[Congressional Record (Bound Edition), Volume 149 (2003), Part 22]
[House]
[Pages 30804-30855]
[From the U.S. Government Publishing Office, www.gpo.gov]




 CONFERENCE REPORT ON H.R. 1, MEDICARE PRESCRIPTION DRUG, IMPROVEMENT, 
                     AND MODERNIZATION ACT OF 2003

  Mr. THOMAS. Mr. Speaker, on behalf of seniors and taxpayers, pursuant 
to House Resolution 463, I call up the conference report on the bill 
(H.R. 1) to amend title XVIII of the Social Security Act to provide for 
a voluntary program for prescription drug coverage under the Medicare 
Program, to modernize the Medicare Program, to amend the Internal 
Revenue Code of 1986 to allow a deduction to individuals for amounts 
contributed to health savings security accounts and health savings 
accounts, to provide for the disposition of unused health benefits in 
cafeteria plans and flexible spending arrangements, and for other 
purposes.
  The Clerk read the title of the bill.
  The SPEAKER pro tempore (Mr. Hastings of Washington). Pursuant to 
House Resolution 463, the conference report is considered as having 
been read.
  (For conference report and statement, see proceedings of the House of 
November 20, 2003, Book II at page 11877.)
  The SPEAKER pro tempore. Pursuant to the order of the House of today, 
the gentleman from California (Mr. Thomas) and the gentleman from New 
York (Mr. Rangel) each will control 1 hour.
  The Chair recognizes the gentleman from California (Mr. Thomas).
  Mr. THOMAS. Mr. Speaker, I yield one-half of my time to the gentleman

[[Page 30805]]

from Louisiana (Mr. Tauzin), chairman of the Committee on Energy and 
Commerce.
  The SPEAKER pro tempore. Without objection, the gentleman from 
Louisiana will control 30 minutes.
  There was no objection.
  Mr. THOMAS. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I called up this bill for seniors and for taxpayers. 
This evening you are going to hear some very harsh rhetoric. But what I 
really want to do is remind everyone here that since Republicans became 
the majority in this House in 1995, there has been a very positive and 
remarkable change to Medicare. Probably most important has been the 
introduction of preventive and wellness. For many years, it was 
available to be added to Medicare, but it was not. It took the 
Republican majority to add the testing and the education for diabetes, 
for osteoporosis, for improved mammography, for colorectal cancer 
screening, for prostate screening; and even today in this bill we 
continue with cholesterol screening and physical exams.
  Tonight, the Republican majority is going to add prescription drugs 
to Medicare. We earnestly seek our friends across the aisle help in 
doing this. The conference report before us is bipartisan. It is 
bipartisan because of the House and the Senate structure. Tonight our 
friends across the aisle have a chance to make it bipartisan in the 
House. Our friends say that we are trying to destroy Medicare; but if 
we are trying to destroy Medicare, why is the American Association of 
Retired People supporting this proposal? Why is the AARP in favor of 
this bill? You have heard some very harsh rhetoric from my friends 
across the aisle describing their abandonment by the AARP. My friends, 
the AARP has not abandoned you. You have abandoned seniors. AARP has 
chosen to be with seniors, and they have chosen to be with us.
  Fact: current Medicare cannot sustain itself financially. Question: 
Why in the world would we then be adding a $400 billion expansion of 
benefits under Medicare? Answer: today's medicine demands that we do 
so. Yesterday's medicine was hospitals and doctors. Hospitals and 
doctors still play a role, but prescription drugs play a central role. 
We simply would not be doing justice to our seniors if we did not try 
to add prescription drugs to Medicare.
  But I also called this bill up for taxpayers, because if we add 
prescription drugs to Medicare, we need to be able to tell our 
taxpayers that we are also changing the funding structure of Medicare 
as well.

                              {time}  2345

  It cannot sustain itself, and we are adding an enormous new benefit. 
It would be irresponsible of us to simply think all we need to do is 
add prescription drugs. What we need to do is add prescription drugs, 
modernize Medicare, and make sure that those people who pay taxes today 
in the hopes of having a program tomorrow will be able to have one.
  This bill protects low-income seniors. No one wants to place a 
financial burden on those unable to pay. But, Mr. Speaker, it is 
overdue to ask those who are financially well off enough to share.
  We are hearing things from our friends across the aisle about how 
horrendous the suggested financial burdens are. For example, in today's 
voluntary, optional Part B Medicare, the premium is 75 cents on the 
dollar paid for by the taxpayers, 25 cents on the dollar paid for by 
the beneficiaries. This legislation is so radical, so extreme, that 
what it does is it asks people who are making $100,000 a year in 
retirement to pay 50 cents on the dollar and have the taxpayers pay 50 
cents on the dollar. Ironically, that was the financial split when Part 
B Medicare began. All we are asking is for those who have the 
wherewithal to help share the financial burden. And where? There is an 
opportunity to provide a modest copay, one of the most significant 
factors in inhibiting overutilization. We ask those who are going to 
have a prescription drug, $2 on a generic prescription, $5 on a brand 
name. It will have a significant impact on utilization. It will also 
show that we understand, we need to be sensitive to taxpayers. Today 
they foot the bill, but tomorrow they also want a program. This bill is 
really all about a fair deal. Modernize Medicare with prescription 
drugs but put Medicare back on a sound financial basis as well.
  We are going to hear a lot about what we are going to do for up to 40 
million seniors in this legislation. Please understand with the modest 
structural changes we are asking for, there are going to be 140 million 
taxpayers who are going to be pleased as well.
  This program cannot sustain itself. Add a new benefit and modernize 
the program. Medicare is not a Democrat program; they do not own it. 
Medicare is not a Republican program; we do not own it. It is a program 
that is in need of modernization, prescription drugs and better 
financing. The American people's Medicare, the seniors who receive the 
benefits, and the taxpayers who foot the bill deserve H.R. 1.
  Mr. Speaker, I reserve the balance of my time.
  Mr. RANGEL. Mr. Speaker, I ask unanimous consent to turn one-half of 
the time allotted to the distinguished gentleman from Michigan (Mr. 
Dingell), a member of the Committee on Energy and Commerce, the dean of 
the House of Representatives, the son of the author of the Medicare 
bill, who was denied admission into the conference.
  The SPEAKER pro tempore (Mr. Hastings of Washington). Is there 
objection to the request of the gentleman from New York?
  There was no objection.
  Mr. RANGEL. Mr. Speaker, I yield myself such time as I may consume.
  This must be a very important piece of legislation, Mr. Speaker. It 
is 10 minutes to 12. When else would the majority bring out an 
important piece of legislation but in the middle of the night?
  But more importantly than that, tomorrow for many of us is a date 
that many of us will never, never forget, at least those of us that 
were old enough to know of and to love the late John F. Kennedy. Most 
all of us will remember where we were or what we were doing on November 
22. And I suggest to the Members that history will record what we do 
this evening and what we do tomorrow. The arrogance that has been 
displayed on this landmark piece of legislation defies description 
tonight, but history will record it. The audacity for people to talk 
about bipartisan here where for hundreds of years we inherited a House 
of Representatives that whether one was a Republican or Democrat, 
liberal or conservative, we could say in this House the people rule, 
and we have enjoyed saying that. Where do the Republicans get the 
audacity to say that when there is a conference, they would select the 
willing coalition, that they could look at a person and because they 
are a Democrat, appointed by the Speaker of this great House of 
Representatives, they exclude them? And let me tell the Members 
something else I am proud of, not just being a Member of this House, 
but sitting on this side of the aisle and taking a look at the faces 
and the backgrounds of the Members and where they come from, from the 
rural areas, from the inner cities, from America. We do not have senior 
citizens? We do not have a contribution to make? We can be excluded? 
And then to have the audacity to come to this floor, even if it is in 
the middle of the night, and call it bipartisan because you borrowed 
two Democrats from the other side. That is shameful.
  No, our citizens really will recall what we do tonight, what you have 
done for AARP, what you have done for the pharmaceuticals, what you 
have done for the private sector whom you have subsidized. The bill is 
only 1,100 pages, but seniors know that they asked for some help for 
prescription drugs. No, they did not ask for competition. They did not 
ask for you to set up paper outfits. They did not ask for, at the end 
of the day, that you try to run them out of business. And I am 
suggesting to you, how would you know what you are going to hear on 
this side when just common decency

[[Page 30806]]

prevented you from allowing you to follow the mandate that the Speaker 
set when he said that the House and the Senate, Republicans and 
Democrats, please go to conference, and you locked the door? One thing 
is clear. Seniors understand it better than a whole lot of Members do 
because it may in the middle of the night, but tomorrow they will be 
reading what we have done tonight.
  Mr. Speaker, I yield the balance of my time to the gentleman from 
California (Mr. Stark), who has worked hard for decades on this 
legislation, and I ask unanimous consent that he be allowed to 
administer the remainder of the time that has been allotted to me.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from New York?
  There was no objection.
  Mr. THOMAS. Mr. Speaker, I yield the remainder of my time to the 
gentlewoman from Connecticut (Mrs. Johnson), the chairperson of the 
Health Subcommittee of the Committee on Ways and Means, and I ask 
unanimous consent that she control the remainder of my time.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from California?
  There was no objection.
  Mrs. JOHNSON of Connecticut. Mr. Speaker, I yield 2\1/2\ minutes to 
the gentlewoman from Washington (Ms. Dunn).
  Ms. DUNN. Mr. Speaker, it is time to keep our promise and provide a 
comprehensive and voluntary prescription drug benefit for all seniors. 
Seniors cannot afford the frighteningly increasing cost of drugs any 
longer. This bill will protect the poorest seniors by helping pay for 
their drug costs immediately. By using the same principles already used 
by private companies, this bill will lower drug costs for seniors by 
passing along to them larger discounts from manufacturers.
  As a result, over 775,000 Medicare beneficiaries in my State of 
Washington will get access to the drugs they need at affordable prices. 
The poorest seniors in Washington State, over 206,000 people living on 
fixed incomes, will pay only nominal fees, and I am talking about $2 to 
$5 for prescriptions, that is all, while qualifying for full assistance 
on their premiums, their deductions, and their coverage.
  We can only strengthen Medicare's future if we are able to ensure 
access to the services that seniors need today. In this bill, we 
increase payments to doctors and hospitals, especially in rural 
communities, so that doctors will have some reason to stay in practice 
and seniors will get access to health services that they need.
  For Medicare HMOs this bill requires Medicare to account for military 
retirees in the formula resulting in higher reimbursements in counties 
with military facilities. To help every State, the Federal Government 
will assume the drug costs for people eligible for both Medicare and 
Medicaid. This is hugely important. It will help 82,000 beneficiaries 
who qualify for both programs in my State with their drug costs, but 
this bill will also save my State $500 million, half a billion dollars 
over the next 8 years on drug coverage for its Medicaid population. In 
all, Washington State will receive at least an additional $800 million 
to serve our seniors.
  Strengthening Medicare also means improving the quality of life for 
every senior. For this reason, I am very happy that we are able to 
provide preventative services to all seniors like a first-time initial 
physical exam. For the first time, seniors will have access to 
innovative treatments to deal with rheumatoid arthritis and other 
diseases. Seniors also will profit from disease management care, which 
means there will be coordination to help those seniors who suffer from 
multiple serious illnesses.
  Mr. Speaker, these treatments will allow seniors to receive 
treatments in their homes, take the burden off physicians or hospitals, 
and I will tell the Members for too long our parents and grandparents 
have paid too much for the drugs they need. The time has come to 
strengthen the Medicare program so that seniors can get the care that 
they need and they deserve.
  Mr. STARK. Mr. Speaker, I yield myself 2 minutes.
  I first start by reminding the distinguished gentlewoman from 
Washington that the Seattle Times said that one suspects that many 
conservatives do not really care how the chips fall as long as they are 
heavy enough to break the back of traditional Medicare. All this talk 
about choice and updating or modernizing Medicare with market 
competition is pure malarky. So it does appear that somebody from the 
State of Washington understands what is going on here tonight.
  But we are faced with a problem, and the Republican Party from the 
very top of its leadership to the very bottom have been lying to us. 
They have been lying to us about the war. They have been revising 
history. They have been going back on their word to give us 3 days. 
They have proven that we cannot trust them.
  Just recently, the past few minutes, the chairman of the Committee on 
Ways and Means indicated that they had attempted to put in preventative 
measures. He seems to have forgotten that in 1995 he voted against 
colon cancer testing. He voted against prostate cancer testing. He 
voted against annual mammography. He voted against diabetes management. 
He has voted more often to cut Medicare benefits than he can remember, 
it appears.
  So we are faced tonight with people who want to destroy Medicare. 
They will lie to us. They will lie to seniors for the pure purpose of 
their own messianic desires to destroy a system that will protect the 
fragile seniors in this country.
  Mr. Speaker, I reserve the balance of my time.
  Mrs. JOHNSON of Connecticut. Mr. Speaker, I yield 2 minutes to the 
gentleman from Pennsylvania (Mr. English).
  Mr. ENGLISH. Mr. Speaker, I rise tonight without any messianic 
pretensions to urge my colleagues to cast a vote for our seniors and 
support improved health care by voting for this bipartisan Medicare 
bill.
  Mr. Speaker, today we have the best, and perhaps the last, 
opportunity to provide America's seniors with a voluntary and 
affordable prescription drug benefit as a part of Medicare. This is an 
unprecedented expansion of an entitlement program that will make life 
easier and health care better for many millions of Americans.
  Mr. Speaker, I acknowledge this legislation is not perfect. There are 
things I wanted to see included that are not in the bill.

                              {time}  0000

  Yet, I am convinced that this is the best and most realistic 
compromise Medicare bill that Congress has so far developed. There are 
some here, I realize, who would make the perfect enemy of the good. But 
when you strip away all of the rhetoric and the partisanship, it really 
comes down to this: Do you support adding a prescription drug benefit 
to Medicare, or not?
  In my district in western Pennsylvania, we have a diverse population 
of seniors. Some live on very low incomes and qualify for our State 
prescription drug benefit, PACE. Others are happy with their own 
private health plans, and some live in areas where there is only one 
hospital within a reasonable driving range.
  This bill helps all of these seniors by offering a benefit that wraps 
around PACE, allows seniors to selectively participate in the Medicare 
plan, and includes a number of provisions to ensure that rural health 
facilities remain open and accessible.
  Mr. Speaker, in 1965, our predecessors took the courageous and 
compassionate step of creating this important program. Now we have the 
best opportunity in years to build on their work by guaranteeing access 
to lifesaving drugs for our seniors. It is time for Congress to put 
people over politics and pass this Medicare bill.
  I urge my colleagues to join AARP, America's doctors, America's 
hospitals, and major health care providers and vote ``yes'' on 
prescription drugs for our seniors.
  Mr. STARK. Mr. Speaker, I am honored to yield 1\1/2\ minutes to the 
gentleman from Michigan (Mr. Levin),

[[Page 30807]]

who understands that the United Steel Workers of America have said a 
vote for this measure is a vote to destroy the stability and long-term 
viability of the Medicare system.
  Mr. LEVIN. Mr. Speaker, the key question: Why not add a prescription 
drug benefit to Medicare like for physicians and hospital bills? 
Because Republicans want to force seniors to get their drugs from 
private insurance companies and HMOs, with no set premium, and 
insurance companies would decide the benefits and could change them 
every year.
  So again, why not simply add a drug benefit directly to Medicare? 
Because Republicans want to make sure the government has zero 
involvement in lowering drug prices for consumers. Indeed, their bill 
would prohibit Medicare from negotiating lower prices for drugs, and 
the only thing the government could do would be to keep people from 
buying cheaper drugs from Canada.
  Again, why not simply add a drug benefit to Medicare? Because the 
real Republican goal is to use a drug benefit as a vehicle for 
fundamentally changing and undermining Medicare.
  The President's Medicare administrator called Medicare a dumb system. 
Under this bill, there would be a global cap on the size of the 
Medicare program and a voucher to buy private health insurance instead 
of getting regular Medicare, with the deck loaded against Medicare, $14 
billion to HMOs.
  Republican reforms are Medicare's destruction. Vote ``no'' on this 
Republican bill.
  Mrs. JOHNSON of Connecticut. Mr. Speaker, I yield myself 1 minute and 
15 seconds.
  I would remind the gentleman from Michigan that 28 percent of his 
seniors will have no more costs than either $1 per generic or $2 per 
generic or $3 for prescription and $5, and 35 percent of Michigan 
seniors have incomes under 150 percent of poverty and will be totally 
protected under this bill.
  Mr. Speaker, I think as we proceed in this discussion, we ought to 
remember that 38 States, 38 States provide Medicaid coverage for people 
whose income is 74 percent of the national poverty income. So 38 States 
are not even at 100 percent of poverty income. We cover people 
completely, everything, except $1 per generic or $2, depending on 
income, and $3 or $5 per prescription drug.
  Do my colleagues understand that of the Medicare population, 57 
percent are women? Mr. Speaker, 57 percent are women, and half of them, 
half of those women will pay no more than $2 per generic or $5 per 
prescription. They will have no other obligation, all the way up 
through catastrophic. Half the women on Medicare. This is a giant 
stride forward in women's health.
  Mr. Speaker, I reserve the balance of my time.
  Mr. STARK. Mr. Speaker, I am pleased to yield 1\1/2\ minutes to the 
gentleman from Maryland (Mr. Cardin), who knows that all of the other 
members of the Older Women's League understand that this bill was 
supposed to modernize Medicare, not eviscerate it; and to deny basic 
health services for those who need it most, to increase the profits of 
the health care industry is criminal.
  Mr. CARDIN. Mr. Speaker, I am very disappointed. I had hoped that I 
would have an opportunity to vote for a real prescription drug benefit 
within the Medicare system, or at least I would be able to vote on a 
bill that provides the foundation on which we could build a real 
benefit within Medicare. Instead, this conference report provides no 
guaranteed benefit whatsoever to our seniors for prescription drugs. It 
uses what is known as ``actuarial equivalent'' which depends solely 
upon private insurance companies.
  We know what happened to Medicare+Choice with private insurance 
companies. The eight that were operating in my State of Maryland are 
all gone, leaving my seniors.
  It has an ineffective mechanism to control prescription drug costs. 
It denies the government the tools that every other industrial nation 
in the world is using to bring down the cost of prescription medicines.
  But worse than this, Mr. Speaker, it actually causes harm to our 
seniors. The Congressional Budget Office has estimated that 2.7 million 
retirees will lose their prescription drug benefits by the enactment of 
this bill. Mr. Speaker, this is not a voluntary bill for those 2.7 
million Americans; they have no choice. It cost-shifts costs on to our 
seniors from basic Medicare because of premium support and triggers and 
caps. We overpay HMOs, using money that could be available to help our 
seniors. We make it more difficult for our seniors to get cancer 
treatment by the changes that we make on the reimbursement for cancer 
drugs.
  So, Mr. Speaker, this bill does more harm than good. I support 
providing our seniors with a meaningful prescription drug benefit 
within the Medicare system that will strengthen Medicare. Therefore, I 
must oppose this conference report and urge my colleagues to do the 
same.
  Mr. Speaker, I rise to express my disappointment with the conference 
report on HR 1. For the past several years, I have worked toward 
enactment of a prescription drug benefit for those who rely on the 
Medicare program for their health care needs.
  A meaningful Medicare prescription drug benefit must be affordable, 
guaranteed, and available to all, it must contain an effective 
mechanism to lower the cost of medicines and it must be built on a 
sound structure that can be improved upon in future years.
  I have carefully considered the legislation that is before us today, 
and it fails each of these tests. This Congress has missed an 
opportunity to enact far-reaching, bipartisan legislation that would 
provide the help that millions of seniors need and deserve.
  Some have criticized the Medicare program as outdated, inefficient, a 
dinosaur. These members are ignoring Medicare's success in providing 
universal, comprehensive coverage. They are ignoring Medicare's low 
administrative costs--3%--relative to private insurers at 15 to 20 
percent. They are ignoring Medicare's ability to cover a population 
that has been shunned by private insurers for decades.
  Before Medicare was enacted, there was little private interest in 
covering elderly and disabled Americans. And there is still little 
private interest in doing so. That is why in my own state of Maryland, 
several hundred thousand seniors who once had the choice of eight 
Medicare HMOs, now have no HMO options available to them. As the 
options dwindled between 1998 and 2002, the remaining plans quadrupled 
their premiums, slashed their drug coverage and eliminated extra 
benefits. By 2003, the M+C HMO penetration rate in Maryland was zero 
percent. Nationwide, since 1997, more than 2.4 million seniors have 
been abandoned by private insurance plans, even though the plans were 
paid at 119 percent of fee-for-service Medicare costs.
  This conference report changes the name ``Medicare+Choice'' to 
``MedicareAdvantage,'' and adds $20 billion in subsidies to private 
plans, boosting their payments to equal more than 125 percent of the 
amount paid for traditional Medicare. But it cannot create private 
interest in the senior market. We have tried that and failed.
  To be successful, a drug benefit must be within basic Medicare and 
based on a sound structure that can be improved over time. Only a 
benefit that is based on a solid foundation will give seniors the 
stability they need and deserve. Rather, this bill relies solely on the 
willingness of private insurance companies to offer the benefit. In the 
Ways and Means Committee, I fought for a fallback within Medicare that 
would be available to every beneficiary in the country. It would have a 
set premium, deductible, and copays that would always be there 
regardless of where seniors live and what plans enter their region. If 
the private sector offered a superior, more efficient plan, seniors 
would choose the private plan. But if the private plan never 
materialized, or if it offered a premium that was unaffordable, 
Medicare would be there for them. In rejecting my amendment, and 
choosing a ``fallback'' that could come and go from year-to-year, the 
conferees bypassed the opportunity to continue Medicare's promise of 
universally available health care for all seniors.
   Ask your constituents if they want a choice of more private plans. 
They do not. They want a choice of hospitals and doctors, and they want 
stability, reliability, and real help with paying their prescription 
drug costs.
  This conference report lets them down. It offers seniors an 
inadequate benefit. The President and the Republican leadership say 
that this plan gives seniors the same benefits enjoyed by Members of 
Congress and federal employees. That is untrue for several reasons. 
First, the benefit packages are nearly mirror images of one another. In 
most FEHBP plans,

[[Page 30808]]

federal employees receive 80% coverage for prescription drugs. A 
federal employee with annual drug costs of $5,000, would pay about 
$1,000 out-of-pocket. But under this legislation, seniors with annual 
drug costs of $5,000 would have to pay $4,020 out-of-pocket.
  Second, the Medicare drug benefit has a wide coverage gap that will 
leave many of our seniors paying premiums for several months when they 
are receiving no benefits. There is no plan approved by OPM that would 
require federal employees to continue paying premiums when we are 
receiving no benefits. Seniors should not have to do that either.
  Third, under this bill, seniors who want to remain in traditional 
Medicare would have to enroll in a stand-alone drug plan to get 
prescription drug benefits, but there is no such plan in the under-65 
market. The conference report does not guarantee them what their 
premium will be; only that a private company will offer them an 
actuarially equivalent benefit that can change from year to year. It is 
a level of uncertainty that our senior should not have to face.
  Our seniors now know the details of this bill. They are calculating 
their prescription drug costs at kitchen tables across the country 
tonight. They are calling Congress to say how disappointed they are at 
the inadequate benefits this bill provides, and they are urging us to 
vote no.
  Rather than providing relief to our seniors, this bill shifts 
additional costs from government onto their backs. Although the drug 
benefit premium is estimated at $35, the conference report gives 
insurers license to charge much more. The Medicare Part B deductible 
will increase by ten percent in 2005 and then by program costs each 
year.
  Some of my colleagues have tried for years to curtail Medicare 
spending by hundreds of billions of dollars, usually in the form of 
targeted provider cuts. But our hospitals, doctors, nursing homes and 
rehabilitation providers need fair reimbursement, and Congress has 
usually answered the call. In addition, these members have found 
difficult to argue the need for drastic cost containment given that 
Part A Medicare solvency is now the third longest in the history of the 
program. So the conferees have taken a surreptitious approach, adding a 
provision that was not in the House or Senate-passed bills. They 
created a new definition of insolvency that caps Medicare's use of 
general revenues at 45 percent of total Medicare costs and would force 
government to cut benefits or raise payroll taxes if this limit is 
exceeded. By triggering an increase in payroll taxes, which 
disproportionately affect lower-income Americans, this provision shifts 
the burden of Medicare away from those most able to support it to those 
who are least able, further jeopardizing Medicare's long-term 
stability.
  Because we are limited to $400 billion in this bill, it would make 
sense to use every instrument possible to get the best price for 
prescription medicines. But the conference report contains an 
inadequate mechanism to lower the price of drugs, which have escalated 
steadily over the past few years, and show no signs of decreasing. This 
bill specifically prohibits the Secretary of HHS from using the federal 
government's purchasing power to negotiate lower drug prices, a tool 
that has been used effectively in nearly every other industrialized 
nation in the world. Instead, it relies on pharmaceutical benefit 
managers, which have had mixed results in past years.
  I had hoped that this bill would improve health care for seniors. 
Unfortunately, the provisions affecting oncology drug reimbursement 
will do just the opposite for cancer patients and reduce their ability 
to get needed cancer care. The final bill still contains severe cuts to 
cancer care providers, nearly $1 billion annually. If this bill becomes 
law, many cancer centers will close, others will sharply reduce their 
staffs, and others will be forced to turn away patients.
  The Ways and Means Committee and the Energy and Commerce Committee 
have examined this issue carefully. We recognize that the current 
payment system for cancer care needs to be fixed. Medicare over-
reimburses for the drugs themselves, while it under-reimburses for the 
services that oncologists provide. I support appropriate reimbursement 
for cancer drugs, but we cannot make cuts of this magnitude without 
simultaneously paying oncologists fairly for the care they render. To 
do so will endanger the lives of cancer patients.
  Finally I cannot support a conference report that harms currently 
covered retirees. I remain concerned about the impact of this bill on 
retirees with employer-sponsored drug coverage. Because of the 
inadequate reimbursements to retiree health plans, CBO estimates that 
2.7 million retirees are expected to lose their benefits. The bill also 
encourages employers to drop the coverage they now provide by excluding 
private plan spending from counting toward the catastrophic limit. 
Because of provisions written into the bill, most seniors with retiree 
coverage and high drug costs will never reach the point at which 
Medicare resumes coverage. The authors of this bill say that the 
benefit they're devised is voluntary, but for those seniors who lose 
their private retiree health coverage, this plan won't be optional, it 
will be the only game in town.
  Tonight's vote caps several years' efforts to provide Medicare 
beneficiaries with desperately needed prescription drug coverage. 
Unfortunately, the conferees have produced a bill that won't result in 
better health care for our seniors, a more efficient Medicare program, 
or fiscal responsibility. It will eventually do more harm than good to 
Medicare, and to those who depend on it for their health care needs. I 
support providing our senior a meaningful prescription drug benefit 
within the Medicare system that will strengthen Medicare. Therefore I 
must oppose this conference report and urge my colleagues to do the 
same.
  Mrs. JOHNSON of Connecticut. Mr. Speaker, I yield myself 15 seconds.
  Mr. Speaker, if the gentleman will note and other Members will note, 
and the listening public will note, on pages 49 to 53 of the bill, 
which is all on the Internet, they will see that there is what we call 
a hard fall-back. That is, if private plans do not offer prescription 
drugs to our seniors, the government will. The seniors will be 
guaranteed a drug plan; that is in the statute.
  Mr. Speaker, I yield 2 minutes to the gentleman from Arizona (Mr. 
Hayworth).
  Mr. HAYWORTH. Mr. Speaker, I thank my good friend, the chairwoman of 
the Subcommittee on Health of our full committee, for yielding me this 
time.
  It has been interesting to listen to the debate thus far this 
evening. In fact, it evokes memories of an earlier time when I first 
arrived in this Chamber and, much to my surprise, heard all of these 
horror stories about what might happen to senior Americans and how 
schoolchildren might be starved and all sorts of villainy and 
demonizations that had no basis in fact.
  Mr. Speaker, good people can disagree, but it is important to take a 
look at what we are doing with this legislation. The first thing we are 
doing is actually strengthening Medicare and preparing it for the 21st 
century, for the influx of more seniors, demographically what we will 
see in the 21st century, in just a few short years. And what we are 
also doing is updating Medicare for the 21st century to reflect changes 
in medicine. Prescription drugs are the first line of defense for 
America's seniors. This legislation recognizes that reality and moves 
to cover it. But moreover, Mr. Speaker, we first reach out to those 
seniors most in need, and we provide for all seniors next year 
immediate discounts, with our discount drug cards. Very, very 
important.
  Now, we have heard a lot of wailing and gnashing of teeth about the 
endorsement of this plan by the AARP. I think rather than tearing up 
cards or engaging in personal attacks on those who may serve very 
competently in that association, it might be good to actually listen to 
the words of our seniors who belong, the millions of seniors who depend 
on prescription drugs and believe in the AARP. And they readily admit, 
as all of us would admit, this legislation may not be perfect, but it 
is a good place to start. We all know, on both sides of the aisle, 
change comes incrementally. Let us adopt this legislation for America's 
seniors and for future seniors.
  Mr. STARK. Mr. Speaker, I yield 1\1/2\ minutes to the gentleman from 
Wisconsin (Mr. Kleczka), who agrees with the Arizona Daily Star from 
Tucson that by doing nothing to address the cost of medicines and by 
raising payments to private HMOs that want to compete with Medicare, 
the bill dooms the Medicare program to major problems down the road.
  Mr. KLECZKA. Mr. Speaker, the gentleman from Arizona who just spoke 
advised us to listen to our seniors; and many of us, I say to my 
colleagues, are doing just that with our vote today. Here is a senior 
from my district who advises me to oppose this bill, and they

[[Page 30809]]

just canceled their AARP membership this morning.
  What is going on here? This bill started out as a drug bill for 
senior citizens and, all of a sudden, we find the bill before us has 
over $100 billion for special interests in this country, and the calls 
we are getting to support the bill are from those special interests. 
They are saying, here is 200,000 specialty physicians; support the 
bill. Here, a big fat letter. And not once do they mention Medicare 
drugs for seniors. They are worried about their own pocket. Letter 
after letter in my office and on my fax machine are from special 
interests who have lobbyists in town urging Members to vote for this 
bill because they are getting something out of it: more money. And none 
of them are saying, and also the senior provision is good.
  That is what is going on here. The seniors who call us are against 
the bill. The special interests who, in a campaign period can give us 
$10,000 in campaign contributions, are encouraging us to vote for the 
bill. Who do you think is going to win at the end of the day, huh? The 
seniors do not got a PAC. They do not give us $5,000 a crack, $10,000 a 
crack. That is what is happening, I say to my colleagues. And let us 
not forget it.
  Mrs. JOHNSON of Connecticut. Mr. Speaker, I yield myself 15 seconds.
  I do not consider the AARP a special interest group, or the Coalition 
to Ensure Patient Access a special interest group, or the Alzheimer's 
Association a special interest group, or the Kidney Cancer Association 
a special interest group.
  Mr. KLECZKA. The Hospital Association, the American Medical 
Association, that is who I am talking about.
  Mrs. JOHNSON of Connecticut. Mr. Speaker, it is my time.
  Mr. KLECZKA. Let us not kid a kidder; we know who they are.
  The SPEAKER pro tempore (Mr. Hastings of Washington). The gentleman 
will suspend. The gentlewoman from Connecticut has the time.
  Mrs. JOHNSON of Connecticut. The Mental Health Association of Central 
Florida, the Larry King Cardiac Foundation, the Latino Coalition.
  Mr. Speaker, I yield 1 minute to the gentleman from Georgia (Mr. 
Gingrey).
  Mr. GINGREY. Mr. Speaker, I rise tonight in support of the House-
Senate Medicare agreement. For those of us who had hoped that this bill 
would contain more reforms or greater cost constraints, I agree. We did 
not accomplish all that we had hoped. But as a physician, I realize the 
medical reality of the bill, a medical reality that the prescription 
drug benefit itself is fiscally responsible and a potential cost-saver 
for Medicare.
  By providing a prescription drug benefit, providers will be able to 
take the necessary preventive action to potentially stave off or treat 
an illness in an earlier stage, making it easier to control the cost of 
treatment.

                              {time}  0015

  The medical reality is that prescription medication can help seniors 
live longer, healthier lives, while saving a tremendous amount of money 
on treatment by avoiding costlier options.
  Although I hope the future will bring about more changes and 
modernization to Medicare, the Medicare agreement will be a great 
start. And I urge my colleagues to take this fiscally responsible step 
and pass the Medicare conference report.
  Mr. STARK. Mr. Speaker, I yield for the purpose of making a unanimous 
request to the gentleman from Minnesota (Mr. Oberstar).
  Mr. OBERSTAR. Mr. Speaker, I rise in opposition to the conference 
report.
  Mr. STARK. Mr. Speaker, I yield 1\1/2\ minutes to the gentleman from 
Georgia (Mr. Lewis).
  Mr. LEWIS of Georgia. Mr. Speaker, I stand in strong opposition to 
H.R. 1. I believe in Medicare, I believe that Medicare is a sacred 
trust between the Federal Government and the American people. I believe 
with all my heart, with all my soul, and with all my being that 
Medicare must have a dependable, affordable, and strong prescription 
drug benefit. And that is why I cannot support this bill.
  Mr. Speaker, 38 years ago the Republicans did not like Medicare and 
they do not like it now. Republican Speaker Newt Gingrich gleefully 
stated that he wanted to see Medicare wither on the vine. Mr. Speaker, 
my colleagues, Newt Gingrich is back, and his fingerprints are all over 
this bill.
  If this bill is passed, it would be a dagger in the heart of Medicare 
as we know it. This bill is an attempt by the Republican party to 
privatize Medicare. I stand against privatizing Medicare, and I stand 
against this bill.
  Medicare is a sacred trust. It is a covenant with our seniors. Let us 
not breach this trust. Let us not violate this covenant. We must do 
what is right.
  I urge my colleagues to vote against this unreliable bill, vote for 
the seniors, vote for those that are in need. Vote against this bill.
  Mrs. JOHNSON of Connecticut. Mr. Speaker, I reserve the balance of my 
time.
  Mr. STARK. Mr. Speaker, I yield 1\1/2\ minutes to the distinguished 
gentleman from Massachusetts (Mr. Neal), who agrees with the Boston 
Globe that this experiment needs to be stopped before the Republicans 
in Congress damage a program that has served the elderly well for 38 
years.
  Mr. NEAL of Massachusetts. Mr. Speaker, it is not always an easy task 
to agree with the Boston Globe.
  Mr. Speaker, I thank the gentleman from California (Mr. Stark). Well, 
here we are again in the dark of night, whether it is doing Trade 
Promotion Authority or whether it is doing tax cuts, or whether it is 
doing the privatization of Medicare, we do it in the dark of night.
  Only could the gentleman from California (Mr. Thomas), the chairman 
of the Committee on Ways and Means, talk about the crisis that 
confronts Medicare after they led the charge to rip $2 trillion out of 
the Federal budget over the next 10 years. Tonight we are children of 
Roosevelt on this side and Johnson, and let us not forget it. When you 
hear them talk about their newfound affinity for Medicare, recall that 
it was Dole and Michael and Rumsfeld and Ford who voted against the 
establishment of Medicare.
  And I want to say something to my colleagues on the democratic side 
tonight who are tempted by what is about to happen. You mark my words, 
we are going to be back here in a year, and the next step is Social 
Security. That is where they are headed. Medicare is an amendment to 
the Social Security Act. America is a more egalitarian society today 
because it was our party who stood against the forces of privilege. 
They are the ones that said no.
  Turn down this privatization of Medicare.
  Mrs. JOHNSON of Connecticut. Mr. Speaker, I yield 1 minute to my 
colleague, the gentleman from Pennsylvania (Mr. Peterson).
  Mr. PETERSON of Pennsylvania. Mr. Speaker, I want to congratulate 
those that have worked on this very complicated bill. I was pleased 
this morning to receive from the Governor of Pennsylvania, Governor 
Rendell, an endorsement of this plan. Why would a democrat governor 
from Pennsylvania support his plan? His people were here and reviewed 
it.
  This allows states like Pennsylvania and 20 other states who have 
pharmacy plans to wrap around and make a really comprehensive pharmacy 
program for their state with a state effort and the Federal effort.
  Now, those of you who come from rural America better think seriously 
about voting against this bill. Rural health care has been fighting for 
its life. This is a lifeline that will for once and forever help 
stabilize Medicare payments. In rural America what good does a pharmacy 
program do if you do not have a doctor in a hospital and a home health 
care agency for him or her to work in?
  This program does more to help rural health care than has ever been 
done. The urban areas of this country have had Medicare Plus Plus while 
rural America has had Medicare Minus Minus. An unfair system. And this 
bill does more to equalize that. It also preserves cancer care that has 
been under

[[Page 30810]]

threat. And it brings health savings accounts that will be an offering 
to our businesses more seriously considering about walking away from 
health care because they cannot afford the current plan.

                                     Commonwealth of Pennsylvania,


                                       Office of the Governor,

                                Harrisburg, PA, November 21, 2003.
     Hon. John Peterson,
     Cannon Building,
     Washington, DC.
       Dear Representative Peterson: I am writing to thank you for 
     your efforts to develop provisions in the Medicare 
     Prescription Drug bill to allow PACE to continue to be the 
     primary source of drug benefits for qualifying seniors in 
     Pennsylvania. As of early 2004, we expect approximately 
     325,000 Pennsylvania seniors to be in the PACE program, and 
     we owe it to all of them to ensure the program on which they 
     rely continues to work for them.
       As the Medicare drug benefit legislation had been in 
     development, our goals have been to ensure seniors in the 
     PACE program would be able to benefit from the new federal 
     benefit without experiencing any changes in the way they 
     obtain prescription drugs and without being forced through a 
     bureaucratic process along the way. Federal legislation must 
     allow for a seamless transition for PACE beneficiaries while 
     at the same time allowing PACE to expand its prescription 
     drug program and services to more of our seniors.
       I am informed that the language in the Medicare drug 
     benefit bill achieves our major goals relating to the PACE 
     program. This is good news for our constituents and I 
     appreciate very much all the hard work you and others in the 
     Pennsylvania delegation did to make this happen.
       Should the legislation ultimately be enacted, I look 
     forward to working with you and Secretary Thompson to make 
     sure the PACE-related provisions are implemented as we all 
     believe they should be.
       Thank you again for your efforts on behalf of 
     Pennsylvania's seniors.
           Sincerely,
                                                Edward G. Rendell,
                                                         Governor.

