[Congressional Record Volume 150, Number 87 (Tuesday, June 22, 2004)]
[House]
[Pages H4738-H4745]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


[[Page H4738]]
                 REPUBLICANS ACCOMPLISH MEDICARE REFORM

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 7, 2003, the gentleman from Florida (Mr. Bilirakis) is 
recognized for 60 minutes as the designee of the majority leader.


                             General Leave

  Mr. BILIRAKIS. Mr. Speaker, I ask unanimous consent that all Members 
may have 5 legislative days within which to revise and extend their 
remarks on the subject of this Special Order.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Florida?
  There was no objection.

                              {time}  1900

  Mr. BILIRAKIS. Mr. Speaker, we are here tonight, I guess it is 
tonight, to talk about the Medicare Modernization Act. I will say that 
I was proud to be a part of that small conference committee that worked 
hours, weekends, weeks that produced this landmark bipartisan 
legislation. I am the first to say, and I have said it oftentimes to 
many of my colleagues, and certainly members of the staff, that this 
law is not perfect. It is far from perfect. But it targets an awful lot 
of money towards the areas where it will do the most good; towards the 
areas that will do the most good. The poorest and the sickest among us 
will certainly benefit the most from this new law.
  Back in the mid 1960s, Mr. Speaker, the Congress passed the Medicare 
bill. Since then, there have been very few major changes made to it. 
The bill today, the law today regarding Medicare would offer Medicare 
beneficiaries the basic part A and part B coverage. It would offer 
very, very little preventive care. In fact, until a few years ago, it 
offered no preventive care at all.
  We added a few things in a few years ago. The gentleman from 
California (Mr. Thomas) and the gentleman from Maryland (Mr. Cardin) 
and I got together and we added some preventive care to the bill. No 
prescription drug coverage available. Very little choice in plans 
available. If you live in a rural area, much harder to get access to 
that Medicare.
  Today, we have a plan as a result of what this particular Congress 
did that adds some form of prescription drugs to those benefits. It 
also adds in an awful lot of preventive health care by way of what we 
call ``Welcome to Medicare,'' so that when a person is eligible to get 
on Medicare, Medicare will cover a physical, which is intended, of 
course, to pick up things that can get an awful lot worse as time goes 
on. It certainly will result in a lot of savings of money. But the 
point of the matter is that, hopefully, it will result in a better 
quality of life for that particular beneficiary because you are picking 
up something early.
  It also provides for much better access in rural areas. One of the 
fears that Medicare beneficiaries have, those that have retired or 
their families are retired from some of the larger companies that have 
given them tremendous retirement coverage, particularly in health care, 
there is concern as to whether or not they would lose that particular 
coverage in spite of the fact that over the last few years, and it has 
nothing at all to do with this Medicare bill, but something like 40 
percent of all coverage has been dropped as the result of the high cost 
of medical costs. But there is some form of protection in this bill. 
And an additional preventive health care provision is disease 
management. And there are other areas in it, but those are the 
additional things.
  So, what are the fears or what are the concerns among the 
beneficiaries out there? God knows an awful lot of Members of this body 
are certainly working on those fears and on those concerns. Many are 
concerned that they will lose their traditional fee-for-service 
coverage. We keep harping on the fact that the bill does not take away 
that option from them. They can retain traditional fee-for-service and 
not do anything at all regarding this piece of legislation. There is 
nothing mandatory whatsoever about it. They can retain fee-for-service 
and decide to additionally pick up this legislation. So they have the 
best of two worlds, if you will, if they are in love with the 
traditional fee-for-service plan that they now have.
  I have already said it is not a mandatory plan. People can keep 
exactly what they have. We have placed money in there to try to 
encourage employers to keep from dropping. Something has been 
happening, like I have already said, something like 40 percent over the 
past few years have already dropped their plans. But we have put some 
seed money in here, if you will, if you can call $80 billion seed 
money, to keep employers from dropping plans, and, of course, better 
accessibility to rural areas.
  Mr. Speaker, the history of, let us say the other party, the 
Democrats, insofar as prescription drug coverage is concerned, is that 
back in 1999, during the 106th Congress, my friends from the left 
introduced a bill for prescription drugs, H.R. 1495, which they called 
the Access to Prescription Medications Act of 1999. Given this 
legislation, I am puzzled as to why they are having so much difficulty 
with the benefits in our bill. Why are they having so much difficulty 
with those benefits? What did that bill, led by the gentleman from 
California (Mr. Stark), the gentleman from Michigan (Mr. Dingell), the 
gentleman from California (Mr. Waxman), the gentleman from Ohio (Mr. 
Brown), et al, offer?
  It offered a $200 deductible. It offered a 20 percent cost sharing up 
to $1,700. It offered catastrophic coverage after $3,000 out-of-pocket. 
I would ask Members of Congress, through you, Mr. Speaker, to relate 
those particular provisions with what we are doing in this bill. And 
there was no defined premium. The program would have used PBMs, which 
is what we call pharmacy benefit managers. They take issue with that in 
our bill, but this is what they would have done. Now, you may ask how a 
PBM would have been selected? How? By competitive bidding, no less. 
Furthermore, the contracts would be awarded on, among other things, 
shared risk, capitation or performance.
  I make these points, Mr. Speaker, to highlight how far we have come 
and how obvious it is that Democrats simply want to play politics with 
seniors' medication needs. Now, the bill they had was not perfect, and 
I have already said, nor is ours. But what I am wondering about is if 
it was good enough for them in 1999, what is wrong with it in 2003 when 
this legislation passed?
  I would also be remiss not to address the notion that some of the 
fatal flaws in their legislation back in 1999 is that they would have 
placed numerous onerous requirements under the winning bidder, which 
would have likely raised drug prices for seniors.
  In 2000, the Democratic budget substitute for fiscal year 2001, 
offered by the gentleman from South Carolina (Mr. Spratt) their ranking 
member on the Committee on the Budget, included $155 billion for a 
Medicare prescription drug benefit. All of their leading leaders over 
there supported this figure. Our bill is at $390 billion, $395 billion, 
depending on what figure you want to believe. They had $155 billion. We 
are well over twice that.

