[Congressional Record (Bound Edition), Volume 148 (2002), Part 8]
[House]
[Pages 10588-10595]
[From the U.S. Government Publishing Office, www.gpo.gov]




                       PRESCRIPTION DRUG COVERAGE

  The SPEAKER pro tempore (Mr. Kennedy of Minnesota). Under the 
Speaker's announced policy of January 3, 2001, the gentleman from 
Kentucky (Mr. Fletcher) is recognized for 60 minutes as the designee of 
the majority leader.
  Mr. FLETCHER. Mr. Speaker, as we speak tonight, there is a committee 
marking up the prescription drug bill which will provide prescription 
drug coverage for all seniors in this country. I believe it is one of 
the most pressing issues in health care that we face today, and so I am 
glad that we are going to spend this next hour talking about the House 
prescription drug plan; and I thank the gentleman from Louisiana 
(Chairman Tauzin), and the gentleman from Florida (Mr. Bilirakis), the 
chairman of the subcommittee, for their leadership in bringing this 
bill to the floor and making sure that we have a plan that is 
reasonable, doable, and will provide immediate relief for seniors.
  I am accompanied by some of my colleagues today, and at this time I 
yield to the gentleman from Kentucky (Mr. Whitfield). I know this has 
been an important issue that the gentleman has worked on.
  Mr. WHITFIELD. Mr. Speaker, prescription drugs for seniors on 
Medicare, this is an issue which has been before the Congress for quite 
some time. There has been a discussion about it for a number of years. 
If Members will recall, last year for the first time the House of 
Representatives under our leadership did pass a meaningful prescription 
drug benefit for senior citizens throughout the country. We all know 
how difficult it is for some of these seniors to pay for the 
prescription drugs that they have been prescribed for their particular 
condition.
  One of the disappointing things about last year was that although the 
House passed a meaningful prescription drug benefit, the Senate did not 
pass one. So we found ourselves back this year at the same place that 
we started last year. So we made it very clear on the Republican side 
of the aisle that we were committed to a meaningful prescription drug 
benefit for senior citizens that would not bankrupt the country. 
Because, obviously, we can spend a trillion dollars over 10 years, or 
$2 trillion over 10 years, but that certainly would not be fair to the 
young men and women who are out working today with children.
  Their employer does not provide health insurance for them, and they 
have made too much money for Medicaid to provide their health coverage, 
and they are not old enough for Medicare and yet they are paying taxes 
that go for the Medicare beneficiary and the Medicaid beneficiary. We 
tried to be reasonable about this to get a prescription drug benefit on 
the books to get started in a meaningful way, and our proposal will 
spend $350 billion over 10 years. I have a chart here that shows the 
House Republican principles on this issue.
  One, we obviously want to strengthen Medicare, and we are committed 
to a prescription drug benefit.
  Two, we want to lower the cost of prescription drugs now. We want to 
guarantee that for all seniors, prescription drug coverage will be 
covered under Medicare.
  We want to improve Medicare with more choices and savings, and 
obviously we want to strengthen Medicare for the long-term future.
  The other side of the aisle has made a lot of arguments that we are 
not spending enough money on prescription drugs. As I stated earlier, 
many of us agree with that. But when we have a Nation at war against 
terrorism, when we are just coming out of a recession, it is important 
that we get this on the books and that we be reasonable in our 
approach; and I think that is precisely what we are doing.
  But yet I want to make it very clear because the other side of the 
aisle has indicated that this is not a meaningful prescription drug 
benefit program, which I would disagree with. But if, for example, you 
are a single person on Medicare today under our bill, if your salary is 
$13,000 and below, then all of your prescription drugs will be paid for 
by the Federal Government. If you are a married couple and your joint 
income is $17,910 or less, then all of your prescription drugs will be 
paid for by the Federal Government.

                              {time}  1715

  And if you are married and you are making about $21,000 a year, under 
our proposal even some of that will be subsidized for you in addition 
to the other benefits that will be there for you.
  So I am quite excited that tomorrow the Committee on Energy and 
Commerce will begin marking up this important legislation to provide 
finally prescription drugs for our senior citizens. My only hope is, 
and I am convinced, by the way, that the House of Representatives will 
pass it again, and my only hope is that the U.S. Senate

[[Page 10589]]

