[Congressional Record (Bound Edition), Volume 146 (2000), Part 13]
[House]
[Pages 18830-18836]
[From the U.S. Government Publishing Office, www.gpo.gov]



                       PRESCRIPTION DRUG COVERAGE

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 1999, the gentleman from Pennsylvania (Mr. Greenwood) is 
recognized for 60 minutes as the designee of the majority leader.
  Mr. GREENWOOD. Mr. Speaker, this evening, several of my colleagues 
and I want to talk about prescription drug coverage. I want to talk 
about one of the most important issues that this Congress is 
deliberating upon and one that we believe there is a solution to and 
particularly a bipartisan solution.
  I want to begin by reading from a letter that I received from a 
constituent of mine, a 70-year-old widow. She actually has some 
prescription drug coverage, but it is a $500-per-year limit, and this 
is what she writes: ``I am in pain daily, and I cannot correct the 
problems because of financial difficulty. I have stopped taking 
Prilosec, which cost $285 per month, Zoloft, which costs $100 per 
month, Lossomax, which also costs $100 per month, Zanaz, which costs 
$100 a month and Zocor, which costs over $100 a month. I need these 
drugs filled monthly and simply cannot afford them.
  I am also in need of a pain pill, Vioxx, approximately $89, and I 
have not been able to purchase it. I have cried myself to sleep over 
this dilemma.''
  Mr. Speaker, those words touched my heart when I read that letter, 
and that is why I have read it today, and I read it in many places 
across this country. My constituent does not care whether Republicans 
solve her problem or whether Democrats solve her problem or whether the 
Congress solves her problem or whether the President solves her 
problem. What she cares about is whether the pain goes away. What she 
cares about is whether the glaucoma that is making her eyesight weak is 
cured. What she cares about is whether she's depressed.
  We have an opportunity now, right now, still this year, to put people 
before politics and solve the problem of my constituent, and solve the 
problem of elderly women and elderly men and disabled men, women and 
children all over this country if we can provide a prescription drug 
benefit.

                              {time}  1515

  This House has passed a benefit. I just want to talk about how we got 
here. In 1965 the Medicare program was created and it was a milestone 
in American history. Prior to that time, if you became elderly and you 
lost your health care, you lost your job, you retired. Unless you were 
among the fortunate, you really were without and devastating illnesses 
shortened life and certainly lessened the quality of life for many of 
our elderly.
  So the Congress, in 1965, did exactly the right thing, created the 
Medicare program, a wonderful thing, a wonderful part of Americana. But 
in those days, I do not think they even really gave serious 
consideration to creating a prescription drug benefit. Why? Because 
prescription drugs were not used nearly as frequently as they are 
today, and also because they had just bitten off a pretty big piece, in 
terms of the cost and the complexity of the program, to assure 
hospitalization care, to assure doctors' visits were going to be paid 
for. It was a huge accomplishment.
  Now, in the 35 years that ensued between the creation of Medicare in 
1965 and today, our constituents have told us, with increasing 
frequency, with increasing poignancy, that they are making horrible 
decisions between choosing to pay for the prescriptions that their 
doctors tell them they must have and putting food on the table; between 
taking the three or four pills that they are prescribed per day or 
maybe only taking one because they are trying to stretch out their 
medicines, which really is not in the interest of their health.
  The Congress has not done anything. Congress has not done anything 
for 35 years. Why not? Well, the fundamental reason is because 
Congress, in most of

[[Page 18831]]

