies at the
expense of seniors and American taxpayers of all ages. This bill does
essentially nothing to bring down drug prices. It does not
appropriately provide for reimportation despite this body
overwhelmingly voicing its support of reimportation. Moreover, it
expressly prohibits the government from trying to negotiate lower drug
prices like other government entities have been able to do with much
success.
Incredibly, Republicans are electing to protect drug company profits
over the cost to our government. I have to wonder whose side the
Republicans are really on?
Tonight Republicans are asking us to vote for a bill they claim will
help seniors with their drug costs. Only the catch is that, in the
process, we have to destroy Medicare, give billions to insurance
companies and drug companies, and push seniors into HMOs. This bill is
a slap in the face of the ideals that Medicare has stood for. This bill
is a slap in the face of seniors who have waited far too long for a
real prescription drug benefit.
But don't take my word for it. Listen to what the lead author,
Republican Congressman Bill Thomas of California said about this bill--
a bill he wrote--and I quote him, ``To those who say that the bill
would end Medicare as we know it, our Republican answer is: We
certainly hope so.'' Protect Medicare--oppose this sham bill.
Mrs. JOHNSON of Connecticut. Mr. Speaker, I yield 2 minutes to the
gentleman from New York (Mr. Houghton).
Mr. HOUGHTON. Mr. Speaker, in any situation where there is an
argument at stake, there are two things that are important. First of
all, it is to get the facts. Secondly, to face the fact, and I do not
mean to oversimplify this, and a lot of people know much more of the
details, but it seems to me two things come to the floor. One, Medicare
needs an update, seniors need help with their drug costs, and I think
this bill does both those things.
I have since learned that virtually any piece of legislation that
comes before this body can be argued and attacked and counterattacked
to death, but who are the customers? Who are we trying to help and are
they being helped? Are the seniors being helped? Yes, probably not
enough, but we do not know yet. Are the hospitals being helped? Yes,
but they certainly could be helped more, but this is a never ending
process. Are the doctors being helped who are opting out of the
Medicare program? Yes. Are the ambulance drivers being helped? Yes, and
it is about time.
Will the companies be helped who are thinking about whether to drop
programs for their retirees? Absolutely. Will those purchasing drugs be
helped? According to the arithmetic I read, there is absolutely no
question about this.
I would rate this bill a B+, and the reason I do this is I do not
think there is any bill that can come before this body that can get an
A, not with the attack and counterattack process we use.
One of the great poets of this country, Ralph Waldo Emerson, used to
say history is no more than a biography of a few stout individuals. It
is the few stout individuals, Mr. Speaker, that we need tonight.
Mr. STARK. Mr. Speaker, I yield 45 seconds to the gentleman from
Texas (Mr. Reyes), who agrees with the Albany Times Union that what
older Americans can least afford is for Congress to rush into a
sweeping overhaul of a successful health care program without doing its
research. This is not only an imperfect bill. It may also be a
disastrous one.
(Mr. LAMPSON asked and was given permission to revise and extend his
remarks.)
Mr. LAMPSON. Mr. Speaker, the previous speaker said that we do not
know, and we do not know what all is in this bill, but during this week
I have heard from representatives of thousands of senior citizens in
southeast Texas, like my 93-year-old mother, that they overwhelmingly
oppose this proposal, and they give three reasons why.
They believe the privatization provisions will cause Medicare to
wither. They are astounded that the bill prohibits our government from
bargaining for better drug prices. They are concerned about the
uncertainty of being put back into HMOs that dumped them recently.
Do our seniors a favor, slow this train down. Put some dignity back
in the process and open it up. The benefits will not even go into
effect for 2 years. What is it going to hurt to wait two more weeks and
do what the seniors requested at that White House Conference on Aging
in 1995 at the beginning of this debate. Save Medicare and
[[Page H12259]]
let us live our lives in dignity and independence.
In 1995 I was sent as a delegate to the White House Conference on
Aging. 4000 seniors gathered for this non-partisan meeting. They set
goals at that meeting and asked our government to do 3 things: protect
medicare; protect social security; and allow seniors to live their last
years in dignity and independence.
We have been debating medicare and a medicare drug component for
years now. I have promised to work to create a program that would help
seniors achieve the goals I just listed.
During this week I have heard from the representatives of thousands
of seniors in Southeast Texas, like my 93 year old mother, that they
overwhelmingly oppose this proposal . . . and the reasons they give are
3:
They believe privatization provisions will cause medicare to wither
and die;
They are astounded that the bill prohibits our government from
bargaining for better drug prices;
They are concerned about the uncertainty of having to go back into
HMO's that dumped them.
My colleagues, do our seniors a favor, slow this train down. Put some
dignity back into this process and open it up. The benefits won't even
go into effect for 2 years. Let's take a couple more weeks and do what
the seniors of this country asked at the beginning of this debate 8
years ago . . . save medicare and let them live their last years with
dignity and independence.
Mrs. JOHNSON of Connecticut. Mr. Speaker, I ask what time remains on
each side.
The SPEAKER pro tempore. The gentlewoman from Connecticut (Mrs.
Johnson) has 2\3/4\ minutes remaining. The gentleman from California
(Mr. Stark) has 4 minutes and 15 seconds remaining.
Mrs. JOHNSON of Connecticut. Mr. Speaker, I reserve the balance of my
time.
Mr. STARK. Mr. Speaker, I yield 45 seconds to the distinguished
gentlewoman from Oregon (Ms. Hooley).
Ms. HOOLEY of Oregon. Mr. Speaker, despite the hard work and good
intentions of many Members of Congress on both sides of the aisle, we
have lost the forest for the trees, and so I rise today in opposition
to conference report on H.R. 1.
We have lost sight of what seniors struggle with most, drug costs and
the cost of coverage, and believe me, seniors have noticed that we have
lost sight of them.
In the beginning and in the end, for me this issue has always been
about the high cost of drugs and the need to affordably expand
coverage. Regrettably, this bill prohibits ways to lower costs of drugs
for American seniors, and for many, the coverage provided in the bill
comes at a high price they simply cannot pay.
I urge my colleagues to reject this bill. Please go back to the
negotiating table and give seniors what they really need, affordable
drugs and affordable drug coverage.
Mrs. JOHNSON of Connecticut. Mr. Speaker, I yield myself 10 seconds.
The gentlewoman from Oregon should know that with this prescription
drug insurance plan Medicare recipients in Oregon who are covered will
go from 60 percent up to 96.6 percent. This bill brings a benefit to
Oregon.
Mr. Speaker, I reserve the balance of my time.
Mr. STARK. Mr. Speaker, I yield 45 seconds to the gentleman from New
York (Mr. Hinchey), and pending that, I would like to remind the
gentlewoman from Connecticut that 41,000 people in Connecticut are
likely to lose employer-sponsored coverage under this bill.
Mr. HINCHEY. Mr. Speaker, very few people are surprised that as soon
as the Republican Party has control of both Houses of the Congress and
the White House they move to destroy Medicare, and that is what this
bill essentially will do. It will drive Medicare into the ground.
The disguise that they seek to use in order to accomplish that is a
prescription drug program, but just today the National Center on Policy
Analysis told us that only $1 out of every $16 in this bill will be
spent to provide drugs for senior citizens who would not otherwise get
them. Most of the rest of the money goes to drug companies and to
insurance companies.
But the thing that surprises me about this bill is the Republican
party is engaging in price fixing. They fixed the price of drugs so
that they cannot go down, they can only go up. They have made sure that
we cannot import drugs from Canada or other places at a cheaper price,
and they guarantee that every time the prices change it will go up.
Price fixing, increasing the cost of drugs.
Mr. STARK. Mr. Speaker, may I inquire as to the amount of time
remaining?
The SPEAKER pro tempore. The gentlewoman from Connecticut (Mrs.
Johnson) and the gentleman from California (Mr. Stark) have 2\1/2\
minutes remaining.
Mr. STARK. Mr. Speaker, I yield 45 seconds of that precious time to
the gentleman from Texas (Mr. Reyes).
Mr. REYES. Mr. Speaker, I thank the gentleman for yielding me the
time.
Mr. Speaker, I have a long been a strong advocate for an affordable,
comprehensive Medicare prescription drug benefit, but I am opposed to
this bill. I am opposed because the bill before us tonight would harm,
rather than help, more than 77,000 Medicare beneficiaries in my
district by breaking this program's promise of guaranteed quality
health care for our seniors.
In my district, where approximately one in five seniors live below
the poverty line, Medicare and Social Security are their only safety
net in retirement. To jeopardize this safety net would be
unconscionable.
Mr. Speaker, I urge my colleagues to oppose this conference report so
Congress can instead offer America's seniors the kind of Medicare
prescription drug benefit that they need and more than anything that
they deserve.
Mr. STARK. Mr. Speaker, I am delighted to yield 45 seconds to the
gentleman from Arkansas (Mr. Berry), one of the gentlemen who was a
conferee but does not know.
Mr. BERRY. Mr. Speaker, I thank the gentleman from California, and I
appreciate his leadership on this matter for many, many years.
In the document that founded this great Nation, it says all men are
created equal. Under this bill, the drug companies are a lot more equal
than the seniors I can tell my colleagues. Why would we for any reason
prohibit the negotiation of lower prices by Medicare? Why would we do
that?
Tonight, we make a choice. We either serve the drug companies or
serve our seniors. I find this a very easy choice to make. I choose to
serve our seniors. I will not be a part of the continued effort to
allow the prescription drug manufacturers of this country to rob the
senior citizens of America.
Mr. STARK. Mr. Speaker, I yield the balance of our time to the
gentleman from New York (Mr. Rangel), the distinguished ranking member
of the Committee on Ways and Means.
Mr. RANGEL. Mr. Speaker, I thank the gentleman from California (Mr.
Stark) for the fine work he has done over the years on this subject,
and as we close one-half of this debate on this historic subject, I
would just like to remind those who are recording this event that when
you excluded the Democrats from participating in the conference, you
excluded 20 Members who are members of the Hispanic Caucus, 39 Members
that are members of the Black Caucus.
{time} 0100
You excluded the Congressional Asian Pacific Caucus. And you had the
arrogance to believe that you had to be Republican to be concerned
about our senior citizens. But the three that were selected by the
Speaker, the Republican Speaker, was the gentleman from Arkansas (Mr.
Berry), who knows the problems of our seniors out there. It was me, who
served for decades on the Committee on Ways and Means and has worked
hard to participate to make this a better bill and a better Congress.
But it also was the gentleman from Michigan (Mr. Dingell), former
chairman of the Committee on Energy and Commerce and a person who
fashioned a program for the aged who are poor. He too was excluded.
So it is a great honor for me to invite up to manage the other half
of the time here the gentleman from Michigan (Mr. Dingell). He is the
dean of this Congress, and we should feel proud that we are able to
serve with him. His father is the author of the Medicare bill, and we
should feel ashamed that he was excluded from the conference.
Mrs. JOHNSON of Connecticut. Mr. Speaker, I yield myself the balance
of
[[Page H12260]]
my time, and I rise in strong support of this legislation. And, indeed,
I believe its founders would be proud that tonight we bring a
voluntary, generous drug benefit to all seniors under Medicare.
This is a milestone. That is why AARP describes it as a historic
breakthrough in the Nation's commitment to strengthen and expand health
security for its citizens. Something that has not been talked about
much here tonight is the new support for seniors with chronic illness.
We forget that one-third of our seniors have five or more chronic
illnesses and use 80 percent of the money under Medicare, and yet
Medicare has no way of supporting them to prevent their chronic illness
from progressing.
In this bill, we couple the drug benefit and the disease management
program to help our seniors prevent their chronic illness from
progressing and thereby keep them healthy and keep Medicare costs under
control. This is particularly important for minorities, for they tend
not to use the medical system early, and they tend not to be diagnosed
early. In this bill, we provide an entry-level physical so we can see
what early signs of chronic illness they have, and we can help them
prevent their chronic illness from progressing.
This will be an extraordinary boon to the well-being of our senior
citizens. This is a historic advancement in both bringing prescription
drugs to Medicare and improving the quality of health care Medicare is
able to deliver, and in assuring that Medicare will be able to deliver
21st-century, cutting-edge health care.
And this is a historic bill for the rural communities of our Nation.
Without it, they will not be able to attract the next generation of
physicians as the current generation retires. They will lose small
hospitals. They will lose small home health agencies. In fact, without
this, our inner-city hospitals will not be able to continue to provide
clinics for the poor, clinics for those with mental health problems.
This is an important payer package because it restores fairness to our
payment system.
And lastly, it cuts prices dramatically. It cuts prices dramatically
by bringing the bargaining power of the seniors to the table to reduce
prices and piercing right through that price support system that keeps
State prices high. I am proud to support this legislation, and I urge
my colleagues to do likewise, for half of America's women will
experience free health care under this bill.
The SPEAKER pro tempore (Mr. Hastings of Washington). Pursuant to a
previous order of the House, the gentleman from Louisiana (Mr. Tauzin)
will control 30 minutes and the gentleman from Michigan (Mr. Dingell)
will control 30 minutes.
The Chair recognizes the gentleman from Louisiana (Mr. Tauzin).
Mr. TAUZIN. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I hope you will all bear with me for a second as I tell
a short story. I recently accompanied my son, Tom, who is 25 years old,
to see the movie ``Matrix,'' the third in the evolution of the
``Matrix'' movies, a rather complex series of movies. Young people
follow them, I think, better than my generation; but I try to follow
them with him.
When we came out of the movie, I said, Son, what did you take from
this? What did this mean to you? And he thought a long while and in the
car with me he said, what I take from this movie, Dad, is that freedom
is meaningless without choice. And I thought about that and I thought,
that is pretty profound for a 25-year-old. What he was saying,
basically, from this movie, is that if someone else is making all the
choices for you, if you are without choice, you are not really free.
Freedom, by definition, is choice. It is your capacity to choose for
yourself right or wrong what you do with your life.
And then it occurred to me how meaningful that little profound
conversation we had was and how it relates to this issue tonight.
Because we are talking about a generation of Americans who Tom Brokaw
called the Greatest Generation of Americans, who fought for this entire
world to be free, for we in this country to have freedom of choice in
our lives. And every day that we live in freedom, we have that
generation to thank for it. And the ironic thing about it, when it
comes to their health care, is that so far we have not given them
choice. We have basically said if you want health care as you get
older, after you fought to give us freedom, we will give you one plan.
We will give you the choice of government Medicare. And if it works for
you, great; if it does not work well for you, sorry, that is your
choice.
Every despot, every tyrant, every monarch and feudal lord in medieval
time took the attitude that the peasants, the servants were not smart
enough to make choices for themselves; that they had to make all the
decisions for them. That is the nature of people who think government
always knows best and always knows the right answer and people are not
wise enough to make good choices for themselves. The essence of this
debate tonight is whether we are freedom-loving enough in this body,
whether we understand and appreciate the freedoms that they fought for
and gave to us, that we can, in the context of health care, give our
seniors some real choice about how and where they take their health
care and their coverage.
Now, it is about adding a significant new benefit to Medicare. It is
that. But it is also about creating other choices for seniors. And I
brought a picture of my mother with me tonight. I thought about her
this evening. It is a small picture, but I wish you could all see it.
She is a beautiful lady. She is 85 years old. She chose to remain in
Medicare when she had a choice of a private plan in our hometown. She
probably is going to choose to remain in Medicare and take her
prescription drug benefit from Medicare when this program is completed
and we pass this bill and it is signed into law. But I want her to have
a choice to choose between that plan and any other plan that might be
available, the same way we in this government, the workers and the
Members of Congress, have choices to choose different plans for our
medical needs.
I want Mom to have the same choice. Her generation fought for me to
have choices and to make choices, right or wrong. And sometimes it hurt
her deeply when I made bad choices, but she always knew I had the right
to make them. And people died to give me that right. I think we owe
that generation choice. And that is one of the things we do tonight, we
give them choice how they take this new benefit. And if they want to
choose, like my mother, to stay with Medicare, we fought for the right
to make sure it is still in the Medicare bill, and she will have that
right.
The other thing we did was to make sure if she chooses to have
Medicare, that, indeed, it is still going to be around for her for as
long as, God willing, she lives. She is a three-time cancer patient. A
marvelous woman. She won eight gold medals at the Senior Olympics again
this year. She took top place in the shot put. You do not mess with
Mamma Tauzin. She is quite a gal. And she will probably choose to take
her prescription drugs out of Medicare in this program. But if she ever
wants to take it out of one of the PPOs or the new programs we develop
out of this bill, I want her to have that choice. She deserves it. She
ought to get it.
And I think that is why AARP has endorsed our bill, because they know
we have gotten a great generous coverage for the low-income American
seniors who want to stay in Medicare or who want to choose something
else. And we create new plans for seniors and nonseniors to begin
saving in their own health accounts; tax free in, tax free out, to
build their own long-term care the way they want to design it. And I
guess some people do not like that. I guess they think government ought
to design it all and say, You got one choice, Mamma Tauzin, and that is
it.
But I think, I think the benevolent government of the United States
of America, respecting the freedom that so many fought and died for to
give us choice and freedom, this government now, that we serve as
Members of Congress, with such great appreciation of the people who
sent us here, we ought to say here in Washington that we return the
gift of freedom; that we give seniors more choices, and we give them a
brand-new drug coverage program so they do not have to take chances on
the Internet or go anywhere else to get drugs they cannot afford, that
they can afford them under an insurance coverage here in America, and
they can
[[Page H12261]]
get it under a program they choose to live under.
Mr. Speaker, I reserve the balance of my time.
Mr. DINGELL. Mr. Speaker, I yield myself 3 minutes.
(Mr. DINGELL asked and was given permission to revise and extend his
remarks.)
Mr. DINGELL. Mr. Speaker, almost 40 years ago, this body enacted
Medicare. It was a great triumph for the senior citizens. Perhaps the
most beloved program, with the exception of Social Security, was
Medicare. It is also one of the most financially responsible and
successful programs in the history of this country. Tonight, the fight
is not about whether or not we are going to give prescription drugs to
our seniors; it is about saving Medicare from my Republican colleagues,
who now, finally, have figured a way to destroy it.
I want my colleagues to look at the kind of competition that the
Republican Party is forcing upon the senior citizens of the United
States: 120 or 125 percent of the costs of competing with Medicare is
going to be given by the Federal taxpayers and by Medicare to, guess
who, the HMOs. The Republicans have been trying to destroy this part
for years. They are very close tonight.
A flawed process has brought forth a bad bill, which is laid before
the House of Representatives in the wee hours of the morning so that
the people will not know what is going on. What is at stake here is the
existence of the most successful program to provide health care for our
senior citizens.
Let me just tell my colleagues, the competition is unfair, 120
percent and more they give. They put forward a sham discount card,
which will probably be given mostly by the retailers, not by the
prescription pharmaceutical manufacturers. The senior citizens will not
get much out of that.
Now, Medicare is going to be rewarding now the Republicans' friends
in the HMOs and the pharmaceutical houses, huge amounts of money to
each. No competition whatsoever will take place with regard to
prescription pharmaceutical costs. Why? Because the Republican Members
absolutely forbid that.
No wonder they want to do this at 2 a.m. in the morning. No wonder
they want to foreclose the public from knowing. No wonder they would
not let the people on this side of the aisle, they would not allow the
Democrats into the meeting. Because it was the only way they could
bring forward this slippery and dishonest program which is directed at
destroying Medicare as we know it. And take the word not of myself on
this, but of Mr. Newt Gingrich, of Mr. Armey, and the chairman of the
Committee on Ways and Means on the Republican side. They want to
destroy Medicare as we know it. That is what is at stake.
We can anticipate that they will allow Medicare to slowly wither
away. And the senior citizens who are dependent upon it will no longer
have the assurance that a program that they know they can choose their
doctor and their hospital will be available to them. They will have to
belong to the HMOs or pay more for it, and all in exchange for a
proposal which has a huge donut hole which denies senior citizens care
after they pay $2,000.
{time} 0115
It does not add it at that point, it takes it away. This is a sham.
It is a bad bill. It is one which takes from the senior citizens. It is
one which threatens Medicare. It is an unfair, dangerous piece of
legislation conceived in the darkness of night and slipped through over
the heads of the senior citizens.
Mr. TAUZIN. Mr. Speaker, I yield 3 minutes to the gentleman from
Florida (Mr. Bilirakis), the chairman of the Subcommittee on Health of
the Committee on Energy and Commerce.
Mr. BILIRAKIS. Mr. Speaker, I would say I wish I had $100 for every
hour that I spent in the wee hours of the morning during the time that
the gentleman's party was in charge of this House.
Mr. Speaker, we have before us today an opportunity to finally
provide our constituents with a meaningful prescription drug benefit
that our Nation can afford. To finally do it; to finally do it, not to
merely talk about it and to demagogue it. For four decades the other
party controlled, and they did nothing. It seems every time we, since
gaining the majority, attempt to meet a need, the Democrats finally
awaken with nay comments. They do nothing. We attempt to do something,
and they call our efforts a charade. We have not taken a pass, as one
gentleman from the other side of the aisle said earlier. I would
suggest the gentleman's party, which controlled for 40 years, took the
pass.
While the bill before us certainly is not perfect, and we have
admitted that, it targets the $400 billion available under our budget
resolution towards areas where it can do the most good. Our bill
provides a great deal of assistance to our low-income seniors. In fact,
seniors who earn under $13,470 as a single or $18,180 as a couple will
only be responsible for nominal copayments and will not experience a
coverage gap. This is very generous coverage for the population of
seniors who need it the most.
The conference report will also ensure that seniors will have the
peace of mind of knowing that they will only be responsible for a very
small amount of cost sharing once their out-of-pocket drug costs exceed
$3,600 annually. It is a critical provision, and one I strongly
support. This bill helps the poorest and sickest, and who can argue
against that.
The conference report makes many other improvements to the Medicare
program; in fact, too many to list tonight. However, I want to point
out that the bill contains two provisions that I have long advocated
for: Improved reimbursements for our Nation's physicians, and Medicare
coverage for a physical exam upon entering the program. I call that the
Dr. William Hale, ``Welcome to Medicare Program.'' Dr. Hale of Dunedin,
Florida, gave me the idea some time ago. I am confident that this new
benefit will ultimately save the program billions of dollars in the
long term.
I would like to close by quickly dispelling a number of myths that we
have heard on the House floor tonight, and over the past few months.
The conference report does not privatize Medicare. It improves it,
namely by adding a voluntary prescription drug benefit available to
everyone, including those who do not wish to leave traditional fee-for-
service Medicare. We are not pushing seniors into HMOs; I will not be a
part of that. Or creating a voucher system. We are offering seniors
voluntary choices other than traditional Medicare. And, finally, the
conference report does not signal the end of Medicare. Instead, it
marks the beginning of a new, better Medicare that will be available
for generations to come.
Mr. Speaker, I would like to close by thanking all of the staff
members who have worked to help make this bill possible.
Mr. DINGELL. Mr. Speaker, I yield 2 minutes to the gentleman from
Ohio (Mr. Brown).
Mr. BROWN of Ohio. Mr. Speaker, I thank the gentleman from Michigan.
Earlier this year President Bush stood in this well and pronounced
solemnly, ``Medicare is the binding commitment of a caring society.''
Today just a few short months later, those words sound so empty.
Our Medicare offers the same reliable health coverage to retired and
disabled Americans regardless of whether they are rural or urban,
whether they are rich or poor, whether they are healthy or sick. Our
Medicare is equitable, dependable, it is flexible, and cost efficient;
but their bill takes $20 billion out of our constituents' pockets and
showers those dollars on HMOs. It rigs the game so that the coverage
seniors have today, the equitable, reliable, flexible coverage they
have today, is sure to wither on the vine. That is the way they have
set it up. As one of the authors of this bill, the gentleman from
California (Mr. Thomas) said, ``To those who say this bill would end
Medicare as we know it, our answer is we certainly hope so.''
A binding commitment, Mr. President? Their bill leaves seniors with
such high drug costs they still will not be able to afford their
prescriptions. Their bill places retiree drug coverage of $12 million
seniors at risk. Their bill forces seniors to either pay significantly
more if they want to keep their doctor and their hospital, or join an
HMO that may or may not cover needed drugs, that may or may not raise
premiums beyond the $35 guesstimate,
[[Page H12262]]
that may or may not skip town if projected profits are not met. A
caring society, Mr. President?
This bill is a big win for drug companies who stand to earn $139
billion in additional profits. No surprise there, the drug companies
helped write the bill because the drug companies have given $50-60
billion to President Bush and to the Republican majority. It is a big
win for insurance companies who are the beneficiaries of a $20 billion
slush fund, no surprise there because the insurance industries and the
HMOs gave tens of millions of dollars to the President and Republican
leadership.
This is a tragic loss for America's seniors. Medicare should be the
binding commitment of a caring society.
Mr. TAUZIN. Mr. Speaker, I yield 2 minutes to the gentleman from New
Jersey (Mr. Ferguson), a valuable, distinguished member of the
Committee on Energy and Commerce.
Mr. FERGUSON. Mr. Speaker, in addition to expanding Medicare to
include prescription drug coverage for 40 million seniors, this
important conference report also represents significant benefits for my
home State of New Jersey. For years, my State has offered one of the
Nation's most generous prescription drug benefits. It is called PAAD.
Under this historic agreement to strengthen Medicare, New Jersey wins
big time. In addition to ensuring a seamless integration of the new
Medicare drug benefit and PAAD, this conference report also provides
New Jersey with billions of dollars to strengthen PAAD and expand the
number of seniors who benefit.
By using the drug discount card before the PAAD coverage begins, the
State government will save $73 million. Because PAAD's enrollees will
receive their drug benefit from Medicare, the State will save $2.8
billion. New Jersey will receive a 28 percent tax free subsidy to
offset the drug costs it provides for retired State employees, saving
the State $222 million. PAAD will no longer be forced to pay drug costs
for seniors who qualify for both Medicare and Medicaid, saving the
State $872 million.
How else does New Jersey benefit? In addition to $80 million for
increasing the Medicaid reimbursement rate, an additional $756 million
will be forwarded to New Jersey's hospitals. That is nearly $5 billion
in Federal aid for New Jersey.
This bill has language to require coordination between Medicare and
PAAD, no disruption for any senior currently enrolled in PAAD, and
billions and billions for our State government to strengthen PAAD,
offset low-income seniors' drug costs and expand the number of seniors
who are served under PAAD.
My colleagues from New Jersey on the other side of the aisle can try
to hide behind their partisanship, but they cannot ignore the fact that
this conference report represents one of the biggest and most important
victories New Jersey has ever, ever received in Congress.
Mr. Speaker, shame on them.
Mr. DINGELL. Mr. Speaker, I yield 2 minutes to the gentleman from
California (Mr. Waxman).
Mr. WAXMAN. Mr. Speaker, today we should be voting on legislation
that makes a good prescription drug benefit a part of the Medicare
program. We should give people real help without gaps in coverage
requiring seniors and the disabled to pay thousands of dollars for
drugs out of their own pockets.
Instead, what we have got is a bill that makes seniors buy private
insurance to get drug coverage or go into HMOs where they might not be
able to see their own doctor, a bill that lets insurance companies
interested in their own profits decide what premium to charge and what
drugs to put on their formulary, and a bill that will lead people
holding the bag for most of their drug costs in far too many cases.
This is not what seniors and the disabled want. This bill uses the
cover of providing drug coverage, inadequate as it is, to make very
dangerous changes in Medicare. This bill is based on the point of view
that Medicare was a mistake, that we should have left it to private
insurers to provide health care for our seniors. Well, if we had done
that, we would have a lot more seniors today who would be uninsured and
struggling with their medical bills.
I do not want to turn the clock back on Medicare, I want to make it
better. Much as I want prescription drug coverage for seniors, this
inadequate drug benefit is not worth destroying Medicare. I do not want
a Medicare where seniors and disabled people have to spend a lot more
just to be able to stay in regular Medicare. I do not want a Medicare
where seniors in Los Angeles have to pay premiums that are twice as
high as premiums in some other area of the country, and depend on
private insurance companies for what benefits they get.
So we might wonder, who benefits from this bill? Well, not the almost
3 million retirees who will end up losing the drug coverage they now
have, not the 6 million of our poorest seniors who end up being worst
off, and not the 40 million Medicare beneficiaries who cannot use their
bargaining power to get lower prices from the drug companies, and not
the people who have been able to get their drugs cheaper by going to
Canada. It is the drug companies and the insurance companies who
benefit from this bill. Let us improve Medicare, not ruin it.
Mr. TAUZIN. Mr. Speaker, I yield 2 minutes to the gentleman from
Georgia (Mr. Gingrey), one of the three Members of the House who is an
OB-GYN physician, and who happens to know something about health care.
Mr. GINGREY. Mr. Speaker, I thank the gentleman from Louisiana (Mr.
Tauzin) for yielding me this time.
Mr. Speaker, 35 million senior Members of AARP, 330,000 physician
members of the American Medical Association who are providing care to
hundreds of millions of Americans and 40 million Medicare
beneficiaries, the American Hospital Association, the Rural Hospital
Association, the United States Chamber of Commerce; Mr. Speaker, with
so many for a prescription drug and Medicare modernization for our
beloved seniors, who could be against it, and why?
The answer to that first question is pretty obvious, obstructionist
Democrats. And why? Because they are more interested in attempting to
embarrass President Bush and the Republican leadership of this House
than they are in doing the right thing, the compassionate thing.
To suggest that this bill is nothing but a windfall for the
pharmaceutical industry is like suggesting that Medicare Part A is
nothing but a windfall for the hospital. Who is going to provide the
prescription drugs, the chocolate chip cookie company? Give me a break.
But I say to my colleagues on the other side, stop the alliteration,
stop the bizarre logic, the Mediscare rhetoric. Vote with us, vote for
our seniors and make this truly a bipartisan victory.
Mr. DINGELL. Mr. Speaker, I yield 2 minutes to the gentleman from New
Jersey (Mr. Pallone).
{time} 0130
Mr. PALLONE. Mr. Speaker, I have listened to the rhetoric of the
Republicans this evening, and it is cynical. They are trying to fool
the seniors. I listened to the gentleman from Louisiana say that
seniors are going to have a choice. They are not going to have any
choice. They are going to lose their choice of doctors because they are
going to be forced into an HMO. I listened to the gentleman from
Florida say that seniors are going to get a meaningful benefit. Again
they are fooling the seniors. There is no meaningful benefit here. They
are going to have to shell out more out of pocket than they are going
to get back in terms of a drug benefit. I listened to the gentlewoman
from Connecticut earlier saying that she is going to give the seniors a
discount. What a joke that is. There is no cost containment in this
bill. The bill says that the Secretary cannot in any way negotiate
price reductions. There is no reimportation in this bill. There is no
way you are even going to be able to get discount drugs from other
countries. There is no discount. There is no savings. They are just
trying to fool the seniors.
I heard another speaker say that Medicare is going broke. The only
reason it is going broke is because you have taken money away from
their trust fund through your tax policies. You are trying to fool the
seniors again. And then you are saying that the seniors are going to be
able to have traditional Medicare, they can stay in
[[Page H12263]]
their traditional Medicare. Again you are trying to fool them because
they are going to be forced out of traditional Medicare. You are going
to limit them to a voucher, a certain amount of money. You have
something in the bill that would cap the amount of money that comes
from the Federal Government. They are not going to be able to stay in
traditional Medicare. They are going to be forced out of it. Then
finally you say, oh, they are going to get the drug benefit
immediately. You talk about the drug card or whatever it is, the
discount card. Again you are fooling the seniors. This bill does not
even take effect, there is no drug benefit until the year 2006.
I want to tell you, the last thing of all was when I listened to my
colleague tonight here from New Jersey (Mr. Ferguson) say that New
Jersey is going to benefit from this. There are 1.2 million Medicare
beneficiaries in New Jersey; 91,000 of them will lose their employer-
based prescription drug benefits; 186,000 of them in South Jersey would
be subject to premium support and will lose their traditional Medicare.
The list goes on. New Jersey is no different than any other State. You
are not going to be able to fool the seniors. You should not try to.
You ought to be ashamed of yourselves.
Mr. TAUZIN. Mr. Speaker, I yield myself 30 seconds to point out that
the statement that this bill does not go into effect until 2006 is
erroneous. The fact is that the drug discount card is effective
immediately when this bill goes into effect early next year. The fact
is that $600 per senior for drug costs is allocated immediately, next
year. Not only that, but the $1,200 per couple that is allocated for
drug costs for seniors is rolled over. If the senior does not use it
the first year, they can use it the second year. It becomes a $2,400
benefit for seniors for that second year while the full program is
enacted by the year 2006.
Mr. Speaker, I yield 2 minutes to the gentleman from Michigan (Mr.
Upton), the distinguished chairman of the Subcommittee on
Telecommunications and the Internet of the Committee on Energy and
Commerce.
(Mr. UPTON asked and was given permission to revise and extend his
remarks.)
Mr. UPTON. Mr. Speaker, I would like to focus on one misconception
about this plan that we are debating today and set the record straight.
I have heard from a lot of retirees who have been led to believe that
enacting the conference agreement will cause them to lose their
employer-provided prescription drug and health care coverage. That is
not true.
First, it is important to note that under current law, employers who
provide solid retiree health care benefits receive no assistance at all
from the Federal Government. And even in the absence of a Medicare
prescription drug plan, many of these same employers under increasing
pressure from rising prescription drug and other related health care
costs are already cutting back or entirely dropping their coverage that
they provide to their retirees today. Under this plan if we pass it
today, the Federal Government will partner with employers who maintain
or improve their current health care retiree health plans. They will
receive a subsidy of up to 28 percent of their retiree drug costs
between $250 and $5,000 and the subsidy will not be subject to
taxation. So the reality is if we do not enact this plan, there will be
no incentives for those employers to maintain or improve their current
retiree coverage. Thousands of retirees will wind up with no help with
their prescription drug costs, and we most likely will continue to see
those retiree benefits continue to be slashed. With this plan, they
will have an incentive to keep it.
I also remember back to the days when we passed a catastrophic health
care plan, back in the early nineties. It was mandatory. Guess what? We
repealed it because it was mandatory. This is voluntary. You can
participate if you want; and if you do not want, you do not have to
participate. I also remember a woman that came up to me at my son's
little league game. Her mom had just had a stroke, $600 in additional
costs that she was going to face every month. She said, Mr. Upton, will
this plan help my mom? Yes, it will help her a lot. It will in fact
save her family thousands of dollars, provide her with some quality of
life that her family expects and the plan will help.
I urge my colleagues to vote for this plan this morning.
Mr. DINGELL. Mr. Speaker, I yield 1\1/2\ minutes to the distinguished
gentlewoman from California (Ms. Eshoo).
Ms. ESHOO. Mr. Speaker, we have all not only been taught but tried to
abide by something, part of the Ten Commandments, honor thy father and
thy mother. I think more than anything else this evening, that is
really what we are talking about, honoring our fathers and our mothers,
our grandfathers and our grandmothers, the seniors, the elders of our
Nation that are part of our Nation's family. It is not just my mother
and father, and it is not just yours. It is collectively those that
have built the country and handed it over to a new generation.
I do not believe that the process in this House for this bill is
anything for the Members of Congress to be proud of, because if you do
not honor those that represent the mothers and fathers of this country,
it is a singular disgrace. So I start with that process. And I do not
believe my friends, whom I have worked with day in and day out on the
other side, tonight in their heart of hearts can be proud of that. It
is dark. It is bad. It is wrong. And it has set a very bad tone for
this bill.
We love Medicare on this side. You cannot drive a wedge between us
and Medicare. If this were prescription drugs only, it would sail
through the House. But that is the loss leader on this. This is about
rewriting the contract between our mothers and fathers and our Nation.
We object. We do not think it should be parceled out. My grandparents
never said God bless the insurance companies. They said God bless
America. Vote against this bill. It is wrong and it is bad. It
dishonors our mothers and fathers and our grandparents.
Mr. TAUZIN. Mr. Speaker, I am pleased to yield 2 minutes to the
distinguished gentleman from Oregon (Mr. Walden), a member of our
committee.
Mr. WALDEN of Oregon. Mr. Speaker, my parents are both gone now. They
died before this Congress could act to provide prescription drug
coverage for them under Medicare. So they both paid for it out of their
pocket. Let us talk about what this bill would do for those who
survive. The agreement would provide 514,456 Oregonian seniors with
access to a Medicare prescription drug benefit for the first time in
the history of this program. Beginning in 2006, there would be 129,000
Medicare individuals in Oregon who would have access to drug coverage
they would not otherwise have, and it will improve it for many more.
They will get a $600 card if you are in the lower-income level of
$12,000 a year. Couples who make $16,000 a year who lack prescription
drug coverage today would be given $600 in annual assistance to help
them afford their medicines along with the discount card of 15 to 25
percent. That is a total of $92 million for Oregon seniors that would
help 76,000 of them be able to pay for their drugs in 2004 and 2005.
There are 151,000 seniors in Oregon who have limited savings and low
incomes who will qualify for even more generous coverage. They will pay
no premium, no deductible for their prescription drug coverage, and
they will just be responsible for a minimal copayment. They will get
the coverage. If you are low income under this plan, they get the
coverage. Perhaps that is part of why the Portland Oregonian has
endorsed this program. More importantly, my State like many has faced
some fairly difficult fiscal challenges. I was there when we
implemented the Oregon health plan and helped put it into place. Today
because of the fiscal challenges, they are having to cut people off of
Medicaid in Oregon. This plan over 8 years will return $279 million by
having Medicare pick up the cost of those senior low-income people.
