[Congressional Record Volume 150, Number 101 (Tuesday, July 20, 2004)]
[Senate]
[Pages S8479-S8481]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BINGAMAN:
  S. 2694. A bill to amend title XVIII of the Social Security Act to 
provide for the automatic enrollment of medicaid beneficiaries for 
prescription drug benefits under part D of such title, and for other 
purposes; read the fist time.
  Mr. BINGAMAN. Mr. President, today I am reintroducing the Medicare 
Assurance of Prescription Transition Assistance Act of 2004. It is my 
hope that this will be put on the Senate Calendar so it can be 
considered under rule XIV.
  Let me give a little background about what this legislation is 
intended to correct.
  As all of us know, this last year we passed a major revision, a major 
amendment to the Medicare Act. The Medicare Act was passed in 1965. In 
this last year, the prescription drug bill has been added to it. That 
was a controversial piece of legislation which I wound up opposing in 
its final form. I supported the version we passed through the Senate 
initially. I opposed the version that finally came from the conference 
and was sent to the President for signature.
  But there was one part of that prescription drug legislation that 
contained a very real benefit for a lot of low-income Americans. That 
is the $600 subsidy that was made available this year and again next 
year for Medicare recipients with incomes in this category that allowed 
them to take advantage of the benefit.
  The legislation I am introducing today will provide simply that CMS 
automatically enroll many of these low-income Medicare seniors and 
people with disabilities into this prescription drug card in order that 
they get the benefit of the discount card. Of course, that benefit is 
hard to quantify. They would get that benefit, but more importantly, 
they would get access to

[[Page S8480]]

this $600 subsidy this year and another $600 subsidy next year, which 
would go against the cost of prescription drugs they incur during those 
2 years.
  Underscoring the need for this legislation, yesterday Dr. Mark 
McClellan, the Administrator of the Centers for Medicare and Medicaid 
Services, or CMS, testified before the Senate Special Committee on 
Aging that only 1 million of the more than 7 million low-income 
Medicare beneficiaries who are eligible for the $600 subsidy under the 
Medicare prescription drug card are currently enrolled.
  This chart makes that point very clearly. The title of this chart is 
``Low Enrollment Plagues Prescription Drug Plan.'' This first bullet 
states that 7 million low-income Medicare beneficiaries are eligible 
for this $600 subsidy. The number of low-income beneficiaries that CMS 
projected would actually enroll would be 5 million. So 5 million of the 
7 million were supposed to enroll. In fact, the number of low-income 
beneficiaries who have enrolled turns out to be 1 million.
  So there are 6 million Americans eligible for the $600 transition 
assistance under the Medicare prescription drug bill who are not 
receiving any help. In other words, 14 percent of those who are 
eligible for this $600 subsidy are actually getting assistance at the 
present time. Unfortunately, many of those seniors who are eligible 
live in my home State of New Mexico, and I am very anxious that we 
provide this benefit to them since it is a part of the law.
  The President and the leadership in the Senate have vowed to bottle 
up any legislation that would reopen the Medicare prescription drug 
bill at this time, or before the end of this Congress. Unfortunately, 
that would include bills such as the one I am reintroducing today, 
which is really intended to ensure that the people who are eligible for 
the limited benefit provided under this bill actually receive that 
benefit.
  If we are serious about trying to provide assistance to our Nation's 
most vulnerable low-income seniors and people with disabilities, then 
we should undertake the rather straightforward but significant step 
that is called for in this legislation, and that is automatically 
enrolling those who are eligible for the $600 subsidy into the discount 
drug card program.
  Considering that it is unclear whether the savings offered by the 
drug discount card itself will amount to much, and that is just hard to 
quantify, frankly, the main benefit is not the discount card itself; it 
is the $600 credit which is available to low-income individuals.
  Specifically, the $600 is available to any individual whose income is 
less than $12,569 per year or any married couple whose income is less 
than $16,862 per year. For those Medicare savings program beneficiaries 
who get cost-sharing assistance through Medicaid because they have 
incomes below 135 percent of poverty but are not receiving prescription 
drug coverage, they clearly meet the income criteria under the act and 
their automatic enrollment is the only way to ensure they will receive 
the $600 subsidy that those of us in Congress intended they receive.
  In fact, when the prescription drug bill was passed, the 
administration claimed that 65 percent of those eligible for the $600 
transitional assistance would actually be enrolled.
  According to the Centers for Medicare and Medicaid Services, or CMS, 
the agency expected 5 million people of the 7 million--again, as is 
stated on this chart--including 29,000 of the estimated 45,000 in my 
home State of New Mexico, would actually enroll. Under the CMS 
assumptions, those beneficiaries combined would save $5 billion 
nationally, or $35 million in my home State of New Mexico, over this 2-
year period.