  In 2001, the Democratic budget substitute for fiscal year 2002, 
offered by the gentleman from South Carolina (Mr. Spratt), upped the 
ante and called for a $330 billion reserve fund to help create a 
Medicare prescription drug benefit. Their leadership all supported that 
figure.
  I wish I could tell you what the Democrats support in 2002 and their 
fiscal year 2003 substitute, but I cannot, because they did not offer 
one. Of course, that did not stop them from offering a $1 trillion 
benefit during committee consideration of H.R. 4954, the Medicare 
Modernization and Prescription Drug Act of 2002.
  The fiscal year 2004 budget resolution offered, Mr. Speaker, by the 
Democrats this year, does not reference a specific dollar figure 
regarding Medicare modernization and prescription drugs. It just says 
that the cumulative effect of Medicare reform and programs for the 
uninsured cannot increase the deficit by more than $528 billion over a 
10-year period. Yet they still busted their own budget by offering a 
drug bill that CBO estimated would cost, what? $1 trillion.
  So I think, Mr. Speaker, the point here is obvious. No matter what 
Republicans commit to Medicare reform and prescription drugs, the 
Democrats will always outbid us in an attempt to scare seniors and 
score political talking points. Unfortunately, for them, the Republican 
majority, along with President Bush, has put $400 billion on

[[Page H4739]]

the table to craft a prescription drug benefit that will greatly assist 
our Nation's seniors. And that is why it was endorsed by AARP and a 
long list of others that I might read into the record as time goes on.
  Mr. Speaker, I will now yield at this point to the gentleman from 
Pennsylvania (Mr. Greenwood), a member of the Subcommittee on Health to 
supplement and complement my remarks
  Mr. GREENWOOD. Mr. Speaker, I thank the chairman for yielding to me, 
and I thank him for hosting this special order. I worked with the 
chairman and other members of the Republican conference for years to 
try to bring this prescription drug benefit into law. And while I did, 
there were two images that I kept in my mind that drove me as many long 
hard nights as it took to get this legislation passed.
  One of them was a letter I received from an 86-year-old woman that 
was handwritten several years ago. I do not know if she is still alive, 
but she described in detail how she has to take six medications. She 
had no prescription drug benefit whatsoever. She had to pay for those 
medications out of the little meager Social Security check that she 
received. And she said to me in this letter that she can barely afford, 
but she could manage to buy her heart medicine, because that she needed 
or she would not stay alive. She would die. She could scrape enough 
money to pay for the medicine that kept the diabetes she was suffering 
from from killing her.
  She was able to get blood pressure medicine that she needed to stay 
alive, and even pay for the cholesterol-lowering drugs. But she had no 
money left for the medication that she needed to end her pain from 
arthritis, and she had no money left to end the emotional pain she 
suffered from her depression.
  So there she was, in a dilemma: Able to pay for the drugs necessary 
to keep her alive, but not able to pay for important drugs that would 
make her life worth living.
  The other image that I recall vividly is that in one of my offices in 
the district there is a watchman, a security guard. An elderly 
gentleman. A wonderful fellow. And every time I walk through the doors, 
I would go past his desk. And particularly years ago when my daughters 
were younger, he would always give me two lollipops for my daughters. 
And he would say, How are you guys in Washington doing on that 
prescription drug benefit? Because my wife is very ill and she needs so 
much medication, and we have no benefit. And the reason I have to work 
at my age is just to make enough money to try to pay for her drugs. And 
every day I would say, we are working on it, we are working on it, we 
are going to get it done. And I would almost be afraid to go in a week 
later and say we had not succeeded.
  In fact, we passed a prescription drug benefit in this House in the 
year 2000. We did it again; it died in the Senate. We did it again in 
2002; died in the Senate. Finally, in 2003, we got the bill passed in 
the House, as we all know by one vote. The Senate passed it with 
bipartisan support and the President signed it. And finally, finally, 
after all of these years, after seniors waiting for nearly 40 years for 
a prescription benefit, we have created it.
  Now, what happens? We are subject to criticism night after night. As 
I am working in my office, I am looking on the monitor watching C-SPAN 
and I see some of the Democrats on the other side railing and railing 
against the prescription drug benefit, which, as the chairman just 
pointed out, amazingly, amazingly, the most liberal Members of the 
Democratic party had, not too long ago, introduced a bill that did 
precisely the same thing; used precisely the same mechanisms.
  The problem is, they have a political problem. The political problem 
they have is that the Democratic party has always said, oh, we are the 
party that loves the senior citizens. We are the party that will 
deliver them the benefits under Medicare. But they failed. And they 
failed for all of the time in which they had control of the Congress. 
And it kills them that it was a Republican House and a Republican 
Senate and a Republican President that actually got it enacted in law. 
It is driving them crazy.
  So what do they do? They have no choice but to come and trash the 
very bill that parallels the bill they introduced and try to scare 
senior citizens into not taking advantage of it. In my district, we 
hold meetings to explain the new Medicare drug card so seniors 
understand it. But in the districts of those who come to the floor and 
oppose it, there is no one there to even help them. Their 
Congressperson and staff does not help the seniors to understand and 
navigate the system.
  Fortunately, the Medicare program over at CMS has a wonderfully 
helpful Web site that seniors can go to. They just go to the Web site, 
and if they do not have access to a computer, they can go to a library 
or a senior center and get help there. They put in the drugs they take, 
and they look at the variety of discount cards and pick the one that is 
best for them.
  But it is when you do something, it is when you actually accomplish 
something and get it done that you are subject to criticism. It is hard 
to criticize someone in detail about something they never accomplished. 
We got the job done, so we suffer the criticism. That is fine. The 
bottom line is that the seniors and those who are physically disabled 
in America now have the benefit.
  The full benefit could not come overnight. You cannot go from zero to 
100 miles an hour overnight. You have to set up a system. So we have 
this interim period with the drug cards. If you are poor, $600 of free 
drugs and a discount.

                              {time}  1915

  If you are not poor, you get the discount; and you get a discount 
tailored to your needs.
  In January of 2006, the full benefit becomes available to every 
Medicare recipient, every elderly person, every disabled person in the 
country, a historic occasion, a historic occasion for this country. 
Finally, everyone in America in those categories will have access to a 
first-rate pharmaceutical program.
  I am proud to say that in Pennsylvania my constituents in my State 
will have the best program in the country, because what we did in 
Pennsylvania is we made sure that the Pennsylvania Pace Program, which 
is now spending $400 million a year, dollars derived from our lottery, 
that $400 million a year is no longer going to be needed to pay for 
drugs for the poor people in Pennsylvania, because our Medicare program 
will do that.
  So now with that extra money, we are going in Pennsylvania to be able 
to fill in some of the shortages in coverage, the so-called doughnut 
hole, and be able to pay some of the shared cost for our recipients. 
The people in Pennsylvania will have an exquisitely generous program, 
and people across the country will have a very good program beginning 
in January 2006.
  I am proud to have worked so hard to gain the success. I am proud of 
the chairman, the gentleman from Florida (Mr. Bilirakis), for his work; 
proud of the President for supporting this bill and signing it; and I 
think it is high time that instead of fear-mongering for political 
purposes, every Member of Congress ought to get on with the business of 
encouraging their seniors back home to take advantage of this program. 
It is in their interest to do so and explain to them how it is to their 
benefit to do so. That is public service. Public service is helping the 
elderly and the disabled in their district get access to a very helpful 
program. It is not public service to simply malign the program for 
political purposes.
  Mr. BILIRAKIS. Mr. Speaker, I thank the chairman, the gentleman from 
Pennsylvania (Mr. Greenwood). He has worked hard; and he has been a 
real leader on this subject and, frankly, on all health matters, 
because I chair the Committee on Energy and Commerce Subcommittee on 
Health, and he is a very vocal and active member of it.
  I would like to say that we have heard all sorts of arguments against 
what we have done. The doughnut hole, which is a gap in terms of 
dollars and what benefits can be acquired during that time and before 
and after that, the Democrats, as I have already said, have in their 
1999 bill a $200 deductible and they had a cost sharing up to $1,700 
and then catastrophic coverage after $3,000 out of pocket. So they had 
a doughnut hole from $1,700 to $3,000. We also have a doughnut hole 
because of the limited dollars that were available.

