[Congressional Record Volume 152, Number 47 (Wednesday, April 26, 2006)]
[House]
[Pages H1830-H1836]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                            MEDICARE PART D

  The SPEAKER pro tempore. 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. Madam Speaker, thank you so much. It is great to be here 
again tonight talking to my colleagues as part of the Republican health 
care public affairs team, and I am pleased that a number of my 
colleagues will be joining me, hopefully, during the hour, and we will 
be hearing from them later.
  Madam Speaker, I ask this question. If there was a way to save more 
than $1,000 a year on your heating bill or your food costs or car 
payments, you would want to know about it, right? I know that my 
colleagues, I think on both sides of the aisle, would definitely want 
to know. Well, seniors are saving an average of $1,100 a year on 
prescription drug costs with the Medicare Part D prescription drug 
program, $3,700 a year for those low-income seniors who qualify for 
supplemental help. For many seniors, Medicare Part D marks the first 
time that they have been able to afford the medications that they need 
to stay well. For many more, Medicare Part D means they will not have 
to choose between their medications and other necessities like food and 
housing costs.
  Madam Speaker, I wanted to start out by going through a couple of 
these slides and pointing out some of the statistics that really just 
literally jump off the page at you. More than 30 million seniors now 
have coverage under Medicare Part D. These are our latest statistics. 
More than 30 million. There are about 43 million Medicare 
beneficiaries, mostly because of age 65, and maybe 6 million of those 
because of a disability at a young age.

                              {time}  2045

  But when you look at here, and we have not even reached at that magic 
date yet in this first year, that more than 30 million now have 
coverage, it is an amazing success story.
  And continuing that success story, pharmacists in this country are 
filling 3 million Medicare part D prescriptions a day. That is 3 
million times a day that seniors are saving with prescription drug 
coverage. And many of these seniors were paying sticker price until 
they finally had the opportunity to save under this great addition to 
the Medicare program.
  Seniors, as I said, are saving an average of $1,100 a month. And 
$1,100 a month is a great number and a great benefit in itself, and 
this is on average, but low-income seniors, of course, are paying now, 
under this program, $1 for a generic drug and up to $5 for brand name 
as a copay, and that is it. That is it. Let's say you are on 5 
prescription drugs, and they are filled on a monthly basis, usually a 
30-day supply. That is $5 a month, or $60 a year.
  And I don't want you to just take Congressman Dr. Gingrey's word for 
that, my colleagues. We have some stories, some anecdotes, to share 
with you, some actual patients that want to tell you more about that in 
these following charts. In fact, some of those very seniors are going 
to be up here on the Hill tomorrow for a press conference, and we will 
hear it directly from them. I look forward to that, and I hope many of 
my colleagues will have an opportunity to attend that press conference.
  Well, the newspapers, sometimes we wonder if they give the facts as 
we know them. I want to share with you on this next slide some of the 
newspapers and what they are finally saying now that we are about 3 
weeks away from May 15. And of course we all know that this bill was 
passed by this Congress, actually the 108th Congress, in November of 
2003, and we have gone through the transition program with the Medicare 
prescription discount cards, where seniors were definitely saving 
money. Indeed, the low-income seniors got a $600 credit each of the 2 
years. It wasn't quite 2 years, but for each of the 12-month increments 
they got a $600 credit, and then as we rolled into the actual insurance 
program January 1 of this year.
  But listen to what the Washington Times is saying now. ``Even with 
the myriad prescription drug plans open to beneficiaries, seniors are 
not overburdened by choice, two recent surveys demonstrate. The 
surveys, sponsored by America's health insurance plans, show that of 
seniors who signed up for the Medicare drug benefit, the vast majority, 
84 percent, had no difficulty, no difficulty, enrolling. And finding 
the right plan is worth the effort of shopping around, two-thirds said. 
For those who were automatically enrolled, 90 percent had little 
difficulty receiving their prescription drugs.''
  The ones that were automatically enrolled, of course, were those 
seniors that we refer to as either dual-eligible, in other words, they 
are on Medicare and the State Medicaid because of their low-income 
situation, or their income is maybe not low enough to qualify for the 
Medicaid, but the State helps them pay their deductibles and copay 
under Medicare. All of those seniors, if they didn't sign up, they were 
automatically enrolled.
  Now, listen to what The New York Times says, and this New York Times 
is not the bastion of conservatism, of course, as we know. ``Many 
seniors are clearly saving money on drug purchases. Complaints and call 
waiting times are diminishing, and many previously uninsured patients 
are clearly saving money on drug purchases.'' That was in an editorial 
in The New York Times on April 3, so just a couple or 3 weeks ago.
  Well, I said at the outset, Madam Speaker, that I would be joined by 
some of my colleagues on the Republican health care public affairs 
team. We have a great group of Members who have expertise not only on 
this issue, but a lot of issues that we are taking the leadership on in 
regard to health care in this country, whether we are talking about 
leveling the playing field in regard to civil justice, so-called 
medical tort system; or whether we are talking about passing, as we 
have done so many times under this Republican leadership in this body, 
something that is referred to as association health plans, which allow 
small companies who really cannot afford to purchase health insurance 
for their employees when their numbers are small, 5, 10, 15 employees, 
to come together in a group and enjoy that benefit of purchasing a 
policy that is affordable to their employees, health savings accounts; 
or

