[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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