[Congressional Record Volume 153, Number 7 (Friday, January 12, 2007)]
[House]
[Pages H440-H489]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              {time}  0930
        MEDICARE PRESCRIPTION DRUG PRICE NEGOTIATION ACT OF 2007

  Mr. DINGELL. Mr. Speaker, pursuant to section 510 of House Resolution 
6 and as the designee of the majority leader, I call up the bill (H.R. 
4) to amend part D of title XVIII of the Social Security Act to require 
the Secretary of Health and Human Services to negotiate lower covered 
part D drug prices on behalf of Medicare beneficiaries.
  The Clerk read the title of the bill.
  The text of the bill is as follows

                                 H.R. 4

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Medicare Prescription Drug 
     Price Negotiation Act of 2007''.

     SEC. 2. NEGOTIATION OF LOWER COVERED PART D DRUG PRICES ON 
                   BEHALF OF MEDICARE BENEFICIARIES.

       (a) Negotiation by HHS.--Section 1860D-11 of the Social 
     Security Act (42 U.S.C. 1395w-111) is amended by striking 
     subsection (i) (relating to noninterference) and inserting 
     the following:
       ``(i) Negotiation of Lower Drug Prices.--
       ``(1) In general.--Notwithstanding any other provision of 
     law, the Secretary shall negotiate with pharmaceutical 
     manufacturers the prices (including discounts, rebates, and 
     other price concessions) that may be charged to PDP sponsors 
     and MA organizations for covered part D drugs for part D 
     eligible individuals who are enrolled under a prescription 
     drug plan or under an MA-PD plan.
       ``(2) No change in rules for formularies.--
       ``(A) In general.--Nothing in paragraph (1) shall be 
     construed to authorize the Secretary to establish or require 
     a particular formulary.
       ``(B) Construction.--Subparagraph (A) shall not be 
     construed as affecting the Secretary's authority to ensure 
     appropriate and adequate access to covered part D drugs under 
     prescription drug plans and under MA-PD plans, including 
     compliance of such plans with formulary requirements under 
     section 1860D-4(b)(3).
       ``(3) Construction.--Nothing in this subsection shall be 
     construed as preventing the sponsor of a prescription drug 
     plan, or an organization offering an MA-PD plan, from 
     obtaining a discount or reduction of the price for a covered 
     part D drug below the price negotiated under paragraph (1).
       ``(4) Semi-annual reports to congress.--Not later than June 
     1, 2007, and every six months thereafter, the Secretary shall 
     submit to the Committees on Ways and Means, Energy and 
     Commerce, and Oversight and Government Reform of the House of 
     Representatives and the Committee on Finance of the Senate a 
     report on negotiations conducted by the Secretary to achieve 
     lower prices for Medicare beneficiaries, and the prices and 
     price discounts achieved by the Secretary as a result of such 
     negotiations.''.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall take effect on the date of the enactment of this Act 
     and shall first apply to negotiations and prices for plan 
     years beginning on January 1, 2008.

  The SPEAKER pro tempore (Mr. Marshall). Pursuant to section 510 of 
House Resolution 6, the gentleman from Michigan (Mr. Dingell) and the 
gentleman from Texas (Mr. Burgess) each will control 90 minutes.
  The Chair recognizes the gentleman from Michigan.


                             General Leave

  Mr. DINGELL. Mr. Speaker, I ask unanimous consent that all Members 
have 5 legislative days in which to revise and extend their remarks and 
include therein extraneous matter.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Michigan?
  There was no objection.
  Mr. DINGELL. Mr. Speaker, I ask unanimous consent to yield 40 minutes

[[Page H441]]

to the distinguished gentleman from New York (Mr. Rangel) and 10 
minutes to the gentlewoman from Missouri (Mrs. Emerson), and that they 
each be permitted to control their own time in their own way.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Michigan?
  There was no objection.
  Mr. DINGELL. Mr. Speaker, I yield myself 5 minutes.
  Mr. Speaker, I rise today in support of H.R. 4, the Medicare 
Prescription Drug Price Negotiation Act of 2007. This legislation is 
bipartisan. It is an overdue step to improve part D drug benefits for 
the millions who depend on that section.
  The bill is simple and straightforward. It removes the prohibition 
that prevents the Secretary of Health and Human Services from 
negotiating discounts with pharmaceutical manufacturers, and ensures 
that our friends in the executive branch take this opportunity 
seriously. It requires the Secretary to negotiate.
  This legislation is simple and common sense. It will deliver lower 
premiums to the seniors, lower prices at the pharmacy and savings for 
all taxpayers. The American public subsidizes more than three-quarters 
of the part D benefit, paying the bulk of premiums and 80 percent of 
catastrophic costs. They also pay for most or all of part D medicines 
used by the lowest-income Medicare beneficiaries. These savings add up.
  It is equally important to understand that this legislation does not 
do certain things. H.R. 4 does not preclude private plans from offering 
drug coverage under Medicare from getting better or additional 
discounts on medicines they offer seniors and people with disabilities. 
H.R. 4 does not interfere with the ability of doctors to prescribe a 
particular drug for their patients by establishing a national 
formulary. In fact, page 2 of the legislation reads: ``Nothing in 
paragraph (1) shall be construed to authorize the Secretary to 
establish or require a particular formulary.'' I do not think that 
there is any clearer way to state these matters than in that fashion.
  I have confidence that Secretary Leavitt can cut a good deal with the 
bargaining power of 43 million beneficiaries of Medicare behind him 
without restricting access to needed medicine.
  H.R. 4 does not require price controls. Quite the contrary, the bill 
gives the Secretary an additional power and makes him an additional 
player with whom drug companies must negotiate. And I say with some 
sympathy for the drug companies that they have been doing so well that 
I can understand their opposition to this matter.
  H.R. 4 does not hamstring research and development by pharmaceutical 
houses. The most recent Securities and Exchange Commission filings by 
the seven largest drug manufacturers based in the U.S. show that, on 
average, these companies spend more on marketing, advertising and 
administration than they do on research and development; and those who 
insist that the sky is falling if the drug companies negotiate lower 
prescription prices are arguing that those drug companies should 
continue to skin a fat hog at the expense of the taxpayers and the 
beneficiaries.
  I further note that H.R. 4 does not require HHS's Secretary to use 
Department of Veterans Affairs' price schedule or to adopt a VA-like 
system. In fact, you will not find the words ``veterans'' and 
``affairs'' in this legislation.
  Independent studies confirm that Medicare overpays drug companies in 
purchasing medicines. I will repeat that: Medicare overpays drug 
companies in purchasing medicines. One study has found that half of the 
top 20 drugs used by senior citizens fall into that category. Medicare 
drug plans paid at least 58 percent more than the prescription program 
of the Department of Veterans Affairs. Even if the Secretary does not 
get those same discounts, it is clear that Medicare can do better, and 
we must see that they do so.
  Senior citizens and people with disabilities deserve better, and 
after the past 6 years of pillaging the Treasury of the United States, 
our taxpayers deserve better.
  While this legislation is an important step forward, H.R. 4 does not 
address other problems with part D. I anticipate we will be doing so at 
an early time. The list of wrongs that need righting in connection with 
this legislation is long, and, as I said, we will introduce legislation 
and deal with these matters in other ways.
  I urge my colleagues to vote for H.R. 4, the Medicare Prescription 
Drug Price Negotiation Act. Let the Secretary of Health and Human 
Services use the power of 43 million beneficiaries to get a better deal 
for their prescription medicines, for them, and for the taxpayers

                [From the New York Times, Jan. 12, 2007]

                     Negotiating Lower Drug Prices

       From all the ruckus raised by the administration and its 
     patrons in the pharmaceutical industry, you would think that 
     Congressional Democrats were out to destroy the free market 
     system when they call for the government to negotiate the 
     prices of prescription drugs for Medicare beneficiaries. Yet 
     a bill scheduled for a vote in the House of Representatives 
     today is sufficiently flexible to allow older Americans to 
     benefit from the best efforts of both the government and the 
     private drug plans.
       The secretary of health and human services should be able 
     to exert his bargaining power with drug companies in those 
     cases in which the private plans have failed to rein in 
     unduly high prices--leaving the rest to the drug plans. The 
     result could be lower costs for consumers and savings for the 
     taxpayers who support Medicare.
       Under current law, written to appease the pharmaceutical 
     industry, the government is explicitly forbidden from using 
     its huge purchasing power to negotiate lower drug prices for 
     Medicare beneficiaries. That job is left to the private 
     health plans that provide drug coverage under Medicare and 
     compete for customers in part on the basis of cost.
       The Democrats' bill would end the prohibition and require--
     not just authorize--the secretary of health and human 
     services to negotiate prices with the manufacturers. That 
     language is important since the current secretary, Michael 
     Leavitt, has said he does not want the power to negotiate.
       No data is publicly available to indicate what prices the 
     private health plans actually pay the manufacturers. But 
     judging from what they charge their beneficiaries, it looks 
     like they pay significantly more for many drugs than do the 
     Department of Veterans Affairs--which by law gets big 
     discounts--the Medicaid programs for the poor, or foreign 
     countries.
       The administration argues, correctly, that the private 
     plans have held costs down and that there is no guarantee the 
     government will do any better. The bill, for example, 
     prohibits the secretary from limiting which drugs are covered 
     by Medicare, thus depriving him of a tool used by private 
     plans and the V.A. to win big discounts from companies eager 
     to get their drugs on the list. The secretary does have the 
     bully pulpit, which he can use to try to bring down the cost 
     of overpriced drugs.
       The bill also does not require the secretary to negotiate 
     prices for all 4,400 drugs used by beneficiaries. A smart 
     secretary could simply determine which prices paid by the 
     plans seemed most out of line with the prices paid by other 
     purchasers and then negotiate only on those drugs. The 
     private plans are explicitly allowed to negotiate even lower 
     prices if they can. This sort of flexibility should pose no 
     threat to the free market. It is time for the Medicare drug 
     program to work harder for its beneficiaries without worrying 
     so much about the pharmaceutical companies.

  Mr. Speaker, I reserve the balance of my time.
  Mr. BURGESS. Mr. Speaker, I ask unanimous consent that the time on my 
side be divided, with 40 minutes going to the distinguished gentleman 
from Louisiana (Mr. McCrery), the ranking member on the Ways and Means 
Committee; and 50 minutes reserved for the Committee on Energy and 
Commerce.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Texas?
  There was no objection.
  Mr. BURGESS. Mr. Speaker, I yield myself such time as I may consume.
  I might ask, does ideological purity trump sound public policy? Of 
course, it shouldn't, but, unfortunately, it appears we are on the 
threshold of profound changes in the Medicare part D prescription drug 
program, a program that is working well, a program that has arrived on 
time and under budget.
  Think of that, Mr. Speaker. Here is a Federal agency that delivered 
on a promise that we made here in Congress, daybreak, November 22, 
2003, and it arrived on time and under budget. When have you known a 
Federal agency to behave in such a way?
  The changes are not being proposed because of any weakness or defect 
in the program, despite the comments of my distinguished chairman. The 
changes are being proposed because a

[[Page H442]]

viable program lacks the proper partisan label.
  Since the inception of the part D program, America's seniors have had 
access to greater coverage at a lower cost than at any time since the 
inception of Medicare, well over 40 years ago. Indeed, over the past 
year, saving money has not just been a catchy slogan; it has been a 
welcome reality for the millions of American seniors who previously 
lacked prescription drug coverage.
  Under the guise of negotiation, the Democrats propose to enact 
draconian price controls on pharmaceutical products. The claim is 
billions of dollars of savings. But the experts in the Congressional 
Budget Office yesterday denied that the promised savings will actually 
materialize. The reality is competition has brought significant cost 
savings to the program and, subsequently, to the seniors who depend 
upon this program every day.
  Consider that the enrollment in the part D program began just a 
little over a year ago and has proven to be a success. CMS reports that 
approximately 38 million people, 90 percent of all Medicare 
beneficiaries, are receiving comprehensive coverage, either through 
part D, an employer-sponsored retiree health plan, or other credible 
coverage, including the VA.
  But consider this: retiree health coverage was disappearing at a rate 
of 10 percent a year prior to the enactment of the Medicare 
Modernization Act 4 years ago. Further, the cost of the program for 
2006 was $13 billion below budget estimates. Half of that amount of 
savings was attributed to competition. The projected average premium 
was originally $37 a month. That is what the HHS figured out was going 
to be the basic premium. That is the best their actuaries could do.

                              {time}  0945

  We will get that premium down to $37 a month. But the beneficiaries 
are actually paying an average premium of less than $24 a month.
  Ninety-two percent of all Medicare beneficiaries will not enter the 
Medicare's cost coverage gap because they will not be exposed to the 
gap or they have prescription drug coverage from plans outside of part 
B, or their plan covers in the so-called gap. Eighty percent of the 
Medicare drug enrollees are satisfied with their coverage, and a 
similar percentage say that out-of-pocket costs have decreased.
  With all that is going right about the program, it seems unwise and 
unkind to jeopardize its success. Specifically, just a month ago, the 
Wall Street Journal reported that negotiating prescription drug prices 
may actually lead to higher prices for consumers. Further, the 
Manhattan Institute For Policy Research advised that Federal price 
limitations will result in decreased investment and research and 
development on less new medicines and ultimately an overall negative 
impact on available pharmaceuticals. Available to whom? Available to 
the American people, Mr. Speaker.
  Again, consider: Under the cloak of negotiation, the reality is that 
Federal price controls could have an extremely pernicious effect on the 
price and the availability of current pharmaceuticals and those 
products that may be available in the future to treat future patients. 
Is ideological branding so critical it trumps providing basic coverage 
to senior citizens?
  Mr. Speaker, in a former life I used to study medical irony a lot. In 
the past 4 years, I have come to study political irony. The irony of 
this situation is that, for 40 years, various Presidents and Congresses 
tried to provide this benefit to the American people, to the American 
seniors, and it couldn't be done. It took a Republican President, a 
Republican House and a Republican Senate to provide this benefit. And 
therein is the problem. It lacks the proper partisan branding.
  Mr. Speaker, while crafting policy that ultimately became the 
Medicare Modernization Act of 2003, the concept of protecting the 
inclusion of market forces in the legislation was a critical aspect of 
the ultimate bill; and keeping in mind that the central tenet of 
providing recipients of the large Federal program access to Federal 
drugs with the emphasis being on taking care of those who were least 
well off and those who had the greatest health problems.
  The Republican policy trusted the marketplace. They trusted the 
marketplace, with some guidance, to be the most efficient arbiter of 
distribution to achieve the above goals. We had no shortage of 
individuals who were concerned about the overall concept and scope of 
the program on the Republican side during the debate. But it is useful 
to compare the proposals that were proffered by the other side of the 
aisle during this time.
  Specifically, there would have been limits on access to medicine to 
seniors, limits on pharmacies, and right from the beginning, there was 
a tacit acknowledgment that the program would cost considerably more 
money over time.
  Mr. Speaker, I reserve the balance of my time.
  Mrs. EMERSON. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I welcome this debate today as we discuss an idea with 
merit to apply the savings of bulk negotiation to the prescription 
drugs taxpayers purchase through the Medicare program.
  This debate rests on a single question: Where would we be if the 
taxpayer dollar was used to buy ammunition for our soldiers one bullet 
at a time? What would happen if the Department of Transportation 
purchased concrete mix one bag at a time? Would we instruct the IRS to 
purchase paper one sheet at a time? Why then do we bar the Secretary of 
Health and Human Services from acting on the taxpayers' behalf and, 
instead, expect Medicare to buy drugs one plan at a time, one pill at a 
time?
  This bill corrects that inequity, and I look forward to our debates 
today.
  Mr. Speaker, I reserve the balance of my time.
  Mr. DINGELL. Mr. Speaker, I yield to my distinguished colleague and 
friend, the gentleman from California, for a unanimous consent request.
  (Mr. GEORGE MILLER of California asked and was given permission to 
revise and extend his remarks.)
  Mr. GEORGE MILLER of California. Mr. Speaker, I rise in strong 
support of H.R. 4, and I want to thank the committee for bringing this 
bill to the floor and look forward to its passage.
  In 2003, I opposed the President's prescription drug plan because it 
was clear that it would not help America's elderly and America's sick.
  Instead, the bill guaranteed high prices to drug makers, by 
prohibiting the Federal Government from negotiating lower drug prices 
on behalf of seniors.
  Today we have an opportunity to correct one of the wrongs instituted 
by that bill. The bill before us today is part of our ambitious agenda 
for the first 100 hours in this new Congress, and will start to put the 
interests of seniors before those of drug companies.
  The states, the V.A., Fortune 500 companies, and large pharmacy 
chains all use their bargaining clout to obtain lower drug prices for 
their patients. Medicare beneficiaries deserve the same opportunity.
  Giving HHS drug price negotiating authority for Medicare has 
overwhelming bipartisan support across the country; along with support 
from organizations like AARP, Consumers Union, and AFL-CIO.
  Negotiating for lower prescription drug prices will be the first step 
towards fixing this highly flawed system and helping our seniors.
  Mr. DINGELL. Mr. Speaker, I yield now to the distinguished gentleman 
from New Jersey, the chairman of the Health Subcommittee, Mr. Pallone, 
for 3 minutes.
  Mr. PALLONE. Mr. Speaker, a principal goal of this new Democratic 
majority is to make health care more affordable for all Americans, and 
that is the reason I rise in strong support of H.R. 4. This legislation 
will help lower prescription drug costs for our Nation's seniors and 
the disabled by simply repealing the provision inserted by the 
Republican majority into the 2003 law that prohibits the Secretary of 
Health and Human Services from negotiating lower drug prices.
  Now, Mr. Speaker, it is a national embarrassment, in my opinion, that 
we have the tools to lower drug prices for America's seniors and the 
disabled and yet we do not utilize them. It is simply time for a new 
direction. This provision that we are repealing never made any sense, 
except to the pharmaceutical industry.
  My colleague who is controlling the bill on the other side talked 
about reality and talked about irony. The reality is that this 
provision was inserted by the pharmaceutical industry, a special 
interest, because of their alliance

[[Page H443]]

essentially with the Republican majority. And the irony is that that 
gentleman continues to talk about saving money when in reality we would 
save a tremendous amount of money by having this provision repealed. 
That savings, as Mrs. Emerson said, could actually be used to increase 
the quality of the program, perhaps by filling up the donut hole or 
doing other things that would make it possible for seniors to have even 
more access to prescription drugs at a lower cost.
  Now, my Republican friends point to the fact that seniors may be 
receiving lower prices thanks to negotiations between private drug 
plans and drug manufacturers. But I will argue that significantly more 
savings could be achieved, and a majority of Americans, both Democrats 
and Republicans, agree that the government should be given the choice 
to further lower drug costs through negotiations.
  This is a no-brainer. Let us try it. It makes sense. Common sense 
alone tells us that the collective purchasing power of 43 million 
seniors will undoubtedly be a powerful bargaining tool in lowering drug 
costs. In their opposition to this legislation, Republicans and their 
special interest friends are using two arguments that are 
contradictory. First, they say price negotiations will have little 
impact in reducing drug costs; then they turn around and say we are 
killing innovation.
  How can we kill innovation if our legislation has no chance of 
lowering drug costs? Both of these statements can't be true. In fact, 
both are false. The truth is these are the same worn-out scare tactics 
our Republican friends in Congress and the administration have used 
against us before. These scare tactics will no longer work in this 
House where the Democrats have the majority, and this new Democratic 
majority is moving forward with our promise to make health care more 
affordable and more accessible.
  Vote ``yes'' on H.R. 4. I know we have some Republicans joining us on 
this because it is simply common sense.
  Mr. BURGESS. Mr. Speaker, I ask unanimous consent that I be allowed 
to yield to the distinguished ranking member of the full committee, Mr. 
Barton of Texas, and that he may control the time and yield as he sees 
fit.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Texas?
  There was no objection.
  The SPEAKER pro tempore. The Chair recognizes the gentleman from 
Texas (Mr. Barton).
  Mr. BARTON of Texas. Mr. Speaker, I yield myself such time as I may 
consume.
  First, I want to apologize to the body. I thought that we went in at 
10 o'clock this morning. When I left last evening, that is what it 
said. My staff did call me last night and tell me I needed to be on the 
floor by 9:30, but I thought they were gaming me, trying to get me here 
by 10 and telling me I had to be here by 9:30. Obviously, we did 
convene at 9, and I showed up at about 10 till. I thought I was 10 
minutes early. So I apologize to my brethren for not being here.
  There is an old saying that an apple a day keeps the doctor away, and 
a lot of us try to live by that. But in spite of our best efforts, 
sometimes we need prescription drugs. I am living proof of that. About 
a year ago, a year and a month ago, I was in a conference here in this 
Capitol with my friends in the other body, negotiating budget 
reconciliation instructions, and I had a heart attack.
  Until that day, I had seldom had to take prescription drugs. Since 
that day, I take five or six. I take a drug to lower my blood pressure. 
I take a drug to thin my blood. I take all kinds of drugs so that I 
don't have a repeat of the heart attack that I had 13 months ago.
  Now, I am not 65, so I am not covered by Medicare. I am in the 
standard Federal health benefit plan, Blue Cross/Blue Shield. And it 
does have a prescription drug benefit that partially pays for those 
drugs. But if I were to be over 65, which we have some Members of this 
body that are, I would have to be a part of Medicare and I would have 
an option under the current law to participate in Medicare part D, the 
prescription drug benefit program.
  Now, when my friends on the other side were in the majority for 40 
years, from 1954 to 1994, many of them sincerely, consciously wanted 
prescription drug benefits for Medicare. For whatever reason, it never 
quite happened. When the Republicans became the majority in 1994 and 
took over in 1995, it took us a while, we didn't get it done right 
away, but 3 years ago, we did pass a prescription drug benefit for part 
D, and it kicked in in the last Congress.
  It is voluntary. Seniors that don't want to participate don't have 
to. Approximately 90 percent of the seniors that are eligible, we are 
led to believe, have chosen some plan for a prescription drug benefit.
  Now, there are various plans. There are approximately 100 plans. 
These plans, some of them are very comprehensive. Some are very 
specific. Some are national, and some are regional. The long and the 
short of it is that every senior citizen in this country that wants a 
prescription drug benefit that is covered by Medicare can get one, and 
about 90 percent have chosen some plan; and of that, somewhere between 
75 and 80 percent seem very, very satisfied.
  The average cost in monthly premium is $22 a month. Twenty-two 
dollars a month. There are some plans, I am told, that have zero 
premiums; you don't have to pay to participate. Within those plans, 
over 4,400 drugs are covered. In some of these plans, generic drugs are 
free. In some of these plans, the donut hole does not exist.
  So through diversity and market competition, we have created a 
prescription drug benefit for senior citizens in America that seems to 
be working very, very well.
  Now, my friends on the Democrat side, the new majority, have come in, 
and they have got this bill up today. They want the government to 
negotiate prescription drug prices. On the surface, that may seem like 
a good idea. In reality, it would be a terrible idea. Who is going to 
do better than market forces with thousands and thousands of people and 
hundreds of plans and millions of people choosing whether to 
participate in this plan or that plan? What government bureaucrat, even 
somebody as smart and distinguished as the current Secretary of HHS, 
Secretary Levitt, who is going to do better than that?
  Now, this concept that the government can negotiate a better price is 
simply not true. The CBO has come out and said it is not true, various 
think tanks have come out and said it is not true. But if you think it 
might be true, think of the products for which the government is the 
only purchaser and ask yourself, do we get the absolute best price?
  There are not many products that the government is the only 
purchaser, but there are some. Aircraft carriers. There is not much 
demand for an aircraft carrier in the private market, so the U.S. 
Government is the only purchaser of aircraft carriers. An average cost 
of an aircraft carrier right now, I think, is about $5 billion. Now, we 
get a very quality product. The USS Reagan is the epitome of an 
aircraft carrier. But I don't believe we could say that we buy it at 
the absolute rock bottom price.
  Now, we may not want to when it comes to some of our military 
equipment. We may not want to get the absolute best price. We may want 
to get the absolute best product, and so we are willing to pay a 
premium for that.

                              {time}  1000

  But there is really no way that a person in the Federal Government, 
or a group of people in the Federal Government, is going to replicate 
the thousands and thousands of market forces that are in play today.
  So of all the ideas that my friends in the new majority have brought 
forward in their first 100 hours, I would respectfully say this has got 
to be the worst one. And I don't mean that in a mean way.
  We have a program, Medicare part D prescription drug benefit, that is 
working. The people that can participate are choosing wisely. The 
premiums are coming down. The cost is coming down. It covers over 4,400 
drugs. It is working.
  As they say in many parts of our country, if it ain't broke, don't 
fix it. So I would respectfully urge the body later today to defeat 
this program.
  Mr. Speaker, I rise in opposition to H.R. 4, the Medicare 
Prescription Drug Price Negotiation Act of 2007. This bill reduces 
access to drugs, creates a massive new pricing bureaucracy, slows 
access to drugs, and disrupts a

[[Page H444]]

program that works. Let me restate--this program works. Beneficiary 
premiums are 42 percent lower than expected, overall costs are 30 
percent lower than anticipated, and more importantly, seniors like what 
they are getting. Beneficiary satisfaction with their drug benefit is 
80 percent or higher. So if it works, why break it?
  Upon reading H.R. 4 there are some things that I know, some things 
that I don't know, and some things that I fear to be the case. Here's 
what I know. I know that there's a prescription drug benefit available 
in this country for 43 million Medicare beneficiaries. Of those folks, 
90 percent now have some form of drug coverage.
  I know that premiums are now down to around $22 per month for those 
that choose to enroll in this new benefit. And that's lower than last 
year because competition continues to drive the premiums down.
  I know that beneficiaries like their new drug benefit. I know that 
beneficiaries are getting the drugs of their choice at the pharmacies 
of their choice, all at low costs. And I'm told, sometimes at zero cost 
for some drugs if they choose generics. Should I say that again? That's 
zero costs for some drugs. Here's a question--how does the government 
negotiate a lower price than zero?
  H.R. 4 will not produce any savings. Why do I say that? The 
Congressional Budget Office has stated multiple times the federal 
government can not get lower prices than those currently achieved 
through competition. CBO must also know, what I know, and that is 
competition works.
  Here's what else I know--H.R. 4 requires the government to negotiate 
prices that may be charged for drugs. But what else does H.R. 4 do? 
That's hard to tell because H.R. 4 doesn't say much more. Is the bill 
just poorly drafted or is it intentionally silent about the multitude 
of beneficiary and pharmacy protections in the current drug program 
that could be eliminated?
  Upon reading H.R. 4, I do not know if plans will be able to offer the 
same wide array of drug choices as under the current program. I do not 
know if our seniors are protected from being stripped down to just one 
or two drugs offered from the many they may now choose from to best 
suit their health needs. I do not know if there are protections in 
place to assure access to robust pharmacy networks, and I do not know 
if pharmacy reimbursement associated with dispensing drugs could be 
limited, eliminated, or otherwise restricted.

  What I fear is that H.R. 4's silence on these very important 
questions means that such beneficiary and pharmacy protections have not 
been considered. What I fear is the effect H.R. 4 may have on 
beneficiary access to drugs and pharmacies. Unfortunately, there have 
been no hearings or mark-ups to discuss and debate these important 
issues.
  And even with knowing that H.R. 4 produces no savings, that 
beneficiaries overwhelmingly like this benefit, that the benefit works, 
that pharmacies are participating, and that premiums and overall costs 
are down, Democrats--led by Speaker Pelosi--feel compelled to blindly 
undermine this program with no legislative record to back up their 
claims. I am saddened. I am sad today for America's seniors because 
H.R. 4 serves no purpose other than a political one. We should not be 
playing politics with our seniors' access to drugs and pharmacies. We 
should be encouraging more seniors to enroll in this benefit, not tear 
it apart. Sadly, that is not what the Democrats have chosen to do in 
their first 100 hours of power.
  And for what? We know from the experiences in other countries that 
government mandated drug formularies and interference in drug pricing 
leads to substantially less drug innovation and rationing of access to 
the new medicines that do come to market. Under the current program, a 
senior can choose a plan that will provide access to new drugs that 
slow heart disease, ease pain, keep families together longer, cure 
disease, and provide a longer and higher quality of life. In other 
countries with government run prescription drug plans citizens must 
wait years for new therapies. That's if the government chooses to 
provide the drug at all, just ask the cancer patients in the United 
Kingdom who waited years for the new breakthrough drug Herceptin to be 
covered.
  How big and slow will this Big Government Pricing bureaucracy be? 
It's hard to tell with no hearings. With over 4,000 drugs, different 
economic conditions every year, new drugs entering the market all the 
time, and incredibly complicated questions about how this would work, 
the Pelosi plan will create a bureaucratic nightmare, but more 
importantly will endanger access to life improving and lifesaving 
medications and therapies. If you are as frustrated as I am about the 
unfairness of how the government pays physicians under Medicare, be 
prepared for more frustration on getting this political pricing scheme 
to work.
  What about the effect of H.R. 4 on taxpayers receiving health 
coverage through private insurance or other federal purchasers? The 
non-partisan Government Accountability Office (GAO) said in a 2000 
report entitled Expanding Access to Federal Prices Could Cause Other 
Price Changes that this type of system could raise drug prices for non-
governmental purchasers. So according to the GAO, government 
negotiation in Medicare could lead to higher insurance costs for people 
with an employer sponsored health plan, a labor union plan, or even an 
individual insurance policy. Yet the Democrats have not held one 
hearing on this bill.
  I ask what we are doing here today. Research firm after research firm 
has shown that large majorities of beneficiaries have a positive view 
of the prescription drug benefit. That is probably what is galling the 
Democrat leadership. A Republican Congress and President has passed and 
worked hard to administer a very popular program.
  Within 100 hours the Democrat leadership has reneged on its campaign 
statement of bipartisanship, reneged on their campaign statement of 
open and considered legislative process, flip-flopped from a position 
of non-interference that they held in numerous bills, made hollow their 
statement of supporting an innovation agenda, and again shown their 
penchant for favoring Big Government mediocrity over choice, 
competition and accountability.
  I was here for Contract with America. Those bills we passed with the 
Contract had hearings with many witnesses, Committee mark-ups and 
amendments, and opportunities for amendments on the floor. Who is hurt 
by lack of process on H.R. 4? Beneficiaries. Taxpayers. Pharmacists. 
Everyone. Without hearings on H.R. 4, without opportunity to develop 
solutions to concerns and understand the consequences of our actions, 
everyone loses. Particularly seniors.
  In Speaker Pelosi's district there are over 81,000 Medicare 
beneficiaries and 103 pharmacies. How many hearings have there been to 
consider whether there are any beneficiary and pharmacy protections 
under H.R. 4? Zero.
  Let's build that out a little more. The total number of Medicare 
beneficiaries represented by Members of the Energy and Commerce 
Committee is 5.4 million and there are 6800 pharmacies.
  The total number of Medicare beneficiaries represented by Congress is 
close to 43 million. There are over 53,000 pharmacies. The consequences 
of this legislation are potentially grave and yet there has been 
absolutely no process given to determine how it would affect these 
important constituencies.
  I don't mind an open discussion on the new Medicare drug benefit. We 
have had hearings on the benefit when I was the Chairman of the Energy 
and Commerce Committee. I like the fact that the Energy and Commerce 
Committee plans to hold more hearings this year. It gives me an 
opportunity to tout the program's successes. Seniors are seeing real 
savings and the cost of the program continues to decrease thanks to 
choice and competition. What I don't like is the purely political 
exercise we are being put through today that will jeopardize the access 
to needed drugs that the 63,000 beneficiaries in my district currently 
enjoy. I urge all members to oppose this process and oppose this ill 
conceived piece of legislation.
  Mr. Speaker, I reserve the balance of my time.
  Mr. DINGELL. Mr. Speaker, it is with great pleasure that I yield to 
the distinguished gentlewoman from Florida, a very able Member of this 
body, 1 minute to our distinguished friend and colleague from Florida, 
Kathy Castor.
  Ms. CASTOR. Mr. Speaker, I urge my colleagues to act today to require 
the Bush administration to negotiate prescription drug prices under 
Medicare part D so that we can achieve savings for our seniors and for 
all Americans.
  In my district in the Tampa Bay area, one in seven residents is 
dependent upon Medicare for their health care needs. And over the past 
year, assisted seniors were struggling with the complicated and 
confusing part D. They do not like being forced into HMOs. Many were 
frustrated in Florida from having to choose from 43 different HMO 
plans. And then they did not receive straightforward assistance from 
the Bush administration.
  I thank the chairman for his pledge to fight for greater reforms, but 
today is our first step.
  It is unfair that HMOs and drug companies are making huge profits off 
the backs of our seniors. In the last Congress, part D was crafted to 
benefit the HMOs and insurance companies and not our seniors. But the 
Democrats know how to fix this.
  A recent Family USA study found that for the most prescribed drugs, 
VA prices are much lower than the prices charged by insurers.
  So let's act today and prove to our older neighbors and all taxpayers 
that we heard their pleas for help.

[[Page H445]]

  Mrs. EMERSON. Mr. Speaker, at this time I yield 2 minutes to the 
distinguished colleague of ours from Farmville, North Carolina (Mr. 
Jones).
  Mr. JONES of North Carolina. Mr. Speaker, I rise in support of H.R. 
4, the Medicare Prescription Drug Price Negotiation Act, a bipartisan 
bill to allow the Federal Government to negotiate the best price on 
prescription drugs for our seniors.
  The current Medicare prescription drug law prohibits the Federal 
Government from negotiating the best prescription drug prices for 
Medicare's 43 million beneficiaries.
  Mr. Speaker, let me share with the House a practical example of how 
severe the problem of rising prescription drug prices is for our 
seniors. A woman from my district in eastern North Carolina saw her 
monthly prescription bill go from $6 per month to almost $60 a month. 
She spoke to a local TV station and said she would not have money for 
food if she had to pay that much each month. From $6 to $60 a month.
  Mr. Speaker, the American people want us to pass this legislation. In 
a recent poll, 92 percent of Americans voiced their support for this 
bill. Ninety-two percent of the American people.
  I have read reports that the President has pledged to veto this 
legislation. Sadly, yet again, the President is not listening to the 
American people.
  Mr. Speaker, this is a bipartisan bill with support from both sides 
of the aisle and the support of the American people.
  Mr. Speaker, it is time that this House listens to the American 
people, and it is time that this administration listens to the American 
people. And it is time for this House and the President to listen to 
this woman who represents millions of people across this Nation whose 
bill is going to go from $6 to $60 a month.
  Mr. Speaker, I hope that the House will pass this legislation, and I 
hope that we will have the number of votes to override the President's 
veto.
  Mr. BARTON of Texas. Mr. Speaker, I yield 3 minutes to the 
distinguished member of the full committee, Mr. Upton of Michigan.
  Mr. UPTON. Mr. Speaker, I have to believe that we all support 
ensuring that Medicare beneficiaries are getting the very best deal 
possible on their prescription drugs and that they want that, that they 
have access to drugs that their doctors believe will work best for 
them, and that they will continue to get their prescriptions filled at 
their local pharmacist. And in many rural communities, and in urban 
ones too in Michigan and across the country, the local pharmacist, in 
fact, is on the front line of health care. H.R. 4 doesn't get us there.
  As many have mentioned and will mention today, the CBO estimates that 
having the government negotiate drug prices would, in fact, have a 
negligible effect on prescription drug prices. The current program 
which relies on the experience and expertise of the private sector drug 
plans and on strong market-based initiatives, incentives, is producing 
significant savings today for our seniors.
  Here's a real example: one of my staffers reported that her mom 
signed up for a Medicare prescription drug plan. It took a bit of doing 
to sort through the many options available, but she is very glad that 
she did. She was paying before $106 for her Glucovance diabetes 
prescription. Now she is paying $5. She was paying $202 for Actos, 
another diabetes medication that she needs. She is now paying $30. And 
she was paying almost $29 for Coumadin. Now she is paying $5.
  While failing to produce savings like these, many are concerned that 
H.R. 4, as currently written, would undermine access to medically 
necessary drugs for persons with HIV/AIDS, serious mental illnesses, 
ALS, epilepsy and other diseases and conditions. And let me quote from 
a letter I received this morning from the President of the Michigan 
Brain Injury Association: ``Let me exhort you to take the time to have 
adequate committee deliberations on H.R. 4 prior to its passage on 
behalf of our constituents and all persons with disabilities. 
Significant modifications are necessary to protect patients' access to 
prescription drugs as currently provided under Medicare part D.''
  Needless to say, we have not had a minute of committee negotiations 
since we were sworn in.
  Finally, while the current program includes requirements that 
beneficiaries have ready access to prescriptions through their local 
pharmacies, real concerns have been raised that H.R. 4 could seriously 
undermine that local access. That is why we need to vote for the motion 
to recommit which addresses those concerns.
  Mr. Speaker, the bottom line is this: we do, everyone here does, want 
folks with Medicare to get all of the prescription drugs at the very 
best price. And I believe that consumer choice and the private sector 
competition can better drive lower cost and more availability than 
forcing the government to negotiate prices which may, indeed, lead to 
the withdrawal of drugs from the program alltogether.
  As Secretary Leavitt wrote earlier this week: ``There is a proper 
role for government in setting standards and monitoring those who 
provide the benefit. But government should not be in the business of 
setting drug prices or controlling access to drugs.''
  Mr. DINGELL. Mr. Speaker, I am delighted at this time to yield to the 
distinguished chairman of the Oversight and Investigation Subcommittee, 
my distinguished colleague from Michigan (Mr. Stupak) 2 minutes.
  Mr. STUPAK. Mr. Speaker, today Democrats are keeping another promise 
to the American people as we bring H.R. 4, the Bipartisan Prescription 
Drug Negotiation authority to the floor.
  While Members may not agree on how best to address the health care 
needs of America, one thing is certain: the United States has the 
highest drug prices in the world, and those prices keep going up. 
Today's legislation is a first good step to help lower the costs of 
prescription drugs for Americans. We can, and Democrats will, do more 
to lower the cost of prescription drugs in this country.
  In America, everyone pays something different for their prescription 
drugs. If you have private insurance, your health plan negotiates lower 
drug prices for you. If you are covered by Medicaid, each State 
Medicaid program determines its own drug acquisition costs, and your 
State may negotiate additional rebates or discounts from drug 
manufacturers to further lower the price. If you are a veteran 
receiving health care at the VA, the Federal Government negotiates drug 
prices for you.
  According to a recent Families USA study, the lowest price charged by 
the largest part D Medicare insurers for prescription drugs is at least 
58 percent higher than the price under the system used by the Veterans' 
Administration.
  It makes no sense for one Federal program to use its purchasing power 
to leverage lower prices, while another Federal program, Medicare, is 
forbidden by law, Republican law, from acting on behalf of its 
beneficiaries. The result is windfall profits to the drug companies.
  The current Medicare prescription drug law prohibits the Secretary of 
Health and Human Services from conducting low cost-reducing 
negotiations. Today the House will repeal that provision.
  I urge the Members to vote ``yes'' on H.R. 4, as it is a good step, 
the first step in lowering the cost of prescription drugs for seniors 
and all Americans.
  Mr. BARTON of Texas. Mr. Speaker, I yield 3 minutes to the 
distinguished ranking member of the Health Subcommittee, Mr. Deal of 
Georgia.
  Mr. DEAL of Georgia. Mr. Speaker, as a member of the Energy and 
Commerce Committee, which spent hundreds of hours passing and dealing 
with hearings relating to this prescription drug benefit under Medicare 
part D, I rise in opposition to H.R. 4. I think it is hastily 
considered legislation that has been brought without the opportunity to 
evaluate several important ingredients, one being its impact on our 
local community pharmacists and their ability to provide access to 
citizens in our community.
  One aspect of the current prohibition against the government 
negotiating is that it also prohibits the government from negotiating 
pharmacist fees. This reimbursement that they receive often comes in 
the form of dispensing fees which they use to help pay for their 
services in filling the prescriptions, of course. And I believe they 
are vital to the operation of local pharmacies because they help cover 
all of their costs associated with performing their duties.

[[Page H446]]

  Yet, this legislation provides no protection for the nearly 2,000 
pharmacies in my State, or over 50,000 across the country.
  The independent actuaries at CMS have already indicated that the 
Secretary will have limited ability to negotiate drug prices without 
the authority to establish formularies, an authority which is 
explicitly prohibited in this bill. Therefore, as the government seeks 
to fulfill the mandate of H.R. 4, to negotiate lower prices on drugs, I 
believe they will be forced to save in other areas, specifically 
cutting dispensing fees to pharmacists.
  Without guaranteed dispensing fees for the pharmacists, many local 
pharmacists are going to have to leave the Medicare drug program, or 
the government's negotiations may lead to seniors being forced to fill 
some of their prescriptions by mail order and being unable to use their 
local pharmacist. At the least, these pharmacists will feel an 
unnecessary squeeze from this Democratic meddling into a successful 
program that has saved seniors millions of dollars and with which most 
of them are overwhelmingly happy.
  I recognize that there are certain pharmacy groups that have 
supported this measure, but I believe that their letters of support do 
not address the real basic concern, and that is, the fact that 
dispensing fees may be the part that is in jeopardy.
  For example, if the government has negotiated a set price for all 
programs, how is program A going to differentiate itself in premium 
from the program of company B?
  I believe that it is going to squeeze the dispensing fee, and the 
pharmacist is the only one left in the middle to be squeezed. I would 
say, for the sake of our seniors and their access to their local 
pharmacists and for those pharmacists who want to stay in business and 
be a part of this program, I would urge support of the Republican 
motion to recommit which takes steps to protect the local pharmacist 
and receive a fair dispensing fee.

                              {time}  1015

  Mr. DINGELL. Mr. Speaker, I yield to the distinguished gentleman from 
Rhode Island (Mr. Kennedy) for 1 minute.
  Mr. KENNEDY. Mr. Speaker, I am thrilled to join my colleagues in 
support of H.R. 4, legislation that will give the Secretary of Health 
and Human Services the power to negotiate with drug companies for lower 
prices for Medicare beneficiaries. I would like to thank the gentleman 
from Michigan and my good friend, the Chairman of the Energy and 
Commerce Committee for his good work on this legislation in bringing it 
to the floor.
  Mr. Speaker, this is an important day, because this is a day where we 
take this Congress back from the special interests. We take it back 
from the drug companies and the HMOs, and we give it back to the people 
of this country and to the taxpayers. We take it from the drug 
companies who are charging excessive costs for profits for these 
prescription drugs to the detriment of our senior citizens who are 
paying exponentially high drug costs in the donut hole, and our 
taxpayers, who are paying 80 percent higher for these costs, and now we 
are going to be able to save those taxpayers and those consumers 
dollars by negotiating lower drug costs.
  The taxpayers and the consumers are winners under H.R. 4. I urge its 
passage.
  I am thrilled to join my colleagues in support of H.R. 4, legislation 
that will give the Secretary of Health and Human Services (HHS) power 
to negotiate with drug companies for lower prices for Medicare 
beneficiaries.
  I would like to thank the gentleman from Michigan, and my good friend 
and Chairman of the Energy and Commerce Committee for his work to bring 
this issue to the floor today.
  I hear my friends on the other side of aisle singing praises for 
Medicare Part D, the new prescription drug plan.
  But I wonder if the constituents I speak with receive the same 
benefit that these members are describing.
  When I meet with seniors back home in Rhode Island, I hear about 
confusing formularies and crippling costs in the so-called ``donut 
hole.''
  I hear about nursing home patients who are no longer able to afford 
their new co-pays.
  And then I hear a statistic stating that drug prices under Part D are 
more than 80 percent higher than prices negotiated by other agencies in 
the federal government.
  When the Medicare Part D law was written, the drug companies had the 
loudest voice at the table.
  Today, we are here to bring the voice of our seniors back to the 
bargaining table, and back to the floor of the U.S. House of 
Representatives.
  I urge my colleagues to vote in support of H.R. 4 and to put the 
needs of the American people before those of special interests.
  Mr. BARTON of Texas. Mr. Speaker, I am going to yield 2 minutes to 
one of our most distinguished Members, Dr. Price, for 2 minutes.
  (Mr. PRICE of Georgia asked and was given permission to revise and 
extend his remarks.)
  Mr. PRICE of Georgia. Mr. Speaker, this is a solution truly in search 
of a problem. We have heard of the success of the current program. We 
have heard a lot about special interests. Well, I rise to tell you that 
the patients of this Nation are my special interests. As a physician, I 
have seen and know that increased governmental involvement will 
decrease the drugs available and will harm patients. Some say, well, 
the VA system works just fine, and the government negotiates prices 
there; why not use that same system?
  Well, there is no way to compare those two systems, Mr. Speaker. They 
are absolutely apples and oranges. VA is a closed system. Medicare is 
an open system that offers choice that patients want. VA has no retail 
pharmacy benefits, none. Medicare provides access to community 
pharmacists, where many seniors receive great information and support.
  I have worked in the VA. I know what it means when they offer you, 
when they give the physicians a list of drugs that they are able to 
provide the recipients in a VA system. It doesn't work. It is a 
decreased formulary. There are those who think that they are going to 
get the pharmaceutical companies by adopting this bill.
  Mr. Speaker, all they will do is hurt patients. We will ultimately 
see higher costs, fewer drugs available, less quality health care and 
patients harmed. Those supporting H.R. 4 think that they know what is 
best for patients. We simply believe that as a matter of principle it 
is patients and doctors who should be making personal health care 
decisions, including the medications used.
  Mrs. EMERSON. Mr. Speaker, I yield myself such time as I may consume.
  I simply want to respond to an issue that was raised by our colleague 
from Georgia with regard to the impact on community pharmacists. I 
would submit for the Record this letter, statement by the Association 
of Community Pharmacists in support of H.R. 4 saying H.R. 4 does no 
harm to community pharmacists. We cannot find any provision in H.R. 4 
that would either improve or diminish the situation that they are 
currently faced with regard to the pharmacy benefit managers who are 
negotiating with them as well as well as taking profit from the 
pharmacies. This is what is happening because of Medicare part D today.

   The Association of Community Pharmacists Statement on H.R. 4 and 
 Response to Assertions That H.R. 4 Is Harmful to Community Pharmacists

       H.R. 4 does no harm to community pharmacists. The real harm 
     done to community pharmacists occurred when Congress passed, 
     and the President signed into law, the original Medicare 
     Modernization Act (MMA) in 2003. Direct negotiation as 
     contained in H.R. 4 will not directly impact pharmacies 
     because pharmacies are currently being reimbursed at a loss 
     regardless. If this legislation succeeds in bring drug prices 
     down, it will only reduce the top line sales figure--but will 
     have no effect on the gross margin of pharmacies or the 
     ability of pharmacies to continue to operate.
       The MMA allowed for Pharmacy Benefit Managers (PBMs) to 
     mandate ridiculously low dispending fees with no minimum to 
     protect pharmacies. ACP cannot find any provision in H.R. 4 
     that would either improve or diminish this situation.
       The real problem in Medicare Part D is that PBM profits 
     have increased at the expense and detriment of beneficiaries 
     and community pharmacies. Beneficiaries and community 
     pharmacies will not have any true relief until Congress stops 
     the PBMs from taking a vast and disproportionate share of the 
     money out of the system.

