[Congressional Record Volume 150, Number 29 (Tuesday, March 9, 2004)]
[House]
[Pages H913-H919]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                    MEDICARE PRESCRIPTION DRUG PLAN

  The SPEAKER pro tempore (Mr. Bonner). Under the Speaker's announced 
policy of January 7, 2003, the gentlewoman from Florida (Ms. Ginny 
Brown-Waite) is recognized for 60 minutes as the designee of the 
majority leader.
  Ms. GINNY BROWN-WAITE of Florida. Mr. Speaker, I rise tonight to 
dispel the many myths that too many Democrats in this Chamber and 
Presidential candidate John Kerry have been spreading at the historic 
progress that this Republican Congress has made and that the President 
signed making finally the promise that was made to seniors on 
prescription drugs come true.
  The Mediscare that is taking place is shameful. They are trying to 
frighten seniors into believing that this is not a bill that will help 
them, help seniors; and that is a shame. When the elderly are watching 
TV and they see the nasty ads on moveon.org, which are very despicable 
ads, I think that the record needs to be set straight on exactly the 
benefits of the Medicare prescription drug improvement bill that was 
passed and finally signed into law.
  I held some town hall meetings in my district, and we discussed the 
myths that were out there; and when I gave the seniors the facts, every 
one of them was very happy that this bill passed and is law and will 
benefit them. Let me give my colleagues an example.
  Myth number one is that seniors will be forced into a Medicare 
prescription drug plan. That is so far from the truth. The Medicare 
prescription drug plan is entirely voluntary. No one will ever be 
required to join. If you do not need it or if you do not want 
prescription drug coverage, you certainly do not have to enroll, not 
now, not ever, never, if that is what you want.
  In addition, you actually are prohibited from joining the 
prescription drug plan if you already receive coverage from another 
plan. Many seniors are fortunate because either they or their spouse 
retired from a company or government entity that offers prescription 
drug plans.
  The second myth that I was very happy to dispel was if they had 
prescription drug coverage now from their previous employer or their 
spouse's previous employer that that coverage would automatically be 
dropped. The fact is that the nonpartisan Employee Benefit Research 
Institute actually predicts that virtually no employees will lose 
coverage because of the very lucrative tax-free incentive that 
employers associations and labor unions will receive through this new 
law.
  It is very interesting that many of the congressional offices had 
calls that were placed when this bill was under consideration, and they 
were placed by many former union members who were frightened into 
believing that this bill would not benefit them. What the unions were 
not saying is that they would actually receive funding as an incentive 
to continue the prescription drug plan that they may have for retirees.
  When you look at the number of employers and associations and labor 
unions offering health care benefits, the number actually has declined 
from 66 percent in 1988 to only 34 percent in 2002. That was because of 
the rising costs of health care and prescription drug coverage.
  This bill allows employers to negotiate better discounts from 
manufacturers and also provides incentives for them to continue their 
prescription drug coverage. This is what employers have been waiting 
for, and that is, some government incentives to continue their 
prescription drug coverage. For every dollar that the employer or union 
spends between $250 and $5,000 for the individual's coverage, for every 
dollar that they spend there they will actually get a 28 cent subsidy, 
and that is a tax-free subsidy which if you do the math equals about a 
40 percent tax-free amount. Never before has government ever offered 
this kind of an incentive to private enterprise to continue health care 
coverage.
  The third myth which, again, seniors, because of the moveon.org ads 
and some mailings that went out in many districts where there is a high 
number of seniors, and that was the myth that the new law would provide 
them with inadequate health care prescription drug assistance. The 
truth of the matter is that when a full prescription drug benefit takes 
effect, seniors could see their senior prescription drug spending 
reduced 25 to 75 percent, and that would be in exchange for a small 
premium estimated to be somewhere around $35. If we had not passed the 
bill last year, most would continue to pay full retail value for 
prescription drugs and would not see any savings unless you were 
covered under a private plan.
  The fourth myth was that it only provides coverage for drug costs up 
to $2,250. It does include a donut provision and individuals are being 
told that there was no coverage for catastrophic expenses. Once armed 
with the truth, the seniors were very convinced that this was a good 
bill because the Medicare prescription drug plan pays 95 percent of 
catastrophic costs of $3,600 or higher and the average senior spends 
somewhere around $1,450 a year on prescription drugs, and the 
prescription drug plan included in this bill will actually cover about 
75 percent of the cost between $250 and the $2,250. This is $750 more 
than the average senior spends.
  For those expenses between $2,250 and $3,600, which are the 
``donut,'' there still is an estimated 25 percent discount that will be 
available and then the person will only have to pay 5 percent of the 
drug costs once they reach that $3,600 amount. In other words, the 
government will be paying 95 percent of the pharmaceutical costs above 
$3,600.

                              {time}  2200

  Unfortunately, one of the other scares that were perpetrated on 
seniors was that it privatizes Medicare. This bill modernizes Medicare 
to provide better health care within the existing Medicare program. 
Medicare will continue to be administered, controlled, and regulated 
and, lest we not forget, paid for by the Federal Government. Medicare 
already provides health care from private doctors, hospitals, and even 
allows participation in private integrated managed health care plans.