  Mr. STARK. Mr. Speaker, I yield 15 seconds to the gentleman from 
Pennsylvania (Mr. Doyle).
  Mr. DOYLE. Mr. Speaker, I just spoke with the Governor's office 
earlier this evening. I was aware of this letter that was sent out to 
four Republicans. Governor Rendell does not endorse this program. He 
does not support this program. And I just want that to be reflected in 
the Record.
  Mr. STARK. Mr. Speaker, I yield 1\1/2\ minutes to the gentleman from 
Texas (Mr. Sandlin) who agrees with the Houston Chronicle, the 
Republicans are interested only in the illusion of providing a popular 
benefit, a Republican driven bill to, quote, improve Medicare is 
impossible.
  Mr. SANDLIN. Mr. Speaker, we have heard a lot of pretty words from 
the Republicans tonight, but every one on both sides of the aisle knows 
that this bill is nothing but a sham, a charade, a shameless trick on 
America's seniors.
  America's seniors need help right now and yet the bill advanced by 
the Republicans does not even take effect until 2006. No coverage in 
2003, no coverage in 2004, no coverage in 2005, and who knows what will 
happen in 2006.
  Our seniors cannot afford prescription drugs, and in the face of that 
challenge, the Republicans have presented a bill that requires seniors 
to pay out of their pockets over $4,000 of the first $5,000 spent on 
drugs. That is no benefit at all.
  Now, have the Republicans done anything to reduce the cost of drugs? 
No. The HMOs and the pharmaceutical companies will not let them do it. 
And this bill that is supposed to make drugs more affordable, there is 
no control over the prices charged by the pharmaceutical companies. 
Their greed is what got us in this situation in the first place. Do you 
think that philanthropy has suddenly invaded the boardroom of the 
pharmaceutical companies. Is that what you think?
  Amazingly, this bill prohibits, makes it illegal, against the law for 
the government to negotiate for lower prices with a pharmaceutical 
companies. They supply the product, they set the price, the seniors 
foot the bill, that is a sweet deal for them. And can the seniors save 
money by getting drugs from Canada or Mexico? Oh, no, the Republicans 
in this bill that was written by the pharmaceutical companies say no. 
And that is the way it is.
  Finally, Mr. Speaker, the Republicans have the audacity to support a 
plan that lines the pockets of HMOs by taking $10 billion out of cancer 
treatment, leaving America's seniors both broke and dying. If this bill 
passes, it passes on the back of the America's seniors. The Republicans 
will have to answer. They can run in the middle of the night, but they 
cannot hide.
  Mrs. JOHNSON of Connecticut. Mr. Speaker, I reserve the balance of my 
time.
  Mr. STARK. Mr. Speaker, I yield 1\1/2\ minutes to the gentlewoman 
from Ohio (Mrs. Jones), who is a woman who agrees with Al Hunt, who 
wrote in the Wall Street Journal that this is an open rip-off by HMOs. 
There is a reason most Americans and, virtually all who have endured 
serious medical issues, despise HMOs. They are, with few exceptions, 
vultures.
  Mrs. JONES of Ohio. Mr. Speaker, I am proud to have had the 
opportunity to serve my first year on the Committee on Ways and Means. 
And I think it is important for America to know that, finally, we had 
an African American male on the Committee on Ways and Means who rose to 
ranking member, who rose to representation on the conference committee, 
and he was excluded from being part of the willing coalition.
  I say to people across America, particularly the African Americans in 
this country, you were not at the table, your interests were not 
represented. Let me, in addition, say that since we have two Houses in 
this Congress, the House of Representatives and the Senate, that the 
House was not represented on the Democratic side in this report.
  But let me address another issue. And I have got a written statement 
that I will submit for the Record. Everybody keeps saying about AARP 
and how renowned they should be. But they do not talk about that in the 
last 4 years AARP made $608 million in insurance-related expenses, 30 
percent of its income. They do not talk about that AARP had a 10-year 
Medigap contract with some company and the business is now worth $3.7 
billion. They do not talk about that AARP made $10.8 million last year 
by selling its member list to insurance companies. And they do not talk 
about the fact that AARP spends $7 million in support of this 
legislation. Talk about a conflict of interest. If there ever was one, 
it is right there. So I say to you, we are going to ruin neighborhood 
drug companies. We are not drug pharmacies. Do not vote for this bill. 
This bill is not in the interest of senior citizens.
  Mr. Speaker, I rise in opposition and with great disapproval of the 
Medicare conference agreement. The republican leadership in the House 
of Representatives has excluded Democratic Members from the 
negotiations and has written a Medicare bill that bows to major drug 
companies and prevents Medicare from negotiating better prices. This 
agreement masquerades as an attempt to add a long-overdue prescription 
drug benefit, but this is really a Trojan horse designed to dismantle 
Medicare, as we know it.
  This agreement is flawed in countless ways. Its concentration on 
privatization is misguided at best and devastating. This is a special 
interest giveaway to the insurance companies with provisions including 
a $12 billion slush fund to bribe HMO's and PPO's to participate, all 
at the expense of taxpayers and the elderly alike. The agreement leaves 
a substantial number of the 6.4 million low-income Medicare 
beneficiaries who are also eligible for Medicaid worse off by requiring 
them to pay higher co-payments for prescription drugs than they pay 
today. This agreement also prevents Medicaid from filling in the gaps 
of this new, limited benefit. This bill squanders $6 billion needed for 
coverage on tax breaks for the wealthy which in fact creates an 
unprecedented tax loophole that would undermine existing employer 
coverage and adds to the ever-growing number of uninsured. These funds 
should be used to prevent employers from dropping coverage or to 
improve the drug benefit. Even worse, this bill would force some low-
income seniors who have modest savings to impoverish themselves in 
order to take advantage of the extra help allegedly available in this 
bill. A disproportionate share of African American Medicare recipients 
are disabled. The cut-off points chosen in this conference agreement 
will pigenhole African Americans into what is referred to as the 
``donut'' on paying for the drug benefit. This will unreasonably hurt 
African American Medicare recipients, many of whom

[[Page 30811]]

have chronic ailments. We are forcing our seniors to choose among 
purchasing food, prescription drugs or paying for a roof over their 
heads.
  In closing, please let me inform America that this bill does not 
address the needs of our citizens. This bill would manufacture a crisis 
when an arbitrary cap on general revenue funding is reached, which 
would trigger a fast-track process for consideration of legislation to 
radically cut Medicare, including benefit cuts, payment cuts for 
hospitals, nursing homes, home health providers and increased cost 
sharing. Without hesitation, Congress provided $87 billion to rebuild 
Iraq; is it too much to provide the appropriate funding needed to give 
our Nation's seniors what they deserve--an affordable and guaranteed 
medicare drug benefit?
  Mr. Speaker, I represent 206,000 constituents in my district who are 
65 and older and are below the federal poverty level. The same 
constituents I promised that I would vote for a Medicare prescription 
drug bill that would be affordable with reasonable premiums and 
deductibles that are designed to significantly reduce the price of 
prescription drugs; a meaningful medicare prescription drug bill that 
would be defined, provide guaranteed benefits, there would be 
absolutely no gaps; no separate privatized plan; and most important, I 
repeatedly told my constituents that I would support a Medicare 
prescription drug bill that would be available to all seniors and 
disabled Americans. The results of the Medicare conference agreement is 
not what I expected. Dear colleagues, I ask that you join me and vote 
against this measure.

                    [From USA Today, Nov. 21, 2003]

                  AARP Accused of Conflict of Interest

                 (By Jim Drinkard and William M. Welch)

       Washington.--AARP, the nation's leading lobbying force for 
     retirees, has a major conflict of interest in its backing for 
     a new Medicare prescription drug plan, opponents charge.
       The organization receives millions of dollars a year in 
     royalties for insurance marketed under its name. It stands to 
     reap a windfall from the plan, which would pump $400 billion 
     into a new drug benefit and open Medicare to private 
     insurance competition.
       AARP's annual reports show it has received about $608 
     million in insurance-related income over the four most recent 
     years for which data are available. That's 30% of its total 
     income, roughly equal to what it collects in membership dues.
       ``It's almost unimaginable that they wouldn't stand to 
     gain'' if the new benefit is passed, says David Himmelstein 
     of Harvard Medical School. He is a proponent of national 
     health insurance.
       Much of AARP's insurance business is in policies that pay 
     costs not covered by Medicare--so-called Medigap insurance. 
     UnitedHealth Group signed a 10-year contract with AARP in 
     1998 to provide health coverage to its 35 million members. 
     The business was worth $3.7 billion last year to the 
     insurance company.
       ``The same folks who are in the Medigap market would want 
     to get into this, and the best route in is through the AARP 
     membership list,'' Himmelstein says.
       AARP also collects millions of dollars a year from 
     insurance and drug companies that advertise in the magazine 
     it mails to members. It also makes money--$10.8 million last 
     year--by selling its members list to insurance companies.
       From its earliest roots in the 1950s, AARP has been closely 
     tied to the insurance business. It grew out of a retired 
     teachers group that sought to provide health insurance to its 
     members. ``They have always had this commercial identity,'' 
     says Jonathan Oberlander, a political scientist at the 
     University of North Carolina who has studied the politics of 
     Medicare.
       The breadth of AARP's business activities--which include 
     not only insurance but credit cards, travel packages and 
     prescription drugs--has drawn unwanted attention before. In 
     1995, Sen. Alan Simpson, R-Wyo., convened hearings that 
     alleged the group was abusing its non-profit status. AARP was 
     forced to pay back taxes on its earnings from those 
     commercial ventures. and the group has faced periodic 
     questioning about whether its business interests at times 
     overshadow the interests of its members.
       Simpson, now retired from the Senate, remains one of the 
     group's sharpest critics. ``If there was a sublime definition 
     of conflict of interest, it would be AARP from morning to 
     night,'' he says.
       AARP is tax exempt and officially non-partisan. ``We made 
     public policy decisions without regard to business 
     considerations,'' says the group's policy director, John 
     Rother. Spokesman Steve Hahn says some of its Medigap 
     policies and mail-order pharmaceutical sales are likely to be 
     hurt by passage of the Medicare bill because it will increase 
     competition.
       Democrats in Congress seemed stunned this week when AARP 
     announced it would support the Republican-drafted Medicare 
     compromise and pour $7 million into a TV ad campaign urging 
     passage.
       Senate Minority Leader Tom Daschle, D-S.D., and House 
     Minority Leader Nancy Pelosi, D-Calif., say the legislation 
     would sell out the interests of senior citizens. It 
     ``undermines Medicare and serves the agendas of big drug and 
     insurance companies,'' they wrote in a letter to AARP head 
     William Novelli. They asked Novelli to pledge not to profit 
     from any program that might be created.
       Rep. Pete Stark, D-Calif., called the legislation a 
     ``special-interest boondoggle'' that will split AARP's 
     leaders from its grass roots. On Thursday, a message board on 
     the group's Web site was peppered with angry postings from 
     members, including 839 new missives under the title, ``AARP 
     sellout.''
       For a decade, AARP has been a sleeping giant. The 
     organization felt burned after its support for a catastrophic 
     insurance benefit in 1988 backfired with seniors and had to 
     be repealed. It had since been reluctant to take positions on 
     hot political issues. Its membership is evenly divided among 
     Democrats, Republicans and independents, making it hard to 
     take sides in policy fights.
       But when the group does decide to engage, its clout is 
     unmatched. ``They are the most important and well-organized 
     association in Washington,'' says James Thurber, who teaches 
     lobbying at American University in Washington.

  Mrs. JOHNSON of Connecticut. Mr. Speaker, I yield 1 minute to my 
colleague, the gentlewoman from Florida (Ms. Ginny Brown-Waite), who 
has experience legislating in the area of health care reform.
  Ms. GINNY BROWN-WAITE of Florida. Mr. Speaker, I am one of those 
Republicans who grew up very poor. My dad was a Democrat. And I 
remember asking him why he was a Democrat, and he said because the 
Democrats protect the poor.
  What I am hearing here tonight says the Democrats do not care about 
the poor. They do not care about the little old lady whose income is 
about $11,000, who only has Social Security, who cannot get 
prescription drugs today. That is the wrong message to be sending if 
they hope to be the savior of the poor and the drowntrodden.
  I also teach health care. One of the things that I teach in my class 
are statistics. And the statistics are that the African American 
community and the Hispanic community pass away at a much earlier age 
from heart attacks, from coronary artery problems, and you know what? 
These are the prescription drugs that will be available under this 
prescription drug plan. How can they go back home and say that they are 
protecting the poor and the down-trodden? These are the same, the poor 
and the down-trodden, these are the people that are going to benefit 
from this prescription drug plan. I fully support it. It is a good bill 
for everyone.
  Mr. Speaker, I rise today in support of the Bipartisan Medicare 
Prescription Drug, Improvement, and Modernization Act because it 
finally provides the much needed prescription drug relief seniors have 
asking for, offers help to our rural hospitals and our nation's 
doctors, and begins the real modernization and reform of a Medicare 
program in dire need.
  Throughout my public service, I have heard a persistent question from 
my seniors how are you going to help us with the cost of prescription 
drugs? With the passage of this bill, I feel that I can finally begin 
to answer that question.
  For the first time in history, we are going to provide all 40 million 
seniors and disabled Americans with prescription drug coverage.
  It gives me great comfort to know that in 2006, with this 
Prescription Drug Plan, drug costs for seniors could be cut almost in 
half. And as early as next year, senior will begin to save an estimated 
25 percent on prescription drugs with their Medicare prescription drug 
card. In the first year we expect seniors to save an estimated $365.
  As a member of the Speaker's Prescription Drug Task Force, this is 
something we fought for, and this is something we got.
  In addition, we are giving Americans more control over their health 
care by creating Health Savings Accounts, where they can contribute up 
to $2,500 a year into these tax-free accounts and citizens 55 years or 
older are permitted to make ``catch up'' payments. These accounts can 
be used for future medical expenses and may prove to be an additional 
much needed asset to our aging population.
  Mr. Speaker, I would also like to bring to the attention of my 
colleagues a very important component to this bill. As we are all 
aware, in 2004, the prescription drug discount card in Medicare will 
offer seniors up to 25 percent off

[[Page 30812]]

their drug costs and provide low-income seniors, those with incomes of 
less than 135 percent of poverty into account, a $600 subsidy on top of 
the discount card. That's great savings, especially for wealthier 
seniors.
  But what if you have an income of over 135 percent of poverty and 
you're disqualified from receiving the cash subsidy? Currently, 
hundreds of thousands of seniors in this country are provided discount 
cards from the prescription drug companies that offer significant 
savings on medications that a particular company produces. The income-
restrictions on these cards are in some cases up to 300 percent of 
poverty. This means virtually all seniors in my district are eligible 
for this savings, which in many cases equals up to 80 percent off the 
retail cost of the drug. For example, Mr. Speaker, Eli Lilly makes 
Prozac; and if one of my 5th district seniors needs assistance with the 
cost of that drug, they can sign up to receive a card from Eli Lilly 
that entitles them to receive a 30-day supply of any Eli Lilly product 
for just $12. If, due to the new Medicare discount card, these 
important voluntary programs were discontinued, many of our Nation's 
seniors would end up paying higher prices. My constituent would end up 
paying over $75 for the same Prozac he or she is now receiving for only 
$12. Just as there was a fear this benefit would cause employers to 
drop coverage once it became available, I was concerned that the drug 
card would cause drug manufacturers to discontinue their cards.
  Mr. Speaker, working with you, Majority Leader DeLay, Majority Whip 
Blunt and many of my other colleagues in this House, I took the lead 
and fought to protect seniors who are benefiting from the current 
prescription drug cards.
  Now, on page 64 of the report language addendum and addressing 
section 1860D-31 of Conference agreement; Section 105 of House bill; 
Section 111 of Senate Bill reads:

       Seniors currently benefit from prescription drug assistance 
     programs offered by pharmaceutical companies. Conferees 
     intend that these programs continue to be offered until the 
     full implementation of the prescription drug benefit. Nothing 
     in this conference report shall be interpreted as encouraging 
     the discontinuation or diminution of these benefits.

  Additionally, I have secured several letters from drug manufacturers 
in this country indicating their commitment to continuing to offer 
these worthwhile and necessary card programs, copies of which I'd like 
to insert into the Record.
  Mr. Speaker, I simply want to bring this to the attention of my 
colleagues on both sides of the aisle and especially to the seniors in 
my district. Neither conference staff nor most of the members of this 
body were aware of this glitch in the proposal and I am very proud of 
the work we were able to do together.
  In closing, Mr. Speaker, friends, colleagues, the citizens of the 5th 
Congressional District of Florida elected me to this seat because they 
believed my voice would be heard and that I would stand with them in 
making a prescription drug benefit in Medicare a reality. It simply has 
been too long that our Nation's seniors have had to choose between 
life-saving drugs and food and this is unacceptable.
  No one in this chamber believes that this bill is perfect, including 
myself, but I believe this bill is a good beginning and it signifies 
progress in our efforts to provide all of our constituents with the 
best, safest, and most affordable health care the world has to offer. 
In the months and years ahead, it is my hope and my promise that I will 
continue to work with Democrats and Republicans, to continue to make 
progress in our ongoing battle to improve health care for all 
Americans, including additional protections for retirees currently 
receiving health care benefits and addressing the rising costs of 
prescription drugs.
  But tonight we have a choice to make--to take a step forward or to 
accept the status quo. Instead of concentrating on the weaknesses of 
this proposal, we must each embrace its strengths and dedicate 
ourselves to the next step forward. Accordingly, I urge my colleagues 
to vote in favor of the Prescription Drug and Medicare Modernization 
Act.
  Mr. STARK. Mr. Speaker, I am delighted to yield 2 minutes to the 
minority whip, the gentleman from Maryland (Mr. Hoyer).
  Mr. HOYER. Mr. Speaker, this Medicare conference report is, sadly, a 
missed opportunity. I was here in 1983. Ronald Reagan, Tip O'Neill, and 
Bob Michael joined together to save Social Security. They came 
together, President Reagan, Speaker O'Neill, and Minority Leader 
Michael and said, we need to have a bill that has bipartisan support 
and will get the job done.

                              {time}  0030

  It did.
  The Republicans rejected that model. Most Members of this body on 
both sides of the aisle recognize that it is long past time that we 
provide for our seniors and give them a prescription drug program; but 
it is not this bill that they expected, a feeble benefit that forces 
them to pay 80 percent of their costs.
  I will tell the gentlewoman from Florida (Ms. Ginny Brown-Waite) her 
dad was right. He was a Democrat because this party has historically 
and now believes that we should have done better by our seniors. Even 
the conservative Heritage Foundation, which is against this bill 
because they want to see Medicare done away with, says this, ``The 
politically engineered premiums and deductibles, coupled with the odd 
combination of `donut holes' or gaps in drug coverage, are likely to be 
unpopular with seniors.''
  The Heritage Foundation said that. Not Steny Hoyer, not Democrats. 
Even Dick Armey, the immediate past leader of our party wrote in the 
Wall Street Journal on Friday that this conference report is ``bad news 
for seniors.''
  Your majority leader just past said that. Now, he wants to do away 
with Medicare. He does not believe we ought to have Medicare. He 
nevertheless says this is bad news for seniors. Because it is bad news 
for seniors, we ought to vote against this bad bill.
  Mrs. JOHNSON of Connecticut. Mr. Speaker, I yield myself 10 seconds. 
I remind the gentleman from Maryland (Mr. Hoyer) that of his 713,000 
seniors, 31 percent will get total drug coverage under this bill.
  Mr. Speaker, I yield 2 minutes to the gentleman from Illinois (Mr. 
Weller), a member of the Committee on Ways and Means.
  Mr. WELLER. Mr. Speaker, this is historic legislation tonight. Again, 
we make another positive step forward in modernizing Medicare, a 
process we have been working on every year the nine years that I have 
served in the House of Representatives.
  I am proud that a majority of House Republicans voted in favor of 
Medicare when it was created. I am proud a majority of this House, who 
is the majority, continues to work to modernize and improve Medicare 
for our seniors.
  This legislation that came out of bipartisan work, it is endorsed by 
the AARP, a trusted organization that represents millions of American 
seniors. And in the case of Illinois, my home State, 1.7 million 
seniors benefit in the State of Illinois. They benefit because they 
will have for the first time ever prescription drug coverage that is 
voluntary, it is affordable, and it is universal, available for every 
senior citizen. It will be immediately available.
  In fact, within 6 months of this legislation becoming law, seniors 
will have a prescription drug card immediately this coming year 
allowing them to see up to a 25 percent savings; and 2 years later, 
2006, every senior again will have the opportunity to see up to a 75 
percent savings on prescription drugs. They choose to enroll in a 
prescription drug plan available through this modernization of 
Medicare. In fact, at a cost of about $1 a day, they can see a 75 
percent savings, up to a 75 percent savings. And if they are low 
income, they will pay little or no premium. This is a good plan. That 
is why it has bipartisan support.
  I want to salute Senator Breaux and Senator Baucus for working with 
Republicans to come up with a bipartisan plan.
  I would also note that hospitals and community health centers do 
benefit because when you modernize Medicare, you also fix the 
reimbursements. In communities that I represent, almost all of our 
hospitals, I think every one of them, is a not-for-profit. They 
struggle, both the hospitals and community health centers. Some call 
them special interests, but they get big improvements back for 
Illinois, $400 million in additional reimbursements as a result of this 
legislation.
  Mr. STARK. Mr. Speaker, the Republicans can lock out two of the 
leading Democratic legislators from their conference committee, but 
just to show you that we are bigger than all that, we will turn the 
other cheek. I yield 2 minutes to the gentleman from Indiana (Mr. 
Burton).

[[Page 30813]]


  Mr. BURTON of Indiana. Mr. Speaker, first of all, I want to make it 
clear, I am a Republican and I am very proud to be a Republican. 
However, there are problems with this bill that make it impossible for 
me to vote for it.
  It has been said tonight that 35 million AARP members cannot be 
wrong, but I am telling you AARP does not speak for all seniors. And 
when the seniors find out what is in this bill, that most of them 
initially are going to pay about $4,000 of the first $5,000 they are 
going to spend on pharmaceuticals, they are going to be so angry it is 
going to be like 1988 all over again.
  Now, I want to talk a little bit about the pharmaceutical industry. 
There is nothing in here that allows our government to negotiate the 
prices with the pharmaceutical industry. We pay the highest prices in 
the world for pharmaceuticals. We pay seven, eight, nine, 10 times as 
much for Tamoxifen, a woman who has breast cancer and has to have it, 
than they do in Canada; and yet there is no provision in this bill for 
negotiation.
  You say we have a 25 percent discount card. Twenty-five percent of 
what? If the pharmaceutical industry has these high prices and you 
knock 25 percent off, they are still a hell of a lot higher than they 
are in Canada or Germany, and yet we cannot reimport. Why? It does not 
make sense.
  Do we believe in free trade? We have NAFTA. You can import everything 
back and forth across the borders, but not pharmaceuticals because it 
is not safe. Yet when we talk to the Canadians, and I had four hearings 
on it, they could not find one case where there was a problem. This is 
not a safety issue. The problem is profit and price.
  I want to tell you something. It has been said that for too long 
seniors have paid too much. They have been paying too much. But we are 
not doing anything in this bill to lower the price of pharmaceutical 
products.
  Now, I want to say to my colleagues also there is $70 billion in this 
bill, a pay-off to Big Business to keep their employees and their 
former employees covered under this plan.
  I want to tell you something. As a businessman, they are going to 
look down the road and they are going to say, hey, Congress changes 
from time to time and they are going to start dumping their employees 
on the Federal plan. And when they do, those retirees are going to be 
so angry at us, you are not going to believe it.
  Mrs. JOHNSON of Connecticut. Mr. Speaker, I yield for the purpose of 
making a unanimous consent request to the gentleman from Florida (Mr. 
Young).
  Mr. YOUNG of Florida. Mr. Speaker, as one who represents the largest 
groups of senior citizens, older Americans who are on Medicare and 
Social Security, I rise in support of this bill.
  Mr. Speaker, I rise in support of H.R. 1, The Medicare Prescription 
Drug, Improvement, and Modernization Act of 2003. This is the most 
important and comprehensive improvement to the Medicare program since 
it was established 38 years ago.
  For the first time, Medicare will provide prescription drug coverage 
for 40 million older Americans. It will provide lifesaving help for the 
millions of seniors who today forgo taking prescription drugs because 
they have no coverage and cannot afford them. It will allow seniors to 
take their full dose of medicine as prescribed rather than cut them in 
half or skip days to make the supply last longer. And it will eliminate 
the heart wrenching decisions many seniors must make over whether to 
buy food or prescription medicine, because they cannot afford both.
  One of the reasons Americans are healthier and living longer is that 
prescription medication is available to control many chronic diseases 
such as high blood pressure, cholesterol, and diabetes. Unfortunately, 
these medicines are oftentimes not available to those living on fixed 
incomes. This legislation changes that by creating a tiered benefit 
program that provides prescription drug coverage for everyone eligible 
for Medicare. Yet it still allows those who receive prescription drug 
coverage through their employers or other health benefit plans to elect 
to retain that coverage.
  Because of the complexity of bringing the new Part D prescription 
benefits on line, those benefits will not take effect until 2006. In 
the interim, however, Medicare beneficiaries will be eligible beginning 
next April to receive a Medicare-approved drug discount card. Seniors 
will take this card to their local pharmacy to receive discounts of 10 
to 25 percent off their prescription medicine. This will provide 
immediate savings to seniors while preparations are underway to launch 
the full Medicare prescription drug program in 2006.
  Once implemented, seniors electing prescription drug coverage will 
pay a monthly premium of $35. Following a $250 deductible, they will 
receive federal coverage for 75 percent of the costs of their 
prescription drugs up to $2,250. For each prescription filled, there 
will be a $2 co-payment for generic drugs and a $5 co-payment for brand 
name drugs. If a senior incurs catastrophic drug costs, exceeding 
$3,600 in out-of-pocket costs, Medicare will cover 95 percent of drug 
costs over that amount.
  For those on small fixed, limited incomes (below $12,123 for 
individuals and $16,362 for couples), they will pay no deductible and 
no premium and there will be no gap in coverage between the initial 
coverage limit of $2,200 and the catastrophic coverage threshold of 
$3,600. For those with incomes between those levels and 150 percent of 
the federal poverty level ($13,470 for individuals and $18,180 for 
couples), the premiums and deductibles will increase on a sliding 
scale.
  In addition, it is estimated that this legislation will drive down 
the price of prescription medication by as much as 20 percent, to yield 
further savings for seniors. It also sets in place new federal laws 
that will allow drug manufacturers to bring to market quicker, more 
affordable generic drugs.
  In addition to the new prescription drug coverage, this legislation 
will improve the quality of care for seniors in a variety of other 
ways. Most notably, it provides coverage for the first time for 
important new preventative benefits. Beginning in 2005, all newly 
enrolled Medicare beneficiaries will be covered for an initial physical 
examination. All beneficiaries will be covered for cardiovascular and 
screening blood tests and those at risk will be covered for a diabetes 
screen. These new benefits will allow for the screening of patients to 
catch many illnesses and conditions early, allowing them to be treated 
and managed in a way that improves their health and quality of life 
while at the same time lowering medical costs to individuals and the 
program by preventing later serious health consequences.
  Finally, this legislation will ensure that Medicare payments for 
physician and hospital services keep pace with inflation so that we do 
not lose health care providers who are available to care for the 
growing population older Americans. It also seeks to stabilize the 
reimbursement rates and drug coverage for cancer patients, who have 
faced increasing problems with the reduction in Medicare payments for 
these services over the past few years.
  Mr. Speaker, as the representative of one of the largest populations 
of Medicare recipients in this Congress, I know first hand the life-
line that this program provides for seniors. My highest priority in the 
development of this legislation was to ensure that we do nothing to 
diminish or endanger the health care coverage it provides. We have done 
a good job in seeing that just the opposite is true. With its 
enactment, H.R. 1 will provide expanded benefits and will ensure that 
these benefits are more affordable and more available to all.
  H.R. 1 also responds to the three major concerns I have heard from my 
constituents throughout the development of this legislation. First, it 
guarantees access to the traditional Medicare program, services, and 
benefits that they currently receive. It will, however, allow those who 
are interested to consider new Medicare-approved plans where drug 
coverage is integrated into broader medical coverage or lower cost 
managed care plans offering expanded benefits.
  Second, H.R. 1 maintains the full Federal commitment and backing of 
the Medicare program. Some were concerned that the final legislation 
would in some way privatize the delivery of these health care benefits. 
That is not the case in this bill.
  Third, H.R. 1 does not in any way encourage employers or private 
health care plans to drop current employees or beneficiaries from their 
health care or prescription drug plans. Instead, it provides a number 
of important incentives for employers and private health care plans to 
retain employees and beneficiaries in their health care plans and 
allows the new Medicare benefits to supplement the benefits they 
already receive privately.
  Addressing these concerns is one of the many reasons the American 
Association of Retired Persons has endorsed H.R. 1. In a statement 
earlier this week, AARP said, ``AARP believe that millions of older 
Americans and their families will be helped by this legislation . . . 
The bill represents an historic breakthrough and important milestone in 
the nation's commitment to strengthen and expand health security for 
its citizens at a time

[[Page 30814]]

when it is sorely needed. The bill will provide prescription drug 
coverage at little cost to those who need it most: People with low 
incomes, including those who depend on Social Security for all or most 
of their income. It will provide substantial relief for those with very 
high drug costs, and will provide modest relief for millions more. It 
also provides a substantial increase in protections for retiree 
benefits and maintains fairness by upholding the health benefit 
protections of the Age Discrimination and Employment Act.''
  Mr. Speaker, the historic legislation before us today provides long 
overdue reforms to the Medicare program. It provides for the first time 
prescription drug coverage for older Americans. For those seniors 
currently unable to afford their medicines, it provides important new 
access to many preventive drugs. It also provides access for them to 
treat serious conditions before they worsen and require emergency room 
or hospital care.
  This legislation also improves Medicare coverage for preventative 
health care including physicals and cardiovascular health and diabetes 
screening tests. This too will improve the quality of medical care our 
seniors receive and will forestall many serious and costly medical 
problems.
  Finally, this legislation modernizes the Medicare program to provide 
21st Century solutions to give seniors more health care choices. It 
also will bring market forces to bear to ensure that they receive 
better medical care at more affordable and competitive prices.
  This is the culmination of a six year legislative effort that 
included the consideration of three separate prescription drug bills in 
the House. Our colleagues in the House and Senate have taken a hard 
look at the problems facing older Americans who receive their care 
through Medicare and have agreed upon a thoughtful and comprehensive 
approach. Certainly we will identify problems that will need correcting 
as the next step in implementing this complex program begins. For our 
seniors, however, this legislation fulfills a promise to give them 
access to prescription drug coverage for the first time through the 
Medicare program. It is a good response to a long overdue problem and I 
urge support for its final passage.
  Mrs. JOHNSON of Connecticut. Mr. Speaker, how much time remains on 
each side?
  The SPEAKER pro tempore (Mr. Hastings of Washington). The gentlewoman 
from Connecticut (Mrs. Johnson) has 9\1/2\ minutes remaining. The 
gentleman from California (Mr. Stark) has 8 minutes remaining.
  Mrs. JOHNSON of Connecticut. Mr. Speaker, I yield myself 30 seconds.
  I would like to note that the 25 percent discount means you pay 25 
percent less. And once the subsidies go into effect, you pay 75 percent 
less, and half the Medicare recipients are women and half of those 
women will be covered totally. So this is a big, powerful prescription 
drug bill that will help half the women on Medicare by providing all of 
their drug coverage.
  Mr. Speaker, I yield 2 minutes to the gentleman from Iowa (Mr. 
Nussle), chairman of the Committee on the Budget.
  Mr. NUSSLE. Mr. Speaker, I thank the gentlewoman for yielding me time 
and for her leadership on this issue, as well as the chairman of the 
Committee on Ways and Means.
  Mr. Speaker, America has got a big decision tonight and seniors have 
been waiting a long time. The previous gentleman said that seniors when 
they wake up tomorrow, if this passes, will find out they still have to 
pay a little bit of money. Some will not have to pay at all, but 
seniors will really be mad if they wake up tomorrow morning and find 
out that we failed yet again.
  Four budgets in a row we have had the pleasure of putting into our 
budget plan a prescription drug benefit. This year is the first time we 
have been able to get it to this point, a conference report; and that 
is because the President of the United States has provided the 
leadership to get us to this point.
  In Iowa we have been waiting for 20 years for fairness when it comes 
to reimbursement. We have been waiting for 20 years when it comes to 
the difficulty of recruiting physicians and other health care 
providers. We have been waiting 20 years to stop the cost shifting to 
the private side of health care that drives up the cost for small 
business people and farmers. We have been waiting for 20 years for 
seniors to have prevention and drug benefits and basic services.
  Tonight we have the opportunity to solve so many of these problems. 
It is not perfect, as many people have said; but it is on the road 
toward making Medicare a fiscally responsible, sound and a very 
beneficial program for seniors. And it is fiscally responsible. I know 
there are Members who are suggesting that somehow this may not be 
perfectly fiscally responsible. Let me ask you the question, If we do 
nothing tonight, is Medicare going bankrupt? Wake up if you want to 
talk about fiscal responsibility. We are seeing a program go bankrupt 
before our very eyes. Doing nothing is not an option.
  It is fiscally responsible to fix a program that we know is going 
bankrupt, to fix a program that would have a prescription drug benefit 
if it were created today, to fix a program that is not paying the bills 
in rural America and keeping doctors and health care professionals 
located there to provide quality health care.
  Vote for this bill because it is fiscally responsible. We have been 
waiting long enough. Seniors deserve our answer tonight.
  Mr. STARK. Mr. Speaker, I yield myself 15 seconds.
  I remind the gentlewoman from Connecticut (Mrs. Johnson) that the 
seniors do not need to be misrepresented. I will not call it lying, but 
nowhere in that bill does it mention any percentage that they will save 
on the drug discount. You cannot find it in the bill because it is not 
in there. So do not tell the seniors something that is not true. It is 
not respectful.
  Mr. Speaker, I yield 45 seconds to the gentleman from Illinois (Mr. 
Emanuel).
  Mr. EMANUEL. Mr. Speaker, I rise in opposition to this conference 
report.
  The conferees have three opportunities in this bill to lower the 
price of prescription drugs. They could have opened the markets and 
allowed prescription drugs to compete and allowed competition and 
choices to bring prices down. They passed.
  They could have allowed Tommy Thompson to lower prices and create a 
Medicare Sam's Club, a right enjoyed by private companies and 
businesses everywhere in this country. They took a pass.
  They could have included meaningful provisions for generics to get to 
market to create competition. They took a pass.
  This box of Zocor, a cholesterol drug, was purchased in Germany for 
$41. Here in the United States it cost $90. It went up 10 percent the 
last year. It is going up another 10 percent this year.
  The only immediate benefit that comes out of this bill is the 
political benefit that its supporters are expecting in 2004. The 
elderly, on the other hand, will have to wait until 2006. Hopefully, 
they can survive 2 years while the politicians take their victory lap.
  Mrs. JOHNSON of Connecticut. Mr. Speaker, I yield 2\1/2\ minutes to 
the gentleman from Ohio (Mr. Portman), a member of the committee.
  Mr. PORTMAN. Mr. Speaker, I thank the gentlewoman for yielding me 
time, and I thank her for her leadership as chair of the Subcommittee 
on Health, as well as the gentleman from California (Mr. Thomas), in 
getting us to this point.
  This is not the first time we have had a Medicare prescription drug 
bill on the floor, but I think we have the best one. I think it is a 
great program that has been misdescribed tonight by a number of the 
speakers, and I just wanted to clarify a few things.
  First of all, it is voluntary. People have come to the floor and 
talked about this is a mandate and people will be forced to get off 
their existing plans and get on this plan and so on. It is voluntary. 
If seniors do not choose to take up the prescription drug plans, they 
do not have to. Those who have looked at it, the Department of Health 
and Human Services, Special Budget Office, nonpartisan analysts think 
most seniors will, 90-some percent.
  Second, I have heard people talk about the fact that, gee, some 
people have employer plans already. Let me give some statistics. In 
1993, 40-some percent of employers provided coverage

[[Page 30815]]

for their retirees. In 2002 it was 27 percent. It is happening. It is 
bleeding. People are not providing retiree benefits as they used to.
  What I love about this bill is it goes the other way. It puts $88 
billion into helping people be able to stay with their employer plans.
  EBRI, which is a nonpartisan group that is called the Employee 
Benefit Research Institute, has studied this this week. Their analysis 
is that 2 percent, 2 percent of seniors will migrate from their 
existing retiree plans because their employers no longer offer it, into 
this. If this does not get passed, it will be greater than 2 percent. 
So those who have said this will result in a problem, I think it is 
just the opposite.
  We are beginning to stop what is happening anyway. I think that is a 
good part of the plan.
  People have talked about how puny the benefit is. Well, I have to 
tell you, over 35 percent of the American seniors, one figure says 38 
percent, let us say over 35 percent of Americans who are seniors, who 
are low income, meaning they are less than 150 percent of poverty, 
their income, are going to be able to get prescription drug coverage 
with no premium, no deductible, no share. All they will do is pay a 
nominal co-pay, $5, $3.

                              {time}  0045

  That is over 35 percent of our seniors, represented by all of us. 
Some of us in this House have districts where that number will be as 
high as 60 percent. So a puny benefit, I do not know where that comes 
from.
  For other seniors that additional, let us say, 65 percent of seniors 
more than half of their drug costs, some say as high as 70 percent, 
more than half of their drug costs for the average senior, that is no 
average senior, but average senior costs for drugs will be covered, 
more than half of the drug cost.
  This is why the AARP supports this. This is why the AARP is standing 
up for their seniors. Some people on my side of the aisle think it is 
too generous. People on the other side of the aisle ought to look at 
this plan, at what it is, not the politics, but the substance. It is a 
good plan, and I hope people on both sides of the aisle tonight will 
support it.
  Mr. STARK. Mr. Speaker, I yield myself such time as I may consume.
  There they go again. I do not think they understand their own bill. 
Between 135 percent and 150 percent of poverty, there is a 15 percent 
copay, and regardless of what my colleague says, there are many, many 
poor seniors are going to pay more under this bill than they do now, 
but it is sad that the people who wrote the bill do not know what they 
are talking about.
  Mr. Speaker, I yield 45 seconds to the gentleman from Arkansas (Mr. 
Ross), the distinguished member of our caucus who is in the 
pharmaceutical business.
  Mr. ROSS. Mr. Speaker, as the owner of a small town family pharmacy 
and a wife who is a pharmacist, I see seniors who cannot afford their 
medicine. So I came here to help our seniors with the high cost of 
prescription drugs. This bill does not do that.
  This morning we must decide whether to decide with the big drug 
manufacturers or side with America's seniors. In 2001, the gentlewoman 
from Missouri (Mrs. Emerson) and I sponsored a bipartisan bill that 
would truly modernize Medicare to include medicine for our seniors, and 
the Republican leadership refused to give us a hearing or a vote on 
that issue, and now 2 years later the Republicans offer us a bill that 
does what? That says the Federal Government shall be prohibited from 
negotiating with the big drug manufacturers to bring down the high cost 
of medicine and provide seniors $1,080 worth of help on a $5,100 drug 
bill.
  Have my colleagues ever heard of Medicare fraud? This is Medicare 
fraud.
  Mrs. JOHNSON of Connecticut. Mr. Speaker, I would like to inquire as 
to the time remaining.
  The SPEAKER pro tempore (Mr. Hastings of Washington). The gentlewoman 
from Connecticut (Mrs. Johnson) has 4\1/2\ minutes remaining. The 
gentleman from California (Mr. Stark) has 6 minutes remaining.
  Mrs. JOHNSON of Connecticut. Mr. Speaker, I reserve the balance of my 
time.
  Mr. STARK. Mr. Speaker, I yield 45 seconds to the distinguished 
gentleman from New York (Mr. Crowley).
  Mr. CROWLEY. Mr. Speaker, I thank the gentleman for the time.
  Mr. Speaker, let me see if I got this straight. In 1965, with a 
Democratic President, a Democratic House and a Democratic Senate the 
Medicare program was founded. Am I to believe today with a Republican 
President, a Republican House and a Republican Senate that somehow you 
all are going to save a program you did not support in the first place? 
We have an expression in New York and all around this country, give me 
a break. You are not about saving Medicare or Social Security. You are 
about dismantling it, and in 40 years, when I look at my children and 
they ask me where were you when they tried to dismantle Medicare, I 
will look them in the eye and I will be able to tell them that I voted 
against the dismantling of this great program.
  I will vote against this, and I will vote against any chance that you 
may bring up to this floor to dismantle Social Security as well.
  Mr. Speaker, I rise to support Medicare and oppose the incredibly 
offensive bill before us tonight. Medicare was created nearly 40 years 
ago to protect the health of seniors. And today, sadly, Members of this 
Congress are seeking to destroy the very program that has been so 
helpful to so many. In its place, Republicans claim they are inserting 
a new, better, and expanded program. But the reality is that this is 
not a bill about providing drug coverage under Medicare.
  This is a bill about giving billions of dollars to insurance 
companies and drug companies. This is a bill about killing the Medicare 
program that seniors have depended on for generations.
  Seniors in my district want and deserve prescription drug coverage. 
This could not be more true, as far too many of them are struggling 
without it. But I have yet to hear from a senior in my district who is 
asking for a $17 billion slush fund to be created for private insurance 
companies. Not one senior has talked to me about making sure that big 
drug companies are able to protect their massive profits. Not one of 
them has asked me for a prescription drug benefit where they have to 
pay $4,000 out of their first $5,000 in prescription drug costs. Not 
one of them has asked for a bill that would force seniors out of 
Medicare and push them into HMOs. And yet that is exactly what 
Republicans are giving them with this bill.
  This bill seeks to help drug companies and insurance companies at the 
expense of seniors and American taxpayers of all ages. This bill does 
essentially nothing to bring down drug prices. It does not 
appropriately provide for reimportation despite this body 
overwhelmingly voicing its support of reimportation. Moreover, it 
expressly prohibits the government from trying to negotiate lower drug 
prices like other government entities have been able to do with much 
success.
  Incredibly, Republicans are electing to protect drug company profits 
over the cost to our government. I have to wonder whose side the 
Republicans are really on?
  Tonight Republicans are asking us to vote for a bill they claim will 
help seniors with their drug costs. Only the catch is that, in the 
process, we have to destroy Medicare, give billions to insurance 
companies and drug companies, and push seniors into HMOs. This bill is 
a slap in the face of the ideals that Medicare has stood for. This bill 
is a slap in the face of seniors who have waited far too long for a 
real prescription drug benefit.
  But don't take my word for it. Listen to what the lead author, 
Republican Congressman Bill Thomas of California said about this bill--
a bill he wrote--and I quote him, ``To those who say that the bill 
would end Medicare as we know it, our Republican answer is: We 
certainly hope so.'' Protect Medicare--oppose this sham bill.
  Mrs. JOHNSON of Connecticut. Mr. Speaker, I yield 2 minutes to the 
gentleman from New York (Mr. Houghton).
  Mr. HOUGHTON. Mr. Speaker, in any situation where there is an 
argument at stake, there are two things that are important. First of 
all, it is to get the facts. Secondly, to face the fact, and I do not 
mean to oversimplify this, and a lot of people know much more of the 
details, but it seems to me two things come to the floor. One, Medicare 
needs an update, seniors need help with their drug costs, and I think 
this bill does both those things.

