[Congressional Record Volume 149, Number 174 (Tuesday, November 25, 2003)]
[Senate]
[Pages S15930-S15932]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                THANKING STAFF FOR HARD WORK ON MEDICARE

  Mr. BAUCUS. Mr. President, I thank my good friend, Senator Byrd, from 
West Virginia.
  There have been many comments about the Medicare bill that just 
passed, all the time and effort, and the controversies that surround 
it. My personal view is that it is not just a good bill, it is a very 
good bill. It will help senior citizens and a lot of others who need 
help.
  I understand some of the criticisms made against the bill. Some of 
them are overdrawn and exaggerated. But I understand the core points 
some critics have made. As with all legislation, and as with all things 
human, there is some truth all the way around. I pledge my time and 
effort to work to correct any imperfections in this legislation that 
may arise. But all in all, we have to make decisions. We have made a 
decision; and that is, to pass this legislation. I think it is a good 
bill that is going to help a lot of people. It is a major advance to 
the Medicare Program.

  The Medicare Program, which was enacted 38 years ago and signed by 
President Lyndon Johnson in Independence, MO, has been a tremendous 
success for our senior citizens.
  This bill represents the next major advancement. It is a new 
entitlement for prescription drug benefits for our seniors not 
contained in the original Medicare Act that passed 38 years ago.
  There are a lot of people to thank. And my point here today is not to 
dwell on the bill but, rather, to thank people who worked so hard and 
who ordinarily receive so little credit.
  The most noble human endeavor is service. It is service to church, to 
community, to family, to spouse, to children. It is service in whatever 
way makes the most sense for each one of us. There are many people who 
served to the maximum in helping to write good legislation, and I shall 
mention their names.
  Members of the House and the Senate who serve get the benefit of 
their names in newspapers and shown on TV--usually it is a benefit, 
sometimes it is not--but at least they get the credit or the blame. But 
there are other people who work very hard behind the scenes. That is, 
the staff, who probably work even harder and receive little or no 
recognition. So I would like to recognize a few of those people who 
played a central role in this legislation.
  First, my Finance Committee health care team, led by the wonderful 
Liz Fowler. Those of you who have worked with Liz Fowler know what I 
mean. There is none better. She works so hard, she is so smart, and she 
has a wonderful disposition, working hard to help provide better health 
care for Americans.
  Jon Blum. He was the ace numbers guy. I think in many cases he knew 
more about the various intricacies of this bill than anyone else; an 
amazing man.
  Pat Bousliman, the same. Pat worked extremely hard and knew the ins 
and outs of all the provider positions--the physician and the hospital 
payment provisions, and home health care, so well.
  Andy Cohen, who worked primarily on Medicaid and low-income issues, 
and then Dan Stein, who was the cleanup hitter--he is wonderful. And 
I'd like to recognize former staff persons, who also worked so hard on 
this bill earlier in the process, but have since taken advantage of 
different jobs or opportunities.
  Kate Kirchgraber. Kate was our Medicaid specialist.
  Mike Mongan is a young man, who is brilliant. I was able to hold onto 
him for one extra year before he finally decided to go off to law 
school.
  Those are the members of my Finance Committee health care team who 
worked so hard.
  Others in the Finance Committee who played a very key role are Jeff 
Forbes, the minority staff director, and Bill Dauster. Many people know 
both Jeff and Bill. Bill has served the Senate in many capacities, 
particularly with his expertise in budget matters and Senate 
procedures. He was invaluable to me.
  Russ Sullivan is my top tax person. And Judy Miller. Judy is from my 
home State of Montana and, she knows pension issues better than anyone 
I can think of. The two of them worked on the tax provisions in this 
bill.
  Laura Hayes handled press for the Finance Committee.
  Tim Punke is my chief trade person. And Brian Pomper, also on the 
trade staff. There are several trade provisions that came up in this 
bill, particularly with respect to reimportation from Canada.
  Two of my former staff who left a year ago, or less than that, are 
wonderful people and also deserve recognition. One is my former staff 
director, John Angell; and my chief counsel, Mike Evans, who, during 
the course of this bill, would call in. They would call in and give 
lots of advice.
  Senator Grassley, Chairman of the Committee--his health team have all 
been wonderful to work with. Linda Fishman, Mark Hayes, Colin Roskey, 
Jennifer Bell, and Leah Kegler--all working so hard. And others on 
Senator Grassley's team, Ted Totman, who has been with Senator Grassley 
for many years, and Kolan Davis, who is Chairman Chuck Grassley's staff 
director.

