[Congressional Record Volume 151, Number 151 (Tuesday, November 15, 2005)]
[House]
[Pages H10208-H10214]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
MEDICARE PRESCRIPTION PART D DRUG PLAN
The SPEAKER pro tempore (Mr. Davis of Kentucky). Under the Speaker's
announced policy of January 4, 2005, the gentleman from Georgia (Mr.
Gingrey) is recognized for 60 minutes as the designee of the majority
leader.
Mr. GINGREY. Mr. Speaker, I have an hour as the designee to talk
about the subject that I want to bring to my colleagues, but I think I
need to take at least a few seconds of my time from this side of the
aisle to express my and our heartfelt sympathies to our colleague, the
gentlewoman from California (Ms. Roybal-Allard), on the death of her
father.
I spent the last 15 minutes listening to their special hour and
learning about that great, great American who represented the State of
California so well in this body for 30 years; and I want to express my
sympathy to my colleague from California.
Mr. Speaker, today, November 15, is a historic day and not just
because it is my wife Billie's birthday, which it is. Happy birthday,
honey. But really the historic aspect of today is the roll-out and the
sign-up today for the first of a 6-month window of opportunity for our
seniors to voluntarily sign up for the Medicare part D prescription
drug plan which this Congress made available to them in December of
2003. So indeed, Mr. Speaker, today, November 15, is indeed a historic
day.
I have seen clips of the original signing of the Medicare legislation
back in 1965 when President Lyndon Baines Johnson signed that bill into
law. Actually, the very first person to sign up for the other voluntary
part of Medicare, the part B which is applicable to the physician care
and outpatient testing, not the hospital part but the voluntary part,
the first individual to sign up for that was former President Harry
Truman, that being 40 years ago.
Here we are now finally, Mr. Speaker, after all of these years,
offering something that was left out of that original program, I guess
for a fairly good reason. Maybe back then, I was a freshman in medical
school, I barely knew who was happening, but there was not quite the
emphasis then on prescription drug treatment. We had some good
prescriptions but not nearly what is available to our public and our
seniors today; and there was much more emphasis on trying to get
hospital care and needed surgery, emergency room care, indeed long-term
care, skilled nursing home care for people who had, as an example,
suffered a stroke.
So this was all very, very important in the program; and I know my
colleagues on both sides of the aisle would agree with me it has been a
great success. There was some concern, though, I remember this much
about it as I was working as a scrub technician during the summertime
hearing the doctors at the scrub sink before they went into surgery,
talking about this new law that was going into effect, this Medicare
bill. There was some naysayers, no question about it, and some were
downright opposed to it. But so many seniors were living in poverty and
not getting needed health care, and it at that time was a Godsend for
them.
Mr. Speaker, I will say this. I think today, starting today, November
15, 2005, some 40 years later another Godsend is coming to our seniors,
brought to them by this Congress and this President, this
administration, and that is the Medicare part D prescription drug
coverage. It is especially a Godsend for those seniors who are living
at or near the Federal poverty level, and I say that because heretofore
they have not been able to afford prescription drugs.
They go to their doctor and get maybe a handful of prescriptions
because many of our seniors who are living just off of a Social
Security check are the very ones that have what are called co-
morbidities, more than one disease, maybe high blood pressure, heart
disease and diabetes; and they need to take four or five or maybe six
prescriptions a day. They are the very ones who cannot afford it, not
that they do not want to. They want to take care of themselves, but
they also want to eat, and they want to have a roof over their head,
and they have to pay their utility bills, so this program is so
necessary for them.
In the past, Mr. Speaker, what has been happening is they would put
off taking care of themselves because they have could not afford the
prescriptions. Then, when some catastrophe would occur, they would
finally get care, whether it was in the emergency room because their
high blood pressure led to a stroke or whether it was on the operating
table because their blood sugar, their diabetes was out of control and
led to a limb becoming gangrenous and needed an amputation or maybe
even because of high cholesterol they would have to have open heart
surgery.
{time} 2130
We have finally begun this prescription drug part D sign-up as of
today, and that is what makes November 15, 2005, so historic.
I want to spend most of my time then talking about this aspect of the
Medicare Modernization Act of 2003. There are other things that I think
are going to be tremendously helpful.
I will mention just briefly, Mr. Speaker, the fact that with this
change in the law, for the first time a senior can actually go to his
or her internist or family practitioner, we call them primary care
specialist, and get a complete, thorough physical examination when they
turn 65, if you want to call it an entry-level physical examination. In
the past, that was not paid for, and a lot of these diseases that I
have already spoken of in their earlier stages have no symptoms at all,
and people really do not know, but with this new program, they get an
opportunity to go have that physical exam.
Also included in the modernization piece is the coverage for a lot of
screening tests that were not included in the original Medicare. I am
talking about things like mammograms, screening for breast cancer
obviously; colonoscopies, screening for colon cancer; PSA blood
testing, screening for prostate cancer. I am talking about checking
blood sugar. I am talking about getting a cholesterol level to see if
the patient needs to be on one of these statin drugs that do such a
great job of hopefully preventing heart attacks.