[[Page H4740]]

  Our doughnut hole goes from $2,250 to $3,600. So they had a $1,700, 
as I understand it, as I interpret it, up to $3,000; and we have a 
doughnut hole from $2,250 up to $3,600. So we learned about the 
doughnut hole from them.
  I would now gladly recognize the gentleman from Texas (Mr. Burgess) 
to talk more specifically about the Medicare-endorsed prescription drug 
card program, because as the gentleman from Pennsylvania (Mr. 
Greenwood) has already shared with us, the prescription drug provisions 
go into effect in January of 2006. So during that interim period of 
time, we wanted to be able to afford some help to the potential 
beneficiaries, and that is where the discount card program came into 
effect.
  Mr. Speaker, I yield to the gentleman from Texas (Mr. Burgess).
  Mr. BURGESS. Mr. Speaker, I thank the gentleman from Florida (Mr. 
Bilirakis) for yielding the time and especially for his leadership in 
calling this hour this evening, because I do think it is so important 
that we get the word out, that we get the story out to seniors across 
the country of what is available.
  Mr. Speaker, I sat on the floor of this House in January of 2003 and 
heard the President deliver the State of the Union message, the first 
State of the Union message that I had ever heard as a United States 
Congressperson; and the President said in that State of the Union 
message that the Medicare prescription drug benefit was so important 
that it would not wait for another President, and it would not wait for 
another Congress.
  True to his word, he proposed legislation that worked its way through 
two committees and came to the floor, just about a year ago, the end of 
June 2003. We voted on the conference report in November, and the 
President signed it into law in December. And this bill provided what 
has been the missing link in Medicare for the past 38 or 39 years, and 
that is a prescription drug benefit.
  Now, Mr. Speaker, I was in my former life a simple country doctor, a 
practicing physician. I was not around when Medicare first came along; 
but back in those days, if a senior faced a hospitalization or a doctor 
bill, those would be the primary medical expenses that he could expect 
to encounter; but nowadays, we can do so much more with prescription 
drugs.
  Back in 1965, it perhaps was not important to have a prescription 
drug benefit, because there were only two medications, antibiotics and 
corticosteroids, and they were interchangeable; but now we can do so 
much more with prescription drugs.
  In January 1, 2006, the prescription drug benefit is going to come 
online; but between now and then, starting the first of this month of 
June of 2004, until that January 1, 2006 date, the prescription drug 
discount card is going to become available; and for the first time, for 
the first time seniors will have available to them complete 
transparency in the marketplace. They can call 1-800-Medicare. They can 
log on if they have the Internet or have their grandchildren log on for 
them to www.medicare.gov.
 You need to know a couple of things before you make that telephone 
call or before you log on. You need to know your ZIP code, and you need 
to know the medications that you are taking and the dosages that you 
are taking.
  You do need to know the specific medication names. It will not do to 
say that I have a little white pill in the morning and a little green 
pill at noon. You have got to know the specific medication names, but 
that is not that difficult.
  If you have those pieces of information, you can log on or call the 
1-800 number, and get information that never before has been available 
to any group of consumers buying drugs in this country. That is, you 
can get very powerful market-driven transparent information about what 
the costs of drugs are.
  Mr. Speaker, what we have found in the first few weeks of this 
program is indeed the cost of drugs on those programs has come down as 
that transparency has worked its magic in the marketplace. I believe it 
was important to offer this discount prescription drug card as a 
transitional benefit. The chairman has already correctly pointed out 
that you cannot just start up with that part B Medicare that is going 
to be coming online in 18 months, but this is also giving us an 
opportunity to make sure that benefit when it comes online on January 
1, 2006, is going to be the best benefit possible and there is going to 
be an enormous amount of data that is accumulated during that 18 
months' time.

  Seniors starting the first of this month, June, so they can already 
be going onto the Medicare Web site, www.medicare.gov, or call 1-800-
MEDICARE and enroll for a prescription drug discount card. They can 
either be walked through the process on the telephone or take 
themselves through that process online, but what they will get at the 
end of that interview or the end of that online session is a printout 
of what prescription drug cards are available in their market and what 
the costs of those cards are.
  By law it can be no more than $30. Many of those cards cost less than 
$30, and some are at no charge at all. Then they can comparison price. 
Do they want to shop at their neighborhood pharmacy, or do they want to 
use a mail order pharmacy? That pricing information will be available 
to them on that printout that they received at the end of the online 
session or calling into the 1-800-MEDICARE number. Mr. Speaker, it is 
easy. I did it myself. My hope is that as this process goes forward 
that caregivers, doctors, nurses will help patients with that; if 
patients are unsure how to negotiate the system, caregivers will help 
them chart those waters themselves and find out for themselves what the 
benefits for seniors out there are.
  A very important part of this, and the chairman has already alluded 
to that, it was important to cover the people who were sickest and the 
people who were poorest. Of those seniors who are at 135 percent of the 
Federal poverty level, there is going to be a $600 subsidy available 
this year, right now, on the prescription drug card, and there will be 
a similar benefit available next year. In fact, since this year is 
relatively short, what is left with this year, if there is money not 
used from that $600 benefit, it will roll over into next year. So there 
is basically a $1,200 benefit for the 18 months between now and the 
time the prescription drug card comes online.
  Again, Mr. Speaker, I would stress, this is a competitive, market-
based solution that is available. It is the first time for any group of 
purchasers of prescription drugs that they are going to have the power 
of that transparency in the marketplace. I think we are going to find a 
number of good things come from that. I for one am very proud to have 
been part of the process. I realize that I came late to the table, but 
I appreciate very much having been here last year and watching that 
process through to its fruition.
  Mr. BILIRAKIS. Mr. Speaker, day after day we hear a good deal of 
criticism about many aspects of this new Medicare discount card that 
the gentleman from Texas was referring to. We hear, of course, 
criticism about the entire thing, but particularly that. Some will say 
that the savings are not large enough. To that I would say that the 
savings available through these cards, and, more importantly, as the 
gentleman from Texas said, the $600 per individual transitional 
assistance for the poorest of our seniors, are a heck of a lot better 
than what many seniors were getting before this Congress and this 
President acted to provide Medicare beneficiaries with prescription 
drug coverage. I have always maintained, I have already said it, that 
since we have limited resources available to us, we should target our 
resources to those who need help the most, the poorest and the sickest. 
The transitional assistance available under these cards will provide a 
lot of help to an awful lot of people.
  Mr. Speaker, I am aware that other Members will argue that the high 
number of drug discount card sponsors will needlessly confuse seniors. 
We have had a presentation, and there are a large number. Granted there 
is some confusion there. The system still has a few kinks that need to 
be worked out. I agree that some beneficiaries will need extra 
assistance in choosing the card that is right for them. But, Mr. 
Speaker, I would enter into the Record here a 1966 article in The 
Washington Post that is entitled Medicare Bug, Thousands Fail to Pay 
Premiums. It

[[Page H4741]]

goes on to say, Thousands of elderly workers have gotten off to a bad 
start with Medicare by failing to pay their premiums on time. The 
Social Security Administration has reported delinquency rates for the 
$3-a-month payments are running as high as 50 percent in some parts of 
the South, a spokesman said. Nationally it is about 30 percent. The 
payments were due July 1. The slow payments, it goes on to say, 
represent only one of several bugs to appear in the massive machinery 
of Medicare during its first 6 weeks of operation. It goes on to say, 
however, the program generally is working better than expected and an 
official said, he is quoted in here, We think there is some confusion.
  There was confusion in the mid-1960s. If the Congress had taken a 
look at that confusion and all those problems and whatnot and done what 
so many in this body on the other side of the aisle do, complaining 
about it and calling it names and trying to discourage the seniors from 
going into it, we would not have Medicare today.