[[Page H1831]]

our initiative on electronic medical recordkeeping and reduction of 
medical errors, Madam Speaker.
  All of these things this Republican leadership is leading the way on, 
leading the charge on, and I am very proud to have some of my 
colleagues with me tonight. And especially am I proud to yield time to 
my colleague from the great State of Georgia, who just happens also to 
be a physician Member, and I am proud of that as well. And at this 
point I would like to turn over the mike to my good friend and 
colleague, Dr. Representative Tom Price.
  Mr. PRICE of Georgia. Thank you so much, Congressman Gingrey. I 
appreciate the opportunity to join you today. I want to thank you for 
your leadership on this issue. You have been one of the stalwart 
champions of appropriate health care, health system reform, and come 
with such a wonderful background of information. You and I served in 
the State legislature in Georgia together, and now here, and it is just 
a privilege to join you tonight. I appreciate the opportunity to be 
with you.
  I also want to thank the leadership for making certain that we bring 
this wonderful news, exciting news for America's seniors to the House 
of Representatives and to the Nation because it is a time of great 
opportunity for seniors all across our Nation. We are in a period of 
time right now, as you mentioned, that seniors are able to sign up 
voluntarily, voluntarily, and I think it is important that people 
remember that, it is a voluntary program, and participate in this new 
Medicare part D program.
  As you mentioned, I am a physician as well. We used to practice 
together in the Atlanta metropolitan area. I am a third-generation 
physician. My father and grandfather were doctors as well. And the 
things that I was able to use to care for my patients were a whole lot 
different than those things that my father and grandfather were able to 
use, and that is because medicine is an evolving science. It is not set 
in stone. Things change, and things change virtually daily. But 
Medicare is a program that has not kept up with medicine. Medicare is a 
program that has not kept up with medicine.
  When Medicare started 40 years ago, there were no drugs included in 
the program. In fact, drugs at that time, medications at that time 
really weren't used, well certainly weren't used as much as they are 
now, but weren't used to the percentage they were in terms of the 
numbers of patients who utilized medications, and things have changed a 
lot in those 40 years, as you well know, Madam Speaker.
  Over the past 40 years, there have been wonderful opportunities for 
drug treatments to prevent and to cure diseases. Yet until now Medicare 
didn't include a single medication, not a single drug, in its plan. 
None. None. They would cover the expensive surgery it took to take care 
of a bleeding ulcer, but it wouldn't cover the drugs. It wouldn't cover 
the medications to prevent the ulcer in the first place. It would cover 
the surgery, the expensive surgery, and hospitalization to care for a 
patient that had a stroke, but it wouldn't cover the medications to 
control the blood pressure in the first place and prevent the stroke.
  Now, that, Madam Speaker, certainly doesn't make any sense, and 
everybody appreciates that it didn't make any sense, and that is why 
this program was instituted. All that is changing now with the Medicare 
part D program, which, again, is voluntary, a voluntary program for 
seniors all across our Nation.
  And I will tell you, Madam Speaker, that most seniors, most seniors, 
would be helped and assisted in their ability to purchase their 
medications by using this new program. Some say that it is confusing, 
that it is just too complicated. But when you talk to, as Congressman 
Gingrey mentioned, when you talk to those folks who have already signed 
up in these first few months of the program, they say that it really 
isn't that confusing. You just have to tackle it. And most of them, the 
vast majority, are remarkably satisfied.
  I would encourage all of my colleagues, both sides of the aisle, 
Republicans and Democrats, to assist further in educating their 
constituents, educating their seniors about the program. I have held, 
as I know you have, Congressman Gingrey, a lot of seminars and meetings 
with seniors around our districts to help them understand about the 
program, what it means and what the specifics are, and assist them in 
being able to sign up for the program.
  Those folks at CMS, the Center for Medicare and Medicaid Services, 
have been remarkably helpful as well in assisting seniors in my 
district, and I know yours and so many across this Nation, to be able 
to understand the nuances of the program. We need to remember, as we 
look at this program, that the Medicare program on December 31, 2005, 
had no medications available, and now it does, and now it does. And 
that is the important thing to remember for seniors.
  Now, you mentioned the important date that is coming up: May 15. May 
15 is the deadline to sign up for Medicare part D. It is a deadline 
that is necessitated because this is a new insurance. This is a new 
aspect of insurance. And unless individuals sign up by a particular 
time, then you can't reach the savings that you can get in this kind of 
program. So I want to commend all seniors to take a serious look at 
this.
  Again, it is a voluntary program, but the vast majority of seniors 
will be aided by this. Unless seniors have had prescription medication 
covered through a previous employer, then it is likely that the seniors 
who could access this program would be benefited by it. I know that in 
my area all of the seniors that were on the Medigap plan to cover 
prescription medications, not a single one of those would be able to 
have access to a plan that is as helpful in terms of improving their 
health as this plan.
  So this is a good program. It is a step in the right direction. It is 
not what all of us would have designed, I am certain, but it is a move 
in the right direction. And I want to commend my colleagues who will be 
here this evening to share information about this program with the 
House of Representatives and with our Nation and our Nation's seniors 
for their activity, and I want to thank you very much for the 
opportunity to join you tonight and commend you for your leadership on 
this, and I yield back to you.
  Mr. GINGREY. Dr. Price, thank you so much for those comments. They 
are very accurate and very timely.
  I know one thing that Representative Price mentioned about this 
deadline, and of course it is approaching. We are 3 weeks away. Of 
course, a 6-month window of opportunity that started November 15, and 
we have been doing town hall meetings, of course, since long before 
that and letting people know. I think there has been a tremendous 
amount of information both from the Committee on Medicare and Medicaid 
Services, CMS we call it, the Social Security department, and senior 
organizations in each community, in every county, in every State in 
this Nation have been making sure that this information gets out there.
  But, still, as we get down to the wire, we have some seniors, 
unfortunately there may be as many as 8 million, that could still sign 
up for this benefit. And while some of them clearly will choose not to, 
because it is an optional plan, we don't want to miss the opportunity 
of those in that group who are a part of that low-income portion, Madam 
Speaker, because, as I have said many times from the well of this House 
floor, for them it is not only a no-brainer, it is a godsend.
  So that is why we continue to have these Special Orders. That is why 
the leadership, our Speaker, our majority leader, our conference 
chairwoman Representative Deborah Pryce, wants us to come down and 
spend this hour, and allows us to do this, and as Congressman Price was 
just saying, to talk to Members on both sides of the aisle, because 
this is not the time to politic over this. This is the time to get the 
policy right.

