[Congressional Record (Bound Edition), Volume 149 (2003), Part 12]
[Senate]
[Pages 15938-15940]
[From the U.S. Government Publishing Office, www.gpo.gov]




   PRESCRIPTION DRUG AND MEDICARE IMPROVEMENT ACT OF 2003--Continued

  Mr. FRIST. Mr. President, as we bring this very busy day to a close, 
I wish to reflect on where we are with this very historic bill that 
will provide prescription drugs and, at the same time, strengthen and 
improve Medicare for our seniors and individuals with disabilities.
  It is a historic week in many ways, but primarily because we will 
accomplish something that many thought would be impossible even a 
couple of months ago that will benefit America's seniors; historic 
because during this week, both Houses will likely pass the first major 
reform of Medicare in the almost 40 years of that program's existence.
  Thanks to the strong leadership of President Bush, as well as the 
bipartisan support of this body, I am optimistic that by the end of 
this week, we will have added a $400 billion prescription drug benefit 
for our deserving seniors for their health care security. And indeed, 
it has been a long time in coming. A lot of us have talked about it, 
have known we should move in that direction, and now after a lot of 
participation we will be able to deliver on that for which we have all 
worked so hard. Both parties have promised action in the past. 
America's seniors have demanded it. Indeed, America's seniors deserve 
it.
  As part of this current legislation, not a lot has been said on this 
particular aspect of it, so I do want to mention it. Within 8 months or 
9 months after the President signs the final product of our 
discussions, when he signs this bill, seniors will have access to a 
prescription drug card that will provide immediate savings for them. 
This is an important interim move that allows us to say to seniors: 
Help is, indeed, on the way.
  During this period of time of a year and a half or a couple years 
while they have that prescription drug card, we will be constructing 
the appropriate infrastructure to provide that prescription drug 
benefit for that population that wishes to stay in traditional Medicare 
or that population that wishes to take advantage of a new, transformed 
type of Medicare that will allow continuous, ongoing quality care in a 
more seamless fashion, a fashion that will involve preventive medicine 
and chronic disease management, as well as prescription drugs.
  The great aspect about what we are doing, at the same time we are 
offering this new benefit of prescription drugs, which our seniors 
deserve, is that we are modernizing the Medicare Program, strengthening 
it, improving it in a way that can be sustained long term, and 
hopefully there will even be some cost savings in the future, but at 
the same time I am absolutely positively sure that the quality of care 
will be better. I say that because of this focus on preventive 
medicine, chronic disease management, and overall disease management 
which is simply not provided in traditional Medicare.
  I wish to list a couple of principles.
  First, individual choice versus a one-size-fits-all system. Seniors, 
for the first time, will be given an opportunity to choose the health 
care coverage which will best meet their individual needs. It is very 
different from the one-size-fits-all type program that is provided 
today.
  Second, private sector competition versus Government price setting. 
Private insurers--I mention private insurers and private plans because 
we hear a lot today from certain think tanks that not very much is new 
in this bill. There is not very much reform, there is not very much 
modernization.
  My simple response to them is, yes, there is a new entitlement in 
terms of this drug benefit, but it is going to be delivered 100 percent 
through the private sector, through private plans. Yes,

[[Page 15939]]

regulated by Government, but the entities, the mechanisms of delivering 
these prescription drugs, whether it is in a freestanding plan or part 
of the traditional Medicare+Choice or part of a new PPO system, are 100 
percent competitively bid with market-based principles.
  That allows us to step back and say: Yes, there is something new that 
over the long haul, if carried out well, if appropriately structured, 
will allow seniors to have better value, a higher quality of care for 
the same input, the same amount of money that is spent.
  So this market-based competition is important and, I would argue, is 
very important to the long-term sustainability of the program because 
of this huge demographic shift of the doubling of the number of 
seniors.
  Third, innovation versus bureaucratic delays. The participation of 
private health plans in Medicare will help ensure up-to-date coverage. 
Because Medicare is so rigid, it takes a long time for Medicare to 
incorporate innovation, new technology, new and better ways of doing 
things. When you have Government bureaucrats making the decisions or 
politicians or political figures deciding what is covered and what is 
not, it simply takes a longer time than occurs in the more responsive 
private sector.
  Four, long-term savings versus spiraling costs. There is a lot of 
debate in this Chamber, but I would argue, consistent with what the 
Medicare actuaries tell us, that the most efficient private plans today 
have the potential for beating Medicare costs by as much as 2.3 
percent. Compounded over time, that can result in significant cost 
savings to the program. Thus, for the same input of dollars, you will 
have better output, better care delivered, and better quality of care.
  The final point I will close with is regulatory relief versus the 
redtape of bureaucracy that is so characteristic of our Medicare system 
today. In this bill, there are several rulemaking and regulatory relief 
changes for health care providers that will allow them to focus on what 
they should be doing; that is, providing that clinical care, that 
patient care, instead of filling out paperwork or spending a lot of 
time on redtape activity.
  A recent study by Price Waterhouse estimated that for every hour in 
the emergency room, there are about 30 minutes of paperwork required by 
emergency personnel. There is just no reason for that today, and this 
bill helps address that regulatory relief.
  So a new benefit, individual choice, market-based competition, rapid 
assimilation of new technology, as well as new medicines, long-term 
savings, relief from this red tape, health security for seniors, that 
is what this bill is all about.


