[Congressional Record Volume 156, Number 39 (Wednesday, March 17, 2010)]
[House]
[Pages H1574-H1580]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
HEALTH CARE REFORM FOR SENIORS
The SPEAKER pro tempore (Mrs. Halvorson). Under the Speaker's
announced policy of January 6, 2009, the gentlewoman from Illinois (Ms.
Schakowsky) is recognized for 60 minutes as the designee of the
majority leader.
Ms. SCHAKOWSKY. Madam Speaker, I'm so happy to be here tonight,
particularly after I have heard what my colleagues had to say. One of
them said, Our people need to hear the truth about the health care
legislation. That's exactly what we're going to talk about tonight.
Tonight we're going to talk about how this legislation helps our older
Americans, our senior citizens.
We're going to talk about how this bill protects Medicare for the
next 10 years. It's solvent for an extra 10 years so we keep our
promise for an aging population and take care of our citizens when they
get older. We're going to talk about closing the doughnut hole, about
protecting seniors from elder abuse, about making visits to the
hospital safe.
I have the pleasure of being the cochair of the Democratic Task Force
on Senior Citizens, on seniors, and my cochair is the gentlelady from
California, Doris Matsui.
And Doris, I'm going to turn it over to you to get us started
tonight.
Ms. MATSUI. Thank you very much, dear colleague, and I really
appreciate being the cochair with you. We certainly have the passion
for our senior citizens, and I believe that most of America understands
that, too. But I rise today to recognize significant benefits that the
emerging health care bill will have on American seniors.
Simply put, the health care bill will put forth, provides a better
deal for America's seniors than our current system. Our health care
plan takes great strides towards improving the quality of care our
seniors receive.
For starters, our bill eliminates copayments and deductibles for
preventative services under the Medicare program. This is crucially
important because we know that many seniors are not getting the
preventative care they need and are often foregoing tests because
they're too worried about the costs.
The sad fact is one out of every five women over the age of 50 has
not had a mammogram in 2 years. Also, more than a third of adults over
the age of 50 have never had a colonoscopy. Without our bill's
investments in primary care and its improved access to preventive care
under Medicare, beneficiaries will continue to lose access. We are
going to reverse this trend with the bill we pass this week.
Madam Speaker, we all know that preventative care is good for the
health of individual patients and it's good for the overall health of
our system, but without doctors to treat Medicare beneficiaries, the
entire system structure, the systemic structure just collapses. That is
why our legislation creates a more immediate pathway for more primary
care doctors, the doctors that stay with you for a lifetime and know
your medical history.
Primary care doctors are the backbone of Medicare and of our system
in general, and our bill gives medical students incentives to go into
primary care. These include grants for primary care training as well as
incentives under Medicare for primary care doctors to practice in areas
that currently have a shortage.
Right now, we know that we need many more primary care doctors in
this country. The shortage is exacerbated by the high cost of
education, which pushes more and more medical students into specialty
fields and strains Medicare. Today, about 12 million Americans lack
access to primary care doctors in their community, but by providing
immediate support for primary care physicians, we can help minimize
these shortages and restore the promise of Medicare.
Our bill also emphasizes coordinated care so that people can avoid
unnecessary tests. It provides incentives for
[[Page H1575]]
doctors to work together to provide seniors with high quality care that
every American needs and deserves.
This bill is about strengthening Medicare for America's seniors and
restoring the confidence that we have in our health care system. We
know that we have the best doctors and hospitals in the world. In my
hometown of Sacramento, we have models of care coordination and chronic
disease management that are the envy of other cities across this
country.
But when seniors, especially in Sacramento, are splitting pills
because they can't afford to refill their prescriptions and skipping
meals to make ends meet, this system is not working. And one of the
surest ways to help us get back on track is to close the doughnut hole
that affects millions of seniors every single day.
Between 2009 and 2010, monthly prices in the doughnut hole increased
by 5 percent or more for half of the 10 most popular brand-name drugs.
This means that brand-name drugs in the doughnut hole became more
expensive relative to the medical care of other goods. And this is not
just a recent phenomenon.
Between 2006 and 2010, prices for popular brand-name drugs in the
doughnut hole went up more than 20 percent. This means that America's
seniors are being forced to spend a greater percentage of their fixed,
disposable income on brand-name drugs. This is why it is so important
for us to pass the health insurance reform bill, which will start
closing the doughnut hole this year and completely close it within 10
years
Madam Speaker, American seniors deserve more than the status quo. Our
plan for health care reform will extend the solvency of Medicare, lower
seniors' costs for prescription drugs by beginning to close the
doughnut hole, improve the quality of seniors' care with better
coordination among doctors, cover the cost of preventive care for
Medicare patients, and expand home- and community-based services to
keep people in their homes.
{time} 1900
America's seniors deserve the best possible health care we can
provide. And that's what our health care plan will do, ensure access to
quality, affordable health care for all Americans.
Madam Speaker, I thank my wonderful colleague, and I yield back time
to her.