will step up to the plate and not make this a political issue just 
because we are approaching an election but will step up to the plate 
and enter into meaningful dialogue so that they too will pass a 
prescription drug benefit that we can send to the President; and I know 
that President Bush has indicated time and time again that he will sign 
the legislation.
  I think tomorrow is a big day for senior citizens throughout the 
country and for all of us who have parents and aunts and uncles who 
need this benefit, because, as I said, we will begin marking this up 
tomorrow and I think within 3 days it will be coming out of our 
committee and then hopefully going to the floor. I appreciate very much 
the gentleman yielding to me this evening. I look forward to working 
with him tomorrow and the next 2 to 3 days as we try to finish this 
matter up.
  Mr. FLETCHER. I thank the gentleman from Kentucky for coming and 
joining us tonight. You were talking about the Democrats and some 
people talking about this is not a big enough plan, but it is 
interesting when we look to just a year ago, there was an amendment 
offered by the gentleman from South Carolina (Mr. Spratt), a Democrat, 
that set aside only $303 billion and we have a list, and I think this 
is virtually every Democrat, voted for that. Yet now 1 year later, in a 
political year, in an election year, we have a political statement that 
it is not enough, even though we increased it from $303 billion in our 
budget, set aside for prescription drugs and enhancing and improving 
Medicare, to $350 billion. All of a sudden in an election year we hear 
this demagoguery, it is not enough. I really appreciate what you have 
said on that.
  Mr. WHITFIELD. If I may make an additional comment. You are exactly 
correct. We are being challenged, also, of trying to raid the Social 
Security trust fund to pay for this. I would point out that between 
1936 when Social Security started and 1995, a period that was 
controlled by Democrats except for about 4 years, they spent over $800 
billion from the Social Security trust fund; and no one raised 
questions about it, no one objected about it; and not until 1994 when 
the leadership of this House changed were we able to start reversing 
that.
  One other comment that I would make is that the U.S. Senate, I am 
sure of what they are going to do is they are going to put out a 
prescription drug plan that may be in the trillions of dollars, who 
knows what it will be, which is very easy for them because they did not 
pass a budget on their side of the aisle. And so they are not bound by 
any constraints whatsoever. So for them to criticize us about spending 
too much money and bankrupting Social Security, which is a false 
allegation, they do not even have a budget. And so they are going to 
send a plan over here that we know will be so expensive that we will 
not be able to adopt it. But this is a great starting point. You have 
provided great leadership on this issue since you have been in 
Congress. I want to commend you for that.
  Mr. FLETCHER. I thank the gentleman from Kentucky.
  Next I would like to recognize another gentleman that has joined us 
this evening on this discussion, a very important subject, prescription 
drugs, one of our newer Members who has taken a leadership role on 
this, the gentleman from Oklahoma (Mr. Sullivan). We are glad to have 
him here this evening. Certainly we appreciate him coming and sharing 
his remarks as we address this very important issue.
  Mr. SULLIVAN. Mr. Speaker, I thank the gentleman from Kentucky for 
all his hard work on this very important issue. I have only been in 
Congress for about 4 months. When I was campaigning, I would go door to 
door. One of the biggest issues I heard from seniors was about Social 
Security, people living on fixed incomes, maybe had a small pension, 
but it was about prescription drugs. One lady that did not live too far 
from me, I remember going to her house. She said that she got about 
$900 a month from Social Security and her husband had passed away, he 
had a small pension from the railroad, and she was paying $1,000 a 
month for prescription drugs. Luckily she had a son that had an okay 
job and was helping her out. We need to change that.
  Over the recess, this last recess we had, I went home and visited 
many senior centers in Tulsa and the surrounding areas. After meeting 
with thousands of seniors, it became clear that prescription drugs is 
definitely needed. It is a simple fact that every senior should have 
access to the prescription drugs they need. Yet we know that ``simple'' 
is not always synonymous with ``easy.'' I firmly believe that it is 
important to pass legislation that will not just last for 10 years like 
the Democrat plan, but for generations and future generations to come. 
Therefore, as this body of Congress debates legislation, we must be 
responsible. The bill must be fiscally achievable this year, next year 
and for years to come. We must not fail our seniors today, tomorrow or 
50 years from now.
  The legislation that has been introduced by the House Republicans 
provides a guideline that accomplishes these goals by offering coverage 
on a voluntary basis to all seniors. Most seniors pay between $1,800 
and $1,900 per year on their prescriptions. This bill will cover the 
majority of seniors' costs, including 80 percent of the first $1,000 
after a deductible and 50 percent on the next $1,000.
  This plan is workable, this plan is simple, and this plan is right 
for American seniors. I urge my colleagues to join me in supporting 
this commonsense approach to ensuring our seniors have the prescription 
drug coverage they need and deserve. I would like to again thank the 
gentleman for Kentucky for all his hard work.
  Mr. FLETCHER. I thank the gentleman from Oklahoma. Before he leaves, 
let me just ask him a question and make a remark. It certainly sounds 
like you have had a number of town hall meetings. As I go around my 
district in central Kentucky and I have had some town hall meetings 
with seniors, I really hear that this is probably the most pressing 
issue. You mentioned that illustration of the $1,000 a month of income. 
I hear this, especially from widows, women that have worked very hard 
all their life but they worked in the home. They are left with Social 
Security, which is very inadequate to provide for all the things they 
need in addition to prescription drugs. I just want to thank you and 
see if you have any further comments on that and this plan that we 
brought out here that would pay virtually 100 percent of coverage for 
those individuals that you talked about.
  Mr. SULLIVAN. A lot of women are outliving men, too. You hear a lot 
of that at these meetings as well. A lot of times, too, they say, Well, 
John, we have heard this a lot about prescription drugs and we know you 
can't just give drugs to everybody. We want a plan that you can 
actually do. I have told them that we passed a budget, we put the money 
in this budget to accomplish this goal, and we can get this done in 
this Congress. This is not pie in the sky; this is a doable plan that 
we can accomplish this session of Congress. We all know that the 
President has said that he wants this done, he wants it on his desk, he 
will sign this bill. So it will be a travesty if this does not pass.
  Mr. FLETCHER. We certainly appreciate the gentleman from Oklahoma 
being here tonight and his leadership on this very important issue, 
taking up this issue in a manner that, as you have described, is 
reasonable, responsible and, the big word, ``doable.'' This is doable. 
When you look at the alternative plans that the minority is offering, 
this is a plan that escalating costs would require ever, ever, ever-
increasing taxes on hard-working Americans. Yet they have offered no 
explanation other than saying, well, we will sunset this plan after a 
few years so that we do not have to deal with the runaway costs that 
their plan incurs. You are absolutely right as you have taken the 
leadership to represent your folks back in Oklahoma, that this plan is 
very reasonable, it is very fiscally responsible, it is a tremendous 
benefit to our seniors, and it is doable. It can be done. I want to 
thank the gentleman for joining us this evening.

