[Congressional Record (Bound Edition), Volume 149 (2003), Part 12]
[House]
[Pages 15879-15883]
[From the U.S. Government Publishing Office, www.gpo.gov]




                    IMPACT OF PRESCRIPTION DRUG BILL

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 7, 2003, the gentleman from Arkansas (Mr. Berry) is recognized 
for half the time until midnight as the designee of the minority 
leader.
  Mr. BERRY. Mr. Speaker, we are here this evening to talk about the 
impact of this very cynical prescription drug bill that is proposed by 
the majority side and what would happen if that bill, were we so 
unfortunate as a Nation as to have that bill enacted into law and put 
upon our senior citizens.
  We are indeed pleased that the gentleman from North Carolina (Mr. 
Ballance) is here with us, and at this time I would like to yield the 
floor to him and let him make whatever comments he sees fitting in 
regard to this particular issue; and we thank the gentleman from North 
Carolina.
  Mr. BALLANCE. Mr. Speaker, I want to say at the outset that it is an 
honor for me to be standing in these hallowed halls as we address 
issues of such great import to the people of this country.
  A little more than a year ago, I campaigned in rural eastern North 
Carolina. I spoke to citizens at AARP meetings, at senior centers, at 
residences and elsewhere; and like most of my colleagues in this 108th 
Congress, I made a solemn promise that I would support and vote for a 
prescription drug benefit program. Each of us, I believe, most of us I 
know, made that promise to our constituents; and I, and I hope most of 
my colleagues, will keep that promise. I know that I will keep mine, 
and I will not vote for a plan that simply has the label on it.
  The plan that the Republican leadership of this Chamber has proposed 
would not benefit our seniors in the way that they need and deserve. It 
is not a real prescription drug plan. It is what I would call an empty 
promise.
  Mexico, Canada, Germany, England and France, what do all these 
countries have in common? Their seniors all pay lower prices for the 
exact same prescription drug medication that American seniors today 
cannot afford. One month's supply of Zocor, a prescription commonly 
taken by seniors to lower their cholesterol, costs $124 in the United 
States. In Europe, the same medication costs $28. The antidepressant 
Prozac, also widely prescribed throughout America, costs nearly $100 
for just 20 pills. In Canada, those same 20 pills cost $20.
  Throughout America, seniors have for years been forced to choose 
between food on the table and medication, stories that we have heard 
about cutting pills in half or going without. Hardest hit are seniors 
and disabled of rural America, such as those in Arkansas and in North 
Carolina, the area that I represent.
  We have three plans before this Congress: the House Republican 
measure that focuses on nothing less than the absolute dismantling of 
Medicare as we know it; a Senate bipartisan measure that is somewhat 
better, although still falls far short; and we have a Democratic plan 
that is affordable, it is available, guaranteed and will maintain 
Medicare. Our plan has no gap in coverage, no doughnut hole, does not 
depend on the whims of HMOs or private insurance companies. However, we 
all know full well that, because it is a real plan, it probably will 
never see the light of day.
  Hopefully, however, the Democratic plan will force the Republican 
leadership to reconsider their devastating proposal and treat our 
seniors fair. So tonight we focus on the reality of how House 
Republican leadership efforts hurt seniors in rural America, 
disenfranchise, dismantle and ultimately devastate.
  That is what we can expect in eastern North Carolina if the House GOP 
has its way with this prescription drug coverage. That plan will 
privatize the prescription drug benefits by relying heavily on HMOs to 
facilitate these programs.
  Anyone who lives in rural America, such as eastern North Carolina, 
already knows the health crisis facing families and seniors, as big 
HMOs have abandoned them and consider them unprofitable.
  I am going to close because I think we know what we are facing. We 
know what we must do. We must fight to ensure that even hard-to-reach 
rural communities are included equally and with real results in a much-
needed drug coverage plan; and we, Mr. Speaker, must keep our solemn 
promise.
  Mr. BERRY. Mr. Speaker, I thank the gentleman from North Carolina for 
his comments, and appreciate his leadership in this matter that is so 
critical to the senior citizens of this country and the tremendous 
impact it will have not only on our seniors but on all Americans 
because when the government makes it possible for one person or group 
of persons like the prescription drug manufacturers of this country, 
when the government makes it legal for them to rob and to steal from 
senior citizens, when the government allows that to go on day after day 
after day, it is our job to speak out. It is our job as best we 
possibly can to do something about it.
  It is an interesting thing, every speaker that talks about this 
refers to the fact that the United States of America and American 
citizens pay three to four times as much for their medicines as any 
other nation in the world, and yet the President of the United States 
has within his power the ability to change that with the spoken word. 
All he has to do is tell the Secretary of Health and Human Services, 
Mr. Thompson, certify that we can put