                              {time}  2100

  So that is really what we are about.
  Again as I predicted at the outset, I would be joined by my 
colleagues on the health care public affairs team, not the least of 
which is my cochair. And I would like to call on him. I would like to 
say a word or two about Representative and Dr. Tim Murphy from the 
great State of Pennsylvania. He is a clinical psychologist, a teacher 
and an

[[Page H1832]]

author of several books. He has taken a leadership role not only in the 
overall committee that we cochair, but also especially on the issue of 
electronic medical recordkeeping and reduction of medical errors and 
saving lives and saving money. That is something that both Dr. Murphy 
and former Speaker Newt Gingrich have written a book on. We can talk 
about that later as we get beyond May 15, but at this time I yield to 
Mr. Murphy.
  Mr. MURPHY. I appreciate the gentleman yielding me this time and your 
continued leadership in helping this Nation understand the importance 
of the Medicare prescription drug plan.
  I wanted to echo with you the issues involved with this, which are so 
important not only to our constituents but actually to people across 
the Nation as they look at this and reflect back a couple of years ago 
when many folks were traveling to Canada, looking at trying to import 
some medications from around the world in an attempt to save money.
  The net result of that, the overall savings that came from importing 
medications from Canada as opposed to price shopping in America, was 
not that dramatic. And compared to our generic medications, generics 
still saved a lot more money. But nonetheless, many folks were 
searching for ways to find less expensive medications.
  Secondly, when people were involved in importing drugs from around 
the world, from Web sites or mail order, what they found many times 
were counterfeit medications. In one case they were supposed to be a 
prescription medication, but they were white pills that said the word 
``aspirin.'' It is not hard to guess what those were.
  In other situations they were completely counterfeited by using paint 
and other materials to try and make the pills mimic professionally 
manufactured medications. In other words, people were attempting to 
save money, and spent more after paying for counterfeit medications.
  So along came the prescription drug plan, and people reported to me 
they did find savings. Some looked at their VA program and were happy 
with that. In Pennsylvania, we have what is called the PACE program, or 
the Prescription Assistance Contract for the Elderly. Many were happy 
with that, and that is fine.
  Others said as they looked at their Medicare benefits, they found 
significant savings. One woman, as she was looking through that, told 
me she was saving hundreds of dollars. The point is it was voluntary. 
People compared different plans and found what saved money for them. 
The main thing is getting people on the medication that they need, 
rather than trying to seek some discount plan that really does not save 
them money.
  Of course, there are other parts of this Medicare bill that we 
recognize. One is getting people their checkup with their doctor so 
someone can review their needs; and also having pharmacists review the 
medications people take to make sure that we are avoiding duplication 
and improper doses, which also add costs.
  We have to remember one of the ways to reduce the cost of medicine is 
not just look at discounts and ways the government can help supplement 
payments, but also patients need to make sure that they are taking only 
the drugs they need. When people see multiple doctors and go to 
multiple pharmacists, that is one of the huge risks that occur for 
senior citizens where they end up with medical problems.
  One study read, and I think the CDC sponsored this, it said in 
Medicare alone, taking the wrong doses for the wrong person has 
contributed to some $29 billion in costs that were avoidable. So it is 
important to have all medications coordinated under one plan rather 
than going to multiple doctors and multiple pharmacists.
  But not only is it important for us to look at this program to 
provide medications that are affordable, but it is also important for 
us to note when people look at the cost of the prescription drug 
program for Medicare, what they consistently fail to take into account 
is what money it saves for health care overall.
  I am going to read a couple of points about some medications, and I 
recognize, although I work in the field of psychology, some of these 
are areas of expertise for some of the other physicians here on the 
floor. Some comments I will make, and Dr. Gingrey has commented on this 
too, that taking the correct medication is a money-saving as well as a 
life-saving factor that unfortunately the Congressional Budget Office 
and others who have looked at the cost of the Medicare prescription 
drug never take into account.
  Here is one point dealing with heart disease. Patients with heart 
failure who are treated with beta-blockers live longer, and treatment 
costs are about $4,000 lower than patients who do not take these 
medications. A January 2004 study by Duke researchers found that beta-
blocker therapy improves clinical outcomes of heart failure patients 
and is cost saving to society and Medicare.
  Looking more broadly, the researchers found that 5 years of treatment 
for heart failure without beta-blockers cost a total of $53,000. But 
with beta-blockers, treatment cost fell by $4,000, and patient survival 
increased by an average of 3\1/2\ months.
  Here is a study on depression. New medicines have brought down the 
cost of treating depression in the 1990s by reducing the need for 
hospitalization. Medications like Prozac and Paxil are responsible for 
this. New studies show how newer, better medicines reduce the cost of 
treating patients with depression. The cost of treating a depressed 
person fell throughout the 1990s, largely because of a switch from 
hospitalization to medication and psychotherapy, one study said.
  A study that was published in the Journal of Clinical Psychology in 
December 2003 found that per-patient spending on depression actually 
fell by nearly 20 percent over the course of the 1990s.