All of this is now available to our seniors. I am not going to spend
a lot of time, as I say, Mr. Speaker, on that aspect of the bill
because I really do want to spend most of the hour talking about the
prescription drug part because it is so important.
I have got a few posters here, and we will be referring to them from
time to time. I also have some of my colleagues that have worked so
hard and been so supportive of this legislation and are working hard in
their districts as we roll out this program. As they go home, usually
we get back into the district on Thursday or Friday morning, and I know
a lot of our colleagues on both sides of the aisle are holding town
hall meetings and trying to explain to the seniors and assure them that
although this is somewhat complicated, there are people there to help
them through the process and encouraging them, especially the low-
income individuals that I spoke of, to sign up and sign up early.
They do have 6 months to do it. It starts November 15, today, and
goes until May 15 of 2006. They have that window of opportunity; but it
would be a real mistake, particularly for our low-income seniors, not
to get signed up before the end of the year because the program really
starts, Mr. Speaker, and I know my colleagues are aware of this, it
starts on January 1. So if they wait till the last minute into May of
2006, they will have actually missed 5 months of opportunity, in many
instances, to get their prescription drugs with hardly any cost, and I
will repeat that, with hardly any cost except
[[Page H10209]]
maybe $1 if their medication is a generic drug and $3 to $5 if it is a
brand-name prescription drug.
So I will have a number of my colleagues joining me, and we will be
calling on them in just a few minutes. I want them to take as much time
as they would like to talk about what they are doing in their
districts, how they feel about this program, what sort of feedback they
are getting from their seniors, and then maybe we will engage also in a
little bit of colloquy.
Let me call my colleagues' attention to this first slide, which I
think begins to tell the story: ``Helping seniors get the medicine they
need to stay well.'' That is what it is all about. It is not an
emphasis on episodic treatment and maybe trying to catch the horse
after the barn door has been left open when some catastrophe occurs. It
is so much more difficult, rather, to get the medicine they need to
stay well. I do not think we can really emphasize that too much.
Now, Medicare helps seniors prevent disease in addition to treating
it. I said at the outset, in 1965, all of the emphasis was on treating
it, and that was good, but not the 21st century medicine. We need to
emphasize the prevention of disease.
Medicare part D, it is important that our seniors know that this
option, prescription drug coverage, really is for all seniors. It is
not just the low-income. I mentioned them, and we will talk about
throughout the hour, but no matter what a person's income, if they are
a Medicare recipient, either because they are 65 years old, and that is
probably 36 or 37 million in this country, or because of a disability
at a younger age, and there are probably 6 million or 7 million of our
citizens who are on Medicare because of a disability, but all of them,
no matter what their income level, they are eligible for Medicare part
D.
As I point out in this next slide, it is a voluntary program. Seniors
must choose to enroll. They will be getting lots of information and
have gotten lots of information, whether it is public service
announcements on television or mail pieces that have come from CMS, the
Committee on Medicare and Medicaid Services, information maybe they
obtained from a senior center, from their physician's office or,
indeed, from their Member of Congress' office, either in Washington or
in the district, but they do have to make that decision. It cannot and
will not be made for them.
There are going to be many plans. Seniors will have a choice of
plans. We estimate that the monthly premium, and it is premium-based
just like Medicare part B, Mr. Speaker, is a premium-based and an
optional program. By the way, I would guess that I am accurate in
saying that 98 percent, maybe more, of seniors have chosen and will
continue to choose to enroll in that premium-based part B that covers
the doctor's expense and outpatient testing and surgery because it is a
very good deal.
We will talk a little bit later about what percentage of seniors we
think will want to sign up for the Medicare part D, the prescription
drug part; but it will be a substantial number. We are estimating that
the monthly premiums for that monthly benefit will be about $25 on
average, some plans less, some plans more, depending on what the
coverage is.
All Medicare-approved plans cover both prescription and generic
drugs, and they are accepted at local pharmacies. That is very
important because people want to know if they can continue to go to
that corner druggist. In no way am I suggesting that the chains, the
Eckerds, the Walgreens, the CVSs that do such a great job, are not a
wonderful place to go and get prescriptions filled. They are. Many of
our seniors will choose that type of location, but others who have a
pharmacist friend that they have known for many years, they call them
doctor and go to church with them, a lot of times they are able to
charge their prescriptions and pay a little bit along, the kind of
service that only a small corner druggist can give. That is very
important that they know that they will be able to continue as part of
this program to be serviced by those great pharmacists that we call
corner druggists.
Mr. Speaker, before I call on my colleague, the gentleman from Texas
(Mr. Carter), for his remarks, I want to just present one more poster;
and, again, I do not think we can emphasize this too much, that is,
this issue of the dates; and I have already mentioned several times
that today is the starting date, November 15, for enrollment. This
little icon, if you will, shows an hourglass, and that means that
starting today the sands of time, that 6 months, is ticking away. Of
course, the program, if you get signed up right away, you reap the
benefits starting January 1. Then if you sign up before May 15, that 6-
month window, then you incur no penalties; but after that, there are
some penalties for signing up late. Again, I am sure some of my
colleagues will talk about that.
