[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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