[[Page 10590]]

  Next I would like to recognize, and I have spoken about the chairman 
of the Committee on Energy and Commerce who has just been tremendous in 
taking the leadership. This is a very, very tough issue. I am very 
pleased and honored to serve with the gentleman from Louisiana (Mr. 
Tauzin) on the Committee on Energy and Commerce and want to certainly 
yield to him on this issue. I again thank you for your leadership. We 
plan on marking up this bill tomorrow and because of your leadership, 
we are going to be able to do that.
  Mr. TAUZIN. I thank the gentleman from Kentucky. Let me also thank 
you as the newest member of the Committee on Energy and Commerce not 
simply for taking the lead to literally organize our efforts here on 
the floor to make sure that this bill is not just successful through 
the committees but that we actually pass it through the floor of this 
House and give the Senate time and a chance to work on their version of 
this bill so we might accomplish it before the November elections 
instead of just talking about it interminably. I want to thank you for 
all the great work you have already done on health care issues in the 
past and again what a great asset you have become to the Committee on 
Energy and Commerce and our work on health care.
  Let me perhaps sum up the major components of what we have negotiated 
with the Committee on Ways and Means and which we will hopefully bring 
to the floor in good shape next week as we go through our committee 
process this week. The major components of what we are suggesting is 
that it is time to quit talking and to put in place a real and 
sustainable entitlement program within Medicare that will provide 
access to drugs at more affordable cost to the seniors of America who 
must depend upon drugs today for their daily and annual health care 
needs. The same way seniors in the 1960s depended upon hospitals and 
clinics, seniors now depend upon drugs to maintain their lives in 
successful quality time.
  Those of us who still enjoy parents and grandparents, I still have a 
mother whom I love dearly, know that were it not for the Medicare 
system being there for her and the amazing advances of drug therapies 
and the capacities of modern pharmaceuticals to continue to make her 
life not only comfortable and enjoyable but vibrant and alive, 
understand how critical it is we change Medicare to create this new 
benefit.
  Unlike the Senate bill, which they can outbid us on the dollars they 
can spend because they are not bound by any budget, they have never 
passed a budget, and I should say the other body, just as the other 
body can outbid us, so can our colleagues in the House outbid us if 
they do not want to abide by the budget numbers. But the budget numbers 
provide us with $350 billion. We were charged with crafting an 
entitlement program, a program that would last forever, that would not 
be sunsetted, that would be available to seniors and they would know it 
is available for the rest of their lives. That is the first thing we 
did. We crafted a drug benefit within Medicare that was truly an 
entitlement.
  The second thing we did was to make it voluntary, just as part B is, 
just to make sure that seniors know that if they like it, they can sign 
up and accept the benefits of it or they can decide they would rather 
not have it, they would rather have a private insurance plan that they 
are enrolled in or perhaps not invest in this plan at all. What we know 
from those who have looked at our plan is that we expect, from the 
managers of Social Security and from CBO estimates, that as many as 93 
to 97 percent of the seniors of America will likely take advantage of 
this new drug benefit. Why? First of all, because if any senior lives 
under 175 percent of poverty, the plan provides total subsidy of the 
premium, in other words, total subsidy support, total support within 
this $350 billion that we are going to spend over 10 years toward the 
purchasing of this drug coverage for them.
  Secondly, we know that seniors are going to like this. Even though 
they may not get all of the drug cost covered in the first $1,000 and 
$2,000 under the plan, we know they are going to like it for one very 
important reason, because it includes catastrophic coverage. Because it 
says at some point, whatever number we eventually agree upon in our 
markup, at some point the medical drug expenses will not bankrupt a 
senior, that at some point the costs get covered by this program and 
they will not have to suffer the loss of their home or their pension or 
their savings as a result.
  When I talked to my mom about our plan and I explained to her that 
for $35 a month, she would have a plan that covers 80 percent less a 
deductible of the first $1,000 of expenses, 50 percent of the second 
$1,000, but, more important, I said, Mom, at some point once you have 
reached the out-of-pocket limit of the bill, whatever we decide it may 
be and we think it is going to be under $4,000, at that point you have 
no more drug expenses, that this plan will cover you and you won't lose 
the savings account that Dad left for you and you won't lose the house 
that he built for you and you won't lose your security, you won't have 
to spend yourself into poverty to get drug coverage.
  Mom said, Sign me up today. Sign me up now, son. Get me in this 
program. The bottom line is we know that seniors are going to want to 
look for something that is permanent, voluntary and gives them these 
kinds of benefits.
  The other thing I want to point out is that in this bill we also 
repair a lot of the reimbursements to Medicare, hospitals and doctors 
and nurses and teaching facilities, not 100 percent yet because we 
still have some work to do to do total repair, but we repair some of 
those reimbursement concerns and we make sure that the doctors in fact 
get a positive reimbursement in the years ahead and that nurses and 
hospitals get positive reimbursements to make sure that Medicare is 
always available in all the communities of America.
  The last thing we want to see is some community lose its Medicare 
providers because we failed to take care of some of the reimbursement 
concerns and the cliffs and the walls that some of these providers are 
about to hit. And so this bill addresses, within the confines of the 
dollars available to us in the budget, this drug benefit program but 
also the needs of the provider community to make sure that, in fact, 
doctors and nurses and hospitals are still available to carry out 
ordinary Medicare services to folks like my mom and to folks like your 
seniors in your community.

                              {time}  1730

  Last of all, in the bill we obviously want to make sure that the 
Medicare+Choice programs that have been available and are still 
available as an option to seniors in this great country are still 
available. So we help make sure we stabilize those programs within this 
bill.
  In other words, we want to make sure that seniors have as many 
options as possible, options in Medicare+Choice, where it is available, 
and hopefully stabilize it so it continues to be available; secondly, 
options to continue to receive health care through Medicare at the 
hospitals and clinics, through the nurses and doctors and providers of 
our Medicare system; and, most importantly, to add this important new 
drug benefit option to seniors.
  Now, can we get it done? You betcha. Can we get it done this year, 
pass it into law this year? Yes, we can. This is doable. This is not a 
program that ends in 5 years, as the other body would provide. It is 
not a program that goes over our budget. It is within our budget, and 
it is doable.
  We pass it on this floor next week, and the other body has all the 
time in the world to get their act together and meet us in a conference 
and make it happen this year for the seniors of America.
  Listen, this is not a benefit that can wait. Seniors are desperate 
for some help in their drug coverage. Seniors are desperate for us to 
pass this into law, and we have got our chance next week.
  I want to thank the gentleman and all the Members of the Committee on 
Energy and Commerce who began the markup process today and are going to

