[Congressional Record Volume 150, Number 93 (Thursday, July 8, 2004)]
[Extensions of Remarks]
[Page E1329]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




 INTRODUCING THE MMA TERRITORIAL EQUITY FOR LOW-INCOME INDIVIDUALS ACT 
                                OF 2004

                                 ______
                                 

                       HON. MADELEINE Z. BORDALLO

                                of guam

                    in the house of representatives

                         Thursday, July 8, 2004

  Ms. BORDALLO. Mr. Speaker, today I am introducing legislation that 
will treat Medicare-eligible citizens of Guam, the Virgin Islands, 
American Samoa, the Commonwealth of Puerto Rico and the Commonwealth of 
the Northern Mariana Islands the same as low-income citizens in the 50 
States and the District of Columbia with respect to the Medicare 
prescription drug transitional assistance program and, beginning in 
2006, premium and cost-sharing subsidies under the national Medicare 
prescription drug program. I am joined by Congresswoman Donna M. 
Christensen of the Virgin Islands, Congressman Eni F. H. Faleomavaega 
of American Samoa and Resident Commissioner Anibal Acevedo-Vila of 
Puerto Rico as original co-sponsors of this legislation, which will 
provide health care equality to seniors in the insular areas with 
respect to the prescription drug benefit.
  Currently, citizens of the insular areas contribute to the Medicare 
Trust Fund in the same manner as citizens in the 50 States and the 
District of Columbia. However, while the Medicare Modernization Act 
(MMA) created a transitional assistance program authorizing up to $600 
in prescription drug subsidies for individual low-income Medicare 
beneficiaries in both 2004 and 2005, the territories receive only a 
small Federal block grant ($35 million in aggregate for both years to 
cover an estimated 450,000 Medicare beneficiaries) to help defray the 
costs of implementing local prescription drug plans through their 
respective public health departments. While exact data is not 
available, it is estimated that beneficiaries in the insular areas will 
receive significantly less relief than their counterparts in the 50 
States and the District of Columbia. The MMA also does not include 
citizens in the territories for the purposes of the full national 
prescription drug plan authorized for Medicare beneficiaries beginning 
on January 1, 2006. Again, a separate Federal block grant is allotted 
to the territories in lieu of full participation.
  Citizens of the insular areas face greater challenges to accessing 
adequate health care and prescription drug services than citizens in 
the States and the District of Columbia. Transportation costs and 
smaller economies of scale increase the cost of prescription drugs 
available in these areas. Furthermore, the insular areas are home to 
many different minority groups, many of which are genetically disposed 
to certain illnesses. For example, African American, Hispanic and 
Pacific Island Americans are all genetically disposed to diabetes, 
which is particularly prevalent among the age 40-and-over category. 
Therefore, access to prescription drugs will, in addition to increasing 
the quality of life among citizens of the insular areas, help resolve 
other health disparities such as prevention and treatment of 
genetically-disposed illnesses.
  My legislation recognizes that health care inequalities exist with 
respect to the treatment of citizens in the insular areas. It further 
recognizes that, in the case of the new transitional assistance and 
prescription drug programs authorized under the MMA, citizens of the 
insular areas pay into the Medicare Trust Fund in the same manner as 
citizens in the 50 States and the District of Columbia and should, 
therefore, receive parity with respect to benefits. The current 
protocol for block granting prescription drug funding to the insular 
areas will ensure that health care disparities will continue to exist 
in these areas. The best solution with regard to fairness and parity is 
to allow citizens of the territories to participate directly in these 
Federal prescription drug assistance programs.
  My bill would ensure parity with respect to the application of the 
MMA in the insular areas by eliminating the current prescription drug 
block grant formula in favor of including low-income Medicare 
beneficiaries in Federal prescription drug assistance programs. Support 
for this legislation will ensure that all Americans receive the 
benefits to which they are entitled under the MMA.

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