This is a balanced plan that will help our seniors get the
prescription drug coverage they need. We ought to enact it.
Mr. DINGELL. Mr. Speaker, I yield 1\1/2\ minutes to the distinguished
gentleman from New York (Mr. Engel).
Mr. ENGEL. Mr. Speaker, for many years I have sponsored and worked
for a real prescription drug bill for seniors and this bill breaks my
heart. This bill is not a bipartisan bill. It is a Republican fraud.
The Republican leadership
[[Page H12264]]
would like to privatize Medicare and replace it with private insurance
vouchers and HMO health care. That is what this bill does. It is the
beginning of the destruction of Medicare and the destruction and
privatization of Social Security is next.
You mark my words. We should be giving seniors a clean prescription
drug bill under the Medicare program, but we do not have money for that
because the Republican tax cuts for the rich and the stealing from the
Social Security trust fund make it impossible to have any money left to
pay for a real prescription drug program. The hodgepodge of benefits
will do nothing but confuse seniors. After spending $2,200 in drug
bills, seniors will have to pay the next $1,400 out of pocket without
any help whatsoever while they still pay their monthly premiums. What
kind of assistance is that? Seniors want a real drug bill and they want
it to begin now, not in 2006. They want help in bringing drug prices
down. This bill does none of that.
When I first came to Congress 15 years ago, I asked my mother what
was the best thing we could do to help senior citizens and she said,
give us a prescription drug program. Tonight, my colleagues, my mother
gave me some more good advice. She said, vote against this sham bill.
And that is exactly what I am going to do. Shame on this Congress for
betraying our seniors and ramming this bill through in the middle of
the night.
Mr. Speaker, I rise today in strong opposition to the Medicare
Prescription Drug and Modernization Act. When I came to Congress 15
years ago, one of my highest priorities was to strengthen Medicare,
provide drug coverage for seniors, and ensure that my children and
generations to come would always have access to quality health care in
their golden years. What the Republican leadership has put before us
today does none of these things and threatens the very fabric of the
Medicare program. The Republicans chose to give the richest Americans
billions and billions of dollars in tax cuts rather than truly provide
our seniors with relief from the high cost of prescription drugs. If
this legislation is enacted, Medicare, and the cornerstone of Lyndon
Johnson's Great Society, will be decimated.
There is nothing I would like more than to vote for legislation that
would provide a meaningful Medicare drug benefit for seniors. In fact,
I authored legislation to do just that. My legislation would have
provided seniors with coverage comparable to most private plans and
those utilized by federal employees. But what we have in this
Conference Report is a fraction of that coverage. Most seniors will see
little relief from the high cost of prescription drugs. Seniors will
pay at least $35 a month in premiums with a $250 deductible, but these
are just benchmarks and seniors may wind-up paying much more. There is
also a gap in coverage where seniors will pay the premium while
receiving no benefit. The gap in coverage is between $2,200 and $3,650
of out-of-pocket drug costs. This could mean that for half the year a
senior will be paying a premium and getting no assistance.
Additionally, the drug benefit doesn't even begin until 2006. Seniors
in my district tell me they need help now. They don't want to wait two
more years for this benefit to begin. I certainly think that they have
waited long enough for assistance in paying for medicines that save and
improve their lives. Our seniors deserve better treatment than this.
In keeping with the poor design of this benefit, it is expected that
millions of retirees currently receiving drug benefits from their
employers will lose it. So the Republican bill offers seniors a paltry
benefit while taking away the quality benefits they currently enjoy.
Wait till our seniors get a load of this.
As bad as all this sounds, it only gets worse. Despite the large
outcry by seniors and Democrats across the country, this Conference
Report embodies not the first small step toward privatization, but a
giant leap that breaks the promise we made to our seniors and have kept
since 1965 when Medicare was created. What is being dubbed as a demo
project to ``test'' premium support, what is at best a voucher program,
will encompass about \1/6\th of Medicare beneficiaries. We're talking
about 7 million people being forced out of traditional Medicare and
into HMO's. These, the unluckiest of all the Medicare population, will
pay higher premiums and receive some type of benefits, but we don't
know what they are because the HMO's will package them as they see fit.
For the first time in history seniors in different areas will be paying
different premiums and receiving different benefits.
What is most troubling is that this legislation is setting Medicare
up to fail. This legislation includes a provision that automatically
triggers cuts in the program if Medicare spending increases to an
amount determined by the Republicans. The likely scenario regarding
this is that sometime over the next several years Medicare spending
will increase triggering the cuts. In order to get under the arbitrary
cap traditional fee-for-service Medicare will be decimated. Republicans
will then point to their privatization as Medicare's savior and they
will have finally succeeded in their ultimate goal of ending Medicare
and leaving seniors to fend for themselves in the private market where
HMO's will be the order. Make no mistake, we agreed on the path to full
privatization and an end to one of the most successful government
programs in our history.
We have all heard that this group endorsed the bill and that group
endorsed the bill, so why are Democrats opposing it. The only reason
this legislation has any life in it is because the Republicans have
doled out billions of dollars in payouts to insurance companies, drug
companies, and other special interests. These groups are not endorsing
the bill because it helps seniors, they are looking out for themselves.
Well I am not going to sell out our seniors.
Mr. Speaker, the greatest generation is about to face the brunt of
the greatest hoax since since I have been in Congress. Most seniors are
not watching this debate. They will have on their local news that
Medicare will soon be covering their prescription drugs and they will
be ecstatic. ``Finally'' many will say. What a shame it is that we re
playing a political game with the lives of seniors around the country.
I urge all of my colleagues to vote this bill down so that the can
enact a real benefit that strengthens Medicare and provides a
comprehensive drug benefit that will make this wonderful program even
better.
Mr. TAUZIN. Mr. Speaker, I am pleased to yield 2 minutes to the
gentleman from Texas (Mr. Brady).
Mr. BRADY of Texas. Mr. Speaker, I appreciate the leadership of our
chairman on this important issue. For the last 4 decades, Medicare has
helped millions of American seniors get needed health care, helping
them live longer than any other generation before them. However,
Medicare has become dangerously outdated. In America today, Medicare
refuses to pay $80 a month for Lipitor to prevent heart disease, but
will pay $20,000 in hospital costs after a life-threatening emergency
has occurred. That does not make sense. Medicare needs to keep pace
with these medical breakthroughs.
Medicare must also be preserved and strengthened for future
generations. We worked hard and we must act now so that seniors, baby
boomers, and our young people can count on Medicare decades from now.
We have worked hard to make sure Medicare is more like the health care
plans Congress enjoys, more choices, better plans, and lower expenses
for Medicare down the road. There are thoughtful new reforms to keep
Medicare costs from ballooning out of control, and there are exciting
new savings accounts that give Americans of every age more freedom to
determine their health care costs.
Our seniors deserve a modern prescription plan now and future
generations deserve Medicare that they can count on. The bottom line is
we can invest a dime now to help seniors afford their medicines, or we
can pay a dollar later when they end up in the hospital or face
emergency surgery that we could have prevented. Our seniors deserve a
modern prescription plan today, and Republicans in Congress are going
to deliver it.
Mr. DINGELL. Mr. Speaker, I yield 1\1/2\ minutes to the distinguished
gentleman from Texas (Mr. Green).
(Mr. GREEN of Texas asked and was given permission to revise and
extend his remarks.)
Mr. GREEN of Texas. Mr. Speaker, I rise in opposition to this so-
called Medicare prescription drug conference report. Much as I want to
support legislation creating a prescription benefit for our Nation's
seniors, I cannot support this bill. First, the bill does absolutely
nothing to drive down the outrageous costs of prescription drugs. In
fact, it expressly prohibits Medicare from negotiating for 40 million
seniors lower prices, and yet it still allows the insurance companies
to do it. But they prohibit the government from doing it. The benefit
has a huge doughnut hole that forces seniors to pay all their costs
from $2,250 to $5,100. I guess I am so frustrated with this bill the
best I can do is read a poem about America's Greatest Generation.
Rest gently, America's Seniors
You saved democracy in WW II
You survived a depression, too.
You built this Nation
[[Page H12265]]
to a great world power
so it is right you rest
at this late hour.
{time} 0145
But while you slumber
There are voices raised
In our Capitol yonder
Of your high costs for your drugs of wonder.
This proposed legislation
Considered in the dark of night
Will not reduce your cost a ``widow's mite.''
Awake you will from your night's slumber
To repay and respond to those who plunder
Your hard-earned Medicare benefits.
Mr. Speaker, I rise in opposition to this so-called Medicare
prescription drug conference report.
Much as I want to support legislation creating a prescription drug
benefit for our Nation's seniors, I cannot support this bill.
The bill does absolutely nothing to drive down the outrageous costs
of prescription drugs. In fact, the legislation expressly prohibits
Medicare from using the negotiating power of 40 million seniors to
demand reasonable prices for our Nation's seniors but allows insurance
companies to negotiate.
The benefit has a huge ``donut hole'' that will force seniors to pay
for all of their costs from $2,250 until their costs exceed $5,100.
So if you have drug costs that are $300-400 per month, you're only
going to get a benefit for the first half of the year.
The rest of the year, you'll continue to pay premiums, but get
absolutely nothing from them.
And finally, this plan would require Medicare to compete with private
plans that would be paid more to treat healthier seniors.
There is no way Medicare could honestly be expected to compete with
these overpaid plans, and I think the bill's crafters did that on
purpose.
Mr. Speaker, this legislation leaves people worse off than they were
before it. The CBO estimates that 2.7 million employees will lose their
retiree benefits.
More than 6.4 million Medicaid beneficiaries will lose their wrap-
around coverage.
And in the long run, seniors will be left shouldering a significantly
higher portion of their health care costs. This is unacceptable, and I
urge my colleagues to vote against this bill.
Mr. TAUZIN. Mr. Speaker, I reserve the balance of my time.
Mr. DINGELL. Mr. Speaker, I yield 1 minute to the distinguished
gentleman from Ohio (Mr. Strickland).
Mr. STRICKLAND. Mr. Speaker, I thank my friend for yielding this
time.
I probably will not need a minute to say what I want to say. But this
bill was written by and for the pharmaceutical companies. Do the
Members want an example of why I say that? A few days ago the Blue Dogs
met with our Secretary of Health and Human Services, Mr. Tommy
Thompson, and two Democratic Senators were there, Senator Breaux and
Senator Baucus. And in that meeting, a question was asked: Why is there
a prohibition against the Secretary from negotiating discounted costs
for America's senior citizens? And Senator Baucus said it is in there
because PhRMA insisted that it be in there. Shame, shame, shame on you.
Mr. TAUZIN. Mr. Speaker, I yield myself 30 seconds.
I want to point out that the language that the gentleman just
referred to in the bill first appeared in the motion to instruct by
none other than the gentleman from California (Mr. Stark), who offered
a motion to recommit H.R. 4680 with instructions that included the very
same language that the gentleman is complaining about that was
referenced in the Blue Dog meeting.
Mr. Speaker, I reserve the balance of my time.
Mr. DINGELL. Mr. Speaker, I yield 1\1/2\ minutes to the distinguished
gentlewoman from Colorado (Ms. DeGette).
Ms. DeGETTE. Mr. Speaker, the Hypocratic oath requires that doctors
first do no harm. There is no such oath for Members of Congress. But we
would be wise to heed it when we consider the Medicare prescription
drug benefit tonight, for this bill certainly will do harm to millions
of Americans. I know this. My constituents know this, and seniors
across the country know this. They are furious with the organizations
and the Members of Congress that support this plan.
This is not an abstract debate. This has a huge impact on real
people. It will do harm to people like Helen Lay, my constituent, a
retiree in Colorado. Helen is worried because, as she sees it, this
bill has something in it for everyone except the senior citizens. Helen
and her husband, Frank, are fortunate enough to have good prescription
drug coverage through their retirement plan. Right now, they spend
about $800 a year on prescription drugs. Without insurance, they would
be spending nearly $12,000.
This bill will do great harm to Helen and Frank and millions of other
seniors because it will encourage employer retirement plans to end
prescription drug coverage, forcing seniors into substandard plans that
cost more, and no one knows what the coverage or the price will be.
Helen and Frank have other serious problems. They take 12 brand-name
medications per month. But this bill specifically prohibits Medicare
from negotiating drug prices, even though private companies like Wal-
Mart and agencies like the Veterans Administration are able to
negotiate cheaper drugs. That means even if this bill passes, Helen and
Frank will still pay exorbitant prices.
I say to Helen that we are here to stand up for her today.
Congress first must do no harm. Send this plan back.
Mr. TAUZIN. Mr. Speaker, I reserve the balance of my time.
Mr. DINGELL. Mr. Speaker, I yield 1\1/2\ minutes to the distinguished
gentlewoman from California (Mrs. Capps).
Mrs. CAPPS. Mr. Speaker, I rise in opposition to the Medicare
conference report. Seniors deserve a good prescription drug benefit
through Medicare. This bill cripples Medicare and truly is not a
prescription drug benefit at all. It forces seniors into private
insurance plans to get all of their health care and contains a time-
released poison pill that will starve Medicare of needed resources by
arbitrarily capping federal funds.
But on top of this, the conference report cuts cancer care by $1
billion a year, $10 billion over 10 years. So many rural cancer centers
will close as a result, and others will lay off oncology nurses and
critical support staff. These centers are essential to the delivery of
cancer care today. How can we do this to cancer patients? It is hard
enough to live with this dreaded diagnosis, let alone the horrendous
side effects of the treatments. And now this.
I repeat. This bill cuts $1 billion out of cancer care. I am ashamed.
Mr. TAUZIN. Mr. Speaker, I yield 2 minutes to the gentleman from
Michigan (Mr. Rogers) for the purposes of colloquy.
Mr. ROGERS of Michigan. Mr. Speaker, I thank the chairman for his
leadership on this for the millions of seniors who today have no
access, no access to prescription drugs that will have that when this
bill is signed into law. I thank him for each and every one of them.
For the purposes of colloquy, it is certainly not the chairman's
intent that the cuts to oncology practices across the country would go
below such a level that would cause practices to close, thus jeopardize
access to care for thousands of cancer patients, and should we see that
CBO's projections were wrong and that oncologists were found not to be
made whole for their drug reimbursement under the new Average Sales
Price that we would swiftly reverse this payment methodology?
Mr. TAUZIN. Mr. Speaker, will the gentleman yield?
Mr. ROGERS of Michigan. I yield to the gentleman from Louisiana.
Mr. TAUZIN. Mr. Speaker, the gentleman is correct, but let me point
out that CBO's estimates now indicate that this bill makes oncologists
perfectly whole in this first year of the changeover. In fact, for the
first 2 years, it is a neutral completely, and oncologists will be
getting something like 2\1/2\ to 3 times the practice expense allowance
that CMS now estimates they would get under their own data. This bill
will actually give oncologists 100 million more dollars than they are
currently getting under the old AWP formula this year, 2004, and $100
million less the second year. So it is a total neutral policy for that
2-year period.
Mr. ROGERS of Michigan. Reclaiming my time, Mr. Speaker, I thank the
gentleman for clarifying.
In addition, it is not the chairman's intent that small rural cancer
centers across the country would be detrimentally impacted under the
new Average Sales Price reimbursement method for their drugs based on
their inability to buy in volume like their suburban
[[Page H12266]]
neighbors. And if we found that to be the case, we would swiftly review
the specific impact such a payment methodology had on access to care in
these rural areas.
Mr. TAUZIN. Mr. Speaker, will the gentleman yield?
Mr. ROGERS of Michigan. I yield to the gentleman from Louisiana.
Mr. TAUZIN. Mr. Speaker, the gentleman is of course correct. That is
why we built an ASP, Average Sales Price, plus a percentage to give the
smaller oncology units a chance to buy, in case the larger units buy at
a lower price, they could at least get coverage on top of the Average
Sales Price to reimburse them, but we would always review that to make
sure cancer care is indeed preserved.
Mr. ROGERS of Michigan. Mr. Speaker, I thank the gentleman for his
attention on this matter.
Mr. DINGELL. Mr. Speaker, I yield 1\1/2\ minutes to the distinguished
gentlewoman from Illinois (Ms. Schakowsky).
Ms. SCHAKOWSKY. Mr. Speaker, I thank the gentleman for yielding me
this time.
Earlier the gentleman from Louisiana (Chairman Tauzin) waxed poetic
about the deep meaning of a movie, of all things, and about the
centrality of choice in our democracy. And I agree about choice.
But I have to tell the Members in all the years that I have worked
for and with seniors, never, not once, did a senior citizen come up to
me and say ``What I really want is a choice of insurance plans. I want
more salesmen to call me, send me those brochures, include all those
charts and graphs and fine print. I cannot wait to sit down each year
and choose among HMOs.'' Never, not once.
Seniors want a choice all right. They want to choose their doctor.
They want to choose the drug that their doctor prescribes for them.
They want the choice of their pharmacy if they want to go to their
neighborhood pharmacy. They want the kind of real choice they get under
Medicare, the Medicare that they know and love. And that is the kind of
choice they will lose under this bill and under a pile of brochures
that they are going to be burdened with. But do the Members know what?
That is okay. I want to tell the Members it is okay because the seniors
know the difference between real choices and phony choices. And we can
put all kinds of fancy pictures on it, but senior citizens will know,
and I want to tell the Members that it is to their peril that they vote
for this legislation and give seniors a phony choice.
Mr. TAUZIN. Mr. Speaker, I yield 1\1/2\ minutes to the gentleman from
Arizona (Mr. Renzi).
Mr. RENZI. Mr. Speaker, I thank the chairman for yielding me this
time.
There has been some talk about this not being about prescription
drugs and more about the changes that we are looking at for Medicare.
In the 1950's and 1960's on the border of Nevada and Arizona at the
test sites for the atom bomb, the schoolchildren in Arizona, in
Kingman, Arizona, were given the day off to go up on the mountains and
watch the A-bomb blasts. The skies would turn brilliant pink and
orange. Years later, those adults are the ones that come down with the
highest cluster rates of cancer in America. A lot of the folks in the
Rust Belt send their cancer patients out to beautiful, warm Arizona,
whereas one of the benefits of their suffering has been our ability to
understand how to better treat cancer in these communities now rather
than in the hospitals.
The nurses who provide that cancer care under the current Medicare
are not allowed to bill and get their full amounts. That is because
Medicare has not changed enough or at all since its inception.
Medicare must be updated. It must be modernized. To do so denies the
ability to provide the proper billable hours for our nurses who provide
cancer care and the better system of cancer care that we are seeing out
in the West.
Modernize Medicare. Do not deny those nurses that kind of coverage.
Mr. DINGELL. Mr. Speaker, I yield 1\1/2\ minutes to the distinguished
gentleman from Maine (Mr. Allen).
Mr. ALLEN. Mr. Speaker, I thank the gentleman for yielding me this
time.
Mr. Speaker, we have talked a lot about this bill. I want to say just
a couple of words about my seniors up in Maine. Two points. First, they
are desperate for lower prescription drug prices. Number two, they want
to keep the Medicare program that they have because it is all they
have. There are no HMOs in Maine to provide services to them.
And here is what they do. To get lower prescription drug prices, they
call my office in Maine every day. They pile into buses to go to
Canada. They try to get their prescription drugs from Canada over the
Internet.
And so what do they get out of this bill? They get a provision that
says the government will not be able to negotiate lower prices for
them, will not be able to negotiate lower prices. They get an
inadequate benefit that is not as helpful to most seniors in Maine as
the Canadian drug prices. It is a big win for PhRMA and a big loss for
people in Maine.
Our seniors have come to rely on the stability, predictability, and
continuity of Medicare. The chairman of the committee did talk about
choice, but as in Illinois, no one in Maine has ever asked me for a
choice between insurance plans. They have got the choice that matters
now, a choice of doctors and hospitals. This bill over time drives them
out of fee-for-service Medicare into HMOs. It is funded by an
outrageous overpayment to private plans and HMOs.
My parents for 1 year were in a Medicare+Choice plan. It was not
golden. It was not modern, not efficient, not fair. Just a bureaucratic
nightmare. Defeat this Medicare bill. It is bad for Maine's seniors.
{time} 0200
Mr. TAUZIN. Mr. Speaker, I reserve the balance of my time.
Mr. DINGELL. Mr. Speaker, I yield 1 minute to the distinguished
gentleman from New York (Mr. Israel).
Mr. ISRAEL. Mr. Speaker, last June I was one of nine Democrats who
voted to move Medicare modernization into a House-Senate conference.
That bill was flawed, but I wanted to give it a chance for bipartisan
compromise and improvement. It saddens me that this bill was not
improved, Medicare was not modernized; it has been privatized in this
bill. I said when I voted for H.R. 1 that if it looked like
privatization, if it sounded like privatization, if it felt like
privatization, if it smelled like privatization, that I would oppose
final passage. This bill sounds, it feels, it smells, it looks, it is
privatization; and I have to oppose final passage.
Now, some say, well, it is not really privatization; this is just an
experiment in six different areas. Do not worry. Mr. Speaker, when you
are the guinea pig, you tend to worry.
We could have done a much better job with this bill, Mr. Speaker. We
could have come up with a bill that Republicans and moderate Democrats
could embrace, a bill that protects seniors and does not subvert them.
I gave this bill every chance that I could. Tonight this bill robs our
seniors of any hope that they have had for true Medicare reform.
Medicare should be the Federal Government's obligation to seniors who
need the right bill, not a profit center for the special interests who
wrote this bill.
Mr. TAUZIN. Mr. Speaker, I reserve the balance of my time.
Mr. DINGELL. Mr. Speaker, I yield 1 minute to the distinguished
gentleman from New Jersey (Mr. Andrews).
(Mr. ANDREWS asked and was given permission to revise and extend his
remarks.)
Mr. ANDREWS. Mr. Speaker, I thank the gentleman for yielding me this
time.
Several Members of the majority have said that this is a historic
morning. They are correct. History will record that this is the day
that any pretense the majority had, the Republican Party had of fiscal
responsibility, ended.
Mr. Speaker, for every $100 we are spending to run our government
tonight, we are only taking in $80, and you are taking every nickel out
of the Social Security trust fund and then some to make up the
difference. So what is your strategy to deal with this deficit? It is
to add a $400 billion entitlement that you cannot pay for. You are
using Social Security funds that are supposed to fund future
retirements for our kids to pay for a sham prescription drug benefit
for our grandparents.
[[Page H12267]]
This borrowing will purchase a Trojan horse, a massive giveaway to
the health insurance industry disguised as a prescription drug benefit
for senior citizens.
I listened to your speeches when you came here 10 years ago and said
we could not afford to expand entitlements, and many of us on our side
stood with you and made sure that we did not do that.
To have a real prescription drug benefit, you should repeal your
sacred tax cut and pay for what is really necessary for America's
seniors. Shame on the Republican Party for turning its back and
releasing a torrent of red ink that we will pay for, for generations to
come, when this bill metastasizes in the future. Oppose this ill-
considered bill.
Mr. TAUZIN. Mr. Speaker, I yield myself 30 seconds. That was an
interesting speech, but I got a letter from the Congressional Budget
Office indicating that they prepared a preliminary estimate of the
impact of the Democratic amendment to H.R. 1, the Democratic plan; and
the estimate of CBO of their plan is $1 trillion. So a speech
complaining about the fact that we in this House passed a budget that
included $400 billion for this important program for seniors is wrong,
when the other side prepared an amendment for $1 trillion; that is a
little outrageous.
Mr. Speaker, I reserve the balance of my time.
Mr. DINGELL. Mr. Speaker, I yield 30 seconds to the distinguished
gentleman from Arkansas (Mr. Berry).
Mr. BERRY. Mr. Speaker, I rise at this time to just express my
gratitude and the gratitude of my caucus to the two gentlemen who have
worked tirelessly for years on this issue, the gentleman from Michigan
(Mr. Dingell) and the gentleman from New York (Mr. Rangel). And I hope
that this entire body, even though they have been treated shamefully
and disgustingly by the Republican leadership and by this conference
committee, I hope that everyone here this evening will join me in
thanking them for the magnificent job that they have done for America
and America's seniors.
Mr. TAUZIN. Mr. Speaker, I yield myself 30 seconds. While he is not
here, I think the Members on our side ought to show their appreciation
for the chairman of the Committee on Ways and Means, the chairman of
the conference who did an amazing job in bringing this excellent bill
to the floor for our consideration, the gentleman from California (Mr.
Thomas).
Mr. Speaker, I reserve the balance of my time.
Mr. DINGELL. Mr. Speaker, I yield 1\1/2\ minutes to the gentleman
from Massachusetts (Mr. Markey).
Mr. MARKEY. Mr. Speaker, 40 years ago today, President Kennedy's
assassination released an energy in our country that led to the passage
of the Civil Rights Act and Medicare. By contrast, the bill before us
today was conceived in secret, crafted by special interests, and
cloaked in a prescription drug benefit to disguise its real purpose:
the destruction of the Medicare program as we have known it in the
United States over the past 40 years.
This bill is a Thanksgiving turkey, and this turkey will not fly. It
forces senior citizens into HMOs. It gives HMOs billion-dollar
subsidies. It raises drug costs for the poorest Americans, and it drops
millions of seniors from their retirement plans.
Some claim this bill will provide America's senior citizens with new
prescription drug coverage, but it will force millions of our frail
elders to pay more for prescription drugs than they do now. Some claim
it will lower Medicare premiums, but it will require Medicare
beneficiaries to forfeit the power to choose their own doctors or their
own drugs. Some claim it will make the Medicare program more efficient,
but it will stick taxpayers with the bill for billions of dollars in
subsidies to HMOs and new tax shelters for the rich.
This bill is not the elixir for Medicare; it is, rather, a poison
pill that leads to the destruction of the Medicare program as John F.
Kennedy and Lyndon Johnson envisioned it.
Mr. TAUZIN. Mr. Speaker, I yield myself 3 minutes.
Mr. Speaker, it is the season of Thanksgiving, and this House is
about to say thank you to a generation of Americans who we ought to say
thank you to, and we are about to say it in the most important way we
can. We are about to pass a $400 billion-insured drug account for these
citizens who have no drug insurance today. We are about to pass a
voluntary plan that gives them the right to join or not join, their
choice, not mandated by government. It includes catastrophic coverage
so they never have to lose everything they have worked for and saved
for all of their lives. And we give to all Americans on this
Thanksgiving holiday a chance to open up health savings accounts, tax-
free in, tax-free out, tax-free interest earned to build their own
long-term health care plans for the future.
This, indeed, is a time of Thanksgiving, and it is indeed a time for
this generation to be true to our obligations of the previous
generation. This bill does that. It gives the new generation choice in
drug coverage for the first time.
It is amazing to me tonight, this debate. I have taken my parents to
the hospital many times during my dad's life and my mom's. I do not
ever once remember a doctor asking me as I checked in to the room there
whether my mom was a Democrat or a Republican. This is not a partisan
issue. I have gone and filled my mom's prescriptions every now and then
for her. They never asked me at the pharmacy what party she belongs to.
And when health deserts us in our senior years, when the ravages of
time take us and we pass away, no mortuary worker stamps Democrat or
Republican on our tombstones.
Health care is not a partisan issue, and it should not be a partisan
issue. We have a chance today to do something that seniors desperately
need, and we ought to join tonight together to do it.
There are a lot of people who helped write this bill. Let me tell you
who they were. They were, of course, the members of the conference
committee who worked together to put this bill together, but there were
a lot of staffers; and I want to mention them today. They are the staff
of the House and Senate legislative counsel. Special thanks to the
House legislative counsel, Ed Grossman, who is a draftsman
extraordinaire. Additional thanks go to Pierre Oisson and Peter
Goodlow.
From the Senate side, Ruth Ernst and John Goetchus and Jim Scott.
Other staff members of the Congressional Budget Office and analysts,
these individuals deserve great compliments for their analysis, their
integrity, and their hard work. I want to thank Doug Holtz-Eakin and
Steve Lieberman, Tom Bradley, and the entire CBO staff who worked night
times and days for us.
I want to thank Tom Scully and the whole staff at HHS and CMS who sat
and worked with us day after day to craft this bill.
I specifically want to thank the staffs of our committees. From Ways
and Means, John McManus, who did such a great job; Madeleine Smith and
Deborah Williams, and Joel White. From the majority side of the Finance
Committee, I would like to thank Linda Fishman, Mark Hayes, Leah
Kegler, Colin Roskey, and Jennifer Bell. Recognition is deserved to Liz
Fowler and Andrea Cohen, Pat Bousilman and Jonathan Blum.
Last, but not least, all of the Committee on Energy and Commerce
staff who toiled so hard for us, let me thank them again, over and over
again: Dan Brouilette, Patrick Morrisey, Chuck Clapton, Jeremy Allen,
Patrick Ronan, Kathleen Weldon, and Jim Barnette. They did a marvelous
job for this House, and we owe them a debt of thanks. Thank you all.
Mr. DINGELL. Mr. Speaker, I yield such time as she may consume to the
gentlewoman from California (Ms. Roybal-Allard).
(Ms. ROYBAL-ALLARD asked and was given permission to revise and
extend her remarks.)
Ms. ROYBAL-ALLARD. Mr. Speaker, I rise in strong opposition to this
bill.
Mr. Speaker, I rise in strong opposition to this extremely flawed
bill. A bill that takes care of drug and insurance companies at the
expense of our Nation's seniors.
Instead of helping our seniors, Mr. Speaker, this bill will result in
higher drug prices, increased Medicare premiums for seniors who refuse
to be forced into HMOs, and the erosion of retiree coverage for over
two million seniors.
[[Page H12268]]
These are just a few of the problems with this bill, Mr. Speaker.
There are far too many to name in the limited time I have.
Our seniors deserve better. They have worked and sacrificed and
contributed greatly to our country.
We must not turn our backs on them, Mr. Speaker, with the passage of
this bill. Instead let us honor our seniors by defeating this bill and
coming back with a prescription drug plan that is affordable,
comprehensive and guaranteed. A plan, Mr. Speaker, that protects
Medicare not destroys it.
Let tonight's victory be for our seniors, not the pharmaceutical and
insurance companies.
Mr. DINGELL. Mr. Speaker, I yield such time as he may consume to the
gentleman from South Carolina (Mr. Spratt).
(Mr. SPRATT asked and was given permission to revise and extend his
remarks.)
Mr. SPRATT. Mr. Speaker, I rise in strong opposition to this bill.
Mr. Speaker, when we began this quest several years ago, our object
was to make Medicare better by filing a big gap in its coverage. This
conference report covers that gap with a drug benefit that is barely
adequate and badly in need of redesign. The bill then goes on not to
make Medicare better, but to move Medicare toward privatization,
heavily subsidizing managed care with funds that could better be used
to improve the meager drug coverage this bill provides.
I will vote against this bill not to kill it but to send it back to
an open conference, where all participate, in an effort to make the
bill worthy of our senior citizens who badly need this coverage, and
depend on Medicare.
Here are some of the problems and objections that I find with this
bill:
H.R. 1 couples meager drug coverage with major changes that move
medicare toward privatization. The terms of coverage seem reasonable at
first until you realize that they are not guaranteed. The premium of
$35, the deductible of $250, and the co-payment of 25 percent are
illustrative of what insurance companies may offer, but not written in
stone. In any event, coverage stops after $2,250, just when it is
needed most, and catastrophic coverage does apply until one has spent
$5,100. For this first $5,100 in coverage, the consumer pays $4,020.
Put another way, the plan pays 20 percent the consumer pays 80 percent.
Catastrophic coverage starts after $5,100 has been spent, and seems
reasonable, until you realize that this threshold, like all the other
terms of coverage, is indexed to the rising cost of prescription drugs,
and is likely to double in ten years. This is meager coverage, and a
poor trade-off for all the changes crammed into this package to move
Medicare toward privatization.
H.R. 1 contains a drug benefit that is flawed and needs to be fixed
before it becomes law. Rather than providing continuous coverage, the
Medicare benefit has a $2,850 gap in coverage that will leave millions
of seniors without drug coverage for a good part of the year, even
though they continue to pay premiums.
The drug benefit has a deductible of $250, and a coverage gap that
begins at $2,250 in drug spending and ends at $5,100. According to CBO,
this coverage gap of $2,850 will double to $5,065 by 2013. The
structure of the benefit means that there will be several months out of
the year when seniors are paying premiums and are not receiving any
additional drug coverage. This odd benefit design, with its coverage
gap does not currently exist as an insurance product.
H.R. 1 needlessly complicates prescription drug coverage by making it
available only through private insurance policies and not through
medicare. Even through stand-alone drug policies don't exist, and
health insurance companies, fearing adverse selection, have made clear
that they do not wish to write it, this bill provides primarily for
private insurance coverage. Out of disdain for Medicare, the bill does
not choose the simple solution and make drug coverage a feature of
Medicare. Instead, in one of many steps toward privatization, this bill
calls for drug coverage to be written by private insurance companies,
adding unnecessary cost, complexity, and uncertainty.
H.R. 1 requires that drug coverage be purchased from a private
insurance company even when there is only one underwriter and no
competition. In regions where only one insurance company offers a drug-
alone policy, Medicare will not provide ``fallback'' coverage under
this bill, so long as there is a Medicare PPO or HOM in the area. The
beneficiary will have three unappealing choices: take the coverage at a
non-competitive price, leave Medicare fee-for-service and join the HMO,
or go without drug coverage.
H.R. 1 bars the Federal Government from using the purchasing power of
40 million seniors to drive down the price of drugs--H.R. 1 flat
prohibits the Secretary of Health and Human Services from negotiating
better prices for prescription drugs. The bill divides Medicare's 41
million beneficiaries into numerous regions and to one or more private
plans within each region. This fragmentation runs contrary to trends at
the state level, where states have used the purchasing power of big
beneficiary pools to negotiate better prices. This prohibition also
flies in the face of prevailing federal practice, which requires
government officials to seek the best possible price when spending the
taxpayers' money--especially when spending $400 billion.
H.R. 1 overpays HMOs to induce them to join medicare and draw seniors
into private plans--H.R. 1 provides $16.5 billion to sweeten subsidies
paid to managed care plans and induce them to enter markets they have
not found profitable. After spending billions to subsidize managed care
plans, this bill then forces traditional Medicare to compete with the
plans. This competition, known benignly as ``premium support,'' will
destabilize Medicare as we have known it and lead to premium increases
for seniors who want to stay with the government-run program.
According to the Medicare Payment Advisory Commission, Medicare
already overpays managed care plans by 19.6 percent. They are paid 19.6
percent more than their members would cost if enrolled in traditional
fee-for-service Medicare.
H.R. 1 increases HMO payments by another $4.5 billion and sets up a
$12 billion fund to induce private plans to enter new markets.
According to MedPAC, these changes will result in overpayments to
managed care plans of 25 percent.
Medicare fee-for-service will then have to compete with private plans
in six metropolitan areas starting in 2010. Obviously, the increased
payments will allow private plans an advantage in the competition, one
they will enhance by marketing their services to healthy seniors.
Managed care plans have a record of designing and marketing benefit
packages that appeal to healthy beneficiaries. As private plans
``cherry pick'' healthier beneficiaries, traditional Medicare will be
stuck with sicker, more expensive beneficiaries. If competing private
plans run costs below traditional Medicare, the beneficiaries in fee-
for-service Medicare will be assessed the difference through their Part
B premiums. Traditional Medicare premiums will spiral upwards, forcing
seniors who cannot afford the rising premiums to move into private
plans that limit their access to doctors. The process will repeat
itself year after year, beginning an insurance `'death spiral'' that
will destroy traditional Medicare.
H.R. 1 will cause over six million low-income seniors to be worse
off--The 6.4 million low-income and disabled individuals who now
receive health coverage from both Medicare and Medicaid will be worse
off under this bill.
Under current law, when a benefit or service is covered by both
Medicare and Medicaid Medicare serves as the primary payer and Medicaid
``wraps around'' that coverage. Medicaid fills gaps in coverage that
exist under the Medicare benefit. Medicaid also picks up most or all of
the beneficiary co-payments that Medicare charges.
This bill largely eliminates Medicaid's supplemental--or ``wrap
around``--coverage under the new Medicare drug benefit. As a result,
substantial numbers of poor elderly and disabled people would be forced
to pay more for their prescriptions than they now do.
In addition, in cases where Medicaid covers a prescription drug but
the private plan that administers the Medicare drug benefit in the
local area does not provide that particular drug under Medicare, poor,
elderly and disabled beneficiaries who now receive the drug through
Medicaid could lose access to it.
Under current law, low-income beneficiaries have co-payments that run
from zero to as high as $3; but these amounts do not increase from year
to year. The conference report raises cost-sharing for those with the
lowest incomes by requiring $1 and $3 co-payments for beneficiaries
whose income is less than $8,980 a year and $2 and $5 co-payments for
beneficiaries whose income is between $8,980 and $12,123 a year. In
addition, the $1 and $3 co-payments grow at CPI (1.5 percent to 3
percent). The $2 and $5 co-payments will rise at the same level as
prescription drug spending, which is projected to average 10 percent a
year, far exceeding the annual 1.5-3 percent. Social Security COLAs.
[[Page H12269]]
According to the Center on Budget and Policy Priorities, this
provision will result in higher drug costs for 4.8 million seniors.
H.R. 1 will cause nearly 3 million seniors to lose retiree coverage--
According to CBO, some employers will stop providing retiree coverage
due to the structure of the drug bill, and this will result in 2.7
million seniors losing retiree drug coverage, in many cases far better
than this plan.