Ms. SCHAKOWSKY. Thank you so much, Representative Matsui, for being
such a strong advocate for older Americans, really for all Americans,
that are going to be helped by this legislation. And we are going to be
talking much more about that.
I wanted to just let everyone know that for 5 years I had the
pleasure of being the executive director of the Illinois State Council
of Senior Citizens. It was between 1985 and 1990, and those were among
the most fun years and learning years my life. I was a lot younger
then, not a senior citizen as I have reached today, and what I learned
is that our older Americans, while facing many, many challenges, are
the people who really helped build our middle class, who helped build
our society, and now in their older years, especially in this time of
economic downturn, are facing incredible difficulties in getting their
health care. Thank goodness for Medicare. We will talk more about that
program that was passed in 1965.
There is a reason why every advocacy group for older Americans is
supporting this legislation. If you look at the list, and I'm going to
read it, you will see that the people who know best, because they
either are made up of older Americans or their job is to advocate for
older Americans, are supporting this legislation. That would include
the AARP, which represents tens of millions of older Americans, people
from 50 and upward, and we will talk about how this legislation not
only helps people 65 and older, but 50 and older, the National
Committee to Preserve Social Security and Medicare, the Alliance for
Retired Americans, the Center for Medicare Advocacy, Families USA, the
Retirees of AFSCME, B'nai B'rith International, National Senior Corps
Association, National Academy of Elder Law Attorneys, National Council
on Aging, Service Employees International Union, National Association
of Professional Geriatric Care Managers, Easter Seals, Medicare Rights
Center, American Federation of Teachers Program on Retirement and
Retirees, Volunteers of America, the American Society on Aging, and
National Senior Citizens Law Center.
I'm sure there are more that aren't on my list. I have some other
data from some of these organizations. These are the people who know
what seniors want. That is their business. They are made up of seniors
and certainly of their advocates.
And one of the advocates for the elderly is a great colleague mine.
Rush Holt from the great State of New Jersey is here tonight to talk
about how people in his State and around the country, older Americans,
are going to benefit from this legislation.
Mr. HOLT. I thank the gentlelady from Illinois for reserving this
time to take the message out. For a moment, let me speak to the 103,000
Medicare beneficiaries in the 12th Congressional District in New
Jersey, more than 100,000. This legislation would improve their
benefits. It would provide free preventive and wellness care. It would
improve the primary care and better coordination of care, not just so
there is more efficiency and less waste, although there would be, but
so that patients don't get the runaround. It does not help their health
to have unnecessary or counterproductive tests or procedures. It would
enhance nursing home care. And it would strengthen the Medicare Trust
Fund, extending solvency for another 8 or 9 years. That is real.
You had spoken earlier about the doughnut hole. I always hesitate to
talk about the doughnut hole. I think of it as a cliff. Depending on
how expensive your monthly medication is, along about August or
September or October, you have exceeded the expenditure limit on
Medicare, the way things stand now, and you fall off the cliff. And if
you want to keep taking the medicines, you have got to pay out of
pocket.
Under the bill, the beneficiaries not only would receive in 2010 a
$250 rebate and 50 percent discounts on brand-name drugs beginning in
the coming year, but also complete closure of this doughnut hole, or
better yet, filling in this cliff in the years to come. A typical
beneficiary who enters the so-called doughnut hole, again, that is too
benign a term, who falls off the cliff, will see savings of over $700
in the coming year and over $3,000 in coming years. So this is
something that, yes, it helps small businesses. Yes, it helps young
adults trying to get a start after college. Yes, it helps people who
find themselves between jobs or people who want to start small
businesses. It helps employees of large businesses. It helps anybody
who has a health insurance policy now. But tonight, we are talking
about how it will help senior Americans.
I thank the gentlelady for reserving this time. Let me turn it back
to you, and I will add some comments as we go along if I may.
Ms. SCHAKOWSKY. Great. I thank you so much.
I wanted to talk in very specific terms. Again, you talked a little
bit about some of the issues, how this bill actually, in a concrete
way, on a day-to-day basis, is going to help older Americans. I think
it's so important that we explain the details of this bill because
there have been a lot of myths out there particularly aimed at older
Americans. And it really makes me mad. There has been a lot of fear
about how somehow this bill is going to cut Medicare. And I'm going to
talk about how that is exactly the opposite, how this bill is actually
going to extend the life of Medicare, not cut any benefits.
So let's look at some of these things, how health care reform means
security and stability for America's seniors, extends the solvency of
Medicare. What does that even mean? Extend the solvency of Medicare.
What that means is that currently if you look at the Medicare funds, by
2017, that fund is going to be in some trouble. Aha. But we pass this
bill, and the solvency, the health of the Medicare Trust Fund is going
to be extended another 9 years. So we are now up to 2026. We want to
figure out ways to even go beyond that, but that's a pretty good start,
to extend it to 2026.