those years, was spending money like mad and plunging this Nation into 
what seemed like an irreversible dive into debt, adding hundreds of 
billions of dollars to the national debt every year to the point where 
the public debt was approaching $6 trillion. There was just no way for 
Congress to seriously consider adding a new entitlement to the Medicare 
program, no matter how important it was, when we did not have any idea 
how we were going to pay for what we were already spending here in 
Washington.
  Well, that has changed now; and since 1995 there has been a big 
change in this country. In 1997, we balanced the budget. In 1994, the 
Congressional Budget Office predicted that this year, I think that the 
deficit, the annual deficit that we would add to the national debt, was 
going to be something in excess of I think $240 billion or something 
like that. That was the projection. Today, because of the steps that we 
took in 1995, in 1996, in 1997, we balanced the budget and, in fact, 
this year, in 2000, we do not have a quarter of a trillion dollar 
deficit; we have a quarter of a trillion dollar surplus.
  Now, we took the next step, this fiscal year, we said and we will not 
spend another penny of the Social Security revenues for anything else, 
as Congress had done for years and years, except Social Security. We 
locked it away, and we still have this surplus. We are paying down the 
debt. We have surplus. We have given some tax relief where it was 
needed and now we are in position to provide this benefit, and we can 
do it.
  I have something in my wallet. It is a prescription drug card. I take 
a prescription for my cholesterol level, and when I go to the drugstore 
to fill out my prescription I take this little card out of my wallet 
and I give it to the pharmacist and the pharmacist gives me a 
prescription, and I give the pharmacist a few dollars in copay for that 
prescription. When my wife needs her prescriptions filled or my 
children are sick, we do the same thing. I am a fortunate man. My 
family is fortunate.
  But every American in this country needs to have one of these. Every 
American, particularly the elderly, I mean I have one prescription, but 
my 70-year-old widowed constituent has numerous prescriptions, 
obviously, and she does not have one of these, except that it is good 
for $500 for the whole year. Mine is good all year around. The bill, 
the legislation we passed in this House earlier this year, would make 
sure every American senior and every disabled Social Security 
beneficiary has a card just like this to take to the drugstore to 
provide for their drugs. That is what we are going to talk about this 
evening.
  Mr. Speaker, I am going to next yield the gentleman from Pennsylvania 
(Mr. Sherwood), my distinguished colleague.
  Mr. SHERWOOD. Mr. Speaker, I am very grateful to my colleague, the 
gentleman from Pennsylvania (Mr. Greenwood), for arranging this 
opportunity to discuss the importance of making prescription drug 
coverage available to all older Americans. I see it as really vital to 
the health and well-being of seniors throughout the Commonwealth of 
Pennsylvania and all across the country, and that is why I voted for 
the Medicare Prescription 2000 Act, H.R. 4680 when it passed the House 
in June of this year.
  In Pennsylvania, we are very fortunate to have the PACE program and 
the PACE Net program, which is available for low-income seniors. I am a 
strong supporter of the PACE program, which was enacted in 1984 by the 
Pennsylvania legislature and is administered by the Department of 
Aging. I know just how vital the PACE program is to those Pennsylvania 
seniors who qualify, but I also recognize that there are many 
individuals who have exorbitant prescription drug bills and limited 
incomes and are not covered by PACE.
  For that reason, I supported H.R. 4680, which helps States with 
pharmacy assistance programs and allows them to expand coverage to more 
seniors.
  For instance, PACE today, the State pays $205 million for people of 
low income. Then the State has $131 million annually for low- to 
moderate-income people. Now, PACE tomorrow, with the addition of the 
money for our prescription bill, would mean that the Federal Government 
would pay that $205 million that PACE was picking up for Pennsylvania's 
poor and low income.
  So the State then would have $336 to spend for low- and moderate-
income. So what would happen, the Federal Government would take over 
the prescriptions for the very limited-income Pennsylvanians, and the 
Pennsylvania program then could be a great help to the middle class.
  New Federal subsidies would allow governors to expand popular State 
pharmacy assistance programs to the middle class. The Republican 
Congress can really take credit for creating these subsidies. The bill 
we passed in the House allows States flexibility to take advantage of 
these new Federal subsidies.
  Speaker Hastert wrote to Governor Ridge to advise him that there 
would be a seamless transition to all seniors and the disabled to this 
new pharmaceutical assistance program. Our delegation is working 
closely with the leadership to assure that all Pennsylvania seniors 
have access to affordable, voluntary prescription drug benefit.
  All the costs incurred by the PACE program, for those under 135 
percent of poverty, would be picked up by the Federal Government under 
our new plan. Any costs incurred after $6,000 are picked up by the 
Federal Government. States are completely off the hook for the big 
expense and the low-income people. For beneficiaries of 135 percent to 
150 percent of poverty, there is a partial subsidy and it allows States 
like Pennsylvania, New Jersey and Connecticut to greatly expand their 
coverage to the middle class.
  This new Federal benefit goes into effect in 2003, giving our 
governors the time necessary to make any changes to their State 
programs. The bipartisan bill transfers financial liability for the 
millions of dually eligible beneficiaries from medicaid to Medicare, 
giving the governors $22.8 billion, that is billion with a ``B'' in 
additional funds to expand drug coverage.
  The substitute bill sought to keep prescription drug coverage as a 
financial responsibility of the Medicaid program for which States must 
fund half the cost. Nothing in our bill 4680 prevents the States from 
funding senior access to any pharmacy. This is a cost already incurred 
by State pharmacy assistance programs.
  My colleagues and I are totally committed to enacting a Medicare 
prescription drug benefit program which will allow seniors to take full 
advantage of a subsidized plan to hold down drug prices. The folks in 
this country that pay the most for a prescription are the ones that go 
in and buy it on their own without having the benefit of being in any 
plan. So that card that my colleague, the gentleman from Pennsylvania 
(Mr. Greenwood), held up a few minutes ago, if we all had access to 
that, that means that all prescription drugs to seniors would most 
probably be reduced in price from 25 to 40 percent. That, in addition 
to these subsidized benefits is real progress for our seniors.
  Prescription drugs for seniors is far too an important issue to be 
playing partisan politics with. We owe it to our seniors to have a plan 
which is voluntary, affordable and available.
  My colleagues and I are totally committed, before we go home this 
year, to having such a plan enacted.
  Mr. GREENWOOD. Mr. Speaker, the gentleman from Pennsylvania (Mr. 
Sherwood) has made a really important point here on the floor of the 
House with regard to our State of Pennsylvania. If we take the 
legislation that we passed and match it to our current program, our 
PACE program, which by the way is the best program in the whole 
country, there are, I think, 300,000 low-income seniors in Pennsylvania 
who receive almost virtually cost free drugs under the PACE program 
financed by our lottery, the PACE Net program elevates the standard, so 
with some copay even more middle-class Americans, Pennsylvanians, I 
should say, get the benefit.
  And the legislature, because the State of Pennsylvania also has a 
surplus, has just proposed even raising the levels higher to reach into 
the middle

[[Page 18832]]

class. So by the time we take this Federal legislation that we have 
passed here and relieve the State of Pennsylvania, our State, of the 
burden of the lowest income and then you add all of those new State 
dollars and the existing lottery dollars to that, we will have 
virtually cost free or certainly no premiums, no copays, no deductibles 
for a very significant portion, well up into the middle class, in 
Pennsylvania, and so it makes these benefits completely affordable to 
every one of our constituents.
  I know that the gentleman from Pennsylvania (Mr. Sherwood) shares 
that.