[[Page H914]]

This bill, which was signed into law, actually gives seniors more of a 
choice in doctors while providing the benefits that absolutely needed 
to be guaranteed.
  The sixth myth was that there were no price controls in the Medicare 
prescription drug bill and that the cost of prescription drugs was not 
addressed. Again, another untruth that was told because some people are 
just angry because we finally did pass a Medicare prescription drug 
bill, and that issue will now be this side of the aisle's to brag about 
and to tell people about back in their district.
  The bill does include reforms that will accelerate cheaper generic 
drugs to the market and it also removes the artificial ``S Price'' 
requirement. The Congressional Budget Office estimates that with these 
changes consumers will achieve billions of dollars in savings.
  One of the other savings that we actually will achieve from this bill 
is that we will be keeping seniors out of hospitals. Let me give a very 
brief example:
  I know of a woman in my district, her name is Fran, and she was on a 
multitude of medicine. She was 85 years old. Fran was actually cutting 
the medicine in half because she could not afford the cost of the 
prescription drugs. With this kind of coverage, she clearly will be not 
hospitalized as often and she will have the medication that she needs.
  In the meantime, she is taking advantage of some of the cards that 
are out there. She will be very happy when the card comes out in May of 
this year, the discount card, and also she prevailed upon her family to 
help her. This prescription drug plan that was finally signed into law, 
Mr. Speaker, means that she will not feel as if she has to be dependent 
upon her family.
  Another myth is that it does nothing to help Florida with our drug 
and health care costs. As you know, Florida is a great haven for 
seniors because of the wonderful weather and low taxes. This bill 
actually provides billions of dollars to the State for seniors and for 
those duly eligible Medicare and Medicaid retirees. This proposal 
provides 650,000 lower-income seniors in Florida, who are not eligible 
for Medicaid, $10 billion worth of prescription drug benefits. It also 
provides an additional 490,000 Floridians who are duly eligible for 
Medicare and Medicaid with over $6.7 billion annually in prescription 
drug coverage with no gap in that coverage.
  Currently, there are a large number of seniors in Florida who are 
reimporting drugs from Canada, and there was a fear out there that they 
would no longer be able to continue to import pharmaceutical products 
from Canada. When I informed them that the truth of the matter is that 
H.R. 1 requires both HHS and the Federal Trade Commission to study the 
safety and trade issues surrounding drug reimportation so that their 
safety would be of paramount concern, and that we are going to resolve 
the safety issue in an expeditious manner, they felt a great deal of 
comfort in that.
  One of the last myths that happily we dispelled was that it does not 
address preventive care. The fact is that under H.R. 1, all new 
enrollees will be eligible for a Welcome to Medicare physical. In 
addition, all Medicare beneficiaries will receive cholesterol screening 
and be part of a disease management program.
  Senator Kerry and our colleagues on the other side of the aisle 
should be ashamed. When this monumental bill came before Congress, 
Senator Kerry did not even take the time to cast his vote or to speak 
before his colleagues. Yet now he stands in criticism. Moreover, time 
and time again he voted to cripple America's health care system by 
opposing curtailments on frivolous lawsuits that drive up the cost of 
health care for all Americans.
  Seniors deserve peace of mind when making health care decisions. For 
the first time in history, we are protecting seniors by preserving 
their Medicare benefits while providing them with more choices. And, 
again, I want to stress, this is a voluntary program.
  Mr. Speaker, I am very pleased to have some of my colleagues here 
this evening, and I want to yield to the gentleman from North Carolina 
to give him an opportunity to express his views because I know he was 
very supportive of this bill.
  Mr. HAYES. Mr. Speaker, I thank my friend and colleague, the 
gentlewoman from Florida (Ms. Ginny Brown-Waite), for yielding to me.
  We have been here a long time tonight, Mr. Speaker, and I cannot 
believe some of the things that I have heard. My good friend and 
colleague, the gentleman from Massachusetts (Mr. Delahunt) is a 
liberal, whose views are widely respected. He has been here many years 
and there is no question about his philosophy. It is admirable that he 
sticks to his guns.
  My colleague from Illinois is the son of a pediatrician, a very noble 
profession, but he failed to mention that he was integrally involved 
for 8 years in the ``immaculate deception'' known as the former 
administration that brought America's citizens the largest tax increase 
in history; the administration that brought this country the Cole, the 
bombing of Khobar Towers, virtually looking the other way on terrorism, 
yet he has the nerve to stand before us and the American people tonight 
and point to, in a mocking way, a way that mocks our courageous men and 
women in uniform in Iraq for using money that was taken from the Iraqi 
people, extorted and stolen by Saddam Hussein, our men and women are 
taking that money and helping them to build a society that not only 
puts them on their feet, but takes the feet out from under terrorists 
in Iraq and around the world.
  No, America does not have to ask permission to defend our citizens, 
our shores and our country from terrorists. I think it is important 
that we focus on that tonight as we look at one of the many 
achievements of this majority party and this administration of George 
W. Bush.
  We have cut those taxes, we have put money back in the pockets of 
Americans so that they grow our economy. We have equipped our men and 
women in uniform so that they can protect us from terrorists, whether 
they be from Iraq, Afghanistan, or wherever they might be. And also we 
have spoken to the needs not only of our senior citizens but health 
care across the board.
  My colleague tonight has chosen to bring forth some important facts 
about Medicare. And what she has said is true, unlike many of the other 
things we have heard tonight. Let me personalize for a minute, if I 
can, the things that my friends, my constituents in North Carolina's 
Eighth District have said about Medicare reform. And also, I might add, 
that I was not good in calculus, Mr. Speaker. But in basic math I was 
okay. Two times zero is zero; ten times zero is zero. Forty years of 
control by the other party yielded no Medicare reform nor prescription 
drug benefits, but it has yielded an awful lot of empty rhetoric.
  America's seniors know this body is committed to strengthening and 
sustaining Medicare. We are closely monitoring its implementation and 
eagerly anticipating the roll-out of the discount card this spring, 
making the way for the Part D benefit in 2006. Mr. Speaker, America's 
seniors faced a challenge over the years. Medicine made advances in 
ways they never imagined as children, but their health care delivery 
system, Medicare, was stuck in the 1965 mode. Medicine was modern but 
Medicare was not.
  The legislation this body passed closes a huge gap between the 
Medicare system and the way modern medicine is practiced. My 
colleagues, the gentleman from Georgia (Mr. Gingrey) and the gentleman 
from Texas (Mr. Burgess), I am sure, will speak to that.
  Mr. Speaker, my district stretches from the urban center of 
Charlotte, North Carolina east of Fayetteville, and includes all the 
beautiful rural communities in between. In January, I made nine stops 
across my district to talk with folks about the new Medicare reform 
plan. Overwhelmingly, my constituents told me that they were grateful 
that finally this body had acknowledged their need for real 
prescription drug coverage, not some pie-in-the-sky promise that 
promised but never produced. Over and over again, they told me how 
grateful they were that finally the help they needed was on the way.
  Mr. Speaker, I want to tell you a little more about what the folks 
are saying at home. Before the passage of this critical legislation, 
county officials told me that Medicaid was an increasing burden they 
could not bear much longer. Now county officials tell me