Lower costs for prescription drugs. You talked a bit about the
doughnut hole. And, again, you're right, you talk about the doughnut
hole. Not only does it sound benign, a lot of people don't know what
we're talking about when
[[Page H1576]]
we say that. But there is this gap in coverage. And so I'm going to
tell you about one of the seniors who actually had this pretty horrible
experience when she went to the drugstore and found out that she was
not covered. Here she is. My constituent had a Humana part D Medicare,
that is a prescription drug plan, and had trouble paying the monthly
premium. Humana originally told her that she would never pay more than
a few dollars for her medications. Sounds pretty good. One day she went
to CVS, she went to the drugstore, and was told that one medication out
of the eight that she is taking was going to cost $130, whereas the
previous month the cost was $20. From $20 to $130.
At that point, the pharmacist told her about the doughnut hole. She
found out that from then on she was going to have to pay out of pocket
until she paid $3,600 out of pocket. She would continue to pay her
premiums every month, but her drug costs were going to be out of pocket
until she had paid $3,600 more.
Well, what she told us was that she stood at the pharmacy counter and
cried because she just couldn't afford to get her medicine. So she
walked out of the pharmacy. She called our office, and she was
concerned that she wouldn't be able to take her lifesaving medicine
because she didn't have the money.
And fortunately, there was an Illinois program in existence at the
time called Illinois Cares Rx, and she is able to get her medication
through that program. But fortunately, she fit the eligibility
requirements. Plenty of people don't. And then her physician gave her
some free samples. And you know that doesn't last forever. So we are
going to permanently close that doughnut hole, and we are going to
begin to do it on day one, lowering the cost of prescription drugs.
We are going to improve the quality of seniors' care with better
coordination among the doctors. And that is going to be cost savings,
too, because we are going to have coordinated care so that they get
this continuum of care. We are going to train more primary care
doctors. That's what we need to do. We are going to provide incentives
to make sure that we have more primary care doctors. We're going to
cover the cost, as you mentioned, Representative Holt, of preventive
care for Medicare patients. No more out-of-pocket costs. You have your
Medicare card--that's all you're going to need for those preventive
services.
And we're going to expand home and community-based services to keep
seniors in their homes, which, we should add, is exactly where they
want to be. People don't want to be forced into nursing homes. They
want to be able to stay at home. If we expand those home- and
community-based services, someone being able to come into the home at a
price they could afford, adult day care centers where people can go
during the day and be safe and active, then they are going to be able
to stay in their homes.
That's just the beginning of what we do for seniors.
Let me turn it back to Representative Holt for just a minute because
we were talking earlier about how frustrating it is that there is a
question about Democrats, the majority, wanting to somehow cut
Medicare.
Mr. HOLT. I thank Representative Schakowsky, my good friend. This is
something that has been one of the great accomplishments, not just of
the Democratic Party, but of the United States. Medicare has been a
success. It has been medically a success. It has been socially a
success. This legislation before us will only strengthen Medicare.
And to underscore a point that you were making, Ms. Schakowsky: By
getting better coordination among doctors, by having more primary care
doctors, by covering preventive care, by making sure that beneficiaries
have access to medicine, we not only get efficiencies, but each patient
gets better care.
{time} 1915
We begin to shift more attention toward the outcome, the health of
the patient.
Having extra procedures or having to go to a specialist when you
don't need to go to a specialist but only because you don't have a
primary care physician available is not only costly but it is not
healthful. It does not produce the best outcome, and it leaves the
patient frustrated and getting the runaround.
So people ask me, well, in this health care bill, how can you claim
to cut costs and not cut our benefits? How can you claim to cut costs
and not give us worse care? Well, in fact that is the point exactly. By
having primary care physicians, by paying for the medical education of
those physicians to have more of them available, to have better
coordinated care among doctors, the patients will get better care. So
it is not just a matter of efficiency, but it is that also.
And to continue on your point. The debate that we are having right
now strongly echoes the debate of the 1960s over Medicare.
``Inefficient and costly government.'' ``Putting the government between
the doctor and the patient.'' ``Socialized medicine.'' Yes, we have
heard all of those phrases this week, in fact tonight here, previously,
from the other side of the aisle. Those are quotes from the 1960s.
Now, few people today would call for a repeal of Medicare given its
success for seniors, yet it was very controversial back then. The same
arguments were made against health care reform then as are being made
now.
Some leaders, from Ronald Reagan to Bob Dole to Gerald Ford, fought
the program and voted against its creation. Since then, some opponents
of Medicare have tried to cut, or cut, Medicare. Former Speaker of the
House Gingrich spoke of cutting back Medicare so that it could, quote,
wither on the vine.
Does anybody really think that Democrats, who are so proud of the
accomplishments of Medicare, would for a moment consider cutting back
on Medicare? Does anybody reasonably think that?
This is a successful program that has taken us from 1965, when 44
percent of seniors were uninsured. They had no place to go except maybe
the emergency room if they got really sick. It has taken us to a point
where barely 1 percent of seniors today have no coverage. Seniors had
limited choices back then. They could deplete their savings or seek
assistance from their children or look for charity care, or, as was so
often the case, forego medical care entirely. Within 11 months after
President Johnson signed Medicare into law, almost 20 million Americans
had enrolled in the program, and it has virtually eliminated
uninsurance among older Americans. Today, about 1 percent of those 65
and older lack health care coverage.