According to the Congressional Budget Office, 11.7 million seniors
currently have retiree coverage through their former employers.
However, 23% of these seniors, or 2.7 million individuals, will lose
this coverage. This loss of coverage results from the structure of the
drug benefit, which gives employers an incentive to drop retiree
coverage.
The drug bill targets Federal assistance toward those seniors who
lack supplemental private drug coverage, most noticeably through the
requirement that payments made by supplemental coverage don't count
toward the beneficiaries' out-of-pocket limit. In effect, the out-of-
pocket provision reduces Federal subsidies for beneficiaries with
supplemental insurance. As a result, it provides a clear financial
disincentive for employers to supplement the benefit.
Second, some employers see the enactment of a drug benefit as an
opportunity to reduce the costs and risks of providing drug coverage.
H.R. 1 spends nearly $7 billion on tax shelters for the healthy and
wealthy--Rather than marshaling funds to improve drug coverage, H.R. 1
diverts $7 billion to Health Security Accounts, which have nothing to
do with Medicare drug coverage, and create an unprecedented tax break,
which could undermine our employer-sponsored insurance system.
Under H.R. 1, tax-advantaged savings accounts to pay out-of-pocket
medical expenses would be made universally available. These could be
used with high-deductible health policies, but not with the
comprehensive health coverage traditionally offered by employers.
Holders of these accounts could make tax-deductible deposits, watch the
earnings compound tax-free, and pay no tax upon withdrawal if the funds
are used for medical expenses.
This would establish an unprecedented and lucrative tax shelter. In
the existing tax code, when funds deposited in a tax-favored account
are deductible, withdrawals are taxed. On the other hands, withdrawals
are not taxed when deposits are not deducted. There is no precedent in
the tax code for providing both ``front end'' and ``back end'' tax
breaks. The political pressure to do the same for other types of
savings and retirement accounts could become irresistible. A
proliferation of such tax-free accounts would only send Federal
deficits higher.
These savings accounts would also undermine comprehensive health
insurance. Healthy, affluent workers would have an incentive to opt out
of comprehensive health insurance in favor of the Health Security
Accounts. They would receive a large tax break, and would not be much
affected by switching to a high-deductible health policy since they
generally use fewer health services. If large numbers of such workers
opt out of comprehensive plans, the pool of people left in
comprehensive plans would be older and sicker, causing premiums for
comprehensive insurance to rise significantly.
That, in turn, would drive still more healthy workers out of
comprehensive insurance, making those that remain even more costly to
insure, adding pressure on employers to stop offering comprehensive
coverage. Older and sicker workers could wind up paying more for health
coverage or losing it altogether and becoming uninsured.
This suggests what could be done to make this bill better if it were
taken back to a fair and open conference committee. The $7 billion
allocated to Health Security Accounts and the $17 billion allocated to
subsidizing HMOs could be used instead to narrow the ``doughnut hole,''
the zone where there is no coverage between $2,250 and $5,100. This is
just one example of how this bill can be fixed and improved, and should
be before it is passed.
Mr. DINGELL. Mr. Speaker, I yield such time as he may consume to the
gentleman from Pennsylvania (Mr. Fattah).
(Mr. FATTAH asked and was given permission to revise and extend his
remarks.)
Mr. FATTAH. Mr. Speaker, I rise in opposition to this conference
report.
Mr. DINGELL. Mr. Speaker, I yield 1 minute to the distinguished
gentleman from Arkansas (Mr. Ross).
Mr. ROSS. Mr. Speaker, I thank the gentleman from Michigan for
yielding me this time.
Mr. Speaker, in 2001, the Republican Congresswoman, the gentlewoman
from Missouri (Mrs. Emerson), and I offered up a bipartisan plan that
would truly modernize Medicare to include medicine for our seniors,
that recovered 80 percent of the cost of prescription drugs for our
seniors, while taking on the big drug manufacturers, and the
Republicans told us that we could not afford it. They said we could not
afford $750 billion over 10 years.
But what has happened since then? They passed a $350 billion tax cut
for the wealthy, and now they are proposing a $400 billion major
prescription drug plan. I was not real good in math in high school, but
I think I can figure that one out. That totals $750 billion. Two years
later, we are getting a plan that does not even kick in until 2006. Our
plan would be in effect today.
{time} 0215
Seniors get $1,080 worth of help on the first $5,100 worth of
medicine they need every year, and the Republicans even had the nerve
at the urging of the big drug manufacturers to put language in the bill
that says the Federal Government shall be prohibited from negotiating
with the big drug manufacturers to bring down the high cost of
prescription drugs. This is a bad bill. This is a bill that does not
even fit our seniors, only the big drug manufacturers.
Mr. TAUZIN. Mr. Speaker, I yield myself 30 seconds.
Mr. Speaker, again let me read the language of the bill that the
gentleman just referred to, that terrible piece of language. It says in
effect that in administering the prescription drug benefit program
established under this, the Secretary may not, number two, interfere in
any way with negotiations between private entities and drug
manufacturers or wholesalers; or, three, otherwise interfere with the
competitive nature of providing prescriptive drug benefit through
private entities. That language in the bill comes from a motion to
recommit prepared and filed in this House in the 106th Congress by the
gentleman from California (Mr. Stark) on his motion to recommit. It is
language of the other side that they are complaining about.
Mr. DINGELL. Mr. Speaker, I yield 2\1/2\ minutes to the gentleman
from Texas (Mr. Turner) for purposes of explaining the motion to
recommit, which will be offered at the conclusion of the debate. I hope
my colleagues will listen closely to this.
Mr. TURNER of Texas. Mr. Speaker, for years the pleas of our hurting
seniors fell on the deaf ears of our Republican majority until one day
our Republican friends were struck with an ingenious idea, wrapping a
plan to privatize Medicare into a deceptive package called prescription
drugs for seniors.
It keeps the drug companies happy because they can still charge twice
as much for medicine here as anywhere else in the world. It keeps
insurance companies happy by paying them 25 percent more to cover
seniors than taxpayers pay to cover seniors under traditional Medicare.
It keeps doctors and hospitals happy by paying them billions while
leading them like sheep into the perils of managed care.
And it costs taxpayers $400 billion for a meager prescription drug
savings of 25 percent, a savings that could be achieved at no cost to
taxpayers by giving seniors the right to buy drugs at the same price
they can get them in Canada. All this slight of hand to force seniors
into private insurance and some day to give them a voucher and tell
them fend for yourself. No security, no certainty, no guaranty of
coverage, you are on your own. And the promise of Medicare is no more.
My seniors in east Texas see right through this. In a poll conducted
tonight, over 6,000 seniors in my district, 85 percent said they were
opposed to the Republican plan. Dress it all up as fancy as you can, it
is a bad deal for America's seniors and they know it.
Mr. Speaker, I will be offering a motion to recommit to give seniors
a meaningful prescription drug plan. This motion matches the conference
report dollar for dollar on provider payments. It allows the Secretary
of HHS to negotiate lower drug prices. It eliminates premium support
ensuring that seniors will not have to pay more to keep the Medicare
coverage they know and trust. It rejects the poison pill language that
guts reimportation, and it prevents millions of retirees from losing
their benefits and protects
[[Page H12270]]
low-income seniors by allowing Medicaid to provide wrap around
coverage.
Mr. Speaker, let us give the greatest generation the certainty, the
security, and the guarantee they deserve. Vote for this motion to
recommit.
The SPEAKER pro tempore (Mr. Hastings of Washington). The Chair would
advise Members that there are 2 minutes remaining on either side. The
gentleman from Louisiana (Mr. Tauzin) has the right to close.
Mr. TAUZIN. Mr. Speaker, I might inquire of the gentleman from
Michigan (Mr. Dingell) if he has further speakers. I am reserving for
the Speaker of the House to close.
Mr. DINGELL. Mr. Speaker, at this time I would inform my
distinguished friend in the House, the gentleman from Louisiana (Mr.
Tauzin) that we have only one speaker remaining who will close for this
side.
Mr. TAUZIN. Mr. Speaker, then I would advise my friend to take
advantage of that time at this time and the Speaker will close on the
Republican side.
Mr. DINGELL. Mr. Speaker, is my good friend assuring me he has only
one speaker remaining?
Mr. TAUZIN. Mr. Speaker, I can assure my friend that is true.
Mr. DINGELL. Mr. Speaker, then with a great deal of pride and
pleasure I yield the remainder of my time to the distinguished minority
leader, the gentlewoman from California (Ms. Pelosi).
Ms. PELOSI. Mr. Speaker, I first I want to invite my colleagues to
join me in expressing our appreciation to our Democratic conferees who
have been true champions of a defined affordable prescription drug
benefit under Medicare, the dean of the House and ranking Democrat on
the Committee on Energy and Commerce, the gentleman from Michigan (Mr.
Dingell), the distinguished ranking Democrat on the Committee on Ways
and Means, the gentleman from New York (Mr. Rangel), and a true
champion for health care in this Congress and the country, the
gentleman from Arkansas (Mr. Berry), all for their leadership on this
important issue.
Sadly, Mr. Speaker, the Republicans would not let these appointed
conferees into the conference room. And this bill does not reflect the
benefit of the thinking and experience of our very diverse caucus. That
is a great loss to this debate and a great loss to our country.
Mr. Speaker, the Democratic Party has made ensuring the dignity and
security of our seniors a cornerstone of our mission for generations.
Nearly 40 years, ago a Democratic Congress and the Democratic
President, Lyndon Johnson, honored that mission by making Medicare the
law of the land. Ever since then, America's seniors have known where
Americans stand. We created Medicare, we want to protect it and
strengthen it.
Americas seniors have also known where Republicans stand. For 40
years, they have waged war on Medicare. When Congress passed Medicare
in 1965, only 13 Republicans in Congress supported it. Only 13 in
Congress supported it. When Newt Gingrich and the Republicans tried to
gut Medicare in 1995, President Clinton stopped them. That same year,
Newt Gingrich made his intentions about Medicare clear. He said, ``Now,
we did not get rid of it in round 1, because we do not think that is
politically smart, but we believe it is going to wither on the vine.''
And tonight the Republicans want to deliver the final blow. On behalf
of America's seniors and disabled, we must stop them.
Recognizing the desperate need of America's seniors citizens,
Democrats proposed a guaranteed, defined, affordable prescription drug
benefit under Medicare. Instead of joining us in this historic
opportunity, Republicans offered up a Trojan horse, a deceptive gift
intended to win their 40-year war against Medicare.
Republicans said this is a first step toward a prescription drug
benefit. This Republican plan is not a first step, it is a false step,
it is a mistake. It puts profits for HMOs and big pharmaceutical
companies over seniors, providing a $12 billion slush fund for HMOs and
gives a $139 billion in windfall profits to the pharmaceutical
companies over 8 years.
The Republican plan does not lower costs for prescription drugs. It
prohibits the government from negotiating for lower prices. It
privatizes Medicare and pushes seniors into HMOs. It makes seniors pay
more to keep the Medicare they know and trust. It does all of this for
a deceptive plan that makes most seniors pay $4,000 out of their first
$5,000 in prescription drug costs. How do you explain that to mom? You
are going to get a new benefit, this is the Republican plan. And of the
first $5,000 of prescription drugs cost, you, senior citizen of
America, are going to pay the first $4,000.
Nearly half of all Medicare beneficiaries, up to 20 million seniors
and disabled Americans, will fall into a coverage gap, meaning they
will pay premiums all year without receiving benefits all year. Under
the plan most seniors will be worse off than before, and millions of
retirees will lose their existing employer provided coverage.
Republican priorities are clear: They place the special from interest
of the HMOs and the pharmaceutical companies before the public interest
of America's seniors and disabled. This is not the beginning of a real
prescription drug benefit under Medicare. On the contrary, this is the
beginning of the end of Medicare as we know it. The more seniors across
America learn about the details of this scheme, the less they like it,
and the more they want us to keep fighting for real prescription drug
benefit that really answers their needs.
Mr. Speaker, this is an hour of decision. Tonight there is own one
way to improve this bill and that is to and to provide the benefit
seniors need and deserve and that is to vote no. I urge my colleagues
to vote against this Republican hoax. I urge them to send all of the
conferees, Democrats and Republicans, to the conference room to produce
a bipartisan bill that will be sustainable over time and meet the needs
of our seniors and disabled. I urge them to stand with 40 million
seniors and disabled Americans who look to us for help and hope at this
defining moment.
Speaking on the day when he signed Medicare into law, President
Johnson said that this Nation's commitment to its seniors was part of a
noble tradition that calls upon us never to be indifferent toward
despair, never to turn away from helplessness, never to ignore or spurn
those who suffer untended in a land that is bursting with abundance.
Tonight the hopes of 40 million seniors and disabled Americans rest
upon us. They have waited too long, fought too hard, endured too many
broken promises, only to be sacrificed on the alter of the special
interest. We cannot, we must not, and we will not abandon them now.
Mr. TAUZIN. Mr. Speaker, in order to close this historic debate we
yield the balance of our time to the distinguished Speaker of this, the
whole House of Representatives, the gentleman from Illinois (Mr.
Hastert).
Mr. HASTERT. Mr. Speaker, I thank the gentleman from Louisiana (Mr.
Tauzin). I also want to thank those many, many staff members who spent
uncounted hours, night and day, to help make this bill possible. I
especially want to thank my own staff member, Darren Willcox, who
sacrificed many late nights and early mornings and long weekends
despite having a wife and a baby boy at home. I want to thank Brett
Shogren of the majority leader's staff, and many, many other young men
and women who committed their time, dedicated their time to try to do a
good job in this people's House.
I want to thank those folks at the legislative counsel who spend
untold hours of trying to craft the right language to make this
legislation the right legislation for the American people, and those
folks at the Congressional Budget Office who crunched numbers day after
day after day to make things work.
In this time and space of legislative arena, there are times when
things come together. There are times of great opportunity. And there
is a time for change.
{time} 0230
This, indeed, is one of those times for that opportunity. This,
indeed, is one of those times for great change. A poet once said that
``things fall apart, the center cannot hold. The best lack conviction
while the worst are full of passion and intensity.''
For the good of our senior citizens and for the good of our Nation,
the center must hold. The best must be full of
[[Page H12271]]
passion and intensity. And today, we must pass this historic
legislation.
I want to thank all of those who have put aside their partisanship
and worked together for the good of this Nation. I want to thank the
conferees, especially the gentleman from Louisiana (Mr. Tauzin), the
gentleman from California (Mr. Thomas), the gentleman from Texas (Mr.
DeLay), the gentlewoman from Connecticut (Mrs. Johnson), the gentleman
from Florida (Mr. Bilirakis) in the House, and Senator Frist and
Senator Baucus and Senator Breaux of the Senate.
They have worked long and they have worked hard on this product
through many late nights and long weekends, and they deserve our
gratitude.
The third time is a charm when it comes to prescription drugs. This
Congress under this leadership passed drug prescription legislation in
the 106th Congress. The House passed a prescription drug bill only to
see it die in the Senate. In the 107th Congress, we passed a
prescription drug bill only to see it die in the Senate. And finally,
we are poised to complete this long journey.
When Medicare was first conceived, the baby boomers were young adults
and most seniors got their health care from a doctor's visit or a trip
to the hospital. Thus, those who constructed the program were not
overtly concerned about long-term cost projections or about
prescription drugs.
Today, we face a different story. The baby boomers are now thinking
about retirement, and they want their prescription drugs. Prescription
drugs now make up more than a third of health care costs.
This conference report makes two fundamental changes to the Medicare
system. It makes it more sustainable in the future, and it provides
seniors with a prescription drug benefit. Why do we have to make
Medicare more sustainable in the future? Because if we do not, my kids
and all those other young adults out there will be forced to pay 30
percent of their salary in the next decade or two for the Medicare
program. And I just do not think we can make that happen, and that will
not sustain Medicare; and I do not think it is fair to them.
So in this bill we start the process of making Medicare more
sustainable. We means test the part B premium and index the deductible
to inflation. We introduce free-market principles and give consumers
more power to choose their health care. We include cost-containment
measures so that if Medicare costs grow too quickly, the Congress and
the President will be forced to confront that fact.
Finally, we create health savings accounts which might be the most
dramatic and exciting reform of our health care system in generations.
These health savings accounts give consumers the ability to make health
care choices. This will hold down skyrocketing health care costs and
deliver better health care for our citizens and for our seniors.
As we make these necessary financial reforms in Medicare, we also
modernize the program with a prescription drug benefit. And after this
legislation goes into effect, low-income seniors will never be
confronted with the choice of putting food on the table or paying for
life-saving prescription drugs. Low-income seniors will finally have
the benefit that will take care of their drug costs, and this will save
the deposit money in the long run. For example, if a low-income senior
has diabetes, the monthly cost of Glucophage, a drug that helps control
that disease, is about $30 a month. But if diabetes is left untreated,
a single hospitalization for renal kidney failure is about $6,700. The
benefit is both penny-wise and pound-wise.
It will also help the typical senior by cutting down their drug costs
by 40 percent. And those seniors with high drug costs will save even
more, up to 60 percent or more. In other words, this prescription drug
benefit is a good deal for all seniors.
This legislation has other important factors. It includes incentives
to employers so that they will not drop their current plans. In fact,
this bill will make it more likely that if you have coverage with your
employer, that employer will continue to offer that benefit. It also
includes vitally important help to rural America. And if you live in
the cities or urban America, it is probably not a problem. But if you
are trying to compete with your rural hospitals and keep doctors and
hospitals going in rural areas, you know that is a problem.
This bill solves the problem. It takes care of rural hospitals. It
provides rural health care. That is something that many of us have been
fighting for for a long, long time. Let me be the first to admit that
this conference report is not perfect. The far left does not like it.
And some of our friends on the far right do not like it. But let me
tell you who does like it.
The AARP has endorsed it. So has the American Hospital Association
and the American Medical Association and almost every other major
seniors organization and doctor and patient group.
I urge my colleagues to put politics aside. I urge you to consider
this piece of legislation for the good of this Nation. I urge you to
stop and think when is the last time that we have really been able to
change the paradigm of health care in this country. When is the last
time that we have really had the chance to offer our seniors in this
country a future for good health care, for good pharmaceutical coverage
and for a chance to live and enjoy a great future.
I ask for a positive vote.
Mr. FILNER. Mr. Speaker, I rise today to say shame on this body for
passing this reprehensible Medicare bill that has been rammed through
Congress today by the Republican leadership.
This legislation does nothing that its supporters claim it does. They
claim that this bill will help seniors with their prescription drug
costs and give them more choices in their healthcare. But actually,
this bill does none of that. It does not provide a comprehensive,
affordable or reliable prescription drug benefit. Further, it unravels
the consistent, guaranteed healthcare coverage that seniors have come
to expect under Medicare. This bill is so bad, that even some
Republicans refused to support it. Opponents of this terrible
legislation see through the smoke and mirrors that supporters are
putting up and realize that this bill was not about helping seniors pay
for their prescription drugs or giving them access to better care, but
that this bill was actually about helping the bottom lines of private
insurance companies, HMOs and the pharmaceutical companies.
There are many, many bad provisions in this legislation, and I would
like to highlight some of the worst of them here.
One: Under this bill, Medicare as we know it is completely unraveled.
First, Medicare Part B will be forced to compete with private managed
care plans. This leaves the health of our seniors to the whims of
private insurance companies and does not guarantee that all seniors
will be receiving the same benefits across the country. That means
seniors in my District in San Diego, CA, might have better coverage
than seniors in New York. Or seniors in New York might have better
coverage than those in San Diego--we just don't know--it's completely
up to the private insurance companies and HMOs to decide how much
coverage they want to provide. Not only is the amount of coverage going
to vary, but so are the costs of the premiums. Again, that means
seniors in San Diego might pay more than seniors in New York--or vice
versa--depending on how much the private insurance companies and the
HMOs decide they want to charge!
Secondly, this bill would institute a ``means test.'' In layman's
terms, that means that in 2007, the Medicare part B premium would be
linked to income. This not only goes against the main tenet of
Medicare--which grants coverage to everyone, regardless of income--but
also, higher premiums create an incentive for healthier seniors to
leave Medicare. This would leave only the sickest seniors in Medicare
and drive up premiums even more.
Two: The so-called prescription drug ``benefit'' is absolutely
inadequate and actually decreases coverage for some seniors and can
cost them more than they're paying right now. Supporters of this bill
claim that the prescription drug benefit will help seniors cover the
costs of their medications. However, there are so many problems with
this benefit that it's hard to decide where to begin. First of all,
this benefit does not even kick in until 2006. When it finally does
begin, seniors are expected to pay a high deductible. Then, there is a
piece de resistance of this so-called benefit: there is a big hole in
coverage. Rather than providing continuous coverage throughout the
year, this bill has a $2,850 coverage gap in which seniors don't
receive any coverage at all. Half of America's seniors fall into this
hole. The icing on the cake is that despite the fact that they would
not be receiving coverage for part of the year, they are still expected
to continue to pay the premiums.
Additionally, more than 2 million retirees, who currently have drug
coverage through
[[Page H12272]]
their former employers, will lose that coverage. Because drug costs
keep rising and this bill has no measures to keep drug costs low, it is
very tempting for employers to simply drop their coverage and force
seniors onto this inadequate drug coverage plan. Furthermore, rather
than having Medicare kick in when a retiree reaches catastrophic
coverage, this bill forces the employer-provided benefits to cover
those costs--yet another reason for employers to pull their coverage.
Three: This bill explicitly prohibits the government from negotiating
with drug companies for lower drug prices. One of the greatest
strengths of a prescription drug plan under Medicare is that it could
reduce drug prices for participants using the large number of
participants in the Medicare program to bargain with pharmaceutical
companies for better prices on their products. Yet this bill denies
Medicare participants those lower costs, ensuring continued
skyrocketing prescription drug prices.
It is for those reasons--and many many more--that I could not support
this poison pill for Medicare and a placebo of a prescription drug
benefit.
Mr. THORNBERRY. Mr. Speaker, like most bills brought before us, this
bill is a mixture of provisional I support and provisions I oppose.
Unlike most bills brought before us, it affects every American and will
have significant, long-term consequences for our Nation.
I believe that providing access to quality health care is one of the
most formidable challenges facing our Nation now and in the decades to
come. The retirement of the baby boom generation, which begins in less
than 8 years, will make that challenge enormously difficult.
When the House considered its version of this bill in June of this
year, I said that our objective should be to ``update and strengthen
Medicare so that it does a better job of providing health care for
seniors and at the same time put Medicare on a sound financial footing
so that it can be sustained through the baby boom generation
retirement.'' This conference report does begin to update Medicare by
adding prescription drug coverage. It does little to put Medicare on a
sound financial footing.
Making prescription drug coverage available to all seniors is very
important. Not only will that benefit keep seniors from having to
choose between buying medicines and other necessities of life, it will
help them stay healthier. As they stay healthier longer, hospital and
other medical expenses should be less.
This bill includes reforms of the system which are also important.
Allowing all Americans to choose Health Savings Accounts gives everyone
a new option to pay for health care and could help stem the tide of
rising insurance rates and rising health care costs. Beginning to
consider income in calculating Part B premiums is a significant change
in the law. Other provisions related to provider reimbursements and
reducing the discrimination against rural health care providers are
worthy of support.
I am concerned that the total cost of this bill is vastly
underestimated, as has happened before in Medicare. There are payments
or tax credits for virtually every group interested in health care, yet
of all of the groups affected by this bill, I worry that the interests
of those paying the bills, especially future taxpayers, are given the
least consideration.
So, we are left weighing the benefit of modernizing Medicare and some
reforms versus the danger that this bill will hasten the day of
Medicare' collapse. It is not an easy judgment to make.
It is clear that if we do nothing, millions of seniors will go
without the prescriptions they need and that none of the reforms
essential to Medicare's survival will occur. We must begin somewhere.
Reluctantly, I have concluded that this most imperfect bill is at least
a place to start.
If we are honest, we have to admit that this bill is something of a
gamble. We are betting that the limited reforms begun here will
flourish and work to strengthen Medicare for the 21st century. If we
are wrong, the added benefits and payments may sink the entire program.
Tonight, I choose to vote with my hopes rather than my fears,
prayerfully mindful of both my parents and my children.
Mr. UDALL of Colorado. Mr. Speaker, I want to support a Medicare drug
bill, but I can't support this bill. Instead of giving us a foundation
to build on, I believe it will compromise the effectiveness of a very
popular healthcare program for seniors in order to deliver an
inadequate, unreliable and unfair drug benefit. Under this bill seniors
will pay higher premiums, higher deductibles and higher prices for
drugs. It will force seniors into HMOs, and millions of seniors will
lose drug benefits that they get through their retirement plans.
Instead of crafting a drug bill, the Republican leadership has used the
opportunity to dismantle Medicare and turn it over to private insurance
and drug companies.
I have long believed that Congress should act to help seniors with
their prescription drug expenses. Congress should give seniors greater
choice in coverage, but it should not force seniors into HMOs in order
to get a drug benefit. Colorado could be chosen as part of the
demonstration project under this bill, which would force seniors into
HOMs in order to get the drug benefit. According to a recent analysis
by the Department of Health and Human Services, most seniors would see
increases in their premiums with some facing increases as high as 88
percent. Colorado seniors would pay some of the highest premiums in the
country. For example, seniors in Adams County, CO would pay $100 a
month while seniors in some parts of North Carolina will pay $58 a
month. Why should Coloradans pay higher premiums than seniors in other
parts of the country for the exact same benefit?
It's no wonder that seniors in my district are skeptical about this
plan. Let's not forget, we tried private competition in Medicare when
HMOs were allowed to participate in the program as a result of
legislation that passed in 1997. Seniors were told that managed care
was better able to deliver healthcare services to them. Managed care
aggressively courted seniors to join Medicare+Choice plans and then
dropped them because they couldn't make a profit. That left millions of
seniors searching for doctors and coverage. Now, this bill includes
billions of dollars in subsidies to managed care to provide coverage.
If privatization is such a good idea, why do insurance companies need
these large subsidies in order to participate in Medicare?
There are a few provisions in this bill that I support, such as the
payment increases for hospitals and physicians and other providers. In
fact, I have consistently voted to increase provider payments and I
have cosponsored legislation to change the flawed formula upon which
these payments are based. But those payments should have been brought
up separately rather than as part of the Medicare bill.
It is grossly ironic that Medicare will pay for a senior's care
following a stroke but will not pay for the anti-hypertension drugs
that prevent them. The time is ripe to pass a Medicare prescription
drug benefit, but not as proposed in this legislation. I had hoped that
we would vote on a bill that created a fair, workable, financially
sound prescription drug benefit. But I am not willing to set in motion
forces that will lead to the destruction of a program that seniors and
the disabled have trusted for nearly 40 years in exchange for a feeble
prescription drug benefit. We should work to get it done right rather
than get it done right now.
Mr. BUYER. Mr. Speaker, the measure before the House tonight, the
conference agreement on the Medicare Prescription Drug and
Modernization Act, H.R. 1, is not a perfect bill. But, it is also not
the bill that I opposed several months ago when the House first
considered the measure. As with any conference agreement, this bill is
a product of compromise and negotiations. It is an improvement in the
House-passed bill in some respects, a disappointment in others.
Nonetheless, I think it is time to end the debate on a prescription
drug plan in Medicare and move forward.
While this bill has some troubling flaws, it does take major steps
forward in improving access to health care of our nation's seniors. It
serves as a blueprint for enhancements to Medicare that will enable
Congress to resolve the long-term solvency issues in Medicare's
structure.
Reform cannot occur in a vacuum. We must be vigilant as we take these
necessary steps to reform Medicare to provide greater choice and health
care services to beneficiaries.
This measure will require close scrutiny by Congress to oversee the
implementation of the drug plan to insure that it provides cost
containment and prevention of drug overutilization. The provisions
before us to enhance Medicare are likely to require annual maintenance
by Congress.
If the provisions of this bill that expand Medicare Advantage plans,
that improve Medical Savings Accounts in Medicare, and that create
Health Savings Accounts, are successful in the marketplace,
beneficiaries will have alternatives to government-run health care and
greater choices to meet their health care needs.
I applaud the inclusion in this bill of provisions to address the
needs of rural providers, especially rural hospitals. Under this bill
rural hospitals will see an equalization on reimbursement on inpatient
care as compared to their urban counterparts. This bill includes
provisions which I have urged that give Critical Access Hospitals more
flexibility in their bed limits. I also applaud the conferees for
including a provision that will enable hospitals to seek a
reconsideration of their classification. The bill also extends Medicare
cost contracts until Medicare Advantage plans are available. These are
good provisions that will directly address patient care in my district.
I am also pleased to see the inclusion of regulatory reforms that
this House has passed twice.
[[Page H12273]]
Finally, the bill gives seniors help with their prescription drugs
almost immediately by authorizing a discount drug card. In a serious
level of effort, I worked with four of my colleagues in drafting
legislation to add a drug card to the Medicare program. Under our
approach seniors would have been able to choose from a variety of
discount drug cards available at a very low annual fee. We also
included funds for seniors, based on income, to help seniors pay for
drugs; a catastrophic limit; and a mechanism for seniors to save and
for others to help seniors pay for their drugs.
Frankly, I think this is a better approach and I would have preferred
to see it made a permanent feature of this bill, rather than expiring
at the end of 2 years. Nonetheless, the discount drug card provisions
of H.R. 1 do incorporate many of the ideas that my colleagues and I
advocated. It would be my hope that Congress will see the wisdom of
extending the drug card program.
I am troubled by the present fallback provisions, by the extent of
the subsidies permitted under the bill, and by the uncertainty as to
whether Medicare will be adequately reimbursing physicians for
providing care to patients needing injectable drugs. I am also
concerned that this bill still does not effectively keep the costs in-
line with the ability of the taxpayers to fund the benefits.
Nonetheless, the bill, on the whole, is more positive and I am fully
aware that Congress will have to tackle difficult issues down the road,
however, I will support H.R. 1, to add a prescription drug benefit to
Medicare and create long-term solutions to solve access, choice, and
solvency of Medicare when baby boomers become seniors.
Mr. BEREUTER. Mr. Speaker, this Member wishes to add his support for
the Medicare conference report and would like to commend the
distinguished Chairman of the House Ways and Means Committee (Mr.
Thomas); the distinguished Chairman of the House Energy and Commerce
Committee (Mr. Tauzin); and the other Medicare conferees for their
leadership, expertise, and good efforts on this comprehensive Medicare
reform package. This Member would especially like to thank the
distinguished gentleman from California (Mr. Thomas) and his staff for
the time he spent briefing this Member on the rural health provisions
as Medicare conference negotiations were taking place and for his work
to bring greater equity to the rural health care delivery system.
This measure may well be one of the most complex and important bills
that this Member has ever had to consider during his tenure in
Congress. Although the conference report lacks immediate controls on
the high cost of pharmaceuticals--the market-oriented and pro-
competition cost-containment provisions provided for the existing
Medicare program are critically important reforms. The conference
report makes Health Savings Accounts available for the first time ever
to all Americans, and includes the undoubtedly controversial, but
necessary means-testing of Part B premiums on a sliding scale,
beginning at $80,000 (for singles). The rural health care reforms are
also exceedingly important for millions of Americans. The conference
report is certainly not perfect, for the prescription drug benefits may
be both unaffordable and a huge disappointment to the intended
beneficiaries. Yet, the Medicare reform and greater Medicare equity for
citizens of rural and non-metropolitan areas make this conference
report on H.R. 1 worthy of an ``aye'' vote. Congress will have ample
time and opportunity to address concerns, enhance, revise, and improve
upon this historic legislation.
Until this year, there has been nothing but gridlock and delay in
terms of how to reform the Medicare program. The Medicare conferees
worked long and diligently to develop the Medicare reform agreement
before us today. We cannot afford to let this prospect of Medicare
reforms slip away.
Mr. Speaker, the rising cost of prescription drugs has become an
issue that simply must be addressed. Senior citizens in Nebraska and
throughout the United States should not have to compromise their
quality of life or their health because the cost of their prescriptions
is more than their income allows. Without an end to the ever higher
prescription drug cost--the product largely of huge international cost-
shifting onto the backs of American consumers--the prescription drug
benefits we are adding will cost more than the $400 billion allocated--
it will quickly be too expensive for our Nation to bear, even with
Federal taxpayer funds. Therefore, this Member is very concerned that
the measure lacks immediate restraints on the high cost of
pharmaceuticals.
This Member is extraordinarily disappointed, but not surprised, with
the intentionally unimplementable reimportation language included in
the conference report. Drug re-importation from Canada was not the best
approach to meeting the problem of escalating drug costs and it could
be only an interim approach, but it is the only tool now available. The
provisions of the bill allow for the importation of drugs from Canada,
but the measure contains language in which the Department of Health and
Human Services can say it cannot responsibly or legally implement the
provision, as it has done on two previous congressional efforts. This
language is the ``poison pill,'' and it is wholly unsatisfactory.
Mr. Speaker, it is additionally important that the conference
agreement authorizes $50 million for fiscal year 2004 for the Agency
for Healthcare Research and Quality (AHRQ) to conduct research on
health care outcomes, comparative clinical effectiveness, and
appropriateness of health care items and services--including
prescription drugs. This Member has been a strong advocate for such
research, as evidenced by his amendment to the Labor, Health and Human
Services, and Education appropriations bill (H.R. 2660).
Americans deserve the best health care for their dollar. Clinicians,
patients, and those financing health care services need credible,
objective information on the benefits, risks, and costs of prescription
drugs so that they can make informed decisions about the prescriptions
they consume and prescribe. Consumers need information regarding the
effectiveness, quality, and cost-effectiveness of new drugs, in
comparison with existing alternatives, especially when new drugs can
cost much more than those now on the market. This Member is pleased
that the conference report language authorizes the AHRQ to conduct such
research and that comparative clinical effectiveness is referenced but
is concerned that cost-effectiveness is also not mentioned.
Mr. Speaker, in addition to adding a long overdue prescription drug
benefit to the Medicare program, the conference report provides for
robust reform of the rural health care delivery system. It is the best
bill ever for the health care of citizens living in rural and non-
metropolitan areas; it moves them to a more equitable position with
respect to their urban counterparts.
This Member is extremely pleased that the Medicare conference report
includes a substantial amount of funding specifically for rural areas
and small communities. As the Interim Co-Chair of the House Rural
Health Care Coalition, this Member has been working diligently to
address rural health care issues and the needs of those individuals who
practice, work, and live in rural areas. This conference report
includes funding that is dedicated to assisting community hospitals,
outpatient facilities, home health agencies, skilled nursing
facilities, ambulance service providers, rural physicians, and other
skilled health professionals. Such funding is crucial for cash-strapped
rural facilities which are near a breaking point and in need of urgent
aid.
This Member is especially pleased that the Medicare conference report
includes language to address the significant differential in Medicare
reimbursement levels to urban and rural skilled health care
professionals. For the past 2 years, this Member has introduced the
Rural Equity Payment Index Reform Act to assure that physician work is
valued, irrespective of the geographic location of the physician. The
Medicare conference report establishes a 1.0 floor on the Medicare
physician work adjuster from 2004 to 2006, thereby raising all
localities with a work adjuster below 1.0 to that level. This is a huge
victory for this Member, my very able legislative assistant, Ms.
Michelle Spence, for Nebraska, and for all Medicare localities with a
physician work adjuster below 1.0.
Several other provisions are included in the Medicare conference
report to assist rural areas physicians and other skilled health
professionals. For example, the measure protects senior citizens'
access to physicians by replacing a 4.5 percent across-the-board
physician payment cut--scheduled to take effect on January 1, 2004--
with 2 years of payment increases. Additionally, this Medicare
agreement provides a five percent bonus payment for primary and
speciality care physicians who practice in scarcity areas.
This Member is also pleased that the Medicare conference report
addresses hospital payment disparities to ensure that facilities in
rural areas and small cities can stay in business and continue serving
patients who need care by permanently extending the standardized base
payment. This policy will help maintain access to care in rural and
less populated urban areas of the country by better aligning hospital
payments to actual costs. The estimated impact of eliminating the base
rate differential will result in $26.7 million over 10 years for
Nebraska hospitals in the First Congressional District, according to
the American Hospital Association.
Additionally, the Medicare conference report lowers the labor share
of hospital wage index to 62 percent. This change will increase
inpatient reimbursement for many rural hospitals and will more
accurately reflect the labor costs of many rural facilities. According
to the American Hospital Association, this provision would bring $3.3
million over 10 years to the First Congressional District of Nebraska.
[[Page H12274]]
Several other provisions are included in the Medicare conference
report to address rural hospitals. For example, the agreement increases
disproportionate share hospital payments for small rural and urban
hospitals and increases critical access hospital payments to 101
percent of reasonable costs.
Mr. Speaker, in closing, this Member supports the Medicare conference
report. It finally gives the American people some of the critical
reforms that are essential if the system is to avoid fiscal disaster or
unaffordable burdens on American employers and employees. And, on what
is a gamble, at least until we reduce the huge international
pharmaceutical cost-shifting onto Americans, it will provide senior
citizens with access to prescription drugs when they need them most and
it will greatly improve health care for Americans living in rural
areas.
Mrs. MALONEY. Mr. Speaker, the seniors in my district have made their
views on Medicare clear.
They believe that it should provide the same coverage for
prescription drugs that it does for doctors' appointment and hospital
stays. And they think that they should no longer pay the highest
prescription drug prices in the world.
Unfortunately, however, the bill before us will provide inadequate
benefits that would leave half our seniors paying more out of pocket
for prescription drug coverage than they do now. And it contains a gap
in coverage that will leave half of seniors without any drug coverage
for part of the year.
