[Congressional Record (Bound Edition), Volume 149 (2003), Part 12]
[Senate]
[Pages 16875-16876]
[From the U.S. Government Publishing Office, www.gpo.gov]




             PRESCRIPTION DRUG AND MEDICARE IMPROVEMENT ACT

  Mr. AKAKA. Madam President, I rise today to speak on S. 1, the 
Prescription Drug and Medicare Improvement Act of 2003.
  For far too long Medicare has lacked a prescription drug benefit. The 
lack of this benefit has been the gaping hole in the Medicare safety 
net. Prescription drugs are the largest out-of-pocket health care cost 
for seniors. Many who cannot afford drug coverage often break the drugs 
in half, skip doses, or do not fill their prescriptions.
  The legislation the Senate passed last night will finally establish a 
benefit. I supported this bill because it is an important step forward 
in meeting the prescription drug needs of seniors. However, I am 
particularly concerned that the bill provides insufficient prescription 
drug coverage for seniors and depends excessively on private plans.
  Medicare beneficiaries will experience a gap in their prescription 
drug coverage after their drug expenditures reach $4,500. They will not 
receive any benefits until their total drug expenditures reach at least 
$5,813 unless they qualify for the additional low-income support. This 
gap in coverage will occur while they are still paying premiums. It is 
unfortunate that amendments designed to fill in the gap were defeated. 
This issue must be revisited in the future. Also, the eligibility 
requirements for the additional low-income support are too restrictive 
and will deny many seniors in need the extra help that they need.
  The dependence on private insurers to administer this benefit 
presents additional challenges to providing seniors with access to 
prescription drugs. Prescription drug-only insurance policies are 
currently not offered and they will need to be developed. The 
utilization of private plans creates a system in which insurers have 
incentives to limit access to needed drugs. In addition, the premiums 
that seniors pay for coverage are likely to vary depending on what 
region people live in. It is not equitable

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for a Federal benefit to have different prices across the country. 
Seniors should have the option of choosing a Medicare-administered plan 
instead of one that is run by a private insurer.
  It is unfortunate that amendments to strengthen the prescription drug 
coverage and to provide seniors with an option to enroll in a Medicare 
administered plan were defeated. I look forward to continue working 
with my colleagues to address these important issues to improve the 
Medicare prescription drug benefit.
  Again, I supported this bill because it is an important step towards 
providing much needed prescription drug coverage for seniors. Also, I 
am pleased that my amendment to restore a Medicaid disproportionate 
share hospital, DSH, allotment for Hawaii was adopted. This amendment 
is vital to Hawaii's hospitals which are struggling to meet the 
elevated demands placed upon them by the increasing number of uninsured 
patients. DSH payments will help Hawaii hospitals meet the rising 
health care needs of our communities. I hope that this provision is 
retained in conference.

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