  Senator Breaux, my chief negotiating partner: On his staff is Sarah 
Walter. Sarah is very smart. She is very good. Michelle Easton and 
Paige Jennings, both of whom have also contributed significantly to 
this bill.
  Other conference members, of course, were Chairman Bill Thomas and

[[Page S15931]]

Chairman Billy Tauzin, Majority Leader Frist, Speaker Hastert, and 
Majority Leader Tom DeLay in the House played a great role. Their 
staffs did, too, especially John McManus, who is the chief health staff 
for Chairman Thomas, and his staff, Madeline Smith, Joel White and Deb 
Williams; Pat Morrissey, the deputy staff director for Chairman Billy 
Tauzin, and his staff Kathleen Weldon, Chuck Clapton, Pat Ronan and 
Jeremy Allen; and then for Majority Leader Bill Frist, Dean Rosen and 
Liz Scanlon. They are all very able, wonderful, extremely capable 
people, along with everybody else we have been working with who I have 
not mentioned by name.
  On the administration side, Ziad Ojakli, Matt Kirk, and Jennifer 
Young all played a significant and helpful role. And Erik Ueland on 
Senator Frist's staff played a valuable role in the coordinating 
between the Congress and the White House.
  Senator Nickles, Senator Kyl, Senator Hatch, Congresswoman Nancy 
Johnson, and Congressman Mike Bilirakis and their staffs played an 
immeasurable part in this bill.
  Other conferees who were, unfortunately, excluded from the 
conference--that is, from the working group--played very strong roles 
in making this bill better than it otherwise might have been: Minority 
Leader Tom Daschle, Senator Rockefeller, Representatives Dingell, 
Rangel, and Berry. Believe it or not--they may not believe it--but 
their views helped to shape this bill; many of the low-income 
provisions, their views on premium support, and lots of areas where 
their strong views helped Senator Breaux and I a lot.
  I need to mention, also, the Congressional Budget Office and the 
House and Senate legislative counsel.
  The Congressional Budget Office, CBO, as we call it, is headed up by 
Douglas Holtz-Eakin. He works long hours, as do his top people, Steve 
Lieberman and Tom Bradley and all of their staffs. Particularly in the 
final weeks of this bill, when we had to call up and say: What is the 
CBO estimate for this change? What is the CBO estimate for that change? 
It is an almost impossible job because we were asking for lots of 
different changes.
  The House and the Senate legislative counsel--Ed Grossman, John 
Goetcheus, Pierre Poisson, and Jim Scott. Man, oh, man, did they work 
hard. They probably put in more hours than anybody else. Once we had 
the concepts, they would have to write the language. And this world, 
which is run by deadlines, we were always waiting until the very end, 
unfortunately, before decided on a direction to write the legislation. 
And Ruth Ernst, who also worked extremely hard.
  On my personal staff: Zak Andersen, who is my chief of staff, in 
helping to coordinate all these matters; Sara Roberts, my legislative 
director; Farrar Johnston, my scheduler; and Sara Kuban--all in the 
office here in Washington, DC. And back home in my State of Montana: 
Barrett Kaiser, Jim Foley, and Melodee Hanes, working all the time to 
answer tons of telephone calls about this bill and coordinating all of 
our outreach and education efforts.
  Others here in my DC office, two persons who work in the receptionist 
area, Megan Mikelsons and Rachel Sherouse answered many telephone 
calls, too, and handled them all very directly and with great grace and 
civility.
  There are many others, Mr. President, on other staffs who I have not 
mentioned, but I mention these people because I know personally how 
hard they have worked. I also mention them as representative of all the 
other people who have worked for Senators, who have worked in different 
capacities up here in the Senate and over in the House and who have 
just poured their hearts out. They are here because they want to do the 
right thing. They are here because they want to help people. They are 
here because they want to make this a better place. Essentially, they 
are here because they are fulfilling a very deep moral obligation. I 
think all of us have an obligation to make this place as good or even 
better than we found it, in whatever way we do that. For some of us, it 