Just as bad, this bill will impose a global ceiling on the size of
Medicare. If the overall cost of the Medicare program exceeds a pre-
determined cap, Congress will immediately be forced to slash benefits
or hike premiums for those currently on Medicare.
To add insult to injury, this bill will undermine initiatives to cut
the cost of prescription drugs. It would bar by law any effort by the
Secretary of Health and Human Services to try to negotiate with
pharmaceutical companies to lower prescription drug prices.
This bill will undermine and ultimately destroy Medicare as we know
it.
It's not a magic potion. It's a poison pill.
I urge my colleagues to vote ``no.''
Mr. LANGEVIN. Mr. Speaker, I rise today gravely disappointed by, and
opposed to, the Medicare Modernization and Prescription Drug Act of
2003. The 108th Congress has squandered our best opportunity yet to
provide a meaningful prescription drug benefit for our nation's
seniors. I am outraged that the republican leadership has taken
advantage of the public's cry for medication coverage. They have used
the demand to exploit the elderly, funnel money to drug and insurance
companies and privatize Medicare. Sadly, this debate is no longer
simply about a prescription drug benefit. This debate is about the
survival of the health care system that has been serving and protecting
our seniors since 1965.
In a striking divergence from the universal nature of Medicare, the
conference report we are voting on today establishes a system wherein
seniors rely on private, drug-only companies to administer their drug
coverage. Each of these companies will develop their own rules about
premiums, deductibles and what medicines are covered. The standard this
bill sets for the companies only offers 75 percent coverage of the
costs up to $2,250--and no coverage at all until the expenses then
reach $5,100. During that significant gap in coverage, seniors will
still be responsible for paying a $35 monthly premium. Even more
infuriating, that premium will not count toward their out of pocket
expenses, making it take even longer for them to reach the catastrophic
level. The Republican conferees claim to offer help for the poor, and
indeed, premium subsidies are available to individuals earning less
than $6,000 a year or couples earning less than $9,000. But these
vulnerable, low-income seniors must first meet a strict assets test,
where cars, burial plots and even wedding rights will be counted as
assets. Additionally, I remain deeply concerned that the legislation
fails to include a meaningful fallback plan seniors can rely on if
private companies fail to emerge in their area, an all too likely
scenario that it is our duty to protect against.
The prescription drug component of this bill contains a particularly
troubling provision that strictly forbids the Secretary of Health &
Human Services from using the bulk purchasing power of Medicare
beneficiaries to negotiate for lower drug prices for senior citizens--a
tactic that has proven effective in the state programs, as well as 25
other industrialized nations. America's seniors have made it clear that
they want the government to assist them in obtaining their prescription
drugs at a fair price. It infuriates me that that we have over 40
million people with a common and basic, need, yet instead of taking
advantage of that power to secure lower prices for the most rapidly
increasing component of health care, the Federal Government, under the
proposal put forward, would outlaw that practice. This tremendous
missed opportunity makes it clear to me that this bill was written with
the interests of drug companies, not America's seniors, in mind.
The problems with this conference report go far beyond the inadequacy
of the drug benefit. This bill not only fails to meet the needs of
seniors and jeopardizes the retiree coverage used by 12 million
Americans, it also lays a strong foundation for the demise of the
Medicare program as we know it. Beginning in 2010, this agreement will
expose millions of seniors to new cost and benefit uncertainties in as
many as six large metropolitan areas, possibly including my home state
of Rhode Island and neighboring Massachusetts.
This vast demonstration project, which will involve up to 7 million
seniors, will subject Medicare to competition with private companies,
coercing seniors into HMOs and private plans. These private companies
will be given huge financial incentives to offer health coverage for
seniors, funneling critical resources away from Medicare and those who
rely on it. If a senior wishes to stay in the Medicare program, he or
she will be required to pay the difference between the cost of the
private plan and the cost of Medicare--which will, no doubt, skyrocket
as private plans court the healthier seniors out of Medicare, leaving
Medicare the more costly task of providing for a sicker, poorer risk
pool. This plan breaks the fundamental promise of Medicare. It replaces
a guarantee of quality health care with increased premiums, provides a
voucher for health insurance, and leaves seniors and people with
disabilities to fend for themselves in a market where they may not be
able to find a health care plan that meets their needs. Medicare was
created in 1965 because the private industry was unable to provide
adequate health coverage for this population. The virtue of the system
is that it creates a large risk pool. Injecting private competition,
and subsidizing that competition with billions of taxpayer dollars,
will leave the healthiest seniors with the ever-changing and unstable
options of private plans, and will resign those who are not as
fortunate, our most vulnerable population, to an even more uncertain
fate.
Seniors in Rhode Island, and no doubt the rest of the country, will
see through this scheme. My constituents remember the devastating
effect of the abrupt departure of Harvard Pilgrim, an HMO that covered
over 150,000 Rhode Islanders. The scramble to find a health insurance
plan that would allow patients to keep their doctors, and the struggle
to understand new sets of benefits that followed Harvard Pilgrim's exit
from our state would be replicated on a regular basis in the regions
affected by the so-called demonstration project contained in this bill.
I must also touch upon the issue of provider relief. I am a strong
supporter of doctors and hospitals that serve Medicare beneficiaries,
and voted three times this year in favor of striking the premium
support provision from this bill and using that money to update
provider payments instead of subsidizing private companies. The
conferees failed to take this approach, instead providing some
temporary relief to providers for the upcoming year, but no long term
fix to the systemic problem that plagues doctors and hospitals year
after year. Providers are already overburdened by Medicare-related
paperwork and receive lower-than-average reimbursement rates for their
services. Should the premium support provisions in this conference
report become law, providers will be forced to negotiate new terms for
payment annually with every private plan that emerges to serve Medicare
beneficiaries in a region. This bill signs away the rights and
responsibilities Congress currently has to these providers, leaving
decisions about provider payments up to the CEOs of insurance
companies. The high turnover rate of providers in participating
Medicare + Choice plans signals the instability this will cause, for
providers and patients alike.
In this year's debate over Medicare, once again, Congress has lost
sight of what the public has asked for, and what American seniors need.
Our seniors are choosing between paying their rent of buying food and
obtaining the medication they need to stay alive. They need relief from
prescription drug costs. They do not need the additional challenges,
burdens and costs of navigating through a system of HMOs, subjected to
a different plan, a different doctor and higher premiums each year. Our
Medicare providers need a fair payment system over the long term. All
Americans need their government to take action against the soaring cost
of prescription drugs. Given the opportunity to make a difference in
each of these areas, the Republican leadership chose to put their
resources and their trust in the hands of insurance companies and drug
companies. This Is a matter of priorities and principles. I urge my
colleagues to make American seniors our priority, vote no on the
conference report and immediately begin to take meaningful steps to
solve these problems.
Ms. HOOLEY of Oregon. Mr. Speaker, over the last 7 years, Oregon
seniors have told me
[[Page H12275]]
that their top concern is the high cost of prescription drugs coupled
with the lack of coverage for these lifesaving medicines under the
Medicare program.
Regrettably, the bill before us today does nothing to address the
high cost of drugs, and it comes at too high a price for coverage. Many
seniors would lose the expanded coverage they currently have through
their retirement and many others couldn't afford the high premiums,
deductibles and gaps in coverage.
Despite the hard work and good intentions of many members of Congress
on both sides of the aisle, we have lost the forest for the trees.
And so I rise today in opposition to the conference report on H.R. 1.
In August, I sat in the House gallery with some guests as the
reimportation bill came to the floor. We sat with a group of interns
and junior staffers. Along the back wall was a line of representatives
of the pharmaceutical industry. It was an interesting mix.
From that unique vantage point, we watched members on the floor who
were not speaking to represent ``sides of the aisle,'' but who joined
together across the aisle to form the People's House. It was an
interesting perspective on the situation.
You couldn't necessarily tell what anyone's party affiliation was by
the impassioned way they spoke about an issue that cuts across party
lines. The vast majority of us were adamant about fighting for the
people we represent back home who are no longer willing to tolerate the
fact that people in Mexico and Canada can get their drugs for less than
Americans.
That bill passed overwhelmingly, and yet this conference report has
failed to include drug reimportation. It has failed to address the
elephant in the middle of the living room: the high cost of drugs.
Seniors can't afford drugs, and they can't afford high priced
coverage, or loss of coverage they currently enjoy.
Unfortunately, when we were closest to getting agreement on making
medicines more affordable for all of the Nation's seniors, the
pharmaceutical companies, who make the lifesaving drugs that patients
need, killed every attempt to allow Americans to benefit from the same
low drug costs that other countries enjoy.
They also made sure that this legislation specifically prohibits the
Medicare program from negotiating the prices of drugs, a power that
even other government agencies, such as the Department of Veterans'
Affairs, have. Why? Because seniors would finally have the leverage to
lower drug costs for themselves in this country. They would make one
heck of a purchasing pool.
And, when we were closest to getting agreement on improving coverage
for everyone, the conferees failed to adequately protect retirees'
health coverage. Unfortunately, somewhere along the way we forgot that
this isn't just a pharmaceuticals bill, this is a seniors' bill.
We lost sight of what senior's struggle with most . . . drug costs
and the cost of coverage. And believe me, seniors themselves have
noticed that we've lost sight of them.
Take 79-year old Ruth Beale of Portland who was just diagnosed with
Parkinson's disease who writes: ``I still work 3 days a week as a
companion to a 103 year-old. This gives me just enough cash to pay the
$300/month for my prescriptions. Of course that doesn't include the
pain medication for the Parkinson's, my doctor gives me free samples
when she can, though sometimes she runs out.
My Social Security check is barely enough to cover rent, (and I live
in a subsidized senior apartment), food and the $72 per month for my
Medicare HMO premium. Under this plan, I wouldn't get any help for my
drug costs. I really can't afford to pay any more than I do now. So I
guess I'll just keep on working until I can't anymore--I'm going to
give this Parkinson's a run for it's money though.''
And God bless her.
Although Dorothy Patch of Salem has supplemental insurance, she still
pays over $230.00 per month out of pocket for her prescription drugs.
Dorothy is concerned about being pushed out of the coverage.
Dorothy figures that she would actually pay more for her coverage if
this legislation passes. Why?
1. Only 75 percent of her drugs would be covered up to $2,250 per
year.
2. From $2,250 to $5,100 Dorothy would fall into the ``donut hole''
and not receive any coverage at all, while she is still responsible for
paying a $250.00 deductible and $35.00 monthly premiums.
3. Even though under her current plan, Dorothy is paying $230.00 per
month, there is no donut hole in her coverage and she is covered no
matter how high her drug costs become per year.
4. She is using a fee for service system and does not want to be
forced into an HMO.
The truth of the matter is that people who currently have no coverage
would gain a little at a very high price, a cost that many who have
contacted me say they cannot afford. For many in the district I
represent, this legislation is a step backwards. For others, it is a
sore disappointment that we were unable to slay the giant and make
reasonably priced medicines within their grasp.
At the beginning and in the end, for me, this issue has always been
about the high cost of drugs and the need to affordably expand
coverage. Regrettably, this bill prohibits ways to lower drug costs for
American seniors and, for many, the coverage provided in the bill comes
at a high price they simply cannot pay.
I urge my colleagues to reject this bill, go back to the negotiating
table and give seniors what they really need: affordable drugs and
affordable drug coverage.
Mr. MATSUI. Mr. Speaker, I rise to express my strong opposition to
the Medicare conference report before us today. It shortchanges seniors
who have waited far too long for a comprehensive, affordable
prescription drug benefit and it undermines the Medicare coverage they
have counted on for almost four decades.
First, the drug benefit in this bill is woefully inadequate. Seniors
will have to pay a $250 deductible before they receive any benefit, and
there is a significant gap in coverage, or ``donut hole'', where
seniors will continue to pay monthly premiums but receive no assistance
towards the cost of their drugs. In fact, a senior with $5,100 in
annual drug costs would pay $4,020 of that cost out of their own
pocket.
The fact that seniors have to pay 80 percent of their first $5,100 in
drug costs is appalling. But, it doesn't stop there. This bill does
nothing to lower drug prices. To the contrary, it explicitly prohibits
the government from using the collective purchasing power of more than
40 million seniors to negotiate lower drug prices. So, not only does
this bill make seniors pay 80 percent of their first $5,100 in drug
costs, it prevents the use of reasonable tools to bring those costs
down.
Now, let me address for a moment the 12 million retirees who already
have health insurance from their former employers. The Congressional
Budget Office estimates that this bill will cause 2.7 million of them
to lose their existing coverage. This happens because the bill excludes
employer contributions from counting towards the prescription drug
catastrophic cap. This will incentivize employers to reduce their
coverage to the level in this bill or drop it altogether to avoid
having to pay the cost of prescription drugs in the donut hole.
Finally, this bill undermines the fundamental commitment of Medicare
to seniors. Beginning in 2010, Medicare will be forced to compete with
private companies for the provision of all Medicare and prescription
drug benefits. Often referred to as ``premium support'' or
``privatization'', this provision shifts Medicare from the guaranteed,
defined-benefit program it currently is to a defined contribution plan.
Under this legislation, privatization is aided by almost $20 billion in
subsidies to insurance companies and HMO's, creating a competitive
advantage that allows them to attract healthier seniors, leaving sicker
or chronically ill seniors in Medicare. The result will be a Medicare
program that is unaffordable for the seniors who need it the most.
Mr. Speaker, as we consider the merits of this legislation, it is
critical to look at the history of health coverage for seniors in this
country. Medicare was created in 1965 because seniors were unable to
find health insurance in the private marketplace. The bill before the
Congress today would return us to that very same scenario and I urge my
colleagues to vote against it.
Mr. CASTLE. Mr. Speaker, I rise today in support of the Medicare
Prescription Drug Conference Report, and thank all the Conferees for
their dedication to providing relief for our seniors. This landmark
legislation updates Medicare and finally brings the program into the
21st Century by modernizing the program and providing a prescription
drug benefit. While not perfect, this bill presents us with an historic
opportunity of providing 40 million Medicare beneficiaries with relief
in the face of rising prescription drug costs. Every member of this
body has identified health care reform as a top priority and now we
have the opportunity to make progress. The reality is clear--every year
we postpone this debate and fail to compromise on a Medicare and
prescription drug bill, while the burden of drug costs on seniors
continues to increase.
In 1965 when the Medicare program first began, the average senior's
spending for prescription drugs was $65 a year. In 2002, overall
spending had risen to $2,149--a 35-fold increase. The average retail
prescription price increased more than three times the rate of
inflation from 1998 to 2000. Over 60 percent of seniors spend more than
1,000 per year on prescription drugs and of those seniors, 17 percent
spend more than $5,000. And with 80 percent of retirees using a
prescription drug every day, the expense for many is out of reach.
These statistics clearly show the transition of patients relying mostly
on hospitals and
[[Page H12276]]
physician for their health care needs to patients relying more on
prescription drugs as measures for health treatment and prevention.
The bill aims to make prescription drugs more affordable and more
accessible by creating a voluntary prescription drug benefit. For the
first time, since the creation of the Medicare Program, seniors, no
matter where they live, will be able to receive financial assistance to
help pay for these drugs, which are becoming increasingly integral to
disease prevention, management and treatment. Seniors can keep whatever
drug coverage they have now, choose a private plan or stay in the
traditional Medicare program.
Once the benefits is in place, Medicare will pay 75 percent of
seniors' drug costs up to $2,250 per year, with a $250 deductible and a
monthly premium of $35. With the CBO estimate indicating that the
average senior will spend $1,891 on drugs in 2006, I think most seniors
will find this to be a strong improvement. Importantly, this
legislation provides the most generous benefit to the lowest income
seniors. These seniors do not pay a premium, nor do they have a
deductible and there will not be gaps in coverage for the drug benefit.
This bill also takes strong steps towards preparing Medicare for
future challenges, such as being equipped to meet the needs of retiring
baby boomers. We offer new preventatives measures including an initial
physical and certain preventative benefits such as diabetes and
cholestrol screening as well as chronic care disease management. These
common sense reforms are long over due--who can believe that Medicare
was not covering an initial physical for our seniors? Encouraging
beneficiaries to participate in preventive and early detection programs
can not only improve their immediate health, but has potential to save
billions in future healthcare costs.
Another key component of this legislation are incentives for
employers to retain and enhance retiree coverage. During the debate in
both the House and Senate a significant amount of time focused on
employer-based coverage. With increasing costs of health care as a
whole, it is logical that employers are looking for a way to reduce
their overhead. Most likely, retirees who tend to be more costly than
younger, healthier workers, are targeted for cost cutting measures.
These are concerns that provisions would be included in this
legislation to allow employers to drop coverage based on age, but
fortunately, due to the work of many, that did not happen.
One-third of all Medicare beneficiaries currently have prescription
drug coverage through their former employers. Retirees want to keep
that coverage and frankly, I believe they should be able to make that
choice for themselves. This legislation provides a percentage subsidy
to employers who maintain coverage for their retirees, which also saves
Medicare money. Specifically the legislation will provide a federal
subsidy to employers equal to 28 percent of drug spending by their
retirees between $250 and $5,000. This applies not only to private
companies, but also to state governments, and unions, like teachers
unions, which often have very generous retiree packages. Of course,
this is not a fail-safe solution. The higher costs associated with
retiree health care coverage is an expensive matter for most
corporations, unions and other providers. But, we hope that these
incentives will help curtail the problem.
Importantly, this legislation also contains numerous provisions
intended to speed the entry of generic drugs into the market by
preventing multiple 30-month stays by brand drugs and incentives for
generic manufacturers to challenge weak or inappropriately listed
patents. Generic drugs often provide consumers with a low cost
alternative and I hope that the medical community will continue to make
efforts to inform patients about the availability of generic drug
options.
We also address the reoccurring problem of physician fee cuts by
increasing reimbursements by 1.5 percent instead of earlier proposals
to cut them by 4.5 percent. I have spoken to a lot of doctors in
Delaware who said these cuts were likely to put them out of business.
With the rising cost of malpractice premiums compounded by cuts in
reimbursements, some physicians may have already been forced to close
their doors, which clearly impacts all of us. However, this is only a
temporary fix. We must now move forward to fix this physician fee
formula that was laid out in the Balanced Budget Act so doctors are not
strung along year in and year out worrying about this potential cut. I
hope to work with my colleagues to ensure this formula is fixed in the
coming years.
This legislation is not perfect and no one here today will tell you
that it is. One of the major issues missing from this bill is a good
faith provision allowing the reimportation of prescription drugs.
Despite the overwhelming support in the House for true reimportation,
this bill simply encourages the status quo by requiring the Secretary
of Health and Human Services to certify the safety of these drugs
coming from Canada. Essentially this is the current law of the land,
yet we do not see pharmacists and wholesalers importing drugs from
Canada and passing those savings on to consumers. Seniors will be
forced to continue the bus trips to Canada and mayors and governors
will continue to negotiate agreements with Canada, until we truly
address our prescription drug costs. This bill does include a study to
research the major safety and trade issues regarding reimportation, and
I hope it will be conducted in good faith and in a timely manner so we
can return to this important discussion.
I also have serious concerns about premium support and forcing
Medicare to directly compete with private insurance plans because I
believe it can lead to higher costs for those seniors who choose to
stay in Medicare. While I believe the demonstration language in this
legislation is far less disconcerting than a full premium support
provision, I will continue to monitor this closely. In the end, we
cannot undermine the basic tenets of the Medicare program, which has a
history of providing an equal benefit no matter where seniors live.
Varying premiums within and among states is surely not the message we
want to send our seniors. Hopefully this demonstration program will
yield positive results that drive costs down--only time will tell. I
will work to ensure that Medicare is viable and that seniors who choose
to stay in Medicare are protected.
I commit myself and I hope others will join me, in continuing to
address the rising cost of health care, prescription drugs and the
rising ranks of the uninsured. According to the U.S. Census Bureau, an
estimated 15.2 percent of the population or 43.6 million people were
without health insurance coverage during the entire year of 2002, up
from 14.6 percent in 2001. That is an increase of 2.4 million people.
What's even more disconcerting is the percentage of people who are
employed but lack health care coverage. That number dropped from 62.6
percent to 61.3 percent. However, these are clear and challenging
issues that we must address in the upcoming session.
Despite these and other concerns I have, I am supporting this
legislation because I believe it provides desperately needed relief to
Americans suffering from their overwhelming health care costs. American
seniors have waited long enough for this assistance and I encourage my
colleagues to provide them with the immediate relief in this bill.
Mr. RODRIGUEZ. Mr. Speaker, I rise to express my strong opposition to
the Medicare Prescription Drug Conference Report that we will be forced
to vote on today. This bill has been crafted behind closed doors with
the help of those corporate interests which will most benefit.
Unfortunately, the bill they have created offers nothing more than
empty promises to our Nation's seniors.
Medicare was built on the principle that all seniors should have
access to health care, regardless of how much you make or where you
live. And for over forty years, this program has successfully worked to
provide access to health care, offering hope and security to America's
seniors. As the nature of health care has changed over the years,
however, we recognize there is a need to improve upon the program and
address the prescription drug price crisis.
Seniors that I have met with back home have asked that I fight for a
prescription drug benefit under the traditional Medicare plan and that
is exactly what I have done. Over the years, I have worked to enact
legislation that would establish a guaranteed and affordable
prescription drug benefit for all Medicare beneficiaries.
The industry-backed bill that Congress will vote on today falls far
short of a benefit that will truly fit seniors' needs. While the bill
provides $112 billion to entice managed care companies to participate
in the program, seniors will receive little assistance with their drug
costs. For the first $2,000 of coverage, the consumer will pay over
$1,100; for the first $5,100 of coverage, the consumer will pay
approximately $4,000. Put another way, if a consumer buys approximately
$5,100 of drugs a year, the consumer will pay nearly 80 percent of that
cost.
Despite the $400 billion price tag, millions of retirees and low-
income beneficiaries will find themselves in an even worse situation.
Up to 6.4 million of the poorest and sickest Medicare beneficiaries,
including close to 390,000 Texans, could have drug coverage reduced.
The bill prohibits Medicaid, the nation's low-income health insurance
program, from helping with co-payments or paying for prescription drugs
[[Page H12277]]
not on the formularies of the private insurers administering the new
Medicare benefit. And 2 to 3 million seniors could lose retiree
prescription coverage, including at least 132,000 Texas retirees, due
to a provision that lowers Medicare assistance to employer-sponsored
retiree health plans.
Furthermore, by relying on private companies to deliver a benefit, we
force seniors into the arms of the health insurance industry. We have
learned all too well that private Medicare insurance plans do not work.
In the early 1990s, Medicare HMOs were touted as the way to control
escalating costs, but by the end of the decade, private plans abandoned
thousands of seniors in rural regions. Over the past couple of years,
Medicare+Choice beneficiaries in metro areas have faced dramatic
increases in premiums and co-payments, and reduced benefits. Given that
the Republican Medicare bill does not guarantee a defined premium and
plans will have substantial flexibility to create their drug benefit,
millions of beneficiaries will face the same situation in the years to
come.
Lastly, this bill forces us down a path towards privatization. By
employing measures like the voucher-type premium support system and the
creation of an overall budget cap, we end Medicare as we know it.
Congress established Medicare to rescue seniors from the failure of the
private sector to offer insurance or health coverage. Now we are going
back.
This 600-page measure will produce the biggest change to our safety
net system in over forty years. The crafting of the legislation was
done behind closed doors with the help of special interest groups.
Incredibly, most Members of Congress have had less than twenty-four
hours to pore through the pages and analyze how the bill will truly
impact America's seniors.
I understand there are important provisions in this bill for certain
hospitals and providers such as increased Medicare reimbursement rates
for physicians and an increase in the Medicare DSH cap for rural
hospitals. I have supported similar measures in the past either by
cosponsoring legislation or voting in support of such legislation.
However, there are also provisions in this bill that will hurt
patients tremendously. The Medicare bill still contains drastic cuts to
our nation's cancer care system. Despite several efforts by the cancer
community to reach a compromise, the bill will deprive America's cancer
care system of $1 billion a year. A cut like this will be devastating
to cancer care. If this happens, many cancer centers will close, others
will have to admit fewer patients, and still others will lay off
oncology nurses and other critical support staff.
Mr. Speaker, I urge my colleagues to vote against this bill. I do not
agree with those who say something is better than nothing. I say a bad
bill is worse than no bill at all. This proposal goes against the
fundamental principles of a program created to serve all seniors. Let's
not give America's seniors more bad medicine. Reject the Republican
plan and adopt one that provides real coverage for all seniors.
Mrs. TAUSCHER. Mr. Speaker, ``I strongly believe that seniors deserve
and need a prescription drug benefit that's part of Medicare. I believe
we should strengthen Medicare by adding drug coverage that will save
seniors money and preserve the choices that matter. I will vote against
this bill because it does not get us where we need to be.
``This legislation prohibits Medicare from negotiating lower drug
prices; gives big drug and insurance companies $82 billion in subsidies
just to compete with Medicare; and will privatize Medicare by pushing
seniors into HMOs.
``I introduced a bill that would have provided immediate, real drug
discounts to all seniors without turning over part of Medicare to HMOs.
Unfortunately, it was not brought to a vote.
``There are many serious problems with the bill being debated today
that people are trying to sweep under the rug. Up to a quarter of
seniors on Medicare would pay more for prescriptions than they do now.
Up to seven million seniors would pay higher Medicare premiums unless
they join an HMO and give up their choice of doctor. Two to three
million retirees would lose the drug coverage provided by their former
employers. Millions of seniors would go without drug coverage for parts
of every year, even though they would be charged premiums year-around.
Seniors would be prohibited from purchasing American-made drugs from
Canada at lower prices. After they have spent $1,169 on prescription
drugs, seniors will have to pay their full drug costs until they reach
$3,600 in drug expenditures.
``I am deeply suspicious that this bill, written almost entirely by
Republicans, put the special interests of HMOs and pharmaceutical
companies over seniors' interests. It will give $82 billion to private
insurance companies so they can compete with Medicare, yet Medicare
will be forbidden from negotiating lower drug prices with drug
companies and competing in the same way. Even AARP has a financial
stake in this bill. The company derives almost 60% of its annual
revenue from selling insurance products. If they capture even 10% of
the prescription drug market, their profits would be $1.5 billion.
``As a former investment banker, I know risk management. The magic of
Medicare is that everyone has always been in the pool--the wealthy and
healthy as well as sick and lower-income seniors. This bill will turn
that on its head--driving the healthy and wealthy out of Medicare and
creating large tidal pools in which sick and lower-income people are
left without anything.
``It is a bad bill that will hurt millions of seniors and not really
benefit anyone but the drug and insurance companies. I will vote
against it, and I encourage all of my colleagues to stand up for
seniors and do the same.''
Mr. HOLT. Mr. Speaker, I rise in opposition to this legislation.
As my constituents in central New Jersey know, I have been working
ever since I came to Congress to provide Medicare beneficiaries with
coverage for the prescription drugs that improve their quality of life
and often save or extend lives. Today we are considering a bill that
purports to provide such coverage, but unfortunately fails on several
counts.
I have pledged to the seniors in my district that I will not support
any legislation that undermines Medicare, a program that has succeeded
in providing adequate health care to tens of millions of seniors for
nearly 40 years. That is why I cannot and will not support the proposal
that is before us. We can do much better, and with something this
important, we should not get it wrong.
First and foremost, this legislation would devastate the Medicare
program. It forces several million seniors into private plans and lays
the groundwork for privatizing the traditional fee-for-service program.
In New Jersey alone, an estimated 186,000 seniors will be affected. We
need to strengthen Medicare with a drug benefit, not use prescription
drug coverage as a mechanism for dismantling the entire program. It is
simply not good policy to spend $12 billion of taxpayers' money just to
set up a for-profit competitor to Medicare.
Second, even after the government spends all this money, seniors will
not even get a very good benefit. It is true that any level of
assistance will be of some help to seniors, but the gap in coverage
under this bill will leave most seniors still paying thousands of
dollars out-of-pocket. In fact, seniors with high drug costs must pay
over $4,000 to receive $5,100 worth of medications. For many seniors,
after August or September or whenever their drug bills reach $2,250,
they would get no benefit--even though they would continue to pay their
monthly premiums.
Third, this bill clearly undermines the universal nature of the
Medicare program. Everyone, no matter what his or her income level,
pays Medicare payroll taxes, and everyone is entitled to an equal
benefit. But under this legislation, many low-income seniors would be
subject to an assets test to see if they qualify for low-income
subsidies. I know seniors in my district will be up in arms when they
hear they have to send in bank statements or declare the value of
things they own, potentially even having to sell some to get the
benefit.
This bill is also bad news for the 220,000 seniors who currently
receive prescription drug coverage through New Jersey's highly
successful Prescription Drug Assistance for the Aged and Disabled
(PAAD) program. While the bill will allow the state to receive Medicare
funds for its PAAD spending, it also means that seniors will not
receive their prescription drugs in the same simple, reliable way they
did under PAAD. Seniors may find themselves limited to a list of
approved drugs and face other restrictions not imposed by PAAD.
The bill also fails our physicians and other health care providers.
While it purports to solve the problem of insufficient reimbursements,
it actually offers little more than a Band-Aid. Two years of a 1.5
percent increase will provide some small measure of relief, but
Congress must still address the long-term problems inherent in the
current physician payment system.
Health care providers should also be alarmed by the provision that
triggers an automatic congressional procedure once general revenues
make up an arbitrary proportion of Medicare spending. This means that a
few years down the road, providers may find themselves facing
drastically insufficient reimbursement levels, and seniors will find
themselves with fewer benefits and fewer doctors willing to accept
Medicare patients. One editorial writer noted that the spending trigger
would sound an alarm if Medicare spending exceeds certain levels, but
the bill itself does almost nothing to control spending.
This bill fails our seniors, and unfortunately, it will fail the test
of history. We have a historic opportunity to craft a bill that
genuinely helps seniors afford the medicine they need. Sadly, the
Republican leadership has decided to write a bill that privatizes
Medicare, moves
[[Page H12278]]
seniors into managed care plans, leaves gaping holes in coverage, and
puts current retirees' benefits in jeopardy. I will not support such a
plan.
I urge the Congress to address this again in January. I firmly
believe we can pass a bipartisan prescription drug benefit that is
universal, voluntary, dependable, and affordable, if we make the
choices that put seniors first.
Mr. SKELTON. Mr. Speaker, there is no truer indication of a nation's
priorities than the investment it makes in the health of its citizens,
particularly our senior citizens. Medicare was created nearly 40 years
ago with a basic fundamental principle in mind: health care coverage
should be guaranteed, affordable, and equitable to all seniors.
Throughout the time I have been privileged to serve in Congress, I have
worked to make sure Medicare remains strong for those currently
benefitting from its coverage and for those who will rely upon its
benefits in the years ahead. As a member of the Rural Health Care
Coalition, I was pleased when the administration and congressional
leadership announced earlier this year that providing a prescription
drug program within the reliable Medicare system was a high priority
for the 108th Congress. However, it has become clear throughout the
year that efforts to provide a meaningful prescription drug benefit
within Medicare were being undermined by a systematic attempt to
destroy the Medicare program. I am disappointed that the bill before us
today, H.R. 1, does just that, undermining the very foundation of
Medicare while creating a confusing and inadequate prescription drug
coverage program for rural Missouri's seniors.
As I visit with seniors throughout Missouri's Fourth Congressional
District, it remains clear that they depend on Medicare for their
health care. They understand Medicare and trust it cannot be taken from
them. Medicare is part of a health care contract with the senior
citizens who brought this Nation out of the Depression, fought in our
wars, and paid into the Medicare trust fund so they would have health
coverage when they need it most. Unfortunately, H.R. 1 seeks to destroy
the Medicare system on which these Americans have depended for nearly
40 years. Under this bill, in just six short years, millions of senior
citizens in America could be coerced out of Medicare and into private
insurance plans that generally don't do business in rural America.
While the drafters of this measure explain that these private plans are
simply a demonstration project and seniors don't have to participate if
they don't want to, once the door is open to privatizing this vital
government program, I am afraid it will not be closed.
It is also troubling that if these so-called demonstration projects
take root around the nation as H.R. 1 prescribes, seniors within
Missouri could be paying very different prices for the exact same
health care benefit. It would create a very confusing situation, where
folks in Versailles could pay more than citizens of Blue Springs or
Lamar for their health care needs. Show-Me State seniors trust Medicare
because they know that everyone participating in this program will pay
the same rate for their health care insurance no matter where they
reside. H.R. 1 undermines this fundamental principle, which could
create even more disparity in the health care coverage of rural
Missourians.
In addition to undercutting Medicare, I am concerned that the
prescription drug portion of H.R. 1 will negatively impact seniors
living in rural Missouri. This measure would require Medicare
beneficiaries who wish to receive the new prescription drug benefit to
enroll in private drug plans which rarely operate in rural America.
These plans would be run by large insurance companies that would likely
charge different premiums for the same prescription drugs. As an added
benefit to large insurance companies, H.R. 1 would provide them with a
$12 billion taxpayer subsidy while creating a $2,800 gap in
prescription drug coverage for seniors. According to an article
published in The Wall Street Journal on November 18, 2003, ``for the
drug industry, the legislation is good news, at least in the short
run.'' This is just plain wrong.
For rural Missourians, H.R. 1 would also impose an assets test on
low-income seniors who earn below 150 percent of the federal poverty
level. Seniors whose income falls within this financial threshold may
be forced to either pay additional prescription drug costs if their
assets--their car, their farm equipment, or their acreage, for
example--total $10,000 per individual or $20,000 per couple, or sell
their possessions to get cheaper pills. Many seniors in rural areas
rely solely on their Social Security checks to get by each month and
they should not be forced to sell their belongings or their property to
qualify for a more comprehensive drug benefit.
While I am dismayed that the leadership of this Congress would work
to dismantle Medicare through this legislation, I am pleased that
conferees were able to address Medicare reimbursement rates for rural
doctors and hospitals. Through the years, I have worked with my
colleagues in the Congressional Rural Caucus to boost reimbursements to
those who provide health care in rural America. In fact, time and time
again on the House floor, I have voted to instruct the conferees
writing the Medicare bill to abandon divisive ideas of privatization in
order to provide more adequate reimbursement to rural providers.
Unfortunately, these motions were defeated each time.
Mr. Speaker, senior citizens throughout Missouri understand and trust
Medicare. They have worked all their lives, paid their taxes, and
contributed to a system that takes care of their health care needs.
Medicare is a contract with our seniors that should not be broken. That
is why I will oppose H.R. 1 and urge all my colleagues to do the same.
In the days ahead, I look forward to working with my colleagues in a
bipartisan manner to provide senior citizens with a real prescription
drug benefit that strengthens Medicare.
Ms. CORRINE BROWN of Florida. Mr. Speaker, today the Republican party
will finally do what it has been trying to do for 35 years, destroy
Medicare.
Claude Pepper, my mentor on health care issues, the most well known
advocate for seniors, a man who fought for years and years to
strengthen Medicare and Social Security, would be rolling in his grave
if he were here today.
This is a life and death issue for many of our senior citizens, and
this hollow bill does nothing for them.
A snake is a snake, no matter what color it is. And AARP is getting
into bed with a snake, the Republican party, in supporting this bill.
To the AARP leadership, I have some sage advice that my Grandmother
used to tell me: ``Those who sleep with dogs, wake up with fleas''.
Each provision in this bill is one more nail in the coffin of a
program that has guaranteed health care for this Nation's seniors for
38 years. Under the Republican plan, HMO's that offer an alternative to
Medicare will pick and choose their customers, and get paid more than
Medicare to do it. And yes folks, these are the same Plus Choice
providers that are fleeing your districts in droves, and leaving your
seniors with absolutely no healthcare options.
Even more disturbing is the fact that this bill prohibits, yes,
prohibits, Medicare from using its bargaining power to cut drug prices.
What happened in the 2000 election is a U.S.A. coup d'etat. This is
what happens when you don't have fair elections. Folks, it matters who
is in the White House. This is entirely a Republican initiative, and
their goal is to destroy Social Security and Medicare entirely. Their
goals is not to modernize it, but to have it wither on the vine.
Mr. STRICKLAND. Mr. Speaker, today, this Congress is missing a golden
opportunity to pass a real prescription drug benefit for all seniors.
During the Energy and Commerce Committee's consideration of the
prescription drug bill this summer, my colleagues and I offered many
amendments that would have improved this bill to ensure that all
seniors, regardless of where they live, have access to an adequate,
affordable, reliable prescription drug benefit. But my Republican
colleagues defeated our amendments and pushed through a partisan bill
that will do little to give meaningful help to the middle income
seniors who most need a prescription drug benefit.
In other words, Congress is passing up an opportunity to ensure that
the retired, 68-year-old steelworker who had a heart surgery last
spring and lost his retiree health insurance this summer, and who,
along with his wife, has an annual income of about $28,000 can afford
the prescription drugs they need to stay healthy. This bill does not
even ensure that a person under these circumstances can access
affordable prescription drugs from Canada or elsewhere in the world.
For shame that we are passing up such an opportunity to do the right
thing by our seniors.
