[Congressional Record (Bound Edition), Volume 146 (2000), Part 16]
[Senate]
[Pages 23087-23089]
[From the U.S. Government Publishing Office, www.gpo.gov]



                           REFORM OF MEDICARE

  Mr. BRYAN. Mr. President, I am now in my last days of serving the 
people of the State of Nevada as a U.S. Senator. It is a role in which 
I am proud and privileged to have had an opportunity to serve. I am 
also very proud of the opportunity I have had to serve as a member of 
the Finance Committee, the committee with jurisdiction over the 
Medicare program.
  Having said that, I am greatly troubled by this body's failure to 
take action on several fronts as it relates to Medicare. I am 
disappointed that we failed to act on Medicare coverage for 
prescription drugs as well as the proposed payment changes in the so-
called BBA relief bill, a piece of legislation that deals with provider 
payment enhancements to those services and companies that provide 
service to Medicare patients.
  The impact of Medicare over the past 35 years cannot be 
overemphasized. Prior to enactment of Medicare in 1965, fewer than half 
the seniors in America had any kind of health care coverage at all. 
Today, as a result of Medicare's enactment, 99 percent do. As a result, 
health care for the Nation's seniors has been improved and the burden 
of health care costs for them has been greatly ameliorated. But a 
Medicare program without prescription drug coverage does not meet the 
promise we made to seniors in 1965.
  In 1965, the Medicare program roughly paralleled what was available 
in the private sector. Today, as all of us know, prescription drugs 
play such a vital role, a greatly enhanced role in terms of our own 
Medicare treatment. We had a historic opportunity this year to fulfill 
the promise of Medicare and to guarantee access to comprehensive 
prescription drug coverage for Medicare beneficiaries. Yet we have 
squandered it.
  There is no legitimate reason for the Republican leadership to have 
pushed meaningful prescription drug reform off for another year. The 
Finance Committee has spent the last 2 years considering prescription 
drugs. We have heard from experts on all sides of the issue. We have 
talked to our constituents. Many of us have worked diligently to put 
together legislation to provide a meaningful, comprehensive, affordable 
benefit for all Medicare beneficiaries. Yet the Finance Committee did 
not even hold a markup of a prescription drug benefit bill. By that I 
mean, for those who are not familiar with legislative language, we did 
not have the opportunity to vote on a Medicare bill in the Finance 
Committee, move it from the committee, and debate it on the floor.
  I consider it a great tragedy that could have made a difference in 
the lives of our seniors. Our inaction will consign some 227,000 
Medicare beneficiaries in my own State of Nevada and 39 million 
beneficiaries nationally to yet another year of spending an ever-
increasing share of their fixed incomes on medically necessary drugs or 
trying to stretch their prescriptions by taking them every other day 
instead of every day or sharing them with spouses and friends or, 
worse, even going without.
  We will be voting on the conference report to accompany the 
Agriculture appropriations bill this afternoon. The prescription drug 
importation provision is included in the conference report. I was 
pleased to join Senators Dorgan and Jeffords in their amendment in 
July. I believe this amendment is an important measure that can be 
helpful. There is no credible reason, no defensible basis that only 
drug manufacturers should be allowed to reimport prescription drugs.
  A well defined reimportation program could help to make drugs more 
affordable for American consumers. The majority of our seniors are 
often faced with the difficult choice of paying extremely high prices 
at retail outlets or forgoing medically necessary prescription drugs 
because they simply do not have the financial resources to pay for 
them. However, the best designed reimportation provision is not a 
sufficient answer to the millions of Medicare beneficiaries who lack 
prescription drug coverage.
  I hope my colleagues will not hide behind this provision when they 
are asked by their constituents why the Senate didn't approve a 
Medicare prescription drug benefit this year.
  Moreover, the important provision has been altered by the Republican 
leadership such that it is extremely questionable whether it will 
actually meet the goal Senators Dorgan and Jeffords and others 
desired--that of lowered prices.
  One very basic problem with the provision is that a ``sunset'' date 
was added so that the importation system would end 5 years after it 
goes into effect. In order to assure the safety of the drugs being 
imported, laboratory testing facilities would be required. Distribution 
systems would also clearly be needed. I have serious doubts that the 
private sector investment to carry out this program will materialize if 
it is known that the program will only be in operation for 5 years. Why 
spend the money to develop the infrastructure for such a short-lived 
program? There is also a serious labeling problem that gives 
manufacturers the ability to shut down the program.
  It is unquestionably and undeniably wrong that American citizens pay 
the highest prices for prescription drugs--particularly when many of 
these drugs are developed on American soil, by American companies who 
are receiving enormous tax breaks, patent protections and the benefit 
of billions of NIH research dollars.
  I have been hoping to offer a germane amendment to the Foreign Sales 
Corporation (FSC) legislation that would