  A study on diabetes indicated that medicines that control diabetes 
help prevent serious complications, reducing the cost of care by about 
$747 per patient every year. New diabetes medicines are helping 
patients avoid serious complications and death, and can reduce overall 
health care spending. One recent study found that effective treatment 
of diabetes with medicines and other therapy yields annual health care 
savings of $700 to $950 per patient within 1 to 2 years.
  Another study corroborated these results, finding that the use of a 
disease management program to control diabetes, along with medication 
and patient education, generated savings of $747 per patient per year.
  I might add that the University of Pittsburgh Medical Center found 
when they engage these disease management programs, they reduced 
hospitalizations by some 75 percent.
  Let me mention Alzheimer's disease. One Alzheimer's medicine was 
found to reduce spending on skilled nursing facilities and hospital 
stays. A study of the effects on costs in a Medicare managed care plan 
showed that, although the prescription cost for the group receiving the 
drug were over $1,000 higher per patient, the overall medical costs 
fell to $8,000 compared with $11,947 for the group not receiving drug 
treatment. This one-third savings was as a result of reduced costs in 
other areas such as hospital and skilled nursing facilities.
  So one of the things that is so important for citizens to take into 
account as they look at these programs is to please understand not only 
the cost savings the program has overall, but the more that patients 
get engaged in following the prescriptions, following the doctor's 
orders, not only for the medicines themselves but patient education, 
diet, other therapies that may be recommended, the overall cost of 
health care goes down. And that is one of the untold stories of how the 
prescription drug plan works. It saves lives and saves money.
  Overall, if Congress continues to pay attention to the bigger picture 
of how using electronic medical records and electronic prescribing, 
patient management profiles, to use integrated care of looking at 
psychiatric care coordinated with medical care, to look at some of 
these many areas, we will continue to see, I believe, massive savings 
in health care, which is what we want to do. We want to coordinate all 
of these efforts in health care so it is not just a matter of saying 
health care is too expensive, so let us increase copays or deductibles 
or premiums or reduce coverage. None of those are viable alternatives. 
Nor is a method used to reduce payments to doctors or hospitals. That

[[Page H1833]]

