[Congressional Record (Bound Edition), Volume 148 (2002), Part 11]
[Extensions of Remarks]
[Pages 14866-14867]
[From the U.S. Government Publishing Office, www.gpo.gov]




              ESSENTIAL MEDICINES FOR MEDICARE ACT OF 2002

                                 ______
                                 

                        HON. BENJAMIN L. CARDIN

                              of maryland

                    in the house of representatives

                        Thursday, July 25, 2002

  Mr. CARDIN. Mr. Speaker, it has been three years since Congress began 
in earnest to address the issue of prescription drug coverage in the 
Medicare program. The problems we have faced in creating a drug benefit 
demonstrate that the solution will be both complex and expensive. 
America's seniors will be closely watching the House of Representatives 
between now and the end of this Congress. They will be looking for 
bipartisanship, for cooperation, for a good faith effort to provide 
them with the lifesaving medicines they need. The lack of prescription 
drug coverage is one of the most pressing problems facing America's 
older and disabled citizens today. Because Medicare does not include a 
drug benefit, its promise--access to comprehensive medical care for the 
elderly and disabled--is unfulfilled. I rise today to introduce the 
Essential Medicines for Medicare Act, legislation that will move us one 
step closer toward keeping that promise of comprehensive coverage.
  Medicare, the federal health insurance program for the elderly and 
disabled, covers a large number of medical services--inpatient 
hospitalization care, physician services, physical and occupational 
therapy, and skilled nursing facility, home health and hospice care are 
all covered by the Medicare program. Despite Medicare's success in 
eliminating illness as a potential cause of financial ruin for elderly 
Americans, the burden of high prescription drug costs remains a source 
of hardship for many beneficiaries.
  When Congress created Medicare in 1965, prescription drugs were not a 
standard feature of most private insurance policies. But health care in 
the United States has evolved considerably in the last 34 years. Now 
most private health plans cover drugs because they are an essential 
component of modern health care. They are viewed as integral in the 
treatment and prevention of diseases. But Medicare, for all its 
achievements, has not kept pace with America's health care system. It 
is time for Medicare to modernize.
  Because Medicare does not pay for prescription drugs, its 
beneficiaries, 80 percent of whom use a prescription drug each and 
every day, must either rely on Medicaid if they qualify, purchase 
private supplemental coverage, join a Medicare HMO that offers drug 
benefits, or pay for them from their fixed incomes. These costs can be 
extraordinarily burdensome for the elderly, who already have the 
highest out-of-pocket costs of any age group and who take, on average, 
eighteen prescriptions each year.
  There is no question that Congress should enact a comprehensive 
Medicare prescription drug benefit without further delay. I support a 
benefit package that covers all necessary drugs for seniors as a part 
of basic Medicare. However, I am concerned that the 107th Congress 
appears to be headed down a previously traveled road.
  Two years ago, this House debated legislation that would require 
seniors to contract with private insurance companies for prescription 
drug coverage. It passed narrowly along party lines. As predicted, the 
Senate never considered that legislation, and no drug bill was signed 
into law. At the time, most seniors deemed the House Republican plan 
unworkable; another program based on the same premise--relying on the 
participation of private insurance plans--had failed to provide for 
Medicare beneficiaries. Since the June 2000 vote, that concept, the 
Medicare+Choice program, has abandoned a million more seniors.
  Other once reliable sources of coverage have dissipated. Nearly 60 
percent of Medicare beneficiaries with incomes below the federal 
poverty level were not enrolled in Medicaid as recently as 1997. And 
even Medicaid enrollees with drug benefits must forgo some of their 
medications. With the recent economic downturns, more and more state 
Medicaid programs are reducing their benefits. The high cost of these 
Medigap policies puts them out of reach for most low-to-moderate income 
Medicare enrollees. Finally, employer-sponsored plans no longer offer 
reliable prescription drug coverage. Although between 60 and 70 percent 
of large employers offered retiree health benefits in the 1980s, fewer 
than 40 percent do so today. Of these, nearly one-third offer no drug 
benefits.
  Finally, as members across the country can attest to, the benefits 
offered by Medicare+Choice plans are neither guaranteed nor permanent. 
Because they are not part of the basic Medicare benefit package, which 
by law must be included in all Medicare+Choice plans, drug benefits are 
considered ``extra'' and as such can change from year to year. This 
means that even in those counties where plans remain in the Medicare 
market, there is no certainty that they will continue to offer drug 
benefits or that they will not severely reduce the benefits.
  These statistics combine to make us painfully aware of the gaping 
hole in Medicare's safety net, This Congress can move this session to 
provide a benefit before more elderly and disabled citizens fall 
through. My bill, the Essential Medicines for Medicare Act, recognizes 
the importance of preventive care and provides coverage for drugs that 
have been determined to show progress in treating chronic diseases. Why 
chronic diseases? Because

[[Page 14867]]

the average drug expenditures for elderly persons with just one chronic 
disease are more than twice as high than for those without any. And 
because we know from years of advanced medical research that treating 
these conditions will reduce costly inpatient hospitalizations and 
expensive follow-up care. Furthermore, this bill addresses those 
beneficiaries who have the greatest need for assistance with purchasing 
their medications: a review of the Medicare+Choice program reveals that 
seniors who join HMOs are younger and healthier than those in fee-for-
service Medicare. This tells us that it is the older, sicker seniors, 
precisely the ones who need prescriptions the most, who have reduced 
access to drug benefits.
  Our bill addresses their needs. It begins with five chronic 
diseases--diabetes, hypertension, congestive heart disease, major 
depression, and rheumatoid arthritis--that have high prevalence among 
seniors and whose treatment will show improvement in beneficiaries' 
quality of life and reduce Medicare's overall expenditures.
  The Medicare costs associated with inpatient treatment of these 
diseases are exorbitant. I have attached for the record fact sheets 
that illustrate the enormous price tags that borne by the Medicare Part 
A Trust Fund when these chronic conditions remain untreated.
  The bill I have introduced provides coverage for certain medications 
after an annual $250 deductible is met, with no copayment for generics 
and a 20 percent copayment for brand-name drugs. Lower-income 
beneficiaries will be exempt from deductibles and copays. The Agency 
for Healthcare Research and Quality will review available data on the 
effectiveness of drugs in treating these conditions, and based on 
AHRQ's review, the Department of Health and Human Services will 
determine the drugs to be covered. Pharmacy Benefit Managers, PBM, 
under contract with the Centers for Medicare and Medicaid Services will 
negotiate with pharmaceutical manufacturers to purchase these drugs and 
will administer the benefit.
  This bill covers five major chronic conditions, but I recognize that 
there are others that should be covered as well. The legislation 
provides a process for the Institute of Medicine to determine the 
effectiveness of this benefit and the Medicare savings it produces, and 
to recommend additional diagnoses and medications that should be 
considered for coverage.
  Mr. Speaker, modern medicine has the capability of doing 
extraordinary things. But no medical breakthrough, no matter how 
remarkable, can benefit patients if they can't get access to it. This 
cost-effective, economically sound approach to prescription drug 
coverage is a matter of common sense: if Medicare beneficiaries can 
secure the medications they need, they will be able to manage their 
conditions, and will be much less likely to require extended and costly 
inpatient care. This legislation is a first step, a major step, toward 
making this happen. I urge the House to consider this approach to 
providing a solid package of prescription drug benefits, an approach 
that will modernize Medicare for the 21st century for the millions of 
elderly and disabled Americans who depend on it.

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