[Congressional Record Volume 150, Number 126 (Thursday, October 7, 2004)]
[Senate]
[Pages S10617-S10620]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                                MEDICARE

  Mr. GRASSLEY. Mr. President, just over 10 months ago, we passed a 
bipartisan bill called the Medicare Modernization Act dealing more with 
the prescription drug issue than anything else. But regardless of what 
you want to call it, it is the most sweeping improvement in Medicare 
since its creation. The Medicare Modernization Act delivered on a 
promise, a promise to provide beneficiaries a much needed prescription 
drug benefit and to revitalize Medicare so beneficiaries can receive 
quality care and benefits into the future with no sunset.
  The Medicare bill passed with the support of a bipartisan coalition 
and more than 300 organizations ranging from the AARP to the U.S. 
Chamber of Commerce. Advocacy groups that did not necessarily support 
the bill then went on to form an organization called the Access to 
Benefits Coalition. They worked after passage of the MMA to ensure that 
low-income beneficiaries enroll in the Medicare drug card and get the 
real assistance to which every senior is entitled.
  Still, on the floor of the Senate, we hear partisan attacks against 
this Medicare bill, continuing yet 10 months since it was signed into 
law. This is much to the consternation of organizations such as the 
Access to Benefits Coalition, which is saying that partisanship ought 
to be set aside and we ought to concentrate on getting people into the 
benefits that are in the program, even if you don't necessarily agree 
with the legislation.
  Week after week, month after month, we have heard attack after attack 
against this Medicare bill. This is despite the fact that study after 
study shows the drug card program, for example--and that is only a 
small part of this most comprehensive improvement in Medicare in its 
38-year history--is delivering real savings to beneficiaries.
  As I listen to these attacks, I am reminded that it is always easier 
to tear down than to build. But if you tear something down, it seems to 
me those tearing it down ought to have something to replace it. So what 
was their plan? I haven't heard about a plan for the future, so I have 
to look back. What were they suggesting at that time when they had an 
alternative plan? And this was when the Democratic Party controlled the 
Senate. They did have a plan to offer, but the Democratic leader 
bypassed the Finance Committee, where we developed bipartisanship, to 
bring their proposal to the floor because they didn't want a bipartisan 
program. They wanted their own program. They knew they couldn't get 
their own program. They wanted an issue for the 2002 election rather 
than a product.
  This alternative was drafted by Senator Graham and Senator Kennedy. 
Their bill was S. 2625. It had 30 Democratic cosponsors, including the 
Democratic leader. They offered two proposals as amendments on the 
Senate floor. Fifty Democrats voted in favor of the first proposal. 
Forty-five Democrats supported the second, which, I might add, was 
worse than the first. The Democratic Leader as well as Senator Kennedy 
and Senator Kerry supported both of these Democratic proposals.

[[Page S10618]]

  In stark contrast with the bill that the President signed last 
December, the Democratic proposal, Graham-Kennedy, had a drug benefit 
that was not permanent. Our legislation is permanent. That is right. 
Their proposal would have ended at about the time baby boomers were 
beginning to retire. What a promise: Prescription drugs, and in 2010 
you have nothing.
  Chart No. 1 has the language of one section of their legislation. I 
read:

       No obligations shall be incurred, no amounts shall be 
     appropriated, and no amounts expended, for expenses incurred 
     for providing coverage of covered outpatient drugs after 
     December 31, 2010.

  You can't be clearer than that. Seniors and individuals with 
disabilities deserve better than the false hopes of a drug benefit that 
expires after 6 years. But that is exactly what the first Graham-
Kennedy amendment did. It simply rode off into the sunset after 2010, 
just at the very time that 77 million baby boomers start to retire. The 
fact that the Graham-Kennedy proposal offered a drug benefit that ended 
6 years after it started ought to be unbelievable. You would never 
think that Senators would think of doing something like that--false 
promises, a costly program for a few years, and then it ends. But they 
sunset the benefit to hide the true cost of their proposal. At the time 
the Congressional Budget Office said it would cost over $100 billion 
each year to extend the Graham-Kennedy drug benefit past the sunset, 
$100 billion a year, and they had no plan to pay for this enormous 
cost.