is shifting the cost of care, that is not improving care. And this 
Medicare prescription drug plan which coordinates those benefits so 
much better for patients is a very important aspect that we encourage 
people to take a look at.
  I commend Dr. Gingrey for his work on maintaining this important 
issue and bringing it before the American public to review and 
understand. I am sure you agree that the issue of the medication, when 
we only look at the cost up front and not look at the cost of what it 
saves, we are missing the point. That involves a lot of foresight by 
those who drafted this legislation to make sure there was coordination 
of medical treatment and that it was put into this bill.
  Mr. GINGREY. I thank Dr. Murphy, and really among the many important 
points that you made, there is one that I would like to elaborate on 
before turning to our next speaker, and that was this issue that Dr. 
Murphy mentioned in regard to seniors buying their drugs from Canada, 
and in some instances not knowing if they were actually coming from 
Canada.
  But I think all of our colleagues understand why they found the need 
to do that; and our colleague, well, three on our side of the aisle in 
particular, the gentleman from Minnesota (Mr. Gutknecht), the 
gentlewoman from Missouri (Mrs. Emerson) and the gentleman from Indiana 
(Mr. Burton), spent many hours in this Chamber during Special Orders, 
talking about the fact that seniors were having to pay so much more in 
this country for prescription drugs than they could get from north of 
our border. And in many instances, most instances, the exact same 
product safely packaged. And who could blame them because what has been 
happening, until we finally came forward and delivered on this promise 
after so many years of prior administrations and other leadership on 
the other side of the aisle and other Presidents, we finally delivered.
  This is what has happened. Let me just give a quick summary of some 
of this before we turn to my good friend from Texas.
  In Minnesota, while enrollment in the Medicare drug benefit rose by 9 
percent last month, sales of low-cost Canadian drugs fell by 52 
percent. Listen to what a State health official says in Minnesota. 
State officials say that it is impossible to say for sure why sales of 
Canadian mail order drugs fell to $39,000 this March, the least since 
that State's program's first month in February 2004. The State actually 
had a program to help seniors buy from Canada. There could be lots of 
reasons, they say, but the Medicare drug program probably is one of 
them. That was by a spokeswoman for the Department of Human Services in 
Minnesota which operates Rx Connects.
  I just want to say to my colleagues that we are pushing so hard for 
what we refer to as reimportation, making that legal, and while 
certainly no one has ever been prosecuted for purchasing in that 
fashion, my feeling all along was when we passed this bill, as we did 
in November of 2003, Medicare modernization with a prescription drug 
benefit, the seniors are going to see those prices fall to the point 
that they will not have to literally take that chance on breaking the 
law, but, more importantly, risking the possibility that they will be 
getting some knock-off drug or something that is lower quality or not 
the right dosage. This is what has happened.
  I think the gentleman from Minnesota (Mr. Gutknecht) and others may 
not completely agree with me and I understand that, but hopefully we 
will be able to take that argument off the table as this program 
matures, and I feel confident that is going to happen.
  At this time, I call on the gentleman from Texas, who is not only my 
physician colleague and part of this health care team, but he is also 
an OB-GYN specialist, as I am. I do not think he has delivered quite as 
many babies as I have, but he constantly reminds me he is not as old as 
I am either.
  At this time, I yield to Doctor and Congressman Mike Burgess from 
Dallas, Texas.

                              {time}  2115

  Mr. BURGESS. I thank the gentleman for yielding. And actually that is 
Ft. Worth, Texas. We are sensitive about that in Ft. Worth.
  I wanted to spend just a minute this evening. We have heard a lot. 
The gentleman is quite right. His leadership on this, too, by the way, 
has just been exemplary. I am reminded tonight of how many nights we 
have spent here on the floor of this House talking about this very 
issue since 2003 when we both started.
  But I wanted to take a moment. We have heard a lot about how 
complicated the program is, and that it is just too complicated, 
seniors just can't understand it, and make it simpler and then come 
back and try again. I need to address that.
  Remember that if you picked up the Washington Post from a while ago, 
read the article where the new Medicare benefit is so complicated no 
one can understand it, no one's going to sign up for it, but I would 
remind the Speaker and the gentleman from Georgia that this was a 
Washington Post article from 1966 when Medicare first started. The 
program itself was complicated then. But guess what? We got a little 
bit better and a little bit better year over year, to the point where 
the Medicare system now is one of the more successful Federal programs.
  But instead of talking about how complicated it is, let me take 
another tack. And I want to show you, Madam Speaker, just how easy, how 
easy it is to sign up for the Medicare program. You take your 
prescription drugs in one hand so you can read the labels and you can 
read the dosage and you can read the amount. I apologize, that is not a 
real Medicare card, but I don't own one yet. But this is a reproduction 
of a Medicare card. It is actually red, white and blue if you have a 
real one, and it will have your Medicare number on it.
  Now, if you have got your prescriptions, and you have got your 
Medicare card with your name and your Medicare number on it, you have 
got all the information you need to sign up for this program. Then take 
the very simple step of calling 1-800-MEDICARE, talk to the nice people 
on the other end about your medicines, the dosage you take and the 
amount that you take, and they will help you work through this program.
  Now, for those savvy enough to be on the Internet, there is an 
Internet plan finder tool that I have found is very, very user-
friendly, very amenable to working through it. What I tell people to 
concentrate on when they look at this program is look at it from the 
standpoint of cost, coverage and convenience.
  If you just print out the plans that are available in the State of 
Texas, there are 20 plans offering several different options, so there 
are 47 overall combinations of plans that are available. If you just 
looked at those in tabular form, it is pretty easy to pick out the 
cheapest, the next cheapest and the third cheapest. So very quickly you 
have done a survey that, based on cost, can tell you the least 
expensive plan.
  Now, you also need to look at more than just the monthly premium. You 
need to look at the deductible. You do need to know about coverage, 
because that is critical. Make certain that the plan you select covers 
the medications that you are taking.
  And then finally, convenience. Do you want to do mail order? Do you 
want to do one of the chain drug stores? Do you want to do the corner 
drug store, the mom-and-pop pharmacy down on the corner? Each of those 
is available to any senior signing up on this program, and all of that 
information on cost, coverage and convenience is readily available on 
the plan finder tool.
  Finally, I want to tell the gentleman from Georgia, I am going to be 
fairly brief tonight, but the gentleman from Pennsylvania was talking a 
lot about the costs and the cost savings available with this program. 
He mentioned about the cost of treatment of heart disease and how that 
can be lowered with this program. I would submit that since the mid-
1960s, according to figures from the National Institutes of Health, 
there has been a reduction in cardiac deaths in this country such that 
there were 800,000 less premature deaths from cardiac disease than 
would have been predicted back in 1965 or 1966 when Medicare was first 
stood up. The reason that that is important is those reductions in 
premature deaths are largely the result of pharmaceuticals, timely 
treatment of blood pressure problems, timely treatment of diabetes, the 
introduction