  Mr. DINGELL. Mr. Speaker, I am delighted to yield to the 
distinguished gentlewoman from California, valuable member of the 
committee, Ms. Eshoo, 2\1/2\ minutes.
  Ms. ESHOO. I thank our distinguished chairman and am proud as an

[[Page H447]]

original cosponsor to support the bill that is before us.
  Mr. Speaker, when the Medicare part D legislation was brought to the 
floor of the House of Representatives in 2003, I voted against it. I 
think it is worth recalling that evening. I think it is worth recalling 
that evening. The 15-minute vote on the clock was left open for almost 
3 hours, where arms were broken and twisted in order to secure passage 
of the bill.
  One of the most troubling aspects of the legislation to the American 
people, and we have all heard it from our constituents, was that the 
legislation said that the Secretary of Health and Human Services was 
prohibited, prohibited, from securing the best price to purchase 
pharmaceutical drugs. That is a bad rub with the American people.
  They saw through it, and we are here today to correct that provision. 
Drug prices under the current Medicare prescription drug plan are more 
than 80 percent higher than prices negotiated by other agencies in the 
Federal Government.
  They are more than 60 percent higher than prices in Canada. This year 
alone, many beneficiaries and private drug plans will see their 
premiums increase by an average of 10 percent, while some premiums will 
rise to more than six times their current costs to beneficiaries. So 
this effort today is a very full and clear and purposefully directed 
one, and that is to get better prices for prescription drugs.
  Whether you are covered by insurance or not, some here are in 
Medicare, some not, as Members of Congress, but you know, that when you 
go to buy, when you go to purchase, that we are paying high prices. We 
all support the innovation of the pharmaceutical industry.
  We know how important the innovation of the pharmaceutical industry 
is. This is not a vote or a bill to harm that or to damage it, but we 
want to be fair to the American people. We made a pledge that we would 
do this. This correction is more than in order.
  I ask my colleagues to support this bipartisan legislation. I want to 
congratulate Mrs. Emerson for the courage that she has demonstrated on 
this issue over the years.
  Mr. Speaker, as an original cosponsor, I rise in support of H.R. 4, 
the Medicare Prescription Drug Price Negotiation Act of 2007 which will 
repeal a provision of the 2003 Medicare law which prohibits the 
Secretary of HHS from negotiating lower drug prices for Medicare's 43 
million beneficiaries. The bill not only permits the Secretary to 
negotiate, it requires him to.
  Mr. Speaker, I opposed the Medicare Part D prescription drug plan 
passed by the House in 2003, and in the nearly three years since its 
passage it has been demonstrated conclusively that it does not contain 
drug price inflation, nor does it offer our nation's seniors the best 
prices for their prescription drugs. A recent Families USA study shows 
that under the current policy, prices charged by Medicare drug plans 
are in fact rising at more than twice the rate of inflation.
  Drug prices under the current Medicare prescription drug plan are 
more than 80 percent higher than prices negotiated by other agencies in 
the federal government and they are more than 60 percent higher than 
prices in Canada. This year alone, many beneficiaries in private drug 
plans will see their premiums increase by an average of 10 percent, 
while some premiums will rise to more than six-times their current cost 
to beneficiaries.
  This week the University of Michigan Medical School released a study 
which found that people who live in different states but take the same 
drugs, pay dramatically different prices for their prescription drugs, 
at times differing by thousands of dollars. The authors of the study 
found the extreme disparities were due to the fact that individual drug 
plans negotiate with pharmaceutical companies to devise their own drug 
lists, premiums and co-pays.
  Under the legislation before us, the Secretary of Health and Human 
Services will not only be required to conduct important cost-saving 
negotiations, but individual drug plans will still be permitted to 
obtain further discounts or prices lower than the price negotiated by 
HHS for covered prescription drugs. This will encourage increased 
competition in the marketplace, which will help guarantee America's 
seniors the lowest price possible on their prescription drugs.
  In an additional effort to encourage lower drug prices, the bill also 
expressly prohibits the Secretary from limiting seniors' access to 
certain medications, or from favoring one drug over another through 
restrictive formularies.
  The House Committee on Oversight and Government Reform estimates H.R. 
4 will reduce overall drug costs by 25 percent. Over a 10-year period, 
the total savings for Medicare beneficiaries would reach an estimated 
$61 billion. These savings would be reflected in lower premiums, I 
reduced co-pays, and lower out-of-pocket costs for beneficiaries in the 
``doughnut hole.''
  Mr. Speaker, America's seniors deserve better than the current 
Medicare drug plan, and the American people know it.
  Mr. BARTON of Texas. Mr. Speaker, I would like to yield 2 minutes to 
the distinguished Congresswoman from Florida (Ms. Ginny Brown-Waite).
  Ms. GINNY BROWN-WAITE of Florida. I thank the gentleman for yielding.
  Mr. Speaker, I rise today to let Florida's seniors and all of 
America's seniors know the scary truth about H.R. 4, the legislation 
to, quote, negotiate prescription drug prices in Medicare. While the 
rhetoric would lead you to believe that H.R. 4 is the same legislation 
from the past that I actually supported, kind of like GM said, it is 
not your father's Oldsmobile. This is not the same bill as last year.
  Last year's legislation, I believe, was based on sound policy. 
Unfortunately, the bill before us today was crafted kind of like in the 
middle of the night, with no real input from the other side, and it 
could be described as a bait-and-switch game foisted on America's 
seniors.
  As I said at the outset, I believe that this bill will actually harm 
America's seniors. Supporters of the bill talk about negotiation. The 
government doesn't really negotiate.
  Let me give you an example. Here is the example of the Medicare part 
D, actually, the AARP plan, where over 100 great drugs are covered.
  However, if you look at when government does negotiate, it excludes 
some very important drugs to seniors, such as Crestor, Detrol, Evista, 
Flomax, Lipitor, Prevacid and Vytorin. How many seniors are on 
medicines such as Lipitor? A large number. It is absolutely necessary 
for lowering cholesterol. But when you start to negotiate, that array 
of drugs that are available is suddenly shrunk.
  Prescription drug access is not a partisan issue. My constituents 
know that I am not afraid to cross party lines to get things done. 
Throughout this entire 2-week period, I voted for legislation, but I 
don't support this bill because it is a bait-and-switch.
  I do not stand alone in this belief. Veterans' organizations, mental 
health organizations and even CBO say it is a bad bill.
  Mr. Speaker, I rise today to let Florida's seniors know the scary 
truth about H.R. 4, legislation to negotiate prescription drug prices 
in Medicare.
  While the rhetoric from the other side would lead you to believe that 
H.R. 4 is the same legislation debated in the past, I rise to tell you 
that H.R. 4 is not your father's Oldsmobile.
  In the I09th Congress, I supported bipartisan legislation introduced 
by Representative Jo Ann Emerson that would have allowed HHS to 
negotiate prescription drug prices for Medicare.
  Mrs. Emerson's legislation was based on sound policy, and would have 
been open to amendment on the House floor.
  Unfortunately, the bill before the House today was crafted by 
Democrats in the middle of the night, and with no Republican input. It 
is nothing but a dangerous bait and switch game foisted on American 
seniors.
  Even more damning to the Democrat's commitment to open government, 
this bill is being debated under a martial law rule, with no 
possibility to offer amendments or make improvements.
  As I said at the outset, this bill will harm American seniors.
  Supporters of H.R. 4 hold up the Department of Veterans Affairs as a 
resounding prescription drug success. And I agree this is a great 
program.
  However, these misinformed Members are comparing apples to oranges.
  The VA does not haggle over prices with pharmaceutical companies; 
rather, it follows certain formulas set in federal law.
  Medicare has 4,300+ drugs approved; the VA only has 1,300 drugs 
approved.
  Medicare supports the newest and most widely used drugs; the VA 
relies on older and less effective drugs. Lipitor, for example, which 
helps lower cholesterol and prevents heart attacks, could be 
eliminated. The VA does not offer it!
  These three examples make it clear that if the Democrats follow the 
VA model, seniors will have fewer choices and older, out-of-date drugs.
  In fact, groups like the Military Order of the Purple Heart and the 
American Legion believe that Medicare drug negotiation will actually 
increase drug prices and cost American veterans even more each month!

[[Page H448]]

  You know, all of us fill our shopping cart at the grocery store each 
week. The consequence of H.R. 4 will be to force your grocery store to 
offer fewer items and limit your shopping choices. Here's just one 
example.
  Eighteen months ago, I met a World War II veteran who told me that he 
and his wife were paying $2,000 a month out of pocket for a 
breakthrough medication that her doctor prescribed (Glevac).
  This was a severe financial burden, just to purchase the medicine to 
keep her alive.
  Today, with the Medicare Prescription Drug plan, this couple not only 
gets Glevac medication, but has had their costs cut to almost nothing.
  If H.R. 4 were to become law, it is likely that anti-cancer drugs 
like this one would be taken off the Medicare list and replaced with 
older and less effective ones.
  Let me be clear to everyone watching on C-SPAN.
  Prescription drug access is not a partisan issue.
  My constituents know that I am not afraid to cross party lines to get 
things done.
  Just yesterday I voted to support stem cell research. The day before 
that I voted to raise the minimum wage.
  And, I do support allowing HHS to negotiate prescription drug prices.
  But this bill is a bait and switch tactic.
  The Democrats have crafted a seriously flawed plan, one that I 
believe will cause irreparable harm to millions of seniors.
  And I do not stand alone in this belief. Veteran's organizations, 
mental health organizations, and others all have come out in opposition 
to H.R. 4. The non-partisan CBO says it will not save money.
  Listen up America--let's be cautious on this issue. The last thing 
Congress needs to do is to take steps that unwittingly hurt our 
seniors.
  I urge my colleagues to oppose this bill.
  Mr. DINGELL. Mr. Speaker, I yield 2 minutes to our able colleague and 
dear friend, Mr. Gene Green of Texas.
  Mr. GENE GREEN of Texas. I thank the chairman of my committee for 
yielding to me.
  Mr. Speaker, when Congress created the Medicare prescription drug 
benefit over 3 years ago, it failed to put seniors first. Our 
committee, the Energy and Commerce Committee, sat through the all-night 
markup in our own committee to see this bill come out of committee.
  The whole House sat in this Chamber, an all-night vote, to pass that 
bill by such a narrow margin after the vote was held open. Today is the 
day we get a chance to correct the problems that were created 3 years 
ago.
  This bill, the law, put the pharmaceutical industry ahead of our 
seniors. It put the health insurance industry ahead of our seniors. The 
bill will correct those mistakes. Opponents of this bill raise the 
charges of big government saying, let the market work. That is exactly 
what this bill will do. It will leverage the buying power of 42 million 
American seniors that negotiate costs of prescription drugs under 
Medicare.
  Negotiation of drug prices is alive and well in every sector of the 
health care industry. States negotiate for lower prices on their 
Medicare programs. Pharmacy chains do the same thing for the drugs they 
purchase. They don't have formularies. They purchase drugs for their 
customers, so pharmacy chains can do the same thing.
  All this bill does is allow the Medicare program to use a tool for 
free market bargaining best prices for its beneficiaries. Rarely will 
you see overwhelming support for an issue like we have seen on this 
one. Ninety-two percent of Americans agree that we should take off the 
handcuffs that have been restraining the Medicare program and give it a 
chance to achieve greater discounts.
  The alternative is increasing drug costs and increasing premiums that 
make the benefit harder for our seniors to afford. The numbers don't 
lie. Under the current structure, 77 percent of seniors saw their 
premium part D increase in 2006 and 2007, and more than one-quarter of 
them saw their premiums rise more than 25 percent.
  Drug prices under part D are increasing too with costs for the top 20 
drugs increasing 3.7 percent in the last 6 months.
  When Congress created the Medicare prescription drug benefit over 
three years ago, it failed to put our seniors first. It put the 
pharmaceutical industry ahead of our seniors. And it put the health 
insurance industry ahead of our seniors. This bill will correct those 
mistakes.
  Opponents of this bill raise charges of big government, saying to let 
the market work. That's exactly what this bill does by leveraging the 
buying power of 42 million American seniors to negotiate the cost of 
prescription drugs under Medicare.
  Negotiation for drug prices is alive and well in every other sector 
of the health care industry. States negotiate for lower prices under 
their Medicaid programs. Pharmacy chains do the same for the drugs they 
purchase.
  All this bill does is allow the Medicare program to use a tool of the 
free market--bargaining--to obtain the best prices for its 
beneficiaries. Rarely do we see overwhelming support for an issue like 
we've seen for this one. 92 percent of Americans agree that we should 
take off the handcuffs that have restrained the Medicare program and 
give it a chance to achieve greater discounts.
  The alternative is increasing drug costs and increasing premiums that 
make the benefit harder for seniors to afford. The numbers don't lie. 
Under the current structure, 77 percent of seniors saw their Part D 
premiums increase from 2006-2007. And more than one-quarter of them saw 
their premiums rise more than 25 percent.
  Drug prices under Part D are increasing too, with costs for the top 
20 drugs increasing 3.7 percent over six months. That's 7.4 percent 
over a year--an increase twice the rate of inflation and one that will 
cause our seniors to hit the doughnut hole even sooner.
  We have a chance today to do better by our seniors. It's about time 
we put our seniors first and let Medicare work for them.
  Mr. BARTON of Texas. Mr. Speaker, I would like to yield to the 
distinguished gentleman from Nebraska, a member of the committee, Mr. 
Terry, for 2 minutes.
  Mr. TERRY. Mr. Speaker, I rise today in opposition of this bill. I am 
committed to reducing drug prices for seniors, but this bill does not 
do it. I have worked as hard as anyone in this Chamber to help seniors 
enroll in prescription part D.
  It has been in place for a little over a year now. I think it is time 
that we kind of look at how effective it is in ways that we can ensure 
that we are getting the lowest prices for our seniors. Now, let us look 
at how we do this.
  I want to stress one difference. We have been tagged as somehow part 
of a big conspiracy because of barring government from price setting.
  By the way, if you look at this week and its agenda, it is the week 
of wage and price controls by big government. That is what this is 
about. It is a philosophical battle of whether you trust the private 
sector to use their power of bulk purchases to receive the lowest 
prices, or you put government at the table to quote-unquote, negotiate.
  Every time I say that in quotations, I really mean that in a 
satirical way because government doesn't really negotiate; they price 
set. That is the heavy hand of big government at work today.
  Frankly, even using that heavy hand of government, the CBO reports 
that any negotiation, in quotations, by big government for lower drug 
prices would be negligible, because it would at least, in its best day, 
equate what the market has already done.
  There has been no ban on negotiations; it has just simply been who 
does it, private sector or government? I am a private sector guy. I 
trust the private sector. Part of the problem here is that the 
government lacks the leverage in any type of negotiations. That is why 
they can only use the heavy hand as the leverage in negotiations, for 
example, ultimately price setting. That is why I voted to ban the 
government from setting prices, and I will not start down that slippery 
slope today.
  Mr. Speaker, I rise today in opposition to H.R. 4. I am committed to 
reducing drug prices for seniors, but this bill does not do it.
  I have worked as hard as anyone on this floor on behalf of seniors in 
the implementation of Part D. Now that we have had the program in place 
for over 1 year, opportunity to evaluate the effect of the program on 
seniors' drug prices.
  Much to the dismay of the members of the majority who have done 
nothing to assist seniors with this program, the program is working 
well. Costs are down and seniors are satisfied. Requiring the 
government to negotiate drug prices is not going to save the program 
any money, according to both CBO and CMS actuaries. CBO states that, 
``H.R. 4 would have a negligible effect on federal spending.'' And the 
claims by the majority that savings would close the so-called donut 
hole are simply untrue. The size of the donut hole is estimated at 
almost $500 billion. Even if this provision

[[Page H449]]

created major savings, it wouldn't come close to closing the donut 
hole.
  Dr. Mark McClellan, the former CMS Administrator, has said that 
competition among private companies and their negotiations with drug 
companies have lowered the estimated cost of the program over the next 
10 years by nearly 20 percent and may reduce it by another 10 percent 
next year. The average premium, originally estimated to be $37 per 
month, has fallen to an average of $22 per month. I am encouraged that 
competition in the private sector has done what the free market does 
best--lower costs.
  The key here is leverage. Negotiation means nothing if you don't have 
something to leverage. Part D private plans already have natural 
leverage built in. As CBO has stated, the private plans have a huge 
financial stake and formulary limitations which give them the ability 
to negotiate drug prices.
  The requirement for the Secretary of Health and Human Services to 
enter into pricing negotiations as contained in H.R. 4 simply cannot 
work. The bill prohibits a single national formulary from being 
established. If the government is not allowed to limit or restrict the 
number of drugs covered, it will have absolutely no leverage to 
negotiate with drug manufacturers. Such a mandate, I believe, would be 
extremely unattractive to our Nation's seniors. They would not have the 
flexibility to choose a plan that best meets their drug needs, as is 
the case right now.
  I do not support H.R. 4 because I oppose turning a program over to 
the government that is working efficiently and effectively in the 
private sector. Congress created the Part D program to allow market 
forces to drive costs down and that is exactly what is happening. It 
would be disastrous to our seniors to make such a draconian change when 
the cost savings have been so great.
  When the private sector can perform more efficiently and achieve 
better results than the Federal Government, the private sector should 
do so. Adoption of this bill will put us on the way to socialized 
healthcare, a result I don't believe any American really wants. Vote 
``no'' on H.R. 4.
  Mr. DINGELL. Mr. Speaker, I am delighted to yield to the 
distinguished gentleman from Wisconsin (Mr. Kagen) 1 minute.

                              {time}  1030

  Mr. KAGEN. Mr. Speaker, health care costs in this country are 
impossible for everyone. For small businesses, for local, State and 
Federal governments, the uninsured, for working families, and most 
especially for our senior citizens.
  As a physician, I see and feel this crisis every single day. Today in 
America the real price of a pill is whatever they can get. My patients 
and my constituents want to know the price of a pill before they 
swallow it, and they would prefer to pay less rather than more.
  H.R. 4 will allow our government, ``We, the People,'' to negotiate 
more affordable prices for the necessary prescription drugs our seniors 
require. Our health care crisis that we all are facing blurs the lines 
between Republicans and Democrats.
  Allow me, please, to share with you the comments of one of my 
constituents, a Republican, Dorey Hoffman from Appleton, when she says: 
``When I went to receive cancer treatment, I saw this at the 
reception's desk at the cancer center. I thought of you being the voice 
for all of us and of course all the cancer patients. We all need 
someone to help us in our everyday lives.''
  Please join with me in support of H.R. 4 and help Dorey and millions 
of other senior citizens.
  Mr. BARTON of Texas. Mr. Speaker, I wish to recognize the 
distinguished gentleman from New Jersey (Mr. Ferguson) for 2 minutes.
  Mr. FERGUSON. Thank you, Mr. Chairman.
  Mr. Speaker, unfortunately today we are hearing a lot from the 
proponents of H.R. 4. We are hearing a lot of misinformation and lot of 
rhetoric, and I think some of these things need to be corrected for the 
record.
  The biggest misconception is that the buying power of Medicare 
patients is currently unused, and that somehow this new plan is the 
only way to leverage lower prices for prescription drugs. In fact, 
prescription drug plans under Medicare part D right now are 
aggressively negotiating discounts; they have been before part D, and 
they continue to do so very well since the program's inception and they 
are going to continue to look to negotiate lower prices. They have been 
negotiating and giving beneficiaries choices and access to the newest 
breakthrough therapies.
  Through Medicare part D, in its current form, beneficiaries have 
access to over 4,000 prescription medications at a much lower cost than 
previously estimated when we passed this legislation a few years ago. 
CMS has indicated that beneficiaries are saving an average of $1,200 
annually on their drug costs.
  Program costs are an estimated 30 percent less in 2006 and 21 percent 
less over the next 10 years due in large part to competition and 
negotiating of lower drug costs.
  Currently, Medicare prescription plans have the discretion to use 
cost-containment tools. They can use formularies, and many of them do. 
Unlike Medicaid and the VA, Medicare beneficiaries actually have the 
power to choose which plan they want. If they see a plan with a 
formulary they like or don't like, they can choose or not choose that 
based on their own discretion; but if Medicare or the government, as 
prescribed under this bill, under H.R. 4 and its required mandatory 
negotiations, it will have to impose a uniform restriction on 
medicines, patients will lose their choices, and they will be stuck in 
a one-size-fits-all plan. They will be stuck with a restrictive 
national formulary and no choices whatsoever.
  You have to be hiding under a rock recently if you have missed the 
numerous experts that are telling us that this brand of negotiation 
will limit choice and will not save money. I urge a ``no'' vote on H.R. 
4.
  Mr. DINGELL. Mr. Speaker, I am delighted to yield to the 
distinguished gentlewoman from California (Mrs. Capps) 2 minutes.
  Mrs. CAPPS. Thank you, Chairman Dingell.
  Mr. Speaker, I believe that today in the House of Representatives 
there is no one here who would dispute the fact that the large 
pharmaceutical companies have raked in record profits under the 
Medicare prescription drug plan we are currently seeking to improve.
  Today, in this vote before us we are facing a clear choice. We can 
continue to reward these companies, or we can consider our 
constituents, our frail seniors, those with disabilities, many of whom 
are still struggling to make heads or tails out of Medicare part D that 
we seek to improve.
  Common sense tells me that the big drug and insurance companies 
wouldn't be so adamantly opposed to this bill if they didn't fear that 
it would result in actual price reductions. Common sense also tells me 
we should take every possible step to lower the cost of prescription 
drugs, and this bill can achieve that.
  There is precedent for the Federal Government obtaining good 
discounts for prescription drugs; our seniors know that, and they 
believe it. Don't be fooled into believing that this bill might somehow 
leave seniors losing access to important medications. The bill 
explicitly prohibits the government from establishing formularies.
  It is going to also address one of the biggest challenges still 
facing our seniors, the fact that they have to decide every December 
which plan they will choose, hoping that it will offer the cheapest 
price for drugs that they are going to take for a whole year. The 
problem is that not everyone takes the same prescriptions from one 
January to the next; and reducing prices across the board will ensure 
that when a beneficiary's doctor changes their prescription halfway 
through the year, their new medication will also be available at a 
lower cost.
  I urge all of my colleagues to think about our seniors, think about 
those with disabilities. Vote ``yes'' on H.R. 4. Fulfill a promise to 
serve the best interests of the constituents, not the best interest of 
profit-hungry big business.
  Mr. BARTON of Texas. Mr. Speaker, I yield myself 2 minutes to put 
into the Record the Democrat vote on the motion to recommit to H.R. 
4680, rollcall 356 back in 2000. This was a Democrat motion to recommit 
to the Republican drug benefit that later went to the Senate and was 
not acted upon. 205, and I assume that was the total number of 
Democrats in the House, all 205 Democrats voted for it, including Mr. 
Dingell, Ms. Pelosi, Mr. Rangel, and every member of the Energy and 
Commerce Committee who is currently serving who was in the body at that 
time. This was a recommit motion by Mr. Stark of California, and I am 
going to read what it says:

[[Page H450]]

  ``Noninterference by the Secretary. In administering the prescription 
medicine benefit program established under this part, the Secretary may 
not:
  One, require a particular formulary, institute a price structure for 
benefits or in any way ration benefits;
  Two, interfere in any way with negotiations between benefit 
administrators and medicine manufacturers or wholesalers; or
  Three, otherwise interfere with the competitive nature of providing a 
prescription medicine benefit using private benefit administrators, 
except as is required to guarantee coverage of the defined benefit.''
  This is exactly the opposite to the bill that is currently before us, 
exactly the opposite.
  Back in 2000, every Democrat currently in the House at that time, I 
think, or at least 205, voted for it, including all of our senior 
members who are leading the fight 180 degrees opposite this today.

     Democrats That Voted in Favor of Representative Stark's ``Non-
                    Interference'' Provision in 2000

       Abercrombie
       Ackerman
       Allen
       Andrews
       Baca
       Baird
       Baldacci
       Baldwin
       Barcia
       Barrett (WI)
       Becerra
       Bentsen
       Berkley
       Berman
       Berry
       Bishop
       Bagojevich
       Blumenauer
       Bonior
       Borski
       Boswell
       Boucher
       Boyd
       Brady (PA)
       Brown (FL)
       Brown (OR)
       Capps
       Capuano
       Cardin
       Carson
       Clay
       Clayton
       Clement
       Clyburn
       Condit
       Conyers
       Costello
       Coyne
       Cramer
       Crowley
       Cummings
       Danner
       Davis (FL)
       Davis (IL)
       DeFazio
       Delahunt
       DeLauro
       Deutsch
       Dicks
       Dingell
       Dixon
       Doggett
       Dooley
       Doyle
       Edwards
       Engel
       Eshoo
       Etheridge
       Evans
       Farr
       Fattah
       Forbes
       Ford
       Frank (MA)
       Frost
       Gejdenson
       Gephardt
       Gonzalez
       Gordon
       Green (TX)
       Gutierrez
       Hall (OH)
       Hall (TX)
       Hastings (FL)
       Hill (IN)
       Hilliard
       Hinchey
       Hinojosa
       Hoeffel
       Holden
       Holt
       Hoyer
       Inslee
       Jackson (IL)
       Jackson-Lee (TX)
       Jefferson
       John
       Johnson, E. B.
       Jones (OH)
       Kanjorski
       Kaptur
       Kennedy
       Kildee
       Kilpatrick
       Kind (WI)
       Kleczka
       Klink
       Kucinich
       LaFalce
       Lampson
       Lantos
       Larson
       Lee
       Levin
       Lewis (GA)
       Lipinski
       Lofgren
       Lowey
       Lucas (KY)
       Luther
       Maloney (CT)
       Maloney (NY)
       Mascara
       Matsui
       McCarthy (MO)
       McCarthy (NY)
       McDermott
       McGovern
       McIntyre
       McKinney
       McNulty
       Meehan
       Meek (FL)
       Meeks (NY)
       Menendez
       Millender-McDonald
       Miller, George
       Minge
       Mink
       Moakley
       Mollohan
       Moore
       Moran (VA)
       Murtha
       Nadler
       Napolitano
       Neal
       Oberstar
       Obey
       Olver
       Ortiz
       Owens
       Pallone
       Pascrell
       Pastor
       Payne
       Pelosi
       Peterson (MN)
       Phelps
       Pickett
       Pomeroy
       Price (NC)
       Rahall
       Rangel
       Reyes
       Rivers
       Rodriguez
       Roemer
       Rothman
       Roybal-Allard
       Rush
       Sabo
       Sanchez
       Sanders
       Sandlin
       Sawyer
       Schakowsky
       Scott
       Sherman
       Shows
       Sisisky
       Skelton
       Slaughter
       Smith (WA)
       Snyder
       Spratt
       Stabenow
       Stark
       Stenholm
       Strickland
       Stupak
       Tanner
       Tauscher
       Taylor (MS)
       Thompson (CA)
       Thompson (MS)
       Thurman
       Tierney
       Towns
       Turner
       Udall (CO)
       Udall (NM)
       Velazquez
       Visclosky
       Waters
       Watt (NC)
       Waxman
       Weiner
       Wexler
       Weygand
       Wise
       Woolsey
       Wu
       Wynn
       Representative Stark included this language in his motion 
     to recommit on H.R. 4680 (roll call vote 356):


           Section 1860(b)--NONINTERFERENCE BY THE SECRETARY

       In administering the prescription medicine benefit program 
     established under this part, the Secretary may not B (1) 
     require a particular formulary, institute a price structure 
     for benefits, or in any way ration benefits; (2) interfere in 
     any way with negotiations between benefit administrators and 
     medicine manufacturers, or wholesalers; or (3) otherwise 
     interfere with the competitive nature of providing a 
     prescription medicine benefit using private benefit 
     administrators, except as is required to guarantee coverage 
     of the defined benefit.
  Mr. Speaker, I reserve the balance of my time.
  Mr. DINGELL. Mr. Speaker, I yield to the distinguished gentleman from 
Maine (Mr. Allen) 2 minutes.
  Mr. ALLEN. Mr. Speaker, this day has been a long time coming for many 
of us.

[[Page H451]]

  Back in 1998, I was hearing from my constituents in Maine about the 
high price of prescription drugs, and I introduced a bill to tie drug 
prices for Medicare beneficiaries to the negotiated prices that the VA 
gets. The Congress didn't act, but in Maine we enacted Maine Rx. We 
negotiated lower prices, and we got them for so many people in Maine 
who were really desperate for lower-priced prescription drugs.
  The Congress, under Republican leadership in the House and Senate, 
delayed and delayed. Eventually, it got to be too hot to handle and we 
passed Medicare part D.
  Today, the defenders of Medicare part D are saying, Well, it is doing 
well because it doesn't cost as much as we thought it would cost. In 
truth, the real winners are on Wall Street.
  Last November, in reviewing pharmaceutical profits, the New York 
Times said: ``For big drug companies, the new Medicare prescription 
drug benefit is proving to be a financial windfall, larger than even 
the most optimistic Wall Street analysts had predicted.'' Well, if it 
is a financial windfall for PhRMA, it is a lousy deal for the American 
taxpayer. Market forces, some say, will yield the lowest prices, but 
the VA gets lower prices, Medicaid gets lower prices, other countries 
get lower prices than the Medicare D plans.
  It is very clear that negotiation will drive down prices, 
particularly if the Secretary negotiates especially strongly on those 
highest priced drugs, those drugs that are most out of line.
  Secondly, the advocates are arguing that PhRMA and its allies are 
saying that negotiated prices will reduce revenue so much they will 
have to cut R&D. We have heard that for over 20 years; it has never 
happened.
  This bill, finally, will be a good deal for taxpayers and a good deal 
for our seniors.

       ``For big drug companies, the new Medicare prescription 
     drug benefit is proving to be a financial windfall larger 
     than even the most optimistic Wall Street analysts had 
     predicted. . . . Wall Street analysts say they have little 
     doubt that the benefit program. . . has helped several big 
     drug makers report record profits.''(NYT, 11/6/06)

  Mrs. EMERSON. Mr. Speaker, at this time I yield 1 minute to my friend 
and neighbor from Kansas (Mr. Moore).
  Mr. MOORE of Kansas. Mr. Speaker, I rise today in support of H.R. 4, 
the Medicare Prescription Drug Price Negotiation Act. All of us know 
that the Medicare prescription drug law expressly prohibits the 
Secretary of Health and Human Services from negotiating with drug 
companies on behalf of Medicare beneficiaries, 43 million in this 
country, for lower prices. Because of this, these beneficiaries in 
America are a one-person buying group and you have no leverage when you 
are a one-person buying group. The Veterans Administration has been 
very successful in working a good benefit for the veterans in this 
country, 34 million American veterans in this country, and getting a 
good drug benefit there.
  While private plans have been successful in negotiating some 
discounts for seniors under the program, a recent study released by 
Families USA shows that seniors still pay as much as 10 times more for 
some of the commonly prescribed drugs under Medicare than veterans do.
  Secretary Thompson when he left office said, ``I would like to have 
had the opportunity to negotiate.'' And he said to me in a conversation 
that if he had had the ability to negotiate like a bill that I filed 
with the gentlewoman from Missouri, we could drive down prices.
  As you all know, the Medicare Prescription Drug law expressly 
prohibits the Secretary of Health and Human Services from negotiating 
with drug companies on behalf of Medicare beneficiaries for lower 
prices. Because of this, each of the 43 million Medicare beneficiaries 
in America is a one-person buying group, giving our seniors no leverage 
to negotiate for better prices.
  The Veterans Administration which has had the authority to negotiate 
prices since 1992, does so for 34 million American veterans, as do 
large companies on behalf of their employees. Medicare should have the 
authority to negotiate a group discount for our seniors.
  While private plans have been successful in negotiating some 
discounts for seniors under the program, a recent study released by 
Families USA shows that seniors still pay as much as 10 times more for 
some of the most commonly prescribed drugs under Medicare than veterans 
do under their federal drug benefit.
  When Health and Human Services Secretary Tommy Thompson announced his 
resignation in December 2004, he spoke out against the provisions in 
the new Medicare law barring him from negotiating with drug companies 
for lower consumer prices saying, ``I would like to have had the 
opportunity to negotiate.''
  Secretary Thompson based his support on his previous success in 
negotiating drugs on behalf of the government.
  Following the anthrax attacks in 2001, the government negotiated the 
purchase of 100 million tablets of Cipro, achieving significant 
savings. Then in 2003, during a flu vaccine shortage, former Secretary 
Thompson was very successful in negotiating reductions in the price of 
the FluMist vaccine from $46 per dose to $20 per dose, saving over 55 
percent.
  It has been one of my main priorities in Congress to allow seniors 
enrolled in Medicare this same ability to utilize their market power to 
benefit from lower prices.
  In January of 2004, just weeks after the new Medicare Prescription 
Drug Plan became law, I introduced the Medicare's Equitable Drugs for 
Seniors Act, the MEDs Act, with my friend Representative Jo Ann 
Emerson. This legislation, which gained 175 bipartisan cosponsors in 
the 108th Congress, would have given the Secretary of HHS explicit 
authority to negotiate lower pharmaceutical drug prices on behalf of 
Medicare beneficiaries.
  In the 109th Congress, we reintroduced this legislation and we were 
once again able to form a large bipartisan coalition in support of the 
legislation.
  Despite our success in forming this coalition, we have been unable to 
bring this issue to a vote until today. I am very pleased that the 
leadership has chosen to include this as a priority for the House 
during the first 100 hours of the new Congress and I urge my colleagues 
to support H.R. 4, which, if enacted into law, will help reduce the 
cost of prescription drugs for all American seniors.
  Mr. BARTON of Texas. Mr. Speaker, could I inquire as to the balance 
of the time amongst the many people on the floor today.
  The SPEAKER pro tempore. The gentleman from Texas has 22 minutes, the 
gentlewoman from Missouri has 5 minutes, and the gentleman from 
Michigan has 18\1/2\ minutes.
  Mr. BARTON of Texas. Mr. Speaker, I yield 3 minutes to a 
distinguished member of the Energy and Commerce Committee and also a 
member of the Veterans Committee, Mr. Stearns of Florida.
  (Mr. STEARNS asked and was given permission to revise and extend his 
remarks.)
  Mr. STEARNS. I thank the distinguished chairman for yielding.
  Mr. Speaker, the chairman of the Energy and Commerce Committee, Mr. 
Dingell, has been here in Congress the longest, he is the dean of the 
House of Representatives, and I am sure that he remembers under the 
Clinton administration when they attempted to expand the discounts for 
a segment of the population using this same approach you are doing with 
H.R. 4. In fact, this occurred in 2000 in a hearing on the Veterans 
Administration. I would like to take you through this, Mr. Dingell, and 
perhaps even be willing to let you reply to some of the questions I 
have for you. Because if you think you can repeal the law of economics, 
you can't, because in 1990, Congress gave Medicaid access to the low 
prices that are achieved by the Veterans Administration and the results 
were not good for our veterans.
  The drug manufacturers in turn reacted. What did they do? It ended up 
that the deep discounts that the veterans were getting were not 
provided. In some cases the VA saw the prices for the drugs for our 
veterans go up by 300 percent. That is why the American Legion has come 
out against this bill, H.R. 4. They feel it is going to impact veterans 
so significantly that the prices will go up, like they did in 1990, 300 
percent.
  Advocates of this bill claim that negotiations will lower drug prices 
for Medicare part D beneficiaries. When I look at my congressional 
district, almost 80 percent of the seniors on Medicare are covered with 
drug coverage from Part D and they are all satusfield. So I again can't 
understand in light of the fact it is going to perhaps see cost-
shifting to the veterans in this country like the American Legion 
thinks, why would you want to change something that is working so 
fabulously after all the extensive work that the seniors have done to 
comply and get involved?

[[Page H452]]

  Various times during the Clinton administration, not the Bush 
administration, the Clinton administration, proposals were made to 
expand the discount veterans enjoy to a wider population, just like you 
want to do today.

                              {time}  1045

  One was a simple demonstration to add some Federal Employee Health 
Benefit Plan, FEHBP, participants to the Federal Supply Schedule (FSS) 
Drug Pricing Program and later to extend the FSS to the Medicare 
population. Does this sound familiar to my colleagues? So back in 2000, 
July, the Clinton administration wanted to do precisely what we are 
doing today. The veterans had a hearing on this. Testimony was offered 
by the Clinton administration. The Clinton administration officials 
came out, and let me give you one of their quotes:
  This is from the honorable Edward Powell, Jr., Assistant Secretary 
for Financial Management, Department of Veterans Affairs. He said: ``VA 
is concerned about any significant cost impact to its program resulting 
from this pilot . . . ''
  I would just conclude that, Mr. Dingell, this has already been tried. 
It doesn't work.

            Veterans' Drug Prices Go Up With H.R. 4 Passage

       Advocates of H.R. 4 claim that negotiation will lower drug 
     prices for Medicare Part D beneficiaries. This is bad 
     legislation for several reasons. Of special concern to me is 
     the harm it would do to veterans who rely on Department of 
     Veterans Affairs (VA) health care for affordable medications.
       Various times during the Clinton administration, proposals 
     were made to expand the discounts veterans enjoy to wider 
     populations. One was a demonstration to add some Federal 
     Employee Health Benefits Plan (FEHBP) participants to the 
     Federal Supply Schedule (FSS) Drug Pricing Program, and 
     later, to extend the FSS to the Medicare population (sound 
     familiar?). On the former, I chaired a hearing July 25, 2000. 
     Testimony, and later analysis, revealed that expanding the 
     discounts veterans get to OPM would have increased drug costs 
     to veterans. Ultimately, the SAMBA demonstration was not 
     carried through because of this objection.
       Here is some testimony from that hearing:
       ``. . . VA is concerned about any significant cost impact 
     to its program resulting from the pilot . . .'' The Honorable 
     Edward A. Powell, Jr., Assistant Secretary For Financial 
     Management, Department Of Veterans Affairs.
       ``We are concerned that this pilot will increase the cost 
     of pharmaceuticals purchased by the VA and will result in 
     diminished health care for sick and disabled veterans.'' 
     Richard A. Wannemacher, Jr., Assistant National Legislative 
     Director For Medical Affairs, Disabled American Veterans.
       ``Perhaps it should go without saying, but I must call your 
     attention to the fact that Congress already has spoken on the 
     issue of expanded access to FSS pricing on several previous 
     occasions. In fact, I am aware of at least four separate laws 
     over the past 10 years enacted purely to correct the 
     unintended adverse consequences on VA of changes in federal 
     pharmaceutical pricing laws. In each of these cases. the 
     unintended consequences were the result of a law passed by 
     Congress to achieve some other purpose, and VA was an injured 
     bystander.'' Robert B. Betz, Ph.D., Executive Director, 
     Department of Veterans' Affairs Pharmaceutical Procurement 
     initiative Adding Federal Employee Health Benefit Plan 
     Participants to the Federal Supply Schedule Drug Pricing 
     Program.
       Following my hearing, an August 2000 GAO report, 
     Prescription Drugs: Expanding Access to Federal Prices Could 
     Cause Other Changes, stated, ``Drug manufacturers could 
     respond to a mandate that they extend federal prices to a 
     larger share of purchasers by adjusting their prices to 
     others. ``
       Still further, former VA Acting Secretary during the 
     Clinton Administration, Hershel W. Gober, wrote in the Sept-
     Oct 2004 issue of DAV Magazine ``Similarly, in 1999, when 
     attempts were made to extend the FSS pricing schedule to the 
     Medicare population we estimated that extending discounted 
     government prices for pharmaceuticals to the Medicare 
     population would increase the VA's annual pharmaceutical 
     costs by $500-600 million. Now, years later, the impact will 
     be even greater on the already constrained VA budget if FSS 
     special discount drug prices are extended to the Medicare 
     population and states.''
       Why are Democrats proposing this harm to veterans again, 
     when Medicare Part D is working?
       Medicare beneficiaries are already receiving substantial 
     drug discounts, through plan negotiation that works just as 
     FEHBP works for federal and legislative employees, including 
     Members of Congress. Do not increase costs for your veterans. 
     Oppose H.R. 4. H.R. 4 will endanger the health, lives and 
     budgets of veterans.

  Mr. DINGELL. Mr. Speaker, I am delighted to yield 1 minute to a 
distinguished Member of this body, our colleague from New York (Mr. 
Hall).
  Mr. HALL of New York. Mr. Speaker, I thank the chairman for yielding.
  Rising drug prices have created an escalating crisis for seniors in 
my home in the 19th District of New York in the Hudson Valley and the 
rest of the country. This passage of H.R. 4 will represent another 
promise kept in our 100 hours with which we begin the 110th Congress.
  When the House passed the bill creating the Medicare drug benefit in 
the dead of night, it took the audacious step of prohibiting Medicare 
from negotiating for the best price. It is unconscionable that a 
government agency serving 43 million seniors was not given the same 
consumer rights as other agencies and private companies. The drug 
companies have reaped record profits, the taxpayers have been 
shortchanged, and seniors have been forced to break the bank to pay for 
drugs.
  Today we are moving to change that. Most importantly, we will make 
sure that our seniors, not the drug companies, get the best deal.
  Rising drug prices have created an escalating crisis for seniors in 
my home in the Hudson Valley and the rest of the country. This passage 
of H.R. 4 will represent another promise kept.
  When the House passed the bill creating the Medicare drug benefit in 
the dead of night, it took the audacious step of prohibiting Medicare 
from negotiating for the best price. It's unconscionable that a 
government agency serving 43 million seniors wasn't given the same 
consumer rights as other agencies and private companies.
  In 2005, a Families USA study found that the median drug price under 
Part D was 48 percent higher than the price negotiated by the VA. More 
recently, the same group found the price spread had grown to 58 
percent.
  When there was a crisis created by the anthrax attacks in 2001, HHS 
negotiated for lower prices for Cipro. There's an ongoing crisis now 
for seniors trying to cope with skyrocketing drug prices, and HHS 
should use its negotiating skill to come to their aid.
  The drug companies have reaped record profits, the taxpayers have 
been short-changed, and seniors have been forced to break the bank to 
pay for drugs. Today, we're moving to change that.
  Directing HHS to negotiate for lower prices will make it easier for 
Medicare beneficiaries to afford the life-saving and life-improving 
drugs they need. It will save billions of taxpayer dollars. And most 
importantly, it will make sure that seniors, not the drug companies, 
get the best deal.
  The Medicare drug benefit was supposed to offer seniors the promise 
of affordable drugs that would help them enter their golden years with 
fewer worries. For too many seniors it turned into a dire financial 
predicament. I'm proud to be a supporter of legislation that will help 
us finally keep our original promise.
  Mr. BARTON of Texas. Mr. Speaker, I would like to yield 2 minutes to 
a distinguished member of the committee, the gentleman from Michigan 
(Mr. Rogers).
  Mr. ROGERS of Michigan. Mr. Speaker, I thank the chairman for 
yielding.
  CBO said this will not save money.
  Something interesting happened. You had the chance, my friends on the 
other side of the aisle, in committee in the negotiation of this bill, 
had the chance to set prices, what this bill would do. And when you 
went out to set prices, you said we cannot do it. The private sector 
cannot do it for any cheaper than $35; so let's protect the American 
people, and we are going to put an amendment into this bill that sets 
those premiums at $35.
  Let me read just from the amendment that was offered by my friends on 
the other side of the aisle and, thankfully, didn't pass. It is to set 
the premium at $35 including, as it says here, for months in the 
subsequent year, and some legal hyperbole here, and then in the 
previous year increase by the annual percentage. So every year you were 
going to increase the prices because the government set the price at 
$35.
  If we had believed that price-setting was the answer in providing 
prescription drugs to families who needed it, who were making the 
decisions between food and prescription drugs, we would have increased 
their cost in my State by 100 percent.
  It doesn't work. You are empowering the same bureaucrats who came up 
with the $500 hammer, and you are asking them to go out and get into 
America's medicine cabinet. As a matter of fact, the ones that do it 
now, they are

[[Page H453]]

even telling you that you can't have certain drugs because it is too 
big for them. There are 4,300 different drugs, 55,000 different 
pharmacies; and when the Secretary right after 9/11 knew that they had 
to purchase Cipro, it took them over a month to negotiate the price 
because government isn't designed to be in the business of negotiating 
prices. They set prices, and it doesn't work very well.
  Why would we take away all of the savings that all of these seniors 
are enjoying today? And that is what you will do, just by your example.
  I would strongly encourage this body to reject price-setting and 
raising the cost of prescription drugs to our seniors around the 
country.
  Mrs. EMERSON. Mr. Speaker, at this time I am privileged to yield 3 
minutes to the gentleman from Indiana (Mr. Burton).
  Mr. BURTON of Indiana. Mr. Speaker, I thank the gentlewoman for 
yielding.
  My first wife died about 5 years ago of breast cancer. And when she 
was going through her chemotherapy, we were sitting in a room with 
about five women that were getting their chemotherapy. And there was 
this one lady who was kind of complaining and actually had a few tears 
in her eyes, and she said that she had to pay $350 a month for 
Tamoxifen, which was the drug of choice. And a lady about three seats 
away from her said, Well, I get mine from Canada for $50. And I 
thought, my gosh, that doesn't sound right.
  So we checked into it, and we found that the price of Tamoxifen was 
seven times higher here in the United States than it was in Canada. And 
I thought, well, that just doesn't seem right.
  So I started checking into a lot of other pharmaceutical products. 
Today Tamoxifen in Munich, Germany is $60, and it is $360 here in the 
United States.
  The point I am trying to make is the prices charged around the world 
are much less for the very same product, pharmaceutical product, than 
it is here in the United States. And Americans, I think, should get the 
same benefit as anybody else in the world. We are not second-class 
citizens.
  Now, we get to the negotiation problem, and I heard the White House 
say, well, we shouldn't negotiate, shouldn't interfere with the free 
enterprise system.
  I want you to know that we negotiate on just about everything right 
now. Let me just give you a few examples.
  We negotiate on some of the aircrafts that we buy. As my colleague 
just said, we negotiated on the Cipro not too long ago. We negotiated 
on all kinds of military equipment. And for us to say that we can't 
negotiate on pharmaceuticals is just crazy.
  When we passed the Medicare prescription drug in the dead of the 
night after 3 hours of keeping this machine open so they could drag up 
at least one vote for victory, we found out that it said in there that 
the government of the United States cannot, is prohibited, from 
negotiating with the pharmaceutical companies for prices. That means 
that they can set whatever price that they want and we have to pay it. 
There is no negotiation. And we hear from the White House and from 
others that we don't negotiate or shouldn't interfere in the private 
sector. We do it all the time. In fact, in the Veterans Administration 
they negotiate for drug prices right now. And many, many of the 
pharmaceutical products the people get in the military hospitals today 
are much, much less than they are buying through the Medicare system.
  All I can say is that there ought to be negotiation. I am a 
Republican. My Democrat colleagues are pushing this bill, but it should 
be a bipartisan bill. The people of the United States should get a fair 
price for their drugs, and we should be able to have the Government of 
the United States negotiate for the benefit of the taxpayers to get the 
best price for the products that we are selling to our consumers.
  H.R. 4 is a bipartisan bill aimed at cutting prescription drug prices 
for millions of seniors and individuals with disabilities.
  The current Medicare prescription drug law explicitly prohibits the 
Department of Health and Human Services from using the strength of 
Medicare's 43 million beneficiaries to negotiate prescription drug 
price discounts.
  Providing HHS with negotiating authority has bipartisan support in 
Congress and across America. In a recent poll, 92 percent of Americans 
stated they supported the proposal.
  The bill requires the HHS Secretary to conduct such negotiations with 
drug companies on behalf of Medicare beneficiaries but provides the 
Secretary broad discretion on how to best implement the negotiating 
authority and achieve the greatest price discounts for Medicare 
beneficiaries.
  The bill continues to prohibit the HHS Secretary from requiring a 
particular formulary (i.e., a list of covered drugs) to be used by 
Medicare prescription drug plans or limiting access to any prescription 
medication.
  The federal government is well equipped with the skills needed to 
negotiate price discounts. It is done when we purchase airplanes for 
the military, when we purchase furniture for government buildings--and 
it is done in the health arena for programs in the Public Health 
Service, VA, and Medicaid.
  We have seen that, even without establishing formularies, CMS can use 
its purchasing power to reduce costs. In times of dire need--Cipro for 
the anthrax attack on the Capitol in 2001 and with flu vaccines in 
2004--CMS has been able to obtain lower prices.
  The bill also clarifies that Medicare Part D drug plans are permitted 
to obtain discounts or lower prices for covered prescription drugs 
below the price negotiated by the HHS Secretary.
  The purpose of this bill is to ensure that all avenues of achieving 
price discounts are being used to benefit the seniors and individuals 
with disabilities in the Medicare program.
  While recent projections do indicate that the Medicare Part D program 
is costing less than originally expected, cost projections alone are 
simply not a strong indicator of the program's success. In the real 
world seniors are still experiencing--complications, confusion and 
increasing premiums in 2007.