The AARP says that the prescription drug bill we are considering
today is better than nothing, that it's one foot in the door. I
disagree. The voucher demonstration program in the bill lays dangerous
groundwork for a privatization scheme that I believe will undermine
Medicare's ability to provide a guarantee of health security for all
Americans when they turn 65. In addition, the drug benefit created by
this bill will force many seniors to private insurance plans for their
drug benefit. My colleagues who support this bill say that seniors want
``choice'' and that the private plans will give them the choice they
want. Well, the seniors I talk to want choice, but not choice of a
private plan. Instead, they want choice of their doctor, pharmacist,
and hospital; they want the ability to choose their treatment plan when
they are sick and the choice to access preventive services to keep them
as healthy as possible. If seniors in my district have the choice of a
private plan, the Medicare safety net as we know it today is no longer
there. This is especially true since the bill we are considering
tonight doesn't require these private plans to offer a standard
premium, deductible,
[[Page H12279]]
or copayment--in fact, where these private plans have been tried,
monthly premiums have ranged as high as $85 a month, not the $35
promised by proponents of this bill. I cannot overstate this: the bill
we are voting on does not mandate a $35 premium.
Additionally, this bill includes a $12 billion slush fund to bribe
private HMOs to participate in Medicare. This $12 billion is in
addition to about $8 billion in huge overpayments to private plans. I
believe that the billions we are spending in this bill in payments to
private plans are simply to support an ideology of privatization that
seeks eventually to destroy Medicare. This ideology is needless when
you consider that traditional Medicare has both a strong track record
with seniors and the amazingly low administrative overhead cost of only
2 to 3 percent.
It is for all of these reasons that I cannot support this bill.
However, it does include some good provisions that I wish I could vote
for today. I wholeheartedly support the physician and hospital
provisions, particularly for rural providers. For the last 2 years,
doctors have faced significant scheduled cuts in their Medicare
reimbursements, leading some to stop-taking new Medicare patients or
drop out of the program altogether. Especially in the current
environment of high malpractice rates, rising medical school costs and
medical school debt, rising overhall health care costs, and a growing
Medicare population, it is unacceptable for Congress to ask doctors to
continue providing the same care for less money. And our rural
hospitals are struggling to maintain their ability to serve as our
health care safety net for the uninsured. Seniors depend on a strong
network of physicians and hospitals to provide care; each time a
physician decides he or she cannot afford to take new Medicare
patients, seniors are forced to look elsewhere to find care. This is
particularly troubling in rural areas, where there are fewer physicians
and where it may be more difficult to travel to a doctor's office.
I realize how important these provider provisions are, and I would
say to the doctors and hospital advocates who are asking me to vote yes
tonight that it is unfair to hold their needed reimbursement increases
hostage in a bill that includes so many controversial provisions. We
can and should pass a provider reimbursement bill apart from this
Medicare package. In fact, I hope that we can defeat this Medicare bill
and immediately pass these provider increases in a stand alone bill
before we leave this session.
In closing, I reiterate my support for adding a strong, adequate
prescription drug benefit to Medicare. Seniors need such a benefit and
Medicare is not a complete health insurance program without it. But the
benefit before us tonight does more harm than good, particularly in the
long term. I urge my colleagues to vote no.
Mr. SERRANO. Mr. Speaker, I rise in strong opposition to the
conference report on H.R. 1, the Republicans' Medicare ``reform'' bill.
On procedure and on substance, the legislation is deeply flawed and the
best course now would be to start all over and work toward a bipartisan
package that truly provides benefits to our elderly and disabled
Medicare participants.
Others have eloquently expressed the reasons to oppose this
legislation, so I will not take much time to repeat what has been said.
But I will quickly mention the major flaws.
This enterprise was meant to help seniors and the disabled get the
prescriptions they need at affordable prices, but that's certainly not
where it is ending up. This bill both increases the burden on seniors
and lays the groundwork for taking Medicare apart altogether.
Coverage is limited and complicated, and there is a huge ``donut
hole'' in coverage that, when combined with premiums, deductibles and
copayments, can leave seniors paying up to $4,000 of the first $5,000
of prescription expenses as well as paying premiums but receiving no
benefits for part of the year. Worse, dual eligibles, the Medicare
beneficiaries who are poor enough also to be eligible for Medicaid,
will end up worse off under an all-Medicare regime.
Drug prices in this country are high and rising fast, keeping even
seniors with drug coverage through their employers facing difficult
choices between medicines and other necessities. But the bill before us
explicitly prohibits the Federal government from negotiating lower
prices for Medicare beneficiaries. It also ignores the will of most
Members of Congress who support reimportation of prescription drugs
from Canada and other select countries. What a windfall for the
pharmaceutical companies!
Millions of retirees who now have coverage through their former
employers may end up without it when the bill's incentives cause
employers to drop retiree health benefits.
The premium support demonstrations present insurers with the
opportunity to cherry-pick healthier, wealthier beneficiaries, leaving
Medicare covering the high-cost sicker and poorer elderly and disabled,
which would force fewer beneficiaries to pay higher premiums until
Medicare became unaffordable and unsustainable.
There are many other reasons to oppose this conference report. Let me
just note that it does not include the Senate provision to remove the
5-year bar on federal health benefits for legal immigrant children and
pregnant women.
The Republicans have not been shy about announcing their intention to
dismantle the Medicare program, and this bill is a major step down that
path.
Mr. Speaker, this is a profoundly bad bill that should go back to the
drawing board. As the National Committee to Preserve Social Security
and Medicare wrote to Members yesterday ``. . . a bad bill is worse
than no bill at all''.
Mr. Speaker, I urge my colleagues to vote ``no.''
Mr. MORAN of Virginia. Mr. Speaker, I rise in opposition to the
Medicare prescription drug benefit conference report that the House is
scheduled to consider today.
I want to make it clear that I strongly support a Medicare
prescription drug benefit for our nation's seniors and am supportive of
a universal, affordable, voluntary and guaranteed Medicare prescription
benefit for all.
Unarguably, the enactment of the Medicare program in 1965 was one of
the wisest things Congress has ever done. At that time, there were very
few prescription drugs with wide applicability, and that is why
Medicare did not cover prescription drugs.
In large part, because of Medicare and Social Security, we have
raised the life expectancy of our citizens, lifted millions of
Americans out of poverty, and vastly increased the quality of life for
our nation's senior citizens.
Unfortunately, this conference report does not reflect the vision and
ideals of Medicare set forth by President Johnson and Congress, and
will, if passed and signed into law, harm the 57,000 seniors that
reside in my congressional district and millions of other seniors in
America.
It had been my hope that any expansion of the Medicare program to
include a prescription drug benefit would be above partisan politics.
We have all heard first-hand from seniors how the high prices of their
prescription drugs negatively impact their already limited incomes.
This issue which cuts across political lines should be about what's
in the collective interest of our nation's seniors.
Unfortunately, this debate on one of the most important domestic
issues, which not only affects today's seniors, but future generations
as well, did not rise above partisan politics or enhance our democratic
process.
In a decade, 10,000 people a day will turn 65 years old and with the
retirement of the Baby Boom generation, America's senior population
will almost double.
This conference report provides a weak prescription drug benefit for
all seniors--regardless of income, and will change the Medicare program
as we currently know it, by overpaying private insurance companies to
administer this drug benefit, while giving them great latitude in
setting premiums, deductibles, and pharmacy choice with little
oversight through a premium support system.
One of the reasons why I voted against the House version of the
Medicare Prescription Drug and Modernization Act of 2003 (H.R. 1) was
that Medicare beneficiaries would pay 20% of their drug costs up to
$2,000 and 100% of drug costs from $2,000 to $3,500, while still
subjecting them to monthly premiums that would result in a gap of
prescription drug coverage for most beneficiaries.
The coverage gap that exists in this conference report is even worse.
Seniors will pay 100% of costs between $2,250 and $5,100--a gap of
$2,800 which will be increased to over $5,000 by the year 2013.
I also cannot support a conference report that does nothing to
alleviate the high costs of drugs imposed on seniors. This conference
report actually prohibits the Secretary of the Health and Human
Services from negotiating lower drug prices with the bargaining clout
of the 40 million Medicare beneficiaries as well as the importation of
drugs from countries where drug prices are lower, except Canada and
only if they are certified by the Food and Drug Administration.
While I am pleased that this Congress has finally addressed the issue
of reimbursement rates for doctors, hospitals, and other important
health providers, I am discouraged that this conference report is still
a bad deal for our seniors, and the endorsement of this legislation by
the AARP, comes into question. The AARP is not recognizing its
membership's need and desire for a true Medicare prescription drug
benefit without the heavy reliance on the private health insurance
industry.
It is with great sadness that I will have to vote no on this
conference report. My constituents want a legitimate Medicare
prescription drug benefit, lower drug prices and better Medicare
services.
This conference report undermines the Medicare system, and I am
afraid, will do
[[Page H12280]]
more harm in the long run than good in the short term for our seniors.
Mr. ETHERIDGE. Mr. Speaker, I rise in opposition to H.R. 1. As the
Representative of North Carolina's 2nd District, I know firsthand how
hard our older people have to struggle to pay for their prescription
medicines. Since I began my service in the people's House in 1997, I
have worked to create a prescription medicine benefit for our seniors.
Seniors deserve a guaranteed Medicare prescription medicine benefit,
not empty promises. I have consistently supported a prescription
medicine benefit plan that features low, predictable premiums and
allows seniors to obtain medicine from any doctor they choose. And I
want seniors to be able to get their medicine from the local pharmacy,
not some huge mail order company.
I oppose H.R. 1 because it does not deliver on its promises. This
bill will force 73,000 Medicare beneficiaries in North Carolina to lose
their retiree health benefits entirely and leave thousands more with
significantly reduced benefits. According to the nonpartisan
Congressional Research Service of the Library of Congress, this bill
will force 222,800 Medicaid beneficiaries in North Carolina to pay more
for the prescription medicines they need. Under this bill 99,500 fewer
seniors in North Carolina will qualify for low-income protections than
under the Senate bill because of the assets test and lower qualifying
income levels. This provision will hit particularly hard the many
farmers in North Carolina whose farm equipment and land are considered
financial assets even if the farmers' income is below the poverty line.
Also according to CRS, under this bill, 37,920 Medicare beneficiaries
in North Carolina will pay more for Part B premiums because of income
relating. And according to the CMS Actuary Tables, the premium
variation under the bill's premium support program would range form
$1,225 in some parts of North Carolina to $675 in other areas of the
state. The bill contains a huge hole in coverage which will result in
no benefit at all for seniors with prescription costs between $2,200
and $5,044.
I oppose H.R. 1 because this bill will have devastating economic
consequences because the $400 billion price tag will be added directly
to our massive national debt of $6.8 trillion. A few short years ago,
we had achieved surpluses as far as the eye could see and were on pace
to erase the national debt. But this Administration's tax policies have
produced record budget deficits that will be compounded by the
conference report on H.R. 1. Deficits matter for our current economy
because in creased borrowing means the government has to spend more and
more tax money on interest costs and will have less available for other
important priorities. ``For example, even before this bill passage,
this year the federal government will pay $156 billion for interest on
the national debt. That is three times what the federal government will
spend on education. When I asked a White House representative where the
money will come from to pay for this bill, I was told that it is ``new
money.'' This is not new money. These are borrowed funds that will be
paid for by our grandchildren and their grandchildren.
Mr. Speaker, prior to holding elected office, I spent nearly twenty
years as a small businessman. There can be no doubt that I strangely
support the private sector. But there are some things the private
sector does well and some things the private sector does not do well.
Medicare was created because the private sector by itself does not do
well at the important priority of providing a strong public health
system for older Americans. This bill is a $400 billion ticket back to
the days when senior citizens were forced to fend for themselves in the
private health care marketplace. This bill sacrifices Medicare as we
know it, and will cast senior citizens to the mercy of HMOs and force
them to give up their own doctors and pharmacists.
Congress should reject this flawed bill and go back to the drawing
board and get it right once and for all for our seniors. I urge my
colleagues to vote ``no'' on the Republican Medicare Privatization
bill.
Mr. EVANS. Mr. Speaker, this has been a disappointing week in
Washington for seniors around the country. Not only are we voting on a
bill that provides a meager prescription drug benefit through Medicare,
but the once-regarded AARP has apparently put their profit margins
before the health of the seniors by endorsing this Republican
Prescription Drug bill.
There are so many disturbing provisions in this bill that I will only
take the time to mention a couple.
This bill explicitly prohibits the Secretary of Health and Human
Services from negotiating lower drug prices on behalf of America's 40
million Medicare beneficiaries. With my support, the Veterans'
Administration adopted this practice some time ago, and the VA enjoys
the ability to negotiate drug prices for numbers of veterans. This
restriction on the Secretary of Health and Human Services clearly
crimps efforts to keep prices down for seniors.
Another troubling provision is the ``demonstration project'' in this
bill that coerces seniors out of the traditional Medicare program they
know and enjoy to sign on with an HMO. Up to 7 million seniors may be
forced to choose between staying in Medicare and purchasing a likely
expensive drug-only plan from a private insurer or leaving their
trusted doctors to join an HMO or other plan that would provide
Medicare-like benefits including drug coverage. This is hardly a choice
for our nation's greatest generation.
As our healthcare delivery system moves increasingly toward managed
care, many people have expressed concerns about the care they receive
from HMOs. Today it is frighteningly common for insurance companies,
rather than doctors, to make the medical decisions that affect people's
lives. As these concerns are aired, we are ready to throw our seniors
into this lion's den. Until doctors are free to give the best medical
advice based on a patient's need, not an insurance company's bottom
line, our seniors are better served by traditional Medicare. While
others have let HMO reform legislation die away, I still believe that
we need to address these concerns, and they should be addressed before
seniors are coerced into the system.
This debate has been fundamentally changed from one focused on
providing seniors with a solid prescription drug benefit to defending
the integrity of one of America's finest programs, Medicare. I have
been part of the Democratic fight for years to add a meaning drug
benefit for our nation's seniors, but I will not be a part of
destroying a vital program that seniors have trusted for almost 40
years to settle for inadequate drug coverage. I strongly urge my
colleagues to reject this bad bill.
Ms. SOLIS. Mr. Speaker, in 1965, Congress created Medicare and
promised seniors that after a lifetime of working and paying into the
system they would have access to health care coverage during their
retirement years, regardless of where they live, their age or their
income. Thirty-eight years later, instead of honoring our commitment to
affordable, accessible health care for all seniors, Congress is set to
create a prescription drug benefit program that will destroy Medicare
as we know it and turn it over to the unreliable for-profit insurance
industry.
A Medicare prescription drug bill should use the purchasing power of
our nation's seniors to negotiate lower prescription drug costs, just
as we do for veterans now, and it should provide assistance to low-
income seniors who need extra help in their retirement years. Our hard
working seniors and their families expect a high quality, affordable,
universal and guaranteed prescription drug benefit within their trusted
Medicare program.
Unfortunately, the Republican plan dismantles Medicare as we know it
by turning it into a voucher system with private HMOs competing with
the traditional Medicare system. Under this system, seniors who want to
stay with the traditional Medicare system they trust would face
premiums that could vary dramatically across the nation. Premiums for
traditional Medicare in the Los Angeles area could be as much as $1,700
per year--119% more than seniors in other parts of California.
This bill is especially troubling for retirees who have health
benefits through a former employer. I have received dozens of calls and
letters from retirees concerned about the Medicare proposal's impact on
the prescription drug coverage they have through a former employer.
Well, under the Republican bill an estimated 244,860 Medicare
beneficiaries in California will lose their retiree health benefits
because the bill does not sufficiently stem the tide of employers
reducing or dropping their retiree health coverage.
Nearly 6,000 seniors in my district are living below the poverty
level, so I am especially troubled about what this bill will mean for
low-income seniors struggling to pay for the medicines they need. The
bill will increase drug costs for six million elderly and disabled
Medicaid beneficiaries by imposing co-payments on their prescription
drugs and prohibiting Medicaid from filling in the gaps of the new
Medicare benefit. It is shameful that this bill would harm our most
vulnerable seniors.
The supporters of this bill talk about the funding it provides for
disproportionate share hospital (DSH) payments to hospitals that serve
a high number of indigent patients and for improved Medicare payments
to physicians. I have a strong record of supporting DSH funding, which
is critical to protecting California's safety not hospitals. I have
also long supported fixing the flaws in the Medicare physician payment
system in order to help doctors who serve elderly patients, and
recently voted to increase physician payments. It is important to note
that the Democratic Medicare prescription drug proposal would have done
substantially more to help doctors and hospitals than the bill before
us today.
I would like to take a moment to comment on AARP's endorsement of the
bill. AARP
[[Page H12281]]
claims to represent the needs of seniors throughout the country, but I
can tell you that the seniors I represent are upset that AARP has
chosen to endorse this wrong-headed bill that doesn't even meet the
criteria they set back in July. I encourage seniors to continue to
contact their lawmakers and let them know their views on this Medicare
bill.
Let's be clear--the endeavor to make prescription drugs more
accessible for seniors began as a bipartisan effort to modernize
Medicare for our new era. Now it has turned into a fight for the soul
of Medicare. I am tremendously disappointed that my Republican
colleagues have chosen to reward the private insurance companies and
big pharmaceutical industry at the expense of seniors. However, I will
continue my efforts to ensure that seniors have access to the medicines
they need.
Mr. REYES. Mr. Speaker, it is with great regret that I rise in
opposition to the conference report on the Medicare Prescription Drug
and Modernization Act of 2003.
I regret that I must do so, because I have long been a strong
advocate for providing America's senior citizens with an affordable,
comprehensive prescription drug benefit under Medicare. Unfortunately,
however, the bill before us today would harm rather than help the more
than 77,500 Medicare beneficiaries in El Paso County, Texas, which I
represent, and millions of others like them across the country.
For example, instead of a comprehensive, continuous prescription drug
benefit, the bill offers a benefit that has a $2,800 gap in coverage
that will leave about half of Medicare beneficiaries without any
prescription drug coverage for part of the year, even though they will
still be paying monthly premiums. While without coverage, many Medicare
beneficiaries in my district will have to pay the entire cost of their
prescription drugs out of their own pockets, which is the very
circumstance we are supposed to be remedying.
Rather than doing more to help low-income seniors, this bill fails to
ensure that they will receive the prescription drugs they need under
the proposed new program. The bill would, for the first time, prohibit
federal Medicaid funding from being used to pay for drugs not paid for
by Medicare. In Texas alone, it is estimated that 389,400 Medicaid
beneficiaries would pay more for their prescription medications under
the bill. In my congressional district, where approximately one in five
people over age 65 lives below the poverty line, this change could be
devastating.
At the same time, the bill requires states to make large annual
payments to the federal government, offsetting the savings states would
have realized by having the federal government provide drug coverage
for low-income seniors under Medicare. In short, for the first time
ever states will have to fund a federal Medicare benefit, at a time
when my state of Texas and many other states are facing budget
troubles.
Insteaad of expanding re-importation of prescription drugs, with
appropriate safety checks, the bill blocks re-importation. By doing so,
it ensures that Americans will continue to subsidize low drug prices in
other countries, while paying the highest drug prices in the world here
at home.
Rather than empowering Medicare with the authority to use its
purchasing power to negotiate better drug prices, as the Veterans
Administration currently does, the bill specifically prohibits Medicare
from doing so. As a result, the pharmaceutical companies benefit, but
hard-working taxpayer will have to foot the bill for the higher costs.
Perhaps most troubling, the bill puts us on a path toward privatizing
the entire Medicare system, breaking our government's solemn promise to
America's senior citizens to provide guaranteed, quality healthcare
under Medicare. Two generations of seniors have relied on Medicare and
Social Security to ensure their quality of life in their retirement
years. For many poor seniors in my district, these programs are their
only safety net. To jeopardize that safety net would be unconscionable.
This bill, with all its shortcomings, will cost the American people
nearly $400 billion over the next decade. It does include a few
provisions that I strongly support and have voted in favor of
repeatedly--most notably provisions providing increased Medicare
reimbursement rates for healthcare providers and funding to reimburse
local governments and emergency medical providers for providing care to
undocumented immigrants. However, the bill would do such significant
harm to Medicare recipients and the Medicare program that, on balance,
I find that I cannot support the legislation.
Mr. Speaker, I urge my colleagues to oppose this conference report,
so Congress can instead offer America's seniors that kind of Medicare
prescription drug benefit they desperately need and truly deserve.
Mr. BACA. Mr. Speaker, I rise in opposition of the Republican
Conference Report on H.R. 1.
I oppose this Republican plan because it is bad for seniors. It's bad
for California. And it's simply bad for the American people.
There are 40 million seniors across this Nation that need a safe and
reliable healthcare plan that protects them, whether they are sick or
not.
This plan will not help seniors. This is a $400 billion plan that
will privatize care and cost seniors more than they pay now.
This plan is similar to having car insurance that doesn't really
protect you. You're fine as long as you don't get into an accident.
Seniors are only fine under this plan if they don't get sick. But
because of privatization, when a senior gets sick, this plan offers no
guarantee that their premium will stay the same or that their carrier
will continue to cover them.
Under Medicare, seniors at least had a guarantee that they would be
insured. They at least had a guarantee that if they got sick; someone
would be looking out for them.
Under this plan, privatization could force as many as 7 million
seniors into HMO's. Seven million. How is this fixing Medicare? Who is
this guaranteeing that all seniors have coverage?
Our parents and grandparents deserve better. They do not need
privatization. They need to know they are going to be insured.
They need to know that they are going to be protected despite the
cost.
Under this plan, there is a $2,800 gap that will leave millions of
seniors without drug coverage. This plan leaves seniors uninsured for
part of the year despite the fact that they are paying premiums.
Much like car insurance, if you knew your car wasn't going to be
insured for half of the year, you wouldn't drive it.
But we can't do that with our health. Seniors can't say I just won't
get sick. It doesn't work that way.
In my district of San Bernardino, California, we have seniors who
board buses to travel down to Tijuana to purchase life saving
prescription drugs.
Will this plan help the seniors in my district get off that bus?
No. If we pass this bill, seniors will still have to travel to Mexico
to get their prescriptions.
The practice of forcing seniors to go across the border must stop. We
have no way of knowing what our seniors are actually purchasing. This
isn't safe and it isn't fair.
This bill could actually raise the cost of prescription drugs for
over 6 million low-income seniors, and one in six Hispanics. In my home
state of California, almost 900,000 will have to pay more.
Those are the people in my district. Those are the people that are
risking their lives, going across the border, to purchase their
prescriptions. And this bill does nothing to help them.
The Republicans are ignoring what seniors need.
Under this plan, over 3 million low-income seniors are going to be
forced to pass a test before they get help paying for prescription
drugs.
If you are a senior and you simply own a home, a car, or even a
burial plot you could be considered too wealthy to get help with
prescription drugs, under this plan.
If you are a homeowner, you'd better catch the bus for Tijuana
because that is the only way you will be able to afford your
prescription drugs because the Republicans think that you are too
wealthy.
Many seniors in my district have worked hard their entire lives
trying to put food on the table for their families. Many of them have
been fortunate enough to have some health coverage from their
employers.
Under this plan, 3 million retirees could lose that coverage. That
affects over 250,000 seniors alone in California.
This plan leaves the seniors in my district will no option but
privatized healthcare.
Our abuelos, our grandparents, have worked too long and too hard to
be ignored.
They need a prescription drug coverage that preserves traditional
Medicare, helps low-income seniors afford prescription drugs and keeps
retirees in employer sponsored health plans.
It's time to give seniors what they want, what they need, and what
they deserve.
Mr. OSBORNE. Mr. Speaker, I rise in support of H.R. 1, the Medicare
Prescription Drug, Improvement and Modernization Act.
Today, this House will consider landmark legislation to help our
Nation's seniors afford their prescription medications. I am
particularly pleased with the generous assistance this legislation
provides for the low-income seniors in my district.
Those seniors with incomes below 135 percent of poverty (individuals
with incomes under $12,123 and couples under $16,362) will be eligible
for a prescription drug discount card that immediately applies $600
annually toward the purchase of their medicines and covers up to 90
percent of their prescription drug costs. Seniors with incomes between
135 and 150 percent of the federal poverty level ($12,123-$13,470 for
individuals and
[[Page H12282]]
$16,632-$18,180 for couples) could ultimately have 85% of their drug
costs covered.
Beginning in 2006, seniors without coverage would have the option to
join a Medicare plan that requires a $35 monthly premium and would cut
seniors' yearly drug costs roughly in half. For example, a senior
without any drug coverage and monthly drug costs of $200 would save
more than $1,700 each year. Seniors with no drug coverage and monthly
drug costs of $800 would save nearly $5,900 on drug costs each year. In
addition, seniors would be protected against high out-of-pockets costs
with Medicare covering as much as 95% of drug costs over $3,600 each
year.
Mr. Speaker, this legislation also provides a historic opportunity to
help strengthen the rural health care delivery system with billions of
dollars in additional Medicare payments. For far too long, Medicare has
short-changed rural health care providers in my district, which
threatens seniors' access to care. This legislation eliminates many of
the disparities that exist between rural and urban physicians,
hospitals, and other health care providers.
Finally, this bill includes important cost-containment provisions.
These accounting safeguards will alert future Congresses and Presidents
if the expenditures of the entire Medicare program exceed 45 percent of
total Medicare spending so they can address the problem.
This may not be a perfect bill, but it is a good bill, and I urge my
colleagues to support the Medicare conference report.
Mr. KANJORSKI. Mr. Speaker, I rise today to speak about the
conference report on H.R. 1, the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003. While I wholeheartedly
support providing a prescription drug benefit to our Nation's seniors,
I cannot support this bill in its current form because it does more
harm than good.
Since the House of Representatives first began debating the creation
of a prescription drug benefit for Medicare recipients, I have
consistently maintained that this proposal must adhere to four key
principles to garner my support. In my view, we must create a benefit
that is affordable, easy to administer, nationally available, and
comprehensive. I believe that the bill crafted by the conference
committee falls short on all counts.
In addition, there are many other provisions folded into this bill
that will substantially alter the Medicare system as we know it. These
provisions would privatize the program, cause millions of seniors to
lose their prescription drug coverage through their employers, and
result in insufficient reimbursements for some Medicare providers.
These ill-crafted proposals also influenced my decision to vote against
this bill.
affordable prescription drugs
In working to create a prescription drug benefit, we must ensure that
the plan is affordable for Medicare participants. The benefit that is
outlined in this legislation, however, will provide little relief for
the senior citizens in my district. Because the plan requires sizable
premiums, deductibles and copayments, seniors can still expect to pay
between 50 and 80 percent of the cost of their prescriptions. This bill
also creates a gap in coverage that will leave millions of seniors with
drug costs between $2,250 and $3,600 without any benefit, even though
they continue to pay premiums. While some may conclude that this is a
good start to providing a prescription drug benefit, I disagree. We
must do more to make prescription drugs affordable.
Seniors across the country, and especially in my district, cannot
afford to pay thousands of dollars each year in prescription drug
costs. Those seniors living on fixed incomes must already sacrifice on
other necessities in order to afford their costly medications. These
seniors need immediate relief and this legislation will not provide
that help. In addition to the cost-sharing provisions of this bill, the
benefit does not even go into effect for another two years. In the
interim, seniors will receive a discount drug card that will provide
only minimal relief.
This legislation also purports to protect low-income senior citizens.
Individuals at the poverty level will not pay premiums under the
program and will have copayments of only $1 to $3 for each
prescription. In addition, for individuals slightly above the poverty
level, assistance with premiums and the deductible will be available.
These individuals, however, will be subject to an assets test.
Individuals must have less than $6,000 in assets to receive the benefit
while married couples must have less than $9,000 in assets. Therefore,
any low-income senior who owns a home, a car, or any other large asset
will not be eligible for this financial assistance. In my view, we
should not force senior citizens to choose between selling their homes
and getting their prescription drugs.
In addition, this legislation does nothing to address the high cost
of prescription drugs. Under the current bill, there is no methodology
for insurance companies to negotiate for lower drug prices. If the
program were administered through Medicare, the Government could
negotiate with the pharmaceutical companies for lower, more affordable
prices because the program would cover a larger number of seniors.
Furthermore, with my support, the House recently passed legislation
that would allow for the reimportation of prescription drugs from 24
foreign countries. These medications are often the same as those sold
in the United States. They are, however, sold at a much lower price.
Unfortunately, this legislation provides only for the reimportation of
drugs from Canada and requires that the U.S. Food and Drug
Administration certify that the reimportation of drugs is safe. While
this may seem like progress, it is not. The Food and Drug
Administration has already indicated its unwillingness to consider such
a certification. Consequently, this legislative sleight of hand on drug
reimportation will not increase the availability of affordable
prescription drugs in the United States.
ease in administration
A Medicare prescription drug plan must also be easy to administer.
The proposal before us fails to meet this standard. This plan will
create a complicated system of payments and programs. As a result, it
will be difficult to administer.
In particular, senior citizens should not have to worry about whether
the amount of money they spend on prescriptions during the year will
leave them paying the whole amount of their drug costs at some point
during the year as this bill does. Seniors who annually spend more than
$2,250 for prescription drugs will find themselves without any coverage
at all for a portion of the year. In order to remain in the program,
however, these seniors will need to continue to pay the monthly
premium, whether the program provides assistance or not.
Such a system will create confusion for seniors. This benefit should
provide a sense of security for the elderly, who are used to receiving
their benefits through the Medicare program. Instead, this complicated
program will only serve to provide older Americans with more worries
about their health care needs.
nationwide availability
An effective Medicare prescription drug plan must also be available
nationwide. By making the benefit available through private insurance
companies, there is no way to ensure that benefits will be equal across
the country. in an area like Northeastern Pennsylvania, this scheme
would have a devastating effect. By moving towards privatization, areas
like mine would be disadvantaged because insurance companies would not
be enticed to operate there. Northeastern Pennsylvania has a higher
concentration of older residents than most areas in the country, and
insurance companies will not want to operate in our area because they
would not find it profitable, unless they charge exorbitant premiums.
As a result, the government fallback provision would engage, but it
would still result in these seniors paying more than those in other
areas across the country.
We have tried such a scheme before. In 1997, we created the
Medicare+Choice program. This failed experiment operated in
Northeastern Pennsylvania for awhile. Initially, this program provided
tens of thousands of seniors in our area with prescription drug
benefits. Insurance companies, however, discovered that they could not
make a profit because of the economics of the region. As a result, they
abandoned the program, leaving thousands of senior citizens without
affordable prescription drugs once again. By providing a prescription
drug benefit through private insurance companies, we can expect this
legislation to result in a similar outcome for Northeastern
Pennsylvanians.
In addition, this faulty Medicare plan already anticipates that there
will be a problem with providing prescriptions through private plans in
areas like Northeastern Pennsylvania. Included in the bill is a
provision to set aside $12 billion to pay insurance incentives to
provide the prescription drug benefit. One must ask why, if we already
anticipate the failure of the program, we are not considering
alternatives, such as adding the benefit through Medicare.
Comprehensive Benefits
Finally, a prescription drug program must be comprehensive. Under a
government program, seniors should have access to any drug prescribed
by their doctor and the program should cover the costs of that drug.
This bill, however, establishes a limited list of categories and
classes of drugs, and only these drugs will be covered under the
program. Hence, this exclusion will leave many seniors to cover more
costly medications and experimental treatments out of their own
pockets.
Privatization of Medicare
In addition to the prescription drug coverage, there are other
changes made to ``reform'' Medicare by this legislation. If passed, for
example, this legislation would put in place a radical system to
privatize Medicare.
For example, rather than providing a prescription drug benefit
through the current Medicare system, it will, as I have previously
noted, instead be offered through private insurance companies, which
can profit from their
[[Page H12283]]
participation in the prescription drug program. Once the system is in
place it will be difficult to go back and make the necessary changes to
make the prescription drug benefit affordable, easy to administer,
available nationwide, and comprehensive. Earlier this year, I supported
the Democratic version of this legislation that would have provided
prescription drugs through Medicare and achieved these objectives. We
should be considering that bill today.
This bill will also change the way the current Medicare program is
run and move it towards a total privatization of the benefits Americans
have worked their whole lives for and have come to depend on in their
golden years. In 2010, this legislation would create a premium support
demonstration program. This program would require seniors to enroll in
a private plan and would provide a voucher for the cost of the
insurance premiums. In addition, this bill would break the country into
sections, providing different benefits in each. Therefore, the amount
of money a person in Northeastern Pennsylvania pays could be
substantially higher than the amount paid by a senior living in another
part of the country.
In my view, this program will move the country on the slippery slope
towards the total privatization of Medicare. Rather than providing
health care benefits to senior citizens that are guaranteed, money
would instead be provided to insurance companies to support seniors in
a private program. We should not allow Medicare to wither on the vine.
There is also no reason to believe that other benefits, such as Social
Security, would not also eventually be privatized if we begin to
privatize Medicare now.
Provider Issues
This prescription drug bill also seeks to increase Medicare payment
to physicians and hospitals. I must acknowledge that some of the
provisions in this bill would provide relief to the doctors and
hospitals in my area. In particular, the bill's provision altering the
weight given to labor costs when determining the reimbursement rate for
an area would provide millions of dollars to the hospitals in my
district. In addition, physicians who are anticipating a 4.5 percent
cut in their payment through Medicare would instead receive a 1.5
percent increase. Further, this bill provides additional funding for
rural hospitals and for teaching hospitals.
For hospitals like the ones in my district, this legislation provides
only minimal relief and these changes should not be used as a
justification for voting for this bill. As one hospital administrator
in my district said, ``If you are dying of thirst in a desert, even a
drop of water looks good.'' Rather than providing a band-aid fix to
these hospitals experiencing genuine financial difficulties, we should
have worked to equalize reimbursements across the country.
In addition, there are portions, of this bill that will have severe
impacts on the providers in my district. For example, the legislation
provides for a system to competitive bidding for durable medical
equipment to begin in 2007. This change in the program will have a
devastating effect on the numerous small- and medium-sized medical
equipment providers in my district. The competitive bidding system will
cause a race to the bottom, resulting in cost cutting measures like
layoffs and the loss of services provided for users of durable medical
equipment.
Retiree Coverage Reduced
Beyond privatizing Medicare, this legislation will result in millions
of retirees losing their employer-sponsored drug coverage, dealing an
irreversible blow to the employer-based system that is the backbone of
our Nation's health care system. Employer-sponsored retiree health
benefits are the single greatest source of drug coverage for retirees,
providing benefits to one in three Medicare beneficiaries. They also
generally offer the best coverage available--generous benefits and low-
cost sharing.
The Congressional Budget Office, however, projects that 2.7 million
seniors in employer-based retiree plans will lose the coverage they
have today due to the discriminatory treatment of seniors with retiree
coverage in this legislation. As a result, those individuals would be
forced into the flawed prescription drug program outlined in this
measure. Men and women who have worked their whole lives with knowledge
that they will have health and prescription drug benefits in their
retirement should not be forced into a program that could leave them
with inadequate benefits.
Closing
In sum, I cannot support this legislation. It falls short of
providing seniors with an affordable, widely available, easily
administered, and comprehensive prescription drug benefit. It will
privatize the program and it will result in millions of retirees losing
coverage through their former employers. Ultimately, this legislation
will hurt senior citizens more than it will help them. We should do
better for Americans in their golden years by defeating this bill and
drafting a new one.
Mr. PASTOR. Mr. Speaker, I strongly support efforts to give
prescription drug coverage to the Medicare patients who do not
currently have it. But, this bill does a poor job of meeting our
prescription drug needs, and it drastically and negatively alters the
overall structure of the Medicare program.
We have the ability to give Medicare patients prescription drug
coverage. But our hands have been tied by the arbitrary budget limits
Congress has set on funding such a program.
Congress and the President decided that, over the next 10 years, $400
billion was all we could spend on helping the elderly who need
prescription drugs. So, in order to meet this number, a prescription
drug bill has been written that will prove inadequate for meeting the
basic needs of today's senior citizens while proving itself a champion
at destroying health care for the senior citizens of the future.
Simply put, Mr. Speaker, this bill is no longer about prescription
drug coverage. It is about ending traditional Medicare coverage.
I oppose this bill for several specific reasons.
First, the bill will do little to alleviate significant out-of-pocket
costs for most senior citizens. A senior who spends $2,200 a year, less
than $200 a month, on prescription drugs, will be required to pay
almost $1,200 for this coverage and the drugs. A senior spending $3,500
a year on prescription drugs will be forced to pay almost $2,500 out of
his pocket. That is 70 percent of the total drug costs. While this bill
provides some help, I fear it will not be enough to keep the poorest of
our elderly from making the difficult choices between buying medicine
and groceries.
I am also opposing this bill because, in essence, it is designed to
privatize Medicare. The ``demonstration'' projects to be established in
six areas of the country, the so-called Premium Support Program, is
nothing more than a first step toward complete privatization. The
authors of this bill hope that more and more people will forego
traditional Medicare for cheaper private HMOs with less overall choice
and coverage. In fact, the private insurance companies would receive
billions of dollars in subsidies for luring patients away from the
traditional program. We all know that the private insurance companies
will only accept the healthiest of patients, leaving the sickest
patients in traditional Medicare. This, in turn, would result in higher
costs for traditional Medicare because it would serve a sicker
population.
Additionally, I am opposing this plan because it will mean that a
good portion of the 75 percent of Medicare patients who already have
prescription drug coverage, many through former employers, will be
dropped from their current plan and forced into a more expensive plan
with less coverage. In hopes of avoiding that event, this bill is
paying a tremendous subsidy to keep these companies from dumping their
beneficiaries.
So, this bill provides billions and billions of dollars to private
companies to help them lure senior citizens away from traditional
Medicare and to continue to provide prescription drug coverage to
former employees.