[[Page H915]]

with Medicare instead of Medicaid assuming the first payer prescription 
drug cost of over 235,000 North Carolina beneficiaries who are eligible 
for both programs, the State will save $882 million over 8 years. Real 
savings to our counties and our communities.
  Before the Medicare Modernization and Prescription Drug Benefit Act, 
doctors in my district said the reality was they were going to have to 
stop seeing Medicare patients because the cost was too great and the 
unfair payment reimbursements were far too low. Now doctors express 
relief the 4.5 percent cut in 2004 and additional cut in 2005 was 
blocked. Instead, physicians will receive a 1.5 positive update.
  Physicians agree it makes sense that Medicare provides screening 
tests for early detection of diseases and diabetes, and initial 
wellness exams for seniors, and it goes on and on.
  Let me hasten to add what people actually have said. Greg Wood, 
President and CEO of Scotland Health Care System, Scotland County's 
third largest employer, which, I might add, this is a jobs bill, 
because proper reimbursements adds jobs, particularly in rural 
communities for health care. This is what Greg Wood said.
  ``For two consecutive months, we have been operating in a budgetary 
deficit. With 40 percent of patients participating in Medicare, the 
program was a critical factor in influencing the economic success of 
the health care system in Scotland County. With the new legislation, we 
will be able to get back several hundred thousand dollars of this 
revenue as well as offer better, more inclusive health care. We believe 
this is the most significant legislation in decades, maybe even since 
Medicaid and Medicare were started.''
  FirstHealth Richmond's CEO John Jackson said, ``As the administrator 
of a small rural hospital, it will certainly help us to be financially 
viable. The passage of the Medicare prescription drug bill will be a 
great benefit for seniors in our community.''
  Another administrator, Bill Leonard, CEO of Sandhills Regional 
Medical Center in Hamlet, North Carolina, says ``The new Medicare bill 
has provisions that will right some of the inequities that have favored 
urban hospitals over hospitals like Sandhills Regional that serves 
small towns across the country. We are pleased with the positive impact 
this legislation will have on Richmond County.''
  Roy Hinson, President of Stanley Memorial, says, ``This represents 
the largest expansion of Medicare since it began in 1967 and includes 
the largest package ever for hospitals in rural areas and small 
cities.''
  Finally, Larry Hinsdale, CEO of Northeast Medical Center in my 
hometown of Concord says, ``It is not often legislation can be passed 
that has such a positive impact for both providers of health care and 
for its recipients. This bill achieves both an improvement in access to 
high quality hospital care and access for seniors to a greatly needed 
prescription drug benefit.''
  Mr. Speaker, in conclusion, our hospitals and our seniors are 
grateful for the efforts that have been accomplished here in this 
Congress, and I appreciate the opportunity to highlight some of the 
benefits and what people are saying about the efforts of this majority 
party and this President.
  Again, I thank my colleague again and yield back to her so that we 
might hear more helpful and enlightening information.
  Ms. GINNY BROWN-WAITE of Florida. Mr. Speaker, I am certain the 
number of retirees in North Carolina are increasing all of the time, 
and I think it is important to remember that because women actually 
outlive men by about 5.4 years that so many times women are left living 
at the poverty level or just slightly above it.
  This certainly will help so many women because, for example, a woman 
who is a widow, or without her husband's insurance, will now have a 
prescription benefit available to them that will save approximately 60 
percent of all drug costs if they choose to enroll. It is going to be a 
godsend for so many women, certainly for the retirees in North 
Carolina, and I know in Florida.
  Mr. HAYES. Mr. Speaker, I thank the gentlewoman for her facts, and if 
I might ask the gentleman from Illinois (Mr. Shimkus) to respond to a 
question.
  Mr. SHIMKUS. Mr. Speaker, if the gentlewoman will continue to yield, 
I would be glad to.
  Mr. HAYES. Mr. Speaker, I listened with great interest to the 
gentleman's colleague from Illinois. Is that not the same gentleman who 
supported in last year's appropriations bill amendments that would have 
added some $16 trillion to the deficit that now all of a sudden, he and 
a few others are concerned with? Is that number, in my mind, somewhat 
correct?
  Mr. SHIMKUS. Mr. Speaker, I have not checked my colleague's voting 
record, but that is probably a good assumption.
  Mr. HAYES. It is a very good number, and I would appreciate it if my 
colleague could help us rein him in, since he is the gentleman's 
neighbor.