  Requiring Medicare to negotiate for lower prices may not save the 
federal government huge sums of money but it will help save seniors 
money by reducing premiums and out-of-pocket costs.
  Whether this bill saves the Federal government money is really a 
function of whether the Secretary uses his authority effectively.
  Congressional Budget Office (CBO) cost estimates are historically 
very cautious and CBO has indicated they will reexamine this estimated 
cost savings of this bill when they have more information from the 2006 
plan year.
  Today's law bars the Secretary from negotiating with drug 
manufacturers solely because the drug industry insisted on the 
prohibition.
  We need to put the interests of America's seniors and people with 
disabilities ahead of the pharmaceutical and HMO industry.
  This bill has bipartisan support and we should move forward to 
improve this vitally needed drug program for seniors and people with 
disabilities.
  Mr. DINGELL. Mr. Speaker, I am delighted to yield at this time 2\1/2\ 
minutes to the distinguished chairman of the Government Reform 
Committee, a member of the Committee on Energy and Commerce, my friend 
from California (Mr. Waxman).
  Mr. WAXMAN. Mr. Speaker, my friend and colleague, Representative Dan 
Burton, who just spoke, I think captured the essence of this issue.
  The question is whether the U.S. Government can get a better price 
negotiating with the drug companies using the millions of seniors as 
leverage or whether individuals can get a better price if they could 
negotiate on their own or whether drug plans can get a better price if 
they can negotiate on their own. Medicare and government overall 
negotiates, and when the Medicare negotiates for physician fees, they 
negotiate what the fee will be and then they say this is the fee we 
will pay. That should be the same for the Medicare drug benefit. We can 
save billions of dollars.
  Now, I know that we hear about the drug companies saying this won't 
work and, in fact, the market is working. Well, the market is not 
working. There is no market there. But it is not working. People can go 
to Canada right now and get a lower price for their drugs than they can 
in the Medicare drug plan as it exists today. People can go to Costco 
and get a better price. They can search around and get a better price. 
But when government negotiates, we get the best price. And we have seen 
it when the government negotiates the prices for the veterans, and we 
saw it when the government negotiated the prices for the Medicaid 
population. They used that buying clout and got deep discounts.
  The drug companies raise all sorts of scare tactics. They say if we 
have the government negotiating prices, people will be denied drugs 
because there will be a formulary. And then the bill prohibits that 
from happening. Then they

[[Page H454]]

turn around and say, well, to confuse the issue, if there isn't a 
formulary, there won't be savings. Most of the opposition to this is 
coming from the drug companies, and whose interests are they looking 
after? Not the seniors and not the taxpayers.
  I urge support for the legislation.
  Mr. BARTON of Texas. Mr. Speaker, I want to yield myself 1 minute 
just to reply to Mr. Waxman.
  The Congressional Budget Office, as far as I know, is not in the 
pocket of the drug companies. They say there are going to be no savings 
to this. The Heritage Foundation, which is admittedly conservative, but 
I don't think they are in the pocket of the drug companies, says there 
are going to be no savings. The Veterans Affairs Administration, which 
is the executive branch part of the Federal Government that is 
currently operated by President Bush, is opposed to this. They don't 
think there are going to be any savings. You can go to Wal-Mart right 
now, whether you are in Medicare or not, and get any number of generic 
drugs for, I think, a fee of $3 a month. Some of the plans that are out 
there in the marketplace give generic drugs away. Some of the plans 
that seniors can choose from have zero premiums. The average premium is 
$22.
  I just think it is flat wrong to think that the Federal Government is 
going to negotiate a lower price than a competitive marketplace.
  Mr. Speaker, I yield 1 minute to the distinguished gentleman from 
California (Mr. Campbell).
  Mr. CAMPBELL of California. Mr. Speaker, I spent 25 years in the 
retail car business, so I have done my share of negotiating. There is a 
golden rule of negotiating to buy something that if you want to get the 
best price, you have to be willing to say, No, I won't buy it.
  So if the government negotiates and says, No, I won't buy it, when 
they say no, which they will say a lot or have to say a lot to get a 
good price, then that means that seniors will be denied various drugs, 
and that is what has happened in the VA.
  If they take the other course and decide they are not going to say 
no, then they are not negotiating; they are price setting. And when 
they set prices, they will either be too low and people won't get what 
they need, or they will be too high and we will be wasting money.
  Mr. Speaker, this is a solution that won't work to a problem that 
does not exist.
  Mr. DINGELL. Mr. Speaker, I am delighted to yield to the 
distinguished gentlewoman from Illinois (Ms. Schakowsky) 2 minutes.
  Ms. SCHAKOWSKY. Mr. Speaker, it is a delight to see you in the chair.
  I rise in strong support of H.R. 4, the Medicare Prescription Drug 
Price Negotiation Act, to require Medicare negotiation for lower drug 
prices, and I thank Chairman Dingell for his leadership.
  In 2003 the pharmaceutical industry spent over $100 million to lobby 
Congress, hiring the equivalent of a lobbyist for every Member to 
protect their interests in the new drug benefit. And they got what they 
wanted.
  As the New York Times reported this past November: ``For big drug 
companies, the new Medicare prescription benefit is proving to be a 
financial windfall, larger than even the most optimistic Wall Street 
analysts had predicted.''
  One of the main reasons for the drug company windfall is the so-
called ``noninterference'' clause, the provision written into the law 
at the behest of the drug companies prohibiting Medicare from using its 
bargaining power to negotiate for drug discounts.

                              {time}  1100

  Just think about it for a minute: Medicare is involved in making sure 
that prices are reasonable and affordable for every other benefit, from 
wheelchairs to hospital charges to hospice care. But it is prohibited 
from doing so for prescription drugs.
  Other large purchasers, from the VA to State governments to large 
employers, use their bargaining clout to get affordable prices. But 
Medicare is prohibited from doing so on behalf of the 40 million 
seniors and persons with disabilities and the taxpayers who help pay 
for benefit.
  This week, Families USA released a study showing that part D prices 
for the top 20 drugs used by seniors are on average 58 percent higher 
than prices at the VA. Other studies show that some part D drug prices 
are as much as 10 times the VA prices, and even higher than the prices 
available at Costco.com or Drugstore.com.
  AARP, which operates a part D plan and supported the original bill, 
wrote to support this bill saying ``plans are not always able to 
exercise the kind of negotiating leverage that could result from 
secretarial negotiation.''
  In the first 6 months of part D's implementation, drug company 
profits increased $8 billion. It is time to protect the interests of 
the American people, not the profits of the drug companies. It is time 
to pass H.R. 4.
  Mr. BARTON of Texas. Mr. Speaker, I would like to yield 1 minute to a 
distinguished congressman from Georgia (Mr. Westmoreland).
  Mr. WESTMORELAND. Mr. Speaker, I thank the congressman from Texas for 
yielding.
  Mr. Speaker, the Congress wields the power of the purse. It can 
declare war, it can create new laws, but it has no power to alter the 
laws of economics. No endeavor in the history of mankind has provided 
more consumer choice, more innovation and more advances than the 
invisible hand of market forces.
  As the country song says, everybody wants to drink the free bubble-up 
and eat the rainbow stew, but in the real world, economics determines 
how we divvy up finite resources.
  Under the current prescription drug plan, market forces have worked. 
Seniors get a choice of the drugs they need while at the same time the 
cost to taxpayers has come in billions below original estimates. 
Without doubt, government regulation of prices will limit prices, just 
as it does under the system used by the Veterans Administration. That 
is why more than a million veterans have signed up for a Medicare plan.
  H.R. 4 is another example of Democrats saying the government can make 
better decisions for the American people than the American people can 
for themselves. We offer choice; they offer smoke and mirrors and empty 
rhetoric.
  Mr. Speaker, I ask that my colleagues vote ``no'' on H.R. 4.
  Mr. DINGELL. Mr. Speaker, I am delighted to yield to the 
distinguished gentlewoman from California (Ms. Solis).
  Ms. SOLIS. Mr. Speaker, on behalf of 70,000 eligible Medicare 
beneficiaries in the 32nd Congressional District of California, I rise 
to strongly support this legislation to reduce the cost of prescription 
drugs through negotiated pricing.
  As a result of the Medicare Modernization Act, millions of low-income 
and minority seniors pay higher prices for their prescriptions. A 
recent report by Families USA revealed that the lowest Medicare part D 
plan drugs are still 58 percent higher than the lowest prices offered 
by those with the authority to negotiate, like the Department of 
Veterans Affairs.
  Negotiated pricing is the difference between receiving needed 
medicine and putting food on the table. This is a reality for one in 
five Latinos above the age of 65 who live in poverty. Latinos are the 
fastest growing sector of the senior population. As chair of the 
Congressional Hispanic Caucus Task Force on Health, I am concerned that 
without negotiated drug prices, Latino seniors will be unable to afford 
their medication and continue to suffer needlessly from chronic health 
diseases.
  The overwhelming majority of Americans favor allowing the government 
to negotiate prescription drug prices for the Medicare program.
  Organizations such as the National Council of La Raza, the Nation's 
largest Hispanic civil rights organization, and the National Hispanic 
Medical Association, which represents licensed Hispanic physicians in 
the U.S., support this legislation because they agree it will make a 
difference in the lives of Latino seniors.
  I am proud that today we are considering this legislation that will 
make a real difference to the health and welfare of all of our seniors.
  I hope my colleagues on the other side of the aisle will help to make 
prescription drugs affordable for all of our constituents for seniors 
across the country.
  I urge my colleagues to support H.R. 4.

[[Page H455]]

  Mr. BARTON of Texas. Mr. Speaker, I yield 1 minute to the 
distinguished gentleman from West Texas (Mr. Conaway).
  Mr. CONAWAY. Mr. Speaker, from the rhetoric we have heard in this 
House today, it is clear that somebody is going to be negotiating on 
behalf of Medicare.
  For my money, I will trust the private enterprise employee who works 
for that prescription drug plan who is negotiating with the drug 
companies to get the lowest price in order to be able to lower premiums 
to the Medicare beneficiary that is going to be paying those premiums. 
That system is working. That is one side of the negotiation.
  If H.R. 4 passes today, we will substitute for that free market 
negotiator a career bureaucrat who keeps their job no matter what 
happens with respect to the price of drugs.
  H.R. 4 is a flawed solution to a problem that doesn't exist. I urge 
my colleagues to vote against it.
  Mr. DINGELL. Mr. Speaker, I am delighted to yield to the 
distinguished gentlewoman from Oregon, a member of the committee, Ms. 
Hooley, 2 minutes.
  Ms. HOOLEY. Mr. Speaker, last year I held over a dozen town hall 
meetings throughout Oregon about the new Medicare prescription drug 
program. And what I heard is it is overly complex and too expensive. 
But it doesn't need to be.
  Lifting the ban that prevents the Department of Health and Human 
Services from negotiating lower drug prices on behalf of Medicare 
beneficiaries is one simple fix that would make medicine a whole lot 
more reasonable for seniors and taxpayers.
  Almost every store in the Nation will offer you savings if you buy in 
bulk; but the Medicare program, one of the largest purchasers of 
prescription drugs in the Nation, is currently prevented from 
negotiating a bulk discount.
  What is the cost of this inefficiency? Zocor helps lower cholesterol 
and is one of the most common drugs prescribed to seniors. At the VA 
where they can negotiate, you can get a year's supply for $130. Under 
Medicare, it will cost $1,200, a 900 percent price difference. No 
reasonable person would pay $23 for a gallon of milk when you can buy 
it at Safeway for $2.65.
  The State of Oregon has bulk purchasing power to negotiate for lower 
prescription drug prices from pharmaceutical companies for thousands of 
low-income and uninsured Oregonians. We know the practice works, 
allowing more people to be covered, enhancing lives and using taxpayer 
dollars wisely.
  In the last Congress, I started a petition that would force the House 
leadership to consider giving Medicare the ability to negotiate for 
lower prices because we knew if we could get the issue on the floor, it 
would pass.
  Well, we have a new Congress, a new majority. We will finally 
overturn that ban on negotiations and defeat the forces that have 
prevented fiscal responsibility. I ask my colleagues to join me in 
supporting H.R. 4, commonsense cost-saving legislation.
  Mr. BARTON of Texas. Mr. Speaker, I yield 1\1/2\ minutes to the 
gentleman from Florida (Mr. Keller).
  Mr. KELLER of Florida. Mr. Speaker, I thank the gentleman for 
yielding.
  As a congressman from Florida, the State with the largest percentage 
of seniors, I very much want low cost for prescription drugs. The 
nonpartisan Congressional Budget Office says this proposal will not 
lower prescription drug costs at all. Seniors are already getting 
volume discounts through pharmacy benefit managers and private sector 
competition.
  Now the Democrats say: It works at the VA, it will work here. So I 
looked into that. I happen to take Lipitor for lower cholesterol. It is 
the number one selling drug in the world. Even Lipitor is not available 
on the VA formulary. That is because the VA only have a limited number 
of drugs, and that is why it is cheaper there. It is also why more than 
1 million veterans are already getting their drug coverage through 
Medicare part D.
  Mr. Speaker, 80 percent of the seniors in this country are happy with 
their drug plans under Medicare part D, and 75 percent of the seniors 
in central Florida have signed up for it and like it. If it ain't 
broke, why are we fixing it?
  Let us give seniors both choices and low prices. Vote ``no'' on H.R. 
4.
  Mrs. EMERSON. Mr. Speaker, I yield myself 15 seconds to respond.
  Number one, I would like to submit for the Record the list of the 12 
different anti-cholesterol drugs on the VA formulary that exist today.
  And second, I would quote from the Institute of Medicine Committee, 
part of the National Academy of Sciences. They concluded that the ``VA 
national formulary is not overly restrictive. In some respects it is 
more; but in many respects, it is less restrictive than other public or 
private formularies.'' I also will submit that for the Record.


             CHOLESTEROL LOWERING MEDICATIONS VA CLASS CV350
------------------------------------------------------------------------
                                                             Local non-
  VISN Generic name Non-formulary           Synonym           formulary
------------------------------------------------------------------------
Atorvastatin Calcium, 10mg tab.....  Lipitor..............
N/F    V-N/F.......................
Atorvastatin Calcium, 20mg tab.....  Lipitor..............
N/F    V-N/F.......................
Atorvastatin Calcium, 40mg tab.....  Lipitor..............
N/F    V-N/F.......................
Atorvastatin Calcium, 80mg tab.....  Lipitor..............
N/F    V-N/F.......................
Cholestyramine, 4gm/5gm (Light)....  Questran Light.......
                                     Prevalite............
Cholestyramine, 4gm/5gm (Light)....  Questran Light.......
Cholestyramine, 4gm/9gm Oral PW....  Questran.............
Cholestyramine, 4gm/9gm Oral PW....  Questran.............
Colesevelam HCL, 625mg tab.........  Welchol..............
N/F    V-N/F.......................
Colestipol Granules................  Colestid.............
Colestipol HCL, 1gm tab............  Colestid.............
Colestipol HCL, 5gm/PKT GRNL.......  Colestid.............
Ezetimibe, 10mg tab................  Zetia................
N/F    V-N/F.......................
Ezetimibe, 10mg/Simvastatin, 10M...  Vytorin..............          N/F
V-N/F..............................
Ezetimibe, 10mg/Simvastatin, 20M...  Vytorin..............
N/F    V-N/F.......................
Ezetimibe, 10mg/Simvastatin, 40M...  Vytorin..............
N/F    V-N/F.......................
Ezetimibe, 10mg/Simvastatin, 80M...  Vytorin..............
N/F    V-N/F.......................
Fenofibrate, 145mg Tab.............  Tricor...............
N/F    V-N/F.......................
Fenofibrate, 160mg Tab.............  Tricor...............          N/F
V-N/F    ..........................
Fenofibrate, 48mg Tab..............  Tricor NFE...........
N/F    V-N/F.......................
Fenofibrate, 67mg Cap..............  Tricor...............          N/F
V-N/F..............................
Fluvastatin NA, 20mg Cap...........  Lescol...............
Fluvastatin NA, 40mg Cap...........  Lescol...............
Fluvastatin NA, 80mg SA Tab........  Lescol XL............
Gemfibrozil, 600mg Tab.............  Lopid................
Lovastatin, 10mg Tab...............  Mevacor..............
Lovastatin, 20mg Tab...............  Mevacor..............
Lovastatin, 40mg Tab...............  Mevacor..............
Omega-3-Acid Ethyl Esters 1000.....  Omacor...............          N/F
V-N/F..............................
Pravastatin NA, 10mg Tab...........  Pravachol............
N/F    V-N/F.......................
Pravastatin NA, 20mg Tab...........  Pravachol............
N/F    V-N/F.......................
Pravastatin NA, 40mg Tab...........  Pravachol............
N/F    V-N/F.......................
Pravastatin NA, 80mg Tab...........  Pravachol............
N/F    V-N/F.......................
Rosuvastatin CA, 10mg Tab..........  Crestor..............
N/F    V-N/F.......................
Rosuvastatin CA, 20mg Tab..........  Crestor..............
N/F    V-N/F.......................
Rosuvastatin CA, 40mg Tab..........  Crestor..............
N/F    V-N/F.......................
Rosuvastatin CA, 5mg Tab...........  Crestor..............
N/F    V-N/F.......................
Simvastatin, 10mg Tab..............  Zocor................
Simvastatin, 20mg Tab..............  Zocor................
Simvastatin, 40mg Tab..............  Zocor................
Simvastatin, 5mg Tab...............  Zocor................
Simvastatin, 80mg Tab..............  Zocor................
------------------------------------------------------------------------

                                                 January 10, 2007.
     Office of The Speaker,
     House of Representatives,
     Washington, DC.
       Dear Speaker Pelosi: the National Community Pharmacists 
     Association (NCPA) represents the owners of more than 24,000 
     independent pharmacies with over 300,000 employees dispensing 
     some 42 percent of the nation's prescription medicines.
       As trusted health care providers, we have always championed 
     affordable medicines for our patients. Our pharmacists are 
     motivated to help our patients find the medication that is 
     most effective for both their health and their pocketbook.
       Your efforts to lower prescription drug prices, especially 
     for seniors, are commendable. NCPA endorses these efforts as 
     contained in H.R. 4, the Medicare Prescription Drug Price 
     Negotiation Act of 2007 introduced by Chairman John Dingell.
       The noninterference clause of the Medicare Modernization 
     Act (MMA) has directly disadvantaged independent community 
     pharmacies throughout the implementation of Part D. NCPA has 
     requested intervention from the Center for Medicare and 
     Medicaid Services (CMS) to affect prompt payment of claims, 
     fully clarify rules on misleading advertising practices, and 
     establish guidelines for adequate reimbursements. In each 
     instance, CMS has not taken action, apparently because of the 
     noninterference clause of MMA.
       As you are aware, there are other issues with regard to the 
     Part D benefit, Medicaid and the pharmacy marketplace that 
     also must be addressed to ensure community pharmacy can 
     continue to play our critical role in patient care; such as 
     prompt payment of claims, Pharmacy Benefit Manager (PBM) 
     transparency, and the encouragement of the use of more 
     affordable generic medications in the Medicaid program. We 
     look forward to working with you on legislation to address 
     these issues.
       Your assistance on the issues critical to community 
     pharmacy will help enhance our

[[Page H456]]

     ability to continue to deliver affordable, quality 
     prescription care to our patients. We thank you for your 
     efforts on behalf of independent pharmacists and the patients 
     we serve.
           Sincerely,
                                                Charles B. Sewell,
                        Senior Vice President, Government Affairs.

  Mr. DINGELL. Mr. Speaker, I am delighted to yield to Dr. Christensen, 
the distinguished representative of the Virgin Islands, a leader in 
health care, 1 minute.
  Mrs. CHRISTENSEN. Mr. Speaker, I thank my chairman for yielding.
  Mr. Speaker, I rise today in support of H.R. 4 on behalf of the 
Medicare beneficiaries in the U.S. Virgin Islands and all of the 43 
million who need this bill.
  We have heard that H.R. 4 would only have a negligible effect on 
Federal Medicare spending. I doubt that. A recent report by Families 
USA showed that in several commonly used drugs, the lowest part D cost 
was still anywhere from 58 to 1,000 percent higher than the negotiated 
VA cost. That is why 90 percent of AARP members support H.R. 4.
  As a physician who took care of many elderly and disabled patients 
and as chair of the Health Braintrust of the Congressional Black 
Caucus, I know why we need H.R. 4. By lowering the price of 
prescription drugs as H.R. 4 will do, we will not only reduce Federal 
spending but also improve access to medication for millions of 
Americans with acute and chronic diseases, a disproportionate number of 
whom are racial and ethnic minorities.
  But we must also make sure that all medications including those like 
Bidil that is proven effective in African Americans are covered.
  This is yet another promise made by Democrats and must be another 
promise kept. I urge my colleagues to vote ``yes'' on H.R. 4.
  Mr. BARTON of Texas. Mr. Speaker, I yield 2\1/2\ minutes to the 
distinguish gentleman from Arizona, a former chairman of the Republican 
Policy Committee and a member of the Energy and Commerce Committee, Mr. 
Shadegg.
  Mr. SHADEGG. Mr. Speaker, I think this debate comes down simply to: 
Do you trust bureaucrats, or do you trust the forces of competition 
which have already delivered a drug benefit under budget?
  To me, the answer is simple. But don't take my word for it. Last 
November, The Washington Post, not exactly a right wing newspaper, 
indeed one of most liberal newspapers in America, editorialized against 
precisely what this bill does. The Washington Post, not John Shadegg, 
said that the drug benefit in the current bill has turned out to be 
cheaper than projected.
  The Washington Post, not John Shadegg, said that most beneficiaries 
are satisfied with the current program.
  My colleagues on the other side of the aisle, Mr. Dingell and others, 
over and over and over and over again in this debate have cited the 
veterans program and said it is much better because they negotiate drug 
prices.
  But The Washington Post, not John Shadegg, said, and I quote, ``that 
is not a fair comparison.'' The Washington Post says that the Veterans 
Administration keeps prices down by maintaining a sparse network of 
pharmacies and a restricted formulary. Indeed, delivering three-fourths 
of its prescription drugs by mail. That's not John Shadegg; that's The 
Washington Post.
  Indeed, the Post points out that more than one-third of the veterans 
in America eligible to sign up for the veterans program instead take 
the Medicare prescription drug program. Why? Because Americans don't 
want to say goodbye to their local pharmacy, which is what my 
colleagues on the other side will make them do.
  If the program is so much better under the veterans, then why do a 
third of America's veterans prefer the current Medicare program? The 
answer for that is, it is a better program.
  The Washington Post answers that by saying, in their words, the 
veterans' programs restricted choice of drugs and restricted list of 
pharmacies is less attractive.
  Let me conclude the way the Post concluded. They said, ``A switch to 
government purchasing of Medicare drugs would choke off this experiment 
before it had a chance to play out and would usher in its own 
problems.'' I urge my colleagues to consider those problems.
  They went on to say, ``For the moment, the Democrats would do better 
to invest their health care energy elsewhere.''
  I urge my colleagues who read The Washington Post regularly to follow 
its advice. This is a bad bill and bad for America's seniors.
  Mr. DINGELL. Mr. Speaker, I yield at this time 2 minutes to the 
distinguished gentleman from New York (Mr. Engel).

                              {time}  1115

  Mr. ENGEL. I thank my friend, the chairman; and I rise today in 
strong support of this bill.
  We have an opportunity today to right one of the most troublesome 
provisions of the Medicare Modernization Act, the provision which 
prohibits the Secretary of HHS from using the bargaining power of 40 
million American senior citizens and disabled Americans who are 
enrolled in the Medicare to negotiate more affordable drug prices.
  It is simply common sense. We know that our senior citizens continue 
to struggle on fixed incomes to be able to purchase their prescription 
drugs in addition to essential basic living necessities, like food, 
electricity and rent. We know costs in the Medicare program continue to 
skyrocket. By negotiating prices, we may be able to achieve record drug 
savings for seniors while also shoring up the fiscal health of the 
Medicare program, thereby protecting U.S. taxpayer dollars.
  I am troubled by the repeated false assertions on the other side of 
the aisle that this legislation would mandate price controls and limit 
seniors' access to drugs. Nothing can be further from the truth.
  H.R. 4 continues to prohibit the Secretary of HHS from requiring a 
particular formulary, and it simply says we should give the government 
the best shot at trying to negotiate lower drug prices. No price 
controls. Even Tommy Thompson, who said he considers this bill one of 
his finest accomplishments, stated that he regretted the clause in the 
bill prohibiting HHS from negotiating drug prices. As Secretary 
Thompson notes firsthand, he was able to use HHS to negotiate key 
savings for Cipro during the anthrax attacks of 2003. So there is room 
for improvement.
  I respect the research and development that the pharmaceutical 
companies conduct. Frankly, we should not bash the pharmaceutical 
companies. They do good work. I have a plant in my district that has 
created and manufactured terrific prescription drugs. I would never 
support a bill that I believe would stifle innovation at the expense of 
the American people. But I believe that we can and should promote 
policies which put more good options on the table. This bill does that, 
and I urge its passage.
  Mr. BARTON of Texas. Mr. Speaker, I yield 1 minute to a distinguished 
member of the committee who is currently on leave from the committee, 
the gentlewoman from Tennessee (Mrs. Blackburn).
  Mrs. BLACKBURN. Mr. Speaker, I thank the gentleman from Texas, 
because this is such an important debate for us and for our 
constituents.
  I have about 70,000 Medicare part D beneficiaries in my district, the 
Seventh District of Tennessee, and they do deserve low-cost 
prescription drugs, and they deserve the option to choose their plans. 
The way Medicare part D is constructed, that is what we have, the 
opportunity to make those choices, to have that control, to actually 
have a private insurance.
  Mr. Speaker, we have had a lot of conversation about the VA and 
veterans. I would like to point out that comparing Medicare part D and 
the VA drug program is like comparing apples to oranges, because the VA 
program is a direct provider of those medical services and part D is an 
insurance program that is run through private plans, so that our 
seniors have the options and the ability to choose, to have control 
over their health care.
  About 40 percent of Medicare-eligible veterans enrolled in the VA 
health care are choosing to benefit from the Medicare drug benefit.
   It's critical that we protect what seniors value most--access to 
quality care in their own community; affordability; and choice of their 
prescription drug plan and pharmacy.
   I urge my colleagues to vote against H.R. 4.

[[Page H457]]

  Mr. DINGELL. Mr. Speaker, I am delighted at this time to yield 1\1/2\ 
minutes to our distinguished colleague, the gentleman from Utah (Mr. 
Matheson), a member of the committee.
  Mr. MATHESON. Mr. Speaker, I thank the chairman.
  Mr. Speaker, I rise in support of H.R. 4. I think it is important 
America's seniors have access to the medicines that they need. Quite 
frankly, that is why I voted for the Medicare Modernization Act when it 
passed the House in 2003. I believed then, as I do now, that the 
Medicare Modernization Act would give patients access to medicines. I 
also believe that the Medicare Modernization Act has made progress. 
There are more people who have prescription drug coverage as a result 
of the legislation.
  Today, I support H.R. 4, as I believe it is an additional measure 
that will likely provide more affordable medicines to those who need 
them. However, I have some concerns I would like to mention for the 
record.
  While it makes sense for efforts to be made toward negotiating better 
prices, I would hope the House would not interpret today's support of 
H.R. 4 as support for government price controls. I have long been a 
supporter of free and open markets. There is no better marketplace for 
consumers than one in which competition dictates the going rate for 
products and consumers are free to choose the products they prefer.
  I would encourage my colleagues to support free and open markets and 
oppose future efforts that would involve the government in actually 
setting price controls, and I encourage support today for H.R. 4.
  Mr. BARTON of Texas. Mr. Speaker, I yield 2 minutes to another 
distinguished member of the Energy and Commerce Committee, the 
gentleman from Oklahoma (Mr. Sullivan).
  Mr. SULLIVAN. Mr. Speaker, I rise in strong opposition to H.R. 4, 
legislation that effectively places the Federal Government in charge of 
the prescription drug program seniors participate in and jeopardizes 
seniors' ability to choose the Medicare plan that best fits their 
needs.
  The Medicare Modernization Act wisely provides Medicare prescription 
drug plans with powerful free market tools that drive deep discounts in 
prescription drug plans. Seniors deserve low drug prices, and that is 
what they are getting with Medicare part D.
  American taxpayers are also benefiting under Medicare part D. In 
fact, since 2003, taxpayers have saved $96 billion through competition 
among health plans. We are already seeing competition drive down prices 
and provide lower costs to Medicare beneficiaries. Competition is the 
reason why. Premiums have dropped from $37 to $22 per month, and the 
average monthly bill seniors spend on prescription drugs has fallen 54 
percent, saving seniors an average of $1,200 a year. Ninety percent of 
all Medicare beneficiaries and more than 90 percent of seniors in 
Oklahoma are seeing real discounts on their prescription drugs.
  If the government is allowed to set costs and control prices with 
Medicare part D, it will limit access to drugs, and seniors may lose 
the right to choose plans. This problem already exists in the Veterans 
Administration. A quarter of our Nation's veterans who receive VA 
health care benefits are also enrolled in Medicare part D.
  This bill shows a clear difference between Democrats and Republicans. 
We want free market choice for our seniors instead of one-size-fits-all 
bureaucratic programs that will deny seniors the opportunity to choose 
drug plans that serve them best.
  Let's not jeopardize a good benefit that 80 percent of our seniors 
are satisfied with and is providing real savings to taxpayers and 
seniors alike. I urge a ``no'' vote on this measure.
  Mr. DINGELL. Mr. Speaker, at this time I reserve the balance of my 
time on behalf of the Energy and Commerce Committee.
  Mr. BARTON of Texas. Mr. Speaker, I yield 1\1/2\ minutes to the 
gentleman from Georgia (Mr. Gingrey).
  Mr. GINGREY. Mr. Speaker, I thank the chairman.
  Mr. Speaker, I rise in strong opposition to H.R. 4. It is 
unbelievable, in fact, that the Democrats would bring this bill to the 
floor. They were not part of the solution when we passed the 
prescription drug act, that they failed to pass for 25 years. I can 
understand them wanting to get on to a rising stock, but, Mr. Speaker, 
I will tell you this: they are betting on the last 10 percent.
  Hanging this albatross around Medicare part D that has been so 
successful is going to drag it to the bottom, and it is going to hurt 
our seniors. It is going to hurt my mom. Seniors are saving an average 
of $1,100 per month because of competition in the marketplace.
  You know, Mr. Speaker, this week, the Democratic majority has 
trampled on the rights of the minority with these four bills, allowing 
us no opportunity for amendment. But, do you know what? I think on this 
particular bill, they have done us a favor. The way they have done us a 
favor is they have not allowed us to bring forth an amendment, trying 
to put lipstick on this legislative pig, and that is a favor to us. 
That is a political win for the Republican Party, but unfortunately, 
Mr. Speaker, it is a loss for our seniors.
  We need to kill this sucker dead.
  Mr. Speaker, I rise today in strong opposition to H.R. 4, the 
Medicare Prescription Drug Price Negotiation Act. Last year, the new 
prescription drug plan, Medicare Part D, was implemented and seniors in 
our country had access to drug coverage for the first time.
  In its first year, the Part D program enjoyed lowered than expected 
cost, high enrollment numbers and an overwhelming vote of satisfaction 
from America's seniors. To me, Mr. Speaker, that is the definition of 
success.
  Let me underscore the specific statistics that back up these 
statements, because in the course of the debate proponents of this 
government price control bill have misconstrued and misrepresented the 
realities of the Part D program.
  First of all, in 2006 Part D cost $26 billion less than expected and 
over the next 10 years it is projected to cost 21 percent less than 
earlier forecasts. Mr. Speaker that represents a savings of over $200 
billion to the American taxpayer--a savings Mr. Speaker, in a 
government program! Which leads to another important aspect of the Part 
D program, competition.
  When Congress created this new prescription drug benefit, it was 
designed to use the power of competition to deliver low prices to 
America's seniors. For instance, Medicare beneficiaries were expected 
to pay an average monthly premium of $37. However in 2006, because of 
the fierce competition among plan providers to provide this benefit to 
our seniors, the average monthly premium shrunk to $24.
  Seniors are overwhelmingly satisfied with their Part D plan. In a 
Kaiser Family Foundation survey, 81 percent of enrolled seniors are 
satisfied with their Medicare drug plan and only 4 percent are 
dissatisfied. In fact, a recent J.D. Power and Associates survey found 
seniors are more satisfied with their Medicare drug plan than with 
their auto insurance, home mortgage and cable service.
  So, Mr. Speaker, that leads us to a very obvious question. Why are we 
debating a major change to this successful and popular program? The 
answer is quite obvious, but extremely disappointing. It is politics.
  My colleagues on the other side of the aisle spent a lot of time over 
the past few years throwing bricks at the ``Republican Part D Plan.'' 
And they didn't stop last year when the surveys and statistics were 
pouring in at how much this program was saving our seniors. And, Mr. 
Speaker, when it became obvious that the program was both successful 
and popular, the Democrats started touting the sound bite that Medicare 
needed the power of government negotiations to deliver even more 
savings to seniors. It seemed they wanted to capitalize on the very 
popularity they were undermining just a few months earlier.
  Unfortunately, for my colleagues on the other side of the aisle, that 
political rhetoric has proven difficult to turn into sound policy. The 
reason is very simple. The Part D program is successful because the 
government has remained out of the negotiation process and private 
companies have fought hard to earn the right to service America's 
seniors.
  Mr. Speaker, the Congressional Budget Office affirmed this in a 
letter to Senator Frist in 2004, and again this week to Chairman 
Rangel. CBO states and I quote, ``We estimate that striking. that 
provision (the non-interference provision) would have a negligible 
effect on federal spending because CBO estimates that substantial 
savings will be obtained by the private plans and that the Secretary 
would not be able to negotiate prices that further reduce federal 
spending to a significant degree.''
  If my Democratic friends are only using this debate to score a few 
cheap political points, they should be ashamed of themselves, 
considering the only people that will pay for this maneuver are our 
struggling seniors.

[[Page H458]]

  Mr. BARTON of Texas. Mr. Speaker, I yield 1 minute to the gentleman 
from South Carolina (Mr. Wilson).
  Mr. WILSON of South Carolina. Mr. Speaker, when a government program 
is not working, we have an obligation to fix it. This is not the case, 
however, with the Medicare prescription part D. In fact, part D is 
working well.
  Just yesterday, the Medicare Prescription Education Network released 
a study showing that 80 percent of seniors enrolled in Medicare part D 
are satisfied with their coverage, and an 80 percent satisfaction rate 
is unprecedented for such an important and positive program. I am 
particularly pleased that a Blue Cross/Blue Shield call center 
assisting recipients with part D enrollment has been operating in the 
district I represent.
  Moreover, government involvement would likely limit access to 
medications and restrict the development of new treatments. As USA 
Today recently editorialized: ``The public would be best served if the 
new Congress conducts an in-depth oversight to gather facts, rather 
than rushing through legislation within 100 hours to fix something that 
isn't necessarily broken.''
  I urge my colleagues to protect part D and vote against H.R. 4.
  Mr. BARTON of Texas. Mr. Speaker, I ask unanimous consent that the 
gentleman from Michigan (Mr. Camp) be allowed to control the minority 
time for the Ways and Means Committee, which I believe is 40 minutes.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Texas?
  There was no objection.
  Mr. CAMP of Michigan. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, I rise today in opposition to H.R. 4. It is a flawed 
piece of legislation. If there was ever a bill that should have gone 
through regular order in the committee process, it is this one, because 
we find as we look at it more carefully that there is much more to it 
than might appear at first glance.
  First and foremost, we should recognize that Medicare part D is 
working. Ninety percent of seniors are covered. Thirty-eight million 
seniors now have prescription drug coverage.
  Additionally, due to private competition, the cost of this program is 
continuing to fall. Estimates from the Center for Medicare and Medicaid 
Services have predicted that this program will cost $373 billion less 
over the next 10 years than was expected in 2005. Seniors are saving an 
average of $1,200 dollars a year because of those declines.
  Market-driven reforms in the 2003 Medicare Modernization Act are 
working to provide more choices and lower prices.

                              {time}  1130

  Rather than establishing a one-size-fits-all government benefits 
package, the part D program allows beneficiaries to choose from a range 
of plans that meet their unique needs and circumstances.
  It is also important to note that the current private sector 
negotiating power of part D is greater than a government-run Medicare 
program. We have heard much from the other side about a government-run 
program having a bargaining power, but in fact, the four top pharmacy 
benefit managers cover over 200 million individuals. So they not only 
negotiate on behalf of the seniors in part D but also on behalf of all 
the other beneficiaries in their programs throughout the United States, 
including most Members of Congress in the Federal Employees Health 
Benefit Plan. So this is over 10 times the number of Medicare 
beneficiaries than the Secretary would negotiate on behalf of.
  Despite these facts, Democrats are continuing to push a bill that 
could significantly disrupt and dismantle the successful and popular 
Medicare prescription drug program. They want to remove private 
competition forces from this successful equation and, instead, have the 
Secretary of Health and Human Services interfere in and implement a 
price control system.
  Medicare part D is successful because seniors are able to choose 
plans that cover their drugs and best meet their health needs. 
Government bureaucrats, instead, would be replaced and would choose 
what drugs seniors would get, and these bureaucrats would be allowed to 
set prices for Medicare covered drugs.
  The government should not be responsible for making decisions that 
should be left to seniors. Currently, seniors are able to choose plans. 
I think we should continue to allow seniors to make their own choices 
and keep bureaucrats out of seniors' medicine cabinets. The Medicare 
prescription drug program is working, and we would be wise to resist 
the Democrats' plan to fix what is not broken.
  We can continue to improve prescription drug programs, but we must 
closely examine these changes so Congress does not do more harm than 
good by enacting new policies. I encourage my colleagues to vote ``no'' 
on this bill.
  Mr. Speaker, I reserve the balance of my time.
  Mr. RANGEL. Mr. Speaker, I would like to say that I wish that we had 
had more time to have gone into the details of this proposal, but I 
want to point out that we have an opportunity to allow the 
administration to decide how we can best reduce the price of drugs for 
all people and to give him the discretion to use every tool that we 
have in the Congress. Now, some people on the other side have indicated 
that this is price control and the free marketplace should work its 
will. It appears to me that common sense and judgment would say that 
the Secretary should have every available tool that he or she thinks is 
necessary in order to reach this common goal that we want to reach.
  Just saying that the power to negotiate prices, which you have to 
admit sounds like it makes good sense, would be restricted and 
prohibited by the person responsible for reaching the goal of lower 
prices makes no sense at all. If indeed some of the objections that 
have been raised by those who don't have the responsibility that the 
Secretary has, if they truly believe this is an impediment to reach 
that goal, then I think that all of us in the Congress have the 
responsibility to change the law and to do whatever is necessary in 
order to reach that goal.
  To say that someone is prohibited from participating in the reduction 
of that price, the price of the drugs when they can buy in quantity 
defies common sense and reason. This is especially so since we would 
like to assume that the pharmaceutical industry would be partners with 
us in getting the maximum amount of medicine necessary to those who 
need it. And even if we had no knowledge of the facts at all as to what 
works and doesn't work, the protest that is coming from the 
pharmaceutical industry should indicate that there is something wrong 
with the system if they do not trust the Federal Government to 
negotiate fairly.
  So for all of those reasons, I hope that those who have a problem 
with the bill would recognize that this is just the beginning of a 
process to improve upon what we already have and that if there are any 
problems, that we will be coming back to the committee to try to make 
those adjustments that would be necessary.
  Mr. Speaker, I would like to ask unanimous consent to yield the 
balance of my time for purposes of controlling the time on this bill to 
Mr. Stark, who is the chairman of the Subcommittee on Health and who 
spent a tremendous amount of time on this.
  And, believe me, there is no politics involved in it. We all want to 
achieve a common goal, and I think this just removes the restriction on 
the Secretary so that together we can be of assistance.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from New York?
  There was no objection.
  Mr. CAMP of Michigan. Mr. Speaker, I yield for purposes of 
controlling time to the ranking member of the full Ways and Means 
Committee, the distinguished gentleman from Louisiana (Mr. McCrery).
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Michigan?
  There was no objection.
  The SPEAKER pro tempore. The Chair recognizes the gentleman from 
Louisiana.
  Mr. McCRERY. Mr. Speaker, I yield myself such time as I may consume.
  I want to begin my remarks by saying that we are hearing today a lot 
of claims from colleagues on the other side of this issue. They quote 
various

[[Page H459]]

studies that they say prove this will help reduce prices to seniors and 
help reduce costs to the government. And as everybody in Washington 
knows, you can generally find a study to say just about whatever you 
want it to say. But if you listen carefully, you will notice that no 
one today, and no one will later today, dispute one fact: The 
nonpartisan official budget scorekeeper for Congress, the analysts that 
Congress is required by law to follow, the Congressional Budget Office, 
says that this bill before us will not save one dime. The bill will not 
save seniors money; it will not save taxpayers money; and it will not 
save the government money.
  Now, in case you are thinking, oh, yeah, yeah, but that is old news. 
That is the old Congressional Budget Office when Republicans controlled 
it. Well, that is what the old Congressional Budget Office said when 
Republicans controlled it. But, guess what? In a letter dated just a 
couple of days ago from the new Congressional Budget Office that 
Democrats control, it says the same thing exactly.
  Now, why won't this bill save any money? Simply because the private 
sector is doing an excellent job already negotiating lower prices for 
our seniors. And without tools that some have said today they do not 
want the Secretary to have, and even the language of the bill states 
the Secretary shall not provide formularies for part D, but without 
those tools, the CBO says, you can't save any money.
  So you can't have it both ways. You can't say, oh, we want lower drug 
prices for seniors; but then at the same time say, yeah, but we don't 
want those formularies. We don't want to restrict access to any drugs, 
like Lipitor, which is not on the VA formulary.
  The Secretary of Health and Human Services cannot do a better job of 
negotiating than the private sector is already doing. The Secretary 
says so. CMS says so, and CBO says so. The only way the Secretary will 
be able to further reduce it is by weakening the drug benefit by 
restricting access.
  So why is the Democratic leadership trying to rush this major 
legislation through the House without a single congressional hearing, 
without input from the committees of jurisdiction? I fear this is an 
example of bumper sticker politics. I am afraid they are looking for a 
good sound bite, not good policy.
  While H.R. 4 won't produce savings, it certainly has the potential to 
disrupt or even destroy one of the most popular programs in our 
history. Today, roughly 90 percent of America's seniors and people with 
disabilities have prescription drug coverage. Four out of every five 
seniors enrolled in a Medicare drug plan say they are satisfied with 
the new drug coverage and would recommend it to their friends.
  Medicare drug plans are negotiating significantly lower prices for 
our seniors. The average senior last year saved $1,200. Initial 
estimates indicate that Medicare prescription drug plans saved seniors 
last year a total of about $30 billion. Competition has resulted in a 
program that is expected to cost $373 billion less over the next 10 
years than was projected just 1\1/2\ years ago.
  Clearly, the current drug benefit, which allows for competition 
rather than government price controls, is working. H.R. 4 could bring 
this success to a screeching halt. If the Secretary of HHS is forced to 
find the savings suggested by the proponents of this poorly drafted 
legislation, it seems certain that some seniors will lose access to the 
prescription drugs they need.
  Currently, Medicare beneficiaries enrolled in a drug plan have access 
to drugs to treat cancer, mental illness, HIV/AIDS, Lou Gehrig's 
disease and Alzheimer's, to name a few. They are guaranteed that. H.R. 
4 does not guarantee that.
  Here is what patient groups have to say about the bill that is before 
us today. The association representing patients afflicted with Lou 
Gehrig's disease says, ``This shortsighted and inappropriately cost-
driven bill will have particularly cruel consequences for people with 
ALS. If Congress makes this change, they will undo what the Medicare 
Modernization Act sought to ensure: access to needed prescription 
drugs.'' The National Alliance on Mental Illness says much the same 
thing; the Kidney Cancer Association much the same thing.
  The Republican motion to recommit, which we will soon offer, ensures 
that access to these important drugs continues.
  H.R. 4 will also hurt our community pharmacies, denying seniors 
access to those local pharmacists that they depend on. Seniors like to 
go to the drugstore to talk to their pharmacists to get advice. If, to 
hear some of the proponents, we go to something like the VA, for 
example, they won't have that opportunity because the VA is a closed 
system, and 80 percent of drugs delivered under the VA are delivered by 
mail order, not local pharmacies.
  Now, let us talk about veterans for just a minute. The American 
Legion, representing our veterans, says H.R. 4 is ``not in the best 
interest of America's veterans and their families. The American Legion, 
which represents nearly 3 million members, strongly urges Congress to 
seriously consider the collateral damage that would result from H.R. 4 
because `each time the Federal Government has enacted pharmaceutical 
price control legislation, the VA has experienced significant increases 
in its pharmaceutical costs.' ''
  H.R. 4 will not save money. It is opposed by groups representing 
victims of disease and opposed by our veterans. H.R. 4 will likely 
restrict seniors' access to the drugs they need and to the pharmacies 
they depend upon. H.R. 4 will certainly disrupt a popular program that, 
despite being just 1 year old, has done a remarkable job.
  That is why we all ought to vote against H.R. 4, but first, vote for 
the Republican motion to recommit.
  Mr. Speaker, I reserve the balance of my time.
  Mr. STARK. Mr. Speaker, I yield myself such time as I may consume.
  I will be submitting for the Record an editorial from today's New 
York Times which concludes by suggesting that the bill, H.R. 4, does 
not require the Secretary to negotiate prices for all 4,400 drugs used. 
A smart Secretary could simply determine which prices paid by the plan 
seem most out of line with prices paid by other purchasers and then 
negotiate only on those drugs. The private plans are exclusively 
allowed to negotiate even lower prices, if they can. This sort of 
flexibility would pose no threat to the free market.