At this time, I am very happy to see the gentleman from Texas (Mr.
Carter) with me again to share one of these hours on health care
issues. The judge knows a lot about legal issues and the judiciary, but
he also knows a lot about health care. So I am honored at this time to
yield to the gentleman from Texas (Mr. Carter).
Mr. CARTER. Mr. Speaker, I thank my colleague, the gentleman from
Georgia (Mr. Gingrey), my good friend, for yielding to me; and I
actually came down here because, Mr. Speaker, the gentleman from
Georgia (Mr. Gingrey) is probably one of the people that has dedicated
more time and effort to the health care issues that affect the American
public than any other Member of this Congress.
On many occasions, he has educated me on health care issues and given
me good advice and good counsel on how we need to make health care
available, because the health of our Nation is very important to the
gentleman from Georgia (Mr. Gingrey) and all Members of this House on
both sides of the aisle. We battle and toil with how exactly we are
going to address health care issues.
I really wanted to start and come down here and share with the
gentleman from Georgia (Mr. Gingrey) an absolutely true event that
happened to me personally; I guess by now it is probably almost 2 years
ago or maybe even better. It was right after I was blessed to join this
august body.
I was back home in my district, and I was back at my pharmacy, that I
am not going to advertise for, but where I regularly buy my
prescription drugs. I was standing in line for my turn to get
prescription drugs, and I am sure people have told this story that I
never had actually experienced, a story like this, until I heard the
story.
There was a lady that was at that time being waited on by the
pharmacist there at the counter and getting her prescription drugs, and
they brought them to her. She was getting two prescriptions as I
recall, one for herself and one for her husband. I do not know how old
this lady was, but she was clearly on Social Security because she said
so. This was when we were still working on trying to come up with a
prescription drug benefit that would help our senior citizens.
She asked the pharmacist how much the two prescriptions were going to
be. The price was very expensive for both of the drugs that she was
going to have to pay, and between the two drugs, it was going to add up
to, as I recall, over $500 for these prescriptions. She told the
pharmacist, well, I cannot get these two prescriptions and continue to
feed my husband and me on what we have to live on; I am just not going
to be able to do it. Would it be possible that I could get half of the
prescription?
The pharmacist said, well, ma'am, the one for you was obviously for
something that had come upon her. The other was an ongoing prescription
for her husband, the way I understood it. He said, your doctor has a
reason he wants you to have this whole prescription. It may have been
an antibiotic or something like that. I am not in the medical
profession, but the pharmacist clearly said you need to take all of
this prescription; you just cannot take half. Well, she said, ma'am, I
just cannot spend that kind of money and take care of my family.
When you heard that, when you actually heard that from a human being,
you said to yourself, we have got to do something to get some relief
for people like this lady that was standing there. I was two people
back from her in line, and what I heard that day from that lady touched
my heart to where I really felt like I had seen the crisis firsthand.
[[Page H10210]]
{time} 2145
We have now put together Medicare part D, as my colleague from
Georgia has been explaining and will be able to explain in far better
detail than I can as to what the benefits are for this, but we have now
got a solution for that lady who was standing in line, and it is now
time for people to start going out and getting signed up for Medicare
part D. That is why I wanted to come join my colleague tonight in the
hopes that people in my district and people across this entire country
will hear our message that the time is here. We have arrived at the
time when they need to go down and register to get involved in Medicare
part D. And benefits will actually start, as Mr. Gingrey has explained,
in January of 2006.
Now, I have traveled my district and I hold town hall meetings, and a
lot of our senior citizens are concerned about, well, this seems so
complicated, I do not know whom to turn to. And we are here to let the
people know this is important to them and their loved ones. There are
people there to assist them.
I would ask the families of those Medicare recipients that need help,
sometimes as we grow into our later years, little things become big
things to folks like my parents, who now are deceased, but I can
remember when they become big things for them as we grow older. And I
would hope that the families of these people along with these folks
will encourage them to go look into getting registered, getting set up
in a plan.
There are multiple plans that are offered. There are people there to
help them understand those plans. There are people to tell them what
fits their life, their life-style, where they come from, and I would
hope not only those people who are going to be eligible for the program
but those people who have folks in their family that will be eligible
for the program will encourage them to go down and talk to folks, get
the help, get signed up.
It is not as complicated as people think it is. There is a lot of
fear that is unwarranted fear of this program. It happens on everything
we do. When we deal with the government in many areas in our lives,
dealing with the government is a frightening thing, dealing with plans
and paperwork. This is cut down to where it is not going to be that
hard to understand the plans.
There are people there to look at what people's circumstances are and
tell them and show them which plans offer them the best options. Every
State except Alaska has a State plan, as I recall. There are regional
plans, and there are 10 nationwide plans that are available. There are
multiple options that they can talk to them about. People can talk to
their pharmacists. Medicare has people that will help them.