                              {time}  2215

  Ms. GINNY BROWN-WAITE of Florida. Mr. Speaker, I yield to the 
gentleman from Illinois (Mr. Shimkus).
  Mr. SHIMKUS. Mr. Speaker, I am going to speak about a couple of 
provisions on the Medicare prescription drug bill. I have been to town 
hall meetings, three hospitals in my community, I have been to some 
editorial boards. It is an issue that the public needs to hear from us 
about.
  This bill has passed and will become law, and we are going to find 
out real soon how helpful this bill is. Come June, the discount cards 
are going to get mailed out, and then the proof is going to be in the 
pudding. Either they are going to lower costs and people get access to 
drugs; or they are not. Either way, we are held accountable by the way 
we vote.
  The first provision I would like to mention is it is voluntary. 
Voluntary means you can do it if you want, you do not have to do it if 
you do not want to, which is very different in the ideological spectrum 
of debate. Republicans believe in freedom. Our primary principle that 
we stand for is freedom; and freedom allows individuals to choose one 
way or the other. The freedom aspect is whether they want to be a part 
of a prescription drug system that supports and helps, or seniors do 
not want to. We trust that seniors will be able to make choices that 
best fit them. That is laudable, and I would rather be on the side of 
trusting seniors than saying, no, the Federal Government has to do it 
for them because our seniors cannot do it themselves.
  The other thing I would like to mention is what is on this chart. 
There is a debate out there that there is not going to be any 
negotiation for lower costs of drugs. Well, obviously, the prescription 
drug cards and the program itself is not going to be prohibited from 
using the market forces and the number of people in the plan to 
exercise buying leverage on the prescription drug industry. It is 
pretty clear.
  Ms. GINNY BROWN-WAITE of Florida. Mr. Speaker, HMOs have used the 
PBMs, the pharmacy benefit management, concept for so long because they 
realize that they are excellent at negotiating the prices of 
prescription drugs. Several of the HMOs in Florida have done that and 
have had significant savings that they then could pass on to the 
seniors who are actually in the Medicare+Choice plan. When you have 
somebody who knows how to drive those prices down, why reinvent the 
wheel.
  Mr. SHIMKUS. Mr. Speaker, that also brings competition to the 
negotiation of prices. If we just have the government negotiating, 
first of all, it is not a for-profit entity. It is not going to have 
the incentive to drive a hard bargain; it is just going to set prices 
with no return. But if we have a handful of companies competing to 
service a senior population in a competitive model, if you believe in 
freedom and competition and all of those things that we do, we are 
going to get a better product. I am excited, and I supported the bill. 
I think it will be helpful for seniors. I wanted to highlight that on 
the prescription drug issue.
  One other aspect of the prescription drug issue is the number one 
thing that seniors came up to me before the vote that they were 
concerned about was whether they would lose the coverage that they had 
that was promised to them in their pension and benefit plans. They 
would pull me off the parade route or after church, wherever I was, 
Will I lose it? There are 41 million seniors in the Medicare system, 
and 13 million are covered by prescription

[[Page H916]]

drug plans through their pension and benefit plans. Thirteen million. 
We could never assume that additional cost, so we have to provide a 
provision in this to incentivize the pension and benefit plans to 
keep providing. That is a promise that we provided to these seniors, 
and that is in the bill. So we met their need.