                              {time}  1145

  It is time for the Medicare drug program to work harder for its 
beneficiaries, without worrying so much about the pharmaceutical 
companies.
  Then, I would also like to respond to what I am sure was not, by one 
of the previous speakers, an intentional fabrication or misstatement, 
just probably a remark due to the inability to read a bill and 
understand what it means. And it is quite correct that in 2000 our 
motion to recommit had some wording that limited interference by the 
Secretary. But it is also important to note that it was a completely 
different bill; and as such, the motion to recommit had no relationship 
to this bill. And to suggest otherwise is an outright lie. And I will 
let it stand with that. If anybody would like to see the previous bill, 
we have information that will cover it.
  I rise in support of H.R. 4. It is a simple, straightforward bill 
that should pass by unanimous consent if the Members of Congress want 
to help senior citizens, rather than the special pharmaceutical 
interests.
  The bill rights a wrong included in the prescription drug act passed 
in 2003. And it takes away the special interest protection that 
prohibits the Secretary from negotiating to get better prices for 
Medicare beneficiaries.
  The present law includes a flat out prohibition against using the 
negotiating ability and clout of 43 million Medicare beneficiaries to 
get better prices. That is wrong. We don't prohibit the government from 
negotiating prices for airplanes, even for oil royalties in the gulf, 
for highway construction or for anything else the government purchases.
  Our bill today eliminates that prohibition and goes one step further. 
It requires the Secretary to use the market strength of Medicare's 43 
million beneficiaries to negotiate better prices for seniors and people 
with disabilities. We had to go further than simply eliminating the 
prohibition because the current administration has been so vocal in 
their opposition to using this tool,

[[Page H460]]

even if given the authority. Indeed, they have threatened to veto.
  Countless studies show that Medicare beneficiaries are not getting 
very good deals on their prescription drug prices. The Bush 
administration has shown their ability to negotiate discounts on other 
drugs. Secretary Thompson did this twice, once when we had the anthrax 
attacks and then again when we faced the flu vaccine shortage.
  This change shouldn't be controversial at all. It is a change that is 
supported by over 90 percent of the American public, and it is a change 
that should lower taxpayers' and seniors' expenses. It is a change 
supported by advocates for Medicare beneficiaries, the physicians who 
care for them, and the community pharmacists who fill their 
prescriptions.
  It is a change that is even supported by AARP, which I continue to 
contend wrongly endorsed the Republican bill in the first place. But 
even they agree that the government should be empowered to negotiate 
better drug prices.
  The only interests standing up against that legislation are the same 
interests who got the prohibition on negotiation included in the first 
place, the pharmaceutical drug lobby and those whose campaigns they 
funded.
  Those days are over. Congress is no longer about special interests. 
It is about the interests of the American people, and that is why we 
brought this bill up as part of the first 100-hour agenda. We urge the 
President to reconsider his opposition to it, and to work with us to 
get Medicare beneficiaries a better deal on their prescription drug 
prices, and to get a better deal for the American taxpayers.
  It is an important first step in our goal to improve the Medicare 
prescription drug program for seniors and people with disabilities. I 
look forward to working with my colleagues and with the administration 
to improve the Medicare program.

                [From the New York Times, Jan. 12, 2007]

                     Negotiating Lower Drug Prices

       From all the ruckus raised by the administration and its 
     patrons in the pharmaceutical industry, you would think that 
     Congressional Democrats were out to destroy the free market 
     system when they call for the government to negotiate the 
     prices of prescription drugs for Medicare beneficiaries. Yet 
     a bill scheduled for a vote in the House of Representatives 
     today is sufficiently flexible to allow older Americans to 
     benefit from the best efforts of both the government and the 
     private rug plans.
       The secretary of health and human services should be able 
     to exert his bargaining power with drug companies in those 
     cases in which the private plans have failed to rein in 
     unduly high prices--leaving the rest to the drug plans. The 
     result could be lower costs for consumers and savings for the 
     taxpayers who support Medicare.
       Under current law, written to appease the pharmaceutical 
     industry, the government is explicitly forbidden from using 
     its huge purchasing power to negotiate lower drug prices for 
     Medicare beneficiaries. That job is left to the private 
     health plans that provide drug coverage under Medicare and 
     compete for customers in part on the basis of cost. The 
     Democrats' bill would end the prohibition and require--not 
     just authorize--the secretary of health and human services to 
     negotiate prices with the manufacturers. That language is 
     important since the current secretary, Michael Leavitt, has 
     said he does not want the power to negotiate.
       No data is publicly available to indicate what prices the 
     private health plans actually pay the manufacturers. But 
     judging from what they charge their beneficiaries, it looks 
     like they pay significantly more for many drugs than do the 
     Department of Veterans Affairs--which by law gets big 
     discounts--the Medicaid programs for the poor, or foreign 
     countries. The administration argues, correctly, that the 
     private plans have held costs down and that there is no 
     guarantee the government will do any better. The bill, for 
     example, prohibits the secretary from limiting which drugs 
     are covered by Medicare, thus depriving him of a tool used by 
     private plans and the V.A. to win big discounts from 
     companies eager to get their drugs on the list. The secretary 
     does have the bully pulpit, which he can use to try to bring 
     down the cost of overpriced drugs.
       The bill also does not require the secretary to negotiate 
     prices for all 4,400 drugs used by beneficiaries. A smart 
     secretary could simply determine which prices paid by the 
     plans seemed most out of line with the prices paid by other 
     purchasers and then negotiate only on those drugs. The 
     private plans are explicitly allowed to negotiate even lower 
     prices if they can. This sort of flexibility should pose no 
     threat to the free market. It is time for the Medicare drug 
     program to work harder for its beneficiaries without worrying 
     so much about the pharmaceutical companies.

  Mr. Speaker, I reserve the balance of my time.
  Mr. McCRERY. Mr. Speaker, before I yield to my colleague from 
Missouri, I just want to challenge anybody on the other side of this 
issue today, anybody that is in support of H.R. 4, to explain to this 
House how the Secretary, using the authority under the bill before us, 
is going to get prices lower. What are the tools that he is going to 
have to negotiate if he doesn't have the power to assure pharmaceutical 
manufacturers market share in the program, if he can't use formularies 
to do the negotiating? I don't think they can do that.
  Mr. Speaker, at this time I would yield 4 minutes to my colleague 
from Missouri (Mr. Blunt).
  Mr. BLUNT. Mr. Speaker, I rise today in opposition to H.R. 4, but 
more than that, in support of prescription drug access that works for 
seniors. This has been a long, hard fight in this Congress to get this 
program to where it is today, and it is working for seniors. They think 
it is working for them, and I think it is working for them.
  The cornerstone of the Medicare prescription drug program is choice 
and satisfaction driven by competition. Competition is a good thing. 
And once again, today we are talking about whether or not we have 
competition in this system.
  Instead of a one-size-fits-all model, the prescription drug benefit 
provides choices for seniors so they can find the best plan for them. 
This competitive model works, and it is doing exactly what Congress 
intended: it is driving costs down and providing more options for 
seniors.
  The current system, as my friend from Louisiana has already said, the 
current system costs less than was anticipated, has more options for 
seniors than was expected, and has a tremendous level of user approval.
  With the competitive Medicare drug program, individual drug plans can 
decide not to sign a contract with a drug company if they can't reach a 
price that they can agree on. Then seniors analyzed what all of these 
competitors out there were able to do. They take the drugs they take to 
the plans available and find out which company was able to negotiate 
the best deal, not for all drugs, but for their drugs. That is why this 
plan has worked in a way that surprised so many people, including the 
seniors that now benefit from this plan.
  What are we really talking about today? Our friends on the other side 
seem to think that we need government to negotiate prices for seniors. 
Well, what does that really mean?
  When the government negotiates for you, it means you are cut out of 
the decision-making process. Government is almost never the best 
negotiator and wouldn't be the best negotiator here.
  Some of my colleagues claim that the change they are proposing today 
is merely minor. But I believe the change we are debating today is the 
major debate about the future of health care in the coming decades. Do 
we believe that government should make the decisions about your health 
care? Or do we believe that these decisions are so fundamentally 
personal that they can only best be made by the individual? Are 
Americans better served by a competitive model or by a government 
mandate that has less access and more cost?
  Opponents of adding prescription drugs to Medicare and the way we did 
it last January have never believed that competitive options for 
seniors were the way to go. They have said so many times. That is the 
reason that I think they are so determined today to take away these 
choices that seniors have.
  When the government negotiates prices, it fixes prices. This means a 
government bureaucrat will be empowered to determine what kind of drugs 
our seniors will have access to. If the government couldn't reach a 
deal with the drug company, seniors wouldn't have access to those 
drugs. That is what happens in the VA system that we are talking about.
  Actually, today, we ought to be talking about how we can provide more 
choices for veterans instead of fewer choices for other seniors. It is 
Economics 101. And if seniors only cared about price, the lowest plan 
available would be the plan all seniors were choosing. They are not 
choosing that plan. They are choosing the best plan for them.
  H.R. 4 will open the door to price fixing and health care rationing 
by the government. It is as simple as that.

[[Page H461]]

  During the campaign, Democrats argued that this bill is needed to 
protect our seniors. But if any senior can point to anywhere in this 
bill where it points out that all the drugs available to seniors today 
would be available in the future, I would suggest not only is it not 
there, but one negotiator couldn't make that deal.
  I urge my colleagues to reject this change, to reject rationing, to 
keep choice out there for seniors, and to believe in competition.
  Mr. STARK. Mr. Speaker, I am pleased to yield 1\1/2\ minutes to the 
gentleman from Connecticut (Mr. Larson) who, like the National 
Committee to Preserve Social Security and Medicare, knows that H.R. 4 
would be an important step to improve part D.
  Mr. LARSON of Connecticut. Mr. Speaker, I rise in strong support of 
this legislation. Look, as we all know, as the cliche goes, the road to 
hell is paved with good intentions. And while our colleagues on the 
other side are heralding the program that they produced, through what I 
believe to be their good intentions, they are terribly misguided.
  But it does draw strong philosophical differences between the two 
parties and our approach. Yes, you would like to privatize Social 
Security. Yes, you would like to privatize Medicare. And this bill, 
essentially, is the privatization of Medicare masquerading as 
prescription drug relief and forbids explicitly the Secretary of Health 
and Human Services from negotiating directly for lower price while the 
VA commissioner does.
  But then you say you introduce competition. Wow. Everybody is for 
competition. So how do all these plans, why were they enticed into it? 
The government pays and incentivizes the private sector to get involved 
in this? That is interesting competition. They incentivize the private 
sector to compete against the government program. They fund them the 
money.
  Oh, and by the way, there is no penalty and no risk if they pull out. 
The only penalty and risk are on the elderlies' backs, because they can 
cancel the formulary, they can pull out with no risk and no penalty. It 
is only the people that fall into the doughnut hole and only the people 
that have to pay the extra prices that understand why it is so 
important that government step up and level the playing field for its 
citizens.
  Mr. McCRERY. Mr. Speaker, I yield 2 minutes to the distinguished 
Member from California, a member of the Ways and Means Committee (Mr. 
Herger).
  Mr. HERGER. Mr. Speaker, I rise in strong opposition to H.R. 4. The 
fundamental question in today's debate is what produces better results, 
the free market or the Federal Government? Medicare part D was founded 
on a belief that free markets get results. It is a system in which 
private companies compete with each other to meet the needs of our 
senior citizens. These private companies negotiate with drug 
manufacturers to get lower prices, and the results have been 
impressive.
  When the Congress created part D, we expected the average premium to 
be around $35 a month. Yet, thanks to the power of competition, 
Medicare beneficiaries actually paid an average of $24 per month, and 
that number is going down to $22 in 2007.
  Mr. Speaker, I hope we can stop and think about what that means. In 
every other area of health care, costs are rising far faster than 
inflation. Where else have we seen an actual decrease in health care 
cost?
  At the same time, we can also see the results of a system in which 
the government imposes price controls or as today's legislation 
basically proposes.

                              {time}  1200

  In Canada, a government-run health care system has resulted in long 
waiting lists for medical care and a massive exodus of talented 
physicians. In our own country, our brief experiment with price 
controls in the 1970s ended with disastrous gasoline shortages.
  Mr. Speaker, I hope this Congress will consider the results and vote 
for the system that gets proven results.
  I urge my colleagues to soundly reject this legislation.
  Mr. STARK. Mr. Speaker, I am pleased to yield 1\1/2\ minutes to the 
distinguished gentleman from California, who agrees with AARP that the 
Secretary can achieve additional savings for beneficiaries under H.R. 
4.
  Mr. THOMPSON of California. Mr. Speaker, I rise today in support of 
H.R. 4, and I am not here to claim that it will instantly bring seniors 
huge discounts on their drugs, but this legislation is an important 
first step, because it gives the Secretary one more tool to maximize 
savings for seniors and value for taxpayers.
  It is important for another reason, lowering drug prices means that 
it will take seniors longer to hit the coverage gap, the donut hole, 
the period during which time they have to pay 100 percent of their drug 
costs.
  Less than 25 percent of the drug plans in my district offer any sort 
of coverage during this donut hole period, and most of them have 
premiums of upwards of $100 a month. A lot of northern California 
seniors can't afford that. When they hit the coverage gap, they foot 
the entire bill, or they go without their medicine.
  Allowing the Secretary to negotiate prices will complement, not 
replace, the negotiations being conducted by the private plans. It is 
one more tool that can be used to lower costs and prolong the amount of 
time it takes before seniors hit their donut hole.
  This legislation does not create price controls, which I oppose, and 
it explicitly prevents the Secretary from setting a national formulary. 
Our Medicare program offers seniors choice and allows seniors access to 
the medicines that they need. This legislation will maintain that 
choice and access, and it is a good first step to bring about lower 
prices.
  I support H.R. 4, and I encourage all of my colleagues to do the 
same.
  Mr. McCRERY. Mr. Speaker, I yield 2 minutes to another distinguished 
member of the Ways and Means Committee, the gentleman from Kentucky 
(Mr. Lewis).
  Mr. LEWIS of Kentucky. Mr. Speaker, I rise today to voice my 
opposition for H.R. 4 and to encourage my colleagues to vote against 
this bill.
  Ronald Reagan once said the nine most terrifying words in the English 
language are, I am from the government, and I am here to help you. Our 
seniors should say, thanks, but no thanks.
  H.R. 4 is certainly a solution in search of a problem. The Medicare 
drug benefit is a quantitative success. Millions of seniors now have 
prescription drug coverage through Medicare part D and over 86,000 
beneficiaries in my district alone are saving money while enjoying 
greater access to the prescription drugs they need.
  Competition has reduced monthly premiums and empowered seniors to 
make their own choices about drug plans. On average, seniors saved 
$1,200 off the cost of their prescription drugs last year. In fact, 80 
percent of recipients nationwide report high satisfaction with the new 
program.
  Actuaries for the Congressional Budget Office, the ultimate 
scorekeeper in Congressional spending, as well as the Centers for 
Medicare and Medicaid Services, both predict that H.R. 4 will produce 
no savings. At the same time, strong competition has lowered drug 
plans, the bids, by 10 percent, for 2007. Overall, analysts estimate 
that part D will cost $373 billion less over the next 10 years than 
initially expected.
  Mr. Speaker, if passed, this bill would allow the Federal Government 
to get into the medicine cabinets of millions of Medicare beneficiaries 
across the country. Part D is working. The changes proposed in this 
bill would create tremendous uncertainty among seniors who are 
benefitting from this successful program. This bill is nothing but a 
veiled attempt at national health care that could end up driving up 
costs, reducing seniors' access to much-needed prescription drugs and 
serving as a downfall of community pharmacies.
  I urge my colleagues to vote ``no'' on this bill.
  Mr. STARK. Mr. Speaker, I am pleased to yield 1\1/2\ minutes to the 
gentleman from Washington (Mr. McDermott), who agrees with AIDS Action 
that an effort to ensure the Secretary of Health and Human Services has 
authority to negotiate drug prices is important to the continuing 
success of part D.
  (Mr. McDERMOTT asked and was given permission to revise and extend 
his remarks.)
  Mr. McDERMOTT. Mr. Speaker, as I listen to my colleagues on the other

[[Page H462]]

side today, it seems like I am back in medical school in 1963 when the 
American Medical Association president told us, if we get that 
Medicare, that will be the end of health care in this country; there is 
no way we will have any kind of good health care in this country.
  Well, the fact is we would never have had it if we waited for you to 
do it. During the 12 years you were in control, you proposed not one 
single way to deal with the 46 million Americans who have no health 
insurance.
  Now with respect to senior citizens, they are isolated in a blizzard 
of confusing programs and options which cost more than a 250 percent 
difference in the same zip code. I live in 98119. You can spent 250 
percent different depending on which program.
  People don't know that. My mother is 97, and you expect them to pick 
this up. They ought to get a lower cost, and we are going to get it for 
them by getting the Secretary to negotiate them, as he should. That 
creates a huge national pool that the companies cannot ignore, and they 
are going to have to work toward the common good.
  Now, it is time we worked for the common good in here, not for the 
pharmaceutical industry or the insurance industry or anybody else but 
the seniors who have to deal with the prices of their drugs. That is 
what they are asking for us. It is the same proposal we have used in 
the VA.
  You would think we would be doing that to the veterans if it was bad? 
Come on. This is good for the veterans, it is good for the seniors, and 
it is finally working toward the common good in this House.
  Mr. McCRERY. Mr. Speaker, I yield 3 minutes to another distinguished 
Member of the Ways and Means committee, the gentleman from Missouri 
(Mr. Hulshof).
  (Mr. HULSHOF asked and was given permission to revise and extend his 
remarks.)
  Mr. HULSHOF. I appreciate the gentleman yielding.
  Mr. Speaker, my colleague from the State of Washington mentioned 
medical school. Let me recount an old axiom that with learned in law 
school. We were told: If the facts are against you, argue the law. If 
the law is against you, argue the facts. If the facts and the law are 
against you, pound the podium.
  Ladies and gentlemen, there has been a lot of podium pounding on the 
other side of the aisle today. The question is this, shall the 
government interfere with or intervene in a prescription drug plan that 
is working?
  Now, the majority seeks through H.R. 4 to strike this nonintervention 
clause. First of all, is anyone having a flashback to 1993 and 1994 
talking about government taking over health care?
  But, more importantly, my colleague from the State of California, the 
incoming chairman of the Health Subcommittee, and 203 of his colleagues 
are about to do an abrupt, en masse, about face. Because in the 
Congressional Record of June 28 of 2000, you had this nonintervention 
clause, and 204 Democrats said, we don't want to give the Secretary the 
ability to negotiate in roll call 356.
  Now, what could possibly explain this inconsistency? Could politics 
be at play?
  The gentleman from Washington talked about some history. Let us go 
back over the committee history, because my colleagues from Ways and 
Means are here.
  First of all, during committee action we were chided there would be 
no plans available under the Republican plan.
  Then, of course, when we saw the plethora of plans, we heard the 
complaints from your side, there are too many confusing choices that 
seniors have across the country. Then you wagged your finger at us and 
said, well, we need to legislate the premium at $35, and then the total 
cost of the program is going to explode the deficit. Remember hearing 
that?
  Yet, on the other hand, as has been discussed, the average premium is 
$22. In the State of Missouri, you could even have a premium for under 
$15 if you choose it. Of course, we have seen how those program costs 
have come down.
  We heard from your side that the drug companies were going to do a 
bait-and-switch, that we were going to have low ball that first year 
and then we would see those prices being jacked up. Lord help us, 
what's happened? Drug prices have gone down. Imagine premiums and 
prices coming down in health care.
  Then my colleague from the State of California said to his 
colleagues, it is okay, once the seniors hit the donut hole, they will 
be angry, and they will be outraged. Then we have seen, of course, that 
every senior at least has had the opportunity to have full coverage, 
including coverage for the donut hole. You just can't find it within 
yourself to say we got one right.
  Just like welfare reform, surely, Mr. Leader, once every 10 years, 
you can say the Republicans got it right. We are witnessing cost 
containment and competition by incorporating private sector market 
principles within the public sector programs provision of drug 
coverage. Let us lighten up on the podium pounding, say no to 
government interference and no to H.R. 4.
  Mr. Speaker, I rise in opposition to H.R. 4, and I would like to 
divide my remarks into two main thoughts: first, ``if it ain't broke, 
don't fix it,'' and second, the laws of intended and unintended 
consequences.
  Mr. Speaker, the Medicare Part D Benefit ain't broke.
  But Medicare was broken before there was a drug benefit. When I came 
to Congress, one of the issues I heard about most often from my 
constituents was the need for prescription drug coverage for seniors. 
In 1965, when Medicare was created to ensure that seniors had some 
access to health care, prescription drugs were not a primary mode of 
treatment, and thus not covered.
  But as medical science advanced, and miraculous treatments became 
available via prescription drugs, Medicare still languished without a 
drug benefit, and many seniors were faced with the brutal decision 
between buying their medicine or paying for food, clothes, housing, and 
other necessities.
  Seniors do not have to make that brutal decision anymore.
  Under the law, millions of seniors who previously could not afford 
prescription drugs are now receiving the medicines they need.
  More than 40,000 volunteers in communities across the country worked 
during the enrollment period, counseling beneficiaries and sponsoring 
events to help people with Medicare. I would like to commend these 
volunteers, volunteers like Debbie Catlett from the Hannibal Nutrition 
Center, who lovingly helped her friends and neighbors sign up for drug 
coverage.
  The system the Republican Congress set-up has been remarkably 
successful: The average premium in 2006, originally projected to be $37 
per month, was only $23; and rather than increasing to the projected 
$40 per month in 2007 it lowered to $22 for this year. In Missouri, we 
have even less expensive options available, the lowest costing only 
$14.90 per month. Imagine that, health care premiums going down!
  Seniors are saving, on average, $1,200 a year on prescription drugs. 
At the same time, Part D recipients saw a 13 percent increase in the 
number of medications available. According to polls, about 80 percent 
of America's seniors are satisfied with their prescription drug plans.
  All that is on the micro level, what individual seniors are enjoying 
and saving; but let's look at the macro level. Over 90 percent of 
seniors now have drug coverage--if these seniors are paying less, the 
government must be paying more to pick up the slack, right?
  Wrong.
  The Medicare drug benefit cost nearly $13 billion less than expected 
in its first year, 30 percent below the $43 billion that had been 
budgeted.
  Long-term savings are even greater. HHS Secretary Leavitt just 
announced that the independent CMS actuaries are lowering their 
estimate of the cost of the benefit over the next decade by another 10 
percent, with almost all of the new savings resulting from competition. 
The actuaries' new estimates show that total net Medicare costs are 30 
percent lower, or $189 billion less, for the same budget window (2004-
2013) than the actuaries originally anticipated before the Medicare 
drug benefit was implemented.
  The long and the short of it is, Medicare Part D is a big, fat 
success.
  Look, the majority is upset that the Republican Congress enacted a 
successful, popular program, and the ``let Medicare negotiate low 
prices like the VA'' polled well for them (I've seen the polling 
numbers). But a bumper sticker phrase aimed at coopting that success 
isn't good policy.
  I've discussed how the program isn't broken and doesn't need fixing, 
now onto the intended and unintended consequences of this bumper 
sticker bill.
  Best case scenario if this Democrat attention grabber of a bill 
becomes law is that

[[Page H463]]

Medicare proves unable to negotiate lower prices than the marketplace 
currently does--and two non-partisan entities, the Congressional Budget 
Office and the CMS Office of the Actuary have said the Democrat 
plan yields no savings for this reason--and no harm is done. But worst 
case scenario is overactive bureaucrats or the next President take this 
negotiating authority and use it to force price controls, ration drugs, 
and deny doctor and patient choice of what medicines are allowed for 
seniors.

  So friends, pick your poison: On the one hand an impotent outcome as 
CBO and the CMS Actuary have foretold, on the other, Medicare setting 
prices and rationing seniors their medicine. I will remain agnostic as 
to which is the intended and which the unintended consequence.
  The reason the two economic models I've mentioned concluded no 
savings via H.R. 4 is that, fundamentally, the government cannot 
negotiate any better than the thousands of prescription drug plan 
managers in the private market. Under current law the millions of 
Medicare beneficiaries, via their prescription drug plans, are coupled 
with the 200 million other health insured Americans. Caremark 
negotiates for 70 million lives, Medco for 54 million, and Express-
Scripts for 51 million. Medicare Part D allows our Medicare 
beneficiaries to piggyback on that huge buying power with professional 
negotiators. And the other side would rather untrained government 
bureaucrats negotiate for my constituents? No thank you.
  So let's look at the worst case scenario under this bill, where 
Medicare commands and controls seniors' medicine.
  Yes, H.R. 4 seems to disallow formularies, but in law school they 
taught me to look closely at the law. Page 3, line 20: ``nothing . . . 
shall be construed to authorize the Secretary to establish or require a 
particular formulary.''
  But banning a national formulary does not protect beneficiaries from 
other government access controls to prescription drugs. For instance, 
the Medicaid program has no national formulary, however, it employs 
various strategies such as a ``preferred drugs list'' to limit access 
of medications. If beneficiaries want to receive a medication that is 
not on the preferred drug list, they must go through a lengthy and 
confusing authorization.
  If the authors of H.R. 4 didn't have this in mind, why did they 
strike the underlying MMA language that would seem to protect against 
this, that said ``The Secretary may not require a particular formulary 
or institute a price structure for the reimbursement of covered part D 
drugs''?
  The Ways and Means Chairman was thoughtful enough to hold a forum on 
this matter yesterday for our committee members, and both his and Mr. 
McCrery's invited witnesses agreed that to get VA prices, you have to 
set a formulary, and a strict one at that.
  Again, the Democrats' bumper sticker slogan is fraught with bad 
consequences--intended or unintended.
  Most importantly, the plan offered by Democrats would limit choice. 
Veterans have access to less than one third the drugs Medicare 
beneficiaries do--the VA formulary covers 1,300 drugs while the 
Medicare drug benefit covers 4,300 drugs. Drugs like Lipitor, Celebrex, 
Flomax, and Prevacid are unavailable in the VA plan. In fact, 20 of the 
top 33 most commonly prescribed drugs for seniors are excluded in the 
VA plan.
  Pharmacy access is another pitfall of the Democrats' slogan. In 
reality, the VA distributes 80 percent of its medications by mail. 
Medicare uses mail for less than 2 percent of its medications. Seniors 
appreciate the opportunity to talk to their local pharmacist and ask 
questions about their prescriptions, and we have 1,077 pharmacies in 
Missouri where they can do just that. The VA has 6 pharmacies in the 
entire state of Missouri (and only 332 nationwide); the Democrat bumper 
sticker slogan loses a lot of its luster when looked at through that 
lens.
  Simply put--seniors would find many of their favorite drugs 
unavailable and that's unacceptable.
  The price control plan offered by the Democrat majority does not 
guarantee that seniors have access to ``all or substantially all'' 
drugs to treat cancer, mental illness, HIV/AIDS, and Lou Gehrig's 
disease. These important protections are in place in the current drug 
benefit and our motion to commit will offer the majority a chance to 
continue to protect drugs for these vulnerable populations.
  While the plan being debated may be labeled ``price negotiation,'' it 
is more accurate to call it ``price fixing.'' Every time price fixing 
has been tried in other countries, it has failed. It has resulted in 
limited therapies and reduced innovation. And if the government saves 
the money from price fixing, the economic models show the cost will be 
shifted to the higher prices for the over 250 million non-Medicare 
Americans. In fact, the Democrat witness at yesterday's forum stated 
``if Medicare gets a better price, some people will have to pay more.''
  It's an easy campaign slogan to say ``let Medicare negotiate low 
prices like the VA.'' But, to get there, you have to make that deal 
with the devil and allow Medicare to set prices and force strict 
formularies.
  In conclusion, in attempting to fix an unbroken system, H.R. 4 faces 
the unintended consequence of either being lamely impotent at 
negotiating lower prices, or dangerously controlling by price fixing 
and restricting seniors access to drugs. Bad outcomes, whether intended 
or not; therefore, I urge a ``no'' vote.
  Mr. STARK. Mr. Speaker, prior to recognizing the distinguished 
majority leader for 1 minute, I would just like to remind my friend 
from Missouri that at least in California we require law students to be 
able to read well enough to understand that bills they wave in the air 
are different from the bill we are considering today.
  I wouldn't call it a lie to suggest that what we passed in 2000 is 
different from what we have today, but I would consider it close to 
shysterism in terms of at least dealing with law.
  Mr. Speaker, I am pleased at this point to recognize the 
distinguished majority leader for 1 minute.
  Mr. HOYER. I thank the gentleman for yielding.
  Mr. Speaker, let me say to my friend, we don't have to say you did it 
perfectly, and that is what we are talking about, making it better. 
That is what this is about, improving. We can argue in debate about 
what is, but what we cannot argue about, I think, is it is not perfect, 
and we can make it better. We are going to have a bipartisan vote on 
this. We are going to have a lot of people on your side of the aisle 
say, yes, we can make it better. That is what this is about, making it 
better.
  By the way, I will tell my friend, 92 percent of the American public 
responds in polls they think this is what we ought to do. That is not 
pounding on the table; it is pounding on democracy.
  Mr. Speaker, I want to, before I further discuss this particular 
bill, discuss the legislation H.R. 4. I would like to take a moment to 
congratulate the Members of the people's House, all of us, on the very 
productive week we have had. This week we worked to make America safer, 
passing bipartisan legislation that implements the 9/11 Commission 
recommendations.
  We worked to make our economy fairer, passing bipartisan legislation 
that raises the Federal minimum wage, and we worked to improve the 
health care for all Americans, passing bipartisan legislation that 
promotes embryonic stem cell research. We are keeping our pledge to the 
American people to lead, govern effectively, and get results.
  Today we consider H.R. 4, the Medicare prescription drug price 
negotiation act. Bipartisan legislation aimed at cutting prescription 
drug prices for millions of seniors and individuals with disabilities.
  I can't believe there is anybody opposed to that objective. Yes, 
there is an issue of how do you do it best.
  Many believe that this is one way to do it, not the only way to do 
it. This legislation repeals, in my opinion, a misguided provision in 
current law that explicitly prohibits the Secretary of Health and Human 
Services from entering into negotiations with drug companies to lower 
the cost of prescription drugs for the 43 million beneficiaries of 
Medicare.
  I tell my friend in the private sector that if the drug manufacturers 
believe there is an alternative, that will go into the price structure, 
I guarantee it. By that, I mean, even if it is not exercised, we 
require it to be exercised, but even if it were not, if that 
alternative were present, it is going to affect the psychology of 
pricing.
  H.R. 4 requires the Secretary to conduct such negotiation but gives 
the Secretary broad discretion in how to most effectively implement 
negotiating authority to achieve the greatest discounts. We want him to 
take steps to be effective in accomplishing the objective of bringing 
drug prices down for seniors.
  The bill also permits Medicare part D drug plans to obtain discounts 
or lower prices below those negotiated by the Secretary.
  As The New York Times observes today in an editorial, the bill is, 
and I quote, sufficiently flexible to allow older Americans to benefit 
from the best efforts of both government and private drug plans.

[[Page H464]]

                              {time}  1215

  Mr. Speaker, this legislation has the overwhelming support of the 
American people, many of whom have experienced firsthand the rising 
costs of prescription drugs. In fact, as I just quoted, a recent 
Newsweek poll indicated that 92 percent, more than nine of every ten 
Americans, believe this is a policy that ought to be supported.
  The people's House is going to reflect that sentiment today. In my 
view, this legislation is a commonsense effort to do right by the 43 
million Americans enrolled in Medicare. It removes an unnecessary 
prohibition on prescription drug negotiations that should not have been 
enacted in the first place and allows the Secretary to do what he was 
hired to do, to put the interests of the American people first.
  As Chairman Dingell and Chairman Rangel have observed, this bill is a 
very important first step in making prescription drugs more affordable. 
In this 110th Congress, we also must commit ourselves to addressing the 
affordability of an accessibility of health care generally.
  I urge my colleagues to support this very important, bipartisanship, 
commonsense step forward in bringing the prices of drugs down for all 
of our seniors and our people. I thank the gentleman for yielding the 
time.
  Mr. McCRERY. Madam Speaker, having heard from the distinguished 
majority leader, the House is now fortunate to be able to hear both 
sides of this from the minority leader. I yield 1 minute to the 
gentleman from Ohio (Mr. Boehner).
  Mr. BOEHNER. Madam Speaker, I thank my colleague from Louisiana for 
yielding and thank my colleague from Maryland for his comments.
  I rise today in opposition to the plan being put forward that I think 
would bring government cost controls to a program that is widely 
popular and is working. We all know that, about 4 years ago, Congress 
passed a prescription drug benefit for seniors. In that bill, we make 
it clear that this benefit is to be provided by the private sector, and 
some 40 plans across the country are out there competing with different 
types of plans for seniors with different needs. And so the number of 
choices out there is overwhelming, but the fact is that the number of 
plans out there are also bringing competition; competition for better 
quality drugs, more access to drugs, bringing down the cost of this 
program by 30 percent. The program costs 30 percent less than what we 
thought it would cost when Congress passed it.
  More importantly, some 80 percent of seniors appreciate their plan. 
They have a choice of their doctor; the doctor has the choice of 
prescriptions that they can offer to their beneficiary, to their 
patient; and the patient can go to their local pharmacy, they can talk 
to their local pharmacist, which all those choices are probably why we 
have an 80 percent approval rating for this program.
  So what do we have here today? We have here today that says the 
government must go out and negotiate directly with drug companies. The 
fact is these 40 different plans that are operating around the country 
have been negotiating with drug plans over these last several years. 
Why do we think the cost has come down? It is that competition in the 
marketplace.
  And I appreciate my colleagues on the other side for their ideas that 
the government ought to go out and directly negotiate this. It is one 
of those big dividing issues that we have between Members here in 
Congress. Some believe strongly that government ought to do it. 
Government ought to do it. We ought to order government to do it. While 
many of us believe that competition, competition and using free market 
principles will in the long run produce better results, lower costs, 
higher quality and more satisfaction among seniors. And that is exactly 
what we have seen with this plan.
  Many people believe that the plan here would begin to look something 
like the plan that we have over at the Veterans' Administration where 
they do in fact negotiate with drug companies, although veterans that 
are taking those benefits have one-third the choice of drugs available 
to them that Medicare recipients have. I don't think there is anything 
we want to do today that would limit the ability of doctors to 
prescribe the correct drugs for their patients.
  Secondly, the veterans' program in many cases requires the 
prescription to be delivered by mail order. Now, this is a growing move 
in the marketplace, but a lot of seniors want to go talk to their 
pharmacists, and I and many believe that the passage of this bill could 
lead to less choices for our seniors when it comes to where they get 
their drugs.
  And so Republicans will offer a motion to recommit that simply says 
that we should not reduce the choices available to seniors, they ought 
to have those choices, and they should not be reduced at all; and 
secondly, that they should also have a choice in terms of where they 
get their drugs. Those are the two issues in the motion to recommit.
  And so I would urge my colleagues to reject the idea of big 
government price controls and to support the motion to recommit that 
will in fact preserve choices for our seniors who rely on this very 
important program.
  Mr. STARK. Mr. Speaker, I would like to recognize the gentleman from 
California (Mr. Costa) for a unanimous-consent request.
  (Mr. COSTA asked and was given permission to revise and extend his 
remarks.)
  Mr. COSTA. Mr. Speaker, I ask my colleagues to vote for H.R. 4 to fix 
the flaws of this program for our seniors and to save our taxpayers 
dollars.
  For many years, I was the principle caregiver for my late mother.
  Through her experience and my own, it became clear to me that the 
prescription drug bill passed by the 108th Congress was seriously 
flawed from the standpoint of being overly complex and not providing 
cost-savings for seniors.
  It's time we make the necessary changes.
  I've heard those opposed to this bill repeatedly claim it is contrary 
to free market principles.
  But I ask you, what could be more apple pie to free market than being 
able to negotiate over pricing?
  Those opposed to this bill also talk about the CBO's evaluation of 
the bill.
  But what they won't mention is that, in 2003 the 10-year cost 
estimate for this bill was $395 billion.
  Do you know what they say now?
  Part D spending will cost the government nearly double the original 
estimates.
  As a Member of this House it is time we support our free market and 
protect our taxpayer dollars.
  Let's correct this injustice for those living on fixed incomes and 
put an end to this prescription drug rip-off.
  This bill is an improvement. We should and can do better.
  Vote for H.R. 4.
  Mr. STARK. Mr. Speaker, I am pleased to yield 1\1/2\ minutes to the 
gentleman from California (Mr. Becerra), who agrees with the Reliance 
for Retired Americans that, by harnessing the bargaining power of 40 
million Medicare beneficiaries, H.R. 4 will bring relief to older and 
disabled Americans.
  Mr. BECERRA. Mr. Speaker, I thank the gentleman for yielding.
  Mr. Speaker, from the sound of it from our colleagues on the other 
side of the aisle, you would think that prescription drug prices were a 
great deal. They say it is working; the system ain't broke, so no need 
to do anything.
  Well, I did a little bit of research. And it is my own research, so I 
took a look at a couple of very popular drugs: Clarinex, which is for 
allergies; Lipitor, which is for cholesterol. I figured out the average 
prices out there at any pharmacy for those drugs per gram, and that 
turns out to be about $733 per gram for Clarinex and about $279 per 
gram for Lipitor. And I said, wait a minute. These are good deals. 
Right?
  So let's find out what an illicit drug on the street costs today. 
And, again, this is all my research. I couldn't tell you that I know 
for a fact what cocaine costs on the street or heroin, but I did some 
research. The U.N. Report of 2006 on Drugs and Crime says that cocaine 
has a street value of about $112 per gram, heroin about $95 per gram.
  So if you take a look at what is going on today, it is a great price 
that you pay four or five times more for a drug to help save a senior's 
life than you have to pay for a drug that you abuse on the streets 
today in America.
  Our drug prices are not okay. The system is broken. We do need to 
change it. And all we are saying is let's try to reduce the price. It 
doesn't hurt to try.

[[Page H465]]

  Anyone here bought a house, bought a car, a truck? Did you pay 
sticker price, or did you try to negotiate the price down? You may not 
have been able to; it may have been a very popular model car or truck, 
or home. But that is what we are saying, let's try to negotiate the 
price down.
  It is like telling a football team you get one down to get to the 
goal, and if you don't, you have got to punt. Or telling the batter, 
you go to the batter's box and you get one strike. Let's give America 
four downs, let's give America three strikes to try to reduce the price 
of these drugs. We should do it. Pass this bill.
  Mr. McCRERY. Mr. Speaker, I yield the remainder of my time to the 
distinguished ranking member of the Health Subcommittee of the Ways and 
Means Committee, Mr. Camp, and ask unanimous consent that he control 
the remaining time.
  The SPEAKER pro tempore (Mr. Boswell). Is there objection to the 
request of the gentleman from Louisiana?
  There was no objection.
  Mr. CAMP of Michigan. Mr. Speaker, I yield 2\1/2\ minutes to a 
distinguished member of the Ways and Means Committee, the gentleman 
from Wisconsin (Mr. Ryan).
  Mr. RYAN of Wisconsin. Mr. Speaker, I thank the gentleman for 
yielding.
  We have heard all this talk about the vote that 203 Democrats took in 
H.R. 4680, motion to recommit; it is apples to oranges; it doesn't 
compare. Let me read the language so it is black and white and not a 
lie:
  Noninterference by the Secretary. In administering the prescription 
medicine benefit program established under this part, the Secretary may 
not require a particular formulary, institute a price structure for 
benefits or in any way ration benefits, interfere in any way with the 
negotiations between benefit administrators and medicine manufacturers 
or wholesalers, or otherwise interfere with the competitive nature of 
providing a prescription medicine benefit using private benefit 
administrators except as is required to guarantee coverage of the 
defined benefit.
  Mr. Becerra voted for it. Mr. Stark wrote it; 203 Democrats voted for 
it. Now it is the wrong thing to do.
  Let's be really clear. This is a bumper sticker bill that doesn't 
work. The policy idea here that 92 percent of Americans want to see 
happen is that we do it just like the Veterans' Administration does. I 
wonder if those 92 percent Americans were told; at the VA you can't 
choose your doctor, you can't choose your pharmacy. Two thirds of the 
top named brand drugs that seniors use aren't even offered by the VA. 
You can't get them. Do you think 92 percent of Americans want that to 
happen for Medicare? Medicare beneficiaries ought to be able to choose 
their doctor; they should be able to go to their neighborhood pharmacy.
  So why are we doing this? CBO, HHS, they all tell us this will do 
nothing to lower prices. This will do nothing to save the government 
money.
  What has the current program done? It lowered the premium 40 percent 
in one year. It lowered the prices so much beyond our expectations that 
this new law which came into law in 2003 is $189 billion less than we 
expected it to be. That is real savings.
  The next argument we hear is, well, we want the Secretary to use the 
negotiating power of Medicare, get the bulk of negotiations going. How 
many people would he conceivably be able to negotiate on behalf of? All 
the people in the PDP, 16.5 million.
  Well, what are the prescription drug plans doing right now? You see, 
they don't just negotiate on behalf of Medicare; they negotiate on 
behalf of everybody they cover. Caremark, 70 million people they are 
negotiating on behalf of, including Medicare. Medco, 54 million people 
they are negotiating on behalf of, including Medicare. Express Scripts, 
51 million. Wellpoint, 36 million. These plans have more negotiating 
power and leverage and strength than Medicare could possibly have. That 
is why they are getting better discounts.
  With that, Mr. Speaker, I urge a ``no'' vote.
  Mr. STARK. Mr. Speaker, I remind my good friend from Wisconsin that 
he is quite right about the motion to recommit, but it was to a 
different bill. It was to H.R. 4770, which has no relationship to the 
bill that we are discussing today.
  Mr. Speaker, I yield 1\1/2\ minutes to the distinguished gentleman 
from Texas (Mr. Doggett).
  Mr. DOGGETT. Mr. Speaker, today's bill is a genuine prescription for 
lower prices for our seniors that should have been adopted a long time 
ago. Too often, our seniors hit the donut hole paying higher premiums 
with no drug coverage while the big drug companies run off with all the 
dough.
  During my service on the Ways and Means Committee, at every 
opportunity, I have offered an amendment for the same purpose as the 
bill we have today, to negotiate to protect our seniors and our 
taxpayers. But due to the power of the mighty pharmaceutical lobby and 
some late night shenanigans that happened right here on this floor and 
kept the Congress up all night to serve the interests of the 
pharmaceutical interests under the old Republican Congress, for the 
first time in this unique situation, we tell seniors and individuals 
with disabilities the government won't help.
  Indeed, I asked the Congressional Research Service to look at every 
statute on the federal books, and, boy, that is a lot of them. And they 
looked, and they were unable to find any language anywhere in any 
federal law like this that says to the government, you can't negotiate 
better prices for taxpayers and for seniors.
  So, today we should repeal that unreasonable one-of-a-kind 
limitation. For these Republicans to come out here who passed 
legislation to deny the choice of the government to negotiate to help 
seniors and today declare themselves to be ``pro-choice'' takes great 
audacity. To harm our community pharmacists the way their bill has 
harmed community pharmacists and now come and claim they are on the 
side of the neighborhoods takes real audacity. But audacity is 
something that is never in short supply from these folks.
  They ought not to be afraid to do something to help our seniors and 
disabled just because Big Pharma says ``no.'' Put seniors and taxpayers 
first. Break the stranglehold of the pharmaceutical lobby and enact 
this legislation.
  Mr. CAMP of Michigan. At this time, Mr. Speaker, we reserve our time.
  Mr. STARK. Mr. Speaker, could I inquire of the time remaining on both 
sides.
  The SPEAKER pro tempore. The gentleman from California has 22 minutes 
remaining. The gentleman from Michigan has 15 minutes.
  Mr. STARK. Mr. Speaker, I am delighted to yield 1\1/2\ minutes to the 
distinguished gentleman from Georgia (Mr. Lewis) who, like the Medicare 
Rights Center, knows if this bill becomes law, lower prescription drug 
prices will help millions of Medicare beneficiaries.

                              {time}  1230

  Mr. LEWIS of Georgia. Mr. Speaker, I want to thank the chairman of 
the Health Subcommittee of the Ways and Means Committee for yielding.
  Mr. Speaker, our seniors are still paying too much for lifesaving 
prescription drugs, and today we must ease that burden.
  Seniors should not have to choose between paying for their medicines 
and paying to heat their homes or putting food on their table, and that 
is still a decision that too many of our seniors have to make. Seniors 
saw their premiums go up and their drug prices go up. People living on 
fixed incomes cannot afford these increases.
  The big drug companies are the big winners under the prescription 
drug plan. They are getting a great deal, but the seniors are getting a 
bad deal, a raw deal. The drug companies' profits increased over $8 
billion in the first 6 months of the prescription drug plan, $8 
billion, while our seniors and taxpayers pay the bill. It is wrong and 
it is unnecessary; and today it is our duty, our obligation and a 
mandate to change that and bring down drug prices.
  It is common sense to negotiate with drug companies to get lower drug 
prices. It is very simple. It is not that difficult. The VA does it and 
HHS has already done it too.
  It is our duty to our seniors and to the taxpayers to lower drug 
prices. To do anything less is unfair to our seniors and a waste of 
money and a gift to the drug companies.