So ask any of the 45 million beneficiaries if they would trade their
Medicare. You will have a hard time finding any.
Ms. SCHAKOWSKY. Thank you very much for reminding everybody, first of
all, that Medicare is the government program of health care for older
Americans. It is not just a made-up story that sometimes people come up
to us and say, Keep government hands off my Medicare. Well, we have to
remind people that this is a 100 percent government program. And thank
God for Medicare, because so many people, that is the only insurance
they have.
And I have to tell you, a lot of people come into my office every
week and saying, I can't wait. I can't wait for my 65th birthday so
that I can finally get the insurance and the care that I need.
I am also, as I said, going to talk about how this bill even helps
people age 50 to 65 with their health care problems. But right now, I
want to introduce somebody who knows a bit about insurance, who knows a
bit about health care, and knows a bit about what seniors in this
country, what Americans in this country need when it comes to health
care. He is a new Member, but he is not new to this issue, and he is
not new to advocacy for all good things for consumers and for the
seniors, and that is John Garamendi, my colleague from California.
Mr. GARAMENDI. I thank you very much, Congresswoman Schakowsky, and
thank you for that terrific description of the history of Medicare.
This has been a Democratic program for more than 43 years now. As
Representative Schakowsky just said, I get the same thing: if I can
just live long enough to get the Medicare.
And I remember as you were saying that an experience I had. I had
visited
[[Page H1577]]
a carpenter who had become ill with cancer and he wanted me to stop by
and see him. This was maybe 10 years ago. He was bedridden, very, very
sick. He was about 60, no longer able to work, and his wife was about
the same age. And he said, I have just got to hang on long enough so
that my wife can get to Medicare. Otherwise, she will have nothing, and
she is a diabetic.
We have got about 45,000 Americans that are dying every year because
they don't have health care and because they haven't been able to live
long enough to get to Medicare.
Medicare is a program that the Democrats have fought for, have fought
very vigorous battles in this Chamber against the Republican Party. You
mentioned Newt Gingrich, who was right out front about the Republican
goals in the 1990s to destroy Medicare.
Well, we are here to protect Medicare. And in this legislation that
will be before us for a vote very, very shortly, there is an explicit
understanding written into it that Medicare will be protected, that
benefits will not be cut, and that cost savings, wherever they may be
found in all of the Medicare system, that those cost savings will be
plowed back into the Medicare program.
So where are the cost savings going to come from? How correct you are
with your chart when you talked about where the cost savings are: well-
care, preventing illnesses, taking care of people in the continuity of
care rather than episodic care.
There is also a lot of fraud in Medicare. We know that. We also know
that it was the Bush-Cheney budget that reduced the appropriations to
fight fraud in Medicare. They basically wiped out the Department of
Health Services and the Medicare program's ability to fight fraud, and
it blossomed. But in the budget that you passed this last year, now
that we have a Democratic President and a Democratic budget, he put
money back in to fight Medicare fraud. That will save money. We have
seen ``60 Minutes''; we have seen the kind of fraud that is out there.
But what really, really makes me upset is the misinformation that is
out there, in many cases the downright lies that you see on television,
most of them paid for by the insurance industry that doesn't want to
lose their 16 percent additional payment over and above the average
cost of Medicare that is given to the insurance companies so that they
can have this Advantage program. What do the seniors get for it? Not
much.
Mr. HOLT. If the gentleman will yield. And these are not lies of
ignorance. These are people who know better.
Mr. GARAMENDI. The insurance companies? You bet they do.
Mr. HOLT. They know that Medicare has an overhead of about 2 percent.
So if I may make a small correction on what the gentleman has said.
There is waste and fraud in Medicare. I think the gentleman said a lot;
actually, it is a little. But when there are 44 million beneficiaries,
almost 45 million beneficiaries, a little bit of error, a little bit of
fraud can add up to a lot of money. But the program itself, if you
count administrative costs as well as waste, fraud, and abuse, it is a
couple of percent. In other words, almost all of the money in Medicare
goes to providing health care.
Ms. SCHAKOWSKY. I have to say that it is not necessarily just a
little bit. At the beginning of September, the Department of Health and
Human Services and the Department of Justice announced the largest
health care fraud settlement in history.
Pfizer, the drug company, agreed to pay $2.3 billion for illegal
marketing practices. That is going to return about $1 billion to
Medicare and Medicaid. So that is not chump change.
Mr. HOLT. On a percentage basis, it is a small amount. When you have
45 million beneficiaries, that adds up to a lot.
Mr. GARAMENDI. The key point here is that in this legislation there
is a specific effort to eliminate the fraud that goes on in the system.