[[Page 15880]]

a stop to this, certify that we can safely reimport medicine and let 
our people be treated fairly, but the President refuses to do this.
  So it is left up to us, once again, to attempt legislation that will 
make it possible for the senior citizens of this country to be treated 
fairly. How can we deny the pain and suffering that this policy, that 
this country has put in place, causes to our senior citizens and to 
their families? How can we continue to let that go on? Yet when a 
remedy is proposed, in this cynical way that we will be presented with 
before the end of this week, I think it is called the Thomas-Tauzin 
bill or the Tauzin-Thomas bill, but we cannot devise a more cynical 
attempt to trick the American people and the senior citizens of this 
country.
  That bill, if we would be so unfortunate to see it enacted, 
specifically prohibits the government from trying to achieve the best 
possible price for our citizens. It specifically makes it possible for 
the drug companies to continue to rob the senior citizens.
  It would privatize Medicare. Medicare came into being because private 
insurance did not want to insure people that were older and sicker, and 
yet now we are going to turn this back to the insurance companies. If 
anyone thinks that that is a good idea, I would suggest that they go 
out and try to buy some health insurance from a private company for a 
65-year-old citizen.
  It will end Medicare as we know it. One of the authors of this bill 
came before the Blue Dog Coalition this afternoon, very proud of his 
work. It was interesting as he sat there and described this; and he 
said, I have softened this part of the bill; instead of just ending 
Medicare as we know it in 2010, we are going to phase that, ending in 
over 3 or 4 years. So it just will not be quite as noticeable.
  I could not help but think as I was listening to that about my 
brother when we were young boys. He had worked hard one summer and 
saved his money, and he wanted to buy himself a shotgun for hunting 
season. He went to town and went to the hardware store, and he asked 
this fellow how much will you take for a certain shotgun. The 
proprietor said, well, I do not have one; but if I did, I would sell it 
to you for $100. So since the fellow did not have one, he went on 
around the square, and he came to another hardware store and went in 
there and asked him if he had that gun. He said, yes, I do. He said, 
well, how much will you take for it? He said, I will take a $110. He 
said, well, the other fellow on the other side of the square said he 
would take $100 for his, but he did not have one. He said, well, if I 
did not have one, I would take $100 for mine.
  That is the way this deal works. It does not even go into effect for 
2 years, 2006. Our seniors have an urgent need today. We have the 
ability to provide relief today; and yet we are going to be presented 
with this cynical, horrible piece of legislation that is nothing more 
than an attempt to trick our senior citizens in desperate need into 
doing something that will make their desperation even worse.
  What kind of a legislative body would do something like that? This is 
absolutely amazing that the leaders of the Republican Party in the 
House would be so cynical that they would be willing to attempt to take 
advantage of senior citizens who have already paid the price, done the 
work, lived by the rules, and built this great Nation into what it is 
today; and now they are going to be treated like this by those of us 
that inherited this wonderful place.