There is some disconnect here. As Robert Robb, the noted Arizona
Republic conservative columnist writes, ``Congress is proposing to
subsidize private drug plans that are currently being offered at no
cost to taxpayers, in order to offer taxpayer-financed drug coverage to
seniors that Congress hopes they won't take.'' He continues, ``See what
I mean about being sort of stupid.''
Mr. Robb and I rarely agree on issues. But he has hit this nail right
on the head.
A more logical solution might be to take these subsidies and use them
to simply pay for prescription drugs for those who don't currently have
coverage.
Mr. Speaker, I say, let's give prescription drug coverage to the
senior citizens who need it. We could do that, in a fair and meaningful
way. We only need the desire to do so. But, let's not hurt the seniors
who have coverage, and all those in future generations, by passing this
ill-advised legislation. We have the opportunity to do something good
and important. Yet, the drafters of this bill have taken it as an
opportunity to change the Medicare program so drastically that it can
only prove devastating to this country's older population. Let's reject
this bill and force ourselves to set aside partisan ideologies and help
the current and future senior citizens of this great land.
Mr. BLUMENAUER. Mr. Speaker, our senior citizens need help with
spiraling drug costs. It is outrageous that moderate income seniors pay
the highest prescription drug prices in the world. The idea was to fix
this problem, but somewhere along the line, the bill was hijacked by
the Republican leadership for other purposes. I can't remember how many
of my Republican colleagues have told me that they think this is a bad
bill. From the Wall Street Journal to consumer advocates, thoughtful
conservatives to people who classify themselves as very liberal, all
find this bill deeply flawed.
Spending what's claimed to be $400 billion, but will actually entail
far more cost to the
[[Page H12284]]
Treasury, and the unprecedented pressure and advertising may pass this
bill. The fascinating reversal of position by the leadership of the
AARP gives a public relations boost, but that move has already been
attacked by its own members.
The authors of this bill are putting something in for almost
everybody: not just the drug companies, but doctors, hospitals,
insurance companies, and so on, but ignoring the fundamental needs of
senior citizens. As over a thousand pages come into focus, details leak
out and are investigated by outside groups, the press, even Members of
Congress, it is clear the bill still does not meet the needs of our
seniors. After all the dust settles, our senior citizens will still pay
out of their pockets the highest drug prices in the world.
There's something wrong when the only people who appear to be happy
with the Medicare Prescription Drug bill are the drug companies. They
were able to strip out provisions that would have allowed reimportation
of cheaper drugs from Canada. It will be illegal for the government to
negotiate lower prices for Medicare recipients. Future price increases
will not be indexed to inflation, but to the rate of runaway drug
costs, ensuring that spending will continue to spiral out of control.
For the drug companies, the holidays may come a little early this
year. Sadly, deserving senior citizens who need help won't even get
this inadequate drug plan until 2006. Told that even in 2006, they will
have to pay $4,000 of their first $5,100 of drug costs, they'll feel
that they didn't get a present. I will vote against the conference
report.
Ms. JACKSON-LEE of Texas. Mr. Speaker, this is about as ugly as it
gets. Just when I thought the Republican Leadership could not work any
harder to undermine the Democratic process, to abuse their power, and
to play politics with critical issues at the expense of the American
people--they have just taken it to a higher, or should I say lower
level. Call it what you will. The Alliance for Retired Americans calls
the Republican drug bill a lemon. Others call it a rotten turkey.
Whatever it is, it sure isn't medicine for the American seniors who
need it.
When Medicare was founded in 1965, U.S. Government formed a covenant
with the people, and said, ``If you work hard and pay your share, we
will make sure that you have access to health care when you retire.''
Modern medicine has made great strides over the past decades at
managing health problems, not just through surgery and
hospitalizations, but also with pharmaceutical drugs developed through
great research at the National Institutes of Health, and in
pharmaceutical companies here and around the world. These drugs can
lead to dramatic improvements in quality of life, by helping Americans
live longer, more comfortable, more productive lives.
As great visionaries Lyndon Johnson and the Members of Congress
designed Medicare, however, they did not predict that prescription
drugs would revolutionize medicine, and therefore they did not include
drug coverage in Medicare. Medicine has changed, but the promise that
the U.S. Government made to the American people has not. It is time for
Medicare to change with the times. It is time to do the right thing and
create a real prescription drug benefit for our Nation's seniors in
Medicare.
I, with my Democratic colleagues, have been fighting day after day to
make that happen. We have gone to the people of this Nation, and to our
academics, and health care providers and developed bold plans to get
people the medicine they need. We had developed great momentum and help
might have been on the way. The problem is that ever since the times of
Newt Gingrich, the Republican dream has been to privatize or destroy
Medicare. That is why the Republican plan is a risky scheme only an HMO
could love.
The Bush administration's Medicare Administrator has called
traditional Medicare dumb and a disaster, highlighting Republicans'
hatred for a program that Democrats have been fighting for since 1965.
While Democrats have worked to modernize Medicare with prescription
drugs, preventive care and other new benefits, Republicans are
insisting on a riskier course even the conservative Wall Street Journal
calls a business and social experiment.
When this process first began, and the President and the House and
Senate leaders proclaimed that they intended to produce a prescription
drug plan, my Democratic colleagues and I tried to give them the
benefit of the doubt. We tried to work in a bipartisan fashion. At one
point, I wrote a letter to the Members of the House-Senate Conference
Committee and encouraged them to include fair provisions for our
physicians and hospitals, so that they would be able to afford to
continue providing excellent care for our seniors. I am pleased to say
that they did respond to that request, and have put in some funds for
those deserving groups. But that is where the collaborations ended. I
wish that they could take the handful of good pieces in this bill and
move them as separate legislation--the reimbursement pieces I asked
for, the rural health provisions, the Hatch-Waxman Reforms--but they
won't. These good things are being held hostage to leverage passage of
a terrible bill.
Ultimately, the core mission of this bill is to provide prescription
drugs to seniors and the disabled on Medicare. On that, this bill fails
horribly. The Democrats on the Conference Committee, among them, had
decades of experience in the field of health policy. No one could
question their commitment to helping seniors, but in a deeply cynical
move by Republican leadership, Democrats were barred from even entering
conference meetings. That is against everything our Founding Fathers
intended this ``People's House'' to be. We got our first glimpse of
this bill just over 24 hours ago. Even in our haste to get it read, we
have found numerous flaws and pitfalls in it. In 2006, if it is allowed
to come into effect, I am sure our seniors will find many more.
Instead of merely blocking our ideas, as they have done for years,
they hijacked this issue and in the name of a prescription drug bill,
they are trying to shove a piece of legislation through Congress that
will destroy Medicare as we know it. It privatizes Medicare, pushing
seniors into HMOs and private insurance plans expecting them to do what
is right for seniors. And we know from Medicare+Choice, that we cannot
count on that. In one year alone, 46 percent of Medicare beneficiaries
in Houston were chopped out of HMOs. Switching plans every year
jeopardizes health and wastes time and money. The Republicans have
invented new gimmicks like artificial caps on spending, and buzzwords,
like ``premium support'' instead of what it really is a ``voucher''
system to replace Medicare in 2010.
It is a misdirected attempt, with a terrible benefit--with a giant
doughnut hole in coverage. And as bad as the benefit package is--even
it is not guaranteed. The entire system is just basically a guideline
that Republicans hope and pray insurance companies will follow, and
develop drug plans for seniors.
It seems like at this point, we might say, ``well money is tight, so
let's just take what we can get, and be happy with this bill.'' But the
conference report that we are now finally getting a glimpse of is so
bad, it would actually leave millions of senior citizens worse off than
they were without it. And as doctors say in the Hippocratic Oath, the
most important rule in healthcare is do no harm.
Furthermore, there is no rush to pass this bill. The Republican
authors conveniently made their plan kick in in 2006, well after the
Presidential elections of 2004. Obviously, they don't want seniors to
go to the polls furious when they realize how bad this plan is. The
point is, we can wait until spring and do this job right--and still
make their 2006 timeline.
AARP used to agree with us on every point I am making, but in a
bizarre twist, this week the group, that supposedly represents the
interests of our Nation's seniors declared that they would support this
lousy bill. I was mystified by this until I learned that, according to
a study done by Public Citizen that AARP will make an extra $1.56
billion in profits if this bill goes through. AARP is in the insurance
business, and has become too tied to that industry and the Republican
leadership. They have breached the trust of the American seniors, and
seniors are angry. It is a sad turn of events.
With the measly Republican benefit, the average senior will actually
be paying more for their prescription drugs a year after the bill kicks
in, than they are paying now. And as every senior knows, it has a giant
donut hole in the benefit plan, where seniors have to pay every nickel
for their medications--thousands of dollars--while they keep paying
premiums. This is tragic for seniors on fixed incomes, and it will be
an administrative nightmare for pharmacies. It is a gimmick to
compensate for the fact that the Republican administration has
squandered and mismanaged our economy to a point that now they say we
have no money to fund critical programs.
It seems that at every turn, the people who need our help are getting
the short end of the stick. Minorities, who already suffer from
tremendous disparities in health and health care, are left behind.
While this bill gives a giant gift to the drug and insurance industries
and other special interests, it does little to reverse those life-
threatening disparities. My Democratic colleagues and I, in both the
House and Senate, all came together recently and put forth the
Healthcare Equality and Accountability Act of 2003. Our bill is the
kind of thoughtful and comprehensive approach that healthcare deserves.
One provision I wrote will create a Center for Cultural and Linguistic
Competence to help every American take advantage of the health
revolution that is upon us. The Republican Medicare bill seems to have
the opposite goal.
For example, this conference report does not contain the Legal
Immigrant Children's Health Improvement Act (ICHIA), included in the
Senate Medicare bill, which would have
[[Page H12285]]
removed the 5-year bar on Federal health benefits for legal immigrant
pregnant women and children. While these children and pregnant women
may still get emergency medical care, States are unable to cover this
population with basic medical services that may reduce the need for
such emergency care. This unnecessarily increases the cost to
taxpayers.
Hispanics are the largest minority group in the United States, and
it's estimated that by 2025, Hispanics will account for 18 percent of
the elderly population. Currently, one in six Hispanics seniors live
under the poverty level. For these Americans, an increase in
prescription drug payments or doctor's visits could mean disaster.
Houston has a strong Hispanic population, and therefore my district
will be hit especially hard by this bill.
And there is more bad news for Texas. 132,300 Medicare beneficiaries
in Texas will lose their retiree health benefits. 389,400 Medicaid
beneficiaries in Texas will pay more for the prescription drugs they
need. 209,000 fewer seniors in Texas will qualify for low-income
protections than under the Senate bill because of the assets test and
lower qualifying income levels. 97,420 Medicare beneficiaries in Texas
will pay more for Part B premiums because of income relating.
When we look at the health care system for our seniors in the United
States today, we see two undisputable facts. One is that Medicare is an
excellent program that seniors trust, and that delivers quality care at
a fair price to those who pay in. The other is that drug costs are out
of control and need to be brought down.
The Republican bill preserves the bad, the high cost of drugs--and it
dismantles the good--Medicare.
Americans pay about twice as much for drugs as people do in other
rich countries in the world--Canada, Germany, England, Japan. This is
outrageous, since many of those drugs were developed here, by our
workers, trained in our universities, funded by our National Institutes
of Health. Our seniors deserve to get the same prices as they get
across the border in Canada. The reason they don't is because the
Canadian government negotiates with the drug companies, and says ``Hey,
there are 30 million of us in Canada buying your products, give us a
fair price.'' Both the Republican bill forbids the Secretary of Health
and Human Services from bargaining on behalf of the 40 million seniors
on Medicare. That is outrageous, especially considering how well such
negotiations have worked at the Veterans Administration. This bill is a
gift to the pharmaceutical industry and HMOs and the insurance
industry.
This bill really is the epitome of just how bad partisanship and
political demagoguery can get. Trying to pass it before Thanksgiving is
a cruel--and expensive--joke on our seniors on Medicare. I don't want
to do that to Houston. Let's don't do that to America.
I will vote against this bill, and keep fighting to get this done
right.
Mrs. CHRISTENSEN. Mr. Speaker, I have listened to the debate tonight,
and I think everyone agrees that some seniors and disabled would
benefit by this bill. But if truth be told, many would lose, which is
not what we set out to do--we need and promised a bill that provides a
prescription drug benefit for all Medicare beneficiaries, not just a
few.
What is clear and why we should oppose this bill, is that if passed
it would sound the death-knell for Medicare.
We must insist that the Republicans provide funding to shore up our
rural hospitals. We must insist that the Republican leadership not only
increase the physician payments this fiscal year, but fix the formula,
so that the payments won't be cut again next year.
But what we must not do, is let this divide and conquer tactic make
us pass a bill that would do more harm than good and physicians and
hospitals should not allow themselves to be used to dismantle the very
program they and the patients they are sworn to serve, depend on for
the long run.
With a few crumbs to seniors and the disabled, and playing on the
dire need of hospitals and doctors, this bill is nothing more than
another corporate give-away.
We can afford to vote this bill down, start again, with an inclusive
process--the benefit doesn't start for two years anyway. What we cannot
afford to do and must not do is to kill Medicare; we must vote no on
H.R. 1.
Mrs. KELLY. Mr. Speaker, I rise in support of this important
legislation. The Medicare Prescription Drug and Modernization Act will
provide prescription drugs to seniors, and provide additional money for
doctors and hospitals, both of which are the front line in providing
health care.
I am particularly pleased with provisions in the bill which seek to
provide financial assistance to hospitals currently experiencing
difficulties with inadequate wage index reimbursement rates. And I am
encouraged by the potential this bill holds for assisting hospitals in
the Hudson Valley which are adversely affected by their proximity to
the New York City Metropolitan Statistical Area (MSA).
I would also like to direct my colleagues' attention to an aspect of
this legislation which perhaps hasn't received a great deal of
attention, and that's the provision that creates Health Savings
Accounts.
For years we have been concerned about the many people in this
country who have no health insurance. Many of the uninsured are small
business owners or employees who simply cannot afford health insurance.
With the Health Savings Accounts established in this bill, the small
business owner can not only save tax free money for health care, but
offer tax free health care money to their employees.
Think of it. Now, because of Health Savings Accounts, the owners of
small businesses across the country can make contributions--tax free
contributions--to their employees.
Money in these accounts can be used for insurance premiums or spent
directly on medical care. This means many more people can buy coverage.
For the first time, health care will be more accessible to the millions
of small businesses in this country.
This is a powerful tool for empowering working Americans who deserve
to control important decisions over their own medical care.
Mr. NUSSLE. Mr. Speaker, I rise today to support a long overdue,
welcome victory for Iowa's seniors and health care providers.
Medicare's policies have penalized health care providers in Iowa and
other rural areas since the 1960s. While Medicare's primary purpose is
to provide health care for seniors, its policies affect both our health
care system and our economy. The flawed policies have had an impact not
only on seniors, but on all Iowans.
As many of my House colleagues know, I have worked long and hard to
address the problems affecting health care providers in rural states
such as Iowa. In fact, I wrote this year's budget to reserve
significant resources for rural health care as part of a $400 billion
Medicare Reserve Fund. Later, in the Ways and Means Committee, I
successfully amended the Medicare legislation to ensure that sufficient
rural health care funds were included in the bill that was reported
from committee. And I continued fighting on the House floor to ensure
that these funds--the most generous rural package ever considered by
the House--remained in the Medicare legislation as it worked its way
through the House.
Today, we are considering a conference report that carries this rural
health care package to the end of the process. The benefits for Iowa
will be multiplied for years to come. This conference report contains
an unprecedented $25 billion rural package including benefits of over
$400 million for Iowa alone. I am proud to have worked toward this day
with the distinguished chairman of the House Ways and Means Committee
and with the senior Senator from my home state of Iowa.
With these significant strides to improve Medicare's reimbursement
policies on Iowa's behalf, we help our health care providers to pay the
bills and to continue recruiting and retaining top-notch professionals.
With a more secure health care system in place, we can further job
creation and economic growth for our state.
In addition to taking several steps to strengthen the overall
program, we are, of course, finally giving seniors what they have
sought since Medicare's inception in 1965--a prescription drug benefit
that is affordable, accessible and completely voluntary. All seniors
will save on their current prescription drug costs.
Another important feature in the bill is the provision to establish
Health Savings Accounts (HSAs). These accounts will allow pre-retirees
to accumulate tax-free savings over their lifetime and these savings
will remain with the individual once they reach Medicare eligibility.
Even with reforms such as these, I want to remind my colleagues that
Medicare will still face long-term demographic pressures and Congress
will likely have to take additional steps to address the program's
sustainability.
Finally, as Chairman of the Budget Committee, I am pleased that the
Medicare conference report--with a total cost of around $395 billion--
is generally consistent with the $400 billion Medicare Reserve Fund
that was laid out in this year's budget resolution. In a year of
intense demands for limited government resources, this Medicare Reserve
Fund was the largest policy initiative in the budget resolution and was
arguably its centerpiece. Because the budget resolution struck a
responsible balance between seniors' needs on the one hand and
affordability on the other, we were able to generally stay within our
own guidelines. I commend the conferees for staying within the $400
billion threshold.
Mr. Speaker, I have been spreading the word and twisting arms for a
long time on behalf of legislation that would meet Iowa's health care
needs. I am gratified that our message has been received and our
persistence has paid off.
Mr. CAMP. Mr. Speaker, I rise in support of H.R. 1.
[[Page H12286]]
In the last five days, I've heard a lot about what this bill doesn't
do. Let me be frank: life is not about what we don't do; it's about
what we accomplish.
And, if I had a friend in need who asked me for $100 and all I had
was $20, I wouldn't give him nothing. But that's what some here are
prepared to do--turn away a friend in need.
For years we have agreed that our seniors needed a prescription drug
benefit in Medicare; but unfortunately we have yet to provide them with
any relief.
This Medicare bill offers a prescription drug benefit through
competing private health insurance plans--marking the first time
private sector plans and consumer choice would be the principal vehicle
for delivering Medicare benefits. It also includes common sense reforms
like preventive care and health savings accounts.
This is the first step in the direction of true reform. It's a step
in the right direction and it is time we take it.
Mr. ORTIZ. Mr. Speaker, Congress created Medicare in 1965 to make
healthcare affordable and available for all senior citizens. My
colleagues and I have fought to maintain this original intent.
Today, the leaders in Congress are pushing dangerous legislation--
called Medicare reform--on South Texas seniors that fails to include an
adequate prescription drug benefit while privatizing Medicare, killing
the program at the end of the decade.
This prescription drug ``coverage'' is not what seniors expect or
deserve. When seniors have more than $2,200 in drugs costs, they will
hit a gap, where Medicare will no longer cover the costs of their
prescriptions until they reach $5,000.
When this happens, these seniors will be forced to pay 100% out of
their own pockets while still paying monthly premiums. Meanwhile, their
HMOs will select their doctors and their pharmacies.
Over 185 organizations with an interest in seniors' issues are wholly
opposed to this bill. While one of the largest senior organizations has
lent support to this bill (The American Association of Retired Persons,
AARP), it is the only one to do so . . . it is the only one that
provides insurance to seniors at a profit of $635 million . . . and the
only one poised to take advantage of billions of dollars in the bill to
entice private insurers to cover seniors.
The bill effectively ends drug reimportation by allowing the
Secretary of Health and Human Services (HHS) to decide what
prescriptions could be reimported. The HHS Secretary has already said
he would allow none.
If this is not the answer, what is? I stand on my record, voting 8
times for a complete Medicare Rx drug plan . . . voting 6 times and co-
sponsoring 6 bills supporting higher reimbursements to doctors and
hospitals . . . voting 6 times not to kill Medicare . . . and voting 8
times and co-sponsoring 3 bills to improve rural healthcare.
Nothing in this bill makes prescription drugs cheaper. Other Federal
programs, such as the Veteran's Administration, get cheap drugs
negotiating directly with the big drug companies. The plan will keep
the government from negotiating for lower drug prices for Medicare
beneficiaries.
This plan protects the profits of drug manufactures instead of
providing real savings to seniors. Rising drug prices are unaddressed
in this bill, a victory for the drug industry for preventing any
attempts to lower drug prices.
Meanwhile, the value of some seniors' property will be used to
determine their level of coverage--including jewelry, cars, and other
property of value for which they worked their entire lives.
In South Texas, for the short term anyway, the bill (which would not
take effect until 2006) would help only about 30% of low-income
seniors. Effectively, that means this bill will not help over two-
thirds of our most needly seniors.
When I think about the seniors that bill will affect, I think of the
ladies who took care of me as I grew up of Robstown, Texas. Life for
them revolves around family and children, paying the bills and finding
health care in their senior years.
These are the people affected by the bill, which ends Medicare as we
know it, privatizing the entire progrm by the end of the decade. It is
thousands of South Texans like these who have raised voices in
opposition to this bill. I stand with them.
Medicare has been a trust between the government and those who do the
hard work in our society, our senior citizens. Too many seniors depend
on Medicare for their healthcare needs, and I will not support a bill
that destroys that trust.
Mr. LARSON of Connecticut. Mr. Speaker, I rise today in opposition to
H.R. 1, the Medicare Prescription Drug and Modernization Act of 2003.
Some may claim that this legislation is the answer to the high prices
seniors are paying for their prescription drugs. That is far from true.
The reality is that this legislation is a Medicare privatization plan
masquerading as a prescription drug relief bill. The big winners in
this bill are not the seniors that desperately need relief, but
pharmaceutical companies and big business.
Does this conference report strengthen the Medicare program that
seniors know and trust? The answer is no. It includes a premium support
demonstration project that is the first step towards forcing all
seniors to choose private insurers to get the prescription drug benefit
they need, or to pay more to stay in the traditional Medicare program.
This bill having any effect at all is contingent upon the willingness
of HMOs and insurance companies to participate, and the track record
does not paint a positive outlook. We in Connecticut remember HMOs
pulling out of Medicare Plus Choice plans because they simply could not
make a profit.
Does this conference report allow the Government to negotiate the
costs of prescription drugs and provide relief to seniors? The answer
is no. The bill specifically prohibits the Secretary of Health and
Human Services from leveraging the tremendous buying power of the
Federal Government to negotiate lower drug prices for 40 million
Medicare recipients, a system the VA currently uses.
Does this conference report allow reimportation of drugs from other
industrialized nations so that seniors will be able to purchase less
expensive drugs? The answer is no. It ignores the reimportation measure
that this House passed this summer and places the decision in the hands
of health officials who have vocally opposed reimportation.
Does this conference report help low-income seniors who need help the
most? The answer is no. First, the proposal actually reduces coverage
for the 6.4 million lowest-income and sickest beneficiaries who qualify
for Medicaid today. It prohibits Medicaid from helping these
beneficiaries with copayments or from paying for prescription drugs not
on the formularies of the private insurers administering the new
Medicare benefits. It also leaves behind 3.9 million seniors that would
have qualified under the Senate bill. One reason for this is the
imposition of an invasive assets test. This means that seniors with
modest savings will not receive any assistance with the cost of their
premiums, the deductible, co-payments, or the cost of the medications
while they are in the $2,850 coverage gap.
Does this conference report help cancer patients? The answer is no.
It falls well short of the drug and practice reimbursements needed to
provide millions of cancer patients with the care they need.
Will this conference report prevent employers from dropping health
insurance for their retirees? The answer is no. Though incentives were
added to encourage employers to maintain their retiree plans, the
Congressional Budget Office estimates 2.7 million retirees will lose
the existing coverage they rely upon and countless others may have
their benefits reduced. Furthermore, it does nothing to protect retired
teachers, firefighters, police officers, State and local government
employees, and those who worked for nonprofit organizations.
Does this conference report help the hospitals and doctors struggling
to meet the needs of their patients? The answer, surprisingly, is yes.
It provides an increase in the Medicare Disproportionate Share Hospital
cap for rural hospitals and urban hospitals with fewer than 100 beds.
It increases payments for indirect medical education that would provide
increased funding for the twenty Connecticut hospitals that have
medical education programs. Also, it eliminates the 4.2% reduction in
payments to physicians in 2004 and replaces it with a 1.5% increase for
the next two years. These provisions are positive. But, this was
intended to be a prescription drug relief bill and these positives are
by far outweighed by the negatives of this legislation.
So, who are the winners in this conference report? The answer is
pharmaceutical companies. They will receive the majority of the $400
billion that this legislation will cost. But, even better for them,
they will not be forced to lower their prices. The Government will not
be allowed to negotiate prices and seniors will not be allowed to
purchase imported drugs from other industrialized nations. Apparently,
the industry's army of lobbyists and $22 million in campaign
contributions were effective.
Who are the losers? The answer is seniors, the ones this bill was
meant to assist. They asked for prescription drug relief and we are
trying to give them a Medicare privatization bill. That is why I urge
my colleagues to join me in voting against this conference report.
Mr. UDALL of New Mexico. Mr. Speaker, I rise today with great
disappointment in the conference agreement that has been brought to the
floor. I sincerely hoped that the bill that passed the House in July
would have been moderated with provisions included in the other
chamber's bill.
Unfortunately, instead of considering legislation today that would
have modernized the
[[Page H12287]]
Medicare program to provide prescription drug cost relief and coverage
for seniors throughout this great nation, we have this agreement that
is geared toward dismantling one of the most successful government
programs ever implemented. Instead of considering legislation to
modernize the Medicare formulas to fix the inequities between rural and
urban areas, we are considering an agreement that wraps these crucial
fixes in with a prescription drug benefit that is designed to achieve
the ideologically extreme goal of privatizing Medicare.
Mr. Speaker, I will certainly admit that the provider package
included in this agreement is excellent. For years doctors, hospital
administrators, and other health care providers have suffered under the
unfair Medicare formulas that severely hampered their ability to
provide care to Medicare beneficiaries. The labor share revision, the
geographic physician payment adjustment, increasing home health
services furnished in rural areas, critical access hospital
improvements--these are all incredibly important provisions that I
strongly support in order to help strengthen the health care system in
rural areas. I also support fixing the inequitable disproportionate
share formula, which is done to a degree in this agreement.
Unfortunately, however, the conference agreement removes language that
would have given New Mexico a larger increase of DSH payments to $45
million. The physician fee formula update is another provision that is
incredibly important. Without this fix, physicians will have no other
choice but to stop seeing Medicare beneficiaries, which will lead to
the total breakdown of a system that is already badly strained to its
limits.
I recognize the importance of these provisions. I understand the
difficulties that those in the health care industry are facing. I
understand the difficulties seniors are facing in trying to purchase
and pay for their medications. That is why I have cosponsored
legislation to fix the disproportionate share provisions, I have
cosponsored legislation to fix the Medicare physician payment updates,
I have written letters supporting these provisions and urging Chairman
Thomas to include these rural fixes in the legislation, I have written
a letter to conferees asking them to retain this provisions, and, when
this bill passed in July, I voted in favor of the Democratic
alternative that not only included stronger rural provisions than those
included in the Majority's bill, but also contained a real prescription
drug benefit--not a benefit engineered to bring about the demise of the
Medicare program.
Mr. Speaker, lets be clear about what our goal was supposed to be. We
were supposed to create a new prescription drug benefit in Medicare.
That's what we were supposed to be doing with this important
legislation.
Unfortunately, we are doing much more than that, and a lot of it is
terrible. We were supposed to be reducing the costs of drugs for
seniors. Yet this plan prohibits the federal government from using its
clout to force down the price of medicine.
We were supposed to help seniors keep their current drug coverage if
they are fortunate enough to have it. Yet this plan may force up to
three million seniors out of their current employer-based plans.
We were supposed to be strengthening the Medicare program by adding a
voluntary benefit for prescription drug coverage. Yet this plan, under
the guise of a premium support demonstration, weakens the Medicare
program by forcing beneficiaries to pay more for Medicare if they don't
give up their doctor and join an HMO.
We were supposed to help low-income seniors who get additional
assistance from Medicaid afford their prescriptions. Yet this plan not
only forces 6 million low-income seniors to pay more for their
medications, but also imposes an unfair assets test that disqualifies
seniors if they have modest savings.
We were supposed to be providing a prescription drug benefit that
would ease the cost and emotional burden seniors face in dealing with
medication purchases. Yet this plan leaves millions of seniors without
drug coverage for part of the year due to the $2800 gap in coverage.
Mr. Speaker, I am extremely disappointed with this agreement. I am
disappointed because what should have been a straightforward approach
took a wrong-turn along the way. I think this is a terrible way to
spend $400 million dollars on a supposed prescription drug benefit, and
I will be forced to vote against this measure. I urge my colleagues to
reject this shameless assault on Medicare.
Mr. STUPAK. Mr. Speaker, I rise today in opposition to this Medicare
bill with limited prescription drug coverage.
This plan is bad for America's seniors and especially bad for rural
areas like Northern Michigan, which I represent.
Medicare should be a right--this Republican Medicare bill threatens
to undercut this right and destroy a program that seniors have trusted
for nearly 40 years.
For most seniors, the prescription drug plan does not begin until
2006 while the Democrats' plan would have begun next year.
The Republican plan has a gap in prescription coverage the size of
the Upper Peninsula. This gap starts at $2,250 and goes on until you
hit $5,100.
We should be giving our seniors a real prescription benefit not one
that gives you part-time coverage.
Illnesses and diseases do not take time off--you're not sick part of
the time--seniors need full prescription drug coverage now.
Those seniors who now have coverage may lose it--CBO estimates that
up to 3 million could lose their existing prescription drug coverage.
I cannot support a bill that will undercut our seniors' right to
Medicare.
While Congress provides universal health coverage for Iraq that
includes full prescription drug coverage--seniors in America will
receive part-time prescription drug coverage but pay 100 percent of the
costs.
Vote ``no'' on this ill-conceived bill.
Mr. DAVIS of Illinois. Mr. Speaker, I have heard my colleagues
describe the prescription drug plan as ``not perfect'' and a ``step in
the right direction.'' However, this legislation is neither. Our
seniors will not gain better health coverage or a prescription drug
benefit that is affordable. Instead the CBO estimates that
approximately 2-3 million seniors, 107,000 alone in my state of
Illinois, who currently have drug coverage from their employer, will
lost that coverage. This bill lowers Medicare's assistance to the
employers making it unaffordable to keep their retirees' coverage. The
new cap on general revenue spending will cause reductions in provider
reimbursement rates, higher out of pocket cost, or even raise the
payroll tax--once again passing the buck along to future generations.
Worst of all for our senior consumers, we do not even allow the
Secretary of HHS to negotiate lower drug prices for them.
I am disappointed in this House for turning its backs on fulfilling
our promise to seniors, but I am extremely disappointed that we are
completely abandoning our Nation's most needy--our Nation's poor
seniors. We are expecting our States to pay the Federal Government 90
percent of the cost of drugs for our low-income seniors. During a time
when States are already faced with large debts and complicated
decisions on what to cut next--how do we expect the States to afford 90
percent of the cost of drugs for our poor seniors? An estimated 6.4
million low-income and disabled people will have significantly worse
coverage under this new plan. It is probably because this bill actually
prohibits Medicaid from helping with copayments or paying for
prescription drugs that are not approved by the private insurers. This
means that certain, needed medications that are currently covered by
Medicaid will no longer be available to seniors. This plan does not
even provide assistance for our seniors that are between 150 percent
and 160 percent of the federal poverty line that is an annual income of
$15,300 to approximately $17,850.
Mr. Speaker, no one is saying that we should give our seniors
something for free. But we are saying lets give them something that is
fair, reasonable, and makes sense.
Mrs. BONO. Mr. Speaker, I rise in strong support of the Medicare
Prescription Drug and Modernization Act of 2003. This has been a very
long and cumbersome process; however, I believe that the American
citizens will be pleased with what we have accomplished. I would
particularly like to laud the accomplishments of the conferees who put
in tireless hours crafting this monumental legislation.
More often than any other concern, I hear from the constituents of
the 45th District regarding health care. They are legitimately
frightened that without reform, they will lose their existing benefits
and the standards of care to which they have become accustomed. The
time had come to pass substantive legislation that will allow seniors
to spend less money on prescription drugs and spend less time
navigating through the red tape and paperwork.
This landmark legislation is responsive to the needs of our seniors
and will allow access to affordable prescription drugs and improve
health care to millions of our most needy senior citizens. This is the
most generous package Congress has considered for rural and suburban
health care giving seniors will have better access to doctors,
hospitals and crucial treatment options, regardless of where they live.
Additionally, this bill addresses the needs of the low income.
I am particularly proud that the bill includes the critical funding
for relief from the drastic payment reductions in the Medicaid
disproportionate share hospital (DSH) program. The provision will go a
long way toward protecting California's fragile health care safety. The
funding in the conference report will restore several hundred million
dollars to safety-net providers in California over the next 10 years.
Safety net hospitals across the state of California, two of which are
located in the 45th District in Moreno Valley and Indio, have had
[[Page H12288]]
to absorb drastic reductions in Medicaid DSH funding at a time when
demand for their services has been increasing. The additional funding
will help ensure that services to the most vulnerable populations are
available.
This bill represents a breakthrough in the nation's commitment to
strengthen and expand health security for its citizens at a time when
it is most needed. I rest assured knowing that our nation's future
generations will continue to receive the highest level of health care
available.
Mrs. BIGGERT. Mr. Speaker, no single piece of legislation is as
important to meeting the health care needs of Americans as is the bill
we will vote on shortly, the conference report to H.R. 1, the Medicare
Modernization and Prescription Drug Act. I rise to express my strong
support for this legislation.
Today is truly a momentous day. Finally, Medicare will catch up with
the realities of twenty-first century medicine. When the program was
first created in 1965, the majority of medical treatment was done in a
hospital. This is reflected in Medicare's current generous
hospitalization benefit and paltry prescription benefit.
Well, times have changed, to say the least. Today, life-saving
medications are helping seniors stay out of the hospital and live
longer, happier and more productive lives. But, as we all know,
prescription drugs are expensive, and seniors too often are forced to
cut back on other necessities to afford the medicine they need. Passage
and enactment into law of this conference report will help to ensure
that this never happens again.
Here's how it works.
Six months from now, seniors will begin to see the benefits. In April
of 2004, any senior who wishes to have one will be issued a voluntary
drug discount card that will save them 10 to 25 percent on their
prescriptions. For low-income seniors, $600 automatically will be added
to their cards to help them afford the drugs they need. The discount
card will work like a supermarket discount card, giving users a
discount at the time of the purchase.
Another very important benefit kicks in beginning in 2005, when all
newly enrolled Medicare beneficiaries will be covered for an initial
physical examination. At last, patients and physicians will have an
early baseline that can signal if problems exist or what areas might
need to be monitored more closely in the future.
All beneficiaries also will be covered for cardiovascular screening
blood test, and those at risk will be covered for a diabetes screen.
These new benefits can be used to screen Medicare beneficiaries for
many illnesses and conditions that, if caught early, can be treated,
managed, and can result in less serious health consequences.
And perhaps most importantly, beginning in 2006, for the very first
time in the history of Medicare, seniors will have a prescription drug
benefit. If they choose to participate, seniors would pay about $35 a
month. Once they have met the $250 a year deductible, 75 percent of
their drug costs will be covered up to $2,250. When drug costs exceed
$3,600 a year, 95 percent of costs will be picked up by Medicare.
No matter where in the country they live, seniors will be able to
choose between at least two prescription drug plans.
If seniors are happy with the coverage they now have--and many in my
district are--they do not have to switch into a new plan. This new
benefit is absolutely, completely, 100 percent voluntary.
But there is much, much more to this bill than a prescription drug
benefit option for seniors. In fact, this bill can affect the health
and welfare of every American citizen, no matter how young or old. How
is this so?
Well, first, this bill will expand access to health care for
everyone.
As you know, physicians who see Medicare beneficiaries are reimbursed
for the extra cost of treating these patients. These payments are
already woefully inadequate and physicians have been forced to stop
taking on Medicare beneficiaries because they simply cannot afford to
keep seeing them. Under current law, these reimbursements will be cut
by an additional 4.5 percent next year.
I am very, very pleased that the conference report addresses this
issue by reversing the scheduled cut and increasing the payments by 1.5
percent. This means that more doctors will be able to treat more
seniors, and more seniors will have a choice of which doctors they see.
Hospitals also will be better off under this bill. The conference
report provides increases in payments to teaching hospitals and
increases funding for hospitals that treat a large number of Medicare
patients. It also reimburses hospitals for the costs of using the most
advanced technology. In short, the conference report ensures that
hospitals can continue to care for Medicare beneficiaries.
Finally, this legislation encourages Americans of all ages to save
for their own healthcare needs. The Health Savings Accounts--HSAs--
will let people save money and accumulate interest--tax-free--in order
to take care of health care premiums and other medical expenses.
HSAs are completely portable, so when people change jobs, they can
take their accounts with them. Individuals also can make ``catch-up''
contributions to their accounts once they turn 55, and still enjoy the
tax benefits.
These accounts will help thousands of individuals who do not have
access to health insurance--or who wish to augment their coverage--to
better afford it.
Our seniors have worked hard throughout their lives. They should be
enjoying their golden years, not worring about how to pay for their
life-sustaining medicines. This legislation will go a long way in
helping them get back to the business of enjoying life.
Drug discount cards, baseline physical examinations, prescription
drug coverage, and disease screenings are just a few of the great new
features that will help seniors stay healthy.
Health savings accounts and improved levels of physician and hospital
reimbursements will go a long way to improving access to health care
for Americans of all ages.
I am honored to support this legislation and I encourage my
colleagues to do so as well.
Mr. CAPUANO. Mr. Speaker, I rise today to voice my strong opposition
to H.R. 1, the Republican Prescription Drug Bill.