  They did ask us, and because it would be very destructive for us, 
already trying to be fiscally conscious, to add $13 million more 
entitlements to a system when they are already receiving benefits.
  The Medicare prescription drug bill is not just about prescription 
drugs, though. It is the best rural health care package ever passed on 
the floor of this House. Now, I represent southern Illinois; I have 30 
counties. They stretch from as many as 250,000 people in one county to 
5,000 in another. I border Indiana, Kentucky, and Missouri. The best 
rural health care package ever passed by the House of Representatives 
was in this Medicare prescription drug bill for community hospitals, 
for critical care hospitals, and for rural home health care agencies. 
That is part of this debate. So people who want to try to change this 
Medicare prescription drug bill, they really are threatening the great 
provisions that have already been passed that will help rural health 
care throughout not just Illinois but throughout the country.
  The other thing that I wanted to highlight was the preventive 
medicine aspects of this Medicare bill. I always talk about modern 
medicine, and I think the debate when you identify when Medicare was 
established in the 1960s, what has stayed the same. We do not drive the 
same cars that were built in the 1960s, we do not live in the same 
style homes, or use the same type of electrical appliances. We have 
computers and turbo-charged engines. The only thing that has stayed the 
same is Medicare. We would pay for reactive measures, not proactive 
measures. In other words, we would pay to try to fix the blindness, to 
deal with the amputations, to deal with the effects caused by diabetes; 
but we would not pay for the drugs needed to treat diabetes, and that 
is a silly way of doing business. First of all, there is no cost 
benefit in that. You are a loser financially when you do that.
  So the preventive aspect, there is going to be a Welcome to Medicare 
physical. Seniors will get a physical to establish where they are in 
the health care continuum, initially to make diagnosis. And, obviously, 
early diagnosis of major diseases through the application of 
prescription drugs is cheaper and healthier for all involved.
  I have taken enough time, and I have a lot of colleagues on the 
floor, and I know they are eager to talk about the great benefits of 
the prescription drug bill. I thank the gentlewoman for yielding me 
this time.
  Ms. GINNY BROWN-WAITE of Florida. Mr. Speaker, one of the other 
things that we need to point out is that there is a scheduled copay 
that was supposed to take effect for home health care. That is 
postponed in the bill, and it is eliminated in the bill.
  Additionally, there was a $1,500 therapy cap. I recently broke a bone 
in my arm, and $1,500 might be okay for a broken bone, but somebody who 
has a stroke, $1,500 worth of therapy would not even touch their needs. 
So we eliminated the $1,500 therapy cap, which I know there are many 
seniors out there that are very grateful for that. That is one of the 
small parts of this bill which means so much to so many seniors.
  Mr. SHIMKUS. Mr. Speaker, this is the beginning of my 8th year here, 
and that therapy cap issue has been presented to us year after year for 
8 years, and I think it is right to bring that up. I am just sorry that 
the gentlewoman had to break her arm to make a point for that therapy 
issue.
  Ms. GINNY BROWN-WAITE of Florida. Mr. Speaker, I yield to the 
gentleman from Alabama (Mr. Rogers).
  Mr. ROGERS of Alabama. Mr. Speaker, I thank the gentlewoman for 
yielding me this time.
  When I first came to Congress, I made a promise to seniors in 
Alabama. I told them I would fight for their interests in Congress. I 
told them I would work to strengthen and secure Medicare for 
generations to come, and I told them I would fight for a new 
prescription drug benefit under Medicare.
  Mr. Speaker, these days I return to my home State of Alabama having 
followed through on that promise. Thanks to the leadership of President 
Bush and a bipartisan group of Members of Congress, the seniors in my 
home State of Alabama will soon have a prescription drug relief 
benefit. It comes not a moment too soon.
  Alabama seniors all across the Third Congressional District continue 
facing high drug costs. In fact, drug prices have risen in the few 
short months since President Bush signed this law. Fortunately for our 
seniors, relief is on the way. Beginning in May, Alabama seniors will 
see immediate relief through a voluntary prescription drug discount 
card. Seniors who choose to enroll in this benefit will see discounts 
of up to 25 percent with this drug card. This means that on a $100 
monthly prescription, seniors will save $25. That is $300 a year. This 
is a voluntary program. No seniors will be forced into anything. 
Seniors happy with their current coverage under Medicare will have no 
changes to their plan. This is a 100 percent voluntary program. Nor 
will seniors with employer-paid drug plans need to worry about their 
coverage. The new Medicare law offers substantial incentives for 
employers to continue to provide prescription drug coverage to 
employees and retirees, but Congress did not forget about those most 
needy seniors, either.
  Alabama seniors with low incomes will soon receive extra assistance 
under this law. In the Third Congressional District of Alabama, the 
area of the country I represent, approximately 21,400 seniors with low 
incomes will soon qualify for a new $600 annual subsidy. Coupled with 
the prescription drug card, this $600 annual subsidy will help Alabama 
seniors with lower incomes decrease their drug bills substantially.
  Mr. Speaker, the promises do not end there. In rural areas across the 
country, like those in my district, seniors, families, and children are 
losing access to health care. In fact, the discrepancies between rural 
and urban health care have long been a concern of mine. That is why I 
am proud that President Bush and a bipartisan group of Members of 
Congress who supported this bill also included increased support for 
rural doctors and hospitals. Under the new Medicare law, rural 
hospitals, doctors, and clinics will receive an unprecedented $25 
billion to improve the quality and availability of health care. Of 
this, nearly $934 million is dedicated to help improve health services 
all across Alabama. Of that amount, nearly $20 million is dedicated 
just for the Third Congressional District of Alabama. That is no small 
amount of money.
  This new funding for rural hospitals will not only help improve the 
health of all our seniors, but it will also help improve the health of 
every single Alabamian young and old. Rural hospitals and clinics will 
be strengthened through significant increases in hospital reimbursement 
rates as well. Because of this law, emergency and primary care will be 
available to Alabama families in rural areas, just like people living 
in big cities like Atlanta.
  Mr. Speaker, I said a moment ago that this new Medicare law is about 
promises. Last year President Bush and the Republican leadership 
promised new prescription drug coverage under Medicare. We kept our 
promise. We promised new benefits to seniors like preventive screening 
and diabetes testing. We kept that promise. We fought for rural 
hospitals, doctors and pharmacies in hopes of improving rural health 
care for all Alabamians. We kept that promise, too.
  Mr. Speaker, the Medicare prescription drug law is about promises 
made and promises kept. I am proud that we worked so hard to improve 
seniors' lives. Our challenge now is to ensure that seniors know about 
the benefits to which they are entitled. We must ensure seniors are not 
confused by the dangerous political posturing and unnecessary, 
confusing double talk. Is this a perfect bill? No. But it is a great 
start, and certainly better than the little or no prescription drug 
coverage most seniors had before. To quote AARP President James Parker 
from a recent statement, ``The bill represents an historic breakthrough 
and an important milestone in the Nation's commitment to strengthen and 
expand health security for current and future beneficiaries.''

[[Page H917]]