                              {time}  1530

  Mr. Speaker, I yield to the gentleman from Pennsylvania (Mr. 
Sherwood).
  Mr. SHERWOOD. Mr. Speaker, I think what is so important about H.R. 
4680 is that it is a flexible plan so that it fits with what we have in 
Pennsylvania. Because as the gentleman said, we have this wonderful 
PACE program, when the Federal Government picks up the part of the 
program that PACE has handled, then Pennsylvania, as I described 
before, has all of this extra money to make PACE a wraparound program 
so that it comes up into the middle class.
  I have so many constituents that have worked hard all their lives and 
they have done everything right, and they own their home, and they have 
saved just a little money, and they have their Social Security benefit. 
If nothing catastrophic comes along, they can get through their golden 
years pretty well. But they all live in fear of a catastrophic illness 
or catastrophic prescription drug cost, which would drain down their 
resources and lose their nest egg or force them to sell their home to 
pay these bills.
  This is a program that removes that fear for senior citizens. By 
supplementing the PACE program, it takes care of a great deal more of 
their prescription costs, and it also puts an absolute cap on the top, 
so that no senior should have to worry about losing their home because 
of the very high cost of prescription drugs.
  The other thing it does is akin to a group purchasing power. As I 
said before, people who pay the most are the people who walk up and buy 
their pharmaceuticals cold turkey and pay with their own money. Anybody 
that is a member of a buying plan buys them at a reduced rate.
  We have heard in the discussion that pharmaceuticals sometimes cost 
less in other countries than they cost here. That is a very involved 
discussion, but we need to pull the costs down here. One way that H.R. 
4680 will do that is by the group purchasing power. If we take all 
pharmaceutical costs and reduce them by 25 to 40 percent before the 
government has to step in and pick up their share, then the 
government's money, your money, goes a lot further.
  So this plan has some very good points to it. It is voluntary. If one 
has a plan through one's former employer or through one's union that is 
superior, one does not have to leave it. One can stay with that and not 
be charged anything because they voluntarily did not get in the plan. 
If this is a better plan than someone has, one can join it. If one is 
low-income, it will take care of all of their prescription costs. If 
one is middle-income, it will take care of a great many more of them 
than they have ever had the opportunity to do before, and it will have 
a level above which they have no responsibility.
  Mr. Speaker, I think that the merging of our plan and PACE and 
PACENET in Pennsylvania would take very good care of our citizens. I am 
very proud to be associated with it.
  Mr. GREENWOOD. Mr. Speaker, I thank the gentleman. The fact is that 
two out of three of our elderly, as the gentleman mentioned, already 
have some kind of coverage. Some, as we have mentioned, have coverage 
through the PACE program. Others who are so low-income that they 
qualify for Medicaid get their drugs through the Medicaid program. Some 
have a fee-for-service Medicare program, and then they buy a Medigap 
insurance that in many cases provides prescription drugs; and others 
have a Medicare HMO, we call it Medicare+Choice, and they get their 
Medicare benefits through an HMO and many of those HMOs have been 
providing a prescription drug benefit.
  The problem, as the gentleman well knows, because he has had me to 
his district to visit his district and to discuss this problem and its 
solution, the problem is that the Medicare+Choice programs have been 
ratcheting back their benefits. They have been providing, they used to 
provide relatively generous prescription drug benefits, but they are 
pulling back. They are pulling back because they feel that the 
Congress, frankly, and the administration has not been providing 
sufficient funds to pay for the full health care benefits of today's 
seniors in managed care Medicare.
  So then the gentleman and I understood that both in my district and 
in his district and throughout Pennsylvania and throughout the country, 
many of these plans announced, just in July, that they were going to 
leave areas.
  Mr. SHERWOOD. Mr. Speaker, there is a very serious problem in my 
district in northeastern Pennsylvania. It is inequitable. The formula 
was set years ago, and then it has grown over the years; and it is now 
that the HMO Plus Choice plans in my most rural counties are reimbursed 
at the rural national rate, and that is approximately $400 a month, and 
in the larger cities, the rate is over $700 a month.
  So what it boils down to is that my rural constituents are going to 
be denied a benefit under Medicare that people that live in more urban 
areas have the benefit of. So this is a basic unfairness in the system. 
I have written HCFA, and I have written the President to try and solve 
this problem, and my colleague and I have a bill together to try and 
solve it, and there are some other bills coming out; but that is very 
important that we make sure that problem is solved before we go home by 
election time. Because it is basically unfair that a senior that lives 
in Bradford County, Pennsylvania, should not be able to get the same 
benefit under Medicare that a senior who lives in Philadelphia County 
in Pennsylvania, or in Washington, D.C., or Houston, Texas, or Miami, 
Florida.
  So I have a great many people in my district that receive these 
notices. I think there are approximately 30,000 people in my 
congressional district that were informed in July that their 
Medicare+Choice provider would cease to do business under the plan on 
the first of January.
  Now, we have asked those Medicare+Choice providers to reconsider, to 
wait until we can do something, and I have written to the administrator 
of HCFA to ask that that date be moved out so that it can be solved. 
But we have to get enough funding to the rural areas that people who 
live in rural areas have the same benefits under Medicare as people who 
live in urban areas.
  Mr. Speaker, it goes back to something that was said earlier. Seniors 
do not care whether the Congress solves it or the President solves it, 
and they do not care whether it is prescription drug prices or HMO Plus 
Choice. It is all health care; it is all health care costs. We need to 
continue to work to make health care more available and more affordable 
for seniors.
  This plan, H.R. 4680, goes a long way towards that. But we will have 
to complement that with some legislation like the gentleman's which 
will solve or help to solve the flight of the Medicare+Choice 
providers.
  Mr. GREENWOOD. Mr. Speaker, if I may, the legislation is ours. I 
serve on the Subcommittee on Health of the Committee on Commerce, and 
it was the gentleman who came to me and said this is a real problem in 
my area; this is a real serious matter, and we put our heads together 
and we wrote that legislation.
  The fact of the matter is, and I do not think the gentleman is even 
aware of this, but it is my expectation that on Tuesday of next week, 
yours and mine, will be taken up by the Committee on Commerce, by the 
full committee, will be part of a comprehensive bill to try to restore 
a variety of payments, probably $21 billion into the