[[Page 10591]]

work with me through the next 3 days to make sure we produce a product 
that this House can act on next week, one we can get done and finished 
so the Senate can move and we can eventually sign this important new 
addition to Medicare into law.
  I thank the gentleman for his sterling work on the Committee on 
Energy and Commerce and for calling this special order tonight.
  Mr. FLETCHER. I thank the gentleman from Louisiana (Chairman Tauzin). 
It is certainly a privilege to serve with the gentleman. Again, I want 
to thank the gentleman for the endless hours that he has put into it, 
him and his staff and the other members on the committee, to put 
together this bill. It is the culmination of several years' work.
  We have improved on the bill we passed a year-and-a-half or 2 years 
ago. We made some tremendous improvements, as the gentleman stated. 
That is why it is estimated that 93 to 97 percent of the seniors would 
find this plan so attractive that they would take advantage of it, just 
as the gentleman's mother said.
  Let me thank the gentleman also for his leadership. The Committee on 
Energy and Commerce has historically taken a very strong leadership 
role in health care, and the gentleman has continued not only that, but 
enhancing that leadership role, and it is a privilege to serve with the 
gentleman. I thank him for coming and sharing the time with us this 
evening.
  As we continue to look at this, the chairman of the Committee on 
Energy and Commerce mentioned that we set aside $350 billion, and yet 
the Democrats, the minority party, did not offer any particular number 
for a budget. They did not offer any kind of plan to set aside any 
money at all for prescription drugs for our seniors. Yet they are 
beginning to roll out a plan that will probably spend between $800 
billion over 10 years to $1.2 trillion.
  They offered no plan to pay for that. They have not said whether they 
are going to cut education, national security or homeland security. Are 
they going to cut health care benefits to other individuals? Where are 
they going to get the money? Or are they going to offer an accompanying 
tax increase bill, because that is what they are talking about. They 
constantly talk about the fact of the tax relief that we passed for the 
American people.
  So it would only make sense if they are offering a bill that rings up 
deficits as far as the eye can see, they would have to offer either 
some offsets in education, health care, national defense, homeland 
security, something to offset that, or offer a tax increase. I just do 
not see that happening.
  I am additionally glad to have the gentlewoman from Pennsylvania, 
around the Pittsburgh area, with us also. She was here the other 
evening and shared some time. She has taken a leadership role on this. 
I know she has a lot of seniors in her district that she is very close 
to and concerned about. The gentlewoman from Pennsylvania (Ms. Hart), 
we are glad to have you here this night. I yield to the gentlewoman.
  Ms. HART. Mr. Speaker, I thank the gentleman from Kentucky (Mr. 
Fletcher) for spending time on this issue.
  People around the country are learning what our plan is all about. 
They are beginning to understand that we are responding to the concerns 
they have discussed with us, our principles: that we lower the cost of 
prescription drugs for every senior; that we guarantee that the 
prescription drug coverage will be available to them under the Medicare 
plan they are so used to receiving their health care through; that we 
improve Medicare, the whole plan, with more choices for them and more 
savings for them; and also that down the road Medicare will still be 
there, that we make sure we strengthen it for the future.
  But the prescription drug issue is one that is new to Medicare, and 
it is one that as I know in the gentleman from Kentucky (Mr. Fletcher) 
traveling in his district and those of us who have had an opportunity 
to speak today have all experienced the discussions with our 
constituents about this issue.
  I am from Pennsylvania, where we actually currently have a State 
prescription drug plan. It is a very good plan, but it does not cover 
every senior. The concerns that I heard while I served in the State 
senate before I came here to Washington included the concerns that 
said, ``You know, I am a senior citizen. I am not poor, but my 
prescription drug costs are so high that they are making us poor.'' It 
is couples that basically were very comfortable until one of them was 
stricken with a more serious illness and was hospitalized, and then 
went out of the hospital to maintain his or her health and found that 
the cost of $1,000 a month or so was going to break them. It is 
something that was not really helped by the State of Pennsylvania's 
PACE program, because it is strictly a benefit available only to people 
who qualify by income.
  I think it is important that we note that. Although Pennsylvania's 
plan has helped a lot of folks and continues to help a lot of folks, 
our plan is more comprehensive.
  I recently held a roundtable discussion at home, and a gentleman who 
was with us that day talked to us about the maintenance and the 
prescription drugs that his wife needed to take for an ailment that she 
had and how they were making the choices that you do not want anyone to 
say they are making between some level of sustenance and the 
prescription drugs they needed to keep their health. It was clear to me 
that no matter whether a person in our roundtable was someone with very 
low income or someone with more moderate or higher means, that they 
believed that the Medicare system should certainly address the issue of 
prescription drugs. That is why we have gone in that direction. It is 
important for us to do that.
  People have come to rely on Medicare as their health coverage once 
they reach retirement. It is something that gives them peace of mind. 
They know they will be taken care of if they go to the hospital, if 
they see their doctor. Those issues that take a little bit of that 
concern away from them also, I think, help with their health. 
Unfortunately, now the worry that many of them have faced as a result 
of not knowing how to pay for their prescription drugs has caused a lot 
more problems for them.
  Our plan will make sure that that worry goes away. It provides 100 
percent coverage for low-income seniors and a small premium for 
coverage for higher-income seniors. The whole point is to make sure 
that people know they will be taken care of.
  Our roundtable discussion gave me the opportunity to talk to the 
senior citizens in my district about what they really want to see. They 
said they like the idea we will make the coverage available to 
everyone, but please do not force them to avail themselves of that 
coverage, because if they have a good pension, and a lot of people in 
my district are doing okay, have a decent pension from their retirement 
that gives them some drug coverage, and they like what they have, they 
want to keep it. So it is a voluntary plan. That is one of the other 
important things. We do not force anybody into a plan they are not 
interested in being part of, but it is available to everyone. So that 
is the key.
  The group wanted to know if it would cover every senior, not just the 
low-income seniors that were covered under Pennsylvania's current plan. 
I said, of course. The plan was to look at what was working well in the 
States that have those kinds of plans, but beef them up with other 
coverage for those who may not be covered by some of the States that 
have plans, like ours. It is called the PACE program. Like I said 
earlier, it is based on income only.
  As you see, if you have a certain low level of income, under our 
Medicare prescription drug coverage plan, you will be covered for free. 
It will be very similar to our program at home. But what is better 
about the Medicare drug coverage plan that we have, that the 
Republicans have proposed, is that it does not stop here. It would 
provide prescription drug coverage for those who are higher income so 
that part of their costs would be covered.