               [From the Washington Post, Aug. 21, 1996]

            Medicare ``Bug,'' Thousands Fail to Pay Premiums

                           (By Philip Meyer)

       Thousands of elderly workers have gotten off to a bad start 
     with Medicare by failing to pay their premiums on time the 
     Social Security Administration has reported.
       Delinquency rates for the $3-a-month payments are running 
     as high as 50 per cent in some parts of the South, a 
     spokesman said. Nationally, it is about 30 percent. the 
     payments were due July 1.
       The slow payments represent only one of several bugs to 
     appear in the massive machinery of Medicare during its first 
     six weeks of operation. However, the program generally is 
     working better than expected.
       The problem of delinquent payment affect only the group of 
     2 million Medicare beneficiaries who are still working. Those 
     who have retired have the monthly $3 checked off their 
     retirement benefits.
       Elderly workers who signed up for Plan B, the part of 
     Medicare that covers doctor bills, were billed for $9 to 
     cover the program's first three months. Payments of $3 or $6 
     also are accepted.


                         3 Months Grace Period

       No one has yet lost any benefits for failure to pay, a 
     Social Security spokesman said. The grace period is three 
     months.
       Biggest lag in premium payments is in Southern States, 
     where as many as 50 percent of the beneficiaries who are 
     supposed to pay in cash failed to send in the money on time.
       ``We think there's some confusion,'' an official said.
       The $3 premium is matched by another $3 from the Federal 
     Treasury to support the program. It pays 80 percent of doctor 
     bills after the first $50.
       That $50 deductible is also causing some confusion, the 
     official reported.
       ``Some people thought they had to pay the first $50 charged 
     by each doctor they saw,'' he said, ``Others thought it was a 
     premium they had to pay whether they needed a doctor or 
     not.''
       As the rule actually works, the $50 deductible must be met 
     only once in each calendar year.
       Another problem reported to the Social Security 
     Administration headquarters by district offices is that many 
     people who turn 65 are late in signing up for Plan B.


                         Should Join Before 65

       Those who wait for their 65th birthday to enroll miss the 
     first month of eligibility. The proper time for joining is 
     from one to three months before the birthday.
       Once enrolled, many persons have caused themselves 
     unnecessary inconvenience by becoming ``overly protective'' 
     of their Medicare cards.
       The wallet-sized cards are issued to identify beneficiaries 
     to doctors and hospitals. Some people are so afraid of losing 
     them, they have rented safe deposit boxes to store them in. 
     Others have sent them to sons or daughters in distant cities 
     for safekeeping.
       ``The card isn't all that important,'' the Social Security 
     spokesman said. ``It's nice to have, but losing it won't keep 
     you from getting benefits. The worst that can happen is the 
     inconveniences of apply for a new card.''

  Mr. Speaker, I would also say in that connection, there are companies 
which have already said that they would offer pharmacy assistance 
programs around the low-income subsidy for the drug card. So once these 
poorest seniors among us use up that $600 that they have available, the 
$600 per individual, $1,200 per couple, these companies have come into 
the picture and said they would go ahead and not charge them anything 
extra.
  Merck. Under the Merck program, once a beneficiary has exhausted his 
or her annual $600 traditional assistance allowance, Merck will provide 
its medicines free to that beneficiary's participating discount card 
plan.
  Johnson & Johnson. After Medicare beneficiaries who are eligible for 
the government's $600 transitional assistance allowance have exhausted 
this benefit, they can receive medicines made by Johnson & Johnson-
operating companies free of charge.
  Eli Lilly will partner with government-approved programs to make the 
LillyAnswers program available to seniors with incomes below 200 
percent, considerably better than just the real low-income, below 200 
percent of the Federal poverty level and who do not currently have 
prescription drug coverage.
  Abbott will partner with drug-discount cards approved by the Centers 
for Medicare and Medicaid Services to offer Synthroid tablets for $5 
per monthly prescription. It goes on and on.
  Pfizer. The Pfizer Share Card program provides qualified low-income 
Medicare beneficiaries, those with gross incomes less than $18,000 
single and $24,000 couple, with access to up to a 30-day supply of any 
Pfizer prescription medicine for a flat fee of $15 per prescription.
  As a result of what we have done here, we have partnered with an 
awful lot of the pharmaceutical companies.
  Mr. Speaker, I yield to the gentleman from Illinois (Mr. Shimkus), 
another terribly valuable member of our committee.

                              {time}  1930

  Mr. SHIMKUS. Mr. Speaker, I thank the chairman for yielding to me, 
and I appreciate this special order.
  I will be brief. I know I have got colleagues here on the floor who 
also want to address this issue.
  Sometimes in this whole Medicare prescription drug debate, we focus 
on the prescription drug benefit, and I am glad we do because it is the 
first time we have ever offered real help to seniors, especially the 
poor, those in need. And I was talking to a group of homecare folks on 
Saturday morning at their in-service and educating them on the 1-800 
number and the www.medicare.gov so that they can help their clients 
access this needed program.
  So that is what we have got to continue to do, and that is what I 
hope all of my colleagues, whether they were for the bill or against 
the bill, if they are for their seniors, they ought to be educating 
them on the benefits of this package.
  But, also, before I even go on the Medicare prescription drug debate, 
I always tell the folks in rural Illinois, and I represent 30 counties 
south of Springfield down to Indiana and Kentucky, that in this bill is 
the best rural package for hospitals ever passed.
  And that is why we have got a good bipartisan vote by some Democrats 
who represent rural America and realize that in the debate on funding 
aspects, there was always the concern, well, if it is rural, it must 
cost less so we can pay less. But when we talk about buying the needed 
high-tech fancy equipment that is needed today and they do not have the 
buying power of a major network, those pieces of equipment come almost 
more costly than they would if they are buying multiple copies of this 
equipment.
  So for anyone who represents rural America, this bill was a huge 
victory in making sure that our rural community hospitals can operate 
and keep their doors open. And I want to thank the leadership of the 
chairman to make sure that that was part of the package.
  The other thing that I am very excited about and I like to talk about 
it all the time because I want feedback from my constituents. In fact, 
Bob Ney, who is the mayor of the District of Columbia, he is our mayor, 
I have asked him countless times to make sure that we get options for 
health care and insurance packages, do your best to make sure we have a 
health savings account provision that we ourselves can look at as part 
of our buying options and your working options for our insurance. The 
health savings accounts are probably, I think, our last great chance to 
reform an entitlement system and get individuals back in control of 
their buying decisions and costs. Making health care decisions based 
upon quality service, timeliness, people they like, and cost.
  What has happened, in my humble opinion, because I am not an expert 
in this field, is that we do not know what we are paying for health 
care delivery and services, and we do not know actually who is paying 
and how much they