The unnecessary payments, the stealing of the Social Security cards,
all those kinds of things that are out there, we know we need to deal
with that. And we are dealing with it. Even before this piece of
legislation, we put money into the budget to deal with that; and then
this legislation strengthens that.
And, in addition to that, we now will have better medical record
technology which will also assist us in keeping track of what is going
on. It is a small piece of a much, much larger piece of legislation
that does help seniors in very, very specific ways.
Why should the insurance companies get an unnecessary boost in their
profits at the expense of the Medicare program? No reason that I know
of. They should be competing and they should be helping seniors, but
not get that additional bump. Those savings are also plowed back into
the benefits for seniors so that they can have those programs that you
talked about, those programs of prevention, of wellness, of being able
to stay in their home. All of those things are important.
If I could just take a personal moment for a moment. My mother phoned
me; she is 87. She is going to have her 88th birthday. If it is 89, I
am in deep trouble back home. But she is going to have her birthday
soon.
She phoned about 3 weeks ago and she said, John, why are you cutting
the Medicare programs? What are you talking about, Mom? Well, the TV
advertisement just said you guys are going to cut the Medicare program.
And I am going, No, we are not. But tell me about the ad.
It was an advertisement run by the U.S. Chamber of Commerce in the
Sacramento region of California. She saw it and became concerned.
So why are these ads out there that are on their face not truthful?
One reason: and that is to upset the seniors and to somehow give the
seniors false information about what this legislation does.
I got her straightened away. She is okay. Although when she sees this
red tie, the good Mary Jane McSorley is not going to be happy. But,
Mom, I have got a green carnation here.
Ms. SCHAKOWSKY. You know, a lot of us have been barraged with phone
calls like your mother said to you. She believed you, didn't she?
Mr. GARAMENDI. Oh, yes. I have been a truthful son.
Ms. SCHAKOWSKY. Good. And I hope that what you have said has now
convinced many others.
But it is really wrong, I think, to put out information that really
causes older Americans who are so dependent on Medicare, and that is
most of the people on Medicare that really rely on it for most of their
health care even if they have a supplemental, to tell them things that
just aren't true, that benefits in some way are going to be cut.
I want to introduce now someone who also has been a great advocate
for the constituents in her district and for older Americans, a great
friend of senior citizens, from Nevada, and that is Congresswoman Dina
Titus.
Ms. TITUS. Well, thank you very much. And thank you for your
leadership on this issue and for organizing tonight's discussion about
something that is so important.
Nevada has had the fastest growing senior population in the country
for the last decade. And even though we have slowed down a little
generally, that percentage is expected to continue. So you can imagine
what an important issue this is for me.
And, like Mr. Garamendi, my mother, too, is on Medicare. So I can't
imagine why anybody would think we would want to hurt Medicare benefits
when our own mothers are beneficiaries, along with so many other
seniors in this country.
I share your frustration, because I have had a lady following me
around to some of our town hall meetings wearing a T-shirt that says
``I am the grandmother you want to kill.'' She believed those early ads
about the death panels in the health care bill.
So there is an awful lot of misinformation out there that we need to
correct, and that is why a discussion like this is so important.
You know, generations of America's seniors have relied on Medicare in
their golden years, and we must ensure that it is there for them in the
future. This means that we need health reform, health care reform as
you have described on your chart there, that strengthens Medicare.
Rising health care costs threaten our current Medicare system, and we
need to be sure that it remains solvent. And we have to enact reform
that strengthens Medicare's financial footing and extends the lifetime
of the Medicare trust fund.
We also must bring down those prescription costs. We need to reduce
costs
[[Page H1578]]
for both Medicare and for seniors, individually, and close the doughnut
hole that so many of our seniors fall into, forcing them to choose
between life-saving medication and other necessities like buying
groceries or paying the power bill.
{time} 1930
It's because of my commitment to seniors that I was proud to support
the House health care reform bill, because in addition to the things
that I just mentioned and you all have been talking about, it also
benefited seniors by removing lifetime caps on coverage and included
free preventive care; in other words, no copays on important tests like
mammograms and colonoscopies. So I'm hopeful that these reforms will be
things that we can enact in the coming days, and I look forward to
seeing that final health care language to be sure that they're in
there.
You know, I'm dedicated to protecting Medicare, and I know how
important it is for the seniors in District Three. I would never do
anything that would reduce or undermine the care that they receive.
That's why I introduced legislation--and I appreciate all of your
support on it--that protected seniors from increases in their Medicare
premiums. It was called the Medicare Premium Fairness Act. We
introduced it last year. It would protect seniors from an increase in
their premiums.
In the past years, seniors have received a cost-of-living increase in
their Social Security to offset any increase in the Medicare premium.
Well, this year, for the first time in 35 years, seniors aren't
receiving that cost-of-living increase, meaning that higher Medicare
premiums would result in lower Social Security benefits, for a net
loss. For seniors on fixed incomes who count on every dollar just to
get by, this is unacceptable, because they will be receiving less in
Social Security. My bill would protect all seniors from an increase in
those Medicare premiums this year until the cost-of-living kicks in in
the future.
