[Congressional Record (Bound Edition), Volume 148 (2002), Part 11]
[Senate]
[Pages 15656-15657]
[From the U.S. Government Publishing Office, www.gpo.gov]




                              HEALTH CARE

  Mr. GRAHAM. Mr. President, this is the last day of a long legislative 
season. We are about to take the month of August to go back to our home 
States, be with our constituents, and maybe have a little opportunity 
to get some personal relaxation and rejuvenation, and come back after 
Labor Day and complete this 107th session of Congress.
  It is exactly this time in the legislative calendar where maybe 
tempers and tolerance are beginning to wear thin and short.
  I share with my friend from Oklahoma high feelings for the persons 
who debated vigorously over the last 2 weeks on an issue whose 
importance we all understand and feel deeply about, which is the issue 
of providing a health care program to 40 million senior Americans by 
adding to that 37-year-old program, at long last, a prescription drug 
benefit. I think the goal is one we all share. We have somewhat 
different ideas as to how to get to that goal.
  The reason I came to the floor earlier today was out of, yes, a sense 
of personal attack but also a sense of the need to set a very obvious 
erroneous record somewhat straighter. My concern was piqued by a 
statement that was made which implied that I, Senator Smith, and 
others, tried to slip something by the Senate. And that ``something'' 
was not a small amount, but a very substantial, maybe as much as a $70 
billion additional cost on the States according to my Republican 
colleagues.
  I knew that was not accurate because I had received from the 
Congressional Budget Office, which had scored our legislation, the fact 
that they had determined that, in fact, there was no additional cost to 
the States and I had made that representation to my colleagues. I felt 
my personal credibility was at stake. So I went back to the 
Congressional Budget Office today to recheck what they had said and 
they reaffirmed the statement that there was no additional cost to the 
States.
  I showed them this--
  Mr. NICKLES. Will the Senator yield?
  Mr. GRAHAM. Let me just finish, get the facts out, and then we will 
talk about the policy.

[[Page 15657]]