[[Page H466]]

  Mr. CAMP of Michigan. Mr. Speaker, I yield for the purpose of making 
a unanimous consent request to the gentleman from Iowa (Mr. Latham).
  (Mr. LATHAM asked and was given permission to revise and extend his 
remarks.)
  Mr. LATHAM. Mr. Speaker, I rise in strong opposition to H.R. 4.
  Mr. Speaker, I rise in strong opposition to H.R. 4, a misguided 
policy that threatens to destroy the positive benefits provided to 
seniors through Medicare Part D. Arguments in support of this bill 
completely ignore the fact that under Medicare Part D, drug plans 
currently negotiate with drug companies to offer lower prices and 
better benefits for seniors. Due to strong competition among drug 
plans, the average Part D premium is now 42 percent less than 
originally projected. CMS actuaries recently announced that in 2008, 
Part D will cost taxpayers 10 percent less than it did this year. That 
will be 30 percent less than originally anticipated. In addition, most 
beneficiaries are satisfied with Part D. National surveys place 
beneficiary satisfaction at approximately 80 percent or higher.
  According to the Congressional Budget Office, there are no projected 
cost savings associated with H.R. 4. This is because the only way to 
squeeze any more savings out of the current system is to limit 
formularies and steer patients to certain preferred drugs on a 
nationwide basis, as the VA does. With H.R. 4 in place, this would be a 
fairly easy step to take in the future. However, the VA model is not 
one we should follow. While 38 percent of the drugs approved by the FDA 
during the 1990s are on the VA formulary, it includes only 19 percent 
of drugs approved since 2000. One million of the 3.8 million Medicare 
age veterans in the VA health system have signed up for the Medicare 
Part D benefit because VA coverage is not adequate.
  In the U.S., 43 million Medicare recipients account for 40 percent of 
all drug spending. With this kind of market share, Federal Government 
``negotiation'' is in reality price setting. In the past, Democrats as 
well as Republicans have rejected federal price setting for Medicare 
drugs.
  Noninterference clauses were included in past Democrat sponsored drug 
benefit legislation, including President Clinton's 1999 Medicare reform 
proposal, and two prescription drug bills offered by House Democrats in 
2000.
  It is important to point out the Federal Employees Health Benefits 
Program, routinely cited as a model for its quality and efficiency, 
relies on private health plans to negotiate drug prices on behalf of 
federal employees and Members of Congress. If federal price setting is 
not good for us, then it is not good for Medicare beneficiaries.
  Mr. Speaker, the bottom line here is that having competing drug plans 
negotiate drug prices--rather than the federal bureaucracy--is the best 
way to administer the Medicare drug benefit. The current system has 
been extremely successful in keeping costs low. Diverse formularies and 
cost sharing arrangements allow seniors to choose the plan that meets 
their needs at the lowest possible cost.
  I urge my colleagues to reject the ill-advised and misguided policy 
proposed by House Democrats and vote ``no'' on H.R. 4.
  Mr. CAMP of Michigan. Mr. Speaker, I reserve the balance of my time.
  Mr. STARK. Mr. Speaker, at this time I am happy to yield 1\1/2\ 
minutes to the distinguished gentleman from Oregon (Mr. Blumenauer).
  Mr. BLUMENAUER. Mr. Speaker, I appreciate the gentleman's courtesy.
  The Medicare prescription drug program was controversial from the 
start in part because of the notorious way it was strong armed through 
the House in the middle of the night after holding the voting machines 
opened for hours. Our new rules will prevent that.
  Part of the controversy was the huge cost of a new unfunded 
entitlement with generous, probably unnecessary, subsidies and a 
prohibition on bargaining for a better price.
  This better price is important because total drug costs for seniors, 
premiums and drugs, are going up. A review of drug company balance 
sheets where advertising and profit dwarfs basic research shows room to 
lower prices without undue stress on their research budget or their 
profit.
  Competition and bargaining power combined with the Secretary's bully 
pulpit can probably save billions of dollars for seniors, hundreds, 
perhaps thousands, for individuals because these costs, remember, for 
most seniors are still going up.
  Our action today is just a first step, a signal and a tool. The 
program is not set in stone. We are committed to the best treatment for 
our seniors and all taxpayers. This is a tool for the administration 
that, if they will use it, can save money and improve the program. It 
is a start on a longer and critical process to provide cost-effective 
quality health care for our seniors and ultimately for all Americans.
  Mr. STARK. Mr. Speaker, at this time I am delighted to yield 1\1/2\ 
minutes to the distinguished gentleman from New Jersey (Mr. Pascrell).
  Mr. PASCRELL. Mr. Speaker, I thank the chairman for yielding.
  Mr. Speaker, I am astonished today. It is only government 
interference when the little guy gets some help from the government. It 
is not government interference when corporations get subsidies and 
royalties from taxpayers. That is a different story. Well, it is a 
different story after November 7.
  This legislation will require the Secretary of Health and Human 
Services to negotiate lower drug prices on behalf of those who enroll 
in the Medicare prescription drug plans. The current Medicare 
prescription drug law explicitly prohibits the Secretary from using the 
market power. The former Secretary wished he had it, under the Bush 
administration, this power for the 43 million beneficiaries. This power 
is splintered now among numerous private plans, and we have headed down 
the slippery slope of privatization of what were guaranteed benefits at 
one time.
  The prices charged by Medicare plans are rising more than twice the 
rate of overall inflation, and many beneficiaries are seeing 
substantial premium increases, some as much as six-fold.
  During the first 6 months of the program, the price for brand-name 
drugs rose 6.3 percent. For an average senior who relies on four drugs 
a day, this translates into an increase of 30 percent in prescription 
drug therapy for 1 year.
  The simple fact is that part D is doing nothing to truly control the 
high cost of prescription drugs. In the past year, the average price of 
20 top-selling prescription drugs rose 3.8 percent. Following suit, the 
average private plan price increased 3.7 percent. That means even with 
part D, Medicare beneficiaries still foot the entire bill for 
escalating drug prices.
  Mr. STARK. Mr. Speaker, I am pleased to yield 1\1/2\ minutes to the 
distinguished gentlewoman from Nevada (Ms. Berkley), who agrees with 
the American Nurses Association that the direct negotiation authority 
in this bill is a commonsense means of improving access to needed 
prescription medications.
  Ms. BERKLEY. Mr. Speaker, I represent the fastest growing senior 
population in the United States. Many of the seniors that I represent 
have no other income than their Social Security check. Many need 
multiple medications. Many cannot afford the medications that they 
need.
  It never made any sense to me that we had a Medicare system that 
enabled seniors to go to a doctor but, when the doctor prescribed the 
medication that they needed, many seniors were unable to afford the 
medication that the doctor prescribed. So I was a great advocate for a 
prescription medication benefit for older Americans.
  The Republicans' prescription medication so-called benefit that was 
passed at 6 o'clock in the morning as we sat here or stood here 
watching in horror as arms were twisted and threats were made on the 
other side of the aisle in order to garner enough votes to pass this 
dog of a piece of legislation, it has never benefited enough seniors 
that were in desperate need of affordable medication. So if it didn't 
benefit our seniors, whom did this legislation benefit? It benefited 
the pharmaceutical industry.
  The bill that was passed was so bad that it is hard to point out the 
worst part of it. But if I were a betting woman, and coming from Vegas 
I am a betting woman, I would say that the worst, the absolute worst, 
section was the one that prohibits our government from negotiating with 
drug companies for lower drug prices for our seniors. It doesn't take a 
genius to know that allowing the government to negotiate drug prices 
will lower the cost. It is common sense. The VA has been negotiating 
for years, and it saves our veterans millions of dollars.
  We should be encouraging our government to negotiate lower prices 
instead of allowing our drug companies to increase the costs.

[[Page H467]]

  Mr. CAMP of Michigan. Mr. Speaker, at this time I yield 2 minutes to 
a distinguished member of the Ways and Means Committee and the Health 
Subcommittee, the gentleman from Texas (Mr. Sam Johnson).
  Mr. SAM JOHNSON of Texas. Mr. Speaker, for all the efforts of the 
proponents of H.R. 4 to confuse this issue, it truly is a simple one, 
basically a choice between hot-air promises and real-life facts.
  Today, some people are claiming we need government negotiation in 
order to increase the pool of Medicare beneficiaries trying to buy 
affordable drugs. Well, unfortunately, that math just doesn't add up. 
The pharmacy benefit managers negotiating drug prices on behalf of 
seniors enrolled in part D are the very same PBMs going to bat for tens 
of millions of the under-65 population, including those of us enrolled 
in the Federal Employee Health Benefit Plan. So if we took the Medicare 
population out from under that huge umbrella, they actually lose 
bargaining power, not gain it.
  Another claim that is being made is that the Secretary will not have 
to limit the formulary in order to achieve promised savings. Mr. 
Speaker, if you believe that, I have got some oceanfront property in 
Arizona I would like to sell you.
  Let us take a look at the VA plan as an example since it is being 
touted as a stellar illustration of government negotiating. The VA 
formulary has 1,300 drugs compared to more than 4,000 for Medicare.
  And all the Medicare plans protect drugs for the most vulnerable, 
including drugs that treat cancer, AIDS, and mental illness. That is 
why H.R. 4 is opposed by the National Alliance on Mental Illness, the 
ALS Association, and others.
  Finally, some are saying this bill will provide outstanding savings. 
Not to let the facts get in the way of a good story, but our own 
Congressional Budget Office says the effects of this bill will not save 
money.
  Drug prices have fallen every year of part D's existence because of 
one thing: competition. And it is working great. As we say in Texas, 
``If it ain't broke, don't fix it.''
  This debate boils down to a choice between government promises and 
free market results. I urge Members to vote against H.R. 4.
  Mrs. EMERSON. Mr. Speaker, I yield myself 15 seconds.
  I would simply say that it is important for my colleagues to know 
that the same pharmacy benefit managers whom we have entrusted to 
negotiate the price of our own seniors' drugs are now being 
investigated in over 25 States for questionable business practices.
  Mr. Speaker, I reserve the balance of my time.
  Mr. STARK. Mr. Speaker, I am happy to yield 1\1/2\ minutes to the 
distinguished gentleman from Wisconsin (Mr. Kind), who agrees with the 
National Senior Citizens Law Center that H.R. 4 is an important step 
toward making the prescription drug benefit simpler, more affordable, 
and reliable.
  (Mr. KIND asked and was given permission to revise and extend his 
remarks.)
  Mr. KIND. Mr. Speaker, I thank my good friend and colleague for 
yielding to me and commend him on his leadership on this issue.
  Mr. Speaker, let us be clear on what we are trying to do here today. 
We are trying to help you. We are trying to help find some cost savings 
on what was the largest expansion of entitlement spending in the last 
40 years that was passed under your rule, with no ability to pay for 
it, all deficit financing, no cost-containment measures.
  All we are saying here today with H.R. 4 is let us give the Secretary 
of Health and Human Services the ability to go out and negotiate a 
better deal for the American taxpayer. And I, for the life of me, don't 
understand why any Secretary, with all due respect to Secretary 
Leavitt's article in the papers yesterday, would not want to have this 
negotiating authority in their arsenal. In fact, the last outgoing 
Secretary of Health and Human Services, Tommy Thompson, during a moment 
of unguarded candor, said after his resignation that the one thing that 
he regretted while serving as Secretary of Health and Human Services 
was ``I would have liked to have had the opportunity to negotiate.'' 
And he based that on his success in negotiating better prices for Cipro 
and FluMist.
  The VA system is already negotiating better prices. It is working 
well. No one in this Congress is proposing any change or repeal with 
the VA system. And except for the administration's penchant for no-bid 
contracts, there is no other product or service in this country where 
we specifically prohibit the Federal Government from going out and 
negotiating a better price for the American taxpayer. We can change 
that today with passage of H.R. 4.
  Let's give it a shot. Let us give the Secretary of Health and Human 
Services the discretion to negotiate better prices for our consumers.
  In Wisconsin, there currently exist several programs that allow the 
state to negotiate with pharmaceutical companies for lower drug costs. 
For instance, Badger Rx Gold is a public-private sector partnership 
between the State and Navitus Health Solution that on average saves 
participants 23 percent on prescriptions. SeniorCare is another program 
that has successfully negotiated lower drug costs for seniors in 
Wisconsin. Since enrollment in Medicare Part D began in May of 2006, 
there has been an increase in the number of participants in SeniorCare 
from 85,000 to over 110,000.
  According to an analysis by AARP Wisconsin, more than 94 percent of 
SeniorCare participants are better off under SeniorCare than they would 
be under Medicare Part D because the co-payments are lower and the 
coverage is more comprehensive. Therefore, it is critical that the 
Secretary of Health and Human Services also have the authority to 
negotiate for lower drug costs so all seniors in our country can 
benefit.
  Mr. Speaker, having clearly seen the success of negotiating lower 
drug costs at both the state and federal level, I enthusiastically 
support the legislation before us today, and I urge my colleagues to 
support H.R. 4.
  Mr. CAMP of Michigan. Mr. Speaker, I reserve the balance of my time.
  Mr. STARK. Mr. Speaker, I am delighted to yield at this point 1\1/2\ 
minutes to one of the authors of the bill, the gentlewoman from New 
Hampshire (Ms. Shea-Porter).
  Ms. SHEA-PORTER. Mr. Speaker, I thank the gentleman from California 
for yielding.
  I am a proud sponsor of this bill. My interest in this bill is both 
professional and personal. I have worked in senior centers for years 
and watched seniors struggle with insurance companies and 
pharmaceutical companies. And then I watched my father struggle, 
through three major illnesses, with insurance companies and 
pharmaceutical companies. My father would have been delighted to have 
somebody come from the Federal Government and say, I am here to help 
you, because my father needed that help, and so do all the other 
seniors in this country. And do not believe for a moment that things 
are better now, because my mother also receives prescription drugs and 
struggles with the cost and worries about what is happening to the 
money that she has left.

                              {time}  1245

  I urge my colleagues to please support this bill. It is a beginning. 
It is the voice of the people, the voice of the taxpayers.
  Who sits at the table right now with the insurance companies and the 
pharmaceutical companies while they negotiate? We don't. The taxpayer 
cannot sit at the table. But if my colleagues pass this bill, the 
American taxpayer, the seniors and all those who require these drugs 
will finally be represented.
  Mr. CAMP of Michigan. Mr. Speaker, I yield 2 minutes to the gentleman 
from Texas, the distinguished member of the Ways and Means Committee, 
Mr. Brady.
  Mr. BRADY of Texas. Mr. Speaker, I am a member of the Ways and Means 
Committee, proud to have helped create the Medicare prescription plan; 
it is really helping a lot of our seniors in Texas, especially those 
who are very poor and have some of the most expensive illnesses.
  I think we can do more to improve the Medicare prescription drug 
plan, we ought to work better together; but I oppose directing the 
Federal Government to interfere with the successful Medicare 
prescription drug plan.
  If you look closely, this is a senior scam. I am warning my mom, who 
is on Medicare, that this is just another senior scam. It sounds 
fantastic, but when

[[Page H468]]

you read the fine print, you realize the only savings you get is, if 
you just restrict the drugs that she can get, you limit where she can 
go to get them, and every expert says this won't save a dime. Sure, I 
can save everyone in this room costs on their medicines. I am just 
going to, like the VA does, I will tell you, you can't have those 
medicines and you can't get them where you need them.
  Our seniors, my mom has a choice of 4,000 drugs, if she was in the 
VA, she would get a choice of a thousand, most of them generics. Now 
she has 55,000 pharmacies, hopefully she won't go to all of them; with 
VA, she would get to go to 300 of them. If she tried to find the drugs 
she needs, a one out of four chance she would find the one she really 
needs.
  The truth of the matter is that we ought to be working together to 
help improve Medicare. We ought not be trying to score political 
points. We ought to be helping seniors lower their drug costs.
  This is a scam; and I predict it will not ever become law because 
this scores political points rather than helping seniors with their 
medicines. Let's find a way we really can work together for our 
seniors.
  Mr. STARK. Mr. Speaker, I am pleased to yield 1 minute to the 
gentleman from Connecticut (Mr. Murphy), who concurs with Consumers 
Union that government-priced negotiations on behalf of consumers could 
cut pharmaceutical drug prices roughly in half.
  Mr. MURPHY of Connecticut. I thank my good friend from California.
  Mr. Speaker, I rise today in support of H.R. 4.
  The average guy out there doesn't ordinarily pay much attention to 
the minute details of Federal prescription drug law. You have to screw 
up pretty bad to create a grassroots movement centered around a one-
line sentence buried deep in the depths of the Medicare Act, but that 
is exactly what happened here.
  For those of us who are coming here anew, we have spent the last 2 
years talking to our seniors and our taxpayers about the horrors of 
this bill. As the cost of this program skyrocketed, as premiums 
increased, as the donut hole expanded, seniors suffered and drug 
companies prospered.
  And guess what? The American people started to notice that little 
sentence buried deep in that Medicare Act that seemed so out of place 
and so unnecessary.
  My presence here today is a living example of this popular discontent 
which those on the other side of the aisle seem so eager to ignore. And 
even if this bill doesn't fix that Medicare drug program overnight, it 
is an unmistakable signal to the people that I represent back home that 
this House is no longer a place where industry can profit off of a 
desperately needed social program; it is a place now where common sense 
comes first.
  Mr. STARK. Mr. Speaker, I am delighted to yield 1 minute to the 
distinguished gentleman from Tennessee (Mr. Cohen).
  Mr. COHEN. Mr. Speaker, it is with great honor that I stand as a co-
sponsor of this bill that is sponsored by Chairman Dingell, Chairman 
Rangel and others.
  One of the major issues I heard during my campaign from seniors was 
how much it cost them to buy drugs and how it is essential for their 
life and well being.
  This weekend we will be celebrating, on Monday, the birthday of Dr. 
Martin Luther King, observing his birthday. Dr. King knew there was 
economic and social justice, both. Dr. King said equality means 
dignity, and dignity means that you can afford some health care, and 
you don't have to spend every penny on the utility bill and on drug 
prices and you run out of money.
  WWMLK, what would Martin Luther King do today? He would vote for this 
bill. I ask everybody else to do it in honor of Dr. King.
  Mr. STARK. Mr. Speaker, I am delighted to yield 1\1/2\ minutes to the 
distinguished member of our Ways and Means committee, the gentleman 
from New York (Mr. Crowley), who agrees with Families USA, the national 
voice of health care consumers, that H.R. 4 is an important first step 
in improving part D.
  Mr. CROWLEY. I thank my friend from California for yielding such 
time.
  Mr. Speaker, I rise in strong support of H.R. 4, bipartisan 
legislation that will correct a glaring flaw in the prescription drug 
law.
  This commonsense bill will require the Federal Government to 
negotiate for lower drug prices for American seniors and people with 
disabilities in the Medicare program.
  It sounds like common sense, right? But the Republicans actually 
wrote into law language explicitly prohibiting the government from 
negotiating for lower prices for American seniors. Instead of using the 
bully pulpit of the Secretary of Health and Human Services to lower 
costs, they put a muzzle on him, banning any negotiations.
  There has never been legislation passed in law prior to that that 
strictly prohibits any agency from negotiating. From war planes to 
medical equipment, the Federal Government has always been able to 
negotiate.
  Furthermore, 85 percent of respondents in a recent Kaiser Family poll 
support legislation to allow the government to negotiate lower drug 
prices.
  The ability to require the Secretary of Health and Human Services to 
negotiate the cost of prescription drugs purchased through the Medicare 
program has the potential to constitute a tremendous savings for 
recipients, and therefore for all taxpayers.
  I am pleased that within the first 100 hours of Democratic control of 
Congress, we are moving to help alleviate the high price of 
prescription drugs on our seniors.
  America is going in a new direction, and that direction is forward.
  Mr. CAMP of Michigan. Mr. Speaker, I would like to place into the 
Record four letters, from the American Legion, the Lou Gehrig's 
Association, the National Alliance on Mental Illness and the American 
Autoimmune Association, all opposed to H.R. 4, concerned about its 
effect on the prescription drug benefit for seniors.

                                          The American Legion,

                                 Washington, DC, January 11, 2007.
     Hon. Nancy Pelosi,
     Speaker, House of Representatives,
     Washington, DC.
       Dear Speaker Pelosi: The American Legion urges you and your 
     colleagues to reevaluate the ``noninterference'' provision of 
     Chairman Dingell's proposed legislation, H.R. 4, The Medicare 
     Prescription Drug Price Negotiation Act of 2007. It would 
     amend part D of title XVIII of the Social Security Act to 
     require the Secretary of Health and Human Services to 
     negotiate lower covered part D drug prices on behalf of 
     Medicare beneficiaries.
       Each time the Federal government has enacted pharmaceutical 
     price control legislation, the Department of Veterans Affairs 
     (VA) has experienced significant increases in its 
     pharmaceutical costs as an unintended consequence. A 
     fundamental principle in the price negotiation process so 
     that the ``lowest price'' establishes the baseline. By simply 
     raising the baseline, it sustains or possibly increases the 
     corporate bottom line based on the projected increased volume 
     in sales. An increased baseline minimizes the margin in 
     future price negotiations.
       The American Legion strongly urges you and your colleagues 
     to seriously consider the collateral damage that would result 
     from listing the current ``noninterference'' provision in 
     section 2 of H.R. 4 on VA's formulary and the Federal Supply 
     Schedule. This ``noninterference'' provision is not in the 
     best interest of America's veterans and their families. VA is 
     a health care provider, whereas Medicare is a health insurer. 
     Any possible Medicare savings would likely result in a 
     reciprocal cost to VA.
           Sincerely,
                                                    Paul A. Morin,
     National Commander.
                                  ____

                                                   The Amyotrophic


                                Lateral Sclerosis Association,

                                  Washington, DC, January 4, 2007.
       Dear Member of Congress: I am writing on behalf of The ALS 
     Association to express our strong opposition to legislation 
     that would eliminate the noninterference provision of the 
     Medicare Modernization Act (MMA). Legislation that authorizes 
     the federal government to negotiate Medicare prescription 
     drug prices will significantly limit the ability of people 
     with ALS to access the drugs they need and will seriously 
     jeopardize the future development of treatments for the 
     disease--a disease that is always fatal and for which there 
     currently are no effective treatment options.
       The ALS Association is the only national voluntary health 
     organization dedicated solely to finding a treatment and cure 
     for amyotrophic lateral sclerosis (ALS). More commonly known 
     as Lou Gehrig's disease, ALS is a progressive 
     neurodegenerative disease that erodes a person's ability to 
     control muscle movement. As the disease advances, people lose 
     the ability to walk, move their arms, talk and even breathe, 
     yet their minds remain sharp; aware of the limitations ALS 
     has imposed on their lives, but powerless to

[[Page H469]]

     do anything about it. They become trapped inside a body they 
     no longer can control.
       There is no cure for ALS. In fact, it is fatal within an 
     average of two to five years from the time of diagnosis. 
     Moreover, there currently is only one drug available to treat 
     the disease. Unfortunately, that drug, Rilutek, originally 
     approved by the FDA in 1995 has shown only limited effects, 
     prolonging life in some patients by just a few months.
       The hopes of people with ALS--those living today and those 
     yet to be diagnosed--are that medical science will develop 
     and make available new treatments for the disease; treatments 
     that will improve and save their lives.
       However, The ALS Association is deeply concerned that the 
     elimination of the MMA's noninterference provision will 
     dampen these hopes and will result in unintended consequences 
     for the thousands of Americans fighting this horrific 
     disease. The potential impacts are significant and include:


                          Limits on Innovation

       While reducing the cost of prescription drugs is an 
     important goal, it should not be done at the expense of 
     innovation. Unfortunately, eliminating the MMA's 
     noninterference provision will limit the resources available 
     to develop new breakthrough medicines. This is especially 
     troubling for a disease like ALS, for the development of new 
     drugs offers patients their best, and likely only, hope for 
     an effective treatment.
       Additionally, by establishing price controls, Congress will 
     undermine the incentives it has established to encourage drug 
     development in orphan diseases, like ALS. As resources 
     available for research and development become more scarce, 
     there will be even less incentive to invest in orphan drug 
     development.


                            Limits on Access

       The elimination of the noninterference provision will have 
     particularly cruel consequences for people with ALS. It means 
     that even if a new drug is developed to treat ALS, many 
     patients likely will not have access to it. That's because 
     price controls can limit access to the latest technologies. 
     Proponents of government negotiated prices cite the 
     Department of Veterans Affairs as a model for how the 
     government should negotiate prices for Medicare prescription 
     drugs. Yet under that system, patients do not have access to 
     many of the latest breakthrough treatments. For example, two 
     of the most recently developed drugs to treat Parkinson's and 
     Multiple Sclerosis, neurological diseases like ALS, are not 
     covered by the VA due to the government negotiated price. 
     Ironically, those drugs currently are covered by Medicare 
     Part D.
       Given this scenario, we are deeply concerned that any new 
     drug that is developed for ALS will not be available to the 
     vast majority of patients who need it. Instead they either 
     will be forced to forgo treatment, or only will have access 
     to less effective treatment options--ones that may add a few 
     months to their lives, but not ones that will add years or 
     even save their lives.


                    People with ALS Rely on Medicare

       A significant percentage of people with ALS rely on 
     Medicare, and the newly established prescription drug 
     benefit, to obtain their health and prescription coverage. In 
     fact Congress recognized the importance of Medicare coverage 
     for people with ALS by passing legislation to eliminate the 
     24-month Medicare waiting period for people disabled with the 
     disease. This law helps to ensure patients have timely access 
     to the health care they need. With the establishment of the 
     Part D benefit, Congress also has now helped to ensure that 
     people with ALS have access to coverage for vital 
     prescription drugs.
       Yet this improved access is threatened by short-sighted and 
     inappropriately cost driven efforts to remove the 
     noninterference provision. If Congress makes this change, 
     they will undo what the MMA sought to ensure: access to 
     needed prescription drugs.
       While the ALS Association appreciates attempts to improve 
     access to affordable prescription drugs, we believe that 
     Congress must consider the implications of its actions on 
     coverage, access and the advancement of medical science. We 
     fear that in an effort to control costs, Congress may limit 
     treatment options, discourage innovation, and extinguish the 
     hopes of thousands of Americans whose lives have been touched 
     by ALS and who are fighting to find a treatment and cure. On 
     behalf of your constituents living with Lou Gehrig's disease, 
     we urge you to oppose legislation to eliminate the 
     noninterference provisions of the Medicare Modernization Act.
           Sincerely,

                                                 Steve Gibson,

                                                   Vice President,
     Government Relations and Public Affairs.
                                  ____

                                              National Alliance on


                                               Mental Illness,

                                   Arlington, VA, January 9, 2007.
     Hon. Nancy Pelosi
     Speaker, House of Representatives,
     Washington, DC.
       Dear Speaker Pelosi: On behalf of the 210,000 members and 
     1,200 affiliates of the National Alliance on Mental Illness 
     (NAMI), I am writing to express concerns regarding H.R. 4, 
     the Medicare Prescription Drug Price Negotiation Act of 2007. 
     As the nation's largest organization representing individuals 
     with severe mental illnesses and their families, NAMI is 
     concerned about the potential impact of H.R. 4, and repeal of 
     the so-called ``non-interference'' provision in the Medicare 
     drug benefit, on critical access protections for the most 
     vulnerable Medicare beneficiaries living with severe mental 
     illness.
       As you know, the ``non-interference'' protection was a part 
     of numerous legislative proposals for extending a 
     prescription drug benefit in Medicare going back nearly a 
     decade. Legislative proposals that were put forward by 
     members of Congress on both sides of the aisle, and by both 
     the Clinton and Bush Administrations, included this 
     restriction on the Secretary negotiating a single price and 
     formulary structure given the diverse treatment needs of the 
     Medicare population. In NAMI's view, this restriction is an 
     important part of ensuring that beneficiaries can work with 
     their doctors to access the treatment that works best for 
     them. While NAMI strongly supports the shared goal of making 
     prescription drug coverage affordable for all Medicare 
     beneficiaries, we also want to ensure that this is properly 
     balanced against the need to ensure broad access to all 
     covered Part D drugs--especially for the most vulnerable 
     beneficiaries.
       NAMI would like to offer the following concerns regarding 
     H.R. 4 and its potential impact on the Medicare Part D 
     benefit for individuals living with severe mental illness.
       (1) H.R. 4 and its Mandated Negotiation Requirement 
     Jeopardize the CMS Formulary Guidance Allowing for Broad 
     Coverage of Psychiatric Medications in Medicare
       For the 2006 and 2007 plan years, CMS has put in place 
     guidance to all Part D Prescription Drug Plans (PDPs) and 
     Medicare Advantage (MA) plans requiring coverage of ``all or 
     substantially all'' of the medications in 6 protected 
     classes: anti-neoplastics, immuno-supressants, 
     antiretrovirals, anti-convulsants, anti-depressants and anti-
     psychotics. Of these 6 protected classes, 3 are essential to 
     effective treatments for mental illness: anti-convulsants 
     (commonly prescribed as mood stabilizers for bipolar 
     disorder), anti-depressants (commonly prescribed to treat 
     major depression) and anti-psychotics (prescribed for both 
     schizophrenia and bipolar disorder).
       CMS put this ``all or substantially all'' coverage 
     requirement in place on top of the basic statutory provision 
     in the MMA for 2 drugs per class. The separation of these 6 
     drug classes is based on the reality that the medications in 
     these categories are not clinically interchangeable and that 
     a limit in formularies of only 2 drugs would pose a dangerous 
     risk to the most vulnerable and medically fragile Medicare 
     beneficiaries.
       It is important to note that this requirement for ``all or 
     substantially all'' coverage is NOT delineated in Section 
     1860D4(b)(3), the statutory requirements for formularies. As 
     a result, this guidance is not part of the Part D 
     regulations. Instead, it is ``sub-regulatory'' guidance given 
     annually to PDPs and MA plans and must be renewed each year. 
     As such, its existence is subject to the discretion of the 
     Secretary and would certainly be displaced by any mandate 
     imposed by Congress to negotiate directly with manufacturers 
     on price.
       Further, it is almost certain that the Secretary's ability 
     to demand ``discounts, rebates or price concessions'' as 
     required in H.R. 4 would be undermined by maintaining this 
     guidance (i.e., the Secretary would have little or no 
     leverage to demand discounts or rebates). NAMI is extremely 
     concerned that placing this new legal mandate on the 
     Secretary would directly result in loss of the ``all or 
     substantially all'' guidance in the 6 protected classes, and 
     therefore poses a significant risk to Medicare beneficiaries 
     with mental illness.
       (2) The Formulary Protections in H.R. 4 are Vague and Could 
     Allow Imposition of a Single Preferred Drug List (PDL) for 
     all Part D Plans as in Medicaid.
       Currently under Medicaid, most states include their 
     pharmacy benefit a requirement for physicians to prescribe 
     off a limited PDL. This PDL is typically distinct from a 
     larger formulary that includes a broader list of available 
     medications. Medications on this preferred list are typically 
     chosen on the basis of manufacturers who are willing to pay 
     higher supplemental rebates (deeper discounts) to the state--
     NOT on the basis of clinical superiority. For years, NAMI has 
     been concerned about the proliferation of such policies in 
     Medicaid and we fought to create and maintain exemptions from 
     these PDLs for medications to treat mental illness.
       NAMI is extremely concerned that the language in H.R. 4 
     that is intended to prevent a single national formulary in 
     Part D (page 2, lines 19-22) would still allow the Secretary 
     to establish a national PDL for all Part D plans. The rule of 
     construction in the bill speaks only to ``a particular 
     formulary,'' not a PDL. Further, the second rule of 
     construction (page 2, line 23) appears to merely restate the 
     existing formulary standards in Section 1860D4(b)(3). If 
     mandatory price negotiation by the Secretary were to follow 
     the pattern established in Medicaid, use of a national PDL is 
     likely a tool that HHS would be forced to employ--and the 
     language in H.R. 4 would not prevent it.
       (3) The Experience of the VA and Medicaid Raise Concerns 
     About Direct Government Negotiation and its Impact on Access.
       Advocates for repeal of the ``non-interference'' protection 
     cite both the Department of Veterans' Affairs and Medicaid as 
     examples of how the government has used negotiation to 
     deliver deep discounts from manufacturers. At the same time, 
     both Medicaid and the VA have also placed significant

[[Page H470]]

     restrictions on access for individuals with mental illness. 
     For example, as noted above PDLs are prevalent across state 
     Medicaid agencies--any of which limit the choice of available 
     anti-psychotics to as few as 2 medications.
       Further, in recent years, Medicaid programs have been 
     increasingly relying on step therapy and ``fail first'' 
     requirements. Likewise, the VA's single national formulary 
     completely excludes a number of anti-depressants that now 
     included in all Part D formularies. Finally, the VA imposes a 
     policy that permits individual VISN clinical directors to 
     require a veteran with a mental illness prescribed an 
     anti-psychotic to first go on one of the older 1st 
     generation ``typical'' agents before being able to access 
     a second generation ``atypical'' agent. NAMI is certainly 
     troubled by references to both Medicaid and VA as viable 
     alternative models to the current Part D program.
       Conclusion.
       NAMI understands that H.R. 4 is being brought to the full 
     House without the benefit of hearings in the Energy & 
     Commerce and Ways & Means Committees where the impact of 
     repeal of the ``noninterference'' protection on access to 
     medications for the most vulnerable Medicare beneficiaries 
     could be explored in greater detail. Likewise, repeal of the 
     ``non-interference'' clause was never voted on by the House 
     in the 109th Congress. NAMI will certainly press the issues 
     related to patient access when H.R. 4 reaches the Senate.
       NAMI shares the goal of all House members to ensure that 
     the Part D program reaches its full potential of meaningful 
     and comprehensive prescription drug coverage. There are a 
     range of legislative changes to Part D that are needed to 
     make the program work better for beneficiaries living with 
     mental illness including codifying the status of the 6 
     protected therapeutic classes, allowing coverage of 
     benzodiazepines, exempting certain non-institutionalized dual 
     eligibles from cost sharing, repealing the asset test for the 
     Low-Income Subsidy (LIS) and permitting private prescription 
     assistance programs to provide free medications in the 
     ``doughnut hole'' coverage gap. NAMI looks forward to working 
     with you and your colleagues to move these needed reforms 
     forward in 2007.
           Sincerely,
                                           Michael J. Fitzpatrick,
     Executive Director.
                                  ____

                                               American Autoimmune


                           Related Diseases Association, Inc.,

                                East Detroit, MI, January 9, 2007.
     Hon. John D. Dingell,
     House of Representatives
     Washington, DC.
       Dear Chairman Dingell: My letter to you today is to urge 
     you to support the Medicare/Medicaid prescription drug 
     benefit as established by the Medicare Modernization Act of 
     2003 (MMS) and to oppose efforts to repeal the non-
     interference provision. All of our feedback from patients is 
     that the current program is working well and that they are 
     satisfied. I am deeply concerned that efforts to give the 
     government responsibility for negotiating drug prices will 
     ultimately lead to a loss of choice and access for patients 
     with serious, disabling autoimmune diseases.
       The American Autoimmune Related Diseases Association 
     (AARDA) is the only national organization dedicated to 
     addressing the problem of autoimmunity--the major cause of 
     chronic illness. AARDA is dedicated to the eradication of 
     autoimmune diseases and the alleviation of suffering and the 
     socioeconomic impact of autoimmunity through fostering and 
     facilitating collaboration in the areas of education, 
     research, and patient services in an effective, ethical and 
     efficient manner.
       As a group, Medicare/Medicaid beneficiaries are 
     particularly vulnerable to the devastating personal and 
     financial effects of autoimmune diseases. Disabling 
     autoimmune diseases can significantly diminish the quality of 
     life and it can entail thousands and thousands of dollars in 
     treatment costs over the course of the illness. For most 
     autoimmune disease sufferers, prescription drugs are the 
     chief and best source of treatment, particularly as newer 
     medications, such as monoclonal antibodies, have been 
     developed that not only work better, but can inhibit the 
     progression of diseases such as rheumatoid arthritis.
       The Medicare/Medicaid prescription drug benefit has been a 
     godsend for thousands of disabled persons struggling with 
     autoimmune-related chronic illnesses. For the first time, 
     they are able to achieve substantial savings on their 
     treatment costs. Even with the so-called ``doughnut hole,'' 
     beneficiaries are saving an average of $1,200 per year.
       Of even greater concern than the costs involved, however, 
     is the likelihood that turning negotiations over to the 
     government will reduce patient access to a wide variety of 
     medications, particularly the newest and most effective 
     medications. Autoimmune disease patients who were with the 
     Veterans' Plan have opted-out because of the difficulties in 
     obtaining the drugs they need.
       The program currently provides Medicare/Medicaid 
     beneficiaries with a choice of plans, enabling them to select 
     the coverage that best meets their needs. For someone with a 
     chronic autoimmune disease, access not just to medication, 
     but to the right medication, is critical. Just as the same 
     autoimmune disease will afflict each individual in a unique 
     way, the same medication will have varying degrees of 
     effectiveness for each patient. Two people with rheumatoid 
     arthritis, multiple sclerosis, or lupus, for example, can 
     take the same medication and have completely different 
     experiences. That is one key reason the element of choice is 
     such a crucial component of the Medicare/Medicaid 
     prescription drug program: Beneficiaries are better assured 
     they can select a plan that will cover medication they and 
     their physician have determined is best for them--rather than 
     being limited to the medications the government may decide to 
     cover. Congress should not do anything that would undermine 
     the success of the program and its benefits for seniors and 
     disabled persons. I believe that repealing the 
     noninterference provision would do just that.
       I have seen firsthand the dramatic difference the Medicare/
     Medicaid prescription drug benefit is making in the lives of 
     people with autoimmune diseases. This program is a bright 
     example of a government effort that works, and works well. I 
     again urge you to support, protect, and expand it, and oppose 
     any measures (particularly government interference in price 
     negotiations) that would limit its potential to help Medicare 
     beneficiaries and improve their lives.
       Thank you for taking the time to consider the concerns of 
     AARDA and its members. I look forward to hearing from you 
     regarding this issue.
           Sincerely,
                                                 Virginia T. Ladd,
                                 President and Executive Director.

  Mr. Speaker, I yield 2 minutes to the gentleman from Illinois (Mr. 
Weller), a distinguished member of the Ways and Means Committee.
  Mr. WELLER of Illinois. I thank the gentleman from Michigan for 
yielding me time.
  Mr. Speaker, I rise today in opposition to H.R. 4. Clearly this 
legislation is a solution in search of a problem, an example of 
politics prevailing over good policy, and frankly one of my 
disappointments as a member of the Ways and Means Committee is it was a 
bill rushed to the floor without hearings and without action in the 
Ways and Means Committee. I believe that is a bipartisan concern for 
all of us today.
  If you look at the record, the system set up in the Medicare 
Modernization Act used the power of competition, and it has been 
successful. Competition is working. Today, a senior's average monthly 
premium for their prescription drug plan is only $22 a month, down from 
$23 this past year. My own parents were expecting a $35 a month 
premium. Today they are enjoying that $22 a month premium and seeing 
real savings. I note that seniors across the board are seeing real 
savings. There are 23 drug plans in the district I represent that have 
a zero premium for low-income seniors. There are 34 drug plans in the 
district I represent with zero deductible. And on average, in the 11th 
Congressional District of Illinois, seniors are saving an average of 
$1,200 over their previous medicine expenses because of Medicare part 
D. It is working. At the same time, seniors have more choices. We have 
seen a 13 percent increase in the number of medications they have 
available, again because of Medicare part D. That is why 80 percent of 
seniors say they like Medicare part D. They like the plan they have. 
That is why so many are concerned about those who want to have the 
government interfere in the health of our seniors, who want to get the 
government into our medicine cabinets.
  My Democrat friends claim that this legislation will repeat practices 
used by the Department of Veterans Affairs, but if you look at the 
record, not only is that approach harmful to Medicare beneficiaries, it 
has been harmful to our veterans. Every time Congress has enacted 
pharmaceutical price control legislation, the Veterans' Administration 
has experienced significant increases in its pharmaceutical costs. That 
is why groups like the Military Order of the Purple Heart and the 
American Legion have said H.R. 4 is not in the best interest of 
America's veterans and their families. That's right. Let's join our 
veterans' organization and vote ``no'' on H.R. 4.
  Mr. STARK. Mr. Speaker, before recognizing the next speaker, I would 
like to concur with the remarks of the gentleman from Illinois. Many of 
us on this side of the aisle shared his concern with the rapidity with 
which we had to bring this to the floor. I want to commend both the 
ranking member and the chairman of the Ways and Means Committee as well 
as the ranking member of the Health Subcommittee for attempting to have 
as much time as we could for Members on both sides of the aisle to work 
on this bill before its coming to the floor today, but I do concur with 
his statement.

[[Page H471]]

  Having said that, I would like to recognize the gentleman from 
Connecticut (Mr. Courtney) for 1 minute.
  Mr. COURTNEY. Mr. Speaker, in 1991, as chairman of the Connecticut 
House Human Services Committee, I brought out to the floor of the 
Connecticut Assembly legislation which created a manufacturer's rebate 
for the State's Medicaid and Connpace prescription drug programs that 
provide coverage to seniors. The rebate gave the State an 11 percent 
discount off the average wholesale price of medications purchased by 
Connecticut. At the time we heard all the same arguments in opposition 
that are being used today, that rebates were price controls, they 
stifle R&D, that the State would be left with a restrictive formulary 
denying needed medications for the elderly. We went ahead and passed 
that bill, and I can say with pride today that this measure has saved 
Connecticut taxpayers tens of millions of dollars yearly and resulted 
in no, I repeat no, harm to Connecticut's seniors or the State's 
pharmaceutical industry.
  I point this history out not to pat myself on the back, although I am 
proud of that legislation, but rather to confirm that H.R. 4's plan for 
price negotiations is not just a theory but, rather, legislation that 
is grounded in real life, empirical, successful experience.
  For those of us who have fought this battle at the State level, this 
debate is like Yogi Berra's ``deja vu all over again.'' For the fiscal 
health of Medicare and for the physical health of our seniors, let's 
vote for H.R. 4.
  Mr. CAMP of Michigan. Mr. Speaker, I yield 1\1/2\ minutes to the 
gentleman from New Jersey (Mr. Frelinghuysen).
  (Mr. FRELINGHUYSEN asked and was given permission to revise and 
extend his remarks.)
  Mr. FRELINGHUYSEN. Mr. Speaker, I rise in strong opposition to this 
legislation which I would suggest is simply a politically motivated 
attempt by some to punish a vital, particularly American industry.
  I come from a State that celebrates thousands of discoveries by 
pharmaceutical researchers for treatments and cures for debilitating 
illnesses such as heart disease, juvenile and adult diabetes, 
Alzheimer's, Parkinson's and HIV that really affects the lives of 
millions of men, women and children. I am very supportive of an 
industry that directly employs over 70,000 of our State's residents and 
nearly half a million Americans nationwide. They don't need to be 
punished nor have their lives, their livelihoods controlled by Big 
Brother.
  This proposal will drive jobs out of my State and our Nation to 
Europe, the Pacific Rim, to China and India. Instead of protecting 
American ingenuity, this proposal will stifle innovation and be a death 
knell for profound medical research advances that were unthinkable a 
decade ago and which we now stand on the threshold of achieving.
  Mr. Speaker, what is more important, the Medicare drug benefit is 
working. The best way to foster innovation, keep prices low and, most 
importantly, ensure seniors have access and choices for their medicines 
is through competition. Competition works.
  Mr. Speaker, I rise in strong opposition to this legislation, which I 
would suggest, is simply a politically motivated effort by the Some to 
punish a vital, particularly American industry.
  Coming from a State that celebrates thousands of discoveries by 
pharmaceutical researchers for treatments and cures for debilitating 
illnesses such as heart disease, juvenile and adult diabetes, 
Alzheimer's, Parkinson's, and HIV that really affect the lives of 
millions of men, women, and children, I am very supportive of an 
industry that directly employs over 70,000 of our State's residents and 
nearly half a million Americans nationwide.
  This legislation makes not only drug manufacturers, but also may I 
add, our local pharmacists and their drug dispensing fees, subject to 
government price controls, endangering the very research and 
development that makes my State the ``Medicine Chest'' of the world.
  This proposal will drive jobs out of my State and our Nation to 
Europe, the Pacific Rim to India and China. Instead of protecting 
American ingenuity, this proposal will stifle innovation and be a death 
knell for profound medical research advances that were unthinkable a 
decade ago and which we now stand on threshold of achieving.
  And, what is far more important, my colleagues, the Medicare Drug 
benefit is working. Nearly 20 million seniors who previously had no 
coverage at all now have access to comprehensive prescription drug 
coverage. The average senior is saving $1,200 a year on their 
prescriptions and 9 milion low-income seniors pay nothing for drug 
coverage. Half a million seniors who never had coverage in New Jersey 
now have it.
  For the past year, we have heard politically inspired promises from 
my Democratic colleagues that they would introduce legislation to close 
the Medicare ``donut hole'' for the few seniors who fall into it. To 
achieve this goal I have heard over and over again from my colleagues 
on the other side that the Veterans Administration system should serve 
as a national model for lowering prices. However, as most know, the VA 
decides which drugs patients receive. Patients do not have a choice and 
neither do their physicians.
  I would then ask my colleagues to point to the provision in this 
legislation that sets aside funds to fill the donut hole for those 
seniors. However, no one can show me this provision because no such 
provision exists. Filling the donut hole carries a price tag of at 
least $450 billion and this bill will not produce anywhere close to 
that kind of savings.
  Actuarial experts from both the Congressional Budget Office and 
outside, independent groups have stated that there is no ability to 
negotiate lower prices without the government approving and rejecting 
which drugs a physician can prescribe a patient.
  Like Hugo Chavez in Venezuela, the new majority heads in the 
direction of nationalizing drug companies, establishing price controls, 
devaluing patents, and disemboweling critical research and development.
  Mr. Speaker, the best way to foster innovation, keep prices low and 
ensure seniors have access and choices for their medicines is through 
competition. Competition works.
  Mr. Speaker, I urge a ``no'' vote on this bill.
  Mr. STARK. Mr. Speaker, I am delighted to recognize the distinguished 
gentleman from Illinois (Mr. Hare) for 1 minute and comment that, 
before joining us, he served for 24 years as Mr. Lane Evans' district 
director, a man who is known on both sides of the aisle for his support 
for veterans' issues.
  Mr. HARE. I thank the gentleman for yielding.
  Mr. Speaker, recently I was at a pharmacy in my district. A man in 
his late seventies went to the counter to pay for his prescription and 
found that he had hit the donut hole. The prescription was $350. The 
people that were there with him passed the hat, and we collected $350. 
It was enough to pay for 5 days of medication for this man. For him and 
for the countless other seniors in my district, I rise today in strong 
support of H.R. 4, the Medicare Prescription Drug Negotiation Act. H.R. 
4 would require the Department of Health and Human Services to 
negotiate with pharmaceutical companies for lower drug prices for 
Medicare beneficiaries.