                              {time}  2230

  I agree, Mr. Speaker. On behalf of Alabama seniors, I thank President 
Bush and the gentleman from Illinois (Speaker Hastert) for their 
leadership in passing this historic bill. I pledge to continue doing 
whatever I can to help strengthen Medicare and to work to improve the 
health of all our Nation's seniors.
  Ms. GINNY BROWN-WAITE of Florida. Mr. Speaker, I yield to the 
gentleman from Texas (Mr. Burgess). It is good to have two doctors, one 
on each side of me here.
  Mr. BURGESS. Mr. Speaker, I thank the gentlewoman for yielding and 
bringing this very important issue up before the floor of the House 
tonight.
  I have done several town halls and talked to my medical staffs back 
in my district, and you do get questions from people back home, why 
undertake this rather complicated process of trying to modernize 
Medicare?
  The fact is, Mr. Speaker, and I believe the gentleman from North 
Carolina (Mr. Hayes) pointed it out earlier, that back in 1965, when 
Medicare was first enacted some 38 or 39 years ago, that the expenses 
that a senior might face with a medical condition would be those 
expenses from a long hospitalization, such as treating pneumonia, or 
surgery.
  In fact, Mr. Speaker, I think they only had two medications back 
then, cortisone and penicillin, and they were pretty much 
interchangeable. But the world has drastically changed since 1965, and 
we have so many more medications available to us.
  The gentlewoman from Florida mentioned the particular problems with 
senior women. Mr. Speaker, in my years of practice in obstetrics and 
gynecology back home in Lewisville, we relied routinely on a medication 
called Fosamax, Actonel, another medication, to treat osteoporosis, 
that were not even thought of in 1965.
  To not have these medications available to patients after making the 
diagnosis of low bone density, Mr. Speaker, it made no sense at all 
that we were going to document the fact they had osteoporosis and then 
not pay for the treatment.
  The sad fact of the matter is, Mr. Speaker, when they came back 1 or 
2 years later with a lower number on their bone density score, we said, 
``Gosh, did you not use the medication I prescribed?'' And then we 
would find out that the medication was not purchased and that is why it 
was not taken, and losing that time for treating that disease, Mr. 
Speaker, that is unconscionable.
  Individuals with osteoporosis are, of course, at increased risk for 
hip fracture. Hip fracture, when it occurs, carries a 25 percent 
mortality within a year after diagnosis, so it is no small issue to 
that group of senior women.
  Mr. Speaker, we also hear some criticism from those on the other side 
of the aisle as to why we left people uncovered in the Medicare bill 
that we passed. The truth is, Mr. Speaker, there was an attempt made to 
cover those people who most needed coverage, and that is people at the 
bottom end of the income scale and people with catastrophic illnesses.
  Yes, it would have been great to cover everyone in between, and 
several of the Members on the other side of the aisle recommended that 
the night we had the debate, but the reality is the cost of the 
Medicare prescription drug program ballooned by over half to up to $1 
trillion over 10 years, and, Mr. Speaker, it was thought that this was 
the prudent way to provide the prescription drug benefit to those who 
needed it most, seniors at the low income level and seniors who faced 
catastrophic coverage.
  Paying for the prescription drug benefit, and that has become an 
issue that we have heard a lot about, in fact, Mr. Speaker, when I was 
back home in my district in December, I picked up an op-ed article from 
Ronald Brownstein out at the Los Angeles Times. He said that there are 
only two ways we pay for healthcare in this program, through either 
private insurance or government-run programs.
  I would like to correct Mr. Brownstein, and I am sure the gentleman 
from Georgia (Mr. Gingrey) will attest to this. Back in the day I was 
practicing medicine, I did a lot of uncompensated care, and that was 
another way that healthcare was paid for, somebody just did not pay 
their bill.
  But another way healthcare is paid for, is people will write their 
own check for healthcare. One of the things that we did in this 
Medicare bill that I am so proud of is the institution and the 
expansion of the old Medical Savings Account into what is now called a 
Health Savings Account. This is not just for seniors, but this is for 
anyone.
  People now can start to put money away tax deferred that will grow 
tax deferred to provide for their medical care at whatever point in 
life that they need it. This is a tremendous advance in being able to 
pay for medical care, and, Mr. Speaker, it was a big boon and a big 
part of the bill that we just passed.
  Finally, let us just talk for a second about the cost estimates that 
we have heard on this bill. We talked about the $390 billion over 10 
years that the Congressional Budget Office assigned this bill, and then 
the White House Office of the Budget came up with a somewhat higher 
figure, and, of course, the folks on the other side said, See, we told 
you you can't do it for that.
  But the reality is both of those are estimates, and, Mr. Speaker, the 
chairman of the Committee on Ways and Means himself admitted that the 
Congressional Budget Office did not even try to take into account the 
fact that we would be treating illnesses on a more timely basis, we 
would be providing for preventive care in this bill, so there is really 
no way to adequately assess the cost, and for someone to come out and 
say it is suddenly 25 percent higher than it was last year, well, those 
are just numbers. It is smoke and mirrors, because no one actually 
knows how the cost of care is going to come down by treating illness in 
a timely fashion.
  Finally, I would just like to say about cost, if the other side is so 
concerned about costs, and I thank the gentlewoman from Florida for 
bringing this up, because this is so important, Mr. Kerry did not see 
fit to be in the Chamber when this bill was voted on, but, more 
importantly, he voted against meaningful liability reform in this 
country last summer.
  Mr. Speaker, a study done at Stanford University back in 1996, so 
these are 1996 dollars that I am talking about, this study showed that 
if doctors were not practicing defensive medicine, and we are not 
talking about the cost of buying malpractice insurance or the cost of a 
lawsuit, we are talking about the cost of defensive medicine, what 
lengths doctors go through to prevent them from being sued, if the cost 
of defensive medicine were subtracted from the system, the Medicare 
system, $50 billion a year, that would pay for your prescription drug 
benefit under either CBO estimates or White House Office of the Budget 
estimates.
  That is so important, and America needs to look at the fact that the 
Senator voted against meaningful liability reform, which would have 
paid for the prescription drug benefit in the bill that we passed last 
December.
  Ms. GINNY BROWN-WAITE of Florida. Mr. Speaker, I want to thank the 
good gentleman from Texas for being here. He is absolutely right, you 
cannot have it both ways. Mr. Kerry cannot vote against meaningful tort 
reform, and then all of a sudden be worried about the high cost of 
healthcare, when we all know what a very high percentage of it is. 
Certainly I have known percentages, anywhere from 30 to 40 percent of 
the cost of healthcare today is because we have become such a litigious 
society.
  I am very happy to yield to the gentleman from my neighbor State of 
Georgia (Mr. Gingrey), also a freshman Member.
  Mr. GINGREY. Mr. Speaker, I thank the gentlewoman from Florida for 
yielding, and I thank my colleagues for bringing such important 
information before the Congress tonight on this very, very important 
issue, the Medicare Modernization Act and Prescription Drug Act of 
2003, a promise that was made to seniors a number of years ago and a 
promise that finally this President, our President, George W. Bush, has 
delivered on. I am proud, of course, as a physician Member of this 
Congress to have been very supportive of this Medicare Modernization 
and Prescription Drug Act.
  Mr. Speaker, I think all of us realize, we are in an election year, 
and not just any election year, but, of course, a