[[Page 30816]]

  I have since learned that virtually any piece of legislation that 
comes before this body can be argued and attacked and counterattacked 
to death, but who are the customers? Who are we trying to help and are 
they being helped? Are the seniors being helped? Yes, probably not 
enough, but we do not know yet. Are the hospitals being helped? Yes, 
but they certainly could be helped more, but this is a never ending 
process. Are the doctors being helped who are opting out of the 
Medicare program? Yes. Are the ambulance drivers being helped? Yes, and 
it is about time.
  Will the companies be helped who are thinking about whether to drop 
programs for their retirees? Absolutely. Will those purchasing drugs be 
helped? According to the arithmetic I read, there is absolutely no 
question about this.
  I would rate this bill a B+, and the reason I do this is I do not 
think there is any bill that can come before this body that can get an 
A, not with the attack and counterattack process we use.
  One of the great poets of this country, Ralph Waldo Emerson, used to 
say history is no more than a biography of a few stout individuals. It 
is the few stout individuals, Mr. Speaker, that we need tonight.
  Mr. STARK. Mr. Speaker, I yield 45 seconds to the gentleman from 
Texas (Mr. Reyes), who agrees with the Albany Times Union that what 
older Americans can least afford is for Congress to rush into a 
sweeping overhaul of a successful health care program without doing its 
research. This is not only an imperfect bill. It may also be a 
disastrous one.
  Mr. LAMPSON. Mr. Speaker, the previous speaker said that we do not 
know, and we do not know what all is in this bill, but during this week 
I have heard from representatives of thousands of senior citizens in 
southeast Texas, like my 93-year-old mother, that they overwhelmingly 
oppose this proposal, and they give three reasons why.
  They believe the privatization provisions will cause Medicare to 
wither. They are astounded that the bill prohibits our government from 
bargaining for better drug prices. They are concerned about the 
uncertainty of being put back into HMOs that dumped them recently.
  Do our seniors a favor, slow this train down. Put some dignity back 
in the process and open it up. The benefits will not even go into 
effect for 2 years. What is it going to hurt to wait two more weeks and 
do what the seniors requested at that White House Conference on Aging 
in 1995 at the beginning of this debate. Save Medicare and let us live 
our lives in dignity and independence.
  In 1995 I was sent as a delegate to the White House Conference on 
Aging. 4000 seniors gathered for this non-partisan meeting. They set 
goals at that meeting and asked our government to do 3 things: protect 
medicare; protect social security; and allow seniors to live their last 
years in dignity and independence.
  We have been debating medicare and a medicare drug component for 
years now. I have promised to work to create a program that would help 
seniors achieve the goals I just listed.
  During this week I have heard from the representatives of thousands 
of seniors in Southeast Texas, like my 93 year old mother, that they 
overwhelmingly oppose this proposal . . . and the reasons they give are 
3:
  They believe privatization provisions will cause medicare to wither 
and die;
  They are astounded that the bill prohibits our government from 
bargaining for better drug prices;
  They are concerned about the uncertainty of having to go back into 
HMO's that dumped them.
  My colleagues, do our seniors a favor, slow this train down. Put some 
dignity back into this process and open it up. The benefits won't even 
go into effect for 2 years. Let's take a couple more weeks and do what 
the seniors of this country asked at the beginning of this debate 8 
years ago . . . save medicare and let them live their last years with 
dignity and independence.
  Mrs. JOHNSON of Connecticut. Mr. Speaker, I ask what time remains on 
each side.
  The SPEAKER pro tempore. The gentlewoman from Connecticut (Mrs. 
Johnson) has 2\3/4\ minutes remaining. The gentleman from California 
(Mr. Stark) has 4 minutes and 15 seconds remaining.
  Mrs. JOHNSON of Connecticut. Mr. Speaker, I reserve the balance of my 
time.
  Mr. STARK. Mr. Speaker, I yield 45 seconds to the distinguished 
gentlewoman from Oregon (Ms. Hooley).
  Ms. HOOLEY of Oregon. Mr. Speaker, despite the hard work and good 
intentions of many Members of Congress on both sides of the aisle, we 
have lost the forest for the trees, and so I rise today in opposition 
to conference report on H.R. 1.
  We have lost sight of what seniors struggle with most, drug costs and 
the cost of coverage, and believe me, seniors have noticed that we have 
lost sight of them.
  In the beginning and in the end, for me this issue has always been 
about the high cost of drugs and the need to affordably expand 
coverage. Regrettably, this bill prohibits ways to lower costs of drugs 
for American seniors, and for many, the coverage provided in the bill 
comes at a high price they simply cannot pay.
  I urge my colleagues to reject this bill. Please go back to the 
negotiating table and give seniors what they really need, affordable 
drugs and affordable drug coverage.
  Mrs. JOHNSON of Connecticut. Mr. Speaker, I yield myself 10 seconds.
  The gentlewoman from Oregon should know that with this prescription 
drug insurance plan Medicare recipients in Oregon who are covered will 
go from 60 percent up to 96.6 percent. This bill brings a benefit to 
Oregon.
  Mr. Speaker, I reserve the balance of my time.
  Mr. STARK. Mr. Speaker, I yield 45 seconds to the gentleman from New 
York (Mr. Hinchey), and pending that, I would like to remind the 
gentlewoman from Connecticut that 41,000 people in Connecticut are 
likely to lose employer-sponsored coverage under this bill.
  Mr. HINCHEY. Mr. Speaker, very few people are surprised that as soon 
as the Republican Party has control of both Houses of the Congress and 
the White House they move to destroy Medicare, and that is what this 
bill essentially will do. It will drive Medicare into the ground.
  The disguise that they seek to use in order to accomplish that is a 
prescription drug program, but just today the National Center on Policy 
Analysis told us that only $1 out of every $16 in this bill will be 
spent to provide drugs for senior citizens who would not otherwise get 
them. Most of the rest of the money goes to drug companies and to 
insurance companies.
  But the thing that surprises me about this bill is the Republican 
party is engaging in price fixing. They fixed the price of drugs so 
that they cannot go down, they can only go up. They have made sure that 
we cannot import drugs from Canada or other places at a cheaper price, 
and they guarantee that every time the prices change it will go up. 
Price fixing, increasing the cost of drugs.
  Mr. STARK. Mr. Speaker, may I inquire as to the amount of time 
remaining?
  The SPEAKER pro tempore. The gentlewoman from Connecticut (Mrs. 
Johnson) and the gentleman from California (Mr. Stark) have 2\1/2\ 
minutes remaining.
  Mr. STARK. Mr. Speaker, I yield 45 seconds of that precious time to 
the gentleman from Texas (Mr. Reyes).
  Mr. REYES. Mr. Speaker, I thank the gentleman for yielding me the 
time.
  Mr. Speaker, I have a long been a strong advocate for an affordable, 
comprehensive Medicare prescription drug benefit, but I am opposed to 
this bill. I am opposed because the bill before us tonight would harm, 
rather than help, more than 77,000 Medicare beneficiaries in my 
district by breaking this program's promise of guaranteed quality 
health care for our seniors.
  In my district, where approximately one in five seniors live below 
the poverty line, Medicare and Social Security are their only safety 
net in retirement. To jeopardize this safety net would be 
unconscionable.

[[Page 30817]]

  Mr. Speaker, I urge my colleagues to oppose this conference report so 
Congress can instead offer America's seniors the kind of Medicare 
prescription drug benefit that they need and more than anything that 
they deserve.
  Mr. STARK. Mr. Speaker, I am delighted to yield 45 seconds to the 
gentleman from Arkansas (Mr. Berry), one of the gentlemen who was a 
conferee but does not know.
  Mr. BERRY. Mr. Speaker, I thank the gentleman from California, and I 
appreciate his leadership on this matter for many, many years.
  In the document that founded this great Nation, it says all men are 
created equal. Under this bill, the drug companies are a lot more equal 
than the seniors I can tell my colleagues. Why would we for any reason 
prohibit the negotiation of lower prices by Medicare? Why would we do 
that?
  Tonight, we make a choice. We either serve the drug companies or 
serve our seniors. I find this a very easy choice to make. I choose to 
serve our seniors. I will not be a part of the continued effort to 
allow the prescription drug manufacturers of this country to rob the 
senior citizens of America.
  Mr. STARK. Mr. Speaker, I yield the balance of our time to the 
gentleman from New York (Mr. Rangel), the distinguished ranking member 
of the Committee on Ways and Means.
  Mr. RANGEL. Mr. Speaker, I thank the gentleman from California (Mr. 
Stark) for the fine work he has done over the years on this subject, 
and as we close one-half of this debate on this historic subject, I 
would just like to remind those who are recording this event that when 
you excluded the Democrats from participating in the conference, you 
excluded 20 Members who are members of the Hispanic Caucus, 39 Members 
that are members of the Black Caucus.

                              {time}  0100

  You excluded the Congressional Asian Pacific Caucus. And you had the 
arrogance to believe that you had to be Republican to be concerned 
about our senior citizens. But the three that were selected by the 
Speaker, the Republican Speaker, was the gentleman from Arkansas (Mr. 
Berry), who knows the problems of our seniors out there. It was me, who 
served for decades on the Committee on Ways and Means and has worked 
hard to participate to make this a better bill and a better Congress. 
But it also was the gentleman from Michigan (Mr. Dingell), former 
chairman of the Committee on Energy and Commerce and a person who 
fashioned a program for the aged who are poor. He too was excluded.
  So it is a great honor for me to invite up to manage the other half 
of the time here the gentleman from Michigan (Mr. Dingell). He is the 
dean of this Congress, and we should feel proud that we are able to 
serve with him. His father is the author of the Medicare bill, and we 
should feel ashamed that he was excluded from the conference.
  Mrs. JOHNSON of Connecticut. Mr. Speaker, I yield myself the balance 
of my time, and I rise in strong support of this legislation. And, 
indeed, I believe its founders would be proud that tonight we bring a 
voluntary, generous drug benefit to all seniors under Medicare.
  This is a milestone. That is why AARP describes it as a historic 
breakthrough in the Nation's commitment to strengthen and expand health 
security for its citizens. Something that has not been talked about 
much here tonight is the new support for seniors with chronic illness. 
We forget that one-third of our seniors have five or more chronic 
illnesses and use 80 percent of the money under Medicare, and yet 
Medicare has no way of supporting them to prevent their chronic illness 
from progressing.
  In this bill, we couple the drug benefit and the disease management 
program to help our seniors prevent their chronic illness from 
progressing and thereby keep them healthy and keep Medicare costs under 
control. This is particularly important for minorities, for they tend 
not to use the medical system early, and they tend not to be diagnosed 
early. In this bill, we provide an entry-level physical so we can see 
what early signs of chronic illness they have, and we can help them 
prevent their chronic illness from progressing.
  This will be an extraordinary boon to the well-being of our senior 
citizens. This is a historic advancement in both bringing prescription 
drugs to Medicare and improving the quality of health care Medicare is 
able to deliver, and in assuring that Medicare will be able to deliver 
21st-century, cutting-edge health care.
  And this is a historic bill for the rural communities of our Nation. 
Without it, they will not be able to attract the next generation of 
physicians as the current generation retires. They will lose small 
hospitals. They will lose small home health agencies. In fact, without 
this, our inner-city hospitals will not be able to continue to provide 
clinics for the poor, clinics for those with mental health problems. 
This is an important payer package because it restores fairness to our 
payment system.
  And lastly, it cuts prices dramatically. It cuts prices dramatically 
by bringing the bargaining power of the seniors to the table to reduce 
prices and piercing right through that price support system that keeps 
State prices high. I am proud to support this legislation, and I urge 
my colleagues to do likewise, for half of America's women will 
experience free health care under this bill.
  The SPEAKER pro tempore (Mr. Hastings of Washington). Pursuant to a 
previous order of the House, the gentleman from Louisiana (Mr. Tauzin) 
will control 30 minutes and the gentleman from Michigan (Mr. Dingell) 
will control 30 minutes.
  The Chair recognizes the gentleman from Louisiana (Mr. Tauzin).
  Mr. TAUZIN. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I hope you will all bear with me for a second as I tell 
a short story. I recently accompanied my son, Tom, who is 25 years old, 
to see the movie ``Matrix,'' the third in the evolution of the 
``Matrix'' movies, a rather complex series of movies. Young people 
follow them, I think, better than my generation; but I try to follow 
them with him.
  When we came out of the movie, I said, Son, what did you take from 
this? What did this mean to you? And he thought a long while and in the 
car with me he said, what I take from this movie, Dad, is that freedom 
is meaningless without choice. And I thought about that and I thought, 
that is pretty profound for a 25-year-old. What he was saying, 
basically, from this movie, is that if someone else is making all the 
choices for you, if you are without choice, you are not really free. 
Freedom, by definition, is choice. It is your capacity to choose for 
yourself right or wrong what you do with your life.
  And then it occurred to me how meaningful that little profound 
conversation we had was and how it relates to this issue tonight. 
Because we are talking about a generation of Americans who Tom Brokaw 
called the Greatest Generation of Americans, who fought for this entire 
world to be free, for we in this country to have freedom of choice in 
our lives. And every day that we live in freedom, we have that 
generation to thank for it. And the ironic thing about it, when it 
comes to their health care, is that so far we have not given them 
choice. We have basically said if you want health care as you get 
older, after you fought to give us freedom, we will give you one plan. 
We will give you the choice of government Medicare. And if it works for 
you, great; if it does not work well for you, sorry, that is your 
choice.
  Every despot, every tyrant, every monarch and feudal lord in medieval 
time took the attitude that the peasants, the servants were not smart 
enough to make choices for themselves; that they had to make all the 
decisions for them. That is the nature of people who think government 
always knows best and always knows the right answer and people are not 
wise enough to make good choices for themselves. The essence of this 
debate tonight is whether we are freedom-loving enough in this body, 
whether we understand and appreciate the freedoms that they fought for 
and gave to us, that we can, in the context of health care, give our 
seniors some real choice about how

[[Page 30818]]

and where they take their health care and their coverage.
  Now, it is about adding a significant new benefit to Medicare. It is 
that. But it is also about creating other choices for seniors. And I 
brought a picture of my mother with me tonight. I thought about her 
this evening. It is a small picture, but I wish you could all see it. 
She is a beautiful lady. She is 85 years old. She chose to remain in 
Medicare when she had a choice of a private plan in our hometown. She 
probably is going to choose to remain in Medicare and take her 
prescription drug benefit from Medicare when this program is completed 
and we pass this bill and it is signed into law. But I want her to have 
a choice to choose between that plan and any other plan that might be 
available, the same way we in this government, the workers and the 
Members of Congress, have choices to choose different plans for our 
medical needs.
  I want Mom to have the same choice. Her generation fought for me to 
have choices and to make choices, right or wrong. And sometimes it hurt 
her deeply when I made bad choices, but she always knew I had the right 
to make them. And people died to give me that right. I think we owe 
that generation choice. And that is one of the things we do tonight, we 
give them choice how they take this new benefit. And if they want to 
choose, like my mother, to stay with Medicare, we fought for the right 
to make sure it is still in the Medicare bill, and she will have that 
right.
  The other thing we did was to make sure if she chooses to have 
Medicare, that, indeed, it is still going to be around for her for as 
long as, God willing, she lives. She is a three-time cancer patient. A 
marvelous woman. She won eight gold medals at the Senior Olympics again 
this year. She took top place in the shot put. You do not mess with 
Mamma Tauzin. She is quite a gal. And she will probably choose to take 
her prescription drugs out of Medicare in this program. But if she ever 
wants to take it out of one of the PPOs or the new programs we develop 
out of this bill, I want her to have that choice. She deserves it. She 
ought to get it.
  And I think that is why AARP has endorsed our bill, because they know 
we have gotten a great generous coverage for the low-income American 
seniors who want to stay in Medicare or who want to choose something 
else. And we create new plans for seniors and nonseniors to begin 
saving in their own health accounts; tax free in, tax free out, to 
build their own long-term care the way they want to design it. And I 
guess some people do not like that. I guess they think government ought 
to design it all and say, You got one choice, Mamma Tauzin, and that is 
it.
  But I think, I think the benevolent government of the United States 
of America, respecting the freedom that so many fought and died for to 
give us choice and freedom, this government now, that we serve as 
Members of Congress, with such great appreciation of the people who 
sent us here, we ought to say here in Washington that we return the 
gift of freedom; that we give seniors more choices, and we give them a 
brand-new drug coverage program so they do not have to take chances on 
the Internet or go anywhere else to get drugs they cannot afford, that 
they can afford them under an insurance coverage here in America, and 
they can get it under a program they choose to live under.
  Mr. Speaker, I reserve the balance of my time.
  Mr. DINGELL. Mr. Speaker, I yield myself 3 minutes.
  Mr. DINGELL. Mr. Speaker, almost 40 years ago, this body enacted 
Medicare. It was a great triumph for the senior citizens. Perhaps the 
most beloved program, with the exception of Social Security, was 
Medicare. It is also one of the most financially responsible and 
successful programs in the history of this country. Tonight, the fight 
is not about whether or not we are going to give prescription drugs to 
our seniors; it is about saving Medicare from my Republican colleagues, 
who now, finally, have figured a way to destroy it.
  I want my colleagues to look at the kind of competition that the 
Republican Party is forcing upon the senior citizens of the United 
States: 120 or 125 percent of the costs of competing with Medicare is 
going to be given by the Federal taxpayers and by Medicare to, guess 
who, the HMOs. The Republicans have been trying to destroy this part 
for years. They are very close tonight.
  A flawed process has brought forth a bad bill, which is laid before 
the House of Representatives in the wee hours of the morning so that 
the people will not know what is going on. What is at stake here is the 
existence of the most successful program to provide health care for our 
senior citizens.
  Let me just tell my colleagues, the competition is unfair, 120 
percent and more they give. They put forward a sham discount card, 
which will probably be given mostly by the retailers, not by the 
prescription pharmaceutical manufacturers. The senior citizens will not 
get much out of that.
  Now, Medicare is going to be rewarding now the Republicans' friends 
in the HMOs and the pharmaceutical houses, huge amounts of money to 
each. No competition whatsoever will take place with regard to 
prescription pharmaceutical costs. Why? Because the Republican Members 
absolutely forbid that.
  No wonder they want to do this at 2 a.m. in the morning. No wonder 
they want to foreclose the public from knowing. No wonder they would 
not let the people on this side of the aisle, they would not allow the 
Democrats into the meeting. Because it was the only way they could 
bring forward this slippery and dishonest program which is directed at 
destroying Medicare as we know it. And take the word not of myself on 
this, but of Mr. Newt Gingrich, of Mr. Armey, and the chairman of the 
Committee on Ways and Means on the Republican side. They want to 
destroy Medicare as we know it. That is what is at stake.
  We can anticipate that they will allow Medicare to slowly wither 
away. And the senior citizens who are dependent upon it will no longer 
have the assurance that a program that they know they can choose their 
doctor and their hospital will be available to them. They will have to 
belong to the HMOs or pay more for it, and all in exchange for a 
proposal which has a huge donut hole which denies senior citizens care 
after they pay $2,000.

                              {time}  0115

  It does not add it at that point, it takes it away. This is a sham. 
It is a bad bill. It is one which takes from the senior citizens. It is 
one which threatens Medicare. It is an unfair, dangerous piece of 
legislation conceived in the darkness of night and slipped through over 
the heads of the senior citizens.
  Mr. TAUZIN. Mr. Speaker, I yield 3 minutes to the gentleman from 
Florida (Mr. Bilirakis), the chairman of the Subcommittee on Health of 
the Committee on Energy and Commerce.
  Mr. BILIRAKIS. Mr. Speaker, I would say I wish I had $100 for every 
hour that I spent in the wee hours of the morning during the time that 
the gentleman's party was in charge of this House.
  Mr. Speaker, we have before us today an opportunity to finally 
provide our constituents with a meaningful prescription drug benefit 
that our Nation can afford. To finally do it; to finally do it, not to 
merely talk about it and to demagogue it. For four decades the other 
party controlled, and they did nothing. It seems every time we, since 
gaining the majority, attempt to meet a need, the Democrats finally 
awaken with nay comments. They do nothing. We attempt to do something, 
and they call our efforts a charade. We have not taken a pass, as one 
gentleman from the other side of the aisle said earlier. I would 
suggest the gentleman's party, which controlled for 40 years, took the 
pass.
  While the bill before us certainly is not perfect, and we have 
admitted that, it targets the $400 billion available under our budget 
resolution towards areas where it can do the most good. Our bill 
provides a great deal of assistance to our low-income seniors. In fact, 
seniors who earn under $13,470 as a single or $18,180 as a couple will 
only be responsible for nominal copayments

[[Page 30819]]

and will not experience a coverage gap. This is very generous coverage 
for the population of seniors who need it the most.
  The conference report will also ensure that seniors will have the 
peace of mind of knowing that they will only be responsible for a very 
small amount of cost sharing once their out-of-pocket drug costs exceed 
$3,600 annually. It is a critical provision, and one I strongly 
support. This bill helps the poorest and sickest, and who can argue 
against that.
  The conference report makes many other improvements to the Medicare 
program; in fact, too many to list tonight. However, I want to point 
out that the bill contains two provisions that I have long advocated 
for: Improved reimbursements for our Nation's physicians, and Medicare 
coverage for a physical exam upon entering the program. I call that the 
Dr. William Hale, ``Welcome to Medicare Program.'' Dr. Hale of Dunedin, 
Florida, gave me the idea some time ago. I am confident that this new 
benefit will ultimately save the program billions of dollars in the 
long term.
  I would like to close by quickly dispelling a number of myths that we 
have heard on the House floor tonight, and over the past few months. 
The conference report does not privatize Medicare. It improves it, 
namely by adding a voluntary prescription drug benefit available to 
everyone, including those who do not wish to leave traditional fee-for-
service Medicare. We are not pushing seniors into HMOs; I will not be a 
part of that. Or creating a voucher system. We are offering seniors 
voluntary choices other than traditional Medicare. And, finally, the 
conference report does not signal the end of Medicare. Instead, it 
marks the beginning of a new, better Medicare that will be available 
for generations to come.
  Mr. Speaker, I would like to close by thanking all of the staff 
members who have worked to help make this bill possible.
  Mr. DINGELL. Mr. Speaker, I yield 2 minutes to the gentleman from 
Ohio (Mr. Brown).
  Mr. BROWN of Ohio. Mr. Speaker, I thank the gentleman from Michigan.
  Earlier this year President Bush stood in this well and pronounced 
solemnly, ``Medicare is the binding commitment of a caring society.'' 
Today just a few short months later, those words sound so empty.
  Our Medicare offers the same reliable health coverage to retired and 
disabled Americans regardless of whether they are rural or urban, 
whether they are rich or poor, whether they are healthy or sick. Our 
Medicare is equitable, dependable, it is flexible, and cost efficient; 
but their bill takes $20 billion out of our constituents' pockets and 
showers those dollars on HMOs. It rigs the game so that the coverage 
seniors have today, the equitable, reliable, flexible coverage they 
have today, is sure to wither on the vine. That is the way they have 
set it up. As one of the authors of this bill, the gentleman from 
California (Mr. Thomas) said, ``To those who say this bill would end 
Medicare as we know it, our answer is we certainly hope so.''
  A binding commitment, Mr. President? Their bill leaves seniors with 
such high drug costs they still will not be able to afford their 
prescriptions. Their bill places retiree drug coverage of $12 million 
seniors at risk. Their bill forces seniors to either pay significantly 
more if they want to keep their doctor and their hospital, or join an 
HMO that may or may not cover needed drugs, that may or may not raise 
premiums beyond the $35 guesstimate, that may or may not skip town if 
projected profits are not met. A caring society, Mr. President?
  This bill is a big win for drug companies who stand to earn $139 
billion in additional profits. No surprise there, the drug companies 
helped write the bill because the drug companies have given $50-60 
billion to President Bush and to the Republican majority. It is a big 
win for insurance companies who are the beneficiaries of a $20 billion 
slush fund, no surprise there because the insurance industries and the 
HMOs gave tens of millions of dollars to the President and Republican 
leadership.
  This is a tragic loss for America's seniors. Medicare should be the 
binding commitment of a caring society.
  Mr. TAUZIN. Mr. Speaker, I yield 2 minutes to the gentleman from New 
Jersey (Mr. Ferguson), a valuable, distinguished member of the 
Committee on Energy and Commerce.
  Mr. FERGUSON. Mr. Speaker, in addition to expanding Medicare to 
include prescription drug coverage for 40 million seniors, this 
important conference report also represents significant benefits for my 
home State of New Jersey. For years, my State has offered one of the 
Nation's most generous prescription drug benefits. It is called PAAD. 
Under this historic agreement to strengthen Medicare, New Jersey wins 
big time. In addition to ensuring a seamless integration of the new 
Medicare drug benefit and PAAD, this conference report also provides 
New Jersey with billions of dollars to strengthen PAAD and expand the 
number of seniors who benefit.
  By using the drug discount card before the PAAD coverage begins, the 
State government will save $73 million. Because PAAD's enrollees will 
receive their drug benefit from Medicare, the State will save $2.8 
billion. New Jersey will receive a 28 percent tax free subsidy to 
offset the drug costs it provides for retired State employees, saving 
the State $222 million. PAAD will no longer be forced to pay drug costs 
for seniors who qualify for both Medicare and Medicaid, saving the 
State $872 million.
  How else does New Jersey benefit? In addition to $80 million for 
increasing the Medicaid reimbursement rate, an additional $756 million 
will be forwarded to New Jersey's hospitals. That is nearly $5 billion 
in Federal aid for New Jersey.
  This bill has language to require coordination between Medicare and 
PAAD, no disruption for any senior currently enrolled in PAAD, and 
billions and billions for our State government to strengthen PAAD, 
offset low-income seniors' drug costs and expand the number of seniors 
who are served under PAAD.
  My colleagues from New Jersey on the other side of the aisle can try 
to hide behind their partisanship, but they cannot ignore the fact that 
this conference report represents one of the biggest and most important 
victories New Jersey has ever, ever received in Congress.
  Mr. Speaker, shame on them.
  Mr. DINGELL. Mr. Speaker, I yield 2 minutes to the gentleman from 
California (Mr. Waxman).
  Mr. WAXMAN. Mr. Speaker, today we should be voting on legislation 
that makes a good prescription drug benefit a part of the Medicare 
program. We should give people real help without gaps in coverage 
requiring seniors and the disabled to pay thousands of dollars for 
drugs out of their own pockets.
  Instead, what we have got is a bill that makes seniors buy private 
insurance to get drug coverage or go into HMOs where they might not be 
able to see their own doctor, a bill that lets insurance companies 
interested in their own profits decide what premium to charge and what 
drugs to put on their formulary, and a bill that will lead people 
holding the bag for most of their drug costs in far too many cases.
  This is not what seniors and the disabled want. This bill uses the 
cover of providing drug coverage, inadequate as it is, to make very 
dangerous changes in Medicare. This bill is based on the point of view 
that Medicare was a mistake, that we should have left it to private 
insurers to provide health care for our seniors. Well, if we had done 
that, we would have a lot more seniors today who would be uninsured and 
struggling with their medical bills.
  I do not want to turn the clock back on Medicare, I want to make it 
better. Much as I want prescription drug coverage for seniors, this 
inadequate drug benefit is not worth destroying Medicare. I do not want 
a Medicare where seniors and disabled people have to spend a lot more 
just to be able to stay in regular Medicare. I do not want a Medicare 
where seniors in Los Angeles have to pay premiums that are twice as 
high as premiums in some other area of the country, and depend on 
private insurance companies for what benefits they get.

[[Page 30820]]

  So we might wonder, who benefits from this bill? Well, not the almost 
3 million retirees who will end up losing the drug coverage they now 
have, not the 6 million of our poorest seniors who end up being worst 
off, and not the 40 million Medicare beneficiaries who cannot use their 
bargaining power to get lower prices from the drug companies, and not 
the people who have been able to get their drugs cheaper by going to 
Canada. It is the drug companies and the insurance companies who 
benefit from this bill. Let us improve Medicare, not ruin it.
  Mr. TAUZIN. Mr. Speaker, I yield 2 minutes to the gentleman from 
Georgia (Mr. Gingrey), one of the three Members of the House who is an 
OB-GYN physician, and who happens to know something about health care.
  Mr. GINGREY. Mr. Speaker, I thank the gentleman from Louisiana (Mr. 
Tauzin) for yielding me this time.
  Mr. Speaker, 35 million senior Members of AARP, 330,000 physician 
members of the American Medical Association who are providing care to 
hundreds of millions of Americans and 40 million Medicare 
beneficiaries, the American Hospital Association, the Rural Hospital 
Association, the United States Chamber of Commerce; Mr. Speaker, with 
so many for a prescription drug and Medicare modernization for our 
beloved seniors, who could be against it, and why?
  The answer to that first question is pretty obvious, obstructionist 
Democrats. And why? Because they are more interested in attempting to 
embarrass President Bush and the Republican leadership of this House 
than they are in doing the right thing, the compassionate thing.
  To suggest that this bill is nothing but a windfall for the 
pharmaceutical industry is like suggesting that Medicare Part A is 
nothing but a windfall for the hospital. Who is going to provide the 
prescription drugs, the chocolate chip cookie company? Give me a break.
  But I say to my colleagues on the other side, stop the alliteration, 
stop the bizarre logic, the Mediscare rhetoric. Vote with us, vote for 
our seniors and make this truly a bipartisan victory.
  Mr. DINGELL. Mr. Speaker, I yield 2 minutes to the gentleman from New 
Jersey (Mr. Pallone).

                              {time}  0130

  Mr. PALLONE. Mr. Speaker, I have listened to the rhetoric of the 
Republicans this evening, and it is cynical. They are trying to fool 
the seniors. I listened to the gentleman from Louisiana say that 
seniors are going to have a choice. They are not going to have any 
choice. They are going to lose their choice of doctors because they are 
going to be forced into an HMO. I listened to the gentleman from 
Florida say that seniors are going to get a meaningful benefit. Again 
they are fooling the seniors. There is no meaningful benefit here. They 
are going to have to shell out more out of pocket than they are going 
to get back in terms of a drug benefit. I listened to the gentlewoman 
from Connecticut earlier saying that she is going to give the seniors a 
discount. What a joke that is. There is no cost containment in this 
bill. The bill says that the Secretary cannot in any way negotiate 
price reductions. There is no reimportation in this bill. There is no 
way you are even going to be able to get discount drugs from other 
countries. There is no discount. There is no savings. They are just 
trying to fool the seniors.
  I heard another speaker say that Medicare is going broke. The only 
reason it is going broke is because you have taken money away from 
their trust fund through your tax policies. You are trying to fool the 
seniors again. And then you are saying that the seniors are going to be 
able to have traditional Medicare, they can stay in their traditional 
Medicare. Again you are trying to fool them because they are going to 
be forced out of traditional Medicare. You are going to limit them to a 
voucher, a certain amount of money. You have something in the bill that 
would cap the amount of money that comes from the Federal Government. 
They are not going to be able to stay in traditional Medicare. They are 
going to be forced out of it. Then finally you say, oh, they are going 
to get the drug benefit immediately. You talk about the drug card or 
whatever it is, the discount card. Again you are fooling the seniors. 
This bill does not even take effect, there is no drug benefit until the 
year 2006.
  I want to tell you, the last thing of all was when I listened to my 
colleague tonight here from New Jersey (Mr. Ferguson) say that New 
Jersey is going to benefit from this. There are 1.2 million Medicare 
beneficiaries in New Jersey; 91,000 of them will lose their employer-
based prescription drug benefits; 186,000 of them in South Jersey would 
be subject to premium support and will lose their traditional Medicare. 
The list goes on. New Jersey is no different than any other State. You 
are not going to be able to fool the seniors. You should not try to. 
You ought to be ashamed of yourselves.
  Mr. TAUZIN. Mr. Speaker, I yield myself 30 seconds to point out that 
the statement that this bill does not go into effect until 2006 is 
erroneous. The fact is that the drug discount card is effective 
immediately when this bill goes into effect early next year. The fact 
is that $600 per senior for drug costs is allocated immediately, next 
year. Not only that, but the $1,200 per couple that is allocated for 
drug costs for seniors is rolled over. If the senior does not use it 
the first year, they can use it the second year. It becomes a $2,400 
benefit for seniors for that second year while the full program is 
enacted by the year 2006.
  Mr. Speaker, I yield 2 minutes to the gentleman from Michigan (Mr. 
Upton), the distinguished chairman of the Subcommittee on 
Telecommunications and the Internet of the Committee on Energy and 
Commerce.
  Mr. UPTON. Mr. Speaker, I would like to focus on one misconception 
about this plan that we are debating today and set the record straight. 
I have heard from a lot of retirees who have been led to believe that 
enacting the conference agreement will cause them to lose their 
employer-provided prescription drug and health care coverage. That is 
not true.
  First, it is important to note that under current law, employers who 
provide solid retiree health care benefits receive no assistance at all 
from the Federal Government. And even in the absence of a Medicare 
prescription drug plan, many of these same employers under increasing 
pressure from rising prescription drug and other related health care 
costs are already cutting back or entirely dropping their coverage that 
they provide to their retirees today. Under this plan if we pass it 
today, the Federal Government will partner with employers who maintain 
or improve their current health care retiree health plans. They will 
receive a subsidy of up to 28 percent of their retiree drug costs 
between $250 and $5,000 and the subsidy will not be subject to 
taxation. So the reality is if we do not enact this plan, there will be 
no incentives for those employers to maintain or improve their current 
retiree coverage. Thousands of retirees will wind up with no help with 
their prescription drug costs, and we most likely will continue to see 
those retiree benefits continue to be slashed. With this plan, they 
will have an incentive to keep it.
  I also remember back to the days when we passed a catastrophic health 
care plan, back in the early nineties. It was mandatory. Guess what? We 
repealed it because it was mandatory. This is voluntary. You can 
participate if you want; and if you do not want, you do not have to 
participate. I also remember a woman that came up to me at my son's 
little league game. Her mom had just had a stroke, $600 in additional 
costs that she was going to face every month. She said, Mr. Upton, will 
this plan help my mom? Yes, it will help her a lot. It will in fact 
save her family thousands of dollars, provide her with some quality of 
life that her family expects and the plan will help.
  I urge my colleagues to vote for this plan this morning.
  Mr. DINGELL. Mr. Speaker, I yield 1\1/2\ minutes to the distinguished 
gentlewoman from California (Ms. Eshoo).

[[Page 30821]]


  Ms. ESHOO. Mr. Speaker, we have all not only been taught but tried to 
abide by something, part of the Ten Commandments, honor thy father and 
thy mother. I think more than anything else this evening, that is 
really what we are talking about, honoring our fathers and our mothers, 
our grandfathers and our grandmothers, the seniors, the elders of our 
Nation that are part of our Nation's family. It is not just my mother 
and father, and it is not just yours. It is collectively those that 
have built the country and handed it over to a new generation.
  I do not believe that the process in this House for this bill is 
anything for the Members of Congress to be proud of, because if you do 
not honor those that represent the mothers and fathers of this country, 
it is a singular disgrace. So I start with that process. And I do not 
believe my friends, whom I have worked with day in and day out on the 
other side, tonight in their heart of hearts can be proud of that. It 
is dark. It is bad. It is wrong. And it has set a very bad tone for 
this bill.
  We love Medicare on this side. You cannot drive a wedge between us 
and Medicare. If this were prescription drugs only, it would sail 
through the House. But that is the loss leader on this. This is about 
rewriting the contract between our mothers and fathers and our Nation. 
We object. We do not think it should be parceled out. My grandparents 
never said God bless the insurance companies. They said God bless 
America. Vote against this bill. It is wrong and it is bad. It 
dishonors our mothers and fathers and our grandparents.
  Mr. TAUZIN. Mr. Speaker, I am pleased to yield 2 minutes to the 
distinguished gentleman from Oregon (Mr. Walden), a member of our 
committee.
  Mr. WALDEN of Oregon. Mr. Speaker, my parents are both gone now. They 
died before this Congress could act to provide prescription drug 
coverage for them under Medicare. So they both paid for it out of their 
pocket. Let us talk about what this bill would do for those who 
survive. The agreement would provide 514,456 Oregonian seniors with 
access to a Medicare prescription drug benefit for the first time in 
the history of this program. Beginning in 2006, there would be 129,000 
Medicare individuals in Oregon who would have access to drug coverage 
they would not otherwise have, and it will improve it for many more. 
They will get a $600 card if you are in the lower-income level of 
$12,000 a year. Couples who make $16,000 a year who lack prescription 
drug coverage today would be given $600 in annual assistance to help 
them afford their medicines along with the discount card of 15 to 25 
percent. That is a total of $92 million for Oregon seniors that would 
help 76,000 of them be able to pay for their drugs in 2004 and 2005.
  There are 151,000 seniors in Oregon who have limited savings and low 
incomes who will qualify for even more generous coverage. They will pay 
no premium, no deductible for their prescription drug coverage, and 
they will just be responsible for a minimal copayment. They will get 
the coverage. If you are low income under this plan, they get the 
coverage. Perhaps that is part of why the Portland Oregonian has 
endorsed this program. More importantly, my State like many has faced 
some fairly difficult fiscal challenges. I was there when we 
implemented the Oregon health plan and helped put it into place. Today 
because of the fiscal challenges, they are having to cut people off of 
Medicaid in Oregon. This plan over 8 years will return $279 million by 
having Medicare pick up the cost of those senior low-income people.
  This is a balanced plan that will help our seniors get the 
prescription drug coverage they need. We ought to enact it.
  Mr. DINGELL. Mr. Speaker, I yield 1\1/2\ minutes to the distinguished 
gentleman from New York (Mr. Engel).
  Mr. ENGEL. Mr. Speaker, for many years I have sponsored and worked 
for a real prescription drug bill for seniors and this bill breaks my 
heart. This bill is not a bipartisan bill. It is a Republican fraud. 
The Republican leadership would like to privatize Medicare and replace 
it with private insurance vouchers and HMO health care. That is what 
this bill does. It is the beginning of the destruction of Medicare and 
the destruction and privatization of Social Security is next.
  You mark my words. We should be giving seniors a clean prescription 
drug bill under the Medicare program, but we do not have money for that 
because the Republican tax cuts for the rich and the stealing from the 
Social Security trust fund make it impossible to have any money left to 
pay for a real prescription drug program. The hodgepodge of benefits 
will do nothing but confuse seniors. After spending $2,200 in drug 
bills, seniors will have to pay the next $1,400 out of pocket without 
any help whatsoever while they still pay their monthly premiums. What 
kind of assistance is that? Seniors want a real drug bill and they want 
it to begin now, not in 2006. They want help in bringing drug prices 
down. This bill does none of that.
  When I first came to Congress 15 years ago, I asked my mother what 
was the best thing we could do to help senior citizens and she said, 
give us a prescription drug program. Tonight, my colleagues, my mother 
gave me some more good advice. She said, vote against this sham bill. 
And that is exactly what I am going to do. Shame on this Congress for 
betraying our seniors and ramming this bill through in the middle of 
the night.
  Mr. Speaker, I rise today in strong opposition to the Medicare 
Prescription Drug and Modernization Act. When I came to Congress 15 
years ago, one of my highest priorities was to strengthen Medicare, 
provide drug coverage for seniors, and ensure that my children and 
generations to come would always have access to quality health care in 
their golden years. What the Republican leadership has put before us 
today does none of these things and threatens the very fabric of the 
Medicare program. The Republicans chose to give the richest Americans 
billions and billions of dollars in tax cuts rather than truly provide 
our seniors with relief from the high cost of prescription drugs. If 
this legislation is enacted, Medicare, and the cornerstone of Lyndon 
Johnson's Great Society, will be decimated.
  There is nothing I would like more than to vote for legislation that 
would provide a meaningful Medicare drug benefit for seniors. In fact, 
I authored legislation to do just that. My legislation would have 
provided seniors with coverage comparable to most private plans and 
those utilized by federal employees. But what we have in this 
Conference Report is a fraction of that coverage. Most seniors will see 
little relief from the high cost of prescription drugs. Seniors will 
pay at least $35 a month in premiums with a $250 deductible, but these 
are just benchmarks and seniors may wind-up paying much more. There is 
also a gap in coverage where seniors will pay the premium while 
receiving no benefit. The gap in coverage is between $2,200 and $3,650 
of out-of-pocket drug costs. This could mean that for half the year a 
senior will be paying a premium and getting no assistance. 
Additionally, the drug benefit doesn't even begin until 2006. Seniors 
in my district tell me they need help now. They don't want to wait two 
more years for this benefit to begin. I certainly think that they have 
waited long enough for assistance in paying for medicines that save and 
improve their lives. Our seniors deserve better treatment than this.
  In keeping with the poor design of this benefit, it is expected that 
millions of retirees currently receiving drug benefits from their 
employers will lose it. So the Republican bill offers seniors a paltry 
benefit while taking away the quality benefits they currently enjoy. 
Wait till our seniors get a load of this.
  As bad as all this sounds, it only gets worse. Despite the large 
outcry by seniors and Democrats across the country, this Conference 
Report embodies not the first small step toward privatization, but a 
giant leap that breaks the promise we made to our seniors and have kept 
since 1965 when Medicare was created. What is being dubbed as a demo 
project to ``test'' premium support, what is at best a voucher program, 
will encompass about \1/6\th of Medicare beneficiaries. We're talking 
about 7 million people being forced out of traditional Medicare and 
into HMO's. These, the unluckiest of all the Medicare population, will 
pay higher premiums and receive some type of benefits, but we don't 
know what they are because the HMO's will package them as they see fit. 
For the first time in history seniors in different areas will be paying 
different premiums and receiving different benefits.
  What is most troubling is that this legislation is setting Medicare 
up to fail. This legislation includes a provision that automatically 
triggers

[[Page 30822]]

cuts in the program if Medicare spending increases to an amount 
determined by the Republicans. The likely scenario regarding this is 
that sometime over the next several years Medicare spending will 
increase triggering the cuts. In order to get under the arbitrary cap 
traditional fee-for-service Medicare will be decimated. Republicans 
will then point to their privatization as Medicare's savior and they 
will have finally succeeded in their ultimate goal of ending Medicare 
and leaving seniors to fend for themselves in the private market where 
HMO's will be the order. Make no mistake, we agreed on the path to full 
privatization and an end to one of the most successful government 
programs in our history.
  We have all heard that this group endorsed the bill and that group 
endorsed the bill, so why are Democrats opposing it. The only reason 
this legislation has any life in it is because the Republicans have 
doled out billions of dollars in payouts to insurance companies, drug 
companies, and other special interests. These groups are not endorsing 
the bill because it helps seniors, they are looking out for themselves. 
Well I am not going to sell out our seniors.
  Mr. Speaker, the greatest generation is about to face the brunt of 
the greatest hoax since since I have been in Congress. Most seniors are 
not watching this debate. They will have on their local news that 
Medicare will soon be covering their prescription drugs and they will 
be ecstatic. ``Finally'' many will say. What a shame it is that we re 
playing a political game with the lives of seniors around the country. 
I urge all of my colleagues to vote this bill down so that the can 
enact a real benefit that strengthens Medicare and provides a 
comprehensive drug benefit that will make this wonderful program even 
better.
  Mr. TAUZIN. Mr. Speaker, I am pleased to yield 2 minutes to the 
gentleman from Texas (Mr. Brady).
  Mr. BRADY of Texas. Mr. Speaker, I appreciate the leadership of our 
chairman on this important issue. For the last 4 decades, Medicare has 
helped millions of American seniors get needed health care, helping 
them live longer than any other generation before them. However, 
Medicare has become dangerously outdated. In America today, Medicare 
refuses to pay $80 a month for Lipitor to prevent heart disease, but 
will pay $20,000 in hospital costs after a life-threatening emergency 
has occurred. That does not make sense. Medicare needs to keep pace 
with these medical breakthroughs.
  Medicare must also be preserved and strengthened for future 
generations. We worked hard and we must act now so that seniors, baby 
boomers, and our young people can count on Medicare decades from now. 
We have worked hard to make sure Medicare is more like the health care 
plans Congress enjoys, more choices, better plans, and lower expenses 
for Medicare down the road. There are thoughtful new reforms to keep 
Medicare costs from ballooning out of control, and there are exciting 
new savings accounts that give Americans of every age more freedom to 
determine their health care costs.
  Our seniors deserve a modern prescription plan now and future 
generations deserve Medicare that they can count on. The bottom line is 
we can invest a dime now to help seniors afford their medicines, or we 
can pay a dollar later when they end up in the hospital or face 
emergency surgery that we could have prevented. Our seniors deserve a 
modern prescription plan today, and Republicans in Congress are going 
to deliver it.
  Mr. DINGELL. Mr. Speaker, I yield 1\1/2\ minutes to the distinguished 
gentleman from Texas (Mr. Green).
  Mr. GREEN of Texas. Mr. Speaker, I rise in opposition to this so-
called Medicare prescription drug conference report. Much as I want to 
support legislation creating a prescription benefit for our Nation's 
seniors, I cannot support this bill. First, the bill does absolutely 
nothing to drive down the outrageous costs of prescription drugs. In 
fact, it expressly prohibits Medicare from negotiating for 40 million 
seniors lower prices, and yet it still allows the insurance companies 
to do it. But they prohibit the government from doing it. The benefit 
has a huge doughnut hole that forces seniors to pay all their costs 
from $2,250 to $5,100. I guess I am so frustrated with this bill the 
best I can do is read a poem about America's Greatest Generation.