[[Page H1834]]

of the statins 10 or 15 years ago that has made such a significant 
difference in the prevention of heart disease.
  Yes, we are going to save money with this program, but more 
importantly, we are going to be saving lives. And I think most 
Americans would agree that is the most important commodity.
  Madam Speaker, with that I will yield back to my friend from Georgia 
and remain close at hand if he has any questions that he needs for me 
to fill in on.
  Once again I would remind the Speaker that 1-800-MEDICARE is where 
you can get easy access to the information on how to enroll for this 
program.
  Mr. GINGREY. I thank the gentleman from Ft. Worth. I guess I have run 
my Dallas-Ft. Worth together. But the gentleman has done a great job in 
working with us on this time, and I appreciate his comments tonight as 
well.
  Madam Speaker, there has been a lot of discussion about extending the 
deadline to say, well, you know, we don't need to be penalizing seniors 
if they don't sign up in time, and that is something that hopefully we 
will have an opportunity tonight to talk a little bit about.
  At this point I am going to call on my good friend and teammate on 
the Republican baseball team, hopefully again this year, and I am 
talking about the gentlewoman from Pennsylvania, who is also a member 
of the Ways and Means Committee. And I will tell you, my colleagues, 
you know, that is so important because the Health Subcommittee on Ways 
and Means is where these issues relating to Medicare are ironed out 
before they come to the general membership, to the floor. And the 
expertise in that committee level is so strong, and so it is wonderful 
to have Melissa Hart with us tonight. And I would like to turn the mike 
over to her at this time.
  Ms. HART. I would like to thank my colleague, Dr. Gingrey from 
Georgia, and a very, very good baseball player, I must say, for 
allowing me to join all the doctors on the floor tonight. I have had a 
lot of experience with this issue, significant senior population in 
western Pennsylvania where I live, and represent a lot of folks who 
have benefited from this program. And I think you and your fellow 
physicians and a lot of our Members have worked very hard to make sure 
that people are aware of the program, they are aware of the offering. 
And so many people who had no coverage whatsoever for prescription 
drugs are now saving a significant amount of money. And even more 
importantly, a lot of folks who believed they couldn't really afford 
their drugs, and so they maybe weren't taking care of themselves the 
way they should, or they were cutting their pills in half and really 
not taking the dosages that they really should have been for their 
health, are now able to do so. They are able to afford the drugs that 
they need. They are able to take the dosages that they need. And we are 
going to see a lot more people be a lot healthier a lot longer, and I 
think that is extremely important.
  I would like to make a couple of points, one obviously being what is 
shown behind me, that seniors are saving on an average of $1,100 a 
month with the Medicare prescription drug coverage. Low-income seniors 
who are not having to pay some of the deductibles, some of the other 
up-front costs, are saving even more, $3,700 a month. That is per 
month. And we are talking about seniors, so most of them are going to 
be on a fixed income. And it is certainly a challenge to pay this kind 
of money out of your pocket if you are working full time.