This bill represents the first step in a Republican plan to end
Medicare as we know it. Under the guise of providing seniors with the
prescription drug coverage they so desperately need, this Congress is
attempting to destroy the program that seniors have depended on for
over 35 years to provide them with the affordable, reliable health care
they need and deserve.
Mr. Speaker, not only does this bill fall far short of what the
senior citizens of this country expected of us, but it fails by the
most basic of standards: it prohibits the federal government from
negotiating for lower-cost drugs; it may lead to 3 million seniors
losing the good prescription drug coverage they currently have through
former employers; it subsides HMOs at 124 percent of what it pays to
traditional fee-for-service Medicare; it creates new Health Savings
Accounts, which benefit mostly the wealthy; and it sets up new ``cost-
containment'' measures, designed to lay the groundwork for future cuts
to beneficiaries and providers. But most alarmingly, this bill contains
a massive demonstration program that it the first step toward the
privatization of Medicare.
The ``premium support'' demonstration project in this bill could
force 7 million seniors to be subject to a social experiment that has
never been tested. Under the demonstration program, HMOs could
``cherry-pick'' healthy and wealthy seniors citizens, leaving the poor
and sick in the traditional program, undermining the social insurance
pool. Premiums for those in the traditional program would be driven up,
and they could also vary by region and fluctuate from year to year.
This is an unacceptable assault on the Medicare program that will only
result in higher profits for the insurance industry.
There is no denying that some people may benefit from this bill. For
example, it does provide some prescription drug coverage for those with
the lowest incomes. Although instituting the first assets-test for low-
income beneficiaries in Medicare's history, it will mean that many of
these senior citizens now have access to prescription drugs.
Further, as the Member representing many of the teaching hospitals in
the Boston area, I am well aware of the important provisions in this
bill that will provide essential funding for the world-class hospitals,
dedicated doctors, and other health care professionals who work so hard
to provide quality care to all the citizens of my district.
However, the positive elements of this bill do not outweigh my
concern for the damage this bill could do to a program that has become
an integral part of our society. The steps toward privatization
contained in this legislation are unacceptable. I am not willing to
gamble with the health of our nation's seniors, placing their well
being in the hands of the insurance industry. I do not believe this is
a risk worth taking. Medicare has served us well for over 35 years. Its
demise would mean an America where senior citizens are left to fend for
themselves in the private insurance market without a safety net. While
this bill may offer some appealing short-term benefits, the price could
be the end of Medicare as we know ti. I cannot and will not be a part
of it.
I urge Members to vote ``no'' on H.R. 1.
Mr. SHERMAN. Mr. Speaker, I rise to protest the process that brings
H.R. 1, the Medicare reform and prescription drug legislation, before
the House today. These procedures could only be described as
undemocratic and unfair.
Republican Leaders were in the room for weeks as this bill was
drafted, and were able to brief their members on its contents.
Democratic Members could not begin to analyze the bill's provisions
until yesterday.
[[Page H12289]]
We were given almost no time to review the conference report for this
momentous legislation. We have waived the rules of the House to allow
for this hasty, almost immediate consideration of a bill more than
1,000 pages long, so that not even the members of this body, to say
nothing of the public, can fully grasp what is included.
There is no way that we, with a fairly full day of debate in this
body, could have read the bill in the short time provided. And it is
not enough that we merely read the bill. One must understand its
implications. This alone demands that we vote ``no'' now, to give
ourselves more time to fully deliberate and debate this legislation.
Mr. Speaker, again, I rise to express my strong opposition to the
process by which we are today voting to overhaul one of the most
important institutions in our country. American seniors deserve better,
and we owe them more of our time; we owe them full deliberation, debate
and our full consideration of this legislation.
Mr. ROTHMAN. Mr. Speaker, for seven years, I have been pushing and
voting for a voluntary prescription drug benefit under Medicare. Such a
plan would give seniors access to the quality, affordable, life-saving
medicines they need. Unfortunately, the final Medicare bill--written in
secret by the very same Republicans who eight years ago shut down the
federal government as part of their strategy to force Medicare to
wither on the vine--does exactly the opposite of what it is supposed to
do. Instead of providing seniors with a voluntary, guaranteed drug
benefit, the bill provides no drug coverage until 2006, and then forces
millions of seniors to pay more for drugs if they don't give up their
doctor and join an HMO--HMOs that can raise premiums at will and will
throw out seniors who get too sick. The bill is nothing less than an
outrageous giveaway of taxpayer funds to the health insurance industry.
A $12 billion slush fund in the bill will be doled out to insurance
companies that offer privatized Medicare services and employers are
given a $70 million windfall to maintain their retiree drug plans.
These subsidies create a huge bias in favor of private plans. That's
not competition, it's corporate welfare, and it's wrong.
The Congressional Budget Office projects that when the drug benefit
begins in 2006, the average senior will spend $3,155 annually on
prescription drugs. Under the Republican bill, because it so loaded up
with giveaways to the private insurance industry, a senior with an
income over $13,500 will pay $2,075 out of the first $3,155 in total
drug costs--66 percent or two-thirds of the total--including the $35
monthly premium and the $250 annual deductible. And on top of these
costs, 52,000 New Jersey seniors will face additional increases in
their Part B premiums.
Also, instead of a voluntary benefit under Medicare, seniors will
lose their doctors and be forced out of the system they know and trust.
Worse still, 220,000 New Jersey seniors enrolled in PAAD and Senior
Gold will have their health jeopardized and their choice of medicines
limited by restrictive drug formularies imposed on the State by managed
care plans. These seniors will face disruption in their coverage and
will likely get less help than they currently receive. And it's a bad
bill for doctors, whose reimbursement rates will be set not by the
federal government, but by HMOs out to make a profit.
It is an especially bad deal for New Jersey seniors. As a result of
the Republican bill, 94,000 New Jersey retirees will lose their drug
coverage, 2-3 million nationwide. Over 150,000 Medicaid beneficiaries
in New Jersey will pay more for drugs and 186,000 New Jersey seniors
will be forced to leave traditional fee-for-service and accept vouchers
to enroll in private plans starting in 2008.
The Republicans controlling the House of Representatives today
dislike Medicare so much that they are literally willing to subsidize
private health insurance companies to compete with Medicare, paying
those companies $82 billion to create new private bureaucracies to
handle prescription drugs for seniors and to even go so far as to build
in a profit for them. We tried this experiment once already, giving
private plans subsidies to offer Medicare services in the form of
Medicare+Choice. But despite these subsidies, private Medicare+Choice
plans felt they could not make enough of a profit, so they cut benefits
and dropped hundreds of thousands of policyholders. Not only will this
bill ultimately destroy Medicare and force seniors and their doctors
into dealing with private HMOs, but the $82 billion could have been
invested into the existing Medicare infrastructure, covering all
seniors with a voluntary prescription drug program and reducing the
premiums and co-pays for our nation's seniors.
Most galling the bill expressly prohibits the federal government from
negotiating prices with the drug industry. The government already
permits such negotiation in prices by the Department of Veterans
Affairs and the Department of Defense--if this is good enough for
veterans and those serving on active duty in the armed forces, why not
for seniors? This is a $139 billion gift to drug companies in windfall
profits. If Republicans were serious about reducing costs, their bill
would not block the Secretary of Health and Human Services from using
Medicare's enormous purchasing power to bring drug prices down.
AARP, which claims to speak for seniors, but is in fact a big
insurance company with over $200 million in commissions on health and
life insurance policies and prescription drug plans, has hastily
endorsed the bill. Like hundreds of rank and file AARP members in my
district who have called my office to disavow the national group's
decision, I am outraged that AARP renounced the anti-privatization
principles it claimed were central to its support. For this reason, I
have resigned my AARP membership.
As many have said, this bill is a Trojan Horse: a radical dismantling
of Medicare masquerading as a prescription drug bill. We must not
forget that only a handful of Republicans voted for Medicare when
Democrats created the program nearly 40 years ago. And at every turn
since 1965, the Republican Party has worked to weaken a popular and
successful health care system that allows seniors and their personal
doctors to manage their own care.
We must not now adopt a privatization scheme that will harm seniors
and risk Medicare's future. Instead, Congress ought to add a simple,
straightforward and voluntary drug benefit to Medicare, save the $82
billion in subsidies to private insurance companies and private plans,
and apply that money to lessen seniors Medicare drug premiums and co-
pays. And then we should engage in a real bipartisan discussion about
the future of Medicare--out in the open and not in a secret
congressional backroom.
Mr. COSTELLO. Mr. Speaker, I rise in strong opposition to H.R. 1, the
Medicare Prescription Drug and Modernization Act of 2003 conference
report. Since coming to Congress, I have consistently promised over
70,000 seniors in my district that I would not support legislation that
would fundamentally change the nature of Medicare and provide a
prescription drug benefit that relies solely on insurance companies.
This legislation does just that and I cannot in good faith support it.
Medicare has been a success because it provides guaranteed coverage
for all elderly and disabled Americans. This legislation would end
Medicare as we know it and may particularly harm rural areas that
depend on the traditional Medicare program. Beginning in 2010, up to
6.8 million people could be part of a demonstration program that forces
the Medicare fee-for-service program for doctors and hospital visits to
compete with private insurance plans. People who wanted to remain in
traditional Medicare would find their premiums going up as other
beneficiaries opted for private insurance coverage. Seniors and the
disabled would essentially be forced out of the traditional fee-for-
service program and into some form of managed care.
In addition, this approach does not guarantee the same benefits for
all seniors. Seniors who live where hospitals and doctors negotiate
lucrative contracts with managed care plans would have to pay more;
seniors with higher incomes would have to pay more; seniors in rural
areas would have fewer choices of doctors and pharmacies; and seniors
with low incomes but with assets such as a savings account might get
nothing at all. These provisions violate the central promise of
Medicare: to provide a consistent, guaranteed benefit that allows
everyone, no matter where they live, how much they have, or how sick
they are, access to quality medical care.
Further, I support a voluntary prescription drug benefit paid for by
Medicare. However, this ill-conceived plan before us today will result
in as many as three million retirees losing their employer-sponsored
drug coverage which is more comprehensive than this legislation. At
present, employer-sponsored retiree health benefits are the greatest
source of coverage for retirees, providing drug coverage for one in
three Medicare beneficiaries. Yet, this conference agreement creates an
incentive for employers to drop retiree coverage they currently
provide, rather than encouraging them to maintain it. In addition, it
fails to help retirees from state and local government, multi-employer
groups, and non-profit organizations. The additional funding, under the
premise of shoring up retiree coverage, is meaningless to those who
retire from public service, such as teachers, firefighters, and police,
or other organizations with no tax liability.
Finally, the conference agreement is flawed because it offers seniors
an inadequate prescription drug benefit. I am committed to providing a
comprehensive benefit that is affordable and dependable for all
beneficiaries with no gaps or gimmicks in its coverage. However, this
legislation provides a huge gap in coverage leaving half of seniors
without prescription drug coverage for part of every year.
[[Page H12290]]
Further, the bill is sorely lacking in any provision that might
restrict the skyrocketing costs of the drugs themselves. It does not
include meaningful reimportation language, strong language ensuring
access to generic drugs, or the ability to negotiate prices as is done
currently by the Veterans Administration.
This legislation relies too heavily on the insurance industry to
bring drug costs down and does not guarantee seniors access to the
medicine prescribed by their doctor or that they can get prescriptions
filled at their local pharmacy. Seniors deserve fair drug prices and a
real, affordable prescription drug plan.
Mr. Speaker, for these reasons, I oppose the conference report. I ask
my colleagues to join me and reject this bill and send it back to the
committee with instructions to bring the bill back to the floor with a
real prescription drug plan that guarantees seniors affordable and
dependable coverage.
Ms. McCOLLUM. Mr. Speaker, tonight, Republican leaders in Congress
are poised to pass an overhaul of Medicare that provides a weak
prescription drug benefit, fails to lower drug costs, and starts the
process for the privatizing of Medicare--a program that seniors have
depended upon and trusted for almost 40 years.
Seniors have been fighting for years for a Medicare prescription drug
benefit that is affordable; available to all seniors and disabled
Medicare beneficiaries by providing meaningful benefits within the
Medicare program.
However, the legislation Republicans have produced does not make
prescription drugs affordable, does not offer a guaranteed benefit
under Medicare and does not sufficiently protect current retiree plans.
Instead, this bill caters to the pharmaceutical industry, bribes the
HMOs with $12 billion in subsidies, and allows the AARP to reap $1.56
billion in profits. This bill threatens the future of Medicare and the
health of America's seniors.
Under this Republican Medicare bill: $88 billion in tax credits will
be given to employers to retain coverage for their retirees, and;
Despite this windfall, 2 to 3 million seniors will still lose benefits
from their employer-based coverage; and millions of seniors will pay
more in Medicare premiums if they refuse to join an HMO.
The prescription drug plan that Republicans have proposed is a sham.
Seniors will pay more than 50 percent of their drug costs for coverage
up to $2,250. Most troubling, the bill leaves a huge ``coverage gap.''
Seniors will have zero prescription drug coverage for medication costs
that run between $2,250 and $5,100--and those beneficiaries will still
have to pay the monthly premium! Over half of all Medicare
beneficiaries would fall into this ``coverage gap.'' And this bill will
scale back coverage for the poorest seniors. Up to 6.4 million low-
income Medicare beneficiaries will get less drug coverage than they
have now as a result of new low-income thresholds and stringent asset
testing. Also, seniors will only be eligible for drug coverage through
private insurance companies that will have wide latitude in setting
premiums and deductibles. Private insurance companies will also be able
to make decisions about which drugs are covered, as well as which
pharmacies seniors can use.
Today, there are approximately 648,000 Medicare enrollees in
Minnesota. According to the Minnesota Department of Health, about 46
percent have no prescription drug coverage. In Minnesota alone, this
bill that may cause at least 39,480 Medicare beneficiaries to lose
their coverage from their former employers and 89,800 Minnesotans will
pay more for prescription drugs.
And the most outrageous part is that the Republican plan benefits the
pharmaceutical industry by explicitly prohibiting the Secretary of
Health and Human Services from negotiating lower drug prices on behalf
of America's 40 million Medicare beneficiaries. It also blocks the re-
importation of drugs from Canada at lower prices. Additionally, the
plan will create health savings accounts, which are tax-free savings
accounts for medical expenditures. This creates an unprecedented tax
loophole that would undermine existing employer coverage and provide
$6.7 billion in tax relief for the wealthy.
Earlier this year, I supported a bill that provides for a voluntary
prescription drug benefit under Medicare. Medicare would pay 80 percent
of drug costs after a $100 deductible and no senior will have to pay
more than $2,000 in costs per year. This plan would cover all Medicare
beneficiaries, regardless of previous health conditions, and guarantee
people's choice of medication, pharmacy, doctor and hospital. The plan
that I supported would also give the Secretary of Health and Human
Services the authority to use the collective bargaining power of 40
million beneficiaries to secure lower costs for the most popularly
prescribed medications to end price gouging by the big drug companies.
Minnesota seniors and persons with disabilities deserve better than
the Republican bill that is before us tonight. I will only vote for a
prescription drug benefit that is affordable and available to all
seniors and disabled Medicare beneficiaries regardless of geographic
location or health condition.
Mr. BISHOP of Georgia. Mr. Speaker, although the massive conference
agreement over Medicare reform contains some of the provisions the
country needs and that I support, the overall legislation is deeply
flawed. Congress can do better. By voting against the agreement, I am
calling on Congress to correct the flawed provisions that would deny
many seniors any prescription drug benefit, increase health care costs
for many lower income citizens, push many seniors into managed care,
put employer-based prescription drug coverage at greater risk, and
create an uncertain privatization process that could change the face of
Medicare forever.
By voting down this proposal, we could fix the critical flaws and
still have time to enact a sound Medicare reform bill that the country
desperately needs before the end of the 2003 session. I am cosponsoring
a bill introduced Friday (11/21) that would shore up rural providers
and maintain the integrity of Medicare for rural communities, while
putting aside the more rancorous issues until later. I urge its
consideration.
Among the agreement's provisions that I strongly support are those
that would provide realistic reimbursements to providers, including
giving rural hospitals parity with urban hospitals. Many community
hospitals have shut down, and many are struggling to survive. This puts
the health of many of our rural citizens, and the vitality of many
rural communities, at risk. Relief for at-risk hospitals is one of the
positive things about the agreement, and it should be a part of any
health care reform enacted by Congress.
But I cannot overlook the agreement's overwhelming downside.
Dr. Kenneth Thorpe, a noted health policy authority from Emory
University, calculates that under this agreement 51,450 Georgians would
lose employer retiree health benefits; 161,300 Georgians would pay more
for prescriptions; 82,000 fewer Georgians would qualify for low-income
benefits than under the Senate version; and 34,000 Georgians would pay
more for Part B premiums for doctor and outpatient care.
There are other sections of this lengthy bill, released the same day
debate began, that few outside the conference committee have had an
opportunity to examine. But much of what we know is disturbing.
There are no measures in this bill to respond to the problem of
skyrocketing of drug costs. Not only would the government be prevented
from negotiating drug prices, the possibility of reimportation of less
expensive medicine from Canada is effectively killed.
The actual prescription drug benefit is skimpy, with an enormous
coverage gap and an asset test designed to limit access for thousands
of truly needy Americans. Moreover, millions of retirees will see the
superior coverage they now receive from their former employers weakened
or eliminated. That's nearly 3 million individuals nationally and more
than 50,000 in the state of Georgia alone.
One of the biggest concerns is the agreement's push to privatization.
As drafted, it appears private insurers would tend to pull in the
healthiest beneficiaries while those with medical problems would remain
with Medicare, causing Medicare costs to sharply rise. This could
create what some are calling a `death spiral' of escalating costs in
traditional Medicare. More and more seniors would be pushed into the
less-expensive HMOs and PPOs simply because they could not afford the
higher cost of Medicare.
From the enormous premium support ``demonstration projects'' to the
weakened Federal fallback for areas without meaningful access to
private prescription drug plans, this agreement reveals a poor
understanding of the needs of rural providers and residents.
All of these flaws make this agreement unattractive in the short
term. But if we look just a bit further down the line, the picture
becomes even bleaker. In 2006, when the prescription drug benefit would
actually begin, the benefit would be essentially worthless to the
average citizen. And, when 45 percent of spending on Medicare comes
from general revenues, extreme measures to curtail Medicare spending
would be triggered. It's extremely cynical to include such a dramatic
cost-containment mechanism while excluding responsible measures to
control Medicare spending.
There is much that is wrong in this bill, and much less that is
right.
Rarely will we consider any legislation that will have a greater
impact on the well being of the American people.
Let's get it right!
Mr. OBERSTAR. Mr. Speaker, Medicare is the most successful health
initiative in American history--improving the quality of life for
America's senior citizens, extending their longevity, and relieving
their anxiety about affording the health care they need.
For the past several years, Democrats in Congress have worked
tirelessly for affordable, comprehensive, and guaranteed coverage for
prescription drugs under Medicare.
[[Page H12291]]
This week, the Republican majority in Congress is poised to pass
legislation that will require seniors to pay significant out-of-pocket
costs for prescription drugs, will eliminate employer-provided health
care coverage for 2.7 million retirees nationwide, and will ultimately
undermine the entire Medicare program. Simply put, the Republicans
brokered a deal that prioritizes the pharmaceutical and the insurance
industries over providing a comprehensive benefit to seniors and the
disabled.
i. effects on medicare beneficiaries
I am particularly concerned with the inclusion of ``premium
support,'' a misguided proposal that will undermine Medicare. Instead
of providing a Medicare prescription drug benefit for seniors,
congressional Republicans have embarked on a radical and untested
social experiment that threatens the future of Medicare. The final
Medicare bill clearly takes the first step toward privatizing Medicare
by implementing a ``premium support demonstration project'' in six
metropolitan areas.
The bill threatens traditional Medicare because it includes
provisions designed to stack the deck in favor of the health insurance
industry. The legislation allots $17 billion to HMOs to lure them into
the market to provide senior citizens with taxpayer-financed health and
drug benefits. As the Washington Post recently pointed out, if Medicare
``privatization is such a good idea, why do the private insurance
companies need such big subsidies to enter the Medicare market? . . .
That's not capitalism or competition. That's corporate welfare.''
Rather than divert $17 billion from Medicare to prop up private sector
competition, it would be far better to invest that money in Medicare's
future.
Seniors will essentially receive a voucher for services to cover the
lowest-cost private insurance plan, if such plans are offered, which is
not at all certain. If this plan does not pay for the services they
need, seniors will have to cover the difference--which could be a big
figure--out of their own meager income. Masquerading as increased
efficiency, this concept disproportionately benefits healthier seniors
and leaves seniors with more costly health care needs paying an
estimated 25 percent more for traditional Medicare. Seniors living in
different regions will also pay different prices for the exact same
benefit. I believe America's seniors deserve a guaranteed drug plan
that is available for all Medicare beneficiaries--regardless of where
they live.
ii. improved medicare reimbursement for rural health care providers
I have strongly supported efforts to eliminate disparities in
Medicare reimbursement for rural areas, and I am very pleased that the
conference report contains significant improvements for rural health
care providers. Health care is essential in greater Minnesota. The
hospitals in many small communities throughout northern Minnesota are
the major employer in town, and the health care they offer is critical
for economic development and tourism.
It is encouraging news that 31 hospitals in my congressional district
would receive $39 million over 10 years under this bill in improvements
in Medicare reimbursement, including fourteen Medicaid Disproportionate
Share Hospitals (DSH) and 12 Critical Access Hospitals (CAHs). Other
notable changes in the policies for CAHs--albeit not attached to a
dollar amount--would improve the delivery of mental health services in
rural northeastern Minnesota by permitting 10 beds to be used for
psychiatric or rehabilitative services. Physicians would see a payment
increase of 1.5 percent rather than a 4.5 percent decrease. Teaching
hospitals would each receive $183,000 spread out over 10 years in
additional payments for Indirect Medicare Education, which would
greatly assist the training of medical students at the University of
Minnesota, Duluth, as they prepare to serve rural Minnesota.
iii. prescription drug benefit
Seniors will be eligible for drug coverage only through private
insurance companies that will have wide latitude in setting premiums
and deductibles. Private insurance companies will also be able to make
decisions about which drugs are covered, as well as which pharmacies
seniors can use.
The plan is difficult to explain, but let me try: it begins with
uncertain private health insurance premiums, estimated to be $35 per
month, but not specified in statute; then, seniors must pay a $250
deductible before they receive any assistance, after which they will
pay a 25 percent co-insurance for up to $2,250 in drug costs. However,
there is a large coverage gap where no assistance is provided between
$2,250 and $5,100 in drug spending, the ``hole in the doughnut,'' where
seniors will be paying premiums but receiving no assistance at all.
Those seniors with $5,100 in drug costs annually will still pay $4,020
under this bill. This plan is as unfair as it is complicated and costly
to older Americans living on fixed incomes.
iv. importation/cost issue
I firmly believe that in order to ensure the continued affordability
of Medicare benefits for seniors, greater efforts must be made to
address escalating health care costs, particularly the price of
prescription drugs. Yet this bill does precious little to contain the
cost of prescription drugs in the future. The legislation once again
deceptively appears to permit drug importation from Canada, while
including a poison pill that the Secretary of the Department of Health
and Human Services must certify to the Congress that its implementation
does not present a health risk. During the Clinton Administration, HHS
Secretary Donna Shalala refused to make such a certification, as has
the current Secretary, Tommy Thompson. When Americans are paying 30 to
300 percent more for prescription drugs than Canadians or people in
other industrialized countries, there must be a concerted effort to fix
the safety concerns in the legislation rather than jettison the entire
effort with this poison pill.
Despite claims that this legislation introduces free market
principles and competition, I am deeply troubled that the Republican
Medicare plan prevents federal cost-saving efforts that would reduce
prescription drug costs for seniors. At a time when many seniors must
pinch their pennies to afford the basic necessities, this bill--
incredibly--explicitly prohibits the Secretary of the Department of
Health and Human Services from negotiating lower drug prices on behalf
of America's seniors. Unlike the Department of Veterans Affairs, which
does have such authority, the Secretary of HHS would not be allowed to
leverage the market power of 40 million Medicare beneficiaries to
reduce prices.
In my view, the big winners are the drug and insurance companies, at
the expense of our nation's seniors. In addition to providing $17
billion to HMOs and prohibiting the Secretary of the Department of
Health and Human Services from negotiating lower prices, the final
Medicare bill will eventually undermine community pharmacies. Pharmacy
benefit manages (PBMs), charged with administering the prescription
drug benefit, will be able to contract out and establish an unequal
playing field whereby mail order companies can sell larger quantities
for lower co-pays than community pharmacies can. There is no
transparency for PBMs--just a conflict of interest; PBMs are not held
responsible to report rebates or kick-backs they might receive from the
pharmaceutical industry for selling specific drugs--that provision was
stripped from the conference report. I am continually dismayed that
Republicans go to great lengths to serve special interests rather than
the public good.
I have voted many times this year in support of a strong prescription
drug program that would strengthen the Medicare program. However, I am
not willing to cast a vote to undermine a program that seniors and the
disabled have trusted for nearly 40 years, in exchange for an atrocious
prescription drug benefit that directs formidable sums of money to
special interests. Congress can do better; our seniors certainly
deserve better.
Mr. DAVIS of Illinois. Mr. Speaker, it is said that the cruelest lies
are often told in silence--in what you don't say. If that's the case,
then the silence is deafening as the Medicare prescription drug
legislation looms ever closer to final passage.
We promised the American people we would protect and strengthen
traditional Medicare. This legislation does the opposite--it begins
coercing millions of seniors out the common Medicare insurance pool
into private HMOs.
It creates huge new tax shelters for the ultra wealthy with the
ironic name of ``Health Savings Accounts.''
Meanwhile the very poorest seniors, those who also qualify for
Medicare, will see their benefits slashed.
The bill places draconian new caps on future Medicare services and
spiraling new tax burdens on middle income working families.
The bill inaugurates the process of means-testing and asset-testing
seniors before providing them benefits--of checking their wallets
before checking their health.
It would also add heavy new financial burdens to state budgets
already strained to bursting by federal cutbacks.
All this in return for a pathetically inadequate prescription drug
benefit and skyrocketing drug company prices and profits as far as the
eye can see.
Fool me once, shame on you. Fool me twice, shame on me. Fooling our
seniors shame on all of us.
Mr. Speaker, this Medicare prescription drug bill is not what it is
advertised to be. It is a cruel hoax and a danger to the health and
well-being of America's seniors.
As Representatives of the American people, we have a special moral
responsibility to be honest with the people.
This legislation breaks that sacred trust. This bill deceives and
dispossesses America's seniors.
I'm with Will Rogers: I'd rather be the man who bought the Brooklyn
Bridge than the man who sold it.
[[Page H12292]]
Mr. VAN HOLLEN. Mr. Speaker, with regret, I rise in opposition to the
Medicare conference report now before us. Rather than giving seniors
the simple, comprehensive and affordable prescription drug benefit they
deserve, this bill recklessly undermines the Medicare program,
threatens many seniors' existing drug coverage and fails to bring down
skyrocketing drug costs.
Let's be clear: This is not about whether we ought to add a
prescription drug benefit to Medicare. Democrats--including myself--
have been calling for a meaningful Medicare prescription drug benefit
for years. Now that the Republican party has dropped its historic
opposition to modernizing Medicare, there is broad consensus--at least
rhetorically--on the importance of this goal.
Additionally, this is not about whether doctors should receive a
positive payment update for services rendered under Medicare. I think
everyone in this chamber understands we could pass a free-standing
positive payment update for physicians today--and by a wide margin.
Frankly, I would be first in line--because I don't think you can ask
providers to participate in a program without adequate reimbursement.
But if we were really interested in giving doctors a fair reimbursement
rate, we would end this untenable ritual of dodging the next round of
scheduled payment cuts with stop-gap, band-aid measures and finally get
around to fixing the obviously flawed Medicare reimbursement formula
once and for all. Unfortunately, that's not what we are doing here
today.
Instead, after months of secretive negotiations and much highly
publicized bickering, the majority is now presenting this House with a
prescription drug bill that blatantly violates the first tenet of
responsible medicine: Do No Harm.
If this conference report is enacted into law, as many as 7 million
seniors will be forced to pay more for Medicare--unless they agree to
give up their doctor and join an HMO, according to analysis done by the
House Ways and Means and Energy and Commerce Committee minority staff.
Additionally, over 2 million retirees who already have private
prescription drug coverage stand to lose that coverage, according to
the same report.
That is also the conclusion reached by the former Republican Majority
Leader of the House Dick Armey, who called on Congress to reject this
misguided bill in today's Wall Street Journal, saying in part: ``(T)his
bill is going to cost millions of seniors their current prescription
drug coverage.''
In my home state of Maryland, an estimated 60,000 Medicare
beneficiaries could lose their existing private prescription drug
benefits, according to analysis based on CBO data prepared by the
Senate Health, Education, Labor and Pension Committee minority staff.
Moreover, similar analysis from the Senate HELP Committee minority
staff using CRS data projects that 75,000 Maryland Medicaid
beneficiaries will pay more than they do now for the prescription drugs
they need.
This legislation puts seniors with existing coverage--and the future
of the entire Medicare program--at risk. And for what? A prescription
drug benefit that--after all the premiums and deductibles and co-pays
and coverage caps and out-of-pocket costs are accounted for--provides
$1 of assistance for every $4 that seniors with significant drug costs
will still have to pay themselves.
There are smarter, more efficient ways to spend $400 billion on a
Medicare prescription drug plan. For starters, we should eliminate the
$12 billion subsidy being offered the private insurance industry as an
inducement to participate in the Medicare market. If PPOs and HMOs are
really more efficient than traditional than traditional Medicare in
delivering high quality care at a lower cost, they don't need a $12
billion taxpayer handout to do it. Additionally, we should scrap the
Administration's ill-conceived and deceptively named ``Health Security
Accounts'', which amount to little more than a $6 billion tax break for
the wealthy. And finally, we should get serious about making drugs
affordable for seniors and for all Americans--through such common sense
steps as permitting re-importation from our industrialized trading
partners and allowing the federal government to negotiate for lower
drug prices on behalf of Medicare's 41 million beneficiaries--something
the bill before us today actually forbids the government to do.
The ultimate value of allowing the Center for Medicare and Medicaid
Services (CMS) to negotiate for lower prices will obviously turn on the
outcome of those particular negotiations. But we know from the
experience of the Veterans Administration--which does currently have
the ability to negotiate for lower prices--that the savings can run
upwards of 60 percent. In the absence of meaningful steps to curb the
exorbitant cost of drugs, this bill does more for the pharmaceutical
industry than it does for consumers.
I believe seniors deserve a real Medicare prescription drug benefit
plan; one that is comprehensive, affordable and easy to understand; one
that will strengthen Medicare rather weaken it; and one that will not
reduce the benefits of seniors who already have prescription drug
coverage.
Mr. Speaker, we should defeat this fatally flawed conference report,
come together on a bipartisan basis and give seniors the meaningful
prescription drug assistance they are asking for and need.
Mr. CUMMINGS. Mr. Speaker, I rise today to speak against the woefully
inadequate Medicare prescription drug conference bill being considered
today.
Mr. Speaker, this report is an insult to our seniors. Instead of a
bill that helps our seniors, we have a bill that makes an untenable
trade-off. A meaningless prescription drug benefit and the dismantling
of the Medicare ``healthcare'' program for 40 million seniors and
disabled Americans as we know it today. Quality healthcare coverage
should come along with a prescription drug benefit, which Democrats
have been fighting for over the past six years, not at the expense of
it. But that is what this bill does. So today, what we have to consider
is a bill that will do more harm than good--one that represents a giant
first step in privatizing and the emasculation of Medicare--a program
that our seniors and disabled know and love.
Under this disastrous plan:
Gone are retiree benefits. Because it gives employers no incentive to
maintain prescription drug coverage for their retirees two or three
million retirees will lose their current private drug coverage. In my
home state of Maryland this includes 59,640 retirees.
Gone are wrap-around services. Six million low-income beneficiaries
will pay more for their prescription drugs. Those who are dually
eligible to receive both Medicare and Medicaid--seniors who are so poor
that they need what we call wrap-around services to have healthcare
coverage--will pay more for their prescription drugs under this plan.
To add insult to injury this bill does not allow states to use their
federal Medicaid monies to supplement them. This includes 75,800
seniors in Maryland.
Gone is the traditional Medicare Program as we know it. They say fee-
for-service stays intact. Well if you as a beneficiary want to be
nickeled and dimed to death--and pay almost 80 percent out of pocket
for Medicare and prescription drug coverage up to $5,044, then it stays
intact. Let me explain, that means that after a senior or disabled
person has paid almost $4,000 out-of-pocket in premiums, deductibles
and contributions, then the traditional Medicare coverage kicks back
in.
Soon to be gone is traditional Medicare. Traditional Medicare is most
threatened by what has been termed premium support. Beginning in 2010,
about 7 million beneficiaries will be forced into a premium support
demonstration that will make them pay more for Medicare if they don't
give up their doctors and join an HMO. This also means that there will
be tremendous premium variation from region to region even in the same
state when this plan is fully rolled-out. While it may be just 7
million seniors in 2010, now make no mistake the goal is to end
Medicare as a social compact, where eventually, Medicare will indeed
``wither on the vine'' and private insurance and pharmaceutical
companies will rule the day. Unfortunately, passage of this legislation
will mean that many of our seniors will wither right along with the
Medicare program--which will no longer be seen as a guaranteed
benefit--a concept our nation embraces.
Here to stay are vouchers for Medicare beneficiaries--to take to an
HMO which will give these folks what they want them to have--there will
be little real choice. Seniors want stability--knowing who their
doctors will be, who will be able to fill their prescriptions, which
drugs will be covered, and in which hospital they can receive services.
I have not ever been told by a single senior that they want to be able
to choose between profit-driven private insurer providers which may or
may not want to have them as clients.
Here to stay is assets testing. What's good about this bill is that
those beneficiaries who are 15 percent below the poverty level are able
to forego paying the monthly premiums of $35 and the yearly deductible
of $275, and to escape the donut hole in coverage from $2,200 to
$5,044. But again our compassionate conservative friends give with one
hand and take with the other.
In order to qualify as low-income, seniors have to go through the
degradation of proving that they are poor enough to receive it--meaning
all of their assets, not just incomes are tested. The one saving grace
of this bill is poisoned by the lack of compassion. This means that low
income seniors will be kicked out of receiving the low-income benefits
of the plan depending on their assets--simply because they have been
able to squirrel away a few thousand dollars into a savings account.
This affects 53,000 seniors in Maryland, many in my district.
I ask, who is going to invade their privacy and check their assets--
isn't it sufficient that
[[Page H12293]]
they're already living off of meager means 150 percent below the
poverty level, should they too have to pay $4,000 to receive both
Medicare and prescription drug coverage? What a trade-off. How
despicable. I think my colleagues can agree that this is a very
troubling proposition and a totally unfair result.
Here to stay is big money to the drug companies and HMOs. In fact,
this bill overpays the private insurance plans by $1,920 per
beneficiary at the expense of traditional Medicare by creating a $12
billion slush fund for these companies just to take on these
beneficiaries. Mr. Speaker, our seniors do not need a hand-out, but a
hand-up--use that $12 billion to give to our current providers and
hospitals who already give outstanding care to our seniors, along with
a meaningful prescription drug benefit.
Here to stay are HMOs that seniors will feel coerced into joining
because they will not be able to pay for the traditional Medicare they
enjoy today.
Additionally, with the establishment of the Voluntary Prescription
Drug Benefit Program, beneficiaries again lose because of the lack of
negotiated prices for the prescription drugs. Why not leverage the
power of the 40 million Medicare beneficiaries? Why not mandate
containment of drug costs in this bill? Why give seniors and the
disabled a prescription discount card they cannot use until 2006 while
the drug companies still get to determine the cost? Why enact health
savings accounts that only the well-off can afford? Why include a
poison-pill that kills any chance of reimportation of affordable
medicines? Why include an artificial budget cap on general revenues
funding for Medicare that triggers a fast-track legislation procedure
that would allow immediate cuts in benefits, cut payments to nursing
homes and home health care providers and increase cost-sharing? Why
leave our seniors and disabled powerless?
I know the answers. It's because this bill is not a reform bill, but
a rewards bill--and the pharmaceutical and the private insurance
companies are the winners.
Mr. KIND. Mr. Speaker, I rise in reluctant opposition to the bill
before us today. It was my hope that the conference committee would
work in a bicameral, bipartisan manner and produce a bill focused on
providing prescription drug coverage to seniors and improving Medicare.
Instead, House Democrats were shut out of the discussion completely,
and special interest groups were given more information than members of
Congress. Even more troubling than the process, however, was the
legislation that came out of this conference. This bill is a bad deal
for American seniors and an even worse deal for our children and
grandchildren. Estimated at $400 billion, this bill is not paid for
and, without basic cost containment measures, like price negotiation or
drug reimportation from Canada, will leave a legacy of debt for our
children and grandchildren to inherit. The easiest thing to do in
politics is pass a bill and don't pay for it.
Certainly, there are portions of this bill which I support--portions
which generously and correctly bring aid and equity to hospitals,
especially those in rural areas like western Wisconsin. For far too
long, rural hospitals and critical access hospitals have been treated
as second-best, and I have long been a champion of bringing equity to
these hospitals which do such important work throughout our country.