     Rest gently, America's Seniors
     You saved democracy in WW II
     You survived a depression, too.
     You built this Nation
     to a great world power
     so it is right you rest
     at this late hour.

                              {time}  0145

     But while you slumber
     There are voices raised
     In our Capitol yonder
     Of your high costs for your drugs of wonder.
     This proposed legislation
     Considered in the dark of night
     Will not reduce your cost a ``widow's mite.''
     Awake you will from your night's slumber
     To repay and respond to those who plunder
     Your hard-earned Medicare benefits.

  Mr. Speaker, I rise in opposition to this so-called Medicare 
prescription drug conference report.
  Much as I want to support legislation creating a prescription drug 
benefit for our Nation's seniors, I cannot support this bill.
  The bill does absolutely nothing to drive down the outrageous costs 
of prescription drugs. In fact, the legislation expressly prohibits 
Medicare from using the negotiating power of 40 million seniors to 
demand reasonable prices for our Nation's seniors but allows insurance 
companies to negotiate.
  The benefit has a huge ``donut hole'' that will force seniors to pay 
for all of their costs from $2,250 until their costs exceed $5,100.
  So if you have drug costs that are $300-400 per month, you're only 
going to get a benefit for the first half of the year.
  The rest of the year, you'll continue to pay premiums, but get 
absolutely nothing from them.
  And finally, this plan would require Medicare to compete with private 
plans that would be paid more to treat healthier seniors.
  There is no way Medicare could honestly be expected to compete with 
these overpaid plans, and I think the bill's crafters did that on 
purpose.
  Mr. Speaker, this legislation leaves people worse off than they were 
before it. The CBO estimates that 2.7 million employees will lose their 
retiree benefits.
  More than 6.4 million Medicaid beneficiaries will lose their wrap-
around coverage.
  And in the long run, seniors will be left shouldering a significantly 
higher portion of their health care costs. This is unacceptable, and I 
urge my colleagues to vote against this bill.
  Mr. TAUZIN. Mr. Speaker, I reserve the balance of my time.
  Mr. DINGELL. Mr. Speaker, I yield 1 minute to the distinguished 
gentleman from Ohio (Mr. Strickland).
  Mr. STRICKLAND. Mr. Speaker, I thank my friend for yielding this 
time.
  I probably will not need a minute to say what I want to say. But this 
bill was written by and for the pharmaceutical companies. Do the 
Members want an example of why I say that? A few days ago the Blue Dogs 
met with our Secretary of Health and Human Services, Mr. Tommy 
Thompson, and two Democratic Senators were there, Senator Breaux and 
Senator Baucus. And in that meeting, a question was asked: Why is there 
a prohibition against the Secretary from negotiating discounted costs 
for America's senior citizens? And Senator Baucus said it is in there 
because PhRMA insisted that it be in there. Shame, shame, shame on you.
  Mr. TAUZIN. Mr. Speaker, I yield myself 30 seconds.
  I want to point out that the language that the gentleman just 
referred to in the bill first appeared in the motion to instruct by 
none other than the gentleman from California (Mr. Stark), who offered 
a motion to recommit H.R. 4680 with instructions that included the very 
same language that the gentleman is complaining about that was 
referenced in the Blue Dog meeting.
  Mr. Speaker, I reserve the balance of my time.
  Mr. DINGELL. Mr. Speaker, I yield 1\1/2\ minutes to the distinguished 
gentlewoman from Colorado (Ms. DeGette).
  Ms. DeGETTE. Mr. Speaker, the Hypocratic oath requires that doctors 
first do no harm. There is no such oath for Members of Congress. But we 
would be wise to heed it when we consider the Medicare prescription 
drug benefit tonight, for this bill certainly will do harm to millions 
of Americans. I know this. My constituents know this, and seniors 
across the country know this. They are furious with the organizations 
and the Members of Congress that support this plan.
  This is not an abstract debate. This has a huge impact on real 
people. It

[[Page 30823]]

will do harm to people like Helen Lay, my constituent, a retiree in 
Colorado. Helen is worried because, as she sees it, this bill has 
something in it for everyone except the senior citizens. Helen and her 
husband, Frank, are fortunate enough to have good prescription drug 
coverage through their retirement plan. Right now, they spend about 
$800 a year on prescription drugs. Without insurance, they would be 
spending nearly $12,000.
  This bill will do great harm to Helen and Frank and millions of other 
seniors because it will encourage employer retirement plans to end 
prescription drug coverage, forcing seniors into substandard plans that 
cost more, and no one knows what the coverage or the price will be.
  Helen and Frank have other serious problems. They take 12 brand-name 
medications per month. But this bill specifically prohibits Medicare 
from negotiating drug prices, even though private companies like Wal-
Mart and agencies like the Veterans Administration are able to 
negotiate cheaper drugs. That means even if this bill passes, Helen and 
Frank will still pay exorbitant prices.
  I say to Helen that we are here to stand up for her today.
  Congress first must do no harm. Send this plan back.
  Mr. TAUZIN. Mr. Speaker, I reserve the balance of my time.
  Mr. DINGELL. Mr. Speaker, I yield 1\1/2\ minutes to the distinguished 
gentlewoman from California (Mrs. Capps).
  Mrs. CAPPS. Mr. Speaker, I rise in opposition to the Medicare 
conference report. Seniors deserve a good prescription drug benefit 
through Medicare. This bill cripples Medicare and truly is not a 
prescription drug benefit at all. It forces seniors into private 
insurance plans to get all of their health care and contains a time-
released poison pill that will starve Medicare of needed resources by 
arbitrarily capping federal funds.
  But on top of this, the conference report cuts cancer care by $1 
billion a year, $10 billion over 10 years. So many rural cancer centers 
will close as a result, and others will lay off oncology nurses and 
critical support staff. These centers are essential to the delivery of 
cancer care today. How can we do this to cancer patients? It is hard 
enough to live with this dreaded diagnosis, let alone the horrendous 
side effects of the treatments. And now this.
  I repeat. This bill cuts $1 billion out of cancer care. I am ashamed.
  Mr. TAUZIN. Mr. Speaker, I yield 2 minutes to the gentleman from 
Michigan (Mr. Rogers) for the purposes of colloquy.
  Mr. ROGERS of Michigan. Mr. Speaker, I thank the chairman for his 
leadership on this for the millions of seniors who today have no 
access, no access to prescription drugs that will have that when this 
bill is signed into law. I thank him for each and every one of them.
  For the purposes of colloquy, it is certainly not the chairman's 
intent that the cuts to oncology practices across the country would go 
below such a level that would cause practices to close, thus jeopardize 
access to care for thousands of cancer patients, and should we see that 
CBO's projections were wrong and that oncologists were found not to be 
made whole for their drug reimbursement under the new Average Sales 
Price that we would swiftly reverse this payment methodology?
  Mr. TAUZIN. Mr. Speaker, will the gentleman yield?
  Mr. ROGERS of Michigan. I yield to the gentleman from Louisiana.
  Mr. TAUZIN. Mr. Speaker, the gentleman is correct, but let me point 
out that CBO's estimates now indicate that this bill makes oncologists 
perfectly whole in this first year of the changeover. In fact, for the 
first 2 years, it is a neutral completely, and oncologists will be 
getting something like 2\1/2\ to 3 times the practice expense allowance 
that CMS now estimates they would get under their own data. This bill 
will actually give oncologists 100 million more dollars than they are 
currently getting under the old AWP formula this year, 2004, and $100 
million less the second year. So it is a total neutral policy for that 
2-year period.
  Mr. ROGERS of Michigan. Reclaiming my time, Mr. Speaker, I thank the 
gentleman for clarifying.
  In addition, it is not the chairman's intent that small rural cancer 
centers across the country would be detrimentally impacted under the 
new Average Sales Price reimbursement method for their drugs based on 
their inability to buy in volume like their suburban neighbors. And if 
we found that to be the case, we would swiftly review the specific 
impact such a payment methodology had on access to care in these rural 
areas.
  Mr. TAUZIN. Mr. Speaker, will the gentleman yield?
  Mr. ROGERS of Michigan. I yield to the gentleman from Louisiana.
  Mr. TAUZIN. Mr. Speaker, the gentleman is of course correct. That is 
why we built an ASP, Average Sales Price, plus a percentage to give the 
smaller oncology units a chance to buy, in case the larger units buy at 
a lower price, they could at least get coverage on top of the Average 
Sales Price to reimburse them, but we would always review that to make 
sure cancer care is indeed preserved.
  Mr. ROGERS of Michigan. Mr. Speaker, I thank the gentleman for his 
attention on this matter.
  Mr. DINGELL. Mr. Speaker, I yield 1\1/2\ minutes to the distinguished 
gentlewoman from Illinois (Ms. Schakowsky).
  Ms. SCHAKOWSKY. Mr. Speaker, I thank the gentleman for yielding me 
this time.
  Earlier the gentleman from Louisiana (Chairman Tauzin) waxed poetic 
about the deep meaning of a movie, of all things, and about the 
centrality of choice in our democracy. And I agree about choice.
  But I have to tell the Members in all the years that I have worked 
for and with seniors, never, not once, did a senior citizen come up to 
me and say ``What I really want is a choice of insurance plans. I want 
more salesmen to call me, send me those brochures, include all those 
charts and graphs and fine print. I cannot wait to sit down each year 
and choose among HMOs.'' Never, not once.
  Seniors want a choice all right. They want to choose their doctor. 
They want to choose the drug that their doctor prescribes for them. 
They want the choice of their pharmacy if they want to go to their 
neighborhood pharmacy. They want the kind of real choice they get under 
Medicare, the Medicare that they know and love. And that is the kind of 
choice they will lose under this bill and under a pile of brochures 
that they are going to be burdened with. But do the Members know what? 
That is okay. I want to tell the Members it is okay because the seniors 
know the difference between real choices and phony choices. And we can 
put all kinds of fancy pictures on it, but senior citizens will know, 
and I want to tell the Members that it is to their peril that they vote 
for this legislation and give seniors a phony choice.
  Mr. TAUZIN. Mr. Speaker, I yield 1\1/2\ minutes to the gentleman from 
Arizona (Mr. Renzi).
  Mr. RENZI. Mr. Speaker, I thank the chairman for yielding me this 
time.
  There has been some talk about this not being about prescription 
drugs and more about the changes that we are looking at for Medicare.
  In the 1950's and 1960's on the border of Nevada and Arizona at the 
test sites for the atom bomb, the schoolchildren in Arizona, in 
Kingman, Arizona, were given the day off to go up on the mountains and 
watch the A-bomb blasts. The skies would turn brilliant pink and 
orange. Years later, those adults are the ones that come down with the 
highest cluster rates of cancer in America. A lot of the folks in the 
Rust Belt send their cancer patients out to beautiful, warm Arizona, 
whereas one of the benefits of their suffering has been our ability to 
understand how to better treat cancer in these communities now rather 
than in the hospitals.
  The nurses who provide that cancer care under the current Medicare 
are not allowed to bill and get their full amounts. That is because 
Medicare has not changed enough or at all since its inception.
  Medicare must be updated. It must be modernized. To do so denies the 
ability

[[Page 30824]]

to provide the proper billable hours for our nurses who provide cancer 
care and the better system of cancer care that we are seeing out in the 
West.
  Modernize Medicare. Do not deny those nurses that kind of coverage.
  Mr. DINGELL. Mr. Speaker, I yield 1\1/2\ minutes to the distinguished 
gentleman from Maine (Mr. Allen).
  Mr. ALLEN. Mr. Speaker, I thank the gentleman for yielding me this 
time.
  Mr. Speaker, we have talked a lot about this bill. I want to say just 
a couple of words about my seniors up in Maine. Two points. First, they 
are desperate for lower prescription drug prices. Number two, they want 
to keep the Medicare program that they have because it is all they 
have. There are no HMOs in Maine to provide services to them.
  And here is what they do. To get lower prescription drug prices, they 
call my office in Maine every day. They pile into buses to go to 
Canada. They try to get their prescription drugs from Canada over the 
Internet.
  And so what do they get out of this bill? They get a provision that 
says the government will not be able to negotiate lower prices for 
them, will not be able to negotiate lower prices. They get an 
inadequate benefit that is not as helpful to most seniors in Maine as 
the Canadian drug prices. It is a big win for PhRMA and a big loss for 
people in Maine.
  Our seniors have come to rely on the stability, predictability, and 
continuity of Medicare. The chairman of the committee did talk about 
choice, but as in Illinois, no one in Maine has ever asked me for a 
choice between insurance plans. They have got the choice that matters 
now, a choice of doctors and hospitals. This bill over time drives them 
out of fee-for-service Medicare into HMOs. It is funded by an 
outrageous overpayment to private plans and HMOs.
  My parents for 1 year were in a Medicare+Choice plan. It was not 
golden. It was not modern, not efficient, not fair. Just a bureaucratic 
nightmare. Defeat this Medicare bill. It is bad for Maine's seniors.

                              {time}  0200

  Mr. TAUZIN. Mr. Speaker, I reserve the balance of my time.
  Mr. DINGELL. Mr. Speaker, I yield 1 minute to the distinguished 
gentleman from New York (Mr. Israel).
  Mr. ISRAEL. Mr. Speaker, last June I was one of nine Democrats who 
voted to move Medicare modernization into a House-Senate conference. 
That bill was flawed, but I wanted to give it a chance for bipartisan 
compromise and improvement. It saddens me that this bill was not 
improved, Medicare was not modernized; it has been privatized in this 
bill. I said when I voted for H.R. 1 that if it looked like 
privatization, if it sounded like privatization, if it felt like 
privatization, if it smelled like privatization, that I would oppose 
final passage. This bill sounds, it feels, it smells, it looks, it is 
privatization; and I have to oppose final passage.
  Now, some say, well, it is not really privatization; this is just an 
experiment in six different areas. Do not worry. Mr. Speaker, when you 
are the guinea pig, you tend to worry.
  We could have done a much better job with this bill, Mr. Speaker. We 
could have come up with a bill that Republicans and moderate Democrats 
could embrace, a bill that protects seniors and does not subvert them. 
I gave this bill every chance that I could. Tonight this bill robs our 
seniors of any hope that they have had for true Medicare reform. 
Medicare should be the Federal Government's obligation to seniors who 
need the right bill, not a profit center for the special interests who 
wrote this bill.
  Mr. TAUZIN. Mr. Speaker, I reserve the balance of my time.
  Mr. DINGELL. Mr. Speaker, I yield 1 minute to the distinguished 
gentleman from New Jersey (Mr. Andrews).
  Mr. ANDREWS. Mr. Speaker, I thank the gentleman for yielding me this 
time.
  Several Members of the majority have said that this is a historic 
morning. They are correct. History will record that this is the day 
that any pretense the majority had, the Republican Party had of fiscal 
responsibility, ended.
  Mr. Speaker, for every $100 we are spending to run our government 
tonight, we are only taking in $80, and you are taking every nickel out 
of the Social Security trust fund and then some to make up the 
difference. So what is your strategy to deal with this deficit? It is 
to add a $400 billion entitlement that you cannot pay for. You are 
using Social Security funds that are supposed to fund future 
retirements for our kids to pay for a sham prescription drug benefit 
for our grandparents.
  This borrowing will purchase a Trojan horse, a massive giveaway to 
the health insurance industry disguised as a prescription drug benefit 
for senior citizens.
  I listened to your speeches when you came here 10 years ago and said 
we could not afford to expand entitlements, and many of us on our side 
stood with you and made sure that we did not do that.
  To have a real prescription drug benefit, you should repeal your 
sacred tax cut and pay for what is really necessary for America's 
seniors. Shame on the Republican Party for turning its back and 
releasing a torrent of red ink that we will pay for, for generations to 
come, when this bill metastasizes in the future. Oppose this ill-
considered bill.
  Mr. TAUZIN. Mr. Speaker, I yield myself 30 seconds. That was an 
interesting speech, but I got a letter from the Congressional Budget 
Office indicating that they prepared a preliminary estimate of the 
impact of the Democratic amendment to H.R. 1, the Democratic plan; and 
the estimate of CBO of their plan is $1 trillion. So a speech 
complaining about the fact that we in this House passed a budget that 
included $400 billion for this important program for seniors is wrong, 
when the other side prepared an amendment for $1 trillion; that is a 
little outrageous.
  Mr. Speaker, I reserve the balance of my time.
  Mr. DINGELL. Mr. Speaker, I yield 30 seconds to the distinguished 
gentleman from Arkansas (Mr. Berry).
  Mr. BERRY. Mr. Speaker, I rise at this time to just express my 
gratitude and the gratitude of my caucus to the two gentlemen who have 
worked tirelessly for years on this issue, the gentleman from Michigan 
(Mr. Dingell) and the gentleman from New York (Mr. Rangel). And I hope 
that this entire body, even though they have been treated shamefully 
and disgustingly by the Republican leadership and by this conference 
committee, I hope that everyone here this evening will join me in 
thanking them for the magnificent job that they have done for America 
and America's seniors.
  Mr. TAUZIN. Mr. Speaker, I yield myself 30 seconds. While he is not 
here, I think the Members on our side ought to show their appreciation 
for the chairman of the Committee on Ways and Means, the chairman of 
the conference who did an amazing job in bringing this excellent bill 
to the floor for our consideration, the gentleman from California (Mr. 
Thomas).
  Mr. Speaker, I reserve the balance of my time.
  Mr. DINGELL. Mr. Speaker, I yield 1\1/2\ minutes to the gentleman 
from Massachusetts (Mr. Markey).
  Mr. MARKEY. Mr. Speaker, 40 years ago today, President Kennedy's 
assassination released an energy in our country that led to the passage 
of the Civil Rights Act and Medicare. By contrast, the bill before us 
today was conceived in secret, crafted by special interests, and 
cloaked in a prescription drug benefit to disguise its real purpose: 
the destruction of the Medicare program as we have known it in the 
United States over the past 40 years.
  This bill is a Thanksgiving turkey, and this turkey will not fly. It 
forces senior citizens into HMOs. It gives HMOs billion-dollar 
subsidies. It raises drug costs for the poorest Americans, and it drops 
millions of seniors from their retirement plans.
  Some claim this bill will provide America's senior citizens with new 
prescription drug coverage, but it will force millions of our frail 
elders to pay more for prescription drugs than they

[[Page 30825]]

do now. Some claim it will lower Medicare premiums, but it will require 
Medicare beneficiaries to forfeit the power to choose their own doctors 
or their own drugs. Some claim it will make the Medicare program more 
efficient, but it will stick taxpayers with the bill for billions of 
dollars in subsidies to HMOs and new tax shelters for the rich.
  This bill is not the elixir for Medicare; it is, rather, a poison 
pill that leads to the destruction of the Medicare program as John F. 
Kennedy and Lyndon Johnson envisioned it.
  Mr. TAUZIN. Mr. Speaker, I yield myself 3 minutes.
  Mr. Speaker, it is the season of Thanksgiving, and this House is 
about to say thank you to a generation of Americans who we ought to say 
thank you to, and we are about to say it in the most important way we 
can. We are about to pass a $400 billion-insured drug account for these 
citizens who have no drug insurance today. We are about to pass a 
voluntary plan that gives them the right to join or not join, their 
choice, not mandated by government. It includes catastrophic coverage 
so they never have to lose everything they have worked for and saved 
for all of their lives. And we give to all Americans on this 
Thanksgiving holiday a chance to open up health savings accounts, tax-
free in, tax-free out, tax-free interest earned to build their own 
long-term health care plans for the future.
  This, indeed, is a time of Thanksgiving, and it is indeed a time for 
this generation to be true to our obligations of the previous 
generation. This bill does that. It gives the new generation choice in 
drug coverage for the first time.
  It is amazing to me tonight, this debate. I have taken my parents to 
the hospital many times during my dad's life and my mom's. I do not 
ever once remember a doctor asking me as I checked in to the room there 
whether my mom was a Democrat or a Republican. This is not a partisan 
issue. I have gone and filled my mom's prescriptions every now and then 
for her. They never asked me at the pharmacy what party she belongs to. 
And when health deserts us in our senior years, when the ravages of 
time take us and we pass away, no mortuary worker stamps Democrat or 
Republican on our tombstones.
  Health care is not a partisan issue, and it should not be a partisan 
issue. We have a chance today to do something that seniors desperately 
need, and we ought to join tonight together to do it.
  There are a lot of people who helped write this bill. Let me tell you 
who they were. They were, of course, the members of the conference 
committee who worked together to put this bill together, but there were 
a lot of staffers; and I want to mention them today. They are the staff 
of the House and Senate legislative counsel. Special thanks to the 
House legislative counsel, Ed Grossman, who is a draftsman 
extraordinaire. Additional thanks go to Pierre Poisson and Peter 
Goodloe.
  From the Senate side, Ruth Ernst and John Goetcheus and Jim Scott.
  Other staff members of the Congressional Budget Office and analysts, 
these individuals deserve great compliments for their analysis, their 
integrity, and their hard work. I want to thank Doug Holtz-Eakin and 
Steve Lieberman, Tom Bradley, and the entire CBO staff who worked night 
times and days for us.
  I want to thank Tom Scully and the whole staff at HHS and CMS who sat 
and worked with us day after day to craft this bill.
  I specifically want to thank the staffs of our committees. From Ways 
and Means, John McManus, who did such a great job; Madeleine Smith and 
Deborah Williams, and Joel White. From the majority side of the Finance 
Committee, I would like to thank Linda Fishman, Mark Hayes, Leah 
Kegler, Colin Roskey, and Jennifer Bell. Recognition is deserved to Liz 
Fowler and Andrea Cohen, Pat Bousilman and Jonathan Blum.
  Last, but not least, all of the Committee on Energy and Commerce 
staff who toiled so hard for us, let me thank them again, over and over 
again: Dan Brouilette, Patrick Morrisey, Chuck Clapton, Jeremy Allen, 
Patrick Ronan, Kathleen Weldon, and Jim Barnette. They did a marvelous 
job for this House, and we owe them a debt of thanks. Thank you all.
  Mr. DINGELL. Mr. Speaker, I yield such time as she may consume to the 
gentlewoman from California (Ms. Roybal-Allard).
  Ms. ROYBAL-ALLARD. Mr. Speaker, I rise in strong opposition to this 
bill.
  Mr. Speaker, I rise in strong opposition to this extremely flawed 
bill. A bill that takes care of drug and insurance companies at the 
expense of our Nation's seniors.
  Instead of helping our seniors, Mr. Speaker, this bill will result in 
higher drug prices, increased Medicare premiums for seniors who refuse 
to be forced into HMOs, and the erosion of retiree coverage for over 
two million seniors.
  These are just a few of the problems with this bill, Mr. Speaker. 
There are far too many to name in the limited time I have.
  Our seniors deserve better. They have worked and sacrificed and 
contributed greatly to our country.
  We must not turn our backs on them, Mr. Speaker, with the passage of 
this bill. Instead let us honor our seniors by defeating this bill and 
coming back with a prescription drug plan that is affordable, 
comprehensive and guaranteed. A plan, Mr. Speaker, that protects 
Medicare not destroys it.
  Let tonight's victory be for our seniors, not the pharmaceutical and 
insurance companies.
  Mr. DINGELL. Mr. Speaker, I yield such time as he may consume to the 
gentleman from South Carolina (Mr. Spratt).
  Mr. SPRATT. Mr. Speaker, I rise in strong opposition to this bill.
  Mr. Speaker, when we began this quest several years ago, our object 
was to make Medicare better by filing a big gap in its coverage. This 
conference report covers that gap with a drug benefit that is barely 
adequate and badly in need of redesign. The bill then goes on not to 
make Medicare better, but to move Medicare toward privatization, 
heavily subsidizing managed care with funds that could better be used 
to improve the meager drug coverage this bill provides.
  I will vote against this bill not to kill it but to send it back to 
an open conference, where all participate, in an effort to make the 
bill worthy of our senior citizens who badly need this coverage, and 
depend on Medicare.
  Here are some of the problems and objections that I find with this 
bill:
  H.R. 1 couples meager drug coverage with major changes that move 
medicare toward privatization. The terms of coverage seem reasonable at 
first until you realize that they are not guaranteed. The premium of 
$35, the deductible of $250, and the co-payment of 25 percent are 
illustrative of what insurance companies may offer, but not written in 
stone. In any event, coverage stops after $2,250, just when it is 
needed most, and catastrophic coverage does apply until one has spent 
$5,100. For this first $5,100 in coverage, the consumer pays $4,020. 
Put another way, the plan pays 20 percent the consumer pays 80 percent. 
Catastrophic coverage starts after $5,100 has been spent, and seems 
reasonable, until you realize that this threshold, like all the other 
terms of coverage, is indexed to the rising cost of prescription drugs, 
and is likely to double in ten years. This is meager coverage, and a 
poor trade-off for all the changes crammed into this package to move 
Medicare toward privatization.
  H.R. 1 contains a drug benefit that is flawed and needs to be fixed 
before it becomes law. Rather than providing continuous coverage, the 
Medicare benefit has a $2,850 gap in coverage that will leave millions 
of seniors without drug coverage for a good part of the year, even 
though they continue to pay premiums.
  The drug benefit has a deductible of $250, and a coverage gap that 
begins at $2,250 in drug spending and ends at $5,100. According to CBO, 
this coverage gap of $2,850 will double to $5,065 by 2013. The 
structure of the benefit means that there will be several months out of 
the year when seniors are paying premiums and are not receiving any 
additional drug coverage. This odd benefit design, with its coverage 
gap does not currently exist as an insurance product.
  H.R. 1 needlessly complicates prescription drug coverage by making it 
available only through private insurance policies and not through 
medicare. Even through stand-alone drug policies don't exist, and 
health insurance companies, fearing adverse selection, have made clear 
that they do not wish to write it, this bill provides primarily for 
private insurance coverage. Out of disdain for Medicare, the bill does 
not choose the simple solution and make

[[Page 30826]]

drug coverage a feature of Medicare. Instead, in one of many steps 
toward privatization, this bill calls for drug coverage to be written 
by private insurance companies, adding unnecessary cost, complexity, 
and uncertainty.
  H.R. 1 requires that drug coverage be purchased from a private 
insurance company even when there is only one underwriter and no 
competition. In regions where only one insurance company offers a drug-
alone policy, Medicare will not provide ``fallback'' coverage under 
this bill, so long as there is a Medicare PPO or HOM in the area. The 
beneficiary will have three unappealing choices: take the coverage at a 
non-competitive price, leave Medicare fee-for-service and join the HMO, 
or go without drug coverage.
  H.R. 1 bars the Federal Government from using the purchasing power of 
40 million seniors to drive down the price of drugs--H.R. 1 flat 
prohibits the Secretary of Health and Human Services from negotiating 
better prices for prescription drugs. The bill divides Medicare's 41 
million beneficiaries into numerous regions and to one or more private 
plans within each region. This fragmentation runs contrary to trends at 
the state level, where states have used the purchasing power of big 
beneficiary pools to negotiate better prices. This prohibition also 
flies in the face of prevailing federal practice, which requires 
government officials to seek the best possible price when spending the 
taxpayers' money--especially when spending $400 billion.
  H.R. 1 overpays HMOs to induce them to join medicare and draw seniors 
into private plans--H.R. 1 provides $16.5 billion to sweeten subsidies 
paid to managed care plans and induce them to enter markets they have 
not found profitable. After spending billions to subsidize managed care 
plans, this bill then forces traditional Medicare to compete with the 
plans. This competition, known benignly as ``premium support,'' will 
destabilize Medicare as we have known it and lead to premium increases 
for seniors who want to stay with the government-run program.
  According to the Medicare Payment Advisory Commission, Medicare 
already overpays managed care plans by 19.6 percent. They are paid 19.6 
percent more than their members would cost if enrolled in traditional 
fee-for-service Medicare.
  H.R. 1 increases HMO payments by another $4.5 billion and sets up a 
$12 billion fund to induce private plans to enter new markets. 
According to MedPAC, these changes will result in overpayments to 
managed care plans of 25 percent.
  Medicare fee-for-service will then have to compete with private plans 
in six metropolitan areas starting in 2010. Obviously, the increased 
payments will allow private plans an advantage in the competition, one 
they will enhance by marketing their services to healthy seniors.
  Managed care plans have a record of designing and marketing benefit 
packages that appeal to healthy beneficiaries. As private plans 
``cherry pick'' healthier beneficiaries, traditional Medicare will be 
stuck with sicker, more expensive beneficiaries. If competing private 
plans run costs below traditional Medicare, the beneficiaries in fee-
for-service Medicare will be assessed the difference through their Part 
B premiums. Traditional Medicare premiums will spiral upwards, forcing 
seniors who cannot afford the rising premiums to move into private 
plans that limit their access to doctors. The process will repeat 
itself year after year, beginning an insurance `'death spiral'' that 
will destroy traditional Medicare.
  H.R. 1 will cause over six million low-income seniors to be worse 
off--The 6.4 million low-income and disabled individuals who now 
receive health coverage from both Medicare and Medicaid will be worse 
off under this bill.
  Under current law, when a benefit or service is covered by both 
Medicare and Medicaid Medicare serves as the primary payer and Medicaid 
``wraps around'' that coverage. Medicaid fills gaps in coverage that 
exist under the Medicare benefit. Medicaid also picks up most or all of 
the beneficiary co-payments that Medicare charges.
  This bill largely eliminates Medicaid's supplemental--or ``wrap 
around``--coverage under the new Medicare drug benefit. As a result, 
substantial numbers of poor elderly and disabled people would be forced 
to pay more for their prescriptions than they now do.
  In addition, in cases where Medicaid covers a prescription drug but 
the private plan that administers the Medicare drug benefit in the 
local area does not provide that particular drug under Medicare, poor, 
elderly and disabled beneficiaries who now receive the drug through 
Medicaid could lose access to it.
  Under current law, low-income beneficiaries have co-payments that run 
from zero to as high as $3; but these amounts do not increase from year 
to year. The conference report raises cost-sharing for those with the 
lowest incomes by requiring $1 and $3 co-payments for beneficiaries 
whose income is less than $8,980 a year and $2 and $5 co-payments for 
beneficiaries whose income is between $8,980 and $12,123 a year. In 
addition, the $1 and $3 co-payments grow at CPI (1.5 percent to 3 
percent). The $2 and $5 co-payments will rise at the same level as 
prescription drug spending, which is projected to average 10 percent a 
year, far exceeding the annual 1.5-3 percent. Social Security COLAs.
  According to the Center on Budget and Policy Priorities, this 
provision will result in higher drug costs for 4.8 million seniors.
  H.R. 1 will cause nearly 3 million seniors to lose retiree coverage--
According to CBO, some employers will stop providing retiree coverage 
due to the structure of the drug bill, and this will result in 2.7 
million seniors losing retiree drug coverage, in many cases far better 
than this plan.
  According to the Congressional Budget Office, 11.7 million seniors 
currently have retiree coverage through their former employers. 
However, 23% of these seniors, or 2.7 million individuals, will lose 
this coverage. This loss of coverage results from the structure of the 
drug benefit, which gives employers an incentive to drop retiree 
coverage.
  The drug bill targets Federal assistance toward those seniors who 
lack supplemental private drug coverage, most noticeably through the 
requirement that payments made by supplemental coverage don't count 
toward the beneficiaries' out-of-pocket limit. In effect, the out-of-
pocket provision reduces Federal subsidies for beneficiaries with 
supplemental insurance. As a result, it provides a clear financial 
disincentive for employers to supplement the benefit.
  Second, some employers see the enactment of a drug benefit as an 
opportunity to reduce the costs and risks of providing drug coverage.
  H.R. 1 spends nearly $7 billion on tax shelters for the healthy and 
wealthy--Rather than marshaling funds to improve drug coverage, H.R. 1 
diverts $7 billion to Health Security Accounts, which have nothing to 
do with Medicare drug coverage, and create an unprecedented tax break, 
which could undermine our employer-sponsored insurance system.
  Under H.R. 1, tax-advantaged savings accounts to pay out-of-pocket 
medical expenses would be made universally available. These could be 
used with high-deductible health policies, but not with the 
comprehensive health coverage traditionally offered by employers. 
Holders of these accounts could make tax-deductible deposits, watch the 
earnings compound tax-free, and pay no tax upon withdrawal if the funds 
are used for medical expenses.
  This would establish an unprecedented and lucrative tax shelter. In 
the existing tax code, when funds deposited in a tax-favored account 
are deductible, withdrawals are taxed. On the other hands, withdrawals 
are not taxed when deposits are not deducted. There is no precedent in 
the tax code for providing both ``front end'' and ``back end'' tax 
breaks. The political pressure to do the same for other types of 
savings and retirement accounts could become irresistible. A 
proliferation of such tax-free accounts would only send Federal 
deficits higher.
  These savings accounts would also undermine comprehensive health 
insurance. Healthy, affluent workers would have an incentive to opt out 
of comprehensive health insurance in favor of the Health Security 
Accounts. They would receive a large tax break, and would not be much 
affected by switching to a high-deductible health policy since they 
generally use fewer health services. If large numbers of such workers 
opt out of comprehensive plans, the pool of people left in 
comprehensive plans would be older and sicker, causing premiums for 
comprehensive insurance to rise significantly.
  That, in turn, would drive still more healthy workers out of 
comprehensive insurance, making those that remain even more costly to 
insure, adding pressure on employers to stop offering comprehensive 
coverage. Older and sicker workers could wind up paying more for health 
coverage or losing it altogether and becoming uninsured.
  This suggests what could be done to make this bill better if it were 
taken back to a fair and open conference committee. The $7 billion 
allocated to Health Security Accounts and the $17 billion allocated to 
subsidizing HMOs could be used instead to narrow the ``doughnut hole,'' 
the zone where there is no coverage between $2,250 and $5,100. This is 
just one example of how this bill can be fixed and improved, and should 
be before it is passed.
  Mr. DINGELL. Mr. Speaker, I yield such time as he may consume to the 
gentleman from Pennsylvania (Mr. Fattah).

[[Page 30827]]


  Mr. FATTAH. Mr. Speaker, I rise in opposition to this conference 
report.
  Mr. DINGELL. Mr. Speaker, I yield 1 minute to the distinguished 
gentleman from Arkansas (Mr. Ross).
  Mr. ROSS. Mr. Speaker, I thank the gentleman from Michigan for 
yielding me this time.
  Mr. Speaker, in 2001, the Republican Congresswoman, the gentlewoman 
from Missouri (Mrs. Emerson), and I offered up a bipartisan plan that 
would truly modernize Medicare to include medicine for our seniors, 
that recovered 80 percent of the cost of prescription drugs for our 
seniors, while taking on the big drug manufacturers, and the 
Republicans told us that we could not afford it. They said we could not 
afford $750 billion over 10 years.
  But what has happened since then? They passed a $350 billion tax cut 
for the wealthy, and now they are proposing a $400 billion major 
prescription drug plan. I was not real good in math in high school, but 
I think I can figure that one out. That totals $750 billion. Two years 
later, we are getting a plan that does not even kick in until 2006. Our 
plan would be in effect today.