  So the concern that a lot of us had, and the reason that the Members 
of the House of Representatives and the Senate decided to support a 
plan within Medicare to provide prescription drugs, was that we want 
people to be able to access the kind of health care that is delivered 
today. And our physicians certainly know very, very well, and I am 
really honored, as a lawyer especially, to be part of the group 
tonight, explaining to a lot of folks who may not be aware of the 
program yet or who may, unfortunately, have heard some of the negative 
comments out there from those who maybe for political reasons don't 
want this plan to succeed. And really I would like to call for a stop 
to some of the misleading and dishonest rhetoric that has been used. It 
seems as though it is designed to purposely scare seniors away from 
this prescription drug program that is available through Medicare, 
which is just the worst thing to do for their health.
  By every measure this program is succeeding in its core mission of 
helping Medicare recipients save money on their prescription drugs. 
Participation in the program has now exceeded its goal of enrolling 30 
million by the conclusion of the first year, and it is only April.
  In addition, since the beginning of last month, seniors have been 
enrolling in the prescription drug plan at the average rate of about 
416,000 seniors per week. So obviously the message is getting out. But 
we need to make sure that it gets out that the truth is that this 
program is helping seniors from coast to coast.
  In my district alone, in western Pennsylvania, more than 90,000 
seniors now have prescription drug coverage, and the Centers for 
Medicare and Medicaid Services project that that number will only 
increase by the end of this year.
  The overwhelming reason why Medicare recipients are enrolling is 
simple. They receive real savings on the cost of their prescription 
drugs. The average senior, as I said earlier, who signs up for this 
plan is saving more than 1,100 on prescription drugs. In fact, the 
robust competition among the Medicare drug plans actually has begun to 
drive down the cost that we expected seniors would pay when we were 
initially discussing the legislation. As Dr. Gingrey knows, we were 
talking about how much the monthly cost would be for the plans, and we 
were worried that some people might not be able to afford the plan. So 
we did everything we could to drive down the monthly cost for the 
prescription drug coverage so that people would buy the coverage and 
then obviously save a lot of money on their prescriptions. It was 
originally estimated that we would be nearly $40 a month, and now the 
average premium is only about $25 a month. And, in fact, some, one that 
we found in our district, is only about $10.14 a month. And so seniors 
who have very little means certainly have an opportunity to get into 
this program even if they don't qualify for the no-cost monthly 
benefit.
  Back home in Pennsylvania, beneficiaries, as I mentioned, have a wide 
range of choices. It is not just the amount that each of these plans 
cost, but it is the level of service as well; the broader-based 
formulary, if you have a lot more needs for different prescriptions. I 
saw Dr. Burgess was holding three prescription drug bottles when he was 
talking. Some seniors may have one or two. Some may have four or five. 
And so it is important that they make sure, as Dr. Burgess suggested, 
that the formulary, that is the list of the drugs that are covered by 
the plan, actually cover the prescriptions that they need to take to 
stay healthy.
  A Medicare beneficiary in Pennsylvania who doesn't currently have 
coverage and uses three different prescriptions per month commonly 
prescribed for diabetes, for high cholesterol and for hypertension is 
an example of a person who can save a significant amount. On average 
this beneficiary can save $920, or 33 percent, by enrolling in a 
Medicare prescription drug plan. This beneficiary can save even more, 
as much as $1,900, or 68 percent, by using a mail order.
  And all of the plans that are offered give each senior options. They 
can choose to be able to go to their local pharmacist, which is very 
important because many people would love to talk to their pharmacist 
every time they have a chance to. Some are very comfortable with their 
prescriptions or medications, and they don't need to do that. They 
would rather save money and can get mail order, and so they have the 
opportunity to save even more that way.
  But every State offers different plans that have different benefits, 
and it is nice to know that whatever your needs are, there is going to 
be a plan to cover them.
  While some outside this Chamber today have sought to discount this 
plan and say it is too complex for seniors, the savings that people are 
realizing is having a very serious positive effect on people across the 
country.
  Madam Speaker, these statistics speak for themselves, and the 
individuals who choose to demagogue the new

[[Page H1835]]

program are not only trying to harm seniors, but they are also 
insulting the intelligence of seniors in the United States. With more 
than 30 million Americans who are now enrolled in the program, we 
should be doing everything we can to help seniors and increase the 
enrollment in the part D program, not scare them. And I really 
appreciate the fact that our health care professionals who are Members 
of Congress are here, because they have the credibility of being 
providers of health care and also now as legislators here in the 
Congress, who have helped us move forward with this legislation, helped 
us get through some of the bumps in the initial roll-out of the program 
to the point now where so many people are benefiting.
  And I want to commend you, Dr. Gingrey, for being one of those 
steadfast individuals who not only represents your district in Georgia, 
but you are doing a world of good for seniors across the country to 
make sure that they know that this is a great plan for them, it is 
going to help them save money, and most importantly, more importantly 
than anything else, to help them stay healthy. And I want to thank you 
for allowing me to join you.
  Mr. GINGREY. I thank the gentlewoman from Pennsylvania. And I want to 
comment, too, that I said at the outset that the work that she does on 
the Ways and Means Committee with Health Subcommittee Chairwoman Nancy 
Johnson from Connecticut and Chairman Thomas and other members of that 
committee where all this great work is done.
  One of the concerns, Madam Speaker, was that the pharmaceutical 
companies that had these prescription discount programs that they 
offered not only to needy seniors, but to people of low income at any 
age, low-income adults.