is health care legislation, and for some of us it is some other area.
  The names I have mentioned are the names of people who I hope are 
remembered and recognized. I urge everyone to dwell a little more on 
the people who really do the work, those I have mentioned, and others 
who work in similar capacities in this body.
  Mr. BAUCUS. Mr. President, 38 years ago, President Lyndon B. Johnson 
signed the Medicare Act in Independence, MO. For millions of senior and 
disabled Americans, the enactment of this legislation heralded an era 
of hope, health, and improved financial security.
  At the signing of the Medicare Act, President Johnson said, ``No 
longer will older American be denied the healing miracle of modern 
medicine . . . And no longer will this Nation refuse the hand of 
justice to those who have given a lifetime of service and wisdom and 
labor to the progress of this progressive country.''
  Over the past 4 decades, the Medicare Program has fulfilled President 
Johnson's vision. Through Medicare, more than 100 million Americans 
have received the protection of health insurance during their most 
vulnerable years. Today, Medicare covers more than 35 million seniors 
and 6 million disabled Americans. Medicare provides assurances to these 
millions of Americans that their health care needs will be taken care 
of.
  And Medicare has stood the test of time. Thirty-eight years after its 
enactment, Medicare remains one of the most extraordinary acts of 
legislation in the history of Congress.
  But we all know that the program is not perfect. It is at times slow 
to adapt to the evolving health care market place. We owe it to our 
seniors to ensure that Medicare changes with the times and continues to 
serve their needs today and into the future.
  The practice of medicine has changed dramatically over the past 4 
decades. Outpatient prescription drugs were not included in Medicare's 
original benefit package. In 1965, medical care emphasized hospital-
based and physician-provided care. Today, medical care increasingly 
relies on the use of prescription drugs.
  As the role and expense of prescription drugs have grown dramatically 
over the past several decades, the lack of a prescription drug benefit 
in Medicare has become a critical flaw.
  Seniors will spend an estimated $2,300 on average for prescription 
drugs this year, with almost $1,000 coming directly from their pockets. 
And while many seniors are fortunate to have coverage through retiree 
health plans, Medicaid, Medigap, and Medicare managed care plans--over 
35 percent of Medicare beneficiaries currently lack any coverage for 
outpatient prescription drugs.
  The lack of prescription drug coverage in Medicare, coupled with the 
rising cost of prescription drugs, is forcing seniors across America to 
make difficult choices. In the wealthiest nation in the world, millions 
of elderly Americans are forced to choose between much-needed 
prescription drugs and basic necessities of daily living.
  Our seniors deserve better.
  With the passage of this bill, we have the opportunity to uphold our 
commitment to America's seniors. With this conference report, we can 
deliver on our promise to add a prescription drug benefit to Medicare.
  This bill provides seniors with much-needed prescription drug 
coverage and protection against high out-of-pocket drug expenses. Under 
the new Medicare Part D, seniors will have access to prescription drug 
insurance for a modest monthly premium. This benefit will provide up-
front coverage for prescription drug expenditures up to $2,250 
annually, and catastrophic coverage for out-of-pocket spending above 
$3,600.
  For the millions of seniors with lower incomes and costly medical 
illnesses, this legislation offers the promise of comprehensive 
affordable prescription drug coverage through Medicare. Low-income 
seniors, more than a third of all Medicare beneficiaries, will receive 
generous assistance for all their prescription drug expenses, including 
premium subsidies, reduced deductibles, and affordable cost-sharing.
  And we have designed a bill that will provide coverage in every part 
of the country. If private drug plans elect not to participate in any 
area of the country, our seniors will have guaranteed access to a 
government fallback, backed by the solemn commitment of Medicare.