                            vote explanation

  Mr. BROWNBACK. Mr. President, I regret that due to a previously 
scheduled White House event celebrating Black Music History Month, I 
was unable to cast a vote on Amendment No. 982 offered by my friend, 
Mr. Lautenberg. I would like the Record to reflect that had I been 
present, I would have voted against the amendment.
  Mr. JOHNSON. Mr. President, as we move forward with debate on 
Medicare prescription drugs, it is important to recognize that this 
bill does very little to address the unrestrained costs of prescription 
drugs. I find it disconcerting that as we are discussing one of the 
most major public program expansions of all time, we have neglected to 
have a real discussion about how to ensure that taxpayers get the most 
bang for their buck in this program, and that seniors who will have 
significant cost sharing responsibilities have as minimal a burden as 
possible.
  For many years, I have been a strong advocate for implementing 
reforms to reduce prescription drug costs for consumers in this 
country. I believe one way to do that is through increasing consumers' 
access to approved, safe and affordable generic prescription drugs. 
Last week the Senate passed an amendment that would accomplish this 
very goal. I was pleased to see that 
the Gregg-Schumer-McCain-Kennedy amendment passed the Senate with wide 
bipartisan support and I want to thank my colleagues for their 
dedication and hard work on this issue. This represents one encouraging 
step towards leveling the playing field and ensuring that prescription 
drug costs under this program are indeed reasonable.
  The generics amendment, which I have cosponsored along with many of 
my colleagues will allow generic drug companies to compete with brand-
name manufacturers by clearing the major obstacles that delay generic 
drug approval. The act levels the playing field for generic drug makers 
to better compete against large, brand-name manufacturers, and it 
represents a bold step in putting consumer health and savings first. 
The legislation seeks to bolster the Hatch-Waxman Act passed in 1984, 
which promoted the growth of the generic drug industry. Loopholes in 
the patent laws, which benefited brand-name drug manufacturers, 
prohibited the bill from ever realizing its full potential.
  Efforts to promote the value of generic drugs are competing with some 
powerful forces, such as direct-to-consumer advertising and the 
unwillingness of many doctors to prescribe generic drugs more 
regularly. However, I believe this amendment, along with greater public 
education efforts directed at consumers and doctors about the 
effectiveness of safe and approved generic drugs, will go a long way 
towards improving greater access and utilization of generic 
prescription drugs.
  I will continue to fight for lower prescription drug costs and will 
oppose any efforts that would deny generic drugs equal access into the 
market. With the enactment of this amendment, we are one major step 
closer to achieving this goal and I hope the House will follow suit and 
make similar provisions a part of their Medicare prescription drug 
legislation. Passage of the generics amendment paved the way, but we 
must not stop here. We must continue the discussion and debate on the 
cost containment of prescription drugs under this program and I urge my 
colleagues to support all amendments that work towards that goal.
  Mr. SMITH. Mr. President, I would like to join my distinguished 
colleague from Iowa as a cosponsor of the ``Money Follows the Person 
Amendment'' to the Prescription Drug and Medicare Improvement Act of 
2003.
  This amendment would authorize the 2004 ``Money Follows the Person'' 
initiative in Medicaid, a part of the President's New Freedom 
Initiative to integrate people with disabilities into the communities 
where they live.
  This amendment would create a 5-year program to help States move 
people with disabilities out of institutional settings and into their 
communities. For example, under this legislation, Oregon's effort to 
help an individual move out of an institutional care facility and into 
a community home would be 100 percent federally funded for 1 year. 
After that first year, the Federal Government would pay its usual rate. 
Under the provisions of this amendment, States like Oregon can take 
advantage of $350 million dollars of Federal assistance for 5 years for 
a total of $1.75 billion.
  This amendment is important to the disabled community for several 
reasons. First, by supporting States' efforts to help Americans who 
have been needlessly placed in institutional settings move into 
community settings, this amendment will help States increase access to 
home and community-based support for people with disabilities.
  Second, by assisting the movement of people who are not best served 
by an institution into a community care facility, this amendment gives 
them the freedom to make choices. Too often, Americans with 
disabilities are unable to take advantage of opportunities others take 
for granted--to choose where they want to live, when to visit family 
and friends, and to be active members of their communities.
  Finally, this amendment would help States comply with the Americans 
with Disabilities Act. As my colleagues in the Senate are well aware, 
we are nearing the 13th anniversary of the