[[Page H918]]

presidential election year, and there is a lot of rhetoric going around 
in these halls and in the respective town halls of districts of Members 
and a lot of criticism of the administration and this President, and 
what I like to call MediScare rhetoric, MediScare rhetoric.
  In the little bit of time I have tonight, let me try to clarify for 
the Members one such MediScare subject, and that is this, that the 
allegation that this prescription drug bill for seniors, for our needy 
seniors is nothing but a giveaway to the pharmaceutical industry.
  Think about that now, nothing but a giveaway to the pharmaceutical 
industry. One could have said in 1965 when Medicare was first enacted, 
some 38 years ago, that Part A, the hospital part of Medicare, was 
nothing but a giveaway to the hospitals. After all, it is the hospitals 
that provide the care under Part A.
  One could also say that Part B, the physician part, was nothing but a 
giveaway to the doctors, those doctors who are performing critical 
surgery, taking care of patients, it is nothing but a giveaway to the 
physicians, because, after all, they are the ones that provide the care 
under Part B.
  Now, here they come in 2004 saying in their MediScare rhetoric that 
Medicare Part D, the prescription drug part which our seniors have 
waited for for years, is nothing but a giveaway to the pharmaceutical 
industry.
  Obviously, the pharmaceutical companies are going to sell more drugs, 
no question about that. Nobody else can do that. Nobody else is in that 
business. Nobody else makes the drugs, the wonderful drugs, because of 
the research and development that has gone into that, that has provided 
the best pharmaceutical prescriptions of any country in the world. That 
is the pharmaceutical companies, and, yes, thank God, finally, they are 
going to be able to sell more drugs because our seniors, at long last, 
are going to be able to afford to buy those drugs. But this is not a 
giveaway to the pharmaceutical industry.
  What is going to happen is because they sell more prescription 
medication, then we are going to lower the price. Anybody, Mr. Speaker, 
any Member of this body, anybody who is paying attention to us here 
tonight, understands the volume discount you get when you sell more of 
a product, whether it is a new car dealer selling 100 units a month 
versus 10 units a month, they can sell them at a lower price. That is 
what this is all about.
  It is nothing but a scare tactic on the other side, not willing to 
give the credit where credit is due, to this President, this Republican 
leadership, this Congress, for finally delivering on a promise that 
others have made when they were in control, but they failed to keep 
that promise.

  I want to just mention, Mr. Speaker, in the few minutes I have got 
left, about some of the organizations that have been so supportive of 
this legislation. I do not have enough time to list them all. I could 
go through every medical sub-specialty, certainly the American Medical 
Association, my Medical Association of Georgia, in the district that I 
represent, the senior organizations. The most well-known, of course, 
which represents some 35 million seniors, including yours truly, Mr. 
Speaker, the American Association of Retired Persons, the AARP. Listen 
to what they say. I just want to call your attention to this poster to 
my left.
  ``AARP believes that millions of older Americans and their families 
will be helped by this legislation. This legislation protects poor 
seniors from future soaring prescription drug costs. The bill will 
provide prescription drug coverage at little cost to those who need it 
most. It will provide substantial relief for those with very high drug 
costs. It also provides a substantial increase in protection for 
retiree benefits.''
  Mr. Speaker, what that says is the American Association of Retired 
Persons endorsed this bill when they made sure that Medicare would do 
everything in its power to prevent companies from dropping their 
healthcare coverage, including a prescription drug benefit, for their 
retirees who had worked sometimes 35, 40 years, for the company. These 
companies were dropping these plans or cutting the benefits, and this 
is what is happening even before this Medicare Modernization and 
Prescription Drug Act was passed. But it was only when we shored up 
those companies to prevent them from dropping these plans that the 
American Association of Retired Persons came on board in support of 
this bill.
  I commend them. No, I am not about to tear up my AARP card. I think 
they represent seniors well, and I am proud of them for their support.
  I could go on and on, and I am not going to do that, because some 
more of my colleagues are here, and I thank the gentlewoman from 
Florida (Ms. Ginny Brown-Waite) for bringing this special hour to the 
Congress to make sure that the Members understand that we are listening 
to a lot of rhetoric now during this election season, a lot of scare 
tactics, but it is unfair to scare our seniors. We are providing a 
benefit to them that is much needed, and the benefit goes to the very 
heart and helps those needy seniors the most.