  To make their drug benefit permanent, Congress would have had to cut 
all other Government programs by more than 10 percent or increase taxes 
on all working Americans by an amount equal to 2 percent or greater. 
That is the same as a tax increase of around $1,500.
  Besides vanishing in 2010, under the first Graham-Kennedy amendment, 
the Government could limit beneficiaries to just a single one-size-
fits-all plan. The Secretary of Health and Human Services could have 
simply decided that you could get your coverage through that one plan--
period, no choice.
  Even more amazing, the first Graham-Kennedy amendment proposed a drug 
benefit that could only cover up to two brand name drugs in any 
therapeutic category. What does that mean? It means if your doctor 
prescribed a different brand name drug and it is not on the preferred 
list, then you don't get the plan to pay for it.
  I will give you some examples. Let's take high cholesterol. There are 
more than eight well-known brand drugs to lower cholesterol. The single 
Government plan under Graham-Kennedy could pick Lescol. Say your doctor 
prescribes Mevacor. Well, you would get no coverage at all. This 
scenario could have been repeated for arthritis, high blood pressure, 
any other chronic condition that many beneficiaries have. Does that 
sound like a plan that is incredibly fair? No. Well, that is the plan, 
and it is far more restrictive than what the private plans offer today. 
Certainly the new Medicare law has no such requirement.
  The first Graham-Kennedy amendment also set co-payment amounts in 
law--$10 for generics, $40 for brand drugs. To offer a lower copayment, 
the plan again had to ask for the Secretary's approval, a bureaucrat in 
the seniors' medicine cabinets for sure, not something that you are 
going to see under the bill that the President signed last December.
  In addition, just like thousands of drugs could have been shut out, 
Graham-Kennedy could have shut out thousands of pharmacies because it 
told the Government to set up a preferred pharmacy network under that 
one Government plan, and the Secretary had to establish the pharmacy 
access standards. In contrast, the bill the President signed set strict 
rules about pharmacy access to make sure that plans include 
beneficiaries' neighborhood pharmacies in their networks.
  So under their plan, there was one choice, with one formulary and one 
pharmacy network that may or may not cover the drugs beneficiaries need 
or allow them to use a pharmacy they want. Take it or leave it.
  Under Graham-Kennedy, that outcome was the strong possibility facing 
beneficiaries who have waited long enough for a prescription drug 
benefit. The MMA established a good program that the President signed 
last December.
  When I think about the Graham-Kennedy prescription for drug coverage, 
I cannot help but think of those little warning labels that you 
sometimes find on the side of your prescription bottle. In this case, 
it should have said this: Warning. This Graham-Kennedy plan may not 
help you at all because if you take a non-preferred drug, it won't be 
covered. You will only be guaranteed ``reasonable'' access to a 
pharmacy, and the Government will determine what is reasonable. Worst 
of all, if you need drug coverage after December 31, 2010, there won't 
be any plan for you or for anybody else.
  Again, 50 Democrats, including Senator Kerry, supported this.
  When that amendment failed, Senator Graham and Senator Kennedy came 
up with an alternative which, hard to believe, was worse. Most seniors 
would not have even gotten a basic prescription drug benefit under the 
second Graham-Kennedy plan because it wasn't a universal benefit. And 
we have a universal benefit signed by the President of the United 
States.
  So that's right, under the Democratic plan, the proposal did not 
offer a basic drug benefit to 70 percent of the seniors who had incomes 
above 200 percent of the Federal poverty level at that time.
  Seniors across the country would have been left behind. Let me show 
you. In my State of Iowa--and I am saying this to Iowans if the plan 
passed by the President doesn't fit just right, it is voluntary, so if 
they don't want to do it, they don't have to. But under the proposal 
offered the year before by the Democrats, 64 percent of the people in 
my State would not have had any basic program whatsoever; 67 percent 
left behind in Arizona; 72 percent left behind in Washington; and 70 
percent left behind in Colorado.
  The second Graham-Kennedy amendment violated a fundamental tenet of 
Medicare--and that is a tenet of the legislation we passed--that it be 
universal. They called for disqualifying any beneficiary who earned 
$1--just $1--more than 200 percent of the Federal poverty level. So $1 
was the difference between eligibility and ineligibility for this basic 
coverage.
  Under the bill that the President signed, all Medicare beneficiaries 
are eligible to participate on a voluntary basis in the Medicare 
prescription drug benefit.
  There is also a big gap in coverage. We also have been hearing from 
opponents of the bipartisan bill that passed the Congress and was 
signed by the President, about the gap in coverage. They refer to it as 
the donut hole.
  Again, looking at their second attempt--we have it here. After 
looking at this plan that was put forth, my only conclusion is that 
this concern about a gap is newly found because most beneficiaries 
would not have received any basic coverage under their plan. To qualify 
for catastrophic coverage, a beneficiary would have to pay $3,300 out 
of pocket.
  Talk about a hole. The majority of beneficiaries would not even get a 
donut.
  The Congressional Budget Office estimated that 66 percent of seniors 
would not meet their catastrophic coverage threshold in 2005.
  For a beneficiary who would meet the threshold, and based on average 
spending, it would take about 10 \1/2\ months--sometime around 
Thanksgiving Day--to get any help under the catastrophic benefit.
  You know that what most beneficiaries got under the second Graham-
Kennedy plan is a 5-percent discount off of their drug costs until they 
spent $3,300. And they proposed setting the 5 percent discount in law.