[[Page 10592]]

  I think the average senior citizen, some statistics we found show 
that the average senior who pays $2,100 in prescription drugs would 
save over 50 percent under our plan. That is a lot of money. All the 
seniors I met with urged me to ensure that those coverages would be 
available. They also said they wanted to make sure that if someone has 
extremely high costs, that they will be helped as well, even if they 
have a higher income. Like I said, it is available to every senior.
  Our plan addresses people who are in a dire financial situation, and 
it does not force them to make a choice between sustenance, between 
food and their prescription drugs; between paying the rent or paying 
that mortgage, if they still have one; or other expenses and 
prescription drugs. They should not have to make that choice. These are 
a lot of the World War II generation, people who have served their 
communities all their lives. The least we can do now is to provide them 
with really what is an updated Medicare coverage.
  It is a good plan. It is voluntary. It reduces costs for every 
senior. Prescription drugs are what people need as they age and they 
face illnesses to keep them healthy and out of the hospital. Our goal 
is to try to keep people as healthy as possible, so our Medicare 
prescription drug coverage is certainly something that is going to help 
them, keep them healthy and active, as they are today, so many seniors.
  If we can keep them healthy and active, in the long run Medicare is 
going to save money, because they will be out and working and being 
active and out of the hospital, which is the key. I think it will be 
better for them, their families, and obviously for their peace of mind.
  I thank the gentleman for allowing me to be part of tonight's 
discussion.
  Mr. FLETCHER. Mr. Speaker, we appreciate the gentlewoman's leadership 
role and her coming.
  As the gentlewoman was talking about those low-income seniors, I was 
reminded of a senior that I talked to. It was a group of seniors, but 
one of the individuals from a senior citizens center came up and talked 
to me who managed it. He said there was a gentleman in that center, and 
that the first half of the month he was just a perfect gentleman in 
every way. The last half of the month, however, his countenance and 
behavior changed substantially. When they really investigated, it was 
because he was a low-income senior, fixed income, and could only take 
his medicine for half a month. That is all he could afford.
  So this plan is doable. It is not a pie-in-the-sky plan that we see 
the minority offering. That pie-in-the-sky plan would actually keep us 
from passing this bill as we pass it if the Senate does not take it up. 
Yet this would provide for that gentleman I am talking about, for the 
seniors the gentlewoman has alluded to and talked about specifically. 
It would provide 100 percent coverage for these low-income seniors. It 
would prevent that gentleman I was talking about from having that 
terrible experience of having to just take half a month of his 
medications and then have the consequences of that.
  So I thank the gentlewoman for joining me.
  Ms. HART. Mr. Speaker, if the gentleman will yield further, I was 
going to add to that that his physician would have sat him down and 
told him exactly what he needed to do to maintain his health. He 
probably has every intention of doing that. All we need to do is help 
him do it, because he is perfectly willing, I am sure, to take the 
medications that he needs to maintain his health. We just need to give 
him the wherewithal to get those medications.
  Mr. FLETCHER. Absolutely. One of the things I find out with these 
seniors in my experience, in practicing medicine with some of these 
seniors, they are very proud people. They are not used to having to 
come up and saying, I cannot afford this for the rest of the month, 
because they worked very hard. We put them in a very awkward position, 
and so it is very difficult for them to come.
  With this kind of plan, it would be within Medicare. Just like the 
plan they receive now, it would be something that is an entitlement, 
they earned this, and it would prevent that from happening.
  The gentlewoman is absolutely right. We appreciate her being here. I 
know the people of Pennsylvania are very proud to have her represent 
them.
  Next as we continue this discussion, I want to just say as we look at 
Medicare, it was established in 1965. The next gentleman has not been 
here that long, but he has been here longer than I have, and he is a 
very distinguished member of the Committee on Energy and Commerce. He 
represents southern Illinois, and in his new district actually he will 
be bordering my home State of Kentucky.
  I yield to the gentleman from Illinois (Mr. Shimkus). We are glad to 
have him here tonight. We appreciate his leadership on the Committee on 
Energy and Commerce, as well as his leadership on the prescription drug 
effort and this bill and being with us here this evening.
  Mr. SHIMKUS. Mr. Speaker, I thank the gentleman. It is an honor to 
have the gentleman on the Committee on Energy and Commerce, and his 
expertise helps us move important health care legislation.
  Mr. Speaker, we do have the best health care in the world, but it has 
problems, and it has challenges. Really one of the most frustrating 
things for me is to try to address how the Federal Government is a good 
or bad partner in all the different aspects of health care.
  A lot of my colleagues have spent a lot of time talking about the 
prescription drug benefits in this plan, but there are some other 
benefits in this package that I also want to make sure that we 
highlight and address.
  One is, of course, a little self-serving, is my own piece of 
legislation, H.R. 4013, which we are going to include, the Rare 
Diseases Act. Being the sponsor of the bill, it encourages better 
treatment, better diagnostic procedures and cures for large numbers of 
rare diseases and disorders.