[[Page 23088]]

deny the export tax benefit to pharmaceutical manufacturers charging 
Americans at least 100 percent more than they charge foreign consumers 
for the same drug. This amendment, if I get the chance to offer it, and 
if approved, would have one of two positive effects for the American 
consumer and taxpayer: either, the price of prescription drugs would 
decrease, or if the manufacturer chooses to continue to exploit 
American consumers, at least the taxpayer would not be providing a tax 
benefit for doing so.
  The prices of prescription drugs could also be lowered through the 
simple measure of providing more information to purchasers of 
prescription drugs. I introduced the Consumer Awareness of Market-Based 
Drug Prices Act of 2000 because purchasers today do not have any 
meaningful price information--and there is no way competition can work 
without information on prices. I believe in the free market, but we 
have to let it work. The availability of real market-based price 
information is critical to the ability of employers and insurers to 
negotiate lower prices for their employees and enrollees.
  Under the current law, that information is denied to those who 
purchase prescription drugs on behalf of either their insureds or those 
who are part of their employee group.
  Not only does the lack of price information keep prices artificially 
high, but it affects the Federal budget. Drug manufacturers have been 
able to manipulate the average wholesale price, which is a meaningless 
statistic, but it results in billions of dollars of Medicare 
overpayments.
  My legislation would simply require the Secretary of HHS to make 
available to the public the market-based information on drug prices 
that she currently collects: the average manufacturer price for each 
drug, and the best price available in the market. These prices are 
already collected to implement the Medicaid prescription drug rebate 
system--so no new bureaucracy or administrative structures would be 
necessary. Legislation is necessary, however, because the Secretary is 
statutorily prohibited from disclosing this information.
  Our legislation would simply lift that prohibition and make that 
information available.
  A reimportation provision without the loopholes and the sunset 
provision could help to lower prices. There are also other ways to 
lower prices--by requiring manufacturers to treat American patients 
fairly if they want to receive generous tax benefits, and by disclosing 
prices--but we also must add an affordable, voluntary prescription drug 
benefit to the Medicare program. Anything less is an empty promise to 
our seniors who often go without much-needed drugs, or pay astronomical 
prices for them.
  Earlier this year, I introduced the Medicare Outpatient Drug Act. 
Like the Vice President's proposal, this bill would provide 
prescription drugs as a defined, comprehensive and integral component 
of the Medicare program to ensure it is available and affordable for 
all beneficiaries.
  The drug benefit must be a part of the Medicare program--if it is 
not, there is no guarantee to our seniors and those Medicare 
beneficiaries with disabilities that it will be available, no guarantee 
that is will be affordable, no guarantee that it will provide 
catastrophic protection, and no guarantee that it will be around the 
following year.
  Only Medicare can ensure that it is guaranteed to be there, that it 
is affordable, that there is catastrophic protection, and that it will 
be there year after year.
  The Democrats offer Medicare beneficiaries choices: the Medicare 
benefit is a voluntary one. If a person has drug coverage through an 
employer or some other source, he or she can keep that coverage. The 
beneficiary can choose to receive the drug benefit as a part of the 
traditional fee-for-service program, or through a managed care plan.
  So there are three choices that are available here: either not to 
accept it, or to have either a fee-for-service program, or a managed 
care program.
  The GOP proposal, in Congress, and as promoted by Governor Bush, 
gives the choices to the insurers. The insurer can choose whether or 
not to offer prescription drug coverage--there is no requirement. The 
insurer can choose the level of the deductible, and the amount of the 
coinsurance the beneficiary must pay for each prescription. The insurer 
can choose whether or not to offer catastrophic coverage. The insurer 
can choose to limit those drugs that are covered to a select few--
either by limiting the diseases that qualify for treatment, or by 
limiting the number of prescriptions that may be filled each month. The 
insurer can choose to keep the benefit the same from year to year, or 
the insurer can choose to change the benefit each year or to 
discontinue coverage.
  The Democrats have tried to pass a bill this year that would provide 
choices for beneficiaries, while our colleagues on the other side of 
the aisle have advocated a bill that would provide choices for 
insurers.
  Given the cost of a prescription drug benefit, it is critical that we 
spend those federal dollars in a way that will ensure that the benefit 
and the choices are going to the Medicare beneficiaries--not to the 
insurers.
  I am also deeply troubled by the way the majority leadership is 
allocating federal dollars in the ``BBA-relief'' bill. While members of 
the Finance Committee have not been allowed to participate in the 
development of this package, I understand that about $10 billion out of 
a total of $28 billion is to go to Medicare HMOs over the first 5 
years. That is over one-third of the money in this package, when only 
16 percent of Medicare beneficiaries are enrolled in Medicare HMOs.
  The HMOs tell us that they need this level of funding to 
``stabilize'' the market, and that without it they will have to 
withdraw from the program, or reduce benefits. But we know from the 
General Accounting Office that we are already overpaying the HMOs--by 
nearly $1,000 per enrollee.
  And yet, our colleagues on the other side of the aisle are not 
requiring any accountability on the part of the managed care plans in 
exchange for this huge influx of funding. They don't require them to 
stay in the market, and they don't require them to commit to a benefit 
package.
  Managed care plans should be provided a reasonable portion of the 
funds in this package. But the majority has provided funds for HMOs at 
the expense of reducing beneficiary cost-sharing for preventive 
benefits and outpatient visits, at the expense of expanding health 
options for legal immigrants, at the expense of patients with Lou 
Gehrig's disease, at the expense of uninsured children, and at the 
expense of persons with Alzheimer's disease.
  This is too great an expense.
  I have a letter signed by 23 senior groups opposing this large 
payment of funds to Medicare+Choice HMOs.
  I ask unanimous consent that this letter be printed in the Record.
  There being no objection, the letter was ordered to be printed in the 
Record, as follows:

                                                Leadership Council


                                       of Aging Organizations,

                                 Washington, DC, October 18, 2000.
     Hon. Richard H. Bryan,
     U.S. Senate,
     Washington, DC.
       Dear Senator Bryan: The undersigned organizations oppose 
     the large payment of funds to Medicare+Choice HMOs rather 
     than using these dollars to help Medicare beneficiaries in 
     the proposed Medicare Balanced Budget Act (BBA). The pending 
     leadership proposal reportedly spends about $10 billion on 
     HMOs and only a small fraction on America's seniors.
       The proposed restoration of funds to HMOs is out of balance 
     with the rest of the bill. Currently less than 16 percent of 
     beneficiaries are enrolled in HMOs, yet one-third of the 
     funds go to these entities. The increase in funds is of 
     particular concern since HMOs are not being held accountable 
     for their participation in Medicare. The plans have not 
     committed to maintaining their benefits or to staying in the 
     program for any length of time. Additionally, the proposed 
     increase flies in the face of the fact that independent 
     experts, such as the General Accounting Office, have found 
     that these plans currently are paid too much.
       Earlier in the year, Congress's budget resolution committed 
     to spending $40 billion on a new Medicare prescription drug 
     benefit. This has not been done. And now rather than spend 
     this $40 billion on direct beneficiary

[[Page 23089]]

     improvements, Republican leaders are proposing only a small 
     fraction of the original amount promised for beneficiaries.
       There are many other senior concerns that are being 
     shortchanged by this legislation including those that relate 
     to quality of care. The bill would not provide sufficient 
     funding to address a number of serious problems Medicare 
     beneficiaries and their families currently face. The 
     priorities related to the balance of payments in this bill 
     must be changed to assure that the group that Medicare is 
     supposed to serve--America's seniors--receive their fair 
     share of the funds.
           Sincerely,
       AFSCME Retirees.
       American Association for International Aging.
       American Federation of Teachers Program on Retirement and 
     Retirees.
       Association for Gerontology and Human Development in 
     Historically Black Colleges and Universities.
       Association of Jewish Aging Services.
       Eldercare America.
       Families USA.
       Meals on Wheels Association of America.
       National Academy of Elder Law Attorneys.
       National Association of Area Agencies on Aging.
       National Association of Foster Grandparent Program 
     Directors.
       National Association of Nutrition and Aging Services 
     Programs.
       National Association of Retired and Senior Volunteer 
     Program Directors.
       National Association of Retired Federal Employees.
       National Association of Senior Companion Project Directors.
       National Association of State Units on Aging.
       National Caucus and Center on Black Aged.
       National Committee to Preserve Social Security and 
     Medicare.
       National Council of Senior Citizens.
       National Council on the Aging.
       National Senior Citizens Law Center.
       National Senior Service Corps Directors Associations.
       OWL.

  Mr. BRYAN. Mr. President, finally, let me conclude by saying that the 
administration has indicated the President may veto this legislation 
because of the heavy tilt toward managed care plans, the lack of 
accountability, and the lack of provisions that would directly help 
Medicare beneficiaries--our intended audience. I would support that 
veto.
  I thank the Presiding Officer. I yield the floor.

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