Unfortunately, and how many times have we seen this--and I'm
expressing my personal frustration, but also of this body, I believe--
one Republican in the Senate has held up the speedy passage of this
bill that's so important to seniors. This shouldn't be allowed to
happen because it's too important to happen in the lives of the
American people. So I'm going to continue to fight to see that that
bill becomes law and in a way that would be retroactive to help the
seniors who may have already seen those deductions kick in.
So thank you again for having this discussion. Medicare is critical
to the health and well-being of our seniors, and I look forward to
working with you on the senior task force to highlight and advocate on
these important issues that affect our senior population.
Ms. SCHAKOWSKY. One of the great things that you pointed out is that
Medicare was passed in 1965, but we continue to work to improve it, to
make it better, to even expand the coverage so that it is more
affordable for the elderly. This is a work in progress. It's really
been a job that has been the life's work of the Democratic Party for
generations to make sure that Medicare really does do what it needs.
When Medicare first came into being in 1965, prescription drugs were
actually a very small part of the whole health care cost. Now they are
at the center--front and center, often--of extending life, of making
life more livable, of preventing death, and so we work to find all the
ways that we can perfect what has been a very successful program.
I want to once again just make sure that people see the advantages to
older Americans, how health care reform means security and stability
for America's seniors, extends the life--that's what solvency means--
extends the life of Medicare, lower seniors' cost for prescription
drugs, improves the quality of seniors' care with better coordination
among doctors, trains more primary care doctors so there will be access
when we add more people to health care.
Some seniors are worried. Okay, add 30 million people to health care
coverage, are there going to be enough doctors? We say we've got to do
that. That's what is in this bill, to make sure that we train and
create incentives for more primary care doctors, and nurses, too, so
that we have the professionals that we need. Covering the cost of
preventive care for Medicare patients, you described that. That's for
things like mammograms and colonoscopies. No out-of-pocket costs.
Expand home- and community-based services to keep seniors in their
homes.
So the question really is: What is the Republican plan if they say
our plan is bad? Well, Paul Ryan, one of the up-and-coming Republicans,
proposed the plan. He's the top Republican on the House Budget
Committee, and he put forth what they call the roadmap. The Republican
roadmap wouldn't improve Medicare. It actually ends it.
Now you're thinking, Oh, this is all partisan. That can't be true.
But, actually, it is true. It would end Medicare, when they get to be
65, for everyone who is now under the age of 55. Once those people who
are under 55 get to be 65, instead of Medicare, they get a voucher. Go
out and find health care for yourself. And the Congressional Budget
Office, the nonpartisan Congressional Budget Office, reports that that
voucher over time would be worth about a quarter of what Medicare is
valued right now. The roadmap wouldn't require that private insurers
actually accept those vouchers or charge affordable premiums or provide
necessary benefits, making those vouchers pretty darn worthless.
Let me tell you what one of the expert groups said. This is the
nonpartisan Center on Budget and Policy Priorities: The Ryan plan
imposes no requirement that private insurers actually offer health
coverage to Medicare beneficiaries at an affordable price or at all.
Did you want to speak to that?
Mr. GARAMENDI. Let me just talk to that for a moment. This is
astounding.
Ms. SCHAKOWSKY. Tell them your background, too.
Mr. GARAMENDI. Well, I was the insurance commissioner in California
from 1991 to 1995, and then 2003 to 2007, so I've got 8 years as the
insurance commissioner in the biggest State in this Nation, with a lot
of seniors. Our seniors haven't grown quite as fast as our friend
talked about from Nevada, but in total numbers we are so much bigger.
Major, major problem for seniors.
You're looking at the most expensive part of the population, the
senior population, and it is absolutely true that the insurance
companies do not want to ensure people that are going to get sick.
Who's going to get sick? It's the seniors. And that's why Medicare came
into place, as was described earlier, because that population has the
most difficult time of obtaining insurance, and it happens to be the
most expensive part.
We figured out here how to provide it. The Republicans are going to
do what? They're going to give you a voucher. So if I'm 54 years old
now--let me see if this is correct. I'm 54, and if the Republicans had
their way, when I become 65 in 11 years, I don't get Medicare, which
provides me with a comprehensive policy that I can take anywhere in
this Nation. I can go to Maine and get the policy. I can go to
California and get the policy. I don't get that. I get a voucher, and
I'm going to go to an insurance company that I know does not want me
because they know that at 65 I'm going to be expensive.
Ms. SCHAKOWSKY. You've got that right. You would get a voucher.
Mr. GARAMENDI. This is the Republican program? Thank you, no.
Mr. HOLT. Let's be very clear. They are saying in this health care
bill, You want to cut Medicare. No. That's the point. We've been saying
over and over again, we're strengthening Medicare. What they want to do
is do away with Medicare, replace it with vouchers, or another term
that has been used in the past is ``privatizing.'' In other words, to
say, Well, you can take care of your health care. We'll even give you a
coupon. Now, the coupon is going to be of declining value over time,
but you're smart enough. You will have saved for your golden years and
you will be okay. That is what they propose to do.