Call that number, 1-800-Medicare, and they will explain how to sign
up. It is so important to your family. Do not let a little fear or a
new world attitude that you do not understand keep you from getting
signed up for a benefit. Because this is going to be able to assist all
Americans in their health care needs, and it is especially going to be
of great assistance to those people who are in the lower economic
sector of our country. In most instances, those people who make, I
think, $11,500 as an individual and $22,000 as a couple, they are
basically not going to have hardly any Medicare costs for drugs. So it
is important that you not let the fear of a new program or something
you might have seen on television or some political rhetoric that was
in some campaign somewhere that got you concerned that you would not be
able to understand what the program is about to keep you from getting
what you need so that you never have to be like that lady who stood in
line in front of me and have to make a decision as to whether you took
your medicine.
Does my colleague know what was really loving about that story? There
was no question she was going to buy her husband's medicine. She never
even blinked on that. She was saying, I will give up so we can live our
life here what I need, but of course there is no question I am buying
the medicine for my husband.
That kind of love permeates American society, and I think we have a
duty to our loved ones who are eligible for Medicare to help them and
encourage them to go get signed up for this. Because Americans do care
about their elderly. Americans do care about those senior citizens who
have given all that they had for us today. It is time for us to give
them the benefits that they need so they do not ever have to have the
kind of experience that that sweet lady did who was standing in front
of me at the drugstore.
That is why I came down here tonight, to join Congressman Gingrey and
speak directly to the American people and say, get out there and help,
get out there and get yourself registered, or get somebody to help you
get registered, because these benefits are important. There are
occasions now where people say, right now, prescription drug benefits
do not mean much to me. One never knows what is right down the road,
and it is important that people get registered now and have those
benefits available. Because in the month of May, they may come down
with something where they have got a permanent situation where for the
rest of their life they are going to be taking medicine, and if they
had not gotten registered, then they would be in a scramble trying to
get registered. So it is important to look at it now.
Mr. Speaker, one of the things that I think is most important as we
sit here this evening is to encourage our seniors and their families to
assist our seniors to get out and learn about the program and get
signed up. Getting signed up is what it is all about. Trained
professionals are available 24 hours a day, 7 days a week at 1-800-
Medicare.
They have got a Web site, and I am reading from Congressman Gingrey's
sign, www.Medicare.gov, for those high-tech seniors, who are probably
better at that than I am, to get out there and do this on-line. There
is a lot of help available.
I hope that that lady who was standing in line in front of me in the
drugstore in Round Rock, Texas, I hope she hears, by accident or
whatever, channel surfing, and tunes into this show tonight and will
say ``I had better go do that.''
I think our colleagues on both sides of the aisle are going to be out
in our districts talking to people and saying do not let something new
keep you away. Get out there and get involved and get signed up.
Mr. GINGREY. Mr. Speaker, reclaiming my time, I thank the gentleman
from Texas for being with me. I appreciate his comments tonight. I
welcome him to, if possible, to stay around and maybe we can get
involved in a colloquy or I can respond to his questions and yield to
him.
Mr. Speaker, the thing that he pointed out, that little anecdote,
true story, about that little lady in Round Rock, that is why it is so
important. I appreciate Judge Carter mentioning that, because this is
real, and the emphasis that he put in his remarks on how important it
is to get signed up is real.
Thanksgiving is going to be upon us pretty soon. I think I am correct
in saying a week from Thursday. And what comes the day after? Well, I
call it ``black Friday,'' Mr. Speaker. That is that big shopping day,
the first day of the Christmas season when everybody hits the malls. I
think that would be a great day for families, children, grandchildren
to sit down with their grandparents, children to sit down with their
parents and help them. That would be a wonderful day. It would save
money as well, probably. The retailers may not like me very much, Mr.
Speaker, for mentioning that, but that would be a great day to just sit
down and say, look, I am pretty good at the computer, Mom, Dad, and let
us go on-line, let us get on www.Medicare.gov.
If I tried to do that, that computer would start smoking, and
everybody in my office knows that. Anytime I need to do anything on the
computer, they have to hold my hand. So I understand the need and the
fear of computers. But really for the younger people especially, it is
a challenge. It is pretty easy for them. They have learned it in high
school and college, and some of them even work in the industry. So help
is readily available, as Judge Carter said; and it is not that
difficult.
I called this morning. I think it was about 8:30, and I decided I was
just going to call 1-800-Medicare just to see how long it took to get
somebody on the telephone. Mr. Speaker, I had a response in about 3
minutes. The first time I dialed, I got a busy signal, and
[[Page H10211]]
so I immediately, within a matter of seconds, dialed again and got
right through and began the process.
Now I am not quite 65, and I did not have a card and a number, so at
some point I had to quit. I had to hang up. It was a bogus call. But I
was very impressed.
Of course, CMS has hired and trained, and that is very important, not
just hired but trained probably by a factor of four the number of
employees that they normally have responding to these calls. So, as
Judge Carter said, that information, that help is there, whether it is
by the telephone or on the Web site, and we will get into the specifics
of how a senior prepares themselves for this process. There is
something called worksheets that are available through CMS. Those are
easily obtained, and people just kind of go through that worksheet. We
will talk about it a little later in the hour, so that when those
questions come up, and, again, they are not difficult, they know the
answers, and we can help them through the process.