[[Page H4742]]

are paying because there are multiple levels.
  I have got a farmer in my district that has moved to a health savings 
account plan, and he is saving $10,000 a year on his catastrophic plan. 
And the deductible portion, which, if he does not use or even if he 
uses a portion of that, that can roll over. Think of the great benefits 
to young kids getting married now. This health savings account, if it 
is going to be offered and if they take advantage of that, having that 
tax-free savings continue to roll over and what it will do in the 
buying decisions and costs, and they are shopping around for the basic 
health care services, eyewear, dental visits, things that now are put 
in this big pool of insurance that some offer and some do not. If they 
need it, they have got it. If they want the preventative care, go get 
it. It is going to save money in the long run. And the more money one 
saves in this health savings account, the more that rolls over in the 
next years.
  So I want to thank the chairman for letting me butt in line, and I 
want to thank my colleagues for allowing me to do that. I would ask our 
colleagues, when we talk about the benefits of the Medicare 
prescription drug bill, spend time on the prescription drug benefit. It 
is a great benefit and people should take advantage of it. But look at 
other portions of the bill. For the rural hospitals, we did great. And 
the future of getting people back in control of their health care costs 
and decisions on their health care savings accounts, I am hoping that 
it is everything that it is going to be advertised to be.
  And I am asking people to let me know if it is doing what we think it 
should do because no piece of legislation that we pass here on the 
floor of the House is perfect. We all know that. We will get another 
look at it. We will have hearings. We will try to reform and adjust. 
And we only do that by getting good feedback from our constituents.
  Mr. BILIRAKIS. Mr. Speaker, I yield to the gentleman from Georgia 
(Mr. Gingrey) to continue on this subject.
  Mr. GINGREY. Mr. Speaker, I would, first of all, like to thank the 
chairman of the Health Subcommittee of the Committee on Energy and 
Commerce and the committee members who are bringing this hour to us 
tonight on such an important subject.
  When we passed this bill in December of 2003, this was a bipartisan 
bill. This is a bipartisan Medicare plan. There were Members on both 
sides of the aisle, my colleagues, who usually sit on the right, the 
Democrats, who usually sit on the left, there were those on the right 
who opposed who felt that this bill, the $400 billion, or maybe it is 
$500 billion, was too costly, that we just simply wanted to do it but 
could not afford it to. And I think some 24 or 25 of my Republican 
colleagues voted against the bill because they just did not think we 
could afford it.
  On the other side of the aisle, the Democrats, some voted for the 
bill, but those who opposed it opposed it because they did not think we 
were doing enough, that we were not spending enough. And they kept 
talking about the doughnut and the hole in the doughnut and 
emphasizing, Mr. Speaker, that the hole was too big. And now that the 
bill has passed, we hear all this what I refer to as ``Mediscare'' 
rhetoric, and one of the first and foremost ``Mediscare'' tactics about 
that hole in the doughnut.

  We see it on television ads. So they are saying to seniors do not eat 
the doughnut. Do not eat the doughnut. Eat the hole. And I can tell 
people the hole has no taste, it has no calories, it has nothing 
because there is nothing there. And I think it really is 
unconscionable, particularly in regards to this interim program, the 
Medicare discount prescription card program to suggest to seniors or to 
advise them not to sign up for the prescription card.
  Mr. Speaker, I cannot think of any reason, not one reason, for a 
senior to not sign up for their prescription discount card. The 
benefits are tremendous for those who need it the most. And we have 
heard my colleagues speak about the $600 credit not just one time but 2 
years and that can roll over into the next year.
  So a senior might have as much as $800 the second year of credit, not 
to mention the 15 to 20 percent overall discount, not that some 
discounts may be higher on certain drugs and lower on certain drugs but 
overall a 15 to 20 percent discount.
  And I say this, Mr. Speaker, to my seniors when I when I do town hall 
meetings in the 11th district of Georgia, South Cobb County and 16 
counties of West Georgia, and we talk about this, and I say to them 
take advantage of this discount card. The most it can cost them, the 
most it can cost them, is $30; but if they are a low-income senior and 
they are eligible for the $600 credit, if their income is below 135 
percent of the federal poverty level, and there is no assets means 
testing, it is just strictly based on income, and they are eligible for 
that, then they get the $600 credit, and they pay nothing for their 
card, and they get that 15 to 20 percent discount on each and every 
medication on an average that they purchase. I mean it is an 
opportunity for anyone. Whether they voted against the bill because 
they thought that it was too expensive and we could not afford it or 
whether they voted against it because they thought we were not doing 
enough, I say that it is unconscionable to advise those seniors not to 
sign up for the prescription drug discount card.
  There are other things, and I do not want to take up too much of the 
time that the chairman has been so kind to allot to me tonight, and I 
know there are other speakers that are coming, but that is just one of 
these ``Mediscare'' tactics. And the other one, and I will just briefly 
mention that, is this idea of this Medicare plan, prescription drug 
plan and Medicare modernization, is nothing but a giveaway to the 
pharmaceutical industry. We have heard that. I know all my colleagues 
have heard that, and hopefully people listen and will understand as I 
explain why that is so fallacious. If that were true, if the new 
Medicare part D prescription drug plan was nothing but a giveaway to 
the pharmaceutical industry, then one could certainly say the same 
thing about part A and part B, going back to 1965, as the chairman did 
earlier in his remarks.
  Part A, of course, one could say was nothing but a giveaway to the 
hospitals, and one could equally say that part B was nothing but a 
giveaway to the doctors because after all, they are the ones who 
provide the services under part A and part B respectively. But talk to 
any of them, and, believe me, they will say very quickly that it is 
hard to see Medicare patients and provide that care, and in many 
instances they are doing it out of the goodness of their heart. The 
pharmaceutical industry certainly will sell more drugs, but they will 
sell them cheaper, just like an automobile dealer who sells 100 new 
cars a month can sell them cheaper than if he just sells 10. And that 
is what is happening. That is what is going to drive these prices down.
  Mr. Speaker, I love to come before my colleagues and talk about this 
bill. We are in the interim phase now, the prescription drug discount 
card. Again, I can think of no reason why a senior should not sign up 
for that and take full advantage of it. In a year and a half, there may 
be some seniors who will have a better plan. Nobody will be forced out 
of Medicare as we know it, traditional Medicare. It is a choice. But 
this is a good bipartisan bill, and it is time to stop all the 
politicking and the rhetoric against it and let the seniors take 
advantage of something that this President and this Congress have 
finally delivered on.
  And I thank the chairman so much for giving me the opportunity to be 
with him tonight.
  Mr. BILIRAKIS. Mr. Speaker, I thank the gentleman for his comments.
  Mr. Speaker, I very much appreciate particularly the gentleman's 
emphasizing the discounts because fortunately for America's seniors, 
and we will not hear this from the other side, the principles of 
competition that drive this new benefit are already showing real, real 
results. And CMS found during the first week, and I am talking about 
the first week in May now, the first week in May, which was really when 
all this started in terms of posting prescription drug discount card 
pricing information, et cetera, the CMS found that the discounted 
prices available through the program had already fallen 11\1/2\ percent 
for brand names and 12\1/2\ percent for generics over that first week.
  I do not know what the current picture is. I have not looked into 
that.

