[Congressional Record (Bound Edition), Volume 149 (2003), Part 17]
[Senate]
[Pages 24168-24170]
[From the U.S. Government Publishing Office, www.gpo.gov]




                       PRESCRIPTION DRUG BENEFIT

  Mr. FRIST. Mr. President, health care affects each of us in very 
personal ways. As a physician, but also being majority leader, people 
will come to me and ask: What are you doing about this particular 
health care issue? It might be a senior who asks: Why don't I have 
access to prescription drugs as I did when I was 60 years of age and 
employed by a company, and all of a sudden it disappears when I go into 
Medicare?
  That is the type of question to which this body has responded and, 
indeed, we have passed a prescription drug benefit appropriately 
coupled with health care--Medicare specific--modernization, in the 
sense that it brings the Medicare Program up to today's standards, the 
type of health care to which other people have access.
  We are addressing in the conference between the House and the Senate 
this Medicare prescription drug package. We had two meetings today with 
the various conferees, in a bipartisan way--the House and Senate 
together working through the details of marrying the House and the 
Senate bill. I am absolutely confident that under the leadership of 
Chairman Bill Thomas in the House and Vice Chairman Chuck Grassley in 
the Senate that this conference will deliver a bill in October that 
will accomplish that goal of health care security and access to 
prescription drugs for all seniors.
  People also ask me: What about those people who do not have access to 
health insurance, those people who are not in Medicare at all? Medicare 
is our program for seniors and individuals with disabilities. What 
about those who are not in Medicaid, which is our unique Federal-State 
partnership through which health care is delivered for the underserved 
and the impoverished or poor of the Nation? What if one is not in an 
employer-sponsored plan as I mentioned?
  Most people who are not in Medicare and Medicaid, the overwhelming 
majority get their health care through employer-sponsored plans. What 
if somebody is not in one of those plans today? What if one is not in 
the SCHIP program, the program that originated in our Congress that 
reaches out to children predominantly run by States,

[[Page 24169]]

or if one is not in a Government program or not in the private program 
and thus uninsured? What are you doing, Senator Frist, and what will 
you do?
  This week, the Census Bureau confirmed what many of us felt and 
feared, and that is that the number of people without health insurance 
increased last year to over 43 million. That is about one out of every 
seven Americans under the age of 65. That represents a 5.7 percent 
increase over 2001. So the uninsured number is increasing, and there 
are a lot of reasons why. We have talked in our various conferences and 
committees and debated why that number is increasing. One can parse the 
statistics and numbers and say that is how many do not have insurance 
over a period of time, and 6 months later many of them will have 
insurance.
  Putting all that aside, I argue that the uninsured are among the 
greatest health care challenge we have in the United States of America 
today. Thus, I believe we have a real obligation not to say we have so 
much else going on that we cannot address that but that we do have 
really a moral obligation to address this issue of the uninsured and to 
do it in a systematic way.
  As I mentioned before, very much of our focus has been on Medicare 
today. I will mention shortly some of what we have been doing with 
regard to the uninsured, but there is still a lot we need to be doing. 
If we step back and look at our economy, although the economy itself is 
improving--and maybe not as quickly as a lot of us would like, but the 
economy is getting better each day--in spite of that, the budget 
pressures at the State level and the job losses from last year combined 
in a very complex way to increase the number of uninsured to 43 million 
people. To me, this is one of the most daunting health challenges--I 
would say it is even beyond health policy challenges--that we have 
affecting our Nation.
  I say that in part because of personal experience. I have had the 
opportunity to treat Medicare and Medicaid patients and the uninsured 
through the transplant program in which I had the opportunity to 
participate in Nashville. Both in the acute care and in the chronic 
care, it is obvious that if one has no health insurance, no help with 
being able to access health care with a lowered financial burden, one's 
quality of health care suffers. It is not as good as the health care of 
people who have some type of insurance, private sector or public 
insurance.
  The uninsured are four times less likely to receive dental care and 
necessary medical care. They are five times less likely to obtain 
prescription drugs. They are four times more likely--and this really 
makes sense--to access the emergency room for routine care rather than 
the more efficient, and arguably more effective, channels of being able 
to see a physician or go to a doctor's office.
  The lack of affordable health care is also one of the key factors 
that affects what we call health care disparities among the underserved 
or minorities themselves; that is, where a person of one race has 
different health care outcomes than those of another race or one 
socioeconomic level versus another socioeconomic level. It does not 
explain it all, but it is clearly one of those variables we can affect, 
and we have to do it in a coordinated way because our health care 
system in America, which is the best in the world, no question about 
it, overall health care in the United States is of higher quality than 
anywhere in the world.
  If we do look at the numbers that were released this week, they were 
a year old, and since they were compiled--because they are historical 
data, being a year old--the economy has improved over that year, and 
indeed almost all economists expect that, depending on how one looks at 
the statistics, we will have annualized growth of nearly 4 percent in 
the coming months. It may go higher than that and come back down a 
little bit, but we will have good, significant growth in the coming 
months.
  Indeed, the Associated Press this week reported:

       America's consumers, flush with tax cuts that left them 
     with extra cash in their wallets, ratcheted up their spending 
     by a strong .8 percent in August, helping to power an 
     economic resurgence.

  So I think we are seeing improvements in our economy. That is only 
just beginning to be reflected in jobs. We did have encouraging news 
earlier this morning from the Labor Department that U.S. companies show 
a net increase of 57,000 jobs. That is good news for the economy, but 
also that is good news overall for health insurance or medical 
insurance. Why? Because most Americans in this country get their health 
care through their employer, through jobs. Thus, as we grow the economy 
and add jobs to the economy, we do have an expansion in medical 
coverage.
  While the recovery takes hold, it is clear that we have an obligation 
to respond with policies and that as we look at the future agenda in 
health care, we need to focus on the uninsured.
  Some of what we are doing now in this body, in response to what we 
recognize is a major problem and one that is growing, are the 
following: Last month, the Senate passed the Labor, Health, and Human 
Services appropriations bill. In that bill, we had $1.6 billion for 
community health centers. We met the President's request for an 
additional $122 million in funding over last year, which was an 
increase over last year. This response by this body enables us to move 
toward the President's goal of enabling community health centers to 
serve an additional 6 million patients by the year 2006.
  We all have community health centers in our States, districts, and 
regions, and we know the vital role they play in reaching out to the 
underserved or those without health insurance today.
  I say we all know, and I say that in part because I have been so 
involved in health care issues, being a physician, but I think we need 
to shine a light on them. They serve a tremendous need and respond in 
an innovative, flexible way that is locally driven, which is something 
that cannot be praised enough.
  Second, as I said, many people get their insurance through Federal 
programs or joint Federal-State programs. There is a program called 
SCHIP. Basically when you hear SCHIP, think health care for children. 
In July, the Senate fulfilled the President's request to extend the 
availability of $2.7 billion in Federal SCHIP funds that either expired 
at the end of 2002 or will expire in the current fiscal year. These 
funds will be available to allow States to continue the program without 
which, if we had not acted, as many as a million children would have 
lost health coverage. That has now become law.
  In addition, in terms of looking at what we are doing, focusing on 
this whole issue of the uninsured, if you look to the jobs and growth 
package, the 2003 jobs and growth package that we passed--people always 
talk about the tax cuts, tax relief which is so instrumental in pulling 
us out of this recession and stimulating our economy, but in there as 
well was $20 billion in fiscal relief that goes directly to the States, 
and about $10 billion of that was specifically targeted at enabling the 
States to maintain gains they had made in health care for the poor 
through their Medicaid Programs through a tool or through the technique 
of the enhanced Medicaid Federal match rate. That is the technical way 
of saying the Federal Government, in an enhanced way, helps the States 
with funds that go directly to the State.
  I mentioned those two or three examples because it is important for 
our colleagues and others on the other side of the Capitol, in the 
other body, and really our constituents, to understand that we in the 
Senate are addressing the issues of the uninsured. President Bush has 
made tax credits, what we call refundable tax credits for low- and 
middle-income families, a major part of his proposal to address the 
issues of the uninsured and to expand health coverage. He also has 
consistently supported medical savings accounts and promoted the 
expansion of medical savings accounts in other ways that can offer 
affordable health care options to those who might not have insurance 
today.