                              {time}  1745

  These are diseases that are very catastrophic to the individual; but 
in terms of the number of population, it is based upon a large 
population of the country, it is a very small percentage. So there are 
great challenges, and people who want to try to invest to find a cure, 
since the population is so small, we have to really encourage people to 
do the research and the development, and we have to encourage them to 
try to find the new medicines to help do that.
  Although each of these illnesses affects less than 200,000 people, a 
total of 25 million Americans, one in nine, today suffer from at least 
one of the 6,000 known rare diseases. A lot of the familiar ones that 
we have heard about, Lou Gehrig's disease is one of these diseases, 
Tourette syndrome is another one, that if not included in this 
provision, would probably get left out, and then we would not have the 
incentive to help this segment of the population that are afflicted by 
some of these terrible diseases.
  So that is why I am excited about the markups that are occurring in 
actually two committees, our committee and the Committee on Ways and 
Means. They are very similar, I think there will be some differences, 
but we will work them out when we bring that bill to the floor.
  But I also appreciate the fact that our bill meets the budgetary 
guidelines, and that is no small task. We pass a budget, we fight over 
the budget, that fight is over. We pass it on the floor, and then we 
have that slice of the financial pie to be able to address a 
prescription drug issue and some reform provisions. It is no small 
task, and I applaud the leadership on both sides, from the Committee on 
the Budget to the chairman, for making that happen.
  Again, the other thing that I wanted to highlight real quickly are 
some of the other provisions in here that are very, very beneficial, 
especially to rural and small communities throughout southern Illinois. 
All people who deliver those services, all hospitals will see 
increasing payments in 2003 for hospitals by reducing the market 
basket, inflation adjustment rate.

[[Page 10593]]

  Sole community hospitals will increase payments in 2003 for rural 
hospitals by the full market basket resulting in a 3.3 percent 
increase.
  There is a lot of terminology here. I come from the military, from an 
Army background; and we had acronyms out of the world. So one we see 
here is the DSH payments, which stands for disproportionate share. This 
bill will increase the DSH payments for rural and small hospitals in 
urban areas by increasing the cap from 5.7 to 10 percent over 5 years 
beginning next year. It addresses an issue of critical access hospitals 
wherein it reinstates special cash-flow provisions, fixes special 
physician payment adjustments; and we can see the complexity of health 
care in here when we have all of these specific areas that we are 
trying to fix with this legislation. The legislation imposes 
flexibility in the size requirement as defined by the number of beds, 
and reauthorizes rural flexibility grants.
  Home health. It benefits home health care, which is a major provider 
of something we believe in and that has really taken a beating since 
1997.
  It also increases hospice care. As an individual, and as many 
families have concerns when someone is dying in the family and hospice 
comes. It is a great service. We need to help that service. It is a 
great way to ease someone into that next transition from this life to 
the next by having care and concern at home, and hospice gets 
reinforced financially.
  It helps direct graduate medical education. It helps teaching 
hospitals in rural areas and in small cities to receive additional 
direct graduate medical education assistance.
  In studies of geographic adjustment for physicians, there is a 
differential in payments for physicians. This will help to quantify and 
qualify for that.
  It addresses ambulance transportation. I have a great aunt on my 
wife's side who had to be moved. Some of the movement was funded, some 
of it had to be paid out-of-pocket, and the out-of-pocket was not a 
very good way to be transported 50 miles.
  The last thing was indirect medical education. There is an increase 
of 5.5 percent in 2003 and 6 percent in 2004.
  Mr. Speaker, a lot of my colleagues have come to the floor and talked 
about the benefits of people having access to prescription drugs. 
Illinois has a pretty good program too for the poor. This will help 
build on that. But there are other provisions in this bill that as we 
get the bill through the committee and as we work with the Committee on 
Ways and Means and we get it on the floor, if we stay within the budget 
guidelines, not only can we provide seniors with some hope for the 
future of some assistance with their prescription drug costs, but we 
can really start addressing some of the catastrophic concerns that have 
evolved based upon the funding mechanisms for rural and poor hospitals.
  That is why I am pleased to come down to the floor and speak in 
support of this bill.
  Mr. FLETCHER. Mr. Speaker, I want to thank the gentleman for coming 
and sharing. He brought out a lot of the other details of this bill 
which are very, very important. We can provide all of the health care 
out there, but if there are no providers that are willing to 
participate in this program, the seniors would have no access to health 
care. This makes some very important corrections, as the gentleman 
mentioned, for rural hospitals, physicians, hospice, home health, those 
things that ensure that not only do we have this coverage for 
prescription drugs, but that we have providers that will participate 
fully so that seniors will have full access to the health care they 
need.
  The gentleman mentioned the rare diseases, and something I think is a 
moral obligation, and I want to thank the gentleman for taking the 
leadership. It is not a large number of people, but if you have ever 
known a family or been in a family or had a family member that is 
afflicted with one of these diseases, it has a tremendous impact. I 
want to thank the gentleman for all of his work and leadership on that. 
We are glad to see that.
  I wanted to ask the gentleman a question. We have the gentleman from 
Illinois (Mr. Kirk) here, and I know Kentucky has shortfalls in 
Medicaid. We have $700 million shortfalls, and that is similar to a lot 
of the States around. This provides, for those that are dual-eligible 
for Medicare and Medicaid, it helps buy out those transitions for 10 
years and saves the States $40 billion, which is tremendously needed in 
Kentucky, and I know the gentleman mentioned that, and I would like to 
give the gentleman an opportunity if he would like to speak to that 
point.
  Mr. SHIMKUS. Mr. Speaker, we have been working with the State 
government in sharing what information we have about the bill being 
presented, and they are very excited about it, not just because of that 
provision, but also because of the assistance with the prescription 
drugs. The States are in financial crisis. Illinois, I think, had a 
$1.2 billion shortfall which they have been wrangling with now for 
months, and they have had to make some tough decisions. We, through 
this legislation, will be able to help bring more flexibility and more 
support for rural health care.
  Health care in America again is a very frustrating thing, if one is 
really following the dollars and cents. I think the only way we survive 
is through partnering, through working with local community hospitals. 
There is a lot of hospitals that are writing off millions of dollars of 
uncompensated care. And they are providing a great public service. 
Maybe not just a public service, maybe a lot of them are religious 
affiliated hospitals and that is part of their mission, but they are 
still writing it off and they are real dollars. So by working with the 
State and the Federal Government partnering, by working with community 
hospitals, whether they are tax-supported or faith-based organizations, 
we can continue to provide the care that this country expects us to 
provide, not just for those of us who are employed and have good plans, 
but for those who are less fortunate or are retirees or are those who 
are in transition away from work at this time.
  Again, I thank the gentleman for the time, and I think the State will 
be very excited to get this bill out of committee and on to the floor. 
The gentleman from Illinois (Mr. Kirk) may make some comments about how 
the State of Illinois will also benefit.
  Mr. FLETCHER. Mr. Speaker, I thank the gentleman. I yield to the 
gentleman from Illinois (Mr. Kirk). We thank him for his leadership and 
the experience that he has brought, not only to this issue, but to 
Congress in general in his work in the past, representing the suburbs 
of Chicago. We thank the gentleman for coming and joining us this 
evening.
  Mr. KIRK. Mr. Speaker, I thank the gentleman. I am absolutely in awe 
of the gentleman's work product and what the gentleman has done. I want 
to help the gentleman in every way possible.
  Mr. Speaker, when Medicare was established in 1965, prescription 
drugs given outside the hospital did very little. Republicans and 
Democrats both left it out of a Medicare program. Today, prescription 
drugs given outside of the hospital carry much of the load in medical 
care. Republicans and Democrats agree on a bipartisan basis that it is 
time to add prescription drugs to Medicare for needy seniors. Many 
States, such as my own home State of Illinois, already have done so; 
but it is time for the Federal Government to do its part.
  The real difference between the two parties, Mr. Speaker, is one of 
cost. The minority's plan would create an open-ended, unlimited program 
to subsidize even very wealthy seniors who are ready to take part and 
already have a prescription drug plan. Costs would skyrocket, dipping 
into Social Security and limiting funding to restore our national 
security. The minority's price tag for their plan could exceed $800 
billion. Do we sacrifice homeland security or national defense or 
Social Security or education to pay for their plan?
  Last year, in a nonelection year, most minority members voted for a