  Much of that savings is not going to be realized by those seniors 
unless we pass the legislation I am introducing today.
  Part of the explanation for the low enrollment is the poor 
advertising campaign that the General Accounting Office has criticized 
and with which we are generally familiar. This poor advertising 
campaign included running ads in Capitol Hill newspapers such as Roll 
Call and the Hill. Unfortunately, most of the low-income seniors in my 
State do not subscribe to either Roll Call or the Hill. In fact, they 
do not know those publications exist.
  According to a national survey by the Kaiser Family Foundation, only 
18 percent of senior citizens are even aware that the low-income 
transitional assistance program was included in the prescription drug 
bill. So it is hard to believe that 65 percent of those who are 
eligible will enroll when less than one-fifth of them even know the 
program exists.
  Fortunately, CMS has already laid the groundwork for this automatic 
enrollment. Two months ago, the agency issued guidance for how State 
pharmacy assistance programs can automatically enroll their members who 
have incomes below 135 percent of poverty in the low-income assistance 
benefit. Those enrollees continue to represent the bulk of those who 
have enrolled and they remain the model for how to ensure that low-
income beneficiaries get the prescription drug assistance they need.
  CMS can take this additional step, which I am calling for in this 
legislation, to automatically enroll MSP members who do not have 
prescription drug coverage. I believe CMS has the authority to take the 
step on its own right now, but the legislation I have reintroduced 
today would clarify the law in this regard and would ensure that low-
income seniors and people with disabilities actually receive this 
transitional assistance as promised by the administration and the 
Congress.
  As the Medicare Rights Center has asked: Given their definite 
eligibility and clear need for help to pay for their prescription 
drugs, why not save these people and the Government the hassle of 
application and automatically enroll them?
  That is exactly the right question to be asked. There are a number of 
low-income seniors and people with disabilities who are very sick, who 
have cognitive and mental illnesses and do not have access to or feel 
comfortable with the use of the Internet. Many will wrongly slip 
through the cracks and fail to get the $600 subsidy that could benefit 
them substantially this year and next year. In such cases, if an 
individual has not enrolled for whatever reason, it begs the question 
as to what choice automatic enrollment would take away at that point.
  It is not enough to say, look, we believe these seniors have a choice 
of a great many discount cards and we do not want to prejudge that for 
them. The truth is, most of the people I am talking about are 
completely unaware that there is such a thing as a drug discount card 
or that there is such a thing as a $600 subsidy for which they could 
qualify. This lack of knowledge on their part is through no fault of 
their own and we should do all we can, and CMS should do all it can, to 
get them enrolled so they can benefit from this $600 subsidy. Either 
CMS or the States should take the affirmative step of automatically 
enrolling these individuals in the program. If we fail to assist them 
in this manner, what is really lost is not the choice that they might 
have between one card or another but the $1,200 in real prescription 
drug assistance that they do today qualify for and that they should be 
receiving.

  As a Kaiser Family Foundation study last year indicated, Medicare 
beneficiaries with no drug coverage were nearly three times more likely 
than people with drug coverage to forgo needed prescription drugs. 
While CMS has estimated that 65 percent of the low-income beneficiaries 
would sign up for the $600 subsidy, by any measure signing up just 14 
percent of these beneficiaries can only be viewed as a major failure. 
It has not been viewed as that so far either by the administration or 
by the Congress.
  Once again, I call on the administration to take this important step 
on its own and enroll these individuals for this benefit. In light of 
the fact they have failed to do so, despite several calls from me and 
other Members of Congress for them to do so, I am reintroducing this 
bill, and I hope the Senate leadership will bring it to the floor for 
immediate action.
  There is over $1 billion of prescription drug assistance for over 1 
million of our Nation's most vulnerable citizens at stake. It is time 
for the Senate to pass this bill.
  Mr. President, I ask unanimous consent that the text of the 
legislation be printed in the Record.

[[Page S8481]]

  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 2694

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act, may be cited as the ``Medicare Assurance of Rx 
     Transitional Assistance Act of 2004''.