[[Page H4743]]

But the fact of the matter is we can see what will happen here with 
competition. And these discounted prices are already less, already 
less, than what seniors without drug coverage are paying for their 
medications.
  And that is why, Mr. Speaker, it is so disappointing that some 
continue to demagogue this issue. When I learn of a partisan analysis, 
if you will, of the prescription drug discount card benefit that 
concludes that the program is a failure, before a single beneficiary 
uses the card, before a single beneficiary uses the card, it makes us 
all wonder. But I guess we do not have to wonder too much. Scare 
tactics are designed to frighten, to confuse seniors. That will only 
ensure that some beneficiaries would choose, as the gentleman from 
Georgia (Mr. Gingrey) said, not to access a benefit that could save 
them hundreds, if not thousands, of dollars annually.
  Mr. Speaker, I yield to the gentleman from Oklahoma (Mr. Sullivan) to 
continue on in this conversation. Newly added to the Committee on 
Energy and Commerce, I am very proud to say.
  Mr. SULLIVAN. Mr. Speaker, I thank the gentleman from Florida (Mr. 
Bilirakis) for all his work on this very important measure.
  Unfortunately, the chairman is right, how this gets demagogued. I go 
back to my district, and seniors are excited about this, but 
unfortunately they get things in the mail and they hear all this 
misinformation. And this is a great bill. This is a historic measure 
and something that is very important.

                              {time}  1945

  Mr. Speaker, I would like to bring to your attention an often 
overlooked provision in H.R. 1, the Medicare Prescription Drug and 
Modernization Act of 2003, that will better the lives of America 
America's seniors.
  As a result of the Medicare reform law, Medicare beneficiaries will 
receive an expansion of coverage that will help them to prevent and 
manage many life-threatening diseases, such as cancer, diabetes and 
cardiovascular disorders, without incurring large medical bills.
  For instance, H.R. 1 provides for an extensive initial medical 
preventative physical examination. This free exam includes measurements 
of height, weight, blood pressure and an electrocardiogram. Health care 
professionals will be on hand during these physicals to offer 
education, counseling and referrals related to other preventative 
services covered by Medicare. These preventative services include but 
are not limited to vaccinations, screening, mammography, prostate and 
colon cancer screening, as well as cardiovascular and diabetes 
screening.
  It is worth noting that cardiovascular and diabetes screening tests 
do not have deductible copays, so beneficiaries do not have to incur 
any cost. This is an additional incentive for those with limited 
resources to go to the doctor and have these vital tests performed so 
that these diseases can be detected as early as possible.
  Many of these diseases, if caught early, can be treated and 
effectively managed resulting in far fewer serious health consequences. 
Such conditions as obesity, diabetes and heart disease could be far 
less severe for millions of Medicare beneficiaries. These are diseases 
that are impacting millions of Americans every year.
  For example, approximately 129 million U.S. adults are overweight or 
obese. Additionally, an estimated 18 million, or 6.2 percent of the 
United States population, have diabetes. This is not to mention the 
fact that heart disease and stroke are the first and third leading 
causes of death in the United States. In 2003 alone, 1.1 million 
Americans will have a heart attack.
  By providing an initial physical examination for all newly enrolled 
Medicare beneficiaries, seniors and disabled Americans will have an 
opportunity to discuss with their physician the importance of 
preventative care and living a healthy lifestyle. These examinations 
will not only save lives, but also save the United States Government 
hundreds of millions of dollars, as catching these diseases early 
lessens the cost of treatment.
  One program that will help many seniors towards the realization of a 
better quality of life is the Chronic Care Improvement Program, which 
was announced as a pilot project by CMS in April. It establishes and 
implements a Chronic Care Improvement Program under fee-for-service 
Medicare to improve clinical quality and beneficiary satisfaction, 
while also achieving spending targets for beneficiaries with certain 
chronic health conditions. This program will help patients manage their 
diseases in a way that will help improve case outcomes and patient care 
when they need it most.
  As a member of Speaker Hastert's Prescription Drug Task Force, I have 
spent many hours meeting with senior citizens and listening to their 
concerns. I know the Medicare reform law we passed in November is 
already having a positive effect on many seniors as they are seeing 
their drug prices fall and their health improve.
  We should all be proud of the fact that we delivered our promise to 
seniors to give them a prescription drug benefit. We should also be 
proud about giving them an opportunity to live happier and healthier 
lives in their golden years by expanding their benefit to include the 
prevention and management of serious diseases.
  Thus, it is my sincere hope, Mr. Speaker, that more American senior 
citizens will take advantage of the prescription drug benefit, as well 
as the preventative service Medicare offers, as they could truly help 
prolong millions of people's lives.
  Mr. BILIRAKIS. Mr. Speaker, I thank the gentleman.
  Before I yield again to Mr. Greenwood, I have in my hand four pages 
worth of supporters of the Medicare conference report. These are all 
patient groups. I am going to read off just a handful of the long list:
  AARP; ALS Association; Alzheimer's Association; American Autoimmune 
Related Diseases Association; American Diabetes Association; Arthritis 
Foundation; Coalition to Protect America's Health Care; Coalition to 
Protect Health Care Access; Cuban-American National Council; Epilepsy 
Foundation of Florida; Florida Coalition on Hispanic Aging; Hepatitis C 
Global Foundation; Kidney Cancer Association; Latino Coalition; Mental 
Health Association of Central Florida; Montel Williams Foundation; 
National Alliance For Hispanic Health; National Alliance For the 
Mentally Ill; the National Council on the Aging; Polycystic Kidney 
Disease Foundation; Robbie Vierra-Lambert Spinal Cord Organization; 
Sickle Cell Disease Foundation of California; 60-plus Association; 
United Seniors Association; We Are Family Foundation; Women Heart 
Group.
  This is just a handful of the long list here, Mr. Speaker, which I 
will include for the Record.