[[Page 18833]]

Medicare program to help our hospitals, to help our nursing care 
facilities, to provide better benefits for home health care, as well as 
to expand the likelihood that these HMOs will be able to stay in place 
and continue to offer that benefit.
  So I am cautiously optimistic. I am actually very optimistic that, as 
the gentleman says, we will do that. We recognize the problem in your 
area and in mine and throughout the country, and we will hopefully 
report that legislation from committee on Tuesday. It will pass this 
House of Representatives, it will be signed by the President, and we 
will have made a real difference.
  Mr. Speaker, it is my fervent hope that those health insurance plans, 
those HMOs that provide the Medicare+Choice benefit all over the 
country, once that is done, will be able to reverse the decision that 
they made, that they announced in July, because they have to do it in 
July, according to law, we require them to make that announcement; but 
they will be able to reverse this judgment and continue to provide 
service, good quality health care for our seniors in the gentleman's 
district and mine.
  Mr. SHERWOOD. Mr. Speaker, that is very good news, and I thank the 
gentleman for continuing to work that bill with the Committee on 
Commerce, because I have made the pledge to my seniors that I will do 
everything in my power to get the HMO plus choice providers to stay in 
our area.
  That is one of the big problems. Health care in rural areas is short 
of money, short of resources; and I have worked with local hospitals to 
fund the blend and to do all of the things that they need to do to 
remain viable, that is, to keep our medical institutions strong. This 
bill would help keep a service to our older Americans that live in 
rural areas that they deserve. I think we will have to be flexible in 
that, and we will have to make sure that there are enough resources 
there that the program works.
  Mr. Speaker, I think there has been nothing since I came to Congress 
that has been as hard for me to get my arms around as health care has 
been. Being a businessperson all of my life, I always thought that I 
could understand any program and put it together very quickly. Well, 
our health care system is very, very complicated. The rules that 
administer it under HCFA have grown over a period of time, and some of 
them need changing. This is one that certainly needs changing, and I 
thank the gentleman for his efforts; and we will be glad to push that 
bill through.
  Mr. GREENWOOD. Mr. Speaker, I thank the gentleman from Pennsylvania 
for participating in this special order this afternoon and for all of 
his hard work on behalf of his seniors in his district. He must be 
known for that one thing in his district, because he sure talks about 
it here in the whole of the House.
  We are joined tonight by another of our colleagues who wants to 
participate, fortunately, in our special order, the gentleman from 
Tennessee (Mr. Bryant). And I yield to him at this time.
  Mr. BRYANT. Mr. Speaker, I thank the gentleman from Pennsylvania who 
certainly has taken the lead in this very important legislation in the 
House and has been there from day one to get it started and to 
participate and lead us down the road, and as we pass this bipartisan 
bill out of the House, has been a consistent proponent of it, a 
spokesman, a worthy advocate of this bill. Certainly the background and 
the experience he brings to this House on this issue and coming from a 
State like Pennsylvania, which has an outstanding program, certainly 
cannot be lessened in any degree and must certainly be valued.
  Several months ago, the gentleman from Illinois (Mr. Hastert), the 
Speaker of the House, appointed a task force of House Republicans to 
study this issue of prescription drugs and Medicare. Along with the 
gentleman from Pennsylvania (Mr. Greenwood), I was privileged to serve 
on that task force; and we worked very diligently over a long period of 
time with the Committee on Ways and Means and the Committee on 
Commerce, the two primary committees that have jurisdiction over this 
issue, and brought forth under the Speaker's very direct, hands-on 
leadership, a bill that ended up being a bipartisan bill in the sense 
that it had both Democrat and Republican support. It had more 
Republicans than Democrats, quite honestly; but there was support from 
both sides of the aisle, although now, that party, the Democrat Party, 
has their own separate bill that is very different, that is the 
President's, the administration's bill that is very different than 
ours; and I will talk about that more in a minute.
  But the Speaker's task force was charged with developing a fair and 
responsible plan to help seniors and disabled Americans with their drug 
expenses. We started with a set of principles that the Speaker gave us. 
He wanted a plan that was a voluntary plan, a universal plan that was 
available to everyone and affordable, and affordable, to all of the 
beneficiaries. He wanted to give seniors meaningful protection, some 
real protection and bargaining power, the ability to use the numbers, 
the bulk in purchasing, to achieve lower prescription drug prices, and 
he wanted to make sure that we preserved and protected all Medicare 
benefits that seniors currently have.
  Finally, the Speaker wanted an insurance-based, public-private 
partnership that set us on a path toward a stronger, a more modern 
Medicare, and which would extend the life of the program for my baby 
boomer generation, and beyond that even.