[[Page 15940]]

Americans with Disabilities Act and of the Olmstead Supreme Court 
decision. That decision ruled that needless institutionalization of 
Americans with disabilities constitutes discrimination under the 
Americans with Disabilities Act.
  I urge my colleagues on both sides of the aisle to support this 
important amendment and to support the freedom of choice for Americans 
with disabilities.


                           Amendment No. 974

  Mr. LEAHY. Mr. President, last November, the Drug Competition Act 
passed the Senate by unanimous consent. This morning, I am proud to 
join Senator Grassley, along with Senators Cantwell, Durbin, Feingold, 
Kohl, and Schumer in offering our bill as an amendment to the 
Prescription Drug and Medicare Improvement Act of 2003, S. 1. I hope 
that in this Congress it is actually enacted into law as part of the 
larger effort to improve the health care of millions of Americans. 
Prescription drug prices are rapidly increasing, and are a source of 
considerable concern to many Americans, especially senior citizens and 
families. Generic drug prices can be as much as 80 percent lower than 
the comparable brand-name version.
  While the Drug Competition Act is small in terms of length, it is 
large in terms of impact. It will ensure that law enforcement agencies 
can take quick and decisive action against companies that are driven 
more by greed than by good sense. It gives the Federal Trade Commission 
and the Justice Department access to information about secret deals 
between drug companies that keep generic drugs off the market. This is 
a practice that hurts American families, particularly senior citizens, 
by denying them access to low-cost generic drugs, and further inflating 
medical costs.
  Last fall, the Federal Trade Commission released a comprehensive 
report on barriers to the entry of generic drugs into the 
pharmaceutical marketplace. The FTC had two recommendations to improve 
the current situation and to close the loopholes in the law that allow 
drug manufacturers to manipulate the timing of generics' introduction 
to the market. One of those recommendations was simply to enact our 
bill, as the most effective solution to the problem of ``sweetheart'' 
deals between brand name and generic drug manufacturers that keep 
generic drugs off the market, thus depriving consumers of the benefits 
of quality drugs at lower prices. Indeed, at a hearing just yesterday 
in the Judiciary Committee, Chairman Timothy Muris of the FTC praised 
the Drug Competition Act in his testimony, and urged its passage. In 
short, this bill enjoys the unqualified endorsement of the current FTC, 
which follows on the support by the Clinton administration's FTC during 
the initial stages of our formulation of this bill. We can all have 
every confidence in the common sense approach that our bill takes to 
ensuring that our law enforcement agencies have the information they 
need to take quick action, if necessary, to protect consumers from drug 
companies that abuse the law.
  Under current law, the first generic manufacturer that gets 
permission to sell a generic drug before the patent on the brand-name 
drug expires enjoys protection from competition for 180 days--a head 
start on other generic companies. That was a good idea--but the 
unfortunate loophole exploited by a few is that secret deals can be 
made that allow the manufacturer of the generic drug to claim the 180-
day grace period--to block other generic drugs from entering the 
market--while, at the same time, getting paid by the brand-name 
manufacturer not to sell the generic drug.
  Our legislation closes this loophole for those who want to cheat the 
public but keeps the system the same for companies engaged in true 
competition. I think it is important for Congress not to overreact and 
throw out the good with the bad. Most generic companies want to take 
advantage of this 180-day provision and deliver quality generic drugs 
at much lower costs for consumers. We should not eliminate the 
incentive for them. Instead, we should let the FTC and Justice look at 
every deal that could lead to abuse, so that only the deals that are 
consistent with the intent of that law will be allowed to stand. The 
Drug Competition Act accomplishes precisely that goal, and helps ensure 
effective and timely access to generic pharmaceuticals that can lower 
the cost of prescription drugs for seniors, for families, and for all 
of us.
  The effects of this amendment will only benefit the effort to bring 
quality health care at lower costs to more of our citizens. The Drug 
Competition Act enjoyed the unqualified support of the Senate last 
year, and I hope my colleagues will recognize that it fits well within 
the framework of the Prescription Drug and Medicare Improvement Act of 
2003. It will do nothing to disrupt the balance struck in the larger 
bill, while aiding the ultimate goal of that legislation. I urge all 
Senators to embrace this effort on behalf of Medicare recipients, and 
of all Americans.

                          ____________________