                              {time}  2245

  It is an absolute Godsend, Mr. Speaker, for them. I thank the 
gentlewoman for giving me this opportunity tonight.
  Ms. GINNY BROWN-WAITE of Florida. Mr. Speaker, it certainly is much 
needed and certainly long overdue, and I think any senior who has been 
out there waiting will tell us that.
  Mr. Speaker, I would like to yield to the gentleman from Indiana (Mr. 
Chocola).
  Mr. CHOCOLA. Mr. Speaker, I thank the gentlewoman for bringing us 
together tonight to talk about a very important subject. Mr. Speaker, 
it is a bit unfortunate that we are actually here tonight, that we have 
to talk about the facts, that we have to cut through the rhetoric, cut 
through the misinformation that has revolved around this very important 
bill that delivers a very important benefit to our seniors.
  The facts are that the Medicare bill is a voluntary bill, and no one 
has to do anything that they do not want to. They can keep the Medicare 
exactly the way it is, or they can add a very significant benefit. The 
facts are that they have a choice, they have a choice that will best 
fit their individual needs, and they can change that choice as their 
needs change. They can also save about 50 percent on their prescription 
drug needs. This bill will lower the cost to the average senior by 
about 50 percent for their prescription drug needs.
  But the facts are, we are here because we have to focus on those 
facts, as our colleagues are doing tonight. Like my colleagues, I did 
about 10 to 15 town hall meetings on this issue; and what I found is 
people came with a sincere interest to learn, a sincere interest to cut 
through the rhetoric and understand how this Medicare bill impacts them 
in their daily lives. I appreciate the comments that my colleagues have 
made to help clarify how this impacts our seniors on a day-to-day 
basis.
  But one of the most difficult questions that I got during those town 
hall meetings was the question, Why can we not bring cheaper drugs in 
from Canada? The answer, Mr. Speaker, is that we can bring cheaper 
drugs in from Canada, so long as the Food and Drug Administration can 
guarantee their safety. Because what we do not hear, Mr. Speaker, is 
there is a provision in this Medicare bill that allows Canadian drugs 
to come into the United States so long as the FDA can guarantee their 
safety, just like we ask the FDA to guarantee the safety of every 
single drug that is sold in America.
  I asked the question, Why would we ever let a drug come into the 
United States that does not live up to the same quality and the same 
safety standards as every drug that is sold inside the United States? I 
had one lady stand up and she said, Well, do not give me any safety 
arguments. Do not talk about counterfeit drugs. I asked her, Well, why 
should I not do that? She said, Because I have a bottle here that says 
made in the USA. In fact, it says Eli Lilly, made right here in the 
State of Indiana. I said, Well, ma'am, how do you know that those are 
not counterfeit drugs? She said, I know because I am smart. And I said, 
Well, with all due respect, ma'am, it does not have anything to do with 
how smart you are or how smart I am; it has to do with whether you have 
a chemical engineering degree, or whether you have a chemical lab in 
the back seat of your car or your basement, because the only way that 
you can determine whether those drugs are counterfeit or not are to do 
the chemical analysis.

[[Page H919]]

  Although she did not necessarily agree with that, she wanted to keep 
talking about it. I said, Well, let me share with you a story. This is 
a story that happened right here on the floor of the House of 
Representatives last summer. Last summer I came on the floor and I sat 
down in the aisle right behind me and I sat down next to the chief of 
staff of the Committee on Agriculture on which I serve. The chief of 
staff turned to me and said, You know what? An hour ago we found out 
that there was a cow in Canada with mad cow disease.
  Mr. Speaker, one may ask, What does mad cow disease have to do with 
counterfeit drugs coming into the United States? The reality is that 
within 12 hours we had shut down our borders. There was no cow that was 
going to come in to the United States from Canada because we were 
concerned about mad cow disease infecting the citizens of this country. 
Well, Mr. Speaker, the reality is, do my colleagues know how many 
people have ever suffered from mad cow disease in the history of the 
world? A little over 100, not one of those people in the United States.
  So we have a national outcry. When one cow in Canada is infected with 
mad cow disease, we will not let one cow cross that border. We will not 
let one ounce of beef from Canada come into the United States. Yet we 
will talk about allowing prescription drugs that could be counterfeit 
coming across those borders.
  Mr. Speaker, I think we as Members of Congress have a responsibility 
to share the facts of the Medicare bill, and we have the responsibility 
to stand up and not do what is politically popular, but what protects 
our constituents, protects consumers of the United States, and focus on 
the real issue, which is the affordability of prescription drugs. And 
this bill addresses that problem with the high cost of drugs, because 
it has a discount card that will provide a 10 to 25 percent immediate 
savings for seniors, it brings market competition into the prescription 
drug health care marketplace, it has health savings accounts, as my 
colleagues have talked about tonight.
  There are a lot of other things we could discuss about the real 
issues; but we should not engage in scare tactics, and we should not 
put the health care at risk of all of the citizens of this country by 
bringing counterfeit drugs in from anywhere, not just Canada, but 
anywhere from outside this country.
  Ms. GINNY BROWN-WAITE of Florida. Mr. Speaker, I have been very 
fortunate to have been named the chair of the Women's Caucus; and so 
much of this bill tonight, for my remaining time, I would like to 
emphasize the importance of the bill to women who are retired.
  Mr. Speaker, in Florida alone, there are 167,000 elderly women who 
live below the poverty level. There are about 750,000 elderly women who 
are between the poverty level and the 150 percent of the poverty level 
who will be helped greatly by this bill. When we combine these 
statistics with the fact that the average woman in Medicare earns about 
half of the income from Social Security as a man, women are facing a 
very serious problem: How do they afford their prescription drug 
coverage?

  Congress obviously responded to these problems and created the new 
voluntary prescription drug bill. Again, I am emphasizing, it is a 
voluntary prescription drug bill.
  Unfortunately, women over the age of 65 suffer more from chronic 
illnesses than men. Over 14 percent of women suffer from arthritis, and 
17 percent more suffer from osteoporosis. Five percent suffer from 
hypertension. Even more women have cardiac problems that will go 
undetected. The new benefit that is included in this bill, Mr. Speaker, 
the Welcome to Medicare physical for the baby boomers who are just 
coming into the Medicare arena, will be there to help detect many of 
these problems, including heart problems that very often historically 
have been misdiagnosed.
  Mr. Speaker, I know that the hour is late and I am running out of 
time, but I did want to say that for the 2.1 million women in my State 
with no husband present, an astounding 30 percent of those women live 
below the poverty line. Republicans in Congress passed the bill that 
will benefit retired women and men; and for that, as more information 
comes out about the bill, as the truth comes out about the bill, I know 
that seniors around the Nation from the many States that were 
represented here tonight will be very grateful and are very grateful 
that we had the courage to finally pass a Medicare prescription drug 
bill for seniors.

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