                              {time}  1545

  Coming up with a good plan that fits all of these guidelines and 
principles that the Speaker laid out was a very tall order. The 
bipartisan Medicare Prescription RX 2000 legislation, in my view, does 
follow these guidelines, and I believe it is the right approach.
  First, our plan provides prescription drug coverage that is 
affordable. Seniors in my district and across the State of Tennessee 
that I represent have been writing and calling me asking for help with 
their high drug costs. We will help more people get prescription drug 
coverage at lower cost by creating, through this plan, the power of 
group purchasing, group buying, without price fixing and without 
government control, something we really, really do not want in this 
process.
  For the first time, Medicare beneficiaries will no longer have to pay 
the highest prices for prescription drugs if we effectively use this 
bulk purchasing power. Under this proposal, seniors will have access to 
the same discounts that the rest of the insured population presently 
enjoys.
  An analyst for the Lewin Group concluded after studying this private 
market-based insurance policy, they concluded that it could reduce 
consumer prescription drug costs by as much as 39 percent, 39 percent. 
That is 39 cents on every dollar.
  Also, our proposed bipartisan plan strengthens Medicare so that we 
can protect seniors against out-of-pocket costs that are very high, 
that threaten the beneficiaries' health and their financial security. 
In other words, sometimes people have such high drug costs that they 
literally, seniors do, literally have to sell their home, they have to 
exhaust their lifelong savings to pay these drug costs. This should not 
be.
  Our plan sets forth a monetary ceiling beyond which Medicare would 
come back in and pay 100 percent of the drug cost of these high cost 
expenses over that ceiling.
  Second, our plan is available to all Medicare beneficiaries. Our 
public-private partnership ensures that drug coverage is available to 
everybody who needs it, by managing risk and lowering premiums. The 
plan calls for the government to share in insuring the sickest seniors, 
those that have those extraordinarily high drug costs, thereby making 
the risk more manageable for the insurers and lowering the premiums for 
every other beneficiary, which is something that will be very 
attractive to our senior citizens.
  We protect the most vulnerable citizens by providing the 100 percent 
Federal assistance for the low-income beneficiaries. In other words, 
those seniors that cannot afford to pay these

[[Page 18834]]