[[Page 10594]]

prescription drug plan that cost $325 billion over 10 years. Now, in an 
election year, the number has nearly tripled. But if we are to adopt a 
plan which costs so much, eventually, we will have to break a promise 
made to seniors.
  The majority plan cares for needy seniors without putting financial 
pressure on Social Security or denying the needs of our men and women 
in uniform in Afghanistan's front lines. Our plan is balanced. It 
protects needy seniors and does not break the bank.
  I just want to close by saying that by not breaking the bank, our 
plan means that a promise made to America's seniors is a promise that 
will be kept, and we need to design a plan we can afford to keep so 
that seniors can count on this.
  I applaud the leadership of the gentleman on this, and I thank him 
for all he has done to bring this plan before the House of 
Representatives.
  Mr. FLETCHER. Mr. Speaker, I thank the gentleman. I think he has made 
some very good points, points that are new and the first time they have 
been made here tonight, and that is, if the plan previously was enough, 
not only in an election year, how are they going to pay for that? 
Particularly the part about an open-ended entitlement for wealthy 
seniors that would actually end up bankrupting Medicare and threaten it 
in the future.
  One of the things that really concerns me is that if we look at the 
Democrats' plan, $800 billion to $1.2 trillion over 10 years, the 
estimated cost of that. Now, where are they going to get that? Are they 
going to get it from education, national defense, homeland security? 
Are they going to have to raise taxes? What we have under their plan is 
that they would have to raise taxes on our hard-working people. These 
are our teachers, these are the folks that are working in the kitchen. 
These are folks that are just barely making it by, new families that 
are trying to ensure that they can buy their first home. We will be 
taking from them, and we will be supporting the prescription drugs 
totally for folks like Ross Perot.
  I think the gentleman pointed out a real moral dilemma and a real 
moral shortfall in their plan, so I thank the gentleman for coming 
tonight.
  Mr. KIRK. Mr. Speaker, if the gentleman will yield, I would just say 
that it is important to note seniors will count on the commitment that 
we are making. So it is important that the commitment that we make is 
one that we can keep. By designing an affordable plan, we will be there 
for seniors in the future.
  Many seniors remember when the Congress created a catastrophic health 
care plan and then revoked it just a short time later, so that the 
promise made was not a promise kept. The gentleman and I both want to 
care for seniors, and we both want to make sure that their house cannot 
be taken away because they have been bankrupted through prescription 
drug costs. Our plan does that. But we do not want to design a plan 
which some future Congress cannot afford to pay for, with all of the 
other demands.
  America's seniors, more than any other generation, knows that there 
is a war on, and that we have to make a responsible commitment that we 
can afford to keep. That is why I applaud the direction that the 
gentleman is going in here with this plan; because under this plan, we 
will make commitments to seniors and we will be able to afford to keep 
them.
  Mr. FLETCHER. Mr. Speaker, again, I thank the gentleman, and I thank 
him for the good representation for the folks from Illinois there.
  I have here a list. The gentleman mentioned that previously the 
Democrats had supported this bill.