                              {time}  0215

  Seniors get $1,080 worth of help on the first $5,100 worth of 
medicine they need every year, and the Republicans even had the nerve 
at the urging of the big drug manufacturers to put language in the bill 
that says the Federal Government shall be prohibited from negotiating 
with the big drug manufacturers to bring down the high cost of 
prescription drugs. This is a bad bill. This is a bill that does not 
even fit our seniors, only the big drug manufacturers.
  Mr. TAUZIN. Mr. Speaker, I yield myself 30 seconds.
  Mr. Speaker, again let me read the language of the bill that the 
gentleman just referred to, that terrible piece of language. It says in 
effect that in administering the prescription drug benefit program 
established under this, the Secretary may not, number two, interfere in 
any way with negotiations between private entities and drug 
manufacturers or wholesalers; or, three, otherwise interfere with the 
competitive nature of providing prescriptive drug benefit through 
private entities. That language in the bill comes from a motion to 
recommit prepared and filed in this House in the 106th Congress by the 
gentleman from California (Mr. Stark) on his motion to recommit. It is 
language of the other side that they are complaining about.
  Mr. DINGELL. Mr. Speaker, I yield 2\1/2\ minutes to the gentleman 
from Texas (Mr. Turner) for purposes of explaining the motion to 
recommit, which will be offered at the conclusion of the debate. I hope 
my colleagues will listen closely to this.
  Mr. TURNER of Texas. Mr. Speaker, for years the pleas of our hurting 
seniors fell on the deaf ears of our Republican majority until one day 
our Republican friends were struck with an ingenious idea, wrapping a 
plan to privatize Medicare into a deceptive package called prescription 
drugs for seniors.
  It keeps the drug companies happy because they can still charge twice 
as much for medicine here as anywhere else in the world. It keeps 
insurance companies happy by paying them 25 percent more to cover 
seniors than taxpayers pay to cover seniors under traditional Medicare. 
It keeps doctors and hospitals happy by paying them billions while 
leading them like sheep into the perils of managed care.
  And it costs taxpayers $400 billion for a meager prescription drug 
savings of 25 percent, a savings that could be achieved at no cost to 
taxpayers by giving seniors the right to buy drugs at the same price 
they can get them in Canada. All this slight of hand to force seniors 
into private insurance and some day to give them a voucher and tell 
them fend for yourself. No security, no certainty, no guaranty of 
coverage, you are on your own. And the promise of Medicare is no more.
  My seniors in east Texas see right through this. In a poll conducted 
tonight, over 6,000 seniors in my district, 85 percent said they were 
opposed to the Republican plan. Dress it all up as fancy as you can, it 
is a bad deal for America's seniors and they know it.
  Mr. Speaker, I will be offering a motion to recommit to give seniors 
a meaningful prescription drug plan. This motion matches the conference 
report dollar for dollar on provider payments. It allows the Secretary 
of HHS to negotiate lower drug prices. It eliminates premium support 
ensuring that seniors will not have to pay more to keep the Medicare 
coverage they know and trust. It rejects the poison pill language that 
guts reimportation, and it prevents millions of retirees from losing 
their benefits and protects low-income seniors by allowing Medicaid to 
provide wrap around coverage.
  Mr. Speaker, let us give the greatest generation the certainty, the 
security, and the guarantee they deserve. Vote for this motion to 
recommit.
  The SPEAKER pro tempore (Mr. Hastings of Washington). The Chair would 
advise Members that there are 2 minutes remaining on either side. The 
gentleman from Louisiana (Mr. Tauzin) has the right to close.
  Mr. TAUZIN. Mr. Speaker, I might inquire of the gentleman from 
Michigan (Mr. Dingell) if he has further speakers. I am reserving for 
the Speaker of the House to close.
  Mr. DINGELL. Mr. Speaker, at this time I would inform my 
distinguished friend in the House, the gentleman from Louisiana (Mr. 
Tauzin) that we have only one speaker remaining who will close for this 
side.
  Mr. TAUZIN. Mr. Speaker, then I would advise my friend to take 
advantage of that time at this time and the Speaker will close on the 
Republican side.
  Mr. DINGELL. Mr. Speaker, is my good friend assuring me he has only 
one speaker remaining?
  Mr. TAUZIN. Mr. Speaker, I can assure my friend that is true.
  Mr. DINGELL. Mr. Speaker, then with a great deal of pride and 
pleasure I yield the remainder of my time to the distinguished minority 
leader, the gentlewoman from California (Ms. Pelosi).
  Ms. PELOSI. Mr. Speaker, I first I want to invite my colleagues to 
join me in expressing our appreciation to our Democratic conferees who 
have been true champions of a defined affordable prescription drug 
benefit under Medicare, the dean of the House and ranking Democrat on 
the Committee on Energy and Commerce, the gentleman from Michigan (Mr. 
Dingell), the distinguished ranking Democrat on the Committee on Ways 
and Means, the gentleman from New York (Mr. Rangel), and a true 
champion for health care in this Congress and the country, the 
gentleman from Arkansas (Mr. Berry), all for their leadership on this 
important issue.
  Sadly, Mr. Speaker, the Republicans would not let these appointed 
conferees into the conference room. And this bill does not reflect the 
benefit of the thinking and experience of our very diverse caucus. That 
is a great loss to this debate and a great loss to our country.
  Mr. Speaker, the Democratic Party has made ensuring the dignity and 
security of our seniors a cornerstone of our mission for generations. 
Nearly 40 years, ago a Democratic Congress and the Democratic 
President, Lyndon Johnson, honored that mission by making Medicare the 
law of the land. Ever since then, America's seniors have known where 
Americans stand. We created Medicare, we want to protect it and 
strengthen it.
  Americas seniors have also known where Republicans stand. For 40 
years, they have waged war on Medicare. When Congress passed Medicare 
in 1965, only 13 Republicans in Congress supported it. Only 13 in 
Congress supported it. When Newt Gingrich and the Republicans tried to 
gut Medicare in 1995, President Clinton stopped them. That same year, 
Newt Gingrich made his intentions about Medicare clear. He said, ``Now, 
we did not get rid of it in round 1, because we do not think that is 
politically smart, but we believe it is going to wither on the vine.'' 
And tonight the Republicans want to deliver the final blow. On behalf 
of America's seniors and disabled, we must stop them.
  Recognizing the desperate need of America's seniors citizens, 
Democrats proposed a guaranteed, defined, affordable prescription drug 
benefit under

[[Page 30828]]

Medicare. Instead of joining us in this historic opportunity, 
Republicans offered up a Trojan horse, a deceptive gift intended to win 
their 40-year war against Medicare.
  Republicans said this is a first step toward a prescription drug 
benefit. This Republican plan is not a first step, it is a false step, 
it is a mistake. It puts profits for HMOs and big pharmaceutical 
companies over seniors, providing a $12 billion slush fund for HMOs and 
gives a $139 billion in windfall profits to the pharmaceutical 
companies over 8 years.
  The Republican plan does not lower costs for prescription drugs. It 
prohibits the government from negotiating for lower prices. It 
privatizes Medicare and pushes seniors into HMOs. It makes seniors pay 
more to keep the Medicare they know and trust. It does all of this for 
a deceptive plan that makes most seniors pay $4,000 out of their first 
$5,000 in prescription drug costs. How do you explain that to mom? You 
are going to get a new benefit, this is the Republican plan. And of the 
first $5,000 of prescription drugs cost, you, senior citizen of 
America, are going to pay the first $4,000.
  Nearly half of all Medicare beneficiaries, up to 20 million seniors 
and disabled Americans, will fall into a coverage gap, meaning they 
will pay premiums all year without receiving benefits all year. Under 
the plan most seniors will be worse off than before, and millions of 
retirees will lose their existing employer provided coverage.
  Republican priorities are clear: They place the special from interest 
of the HMOs and the pharmaceutical companies before the public interest 
of America's seniors and disabled. This is not the beginning of a real 
prescription drug benefit under Medicare. On the contrary, this is the 
beginning of the end of Medicare as we know it. The more seniors across 
America learn about the details of this scheme, the less they like it, 
and the more they want us to keep fighting for real prescription drug 
benefit that really answers their needs.
  Mr. Speaker, this is an hour of decision. Tonight there is own one 
way to improve this bill and that is to and to provide the benefit 
seniors need and deserve and that is to vote no. I urge my colleagues 
to vote against this Republican hoax. I urge them to send all of the 
conferees, Democrats and Republicans, to the conference room to produce 
a bipartisan bill that will be sustainable over time and meet the needs 
of our seniors and disabled. I urge them to stand with 40 million 
seniors and disabled Americans who look to us for help and hope at this 
defining moment.
  Speaking on the day when he signed Medicare into law, President 
Johnson said that this Nation's commitment to its seniors was part of a 
noble tradition that calls upon us never to be indifferent toward 
despair, never to turn away from helplessness, never to ignore or spurn 
those who suffer untended in a land that is bursting with abundance. 
Tonight the hopes of 40 million seniors and disabled Americans rest 
upon us. They have waited too long, fought too hard, endured too many 
broken promises, only to be sacrificed on the alter of the special 
interest. We cannot, we must not, and we will not abandon them now.
  Mr. TAUZIN. Mr. Speaker, in order to close this historic debate we 
yield the balance of our time to the distinguished Speaker of this, the 
whole House of Representatives, the gentleman from Illinois (Mr. 
Hastert).
  Mr. HASTERT. Mr. Speaker, I thank the gentleman from Louisiana (Mr. 
Tauzin). I also want to thank those many, many staff members who spent 
uncounted hours, night and day, to help make this bill possible. I 
especially want to thank my own staff member, Darren Willcox, who 
sacrificed many late nights and early mornings and long weekends 
despite having a wife and a baby boy at home. I want to thank Brett 
Shogren of the majority leader's staff, and many, many other young men 
and women who committed their time, dedicated their time to try to do a 
good job in this people's House.
  I want to thank those folks at the legislative counsel who spend 
untold hours of trying to craft the right language to make this 
legislation the right legislation for the American people, and those 
folks at the Congressional Budget Office who crunched numbers day after 
day after day to make things work.
  In this time and space of legislative arena, there are times when 
things come together. There are times of great opportunity. And there 
is a time for change.

                              {time}  0230

  This, indeed, is one of those times for that opportunity. This, 
indeed, is one of those times for great change. A poet once said that 
``things fall apart, the center cannot hold. The best lack conviction 
while the worst are full of passion and intensity.''
  For the good of our senior citizens and for the good of our Nation, 
the center must hold. The best must be full of passion and intensity. 
And today, we must pass this historic legislation.
  I want to thank all of those who have put aside their partisanship 
and worked together for the good of this Nation. I want to thank the 
conferees, especially the gentleman from Louisiana (Mr. Tauzin), the 
gentleman from California (Mr. Thomas), the gentleman from Texas (Mr. 
DeLay), the gentlewoman from Connecticut (Mrs. Johnson), the gentleman 
from Florida (Mr. Bilirakis) in the House, and Senator Frist and 
Senator Baucus and Senator Breaux of the Senate.
  They have worked long and they have worked hard on this product 
through many late nights and long weekends, and they deserve our 
gratitude.
  The third time is a charm when it comes to prescription drugs. This 
Congress under this leadership passed drug prescription legislation in 
the 106th Congress. The House passed a prescription drug bill only to 
see it die in the Senate. In the 107th Congress, we passed a 
prescription drug bill only to see it die in the Senate. And finally, 
we are poised to complete this long journey.
  When Medicare was first conceived, the baby boomers were young adults 
and most seniors got their health care from a doctor's visit or a trip 
to the hospital. Thus, those who constructed the program were not 
overtly concerned about long-term cost projections or about 
prescription drugs.
  Today, we face a different story. The baby boomers are now thinking 
about retirement, and they want their prescription drugs. Prescription 
drugs now make up more than a third of health care costs.
  This conference report makes two fundamental changes to the Medicare 
system. It makes it more sustainable in the future, and it provides 
seniors with a prescription drug benefit. Why do we have to make 
Medicare more sustainable in the future? Because if we do not, my kids 
and all those other young adults out there will be forced to pay 30 
percent of their salary in the next decade or two for the Medicare 
program. And I just do not think we can make that happen, and that will 
not sustain Medicare; and I do not think it is fair to them.
  So in this bill we start the process of making Medicare more 
sustainable. We means test the part B premium and index the deductible 
to inflation. We introduce free-market principles and give consumers 
more power to choose their health care. We include cost-containment 
measures so that if Medicare costs grow too quickly, the Congress and 
the President will be forced to confront that fact.
  Finally, we create health savings accounts which might be the most 
dramatic and exciting reform of our health care system in generations. 
These health savings accounts give consumers the ability to make health 
care choices. This will hold down skyrocketing health care costs and 
deliver better health care for our citizens and for our seniors.
  As we make these necessary financial reforms in Medicare, we also 
modernize the program with a prescription drug benefit. And after this 
legislation goes into effect, low-income seniors will never be 
confronted with the choice of

[[Page 30829]]

putting food on the table or paying for life-saving prescription drugs. 
Low-income seniors will finally have the benefit that will take care of 
their drug costs, and this will save the deposit money in the long run. 
For example, if a low-income senior has diabetes, the monthly cost of 
Glucophage, a drug that helps control that disease, is about $30 a 
month. But if diabetes is left untreated, a single hospitalization for 
renal kidney failure is about $6,700. The benefit is both penny-wise 
and pound-wise.
  It will also help the typical senior by cutting down their drug costs 
by 40 percent. And those seniors with high drug costs will save even 
more, up to 60 percent or more. In other words, this prescription drug 
benefit is a good deal for all seniors.
  This legislation has other important factors. It includes incentives 
to employers so that they will not drop their current plans. In fact, 
this bill will make it more likely that if you have coverage with your 
employer, that employer will continue to offer that benefit. It also 
includes vitally important help to rural America. And if you live in 
the cities or urban America, it is probably not a problem. But if you 
are trying to compete with your rural hospitals and keep doctors and 
hospitals going in rural areas, you know that is a problem.
  This bill solves the problem. It takes care of rural hospitals. It 
provides rural health care. That is something that many of us have been 
fighting for for a long, long time. Let me be the first to admit that 
this conference report is not perfect. The far left does not like it. 
And some of our friends on the far right do not like it. But let me 
tell you who does like it.
  The AARP has endorsed it. So has the American Hospital Association 
and the American Medical Association and almost every other major 
seniors organization and doctor and patient group.
  I urge my colleagues to put politics aside. I urge you to consider 
this piece of legislation for the good of this Nation. I urge you to 
stop and think when is the last time that we have really been able to 
change the paradigm of health care in this country. When is the last 
time that we have really had the chance to offer our seniors in this 
country a future for good health care, for good pharmaceutical coverage 
and for a chance to live and enjoy a great future.
  I ask for a positive vote.
  Mr. FILNER. Mr. Speaker, I rise today to say shame on this body for 
passing this reprehensible Medicare bill that has been rammed through 
Congress today by the Republican leadership.
  This legislation does nothing that its supporters claim it does. They 
claim that this bill will help seniors with their prescription drug 
costs and give them more choices in their healthcare. But actually, 
this bill does none of that. It does not provide a comprehensive, 
affordable or reliable prescription drug benefit. Further, it unravels 
the consistent, guaranteed healthcare coverage that seniors have come 
to expect under Medicare. This bill is so bad, that even some 
Republicans refused to support it. Opponents of this terrible 
legislation see through the smoke and mirrors that supporters are 
putting up and realize that this bill was not about helping seniors pay 
for their prescription drugs or giving them access to better care, but 
that this bill was actually about helping the bottom lines of private 
insurance companies, HMOs and the pharmaceutical companies.
  There are many, many bad provisions in this legislation, and I would 
like to highlight some of the worst of them here.
  One: Under this bill, Medicare as we know it is completely unraveled. 
First, Medicare Part B will be forced to compete with private managed 
care plans. This leaves the health of our seniors to the whims of 
private insurance companies and does not guarantee that all seniors 
will be receiving the same benefits across the country. That means 
seniors in my District in San Diego, CA, might have better coverage 
than seniors in New York. Or seniors in New York might have better 
coverage than those in San Diego--we just don't know--it's completely 
up to the private insurance companies and HMOs to decide how much 
coverage they want to provide. Not only is the amount of coverage going 
to vary, but so are the costs of the premiums. Again, that means 
seniors in San Diego might pay more than seniors in New York--or vice 
versa--depending on how much the private insurance companies and the 
HMOs decide they want to charge!
  Secondly, this bill would institute a ``means test.'' In layman's 
terms, that means that in 2007, the Medicare part B premium would be 
linked to income. This not only goes against the main tenet of 
Medicare--which grants coverage to everyone, regardless of income--but 
also, higher premiums create an incentive for healthier seniors to 
leave Medicare. This would leave only the sickest seniors in Medicare 
and drive up premiums even more.
  Two: The so-called prescription drug ``benefit'' is absolutely 
inadequate and actually decreases coverage for some seniors and can 
cost them more than they're paying right now. Supporters of this bill 
claim that the prescription drug benefit will help seniors cover the 
costs of their medications. However, there are so many problems with 
this benefit that it's hard to decide where to begin. First of all, 
this benefit does not even kick in until 2006. When it finally does 
begin, seniors are expected to pay a high deductible. Then, there is a 
piece de resistance of this so-called benefit: there is a big hole in 
coverage. Rather than providing continuous coverage throughout the 
year, this bill has a $2,850 coverage gap in which seniors don't 
receive any coverage at all. Half of America's seniors fall into this 
hole. The icing on the cake is that despite the fact that they would 
not be receiving coverage for part of the year, they are still expected 
to continue to pay the premiums.
  Additionally, more than 2 million retirees, who currently have drug 
coverage through their former employers, will lose that coverage. 
Because drug costs keep rising and this bill has no measures to keep 
drug costs low, it is very tempting for employers to simply drop their 
coverage and force seniors onto this inadequate drug coverage plan. 
Furthermore, rather than having Medicare kick in when a retiree reaches 
catastrophic coverage, this bill forces the employer-provided benefits 
to cover those costs--yet another reason for employers to pull their 
coverage.
  Three: This bill explicitly prohibits the government from negotiating 
with drug companies for lower drug prices. One of the greatest 
strengths of a prescription drug plan under Medicare is that it could 
reduce drug prices for participants using the large number of 
participants in the Medicare program to bargain with pharmaceutical 
companies for better prices on their products. Yet this bill denies 
Medicare participants those lower costs, ensuring continued 
skyrocketing prescription drug prices.
  It is for those reasons--and many many more--that I could not support 
this poison pill for Medicare and a placebo of a prescription drug 
benefit.
  Mr. THORNBERRY. Mr. Speaker, like most bills brought before us, this 
bill is a mixture of provisional I support and provisions I oppose. 
Unlike most bills brought before us, it affects every American and will 
have significant, long-term consequences for our Nation.
  I believe that providing access to quality health care is one of the 
most formidable challenges facing our Nation now and in the decades to 
come. The retirement of the baby boom generation, which begins in less 
than 8 years, will make that challenge enormously difficult.
  When the House considered its version of this bill in June of this 
year, I said that our objective should be to ``update and strengthen 
Medicare so that it does a better job of providing health care for 
seniors and at the same time put Medicare on a sound financial footing 
so that it can be sustained through the baby boom generation 
retirement.'' This conference report does begin to update Medicare by 
adding prescription drug coverage. It does little to put Medicare on a 
sound financial footing.
  Making prescription drug coverage available to all seniors is very 
important. Not only will that benefit keep seniors from having to 
choose between buying medicines and other necessities of life, it will 
help them stay healthier. As they stay healthier longer, hospital and 
other medical expenses should be less.
  This bill includes reforms of the system which are also important. 
Allowing all Americans to choose Health Savings Accounts gives everyone 
a new option to pay for health care and could help stem the tide of 
rising insurance rates and rising health care costs. Beginning to 
consider income in calculating Part B premiums is a significant change 
in the law. Other provisions related to provider reimbursements and 
reducing the discrimination against rural health care providers are 
worthy of support.
  I am concerned that the total cost of this bill is vastly 
underestimated, as has happened before in Medicare. There are payments 
or tax credits for virtually every group interested in health care, yet 
of all of the groups affected by this bill, I worry that the interests 
of those paying the bills, especially future taxpayers, are given the 
least consideration.

[[Page 30830]]

  So, we are left weighing the benefit of modernizing Medicare and some 
reforms versus the danger that this bill will hasten the day of 
Medicare' collapse. It is not an easy judgment to make.
  It is clear that if we do nothing, millions of seniors will go 
without the prescriptions they need and that none of the reforms 
essential to Medicare's survival will occur. We must begin somewhere. 
Reluctantly, I have concluded that this most imperfect bill is at least 
a place to start.
  If we are honest, we have to admit that this bill is something of a 
gamble. We are betting that the limited reforms begun here will 
flourish and work to strengthen Medicare for the 21st century. If we 
are wrong, the added benefits and payments may sink the entire program. 
Tonight, I choose to vote with my hopes rather than my fears, 
prayerfully mindful of both my parents and my children.
  Mr. UDALL of Colorado. Mr. Speaker, I want to support a Medicare drug 
bill, but I can't support this bill. Instead of giving us a foundation 
to build on, I believe it will compromise the effectiveness of a very 
popular healthcare program for seniors in order to deliver an 
inadequate, unreliable and unfair drug benefit. Under this bill seniors 
will pay higher premiums, higher deductibles and higher prices for 
drugs. It will force seniors into HMOs, and millions of seniors will 
lose drug benefits that they get through their retirement plans. 
Instead of crafting a drug bill, the Republican leadership has used the 
opportunity to dismantle Medicare and turn it over to private insurance 
and drug companies.
  I have long believed that Congress should act to help seniors with 
their prescription drug expenses. Congress should give seniors greater 
choice in coverage, but it should not force seniors into HMOs in order 
to get a drug benefit. Colorado could be chosen as part of the 
demonstration project under this bill, which would force seniors into 
HOMs in order to get the drug benefit. According to a recent analysis 
by the Department of Health and Human Services, most seniors would see 
increases in their premiums with some facing increases as high as 88 
percent. Colorado seniors would pay some of the highest premiums in the 
country. For example, seniors in Adams County, CO would pay $100 a 
month while seniors in some parts of North Carolina will pay $58 a 
month. Why should Coloradans pay higher premiums than seniors in other 
parts of the country for the exact same benefit?
  It's no wonder that seniors in my district are skeptical about this 
plan. Let's not forget, we tried private competition in Medicare when 
HMOs were allowed to participate in the program as a result of 
legislation that passed in 1997. Seniors were told that managed care 
was better able to deliver healthcare services to them. Managed care 
aggressively courted seniors to join Medicare+Choice plans and then 
dropped them because they couldn't make a profit. That left millions of 
seniors searching for doctors and coverage. Now, this bill includes 
billions of dollars in subsidies to managed care to provide coverage. 
If privatization is such a good idea, why do insurance companies need 
these large subsidies in order to participate in Medicare?
  There are a few provisions in this bill that I support, such as the 
payment increases for hospitals and physicians and other providers. In 
fact, I have consistently voted to increase provider payments and I 
have cosponsored legislation to change the flawed formula upon which 
these payments are based. But those payments should have been brought 
up separately rather than as part of the Medicare bill.
  It is grossly ironic that Medicare will pay for a senior's care 
following a stroke but will not pay for the anti-hypertension drugs 
that prevent them. The time is ripe to pass a Medicare prescription 
drug benefit, but not as proposed in this legislation. I had hoped that 
we would vote on a bill that created a fair, workable, financially 
sound prescription drug benefit. But I am not willing to set in motion 
forces that will lead to the destruction of a program that seniors and 
the disabled have trusted for nearly 40 years in exchange for a feeble 
prescription drug benefit. We should work to get it done right rather 
than get it done right now.
  Mr. BUYER. Mr. Speaker, the measure before the House tonight, the 
conference agreement on the Medicare Prescription Drug and 
Modernization Act, H.R. 1, is not a perfect bill. But, it is also not 
the bill that I opposed several months ago when the House first 
considered the measure. As with any conference agreement, this bill is 
a product of compromise and negotiations. It is an improvement in the 
House-passed bill in some respects, a disappointment in others. 
Nonetheless, I think it is time to end the debate on a prescription 
drug plan in Medicare and move forward.
  While this bill has some troubling flaws, it does take major steps 
forward in improving access to health care of our nation's seniors. It 
serves as a blueprint for enhancements to Medicare that will enable 
Congress to resolve the long-term solvency issues in Medicare's 
structure.
  Reform cannot occur in a vacuum. We must be vigilant as we take these 
necessary steps to reform Medicare to provide greater choice and health 
care services to beneficiaries.
  This measure will require close scrutiny by Congress to oversee the 
implementation of the drug plan to insure that it provides cost 
containment and prevention of drug overutilization. The provisions 
before us to enhance Medicare are likely to require annual maintenance 
by Congress.
  If the provisions of this bill that expand Medicare Advantage plans, 
that improve Medical Savings Accounts in Medicare, and that create 
Health Savings Accounts, are successful in the marketplace, 
beneficiaries will have alternatives to government-run health care and 
greater choices to meet their health care needs.
  I applaud the inclusion in this bill of provisions to address the 
needs of rural providers, especially rural hospitals. Under this bill 
rural hospitals will see an equalization on reimbursement on inpatient 
care as compared to their urban counterparts. This bill includes 
provisions which I have urged that give Critical Access Hospitals more 
flexibility in their bed limits. I also applaud the conferees for 
including a provision that will enable hospitals to seek a 
reconsideration of their classification. The bill also extends Medicare 
cost contracts until Medicare Advantage plans are available. These are 
good provisions that will directly address patient care in my district.
  I am also pleased to see the inclusion of regulatory reforms that 
this House has passed twice.
  Finally, the bill gives seniors help with their prescription drugs 
almost immediately by authorizing a discount drug card. In a serious 
level of effort, I worked with four of my colleagues in drafting 
legislation to add a drug card to the Medicare program. Under our 
approach seniors would have been able to choose from a variety of 
discount drug cards available at a very low annual fee. We also 
included funds for seniors, based on income, to help seniors pay for 
drugs; a catastrophic limit; and a mechanism for seniors to save and 
for others to help seniors pay for their drugs.
  Frankly, I think this is a better approach and I would have preferred 
to see it made a permanent feature of this bill, rather than expiring 
at the end of 2 years. Nonetheless, the discount drug card provisions 
of H.R. 1 do incorporate many of the ideas that my colleagues and I 
advocated. It would be my hope that Congress will see the wisdom of 
extending the drug card program.
  I am troubled by the present fallback provisions, by the extent of 
the subsidies permitted under the bill, and by the uncertainty as to 
whether Medicare will be adequately reimbursing physicians for 
providing care to patients needing injectable drugs. I am also 
concerned that this bill still does not effectively keep the costs in-
line with the ability of the taxpayers to fund the benefits.
  Nonetheless, the bill, on the whole, is more positive and I am fully 
aware that Congress will have to tackle difficult issues down the road, 
however, I will support H.R. 1, to add a prescription drug benefit to 
Medicare and create long-term solutions to solve access, choice, and 
solvency of Medicare when baby boomers become seniors.
  Mr. BEREUTER. Mr. Speaker, this Member wishes to add his support for 
the Medicare conference report and would like to commend the 
distinguished Chairman of the House Ways and Means Committee (Mr. 
Thomas); the distinguished Chairman of the House Energy and Commerce 
Committee (Mr. Tauzin); and the other Medicare conferees for their 
leadership, expertise, and good efforts on this comprehensive Medicare 
reform package. This Member would especially like to thank the 
distinguished gentleman from California (Mr. Thomas) and his staff for 
the time he spent briefing this Member on the rural health provisions 
as Medicare conference negotiations were taking place and for his work 
to bring greater equity to the rural health care delivery system.
  This measure may well be one of the most complex and important bills 
that this Member has ever had to consider during his tenure in 
Congress. Although the conference report lacks immediate controls on 
the high cost of pharmaceuticals--the market-oriented and pro-
competition cost-containment provisions provided for the existing 
Medicare program are critically important reforms. The conference 
report makes Health Savings Accounts available for the first time ever 
to all Americans, and includes the undoubtedly controversial, but 
necessary means-testing of Part B premiums on a sliding scale, 
beginning at

[[Page 30831]]

$80,000 (for singles). The rural health care reforms are also 
exceedingly important for millions of Americans. The conference report 
is certainly not perfect, for the prescription drug benefits may be 
both unaffordable and a huge disappointment to the intended 
beneficiaries. Yet, the Medicare reform and greater Medicare equity for 
citizens of rural and non-metropolitan areas make this conference 
report on H.R. 1 worthy of an ``aye'' vote. Congress will have ample 
time and opportunity to address concerns, enhance, revise, and improve 
upon this historic legislation.
  Until this year, there has been nothing but gridlock and delay in 
terms of how to reform the Medicare program. The Medicare conferees 
worked long and diligently to develop the Medicare reform agreement 
before us today. We cannot afford to let this prospect of Medicare 
reforms slip away.
  Mr. Speaker, the rising cost of prescription drugs has become an 
issue that simply must be addressed. Senior citizens in Nebraska and 
throughout the United States should not have to compromise their 
quality of life or their health because the cost of their prescriptions 
is more than their income allows. Without an end to the ever higher 
prescription drug cost--the product largely of huge international cost-
shifting onto the backs of American consumers--the prescription drug 
benefits we are adding will cost more than the $400 billion allocated--
it will quickly be too expensive for our Nation to bear, even with 
Federal taxpayer funds. Therefore, this Member is very concerned that 
the measure lacks immediate restraints on the high cost of 
pharmaceuticals.
  This Member is extraordinarily disappointed, but not surprised, with 
the intentionally unimplementable reimportation language included in 
the conference report. Drug re-importation from Canada was not the best 
approach to meeting the problem of escalating drug costs and it could 
be only an interim approach, but it is the only tool now available. The 
provisions of the bill allow for the importation of drugs from Canada, 
but the measure contains language in which the Department of Health and 
Human Services can say it cannot responsibly or legally implement the 
provision, as it has done on two previous congressional efforts. This 
language is the ``poison pill,'' and it is wholly unsatisfactory.
  Mr. Speaker, it is additionally important that the conference 
agreement authorizes $50 million for fiscal year 2004 for the Agency 
for Healthcare Research and Quality (AHRQ) to conduct research on 
health care outcomes, comparative clinical effectiveness, and 
appropriateness of health care items and services--including 
prescription drugs. This Member has been a strong advocate for such 
research, as evidenced by his amendment to the Labor, Health and Human 
Services, and Education appropriations bill (H.R. 2660).
  Americans deserve the best health care for their dollar. Clinicians, 
patients, and those financing health care services need credible, 
objective information on the benefits, risks, and costs of prescription 
drugs so that they can make informed decisions about the prescriptions 
they consume and prescribe. Consumers need information regarding the 
effectiveness, quality, and cost-effectiveness of new drugs, in 
comparison with existing alternatives, especially when new drugs can 
cost much more than those now on the market. This Member is pleased 
that the conference report language authorizes the AHRQ to conduct such 
research and that comparative clinical effectiveness is referenced but 
is concerned that cost-effectiveness is also not mentioned.
  Mr. Speaker, in addition to adding a long overdue prescription drug 
benefit to the Medicare program, the conference report provides for 
robust reform of the rural health care delivery system. It is the best 
bill ever for the health care of citizens living in rural and non-
metropolitan areas; it moves them to a more equitable position with 
respect to their urban counterparts.
  This Member is extremely pleased that the Medicare conference report 
includes a substantial amount of funding specifically for rural areas 
and small communities. As the Interim Co-Chair of the House Rural 
Health Care Coalition, this Member has been working diligently to 
address rural health care issues and the needs of those individuals who 
practice, work, and live in rural areas. This conference report 
includes funding that is dedicated to assisting community hospitals, 
outpatient facilities, home health agencies, skilled nursing 
facilities, ambulance service providers, rural physicians, and other 
skilled health professionals. Such funding is crucial for cash-strapped 
rural facilities which are near a breaking point and in need of urgent 
aid.
  This Member is especially pleased that the Medicare conference report 
includes language to address the significant differential in Medicare 
reimbursement levels to urban and rural skilled health care 
professionals. For the past 2 years, this Member has introduced the 
Rural Equity Payment Index Reform Act to assure that physician work is 
valued, irrespective of the geographic location of the physician. The 
Medicare conference report establishes a 1.0 floor on the Medicare 
physician work adjuster from 2004 to 2006, thereby raising all 
localities with a work adjuster below 1.0 to that level. This is a huge 
victory for this Member, my very able legislative assistant, Ms. 
Michelle Spence, for Nebraska, and for all Medicare localities with a 
physician work adjuster below 1.0.
  Several other provisions are included in the Medicare conference 
report to assist rural areas physicians and other skilled health 
professionals. For example, the measure protects senior citizens' 
access to physicians by replacing a 4.5 percent across-the-board 
physician payment cut--scheduled to take effect on January 1, 2004--
with 2 years of payment increases. Additionally, this Medicare 
agreement provides a five percent bonus payment for primary and 
speciality care physicians who practice in scarcity areas.
  This Member is also pleased that the Medicare conference report 
addresses hospital payment disparities to ensure that facilities in 
rural areas and small cities can stay in business and continue serving 
patients who need care by permanently extending the standardized base 
payment. This policy will help maintain access to care in rural and 
less populated urban areas of the country by better aligning hospital 
payments to actual costs. The estimated impact of eliminating the base 
rate differential will result in $26.7 million over 10 years for 
Nebraska hospitals in the First Congressional District, according to 
the American Hospital Association.
  Additionally, the Medicare conference report lowers the labor share 
of hospital wage index to 62 percent. This change will increase 
inpatient reimbursement for many rural hospitals and will more 
accurately reflect the labor costs of many rural facilities. According 
to the American Hospital Association, this provision would bring $3.3 
million over 10 years to the First Congressional District of Nebraska.
  Several other provisions are included in the Medicare conference 
report to address rural hospitals. For example, the agreement increases 
disproportionate share hospital payments for small rural and urban 
hospitals and increases critical access hospital payments to 101 
percent of reasonable costs.
  Mr. Speaker, in closing, this Member supports the Medicare conference 
report. It finally gives the American people some of the critical 
reforms that are essential if the system is to avoid fiscal disaster or 
unaffordable burdens on American employers and employees. And, on what 
is a gamble, at least until we reduce the huge international 
pharmaceutical cost-shifting onto Americans, it will provide senior 
citizens with access to prescription drugs when they need them most and 
it will greatly improve health care for Americans living in rural 
areas.
  Mrs. MALONEY. Mr. Speaker, the seniors in my district have made their 
views on Medicare clear.
  They believe that it should provide the same coverage for 
prescription drugs that it does for doctors' appointment and hospital 
stays. And they think that they should no longer pay the highest 
prescription drug prices in the world.
  Unfortunately, however, the bill before us will provide inadequate 
benefits that would leave half our seniors paying more out of pocket 
for prescription drug coverage than they do now. And it contains a gap 
in coverage that will leave half of seniors without any drug coverage 
for part of the year.
  Just as bad, this bill will impose a global ceiling on the size of 
Medicare. If the overall cost of the Medicare program exceeds a pre-
determined cap, Congress will immediately be forced to slash benefits 
or hike premiums for those currently on Medicare.
  To add insult to injury, this bill will undermine initiatives to cut 
the cost of prescription drugs. It would bar by law any effort by the 
Secretary of Health and Human Services to try to negotiate with 
pharmaceutical companies to lower prescription drug prices.
  This bill will undermine and ultimately destroy Medicare as we know 
it.
  It's not a magic potion. It's a poison pill.
  I urge my colleagues to vote ``no.''
  Mr. LANGEVIN. Mr. Speaker, I rise today gravely disappointed by, and 
opposed to, the Medicare Modernization and Prescription Drug Act of 
2003. The 108th Congress has squandered our best opportunity yet to 
provide a meaningful prescription drug benefit for our nation's 
seniors. I am outraged that the republican leadership has taken 
advantage of the public's cry for medication coverage. They have used 
the demand to exploit the elderly, funnel money to drug and insurance 
companies and privatize Medicare. Sadly, this debate

[[Page 30832]]

is no longer simply about a prescription drug benefit. This debate is 
about the survival of the health care system that has been serving and 
protecting our seniors since 1965.
  In a striking divergence from the universal nature of Medicare, the 
conference report we are voting on today establishes a system wherein 
seniors rely on private, drug-only companies to administer their drug 
coverage. Each of these companies will develop their own rules about 
premiums, deductibles and what medicines are covered. The standard this 
bill sets for the companies only offers 75 percent coverage of the 
costs up to $2,250--and no coverage at all until the expenses then 
reach $5,100. During that significant gap in coverage, seniors will 
still be responsible for paying a $35 monthly premium. Even more 
infuriating, that premium will not count toward their out of pocket 
expenses, making it take even longer for them to reach the catastrophic 
level. The Republican conferees claim to offer help for the poor, and 
indeed, premium subsidies are available to individuals earning less 
than $6,000 a year or couples earning less than $9,000. But these 
vulnerable, low-income seniors must first meet a strict assets test, 
where cars, burial plots and even wedding rights will be counted as 
assets. Additionally, I remain deeply concerned that the legislation 
fails to include a meaningful fallback plan seniors can rely on if 
private companies fail to emerge in their area, an all too likely 
scenario that it is our duty to protect against.
  The prescription drug component of this bill contains a particularly 
troubling provision that strictly forbids the Secretary of Health & 
Human Services from using the bulk purchasing power of Medicare 
beneficiaries to negotiate for lower drug prices for senior citizens--a 
tactic that has proven effective in the state programs, as well as 25 
other industrialized nations. America's seniors have made it clear that 
they want the government to assist them in obtaining their prescription 
drugs at a fair price. It infuriates me that that we have over 40 
million people with a common and basic, need, yet instead of taking 
advantage of that power to secure lower prices for the most rapidly 
increasing component of health care, the Federal Government, under the 
proposal put forward, would outlaw that practice. This tremendous 
missed opportunity makes it clear to me that this bill was written with 
the interests of drug companies, not America's seniors, in mind.
  The problems with this conference report go far beyond the inadequacy 
of the drug benefit. This bill not only fails to meet the needs of 
seniors and jeopardizes the retiree coverage used by 12 million 
Americans, it also lays a strong foundation for the demise of the 
Medicare program as we know it. Beginning in 2010, this agreement will 
expose millions of seniors to new cost and benefit uncertainties in as 
many as six large metropolitan areas, possibly including my home state 
of Rhode Island and neighboring Massachusetts.
  This vast demonstration project, which will involve up to 7 million 
seniors, will subject Medicare to competition with private companies, 
coercing seniors into HMOs and private plans. These private companies 
will be given huge financial incentives to offer health coverage for 
seniors, funneling critical resources away from Medicare and those who 
rely on it. If a senior wishes to stay in the Medicare program, he or 
she will be required to pay the difference between the cost of the 
private plan and the cost of Medicare--which will, no doubt, skyrocket 
as private plans court the healthier seniors out of Medicare, leaving 
Medicare the more costly task of providing for a sicker, poorer risk 
pool. This plan breaks the fundamental promise of Medicare. It replaces 
a guarantee of quality health care with increased premiums, provides a 
voucher for health insurance, and leaves seniors and people with 
disabilities to fend for themselves in a market where they may not be 
able to find a health care plan that meets their needs. Medicare was 
created in 1965 because the private industry was unable to provide 
adequate health coverage for this population. The virtue of the system 
is that it creates a large risk pool. Injecting private competition, 
and subsidizing that competition with billions of taxpayer dollars, 
will leave the healthiest seniors with the ever-changing and unstable 
options of private plans, and will resign those who are not as 
fortunate, our most vulnerable population, to an even more uncertain 
fate.
  Seniors in Rhode Island, and no doubt the rest of the country, will 
see through this scheme. My constituents remember the devastating 
effect of the abrupt departure of Harvard Pilgrim, an HMO that covered 
over 150,000 Rhode Islanders. The scramble to find a health insurance 
plan that would allow patients to keep their doctors, and the struggle 
to understand new sets of benefits that followed Harvard Pilgrim's exit 
from our state would be replicated on a regular basis in the regions 
affected by the so-called demonstration project contained in this bill.
  I must also touch upon the issue of provider relief. I am a strong 
supporter of doctors and hospitals that serve Medicare beneficiaries, 
and voted three times this year in favor of striking the premium 
support provision from this bill and using that money to update 
provider payments instead of subsidizing private companies. The 
conferees failed to take this approach, instead providing some 
temporary relief to providers for the upcoming year, but no long term 
fix to the systemic problem that plagues doctors and hospitals year 
after year. Providers are already overburdened by Medicare-related 
paperwork and receive lower-than-average reimbursement rates for their 
services. Should the premium support provisions in this conference 
report become law, providers will be forced to negotiate new terms for 
payment annually with every private plan that emerges to serve Medicare 
beneficiaries in a region. This bill signs away the rights and 
responsibilities Congress currently has to these providers, leaving 
decisions about provider payments up to the CEOs of insurance 
companies. The high turnover rate of providers in participating 
Medicare + Choice plans signals the instability this will cause, for 
providers and patients alike.
  In this year's debate over Medicare, once again, Congress has lost 
sight of what the public has asked for, and what American seniors need. 
Our seniors are choosing between paying their rent of buying food and 
obtaining the medication they need to stay alive. They need relief from 
prescription drug costs. They do not need the additional challenges, 
burdens and costs of navigating through a system of HMOs, subjected to 
a different plan, a different doctor and higher premiums each year. Our 
Medicare providers need a fair payment system over the long term. All 
Americans need their government to take action against the soaring cost 
of prescription drugs. Given the opportunity to make a difference in 
each of these areas, the Republican leadership chose to put their 
resources and their trust in the hands of insurance companies and drug 
companies. This Is a matter of priorities and principles. I urge my 
colleagues to make American seniors our priority, vote no on the 
conference report and immediately begin to take meaningful steps to 
solve these problems.
  Ms. HOOLEY of Oregon. Mr. Speaker, over the last 7 years, Oregon 
seniors have told me that their top concern is the high cost of 
prescription drugs coupled with the lack of coverage for these 
lifesaving medicines under the Medicare program.
  Regrettably, the bill before us today does nothing to address the 
high cost of drugs, and it comes at too high a price for coverage. Many 
seniors would lose the expanded coverage they currently have through 
their retirement and many others couldn't afford the high premiums, 
deductibles and gaps in coverage.
  Despite the hard work and good intentions of many members of Congress 
on both sides of the aisle, we have lost the forest for the trees.
  And so I rise today in opposition to the conference report on H.R. 1.
  In August, I sat in the House gallery with some guests as the 
reimportation bill came to the floor. We sat with a group of interns 
and junior staffers. Along the back wall was a line of representatives 
of the pharmaceutical industry. It was an interesting mix.
  From that unique vantage point, we watched members on the floor who 
were not speaking to represent ``sides of the aisle,'' but who joined 
together across the aisle to form the People's House. It was an 
interesting perspective on the situation.
  You couldn't necessarily tell what anyone's party affiliation was by 
the impassioned way they spoke about an issue that cuts across party 
lines. The vast majority of us were adamant about fighting for the 
people we represent back home who are no longer willing to tolerate the 
fact that people in Mexico and Canada can get their drugs for less than 
Americans.
  That bill passed overwhelmingly, and yet this conference report has 
failed to include drug reimportation. It has failed to address the 
elephant in the middle of the living room: the high cost of drugs.
  Seniors can't afford drugs, and they can't afford high priced 
coverage, or loss of coverage they currently enjoy.
  Unfortunately, when we were closest to getting agreement on making 
medicines more affordable for all of the Nation's seniors, the 
pharmaceutical companies, who make the lifesaving drugs that patients 
need, killed every attempt to allow Americans to benefit from the same 
low drug costs that other countries enjoy.
  They also made sure that this legislation specifically prohibits the 
Medicare program