                              {time}  2300

  I am astounded that we have to come to this floor this evening and do 
everything we can to try to prevent such an outrageous act by the 
majority.
  Mr. Speaker, I now yield to the gentleman from Texas (Mr. Rodriguez).
  Mr. RODRIGUEZ. Mr. Speaker, let me first of all thank my colleague, 
the gentleman from Arkansas (Mr. Berry), for being out here. It is 11 
p.m. eastern time, and people might wonder what we are doing here this 
late. Well, we are talking about an issue that is important. We are 
talking about an issue when I go to a church on Sunday where people 
still confront me and ask me what we are doing about this issue. I know 
myself and we have the gentleman from Texas (Mr. Sandlin) out here 
tonight to talk about an issue that continues to confront us, yet we 
continue to play games with the American people and with our seniors. 
That is not right. We need to make sure that we do the right thing.
  Mr. Speaker, we know that our seniors are having difficulties. We 
know that the majority of them do not have the resources to pay for 
their prescriptions. We also know on the Republican side and on the 
Democratic side that the private sector, the insurance companies, 
cannot make a profit on our seniors when it comes to prescription drug 
coverage. We recognize that.
  When this all first started, with LBJ, there is a little story that 
is told about this. When LBJ was trying to put Medicare together, the 
biggest obstacles were the insurance companies back then, and the 
doctors. He finally got the insurance companies there and he told them, 
look, I am going to do you a favor. You have been making a profit off 
of the young people and insuring them while they are healthy, and as 
soon as they get sick on you, you have been dumping them and dropping 
them off your insurance rolls. So we know that the companies were doing 
that then and they are still continuing to do that now. So when he got 
them in there he said, look, I will do you a favor. You keep taking 
those profits while they are healthy but allow us to establish Medicare 
so that we can take care of them in their later years when they become 
seniors and they need the assistance, and you can continue to make your 
profits.
  And so now we have a situation where our seniors still reach that age 
where they need that assistance, where they need our help, where they 
need prescription drug coverage, and what angers me the most is that 
the drug companies are the ones that are making a profit off the ones 
who can least afford to pay for these prescriptions.
  We talk about the fact that those same prescriptions are sold, Mr. 
Speaker, in Mexico and Canada, the same company, same brand, only 
cheaper. And why? Because they are sticking it to the Americans. And we 
have allowed that to happen. We have allowed that to continue to occur.
  We talk about free trade but yet we do not allow our own Americans to 
cross the border into Mexico to buy prescriptions. Why not allow free 
trade from that perspective? It is only good for companies, but not for 
the average person to do that.
  So we need to make sure that, number one, the bill has to be 
affordable for people. The senior has to be able to purchase it. I can 
attest to my colleagues that the majority of my district, with a median 
income of $23,000, $21,000, and especially my seniors, who if you live 
in rural Texas or rural America you do not have a pension because you 
did not work for a major corporation or the government, so you do not 
have a pension. All you have is Social Security. So you do not have 
extra money to buy additional coverage. And if you did, believe me, the 
insurance companies do not want that because of the fact that they are 
not going to make a profit off you. We know the data. We know the 
seniors sometimes need up to $2,900 per year. So if you need $2,900 per 
year, close to $3,000, they are not going to make a profit from you. We 
know that. Yet we are playing games and doing gimmicks.
  But this President and this administration has to come up this coming 
year in November for reelection and they are going to have to tell us 
what they have done when it comes to prescription drug coverage. They 
will be asked what they have done. Because I recall the last 2 years, 
and I want to ask my constituents to remember this, because any 
Republican who had serious opposition the last time there were ads that 
came out. We had an ad for the gentleman from Texas (Mr. Bonilla) back 
home, and that ad said, ``Call Congressman Bonilla to thank him for the 
prescription drug coverage you received.'' Well, I am going to ask you 
right now: Have you received anything back home? No. It is a gimmick. 
It is all nothing but sarcasm. It angers