            Groups Supporting the Medicare Conference Report


                             patient groups

       AARP
       ALS Association
       Alzheimer's Association
       Alzheimer's Association, Mid South Chapter
       American Autoimmune Related Diseases Association
       American Diabetes Association
       American Sepsis Alliance
       Arthritis Foundation
       Coalition to Protect America's Health Care
       Coalition to Protect Health Care Access
       Cuban American National Council
       Epilepsy Foundation, Florida
       Erin K Flatley Foundation
       Florida Coalition for Access to Quality Medicine
       Florida Coalition on Hispanic Aging
       Florida Drop-In Association
       Hepatitis C Global Foundation
       International Patient Advocacy Association
       Kidney Cancer Association
       Larry King Cardiac Foundation
       Latino Coalition
       Louisiana Community Volunteers Association
       Louisiana Progressive Alliance
       Louisiana Safe Neighborhood Action Plan
       Louisiana Women's Network
       Loving Others Together Foundation
       Mental Health Association of Central Florida
       Montel Williams MS Foundation
       National Alliance for Hispanic Health
       National Alliance for the Mentally Ill
       National Alliance for the Mentally Ill--Kansas
       National Alliance for the Mentally Ill, Idaho
       National Art Exhibitions By The Mentally Ill, Inc.
       The National Council On The Aging
       National Right to Life Committee, Inc.
       Polycystic Kidney Disease Foundation
       Prevent Blindness Ohio
       Pueblo Health & Educational Programs
       RetireSafe.org
       Robbie Vierra-Lambert Spinal Cord Organization

[[Page H4744]]

       Sacramento Hepatitis C Task Force
       Seniors Coalition
       Sickle Cell Disease Foundation of California
       Sickle Cell Foundation of Florida
       60 Plus Association
       TMJ Society of California
       United Seniors Association
       We Are Family Foundation
       WomenHeart


                        Healthcare Organizations

       AAHP-HIAA
       AdvaMed
       Aetna
       Alliance for Aging, Florida
       Alliance for Quality Nursing Care
       Alliance of Specialty Medicine
       Alliance to Improve Medicare
       American Academy of Dermatology Association
       American Academy of Family Physicians
       American Academy of Ophthalmology
       American Academy of Pharmaceutical Physicians
       American Association of University Women, Louisiana
       American Association of Clinical Endocrinologists
       American Association of Neurological Surgeons
       American Association of Nurse Anesthetists
       American Association of Orthopedic Surgeons
       American College of Cardiology
       American College of Cardiology--MI Chapter
       American College of Emergency Physicians
       American College of Obstetricians and Gynecologists
       American College of Physicians
       American College of Radiology Association
       American College of Surgeons
       American Gastroenterological Association
       American GI Forum
       American Hospital Association
       American Medical Association
       American Medical Group Association
       American Occupational Therapy Association, Inc.
       American Osteopathic Association
       American Physical Therapy Association
       American Society Anesthesiologists
       American Society for Therapeutic Radiology and Oncology
       American Society of Cataract and Refractive Surgery
       American Society of Plastic Surgeons
       American Speech Language Hearing Association
       Anthem
       Association of American Medical Colleges
       BayBio
       BIOCOM
       BioFlorida
       Biotechnology Council of New Jersey
       Biotechnology Industry Organization
       BlueCross BlueShield Association
       California Healthcare Association
       California Healthcare Institute
       California Hep C Task Force
       California Medical Association
       Cardinal Health
       Catholic Health Association
       Cigna
       Coalition for a Competitive Pharmaceutical Market
       Coalition to Ensure Patient Access
       College of American Pathologists
       Colorado Bioscience Association
       Congress of Neurological Surgeons
       Disease Management Association of America
       eHealth Initiative
       Federation of American Hospitals
       Florida Academy of Family Physicians
       Florida Hospital Association
       Florida Osteopathic Medical Association
       Generic Pharmaceutical Association
       Healthcare Institute of New Jersey
       Healthcare Leadership Council
       HealthNet
       Hep and Vet Action Now Foundation
       Highmark, Inc.
       Hispanic Health Care Professional Association, Texas 
     Chapter
       Hospital & Healthsystem Association of Pennsylvania
       Humana
       InterAmerican College of Physicians and Surgeons
       Iowa Biotechnology Association
       Iowa Healthcare Access Network
       Iowa Medical Society
       Maryland Bioscience Alliance
       Massachusetts Biotechnology Council
       Massachusetts High Tech Consortium
       Mayo Clinic
       Medco Health Solutions
       Medical Society of New Jersey
       Medical Society of the State of New York
       Medical Society of Virginia
       Memorial Regional Health Systems
       Missouri State Medical Association
       MNBIO
       National Association of Children's Hospitals
       National Association of Community Health Centers
       National Association of Health Underwriters
       National Association of Public Hospitals and Health Systems
       National Association of Rehabilitation Providers and 
     Agencies
       National Association of Spine Specialists
       National Hospice and Palliative Care Organizations
       National Medical Association
       National Rural Health Association
       New York Biotechnology Association
       Ohio Advocates for Health Care Access
       Ohio Hospital Association
       Ohio State Medical Association
       Oklahoma State Medical Association
       Omeris
       PacifiCare
       Pennsylvania Biotechnology Association
       Pennsylvania Healthcare Technology Network
       Pharmaceutical Care Management Association
       Premier
       Private Practice of the American Physical Therapy 
     Association
       Rural Hospital Coalition
       Scripps Research Institute
       Society of Thoracic Surgeons
       South Carolina Biotechnology Association
       South Florida Hospital and Health Care Association
       Texas Health and Bioscience Institute
       United Health Group
       University of California Health System
       Utah Life Science Association
       VHA
       Wisconsin Biotechnology Association
       Wisconsin Healtcare Access Network


                               employers

       3M Company
       American Benefits Council
       American Chemistry Council
       AT&T
       Bank of America
       BellSouth Corporation
       Bituminous Coal Operators Association
       California Hispanic Chambers of Commerce
       Cargill, Inc.
       Case New Holland, Inc.
       Caterpillar, Inc.
       Cigna
       Coors Brewing Company
       Corporate Health Care Coalition
       Cox Enterprises
       Cummins, Inc.
       DaimlerChrysler
       Deere & Company
       Delphi Corporation
       Dow Chemical Company
       DuPont Chemical Company
       Eastman Kodak Company
       EDS
       Employer Health Care Alliance Cooperative
       Employers' Coalition on Medicare
       ERISA Industry Committee
       Financial Executives International
       Fisher Scientific International, Inc.
       Florida Hispanic Chamber of Commerce
       Food Marketing Institute
       Ford Motor Company
       General Dynamics Corporation
       General Motors Company
       Georgia Pacific Corporation
       Hershey Foods Corporation
       Hewlett-Packard Company
       Honeywell
       HR Policy Association
       IBM
       International Mass Retail
       International Paper Company
       Jostens
       Kellogg Company
       Louisiana Versai Management
       LPA, the HR Policy Association
       Lucent Technologies, Inc.
       Monsanto
       Michigan Manufacturers Association
       Motor & Equipment Manufacturers Assoc.
       Motorola
       National Association of Manufacturers
       National Federation of Independent Businesses
       National Mining Association
       National Retail Federation
       National Rural Electric Cooperative Association
       Northrop Grumman Corporation
       Peabody Energy Company
       Pitney Bowes
       Pittsburgh Plate and Glass
       PPG Industries, Inc.
       Printing Industries of America
       PSEG
       RAG American Coal Holding, Inc.
       Raytheon
       Rohm Haas
       SBC Communications
       Sears, Roebuck and Co.
       Southern Company
       Southwest Florida Hispanic Chamber of Commerce
       Sprint
       Texas Instruments
       The Aluminum Association
       The Boeing Company
       The Business Roundtable
       The Goodyear Tire & Rubber Company
       The Timken Company
       U.S. Chamber of Commerce
       United States Steel Corporation
       UPS
       Verizon
       Washington Business Group on Health
       West Virginia Chamber of Commerce


                                 others

       American Legislative Exchange Council
       Archer MSA Coalition
       California State Association of Counties
       Robert Goldberg, Manhattan Institute
       New Orleans Coalition
       The National Grange
       Women Impacting Public Policy

  Mr. BILIRAKIS. Mr. Speaker, I yield to the gentleman from 
Pennsylvania (Mr. Greenwood).
  Mr. GREENWOOD. Mr. Speaker, I thank the gentleman from Florida 
(Chairman Bilirakis) for yielding.