  I might add that 5 percent is much less than discounts available 
under the Medicare-Approved Drug Discount Card Program.
  Study after study is showing higher discounts. A recent study by the 
Centers for Medicare and Medicaid Services (CMS) showed discounts of 12 
to 21 percent, and in many instances, even more. Competition among the 
card sponsors is leading to higher discounts for beneficiaries.
  So much for the idea that direct Government involvement rather than 
market competition would get beneficiaries a better deal.

[[Page S10619]]

  That is not the end. On top of all this, the last version of Graham-
Kennedy did not even really offer a Medicare drug benefit because 
states would have administered it under their Medicaid programs.
  An analysis conducted by the Centers for Medicare and Medicaid 
Services at that time showed that many States would have had to 
shoulder a sizable new financial burden if the Graham-Kennedy plan 
passed--a $70 billion unfunded mandate.
  Arizona, Arkansas, California, Colorado, Iowa, Louisiana, Montana, 
Oregon, South Dakota, Washington, and West Virginia were among the 
hardest hit States.
  At a time when States were already struggling, the second Graham-
Kennedy approach would have left them with few other avenues except 
raising taxes to implement the drug benefit.
  So while the opponents of the new Medicare drug benefit have been 
here on this Senate floor yelling sometimes at the top of their lungs 
about it, this was their plan, which was supported by 45 Democrats 
including the Democratic leader and Senator Kerry.
  In addition, the second Graham-Kennedy plan--as well as the first--
did nothing to strengthen and improve the Medicare program.
  The Medicare bill we passed last year added new coverage choices and 
benefits. It addressed provider payments issues to make sure that 
beneficiaries have access to physicians and hospitals because otherwise 
a prescription drug benefit--or any benefit for that matter--would be 
meaningless.
  So I think we can clearly see that the Graham-Kennedy proposals were 
bad medicine.
  Mr. President, as I said, it is one thing to tear something down when 
you have a better plan. But, as you can see, this was their plan.
  Their first plan offered a drug benefit that was not a permanent part 
of Medicare and it had limited drug coverage, a one-size-fits-all 
benefit--take it or leave it. Their next plan didn't give 70 percent of 
seniors even basic coverage, it had a huge gap in benefits, and a 
Medicare low income benefit that wasn't even run by Medicare.
  To me, that was unacceptable in 2002 and it's unacceptable today. 
Instead, last year a bipartisan coalition worked to give beneficiaries 
a meaningful and permanent Medicare prescription drug benefit and a 
revitalized Medicare program.
  I yield the floor.
  The PRESIDING OFFICER. The time of the Senator has expired.
  The Senator from Massachusetts is recognized.
  Mr. KENNEDY. Madam President, I yield myself 2\1/2\ minutes.
  I have great affection and respect for the chairman of the Finance 
Committee, but I just listened to distortion and misrepresentations on 
the legislation that I cosponsored with my good friend from Florida. 
The fact is, every senior group in the United States of America 
supported our proposal, and they cannot say the same about the 
Republican proposal.
  Why in the world would all the senior groups support our proposal? 
Because we build on the solemn commitment that was made to the seniors 
in this country in 1964 and 1965. Lyndon Johnson signed the Medicare 
bill in 1965, where we guaranteed to every senior citizen good quality 
health care for the rest of their lives if they paid into the system 
and played by the rules. We guaranteed hospital care and care by 
physicians, but we never did it for prescription drugs.
  That was the commitment that was made by this Government to the 
seniors of this Nation. This was a downpayment to meet the commitment 
Lyndon Johnson made and that every one of us who supported the Medicare 
Program believes in.
  Every day that we fail to provide a real prescription drug program to 
the seniors is a violation of that commitment. The other side ought to 
be telling us how we are going to finish that commitment and close the 
gap for our senior citizens, rather than fly-specking other legislation 
that has been introduced, which did not have massive giveaways to the 
HMOs and massive giveaways to the drug companies.
  President Bush's Medicare bill is a travesty. That is why it is not 
being endorsed by the senior citizens of this country.
  It is astounding that Republicans think they can defend President 
Bush's good-for-nothing Medicare bill by attacking the Graham-Miller-
Kennedy bill offered more than two years ago. Is especially astounding 
because that bill--which received a majority of votes in the United 
States Senate but was blocked by the Republican minority--was so much 