premiums at the lower end get their premium subsidized 100 percent by 
the government under our plan.
  Thirdly, our plan is voluntary and provides seniors the right to 
choose the coverage that best suits their needs. Beneficiaries would be 
able to choose from several competing drug plans. Also, because the 
drug benefit is 100 percent voluntary, it preserves the beneficiaries' 
right to keep the coverage they already have.
  I cannot tell my colleagues how many times I go home and I start 
talking about this, this plan, and somebody stands up and says, listen, 
I do not want the government taking away the present drug benefit I 
have. I am retired. I like the plan I have got. I do not want this one-
shoe-fits-all type government response that you are talking about.
  I tell them, well, that is not what we are talking about here. Our 
plan is voluntary. If one likes what one has, then one can keep that. 
But if one is among those 35 percent of American seniors who do not 
have any drug coverage, this is certainly a good solution for one.
  I could go on and talk about this. I think I have adequately covered 
what I wanted to cover about this plan. I could talk about the 
President's plan and how it is a good start and it moves us along the 
right direction, but it lacks so many of the good parts of our plan, 
that our plan is superior. But we believe that if the White House has a 
sincere interest in providing a prescription drug benefit to senior 
citizens, that they will be willing to begin to work with us and we, as 
a Congress, work with them, a commitment that we made a long time ago, 
and we can come up with a plan that I think that will be beneficial to 
our senior citizens.
  But right now I do not think we sense that willingness, or I am not 
sure how I would put that, but maybe it is an election year. I do not 
know.
  Mr. GREENWOOD. Mr. Speaker, it certainly is an election year. I think 
the thing some of us find so discouraging is we have a tendency 
sometimes to take our eye off the ball and remember that these are real 
people out there.
  I read a letter from a real constituent who, in her letter, said she 
cries herself to sleep because she cannot afford the medicines. That 
story is repeated all over this country. The wealthiest country in the 
world, the most powerful Nation in history, and we have our 
grandmothers who are making these painful decisions, and they are 
suffering from arthritis. They are suffering from all kinds of health 
problems because they do not have access to these prescriptions.
  Now, we did pass a bill. It happens to be the gentleman from 
Tennessee (Mr. Bryant) and I are Republicans, but the bill is a 
bipartisan bill. It had both bipartisan sponsors as well as both 
Republicans and Democrats that voted for it. It is, I believe, the only 
comprehensive prescription drug add-on for Medicare that the Congress 
has ever passed. It is our bill, and we passed it, and that is 
terrific.
  Now, we happen to like our plan better than some of the other bills, 
and that is what one would expect in a democracy where one has the 
lively debate of issues and different points of views and philosophies.
  But what troubles me, frankly, is that what tends to happen, because 
it is an election year, is people say, well, let us take a look at 
their bill and see how many holes we can punch in. Let us take a look 
at their bill and see how many holes we can punch in that. Then we can 
use it in the campaign and see who gets elected to President over this 
issue and see who gets elected the majority in Congress over this issue 
and see how many Republicans and Democrats we can knock out of office 
over this issue. That is pretty cynical, and it does not do the issue 
justice.
  I still believe that if President Clinton wants to, that we can sit 
down and we can find the common ground and we can split our differences 
and we can take the best issues, the best ideas from each side and at 
least solve a good portion of this problem in this year and, if we do 
not solve it all to everyone's liking this year, to continue that next 
year. But we ought not to lose this rare opportunity.
  We are finally one Chamber, the House of Representatives has passed 
the first bill to provide this prescription drug benefit.
  Mr. BRYANT. Mr. Speaker, will the gentleman yield?
  Mr. GREENWOOD. I yield to the gentleman from Tennessee.
  Mr. BRYANT. Mr. Speaker, let me echo what the gentleman from 
Pennsylvania is saying. I was a late baby. My mother is actually 93 
years old and will be 94 her next birthday. The medical technology is 
great. A couple of years ago, she had a pacemaker put in, I think, 
about age 91 or 92, and she is rolling strong again. She has to take 
medication as a result of that, and, fortunately, for her, it is not 
too expensive, and she can pay for that.
  But I think about all those other folks out there who are not as 
fortunate as we are as a family that have these kinds of prescription 
drug benefits that they really need or even higher costs that they have 
to incur and literally in some cases have to pick between paying other 
bills and having their medication filled.
  As the gentleman from Pennsylvania (Mr. Greenwood) pointed out, this 
is the first Congress that has passed this type of bill. Here we are 
literally within reach of getting a bill that can help so many people 
and yet, unfortunately, it seems like the politics are out there 
involved in it. It is going to happen at some point, but it needs to 
happen now, this year, and not be politicked to death.
  I see the gentleman from North Carolina (Mr. Burr) is here to talk a 
little bit about that. He is another expert on that subject. I am going 
to quit talking now and yield back to the gentleman from Pennsylvania 
(Mr. Greenwood) and thank him for what he is doing today and thank both 
of these gentleman for the work they have done on this very worthwhile 
project.
  Mr. GREENWOOD. Mr. Speaker, I thank the gentleman from Tennessee (Mr. 
Bryant) for his contribution and his very great work in the committee.
  We are joined now by the gentleman from North Carolina (Mr. Burr), 
another colleague of mine from the Subcommittee on Health and 
Environment of the Committee on Commerce, who really does work very 
hard day and night on this issue.
  Mr. Speaker, it is a pleasure to yield to the gentleman from North 
Carolina (Mr. Burr).
  Mr. BURR of North Carolina. Mr. Speaker, I thank the gentleman from 
Pennsylvania (Mr. Greenwood) for yielding to me.
  The gentleman and I have done this numerous times. We did it when it 
was not popular to get out and talk about the expansion of a benefit. 
But because both of us worked 2\1/2\ years on reforming the Food and 
Drug Administration, we understood from that process just how many 
people in America were relying on the research and development that not 
only public entities but private companies were doing.
  We understood the great advances we had made in the last 30 years in 
this country in treatment of disease, prevention of disease, through 
the use of pharmaceuticals that did not exist in the 1960s when we 
created Medicare.
  It is not hard for me to believe that, when Medicare was created, 
Republicans and Democrats, neither one perceived that prescription drug 
coverage was a benefit that should be encompassed in it. But we have 
also seen through the evolution of Medicare that today the Health Care 
Financing Administration is, in fact, the wrong agency for us to look 
to to administer a new drug benefit.
  I think that is why many of us took on the great challenge of, one, 
being the first to talk about expansion of a drug benefit for seniors, 
but to, two, do it in a way that addressed what we saw the problems in 
the delivery system, that we needed a new entity whose sole job it was 
to administer this benefit to the 37 million Americans, those seniors, 
the disabled who qualified for Medicare benefits.
  It is a shame that it is an election year. If this was not a 
Presidential election year, we would have a drug benefit, not only 
passed in the House of

[[Page 18835]]

Representatives, it would be passed in the Senate, it would be signed 
today by any President in the White House. But the sheer realities of 
the year 2000 is it is a Presidential election year. The gentleman and 
I have been faced with that before. But because it is a Presidential 
election year, it means that politics do come into health care.
  At a time where we know in America that the senior population over 
the next 10 to 15 years will double, will move from 37 million to 72 
million seniors in this country, all with the same challenges about how 
do I pay for prescription drugs, at a time that the mapping of the 
Human Genome project will be finished, we will be able to treat 
diseases that were chronic or terminal up to that point, we never had a 
cure for, and that in many cases those pharmaceuticals will now give us 
the ability to treat and in some cases hopefully cure, but it does no 
good if people cannot pay for it.
  This is the first real opportunity that we have had to present a plan 
that is market based, that subsidizes those most at risk, that is 
designed in a way that the majority of seniors would want to 
participate out of their pocket to be part of, and for those that 
cannot, that they receive a government subsidy; and that it provides 
them the choice that they look for in any health care plan that they 
might look for when we created Medicare+Choice as an option for seniors 
who had an insurance-based option, many of which are in Pennsylvania 
with the gentleman from Pennsylvania (Mr. Greenwood). We did not limit 
it to one company. We did not say it could only be offered by the 
Federal Government.
  The American people have been very specific. One size fits all does 
not work in health care. Drug benefits should be no different. We 
should supply seniors affordability, choice, access. The sooner we can 
do that, the better they can plan for those later years. But, more 
importantly, long term, the gentleman from Pennsylvania and I both know 
the less expensive health care is going to be to us, because what we 
have been treating or what we have been operating on today might just 
be a prescription drug in the future.
  Heart disease because of high blood pressure is controllable with 
pharmaceuticals today. Bypass surgery could be a thing of the past with 
a noninvasive procedure or with pharmaceutical treatment in the future. 
We will never experience this unless this body, this institution, the 
government moves forward with a prescription drug benefit plan that 
allows seniors access, choice, and affordability.
  Mr. Speaker, I would appreciate the observations of the gentleman 
from Pennsylvania (Mr. Greenwood) on that.