Mr. Speaker, I see that we have been joined by another of our
colleagues and not just any colleague because this is my good friend
and fellow physician, indeed a fellow OB-GYN physician who came in in
the 108th Congress with Judge Carter and me, the gentleman from Texas.
So I yield to the gentleman from Texas (Mr. Burgess) to give us a
little of his insight into this program and what he is doing in his
district.
Mr. BURGESS. Mr. Speaker, I thank the gentleman for yielding to me,
and I thank him for once again bringing this subject to the floor of
the House.
It is a timely subject. Here we are celebrating Medicare's 40th
birthday; and, Mr. Speaker, as the Members will recall, 2 years and 1
week ago we actually passed this legislation, on November 22 of 2003,
which now has become the Medicare Modernization Act and with it the
prescription drug plan.
Mr. Speaker, I have been doing town hall events and informational
groupings throughout my district, and my district is pretty diverse. I
have been very fortunate. I have had someone there from CMS with me,
and together I think we have been able to answer a lot of the questions
that come up. I do not want to get ahead of the program that Dr.
Gingrey has proposed for this evening, but the concept of the
worksheet, the concept of prearranging some of the information in an
organized fashion, is a critical one. It is so important because we are
coming up on a time of year of celebration of holidays, Thanksgiving
and Christmas holiday, when families are going to be together. It is a
great opportunity for them to talk, after they have had all the
football and turkey that they can handle, to sit down and talk about
what are the changes that are coming up in this Medicare program.
The gentleman alluded to calling 1-800-Medicare. I must admit I have
not had the courage to do that myself, but I do go on the Internet, and
we can go into the plan selector part on www.Medicare.gov. They do ask
for their Medicare number, but if they scroll down that page just a
little bit, they can actually fill out the plan finder information
without giving up any information, if they just want to check and see
what is available.
I have done this for Texas. We have got in excess of 40 plans
available to seniors in the Lone Star State, and they are good plans.
Some of them come in with less of a premium and less of a deductible
than what Medicare proposes. In fact, I have seen premiums as low as
$10 and $20, and I have seen some programs with a zero dollar
deductible.
A lot has been made about the so-called gap in coverage that occurs
at some levels. And do remember, Mr. Speaker, we passed this
legislation 2 years ago, and what were we trying to do? We knew we
could not cover every last single person in this country, so we wanted
to provide the greatest amount of coverage to those who were the
poorest and those who were the sickest, and I think we did a good job
in accomplishing that. But it does leave a gap in coverage, or at least
the Medicare proposal, the proposal for the Medicare prescription drug
plan, was to leave a gap. But, actually, there are some plans in Texas
where, if they are willing to accept generics, there is, in fact, no
gap in coverage. So there is complete coverage from the first dollar
spent up and to the so-called catastrophic ranges.
I have had some people complain about the time frame that is
available to sign up for this program. It starts today, and for the
next 6 months people can sign up for any of the Medicare-eligible
programs. Those who have not signed up by May 15, right now Medicare is
proposing a 1 percent penalty per month. That will be 32 cents penalty
the first month of June of 2006, and it will continue at a 1 percent
per month increase thereafter.
{time} 2200
But realistically, this should be thought of as insurance and not an
entitlement. That is what I have tried to explain to my constituents
when they say they do not like the idea that you are forcing me to sign
up. It is a voluntary program. If you decide it is not for you, you are
absolutely free not to sign up.
But when I was a physician and I offered health insurance to my
employees, they would be expected to pay a small part of it. If they
chose not to pay that part, they could opt not to take the insurance.
But they could not just wait until they got sick and then say, I would
like to sign up for the insurance. Otherwise, it would not be fair to
the rest of the people who have been paying their premiums all along.
The program is structured to look like commercial insurance. It is on
purpose not scheduled to look like an entitlement, because it is not.
It is insurance coverage for seniors who need help with paying for
their prescription drugs.
Mr. Speaker, I would just stress as a last point that when people
evaluate these plans for their families or for themselves, that they
look at cost, coverage, and they look at convenience. Many of the plans
cost less than what Medicare has proposed.
The coverage part is important. You want to be certain that you pick
a plan that covers the medicines that you are actually taking. Talk it
over with your doctor. If your doctor is watching a problem like a
mildly elevated blood pressure, be sure that those medications would
likely be covered. Every plan lists on the Web site how many of the top
100 prescriptions covered by Medicare that particular plan covers. Most
are in the high-90 range. I have not seen one less than 82 or 83 of the
top 100 prescriptions covered by Medicare. But check out the coverage.
Finally, convenience. They will provide a pharmacy that is close by.
If your neighborhood pharmacy is the one you want to use because they
have a delivery boy you like, use that tool to help you decide which
one of those pharmacies you want to use. There is also mail order.
There is a lot of flexibility in these plans. Yes, it is complicated.