better than the Bush bill that Republicans passed last year.
  Let's look at the record. Our bill provided $600 billion for 
prescription drugs for senior citizens, not the $400 billion in the 
Bush bill. The Bush priorities are tax cuts for the wealthy. Our 
priorities are health care for senior citizens.
  Under our bill, every dime of the $600 billion went for prescription 
drugs. Under the Bush bill, $139 billion is squandered on windfall 
profits for the drug companies and $46 billion on giveaways to HMOs.
  Under our bill, senior citizens got a real benefit, not one as full 
of holes as a Swiss cheese. Under our bill, senior citizens started 
receiving benefits on the first prescription they fill. Under the Bush 
bill, seniors have to pay a $250 deductible before they see a dime's 
worth of benefits.
  Under our bill, seniors citizens had complete coverage. No doughnut 
holes. No big coverage gaps where seniors must pay the full cost of the 
drugs they need--or go without. Their bill has a huge coverage gap of 
almost $3,000. Once a senior has purchased $2,250 worth of drugs, they 
get no benefits until they spend an additional $2,850. What kind of 
insurance is that!
  Under our bill, senior citizens paid a $25 a month premium for their 
coverage--and it was guaranteed. Under the Bush bill, the average 
premium senior citizens would have to pay was estimated at $35--but if 
insurance companies decided to charge more, it could be $40 or $50 or 
$60 or $90. There was no guarantee and no limits.
  Under our bill, seniors were guaranteed access to any drug they 
needed--even if it was not on the formulary. Under the Bush bill, if an 
insurance company decides not to cover a drug the senior citizens 
needs, the senior citizen is out of luck.
  The bottom line is that under the Bush bill, 15 million senior 
citizens actually will pay more for the drugs they need than they do 
today. Six million of the poorest of the poor on Medicaid will be 
forced to pay more out of pocket. Six million more senior citizens will 
pay more in premiums than they will get in benefits. Three million 
seniors will lose the good retirement coverage they now enjoy from a 
former employer and be forced into the inadequate government program 
the bill creates. Under the Graham-Miller-Kennedy bill, every senior 
citizen is better off. That is one key reason why every legitimate 
organization of senior citizens endorsed the Graham-Miller-Kennedy 
bill, and why the vast majority of senior citizen organizations opposed 
the Bush bill.
  President Bush says in every stump speech that we have a ``moral 
obligation to honor our senior citizens.'' He is right about that, but 
it is typical Bush. Right words, wrong deeds. It is wrong to make 15 
million senior citizens worse off with his good-for-nothing Medicare 
bill. It is wrong to impose the highest premium increase in Medicare's 
entire history on senior citizens. It is wrong to escalate premiums a 
whopping 72 percent in just 2 years, so that the average senior--with 
an income of just $15,000--has to pay almost $1,000 in Medicare 
premiums. It is wrong to tolerate a situation under which, according to 
the Bush Administration's own estimates, the average 85-year-old will 
spend more than 40 percent of her Social Security benefits on Medicare 
premiums and cost-sharing by 2006. It is wrong to give away money to 
drug companies and HMOs that belongs to senior citizens. It is wrong to 
try to privatize Medicare and force senior citizens to join HMOs.
  George Bush has had 4 years to help senior citizens get the 
affordable health care Medicare promises. He has failed. Now he wants 
another chance. He doesn't deserve it.
  John Kerry and Democrats in Congress have a better approach. We will 
repeal and replace the good-for-nothing Bush Medicare bill. We will 
fight for senior citizens. We will put their interests first, not the 
interests of big drug companies and HMOs. We will honor our senior 
citizens with deeds, not just words.

[[Page S10620]]

  I yield the floor.
  The PRESIDING OFFICER. The Senator from Massachusetts has 30 seconds 
remaining.
  Mr. KENNEDY. I withhold that.
  Mr. GRASSLEY. Mr. President, I ask unanimous consent for 15 seconds.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. REID. Madam President, I ask unanimous consent that 15 seconds 
also be added for the Senator from Massachusetts.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. GRASSLEY. Madam President, just to remind the Senator from 
Massachusetts, I was chairman of the committee during this period of 
time for 4 months--from January until May of 2001. The Democratic Party 
chaired this committee from June of 2001 through all of the debate on 
the Medicare issue. I was not in charge of that committee at that time.
  The PRESIDING OFFICER. The Senator's time has expired.
  Mr. KENNEDY. I yield back my time.

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