Mr. GARAMENDI. You're suggesting you go back and take your privatized
Social Security savings? They're going to do away with Social Security,
too.
[[Page H1579]]
So they're going to do away with Medicare and Social Security, the two
programs that provide security for seniors. The Republican Party has
said clearly they want to do away with those. That's not where we are
as Democrats. This program, as Representative Schakowsky has said very
clearly, strengthens Medicare, extends its life for at least 5 years,
some would say 10 years.
Ms. SCHAKOWSKY. Nine years.
Mr. HOLT. The best estimate is 9.
Mr. GARAMENDI. We'll just take 5, 9, whatever. It strengthens it and
pushes it out so it has the financial strength, reduces the doughnut
hole by $500 immediately, and you get----
Ms. SCHAKOWSKY. And then eliminates it over 10 years.
Mr. GARAMENDI. And if you're a senior of low income and moderate
income, some of your prescription drugs are reduced by 50 percent.
Ms. SCHAKOWSKY. That's right.
Mr. GARAMENDI. This is a good deal, and yet we see the TV ads out
there scaring seniors that somehow this is a bad deal for seniors. This
program is a very good deal for seniors, wherever they happen to be,
and for every other American. We're talking about seniors here, but for
every other American they will get access to affordable, good quality
health insurance because of this legislation. Those are the facts.
Ms. SCHAKOWSKY. I think it's really important at this point to just
mention some of the things that do happen as soon as the bill passes. A
lot of people, one of the things that the Republicans have been saying
about this legislation is that, Well, you have to wait until the bill
takes effect for another 4 years. Well, that's true that a number of
the elements of the full rollout of the bill take 4 years, but a number
of things happen right away, and among those is the beginning to close
the gap in coverage, or the doughnut hole.
A lot of seniors out there are worried about their grandchildren.
This legislation, on the day that it's enacted, says that children with
preexisting conditions will not be excluded from health care. Imagine
if you have a grandchild with asthma or a grandchild with autism and
suddenly they're trying to get health insurance for the family. This
child will be covered. Imagine the relief it will take off of the
parents and the grandparents' shoulders if we're able to do that.
Lifetime caps. Many people have chronic illness and right away they
find that they have reached the limit of how much their insurance
company is going to pay.
Mr. GARAMENDI. These are the worthless insurance policies that are
sold across State lines today. They have a very low lifetime cap. You
get a serious illness and you blow through that and you have no more
health insurance from that company. Not only that, but now you've got a
preexisting condition and you can't get insurance from any company. The
legislation changes that.
Thank you for pointing that out.
Ms. SCHAKOWSKY. And annual caps----
Mr. GARAMENDI. That, too.
Ms. SCHAKOWSKY. Where people in the first few months of the year have
great expenses on health care and suddenly they find that they're not
going to be able to be insured any more. That's it. So we do a lot of
things immediately. I will get back to some more of them later, but I
did want to talk a bit about what we do.
Go ahead.
Mr. HOLT. I wanted to address another point that I hear from folks in
central New Jersey about a lot. They get letters from their insurance
companies saying Medicare is going to be cut. Again, it's
misrepresentation, and we want to clear that up.
Let me give a little history about Medicare Advantage. A number of
years back the insurance companies came to the then-Republican majority
in Congress and said, You know, the government is really inefficient.
We, the insurance companies, can provide the benefits of Medicare a lot
more efficiently than the government can. In fact, if you give us 95
cents on the dollar, we will provide benefits to Medicare
beneficiaries.
{time} 1945
Ms. SCHAKOWSKY. Plus additional things. We're so good at it.
Mr. HOLT. Right. We're so good and so eager to move services into the
private sector--in other words, to privatize Medicare. The then-
congressional majority said, Fine. Well, it didn't take more than a
couple of years before the insurance companies came back, tears in
their eyes, hat in their hands saying, Well, we can't really do it for
95 cents on a dollar. It's actually about $1.15 on the dollar. And
those who liked privatization said, Hey, that's still a great deal. So
right now we find ourselves where 20 percent of Medicare beneficiaries
are getting Medicare benefits, and we are paying insurance companies a
15 percent premium to provide those benefits.
Ms. SCHAKOWSKY. And who ends up paying for that?
Mr. HOLT. All taxpayers and the other Medicare beneficiaries. So yes,
those insurance companies, under this health care legislation, are not
going to get paid for doing no more than the Federal Government does at
a dollar on the dollar. We're not doing away with Medicare Advantage.
We're just saying, It's not going to be a giveaway for the insurance
companies. So they'll get a dollar's worth of payment for a dollar's
worth of services rendered.
Mr. GARAMENDI. Oh, that's so unfair to the insurance companies, that
you would take away their bonus for doing nothing more than you can do
in another system.