                              {time}  1800

  Let me read off just a few names of Democrats in a nonelection year 
who voted not for $350 billion, but had voted for less, $303 billion, 
and they thought that was very adequate, very good for prescription 
drugs. Now these same people say that $350 billion is not adequate. 
Maybe it has to do with the fact that this is an election year.
  Let me read some of the names: the gentleman from Missouri (Mr. 
Gephardt), the gentleman from Michigan (Mr. Dingell), the gentleman 
from Michigan (Mr. Bonior), the gentlewoman from California (Ms. 
Pelosi), and the gentleman from California (Mr. Stark). These are 
Members that we will hear talk about this $350 billion not being 
enough. Why? I think clearly we see that they want to make a political 
statement in an election year.
  Our plan, again, is very doable, very reasonable. The real dilemma 
here that we have in America is that no senior should have to choose 
between food and medicine. I think any of us who have been out to our 
senior citizen centers, those who have practiced medicine, have seen 
that dilemma.
  Now, in practicing medicine, we try to give samples, and 
pharmaceutical companies have certainly given away free medication. But 
we have a plan here that will make sure that this is not the order of 
the day in America; that we will eliminate this dilemma by providing 
coverage to those seniors who are having to make that choice now.
  We have gone over some of the principles:
  One, it is a voluntary plan; very important. Members have heard that 
93 to 97 percent of seniors will take advantage of this because this 
plan is so attractive.
  It provides choice; it is a voluntary plan. This is unlike the 
Democrats' plan, the minority plan, which provides one single formula. 
Now imagine that. That means a bureaucrat is going to be managing every 
single pharmaceutical drug that one can have in their medicine cabinet. 
That means we politicize every single new product that comes out that 
is produced.
  Of all the wonderful medications that we have had, and that is the 
reason we have this problem with rising costs is because we have had 
tremendous technological advances in pharmaceutical agents, imagine 
every one of those agents being politicized to the point of deciding 
are we going to add this to the formulary or not.
  We would have the House of Representatives and the Senate and 
bureaucrats micromanaging this sort of thing when it really needs to be 
out there where patients and seniors have a choice between plans, and 
how they choose the plans will drive what medications are on those 
plans. That is why choice is extremely important.
  This plan guarantees every senior will have at least two choices; at 
least two, minimum. We anticipate they will have more than that.
  It is a guaranteed plan. It is not something we put up and say, we 
can afford this very large plan for a few years, and then we are going 
to have to sunset it. That is like putting a chair out and asking the 
senior to have a seat, and then right at the time they begin to sit 
down, we pull it right out from under them. We do not think that is 
responsible, and it is not something we could even fathom doing to our 
senior citizens. So this is a guaranteed entitlement that will go on 
and extend.
  It also provides immediate savings. The CBO has estimated in the past 
it will provide up to 30 percent. We do not know exactly what the 
number is, but we do know it will provide immediate relief. That is now 
for seniors as they walk in.
  If we have an employer-based insurance plan, we walk in and get a 
reduction on our pharmaceutical drugs, but seniors do not. They pay 
sometimes up to 25 percent more. That is not fair. By the power of 
negotiating, we can reduce that and give them savings immediately.
  It also provides catastrophic coverage. Anybody who has out-of-pocket 
expenses of over $4,500 will get those expenses fully covered. What 
does this prevent? It prevents individuals from having to bankrupt 
themselves and spend a lifetime of savings due to runaway drug costs. 
This is a protection we find when we talk to seniors that most of them, 
and overwhelmingly the majority of them, desire.
  So this lowers drug costs now, and guarantees all seniors will have 
coverage under Medicare. It is under Medicare. It will improve Medicare 
with more choices and more savings. We talked about the provider 
changes, the

[[Page 10595]]

hospital changes, and some of the other changes.
  We did not talk a lot about the Medicare+Choice, which has about 5 
million Americans participating in that plan. We want to make sure they 
continue to have the coverage they have, and it will strengthen 
Medicare for the future.
  We talked about, for those low-income individuals, about those making 
$17,910 for couples or $13,290 for singles, this will fully cover their 
expenses, so we will have no low-income seniors or seniors on fixed 
incomes having to decide between food and medicine.
  There are a couple of other charts I would like to get here. Let me 
say, who thinks that $350 billion is enough for Medicare? One, the 
House Democrats thought that. On the Spratt amendment, the gentleman 
from South Carolina (Mr. Spratt) offered House amendment No. 21 to the 
fiscal year 2002 budget resolution which said $350 billion is enough. 
Now, again, they have changed their tune on that. The tripartisan 
Senate group June 7, 2002, said in Congress Daily $350 billion is 
adequate.
  Next, I talked about the expenditures: What is reasonable, what is 
doable. The House Democrats triple Medicare spending in just 1 year. If 
we look, it goes from 400- to over $1.2 trillion in 1 year.
  Now, they talk about tax breaks, and they do a lot of talking about 
the tax relief bill that we gave, yet when we look at that, many of the 
Democrats voted for that tax relief bill. Now they are talking about 
the fact that our prescription drug bill is not affordable because of 
the tax relief we gave to the American people.
  They are offering a bill that triples the expenditures of Medicare. 
They talk about, with class warfare as part of their discussion, that 
we are not able to afford that because we gave some tax relief to the 
hard-working Americans.
  Well, I would like for them to step up and say how are they going to 
pay for this triple expenditure that they have, and is it doable? There 
are some on the Senate side who have offered a bill and sunset it after 
a few years because they know they cannot afford it, particularly in 
the outlying years. Again, that is not, I think, a morally reasonable 
thing and a doable thing that we can enact here. We need to enact a 
bill that is responsible and doable.
  Next, let me point again to tell Members that the Senate Democrat 
plan expires in 2010. We see an expiration. Ours is a continuing 
entitlement that will be for seniors from now on. It is a responsible 
way of doing a bill and will continue to provide those benefits that we 
have talked about.
  Who supports this bill? We could go through: the 60 Plus Association, 
the Alliance to Improve Medicare, the ALS Association, the American 
Academy of Dermatology Association. We could go right on down and look 
at number of associations. The Kidney Cancer Association, the Health 
Association of New York State. Florida AIDS Action sponsors this and 
supports this bill. There is the Society for Thoracic Surgeons, United 
Seniors Association, the Visiting Nurses Associates. We also have 
American Urological, American Association of Cataract and Refractive 
Surgery.
  What we have is an overwhelming number of the providers that are 
actually taking care of patients and seniors, groups that actually are 
speaking on behalf of seniors who support this bill.
  In conclusion, let me say that this bill is a very responsible bill. 
Again, I want to thank the gentleman from Louisiana (Mr. Tauzin) and 
the gentleman from Florida (Mr. Bilirakis) for their work. The 
Committee on Energy and Commerce will be beginning to mark up a bill 
tomorrow to provide a Medicare prescription drug benefit for every 
senior in America.
  I want to close out. I appreciate the opportunity to speak this 
evening on this very important subject. I feel very hopeful that we can 
get this passed and pass it on to the next body to take it up, and pass 
this bill for the seniors across America.

                          ____________________