  So I showed them this chart. They pointed out what was obvious which 
was that this chart only shows half, in fact less than half of the 
equation. It shows the additional costs to the States that will come 
incident to their picking up some of the prescription drug costs. What 
it does not show is that the States are going to be relieved of a 
substantial amount of their current costs.
  The Senator from Oklahoma mentioned one of these costs. But, in 
addition to that, there are other costs from which the States will 
receive relief. For example, there are 31 States that provide State 
pharmacy assistance for low-income senior citizens, the States which 
have received Medicaid waivers in order to allow them to cover 
additional groups of seniors. As the Federal Government has dawdled on 
the subject of providing prescription drugs for senior Americans, many 
States have stepped forward and have done so.
  So within the Medicaid Program as well as in areas where the States 
have tried to fill the void that the Federal Government has left 
behind, there are substantial savings to the States--thus the report of 
the Congressional Budget Office that there is no increased cost to the 
States. But there is no column or figures on this chart which reflect 
the fact that there are these offsetting savings to the States.
  Mr. NICKLES. Will the Senator yield?
  Mr. GRAHAM. What got Enron in trouble was it set up a whole 
constellation of off-budget partnerships in order to hide their 
expenses.
  Mr. NICKLES. Will the Senator yield for a question?
  Mr. GRAHAM. And therefore it overstated their profitability.
  We have a chart here which does the opposite. We have a chart here 
which hides the benefits the States are going to get and only 
highlights those additional costs.
  Mr. NICKLES. Will the Senator yield for a question?
  Mr. GRAHAM. I am almost there.
  Therefore, presenting the impression that the passage of this 
amendment would result in substantial additional cost to the States--
touted to be $70 billion--is a patently untrue statement.
  I wanted to set the record straight before we went home so none of 
our colleagues spend August worrying that they might have been deceived 
into believing there was going to be a very major additional cost to 
the States and that might have influenced their vote on this matter.
  So my only purpose was to make those corrective comments and express 
my hope that in the future we would follow the spirit and custom of the 
Senate, which is when you distribute a document such as this, you put 
your name on it so someone is held accountable. And I suggest it would 
also be helpful if we adopted the custom that there be some source 
given for documents such as this, so those who are interested in 
pursuing the basis upon which the calculation was made would at least 
know whose telephone number to call.
  Mr. NICKLES. Will the Senator yield?
  Mr. GRAHAM. I would be pleased to yield.
  Mr. NICKLES. I am wondering about all these savings. I am looking at 
my State. You said if the State had a prescription drug program, the 
Federal Government might be picking up a lot of that State program so 
therefore it is saving. My State doesn't have that, other than the fact 
we provide Medicaid prescription drugs up to 74 percent, and that is 
limited to three prescriptions per month.
  So where is the savings for my State? HHS said this is going to cost 
my State something like $62 million. My director of Medicaid said it is 
going to cost our State, and we can't afford it.
  There, obviously, under your proposal are some States, maybe a lot of 
States, that would be losers; isn't that correct? It would increase 
their Medicaid costs dramatically?
  Mr. GRAHAM. What CBO has said is that for the States as a collective, 
that there would be no additional cost as a result of this. I have 
asked CBO to prepare a State-by-State analysis of what those offsetting 
savings would be. I do not have those numbers today.
  Mr. NICKLES. Isn't it likely that some States would be losers?
  Mr. GRAHAM. But I think it is a given that no State is going to have 
zero savings. So that every one of these State-by-State numbers is 
overstated.
  Mr. NICKLES. I don't know. I will just state to my friend that these 
are additional new costs. There may be some offsets. I mentioned one 
possibility. You mentioned: Well, if they have the State drug program, 
that might be a savings. I didn't have that program.
  The only offsets I could see is if the Federal Government is taking 
over some of the catastrophic, and I don't see that hardly ever 
happening. So I think these are pretty accurate costs. I will be very 
interested maybe CBO will have a chance to do it. Maybe if we would 
legislate correctly and not just have a new proposal on the floor, we 
would have a chance for CBO to score it, not through e-mails saying 
that we think it is no new net cost but have them give a State-by-
State. Then we could be more thorough in our analysis and in our 
description. And if someone highlights a couple of columns and leaves 
out a couple of columns, that can be brought out in the debate.
  Unfortunately, we did not have that time afforded to us the way this 
bill was brought to the floor and the way we were considering serious 
alternatives.
  I appreciate my colleague saying, wait a minute, maybe this is not 
complete. There should have been a column that shows some offsets. But 
I am absolutely certain that some States would lose millions upon 
millions of dollars, maybe in the hundreds of millions of dollars. And 
some States would be real net losers.
  There might be some that have some better reimbursement from the 
Federal Government. In fact, it may be for some of the States that are 
wealthier, that have more generous programs, we are going to pick up 
the cost of their doing the program which was a previous State program. 
Maybe that is an offset.
  But I hope, and I think my colleague would agree--or wouldn't you 
agree--that we should have a more thorough cost analysis by the 
relevant agencies, whether it is OMB, Labor-HHS, or CBO, when we 
discuss programs of this significance and the significant impact it 
would have on our States?
  Mr. GRAHAM. I completely agree. I think we should have an analysis 
that includes both the debit and the credit side of the accounting 
ledger so we will be able to make an informed judgment as to what the 
real economic consequences of our decisions will be.
  Mr. NICKLES. I thank my colleague.
  Mr. GRAHAM. I think on that note of common agreement I wish to thank 
my friend from Oklahoma for having allowed me to ask him a few 
questions earlier. I hope he has a very good August recess, and I look 
forward to seeing him back here on the day after Labor Day, refreshed 
and ready to complete this session of the Congress.
  Mr. NICKLES. I thank my colleague.

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