[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.

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