Mr. HOLT. Ask your seniors. About 20 percent of the Americans on
Medicare are a part of this Medicare Advantage program. Ask them how
many letters they have gotten from their insurance company saying that
the sky is falling and that if Congress goes through with this health
care reform, it will be curtains. Well, what it means is that there
will be fairness, once again, restored to the Medicare program. And the
Medicare beneficiaries will get a dollar's worth of services and
benefits for a dollar's worth of expenditures. That's the way it should
be.
Mr. GARAMENDI. That current unnecessary bonus that's given to the
insurance companies will be brought back and reinvested in the Medicare
program so that the Medicare program's solvency will be extended into
the future. So we're not taking that money away from the Medicare
program; we're taking it away from the insurance companies and bringing
it back to the Medicare program.
The senior Advantage program is not a free program for seniors.
They're paying for it. They're paying a premium themselves, and the
Federal Government is paying an unnecessary premium to the insurance
companies to do what doesn't cost any more in the regular system. So
it's a great savings. It's something that should be done. And oh, the
tears. The wailing and crying by the insurance companies.
Mr. HOLT. And it's based on a fallacy.
Mr. GARAMENDI. Yes, exactly.
Mr. HOLT. Because Medicare has low administrative overhead. It is an
efficiently run program.
Ms. SCHAKOWSKY. What is it, about 3 percent?
Mr. HOLT. It's a couple of percent.
Mr. GARAMENDI. It's about 2 percent.
Mr. HOLT. And Medicare's costs grow at a slower rate--at least they
have over the past 5 years--than the private health insurance for the
same benefits. So it's just another indication of the efficiency of
Medicare. Every year the government makes some changes. You know, ever
since 1965, there have been changes made from time to time about
Medicare to make it a more efficient program and to make it more
directed toward healthy outcomes for the seniors.
Mr. GARAMENDI. A big piece of what is going to happen in this reform
is that there will be a continuing study going on through the Medicare
offices and the Department of Health Services to find better ways of
treating seniors. You've talked about the home care, which we know is a
better way of doing it, the continuity of care. We know that over time,
new medical devices are found. New medical services are brought online,
and other services that have become obsolete are taken off the benefit
list, and new ones are brought on over time. That's the way it is
because medical services are constantly evolving and changing--drugs,
the kinds of services, the hospital services.
All of those things are evolving over time. So change is constant in
this program. And specifically in the legislation is an effort to bring
online those
[[Page H1580]]
new techniques and technologies that enhance the care of seniors. And,
I will also say, for other Americans. So all of us, as a major part of
the program, but specifically for seniors. And it would roll on.
Proven, clinically proven services, evidence-based services. And these
kinds of things save costs. Again, the insurance companies are going to
cry. The U.S. Chamber of Commerce is spending over $100 million in this
last month or two with advertising designed to kill the reform effort.
Ms. SCHAKOWSKY. Let's talk a little bit more about that, about why it
is that the insurance industry would be against this bill. Because you
could say, Well, 30 million more people are going to go into the
insurance market. Why wouldn't they want more people?
Mr. GARAMENDI. Because they are greedy, profit-driven, profit-before-
people-oriented companies.
Ms. SCHAKOWSKY. And also, they are able to pick right now.
Mr. GARAMENDI. Exactly.
Ms. SCHAKOWSKY. I want to talk a little bit about something else that
stops right away. And that's what is perhaps the meanest of all the
insurance company practices, and this is called rescission. Which in
plain English means canceling your health insurance when you get sick.
We had testimony in our committee from a woman who had been a nurse
most of her working life. She is now in her fifties. She left nursing
to start another kind of career, went out in the private market and
bought insurance that she could afford, thought it covered everything
she needed. Then she was diagnosed with very aggressive breast cancer.
She went to her insurance company. She got scheduled for the surgery.
The Friday before the Monday of her surgery--her name is Robin Beaton.
I will never forget her because we adjourned the committee for 5
minutes while she got herself together. And she said that on that
Friday, they called her and said, I'm sorry. We went back in your
medical records, and what we found is something on there that says that
you had a preexisting condition. And do you know what it was? There
were two things. One was acne that, of course, could lead to some sort
of a cancer cell. They said that she had lied about that. She didn't
even remember that.
Mr. GARAMENDI. She must have been a teenager at that time.
Ms. SCHAKOWSKY. And the other was that she had misstated her weight--
understated her weight. Now I make a little joke, like what woman
hasn't? You know, you have an accident, and people look at the driver's
license and say, Who is this woman? She is not 120 pounds. Anyway. And
so she was out of luck. She spent the next 9 months looking for health
care. Finally--actually it was her Congressman who convinced the
insurance company to do it. And by that time, the cancer had progressed
and was in her lymph nodes. So she was much sicker. That policy of
rescission will end on day one.
I see that we've been joined by someone else, Keith Ellison, a
Representative from Minnesota. I'm happy to turn it over to you. How
time flies.
Mr. ELLISON. To my extreme embarrassment, we're out of time. Support
health care. To the Congressman from California, thank you very much,
Mr. Garamendi.
____________________