[[Page 15881]]

me because they play games with the American people and they play games 
with our seniors.
  So we have to make sure if we come up with a program that it is 
affordable. What the Republicans have is not affordable. Secondly, it 
has to be meaningful. It has to be real. It has to be guaranteed. We 
cannot afford to have these little gimmicks. The reality is that the 
bill that the Republicans have is meaningless. It is private insurers 
that can change the terms of the agreement.
  We had the HMOs. I have rural counties. I had 13 counties, now I have 
11 counties after redistricting, and those counties, wherever the HMOs 
and the managed organizations were not making profits, they did not cut 
the individuals, they cut the whole county. So we are not going to be 
able to have access in rural Texas, in rural America. So it is 
meaningless.
  Finally, we also understand that we have to make sure that we 
guarantee our seniors the accessibility to these prescriptions. This is 
the most powerful country in the world. We have the capability and, 
yes, we have the best health care system in the world. But what good 
does it do if it is not affordable; if it is not accessible; if it is 
just not there? Yet we do have the best health care system. It is 
ridiculous for us to be doing this, and it is unfair to our seniors to 
be playing games with their lives, especially as they reach their 
twilight years when they need this the most and they have to sometimes 
go without buying all the prescriptions that are needed.
  So, Mr. Speaker, I want to thank my colleague for being here tonight, 
and I thank the gentleman from Texas (Mr. Sandlin) for being here and 
spending time talking about this critical issue. I want to personally 
just congratulate my colleagues and let them know that we have to keep 
this fight up. We have to keep talking about this, and we have to stop 
playing games.
  When that Presidential race comes up again, we have to let everyone 
know what he has done for prescription drug coverage. The Republicans 
have control of the Presidency, they have control of the Senate, they 
have control of the House. What are they doing? They are playing games. 
This is not the time to do that.
  Mr. BERRY. Mr. Speaker, I thank the gentleman from Texas and 
appreciate his passion and concern for all senior citizens in this 
country.
  This bill would not only end Medicare as we know it, but, 
interestingly enough, it does not have a defined benefit. It does not 
have a defined premium. It turns this business over to insurance 
companies that have a very poor record of being able to deliver service 
when it is called on to do that.
  We have been fighting the Patient's Bill of Rights battle in this 
House all the time that I have been here. We still do not have a 
Patient's Bill of Rights. But the pressure got to be so great on the 
insurance companies that they did stop the grossest abuses that they 
have engaged in to deny coverage and deny service to our American 
people. They would be allowed to define their own benefit. They would 
be allowed to set their own premium. They would be able to create many, 
many different plans, and it would be nearly impossible for a senior 
citizen to tell the difference.
  I have to believe, Mr. Speaker, that our Founding Fathers would be 
saddened and sickened to see the great Nation that they brought in to 
being, that has succeeded and prospered beyond all imagination, to the 
point where we have the ability to do these wonderful things for our 
seniors, and yet when the opportunity presents itself, the majority 
chooses to use that opportunity in a cynical way and in a way that only 
serves to enrich a few people in this country.
  I want to now yield to the gentleman from Texas (Mr. Sandlin), who 
has worked tirelessly on this issue to defend our senior citizens 
against such activities as would be used against them if this bill were 
to be passed.