                              {time}  1300

  Estimates indicate that drug prices would go down by 35 percent by 
the year 2025, and lower prices would prevent millions of seniors from 
paying out of pocket for their medications.
  Fighting for affordable health care is the reason that I ran for 
Congress, and I start that fight today by voting for H.R. 4.
  Mr. CAMP of Michigan. Mr. Speaker, I yield 1 minute to the 
gentlewoman from Illinois (Mrs. Biggert).
  Mrs. BIGGERT. Mr. Speaker, I thank the gentleman for yielding.
  Mr. Speaker, I rise in opposition to H.R. 4, which would provide less 
choice and no savings. I think my friends on the other side of the 
aisle failed to mention some of the negative aspects of the veterans 
drug plan, which they are now highlighting as a model for government 
negotiation.
  I know they haven't highlighted the fact that many widely used drugs, 
including Lipitor, the most widely used drug in America, isn't even 
available through the VA plan. I wonder if my friends on the other side 
of the aisle are prepared to tell their seniors why they can't get 
Lipitor.
  Are they prepared to tell them they can't go to their local pharmacy, 
but have to go to a VA pharmacy, which could be hundreds of miles away, 
or they have to order their drugs through the mail? I wonder why one-
third of the veterans have already moved to the part D plan.
  Personally, I know my seniors would want to be able to choose a drug 
plan that gets them the best deal for the drugs they use. They don't 
want to be locked into a one-size-fits-all plan that

[[Page H472]]

doesn't cover their drugs, especially since the CBO says it won't save 
them any money.
  Mr. Speaker, I urge opposition to this bill.
  Mr. Speaker, I rise in opposition to H.R. 4, which would provide less 
choice and no savings.
  This morning, as I reviewed all of the letters of support and 
opposition on this bill, I was struck by the lack of patient group 
support for this legislation. I could not find a single letter from the 
American Cancer Society, any diabetes group, or the American Heart 
Association supporting government negotiation under Medicare Part D.
  What I did find was a letter from the Alliance for the Mentally Ill 
of Greater Chicago, in opposition to the bill, which I think represents 
the views of all these groups.
  It states, and I quote, ``To date, government interventions in 
prescription medication pricing, at the federal and state levels, have 
resulted in policies restricting access to medications.''
  Mr. Speaker, I ask unanimous consent that the full text of this 
letter be included in the Record.
  In addition, I think my friends on the other side of the aisle have 
failed to mention some of the negative aspects of the Veterans Drug 
Plan they are now highlighting as the model from government 
negotiation. I know they haven't highlighted the fact that many widely 
used drugs--including lipitor, the most used drug in America--aren't 
even available through the VA Plan. I wonder if my friends on the other 
side of the aisle are prepared to tell their seniors why they can't get 
their lipitor or why they need to fail on a less costly drug first. Are 
they prepared to tell them that they can't go to their local pharmacy 
or that they need to order their drugs through the mail?
  Personally, I know my seniors want to be able to choose a drug plan 
that gets them the best deal on the drugs they use. They don't want to 
be locked into a one-size-fits-all plan that doesn't cover their drugs.
  And then there is the other issue nobody on the other side of the 
aisle wants to talk about. According to the Congressional Budget 
Office, the legislation we are considering today won't save seniors any 
money and won't save the government any money. So why should seniors 
give up their drug coverage if it won't even save them money?
  Mr. Speaker, I oppose this legislation because it threatens to limit 
the drug choices of America's seniors without saving them or the 
government any money. Currently, there are 54,575 seniors in my 
district that utilize the Medicare Part D program, and they save on 
average $1,200 a year. Costs to seniors are already less than 
originally projected and they are expected to fall further. Let's let 
the program continue to work.
  Mr. STARK. Mr. Speaker, I yield to the gentlewoman from Texas (Ms. 
Jackson-Lee) for the purpose of a unanimous consent request.
  (Ms. JACKSON-LEE of Texas asked and was given permission to revise 
and extend her remarks.)
  Ms. JACKSON-LEE of Texas. Mr. Speaker, I thank the chairman for 
yielding.
  Mr. Speaker, I rise today in strong support of H.R. 4, the ``Medicare 
Prescription Drug Negotiation Act of 2007,'' a bill that will require 
the government to negotiate for lower drug prices for Medicare 
beneficiaries and people with disabilities in the Medicare program.
  Mr. Speaker, I would like to pay special tribute to my good friend, 
Chairman John Dingell, for his lifetime of devoted service to the cause 
of affordable health care for all Americans. I also thank the 
Democratic leadership, led by Speaker Pelosi, making affordable 
prescription drugs for Medicare beneficiaries a central issue in the 
last election, which saw the voters return the Democrats to the 
majority in this chamber for the first time in twelve years. Democrats 
promised to chart a new direction for America if given the chance to 
lead. Today, we take another giant step toward fulfilling that promise.
  Mr. Speaker, under the current law, which was passed in the dead of 
night with little time for members of Congress to review the hundreds 
of pages of text involved in such a complex proposal and was written 
largely by and for the pharmaceutical industry, Medicare is explicitly 
prohibited from negotiating lower prices. It is past time for Congress 
to repeal this provision and put the needs of the American people 
before those of special interests.
  Allowing the government to negotiate for lower prescription drug 
prices puts the interests and well-being of ordinary Americans first by 
making health care more affordable for Medicare beneficiaries, who 
include millions of our country's most vulnerable citizens, seniors and 
individuals with disabilities. Our seniors and individuals with 
disabilities should not be forced to choose between buying medications 
and paying for rent or food. Lower prescription drug prices could go a 
long way to eliminate this Hobbesian choice.
  The ability to negotiate the cost of prescription drugs purchased 
through the Medicare program also will generate tremendous savings to 
the taxpayers. We have a duty to the taxpayers to get the best return 
on their hard-earned money, especially on costly pharmaceuticals for 
which the federal government facilitates purchases in such large 
quantities.
  Drug prices under the Medicare prescription drug plan are more than 
80 percent higher than prices negotiated by other agencies in the 
federal government and more than 60 percent higher than prices in 
Canada. In 2007, many beneficiaries in private drug plans will see 
their premiums increase by an average of ten percent, and some premiums 
will rise more than six-fold if they stay in the same plan.
  We cannot afford to stay with the same faulty plan but must change 
direction to reflect the will of the American people. The American 
people overwhelmingly support having the Secretary of HHS negotiate for 
lower prescription drug prices on behalf of Medicare. The bill also has 
the support of a number of organizations including the AARP, the 
National Committee to Preserve Social Security and Medicare, the 
Consumer's Union, the AFL-CIO, and Families USA.
  We have heard the voice of the American people and we must not ignore 
our duty to act in their best interests. Allowing the federal 
government to negotiate for lower drug prices for Medicare 
beneficiaries is merely a start to our fulfilling that duty.
  Mr. Speaker, the Medicare Prescription Drug Negotiation Act of 2007, 
represents a win-win situation. Medicare beneficiaries will be able to 
obtain needed prescription drugs at prices they can afford and the 
taxpayers will get a greater return on their dollars by taking 
advantage of economies of scale. I urge all members to vote for H.R. 4, 
which will enable the federal government to negotiate for lower drug 
prices for Medicare beneficiaries.
  Mr. STARK. Mr. Speaker, I am delighted to yield 1 minute to the 
gentleman from Pennsylvania (Mr. Altmire), one of the cosponsors and 
coauthors of the bill.
  Mr. ALTMIRE. Mr. Speaker, I rise today in strong support of this 
bill, which gives the HHS Secretary the ability to negotiate group 
discounts with drug companies.
  I have to admit that I am amazed that we are even having this debate. 
How could anyone possibly oppose negotiating group discounts to reduce 
the cost of prescription drugs for Medicare beneficiaries? We already 
do it in the VA, and it has worked. Why not allow Medicare 
beneficiaries the same savings? I can't believe anyone would oppose 
such a measure. I find it absurd that Congress would prevent a Federal 
agency from exploring ways to reduce costs for seniors and save the 
American taxpayers money.
  The truth is, Mr. Speaker, that this bill would lower the cost of 
prescription drugs for seniors and save money for the American 
taxpayers. I urge my colleagues to side with our Nation's Medicare 
beneficiaries and support this bill.
  Mr. CAMP of Michigan. Mr. Speaker, I yield 1 minute to the gentleman 
from Nebraska (Mr. Smith).
  Mr. SMITH of Nebraska. Mr. Speaker, I rise with great concern. I rise 
with great concern about H.R. 4, which actually removes the negotiating 
process from the private sector and places it in the public sector. I 
rise with concern because H.R. 4 will not reduce prices. It will reduce 
choice. I also rise with concern because our current premiums are 
actually 42 percent lower than expected.
  Mr. Speaker, the private sector is doing well in this, and I don't 
think we should tamper with that. Should one have to forfeit their 
personal choices to the lowest bidder?
  As a representative of the great State of Nebraska, I rise in concern 
over H.R. 4. There are 208,040 Medicare prescription drug beneficiaries 
in the third district which I represent. Everyone wants to make sure 
that seniors get the prescription drugs they need at the lowest 
possible price. But, H.R. 4 will not reduce their prices, it will 
reduce their choices. The government should not be choosing one drug 
over others.
  According to estimates by actuaries in the Congressional Budget 
Office and the Department of Health and Human Services, H.R. 4 would 
not provide substantial savings to the government or Medicare 
beneficiaries. The reality is that with market based principals 
governing Medicare Part D, premiums are actually 42 percent lower than 
expected levels.
  I disagree with H.R. 4 in a fundamental philosophical way. H.R. 4 
would have the government making decisions for consumers. The 
government would end up picking one drug over others.

[[Page H473]]

  I believe that doctors and patients should consult with each other on 
what medications will best address patients' needs.
  I urge my colleagues to vote against H.R. 4. Constituents of 
Nebraska's Third District and throughout the United States deserve to 
have their doctor's choices of prescription medication protected. 
Should one have to forfeit their personal choices to the lowest bidder?
  Mr. STARK. Mr. Speaker, I yield to the gentleman from North Carolina 
(Mr. Etheridge) for the purpose of a unanimous consent request.
  (Mr. ETHERIDGE asked and was given permission to revise and extend 
his remarks.)
  Mr. ETHERIDGE. I thank the gentleman, Mr. Speaker, and I rise in 
support of H.R. 4.
  Mr. Speaker, nearly 4 years ago, I voted against the legislation that 
created Medicare Part D when the then-Republican Majority passed it in 
the dead of night.
  I rise today in support of H.R. 4 to correct one of its most 
fundamental flaws. H.R. 4 would simply remove the provision of law that 
prohibits the U.S. Secretary of Health and Human Services from 
negotiating the price of prescription drugs to lower costs for Medicare 
beneficiaries. I have never supported price fixing or rationing, and I 
am confident that this legislation is a good first step toward more 
comprehensive Medicare reform.
  Mr. Speaker, many of my constituents work at America's pharmaceutical 
manufacturing companies, and I think it is important to take note of 
the many contributions these employers make to the betterment of our 
communities. Indeed, many of the biotechnology firms in North Carolina 
are among our best corporate citizens, providing employment 
opportunities, investing in America's health and well-being, growing 
the local tax base, providing essential services to our neediest 
constituents and giving back to our communities.
  For example, GlaxoSmithKline offers the free GSK Orange Card savings 
program to help more than 175,000 low-income seniors to save 20 percent 
to 40 percent off the usual price for outpatient GSK medicines. A 
coalition of eight companies offers the free Together Rx Card to poor 
and uninsured Americans, which has helped more than 1.4 million seniors 
to save more than $600 million on their medicines. In addition, U.S. 
pharmaceutical companies annually invest billions of dollars in 
biotechnology research to develop medicines to treat and cure terrible 
diseases and relieve human suffering.
  Mr. Speaker, I rise in support of H.R. 4 and call on this Congress to 
work with the private sector as we move forward to reform Medicare to 
lower prices for beneficiaries while providing vital health care 
products and services.
  Mr. STARK. Mr. Speaker, I am honored to yield 1 minute to the 
gentlelady from Hawaii (Ms. Hirono), a lady for whom I serve as an 
honorary district representative on the island of Lanai.
  Ms. HIRONO. Mr. Speaker, I thank the gentleman for yielding this 
time.
  Mr. Speaker, I rise today in strong support of H.R. 4. Talk about an 
all-American concept, using our purchasing power to lower our costs, 
something big companies do all the time. This is why I am so pleased 
that one of the first pieces of legislation before us will help our 
seniors, our kapuna, as we say in Hawaii, lower their prescription drug 
costs. I am proud to say that in 2002 Hawaii enacted a law creating a 
similar program to allow negotiating for lower prescription drug costs.
  Thousands of American families spent countless hours studying the 
Medicare part D process. My family was one of those. I sat with my 82-
year-old mother as we worked our way through the confusing plans. 
Unfortunately, many of the families' efforts were not rewarded with the 
desired outcome, affordable prescription drugs.
  America can do better for our seniors. By giving Medicare negotiating 
authority, we will take an important step in the right direction. 
Mahalo.
  Mr. CAMP of Michigan. Mr. Speaker, I yield 1 minute to the gentleman 
from Georgia (Mr. Gingrey).
  Mr. GINGREY. Mr. Speaker, this is a hugely important issue. I know 
all Members are listening intently, and I hope the American public is 
listening. I want to remind them what a few of my colleagues on the 
other side of the aisle had to say.
  One of their Members earlier in the debate basically said there was a 
philosophic, fundamental difference between them and us. They believe 
that government should control health care; we believe that the private 
sector should do it. Amen. The private sector should do it.
  Another of their Members stood up and said he couldn't believe that 
the current Secretary of HHS doesn't want to have the requirement of 
negotiated price controls. Well, I will tell you why he doesn't, 
because he is not a typical bureaucrat. He believes, as Ronald Reagan 
believed, that you need to step out of the way; government needs to get 
out of our lives and not be in our medicine cabinet.
  Finally, the gentlelady from Nevada said if she were a betting woman, 
she would bet that these price negotiations would lower the price even 
further. Well, I want to say to her that she is betting on the last 10 
percent, Mr. Speaker. This is a wonderful program, it is working well, 
and she is about to hang an albatross around the neck of the program 
and hurt our needy seniors, including my mom.
  Vote ``no'' on this piece of bad legislation.
  Mr. STARK. Mr. Speaker, at this time I am delighted to yield 1 minute 
to the gentlewoman from Ohio (Ms. Sutton).
  Ms. SUTTON. Mr. Speaker, I thank the gentleman for yielding me time.
  Mr. Speaker, there is something wrong when we have our seniors paying 
record high drug prices and drug companies reporting record profits. 
Our seniors deserve nothing less than access to affordable medicine, 
which they have earned through a lifetime of hard work. This 
legislation helps us achieve this by opening the door for the Secretary 
of the Department of Health and Human Services to negotiate lower drug 
prices.
  Twenty-two million Americans would benefit from this proposal. 
Ninety-two percent of Americans support us providing this negotiating 
authority.
  Mr. Speaker, let's be clear: This proposal is intricately linked to 
ethics reform. Last week we enacted historic changes, and now we are 
putting our seniors first and removing special interests from the 
picture.
  The minority had a chance when they were in the majority to put forth 
a drug bill that helped seniors with the high cost of medicine. 
Instead, with backroom meetings, they choose to help the drug companies 
increase profits.
  I am pleased as a cosponsor of this bill that we act today to help 
our seniors and keep our commitment to put their interests first.
  Mr. CAMP of Michigan. Mr. Speaker, I yield 1 minute to the gentleman 
from Texas (Mr. Sessions).
  Mr. SESSIONS. Mr. Speaker, I thank the gentleman.
  Mr. Speaker, I rise in opposition to H.R. 4, the Medicare part D 
Government Interference Plan, which is what the Democrats have today.
  Mr. Speaker, our colleagues on the other side have made it very 
clear: They believe that price controls will beat what the marketplace 
has done, and yet the Congressional Budget Office has clearly said that 
is not true, there would be no savings.
  What would their plan do, Mr. Speaker? They talk about the important 
part of what the VA does. Of over 3.8 million Medicare eligible 
beneficiaries enrolled in the VA, over 1 million have opted to 
participate in part D because it provides more flexibility and choice 
for the drugs that they want and they need.
  Only 38 percent of the drugs that were approved by the FDA in the 
1990s and only 19 percent since 2000 are available on the VA formulary. 
The Democrats want this for our seniors.
  Mr. Speaker, I believe that doctors and patients should control the 
medicines that are available, and I think they should be available to 
every single senior. We want to make sure that continues. I oppose this 
bill.
  Mr. STARK. Mr. Speaker, I am delighted to yield 1 minute to the 
gentleman from California (Mr. Baca), who agrees with the National 
Community Pharmacists that the non-interference clause has directly 
disadvantaged independent pharmacies throughout the implementation of 
part D.
  Mr. BACA. Mr. Speaker, the rising cost of prescription drugs has 
become a serious problem for millions of our national seniors. Forty-
three million are enrolled in Medicare. In fact, more than 20 percent 
of seniors in Medicare are minorities: 3.9 million are African 
Americans, 3.1 million are Latinos, and 1.7 million are other racial 
and ethnic minorities. Many of them are already

[[Page H474]]

on fixed income. Many of these high prices are forcing them to choose 
between medicine and paying for their rent or doing without something 
else.
  What Republicans pushed through in the Medicare drug program promised 
to bring the drug prices down. Yet they have gone up. Yet they plan to 
protect the rich drug companies' profits and do not go far enough to 
lower these expenses that are affecting a lot of our minorities. I know 
firsthand because I have experienced that.
  It is clear that this legislation has failed to bring down the drug 
prices. Giving the Secretary the authority to bargain with the drug 
manufacturers will result in lower costs for 22 million Medicare 
enrollees in part D. I ask that we support H.R. 4. This is commonsense 
legislation.
  Mr. CAMP of Michigan. Mr. Speaker, I would include in the Record a 
letter from the Congressional Budget Office saying that CBO estimates 
H.R. 4 would have a negligible effect on Federal spending.
                                                    U.S. Congress,


                                  Congressional Budget Office,

                                 Washington, DC, January 10, 2007.
     Hon. John D. Dingell,
     Chairman, Committee on Energy and Commerce,
     House of Representatives, Washington, DC.
       Dear Mr. Chairman: At the request of your staff, the 
     Congressional Budget Office has reviewed H.R. 4, the Medicare 
     Prescription Drug Price Negotiation Act of 2007, as 
     introduced on January 5, 2007. The bill would revise section 
     1860D-11(i) of the Social Security Act, which is commonly 
     known as the ``noninterference provision'' because it 
     prohibits the Secretary of Health and Human Services from 
     participating in the negotiations between drug manufacturers, 
     pharmacies, and sponsors of prescription drug plans (PDPs) 
     involved in Part D of Medicare, or from requiring a 
     particular formulary or price structure for covered Part D 
     drugs.
       H.R. 4 would require the Secretary to negotiate with drug 
     manufacturers the prices that could be charged to PDPs for 
     covered drugs. However, the bill would prohibit the Secretary 
     from requiring a particular formulary and would allow PDPs to 
     negotiate prices that are lower than those obtained by the 
     Secretary. The bill would also require the Secretary to 
     report to the Congress every six months on the results of his 
     negotiations with drug manufacturers.
       CBO estimates that H.R. 4 would have a negligible effect on 
     federal spending because we anticipate that the Secretary 
     would be unable to negotiate prices across the broad range of 
     covered Part D drugs that are more favorable than those 
     obtained by PDPs under current law. Since the legislation 
     specifically directs the Secretary to negotiate only about 
     the prices that could be charged to PDPs, and explicitly 
     indicates that the Secretary would not have authority to 
     negotiate about some other factors that may influence the 
     prescription drug market, we assume that the negotiations 
     would be limited solely to a discussion about the prices to 
     be charged to PDPs. In that context, the Secretary's ability 
     to influence the outcome of those negotiations would be 
     limited. For example, without the authority to establish 
     formulary, we believe that the Secretary would not be able to 
     encourage the use of particular drugs by Part D 
     beneficiaries, and as a result would lack the leverage to 
     obtain significant discounts in his negotiations with drug 
     manufacturers.
       Instead, prices for covered Part D drugs would continue to 
     be determined through negotiations between drug manufacturers 
     and PDPs. Under current law, PDPs are allowed to establish 
     formularies--subject to certain limits--and thus have some 
     ability to direct demand to drugs produced by one 
     manufacturer rather than another. The PDPs also bear 
     substantial financial risk and therefore have strong 
     incentives to negotiate price discounts in order to control 
     their costs and offer coverage that attracts enrollees 
     through features such as low premiums and cost-sharing 
     requirements. Therefore, the PDPs have both the incentives 
     and the tools to negotiate drug prices that the government, 
     under the legislation, would not have. H.R. 4 would not alter 
     that essential dynamic.
       I hope this information is helpful to you. The CBO staff 
     contacts for further information are Eric Rollins and Shinobu 
     Suzuki.
           Sincerely,
                                                 Donald B. Marron,
                                                  Acting Director.

  Mr. Speaker, I yield 1 minute to the gentleman from Alabama (Mr. 
Bachus).
  Mr. BACHUS. Mr. Speaker, is the question to negotiate or not 
negotiate? Is that the question? No, that is not the question. The 
question is, will the government do the negotiating, or will the 
private companies do it. And what will the result be?
  Well, we already know. We don't have to speculate. In Alabama, we 
have 17 companies that have negotiated and provide over 2,000 drugs to 
Alabamians under the present plan. Under the VA, they negotiate and 
they provide less than 1,300 drugs. We have all heard about Lipitor. 
Look at the drugs in Alabama that VA seniors cannot get. They are the 
most modern drugs, they are the cutting-edge drugs, they are the drugs 
that most seniors want.
  CBO says it won't bring down the cost, but it might inhibit the 
delivery of new drugs. You need to read that before you vote.
  The question is not about cost; the question is about choice. And I 
can tell you in Alabama, with the VA, the veterans don't have the 
choices our seniors have.
  Mr. STARK. Mr. Speaker, for the purpose of a unanimous consent 
request, I yield to the gentleman from Massachusetts (Mr. Lynch).
  (Mr. LYNCH asked and was given permission to revise and extend his 
remarks.)
  Mr. LYNCH. Mr. Speaker, I rise in support of H.R. 4, to give seniors 
someone to negotiate on their behalf for lower-price drug prices.
  We all know how in 2003, in the middle of the night, after twisting 
arms and making threats, Congress passed a flawed Medicare prescription 
drug bill. By actually forbidding the Medicare program to negotiate 
directly with drug companies to get the best price for seniors' 
prescriptions and save money, the Republican Congress simply put 
profits for the drug companies ahead of Medicare beneficiaries.
  The medicare drug benefit actually is designed to ensure that 
pharmaceutical and insurance companies maximize their profits.
  By prohibiting Medicare from directly negotiating drug prices with 
the pharmaceutical industry like the VA does, many drugs within 
Medicare are more than twice as high as the prices paid by the VA.
  Since the industry is already making a profit at the price for which 
it sells drugs to the VA, the higher price paid in Medicare is pure 
profit for the drug industry.
  That's why I encourage my colleagues to join me in supporting the 
Medicare Prescription Drug Price Negotiation Act.
  Mr. STARK. Mr. Speaker, I yield 1 minute to the distinguished 
gentlelady from California (Mrs. Davis).
  Mrs. DAVIS of California. Mr. Speaker, I rise in support of H.R. 4.
  Three years ago, during the debate on the Medicare Modernization Act, 
I stood on this floor and told my colleagues that we can do better, 
that we can do better with a bill for our seniors; and today's vote 
will bring us one step closer to providing seniors with affordable and 
reliable prescription drug coverage by allowing the Health Secretary to 
negotiate drug prices.
  As we move forward with H.R. 4, we can and we will safeguard future 
innovation and support lifesaving therapies befitting the 21st century.

                              {time}  1315

  Representing a district with a vibrant biotech community, I applaud 
the leadership's effort to ensure that our seniors have choices. This 
summer, one of my constituents named Judy wrote me, and I quote, ``I 
have reached the doughnut hole and must now come up with the money for 
my high blood pressure, diabetes, thyroid, and cholesterol 
medications.'' The question she asked is, ``which one will I stop 
taking? I cannot afford all of them.''
  We can do better for seniors like Judy, and today, Mr. Speaker, we 
will.
  Mr. CAMP of Michigan. Mr. Speaker, at this time I yield 1 minute to 
the gentleman from Texas (Mr. Hensarling).
  Mr. HENSARLING. Mr. Speaker, once again, the Democrats are telling us 
that somehow bureaucrats in Washington can do more to lower the cost of 
prescription drugs than free market competition. To paraphrase 
President Reagan, ``There they go again.''
  The Congressional Budget Office has already opined that the Secretary 
of HHS would not be able to negotiate prices lower than those that are 
already negotiated by prescription drug plans under current law.
  Let us be very clear: Price negotiations are already taking place on 
behalf of seniors. And for 200 years, it has been market competition, 
not government edict, that has given us the goods that we want at the 
lowest possible price.
  Now, our colleagues on this side of the aisle continue to hold up the 
VA as the model, the model where you cannot choose your doctor, cannot 
choose your pharmacist, and they only cover a third of the drugs that 
Medicare does. They do not cover Lipitor, Crestor or Nexium.
  So, Mr. Speaker, I would like to personally invite Speaker Pelosi to 
come

[[Page H475]]

to Athens, Texas, and tell one of my constituents, 80-year-old Hazel 
Heard, why she is going to take her Lipitor away. Hazel will not be 
happy. And I am told she has a big dog.
  Mr. STARK. Mr. Speaker, I am pleased to recognize the distinguished 
gentlewoman from Connecticut (Ms. DeLauro), who agrees with the Center 
for Medicare Advocacy Assessment that H.R. 4 will keep drug prices from 
skyrocketing. And I yield to the gentlewoman for 1 minute.
  Ms. DeLAURO. Every family in America, every business struggles in 
some way with the rising cost of health care. The key to driving those 
health care costs down is getting control of skyrocketing prescription 
drug prices. It starts with negotiating better prices on behalf of 
Medicare beneficiaries, something the previous majority expressly and 
senselessly prohibited when the Medicare prescription drug law was 
passed in 2003.
  Now, this legislation is not about establishing formularies, setting 
price controls, or picking and choosing on behalf of seniors. It is 
about empowering the government to act on behalf of consumers and 
seniors. And, yes, that is a proper role for government, particularly 
when we have drug companies reporting double-digit profit increases 
while raising prices on top-selling medicines.
  We can get our health care crisis under control. Allow government to 
negotiate drug prices as private insurance plans do for their customers 
and the VA does so successfully for our Nation's veterans.
  Support this bill. Let us for a change do something for the public 
interest rather than continually doing something for the special 
interests.
  Mr. CAMP of Michigan. Mr. Speaker, at this time I yield 1 minute to 
the gentlewoman from West Virginia (Mrs. Capito).
  Mrs. CAPITO. Mr. Speaker, I thank the gentleman for recognizing me.
  Today, I rise in opposition to H.R. 4. When I first ran for Congress, 
this was one of the largest issues, prescription drug plans, for 
seniors. Sixty percent of the senior women in America are on Medicare 
right now, and they have available to them a prescription drug plan 
that they have never had in the past. Congress delivered this plan, and 
people in my district are pleased. Over 80 percent of the seniors on 
part D are pleased with this plan, and 91 percent of West Virginia 
seniors are now participating.
  The prescription drug plan is one of the rare government programs 
that is actually costing less than anticipated, both for the government 
and for the seniors. One reason is that seniors have access to the 
drugs and pharmacy of their choice. Yet, today, my colleagues on the 
other side appear to be willing to sacrifice that access to their drugs 
and their pharmacies.
  Yesterday, the Director of the West Virginia Chapter of the American 
Diabetes Association wrote and asked that I personally oppose this 
legislation because of its potential to decrease access to important 
medications for such diseases as diabetes, one of the most deadly and 
far-reaching diseases in this country.
  I oppose this. I think it will result in higher prices for our 
seniors.
  Mr. STARK. Mr. Speaker, I am delighted to yield our remaining 1 
minute to the gentlewoman from Ohio (Mrs. Jones) to close for our side. 
She recognizes that the Center for Diabetes is a front group for PhRMA.
  Mrs. JONES of Ohio. Mr. Speaker, I am pleased to stand on behalf of 
the Democratic majority in the House of Representatives this afternoon 
to say we are going to pass a prescription drug change in the benefit 
given to seniors last year. And it is not going to take us 3 hours and 
any arm twisting, because this is our opportunity to say to seniors 
across this country that you ought to have your Secretary of Health and 
Human Services be able to negotiate the lowest price.
  Right now it is going great, but we need to put in place in the law 
an opportunity for the Secretary to make a change when the winds of 
time change, because they will change. It is important that our seniors 
understand that they do have a benefit, but the benefit can be 
improved.
  It is always interesting to me that they dump on the Veterans' 
Administration when they want to tout it all the time as not a good 
health care plan. If it ain't a good health care plan for the veterans, 
change it. Make it better for the veterans. They are over there 
fighting and losing their lives.
  A prescription drug benefit is such a significant opportunity for our 
seniors, and so I am glad to stand on behalf of all the Democrats and 
those good-thinking Republicans in the House of Representatives. Pass 
H.R. 4.
  Mr. Speaker, I rise today in strong support of H.R. 4, which will 
require the Secretary of Health and Human Services to negotiate for 
lower drug prices for people enrolled in Medicare prescription drug 
plans.
  As drug prices soar, this issue is becoming more important for 
Medicare recipients and their families.
  According to a recent AARP study, between 2002 and 2005, prices for 
the most widely used brand-name prescription drugs increased an average 
of 6.6 percent per year.
  That is more than twice the 2.5 percent average inflation rate for 
that same period of time.
  It is not fair to expect American families to keep paying such price 
increases for their prescription drugs.
  In my home state of Ohio, we have about 1.8 million Medicare 
beneficiaries who stand to benefit from the lower prices that could 
result if the Secretary of HHS is given the power to negotiate.
  Of those 1.8 million Ohioans, 625,000 are already enrolled in Part D 
and would immediately see the benefits of lower drug prices.
  Congress should no longer stand in the way.
  We need to require the HHS Secretary to negotiate for lower drug 
prices and soften the health and economic burden that millions of 
American families currently experience.
  This would not be anything new.
  Right now, government-funded health programs, such as Medicaid and 
the Department of Veterans Affairs, are able to negotiate with drug 
companies and reach agreements that offer their participants low drug 
prices while still rewarding drug companies for the valuable research 
they conduct.
  According to the Government Accountability Office, the VA achieves 
savings of between 30 and 50 percent for their patients through 
negotiation.
  This same level of saving can also be achieved for Medicare 
beneficiaries.
  Moreover, the result of not allowing the HHS Secretary to negotiate 
lower drug prices puts a disproportionate burden on senior citizens and 
retirees, who are those that need affordable drugs the most.
  Drug companies deserve applause for the advances they have made for 
the good of all people, but we also owe it to the American people to 
ensure they receive the medication they need at a fair price.
  With rising health care, housing, and energy costs, a decrease in 
drug prices would go a long way to helping middle class Americans meet 
their needs.
  Support H.R. 4.
  Mr. CAMP of Michigan. Mr. Speaker, for the purposes of a unanimous 
consent request, I yield to the gentleman from Florida.
  (Mr. YOUNG of Florida asked and was given permission to revise and 
extend his remarks.)
  Mr. YOUNG of Florida. I thank the gentleman for yielding.
  Mr. Speaker, as we conclude debate this afternoon on H.R. 4, the 
Medicare Prescription Drug Price Negotiation Act of 2007, I want to 
include for the benefit of my colleagues today's editorial from my 
hometown newspaper The St. Petersburg Times that warns the House to be 
careful with the passage of this legislation.
  In Rx: dose of reality, the editors say ``that Democrats should walk 
away from this fight. House Democrats may think they can heal the 
Medicare drug program in one easy congressional dose, but their Senate 
counterparts are wise to take more time. Seniors have had enough of 
empty political promises already. They deserve affordable coverage.''
  Indeed, I support making prescription drugs more affordable for all 
Americans, and in particular older Americans who are enrolled in the 
Medicare Part D program. If this legislation did that, I would be the 
first to support it. But as the editorial I have cited as well as the 
nonpartisan Congressional Budget Office has found in analyzing H.R. 4, 
this bill will result in no meaningful savings to consumers or to 
taxpayers.
  Following my remarks, I will include a letter from the Congressional 
Budget Office dated January 10, 2007 which says that H.R. 4 would have 
a ``negligible effect'' on federal spending and drug prices because the 
federal government would not have the authority required to negotiate 
lower drug prices. The primary reason the Congressional Budget Office 
found is that ``without the authority to establish a formulary, we 
believe that the Secretary

[[Page H476]]

would not be able to encourage the use of particular drugs by Part D 
beneficiaries, and as a result would lack the leverage to obtain 
significant discounts in his negotiations with drug manufacturers.''
  If, in fact, this legislation had given the Secretary of Health and 
Human Services the authority to limit the availability of certain 
prescription drugs or even broad classes of prescription drugs, I also 
would have opposed it. Doctors should determine the best medicine for 
their patients, not Congress or the Secretary of Health and Human 
Services.
  Mr. Speaker, there may have been a way to amend this legislation to 
solve some of these problems so we could have achieved the goal of 
lower drug prices while at the same time not limiting the range of 
covered drugs. However, under the procedures we consider this 
legislation today, there is no opportunity to amend this bill. We only 
have the option of voting yes or no. Given that option, I believe the 
best vote today is against H.R. 4 with the hope that we can reject this 
bill and send it back to the committee with the goal of fixing some of 
the flaws identified by The St. Petersburg Times and the Congressional 
Budget Office.

             [From the St. Petersburg Times, Jan. 12. 2007]

                          Rx: Dose of Reality

       Democrats who thing they've found a simple fix for the 
     nation's costly, convoluted Medicare prescription plan need 
     to be careful. They are entering a pharmaceutical quagmire 
     full of restrictive formularies, big-ticket coverage gaps and 
     institutional resistance.
       The fight is a worthy one, and the precipitous veto threat 
     by President Bush only underscores the stakes. But Democrats 
     won't win with campaign rhetoric. The bill set to move 
     through the U.S. House today provides little more than an 
     edict that the secretary of health and human services ``shall 
     negotiate'' lower drug prices, as though the government 
     itself is the one buying. Unfortunately, drugs are bought and 
     dispensed under the 2003 Medicare law by a maze of some 1,875 
     private drug plans.
       The Democratic plan is, at best, incomplete. The current 
     law does, absurdly, outlaw any negotiation of drug prices, 
     which has the principal effect of fattening pharmaceutical 
     bank accounts. But the kind of savings the Department of 
     Veterans Affairs has been able to negotiate for its 
     prescription drugs is not merely the result of its collective 
     bargaining power. The VA, which filled some 120-million 
     prescriptions last year, also restricts the kinds of 
     medicines that are available to patients.
       As James R. Lang, former president of Anthem Prescription 
     Management, told the New York Times: ``For this proposal to 
     work, the government would have to take over price 
     negotiations. It would have to take over formularies. You 
     cannot do one without the other. There's no leverage.''
       Democrats are not being honest about the tradeoffs, and the 
     possible need for some restrictive formularies to help reduce 
     costs. They are also offering a misleading pledge to 
     eliminate the so-called ``doughnut hole.'' To save money, 
     Republicans created a peculiar gap in coverage that nabbed as 
     many as 4-million seniors last year. Under the coverage gap, 
     Medicare recipients pay 100 percent of drug costs each year 
     after the total has reached $2,400 until they pay an 
     additional $3,850 out of pocket.
       During the midterm elections, House Speaker Nancy Pelosi 
     was among the prominent Democrats promising that the savings 
     from lower drug prices would be plowed back into the program. 
     ``We will use that money to fill the doughnut hole,'' she 
     said at one campaign stop, ``so that seniors will have 
     affordability, they will have reliability, and will not be 
     caught in this trap of the doughnut hole.''
       The Congressional Budget Office has projected, however, 
     that eliminating the coverage gap would cost roughly $450-
     billion over 10 years. Few, if any, Democrats are now 
     claiming those new costs can be offset purely by savings from 
     price negotiation. An estimate of drug price reductions 
     prepared by Rep. Henry A. Waxman, D-Calif., pegged the 10-
     year savings at roughly $96-billion.
       The point here isn't that Democrats should walk away from 
     this fight. The current Medicare prescription plan is indeed 
     incomplete, needlessly complex and indefensibly profitable to 
     the pharmaceutical industry. But the plan is also in effect 
     and generally well-received by many seniors. Problems of this 
     magnitude won't be fixed just by ordering a Bush 
     administration bureaucrat to negotiate.
       House Democrats may think they can heal the Medicare drug 
     plan in one easy congressional dose, but their Senate 
     counterparts are wise to take more time. Seniors have had 
     enough empty political promises already. They deserve 
     affordable coverage.
                                  ____

     Hon. John D. Dingell,
     Chairman,
     Committee on Energy and Commerce,
     U.S. House of Representatives,
     Washington, DC
       Dear Mr. Chairman: At the request of your staff, the 
     Congressional Budget Office has reviewed H.R. 4, the Medicare 
     Prescription Drug Price Negotiation Act of 2007, as 
     introduced on January 5, 2007. The bill would revise section 
     1860D-11(i) of the Social Security Act, which is commonly 
     known as the ``noninterference provision'' because it 
     prohibits the Secretary of Health and Human Services from 
     participating in the negotiations between drug manufacturers, 
     pharmacies, and sponsors of prescription drug plans (PDPs) 
     involved in Part D of Medicare, or from requiring a 
     particular formulary or price structure for covered Part D 
     drugs.
       H.R. 4 would require the Secretary to negotiate with drug 
     manufacturers the prices that could be charged to PDPs for 
     covered drugs. However, the bill would prohibit the Secretary 
     from requiring a particular formulary and would allow PDPs to 
     negotiate prices that are lower than those obtained by the 
     Secretary. The bill would also require the Secretary to 
     report to the Congress every six months on the results of his 
     negotiations with drug manufacturers.
       CBO estimates that H.R. 4 would have a negligible effect on 
     federal spending because we anticipate that the Secretary 
     would be unable to negotiate prices across the broad range of 
     covered Part D drugs that are more favorable than those 
     obtained by PDPs under current law. Since the legislation 
     specifically directs the Secretary to negotiate only about 
     the prices that could be charged to PDPs, and explicitly 
     indicates that the Secretary would not have authority to 
     negotiate about some other factors that may influence the 
     prescription drug market, we assume that the negotiations 
     would be limited solely to a discussion about the prices to 
     be charged to PDPs. In that context, the Secretary's ability 
     to influence the outcome of those negotiations would be 
     limited. For example, without the authority to establish a 
     formulary, we believe that the Secretary would not be able to 
     encourage the use of particular drugs by Part D 
     beneficiaries, and as a result would lack the leverage to 
     obtain significant discounts in his negotiations with drug 
     manufacturers.
       Instead, prices for covered Part D drugs would continue to 
     be determined through negotiations between drug manufacturers 
     and PDPs. Under current law, PDPs are allowed to establish 
     formularies--subject to certain limits--and thus have some 
     ability to direct demand to drugs produced by one 
     manufacturer rather than another. The PDPs also bear 
     substantial financial risk and therefore have strong 
     incentives to negotiate price discounts in order to control 
     their costs and offer coverage that attracts enrollees 
     through features such as low premiums and cost-sharing 
     requirements. Therefore, the PDPs have both the incentives 
     and the tools to negotiate drug prices that the government, 
     under the legislation, would not have. H.R. 4 would not alter 
     that essential dynamic.
       I hope this information is helpful to you. The CBO staff 
     contacts for further information are Eric Rollins and Shinobu 
     Suzuki.
           Sincerely,
                                                 Donald B. Marron,
                                                  Acting Director.

  Mr. CAMP of Michigan. Mr. Speaker, I yield 30 seconds to the 
gentleman from Georgia (Mr. Price).
  Mr. PRICE of Georgia. Mr. Speaker, you know, negotiation sounds good, 
but what happens when the government negotiates? It doesn't mean 
negotiate; it means price-fixing, the setting of prices decided by the 
government. That is the only thing that will be allowed. This will, by 
its very design, decrease the number of medications available to 
seniors and ultimately to all Americans.
  This isn't just about Medicare's prescription drug program. This is a 
philosophical question about who ought to be making medical decisions, 
government bureaucrats or patients and physicians. We believe, as a 
matter of principle, it ought to be patients and physicians.
  Mr. CAMP of Michigan. Mr. Speaker, I yield myself the balance of my 
time.
  Mr. Speaker, this noninterference language that we have been talking 
about, that has been in legislative proposals for both Democrats and 
Republicans for the last decade, actually stops the Secretary of Health 
and Human Services from negotiating drug prices. And the reason that 
this has been part of bipartisan legislation for so long and was 
actually a part of the motion to recommit in 2000 that more than 200 
Democrats voted for is because it was important to structure a plan 
that allowed beneficiaries to work with their doctors, not with the 
government, to determine the best access to treatment and the best 
treatment that worked for them. That is why you have seen so many 
coalitions come out against this proposal, particularly those that work 
with the most vulnerable of the Medicare beneficiaries.
  I would urge a ``no'' vote on H.R. 4.
  Mrs. EMERSON. Mr. Speaker, 80 million baby boomers are getting ready 
to retire, and yesterday the General Accountability Office's 
comptroller David Walker said, ``If there is one thing that is going to 
bankrupt America, it is health care.'' Adding that the Medicare

[[Page H477]]

prescription drug benefit alone has added $8 trillion, $8 trillion in 
government obligations, more than all of Social Security over the past 
6 years.
  I would like to remind my friends that this is government obligation 
because Medicare is a government-run program. It is not a private-
sector program.
  But H.R. 4, Mr. Speaker, won't create price controls, it will not 
limit choice, and it will not force pharmacies out of business, which 
is why the National Community Pharmacists Association endorses H.R. 4. 
It could add more competition, more opportunity to lower drug costs for 
our seniors, keeping them out of the doughnut hole just a little while 
longer.
  Let us not solely entrust the negotiations of drug prices, Mr. 
Speaker, to the very companies who profit from the sales of these 
drugs. The American public has entrusted us with their hardearned tax 
dollars. Let us show them that we honor that trust and use every tool 
possible to lower the costs of the Medicare prescription drug program.
  Each of us was elected, Mr. Speaker, to represent our constituents, 
not big PhRMA, not the pharmacy benefit managers who prey on our 
community pharmacists. Support H.R. 4 and bring more competition to 
this position.
  The SPEAKER pro tempore. The Chair would advise that at this time all 
time has expired for the previous managers. We are now back to the 
gentleman from Michigan (Mr. Dingell) with 5 minutes remaining and the 
gentleman from Texas (Mr. Barton) has 4 minutes remaining.
  Mr. BARTON of Texas. Mr. Speaker, may I inquire as to who has the 
right to close?
  The SPEAKER pro tempore. The gentleman from Michigan will have the 
right to close.
  Mr. BARTON of Texas. Mr. Speaker, I yield myself such time as I may 
consume to close for the minority side.
  Mr. Speaker, I am not sure where the Majority Leader's clock is, 
whether we are at the end of the 100-hour period or the beginning or 
the middle. I do know that I have been very confused by this process.
  I understand the effort to bring the minimum wage bill back to the 
floor. Our new majority, for whatever purpose, didn't feel like they 
got a fair shake on that issue in the last several Congresses. So I can 
understand that.
  The stem cell bill we voted on yesterday is the identical bill from 
the last Congress, with the exception of the change in the dates and 
the reversal of the names from Castle-DeGette to DeGette-Castle. I 
understand that. I even voted with the new majority on that one.
  But on this one I am puzzled. We have a program that is working. We 
have a program that has 75 percent approval of the group we are trying 
to help, which is higher than most of our approvals in our 
congressional districts and certainly higher than most of our 
reelection rates. We have a program that the new majority even admits 
isn't going to really save any money. We certainly have an issue that 
there have been no hearings on and there have been no amendments made 
in order.
  In fact, we don't even have a Rules Committee yet established. If my 
good friend Mr. Dingell said, Mr. Barton, I will support you on that 
amendment, there is no place to amend it. We are operating under 
martial law, and maybe they did it this way in the war between the 
States; I don't know. I can tell you that in the 12 years that I was in 
the majority, we always had a Rules Committee you could go to. Now, 
maybe you didn't get your amendment made in order, but at least you 
could go to it. So this one is a puzzlement to me.
  Now, we know that the President has promised to veto this if it 
should somehow get through the Senate in its current form and come to 
his desk.

                              {time}  1330

  In all likelihood it will never come out of the Senate, so this as 
far as it is going to get. So maybe that is what this is all about is 
just a political exercise. And I know, and everybody in this Chamber 
knows, when it comes to the vote, the new majority is going to win. 
They should win. They won an election. They have a right to bring 
issues and they have a right to win some. But that doesn't mean it is 
right and that it is going to be a win for the American people.
  I hope that once we get this foolishness out of the way, that Mr. 
Rangel and Mr. Dingell and myself and Mr. McCrery can work together as 
the leaders of the Energy and Commerce Committee and the Ways and Means 
Committee on a bipartisan basis, actually hold some hearings. If there 
is really something wrong with the current Medicare part D prescription 
drug benefit program, let's work together to fix it. But if there is 
really not anything wrong with it, and it ain't broke, there will be no 
need to fix it.
  So I hope that we vote this down today. I am not myopic, though. I 
can count how many Democrat votes there are and how many Republican 
votes. So it will probably pass, and it will probably go to the Senate 
and it will probably die there, which will be a nice benign death. And 
then we can get back to being responsible.
  So, Mr. Speaker, I hope that the bill fails today and that the 
Democrat 100-hour political program fizzles, and then in the next 2 
weeks we get down to the serious, bipartisan business of working 
together for the American people.
  Mr. Speaker, I yield back the balance of my time.
  Mr. DINGELL. Mr. Speaker, I yield myself the balance of our time over 
here.
  Mr. Speaker, I can understand how my Republican colleagues are 
distressed about this legislation. But I would remind them, first of 
all, that we are simply taking steps to correct earlier abuses of the 
most outrageous sort.
  This legislation part D was crafted in the dark of night, and it was 
done by Republican Members and by lobbyists for the insurance companies 
and the pharmaceutical houses. That is why it is here. And now I can 
understand why my Republican colleagues are so distressed, because we 
are going to take all of those wonderful goodies away, or some of them, 
from the drug houses that so carefully saw that they got them without a 
single Democratic Member appointed by our then-Republican Speaker to 
appear here in the Capitol to address the question of what went into 
that.
  Now, we have been getting a lot of excuses from our Republican 
colleagues. They tell us the bill is working well. Simple fact of the 
matter is it is not. One Federal program pays 60 percent more than 
other Federal programs for procurement of prescription pharmaceuticals, 
that is, part D pays more than the VA pays for the same prescription 
pharmaceuticals. But the reason is no one is able to negotiate on 
behalf of the citizens. You have got a bunch of good-hearted or cold-
hearted prescription pharmaceutical people who have written this 
legislation and who are fixing the prices that are paid by senior 
citizens.
  This says that the Secretary of HHS, a servant of the American 
people, will negotiate prices on prescription pharmaceuticals so that 
the senior citizens can get something other than excuses from our dear 
Republican friends and the insurance companies about why we ought to 
disregard what our common sense tells us, and that is that 43 million 
people can have the purchasing power to perhaps encourage these drug 
houses to give the government and the American retirees a better price.
  Now, let's take a look at that. That is a chance to do real good for 
the people. I would tell you that we are tired of the excuses on these 
matters. Consumers, and particularly those who are living on disabled 
or fixed or limited incomes, watch their pennies. They have to. We 
should watch them too because we owe that to the people.
  Now, the Secretary says it isn't going to save money. CBO says it 
isn't going to save money. But the reason is because they know full 
well that this Secretary probably won't negotiate on their behalf.
  But I will tell you one thing. On this side, we will see that this 
Secretary does negotiate for better prices for our people. We will have 
him up before the committees, and we will give him and the others in 
the administration the oversight which they have lacked for 6 years.
  Now, who is in favor of this legislation?
  Before I say that, the people opposed are the Republicans, the 
administration, the drug houses and the insurance

[[Page H478]]

companies, certainly a logical collection of opponents to a proposal of 
this kind.
  Who favors it? AARP, the National Committee to Preserve Social 
Security and Medicare, Medicare Rights Center, the Alliance for Retired 
Americans. It is also supported by organizations representing people 
with disabilities. The National Council on Independent Living, AIDS 
Action, Breast Cancer Action.
  Consumer groups support it. Consumers Union, Families USA, U.S. PIRG. 
No insurance companies support it, but that is no surprise.
  Provider organizations support it. The National Community Pharmacists 
Association, people who work with the recipients of this. The American 
Nurses Association, the American Medical Association. The doctors say 
this is the thing that we should be doing. The Association of Community 
Pharmacists.
  And, of course, organizations representing tens of millions of 
hardworking Americans. The American Federation of Teachers, the 
National Education Association, SEIU, United Steelworkers, the AFL-CIO, 
and the UAW.
  Some say part D is working well. And for a few lucky folks, that is 
true. The insurance companies are cutting the fat hog on this. And the 
pharmaceutical houses are able to do just what they want on their 
pricing.
  It is time that we correct this. Let's pass this legislation and do 
what we should have done before to protect our senior citizens.
  Ms. BORDALLO. Mr. Speaker, I rise today in support of H.R. 4, the 
Medicare Prescription Drug Price Negotiation Act of 2007. Currently, 
the federal government is prohibited from directly negotiating with 
pharmaceutical companies for lower prescription drug prices for 
individuals enrolled in the Medicare program. This legislation will 
repeal this prohibition. In doing so, it will require that the 
Secretary of Health and Human Services negotiate for lower prescription 
drug prices for the millions of senior citizens who are Medicare 
beneficiaries.
  Today, senior citizens enrolled in Medicare Part D are paying higher 
prices for prescription drugs that are negotiated solely by market 
forces and pharmaceutical companies. Many senior citizens are also left 
without Medicare assistance once their annual prescription drug costs 
reach the threshold amount placing them in the coverage gap known as 
the ``doughnut hole.'' The Secretary of Health and Human Services has 
the leverage and the bargaining power of millions of Medicare 
beneficiaries with which to negotiate prescription drug price 
discounts. We should agree to H.R. 4 in order to empower the Secretary 
to use this leverage and bargaining strength for the benefit of 
Medicare beneficiaries.
  I fully support the innovated research and development conducted by 
the pharmaceutical industry. Advancements made as a result of these 
research and development processes have eradicated diseases and 
alleviated suffering for countless individuals around the world. The 
decreased revenue from the lower drug prices should not necessarily nor 
directly lead to a decrease in investment toward research and 
development by pharmaceutical companies. I acknowledge the many 
contributions made by the pharmaceutical industry toward developing 
medicines that have improved the lives of so many. In no way do I 
believe that this legislation will impede the industry's ability to 
continue to provide great medical advancements for the American people 
and others.
  I represent the territory of Guam. Three prescription drug plans from 
a single insurance company are offered today to Guam's Medicare 
beneficiaries who are enrolled in Medicare Part D. Opponents of H.R. 4 
argue that the private sector can and will adequately negotiate for 
lower prescription drug prices for Medicare beneficiaries lest the 
seniors transfer to a different, less expensive plan. Unfortunately, in 
my district, where only one insurance company currently provides plans 
under Medicare Part D, there is no private competition and limited 
choice among plans. Medicare beneficiaries deserve to have access to 
the lowest prescription drug prices possible. I therefore urge my 
colleagues to vote in favor of H.R. 4 and in favor of providing 
affordable prescription drugs for our senior citizens.
  Ms. WATERS. Mr. Speaker, I rise in strong support of H.R. 4, which 
requires the Secretary of Health and Human Services to negotiate with 
drug companies for lower drug prices for Medicare beneficiaries.
  American seniors are not getting the best possible prices for the 
drugs that keep them alive and in good health. A study by Families USA 
shows that the median drug prices among Medicare plans for the top 20 
drugs prescribed for seniors is increasing at a rate of 7.4 percent per 
year. That's more than twice the rate of inflation. These price 
increases are passed on to seniors in the form of higher premiums and 
out-of-pocket expenses.
  Clearly, the Medicare prescription drug program has not resulted in 
the lowest possible prices for seniors. But it has resulted in record 
profits for drug companies. In November, the New York Times reported 
that the Medicare prescription drug program has proven to be a bigger 
financial windfall for big drug companies than even the most optimistic 
of Wall Street predictions.
  The Veterans' Administration already negotiates with drug companies 
for lower drug prices for American veterans. In the Families USA study, 
the lowest price charged by Medicare prescription drug plans for all 20 
of the top drugs was always higher than the lowest price obtained by 
the Veterans' Administration.
  I am a great defender of our Nation's veterans. They have served our 
country with honor, and they deserve the lowest possible prices for 
their drugs. But so do our Nation's seniors. There is no reason why the 
U.S. Government should negotiate lower drug prices for veterans and not 
for seniors.
  I urge my colleagues to support this bill, and I urge the Secretary 
of Health and Human Services to negotiate in good faith for lower 
prescription drug prices for American seniors.
  Ms. BEAN. Mr. Speaker, I rise today to speak in support H.R. 4, The 
Medicare Prescription Drug Price Negotiation Act.
  I strongly believe Medicare should ensure seniors have access to the 
drugs and treatments that they need. In response to that need, Congress 
passed H.R. 1, The Medicare Modernization Act, in 2003. Today, H.R. 4 
will take a step further by allowing the Secretary of Health and Human 
Services the ability to negotiate with pharmaceutical manufactures for 
drugs covered under Medicare Part D. By removing the noninterference 
provision of the Medicare Modernization Act, we are providing another 
tool to help lower drug prices and make medicine more affordable for 
seniors.
  This bill would require the HHS Secretary to submit a report on the 
negotiations this June, and every six months thereafter. It does not 
call for a national formulary, stifle competition, or limit consumer 
choice.
  When members of the 108th Congress wrote The Medicare Modernization 
Act, they did so with the intention of using market competition to 
contain drug prices. In fact, in its first year, Medicare Part D has 
witnessed bids that are ten percent lower in 2007 than 2006.
  The market is working, and we should not remove competition that 
helps lower drug prices and reduces consumer options. Innovation and 
R&D into future medications, vaccines, and treatments require 
profitable, healthy drug companies that are able to navigate through 
the arduous approval process. So we must balance cost savings with 
continuing to encourage the creation of innovative new drugs.
  Therefore, I encourage my colleagues to support H.R. 4 but to avoid 
additional proposals that could be unduly harmful to future, life-
saving discoveries.
  Mr. CLAY. Mr. Speaker, I rise today in support of H.R. 4, the 
Medicare Prescription Drug Price Negotiation Act of 2007. I commend 
Congress for doing everything possible to make prescription drugs more 
affordable and accessible to Medicare beneficiaries. I wish to 
congratulate my dear friend and colleague from Missouri, Congresswoman 
Jo Ann Emerson, for working tirelessly in a truly bi-partisan fashion 
to enable the Secretary of the Department of Health and Human Services 
to negotiate lower drug prices for seniors.
  My support for this bill is unwavering and it is my sincere hope that 
the conference report assures patient's access to all life saving 
medicines. My constituents deserve nothing less than the best coverage 
available at the lowest price. I am dedicated to improving the Medicare 
prescription drug program and will continue working to advance the 
critical goal of decreasing out of pocket costs for seniors.
  Mr. Speaker, I commend you along with my colleagues Representatives 
Rangel and Dingell for your leadership in helping seniors gain access 
to affordable medicines.
  Mrs. KAPTUR. Mr. Speaker, I rise today in support of H.R. 4, the 
Medicare Prescription Drug Price Negotiation Act of 2007.
  Although the bill before us today does not go as far as it needs to 
go, it is an incremental step towards a long-overdue solution, a 
solution that continues to be blocked by moneyed pharmaceutical 
interests that are more interested in the profits their medications can 
bring than in the good their medications can do. The American people 
deserve better, and that is why I continue to say that if we are to 
achieve real reform in this institution, we need to start with campaign 
finance reform.
  In my view, Medicare represents a covenant between the U.S. 
government and its citizens. During my tenure in the House of 
Representatives, I have always supported Medicare and Social Security 
as important lifelines for seniors in our country.