[[Page 24170]]

  The President and we, or many of us--about half of us; not all of 
us--in this body continue to fight hard for medical liability reform, 
medical litigation reform, malpractice reform. The reason for that is 
not to in any way jeopardize the very good system we have, that if 
there is harm and injury there is just and fair compensation, but the 
purpose for that is to get rid of the unnecessary lawsuits, the 
excessive lawsuits that drive up the costs of health care that 
ultimately are passed on to patients, driving up the cost of health 
insurance for everybody. Meaning, if you don't have sufficient 
resources, you simply give up your health insurance or you can't get it 
in the first place. Again, it is an important part of the President's 
initiative, as well as our own initiative on this floor. For my 
colleagues, I will say we will keep coming back to address this whole 
issue of medical liability.
  The cause of 43 million people who lack insurance today is difficult 
to characterize, in terms of a generalization. It does take a targeted 
approach to identify who the 43 million people are and then target 
specific approaches to them. Therefore, it has to be comprehensive but 
it is also very complex by its very nature.
  I think the tone of a lot of the debate today on the uninsured has 
been polarizing. Because of that polarizing framework, a lot of people 
have been hesitant to put it out front and to put an agenda out front. 
I wish to share with my colleagues my commitment to work to find 
workable solutions to a problem that is increasing, a problem that 
directly affects the health care of 43 million but indirectly affects 
the health care, really, of us all.
  In that regard, I have asked Senator Judd Gregg, our colleague from 
New Hampshire, to lead a Senate Republican task force on uninsured and 
access to affordable health care coverage. I have asked Senator Gregg 
and his task force to propose a series of recommendations to address 
the uninsured issue so we can both debate, discuss, and through 
committees but also on the floor attack this problem head on.
  The task force will be looking at all options, including new ideas. I 
look at it as a place that ideas can be brought, that we can debate and 
discuss, and hopefully we will look at many of the ideas that have been 
proposed in the past but also reach out and obtain new ideas, creative 
ideas, ideas we may not yet have thought about or that we haven't 
addressed in the past.
  I do intend to take these recommendations and use them as a basis in 
establishing a legislative agenda so we can on this floor 
systematically address the issue of the uninsured.
  In closing, I appreciate Senator Gregg's willingness to take on this 
task. I look forward to working with him and his task force in 
addressing this pressing issue. I am confident that out of this task 
force we will get new ideas, innovative thinking, dynamic ideas that 
will allow us to deliver real solutions to the American people who do 
not have health insurance today.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Oregon.
  Mr. WYDEN. Before he leaves the floor, I say to the distinguished 
majority leader how much I have enjoyed working with him over the years 
on this issue of health care. As he knows, Senator Hatch and I have 
worked for many months on a bipartisan proposal that we would like to 
be part of the discussion he is going to launch. I have come to the 
conclusion that, as pressing as the financial issues are with respect 
to health care, the social and ethical issues are going to be even more 
important as we face this demographic tsunami of millions of baby 
boomers who are retiring in 2010 and 2011. So I am grateful the 
majority leader continues his interest in health care.
  I continue to have a bipartisan interest in working with the majority 
leader, who has spent so much time on those issues over the years. I 
know I speak for Senator Hatch in this regard as well.
  We have to break the gridlock on this issue. Literally for 60 years, 
if you look at the parallel between what Harry Truman tried in the 81st 
Congress in 1945 and what was tried in 1993 and up to this day, we see, 
unless we find a way to take a fresh approach, as the distinguished 
majority leader said today, we are not going to break this gridlock.
  So I welcome your statement today. I am anxious to work with you and 
the chairman of the committee, Senator Gregg, to pursue these 
proposals.
  Mr. FRIST. Mr. President, just briefly responding through the Chair, 
I very much appreciate those comments because, just as we have done 
with Medicare, it is going to take strong bipartisan support to get 
good, effective legislation through.
  Second, the point about why now versus 10 years ago, 20 years ago, or 
30 years ago--I agree wholeheartedly. We have this huge demographic 
shift that didn't occur 10 years ago or 20 years ago or 30 years ago or 
40 years ago, that we are realizing right now. It gives us a perfect 
reason for all of us to come together to address these problems--the 
uninsured is a major one for both of us--in a way that may be 
unprecedented, at least in the last 10, 20, or 30 years.
  I very much appreciate those comments and look forward to working 
with my colleague.

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