                              {time}  2310

  Mr. SANDLIN. Mr. Speaker, I would like to thank the gentleman from 
Arkansas (Mr. Berry) who is both a good personal friend of mine and a 
political friend of mine, and I want to thank him for 7 years of 
political leadership in addition to his practical leadership due to the 
fact that he is a pharmacist and speaks with a great deal of authority 
on these issues.
  Mr. Speaker, in looking at this bill it is clear, it is the old bait 
and switch. I rise today to join the gentleman from Arkansas (Mr. 
Berry) and my colleagues in speaking to the Republican House leadership 
abandonment of rural America by crafting a sham prescription drug 
benefit. Because at the end of the day, it is no plan at all. What a 
cruel joke on America's seniors.
  As the United States Representative of rural east Texas, I am 
gratified to have an opportunity on the Committee on Ways and Means to 
be a voice for my constituents at home. The seniors in my district have 
told me clearly that they need real relief for their soaring medical 
expenses; and yet once again this year the majority leadership in 
Congress has rejected its responsibility to deliver a true prescription 
drug benefit to our parents and grandparents and friends at home. Just 
like last year, the Republican majority has delivered an alleged 
prescription drug plan which favors profits over people, insurance 
companies over seniors, HMOs over American families.
  Today I want to talk about choices and who is choosing what. Our 
Republican colleagues in the House of Representatives love to say that 
they are giving our parents and grandparents and friends choices for 
their prescription drug benefit. Mr. Speaker, that is simply not true. 
They also have stated that if our seniors and disabled folks want 
prescription drug coverage, then they have to look to HMOs and private 
insurance companies, not Medicare for help. That is the choice they 
have, and what kind of choice is that? It is clear, it is absolutely no 
choice at all.
  Now anyone who lives in rural areas knows that this little rule is 
anything but a choice. Rural areas have been flat out abandoned by 
private insurance companies. We know this, Medi-care+Choice, the great 
managed care experiment in our Nation's seniors, should have been named 
``Medicare Minus Choice.'' It has been a disaster.
  Just look at the facts. Between 1998 and 2003, the number of Medi-
care+Choice plans dropped by more than half. In the great State of 
Texas, over 313,000 Medicare+Choice enrollees have been dropped just 
since 1999, 313,000 people in my State. Further, this is occurring all 
over the country. The 10 States, including the District of Columbia 
with the highest percentage of their enrollees dropped in any 1 year 
from 1998 to 2003 were South Dakota, the Mount Rushmore State, 99 
percent; Delaware, the First State, 95 percent; Arkansas, the Land of 
Opportunity, 90 percent; New Hampshire, 85 percent; Maine, 82 percent; 
Maryland, 79 percent; Utah, 76 percent; District of Columbia, 71 
percent; Kansas, 54 percent of the people dropped; Connecticut, 52 
percent of the people dropped. It goes on and on.
  Mr. Speaker, over 80 percent of rural Medicare beneficiaries today 
live in an area that private insurance companies have made a choice, 
that is the choice, they have made a choice not to serve. Now please 
note, this is not an entitlement program. This is not entitlement as we 
know it under Medicare. You have no guarantee. This is this kind of an 
entitlement, it is an entitlement to ask to be able to make an offer to 
purchase a plan from a reluctant, profit-seeking insurance company that 
may or may not accept your offer.
  By the way, it is very important to note this: not a single insurance 
company in the United States of America has agreed to take part in this 
program. Let me say that again. Not one single insurance company in the 
United States of America has agreed to take part in this plan anywhere 
in America. That is a fact.
  Furthermore, even if they do decide to participate at some time in 
the future because they think they can make big profits, under this 
latest Republican drug proposal, if the private drug plan or insurance 
company decides rural America is not lucrative enough for their 
company, they can withdraw 


[[Page 15882]]