[[Page 30833]]

from negotiating the prices of drugs, a power that even other 
government agencies, such as the Department of Veterans' Affairs, have. 
Why? Because seniors would finally have the leverage to lower drug 
costs for themselves in this country. They would make one heck of a 
purchasing pool.
  And, when we were closest to getting agreement on improving coverage 
for everyone, the conferees failed to adequately protect retirees' 
health coverage. Unfortunately, somewhere along the way we forgot that 
this isn't just a pharmaceuticals bill, this is a seniors' bill.
  We lost sight of what senior's struggle with most . . . drug costs 
and the cost of coverage. And believe me, seniors themselves have 
noticed that we've lost sight of them.
  Take 79-year old Ruth Beale of Portland who was just diagnosed with 
Parkinson's disease who writes: ``I still work 3 days a week as a 
companion to a 103 year-old. This gives me just enough cash to pay the 
$300/month for my prescriptions. Of course that doesn't include the 
pain medication for the Parkinson's, my doctor gives me free samples 
when she can, though sometimes she runs out.
  My Social Security check is barely enough to cover rent, (and I live 
in a subsidized senior apartment), food and the $72 per month for my 
Medicare HMO premium. Under this plan, I wouldn't get any help for my 
drug costs. I really can't afford to pay any more than I do now. So I 
guess I'll just keep on working until I can't anymore--I'm going to 
give this Parkinson's a run for it's money though.''
  And God bless her.
  Although Dorothy Patch of Salem has supplemental insurance, she still 
pays over $230.00 per month out of pocket for her prescription drugs. 
Dorothy is concerned about being pushed out of the coverage.
  Dorothy figures that she would actually pay more for her coverage if 
this legislation passes. Why?
  1. Only 75 percent of her drugs would be covered up to $2,250 per 
year.
  2. From $2,250 to $5,100 Dorothy would fall into the ``donut hole'' 
and not receive any coverage at all, while she is still responsible for 
paying a $250.00 deductible and $35.00 monthly premiums.
  3. Even though under her current plan, Dorothy is paying $230.00 per 
month, there is no donut hole in her coverage and she is covered no 
matter how high her drug costs become per year.
  4. She is using a fee for service system and does not want to be 
forced into an HMO.
  The truth of the matter is that people who currently have no coverage 
would gain a little at a very high price, a cost that many who have 
contacted me say they cannot afford. For many in the district I 
represent, this legislation is a step backwards. For others, it is a 
sore disappointment that we were unable to slay the giant and make 
reasonably priced medicines within their grasp.
  At the beginning and in the end, for me, this issue has always been 
about the high cost of drugs and the need to affordably expand 
coverage. Regrettably, this bill prohibits ways to lower drug costs for 
American seniors and, for many, the coverage provided in the bill comes 
at a high price they simply cannot pay.
  I urge my colleagues to reject this bill, go back to the negotiating 
table and give seniors what they really need: affordable drugs and 
affordable drug coverage.
  Mr. MATSUI. Mr. Speaker, I rise to express my strong opposition to 
the Medicare conference report before us today. It shortchanges seniors 
who have waited far too long for a comprehensive, affordable 
prescription drug benefit and it undermines the Medicare coverage they 
have counted on for almost four decades.
  First, the drug benefit in this bill is woefully inadequate. Seniors 
will have to pay a $250 deductible before they receive any benefit, and 
there is a significant gap in coverage, or ``donut hole'', where 
seniors will continue to pay monthly premiums but receive no assistance 
towards the cost of their drugs. In fact, a senior with $5,100 in 
annual drug costs would pay $4,020 of that cost out of their own 
pocket.
  The fact that seniors have to pay 80 percent of their first $5,100 in 
drug costs is appalling. But, it doesn't stop there. This bill does 
nothing to lower drug prices. To the contrary, it explicitly prohibits 
the government from using the collective purchasing power of more than 
40 million seniors to negotiate lower drug prices. So, not only does 
this bill make seniors pay 80 percent of their first $5,100 in drug 
costs, it prevents the use of reasonable tools to bring those costs 
down.
  Now, let me address for a moment the 12 million retirees who already 
have health insurance from their former employers. The Congressional 
Budget Office estimates that this bill will cause 2.7 million of them 
to lose their existing coverage. This happens because the bill excludes 
employer contributions from counting towards the prescription drug 
catastrophic cap. This will incentivize employers to reduce their 
coverage to the level in this bill or drop it altogether to avoid 
having to pay the cost of prescription drugs in the donut hole.
  Finally, this bill undermines the fundamental commitment of Medicare 
to seniors. Beginning in 2010, Medicare will be forced to compete with 
private companies for the provision of all Medicare and prescription 
drug benefits. Often referred to as ``premium support'' or 
``privatization'', this provision shifts Medicare from the guaranteed, 
defined-benefit program it currently is to a defined contribution plan. 
Under this legislation, privatization is aided by almost $20 billion in 
subsidies to insurance companies and HMO's, creating a competitive 
advantage that allows them to attract healthier seniors, leaving sicker 
or chronically ill seniors in Medicare. The result will be a Medicare 
program that is unaffordable for the seniors who need it the most.
  Mr. Speaker, as we consider the merits of this legislation, it is 
critical to look at the history of health coverage for seniors in this 
country. Medicare was created in 1965 because seniors were unable to 
find health insurance in the private marketplace. The bill before the 
Congress today would return us to that very same scenario and I urge my 
colleagues to vote against it.
  Mr. CASTLE. Mr. Speaker, I rise today in support of the Medicare 
Prescription Drug Conference Report, and thank all the Conferees for 
their dedication to providing relief for our seniors. This landmark 
legislation updates Medicare and finally brings the program into the 
21st Century by modernizing the program and providing a prescription 
drug benefit. While not perfect, this bill presents us with an historic 
opportunity of providing 40 million Medicare beneficiaries with relief 
in the face of rising prescription drug costs. Every member of this 
body has identified health care reform as a top priority and now we 
have the opportunity to make progress. The reality is clear--every year 
we postpone this debate and fail to compromise on a Medicare and 
prescription drug bill, while the burden of drug costs on seniors 
continues to increase.
  In 1965 when the Medicare program first began, the average senior's 
spending for prescription drugs was $65 a year. In 2002, overall 
spending had risen to $2,149--a 35-fold increase. The average retail 
prescription price increased more than three times the rate of 
inflation from 1998 to 2000. Over 60 percent of seniors spend more than 
1,000 per year on prescription drugs and of those seniors, 17 percent 
spend more than $5,000. And with 80 percent of retirees using a 
prescription drug every day, the expense for many is out of reach. 
These statistics clearly show the transition of patients relying mostly 
on hospitals and physician for their health care needs to patients 
relying more on prescription drugs as measures for health treatment and 
prevention.
  The bill aims to make prescription drugs more affordable and more 
accessible by creating a voluntary prescription drug benefit. For the 
first time, since the creation of the Medicare Program, seniors, no 
matter where they live, will be able to receive financial assistance to 
help pay for these drugs, which are becoming increasingly integral to 
disease prevention, management and treatment. Seniors can keep whatever 
drug coverage they have now, choose a private plan or stay in the 
traditional Medicare program.
  Once the benefits is in place, Medicare will pay 75 percent of 
seniors' drug costs up to $2,250 per year, with a $250 deductible and a 
monthly premium of $35. With the CBO estimate indicating that the 
average senior will spend $1,891 on drugs in 2006, I think most seniors 
will find this to be a strong improvement. Importantly, this 
legislation provides the most generous benefit to the lowest income 
seniors. These seniors do not pay a premium, nor do they have a 
deductible and there will not be gaps in coverage for the drug benefit.
  This bill also takes strong steps towards preparing Medicare for 
future challenges, such as being equipped to meet the needs of retiring 
baby boomers. We offer new preventatives measures including an initial 
physical and certain preventative benefits such as diabetes and 
cholestrol screening as well as chronic care disease management. These 
common sense reforms are long over due--who can believe that Medicare 
was not covering an initial physical for our seniors? Encouraging 
beneficiaries to participate in preventive and early detection programs 
can not only improve their immediate health, but has potential to save 
billions in future healthcare costs.
  Another key component of this legislation are incentives for 
employers to retain and enhance retiree coverage. During the debate in 
both the House and Senate a significant

[[Page 30834]]

amount of time focused on employer-based coverage. With increasing 
costs of health care as a whole, it is logical that employers are 
looking for a way to reduce their overhead. Most likely, retirees who 
tend to be more costly than younger, healthier workers, are targeted 
for cost cutting measures. These are concerns that provisions would be 
included in this legislation to allow employers to drop coverage based 
on age, but fortunately, due to the work of many, that did not happen.
  One-third of all Medicare beneficiaries currently have prescription 
drug coverage through their former employers. Retirees want to keep 
that coverage and frankly, I believe they should be able to make that 
choice for themselves. This legislation provides a percentage subsidy 
to employers who maintain coverage for their retirees, which also saves 
Medicare money. Specifically the legislation will provide a federal 
subsidy to employers equal to 28 percent of drug spending by their 
retirees between $250 and $5,000. This applies not only to private 
companies, but also to state governments, and unions, like teachers 
unions, which often have very generous retiree packages. Of course, 
this is not a fail-safe solution. The higher costs associated with 
retiree health care coverage is an expensive matter for most 
corporations, unions and other providers. But, we hope that these 
incentives will help curtail the problem.
  Importantly, this legislation also contains numerous provisions 
intended to speed the entry of generic drugs into the market by 
preventing multiple 30-month stays by brand drugs and incentives for 
generic manufacturers to challenge weak or inappropriately listed 
patents. Generic drugs often provide consumers with a low cost 
alternative and I hope that the medical community will continue to make 
efforts to inform patients about the availability of generic drug 
options.
  We also address the reoccurring problem of physician fee cuts by 
increasing reimbursements by 1.5 percent instead of earlier proposals 
to cut them by 4.5 percent. I have spoken to a lot of doctors in 
Delaware who said these cuts were likely to put them out of business. 
With the rising cost of malpractice premiums compounded by cuts in 
reimbursements, some physicians may have already been forced to close 
their doors, which clearly impacts all of us. However, this is only a 
temporary fix. We must now move forward to fix this physician fee 
formula that was laid out in the Balanced Budget Act so doctors are not 
strung along year in and year out worrying about this potential cut. I 
hope to work with my colleagues to ensure this formula is fixed in the 
coming years.
  This legislation is not perfect and no one here today will tell you 
that it is. One of the major issues missing from this bill is a good 
faith provision allowing the reimportation of prescription drugs. 
Despite the overwhelming support in the House for true reimportation, 
this bill simply encourages the status quo by requiring the Secretary 
of Health and Human Services to certify the safety of these drugs 
coming from Canada. Essentially this is the current law of the land, 
yet we do not see pharmacists and wholesalers importing drugs from 
Canada and passing those savings on to consumers. Seniors will be 
forced to continue the bus trips to Canada and mayors and governors 
will continue to negotiate agreements with Canada, until we truly 
address our prescription drug costs. This bill does include a study to 
research the major safety and trade issues regarding reimportation, and 
I hope it will be conducted in good faith and in a timely manner so we 
can return to this important discussion.
  I also have serious concerns about premium support and forcing 
Medicare to directly compete with private insurance plans because I 
believe it can lead to higher costs for those seniors who choose to 
stay in Medicare. While I believe the demonstration language in this 
legislation is far less disconcerting than a full premium support 
provision, I will continue to monitor this closely. In the end, we 
cannot undermine the basic tenets of the Medicare program, which has a 
history of providing an equal benefit no matter where seniors live. 
Varying premiums within and among states is surely not the message we 
want to send our seniors. Hopefully this demonstration program will 
yield positive results that drive costs down--only time will tell. I 
will work to ensure that Medicare is viable and that seniors who choose 
to stay in Medicare are protected.
  I commit myself and I hope others will join me, in continuing to 
address the rising cost of health care, prescription drugs and the 
rising ranks of the uninsured. According to the U.S. Census Bureau, an 
estimated 15.2 percent of the population or 43.6 million people were 
without health insurance coverage during the entire year of 2002, up 
from 14.6 percent in 2001. That is an increase of 2.4 million people. 
What's even more disconcerting is the percentage of people who are 
employed but lack health care coverage. That number dropped from 62.6 
percent to 61.3 percent. However, these are clear and challenging 
issues that we must address in the upcoming session.
  Despite these and other concerns I have, I am supporting this 
legislation because I believe it provides desperately needed relief to 
Americans suffering from their overwhelming health care costs. American 
seniors have waited long enough for this assistance and I encourage my 
colleagues to provide them with the immediate relief in this bill.
  Mr. RODRIGUEZ. Mr. Speaker, I rise to express my strong opposition to 
the Medicare Prescription Drug Conference Report that we will be forced 
to vote on today. This bill has been crafted behind closed doors with 
the help of those corporate interests which will most benefit. 
Unfortunately, the bill they have created offers nothing more than 
empty promises to our Nation's seniors.
  Medicare was built on the principle that all seniors should have 
access to health care, regardless of how much you make or where you 
live. And for over forty years, this program has successfully worked to 
provide access to health care, offering hope and security to America's 
seniors. As the nature of health care has changed over the years, 
however, we recognize there is a need to improve upon the program and 
address the prescription drug price crisis.
  Seniors that I have met with back home have asked that I fight for a 
prescription drug benefit under the traditional Medicare plan and that 
is exactly what I have done. Over the years, I have worked to enact 
legislation that would establish a guaranteed and affordable 
prescription drug benefit for all Medicare beneficiaries.
  The industry-backed bill that Congress will vote on today falls far 
short of a benefit that will truly fit seniors' needs. While the bill 
provides $112 billion to entice managed care companies to participate 
in the program, seniors will receive little assistance with their drug 
costs. For the first $2,000 of coverage, the consumer will pay over 
$1,100; for the first $5,100 of coverage, the consumer will pay 
approximately $4,000. Put another way, if a consumer buys approximately 
$5,100 of drugs a year, the consumer will pay nearly 80 percent of that 
cost.
  Despite the $400 billion price tag, millions of retirees and low-
income beneficiaries will find themselves in an even worse situation. 
Up to 6.4 million of the poorest and sickest Medicare beneficiaries, 
including close to 390,000 Texans, could have drug coverage reduced. 
The bill prohibits Medicaid, the nation's low-income health insurance 
program, from helping with co-payments or paying for prescription drugs 
not on the formularies of the private insurers administering the new 
Medicare benefit. And 2 to 3 million seniors could lose retiree 
prescription coverage, including at least 132,000 Texas retirees, due 
to a provision that lowers Medicare assistance to employer-sponsored 
retiree health plans.
  Furthermore, by relying on private companies to deliver a benefit, we 
force seniors into the arms of the health insurance industry. We have 
learned all too well that private Medicare insurance plans do not work. 
In the early 1990s, Medicare HMOs were touted as the way to control 
escalating costs, but by the end of the decade, private plans abandoned 
thousands of seniors in rural regions. Over the past couple of years, 
Medicare+Choice beneficiaries in metro areas have faced dramatic 
increases in premiums and co-payments, and reduced benefits. Given that 
the Republican Medicare bill does not guarantee a defined premium and 
plans will have substantial flexibility to create their drug benefit, 
millions of beneficiaries will face the same situation in the years to 
come.
  Lastly, this bill forces us down a path towards privatization. By 
employing measures like the voucher-type premium support system and the 
creation of an overall budget cap, we end Medicare as we know it. 
Congress established Medicare to rescue seniors from the failure of the 
private sector to offer insurance or health coverage. Now we are going 
back.
  This 600-page measure will produce the biggest change to our safety 
net system in over forty years. The crafting of the legislation was 
done behind closed doors with the help of special interest groups. 
Incredibly, most Members of Congress have had less than twenty-four 
hours to pore through the pages and analyze how the bill will truly 
impact America's seniors.
  I understand there are important provisions in this bill for certain 
hospitals and providers such as increased Medicare reimbursement rates 
for physicians and an increase in the Medicare DSH cap for rural 
hospitals. I have supported similar measures in the past either

[[Page 30835]]

by cosponsoring legislation or voting in support of such legislation.
  However, there are also provisions in this bill that will hurt 
patients tremendously. The Medicare bill still contains drastic cuts to 
our nation's cancer care system. Despite several efforts by the cancer 
community to reach a compromise, the bill will deprive America's cancer 
care system of $1 billion a year. A cut like this will be devastating 
to cancer care. If this happens, many cancer centers will close, others 
will have to admit fewer patients, and still others will lay off 
oncology nurses and other critical support staff.
  Mr. Speaker, I urge my colleagues to vote against this bill. I do not 
agree with those who say something is better than nothing. I say a bad 
bill is worse than no bill at all. This proposal goes against the 
fundamental principles of a program created to serve all seniors. Let's 
not give America's seniors more bad medicine. Reject the Republican 
plan and adopt one that provides real coverage for all seniors.
  Mrs. TAUSCHER. Mr. Speaker, ``I strongly believe that seniors deserve 
and need a prescription drug benefit that's part of Medicare. I believe 
we should strengthen Medicare by adding drug coverage that will save 
seniors money and preserve the choices that matter. I will vote against 
this bill because it does not get us where we need to be.
  ``This legislation prohibits Medicare from negotiating lower drug 
prices; gives big drug and insurance companies $82 billion in subsidies 
just to compete with Medicare; and will privatize Medicare by pushing 
seniors into HMOs.
  ``I introduced a bill that would have provided immediate, real drug 
discounts to all seniors without turning over part of Medicare to HMOs. 
Unfortunately, it was not brought to a vote.
  ``There are many serious problems with the bill being debated today 
that people are trying to sweep under the rug. Up to a quarter of 
seniors on Medicare would pay more for prescriptions than they do now. 
Up to seven million seniors would pay higher Medicare premiums unless 
they join an HMO and give up their choice of doctor. Two to three 
million retirees would lose the drug coverage provided by their former 
employers. Millions of seniors would go without drug coverage for parts 
of every year, even though they would be charged premiums year-around. 
Seniors would be prohibited from purchasing American-made drugs from 
Canada at lower prices. After they have spent $1,169 on prescription 
drugs, seniors will have to pay their full drug costs until they reach 
$3,600 in drug expenditures.
  ``I am deeply suspicious that this bill, written almost entirely by 
Republicans, put the special interests of HMOs and pharmaceutical 
companies over seniors' interests. It will give $82 billion to private 
insurance companies so they can compete with Medicare, yet Medicare 
will be forbidden from negotiating lower drug prices with drug 
companies and competing in the same way. Even AARP has a financial 
stake in this bill. The company derives almost 60% of its annual 
revenue from selling insurance products. If they capture even 10% of 
the prescription drug market, their profits would be $1.5 billion.
  ``As a former investment banker, I know risk management. The magic of 
Medicare is that everyone has always been in the pool--the wealthy and 
healthy as well as sick and lower-income seniors. This bill will turn 
that on its head--driving the healthy and wealthy out of Medicare and 
creating large tidal pools in which sick and lower-income people are 
left without anything.
  ``It is a bad bill that will hurt millions of seniors and not really 
benefit anyone but the drug and insurance companies. I will vote 
against it, and I encourage all of my colleagues to stand up for 
seniors and do the same.''
  Mr. HOLT. Mr. Speaker, I rise in opposition to this legislation.
  As my constituents in central New Jersey know, I have been working 
ever since I came to Congress to provide Medicare beneficiaries with 
coverage for the prescription drugs that improve their quality of life 
and often save or extend lives. Today we are considering a bill that 
purports to provide such coverage, but unfortunately fails on several 
counts.
  I have pledged to the seniors in my district that I will not support 
any legislation that undermines Medicare, a program that has succeeded 
in providing adequate health care to tens of millions of seniors for 
nearly 40 years. That is why I cannot and will not support the proposal 
that is before us. We can do much better, and with something this 
important, we should not get it wrong.
  First and foremost, this legislation would devastate the Medicare 
program. It forces several million seniors into private plans and lays 
the groundwork for privatizing the traditional fee-for-service program. 
In New Jersey alone, an estimated 186,000 seniors will be affected. We 
need to strengthen Medicare with a drug benefit, not use prescription 
drug coverage as a mechanism for dismantling the entire program. It is 
simply not good policy to spend $12 billion of taxpayers' money just to 
set up a for-profit competitor to Medicare.
  Second, even after the government spends all this money, seniors will 
not even get a very good benefit. It is true that any level of 
assistance will be of some help to seniors, but the gap in coverage 
under this bill will leave most seniors still paying thousands of 
dollars out-of-pocket. In fact, seniors with high drug costs must pay 
over $4,000 to receive $5,100 worth of medications. For many seniors, 
after August or September or whenever their drug bills reach $2,250, 
they would get no benefit--even though they would continue to pay their 
monthly premiums.
  Third, this bill clearly undermines the universal nature of the 
Medicare program. Everyone, no matter what his or her income level, 
pays Medicare payroll taxes, and everyone is entitled to an equal 
benefit. But under this legislation, many low-income seniors would be 
subject to an assets test to see if they qualify for low-income 
subsidies. I know seniors in my district will be up in arms when they 
hear they have to send in bank statements or declare the value of 
things they own, potentially even having to sell some to get the 
benefit.
  This bill is also bad news for the 220,000 seniors who currently 
receive prescription drug coverage through New Jersey's highly 
successful Prescription Drug Assistance for the Aged and Disabled 
(PAAD) program. While the bill will allow the state to receive Medicare 
funds for its PAAD spending, it also means that seniors will not 
receive their prescription drugs in the same simple, reliable way they 
did under PAAD. Seniors may find themselves limited to a list of 
approved drugs and face other restrictions not imposed by PAAD.
  The bill also fails our physicians and other health care providers. 
While it purports to solve the problem of insufficient reimbursements, 
it actually offers little more than a Band-Aid. Two years of a 1.5 
percent increase will provide some small measure of relief, but 
Congress must still address the long-term problems inherent in the 
current physician payment system.
  Health care providers should also be alarmed by the provision that 
triggers an automatic congressional procedure once general revenues 
make up an arbitrary proportion of Medicare spending. This means that a 
few years down the road, providers may find themselves facing 
drastically insufficient reimbursement levels, and seniors will find 
themselves with fewer benefits and fewer doctors willing to accept 
Medicare patients. One editorial writer noted that the spending trigger 
would sound an alarm if Medicare spending exceeds certain levels, but 
the bill itself does almost nothing to control spending.
  This bill fails our seniors, and unfortunately, it will fail the test 
of history. We have a historic opportunity to craft a bill that 
genuinely helps seniors afford the medicine they need. Sadly, the 
Republican leadership has decided to write a bill that privatizes 
Medicare, moves seniors into managed care plans, leaves gaping holes in 
coverage, and puts current retirees' benefits in jeopardy. I will not 
support such a plan.
  I urge the Congress to address this again in January. I firmly 
believe we can pass a bipartisan prescription drug benefit that is 
universal, voluntary, dependable, and affordable, if we make the 
choices that put seniors first.
  Mr. SKELTON. Mr. Speaker, there is no truer indication of a nation's 
priorities than the investment it makes in the health of its citizens, 
particularly our senior citizens. Medicare was created nearly 40 years 
ago with a basic fundamental principle in mind: health care coverage 
should be guaranteed, affordable, and equitable to all seniors. 
Throughout the time I have been privileged to serve in Congress, I have 
worked to make sure Medicare remains strong for those currently 
benefitting from its coverage and for those who will rely upon its 
benefits in the years ahead. As a member of the Rural Health Care 
Coalition, I was pleased when the administration and congressional 
leadership announced earlier this year that providing a prescription 
drug program within the reliable Medicare system was a high priority 
for the 108th Congress. However, it has become clear throughout the 
year that efforts to provide a meaningful prescription drug benefit 
within Medicare were being undermined by a systematic attempt to 
destroy the Medicare program. I am disappointed that the bill before us 
today, H.R. 1, does just that, undermining the very foundation of 
Medicare while creating a confusing and inadequate prescription drug 
coverage program for rural Missouri's seniors.
  As I visit with seniors throughout Missouri's Fourth Congressional 
District, it remains clear that they depend on Medicare for their 
health care. They understand Medicare and trust it

[[Page 30836]]

cannot be taken from them. Medicare is part of a health care contract 
with the senior citizens who brought this Nation out of the Depression, 
fought in our wars, and paid into the Medicare trust fund so they would 
have health coverage when they need it most. Unfortunately, H.R. 1 
seeks to destroy the Medicare system on which these Americans have 
depended for nearly 40 years. Under this bill, in just six short years, 
millions of senior citizens in America could be coerced out of Medicare 
and into private insurance plans that generally don't do business in 
rural America. While the drafters of this measure explain that these 
private plans are simply a demonstration project and seniors don't have 
to participate if they don't want to, once the door is open to 
privatizing this vital government program, I am afraid it will not be 
closed.
  It is also troubling that if these so-called demonstration projects 
take root around the nation as H.R. 1 prescribes, seniors within 
Missouri could be paying very different prices for the exact same 
health care benefit. It would create a very confusing situation, where 
folks in Versailles could pay more than citizens of Blue Springs or 
Lamar for their health care needs. Show-Me State seniors trust Medicare 
because they know that everyone participating in this program will pay 
the same rate for their health care insurance no matter where they 
reside. H.R. 1 undermines this fundamental principle, which could 
create even more disparity in the health care coverage of rural 
Missourians.
  In addition to undercutting Medicare, I am concerned that the 
prescription drug portion of H.R. 1 will negatively impact seniors 
living in rural Missouri. This measure would require Medicare 
beneficiaries who wish to receive the new prescription drug benefit to 
enroll in private drug plans which rarely operate in rural America. 
These plans would be run by large insurance companies that would likely 
charge different premiums for the same prescription drugs. As an added 
benefit to large insurance companies, H.R. 1 would provide them with a 
$12 billion taxpayer subsidy while creating a $2,800 gap in 
prescription drug coverage for seniors. According to an article 
published in The Wall Street Journal on November 18, 2003, ``for the 
drug industry, the legislation is good news, at least in the short 
run.'' This is just plain wrong.
  For rural Missourians, H.R. 1 would also impose an assets test on 
low-income seniors who earn below 150 percent of the federal poverty 
level. Seniors whose income falls within this financial threshold may 
be forced to either pay additional prescription drug costs if their 
assets--their car, their farm equipment, or their acreage, for 
example--total $10,000 per individual or $20,000 per couple, or sell 
their possessions to get cheaper pills. Many seniors in rural areas 
rely solely on their Social Security checks to get by each month and 
they should not be forced to sell their belongings or their property to 
qualify for a more comprehensive drug benefit.
  While I am dismayed that the leadership of this Congress would work 
to dismantle Medicare through this legislation, I am pleased that 
conferees were able to address Medicare reimbursement rates for rural 
doctors and hospitals. Through the years, I have worked with my 
colleagues in the Congressional Rural Caucus to boost reimbursements to 
those who provide health care in rural America. In fact, time and time 
again on the House floor, I have voted to instruct the conferees 
writing the Medicare bill to abandon divisive ideas of privatization in 
order to provide more adequate reimbursement to rural providers. 
Unfortunately, these motions were defeated each time.
  Mr. Speaker, senior citizens throughout Missouri understand and trust 
Medicare. They have worked all their lives, paid their taxes, and 
contributed to a system that takes care of their health care needs. 
Medicare is a contract with our seniors that should not be broken. That 
is why I will oppose H.R. 1 and urge all my colleagues to do the same.
  In the days ahead, I look forward to working with my colleagues in a 
bipartisan manner to provide senior citizens with a real prescription 
drug benefit that strengthens Medicare.
  Ms. CORRINE BROWN of Florida. Mr. Speaker, today the Republican party 
will finally do what it has been trying to do for 35 years, destroy 
Medicare.
  Claude Pepper, my mentor on health care issues, the most well known 
advocate for seniors, a man who fought for years and years to 
strengthen Medicare and Social Security, would be rolling in his grave 
if he were here today.
  This is a life and death issue for many of our senior citizens, and 
this hollow bill does nothing for them.
  A snake is a snake, no matter what color it is. And AARP is getting 
into bed with a snake, the Republican party, in supporting this bill. 
To the AARP leadership, I have some sage advice that my Grandmother 
used to tell me: ``Those who sleep with dogs, wake up with fleas''.
  Each provision in this bill is one more nail in the coffin of a 
program that has guaranteed health care for this Nation's seniors for 
38 years. Under the Republican plan, HMO's that offer an alternative to 
Medicare will pick and choose their customers, and get paid more than 
Medicare to do it. And yes folks, these are the same Plus Choice 
providers that are fleeing your districts in droves, and leaving your 
seniors with absolutely no healthcare options.
  Even more disturbing is the fact that this bill prohibits, yes, 
prohibits, Medicare from using its bargaining power to cut drug prices.
  What happened in the 2000 election is a U.S.A. coup d'etat. This is 
what happens when you don't have fair elections. Folks, it matters who 
is in the White House. This is entirely a Republican initiative, and 
their goal is to destroy Social Security and Medicare entirely. Their 
goals is not to modernize it, but to have it wither on the vine.
  Mr. STRICKLAND. Mr. Speaker, today, this Congress is missing a golden 
opportunity to pass a real prescription drug benefit for all seniors. 
During the Energy and Commerce Committee's consideration of the 
prescription drug bill this summer, my colleagues and I offered many 
amendments that would have improved this bill to ensure that all 
seniors, regardless of where they live, have access to an adequate, 
affordable, reliable prescription drug benefit. But my Republican 
colleagues defeated our amendments and pushed through a partisan bill 
that will do little to give meaningful help to the middle income 
seniors who most need a prescription drug benefit.
  In other words, Congress is passing up an opportunity to ensure that 
the retired, 68-year-old steelworker who had a heart surgery last 
spring and lost his retiree health insurance this summer, and who, 
along with his wife, has an annual income of about $28,000 can afford 
the prescription drugs they need to stay healthy. This bill does not 
even ensure that a person under these circumstances can access 
affordable prescription drugs from Canada or elsewhere in the world. 
For shame that we are passing up such an opportunity to do the right 
thing by our seniors.
  The AARP says that the prescription drug bill we are considering 
today is better than nothing, that it's one foot in the door. I 
disagree. The voucher demonstration program in the bill lays dangerous 
groundwork for a privatization scheme that I believe will undermine 
Medicare's ability to provide a guarantee of health security for all 
Americans when they turn 65. In addition, the drug benefit created by 
this bill will force many seniors to private insurance plans for their 
drug benefit. My colleagues who support this bill say that seniors want 
``choice'' and that the private plans will give them the choice they 
want. Well, the seniors I talk to want choice, but not choice of a 
private plan. Instead, they want choice of their doctor, pharmacist, 
and hospital; they want the ability to choose their treatment plan when 
they are sick and the choice to access preventive services to keep them 
as healthy as possible. If seniors in my district have the choice of a 
private plan, the Medicare safety net as we know it today is no longer 
there. This is especially true since the bill we are considering 
tonight doesn't require these private plans to offer a standard 
premium, deductible, or copayment--in fact, where these private plans 
have been tried, monthly premiums have ranged as high as $85 a month, 
not the $35 promised by proponents of this bill. I cannot overstate 
this: the bill we are voting on does not mandate a $35 premium.
  Additionally, this bill includes a $12 billion slush fund to bribe 
private HMOs to participate in Medicare. This $12 billion is in 
addition to about $8 billion in huge overpayments to private plans. I 
believe that the billions we are spending in this bill in payments to 
private plans are simply to support an ideology of privatization that 
seeks eventually to destroy Medicare. This ideology is needless when 
you consider that traditional Medicare has both a strong track record 
with seniors and the amazingly low administrative overhead cost of only 
2 to 3 percent.
  It is for all of these reasons that I cannot support this bill. 
However, it does include some good provisions that I wish I could vote 
for today. I wholeheartedly support the physician and hospital 
provisions, particularly for rural providers. For the last 2 years, 
doctors have faced significant scheduled cuts in their Medicare 
reimbursements, leading some to stop-taking new Medicare patients or 
drop out of the program altogether. Especially in the current 
environment of high malpractice rates, rising medical school costs and 
medical school debt, rising overhall health care costs,

[[Page 30837]]

and a growing Medicare population, it is unacceptable for Congress to 
ask doctors to continue providing the same care for less money. And our 
rural hospitals are struggling to maintain their ability to serve as 
our health care safety net for the uninsured. Seniors depend on a 
strong network of physicians and hospitals to provide care; each time a 
physician decides he or she cannot afford to take new Medicare 
patients, seniors are forced to look elsewhere to find care. This is 
particularly troubling in rural areas, where there are fewer physicians 
and where it may be more difficult to travel to a doctor's office.
  I realize how important these provider provisions are, and I would 
say to the doctors and hospital advocates who are asking me to vote yes 
tonight that it is unfair to hold their needed reimbursement increases 
hostage in a bill that includes so many controversial provisions. We 
can and should pass a provider reimbursement bill apart from this 
Medicare package. In fact, I hope that we can defeat this Medicare bill 
and immediately pass these provider increases in a stand alone bill 
before we leave this session.
  In closing, I reiterate my support for adding a strong, adequate 
prescription drug benefit to Medicare. Seniors need such a benefit and 
Medicare is not a complete health insurance program without it. But the 
benefit before us tonight does more harm than good, particularly in the 
long term. I urge my colleagues to vote no.
  Mr. SERRANO. Mr. Speaker, I rise in strong opposition to the 
conference report on H.R. 1, the Republicans' Medicare ``reform'' bill. 
On procedure and on substance, the legislation is deeply flawed and the 
best course now would be to start all over and work toward a bipartisan 
package that truly provides benefits to our elderly and disabled 
Medicare participants.
  Others have eloquently expressed the reasons to oppose this 
legislation, so I will not take much time to repeat what has been said. 
But I will quickly mention the major flaws.
  This enterprise was meant to help seniors and the disabled get the 
prescriptions they need at affordable prices, but that's certainly not 
where it is ending up. This bill both increases the burden on seniors 
and lays the groundwork for taking Medicare apart altogether.
  Coverage is limited and complicated, and there is a huge ``donut 
hole'' in coverage that, when combined with premiums, deductibles and 
copayments, can leave seniors paying up to $4,000 of the first $5,000 
of prescription expenses as well as paying premiums but receiving no 
benefits for part of the year. Worse, dual eligibles, the Medicare 
beneficiaries who are poor enough also to be eligible for Medicaid, 
will end up worse off under an all-Medicare regime.
  Drug prices in this country are high and rising fast, keeping even 
seniors with drug coverage through their employers facing difficult 
choices between medicines and other necessities. But the bill before us 
explicitly prohibits the Federal government from negotiating lower 
prices for Medicare beneficiaries. It also ignores the will of most 
Members of Congress who support reimportation of prescription drugs 
from Canada and other select countries. What a windfall for the 
pharmaceutical companies!
  Millions of retirees who now have coverage through their former 
employers may end up without it when the bill's incentives cause 
employers to drop retiree health benefits.
  The premium support demonstrations present insurers with the 
opportunity to cherry-pick healthier, wealthier beneficiaries, leaving 
Medicare covering the high-cost sicker and poorer elderly and disabled, 
which would force fewer beneficiaries to pay higher premiums until 
Medicare became unaffordable and unsustainable.
  There are many other reasons to oppose this conference report. Let me 
just note that it does not include the Senate provision to remove the 
5-year bar on federal health benefits for legal immigrant children and 
pregnant women.
  The Republicans have not been shy about announcing their intention to 
dismantle the Medicare program, and this bill is a major step down that 
path.
  Mr. Speaker, this is a profoundly bad bill that should go back to the 
drawing board. As the National Committee to Preserve Social Security 
and Medicare wrote to Members yesterday ``. . . a bad bill is worse 
than no bill at all''.
  Mr. Speaker, I urge my colleagues to vote ``no.''
  Mr. MORAN of Virginia. Mr. Speaker, I rise in opposition to the 
Medicare prescription drug benefit conference report that the House is 
scheduled to consider today.
  I want to make it clear that I strongly support a Medicare 
prescription drug benefit for our nation's seniors and am supportive of 
a universal, affordable, voluntary and guaranteed Medicare prescription 
benefit for all.
  Unarguably, the enactment of the Medicare program in 1965 was one of 
the wisest things Congress has ever done. At that time, there were very 
few prescription drugs with wide applicability, and that is why 
Medicare did not cover prescription drugs.
  In large part, because of Medicare and Social Security, we have 
raised the life expectancy of our citizens, lifted millions of 
Americans out of poverty, and vastly increased the quality of life for 
our nation's senior citizens.
  Unfortunately, this conference report does not reflect the vision and 
ideals of Medicare set forth by President Johnson and Congress, and 
will, if passed and signed into law, harm the 57,000 seniors that 
reside in my congressional district and millions of other seniors in 
America.
  It had been my hope that any expansion of the Medicare program to 
include a prescription drug benefit would be above partisan politics. 
We have all heard first-hand from seniors how the high prices of their 
prescription drugs negatively impact their already limited incomes.
  This issue which cuts across political lines should be about what's 
in the collective interest of our nation's seniors.
  Unfortunately, this debate on one of the most important domestic 
issues, which not only affects today's seniors, but future generations 
as well, did not rise above partisan politics or enhance our democratic 
process.
  In a decade, 10,000 people a day will turn 65 years old and with the 
retirement of the Baby Boom generation, America's senior population 
will almost double.
  This conference report provides a weak prescription drug benefit for 
all seniors--regardless of income, and will change the Medicare program 
as we currently know it, by overpaying private insurance companies to 
administer this drug benefit, while giving them great latitude in 
setting premiums, deductibles, and pharmacy choice with little 
oversight through a premium support system.
  One of the reasons why I voted against the House version of the 
Medicare Prescription Drug and Modernization Act of 2003 (H.R. 1) was 
that Medicare beneficiaries would pay 20% of their drug costs up to 
$2,000 and 100% of drug costs from $2,000 to $3,500, while still 
subjecting them to monthly premiums that would result in a gap of 
prescription drug coverage for most beneficiaries.
  The coverage gap that exists in this conference report is even worse. 
Seniors will pay 100% of costs between $2,250 and $5,100--a gap of 
$2,800 which will be increased to over $5,000 by the year 2013.
  I also cannot support a conference report that does nothing to 
alleviate the high costs of drugs imposed on seniors. This conference 
report actually prohibits the Secretary of the Health and Human 
Services from negotiating lower drug prices with the bargaining clout 
of the 40 million Medicare beneficiaries as well as the importation of 
drugs from countries where drug prices are lower, except Canada and 
only if they are certified by the Food and Drug Administration.
  While I am pleased that this Congress has finally addressed the issue 
of reimbursement rates for doctors, hospitals, and other important 
health providers, I am discouraged that this conference report is still 
a bad deal for our seniors, and the endorsement of this legislation by 
the AARP, comes into question. The AARP is not recognizing its 
membership's need and desire for a true Medicare prescription drug 
benefit without the heavy reliance on the private health insurance 
industry.
  It is with great sadness that I will have to vote no on this 
conference report. My constituents want a legitimate Medicare 
prescription drug benefit, lower drug prices and better Medicare 
services.
  This conference report undermines the Medicare system, and I am 
afraid, will do more harm in the long run than good in the short term 
for our seniors.
  Mr. ETHERIDGE. Mr. Speaker, I rise in opposition to H.R. 1. As the 
Representative of North Carolina's 2nd District, I know firsthand how 
hard our older people have to struggle to pay for their prescription 
medicines. Since I began my service in the people's House in 1997, I 
have worked to create a prescription medicine benefit for our seniors. 
Seniors deserve a guaranteed Medicare prescription medicine benefit, 
not empty promises. I have consistently supported a prescription 
medicine benefit plan that features low, predictable premiums and 
allows seniors to obtain medicine from any doctor they choose. And I 
want seniors to be able to get their medicine from the local pharmacy, 
not some huge mail order company.
  I oppose H.R. 1 because it does not deliver on its promises. This 
bill will force 73,000 Medicare beneficiaries in North Carolina to lose 
their retiree health benefits entirely and