     SEC. 2. AUTOMATIC ENROLLMENT OF MEDICAID BENEFICIARIES 
                   ELIGIBLE FOR MEDICARE PRESCRIPTION DRUG 
                   BENEFITS.

       (a) Automatic Enrollment of Beneficiaries Receiving Medical 
     Assistance for Medicare Cost-sharing Under Medicaid.--Section 
     1860D-14(a)(3)(B)(v) (42 U.S.C. 1395w-114(a)(3)(B)(v)) is 
     amended to read as follows:
       ``(v) Treatment of medicaid beneficiaries.--Subject to 
     subparagraph (F), the Secretary shall provide that part D 
     eligible individuals who are--
       ``(I) full-benefit dual eligible individuals (as defined in 
     section 1935(c)(6)) or who are recipients of supplemental 
     security income benefits under title XVI shall be treated as 
     subsidy eligible individuals described in paragraph (1); and
       ``(II) not described in subclause (I), but who are 
     determined for purposes of the State plan under title XIX to 
     be eligible for medical assistance under clause (i), (iii), 
     or (iv) of section 1902(a)(10)(E), shall be treated as being 
     determined to be subsidy eligible individuals described in 
     paragraph (1).''.
       (b) Assurance of Transitional Assistance Under Drug 
     Discount Card Program.--
       (1) In general.--Section 1860D-31(b)(2)(A) of the Social 
     Security Act (42 U.S.C. 1395w141(b)(2)(A)) is amended by 
     adding at the end the following new sentence: ``Subject to 
     subparagraph (B), each discount card eligible individual who 
     is described in section 1860D-14(a)(3)(P)(v) shall be 
     considered to be a transitional assistance eligible 
     individual.''.
       (2) Automatic enrollment of medicaid beneficiaries.--
     Section 1860D-31(c)(1) of the Social Security Act (42 U.S.C. 
     1395w-141(c)(1)) is amended by adding at the end the 
     following new subparagraph:
       ``(F) Automatic enrollment of certain beneficiaries.--
       ``(1) In general.--Subject to clause (ii), the Secretary 
     shall--
       ``(I) enroll each discount card eligible individual who is 
     described in section 1860D-14(a)(3)(13)(v), but who has not 
     enrolled in an endorsed discount card program as of August 
     15, 2004, in an endorsed discount, card program selected by 
     the Secretary that serves residents of the State in which the 
     individual resides; and
       ``(II) notwithstanding paragraphs (2) and (3) of subsection 
     (f), automatically determine that such individual is a 
     transitional assistance eligible individual (including 
     whether such individual is a special transitional assistance 
     eligible individual) without requiring any self-certification 
     or subjecting such individual to any verification under such 
     paragraphs.
       ``(ii) Opt-out.--The Secretary shall not enroll an 
     individual under clause (i) if the individual notifies the 
     Secretary that such individual does not wish to be enrolled 
     and be determined to be a transitional assistance eligible 
     individual under such clause before the individual is so 
     enrolled.''.
       (3) Notice of eligibility for transitional assistance.--
     Section 1860D-31(d) of the Social Security Act (42 U.S.C. 
     1395w-141(4)) is amended by adding at the end the following 
     new paragraph:
       ``(4) Notice of eligibility to medicaid beneficiaries.--Not 
     later than July 15, 2004, each State or the Secretary (at the 
     option of each State) shall mail to each discount card 
     eligible individual who is described in section 
     1860D14(a)(3)(B)(v), but who has not enrolled in an endorsed 
     discount card program as of July 1, 2004, a notice stating 
     that--
       ``(A) such individual is eligible to enroll in an endorsed 
     discount card program and to receive transitional assistance 
     under subsection (g);
       ``(B) if such individual does not enroll before August 15, 
     2004, such individual will be automatically enrolled in an 
     endorsed discount card program selected by the Secretary 
     unless the individual notifies the Secretary that such 
     individual does not wish to be so enrolled,
       ``(C) if the individual is enrolled in an endorsed discount 
     card program during 2004, the individual will be permitted to 
     change enrollment under subsection (c)(1)(C)(ii) for 2005; 
     and
       ``(D) there is no obligation to use the endorsed discount 
     card program or transitional assistance when purchasing 
     prescription drugs.''.
       (c) Effective Date.--The amendments made by this section 
     shall take effect as if included in the enactment of section 
     101 of the Medicare Prescription Drug, Improvement, and 
     Modernization Act of 2003 (Public Law 108-173; 117 Stat. 
     2071).
                                 ______