every 12 months. So much for our seniors having the choice of 
continuity of care.
  Knowing this, how can we approve a plan that does not even have a 
fall-back option of traditional Medicare providing drug coverage if 
private care pulls out? How is that a fair choice for the 9.3 million 
seniors and disabled folks that live in America? What kind of choice is 
that?
  Let us be clear, this legislation does not and this legislation 
cannot require insurance companies to offer prescription drug plans in 
rural America, and they will not. They have not and they will not. If 
we are going to talk about the choice of being fair, we are going to 
have to talk about prices. Under this bill, the HMOs and pharmaceutical 
companies are given the express choice, there is that word again, they 
are given the choice to determine how much to charge and what 
prescription drugs to offer seniors and the disabled.
  Mr. Speaker, what do you think they are going to choose: high prices 
or low prices? More coverage or will they choose less coverage? Mr. 
Speaker, the answer is clear, it is profits over people. That is their 
choice.
  Yesterday the President said, ``When the government determines which 
drugs are covered and which illnesses are treated, patients face delays 
and inflexible limits on coverage.'' Yet now he wants to turn over 
those very decisions to insurance companies who have a financial 
interest, who have a financial gain to make in denying coverage to 
America's seniors. They make more money, the more seniors they deny, 
the more money they make and the circle goes on and on. That is not a 
good choice.
  We have an opportunity to deliver a true prescription drug plan to 
our seniors this week, and to do so Congress must come together and 
choose to soundly reject this Republican albatross, this madness. If we 
shine a light on this, we can see the many problems with this sham 
prescription drug proposal. It does not provide a guaranteed, defined 
set of costs and benefits; it does nothing to reduce the high price 
Medicare beneficiaries are forced to pay for their prescription drugs. 
For seniors it is simply high on cost and low on benefits with a gap in 
coverage so large that our seniors would forget they have a drug 
benefit if they were not still writing a monthly check for the premium 
while they were not getting any benefits. Still paying a premium, not 
getting any coverage. That is not a nice choice.
  Our Republican colleagues say we do not have enough money to give a 
better prescription drug benefit. Mr. Speaker, that, too, is just a bad 
choice they have made, to enact $1.7 trillion in tax cuts. While we are 
paying $1 billion a day in interest for the wealthy rather than serve 
our Nation's seniors is an outrageous and true reflection of their 
priorities. It shows you where their heart is. You can get lost in the 
details, but the result is clear. This is a terrible piece of 
legislation. Let us forget the gimmicks, it is time to deliver a real 
drug plan to our Nation's seniors. All they want is an affordable drug 
benefit with a reasonable premium cost that is defined and meaningful 
benefits, and that means a benefit without a $3,000 gap in coverage. 
They just want a benefit that is available to all seniors regardless of 
whether they live in Texas or California or New York City.

                              {time}  2320

  The Republican plan is just a shameless smoke and mirrors scheme. Let 
us reject this tired bait and switch scam. We know the end game, do we 
not? Everybody in here does. Former Republican Speaker of the House 
Newt Gingrich said Medicare should wither on the vine, and recently our 
Republican colleague in the other body, Senator Santorum, said 
traditional Medicare should be phased out. That is the goal. That is 
the object. That is the plan.
  Let me read something I did not say, something the Republicans did 
not say, something the Democrats did not say. This is in Newsday June 
23, 2003. ``The House proposal would replace Medicare's guaranteed 
coverage with a guarantee only that the elderly would get a sum of 
money to buy whatever kind of benefits at whatever price private 
insurers chose to offer. Those who want traditional fee for service 
Medicare would be forced to pay higher premiums. So at least now we 
know the drug plan, skimpy and fraught with uncertainties, is merely a 
cover for achieving former House Speaker Newt Gingrich's dream of 
forcing Medicare to wither on the vine.'' Newsday. That is the plan.
  This ill-conceived and inadequate plan is not an attempt to provide 
drug coverage to seniors. It is an attempt to set up the very 
destruction of Medicare and place HMOs and insurance companies in the 
catbird seat. It is as simple as that. We all know that.
  Now Congress has to make a choice. Seniors and healthcare, HMOs and 
profits, privatization or Medicare. Mr. Speaker, it is our choice to 
make. Whom do we stand for? Whom do we stand for in the United States 
Congress?
  Mr. BERRY. Mr. Speaker, I thank the gentleman from Texas for his 
great leadership in this matter and continued willingness to do the 
battle on behalf of our senior citizens in this country.
  I yield to the gentleman from Massachusetts (Mr. Olver).
  Mr. OLVER. Mr. Speaker, I thank the gentleman for yielding, and I 
want to commend the gentleman from Arkansas for bringing this 
particularly important issue before us because this plan is a 
particularly cynical plan as far as it affects rural districts around 
America. People do not usually think of my Massachusetts district in 
the western and northwestern part of the State of Massachusetts as 
being a rural district, but it is in fact that.
  Mr. Speaker, rural seniors like all seniors need help now paying for 
their prescription drugs. The Republican leadership's prescription drug 
plan leaves seniors waiting 3 years more for relief. But by 2006 when 
it finally goes into effect, this ingeniously devious legislation still 
will not give rural seniors a prescription drug benefit because there 
will not be a prescription drug plan available for them to access. The 
Republican leadership claims this plan will provide choice for all 
Medicare beneficiaries. The Republicans say that seniors all across the 
country including rural areas will have access to two different 
prescription drug plans, one, a private HMO health plan which includes 
prescription drugs, and, two, a prescription-only plan offered by a 
private insurance company but deliberately not a part of the Medicare 
that seniors trust.
  Rural seniors know that private insurers are not going to offer such 
plans at an affordable price. The evidence is clear. The 
Medicare+Choice program shows how private HMO's role in Medicare has 
failed in rural areas. These Medicare HMOs have abandoned millions of 
Medicare recipients living in rural districts like mine all over this 
country. Currently four out of five seniors in rural areas have no 
access to an HMO managed care plan under Medicare leaving rural seniors 
with no choice. Why have HMOs abandoned the rural areas? It does not 
take an economist to figure that out. With the sparse populations in 
rural areas, these private HMOs could not turn a big enough profit; so 
they had no compelling reason to stay and provide services. Since 
Republican leadership knows rural seniors will not fall for promises of 
Medicare HMOs again, they have also provided the choice of a 
prescription-only benefit provided by private insurance companies while 
allowing seniors to stay in the Medicare that they do trust.
  But this legislation makes a promise of insurance that does not 
currently exist and can never exist in any affordable form for the 
exact same reason that HMO insurance plans could not make a profit in 
rural areas. Prescription drug costs are exorbitantly high; yet the 
Republican leadership expects that private insurers will be eager to 
provide this prescription-only benefit to the segment of the population 
that uses the most prescription drugs but has the least available cost. 
There are no incentives for the insurance industry to provide this 
benefit.
  In the end the high premiums and high costs will fall to seniors who 
will