                              {time}  2130

  And a lot of concern had been expressed. In fact, the Inspector 
General had some concerns initially and let the pharmaceutical 
companies know that maybe they needed to look very carefully at these 
discount programs because of some antitrust violation or whatever. But 
the members of the Committee on Ways and Means continued to work 
through this and to make sure that the pharmaceutical companies 
understood that they could continue these programs and there would be 
no violation, there would be no penalties or anything of that nature. 
And I think this is great because, as Representative Hart was just 
talking about in regard to that gap in coverage, that does not exist, 
of course, for our lowest-income seniors who qualify, as she said, for 
the low-income supplement. No matter how much money they would incur 
before this program for prescription drugs, they are only going to pay 
$1 a month for each prescription as a copay for generic. Maybe a little 
bit more if it is a brand name.
  But most people in the program do face that gap in coverage where, 
after the first $2,250, then all of the payment is out of their own 
pocket until, Madam Speaker, the point when they have actually spent in 
any one year $3,600, and then after that the benefit is outstanding. In 
fact, 95 percent of any cost above that amount is paid for by the 
insurance program and only a 5 percent burden on the patient. So that 
is a tremendous benefit.
  But in that gap in coverage, where all of a sudden if somebody 
reaches that, $2,250 is not the average amount that an individual 
senior would spend each year on drugs. It is considerably lower than 
that. It may be closer to $1,400, and they would never get to that 
point. But some do, and now we know, because of the good work of the 
Ways and Means Committee, of which Representative Hart is a member, we 
have worked this out so that the pharmaceutical companies can continue 
to offer those discount programs and to provide at a very low cost 
these prescription drugs for those seniors who are getting to that 
point where it is really going to be difficult for them to stay on 
their medications. And I commend her for that and I think that was 
something that was very important.
  The pharmaceutical industry, the companies, have been attacked so 
much by the other side of the aisle, and we have heard that over and 
over and over again, that this is nothing but a giveaway to the 
pharmaceutical industry, and they wrote the bill and the Republicans 
passed it in the dark of night. We have all heard that to a fare-thee-
well. Hopefully, our colleagues will now get on board with us and 
realize that this is a good bill that is saving money, as Melissa Hart 
indicated. It is not averaging $40 a month; it is averaging $25 a 
month, or, in some cases, even less. And there are options, of course, 
the first option being you do not have to sign up for it if you do not 
want to or if you have something better. But it has been a godsend for 
so many.
  And I thank you so much for being with us tonight, Representative 
Hart.
  Ms. HART. It has been a pleasure. I thank you.
  Mr. GINGREY. And as I said, premiums, Madam Speaker, a third lower 
than expected. Even the cost, the overall cost, we got some conflicting 
numbers back towards the end of 2003 when we were debating and finally 
passing this bill. The first number, of course, was it was going to 
cost $450 billion over 10 years extra Medicare spending. Then the 
number went up to $750 billion. We now know that the cost is going to 
be lower than those numbers, and probably a lot lower because as we 
crunch these numbers, the Congressional Budget Office or the Office of 
Management and Budget, they do what we call static scoring. And as my 
colleagues earlier were talking about, and I think Dr. Burgess in 
particular, Madam Speaker, no credit is given for the fact that when 
our seniors, my mom and others, can afford to take these prescription 
drugs and lower that blood pressure, lower that cholesterol, lower that 
blood sugar, then they are not going to need the expensive benefits of 
Part A and Part B, whether it is a long stay in the hospital or in the 
intensive care unit, even more expensive; or on the operating table, 
having a leg amputated; coronaries; bypass; or maybe even in a worse 
situation of high blood pressure, having a stroke and spending the rest 
of their lives in a nursing home covered by Medicare or maybe Medicaid. 
Who wants that if they can avoid it by spending less money on Part D 
and preventing this from happening in the first place?
  So we shift costs, and we do not get any credit for that in this so-
called static scoring that goes on around here, but we should be 
getting a lot of credit for it.
  And I know that my colleagues on both sides of the aisle understand 
this. But despite it, there are Democrats in this Congress and liberal 
groups like Families USA and MoveOn.org who are continuing to play 
politics with our seniors' health, holding town hall meetings to 
encourage seniors not to enroll. Not to enroll. I thought they would 
get over the fact that somebody licked the red off their candy or they 
lost their marbles in a playground game and all of a sudden wanted to 
pick up and go home.
  I remember 1 year ago or 1\1/2\ years ago seeing Members, 
particularly on the other side of the aisle, coming down and literally 
making a big show out of tearing up their AARP card because this 
wonderful senior organization of 35 million, of which I am a proud 
member, had the audacity, audacity, to endorse something that the 
Republicans, Madam Speaker, had put forward for our seniors. And I 
guess the frustration of the other side when they had control of this 
place for 40 years and never could deliver on this promise, I guess it 
does grate at you a little bit. But I want them to get over it, I 
really do, and get on board, because we need to let seniors know, more 
than a few who have not yet signed up, that let us get this done in the 
next 3 weeks. And there is a deadline, and, yes, there is a penalty if 
you do not sign up by the deadline.
  All we hear by the other side is to extend the deadline. You just 
need to give them 6 more months or 6 more years. I do not know what 
they want. But I know this: This Member has a bad habit of 
procrastinating, and if I did not have a deadline, if there was not a 
final deadline of getting your income tax return in every year, I would 
not do it. And that is just human nature. We have to realize that there 
is a time certain, and if you sign up late and expect to come into the 
program and pay the same premium, it is not fair, particularly if 
during that interim

[[Page H1836]]

you went from being on no medications and would cost the program very 
little, and all of a sudden when you have that angina, as we call it, 
chest pain, and you realize you are now on five medications and you 
want to hurry up and sign up for the program, that is not fair to the 
others because, after all, this is an insurance program and it is 
pooled and that is the way we keep costs down. So I think it absolutely 
makes sense to get everybody signed up by the deadline, which is fast 
approaching.
  Madam Speaker, it has, as always, been a pleasure to have the 
opportunity to be given by our leadership, by Speaker Hastert and Mr. 
Leader Boehner and our conference chairman, Deborah Pryce, to spend 
this hour with my colleagues talking about something that is so 
important. And if we can ever in this body, and I know we can, put 
policy ahead of politics and realize that we can work together in a 
bipartisan way when we have got something that clearly is a tremendous 
benefit to our seniors, let us all pull together.
  When we go home tomorrow, if we have got some time on Friday, or 
Monday before we come back to Washington, let us all have town hall 
meetings and workshops and computers and pharmacists there and vendors 
and maybe some health screening kiosk as well, and help our seniors 
take advantage of this great benefit.

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