[[Page H4745]]

  Let me say to the chairman, he has had a long and distinguished 
career in the United States Congress, and I am sure that at the end of 
that career, the gentleman will look back with pride and say, if he is 
proud of anything he was able to accomplish in all of the countless 2 
o'clock in the morning, 3 o'clock in the morning, 6 o'clock in the 
morning sessions we have spent here, I would think it would be that you 
were at the helm when this Congress passed prescription drug benefit 
for seniors. It is an historic accomplishment, and the gentleman should 
be proud of it. I know he is.
  The other people who are proud of it, interestingly enough, are, as 
the chairman just said, the AARP, the American Association for Retired 
Persons, and all of the groups that care and are devoted to the care of 
patients. So if you are an organization like the AARP, there is no 
organization more respected by seniors than they, if you are one of the 
thousands of organizations that are devoted to making sure that people 
with illnesses get medicine, you are for the bill.
  So, how could we imagine that, after 35 years of struggling, nearly 
40 years of struggling without success to get a prescription drug 
benefit, finally the Members of this Congress, the House and the Senate 
in a bipartisan fashion, with the President of the United States 
signing the bill, we get it done, we devote half a trillion dollars to 
these prescription drug benefits, and who in the world would imagine 
that the reaction would be, from some quarters, let us criticize it. 
Let us attack it. Let us destroy it.
  Let me let you in on a little secret: A Democratic pollster provided 
some strategic information to the Democratic Party about how to respond 
to the fact that we had accomplished this great thing as Republicans 
and they needed a political strategy.
  What the pollster said, this is Greenberg Quinlan Rosner Research, 
Inc., in a Lake, Snell, Perry & Associates memo to the Democratic 
Party, they said, ``A message of fixing the bill reinforces the AARP 
message that we have made a good start and might continue to improve 
it. But that would give the message that the law is not all bad,'' so 
what she suggested was that we have to ``shift the debate in our favor 
as the straight negative portrayal of the law.''
  So any sort of sensible approach that says, hey, after all these 
years, we made a great start, let us keep making it better, let us 
enrich the benefit over time, you do not win the political debate if 
you do that. So you have to say the whole darn thing is no good, it was 
done for the worst of reasons, and let us condemn those who tried to 
make it happen.
  It is pretty astonishing hard to believe, hard to imagine that you 
would come along and spend half a trillion dollars to take care of the 
prescription drug benefits and needs of the seniors and the disabled, 
and the response is so negative.
  One of the chief critics of the program is the gentleman from Ohio 
(Mr. Brown), the ranking member on the committee of the gentleman from 
Florida (Mr. Bilirakis). The gentleman from Ohio (Mr. Brown) is a 
friend of mine and a colleague, but he has a penchant for never being 
able to have a debate. He says you think this way and I think that way, 
and that is a philosophical debate. He always has to assume the worst 
of motives.
  One of his criticisms is the way this benefit is delivered it through 
private pharmaceutical benefit managers. We set up a system so various 
companies can compete in the marketplace to deliver low cost drugs to 
seniors. What we know is that they are going to want to be able to make 
some profit on this, so they will go to the drug manufacturers and 
negotiate hard. ``You want me to cover your arthritis drug, you better 
give me a darn low price.''

  That is the way it works in the marketplace, and they get competition 
going between the various drug manufacturers to see who is going to 
give the lowest price. That is why we developed the system that way.
  Interestingly enough, every Member of Congress who chooses to receive 
his or her prescription drug benefit through the Federal Government 
receives their benefits exactly the same way, private companies. We do 
not have a special agency full of Federal employees that dispense drugs 
to Members of Congress, or to the 8 million other Federal employees. 
Eight million Federal employees, it is shocking that there are so many, 
but 8 million Federal employees who are eligible to purchase a 
prescription drug benefit through the government program, they buy it 
using the exact same model that we have provided for the senior 
citizens, the exact same model.
  Every man and woman in the United States military who participates in 
the military health programs gets their drugs the same way that we set 
up for the Medicare program.
  Now, the gentleman from Ohio (Mr. Brown) says no, that is not why you 
did it. You did not do it because it is efficient. You did not do it 
because you get the best prices. You did not do it because the private 
sector can instantaneously put a new drug into the plan, while the 
bureaucratic process would take months and months to add a new product. 
He says we did it because of contributions from the drug companies.
  I am here to say, as one who has never received a contribution from a 
drug company, I did it because I believe it is the right philosophical 
thing to do, it is the right way to benefit the seniors of our country.
  Again, Mr. Chairman, I am proud of you for your work on this, and 
thank you for giving me the opportunity to speak this evening.
  Mr. BILIRAKIS. Mr. Chairman, I thank the gentleman so much for his 
contribution tonight and all through the years. I would again remind 
all of us that the PBM, the pharmacy benefit managers, was an idea, an 
invention of the other party, and we did learn a few things from it. We 
learned about the gap, if you will, or the donut. We learned about the 
PBM and that sort of thing. We took the best, I think, of their ideas 
and cranked them into this and made some minor changes.
  Mr. Speaker, this new prescription drug benefit also functions, and 
this is something I guess we do not talk about as much as we should, as 
a sort of insurance program, when you stop to think about it.
  Most senior citizens that I represent are very risk adverse. One of 
their great fears is to fall victim to a debilitating illness that will 
wipe out their life savings and burden their families.
  Since prescription medications are obviously crucial to the treatment 
of a myriad of conditions, it goes without saying that a long-term 
chronic illness will most likely result in high spending on 
prescription drugs.
  Under this bill, seniors who elect to join the program will pay 
around $35 per month for their Part D coverage. This premium buys them 
two things: First, it buys them the peace of mind that if they suffer 
from a catastrophic illness, that seniors will pay only 5 percent of 
their medications after spending $3,600 out of their own pocket; 
insurance, if you will, for if they really get sick. We all have life 
insurance and all sort of insurances that, God help us, we will never 
use. We do not complain about it.
  Beneficiaries who qualify for low income assistance will not pay 
anything once they reach this threshold. The others will pay 5 percent 
after spending $3,600 out of their pocket.
  Second, the premium buys them very good first dollar prescription 
coverage. After meeting the $250 deductible, their Medicare 
prescription drug plan will pay 75 percent of the drug costs up to a 
$2,250 limit. I have already said the Democrat plan had it up to 
$1,700, so we even go above that. Over half of Medicare beneficiaries 
spends less than this in a year, so for them, this is really a great 
deal.
  Mr. Speaker, the benefits of the bill are clear: Superior assistance 
for those on fixed incomes, peace of mind for all seniors that a 
catastrophic illness will not devastate them financially, and excellent 
first dollar coverage that will benefit millions of American seniors.
  There are a lot of folks who want to see this new bill fail. They 
will say and do most anything to scare senior citizens in their quest 
to discredit this program. I think they are going to fail.




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