[[Page H479]]

  As part of these efforts, I have advocated fair, affordable, easy-to-
use prescription drug coverage for seniors under Medicare. 
Unfortunately, the Medicare Modernization Act falls far short of these 
goals. Ever since its inception, the MMA has been a nightmare both for 
legislators and, more importantly, for the seniors who must try to 
navigate it.
  Under this law, the government is prohibited from using its buying 
power to negotiate lower prices for America's 30 million seniors. I 
object strongly to this provision because I believe firmly that 
something must be done to bring down the cost of prescription drugs in 
America.
  In fact, when the MMA was first being developed and passed through 
the House, I attempted to offer an amendment that would have allowed 
the Secretary of Health and Human Services to negotiate drug prices 
under the auspices of the Medicare program.
  Unfortunately, after being kept waiting until the wee hours of the 
morning, while the Rules Committee met far from the watchful eye of the 
American public and even most Members of Congress, I was not allowed 
even to offer my amendment for consideration.
  Therefore, I am glad that today we are debating a bill that will 
accomplish my goal, and under a system that has already worked to save 
our veterans money under the VA's healthcare system. H.R. 4 will begin 
to save money for beneficiaries both through lower drug costs at the 
pharmacy counter and lower plan premiums.
  Lower prices will also slow entry into the donut hole, when 
beneficiaries must pay the full price of their medicines. And since 
taxpayers fund more than three-quarters of the cost of the drug 
benefit, we will be saving them money, too.
  This bill does not, however, prevent the prescription drug plans from 
getting deeper discounts. And the bill does not allow the HHS Secretary 
to establish a national formulary or otherwise restrict access to 
medicines.
  Mr. Speaker, our nation's seniors, members of the ``greatest 
generation,'' deserve better than having to choose between buying food 
or buying life-sustaining and often, life-saving medications.
  I am pleased today to support this legislation which represents a 
first step in eliminating that cruel choice and helping to ensure that 
seniors can live their lives in good health and with dignity.
  Mr. INSLEE. Mr. Speaker, I rise today to express my support for H.R. 
4, the Medicare Prescription Drug Price Negotiation Act.
  I strongly believe Medicare should ensure seniors have access to the 
drugs and biologics they need. In the past, my reluctance to support 
this kind of legislation has stemmed from the hope that we might find 
an alternative solution to the fact that our citizens, including our 
seniors, are subsidizing the research and development for drugs and 
biologics for the rest of the developed world, which has traditionally 
not paid its fair share of these costs. It is with the recognition that 
such a remedy is not forthcoming that I cast my vote today in favor of 
H.R. 4.
  I applaud the Democratic Leadership's desire to ensure that this 
legislation continues to prohibit the HHS Secretary from requiring a 
particular formulary or list of covered drugs to be used by Medicare 
prescription drug plans or limiting access to any prescription 
medication. As a Member that represents a district with a strong 
biotechnology sector, I believe that America's continuing leadership 
and innovation in developing new treatments would make this 
particularly inappropriate.
  Small, emerging biotech companies are researching and developing 
cures for cancer, Alzheimer's, multiple sclerosis and other devastating 
diseases. The overwhelming majority of biotech companies are small 
companies without approved products, highly reliant on the public and 
private capital markets. It is important that as we seek to ensure that 
our seniors are receiving the best care possible under Medicare, we 
must not take action that hinders this important research, which is 
estimated to cost $1.2 billion and can take over 10 years. Research and 
development that is the lifeblood of the biotechnology industry, and we 
must guard against taking action that would result in fewer 
breakthrough therapies.
  Mr. KILDEE. Mr. Speaker, I rise today in strong support of H.R. 4, 
The Medicare Prescription Drug Price Negotiation Act of 2007.
  This legislation fixes a serious flaw in the Medicare prescription 
drug program that currently prohibits Medicare from negotiating drug 
prices with pharmaceutical manufacturers.
  The Department of Veterans Affairs and state Medicaid-programs are 
already able to use their buying power to negotiate lower prices on 
prescription drugs and this has greatly lowered their prescription drug 
costs.
  Medicare prices for the top 20 drugs prescribed to seniors are 58 
percent higher than those available through the VA. The Government 
Reform Committee found that Medicare negotiating drug prices just 25 
percent lower would save more than $60 billion over the next decade.
  Seniors need a prescription drug benefit under Medicare that is 
affordable, comprehensive, guaranteed and does not harm those retirees 
that are currently covered under private insurance plans.
  This is an important first step in improving Medicare Part D 
prescription drug coverage and I urge my colleagues to support H.R. 4.
  Mr. PAUL. Mr. Speaker, H.R. 4 gives the Secretary of Health and Human 
Services the authority to engage in direct negotiations with 
pharmaceutical companies regarding the prices the companies will charge 
Medicare when the companies provide drugs through the Part D program. 
Contrary to the claims of its opponents, this bill does not interfere 
with a free market by giving the government new power to impose price 
controls. Before condemning this bill for creating ``price controls'' 
or moving toward ``socialized medicine,'' my colleagues should keep in 
mind that there is not, and cannot be, a free market price for a 
government-subsidized good.
  Members concerned about preserving a free market in pharmaceuticals 
should have opposed the legislation creating Part D in 2003. It is odd 
to hear champions of the largest, and most expensive, federal 
entitlement program since the Great Society pose as defenders of the 
free market.
  The result of subsidizing the demand for prescription drugs through 
Part D was to raise prices above what they would be in a free market. 
This was easily foreseeable to anyone who understands basic economics. 
Direct negotiation is a means of ensuring that the increase in demand 
does not unduly burden taxpayers and that, pharmaceutical companies, 
while adequately compensated, they do not obtain an excessive amount of 
Medicare funds.
  The argument that direct negotiations will restrict Medicare 
beneficiaries' access to the prescription drugs of their choice assumes 
that the current Part D system gives seniors control over what 
pharmaceuticals they can use. However, under Part D, seniors must 
enroll in HMO-like entities that decide for them what drugs they can 
and cannot obtain. My district office staff has heard from numerous 
seniors who are unable to obtain their drugs of choice from their Part 
D providers. Mr. Speaker, I favor reforming Medicare to give seniors 
more control and choice in their health care, and, if H.R. 4 were a 
threat to this objective, I would oppose it.
  Federal spending on Part D is expected to grow by $100 billion in 
2007. It would be fiscally irresponsible for this Congress not to act 
to address those costs. I recognize that giving the Department of 
Health and Human Services the authority to engage in direct 
negotiations neither fixes the long-term problems with Medicare nor 
does empowers senior to control their own health care. However, we are 
not being given the opportunity to vote for a true pro-freedom, pro-
senior alternative today. Instead, we are asked to choose between two 
flawed proposals--keeping Part D as it is or allowing the Department of 
Health and Human Services to negotiate prescription drug prices for the 
Part D program. Since I believe that direct negotiations will benefit 
taxpayers and Medicare beneficiaries by reducing the costs of 
prescription drugs, I intend to vote for this bill.
  Mr. CRAMER. Mr. Speaker, I rise in support of H.R. 4, the Medicare 
Prescription Drug Price Negotiation Act of 2007. I applaud our 
leadership's efforts to lower the price of drugs for seniors and other 
Medicare Part D beneficiaries.
  In addition to achieving the lowest possible costs for drugs, I 
strongly believe Medicare should ensure seniors have access to the 
drugs they need. Therefore, it is critical that price negotiations by 
the Secretary of the Department of Health and Human Services not lead 
to government price controls, or any restrictive formularies that could 
limit seniors' access to critical medicines.
  Further, we must not take action that hinders medical research and 
development by the biotechnical and pharmaceutical industries. 
Government price controls could potentially lead to fewer breakthrough 
treatments for diseases such as cancer, Alzheimer's, multiple 
sclerosis, amyotrophic lateral sclerosis, ALS, and other devastating 
diseases.
  Ms. ROYBAL-ALLARD. Mr. Speaker, on behalf of the millions of seniors 
and individuals with disabilities, I rise in support of H.R. 4, the 
Medicare Prescription Drug Price Negotiation Act of 2007. And I thank 
our Speaker Nancy Pelosi for making this issue one of the first 
priorities of the 110th Congress.
  The Medicare Prescription Drug benefit that passed in the 108th 
Congress was supposed to help control the rising costs of prescription 
drugs. But it has failed. According to a Families USA study, during the 
first 6 months of 2006, the median price for the top 20 drugs 
prescribed for seniors among Medicare drug plans actually rose by 3.7 
percent.
  What that means is that over the course of the full year, drug prices 
increased by as

[[Page H480]]

much as 7.4 percent, more than twice the rate of inflation. The 
Medicare Prescription Drug benefit that was passed in 2003 is simply 
not controlling the escalating prices of life saving medications for 
our seniors and those with disabilities.
  An even more tragic consequence of the current drug benefit is that 
last year millions of Americans reached what is known as the ``donut 
hole gap'' in coverage. Many are from my own district in Los Angeles.
  This gap means that in addition to having to continue to pay their 
premiums without the benefit of their coverage, they are required to 
spend almost $3,000 out of their own pocket for their medications 
before their benefits are restored.
  The result has been that many of our Medicare beneficiaries have been 
forced to choose between paying for the multiple medications they need 
to keep them healthy and alive or paying their rent or other necessary 
household expenses.
  The fact is, Mr. Speaker, that the 108th Congress did a grave 
injustice to our seniors and those with disabilities when it passed the 
Medicare prescription drug bill.
  Instead of helping this vulnerable population, the current law simply 
replicates the same private market practices that have resulted in 
exploding prescription drug costs. Sadly, these costs are increasingly 
borne by patients.
  Pharmaceutical companies, like other industries, grant discounts in 
exchange for volume and market share. It stands to reason, then, that 
our federal government should be given the power to negotiate the best 
price possible for the 22 million people whose medications it now 
purchases.
  However, this is not possible because the structure of the Medicare 
prescription drug program expressly forbids our government from doing 
so.
  Instead of relying on the administrative efficiency of a single large 
purchaser, the current Medicare Prescription Drug plan relies on 
thousands of stand-alone plans to separately negotiate with each drug 
manufacturer.
  The benefit of our government being able to negotiate directly with 
drug manufacturers is best exemplified by the U.S. Department of 
Veteran Affairs. The VA uses the volume of its purchasing needs to 
negotiate up to 47 percent lower costs on frequently prescribed drugs 
for the thousands of veterans in its care. By contrast Medicare, the 
single largest prescription drug purchaser in the United States, has no 
power to lower high or unfair drug costs. This is not only bad business 
practice; it is also an unconscionable waste of taxpayers money which 
results in undue hardship for those it is intended to help.
  Recent polls by the Kaiser Family Foundation and Newsweek have shown 
overwhelming bipartisan support among Americans for allowing our 
government to negotiate prescription drug prices for the Medicare 
program. Negotiating drug prices is also favored by the AARP, the 
Consumers Union, and the AFL-CIO.
  Mr. Speaker, I urge my colleagues to join with me today in ending the 
prohibition for Medicare negotiation authority for prescription drugs. 
Let us make one of the first acts of this 110th Congress a Medicare 
Prescription Drug program that truly works for those most in need, our 
seniors and those with disabilities.
  Mr. ORTIZ. Mr. Speaker, it was a dark day when this House strong-
armed and bribed members into passing a prescription drug benefit for 
Medicare that served the pharmaceutical industry--rather than serving 
the seniors unable to afford prescription drugs.
  Finding the way to fix the entire program will take us a while longer 
. . . but I am proud that today we are attacking one of the most 
egregious parts of that law, the portion that was designed as payback 
for the pharmaceutical industry. Paying the full cost of the 
prescription drugs makes the cost for this program astronomical; and 
the fact the law prohibits the government from negotiating for lower 
prices was particularly galling.
  Now, in the first 100 legislative hours of the 110th Congress, we are 
passing this bill to cut the cost of health care and improve access to 
medicines by requiring HHS to negotiate with drug companies or lower 
drug prices for Medicare beneficiaries. This bill we consider today 
will certainly save millions of dollars taxpayers now pay to have a 
prescription drug benefit
  Mr. Speaker, I am incredibly proud to stand today with you, with our 
colleagues, and with millions of seniors and U.S. taxpayers as we 
ensure that Medicare's drug component serves senior citizens, not the 
pharmaceutical lobby.
  Mr. KIRK. Mr. Speaker, I am voting for H.R. 4 because I believe that 
the Medicare prescription drug program can be improved. And one 
improvement is allowing the Secretary an opportunity to negotiate lower 
drug prices.
  At the same time, my support for H.R. 4 is contingent upon the 
principle that this legislation will not allow restrictions imposed by 
the Federal Government on patients' access to medicines. I firmly 
believe that every patient must have access to the medicines their 
doctors prescribe, without government intervention. I interpret this 
legislation to mean Medicare beneficiaries are protected against all 
types of government-imposed restrictions on patients' access to the 
medicines they need, and that no such restrictions will be allowed 
under the Medicare Modernization Act as amended by H.R. 4.
  Seniors should pay less for prescription drugs, and Medicare should 
have more tools to achieve savings for our Nation's elderly. But these 
savings should not come at the expense of seniors ability to discuss 
with their doctors which drugs are best for their health and to have 
access to these drugs in the Medicare Part D program. I am disappointed 
that H.R. 4 was rushed to the floor today without any hearings or 
amendments allowed. I hope the Senate will take a more thoughtful 
approach when considering Medicare Part D reform to add more 
protections for our seniors.
  Mr. CONYERS. Mr. Speaker, I rise in strong support of H.R. 4, which 
would allow the government to negotiate prescription drug prices on 
behalf of our senior and disabled citizens.
  Aside from the bipartisan group of Members, an overwhelming majority 
of Americans favor allowing the government to negotiate prescription 
drug prices for the Medicare program. Eight-five percent of the 1,867 
adults polled in a survey conducted by the Kaiser Family Foundation 
this past week, revealed they were in favor of such negotiations, 
including majorities of Republicans, Democrats, and independents.
  I along with many of my Democratic colleagues promised to repeal this 
provision in the 2003 Medicare drug benefit law that prevents the 
government from engaging in drug price negotiations. Our time has come 
to do so.
  The administration refused to take action on behalf our citizens 
desperately in need of affordable health care, offering them little 
hope for quality health care. Requiring the government to negotiate 
drug prices on behalf of our citizens requires some more details which 
can easily be sorted out through the experts at HHS.
  Under the current Medicare Part D Prescription Drug Program, which 
enrolled 22.5 million people this year, dozens of private insurers 
offer Medicare drug plans in every state, competing on monthly 
premiums, choice of drugs and access to pharmacies. This has placed 
tremendous financial pressure on insurers, through their pharmacy 
benefit managers, to negotiate the best prices they can with drug 
companies and pharmacies, a fact confirmed by experts within the 
system.
  There is no reason why the government cannot sort out difficulties, 
to mimic the few programs that are providing affordable drugs through 
pre-negotiated drug prices, such as the Department of Veterans Affairs. 
This department by law receives a mandatory discount on drugs, and also 
negotiates effectively to secure better prices for the 4.4 million 
veterans who use its drug benefit. With as many as 43 million 
beneficiaries, Medicare will have the ability to do the same.
  Therefore I strongly support H.R. 4.
  Mr. CUMMINGS. Mr. Speaker, I rise today in strong support of the 
Bipartisan Medicare Prescription Drug Price Negotiation Act of 2007, 
H.R. 4.
  H.R. 4, despite the protestations to the opposite, does not require 
price controls, does not hamper research and development, does not 
require the Secretary of HHS to adopt the pricing structure of the 
Veterans Affairs system and does not require a national formulary.
  What H.R 4 does require is for the Secretary of HHS to leverage the 
power of our 43 million Medicare beneficiaries to negotiate with 
pharmaceutical companies to get the best possible drug prices for our 
seniors and disabled under Medicare Part D.
  There are still some of my colleagues who say this legislation is not 
necessary, but the facts indicate otherwise. Manufacturer prices for 
brand-name drugs rose 6.3 percent in the 12 months ending June 2006, 
more than one and one-half times the 3.8 percent rate of general 
inflation over the same period. In 2006 alone, this increase translated 
to an additional $283 for the typical American senior--an increase many 
can ill-afford.
  We know that these prices are only likely to further increase and we 
need to repeal this prohibition now to help our seniors and disabled.
  I urge my colleagues to support this critical legislation.
  Mr. PORTER. Mr. Speaker, I rise today in opposition of H.R. 4, the 
Democrat Drug Price Control.
  Simply put, this measure will limit choice and access to prescription 
drugs for seniors in Medicare. H.R. 4 changes the new Medicare 
prescription drug benefit program by requiring government employees to 
directly negotiate drug prices with manufacturers, instead of retaining 
the current system that gives seniors wide choices and uses multiple 
competing health plans and drug benefit managers to deliver benefits. 
This is not what is best for our seniors.

[[Page H481]]

  Though Democrats are promising lower drug prices, the potential trade 
offs for Medicare beneficiaries are too risky to gamble. By stripping 
the Medicare Modernization Act of the non-interference language, we 
would put the current choice and access that seniors deserve and enjoy 
in jeopardy. Instead, this bill opens the door to government 
bureaucrats picking and choosing what drugs and which pharmacies 
seniors could use.
  Because of the new Medicare prescription drug benefit, thousands of 
seniors currently don't have to choose between groceries and the life 
saving medicine they need. In my district alone, roughly 87,000 seniors 
have enrolled and are saving an estimated $1,100 per year according to 
the Centers for Medicare and Medicaid.
  The Veterans' Administration, VA, which relies on direct government 
negotiation, currently excludes nearly 30 of the top 100 drugs used by 
seniors from its one national formulary. By comparison, the most 
popular Medicare Part D and Federal Employee Health Benefits Program 
plans provide coverage for more than 99 percent of the most widely used 
drugs. Similarly, Medicare and FEHBP enable patients to obtain 
prescriptions at nearly all private pharmacies while the VA requires 
patients to either go to VA facilities to get their drugs or obtain 
them through mail order. Currently, more than 75 percent of VA 
prescriptions are fulfilled via mail.
  Additionally, in 1990, the Democratic 1991 budget reconciliation 
measure which passed Congress gave the Medicaid program access to the 
low prices achieved by VA. Drug manufacturers, faced with mandated 
discounts to Medicaid, 15 percent of the market, decided to end deep 
discounts to VA, 1 percent of the market. In some cases the VA saw 300 
percent price increases. Congress had to pass legislation to correct 
this problem in 1992. Let's not make the same mistake twice.
  I urge my colleagues to oppose H.R. 4, Democrat drug price control.
  Mr. LAMBORN. Mr. Speaker, I rise in strong opposition to H.R. 4 which 
was hastily drafted without proper committee consideration or any by 
the minority party.
  Democrats are fond of citing the Department of Veterans Affairs as 
evidence that Medicare officials could squeeze lower prices out of drug 
makers if the government merely used its negotiating clout.
  However, what they don't tell you is this program from the early 90s 
resulted in a stark increase in VA prices for drug purchases.
  Additionally, independent experts at the Congressional Budget Office 
have said that government involvement in price negotiation will not 
lead to lower costs for seniors and could lead to significant 
restrictions in access to necessary drugs.
  Our seniors can not afford either price increases or restrictions on 
the drugs they need to stay healthy, both of which are likely if this 
measure becomes law.
  That is something I cannot support and I urge opposition to H.R. 4 
today.
  Mrs. MALONEY of New York. Mr. Speaker, I rise in strong support of 
H.R. 4, the Prescription Drug Price Negotiation Act of 2007.
  This is the perfect capstone to an extremely productive week.
  I came to Congress to help our seniors gain access to benefits they 
need and deserve, so I thank Chairman Dingell and the new Democratic 
leadership of the House for bringing this vitally important bill to a 
vote during the first 100 hours.
  In 2003, I voted against the prescription drug bill because, among 
other things, it did not provide adequate benefits to our seniors and 
did nothing to contain the rising costs of drug prices.
  Current law states that the Secretary of Health and Human Services, 
unlike the Veterans' Administration, is expressly prohibited from 
negotiating the best drug prices on behalf of the 43 million seniors 
and others in Medicare who desperately need the lowest price available.
  Price data show that Part D plans are not delivering on the promise 
that competition would bring prices down and that the use of market 
power has not resulted in drug prices that are comparable to the low 
prices negotiated by the VA.
  H.R. 4 cuts the cost of healthcare and improves access to medicines 
by requiring HHS to negotiate with drug companies for lower drug prices 
for Medicare beneficiaries and greater savings for our taxpayers.
  It's commonsense, it's good business sense, and it makes sense for 
our seniors.
  Negotiations that lower prescription drug prices will help many 
consumers avoid the doughnut hole by preventing them from ever hitting 
the coverage gap where they have to pay thousands of dollars of out-of-
pocket expenses for medications while still paying their monthly 
insurance premiums.
  H.R. 4 does not dictate to the HHS Secretary how to negotiate but 
instead provides the Secretary with broad discretion on how to best 
implement the negotiating authority and achieve the greatest price 
discounts for Medicare beneficiaries.
  The bill also ensures that Congress is able to closely monitor the 
administration's progress by requiring HHS to report to Congress every 
6 months on drug price negotiation.
  Under the current system, the pharmaceutical companies are the ones 
who benefit at the expense of our seniors, many of whom are forced to 
choose between paying for their prescription drugs and putting food on 
the table.
  H.R. 4 seeks to help those who need it most. Older Americans are 
watching us today, waiting to see if we will act to make their 
prescription drugs more affordable and more accessible.
  I am proud to cast a vote in support of America's seniors and urge my 
colleagues to do the same.
  Vote ``yes'' on H.R. 4.
  Mr. KING of Iowa. Mr. Speaker, I oppose this legislation, because I 
believe it will make seniors pay higher prices for their drugs and will 
restrict their access to the drugs they need.
  Earlier this week, I met with Dr. Mark McClellan, the former 
administrator for CMS. Dr. McClellan pointed out to me, while no 
program is perfect, Part D has proven to be very successful. Premiums 
seniors pay for the basic drug benefit have fallen over 40 percent from 
the expected premiums. CMS reports that, on average, beneficiaries are 
saving nearly $1,100 a year on their drug costs, with many seniors and 
their doctors having more drugs to choose from under Part D than they 
did before. Also, Part D cost nearly $13 billion less than expected in 
2006, and 10-year costs have been lowered by approximately $180 
billion.
  In order to make drugs cheaper, the Secretary will have to refuse 
coverage for a number of drugs that are regularly prescribed to 
seniors. When Medicare's list of covered drugs is shortened, either 
doctors will be forced to choose cheap drugs which could hurt the 
welfare of their patients, or seniors will be forced to pay out-of-
pocket for many of the important, life-saving medications they need.
  I urge a ``no'' vote on this harmful legislation.
  Mr. YARMUTH. Mr. Speaker, I used to spend weekends at my father's 
used car lot and among other things, I saw a lot of haggling. There was 
a sticker price, but that was just a starting point for negotiation. If 
you wanted to drive the price down really low, your family would buy 
two cars at once. Three cars would really sweetened the deal. If the 
neighborhood had been really smart, they would've all come in at once 
and bought up the whole lot.
  I tell you this, Mr. Speaker, because Medicare Part D is buying up 
the whole lot of prescription drugs and still paying sticker price.
  Last year, this institution offered a plan intended to save seniors 
from paying the exorbitant cost of prescription drugs. Now most of them 
feel cheated by an overly complicated system, many of them aren't 
saving any money, and a good number of them are actually paying higher 
prices than they were before. And because we aren't negotiating on 
their behalf, we can't even tell our struggling Americans that we're 
doing the best we can.
  Medicare part D was written for drug companies, by drug companies, 
and it should be no surprise, it's benefiting drug companies. This 
policy has yielded windfall profits for big pharmaceuticals, at the 
expense of our older Americans.
  We can do better. America expects better. And our seniors deserve 
better.
  I urge my colleagues to pass this common sense measure.
  Mr. BOYD of Florida. Mr. Speaker, I rise today to express my support 
for H.R. 4, the Medicare Prescription Drug Price Negotiation Act of 
2007. I commend the Leadership's efforts to curb prescription drug 
costs for the neediest in our country. As a Representative from the 
state of Florida, I represent a large number of seniors who rely on 
Medicare to help with medical costs, I am proud to be a supporter of 
this bill.
  In 2003, when Congress passed the Medicare Part D Prescription Drug 
Bill Act, I was one of the few Democrats who voted for it. Many of us 
who supported the bill also supported giving the Secretary of Health 
and Human Services the power to negotiate drug prices. I believe that 
by allowing the Secretary to negotiate drug prices with biotech and 
pharmaceutical companies, we will lower prices for seniors who find 
themselves in the gap between stages of coverage when they have to pay 
the full price for the medications they need.
  Not only do seniors need help coping with rising healthcare costs, 
but they greatly benefit from the development of treatments, from 
research and development, and from biologics. It is my intention as the 
Representative of the people of North Florida to see that people get

[[Page H482]]

the medical treatment they need, while also ensuring that this change 
in the Medicare Part D program is not the first step toward government 
price controls, stifling innovation, or corrupting the core design of 
our free market system.
  We need to ensure that Congress is striking a balance between 
providing the aid that seniors need, and providing an environment where 
a healthy market can flourish. Madam Speaker, thank you again for 
allowing me to speak on this issue, and for making our nation's senior 
citizens a priority in this first week of the new leadership.
  Mr. WEXLER. Mr. Speaker, I rise in strong support of H.R. 4, which 
mandates the Secretary of Health and Human Services to negotiate lower 
drug prices for seniors. America's seniors deserve the best possible 
health care that this government can offer. Unfortunately, we have 
failed to live up to this expectation under the new Medicare Part D 
program.
  It is unconscionable that the Republicans who drafted the Medicare 
drug bill actually prohibited the Secretary from obtaining lower prices 
for seniors. In fact, under Medicare Part D, seniors are paying as much 
as 10 times more for the most commonly prescribed drugs than patients 
being treated by the Veterans Administration, and drug prices have 
consistently risen since the bill's enactment. Community pharmacists, 
who have witnessed first hand the difficulties seniors face with ever 
increasing drug prices, endorse this important legislation.
  Today, Congress has the opportunity to empower the Secretary to act 
in the best interest of America's seniors. I strongly urge my 
colleagues to vote in favor of this bill.
  Ms. WOOLSEY. Mr. Speaker, one learns the useful lesson of ``strength 
in numbers'' from an early age, but it seems some of us could use a 
refresher. The more people you have on your side, the better the 
chances of success.
  Well, there are approximately 43 million Medicare beneficiaries in 
this country--more than enough, I'm sure, to throw some considerable 
weight behind the drug price negotiations we're debating today.
  Now let's make one thing clear. The only real beneficiaries of the 
Medicare modernization act were the insurance companies and the drug 
companies whose profits continue to soar.
  Meanwhile, seniors who have worked a lifetime to earn the peace of 
mind our drug program should be have been sacrificed for handouts to 
these industries. Furthermore, they remain responsible for paying a 
majority of their often astronomical prescription drug costs.
  Well today the tides are turning. I'm proud to join my colleagues in 
support of this long-awaited, urgently needed measure that will finally 
bring seniors savings on their prescription drugs.
  On behalf of beneficiaries in Marin and Sonoma counties, I urge you 
to support the seniors in your districts, by voting for H.R. 4.
  Mr. UDALL of Colorado. Mr. Speaker, I am going to vote for H.R. 4, 
the Medicare Prescription Drug Price Negotiation Act of 2007. I support 
making changes to the Medicare Part D plan to make it more accessible, 
affordable and easier to understand.
  H.R. 4 repeals the part of the current law that prohibits the 
Secretary of Health and Human Services from negotiating with drug 
companies for lower prices for those enrolled in Medicare drug plans. 
The bill would instead require the Secretary to conduct cost-saving 
negotiations, and in conducting these negotiations, the Secretary may 
not restrict access to certain medicines in Medicare, for example by 
requiring a formulary to be used by Medicare Advantage plans. Finally, 
the bill would require the Secretary to submit to Congress a report on 
the negotiations conducted no later than June 1, 2007, and every six 
months thereafter.
  I am voting for this legislation because I hear from seniors in my 
district about how they are struggling to pay for the medicines their 
doctors tell them they need to take. No senior should be faced with the 
decision of cutting their pills in half, or pay their drug bill or 
their electric bill.
  However, I have some doubts that this negotiation will actually 
result in lower prices than what private plans are already achieving 
for seniors enrolled in Medicare Advantage plans. The nonpartisan 
Congressional Research Service issued a report on January 5, 2007, 
titled ``Federal Drug Price Negotiation: Implications for Medicare Part 
D,'' which says that the bill ``may not necessarily lead to lower costs 
for beneficiaries.'' The report also says the bill could affect the 
number and types of drugs that would be available to seniors and the 
amount of research and development and innovation by pharmaceutical 
companies. Nonetheless, H.R. 4 gives the Secretary of HHS great 
latitude in how negotiations will be conducted, and it is my hope that 
the Secretary will enter into these negotiations in a way that won't 
harm seniors' access to medicines or negatively impact new drug 
research and discoveries. Large employers, states and large pharmacy 
chains all use their bargaining clout to obtain lower prices for their 
consumers; Medicare should have the same opportunity to bargain for 
lower prices for America's seniors.
  Mr. Speaker, I think we need to try dfferent approaches to make 
lifesaving medicines available to our nation's seniors so I'll vote for 
this bill. I will continue to work on a prescription drug program that 
meets the needs of our nation's seniors.
  Ms. CORRINE BROWN of Florida. Mr. Speaker, last August I held six (6) 
Town Hall Meetings throughout my district on the new Medicare Part D 
Prescription Drug program, and I would encourage my colleagues to do 
the same. Not only did it give my constituents a chance to get help and 
get their questions answered, it gave me an opportunity to really find 
out how the new program is working.
  I've been an elected official for 25 years, and I have never seen a 
program that penalizes somebody for the rest of their life if they 
didn't sign up right away.
  This current Medicare Part D bill was written by and for the 
Insurance and Pharmaceutical industry without the needs of our seniors 
in mind.
  This bill allows the private drug plans to take drugs off their 
approved list, and even charge more for drugs throughout the year, 
while seniors are locked in and cannot change plans until the next 
year.
  Incredibly, the Republican Leadership wrote a bill that specifically 
prevents the Secretary of Health and Human Services from negotiating 
the price of drugs. Even though both the Secretary of Veterans Affairs 
and the Secretary of DoD are negotiating their drug prices right now.
  Could you imagine if we told Wal-Mart that they couldn't get a 
reduced price by buying in bulk? Every member of the Republican Party 
would be on this floor screaming bloody murder, but when it's needed 
drugs for our senior citizens, there is deafening silence.
  This is another perfect example of the Republicans talking out of 
both sides of their mouth. They stand on the floor every day demanding 
that we save the taxpayers money, but when we try to do that with the 
companies that fill their campaign coffers, they say we are hurting 
business. But the real truth is that the drug companies are making 
record profits while seniors and taxpayers are paying higher drug 
prices.
  And one of the most troubling aspects of this bill and one that most 
people don't know about is the ``donuthole'' where no coverage is 
provided after you spend $2,250 until your costs reach $5,100. That's 
$3000 in out of pocket costs that few if any of our seniors can afford.
  I encourage my colleagues to do the right thing for our parents and 
grandparents and allow the secretary to negotiate bulk prices for these 
needed drugs.
  Mr. KUCINICH. Mr. Speaker, on one hand we hear from the opposition 
that this bill will not save seniors money. But then we hear that 
Medicare's negotiation of prices is tantamount to price controls. To 
make that argument, one has to assume money will be saved. Which is it? 
Will it save money or won't it? The answer is that of course it will 
save money.
  It's particularly interesting that Pharma's response is to threaten 
to reduce innovative new drug research by withholding research funding. 
Pharma will not reduce their lobbying army that outnumbers Members of 
Congress. They will not reduce their profits which average almost $5 
billion dollars among the top 8 Pharma companies in 2006 alone. They 
will not reduce their army of salespeople dedicated to influencing the 
prescribing habits of doctors. They will not stop paying scientists to 
influence clinical trial data that is supposed to be the basis for 
impartial judgment of a drug's efficacy and safety. No, they are 
threatening to cut research funds, which they claim will affect 
innovation. But they will not tell you that the number of truly 
innovative drugs they are producing has been declining since 1999 
according to the Government Accountability Office. Why? Because they 
are instead spending their money on making minor changes to existing 
drugs in order to extend their highly profitable patent life. And by 
asking us to reject negotiation of prices for Medicare, they are asking 
us to fund not only their sub-par research agenda but their entire 
influence industry. I'm not buying it.
  Mr. CROWLEY. Mr. Speaker, I rise in support of the H.R. 4 to allow 
the Secretary of Health and Human Services to negotiate the price of 
drugs for our nation's seniors.
  This legislation would require the Secretary of Health and Human 
Services to negotiate with pharmaceutical companies, and would also 
require the Secretary to report back to Congress on his negotiations, 
effectively giving us the right of oversight.
  But I support this legislation because it has the ability to save our 
nation's seniors millions of dollars in drugs they use every day.
  There is evidence to show that this bill could potentially save our 
seniors significant savings

[[Page H483]]

on their prescription drugs. According to Families USA, the average 
senior could potentially save 58 percent on their drugs.
  Additionally, according a Kaiser Family Foundation poll, eighty-five 
percent of respondents feel that the government should be given the 
ability to negotiate lower prices for senior citizens.
  However, this bill, while a step in the right direction is by no 
means the end to this debate. Congress should hold hearings, and 
briefings to further discuss how to lower prices for medication without 
eliminating access to vital medications for our nation's seniors.
  In order to accomplish more access to medications, and an over all 
improvement in the healthcare system, the answer does not lie in 
pointing fingers at each other, but rather the un-obstructed dialogue 
between constituents, elected officials on both sides of the aisle, and 
all interested parties.
  I know that I am willing to work with all parties in this debate if 
it helps my constituents obtain much needed medicine, and access to 
doctors.
  Let's stop blaming each other, and prohibiting each other from trying 
something new. Instead, let's attempt something that could possibly be 
revolutionary. Former President Franklin Delano Roosevelt once said 
``It is common sense to take a method and try it. If it fails, admit it 
frankly and try another. But above all, try something.''
  I agree with him, prevail or not, at least we can say we tried to 
make a difference in the lives of millions of Americans.
  I urge all my colleagues to work together to get this legislation 
passed, both in Congress and out.
  Mr. TANNER. Mr. Speaker, I join my colleagues in support of H.R. 4, 
the Medicare Prescription Drug Price Negotiation Act.
  We all share the goal of adequate access and reasonable prices for 
prescription drugs for our nation's seniors. I believe that the 
Medicare prescription drug program can be improved and one improvement 
will be to allow the Secretary an opportunity to try to negotiate for 
lower prices.
  While I do support this legislation, I want to make it clear that I 
do not support any government-imposed restrictions on patients' access 
to their medicines. Nor do I support government price controls on 
prescription drugs. Each patient must have access to their doctor 
prescribed medicines without a government bureaucrat blocking that 
access. I also do not support the imposition of government price 
controls that might restrict access to medicines and the development of 
new medicines needed by those with conditions like Alzheimers, ALS and 
cancer.
  I believe that provisions in H.R. 4 that protect against government 
imposed formularies is the right policy. In supporting H.R. 4 today, I 
am saying Yes to negotiation, No to government-imposed restrictions on 
patient access to the drugs prescribed by their doctors and No to 
government price controls.
  Mr. SHAYS. Mr. Speaker, I am opposed to H.R. 4. Despite the rhetoric 
we're hearing on this issue, the fact is seniors are already realizing 
significant savings from negotiated prices. With plenty of competition 
between Medicare prescription drug plans driving prices lower, the free 
market is working. Why fix something when it's working?
  Seniors should understand the government isn't in charge of 
negotiating prices because the government doesn't administer the 
benefit. Private plans do. The negotiation takes place through private 
carriers who provide this service already for prescription drug 
beneficiaries like the United Automobile Workers of America.
  Most prescription drug plans use pharmacy benefit managers, or PBMs, 
to negotiate drug prices for them. These PBMs already negotiate drug 
prices for private insurers, and now, with the added market power of 
Medicare beneficiaries, PBMs are getting lower prices not only for 
Medicare beneficiaries, but for everyone on whose behalf they are 
negotiating.
  I noted with interest the Congressional Budget Office report on this 
legislation, which stated that the federal government lacks the 
leverage to achieve savings over what private plans are already 
negotiating. Furthermore, the CBO report notes because Medicare 
prescription drug plans bear substantial financial risk, they already 
have strong incentives to negotiate deep discounts on prescription 
drugs.
  I think it is unfortunate on an issue of this importance, we haven't 
had a single committee hearing or considered a single amendment to this 
legislation, despite significant evidence the legislation will not do 
what its proponents claim it will.
  I share the bill's proponents support for lowering drug prices, but 
H.R. 4 is the wrong solution.
  Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Speaker, I have serious 
reservations about H.R. 4. I am not convinced this provision will do 
anything to really help lower the price of prescription drugs. I will 
reluctantly vote for H.R. 4 because it is a priority for the Speaker.
  I would like to submit an article into the Record published yesterday 
morning in the Washington Post.
  The article points out the faulty approach in comparing the Veterans 
Administration with Medicare Part D, when it comes to drug price 
negotiations.
  While the V.A. is able to offer significant savings in drug prices, 
it offers a limited formulary. Also, the VA--by law--receives an 
automatic 24 percent discount from the average price that wholesalers 
pay.
  Comparing Medicare Prescription Drugs to the V.A. system is apples to 
oranges. I have not seen convincing evidence that the proposal will be 
effective.
  Mr. Speaker, we must do better. We must do more.
  In my opinion, this bill (H.R. 4) leads the seniors to believe that 
we are doing something for them. If we are serious, we would address 
the ``donut hole.''
  Again, I urge my colleagues to review this article, that helps to 
make my point, and I submit it for the Record.

               [From the Washington Post, Jan. 11, 2007]

            Experts Fault House Bill On Medicare Drug Prices

                          (By Christopher Lee)

       Democrats are fond of citing the Department of Veterans 
     Affairs as evidence that Medicare officials could squeeze 
     lower prices out of drugmakers if the government merely used 
     its negotiating clout. But that comparison ignores important 
     differences between the two systems, experts say.
       Unlike Medicare, VA by law receives an automatic 24 percent 
     discount from the average price that wholesalers pay. Its 
     prices are also low because VA, which prescribes medications 
     for 4.4 million veterans annually, has a relatively narrow 
     formulary, or list of approved drugs. The agency secures big 
     discounts from the manufacturers of a few drugs in each class 
     by promising not to offer competing drugs. The Centers for 
     Medicare an Medicaid Services (CMS) is prohibited by law from 
     adopting such a list for the year-old Medicare drug benefit, 
     in part because seniors enrolled in what is known as Part D 
     want to have a wide range of drug choices.
       The legislation that House Democrats hope to pass tomorrow 
     to require the Bush administration to negotiate drug prices 
     for Medicare would neither permit a formulary nor require an 
     automatic discount. It would simply require the secretary of 
     health and human services to pursue negotiations and report 
     back to Congress in six months.
       That is part of the reason that many experts do not expect 
     the measure to deliver significant savings even if it 
     overcomes opposition in Congress and escapes a possible 
     presidential veto.
       In fact, the nonpartisan Congressional Budget Office said 
     yesterday that the House bill would have a ``negligible 
     effect'' on federal Medicare spending because without a 
     formulary the HHS secretary probably could not obtain better 
     drug prices than those negotiated by the many private 
     insurers who offer Medicare drug plans.
       ``The federal government can get lower prices, but only if 
     it's willing to exclude a certain number of drugs from the 
     formulary,'' said Robert Laszewski, a nonpartisan health 
     policy consultant in Washington. ``And that's a huge 
     political leap that I would be very surprised if this 
     Congress took. I don't think they are going to give CMS any 
     teeth.''
       ``The VA is really a different animal than Medicare Part 
     D,'' said Robert B. Helms of the American Enterprise 
     Institute, who was an assistant secretary of health and human 
     services in the Reagan administration.
       But Democrats and their allies say that the gulf between 
     drug prices under the VA system and those under Medicare is 
     too large to ignore, and that requiring the government to 
     negotiate prices for Medicare would help narrow the gap 
     significantly.
       On average, prices are 58 percent higher in Medicare than 
     in the VA system for the 20 drugs most commonly prescribed 
     for seniors, according to a study released Tuesday by the 
     nonprofit advocacy group Families USA. The lowest price for a 
     year's supply of 20-milligram pills of the cholesterol-
     lowering drug Lipitor, for instance, was $1,120 in Medicare 
     and $782 in the VA system, the report said.
       ``These high prices are devastating seniors,'' said Ron 
     Pollack, the group's executive director.
       Rep. Frank Pallone Jr. (D-N.J.), chairman of the House 
     Energy and Commerce subcommittee on health, called 
     eliminating the current prohibition on government 
     negotiations a ``no-brainer.''
       ``It makes absolutely no sense to say that the 
     administration should not be able to negotiate prices for all 
     these seniors,'' Pallone said. ``There's no way it's not 
     going to save a significant amount of money.''
       Pallone said Medicare could obtain prices similar to the VA 
     system's even without a formulary. ``I have every reason to 
     believe that there is enough persuasion power, with different 
     things that could be implemented by the secretary, that could 
     get down to those levels,'' he said. He added that Democrats 
     will consider further changes down the road.
       Energy and Commerce Committee Chairman John D. Dingell (D-
     Mich.), lead sponsor of the House bill, discounted the 
     importance of the CBO analysis. ``Common sense tells you that 
     negotiating with the purchasing

[[Page H484]]

     power of 43 million Medicare beneficiaries behind you would 
     result in lower drug prices,'' he said.
       Critics of the VA comparison note that some of VA's costs 
     are buried in overhead. The department employs the doctors 
     and nurses who write the prescriptions, and it operates the 
     mostly mail-order pharmacies through which 76 percent of 
     veterans' prescriptions are distributed. Medicare does not 
     have that kind of infrastructure, and seniors have 
     demonstrated a preference for retail pharmacies, CMS 
     officials say.
       CMS officials also note that about a quarter of the 3.8 
     million Medicare beneficiaries who get VA health-care 
     benefits are also enrolled in Part D, in which the choice of 
     drugs is broader.
       ``It's apples to oranges,'' former CMS administrator Mark 
     B. McClellan said of the comparison. ``The VA is a closed 
     health-care system relying on mail order and a tighter 
     formulary than Medicare beneficiaries have shown they 
     prefer.''

  Mr. WELDON of Florida. Mr. Speaker, the legislation before us today 
is very different from the campaign promises that were made just a few 
short months ago by the Democrats. Counter to the arguments made today 
by Democrats in support of their bill, experts in the field, including 
the Democrats' own past and present budget directors, say that this 
bill will not save seniors or the government money. The bottom line is 
that this bill is more about politics and partisanship than it is about 
partnership and lowering prices for prescription drugs.
  Rather than the ``Medicare Prescription Drug Price Negotiation Act,'' 
a more appropriate name for this bill might be, ``The Government Price 
Control and Limited Access to Drugs Act.'' Price controls, which 
supporters of this bill advocate, lead to shortages and denial of 
access to many drugs.
  Robert Reischauer, appointed by Democrats as the Director of the 
Congressional Budget Office (CBO) from 1989 through 1995, had this to 
say recently about the Medicare Prescription Drug plan and the 
Democrats' proposed legislation (H.R. 4):

       People said it's going to cost a fortune. And the price 
     came in lower than anybody thought. Then people like me said 
     they're low-balling the prices the first year and they'll 
     jack up the rates down the line. And, lo and behold, the 
     prices fell again. And the reaction was, ``We've got to have 
     the government negotiate lower prices.'' At some point you 
     have to ask: What are we looking for here?