Health care is complicated in the 21st century. These are not easy
decisions. Yet at the same time, Tom Brokaw called you the Greatest
Generation. You beat the Nazis, solved the problems of the Great
Depression, and solved a lot of the problems related to civil rights.
Seniors can solve these problems as well.
This program will become streamlined over time. I am happy about
things like disease management and physicals that will be offered now.
It is good legislation. Mr. Speaker, it is good medicine.
Mr. GINGREY. Mr. Speaker, one thing that the gentleman from Texas
(Mr. Burgess) mentioned was the fact that if a senior is interested in
a mail order opportunity, then as they go through that list, the litany
of companies that provide a benefit, they may want to choose one that
would allow them to get their drugs in a mail-order fashion. So that
option is available.
I had mentioned earlier in the evening talking about the worksheet
and what a senior would need to have if they are dialing the 1-800
Medicare number or dialing the Web site with or without assistance at
www.Medicare.gov, or coming to one of the congressional offices to get
help, they need that work sheet and that work sheet should include and
should already be filled out.
Again, it is information that the seniors know. First and foremost,
it should include a list of the prescription drugs that you are
currently taking, including the dosage, the milligram, the strength, if
you will, and how often you are taking those drugs.
[[Page H10212]]
Secondly, information about any prescription drug coverage you
currently have, be it employer or union-sponsored or a Medigap policy.
Or maybe you are a veteran and have TRICARE for Life, or possibly you
are retired State or Federal employee and you have coverage that
includes a prescription drug benefit. You need to have that information
so we can put that into the formula and help you decide whether you
want to continue with that program or opt for the Medicare part D
program, whichever is better, whichever really is the best deal, unique
to your situation.
And of course the name and address, as Mr. Burgess and Mr. Carter
both said, the name of the local pharmacy that you use to fill
prescriptions. So we will need your ZIP Code as well and the out-of-
pocket amount you spend on prescription drugs each year currently.
Again, I know our seniors know that because they are real good
accountants. They have to watch every dollar, and it is important that
we know that. And then last but not least, your Medicare enrollment
information, your Medicare number and your address and all of those
particulars, whether you are on traditional Medicare or Medicare
Advantage under an HMO or PPO-type program.
Mr. Speaker, I see that we are joined by another health care
professional, the gentleman from Pennsylvania (Mr. Murphy). Mr. Murphy
has been with us on just about all of these hours that we have done on
health care and this particular issue.
Mr. MURPHY. Mr. Speaker, I thank the gentleman from Georgia for
yielding to me. I thought it would be helpful to point out a couple of
things. When an individual contacts 1-800 Medicare or Medicare.gov,
when they have their name, address, medications and dosage level, and
what they are paying for it and their ZIP Code, they can find out a
number of things. They will be able to compare the cost of medications.
Because with the 75 percent discount, 75 percent paid by their tax
dollars and other folks' taxes for the first couple thousand, and then
after $5,000, 95 percent is paid for by the government, but from this
it is important to be able to compare medications.
I have a chart here. This is Pennsylvania, my home State. I want to
point out something, and that is savings for seniors with multiple
chronic conditions for someone in Pennsylvania, this is comparing the
savings in the best plan and savings in an average plan. Let me read.
Jane is a hypothetical medical beneficiary taking the following
medications: Celebrex, 200 milligrams; Fosamas, 70 milligrams; Nexium,
40 milligrams; Singulair, 10 milligrams; Zoloft, 50 milligrams; and
metroprolol tartrate, 50 milligrams.
What comes out of this is in the best plan it appears there is about
a 60 percent savings, or $3,797. In the average plan, about a 32
percent savings, being $2,036 of what they will pay. I am not sure what
sort of medical condition this is, and perhaps you can diagnose based
upon the medications alone, but I am just interested in your comments
on this because it becomes a matter, it is one of the reasons when
somebody calls and says how much is my discount going to be, it gets
complex. In each case, you have to look at the individual's
prescriptions.
I wonder if my physician friends here can tell just what this tells
them and why it is a matter that deals with the discussions of
Medicare.
Mr. GINGREY. Mr. Speaker, I call on the gentleman from Texas (Mr.
Burgess) and enter into a colloquy with you on that issue.
Mr. BURGESS. Mr. Speaker, my understanding is you will be offered the
top three plans based on cost to evaluate. Then you can go to the next
three plans and the next three plans. So the information is given in
those sorts of segment. My understanding is cost, since cost is one of
the principal concerns in people's minds, cost is one of the parameters
upon which the three plans are picked. Here are the top three plans in
your area based on cost, covering some portion of these medications,
and whether there would be a stand-alone prescription drug plan or one
of the PPO- or HMO-type products that would include a prescription drug
plan, those are also included in the choices as they are given.
We have some 47 prescription drug plans in Texas that are recognized
by Medicare as being good products. You cannot evaluate all 47. So give
me the top three based on cost, and let me figure out the coverage and
convenience aspect of those. If you have expanded the search to include
a HMO or PPO product, let me make the decision based on can I see any
doctor I want or would I have to see a select panel of doctors.
