[Congressional Record Volume 149, Number 174 (Tuesday, November 25, 2003)]
[Extensions of Remarks]
[Page E2455]
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

                                 ______
                                 

                               speech of

                           HON. DENNIS MOORE

                               of kansas

                    in the house of representatives

                       Friday, November 21, 2003

  Mr. MOORE. Mr. Speaker, I rise today to oppose this legislation. This 
is a very difficult vote for me, as I have worked for years to add a 
prescription drug benefit to Medicare. I have had little more than 24 
hours to examine this 676-page conference report, but what I know about 
H.R. 1 is this: seniors will pay dearly for a weak benefit that 
undermines their traditional Medicare benefits.
  The benefit provided to seniors under H.R. 1 is very weak and does 
not even take effect until 2006. What insurance plan on earth, except 
one designed by Congress, would create a ``donut hole'' that is 
designed specifically to stop coverage for seniors when they need it? I 
believe that American seniors will rebel when they find out what 
Congress is offering them, especially if they compare it to the benefit 
that Members of Congress themselves receive. This conference report 
asks seniors to pay a monthly premium of $35, which is in addition to 
their existing Medicare premium ($66.60 per month in 2004). 
Additionally, seniors will pay the first $250 of their drug costs each 
year, after which Medicare would then start paying 75% of drug costs. 
But as seniors' drug costs increase, the benefit disappears. When total 
annual drug costs reach $2,250, government support would stop. Seniors 
would be responsible for the next $2,850 in drug costs. Only when their 
drug bill for the year reached $5,100 would Medicare begin paying 95% 
of all further costs.
  This, Mr. Speaker, is the infamous ``donut hole'' into which 
thousands of unexpecting seniors will fall each year. In their effort 
to create legislation that seems to cover every senior, but actually 
does not, this legislation eliminates coverage when seniors need help 
paying for drugs. Even worse, this gap increases to over $5,000 by the 
year 2013.
  Seniors will be angry--justifiably--when they begin to understand 
this donut hole and the deceptive nature of the drug benefit. They 
might ask why it is there. Some will answer that it was necessary in 
order to fit the benefit inside the $400 billion budget. This is true, 
but only because this legislation does not take any action to address 
the high cost of prescription drugs.

  A more generous benefit could have been created for seniors had the 
Republican leadership chosen to take some action to increase the 
affordability of prescription drugs. Under the conference report, the 
Secretary of Health and Human Services is prohibited by law from 
leveraging the buying power of 40 million Medicare beneficiaries to get 
drugs at lower prices for Medicare, just as the Veterans Administration 
does for 25.8 million American veterans, including 252,791 veterans in 
Kansas. Secretary of HHS Tommy Thompson told me two days before the 
vote that he would gladly exercise authority to negotiate lower prices 
if he had it. But the bill specifically denied him that authority. Many 
people covered by insurance are able to get a better price due to the 
fact that they can band together and demand discounts from 
manufacturers.
  Additionally, this conference report fails to allow seniors to 
reimport medicine from industrialized countries where drugs are 
significantly cheaper. This despite the fact that a majority of the 
House approved this concept in passing H.R. 2427, the Pharmaceutical 
Market Access Act, by a bipartisan vote of 243-186, on July 25, 2003. 
H.R. 1 contains a provision allowing Canada-only reimportation, but 
added a ``poison pill'' requiring the Secretary of HHS to certify 
reimportation--something that Secretary Thompson has repeatedly said he 
will not do. Americans should not have to travel to Canada to obtain 
reasonably priced drugs that in many cases were developed in part with 
U.S. tax dollars by U.S. companies and manufactured in U.S.-certified 
facilities. This policy would save American seniors significantly over 
the next ten years, and remove the unfair situation in which American 
seniors often pay double or even more for the same drugs than seniors 
in other industrialized nations.
  The legislation includes several other objectionable provisions. The 
provisions allowing for premium support will undermine the Medicare 
program. Although promoted as a ``demonstration,'' up to 7 million 
beneficiaries could be forced to participate starting in 2010. Under 
premium support, private plans will be allowed to offer health and drug 
benefits to attract low-cost young and healthy seniors from Medicare, 
leaving older and sicker seniors behind. The seniors left in Medicare 
will see their costs rise, forcing more seniors out of the program. 
This is called by some the ``Medicare death spiral,'' and it is proof 
that the conference report puts the profits of pharmaceutical and 
insurance companies ahead of the needs of our seniors and the disabled.
  The H.R. 1 conference report contains drastic cuts to our nation's 
cancer care system. This legislation 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. Legislation intended 
to increase access to prescription drug coverage will do the opposite 
for cancer patients, reducing their ability to get needed cancer care.
  Mr. Speaker, today I am forced to vote against this flawed bill, 
despite the fact that this legislation includes important payment 
increases for Medicare providers. I regret that these needed payments 
were included in this legislation in order to build support for this 
inadequate benefit. I have long supported adequate funding for Medicare 
providers in Kansas, and I have supported legislation in this Congress 
and previous Congresses that would erase the cuts approved in the 1997 
Balanced Budget Act. Additionally, I signed as a cosponsor of H.R. 
3549, introduced by Rep. Baron Hill, legislation that would provide 
payment increases for doctors, hospitals, home health providers and 
others who need and deserve adequate Medicare payments. These 
provisions were included in the larger H.R. 1 and should be enacted 
now, separately.
  If this legislation, despite its great flaws and incomplete benefit, 
is signed into law, I will continue to fight for needed changes. And I 
will do all that I can to ensure that the Medicare prescription drug 
benefit represents what seniors need and expect.

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