  In other words, Mr. Reischauer, who now works for the liberal-leaning 
Urban Institute, says that we have already achieved in the current plan 
what the Democrats say they want to achieve with H.R. 4.
  Further undermining the Democrats' claim is the January 10, 2007, 
cost estimate and analysis of their bill by the CBO concluding that 
H.R. 4 would not save seniors or the government money. The Democrats 
had hoped to use any savings for additional government spending. The 
problem is CBO says there will be no savings. Quoting from that 
analysis:

       . . . the Secretary would be unable to negotiate prices 
     across the broad range of covered Part D drugs that are more 
     favorable than those obtained by PDPs under current law. 
     [PDPs are the current private plans available to seniors 
     under Part D.] [T]he Secretary . . . would lack the leverage 
     to obtain significant discounts in his negotiations with drug 
     manufacturers. . . . [P]rices for covered Part D drugs would 
     continue to be determined through negotiations between drug 
     manufacturers and PDPs. . . . PDPs have both the incentives 
     and the tools to negotiate drug prices that the government, 
     under the legislation, would not have.

  CBO, economists and Republicans understand basic economics: When you 
have no tools at your disposal at the negotiating table, you have no 
leverage and no ability to achieve your goals. The Democrats removed 
from their bill the most important tool in lowering prices. This is the 
very tool that PDPs have used very effectively--their ability to 
establish a formulary for their plan that includes some drugs while 
excluding others. Absent the ability to exclude some drugs from their 
prescription drug plan, the government has no leverage to achieve lower 
prices. When seniors were told that the Democrats were planning to 
establish a plan that excluded some drugs, 89 percent of seniors said 
they would object to such a plan. It was this strong reaction from 
seniors that led Democrats to drop this plan.
  It is this ability to exclude hundreds of drugs that enables the 
Dept. of Veterans Affairs (VA), Dept. of Defense (DOD) and Medicaid to 
negotiate prices with manufacturers. The VA also saves money by 
requiring that over 80 percent of VA prescriptions be filled by mail 
order and by limiting access to local pharmacies. The VA approved drug 
list includes less than 40 percent of drugs approved by the FDA since 
1990, and less than 20 percent of drugs approved by the VA since 2000. 
VA drug prices also do not include the costs of administering the 
program or paying for pharmacy services. The tradeoff for those in 
these programs is that they have access to far fewer than the 4,300 
drugs currently available to seniors across the Medicare drug plans. 
Eighty-nine percent of seniors do not want the government to apply such 
restrictions to Medicare.
  The good news for seniors is that currently there is negotiation for 
drug prices by those who have the leverage and tools at their disposal 
to secure better prices for seniors and the government. The various 
Medicare Part D [PDP] plans do negotiate with drug manufacturers for 
drug prices and they do so in a vigorously competitive environment. 
Each of these plans has a drug formulary (list of drugs available to 
enrollees in that plan) and manufacturers know that if they do not 
provide Part D plan with a reasonable price, their drug will not be 
offered in that plan resulting in the loss of drug sales for their 
drugs. These Part D private plans have the ability to leave the 
negotiating table and exclude drugs from their plan and this has 
lowered drug costs significantly. Medicare recently released a study 
showing that estimated costs of the Part D program have fallen by over 
$100 billion, primarily due to the ability of plans to negotiate 
savings.
  Under the current program, once these plans have completed their 
negotiations, seniors are able to review the plans to see which plan 
best meets their needs in terms of drugs, including copayments, 
deductibles, and other factors. My constituents in Florida District 15 
have dozens of different plans from which to choose.
  There is a saying that, ``You don't fix what ain't broken.'' Given 
that over 80 percent of seniors are satisfied with their current plan, 
it is safe to assume that it isn't broken. Unfortunately, for Part D 
beneficiaries, the Democrats' bill amounts to choosing partisanship 
over partnership. Now-Speaker Pelosi said of the Republican Medicare 
Drug Plan back in 2003: ``The Republican plan is a plan to end 
Medicare. I urge my colleagues to reject this raw deal for America's 
seniors.'' Contrary to her dire prediction, it has turned out to be a 
very good plan for seniors as the average senior is saving hundreds of 
dollars per year.
  Mr. LINCOLN DAVIS of Tennessee. Mr. Speaker, I support H.R. 4, the 
Medicare Prescription Drug Price Negotiation Act of 2007, and its goal 
of reducing prescription drug prices for both the Medicare program and 
its beneficiaries.
  Just like any new program, the current Part D benefit has its flaws. 
Make no mistake, however, the current Medicare prescription drug 
benefit has gone a long way in providing desperately needed assistance 
to seniors in Tennessee and across America in paying for their 
prescription drugs. Though far from perfect, the original bill passed 
in 2003 represented a breakthrough and an important milestone in the 
Nation's commitment to strengthen and expand health security for 
current beneficiaries and future generations. As a representative of an 
extremely rural district, the provisions that directly impacted my 
rural constituency were too good to vote against. Had I voted against 
the legislation, I would have essentially voted against my 
constituents, and I was elected to protect them.
  Tennessee's Fourth District has a little over 27,000 elderly 
individuals with incomes less than 150 percent of the federal poverty 
level. The current benefit has directly assisted them in scaling down 
the cost of medicine and, as a result, has provided much needed 
assistance for low-income individuals. In fact, as of November, over 
50,000 Tennesseans had been deemed eligible for the low-income 
subsidies provided by the original legislation.
  The Medicare Prescription Drug, Improvement, and Modernization Act of 
2003 has directly impacted each of the 435 congressional districts in a 
unique way. While there is room for improvement, no one can deny that 
Part D has made great strides in helping our seniors to afford 
prescription medications. I applaud the program, but like my 
colleagues, I am committed to strengthening the benefit.
  Mr. VAN HOLLEN. Mr. Speaker, I rise in strong support for the 
Medicare Prescription Drug Price Negotiation Act of 2007, H.R. 4.
  This legislation is long overdue. Quite simply, H.R. 4 repeals the 
provision in current law that prohibits the Secretary of Health and 
Human Services (HHS) from negotiating with drug companies for lower 
prices for those enrolled in Medicare prescription drug plans and 
instead requires the Secretary to conduct such negotiations. As it 
stands right now, Medicare is the only entity in this country that 
cannot bargain for lower drug prices. The states, Fortune 500 
companies, large pharmacy chains, and the Veterans' Administration (VA) 
all use their bargaining clout to obtain lower drug prices for the 
populations they serve.
  It is quite astonishing that the current law prohibits Medicare from 
negotiating for lower prices while the VA is able to negotiate for 
lower prices for veterans. By not allowing Medicare to negotiate for 
lower drug prices, the responsibility for moderating drug prices is in 
the hands of the private drug plans that participate in Medicare. With 
the failure of private plans to deliver lower drug prices, Medicare

[[Page H485]]

beneficiaries end up paying higher out-of-pocket expenses. This failure 
is also a burden on taxpayers, as they pay approximately three-fourths 
of the costs of the Part D program.
  We simply cannot rely solely on private market competition to secure 
lower drug prices for Medicare beneficiaries. In fact, a recent report 
conducted by Families USA found that Medicare Part D drug prices are 
much higher than those obtained by the VA. This comprehensive study 
determined that for half of the top 20 drugs prescribed to Medicare 
Part D beneficiaries, the lowest price charged by Part D insurers is at 
least 58 percent higher than the same drugs provided to veterans by the 
VA. It is obvious that the pharmaceutical companies participating in 
Medicare Part D have failed to achieve what former CMS Administrator 
Mark McClellan claimed, ``the best discounts on drugs.'' We can, and 
must, do better in lowering drug prices in the Medicare Part D program.
  We must stand up for seniors and people with disabilities and give 
Medicare the ability to get the lowest possible prices for its 
beneficiaries. America's seniors and taxpayers will benefit from this 
legislation. I urge my colleagues to support the Medicare Prescription 
Drug Price Negotiation Act of 2007.
  Mr. SIRES. Mr. Speaker, I rise in support of H.R. 4, the Medicare 
Prescription Drug Negotiation Act of 2007. A bidding process exists for 
contracts and other goods and services at every level of government. As 
a former Mayor, my experience tells me that bidding and negotiations 
almost always leads to lower prices, which in turn saves the government 
and, ultimately, the taxpayers money.
  Today we have the opportunity to allow the government to negotiate 
and follow a purchasing process that is similar to the ones used by 
local and state governments as well as the Federal Government. Having 
already allowed Veterans Affairs this type of negotiation authority, 
there is no reason why Medicare should not have the same authorization.
  I do not believe this authority is going to limit the choices for 
Medicare beneficiaries as some of my colleagues on the other side of 
the aisle have suggested. This legislation will not force the Secretary 
of Health and Human Services to restrict formularies and will not alter 
any of the current prescription drug plans. Rather H.R. 4 will help 
seniors get lower prices on prescription medications under Medicare and 
that is why I will vote for this bill today.
  Mr. Speaker, I urge all of my colleagues to support H.R. 4.
  Mr. MARKEY. Mr. Speaker, I rise today in support of H.R. 4, The 
Medicare Prescription Drug Price Negotiation Act.
  We've heard about how Wal-Mart reduces costs through the purchasing 
power of their ``Sam's Clubs.''
  Well today we are establishing ``Uncle Sam's Club'', a smart way of 
pooling the enormous purchasing power of the Medicare program and 
enabling the Secretary to drive down the cost of prescription drugs 
through negotiation.
  Fortune 500 companies and large pharmacy chains all across the 
country negotiate for better drug prices on behalf of their patients.
  It is now time for the Secretary of HHS to do the same on behalf of 
millions of seniors in the Medicare program.
  When the Republicans passed their prescription drug bill, they 
explicitly prohibited the Secretary of HHS from negotiating with the 
pharmaceutical industry to get better drug prices for seniors.
  They seem to have forgotten that the government is supposed to work 
for the public interest, not the special interests. Unfortunately, it 
has become necessary to remove that giveaway to the special interests 
and remind the Secretary of his public interest obligations. In this 
bill we require the Secretary to work on behalf of seniors and people 
with disabilities to make sure they get the best possible deal on 
prescription drugs.
  The Republican's prescription drug bill has failed to get the cost of 
prescription drugs under control. Last year drug prices rose at twice 
the rate of inflation.
  The Medicare Prescription Drug Act was supposed to help seniors pay 
for their prescription drugs, but instead it became a means to keep 
drug prices and company profits at record high levels.
  It is long past time for the Secretary to use his negotiating power 
to help seniors avoid choosing between buying the drugs they need and 
paying for their rent or food.
  Vote for your constituents for a change. It is good medicine. Vote 
for H.R. 4.
  Mr. HASTERT. Mr. Speaker, in 2003, for the first time in history, 
this Congress was able to pass historic legislation providing 
comprehensive prescription drug coverage under the Medicare program. 
When we debated this legislation we heard from our Democrat colleagues 
on how it won't work. It will be too complicated, confusing, 
frustrating for seniors and they will pay high premiums and deductibles 
for minimal benefits.
  Then Part D went into effect. Again we only heard from the other side 
of the aisle with tales of unsatisfied seniors who had no help to guide 
them through the process.
  Now just a little over a year after Medicare Part D was implemented 
we find ourselves talking about this program again. So let's talk about 
Part D Mr. Speaker. Let's talk about the 22.5 million seniors who just 
over a year ago had no prescription drug coverage. Let's talk about 
recent polls that show 80 percent of those covered say they are in fact 
satisfied with the program and the benefits they are receiving. And we 
know they are satisfied because they are spending far less money out of 
pocket. On average, seniors are paying less than half of what they were 
just a year earlier when they had no drug coverage at all, many are 
saving even more.
  In fact Mr. Speaker, I recently received an email from a constituent 
of mine in Elgin, Illinois, Mr. Ted Whittington. Ted just wanted to 
thank the Congress for their leadership in providing the prescription 
drug plan because of what it meant for his family. See Ted's mother 
takes medication that cost them nearly $700 a month placing a great 
deal of financial strain on the family. When they enrolled her in Part 
D it immediately reduced those monthly costs to $170--cutting costs 70 
percent. This is just one of the many success stories I have had the 
pleasure of hearing about from my constituents back home in Illinois.
  Before us today is a bill that will take Medicare Part D in the wrong 
direction by removing the free-market tools which are keeping prices 
low. H.R. 4 would replace the free market with price controls. Price 
controls didn't work with gasoline in the 70s and isn't the answer for 
Part D. It won't help seniors. It won't help taxpayers.
  In fact, CBO confirms price control mechanisms aren't practical for 
Part D. Just this week they reported to Congress once again that giving 
power of price control to the Secretary would have a negligible effect 
on lowering prices. Our Democrat colleagues know this, standing before 
this House time after time voting against the very price controls they 
seek to pave the way for today. They did so for one simple reason--
price controls do not work.
  In nearly every way, H.R. 4 undermines the thriving Medicare Part D 
program that is helping millions of seniors. A price control system 
will limit the amount of drugs available to seniors while keeping them 
from being able to get their prescription filled when and where they 
want. And these changes would be far-reaching, increasing drug costs 
for veterans, slowing the course of new drugs available on the market, 
and diminishing the health and well being of those it seeks to help.
  Mr. Speaker, my Democratic colleagues refuse to admit the truth to 
the American people--Medicare Part D is working. For seniors, Part D 
simply means affordability and access to their prescription drugs. From 
community pharmacies to mail order, seniors around the country get the 
prescriptions they need at prices they can afford. Instead of giving 
credit for a job well done and reaching across the aisle to build off 
the successes of this Republican-led program, the new House leadership 
would rather play politics and dismantle the Medicare Part D program.
  Mr. Speaker I urge my colleagues to vote ``no'' on H.R. 4 and let us 
get to work on solving problems--not creating new ones for the American 
people.
  Mrs. TAUSCHER. Mr. Speaker, I rise today to speak on behalf of 
America's senior citizens.
  We in the Congress have a duty to provide the Secretary of Health and 
Human Services with all the tools necessary to grant seniors continuous 
access to affordable prescription drugs.
  This legislation, which I support, helps move in that direction.
  However, we must be careful that our actions do not restrict seniors' 
access to medicines prescribed to them by their doctors.
  And we must be careful to ensure that any changes to Part D do not 
diminish the ability of life sciences and biotechnology companies to 
continue innovation--innovation on the drugs that are extending and 
improving the quality of life for countless people around the globe, 
and innovation on future research that holds limitless promise.
  I also firmly believe that limiting formularies is not the way to go 
because it has a direct impact on limiting choice to seniors.
  We also need to address the donut hole created by the Republican-
authored Medicare bill.
  It is wrong that we provide seniors help with their drugs, and then 
suddenly--that help stops. Coverage needs to be continuous.
  I look forward to working with my colleagues to rectify this problem. 
Our seniors deserve it.
  Mr. HONDA. Mr. Speaker, I rise today in support of H.R. 4, the 
Medicare Prescription Drug Price Negotiation Act of 2007. I commend 
Speaker Pelosi and Representative

[[Page H486]]

Dingell for bringing this important legislation to the floor for 
consideration.
  I strongly believe that Medicare should ensure that seniors have 
access to the drugs and biologics they need. I applaud the leadership's 
effort to avoid the use of government price controls and restrictive 
formularies, while broadening the effort to make medication more 
affordable for our seniors.
  It is critical that the Secretary structure the negotiation process 
so that the result does not limit seniors' access to both proven and 
new therapies.
  Small, emerging biotechnology companies are researching and 
developing cures for cancer, Alzheimer's, multiple sclerosis and other 
devastating diseases. The majority of these companies are small 
companies without approved products, which are highly reliant on the 
public and private capital markets.
  As Medicare negotiates prices, we must be careful to protect this 
important research, which is costly and takes a long time to come to 
fruition but has added much to our quality of life.
  I believe that this legislation is an important first step in 
achieving important cost savings for our seniors and urge my colleagues 
to support it.
  The SPEAKER pro tempore. All time for debate has expired.
  Pursuant to Section 510 of House Resolution 6, the bill is considered 
read and the previous question is ordered.
  The question is on the engrossment and third reading of the bill.
  The bill was ordered to be engrossed and read a third time, and was 
read the third time.


           Motion to Recommit Offered by Mr. Barton of Texas

  Mr. BARTON of Texas. Mr. Speaker, I offer a motion to recommit.
  The SPEAKER pro tempore. Is the gentleman opposed to the bill?
  Mr. BARTON of Texas. I very certainly am.
  The SPEAKER pro tempore. The Clerk will report the motion to 
recommit.
  The Clerk read as follows:

       Mr. Barton of Texas moves to recommit the bill H.R. 4 to 
     the Committees on Ways and Means and Energy and Commerce with 
     instructions to report the same back to the House forthwith 
     with the following amendment:
       In subsection (i) inserted in section 1860D-11 of the 
     Social Security Act (42 U.S.C. 1395ww-111) by section 2(a) of 
     the bill, redesignate paragraphs (3) and (4) as paragraphs 
     (5) and (6), respectively, and insert after paragraph (2) the 
     following:
       ``(3) Assuring continued access to covered part d drugs and 
     pharmacy networks.--In carrying out paragraph (1), the 
     Secretary shall not (directly or indirectly) restrict or 
     otherwise limit any of the following:
       ``(A) Access of beneficiaries to covered part d drugs.--The 
     access of part D eligible individuals enrolled under 
     prescription drug plans or MA-PD plans to any covered part D 
     drug, such as any oral cancer drug, any antiretroviral 
     therapy for individuals with the human immunodeficiency virus 
     or acquired immune deficiency syndrome (HIV/AIDS), any drug 
     for a mental health illness, any drug to treat a neurological 
     disorder (such as Alzheimer's disease or Amyotrophic Lateral 
     Sclerosis), or any immunosuppressant drug to safeguard organ 
     transplants.
       ``(B) Access of beneficiaries to networks of chain and 
     community pharmacies.--The access of such individuals 
     enrolled under such plans to networks of chain and community 
     pharmacies that provide convenient and timely delivery of 
     covered part D drugs, whether or not such restriction or 
     limitation is in the form of restricting delivery of such 
     drugs to mail order, imposing increased cost-sharing, 
     restricting the quantities of such drugs to be dispensed, or 
     lowering the dispensing fees paid to such pharmacies.
       ``(4) Protection against increasing drug prices for 
     veterans.--In carrying out paragraph (1), the Secretary shall 
     not thereby increase prices for prescription drugs for any 
     identifiable group of citizens of the United States.''.

  Mr. ROSS (during the reading). Mr. Speaker, I ask unanimous consent 
that the motion to recommit be considered as read and printed in the 
Record.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Arkansas?
  Mr. BARTON of Texas. I object.
  The SPEAKER pro tempore. Objection is heard.
  The Clerk continued to read the motion to recommit.
  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Texas is recognized for 5 minutes in support of his motion to recommit.
  Mr. BARTON of Texas. Mr. Speaker, I want to apologize to Mr. Ross if 
he thought I was being rude to him. I wasn't.
  We only have 5 minutes on motions to recommit, and I wanted the 
Members to hear the motion and hopefully others that may be following 
the proceedings, because it is very short and it is also very simple.
  We have already heard from the Congressional Budget Office, which is 
nonpartisan, that the bill before us is not going to save any money in 
its current form. Having said that, since it is not going to save 
money, it could still do irreparable harm, if in these negotiations, if 
they were ever to occur, the Secretary, in trying to save money, would 
have to look at the following areas:
  First, he would have to look at some of the very expensive drugs that 
serve small segments of our population like the HIV drugs and some of 
those type of drugs. We don't want that to happen, so we explicitly 
preclude that.
  He would also have to look at access. The VA program that has been 
touted as an alternative to Medicare part D, in spite of the fact that 
over a third of the veterans choose Medicare part D, it achieves many 
of its savings, number one, by restricting the formulary; and, number 
two, requiring that most of the drugs be delivered via mail order. In 
other words, you don't have that local pharmacy point of access. So 
this motion to recommit explicitly says you have to maintain that 
access.
  It also says you can't impact groups like the veterans or any 
recognizable group that may have a group plan, because we don't want to 
squeeze, if you start trying to save money somewhere else, you may 
squeeze them and raise their prices.
  So this is a very straightforward motion to recommit. We simply say 
if you are going to give the Secretary of HHS all this negotiating 
authority, let's be careful that, in doing that, we don't hurt all 
these other segments of our population.
  Mr. Speaker, we have heard a lot of political rhetoric today. That is 
not surprising because the Democrats have made this a political debate 
and not a debate on substance. That is unfortunate because this issue 
is too important to too many Americans.
  There has been a lot of discussion about what this bill does and does 
not do; the truth of the matter is we don't really know. This bill has 
been the subject of no hearings; we have heard from no witnesses; we 
have had no subcommittee or full committee markups; we have had no 
opportunity to debate or even offer amendments. In fact, the Energy and 
Commerce Committee didn't even have its first meeting until 2 days ago.
  Mr. Speaker we do know something about the successes of Medicare part 
D. We know that tens of millions of our seniors have access to 
prescription drug coverage for the first time; we know that tens of 
millions more are saving money when they buy prescription drugs. We 
also know that seniors can choose from competing plans, have access to 
the approximately 4300 prescription drugs available, filled at 
pharmacies of their choice.
  Proponents of H.R. 4 claim that it will have no impact on 
beneficiaries' access to pharmacies or to the range of drugs they may 
take. If that is true then they should all vote in favor of the Motion 
to Recommit.
  The motion is simple but critically necessary. The motion guarantees 
seniors access to all drugs that are available under the current 
program; the motion ensures that seniors suffering from cancer, ALS, 
Alzheimer's, and other debilitating diseases get the drugs they need. 
The motion guarantees that our seniors have access to new and 
innovative treatments as they become available.
  The motion ensures that the government cannot limit or restrict 
beneficiary's access to their local pharmacies; seniors should be able 
to get their prescriptions filled at pharmacies of their choice.
  Finally, the motion ensures that the legislation will not end up 
increasing the cost of drugs for veterans or any other group of 
Americans.
  I urge all Members to vote in favor of preserving access to drugs and 
local pharmacies. Vote in favor of the Motion to Recommit.
  Mr. Speaker, I would like to yield to the distinguished ranking 
member of the Ways and Means Committee (Mr. McCrery) for 2 minutes.
  Mr. McCRERY. Mr. Speaker, I don't believe, based on the evidence, 
that the Democrats' plan can reduce prescription drug prices without 
reducing seniors' prescription drug choices, or without devastating 
local pharmacies, or without raising drug prices for our veterans.
  Now, they claim that won't happen. They claim they can reduce prices 
without doing all those things. Well, the motion to recommit gives them 
a

[[Page H487]]

chance to put their vote where their mouth is.
  One of the things we should be most proud about in the part D program 
is that it mandates that drugs for certain terrible illnesses be 
available. Our motion is simple. It would require that whatever 
government-negotiated plan emerges from this Democratic legislation 
must also ensure continued access to medications for those illnesses.
  The Republican motion says that for cancer, HIV/AIDS, mental illness, 
Alzheimer's, ALS, or Lou Gehrig's disease, you have got to have those 
drugs in those plans. You can't restrict them.
  The second part of our motion deals with community pharmacies. In the 
VA system, 80 percent of prescriptions are filled by mail, and the rest 
of them are gotten at VA centers, veterans hospitals and the like. How 
many people in this Chamber are willing to ask seniors to give up 
talking to their pharmacists?

                              {time}  1345

  If you aren't, and I suspect most of you aren't, then vote for the 
Republican motion to recommit. We guarantee that they will be able to 
talk to their local pharmacists.
  Third part of our motion seeks to protect America's veterans. This 
motion would ensure that requiring the HHS Secretary to negotiate 
Medicare prescription drug prices would not directly result in 
increasing drug prices for veterans, because as we have seen in the 
past, when the government gets involved in setting prices in other 
areas, prices to veterans go up. This motion to recommit won't allow 
that to happen with prescription drug prices for veterans.
  So if those things are what you believe, and what you want, just vote 
for the Republican motion to recommit, and you will ensure that those 
guarantees are in the legislation.
  Mr. BARTON of Texas. Mr. Speaker, may I inquire, do I have any 
additional time?
  The SPEAKER pro tempore (Mr. Boswell). The gentleman has 30 seconds.
  Mr. BARTON of Texas. Mr. Speaker, I would yield that to Mr. Stearns 
of Florida, 30 seconds.
  Mr. STEARNS. I thank the chairman.
  Mr. Speaker, the motion to recommit will mean that under section 4, 
the Secretary's actions shall not result in drug price increases paid 
by veterans. This means, my colleagues, includes the Department of 
Veterans' Affairs or veterans themselves.
  Certainly what both distinguished chairmen have mentioned is clear. I 
think that all Members should understand that. I support the motion to 
recommit.
  H.R. 4 will most certainly increase VA drug prices. (1) This happened 
in 1990, Congress gave Medicaid access to VA, shooting up some VA drug 
prices 300 percent. (2) Next, when the Clinton Administration's Office 
of Personnel Management tried to expand VA's discounts to a group 
within FEHBP in 2000, Clinton's own VA balked, as did a witness from 
Disabled American Veterans. (3) Just recently former Clinton 
Administration VA Acting Secretary Hershel W. Gober, wrote in a 2004 
issue of DAV Magazine that VA estimated in 1999 ``extending discounted 
government prices to Medicare would increase VA's annual drug costs by 
$500-$600 million''.
  Please don't turn your back on the brave men and women who defend our 
Nation. Support this motion to recommit in order to ensure that H.R. 4 
will not adversely affect drug prices for veterans.
  Mr. ROSS. Mr. Speaker, I rise in opposition to this motion to 
recommit.
  The SPEAKER pro tempore. The gentleman from Arkansas is recognized 
for 5 minutes.
  Mr. ROSS. Mr. Speaker, I don't really know where to begin. My wife is 
a pharmacist. We own a family pharmacy back home in Prescott, Arkansas. 
Just minutes ago she shared with me by telephone that she had to turn 
her television set off because she has heard so many untruths and 
misinformation coming from the Republican side of the aisle during this 
debate here today.
  But let me be clear about this: A ``yes'' vote for the motion to 
recommit is a vote for the big drug manufacturers, and a ``no'' vote on 
the motion to recommit is a vote for America's seniors. Now, today we 
are trying to correct a wrong that occurred back in 2003. Let us 
reflect back for a moment.
  We passed the so-called Medicare part D prescription drug benefit 
back in 2003, some 500 pages, gave us less than a day to read it and 
somewhere around 50 or 60, they actually, the Republican leadership 
actually put language in the bill that says the Federal Government 
shall be prohibited from negotiating with the big drug manufacturers to 
bring down the high cost to medicine for America's seniors.
  That is in the bill, and that is what today we are fixing, and then, 
to be sure the big drug manufacturers would not have to lower their 
prices, the Republican leadership back in 2003, they decided that they 
would spread all 43 million Medicare beneficiaries, over 30 companies, 
offering more than 1,200 private plans, so no plan and no company would 
be able to negotiate on behalf of very many seniors. That is what they 
did.
  Now we know, Mr. Speaker, now we know why back in 2003 the vote on 
this occurred at 3:00 in the morning. Now we know why the vote took 3 
hours for passage.
  Today, Mr. Speaker, we are letting the sun shine on our seniors, and 
on the way we conduct business in this Chamber as we hold the big drug 
manufacturers accountable and bring down the high cost of medicine for 
America's seniors.
  Mr. Speaker, I yield to the gentleman from Arkansas (Mr. Berry) for 2 
minutes.
  Mr. BERRY. I thank the gentleman, my colleague and friend.
  Mr. Speaker, as I have listened to this debate, and I am the only 
registered pharmacist in the 110th Congress. I can tell you one thing 
for certain, my distinguished colleagues across the aisle, while well 
meaning, absolutely don't know turnip greens from butter beans about 
what they are talking about.
  They have claimed to be concerned about our seniors. They have 
claimed to be concerned about our neighborhood pharmacies. Their bill, 
passed in 2003, assaulted our seniors and our neighborhood pharmacies.
  I assure you, that bill has done more to threaten those small 
businesses and the health care and well being of our senior citizens 
more than anything that is ever been done by this United States 
Congress, and they should be ashamed of themselves. They should be 
running to punch the green light as we come to the conclusion of this 
debate.
  It was their party that held the vote open for 3 hours just for the 
opportunity to perform this assault on our seniors and on our 
neighborhood drugstores.
  If they were concerned, they would not have passed that bill. They 
would not have made it possible for the PBMs to rob our neighborhood 
pharmacies and our senior citizens.
  I can tell you this, our pharmacists provided millions of dollars in 
medicine out of the goodness of their hearts and a moral obligation to 
see that the senior citizens of this country were taken care of when 
this plan was implemented.
  They did some wonderful humanitarian work. They deserved to be 
treated better than what this Medicare modernization act did. They are 
the victims, along with our seniors. The Republican motion to recommit 
is nothing more than charade intended to prevent Medicare from 
providing lower drug prices to our senior citizens.
  I urge everyone in this House and everyone that cares about our 
senior citizens and the cost of prescription drugs to vote ``no'' on 
the motion to recommit and to vote ``yes'' on H.R. 4.
  Mr. ROSS. Mr. Speaker, I would inquire, how much time do we have 
remaining?
  The SPEAKER pro tempore. The gentleman has 30 seconds remaining.
  Mr. ROSS. Mr. Speaker, reclaiming my time, I now yield the remainder 
of my time to the gentleman from Texas (Mr. Rodriguez).
  Mr. RODRIGUEZ. Mr. Speaker, let me take this opportunity first of all 
on the charges that were made on the other side indicating that the 
prices for the veterans would rise is false and not correct. H.R. 4 
does not require that the manufacturers extend the VA prices to 
Medicare.
  Why we are here today is to make sure that our seniors are well taken 
care of, to make sure that they are having the same opportunities that 
our veterans would have. What's wrong with allowing our taxpayers to 
have a better rate? What's wrong with allowing our seniors to have 
better rates?

[[Page H488]]

Those are the most vulnerable of our communities. I ask you to vote 
``aye'' on this bill.
  The SPEAKER pro tempore. Without objection, the previous question is 
ordered on the motion to recommit.
  There was no objection.
  The SPEAKER pro tempore. The question is on the motion to recommit.
  The question was taken; and the Speaker pro tempore announced that 
the noes appeared to have it.
  Mr. BARTON of Texas. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 9 of rule XX, the Chair 
will reduce to 5 minutes the minimum time for any electronic vote on 
the question of passage.
  The vote was taken by electronic device, and there were--yeas 196, 
nays 229, not voting 10, as follows:

                             [Roll No. 22]

                               YEAS--196

     Aderholt
     Akin
     Alexander
     Bachmann
     Bachus
     Baker
     Barrett (SC)
     Bartlett (MD)
     Barton (TX)
     Biggert
     Bilbray
     Bilirakis
     Bishop (UT)
     Blackburn
     Blunt
     Boehner
     Bonner
     Bono
     Boozman
     Boustany
     Brady (TX)
     Brown (SC)
     Brown-Waite, Ginny
     Buchanan
     Burgess
     Burton (IN)
     Calvert
     Camp (MI)
     Campbell (CA)
     Cannon
     Cantor
     Capito
     Carter
     Castle
     Chabot
     Coble
     Cole (OK)
     Conaway
     Crenshaw
     Cubin
     Culberson
     Davis (KY)
     Davis, David
     Davis, Jo Ann
     Davis, Tom
     Deal (GA)
     Dent
     Diaz-Balart, L.
     Diaz-Balart, M.
     Doolittle
     Drake
     Dreier
     Duncan
     Ehlers
     Emerson
     English (PA)
     Everett
     Fallin
     Feeney
     Ferguson
     Flake
     Forbes
     Fortenberry
     Fossella
     Foxx
     Franks (AZ)
     Frelinghuysen
     Gallegly
     Garrett (NJ)
     Gerlach
     Gilchrest
     Gingrey
     Gohmert
     Goode
     Goodlatte
     Granger
     Graves
     Hall (TX)
     Hastings (WA)
     Hayes
     Heller
     Hensarling
     Herger
     Hobson
     Hoekstra
     Hulshof
     Hunter
     Inglis (SC)
     Issa
     Jindal
     Johnson (IL)
     Johnson, Sam
     Jones (NC)
     Jordan
     Keller
     King (IA)
     King (NY)
     Kingston
     Kirk
     Kline (MN)
     Knollenberg
     Kuhl (NY)
     LaHood
     Lamborn
     Latham
     LaTourette
     Lewis (CA)
     Lewis (KY)
     Linder
     LoBiondo
     Lucas
     Lungren, Daniel E.
     Mack
     Manzullo
     Marchant
     McCarthy (CA)
     McCaul (TX)
     McCotter
     McCrery
     McHenry
     McKeon
     McMorris Rodgers
     Mica
     Miller (FL)
     Miller (MI)
     Moran (KS)
     Murphy, Tim
     Musgrave
     Myrick
     Neugebauer
     Nunes
     Paul
     Pearce
     Pence
     Peterson (PA)
     Petri
     Pickering
     Pitts
     Platts
     Poe
     Porter
     Price (GA)
     Pryce (OH)
     Putnam
     Ramstad
     Regula
     Rehberg
     Reichert
     Renzi
     Reynolds
     Rogers (AL)
     Rogers (KY)
     Rogers (MI)
     Rohrabacher
     Ros-Lehtinen
     Roskam
     Royce
     Ryan (WI)
     Sali
     Saxton
     Schmidt
     Sensenbrenner
     Sessions
     Shadegg
     Shays
     Shimkus
     Shuster
     Simpson
     Smith (NE)
     Smith (NJ)
     Smith (TX)
     Souder
     Space
     Stearns
     Sullivan
     Tancredo
     Terry
     Thornberry
     Tiahrt
     Tiberi
     Turner
     Upton
     Walberg
     Walden (OR)
     Walsh (NY)
     Wamp
     Weldon (FL)
     Weller
     Westmoreland
     Whitfield
     Wicker
     Wilson (NM)
     Wilson (SC)
     Wolf
     Young (AK)
     Young (FL)

                               NAYS--229

     Abercrombie
     Ackerman
     Allen
     Altmire
     Andrews
     Arcuri
     Baca
     Baird
     Baldwin
     Barrow
     Bean
     Becerra
     Berkley
     Berman
     Berry
     Bishop (GA)
     Bishop (NY)
     Blumenauer
     Boren
     Boswell
     Boucher
     Boyd (FL)
     Boyda (KS)
     Brady (PA)
     Braley (IA)
     Brown, Corrine
     Butterfield
     Capps
     Capuano
     Cardoza
     Carnahan
     Carney
     Carson
     Castor
     Chandler
     Clarke
     Clay
     Cleaver
     Clyburn
     Cohen
     Conyers
     Cooper
     Costa
     Costello
     Courtney
     Cramer
     Crowley
     Cuellar
     Cummings
     Davis (AL)
     Davis (CA)
     Davis (IL)
     Davis, Lincoln
     DeFazio
     DeGette
     Delahunt
     DeLauro
     Dicks
     Dingell
     Doggett
     Donnelly
     Doyle
     Edwards
     Ellison
     Ellsworth
     Emanuel
     Engel
     Eshoo
     Etheridge
     Farr
     Fattah
     Filner
     Frank (MA)
     Giffords
     Gillibrand
     Gonzalez
     Gordon
     Green, Al
     Green, Gene
     Grijalva
     Gutierrez
     Hall (NY)
     Hare
     Harman
     Hastings (FL)
     Herseth
     Higgins
     Hill
     Hinchey
     Hinojosa
     Hirono
     Hodes
     Holden
     Holt
     Honda
     Hooley
     Hoyer
     Inslee
     Israel
     Jackson (IL)
     Jackson-Lee (TX)
     Jefferson
     Johnson (GA)
     Johnson, E. B.
     Jones (OH)
     Kagen
     Kanjorski
     Kaptur
     Kennedy
     Kildee
     Kilpatrick
     Kind
     Klein (FL)
     Kucinich
     Lampson
     Langevin
     Lantos
     Larsen (WA)
     Larson (CT)
     Lee
     Lewis (GA)
     Lipinski
     Lofgren, Zoe
     Lowey
     Lynch
     Mahoney (FL)
     Maloney (NY)
     Markey
     Marshall
     Matheson
     Matsui
     McCarthy (NY)
     McCollum (MN)
     McDermott
     McGovern
     McIntyre
     McNerney
     McNulty
     Meehan
     Meek (FL)
     Meeks (NY)
     Melancon
     Michaud
     Millender-McDonald
     Miller (NC)
     Miller, George
     Mitchell
     Mollohan
     Moore (KS)
     Moore (WI)
     Moran (VA)
     Murphy (CT)
     Murphy, Patrick
     Murtha
     Nadler
     Napolitano
     Neal (MA)
     Oberstar
     Obey
     Olver
     Ortiz
     Pallone
     Pascrell
     Pastor
     Payne
     Pelosi
     Perlmutter
     Peterson (MN)
     Pomeroy
     Price (NC)
     Rahall
     Rangel
     Reyes
     Rodriguez
     Ross
     Rothman
     Roybal-Allard
     Ruppersberger
     Rush
     Ryan (OH)
     Salazar
     Sanchez, Linda T.
     Sanchez, Loretta
     Sarbanes
     Schakowsky
     Schiff
     Schwartz
     Scott (GA)
     Scott (VA)
     Serrano
     Sestak
     Shea-Porter
     Sherman
     Shuler
     Sires
     Skelton
     Slaughter
     Smith (WA)
     Snyder
     Solis
     Spratt
     Stark
     Stupak
     Sutton
     Tanner
     Tauscher
     Taylor
     Thompson (CA)
     Thompson (MS)
     Tierney
     Towns
     Udall (CO)
     Udall (NM)
     Van Hollen
     Velazquez
     Visclosky
     Walz (MN)
     Wasserman Schultz
     Waters
     Watson
     Watt
     Waxman
     Weiner
     Welch (VT)
     Wexler
     Wilson (OH)
     Woolsey
     Wynn
     Yarmuth

                             NOT VOTING--10

     Buyer
     Gillmor
     Hastert
     Levin
     Loebsack
     McHugh
     Miller, Gary
     Norwood
     Radanovich
     Wu

                              {time}  1414

  Mr. EDWARDS, Mr. ABERCROMBIE, Ms. CORRINE BROWN of Florida, Mr. SCOTT 
of Georgia, Ms. HOOLEY, and Mr. FATTAH changed their vote from ``yea'' 
to ``nay.''
  Mr. BURTON of Indiana changed his vote from ``nay'' to ``yea.''
  So the Motion to Recommit was rejected.
  The result of the vote was announced as above recorded.
  Stated for:
  Mr. NORWOOD. Mr. Speaker, on rollcall No. 22, on Motion To Recommit 
With Instructions (H.R. 4), had I been present, I would have voted 
``yea.''
  The SPEAKER pro tempore (Mr. Boswell). The question is on the passage 
of the bill.
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.


                             Recorded Vote

  Mr. BLUNT. Mr. Speaker, I demand a recorded vote.
  A recorded vote was ordered.
  The SPEAKER pro tempore. This will be a 5-minute vote.
  The vote was taken by electronic device, and there were--ayes 255, 
noes 170, not voting 10, as follows:

                             [Roll No. 23]

                               AYES--255

     Abercrombie
     Ackerman
     Allen
     Altmire
     Andrews
     Arcuri
     Baca
     Baird
     Baldwin
     Barrow
     Bean
     Becerra
     Berkley
     Berman
     Berry
     Bishop (GA)
     Bishop (NY)
     Blumenauer
     Boren
     Boswell
     Boucher
     Boyd (FL)
     Boyda (KS)
     Brady (PA)
     Braley (IA)
     Brown, Corrine
     Buchanan
     Burton (IN)
     Butterfield
     Capps
     Capuano
     Cardoza
     Carnahan
     Carney
     Carson
     Castle
     Castor
     Chabot
     Chandler
     Clarke
     Clay
     Cleaver
     Clyburn
     Cohen
     Conyers
     Cooper
     Costa
     Costello
     Courtney
     Cramer
     Crowley
     Cuellar
     Cummings
     Davis (AL)
     Davis (CA)
     Davis (IL)
     Davis, Jo Ann
     Davis, Lincoln
     DeFazio
     DeGette
     Delahunt
     DeLauro
     Dicks
     Dingell
     Doggett
     Donnelly
     Doyle
     Edwards
     Ellison
     Ellsworth
     Emanuel
     Emerson
     Engel
     Eshoo
     Etheridge
     Farr
     Fattah
     Filner
     Fossella
     Frank (MA)
     Giffords
     Gillibrand
     Gonzalez
     Goodlatte
     Gordon
     Green, Al
     Green, Gene
     Grijalva
     Gutierrez
     Hall (NY)
     Hare
     Harman
     Hastings (FL)
     Herseth
     Higgins
     Hill
     Hinchey
     Hinojosa
     Hirono
     Hodes
     Holden
     Holt
     Honda
     Hooley
     Hoyer
     Inslee
     Israel
     Jackson (IL)
     Jackson-Lee (TX)
     Jefferson
     Johnson (GA)
     Johnson (IL)
     Johnson, E. B.
     Jones (NC)
     Jones (OH)
     Kagen
     Kanjorski
     Kaptur
     Kennedy
     Kildee
     Kilpatrick
     Kind
     Klein (FL)
     Kucinich
     Lampson
     Langevin
     Lantos
     Larsen (WA)
     Larson (CT)
     LaTourette
     Lee
     Lewis (GA)
     Lipinski
     LoBiondo
     Lofgren, Zoe
     Lowey
     Lynch
     Mahoney (FL)
     Maloney (NY)
     Markey
     Marshall
     Matheson
     Matsui
     McCarthy (NY)
     McCollum (MN)
     McDermott
     McGovern
     McIntyre
     McNerney
     McNulty
     Meehan
     Meek (FL)
     Meeks (NY)
     Melancon
     Michaud
     Millender-McDonald
     Miller (FL)
     Miller (NC)
     Miller, George
     Mitchell
     Mollohan
     Moore (KS)
     Moore (WI)
     Moran (KS)
     Moran (VA)
     Murphy (CT)
     Murphy, Patrick
     Murtha
     Nadler
     Napolitano
     Neal (MA)
     Oberstar
     Obey
     Olver
     Ortiz
     Pallone
     Pascrell
     Pastor
     Paul
     Payne
     Pelosi
     Perlmutter
     Peterson (MN)
     Petri
     Platts
     Pomeroy
     Price (NC)
     Rahall
     Ramstad
     Rangel
     Regula
     Renzi
     Reyes

[[Page H489]]


     Rodriguez
     Ross
     Rothman
     Roybal-Allard
     Ruppersberger
     Rush
     Ryan (OH)
     Salazar
     Sanchez, Linda T.
     Sanchez, Loretta
     Sarbanes
     Schakowsky
     Schiff
     Schwartz
     Scott (GA)
     Scott (VA)
     Serrano
     Sestak
     Shea-Porter
     Sherman
     Shuler
     Sires
     Skelton
     Slaughter
     Smith (NJ)
     Smith (WA)
     Snyder
     Solis
     Space
     Spratt
     Stark
     Stupak
     Sutton
     Tanner
     Tauscher
     Taylor
     Thompson (CA)
     Thompson (MS)
     Tierney
     Towns
     Udall (CO)
     Udall (NM)
     Van Hollen
     Velazquez
     Visclosky
     Walsh (NY)
     Walz (MN)
     Wamp
     Wasserman Schultz
     Waters
     Watson
     Watt
     Waxman
     Weiner
     Welch (VT)
     Wexler
     Wilson (OH)
     Wolf
     Woolsey
     Wu
     Wynn
     Yarmuth

                               NOES--170

     Aderholt
     Akin
     Alexander
     Bachmann
     Bachus
     Baker
     Barrett (SC)
     Bartlett (MD)
     Barton (TX)
     Biggert
     Bilbray
     Bilirakis
     Bishop (UT)
     Blackburn
     Blunt
     Boehner
     Bonner
     Bono
     Boozman
     Boustany
     Brady (TX)
     Brown (SC)
     Brown-Waite, Ginny
     Burgess
     Calvert
     Camp (MI)
     Campbell (CA)
     Cannon
     Cantor
     Capito
     Carter
     Coble
     Cole (OK)
     Conaway
     Crenshaw
     Cubin
     Culberson
     Davis (KY)
     Davis, David
     Davis, Tom
     Deal (GA)
     Dent
     Diaz-Balart, L.
     Diaz-Balart, M.
     Doolittle
     Drake
     Dreier
     Duncan
     Ehlers
     English (PA)
     Everett
     Fallin
     Feeney
     Ferguson
     Flake
     Forbes
     Fortenberry
     Foxx
     Franks (AZ)
     Frelinghuysen
     Gallegly
     Garrett (NJ)
     Gerlach
     Gilchrest
     Gingrey
     Gohmert
     Goode
     Granger
     Graves
     Hall (TX)
     Hastings (WA)
     Hayes
     Heller
     Hensarling
     Herger
     Hobson
     Hoekstra
     Hulshof
     Hunter
     Inglis (SC)
     Issa
     Jindal
     Johnson, Sam
     Jordan
     Keller
     King (IA)
     King (NY)
     Kingston
     Kline (MN)
     Knollenberg
     Kuhl (NY)
     LaHood
     Lamborn
     Latham
     Lewis (CA)
     Lewis (KY)
     Linder
     Lucas
     Lungren, Daniel E.
     Mack
     Manzullo
     Marchant
     McCarthy (CA)
     McCaul (TX)
     McCotter
     McCrery
     McHenry
     McKeon
     McMorris Rodgers
     Mica
     Miller (MI)
     Murphy, Tim
     Musgrave
     Myrick
     Neugebauer
     Nunes
     Pearce
     Pence
     Peterson (PA)
     Pickering
     Pitts
     Poe
     Porter
     Price (GA)
     Pryce (OH)
     Putnam
     Rehberg
     Reichert
     Reynolds
     Rogers (AL)
     Rogers (KY)
     Rogers (MI)
     Rohrabacher
     Ros-Lehtinen
     Roskam
     Royce
     Ryan (WI)
     Sali
     Saxton
     Schmidt
     Sensenbrenner
     Sessions
     Shadegg
     Shays
     Shimkus
     Shuster
     Simpson
     Smith (NE)
     Smith (TX)
     Souder
     Stearns
     Sullivan
     Tancredo
     Terry
     Thornberry
     Tiahrt
     Tiberi
     Turner
     Upton
     Walberg
     Walden (OR)
     Weldon (FL)
     Weller
     Westmoreland
     Whitfield
     Wicker
     Wilson (NM)
     Wilson (SC)
     Young (AK)
     Young (FL)

                             NOT VOTING--10

     Buyer
     Gillmor
     Hastert
     Kirk
     Levin
     Loebsack
     McHugh
     Miller, Gary
     Norwood
     Radanovich

                              {time}  1422

  So the bill was passed.
  The result of the vote was announced as above recorded.
  A motion to reconsider was laid on the table.
  Stated for:
  Mr. KIRK. Madam Speaker, on rollcall No. 23 I was unavoidably 
detained. Had I been present, I would have voted ``aye.''
  Stated against:
  Mr. NORWOOD. Madam Speaker, on rollcall No. 23, on passage of H.R. 4, 
had I been present, I would have voted ``no.''

                          ____________________