Those are the kinds of decisions, the same kinds of decisions people
would make in starting a new job, when they went and met with their
employee benefits manager. Just like we did when we started in the
House 3 years ago, they asked, do you want a HMO, PPO product, and went
through the litany of things that might be available to us.
This would be the type of information that would be given to someone.
And again, this may be too much for an individual 85 years of age to
deal with three plans that are somewhat different in their construct.
That is why it is going to be helpful to have a child, a nephew, a
grandchild to be able to help make those decisions. Probably the person
who helps arrange for those prescription purchases on a regular basis
would be the best person to advocate for that particular senior and
help them make those choices.
Mr. MURPHY. Mr. Speaker, when you are comparing plans, my
understanding is if you look at the most commonly prescribed drugs for
seniors, and not every drug may be covered by every plan, there is 97
to 95 percent overlap.
Mr. BURGESS. That is correct, and that information is listed on the
Web site.
Mr. MURPHY. And the reason a person wants to compare different plans
is to make sure that not only their drug is covered, but different
plans may have different costs for those individual drugs. So the
person can actually shop around on the Internet or on the phone.
Mr. BURGESS. That is correct. The Internet would provide some
transparency that probably is not available to that senior today.
Mr. MURPHY. Mr. Speaker, I was in the grocery store the other day,
and I wanted to buy a loaf of bread. I had not been in this store
before. This store must have had 30 or 40 different types of bread.
Every roll, shape, flat, cut, everything. I said I just want some whole
wheat bread. They helped me find it.
I thought this sort of reminds me with some of the choices with the
Medicare plan. If anything, yes, there are many choices, but it is
important to keep in mind that by working with somebody on the Web site
or on the phone, and many pharmacies and senior centers offer this.
Ultimately the issue is this: that a person should not just compare the
cost of a drug, what is this drug going to cost, but what is it going
to cost me over a year's period of time.
We looked, for this hypothetical person Jane, what does it cost for a
year because in some cases people may say if there is coverage up to
$2,250, and if my drugs cost $3,000, they may ask, do I have to pay
$3,000? And the answer to that is?
Mr. BURGESS. The answer is, if it is over $2,250, it would be $750.
Mr. MURPHY. But the rest is covered. That is part of the confusion
that takes place. We need to make sure that our colleagues and America
understands this is a matter of looking at the overall cost of
medications for your year, and that is why it is important the person
writes down all those numbers, and have those annual costs ready, or
even your monthly costs, so you can compare.
{time} 2215
But it is, I think, the most valuable way that seniors can look at
the overall cost of the Medicare plan.
Mr. GINGREY. If the gentleman from Pennsylvania would yield for just
a second in regard to that issue. As you go through the Web site, it is
important that our colleagues know to let their seniors understand that
there is a page there, and Mr. Murphy was referencing that, where you
are able to compare the different plans. Let us say you have several in
your community that are available to you, and you narrow it down by the
process of whether or not they allow mail order, if they have good
discounts for all of the drugs you are on or three out of the four, and
then you finally narrow it down maybe
[[Page H10213]]
to three or four that you want to choose from.
As you go through this process, and again there is someone right
there to guide you through it, you can see really what your cost per
year, as Mr. Murphy was referring to, what each plan would be and then
make that intelligent choice, based on a lot of factors, but not the
least of which, of course, is that cost factor.
Mr. MURPHY. I thank the gentleman for explaining that. It is such a
critically important thing here. And this is where, when you look at
the cost, a couple of elements that I consider very important, as a
health care practitioner myself, that one of the things we recognize is
for the most part, when a physician prescribes medication, I am sure
the gentleman has seen this too in his practice, prescribe medications,
sometimes patients will not fill that prescription. Sometimes, even if
they fill it, they may not take it all. They may take it in part and
discontinue it, or they may find if they feel they cannot afford it,
they stretch it out. Under such circumstances, when a patient does not
take a medication that the physician feels is needed, it can actually
worsen their health and cost more.
One of the things about this Medicare plan, when the critics were out
there saying this is going to cost more, we have to remember the CBO,
the Congressional Budget Office, does not score savings. And between
the entry physical, between the case management, where there will be
pharmacists and others who will work with the physician to make sure
they are not getting duplicate drugs, there is not confusion, just
checking the dosage and following through, plus the idea that the drugs
are more affordable, lifesaving, life enhancing, the kind of things
that are so important for people's health are more affordable, that
means people will take them. And part of this effect is people will be
staying out of the hospitals and staying out of emergency rooms with
that as well.
Mr. GINGREY. If the gentleman will yield, Mr. Murphy hit the nail, I
think, right on the head. And as we talk about this, the gentleman from
Texas (Mr. Carter) is still with us. He may want to weigh in and share
some of his thoughts on this subject. But there is no question that
this program has the potential to significantly lower prices across the
board, maybe not just for our seniors, but to everybody for some of
these heretofore very expensive pharmaceutical drugs. And we anticipate
that this program, and again, we talked about participation level.
Remember, I said at the outset of the hour that Medicare part D, that
other optional part of Medicare, probably got a 98 percent
participation rate because it is such a good deal.