[[Page 30838]]

leave thousands more with significantly reduced benefits. According to 
the nonpartisan Congressional Research Service of the Library of 
Congress, this bill will force 222,800 Medicaid beneficiaries in North 
Carolina to pay more for the prescription medicines they need. Under 
this bill 99,500 fewer seniors in North Carolina will qualify for low-
income protections than under the Senate bill because of the assets 
test and lower qualifying income levels. This provision will hit 
particularly hard the many farmers in North Carolina whose farm 
equipment and land are considered financial assets even if the farmers' 
income is below the poverty line. Also according to CRS, under this 
bill, 37,920 Medicare beneficiaries in North Carolina will pay more for 
Part B premiums because of income relating. And according to the CMS 
Actuary Tables, the premium variation under the bill's premium support 
program would range form $1,225 in some parts of North Carolina to $675 
in other areas of the state. The bill contains a huge hole in coverage 
which will result in no benefit at all for seniors with prescription 
costs between $2,200 and $5,044.
  I oppose H.R. 1 because this bill will have devastating economic 
consequences because the $400 billion price tag will be added directly 
to our massive national debt of $6.8 trillion. A few short years ago, 
we had achieved surpluses as far as the eye could see and were on pace 
to erase the national debt. But this Administration's tax policies have 
produced record budget deficits that will be compounded by the 
conference report on H.R. 1. Deficits matter for our current economy 
because in creased borrowing means the government has to spend more and 
more tax money on interest costs and will have less available for other 
important priorities. ``For example, even before this bill passage, 
this year the federal government will pay $156 billion for interest on 
the national debt. That is three times what the federal government will 
spend on education. When I asked a White House representative where the 
money will come from to pay for this bill, I was told that it is ``new 
money.'' This is not new money. These are borrowed funds that will be 
paid for by our grandchildren and their grandchildren.
  Mr. Speaker, prior to holding elected office, I spent nearly twenty 
years as a small businessman. There can be no doubt that I strangely 
support the private sector. But there are some things the private 
sector does well and some things the private sector does not do well. 
Medicare was created because the private sector by itself does not do 
well at the important priority of providing a strong public health 
system for older Americans. This bill is a $400 billion ticket back to 
the days when senior citizens were forced to fend for themselves in the 
private health care marketplace. This bill sacrifices Medicare as we 
know it, and will cast senior citizens to the mercy of HMOs and force 
them to give up their own doctors and pharmacists.
  Congress should reject this flawed bill and go back to the drawing 
board and get it right once and for all for our seniors. I urge my 
colleagues to vote ``no'' on the Republican Medicare Privatization 
bill.
  Mr. EVANS. Mr. Speaker, this has been a disappointing week in 
Washington for seniors around the country. Not only are we voting on a 
bill that provides a meager prescription drug benefit through Medicare, 
but the once-regarded AARP has apparently put their profit margins 
before the health of the seniors by endorsing this Republican 
Prescription Drug bill.
  There are so many disturbing provisions in this bill that I will only 
take the time to mention a couple.
  This bill explicitly prohibits the Secretary of Health and Human 
Services from negotiating lower drug prices on behalf of America's 40 
million Medicare beneficiaries. With my support, the Veterans' 
Administration adopted this practice some time ago, and the VA enjoys 
the ability to negotiate drug prices for numbers of veterans. This 
restriction on the Secretary of Health and Human Services clearly 
crimps efforts to keep prices down for seniors.
  Another troubling provision is the ``demonstration project'' in this 
bill that coerces seniors out of the traditional Medicare program they 
know and enjoy to sign on with an HMO. Up to 7 million seniors may be 
forced to choose between staying in Medicare and purchasing a likely 
expensive drug-only plan from a private insurer or leaving their 
trusted doctors to join an HMO or other plan that would provide 
Medicare-like benefits including drug coverage. This is hardly a choice 
for our nation's greatest generation.
  As our healthcare delivery system moves increasingly toward managed 
care, many people have expressed concerns about the care they receive 
from HMOs. Today it is frighteningly common for insurance companies, 
rather than doctors, to make the medical decisions that affect people's 
lives. As these concerns are aired, we are ready to throw our seniors 
into this lion's den. Until doctors are free to give the best medical 
advice based on a patient's need, not an insurance company's bottom 
line, our seniors are better served by traditional Medicare. While 
others have let HMO reform legislation die away, I still believe that 
we need to address these concerns, and they should be addressed before 
seniors are coerced into the system.
  This debate has been fundamentally changed from one focused on 
providing seniors with a solid prescription drug benefit to defending 
the integrity of one of America's finest programs, Medicare. I have 
been part of the Democratic fight for years to add a meaning drug 
benefit for our nation's seniors, but I will not be a part of 
destroying a vital program that seniors have trusted for almost 40 
years to settle for inadequate drug coverage. I strongly urge my 
colleagues to reject this bad bill.
  Ms. SOLIS. Mr. Speaker, in 1965, Congress created Medicare and 
promised seniors that after a lifetime of working and paying into the 
system they would have access to health care coverage during their 
retirement years, regardless of where they live, their age or their 
income. Thirty-eight years later, instead of honoring our commitment to 
affordable, accessible health care for all seniors, Congress is set to 
create a prescription drug benefit program that will destroy Medicare 
as we know it and turn it over to the unreliable for-profit insurance 
industry.
  A Medicare prescription drug bill should use the purchasing power of 
our nation's seniors to negotiate lower prescription drug costs, just 
as we do for veterans now, and it should provide assistance to low-
income seniors who need extra help in their retirement years. Our hard 
working seniors and their families expect a high quality, affordable, 
universal and guaranteed prescription drug benefit within their trusted 
Medicare program.
  Unfortunately, the Republican plan dismantles Medicare as we know it 
by turning it into a voucher system with private HMOs competing with 
the traditional Medicare system. Under this system, seniors who want to 
stay with the traditional Medicare system they trust would face 
premiums that could vary dramatically across the nation. Premiums for 
traditional Medicare in the Los Angeles area could be as much as $1,700 
per year--119% more than seniors in other parts of California.
  This bill is especially troubling for retirees who have health 
benefits through a former employer. I have received dozens of calls and 
letters from retirees concerned about the Medicare proposal's impact on 
the prescription drug coverage they have through a former employer. 
Well, under the Republican bill an estimated 244,860 Medicare 
beneficiaries in California will lose their retiree health benefits 
because the bill does not sufficiently stem the tide of employers 
reducing or dropping their retiree health coverage.
  Nearly 6,000 seniors in my district are living below the poverty 
level, so I am especially troubled about what this bill will mean for 
low-income seniors struggling to pay for the medicines they need. The 
bill will increase drug costs for six million elderly and disabled 
Medicaid beneficiaries by imposing co-payments on their prescription 
drugs and prohibiting Medicaid from filling in the gaps of the new 
Medicare benefit. It is shameful that this bill would harm our most 
vulnerable seniors.
  The supporters of this bill talk about the funding it provides for 
disproportionate share hospital (DSH) payments to hospitals that serve 
a high number of indigent patients and for improved Medicare payments 
to physicians. I have a strong record of supporting DSH funding, which 
is critical to protecting California's safety not hospitals. I have 
also long supported fixing the flaws in the Medicare physician payment 
system in order to help doctors who serve elderly patients, and 
recently voted to increase physician payments. It is important to note 
that the Democratic Medicare prescription drug proposal would have done 
substantially more to help doctors and hospitals than the bill before 
us today.
  I would like to take a moment to comment on AARP's endorsement of the 
bill. AARP claims to represent the needs of seniors throughout the 
country, but I can tell you that the seniors I represent are upset that 
AARP has chosen to endorse this wrong-headed bill that doesn't even 
meet the criteria they set back in July. I encourage seniors to 
continue to contact their lawmakers and let them know their views on 
this Medicare bill.
  Let's be clear--the endeavor to make prescription drugs more 
accessible for seniors began as a bipartisan effort to modernize 
Medicare for our new era. Now it has turned into a fight for the soul 
of Medicare. I am tremendously disappointed that my Republican 
colleagues have chosen to reward the private

[[Page 30839]]

insurance companies and big pharmaceutical industry at the expense of 
seniors. However, I will continue my efforts to ensure that seniors 
have access to the medicines they need.
  Mr. REYES. Mr. Speaker, it is with great regret that I rise in 
opposition to the conference report on the Medicare Prescription Drug 
and Modernization Act of 2003.
  I regret that I must do so, because I have long been a strong 
advocate for providing America's senior citizens with an affordable, 
comprehensive prescription drug benefit under Medicare. Unfortunately, 
however, the bill before us today would harm rather than help the more 
than 77,500 Medicare beneficiaries in El Paso County, Texas, which I 
represent, and millions of others like them across the country.
  For example, instead of a comprehensive, continuous prescription drug 
benefit, the bill offers a benefit that has a $2,800 gap in coverage 
that will leave about half of Medicare beneficiaries without any 
prescription drug coverage for part of the year, even though they will 
still be paying monthly premiums. While without coverage, many Medicare 
beneficiaries in my district will have to pay the entire cost of their 
prescription drugs out of their own pockets, which is the very 
circumstance we are supposed to be remedying.
  Rather than doing more to help low-income seniors, this bill fails to 
ensure that they will receive the prescription drugs they need under 
the proposed new program. The bill would, for the first time, prohibit 
federal Medicaid funding from being used to pay for drugs not paid for 
by Medicare. In Texas alone, it is estimated that 389,400 Medicaid 
beneficiaries would pay more for their prescription medications under 
the bill. In my congressional district, where approximately one in five 
people over age 65 lives below the poverty line, this change could be 
devastating.
  At the same time, the bill requires states to make large annual 
payments to the federal government, offsetting the savings states would 
have realized by having the federal government provide drug coverage 
for low-income seniors under Medicare. In short, for the first time 
ever states will have to fund a federal Medicare benefit, at a time 
when my state of Texas and many other states are facing budget 
troubles.
  Insteaad of expanding re-importation of prescription drugs, with 
appropriate safety checks, the bill blocks re-importation. By doing so, 
it ensures that Americans will continue to subsidize low drug prices in 
other countries, while paying the highest drug prices in the world here 
at home.
  Rather than empowering Medicare with the authority to use its 
purchasing power to negotiate better drug prices, as the Veterans 
Administration currently does, the bill specifically prohibits Medicare 
from doing so. As a result, the pharmaceutical companies benefit, but 
hard-working taxpayer will have to foot the bill for the higher costs.
  Perhaps most troubling, the bill puts us on a path toward privatizing 
the entire Medicare system, breaking our government's solemn promise to 
America's senior citizens to provide guaranteed, quality healthcare 
under Medicare. Two generations of seniors have relied on Medicare and 
Social Security to ensure their quality of life in their retirement 
years. For many poor seniors in my district, these programs are their 
only safety net. To jeopardize that safety net would be unconscionable.
  This bill, with all its shortcomings, will cost the American people 
nearly $400 billion over the next decade. It does include a few 
provisions that I strongly support and have voted in favor of 
repeatedly--most notably provisions providing increased Medicare 
reimbursement rates for healthcare providers and funding to reimburse 
local governments and emergency medical providers for providing care to 
undocumented immigrants. However, the bill would do such significant 
harm to Medicare recipients and the Medicare program that, on balance, 
I find that I cannot support the legislation.
  Mr. Speaker, I urge my colleagues to oppose this conference report, 
so Congress can instead offer America's seniors that kind of Medicare 
prescription drug benefit they desperately need and truly deserve.
  Mr. BACA. Mr. Speaker, I rise in opposition of the Republican 
Conference Report on H.R. 1.
  I oppose this Republican plan because it is bad for seniors. It's bad 
for California. And it's simply bad for the American people.
  There are 40 million seniors across this Nation that need a safe and 
reliable healthcare plan that protects them, whether they are sick or 
not.
  This plan will not help seniors. This is a $400 billion plan that 
will privatize care and cost seniors more than they pay now.
  This plan is similar to having car insurance that doesn't really 
protect you. You're fine as long as you don't get into an accident.
  Seniors are only fine under this plan if they don't get sick. But 
because of privatization, when a senior gets sick, this plan offers no 
guarantee that their premium will stay the same or that their carrier 
will continue to cover them.
  Under Medicare, seniors at least had a guarantee that they would be 
insured. They at least had a guarantee that if they got sick; someone 
would be looking out for them.
  Under this plan, privatization could force as many as 7 million 
seniors into HMO's. Seven million. How is this fixing Medicare? Who is 
this guaranteeing that all seniors have coverage?
  Our parents and grandparents deserve better. They do not need 
privatization. They need to know they are going to be insured.
  They need to know that they are going to be protected despite the 
cost.
  Under this plan, there is a $2,800 gap that will leave millions of 
seniors without drug coverage. This plan leaves seniors uninsured for 
part of the year despite the fact that they are paying premiums.
  Much like car insurance, if you knew your car wasn't going to be 
insured for half of the year, you wouldn't drive it.
  But we can't do that with our health. Seniors can't say I just won't 
get sick. It doesn't work that way.
  In my district of San Bernardino, California, we have seniors who 
board buses to travel down to Tijuana to purchase life saving 
prescription drugs.
  Will this plan help the seniors in my district get off that bus?
  No. If we pass this bill, seniors will still have to travel to Mexico 
to get their prescriptions.
  The practice of forcing seniors to go across the border must stop. We 
have no way of knowing what our seniors are actually purchasing. This 
isn't safe and it isn't fair.
  This bill could actually raise the cost of prescription drugs for 
over 6 million low-income seniors, and one in six Hispanics. In my home 
state of California, almost 900,000 will have to pay more.
  Those are the people in my district. Those are the people that are 
risking their lives, going across the border, to purchase their 
prescriptions. And this bill does nothing to help them.
  The Republicans are ignoring what seniors need.
  Under this plan, over 3 million low-income seniors are going to be 
forced to pass a test before they get help paying for prescription 
drugs.
  If you are a senior and you simply own a home, a car, or even a 
burial plot you could be considered too wealthy to get help with 
prescription drugs, under this plan.
  If you are a homeowner, you'd better catch the bus for Tijuana 
because that is the only way you will be able to afford your 
prescription drugs because the Republicans think that you are too 
wealthy.
  Many seniors in my district have worked hard their entire lives 
trying to put food on the table for their families. Many of them have 
been fortunate enough to have some health coverage from their 
employers.
  Under this plan, 3 million retirees could lose that coverage. That 
affects over 250,000 seniors alone in California.
  This plan leaves the seniors in my district will no option but 
privatized healthcare.
  Our abuelos, our grandparents, have worked too long and too hard to 
be ignored.
  They need a prescription drug coverage that preserves traditional 
Medicare, helps low-income seniors afford prescription drugs and keeps 
retirees in employer sponsored health plans.
  It's time to give seniors what they want, what they need, and what 
they deserve.
  Mr. OSBORNE. Mr. Speaker, I rise in support of H.R. 1, the Medicare 
Prescription Drug, Improvement and Modernization Act.
  Today, this House will consider landmark legislation to help our 
Nation's seniors afford their prescription medications. I am 
particularly pleased with the generous assistance this legislation 
provides for the low-income seniors in my district.
  Those seniors with incomes below 135 percent of poverty (individuals 
with incomes under $12,123 and couples under $16,362) will be eligible 
for a prescription drug discount card that immediately applies $600 
annually toward the purchase of their medicines and covers up to 90 
percent of their prescription drug costs. Seniors with incomes between 
135 and 150 percent of the federal poverty level ($12,123-$13,470 for 
individuals and $16,632-$18,180 for couples) could ultimately have 85% 
of their drug costs covered.
  Beginning in 2006, seniors without coverage would have the option to 
join a Medicare plan that requires a $35 monthly premium and would cut 
seniors' yearly drug costs roughly in

[[Page 30840]]

half. For example, a senior without any drug coverage and monthly drug 
costs of $200 would save more than $1,700 each year. Seniors with no 
drug coverage and monthly drug costs of $800 would save nearly $5,900 
on drug costs each year. In addition, seniors would be protected 
against high out-of-pockets costs with Medicare covering as much as 95% 
of drug costs over $3,600 each year.
  Mr. Speaker, this legislation also provides a historic opportunity to 
help strengthen the rural health care delivery system with billions of 
dollars in additional Medicare payments. For far too long, Medicare has 
short-changed rural health care providers in my district, which 
threatens seniors' access to care. This legislation eliminates many of 
the disparities that exist between rural and urban physicians, 
hospitals, and other health care providers.
  Finally, this bill includes important cost-containment provisions. 
These accounting safeguards will alert future Congresses and Presidents 
if the expenditures of the entire Medicare program exceed 45 percent of 
total Medicare spending so they can address the problem.
  This may not be a perfect bill, but it is a good bill, and I urge my 
colleagues to support the Medicare conference report.
  Mr. KANJORSKI. Mr. Speaker, I rise today to speak about the 
conference report on H.R. 1, the Medicare Prescription Drug, 
Improvement, and Modernization Act of 2003. While I wholeheartedly 
support providing a prescription drug benefit to our Nation's seniors, 
I cannot support this bill in its current form because it does more 
harm than good.
  Since the House of Representatives first began debating the creation 
of a prescription drug benefit for Medicare recipients, I have 
consistently maintained that this proposal must adhere to four key 
principles to garner my support. In my view, we must create a benefit 
that is affordable, easy to administer, nationally available, and 
comprehensive. I believe that the bill crafted by the conference 
committee falls short on all counts.
  In addition, there are many other provisions folded into this bill 
that will substantially alter the Medicare system as we know it. These 
provisions would privatize the program, cause millions of seniors to 
lose their prescription drug coverage through their employers, and 
result in insufficient reimbursements for some Medicare providers. 
These ill-crafted proposals also influenced my decision to vote against 
this bill.


                     affordable prescription drugs

  In working to create a prescription drug benefit, we must ensure that 
the plan is affordable for Medicare participants. The benefit that is 
outlined in this legislation, however, will provide little relief for 
the senior citizens in my district. Because the plan requires sizable 
premiums, deductibles and copayments, seniors can still expect to pay 
between 50 and 80 percent of the cost of their prescriptions. This bill 
also creates a gap in coverage that will leave millions of seniors with 
drug costs between $2,250 and $3,600 without any benefit, even though 
they continue to pay premiums. While some may conclude that this is a 
good start to providing a prescription drug benefit, I disagree. We 
must do more to make prescription drugs affordable.
  Seniors across the country, and especially in my district, cannot 
afford to pay thousands of dollars each year in prescription drug 
costs. Those seniors living on fixed incomes must already sacrifice on 
other necessities in order to afford their costly medications. These 
seniors need immediate relief and this legislation will not provide 
that help. In addition to the cost-sharing provisions of this bill, the 
benefit does not even go into effect for another two years. In the 
interim, seniors will receive a discount drug card that will provide 
only minimal relief.
  This legislation also purports to protect low-income senior citizens. 
Individuals at the poverty level will not pay premiums under the 
program and will have copayments of only $1 to $3 for each 
prescription. In addition, for individuals slightly above the poverty 
level, assistance with premiums and the deductible will be available. 
These individuals, however, will be subject to an assets test. 
Individuals must have less than $6,000 in assets to receive the benefit 
while married couples must have less than $9,000 in assets. Therefore, 
any low-income senior who owns a home, a car, or any other large asset 
will not be eligible for this financial assistance. In my view, we 
should not force senior citizens to choose between selling their homes 
and getting their prescription drugs.
  In addition, this legislation does nothing to address the high cost 
of prescription drugs. Under the current bill, there is no methodology 
for insurance companies to negotiate for lower drug prices. If the 
program were administered through Medicare, the Government could 
negotiate with the pharmaceutical companies for lower, more affordable 
prices because the program would cover a larger number of seniors.
  Furthermore, with my support, the House recently passed legislation 
that would allow for the reimportation of prescription drugs from 24 
foreign countries. These medications are often the same as those sold 
in the United States. They are, however, sold at a much lower price. 
Unfortunately, this legislation provides only for the reimportation of 
drugs from Canada and requires that the U.S. Food and Drug 
Administration certify that the reimportation of drugs is safe. While 
this may seem like progress, it is not. The Food and Drug 
Administration has already indicated its unwillingness to consider such 
a certification. Consequently, this legislative sleight of hand on drug 
reimportation will not increase the availability of affordable 
prescription drugs in the United States.


                         ease in administration

  A Medicare prescription drug plan must also be easy to administer. 
The proposal before us fails to meet this standard. This plan will 
create a complicated system of payments and programs. As a result, it 
will be difficult to administer.
  In particular, senior citizens should not have to worry about whether 
the amount of money they spend on prescriptions during the year will 
leave them paying the whole amount of their drug costs at some point 
during the year as this bill does. Seniors who annually spend more than 
$2,250 for prescription drugs will find themselves without any coverage 
at all for a portion of the year. In order to remain in the program, 
however, these seniors will need to continue to pay the monthly 
premium, whether the program provides assistance or not.
  Such a system will create confusion for seniors. This benefit should 
provide a sense of security for the elderly, who are used to receiving 
their benefits through the Medicare program. Instead, this complicated 
program will only serve to provide older Americans with more worries 
about their health care needs.


                        nationwide availability

  An effective Medicare prescription drug plan must also be available 
nationwide. By making the benefit available through private insurance 
companies, there is no way to ensure that benefits will be equal across 
the country. in an area like Northeastern Pennsylvania, this scheme 
would have a devastating effect. By moving towards privatization, areas 
like mine would be disadvantaged because insurance companies would not 
be enticed to operate there. Northeastern Pennsylvania has a higher 
concentration of older residents than most areas in the country, and 
insurance companies will not want to operate in our area because they 
would not find it profitable, unless they charge exorbitant premiums. 
As a result, the government fallback provision would engage, but it 
would still result in these seniors paying more than those in other 
areas across the country.
  We have tried such a scheme before. In 1997, we created the 
Medicare+Choice program. This failed experiment operated in 
Northeastern Pennsylvania for awhile. Initially, this program provided 
tens of thousands of seniors in our area with prescription drug 
benefits. Insurance companies, however, discovered that they could not 
make a profit because of the economics of the region. As a result, they 
abandoned the program, leaving thousands of senior citizens without 
affordable prescription drugs once again. By providing a prescription 
drug benefit through private insurance companies, we can expect this 
legislation to result in a similar outcome for Northeastern 
Pennsylvanians.
  In addition, this faulty Medicare plan already anticipates that there 
will be a problem with providing prescriptions through private plans in 
areas like Northeastern Pennsylvania. Included in the bill is a 
provision to set aside $12 billion to pay insurance incentives to 
provide the prescription drug benefit. One must ask why, if we already 
anticipate the failure of the program, we are not considering 
alternatives, such as adding the benefit through Medicare.


                         Comprehensive Benefits

  Finally, a prescription drug program must be comprehensive. Under a 
government program, seniors should have access to any drug prescribed 
by their doctor and the program should cover the costs of that drug. 
This bill, however, establishes a limited list of categories and 
classes of drugs, and only these drugs will be covered under the 
program. Hence, this exclusion will leave many seniors to cover more 
costly medications and experimental treatments out of their own 
pockets.


                       Privatization of Medicare

  In addition to the prescription drug coverage, there are other 
changes made to ``reform'' Medicare by this legislation. If passed, for 
example, this legislation would put in place a radical system to 
privatize Medicare.
  For example, rather than providing a prescription drug benefit 
through the current

[[Page 30841]]

Medicare system, it will, as I have previously noted, instead be 
offered through private insurance companies, which can profit from 
their participation in the prescription drug program. Once the system 
is in place it will be difficult to go back and make the necessary 
changes to make the prescription drug benefit affordable, easy to 
administer, available nationwide, and comprehensive. Earlier this year, 
I supported the Democratic version of this legislation that would have 
provided prescription drugs through Medicare and achieved these 
objectives. We should be considering that bill today.
  This bill will also change the way the current Medicare program is 
run and move it towards a total privatization of the benefits Americans 
have worked their whole lives for and have come to depend on in their 
golden years. In 2010, this legislation would create a premium support 
demonstration program. This program would require seniors to enroll in 
a private plan and would provide a voucher for the cost of the 
insurance premiums. In addition, this bill would break the country into 
sections, providing different benefits in each. Therefore, the amount 
of money a person in Northeastern Pennsylvania pays could be 
substantially higher than the amount paid by a senior living in another 
part of the country.
  In my view, this program will move the country on the slippery slope 
towards the total privatization of Medicare. Rather than providing 
health care benefits to senior citizens that are guaranteed, money 
would instead be provided to insurance companies to support seniors in 
a private program. We should not allow Medicare to wither on the vine. 
There is also no reason to believe that other benefits, such as Social 
Security, would not also eventually be privatized if we begin to 
privatize Medicare now.


                            Provider Issues

  This prescription drug bill also seeks to increase Medicare payment 
to physicians and hospitals. I must acknowledge that some of the 
provisions in this bill would provide relief to the doctors and 
hospitals in my area. In particular, the bill's provision altering the 
weight given to labor costs when determining the reimbursement rate for 
an area would provide millions of dollars to the hospitals in my 
district. In addition, physicians who are anticipating a 4.5 percent 
cut in their payment through Medicare would instead receive a 1.5 
percent increase. Further, this bill provides additional funding for 
rural hospitals and for teaching hospitals.
  For hospitals like the ones in my district, this legislation provides 
only minimal relief and these changes should not be used as a 
justification for voting for this bill. As one hospital administrator 
in my district said, ``If you are dying of thirst in a desert, even a 
drop of water looks good.'' Rather than providing a band-aid fix to 
these hospitals experiencing genuine financial difficulties, we should 
have worked to equalize reimbursements across the country.
  In addition, there are portions, of this bill that will have severe 
impacts on the providers in my district. For example, the legislation 
provides for a system to competitive bidding for durable medical 
equipment to begin in 2007. This change in the program will have a 
devastating effect on the numerous small- and medium-sized medical 
equipment providers in my district. The competitive bidding system will 
cause a race to the bottom, resulting in cost cutting measures like 
layoffs and the loss of services provided for users of durable medical 
equipment.


                        Retiree Coverage Reduced

  Beyond privatizing Medicare, this legislation will result in millions 
of retirees losing their employer-sponsored drug coverage, dealing an 
irreversible blow to the employer-based system that is the backbone of 
our Nation's health care system. Employer-sponsored retiree health 
benefits are the single greatest source of drug coverage for retirees, 
providing benefits to one in three Medicare beneficiaries. They also 
generally offer the best coverage available--generous benefits and low-
cost sharing.
  The Congressional Budget Office, however, projects that 2.7 million 
seniors in employer-based retiree plans will lose the coverage they 
have today due to the discriminatory treatment of seniors with retiree 
coverage in this legislation. As a result, those individuals would be 
forced into the flawed prescription drug program outlined in this 
measure. Men and women who have worked their whole lives with knowledge 
that they will have health and prescription drug benefits in their 
retirement should not be forced into a program that could leave them 
with inadequate benefits.


                                Closing

  In sum, I cannot support this legislation. It falls short of 
providing seniors with an affordable, widely available, easily 
administered, and comprehensive prescription drug benefit. It will 
privatize the program and it will result in millions of retirees losing 
coverage through their former employers. Ultimately, this legislation 
will hurt senior citizens more than it will help them. We should do 
better for Americans in their golden years by defeating this bill and 
drafting a new one.
  Mr. PASTOR. Mr. Speaker, I strongly support efforts to give 
prescription drug coverage to the Medicare patients who do not 
currently have it. But, this bill does a poor job of meeting our 
prescription drug needs, and it drastically and negatively alters the 
overall structure of the Medicare program.
  We have the ability to give Medicare patients prescription drug 
coverage. But our hands have been tied by the arbitrary budget limits 
Congress has set on funding such a program.
  Congress and the President decided that, over the next 10 years, $400 
billion was all we could spend on helping the elderly who need 
prescription drugs. So, in order to meet this number, a prescription 
drug bill has been written that will prove inadequate for meeting the 
basic needs of today's senior citizens while proving itself a champion 
at destroying health care for the senior citizens of the future.
  Simply put, Mr. Speaker, this bill is no longer about prescription 
drug coverage. It is about ending traditional Medicare coverage.
  I oppose this bill for several specific reasons.
  First, the bill will do little to alleviate significant out-of-pocket 
costs for most senior citizens. A senior who spends $2,200 a year, less 
than $200 a month, on prescription drugs, will be required to pay 
almost $1,200 for this coverage and the drugs. A senior spending $3,500 
a year on prescription drugs will be forced to pay almost $2,500 out of 
his pocket. That is 70 percent of the total drug costs. While this bill 
provides some help, I fear it will not be enough to keep the poorest of 
our elderly from making the difficult choices between buying medicine 
and groceries.
  I am also opposing this bill because, in essence, it is designed to 
privatize Medicare. The ``demonstration'' projects to be established in 
six areas of the country, the so-called Premium Support Program, is 
nothing more than a first step toward complete privatization. The 
authors of this bill hope that more and more people will forego 
traditional Medicare for cheaper private HMOs with less overall choice 
and coverage. In fact, the private insurance companies would receive 
billions of dollars in subsidies for luring patients away from the 
traditional program. We all know that the private insurance companies 
will only accept the healthiest of patients, leaving the sickest 
patients in traditional Medicare. This, in turn, would result in higher 
costs for traditional Medicare because it would serve a sicker 
population.
  Additionally, I am opposing this plan because it will mean that a 
good portion of the 75 percent of Medicare patients who already have 
prescription drug coverage, many through former employers, will be 
dropped from their current plan and forced into a more expensive plan 
with less coverage. In hopes of avoiding that event, this bill is 
paying a tremendous subsidy to keep these companies from dumping their 
beneficiaries.
  So, this bill provides billions and billions of dollars to private 
companies to help them lure senior citizens away from traditional 
Medicare and to continue to provide prescription drug coverage to 
former employees.
  There is some disconnect here. As Robert Robb, the noted Arizona 
Republic conservative columnist writes, ``Congress is proposing to 
subsidize private drug plans that are currently being offered at no 
cost to taxpayers, in order to offer taxpayer-financed drug coverage to 
seniors that Congress hopes they won't take.'' He continues, ``See what 
I mean about being sort of stupid.''
  Mr. Robb and I rarely agree on issues. But he has hit this nail right 
on the head.
  A more logical solution might be to take these subsidies and use them 
to simply pay for prescription drugs for those who don't currently have 
coverage.
  Mr. Speaker, I say, let's give prescription drug coverage to the 
senior citizens who need it. We could do that, in a fair and meaningful 
way. We only need the desire to do so. But, let's not hurt the seniors 
who have coverage, and all those in future generations, by passing this 
ill-advised legislation. We have the opportunity to do something good 
and important. Yet, the drafters of this bill have taken it as an 
opportunity to change the Medicare program so drastically that it can 
only prove devastating to this country's older population. Let's reject 
this bill and force ourselves to set aside partisan ideologies and help 
the current and future senior citizens of this great land.
  Mr. BLUMENAUER. Mr. Speaker, our senior citizens need help with 
spiraling drug costs. It

[[Page 30842]]

is outrageous that moderate income seniors pay the highest prescription 
drug prices in the world. The idea was to fix this problem, but 
somewhere along the line, the bill was hijacked by the Republican 
leadership for other purposes. I can't remember how many of my 
Republican colleagues have told me that they think this is a bad bill. 
From the Wall Street Journal to consumer advocates, thoughtful 
conservatives to people who classify themselves as very liberal, all 
find this bill deeply flawed.
  Spending what's claimed to be $400 billion, but will actually entail 
far more cost to the Treasury, and the unprecedented pressure and 
advertising may pass this bill. The fascinating reversal of position by 
the leadership of the AARP gives a public relations boost, but that 
move has already been attacked by its own members.
  The authors of this bill are putting something in for almost 
everybody: not just the drug companies, but doctors, hospitals, 
insurance companies, and so on, but ignoring the fundamental needs of 
senior citizens. As over a thousand pages come into focus, details leak 
out and are investigated by outside groups, the press, even Members of 
Congress, it is clear the bill still does not meet the needs of our 
seniors. After all the dust settles, our senior citizens will still pay 
out of their pockets the highest drug prices in the world.
  There's something wrong when the only people who appear to be happy 
with the Medicare Prescription Drug bill are the drug companies. They 
were able to strip out provisions that would have allowed reimportation 
of cheaper drugs from Canada. It will be illegal for the government to 
negotiate lower prices for Medicare recipients. Future price increases 
will not be indexed to inflation, but to the rate of runaway drug 
costs, ensuring that spending will continue to spiral out of control.
  For the drug companies, the holidays may come a little early this 
year. Sadly, deserving senior citizens who need help won't even get 
this inadequate drug plan until 2006. Told that even in 2006, they will 
have to pay $4,000 of their first $5,100 of drug costs, they'll feel 
that they didn't get a present. I will vote against the conference 
report.
  Ms. JACKSON-LEE of Texas. Mr. Speaker, this is about as ugly as it 
gets. Just when I thought the Republican Leadership could not work any 
harder to undermine the Democratic process, to abuse their power, and 
to play politics with critical issues at the expense of the American 
people--they have just taken it to a higher, or should I say lower 
level. Call it what you will. The Alliance for Retired Americans calls 
the Republican drug bill a lemon. Others call it a rotten turkey. 
Whatever it is, it sure isn't medicine for the American seniors who 
need it.
  When Medicare was founded in 1965, U.S. Government formed a covenant 
with the people, and said, ``If you work hard and pay your share, we 
will make sure that you have access to health care when you retire.'' 
Modern medicine has made great strides over the past decades at 
managing health problems, not just through surgery and 
hospitalizations, but also with pharmaceutical drugs developed through 
great research at the National Institutes of Health, and in 
pharmaceutical companies here and around the world. These drugs can 
lead to dramatic improvements in quality of life, by helping Americans 
live longer, more comfortable, more productive lives.
  As great visionaries Lyndon Johnson and the Members of Congress 
designed Medicare, however, they did not predict that prescription 
drugs would revolutionize medicine, and therefore they did not include 
drug coverage in Medicare. Medicine has changed, but the promise that 
the U.S. Government made to the American people has not. It is time for 
Medicare to change with the times. It is time to do the right thing and 
create a real prescription drug benefit for our Nation's seniors in 
Medicare.
  I, with my Democratic colleagues, have been fighting day after day to 
make that happen. We have gone to the people of this Nation, and to our 
academics, and health care providers and developed bold plans to get 
people the medicine they need. We had developed great momentum and help 
might have been on the way. The problem is that ever since the times of 
Newt Gingrich, the Republican dream has been to privatize or destroy 
Medicare. That is why the Republican plan is a risky scheme only an HMO 
could love.
  The Bush administration's Medicare Administrator has called 
traditional Medicare dumb and a disaster, highlighting Republicans' 
hatred for a program that Democrats have been fighting for since 1965. 
While Democrats have worked to modernize Medicare with prescription 
drugs, preventive care and other new benefits, Republicans are 
insisting on a riskier course even the conservative Wall Street Journal 
calls a business and social experiment.
  When this process first began, and the President and the House and 
Senate leaders proclaimed that they intended to produce a prescription 
drug plan, my Democratic colleagues and I tried to give them the 
benefit of the doubt. We tried to work in a bipartisan fashion. At one 
point, I wrote a letter to the Members of the House-Senate Conference 
Committee and encouraged them to include fair provisions for our 
physicians and hospitals, so that they would be able to afford to 
continue providing excellent care for our seniors. I am pleased to say 
that they did respond to that request, and have put in some funds for 
those deserving groups. But that is where the collaborations ended. I 
wish that they could take the handful of good pieces in this bill and 
move them as separate legislation--the reimbursement pieces I asked 
for, the rural health provisions, the Hatch-Waxman Reforms--but they 
won't. These good things are being held hostage to leverage passage of 
a terrible bill.
  Ultimately, the core mission of this bill is to provide prescription 
drugs to seniors and the disabled on Medicare. On that, this bill fails 
horribly. The Democrats on the Conference Committee, among them, had 
decades of experience in the field of health policy. No one could 
question their commitment to helping seniors, but in a deeply cynical 
move by Republican leadership, Democrats were barred from even entering 
conference meetings. That is against everything our Founding Fathers 
intended this ``People's House'' to be. We got our first glimpse of 
this bill just over 24 hours ago. Even in our haste to get it read, we 
have found numerous flaws and pitfalls in it. In 2006, if it is allowed 
to come into effect, I am sure our seniors will find many more.
  Instead of merely blocking our ideas, as they have done for years, 
they hijacked this issue and in the name of a prescription drug bill, 
they are trying to shove a piece of legislation through Congress that 
will destroy Medicare as we know it. It privatizes Medicare, pushing 
seniors into HMOs and private insurance plans expecting them to do what 
is right for seniors. And we know from Medicare+Choice, that we cannot 
count on that. In one year alone, 46 percent of Medicare beneficiaries 
in Houston were chopped out of HMOs. Switching plans every year 
jeopardizes health and wastes time and money. The Republicans have 
invented new gimmicks like artificial caps on spending, and buzzwords, 
like ``premium support'' instead of what it really is a ``voucher'' 
system to replace Medicare in 2010.
  It is a misdirected attempt, with a terrible benefit--with a giant 
doughnut hole in coverage. And as bad as the benefit package is--even 
it is not guaranteed. The entire system is just basically a guideline 
that Republicans hope and pray insurance companies will follow, and 
develop drug plans for seniors.
  It seems like at this point, we might say, ``well money is tight, so 
let's just take what we can get, and be happy with this bill.'' But the 
conference report that we are now finally getting a glimpse of is so 
bad, it would actually leave millions of senior citizens worse off than 
they were without it. And as doctors say in the Hippocratic Oath, the 
most important rule in healthcare is do no harm.
  Furthermore, there is no rush to pass this bill. The Republican 
authors conveniently made their plan kick in in 2006, well after the 
Presidential elections of 2004. Obviously, they don't want seniors to 
go to the polls furious when they realize how bad this plan is. The 
point is, we can wait until spring and do this job right--and still 
make their 2006 timeline.
  AARP used to agree with us on every point I am making, but in a 
bizarre twist, this week the group, that supposedly represents the 
interests of our Nation's seniors declared that they would support this 
lousy bill. I was mystified by this until I learned that, according to 
a study done by Public Citizen that AARP will make an extra $1.56 
billion in profits if this bill goes through. AARP is in the insurance 
business, and has become too tied to that industry and the Republican 
leadership. They have breached the trust of the American seniors, and 
seniors are angry. It is a sad turn of events.
  With the measly Republican benefit, the average senior will actually 
be paying more for their prescription drugs a year after the bill kicks 
in, than they are paying now. And as every senior knows, it has a giant 
donut hole in the benefit plan, where seniors have to pay every nickel 
for their medications--thousands of dollars--while they keep paying 
premiums. This is tragic for seniors on fixed incomes, and it will be 
an administrative nightmare for pharmacies. It is a gimmick to 
compensate for the fact that the Republican administration has 
squandered and mismanaged our economy to a point that now they say we 
have no money to fund critical programs.