[[Page S15932]]

  Thus, all seniors will have equal access to a drug benefit, 
regardless of whether they choose to join a managed care plan or remain 
in traditional fee-for-service Medicare.
  This legislation offers more than a Medicare prescription drug 
benefit. It will finally address many of the Medicare reimbursement 
inequities that have plagued America's rural health care providers. It 
will increase payments to local physicians and community hospitals to 
improve health care services throughout the nation. And this 
legislation will better foster competition between generic and brand-
name pharmaceuticals.
  I have heard from many of my colleagues regarding some of the 
imperfections in the conference report--for example, the gap in 
coverage, the risk that the bill may cause employers to drop retiree 
drug coverage, the potential state shortfalls in the early years of the 
benefit, the increased payments to private plans, and the ``premium 
support'' pilot program.
  While I remain committed to addressing these potential shortcomings 
in the legislation during the upcoming months and years, we must not 
forget that this bill creates a $400 billion expansion of the Medicare 
Program. We must not squander this historic opportunity to 
fundamentally improve the lives of millions of American seniors.
  We would not have this opportunity without the fine leadership in the 
Senate. Senator Grassley, chairman of the Finance Committee, skillfully 
led this effort through the committee, on the floor, and in the 
conference negotiations. Majority Leader Frist was willing to put aside 
party differences to focus on achieving bipartisan consensus. Senator 
Breaux's efforts helped bridge differences. The work of Senator Breaux, 
my steadfast partner in the difficult negotiations, as well as Senators 
Snowe, Hatch, Jeffords, and Graham have greatly contributed to the 
debate over prescription drugs throughout the past several years.
  And Senator Kennedy, the health care expert of the Senate. For over 
25 years, Senator Kennedy has fought to include prescription drug 
coverage within Medicare. Through his continued leadership, 
prescription drugs for seniors are now within reach.
  Senator Kennedy played a key role in getting a good bill out of the 
Senate and throughout the conference. The 76 votes in the Senate are a 
tribute to his efforts, and whatever is positive in this bill is due to 
his dedication and hard work.
  And there is much that is positive in this bill, in my view. Of 
course, the conference report is not perfect by any means. There are 
elements that I would not include if I were writing this bill on my 
own. But it is a true compromise. It reflects a near evenly split 
Congress.
  Let us not forget that the original Medicare Act also represented a 
compromise--in the way that the program was financed through a 
combination of payroll taxes, premiums, and general revenue, and in the 
way it was organized, with fiscal intermediaries and carriers making 
payments for separate Part A and Part B benefits.
  In the final analysis, let us not forget why this bill is important. 
Millions of seniors live today without prescription drug coverage. They 
live in greater pain, and they live shorter lives, because of that.
  With this bill, we will take an important step to make their lives 
better. To help them live longer, fuller lives. That is our purpose 
here today, and that is why I support this conference report.
  For 38 years, Medicare has been a covenant--a pact between the 
generations. All Americans--young and old, rich and poor--pay into the 
promise of Medicare. And the Congress has the responsibility to uphold 
this commitment to those who benefit from it. As part of that 
responsibility, we must continue to improve the program and keep up 
with modern medical care.
  This conference report represents an historic opportunity to 
strengthen Medicare. And as elected officials, we have the obligation 
to take advantage of this opportunity. Of course, we also have the 
responsibility to ensure timely implementation in a way that fulfills 
congressional intent.
  On the day of this historic vote, we take a step to ensure that 
Medicare continues to fulfill Lyndon Johnson's vision. We take an 
important step to deliver on our promise to America's senior citizens.
  I yield the Floor, and I again thank my good friend from West 
Virginia.
  The PRESIDING OFFICER. The Senator from West Virginia.
  Mr. BYRD. Mr. President, I thank my friend from Montana, Mr. Baucus.

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