We will not have that higher participation rate with the part D
because many of our seniors already have prescription drug coverage. We
mentioned some of those categories. But this program, we anticipate
across the board about a 50 percent savings, maybe 11 or $1,200 a year
on average, and that of course includes people that are low-income. It
includes people that are high-income; but on average, we anticipate, is
that not right, Mr. Carter, about a 50 percent reduction.
Mr. CARTER. That is right. And if the gentleman would yield once
again. As we talk about this, let us reemphasize again to our seniors
the importance of getting registered and signed up for the program. You
know, as the gentleman was talking about these drugs, and we read the
list off, of those drugs I am familiar with and some of them I am not.
But I thought about how much medicine has changed. And you are the
doctors. I am just an old lawyer and trial judge. But I can recall that
my father almost died from bleeding ulcers. As a younger man, I was
working my way down that road, and, in fact, at one point in time had
an ulcer. But Tagamet, I am not plugging any particular brand, but that
is the name I know of because that is what I took when Tagamet came on
the market; and with that drug, I have never had any more problems
whatsoever with ulcers, where my father almost died. They had to give
him 7 pints of blood, and he had to be cut from stem to stern like he
had been in a knife fight to try to save his life and they had to
remove two-thirds of his stomach.
Medicine now can stop a condition that we used to solve with major
surgery with prescription drugs. This tool is now available to our
Medicare recipients. It is critical that they understand, do not be
frightened even by what we have tried to make simple here tonight. Some
could even be frightened by that. Do not be frightened by that. Make
the effort to save your life. Make the effort to go out there and have
every tool that you can be one of those blessings to our country, and
that is a senior citizen with long life and good wisdom to pass on to
future generations. And you can only be that way if you take care of
yourself.
And part of taking care of yourself is getting signed up so that
modern medicine can care for you, because with no offense to the great
work that our surgeons do, in the long haul, having had a couple of
those surgeries myself, I will take that pill all day long and into the
night before I want them to cut me wide open because I think modern
medicine has been proven over and over, that good preventive medicine,
which we now have in this plan, meaning going to get your checkups, get
your tests for which you are now covered, do those things that were not
available but are now available to you to make sure you are maintaining
a look at your health.
And the prescription drug plan along with the other normal medical
benefits that have been available before make this a better future for
our senior citizens, a better, healthier, longer future. I cannot
impress it upon our people enough. This is so, so life changing in the
world. It is not perfect, and we all would love for the world to be
perfect. But you know what? When we came in here, somebody hit on it
tonight, when we came in here and signed up for Congress and they
dropped those half a dozen or a dozen plans in front of me, it might as
well have been written in Greek. And I sat there and stumbled and
fumbled and said I am sticking with my Texas plan and stayed right
where I was. And that is my own fault. And I am confessing it right
here in front of God and everybody that that is what I did. But in fact
I thought I had a better plan in Texas anyway. But that is a different
story. But I understand their frustration because it is a frustrating
thing. But that is the world we deal with right now.
Mr. GINGREY. Well, as usual, the gentleman is right on target. And I
think it is important that we remember that the plan, typically, if I
could describe a typical plan for the typical senior, would be about a
$30 a month premium, would be a $250 deductible, would be a 25 percent
copay, that is, the senior has to pay 25 percent of the cost of the
prescription drugs after the 250 out of pocket, up to a total of
$2,250. Then there is this issue of the hole in the doughnut, or the
gap, where any cost above $2,250, up to about $5,100, is 100 percent on
the back of the senior. A lot of people have been concerned about that.
They tend to forget, though, that above that you have this catastrophic
coverage. If you have spent in any one year on Medicare part D
prescription drugs, if you have spent more than $3,600 out of your
pocket, then anything above that is covered at the 95 percent level.
And, really, there are situations like that. Maybe for some seniors
today before they sign up for this program, they already know that they
are spending $3,600 or more, maybe $6,000 a year on prescription drugs.
Now, they very well may want to choose a plan. This slide that I have
in front of me now sort of goes over that, talks about the premium and
the deductible and the gap in the coverage. Well, seniors can choose.
They can literally, if they want, particularly, and I would recommend
this, if they are on a number of drugs already and they have high costs
already and they know that, then they may want to pick a plan that the
monthly premium is a little bit higher than the average of 25 or $30,
maybe it is $50 a month. But it does not have any gap in the coverage.
Those plans are available, and that information of course is what they
will obtain from the Web site.
I know we are getting close to the exhaustion of our time, and I
wanted to call again on my colleague from Pennsylvania to see if he had
any closing remarks before we wrap up this hour. And I want to, before
I run out of time,
[[Page H10214]]
express my appreciation to Mr. Carter, to Mr. Murphy, and Mr. Burgess
for joining us during this hour.
Mr. MURPHY. Actually, I think we are out of time, so I yield back the
floor here and thank the gentleman for leading this.
Mr. GINGREY. I thank my colleagues. Thank you, Mr. Speaker. I yield
back whatever remaining time we have and look forward to the next
session.
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