[Congressional Record (Bound Edition), Volume 146 (2000), Part 9]
[House]
[Pages 12147-12148]
[From the U.S. Government Publishing Office, www.gpo.gov]



           PRESCRIPTION DRUG PLAN NEEDED NOW FOR OUR SENIORS

  The SPEAKER pro tempore. Under a previous order of the House, the 
gentlewoman from North Carolina (Mrs. Clayton) is recognized for 5 
minutes.
  Mrs. CLAYTON. Mr. Speaker, we will be considering a prescription 
medication plan very shortly, and there is a great need for assistance 
with our seniors for prescription drugs. I hope that as we do that we 
will consider a meaningful prescription drug plan that looks at 
affordability, looks at accessibility, and also looks at simplicity.
  Both in rural America as well as urban America, we know there are a 
large number of our seniors who are making decisions about whether they 
can afford to buy their prescriptions, pay their rent, or buy food. 
They are making decisions between acquiring very basic needs. So 
hopefully, as we craft a bill to speak to these critical needs, we are 
not playing politics with the needs of seniors, that we are really 
designing a meaningful bill that will be helpful, easy to assess, and 
affordable by seniors, both in urban America as well as rural America.
  Mr. Speaker, I want to speak a little bit about rural America, 
because that is where I come from. There is a difference. The 
difference comes primarily because of economies of scale, and 
therefore, we do not have the infrastructure that depends on the 
market-driven economy. We do not have large hospitals because we do not 
have a large accommodation of patients to support that. We do not have 
a mix of sophisticated specialists in those areas. So we rely on a 
combination of regional hospitals or tertiary hospitals

[[Page 12148]]

or relationships with community health centers, a variety of networks 
to put together kind of a patchwork in providing health care to our 
citizens. It costs us more in rural areas just because of the lack of 
the economies of scale. So already, there is built in to the health 
services that we receive through the market system, but also the 
current health system assistance we receive from the Federal 
Government.
  Now we are about to craft a prescription drug bill supposedly to help 
seniors who are having to make these critical decisions between being 
able to take their medicine that they desperately need and the food 
that they must have to survive, or paying their bills. So when we do 
this, hopefully, we take into consideration structure, affordability, 
and simplicity.
  Mr. Speaker, if I am hearing correct, the plan that came out of the 
Committee on Ways and Means yesterday has a structure where it is 
predicated on private providers, that HMOs would be the carriers for 
getting the prescription assistance to rural areas.
  Now, nothing would be wrong with that, because I have an HMO myself; 
I am fortunate enough to use an HMO that I get through my employment. 
But I can tell my colleagues that there is not the large number of HMOs 
in rural areas. There are many rural areas where there is no HMO 
whatsoever. So if one is planning a system that is based on having 
HMOs, already we have denied rural areas from having it.
  Again, when I look at the plan, it says that if there is not more 
than two, we would increase the incentive to have two HMOs so that 
there would be some competition.

                              {time}  1445

  A lot of people are going to fall through the cracks if indeed we do 
not put a structure there. For that reason, the Medicare structure 
certainly is simple, it is already known by providers, people are using 
it, individuals are comfortable with it, so it is a familiar assistance 
plan that people will use and the accessibility will be there.
  The other is the cost. Again, we are going to provide senior citizens 
between 125 and 150 percent of poverty. Those are critical areas, but I 
can tell the Members that there are many people in eastern North 
Carolina, rural America, who are between 135 and 150 percent. If we are 
going to have a sliding scale based on poverty, and we are going to 
have a variation of a cost of those premiums, that is going to give the 
whole issue of affordability some serious concerns.
  I doubt whether we could make the case that this would be affordable 
in urban areas, much less in rural areas. The variation of premium 
costs are more likely to be substantial, and if they are substantial, I 
can tell the Members, in rural areas we have lower incomes, in the same 
instance that persons receive their social security and they more 
likely are lower-income seniors, so that would also give them a 
problem.
  So as we consider the prescription drug plan, I hope we will consider 
having those elements in principle that will mean affordability, 
accessibility, and simplicity.

                          ____________________