                              {time}  1600

  Mr. GREENWOOD. The point that I was thinking about making right now 
is that this conversation almost always turns towards the senior 
beneficiary of Medicare, and the gentleman has frequently in his 
remarks cojoined the fact that there are seniors and there is the 
disabled population that in fact are eligible for Social Security. And 
what is important to remember, when we think about that disabled 
community, that disabled community includes those who have very serious 
physical disabilities, frequently because of complicated and 
debilitating illnesses; and these are people who are under the age of 
65.
  We forget about the fact they do not have prescription drug benefits 
either. And they are less likely to have prescription drug benefits 
coming from a an employer, because they are less likely because of 
their disability, obviously, to have worked for an employer long enough 
to have had a prescription drug benefit that carries into the years 
when they cannot work and they are on disability. So this is another 
group of people who certainly need this benefit and they need it soon.
  And some of those, a good number of those, their disability is the 
result of a mental health issue, and of course the treatment of mental 
illness is more and more pharmaceutical. There are more drugs coming on 
to the market all of the time that can help with these serious 
debilitating mental illnesses and in fact help those folks get back 
into the workforce. So our ability to provide a prescription drug 
benefit that also provides the benefit to the disabled population as 
well as the senior population is an important component of what we did 
pass in this House, and I commend the gentleman for remembering to 
remember that Medicare applies to the disabled as well as to the 
elderly.
  Mr. BURR of North Carolina. I know the gentleman from Pennsylvania 
remembers that it would have been easier with a limited pot of money to 
say let us take care of seniors. Those other ones who might be 
ancillary groups, they do not fall into the same category. There was 
that strong argument from Members, but also that sense of 
responsibility that we had that we cannot leave anybody behind.
  This was the most inclusive piece of legislation on prescription 
drugs to be debated in this institution ever. The only regret that I 
have is that it did not yet move past the House of Representatives; 
that we have not had the engagement of our friends at the other end of 
Pennsylvania Avenue, who talk about prescription drugs; but we have 
done something on prescription drugs.
  We have done something that works. It expands the coverage and it 
provides the benefit. It means that those seniors who have had to make 
crucial decisions between rent and drugs, food and drugs, will not have 
to do it because of limited incomes. It means that we have looked at 
that disabled population. We have not excluded them. In many cases 
seniors have more employment opportunities than those who are in that 
disabled category, but we did not leave them behind. We included them 
because we knew the importance of medication but, more importantly, the 
importance of taking medication on a regular basis; not just when you 
can afford it, but on a regular basis. Because we know that those 
individuals, more than most, need that regular routine and that they 
cannot go with interruption based upon their cash flow, their lack of 
work that week, their lack of income that month. That safety net was 
provided for them, as it was for seniors.
  I cannot imagine another issue that this institution could take up 
where we so clearly had enough vision to look down the road and see the 
demographic change that was happening, where we knew that the senior 
population will, in fact, double; where the institution did not use 
that vision to prepare for that future. If we miss this opportunity, 
how in the world will we design a benefit program that is right for my 
mother and that is affordable for my children when we are talking about 
twice as many people and having to learn how to find the right program 
then?
  The smart thing for us to do, even though the gentleman and I know 
that we will not do it this calendar year, is to come back in January, 
to reintroduce this bill, and to make a commitment to whoever is on the 
other end of Pennsylvania Avenue that we are going to pass it and that 
we want to work with them.
  Unlike a lot of talk about prescription drugs in this town, for those 
of us that have worked on it now since January, we have always said our 
door is open; we want to talk. It is just nobody has ever knocked. And 
when we have left it open, no one has ever shown up.
  Mr. GREENWOOD. If I can reclaim time for a moment, the thing that is 
ironic is that, as we have said, in the history of the Congress, 
certainly in the last 35-year history of Medicare, it is only the one 
bill the gentleman and I helped to author that has passed in the House.
  Now, there has been plenty of talk for 35 years from politicians on 
the stump running for this House and the Senate and the presidency. 
They have all talked about this issue. But when it came to sitting 
down, as we did, and saying how would we actually write this; what 
would the words be that we would choose to put in the bill; what would 
the provisions look like; how would we pay for it; how would it be 
flexible; how would we be able to make it affordable to the lower-
income and still be affordable to the taxpayers; how does it reach into 
the middle class; how would we take care of the catastrophic end of 
things; how do we make