This bill will at last begin to equalize the base inpatient payment
rate, increase the cap for Medicare disproportionate share hospitals,
and bring the hospital update to full market basket. Providers also
benefit a great deal from this bill, and I am pleased that instead of
receiving a cut, Medicare providers would receive a 1.5% update for the
next two years. Furthermore, the assistance to our providers is paid
for with offsets in the budget, so it does not add to the historically
large federal deficit. If these provisions were separate from the bill,
I could support them in a heartbeat, and I am confident that such a
bill would pass overwhelmingly in Congress. In fact, just today my
colleagues and I have introduced a bill that is identical to the rural
health care package included in the Medicare Conference Report. We
could still pass such a bill if the Republican leadership wanted to,
but they do not. Instead, they are holding the rural provisions hostage
to all ill-advised and costly prescription drug program to be delivered
to private insurance companies after we bribe them with billions to do
it, even after they have told us they do not want to do this.
As important as it is to sustain our hospitals and our doctors,
aspects of the bill which will hurt our seniors, our pharmacists, and
our states make it impossible to support this bill. Too many seniors in
my district in western Wisconsin have told me stories of skipping meals
in order to afford prescription drugs or cutting their pills in half to
make their expensive prescriptions last longer. I came to Washington to
work towards a real solution to this problem, and I have championed the
New Democratic Coalition's plan, which is simple, progressive, and
affordable. I would be proud to stand on this floor today and support
the Dooley prescription drug plan. I would have been able to compromise
and support a bill that was close to the Senate's bipartisan bill. But
I am unable to support a bill that will do relatively little to provide
seniors with drug coverage, that bribes insurance companies, that
threatens to destabilize existing coverage for retirees, that
undermines Medicaid, and that has no reasonable measures to contain
costs.
Sadly, for all the excitement over a prescription drug benefit, this
bill would bring little relief to struggling seniors. The drug benefit
does no start until 2006, leaving struggling seniors a few more years
before they receive any help in paying for their prescription drugs.
Once 2006 rolls around, many seniors will find a drug benefit far less
generous than the one they expected. In fact, a senior who spends
slightly over $5,000 per year on prescription drugs will have to spend
over $4,000 of his or her own money, meaning the consumer still pays 80
percent of drug costs. This is hardly the relief from expensive
prescription drugs that seniors have been promised and that they
deserve.
Also of concern is the effect this bill will have on seniors who
currently have drug coverage. Astoundingly, an estimated 58,170
Medicare beneficiaries in Wisconsin will lost their retiree health
benefits because of this bill. And they are not the only seniors who
will suffer. Wisconsin's Seniorcare program is a shining example of the
great work that can be done to aid our nation's seniors when federal
and state governments cooperate. The bill before us would punish
Wisconsin's leadership on this issue; Wisconsin would most likely lose
the matching funds it receives for Seniorcare and be forced to
drastically scale back the program. Wisconsin's Seniorcare participants
currently pay a nominal enrollment fee, low drug co-payments, and a
modest deductible, with those seniors below 160 percent of the poverty
level paying no deductible whatsoever.
The Wisconsin Medicaid program, as well as the 110,200 seniors who
are dual eligibles, will see a significant risk in their drug costs as
a result of this legislation. The bill purports to do good things for
low-income seniors, but in my state, it will have exactly the opposite
effect. For the 99 percent of seniors in my state who already have
health insurance, the introduction of a new prescription drug plan
means a confusing new benefit with higher costs to the state and
beneficiaries and less coverage than many Wisconsin seniors already
enjoy.
All of this speculation over a prescription drug plan assumes, of
course, that drug-only plans will be around to offer this less than
substantial coverage. Currently, there are no drug-only insurance
plans, and representatives of the industry have maintained they do not
want to start such plans. Because of this reluctance, the bill bribes
private insurance companies, pouring billions into the industry in an
attempt to entice the companies to create drug-only plans. Clearly,
$400 billion is just a floor, costs will explode, and the insurance
companies will return to Congress in the future to ask for more money
or they will drop coverage of our seniors, just as many Medicare plus
Choice plans are doing today.
The $400 billion price-tag is only the beginning of spiraling costs
to the federal government; we have no idea what costs might be in the
future for this benefit. Incredibly, even the original $400 billion is
not paid for, and there are no attempts at cost control in this
measure. The government, for both Medicaid and the Veterans
Administration, negotiates drug prices. The 40 million Americans
covered by Medicare constitute an immense and potentially powerful
purchasing pool. Great savings could be realized by negotiation, yet
this bill specifically prohibits the government from negotiating with
drug companies. Another potential for savings is reimportation from
Canada; once again, this cost-cutting measure is prohibited, as the
Secretary of Health and Human Services would have to approve
reimportation, and the agency has already indicated no such approval
will be granted.
Finally, Mr. Speaker, I would like to speak of a group that has
received little attention in a debate focused on seniors--our children
and grandchildren. While I fully support providing seniors with a
prescription drug benefit, I do not believe it is right to shift the
costs of this benefit to future generations. We must devise a way to
pay for these benefits now; we cannot and must not rely on future
Congresses and future taxpayers to fix a problem of our creation. The
party in power in Washington today wants tax cuts for the wealthy and
pays no attention to fiscal responsibility. It is wrong to create a
larger deficit than the one we already face. To protect seniors, to
protect our children and grandchildren, I am opposing this bill, and I
urge my colleagues to reject the flawed proposals contained in this
bill. We can and must do better.
Mrs. DAVIS of California. Mr. Speaker, I support providing our
seniors with prescription drug benefits under Medicare. It is one of
the
[[Page H12294]]
most important efforts we have undertaken this session, and, I believe,
one of the most attainable. This is why I rise, with regret, to oppose
this Medicare Conference Report. The legislation before us fails our
seniors and places them at the mercy of private plans and insurance
companies.
There are some good items in this legislation. For example, the
increased funding for hospitals and hard-working physicians is greatly
needed in our communities. Unfortunately, the overall bill does not
accomplish what our seniors need.
When I reviewed this legislation, I needed to answer the following
questions: ``What are the benefits for our seniors?'' and ``What do the
changes mean in the long run?''
In the very limited amount of time I had to review this legislation,
I have concluded that, in reality, this Medicare bill will hurt seniors
by making health care less reliable and more costly.
We needed a prescription drug bill. We received, instead, legislation
that has been called a ``Medicare monstrosity.'' It mandates huge
changes to Medicare, but evades the underlying issue of providing
seniors with a comprehensive prescription drug benefit.
This legislation ends Medicare's guarantees to seniors. It gives
billions for managed care, for tax shelters, and for many other special
interests unrelated to prescription drugs. It significantly worsens
current levels of coverage for millions of Medicare beneficiaries with
increased Part B premiums and threats of disappearing employer
benefits.
Are all of these changes worth a weak drug benefit that will
disappoint millions of seniors? No.
Mr. Speaker, our seniors deserve better!
At townhall meetings and in thousands of letters, phone calls and
emails, seniors have told me that they want a prescription drug benefit
that is affordable, comprehensive, and guaranteed, and they would like
the coverage provided in the current Medicare system. The bill before
us meets none of these standards.
Instead this bill will make our seniors anxious--anxious about
substantial cost increases; anxious about having to switch doctors; and
anxious about losing he security that Medicare has provided for almost
40 years.
The Conference Report before us is a missed opportunity. I hope
Congress does the right thing by going back to the drawing board, and
giving seniors a reliable and affordable prescription drug benefit. We
can do better or our seniors--and we must!
Join me in defeating this bill and working to pass legislation that
truly addresses our seniors' needs.
Mr. RAMSTAD. Mr. Speaker, I rise in strong support of the Medicare
Prescription Drug, Improvement and Modernization Act.
This is truly a historic day. After years of hard work, Congress is
finally on the verge of delivering on our commitment to America's
seniors. The bill before us will honor our promise to create a
meaningful and long overdue prescription drug benefit for Medicare
beneficiaries.
This legislation means seniors will no longer have to choose between
purchasing life-saving drugs or the basic necessities of food and
housing.
In addition to this important new prescription drug benefit, the bill
modernizes and improves Medicare to give seniors better choices and
greater access to state-of-the-art health care.
I am grateful for the many important provisions in this package from
the bill I sponsored, the Medicare Innovation Responsiveness Act (H.R.
941), which will increase seniors' access to lifesaving medical
technology. These provisions provide long needed reforms that will
bring the Medicare program into the 21st Century.
As founded and co-chair of the Medical Technology Caucus, I have
witnessed first-hand the remarkable advances that lifesaving and life-
enhancing medical technology has made to treat and cure debilitating
conditions. The current Medicare system is antiquated because of its
failure to incorporate modern day advances in technology.
Currently, seniors face unconscionable delays of up to 5 years before
Medicare grants access to new technology. This delay can literally be a
matter of life or death for many seniors.
The legislation before us incorporates many of the reforms I proposed
that will vastly improve medicare's coverage, coding and payment
process. These reforms will remove barriers to FDA-approved, lifesaving
technology for millions of seniors. The result will not only improve
lives, but in many cases save lives as well.
Thanks to this legislation, we are finally eliminating the barriers
that discourage innovation and deny America's seniors the medical
technologies they desperately need. Seniors have waited too long for
access to the same treatment options that other Americans routinely
enjoy.
I am also pleased the bill includes legislation I introduced with Mr.
Cardin to break down regulatory barriers facing specialized
Medicare+Choice plans that serve the frail elderly.
I also worked diligently to ensure that seniors suffering from
serious mental illness will have the necessary access, under the new
drug benefit, to the psychotropic medication they desperately need. I
am pleased that this legislation addresses this critical need.
Mr. Speaker, this package of reforms will improve the lives of
today's seniors and seniors for generations to come. I urge my
colleagues to support this landmark legislation and deliver on our
promise to preserve, protect and strengthen Medicare.
Mr. CANTOR. Mr. Speaker, tonight is a truly historic night. Tonight
we will reform and modernize the Medicare system to reflect the needs
of seniors. This legislation will save Medicare for our children while
allowing seniors access to affordable prescription drugs starting next
year.
One important feature of this legislation that allows seniors to have
more control of their health care is the inclusion of new Health
Savings Accounts (HSAs). These tax-preferred savings accounts work like
IRAs and allow individuals, not the government, to make choices that
best suit their needs. HSAs, will put individuals back in the driver's
seat when it comes to their own health care.
The success of 529 college-savings plans and Roth IRAs proves that
HSAs will work. I am glad that we were able to add this conservative
and common sense proposal to the bill.
Tonight for the first time in Medicare's history, we will provide
nearly 1-million Virginians with access to affordable prescription drug
coverage. I am proud to deliver this much-needed and past-due
assistance to my fellow Virginians.
Mr. Speaker, I support the Medicare legislation before us. It is a
critical step in the right direction, and I encourage my colleagues on
both sides of the aisle to support this bill.
The SPEAKER pro tempore (Mr. Hastings of Washington). Without
objection, the previous question is ordered on the conference report.
There was no objection.
Motion To Recommit Offered By Mr. Turner Of Texas
Mr. TURNER of Texas. Mr. Speaker, I offer a motion to recommit.
The SPEAKER pro tempore. Is the gentleman opposed to the conference
report?
Mr. TURNER of Texas. Yes, I am, Mr. Speaker.
The SPEAKER pro tempore. The Clerk will report the motion to
recommit.
The Clerk read as follows:
Mr. Turner of Texas moves to recommit the conference report
on the bill H.R. 1 to the committee of conference with the
following instructions to the managers on the part of the
House:
(1) Strike the provisions of section 1860D-11(i) of the
Social Security Act, as added by section 101(a) of the
conference substitute and relating to noninterference of the
Secretary of Health and Human Services with the negotiations
between drug manufacturers and pharmacies and PDP sponsors.
(2) Substitute the provisions of title I of the Senate
amendment to the bill for title I of the conference
substitute recommended by the committee of conference, but
provide for medicare as primary payor for prescription drug
coverage for low-income individuals (as contemplated by the
House bill), and permit State medicaid programs to provide
wrap-around coverage (as contemplated by the Senate
amendment).
(3) Substitute the provisions of title II of the Senate
amendment to the bill for title II of the conference
substitute recommended by the committee of conference with
the following changes:
(A) Omit the provisions of section 231 of the Senate
amendment (relating to establishment of alternative payment
system for preferred provider organizations in highly
competitive regions).
(B) Omit the provisions of subtitle E (relating to the
establishment of a National Bipartisan Commission on Medicare
Reform).
(4) Within the scope of conference and to the maximum
extent possible, take up and reconsider title VIII of the
conference substitute.
(5) Strike section 1123 of the conference substitute
(relating to a study and report on trade and
pharmaceuticals).
(6) Within the scope of conference and to the maximum
extent possible, take up and reconsider the issue of
importation of prescription drugs.
(7) Within the scope of conference and to the maximum
extent possible, take up and reconsider the issue of special
rules for employer-sponsored programs, including qualified
retiree prescription drug plans.
Mr. TURNER of Texas (during the reading). Mr. Speaker, I ask
unanimous consent that the motion to recommit be considered as read and
printed in the Record.
Point of Order
Mr. THOMAS. Mr. Speaker, I make a point of order.
[[Page H12295]]
The SPEAKER pro tempore. The gentleman will state his point of order.
Mr. THOMAS. Mr. Speaker, do we have the motion to recommit in written
form?
The SPEAKER pro tempore. The Clerk is reading the motion now.
Mr. THOMAS. Mr. Speaker, are we allowed to have the motion?
The SPEAKER pro tempore. The gentleman submitted his motion to the
desk.
The Clerk will read.
The Clerk concluded the reading of the motion to recommit.
The SPEAKER pro tempore. The motion to recommit is not debatable.
Without objection, the previous question is ordered on the motion to
recommit.
There was no objection.
The SPEAKER pro tempore. The question is on the motion to recommit.
The question was taken; and the Speaker pro tempore announced that
the noes appeared to have it.
Recorded Vote
Mr. TURNER of Texas. Mr. Speaker, I demand a recorded vote.
A recorded vote was ordered.
The vote was taken by electronic device, and there were--ayes 211,
noes 222, not voting 2, as follows:
[Roll No. 668]
AYES--211
Abercrombie
Ackerman
Alexander
Allen
Andrews
Baca
Baird
Baldwin
Ballance
Becerra
Bell
Berkley
Berman
Berry
Bishop (GA)
Bishop (NY)
Blumenauer
Boswell
Boucher
Boyd
Brady (PA)
Brown (OH)
Brown, Corrine
Burton (IN)
Capps
Capuano
Cardin
Cardoza
Carson (IN)
Carson (OK)
Case
Clay
Clyburn
Conyers
Cooper
Costello
Cramer
Crowley
Cummings
Davis (AL)
Davis (CA)
Davis (FL)
Davis (IL)
Davis (TN)
DeFazio
DeGette
Delahunt
DeLauro
Deutsch
Dicks
Dingell
Doggett
Dooley (CA)
Doyle
Edwards
Emanuel
Emerson
Engel
Eshoo
Etheridge
Evans
Farr
Fattah
Filner
Ford
Frank (MA)
Frost
Gephardt
Gonzalez
Gordon
Green (TX)
Grijalva
Gutierrez
Gutknecht
Harman
Hastings (FL)
Hill
Hinchey
Hinojosa
Hoeffel
Holden
Holt
Honda
Hooley (OR)
Hoyer
Inslee
Israel
Jackson (IL)
Jackson-Lee (TX)
Jefferson
John
Johnson, E. B.
Jones (NC)
Jones (OH)
Kanjorski
Kaptur
Kennedy (RI)
Kildee
Kilpatrick
Kind
Kleczka
Kucinich
Lampson
Langevin
Lantos
Larsen (WA)
Larson (CT)
Lee
Levin
Lewis (GA)
Lipinski
Lofgren
Lowey
Lucas (KY)
Lynch
Majette
Maloney
Markey
Marshall
Matheson
Matsui
McCarthy (MO)
McCarthy (NY)
McCollum
McDermott
McGovern
McIntyre
McNulty
Meehan
Meek (FL)
Meeks (NY)
Menendez
Michaud
Millender-McDonald
Miller (NC)
Miller, George
Mollohan
Moore
Moran (VA)
Murtha
Nadler
Napolitano
Neal (MA)
Oberstar
Obey
Olver
Ortiz
Owens
Pallone
Pascrell
Pastor
Paul
Payne
Pelosi
Peterson (MN)
Pomeroy
Price (NC)
Rahall
Rangel
Reyes
Rodriguez
Ross
Rothman
Roybal-Allard
Ruppersberger
Rush
Ryan (OH)
Sabo
Sanchez, Linda T.
Sanchez, Loretta
Sanders
Sandlin
Schakowsky
Schiff
Scott (GA)
Scott (VA)
Serrano
Sherman
Skelton
Slaughter
Smith (WA)
Snyder
Solis
Spratt
Stark
Stenholm
Strickland
Stupak
Tanner
Tauscher
Taylor (MS)
Thompson (CA)
Thompson (MS)
Tierney
Towns
Turner (TX)
Udall (CO)
Udall (NM)
Van Hollen
Velazquez
Visclosky
Wamp
Waters
Watson
Watt
Waxman
Weiner
Wexler
Woolsey
Wu
Wynn
NOES--222
Aderholt
Akin
Bachus
Baker
Ballenger
Barrett (SC)
Bartlett (MD)
Barton (TX)
Bass
Beauprez
Bereuter
Biggert
Bilirakis
Bishop (UT)
Blackburn
Blunt
Boehlert
Boehner
Bonilla
Bonner
Bono
Boozman
Bradley (NH)
Brady (TX)
Brown (SC)
Brown-Waite, Ginny
Burgess
Burns
Burr
Buyer
Calvert
Camp
Cannon
Cantor
Capito
Carter
Castle
Chabot
Chocola
Coble
Cole
Collins
Cox
Crane
Crenshaw
Cubin
Culberson
Cunningham
Davis, Jo Ann
Davis, Tom
Deal (GA)
DeLay
DeMint
Diaz-Balart, L.
Diaz-Balart, M.
Doolittle
Dreier
Duncan
Dunn
English
Everett
Feeney
Ferguson
Flake
Fletcher
Foley
Forbes
Fossella
Franks (AZ)
Frelinghuysen
Gallegly
Garrett (NJ)
Gerlach
Gibbons
Gilchrest
Gingrey
Goode
Goodlatte
Goss
Granger
Graves
Green (WI)
Greenwood
Hall
Harris
Hart
Hastert
Hastings (WA)
Hayes
Hayworth
Hefley
Hensarling
Herger
Hobson
Hoekstra
Hostettler
Houghton
Hulshof
Hunter
Hyde
Isakson
Issa
Istook
Janklow
Jenkins
Johnson (CT)
Johnson (IL)
Johnson, Sam
Keller
Kelly
Kennedy (MN)
King (IA)
King (NY)
Kingston
Kirk
Kline
Knollenberg
Kolbe
LaHood
Latham
LaTourette
Leach
Lewis (CA)
Lewis (KY)
Linder
LoBiondo
Lucas (OK)
Manzullo
McCotter
McCrery
McHugh
McInnis
McKeon
Mica
Miller (FL)
Miller (MI)
Miller, Gary
Moran (KS)
Murphy
Musgrave
Myrick
Nethercutt
Neugebauer
Ney
Northup
Norwood
Nunes
Nussle
Osborne
Ose
Otter
Oxley
Pearce
Pence
Peterson (PA)
Petri
Pickering
Pitts
Platts
Pombo
Porter
Portman
Pryce (OH)
Putnam
Quinn
Radanovich
Ramstad
Regula
Rehberg
Renzi
Reynolds
Rogers (AL)
Rogers (KY)
Rogers (MI)
Rohrabacher
Ros-Lehtinen
Royce
Ryan (WI)
Ryun (KS)
Saxton
Schrock
Sensenbrenner
Sessions
Shadegg
Shaw
Shays
Sherwood
Shimkus
Shuster
Simmons
Simpson
Smith (MI)
Smith (NJ)
Smith (TX)
Souder
Stearns
Sullivan
Sweeney
Tancredo
Tauzin
Taylor (NC)
Terry
Thomas
Thornberry
Tiahrt
Tiberi
Toomey
Turner (OH)
Upton
Vitter
Walden (OR)
Walsh
Weldon (FL)
Weldon (PA)
Weller
Whitfield
Wicker
Wilson (NM)
Wilson (SC)
Wolf
Young (AK)
Young (FL)
NOT VOTING--2
Ehlers
Gillmor
Announcement by the Speaker Pro Tempore
The SPEAKER pro tempore (Mr. Hastings of Washington) (during the
vote). Members are advised 2 minutes remain in this vote.
{time} 0301
Mr. SHADEGG, Mrs. BONO and Mrs. JO ANN DAVIS of Virginia changed
their vote from ``aye'' to ``no.''
So the motion to recommit was rejected.
The result of the vote was announced as above recorded.
Stated against:
Mr. EHLERS. Mr. Speaker, on rollcall No. 668 I was delayed on the way
to the floor to vote, and the vote ended just as I walked in the door.
Had I been present, I would have voted ``no.''
The SPEAKER pro tempore (Mr. Hastings of Washington). The question is
on the conference report.
The question was taken; and the Speaker pro tempore announced that
the ayes appeared to have it.
Mr. DINGELL. Mr. Speaker, on that I demand the yeas and nays.
The yeas and nays were ordered.
The SPEAKER pro tempore. Pursuant to rule XX, this 15-minute vote on
adoption of the conference report will be followed by a 5-minute vote
on the motion to suspend the rules on S. 877.
The vote was taken by electronic device, and there were--yeas 220,
nays 215, not voting 0, as follows:
[Roll No. 669]
YEAS--220
Aderholt
Alexander
Bachus
Baker
Ballenger
Bartlett (MD)
Barton (TX)
Bass
Beauprez
Bereuter
Biggert
Bilirakis
Bishop (UT)
Blackburn
Blunt
Boehlert
Boehner
Bonilla
Bonner
Bono
Boozman
Boucher
Boyd
Bradley (NH)
Brady (TX)
Brown (SC)
Brown-Waite, Ginny
Burgess
Burns
Burr
Buyer
Calvert
Camp
Cannon
Cantor
Capito
Carson (OK)
Carter
Castle
Chocola
Coble
Cole
Collins
Cox
Cramer
Crane
Crenshaw
Cubin
Cunningham
Davis (TN)
Davis, Jo Ann
Davis, Tom
Deal (GA)
DeLay
Diaz-Balart, L.
Diaz-Balart, M.
Dooley (CA)
Doolittle
Dreier
Duncan
Dunn
Ehlers
English
Everett
Ferguson
Fletcher
Foley
Forbes
Fossella
Franks (AZ)
Frelinghuysen
Gallegly
Gerlach
Gibbons
Gilchrest
Gillmor
Gingrey
Goode
Goodlatte
Goss
Granger
Graves
Green (WI)
Greenwood
Hall
Harris
Hart
Hastert
Hastings (WA)
Hayes
Hayworth
Hefley
Hensarling
Herger
Hobson
Hoekstra
Houghton
Hulshof
Hunter
Hyde
Isakson
Issa
Istook
Janklow
Jenkins
John
Johnson (CT)
Johnson (IL)
Johnson, Sam
Keller
Kelly
Kennedy (MN)
King (IA)
King (NY)
Kingston
Kirk
Kline
Knollenberg
Kolbe
LaHood
Latham
LaTourette
Leach
Lewis (CA)
Lewis (KY)
Linder
LoBiondo
Lucas (OK)
Manzullo
Marshall
Matheson
McCotter
McCrery
McHugh
McInnis
McKeon
Mica
Miller (MI)
Miller, Gary
Murphy
Myrick
Nethercutt
Neugebauer
Ney
Northup
Nunes
[[Page H12296]]
Nussle
Osborne
Ose
Otter
Oxley
Pearce
Peterson (MN)
Peterson (PA)
Petri
Pickering
Pitts
Platts
Pombo
Pomeroy
Porter
Portman
Pryce (OH)
Putnam
Quinn
Radanovich
Ramstad
Regula
Rehberg
Renzi
Reynolds
Rogers (AL)
Rogers (KY)
Rogers (MI)
Rohrabacher
Ros-Lehtinen
Royce
Ryan (WI)
Saxton
Schrock
Scott (GA)
Sensenbrenner
Sessions
Shaw
Shays
Sherwood
Shimkus
Shuster
Simmons
Simpson
Smith (NJ)
Smith (TX)
Souder
Stearns
Stenholm
Sullivan
Sweeney
Tauzin
Taylor (NC)
Terry
Thomas
Thornberry
Tiahrt
Tiberi
Turner (OH)
Upton
Vitter
Walden (OR)
Walsh
Weldon (FL)
Weldon (PA)
Weller
Whitfield
Wicker
Wilson (NM)
Wilson (SC)
Wolf
Wu
Young (AK)
Young (FL)
NAYS--215
Abercrombie
Ackerman
Akin
Allen
Andrews
Baca
Baird
Baldwin
Ballance
Barrett (SC)
Becerra
Bell
Berkley
Berman
Berry
Bishop (GA)
Bishop (NY)
Blumenauer
Boswell
Brady (PA)
Brown (OH)
Brown, Corrine
Burton (IN)
Capps
Capuano
Cardin
Cardoza
Carson (IN)
Case
Chabot
Clay
Clyburn
Conyers
Cooper
Costello
Crowley
Culberson
Cummings
Davis (AL)
Davis (CA)
Davis (FL)
Davis (IL)
DeFazio
DeGette
Delahunt
DeLauro
DeMint
Deutsch
Dicks
Dingell
Doggett
Doyle
Edwards
Emanuel
Emerson
Engel
Eshoo
Etheridge
Evans
Farr
Fattah
Feeney
Filner
Flake
Ford
Frank (MA)
Frost
Garrett (NJ)
Gephardt
Gonzalez
Gordon
Green (TX)
Grijalva
Gutierrez
Gutknecht
Harman
Hastings (FL)
Hill
Hinchey
Hinojosa
Hoeffel
Holden
Holt
Honda
Hooley (OR)
Hostettler
Hoyer
Inslee
Israel
Jackson (IL)
Jackson-Lee (TX)
Jefferson
Johnson, E. B.
Jones (NC)
Jones (OH)
Kanjorski
Kaptur
Kennedy (RI)
Kildee
Kilpatrick
Kind
Kleczka
Kucinich
Lampson
Langevin
Lantos
Larsen (WA)
Larson (CT)
Lee
Levin
Lewis (GA)
Lipinski
Lofgren
Lowey
Lucas (KY)
Lynch
Majette
Maloney
Markey
Matsui
McCarthy (MO)
McCarthy (NY)
McCollum
McDermott
McGovern
McIntyre
McNulty
Meehan
Meek (FL)
Meeks (NY)
Menendez
Michaud
Millender-McDonald
Miller (FL)
Miller (NC)
Miller, George
Mollohan
Moore
Moran (KS)
Moran (VA)
Murtha
Musgrave
Nadler
Napolitano
Neal (MA)
Norwood
Oberstar
Obey
Olver
Ortiz
Owens
Pallone
Pascrell
Pastor
Paul
Payne
Pelosi
Pence
Price (NC)
Rahall
Rangel
Reyes
Rodriguez
Ross
Rothman
Roybal-Allard
Ruppersberger
Rush
Ryan (OH)
Ryun (KS)
Sabo
Sanchez, Linda T.
Sanchez, Loretta
Sanders
Sandlin
Schakowsky
Schiff
Scott (VA)
Serrano
Shadegg
Sherman
Skelton
Slaughter
Smith (MI)
Smith (WA)
Snyder
Solis
Spratt
Stark
Strickland
Stupak
Tancredo
Tanner
Tauscher
Taylor (MS)
Thompson (CA)
Thompson (MS)
Tierney
Toomey
Towns
Turner (TX)
Udall (CO)
Udall (NM)
Van Hollen
Velazquez
Visclosky
Wamp
Waters
Watson
Watt
Waxman
Weiner
Wexler
Woolsey
Wynn
Mr. MILLER of Florida and Mr. CULBERSON changed their vote from
``yea'' to ``nay.''
Messrs. ISTOOK, FRANKS of Arizona, OTTER, MARSHALL, DOOLEY of
California, and SCOTT of Georgia changed their vote from ``nay'' to
``yea.''
{time} 0553
So the conference report was agreed to.
The result of the vote was announced as above recorded.
The SPEAKER pro tempore (Mr. Hastings of Washington). Without
objection, the motion to reconsider is laid on the table.
Mr. FRANK of Massachusetts. Mr. Speaker, I object.
The SPEAKER pro tempore. Objection is heard.
Mr. FRANK of Massachusetts. Mr. Speaker, I move reconsideration. I
move reconsideration, thanks to your arm-twisting.
The SPEAKER pro tempore. The gentleman will suspend.
Did the gentleman vote on the prevailing side?
Mr. FRANK of Massachusetts. I was until the game started.
The SPEAKER pro tempore. The motion to reconsider may be entered only
by someone who voted on the prevailing side.
Parliamentary Inquiry
Mr. FRANK of Massachusetts. Mr. Speaker, parliamentary inquiry.
The SPEAKER pro tempore. The gentleman will state his inquiry.
Mr. FRANK of Massachusetts. After all the razzle-dazzle, exactly what
was the prevailing side?
The SPEAKER pro tempore. The yeas have it. Without objection, the
motion to reconsider is laid on the table.
Mr. HOYER. Mr. Speaker, reserving the right to object, and I am not
going to object, I am not going to put people to the purpose of voting;
but I will again say the democratic process is that we come to this
floor. I will remind you that you said we had 17 minutes to vote. You
made it very clear. You sent us a notice, and you said come with 15
minutes; we will give you 2 more minutes.
This vote has now been held open longer than any vote that I can
remember. I have been here 23 years. Perhaps some of you have been here
longer. The outrage that was discussed when Speaker Wright held the
vote open for far less time than this was palpable on your side of the
aisle. Democracy is about voting. But just as you cannot say on Tuesday
of Election Day, we will keep the polls open for 15 more hours until we
get the result we want, you ought not to be able to do it here, Mr.
Speaker. We have prevailed on this vote. Arms have been twisted and
votes changed. And I will continue to reserve.
The SPEAKER pro tempore. Is there objection to tabling the motion to
reconsider?
Mr. FRANK of Massachusetts. Objection.
Mr. THOMAS. Mr. Speaker, I move to reconsider the vote just taken.
Motion to Table Offered by Mr. DeLay
Mr. DeLAY. Mr. Speaker, I move to lay the motion on the table.
The SPEAKER pro tempore. The question is on the motion to table the
motion to reconsider. That is not debatable.
The question was taken; and the Speaker pro tempore announced that
the ayes appeared to have it.
Mr. FRANK of Massachusetts. Mr. Speaker, on that I demand the yeas
and nays.
The yeas and nays were ordered.
The vote was taken by electronic device, and there were--yeas 210,
nays 193, not voting 32, as follows:
[Roll No. 670]
YEAS--210
Aderholt
Akin
Bachus
Baker
Barrett (SC)
Bartlett (MD)
Barton (TX)
Bass
Beauprez
Bereuter
Biggert
Bilirakis
Bishop (UT)
Blackburn
Blunt
Boehlert
Boehner
Bonilla
Bonner
Bono
Boozman
Bradley (NH)
Brady (TX)
Brown (SC)
Brown-Waite, Ginny
Burgess
Burns
Burr
Burton (IN)
Buyer
Calvert
Camp
Cannon
Cantor
Capito
Carter
Castle
Chabot
Chocola
Cole
Collins
Cox
Crane
Crenshaw
Cubin
Culberson
Cunningham
Davis, Jo Ann
Davis, Tom
Deal (GA)
DeLay
Diaz-Balart, L.
Diaz-Balart, M.
Doolittle
Dreier
Duncan
Dunn
Ehlers
English
Feeney
Ferguson
Flake
Foley
Forbes
Fossella
Frank (MA)
Franks (AZ)
Frelinghuysen
Gallegly
Garrett (NJ)
Gerlach
Gilchrest
Gingrey
Goode
Goodlatte
Goss
Granger
Graves
Green (WI)
Greenwood
Gutknecht
Harris
Hart
Hastert
Hastings (WA)
Hayes
Hayworth
Hensarling
Herger
Hobson
Hoekstra
Hostettler
Houghton
Hulshof
Hunter
Hyde
Isakson
Issa
Istook
Janklow
Jenkins
Johnson (CT)
Johnson (IL)
Johnson, Sam
Keller
Kelly
Kennedy (MN)
King (IA)
King (NY)
Kingston
Kirk
Kline
Knollenberg
Kolbe
LaHood
Latham
Leach
Lewis (CA)
Lewis (KY)
Linder
LoBiondo
Lucas (OK)
Manzullo
McCotter
McCrery
McHugh
McInnis
McKeon
Mica
Miller (FL)
Miller (MI)
Miller, Gary
Murphy
Musgrave
Myrick
Nethercutt
Neugebauer
Ney
Northup
Nunes
Nussle
Osborne
Ose
Otter
Pearce
Pence
Peterson (PA)
Petri
Pickering
Pitts
Platts
Pombo
Porter
Portman
Pryce (OH)
Putnam
Quinn
Radanovich
Ramstad
Regula
Rehberg
Renzi
Reynolds
Rogers (AL)
Rogers (KY)
Rogers (MI)
Rohrabacher
Ros-Lehtinen
Royce
Ryan (WI)
Ryun (KS)
Saxton
Schrock
Sensenbrenner
Sessions
Shadegg
Shaw
Shays
Sherwood
Shimkus
Shuster
Simmons
Simpson
Smith (MI)
Smith (NJ)
Souder
Stearns
Sullivan
Sweeney
Tancredo
Tauzin
Taylor (NC)
Terry
Thomas
[[Page H12297]]
Thornberry
Tiberi
Toomey
Turner (OH)
Upton
Vitter
Walden (OR)
Weldon (FL)
Weldon (PA)
Weller
Whitfield
Wicker
Wilson (NM)
Wilson (SC)
Wolf
Young (FL)
NAYS--193
Abercrombie
Ackerman
Alexander
Allen
Andrews
Baca
Baird
Baldwin
Ballance
Becerra
Bell
Berkley
Berman
Berry
Bishop (GA)
Bishop (NY)
Blumenauer
Boswell
Boyd
Brady (PA)
Brown (OH)
Brown, Corrine
Capps
Capuano
Cardin
Cardoza
Carson (IN)
Carson (OK)
Case
Clyburn
Cooper
Costello
Crowley
Cummings
Davis (AL)
Davis (CA)
Davis (FL)
Davis (IL)
DeFazio
DeGette
Delahunt
DeLauro
Deutsch
Dicks
Dingell
Doggett
Doyle
Edwards
Emanuel
Emerson
Engel
Eshoo
Etheridge
Evans
Farr
Fattah
Filner
Frost
Gonzalez
Gordon
Green (TX)
Grijalva
Gutierrez
Hall
Harman
Hastings (FL)
Hill
Hinchey
Hinojosa
Hoeffel
Holden
Holt
Honda
Hooley (OR)
Hoyer
Inslee
Israel
Jackson (IL)
Jackson-Lee (TX)
Jefferson
John
Johnson, E. B.
Jones (OH)
Kanjorski
Kaptur
Kennedy (RI)
Kildee
Kilpatrick
Kind
Kleczka
Kucinich
Lampson
Langevin
Larsen (WA)
Larson (CT)
Lee
Levin
Lewis (GA)
Lipinski
Lofgren
Lowey
Lucas (KY)
Lynch
Majette
Maloney
Markey
Marshall
Matheson
Matsui
McCarthy (MO)
McCarthy (NY)
McCollum
McDermott
McGovern
McIntyre
McNulty
Meek (FL)
Meeks (NY)
Menendez
Michaud
Millender-McDonald
Miller (NC)
Miller, George
Mollohan
Moore
Moran (VA)
Murtha
Nadler
Napolitano
Oberstar
Obey
Olver
Ortiz
Owens
Pallone
Pascrell
Pastor
Paul
Payne
Pelosi
Peterson (MN)
Pomeroy
Price (NC)
Rahall
Rangel
Reyes
Rodriguez
Ross
Rothman
Roybal-Allard
Ruppersberger
Rush
Ryan (OH)
Sabo
Sanchez, Linda T.
Sanders
Sandlin
Schakowsky
Schiff
Scott (GA)
Scott (VA)
Serrano
Sherman
Skelton
Slaughter
Snyder
Solis
Spratt
Stenholm
Strickland
Stupak
Tanner
Tauscher
Taylor (MS)
Thompson (CA)
Thompson (MS)
Tierney
Towns
Turner (TX)
Udall (CO)
Udall (NM)
Van Hollen
Velazquez
Visclosky
Waters
Watson
Watt
Waxman
Weiner
Wexler
Woolsey
Wu
Wynn
NOT VOTING--32
Ballenger
Boucher
Clay
Coble
Conyers
Cramer
Davis (TN)
DeMint
Dooley (CA)
Everett
Fletcher
Ford
Gephardt
Gibbons
Gillmor
Hefley
Jones (NC)
Lantos
LaTourette
Meehan
Moran (KS)
Neal (MA)
Norwood
Oxley
Sanchez, Loretta
Smith (TX)
Smith (WA)
Stark
Tiahrt
Walsh
Wamp
Young (AK)
{time} 0613
Mr. FRANK of Massachusetts changed his vote from ``nay'' to ``yea.''
So the motion to table was agreed to.
The result of the vote was announced as above recorded.
A motion to reconsider was laid upon the table.
____________________