[[Page 15883]]

be left with the same exorbitant drug costs they currently pay. Worst 
of all, by the year 2010, the Republican leadership is determined to 
undermine Medicare and eliminate the fee for service program so 
Medicare can be exclusively run like an HMO. This will leave no choice 
whatsoever because rural seniors will have neither of the plans they 
have been promised.
  The Republican leadership is placing the lives of our rural seniors 
in the hands of insurance companies that they do not and cannot trust, 
who have abandoned them in the past but in reality by 2006 the promises 
being made now to rural seniors to provide a prescription drug benefit 
and a Medicare HMO choice will never be kept. Rural seniors will have 
no choice. There will be no private insurance providers riding to the 
rescue, and rural Medicare beneficiaries will still pay the same 
exorbitant drug costs they now pay.
  The Republican bill nullifies every promise to take care of our 
poorest and sickest seniors. It is a sham and a cruel hoax for rural 
America.
  And I want to again thank the gentleman from Arkansas for his 
leadership in bringing this issue before the floor this evening.
  Mr. BERRY. Mr. Speaker, I thank the gentleman from Massachusetts and 
the gentleman from Texas.
  Mr. Speaker, rural pharmacies are the only professional healthcare 
providers we have in many of our rural communities. If this bill were 
to become law, it would wipe out those institutions. It would make it 
impossible for them to stay in business because they would be forced to 
compete with a mail order operation that would be so full of gimmicks 
that it would be impossible. These mail order operations would be set 
up by the prescription drug manufacturers with the cynical reason of 
taking the healthcare providers out of these communities. HMOs will 
have an incentive to put profits before patients. Headlines in the Wall 
Street Journal today documents a situation exactly like that where an 
insurance company or a pharmacy benefits manager chose to put profits 
before patients.
  Let us not wipe out healthcare for senior citizens in rural America. 
Let us deny this bill and send it back until we can do what we know 
that we have the ability to do, and that is to provide to seniors 
citizens of this country with a reasonably priced prescription medicine 
program that will serve them well and serve this country well.

                          ____________________