[[Page 18836]]

sure it is appropriate for the disabled population as well; how do we 
make sure that by offering this we do not create a disincentive for 
employers to continue to provide the benefit; how would we do that, we 
grappled with all of those questions, as the gentleman knows, and we 
had to make decisions.
  We put those decisions into a document and we said, now, can we get 
218 votes out of 435 Members of the House to pass it. That meant we had 
to talk to various constituencies within the House to make sure that it 
worked in the Northeast, and that it worked in the Southwest, and it 
worked in the Southeast and the Northwest, and across the country. We 
had to do that. But when we did that, we had a document and, of course, 
no good deed going unpunished, we become subject to criticism. Because 
now people had an actual document instead of just words, and they could 
take that document, and they could look at it, and they could criticize 
this aspect or that aspect.
  I think that that is what has happened, to a large extent; and I 
think that is unfortunate, that having put something together for the 
first time in history and getting it to pass the House, that we have 
become subject to some criticism about all of that. The hard part for 
us is that right now the President does not have a proposal. We do not 
have a bill from the President that says on paper, a document that 
thick, this is how I would answer all those questions about making sure 
that it is affordable and making sure that it meets all of these needs. 
We do not have that. So we have a real document against just rhetoric, 
and it is making for an unbalanced debate.
  I think if we can get the Members at the other end of this building, 
as well as the gentleman at the other end of Pennsylvania Avenue in the 
White House, to in fact give us some documents, we would have the basis 
about which we could sit in a room and combine them and merge them and 
work out the differences, as we do regularly and is our job.
  I yield to the gentleman from North Carolina.
  Mr. BURR of North Carolina. As the gentleman from Pennsylvania knows, 
it is one thing to talk about catastrophic coverage, which is the 
ability to look at the senior population and say the one thing that we 
can do is put the Federal Government where it should have been in 
health care, the safety net, and assure our seniors that if they ever 
spend out of pocket a certain amount of money in a given year that they 
will never be exposed for any more than a fixed amount, catastrophic 
coverage, a limit. It is one thing to talk about it; it is another 
thing to put it on paper and to pass the test of the Congressional 
Budget Office or the Office of Management and Budget and have that 
number scored. But we did it. We did it and we lived within the 
framework of the available money, and we provided a stop loss for 
seniors of $6,000.
  The President had a bunch of pieces of a plan, and he said he would 
like to incorporate stop loss or catastrophic loss, but the fact is 
that he could never do it in a way that he could put it on paper and 
have that paper scored because of the way he proposed designing the 
original plan, which was no choice, which got very little discount from 
the current price of pharmaceuticals in the marketplace.
  The Congressional Budget Office looked at our approach and said that 
because we had competition, because we had provided seniors and the 
disabled choice in the plans that they could choose from, we will 
achieve at least a 25 percent discount across the board for things that 
are insurance-based purchased and for things that are purchased out of 
pocket, a 25 percent savings just by creating choice that the 
administration does not get with their proposal.
  Mr. GREENWOOD. And if I may, that is before we even apply the Federal 
contribution to the actual price of the item. So that 75 is cut in 
half. And, of course, we pay 100 percent of the remainder for the low-
income and for middle-class folks, a half. So now we are talking about 
going from paying 100 percent of retail price to paying 37\1/2\ percent 
of retail price. It is almost a two-thirds reduction in the cost of the 
pharmaceutical product to the average American.
  Mr. BURR of North Carolina. If there existed truth in advertising on 
this we would have stars all across this plan because it provides at 
every level what seniors want.
  Before the gentleman mentioned employers, I had written the word 
employers on a piece of paper up here because that was one of the 
biggest challenges that our whole task force had. There is a segment of 
America, a large percentage of America that are seniors today that are 
currently provided prescription drugs as a benefit of their retirement. 
As we see prices go up 11 or 12 percent a year, the question we have to 
look out and ask is how long will they continue to offer that benefit. 
Because they are not obligated to, it is just a commitment that they 
made when individuals retired.
  We found a way to incorporate into our plan that those employers that 
provide that benefit, once those individuals reached that stop-loss 
amount, they would be covered under the Federal stop loss, a great 
incentive for employers to continue to provide that first dollar 
coverage for the millions of seniors that are currently under their 
health plans. We found the approach to keep the employer engaged.
  We found a way to incorporate the catastrophic or the stop loss into 
their plan without dislocating them, which made our plan totally 
voluntary to every eligible person regardless of where they currently 
had their coverage, if they did. They could stick with that and still 
utilize that stop-loss protection of the national plan.
  Clearly, we spent a lot of time on that, making sure that we got it 
right. But the fact that it was voluntary, the fact that for those that 
chose to participate there was choice, the fact that everybody, whether 
they were in their employer plan or chose one of the accredited plans 
by that new entity that ran the prescription drug benefit, all of them 
benefited from an annual stop-loss amount that protected every senior 
and made sure that they could not lose everything that they had 
accumulated because they had run into a health care problem that 
required unusual pharmaceutical costs.
  Mr. GREENWOOD. I believe our time has just about elapsed. I want to 
thank the gentleman from North Carolina for his participation, as well 
as my other colleagues from around the country.
  This clearly is, if not the number one issue in America, certainly 
ought to be. There is still time to resolve this issue. All we need to 
do is to work with the House and the Senate and the President together 
and, in fact, we can all be proud of meeting a need that just cries out 
to be met; and we think we have made a good start.

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