[[Page 30843]]

  It seems that at every turn, the people who need our help are getting 
the short end of the stick. Minorities, who already suffer from 
tremendous disparities in health and health care, are left behind. 
While this bill gives a giant gift to the drug and insurance industries 
and other special interests, it does little to reverse those life-
threatening disparities. My Democratic colleagues and I, in both the 
House and Senate, all came together recently and put forth the 
Healthcare Equality and Accountability Act of 2003. Our bill is the 
kind of thoughtful and comprehensive approach that healthcare deserves. 
One provision I wrote will create a Center for Cultural and Linguistic 
Competence to help every American take advantage of the health 
revolution that is upon us. The Republican Medicare bill seems to have 
the opposite goal.
  For example, this conference report does not contain the Legal 
Immigrant Children's Health Improvement Act (ICHIA), included in the 
Senate Medicare bill, which would have removed the 5-year bar on 
Federal health benefits for legal immigrant pregnant women and 
children. While these children and pregnant women may still get 
emergency medical care, States are unable to cover this population with 
basic medical services that may reduce the need for such emergency 
care. This unnecessarily increases the cost to taxpayers.
  Hispanics are the largest minority group in the United States, and 
it's estimated that by 2025, Hispanics will account for 18 percent of 
the elderly population. Currently, one in six Hispanics seniors live 
under the poverty level. For these Americans, an increase in 
prescription drug payments or doctor's visits could mean disaster. 
Houston has a strong Hispanic population, and therefore my district 
will be hit especially hard by this bill.
  And there is more bad news for Texas. 132,300 Medicare beneficiaries 
in Texas will lose their retiree health benefits. 389,400 Medicaid 
beneficiaries in Texas will pay more for the prescription drugs they 
need. 209,000 fewer seniors in Texas will qualify for low-income 
protections than under the Senate bill because of the assets test and 
lower qualifying income levels. 97,420 Medicare beneficiaries in Texas 
will pay more for Part B premiums because of income relating.
  When we look at the health care system for our seniors in the United 
States today, we see two undisputable facts. One is that Medicare is an 
excellent program that seniors trust, and that delivers quality care at 
a fair price to those who pay in. The other is that drug costs are out 
of control and need to be brought down.
  The Republican bill preserves the bad, the high cost of drugs--and it 
dismantles the good--Medicare.
  Americans pay about twice as much for drugs as people do in other 
rich countries in the world--Canada, Germany, England, Japan. This is 
outrageous, since many of those drugs were developed here, by our 
workers, trained in our universities, funded by our National Institutes 
of Health. Our seniors deserve to get the same prices as they get 
across the border in Canada. The reason they don't is because the 
Canadian government negotiates with the drug companies, and says ``Hey, 
there are 30 million of us in Canada buying your products, give us a 
fair price.'' Both the Republican bill forbids the Secretary of Health 
and Human Services from bargaining on behalf of the 40 million seniors 
on Medicare. That is outrageous, especially considering how well such 
negotiations have worked at the Veterans Administration. This bill is a 
gift to the pharmaceutical industry and HMOs and the insurance 
industry.
  This bill really is the epitome of just how bad partisanship and 
political demagoguery can get. Trying to pass it before Thanksgiving is 
a cruel--and expensive--joke on our seniors on Medicare. I don't want 
to do that to Houston. Let's don't do that to America.
  I will vote against this bill, and keep fighting to get this done 
right.
  Mrs. CHRISTENSEN. Mr. Speaker, I have listened to the debate tonight, 
and I think everyone agrees that some seniors and disabled would 
benefit by this bill. But if truth be told, many would lose, which is 
not what we set out to do--we need and promised a bill that provides a 
prescription drug benefit for all Medicare beneficiaries, not just a 
few.
  What is clear and why we should oppose this bill, is that if passed 
it would sound the death-knell for Medicare.
  We must insist that the Republicans provide funding to shore up our 
rural hospitals. We must insist that the Republican leadership not only 
increase the physician payments this fiscal year, but fix the formula, 
so that the payments won't be cut again next year.
  But what we must not do, is let this divide and conquer tactic make 
us pass a bill that would do more harm than good and physicians and 
hospitals should not allow themselves to be used to dismantle the very 
program they and the patients they are sworn to serve, depend on for 
the long run.
  With a few crumbs to seniors and the disabled, and playing on the 
dire need of hospitals and doctors, this bill is nothing more than 
another corporate give-away.
  We can afford to vote this bill down, start again, with an inclusive 
process--the benefit doesn't start for two years anyway. What we cannot 
afford to do and must not do is to kill Medicare; we must vote no on 
H.R. 1.
  Mrs. KELLY. Mr. Speaker, I rise in support of this important 
legislation. The Medicare Prescription Drug and Modernization Act will 
provide prescription drugs to seniors, and provide additional money for 
doctors and hospitals, both of which are the front line in providing 
health care.
  I am particularly pleased with provisions in the bill which seek to 
provide financial assistance to hospitals currently experiencing 
difficulties with inadequate wage index reimbursement rates. And I am 
encouraged by the potential this bill holds for assisting hospitals in 
the Hudson Valley which are adversely affected by their proximity to 
the New York City Metropolitan Statistical Area (MSA).
  I would also like to direct my colleagues' attention to an aspect of 
this legislation which perhaps hasn't received a great deal of 
attention, and that's the provision that creates Health Savings 
Accounts.
  For years we have been concerned about the many people in this 
country who have no health insurance. Many of the uninsured are small 
business owners or employees who simply cannot afford health insurance. 
With the Health Savings Accounts established in this bill, the small 
business owner can not only save tax free money for health care, but 
offer tax free health care money to their employees.
  Think of it. Now, because of Health Savings Accounts, the owners of 
small businesses across the country can make contributions--tax free 
contributions--to their employees.
  Money in these accounts can be used for insurance premiums or spent 
directly on medical care. This means many more people can buy coverage. 
For the first time, health care will be more accessible to the millions 
of small businesses in this country.
  This is a powerful tool for empowering working Americans who deserve 
to control important decisions over their own medical care.
  Mr. NUSSLE. Mr. Speaker, I rise today to support a long overdue, 
welcome victory for Iowa's seniors and health care providers.
  Medicare's policies have penalized health care providers in Iowa and 
other rural areas since the 1960s. While Medicare's primary purpose is 
to provide health care for seniors, its policies affect both our health 
care system and our economy. The flawed policies have had an impact not 
only on seniors, but on all Iowans.
  As many of my House colleagues know, I have worked long and hard to 
address the problems affecting health care providers in rural states 
such as Iowa. In fact, I wrote this year's budget to reserve 
significant resources for rural health care as part of a $400 billion 
Medicare Reserve Fund. Later, in the Ways and Means Committee, I 
successfully amended the Medicare legislation to ensure that sufficient 
rural health care funds were included in the bill that was reported 
from committee. And I continued fighting on the House floor to ensure 
that these funds--the most generous rural package ever considered by 
the House--remained in the Medicare legislation as it worked its way 
through the House.
  Today, we are considering a conference report that carries this rural 
health care package to the end of the process. The benefits for Iowa 
will be multiplied for years to come. This conference report contains 
an unprecedented $25 billion rural package including benefits of over 
$400 million for Iowa alone. I am proud to have worked toward this day 
with the distinguished chairman of the House Ways and Means Committee 
and with the senior Senator from my home state of Iowa.
  With these significant strides to improve Medicare's reimbursement 
policies on Iowa's behalf, we help our health care providers to pay the 
bills and to continue recruiting and retaining top-notch professionals. 
With a more secure health care system in place, we can further job 
creation and economic growth for our state.
  In addition to taking several steps to strengthen the overall 
program, we are, of course, finally giving seniors what they have 
sought since Medicare's inception in 1965--a prescription drug benefit 
that is affordable, accessible and completely voluntary. All seniors 
will save on their current prescription drug costs.
  Another important feature in the bill is the provision to establish 
Health Savings Accounts (HSAs). These accounts will allow pre-retirees

[[Page 30844]]

to accumulate tax-free savings over their lifetime and these savings 
will remain with the individual once they reach Medicare eligibility. 
Even with reforms such as these, I want to remind my colleagues that 
Medicare will still face long-term demographic pressures and Congress 
will likely have to take additional steps to address the program's 
sustainability.
  Finally, as Chairman of the Budget Committee, I am pleased that the 
Medicare conference report--with a total cost of around $395 billion--
is generally consistent with the $400 billion Medicare Reserve Fund 
that was laid out in this year's budget resolution. In a year of 
intense demands for limited government resources, this Medicare Reserve 
Fund was the largest policy initiative in the budget resolution and was 
arguably its centerpiece. Because the budget resolution struck a 
responsible balance between seniors' needs on the one hand and 
affordability on the other, we were able to generally stay within our 
own guidelines. I commend the conferees for staying within the $400 
billion threshold.
  Mr. Speaker, I have been spreading the word and twisting arms for a 
long time on behalf of legislation that would meet Iowa's health care 
needs. I am gratified that our message has been received and our 
persistence has paid off.
  Mr. CAMP. Mr. Speaker, I rise in support of H.R. 1.
  In the last five days, I've heard a lot about what this bill doesn't 
do. Let me be frank: life is not about what we don't do; it's about 
what we accomplish.
  And, if I had a friend in need who asked me for $100 and all I had 
was $20, I wouldn't give him nothing. But that's what some here are 
prepared to do--turn away a friend in need.
  For years we have agreed that our seniors needed a prescription drug 
benefit in Medicare; but unfortunately we have yet to provide them with 
any relief.
  This Medicare bill offers a prescription drug benefit through 
competing private health insurance plans--marking the first time 
private sector plans and consumer choice would be the principal vehicle 
for delivering Medicare benefits. It also includes common sense reforms 
like preventive care and health savings accounts.
  This is the first step in the direction of true reform. It's a step 
in the right direction and it is time we take it.
  Mr. ORTIZ. Mr. Speaker, Congress created Medicare in 1965 to make 
healthcare affordable and available for all senior citizens. My 
colleagues and I have fought to maintain this original intent.
  Today, the leaders in Congress are pushing dangerous legislation--
called Medicare reform--on South Texas seniors that fails to include an 
adequate prescription drug benefit while privatizing Medicare, killing 
the program at the end of the decade.
  This prescription drug ``coverage'' is not what seniors expect or 
deserve. When seniors have more than $2,200 in drugs costs, they will 
hit a gap, where Medicare will no longer cover the costs of their 
prescriptions until they reach $5,000.
  When this happens, these seniors will be forced to pay 100% out of 
their own pockets while still paying monthly premiums. Meanwhile, their 
HMOs will select their doctors and their pharmacies.
  Over 185 organizations with an interest in seniors' issues are wholly 
opposed to this bill. While one of the largest senior organizations has 
lent support to this bill (The American Association of Retired Persons, 
AARP), it is the only one to do so . . . it is the only one that 
provides insurance to seniors at a profit of $635 million . . . and the 
only one poised to take advantage of billions of dollars in the bill to 
entice private insurers to cover seniors.
  The bill effectively ends drug reimportation by allowing the 
Secretary of Health and Human Services (HHS) to decide what 
prescriptions could be reimported. The HHS Secretary has already said 
he would allow none.
  If this is not the answer, what is? I stand on my record, voting 8 
times for a complete Medicare Rx drug plan . . . voting 6 times and co-
sponsoring 6 bills supporting higher reimbursements to doctors and 
hospitals . . . voting 6 times not to kill Medicare . . . and voting 8 
times and co-sponsoring 3 bills to improve rural healthcare.
  Nothing in this bill makes prescription drugs cheaper. Other Federal 
programs, such as the Veteran's Administration, get cheap drugs 
negotiating directly with the big drug companies. The plan will keep 
the government from negotiating for lower drug prices for Medicare 
beneficiaries.
  This plan protects the profits of drug manufactures instead of 
providing real savings to seniors. Rising drug prices are unaddressed 
in this bill, a victory for the drug industry for preventing any 
attempts to lower drug prices.
  Meanwhile, the value of some seniors' property will be used to 
determine their level of coverage--including jewelry, cars, and other 
property of value for which they worked their entire lives.
  In South Texas, for the short term anyway, the bill (which would not 
take effect until 2006) would help only about 30% of low-income 
seniors. Effectively, that means this bill will not help over two-
thirds of our most needly seniors.
  When I think about the seniors that bill will affect, I think of the 
ladies who took care of me as I grew up of Robstown, Texas. Life for 
them revolves around family and children, paying the bills and finding 
health care in their senior years.
  These are the people affected by the bill, which ends Medicare as we 
know it, privatizing the entire progrm by the end of the decade. It is 
thousands of South Texans like these who have raised voices in 
opposition to this bill. I stand with them.
  Medicare has been a trust between the government and those who do the 
hard work in our society, our senior citizens. Too many seniors depend 
on Medicare for their healthcare needs, and I will not support a bill 
that destroys that trust.
  Mr. LARSON of Connecticut. Mr. Speaker, I rise today in opposition to 
H.R. 1, the Medicare Prescription Drug and Modernization Act of 2003. 
Some may claim that this legislation is the answer to the high prices 
seniors are paying for their prescription drugs. That is far from true. 
The reality is that this legislation is a Medicare privatization plan 
masquerading as a prescription drug relief bill. The big winners in 
this bill are not the seniors that desperately need relief, but 
pharmaceutical companies and big business.
  Does this conference report strengthen the Medicare program that 
seniors know and trust? The answer is no. It includes a premium support 
demonstration project that is the first step towards forcing all 
seniors to choose private insurers to get the prescription drug benefit 
they need, or to pay more to stay in the traditional Medicare program. 
This bill having any effect at all is contingent upon the willingness 
of HMOs and insurance companies to participate, and the track record 
does not paint a positive outlook. We in Connecticut remember HMOs 
pulling out of Medicare Plus Choice plans because they simply could not 
make a profit.
  Does this conference report allow the Government to negotiate the 
costs of prescription drugs and provide relief to seniors? The answer 
is no. The bill specifically prohibits the Secretary of Health and 
Human Services from leveraging the tremendous buying power of the 
Federal Government to negotiate lower drug prices for 40 million 
Medicare recipients, a system the VA currently uses.
  Does this conference report allow reimportation of drugs from other 
industrialized nations so that seniors will be able to purchase less 
expensive drugs? The answer is no. It ignores the reimportation measure 
that this House passed this summer and places the decision in the hands 
of health officials who have vocally opposed reimportation.
  Does this conference report help low-income seniors who need help the 
most? The answer is no. First, the proposal actually reduces coverage 
for the 6.4 million lowest-income and sickest beneficiaries who qualify 
for Medicaid today. It prohibits Medicaid from helping these 
beneficiaries with copayments or from paying for prescription drugs not 
on the formularies of the private insurers administering the new 
Medicare benefits. It also leaves behind 3.9 million seniors that would 
have qualified under the Senate bill. One reason for this is the 
imposition of an invasive assets test. This means that seniors with 
modest savings will not receive any assistance with the cost of their 
premiums, the deductible, co-payments, or the cost of the medications 
while they are in the $2,850 coverage gap.
  Does this conference report help cancer patients? The answer is no. 
It falls well short of the drug and practice reimbursements needed to 
provide millions of cancer patients with the care they need.
  Will this conference report prevent employers from dropping health 
insurance for their retirees? The answer is no. Though incentives were 
added to encourage employers to maintain their retiree plans, the 
Congressional Budget Office estimates 2.7 million retirees will lose 
the existing coverage they rely upon and countless others may have 
their benefits reduced. Furthermore, it does nothing to protect retired 
teachers, firefighters, police officers, State and local government 
employees, and those who worked for nonprofit organizations.
  Does this conference report help the hospitals and doctors struggling 
to meet the needs of their patients? The answer, surprisingly, is yes. 
It provides an increase in the Medicare Disproportionate Share Hospital 
cap

[[Page 30845]]

for rural hospitals and urban hospitals with fewer than 100 beds. It 
increases payments for indirect medical education that would provide 
increased funding for the twenty Connecticut hospitals that have 
medical education programs. Also, it eliminates the 4.2% reduction in 
payments to physicians in 2004 and replaces it with a 1.5% increase for 
the next two years. These provisions are positive. But, this was 
intended to be a prescription drug relief bill and these positives are 
by far outweighed by the negatives of this legislation.
  So, who are the winners in this conference report? The answer is 
pharmaceutical companies. They will receive the majority of the $400 
billion that this legislation will cost. But, even better for them, 
they will not be forced to lower their prices. The Government will not 
be allowed to negotiate prices and seniors will not be allowed to 
purchase imported drugs from other industrialized nations. Apparently, 
the industry's army of lobbyists and $22 million in campaign 
contributions were effective.
  Who are the losers? The answer is seniors, the ones this bill was 
meant to assist. They asked for prescription drug relief and we are 
trying to give them a Medicare privatization bill. That is why I urge 
my colleagues to join me in voting against this conference report.
  Mr. UDALL of New Mexico. Mr. Speaker, I rise today with great 
disappointment in the conference agreement that has been brought to the 
floor. I sincerely hoped that the bill that passed the House in July 
would have been moderated with provisions included in the other 
chamber's bill.
  Unfortunately, instead of considering legislation today that would 
have modernized the Medicare program to provide prescription drug cost 
relief and coverage for seniors throughout this great nation, we have 
this agreement that is geared toward dismantling one of the most 
successful government programs ever implemented. Instead of considering 
legislation to modernize the Medicare formulas to fix the inequities 
between rural and urban areas, we are considering an agreement that 
wraps these crucial fixes in with a prescription drug benefit that is 
designed to achieve the ideologically extreme goal of privatizing 
Medicare.
  Mr. Speaker, I will certainly admit that the provider package 
included in this agreement is excellent. For years doctors, hospital 
administrators, and other health care providers have suffered under the 
unfair Medicare formulas that severely hampered their ability to 
provide care to Medicare beneficiaries. The labor share revision, the 
geographic physician payment adjustment, increasing home health 
services furnished in rural areas, critical access hospital 
improvements--these are all incredibly important provisions that I 
strongly support in order to help strengthen the health care system in 
rural areas. I also support fixing the inequitable disproportionate 
share formula, which is done to a degree in this agreement. 
Unfortunately, however, the conference agreement removes language that 
would have given New Mexico a larger increase of DSH payments to $45 
million. The physician fee formula update is another provision that is 
incredibly important. Without this fix, physicians will have no other 
choice but to stop seeing Medicare beneficiaries, which will lead to 
the total breakdown of a system that is already badly strained to its 
limits.
  I recognize the importance of these provisions. I understand the 
difficulties that those in the health care industry are facing. I 
understand the difficulties seniors are facing in trying to purchase 
and pay for their medications. That is why I have cosponsored 
legislation to fix the disproportionate share provisions, I have 
cosponsored legislation to fix the Medicare physician payment updates, 
I have written letters supporting these provisions and urging Chairman 
Thomas to include these rural fixes in the legislation, I have written 
a letter to conferees asking them to retain this provisions, and, when 
this bill passed in July, I voted in favor of the Democratic 
alternative that not only included stronger rural provisions than those 
included in the Majority's bill, but also contained a real prescription 
drug benefit--not a benefit engineered to bring about the demise of the 
Medicare program.
  Mr. Speaker, lets be clear about what our goal was supposed to be. We 
were supposed to create a new prescription drug benefit in Medicare. 
That's what we were supposed to be doing with this important 
legislation.
  Unfortunately, we are doing much more than that, and a lot of it is 
terrible. We were supposed to be reducing the costs of drugs for 
seniors. Yet this plan prohibits the federal government from using its 
clout to force down the price of medicine.
  We were supposed to help seniors keep their current drug coverage if 
they are fortunate enough to have it. Yet this plan may force up to 
three million seniors out of their current employer-based plans.
  We were supposed to be strengthening the Medicare program by adding a 
voluntary benefit for prescription drug coverage. Yet this plan, under 
the guise of a premium support demonstration, weakens the Medicare 
program by forcing beneficiaries to pay more for Medicare if they don't 
give up their doctor and join an HMO.
  We were supposed to help low-income seniors who get additional 
assistance from Medicaid afford their prescriptions. Yet this plan not 
only forces 6 million low-income seniors to pay more for their 
medications, but also imposes an unfair assets test that disqualifies 
seniors if they have modest savings.
  We were supposed to be providing a prescription drug benefit that 
would ease the cost and emotional burden seniors face in dealing with 
medication purchases. Yet this plan leaves millions of seniors without 
drug coverage for part of the year due to the $2800 gap in coverage.
  Mr. Speaker, I am extremely disappointed with this agreement. I am 
disappointed because what should have been a straightforward approach 
took a wrong-turn along the way. I think this is a terrible way to 
spend $400 million dollars on a supposed prescription drug benefit, and 
I will be forced to vote against this measure. I urge my colleagues to 
reject this shameless assault on Medicare.
  Mr. STUPAK. Mr. Speaker, I rise today in opposition to this Medicare 
bill with limited prescription drug coverage.
  This plan is bad for America's seniors and especially bad for rural 
areas like Northern Michigan, which I represent.
  Medicare should be a right--this Republican Medicare bill threatens 
to undercut this right and destroy a program that seniors have trusted 
for nearly 40 years.
  For most seniors, the prescription drug plan does not begin until 
2006 while the Democrats' plan would have begun next year.
  The Republican plan has a gap in prescription coverage the size of 
the Upper Peninsula. This gap starts at $2,250 and goes on until you 
hit $5,100.
  We should be giving our seniors a real prescription benefit not one 
that gives you part-time coverage.
  Illnesses and diseases do not take time off--you're not sick part of 
the time--seniors need full prescription drug coverage now.
  Those seniors who now have coverage may lose it--CBO estimates that 
up to 3 million could lose their existing prescription drug coverage.
  I cannot support a bill that will undercut our seniors' right to 
Medicare.
  While Congress provides universal health coverage for Iraq that 
includes full prescription drug coverage--seniors in America will 
receive part-time prescription drug coverage but pay 100 percent of the 
costs.
  Vote ``no'' on this ill-conceived bill.
  Mr. DAVIS of Illinois. Mr. Speaker, I have heard my colleagues 
describe the prescription drug plan as ``not perfect'' and a ``step in 
the right direction.'' However, this legislation is neither. Our 
seniors will not gain better health coverage or a prescription drug 
benefit that is affordable. Instead the CBO estimates that 
approximately 2-3 million seniors, 107,000 alone in my state of 
Illinois, who currently have drug coverage from their employer, will 
lost that coverage. This bill lowers Medicare's assistance to the 
employers making it unaffordable to keep their retirees' coverage. The 
new cap on general revenue spending will cause reductions in provider 
reimbursement rates, higher out of pocket cost, or even raise the 
payroll tax--once again passing the buck along to future generations. 
Worst of all for our senior consumers, we do not even allow the 
Secretary of HHS to negotiate lower drug prices for them.
  I am disappointed in this House for turning its backs on fulfilling 
our promise to seniors, but I am extremely disappointed that we are 
completely abandoning our Nation's most needy--our Nation's poor 
seniors. We are expecting our States to pay the Federal Government 90 
percent of the cost of drugs for our low-income seniors. During a time 
when States are already faced with large debts and complicated 
decisions on what to cut next--how do we expect the States to afford 90 
percent of the cost of drugs for our poor seniors? An estimated 6.4 
million low-income and disabled people will have significantly worse 
coverage under this new plan. It is probably because this bill actually 
prohibits Medicaid from helping with copayments or paying for 
prescription drugs that are not approved by the private insurers. This 
means that certain, needed medications that are currently covered by 
Medicaid will no longer be available to seniors. This plan does not 
even provide assistance for our seniors that are between 150 percent 
and 160 percent of the federal poverty line that is an annual income of 
$15,300 to approximately $17,850.
  Mr. Speaker, no one is saying that we should give our seniors 
something for free.

[[Page 30846]]

But we are saying lets give them something that is fair, reasonable, 
and makes sense.
  Mrs. BONO. Mr. Speaker, I rise in strong support of the Medicare 
Prescription Drug and Modernization Act of 2003. This has been a very 
long and cumbersome process; however, I believe that the American 
citizens will be pleased with what we have accomplished. I would 
particularly like to laud the accomplishments of the conferees who put 
in tireless hours crafting this monumental legislation.
  More often than any other concern, I hear from the constituents of 
the 45th District regarding health care. They are legitimately 
frightened that without reform, they will lose their existing benefits 
and the standards of care to which they have become accustomed. The 
time had come to pass substantive legislation that will allow seniors 
to spend less money on prescription drugs and spend less time 
navigating through the red tape and paperwork.
  This landmark legislation is responsive to the needs of our seniors 
and will allow access to affordable prescription drugs and improve 
health care to millions of our most needy senior citizens. This is the 
most generous package Congress has considered for rural and suburban 
health care giving seniors will have better access to doctors, 
hospitals and crucial treatment options, regardless of where they live. 
Additionally, this bill addresses the needs of the low income.
  I am particularly proud that the bill includes the critical funding 
for relief from the drastic payment reductions in the Medicaid 
disproportionate share hospital (DSH) program. The provision will go a 
long way toward protecting California's fragile health care safety. The 
funding in the conference report will restore several hundred million 
dollars to safety-net providers in California over the next 10 years.
  Safety net hospitals across the state of California, two of which are 
located in the 45th District in Moreno Valley and Indio, have had to 
absorb drastic reductions in Medicaid DSH funding at a time when demand 
for their services has been increasing. The additional funding will 
help ensure that services to the most vulnerable populations are 
available.
  This bill represents a breakthrough in the nation's commitment to 
strengthen and expand health security for its citizens at a time when 
it is most needed. I rest assured knowing that our nation's future 
generations will continue to receive the highest level of health care 
available.
  Mrs. BIGGERT. Mr. Speaker, no single piece of legislation is as 
important to meeting the health care needs of Americans as is the bill 
we will vote on shortly, the conference report to H.R. 1, the Medicare 
Modernization and Prescription Drug Act. I rise to express my strong 
support for this legislation.
  Today is truly a momentous day. Finally, Medicare will catch up with 
the realities of twenty-first century medicine. When the program was 
first created in 1965, the majority of medical treatment was done in a 
hospital. This is reflected in Medicare's current generous 
hospitalization benefit and paltry prescription benefit.
  Well, times have changed, to say the least. Today, life-saving 
medications are helping seniors stay out of the hospital and live 
longer, happier and more productive lives. But, as we all know, 
prescription drugs are expensive, and seniors too often are forced to 
cut back on other necessities to afford the medicine they need. Passage 
and enactment into law of this conference report will help to ensure 
that this never happens again.
  Here's how it works.
  Six months from now, seniors will begin to see the benefits. In April 
of 2004, any senior who wishes to have one will be issued a voluntary 
drug discount card that will save them 10 to 25 percent on their 
prescriptions. For low-income seniors, $600 automatically will be added 
to their cards to help them afford the drugs they need. The discount 
card will work like a supermarket discount card, giving users a 
discount at the time of the purchase.
  Another very important benefit kicks in beginning in 2005, when all 
newly enrolled Medicare beneficiaries will be covered for an initial 
physical examination. At last, patients and physicians will have an 
early baseline that can signal if problems exist or what areas might 
need to be monitored more closely in the future.
  All beneficiaries also will be covered for cardiovascular screening 
blood test, and those at risk will be covered for a diabetes screen. 
These new benefits can be used to screen Medicare beneficiaries for 
many illnesses and conditions that, if caught early, can be treated, 
managed, and can result in less serious health consequences.
  And perhaps most importantly, beginning in 2006, for the very first 
time in the history of Medicare, seniors will have a prescription drug 
benefit. If they choose to participate, seniors would pay about $35 a 
month. Once they have met the $250 a year deductible, 75 percent of 
their drug costs will be covered up to $2,250. When drug costs exceed 
$3,600 a year, 95 percent of costs will be picked up by Medicare.
  No matter where in the country they live, seniors will be able to 
choose between at least two prescription drug plans.
  If seniors are happy with the coverage they now have--and many in my 
district are--they do not have to switch into a new plan. This new 
benefit is absolutely, completely, 100 percent voluntary.
  But there is much, much more to this bill than a prescription drug 
benefit option for seniors. In fact, this bill can affect the health 
and welfare of every American citizen, no matter how young or old. How 
is this so?
  Well, first, this bill will expand access to health care for 
everyone.
  As you know, physicians who see Medicare beneficiaries are reimbursed 
for the extra cost of treating these patients. These payments are 
already woefully inadequate and physicians have been forced to stop 
taking on Medicare beneficiaries because they simply cannot afford to 
keep seeing them. Under current law, these reimbursements will be cut 
by an additional 4.5 percent next year.
  I am very, very pleased that the conference report addresses this 
issue by reversing the scheduled cut and increasing the payments by 1.5 
percent. This means that more doctors will be able to treat more 
seniors, and more seniors will have a choice of which doctors they see.
  Hospitals also will be better off under this bill. The conference 
report provides increases in payments to teaching hospitals and 
increases funding for hospitals that treat a large number of Medicare 
patients. It also reimburses hospitals for the costs of using the most 
advanced technology. In short, the conference report ensures that 
hospitals can continue to care for Medicare beneficiaries.
  Finally, this legislation encourages Americans of all ages to save 
for their own healthcare needs. The Health Savings Accounts--HSAs--will 
let people save money and accumulate interest--tax-free--in order to 
take care of health care premiums and other medical expenses.
  HSAs are completely portable, so when people change jobs, they can 
take their accounts with them. Individuals also can make ``catch-up'' 
contributions to their accounts once they turn 55, and still enjoy the 
tax benefits.
  These accounts will help thousands of individuals who do not have 
access to health insurance--or who wish to augment their coverage--to 
better afford it.
  Our seniors have worked hard throughout their lives. They should be 
enjoying their golden years, not worring about how to pay for their 
life-sustaining medicines. This legislation will go a long way in 
helping them get back to the business of enjoying life.
  Drug discount cards, baseline physical examinations, prescription 
drug coverage, and disease screenings are just a few of the great new 
features that will help seniors stay healthy.
  Health savings accounts and improved levels of physician and hospital 
reimbursements will go a long way to improving access to health care 
for Americans of all ages.
  I am honored to support this legislation and I encourage my 
colleagues to do so as well.
  Mr. CAPUANO. Mr. Speaker, I rise today to voice my strong opposition 
to H.R. 1, the Republican Prescription Drug Bill.
  This bill represents the first step in a Republican plan to end 
Medicare as we know it. Under the guise of providing seniors with the 
prescription drug coverage they so desperately need, this Congress is 
attempting to destroy the program that seniors have depended on for 
over 35 years to provide them with the affordable, reliable health care 
they need and deserve.
  Mr. Speaker, not only does this bill fall far short of what the 
senior citizens of this country expected of us, but it fails by the 
most basic of standards: it prohibits the federal government from 
negotiating for lower-cost drugs; it may lead to 3 million seniors 
losing the good prescription drug coverage they currently have through 
former employers; it subsides HMOs at 124 percent of what it pays to 
traditional fee-for-service Medicare; it creates new Health Savings 
Accounts, which benefit mostly the wealthy; and it sets up new ``cost-
containment'' measures, designed to lay the groundwork for future cuts 
to beneficiaries and providers. But most alarmingly, this bill contains 
a massive demonstration program that it the first step toward the 
privatization of Medicare.
  The ``premium support'' demonstration project in this bill could 
force 7 million seniors to be subject to a social experiment that has 
never been tested. Under the demonstration

[[Page 30847]]

program, HMOs could ``cherry-pick'' healthy and wealthy seniors 
citizens, leaving the poor and sick in the traditional program, 
undermining the social insurance pool. Premiums for those in the 
traditional program would be driven up, and they could also vary by 
region and fluctuate from year to year. This is an unacceptable assault 
on the Medicare program that will only result in higher profits for the 
insurance industry.
  There is no denying that some people may benefit from this bill. For 
example, it does provide some prescription drug coverage for those with 
the lowest incomes. Although instituting the first assets-test for low-
income beneficiaries in Medicare's history, it will mean that many of 
these senior citizens now have access to prescription drugs.
  Further, as the Member representing many of the teaching hospitals in 
the Boston area, I am well aware of the important provisions in this 
bill that will provide essential funding for the world-class hospitals, 
dedicated doctors, and other health care professionals who work so hard 
to provide quality care to all the citizens of my district.
  However, the positive elements of this bill do not outweigh my 
concern for the damage this bill could do to a program that has become 
an integral part of our society. The steps toward privatization 
contained in this legislation are unacceptable. I am not willing to 
gamble with the health of our nation's seniors, placing their well 
being in the hands of the insurance industry. I do not believe this is 
a risk worth taking. Medicare has served us well for over 35 years. Its 
demise would mean an America where senior citizens are left to fend for 
themselves in the private insurance market without a safety net. While 
this bill may offer some appealing short-term benefits, the price could 
be the end of Medicare as we know ti. I cannot and will not be a part 
of it.
  I urge Members to vote ``no'' on H.R. 1.
  Mr. SHERMAN. Mr. Speaker, I rise to protest the process that brings 
H.R. 1, the Medicare reform and prescription drug legislation, before 
the House today. These procedures could only be described as 
undemocratic and unfair.
  Republican Leaders were in the room for weeks as this bill was 
drafted, and were able to brief their members on its contents. 
Democratic Members could not begin to analyze the bill's provisions 
until yesterday.
  We were given almost no time to review the conference report for this 
momentous legislation. We have waived the rules of the House to allow 
for this hasty, almost immediate consideration of a bill more than 
1,000 pages long, so that not even the members of this body, to say 
nothing of the public, can fully grasp what is included.
  There is no way that we, with a fairly full day of debate in this 
body, could have read the bill in the short time provided. And it is 
not enough that we merely read the bill. One must understand its 
implications. This alone demands that we vote ``no'' now, to give 
ourselves more time to fully deliberate and debate this legislation.
  Mr. Speaker, again, I rise to express my strong opposition to the 
process by which we are today voting to overhaul one of the most 
important institutions in our country. American seniors deserve better, 
and we owe them more of our time; we owe them full deliberation, debate 
and our full consideration of this legislation.
  Mr. ROTHMAN. Mr. Speaker, for seven years, I have been pushing and 
voting for a voluntary prescription drug benefit under Medicare. Such a 
plan would give seniors access to the quality, affordable, life-saving 
medicines they need. Unfortunately, the final Medicare bill--written in 
secret by the very same Republicans who eight years ago shut down the 
federal government as part of their strategy to force Medicare to 
wither on the vine--does exactly the opposite of what it is supposed to 
do. Instead of providing seniors with a voluntary, guaranteed drug 
benefit, the bill provides no drug coverage until 2006, and then forces 
millions of seniors to pay more for drugs if they don't give up their 
doctor and join an HMO--HMOs that can raise premiums at will and will 
throw out seniors who get too sick. The bill is nothing less than an 
outrageous giveaway of taxpayer funds to the health insurance industry.
  A $12 billion slush fund in the bill will be doled out to insurance 
companies that offer privatized Medicare services and employers are 
given a $70 million windfall to maintain their retiree drug plans. 
These subsidies create a huge bias in favor of private plans. That's 
not competition, it's corporate welfare, and it's wrong.
  The Congressional Budget Office projects that when the drug benefit 
begins in 2006, the average senior will spend $3,155 annually on 
prescription drugs. Under the Republican bill, because it so loaded up 
with giveaways to the private insurance industry, a senior with an 
income over $13,500 will pay $2,075 out of the first $3,155 in total 
drug costs--66 percent or two-thirds of the total--including the $35 
monthly premium and the $250 annual deductible. And on top of these 
costs, 52,000 New Jersey seniors will face additional increases in 
their Part B premiums.
  Also, instead of a voluntary benefit under Medicare, seniors will 
lose their doctors and be forced out of the system they know and trust. 
Worse still, 220,000 New Jersey seniors enrolled in PAAD and Senior 
Gold will have their health jeopardized and their choice of medicines 
limited by restrictive drug formularies imposed on the State by managed 
care plans. These seniors will face disruption in their coverage and 
will likely get less help than they currently receive. And it's a bad 
bill for doctors, whose reimbursement rates will be set not by the 
federal government, but by HMOs out to make a profit.
  It is an especially bad deal for New Jersey seniors. As a result of 
the Republican bill, 94,000 New Jersey retirees will lose their drug 
coverage, 2-3 million nationwide. Over 150,000 Medicaid beneficiaries 
in New Jersey will pay more for drugs and 186,000 New Jersey seniors 
will be forced to leave traditional fee-for-service and accept vouchers 
to enroll in private plans starting in 2008.
  The Republicans controlling the House of Representatives today 
dislike Medicare so much that they are literally willing to subsidize 
private health insurance companies to compete with Medicare, paying 
those companies $82 billion to create new private bureaucracies to 
handle prescription drugs for seniors and to even go so far as to build 
in a profit for them. We tried this experiment once already, giving 
private plans subsidies to offer Medicare services in the form of 
Medicare+Choice. But despite these subsidies, private Medicare+Choice 
plans felt they could not make enough of a profit, so they cut benefits 
and dropped hundreds of thousands of policyholders. Not only will this 
bill ultimately destroy Medicare and force seniors and their doctors 
into dealing with private HMOs, but the $82 billion could have been 
invested into the existing Medicare infrastructure, covering all 
seniors with a voluntary prescription drug program and reducing the 
premiums and co-pays for our nation's seniors.
  Most galling the bill expressly prohibits the federal government from 
negotiating prices with the drug industry. The government already 
permits such negotiation in prices by the Department of Veterans 
Affairs and the Department of Defense--if this is good enough for 
veterans and those serving on active duty in the armed forces, why not 
for seniors? This is a $139 billion gift to drug companies in windfall 
profits. If Republicans were serious about reducing costs, their bill 
would not block the Secretary of Health and Human Services from using 
Medicare's enormous purchasing power to bring drug prices down.
  AARP, which claims to speak for seniors, but is in fact a big 
insurance company with over $200 million in commissions on health and 
life insurance policies and prescription drug plans, has hastily 
endorsed the bill. Like hundreds of rank and file AARP members in my 
district who have called my office to disavow the national group's 
decision, I am outraged that AARP renounced the anti-privatization 
principles it claimed were central to its support. For this reason, I 
have resigned my AARP membership.
  As many have said, this bill is a Trojan Horse: a radical dismantling 
of Medicare masquerading as a prescription drug bill. We must not 
forget that only a handful of Republicans voted for Medicare when 
Democrats created the program nearly 40 years ago. And at every turn 
since 1965, the Republican Party has worked to weaken a popular and 
successful health care system that allows seniors and their personal 
doctors to manage their own care.
  We must not now adopt a privatization scheme that will harm seniors 
and risk Medicare's future. Instead, Congress ought to add a simple, 
straightforward and voluntary drug benefit to Medicare, save the $82 
billion in subsidies to private insurance companies and private plans, 
and apply that money to lessen seniors Medicare drug premiums and co-
pays. And then we should engage in a real bipartisan discussion about 
the future of Medicare--out in the open and not in a secret 
congressional backroom.
  Mr. COSTELLO. Mr. Speaker, I rise in strong opposition to H.R. 1, the 
Medicare Prescription Drug and Modernization Act of 2003 conference 
report. Since coming to Congress, I have consistently promised over 
70,000 seniors in my district that I would not support legislation that 
would fundamentally change the nature of Medicare and provide a 
prescription drug benefit that relies solely on insurance

[[Page 30848]]

companies. This legislation does just that and I cannot in good faith 
support it.
  Medicare has been a success because it provides guaranteed coverage 
for all elderly and disabled Americans. This legislation would end 
Medicare as we know it and may particularly harm rural areas that 
depend on the traditional Medicare program. Beginning in 2010, up to 
6.8 million people could be part of a demonstration program that forces 
the Medicare fee-for-service program for doctors and hospital visits to 
compete with private insurance plans. People who wanted to remain in 
traditional Medicare would find their premiums going up as other 
beneficiaries opted for private insurance coverage. Seniors and the 
disabled would essentially be forced out of the traditional fee-for-
service program and into some form of managed care.
  In addition, this approach does not guarantee the same benefits for 
all seniors. Seniors who live where hospitals and doctors negotiate 
lucrative contracts with managed care plans would have to pay more; 
seniors with higher incomes would have to pay more; seniors in rural 
areas would have fewer choices of doctors and pharmacies; and seniors 
with low incomes but with assets such as a savings account might get 
nothing at all. These provisions violate the central promise of 
Medicare: to provide a consistent, guaranteed benefit that allows 
everyone, no matter where they live, how much they have, or how sick 
they are, access to quality medical care.
  Further, I support a voluntary prescription drug benefit paid for by 
Medicare. However, this ill-conceived plan before us today will result 
in as many as three million retirees losing their employer-sponsored 
drug coverage which is more comprehensive than this legislation. At 
present, employer-sponsored retiree health benefits are the greatest 
source of coverage for retirees, providing drug coverage for one in 
three Medicare beneficiaries. Yet, this conference agreement creates an 
incentive for employers to drop retiree coverage they currently 
provide, rather than encouraging them to maintain it. In addition, it 
fails to help retirees from state and local government, multi-employer 
groups, and non-profit organizations. The additional funding, under the 
premise of shoring up retiree coverage, is meaningless to those who 
retire from public service, such as teachers, firefighters, and police, 
or other organizations with no tax liability.
  Finally, the conference agreement is flawed because it offers seniors 
an inadequate prescription drug benefit. I am committed to providing a 
comprehensive benefit that is affordable and dependable for all 
beneficiaries with no gaps or gimmicks in its coverage. However, this 
legislation provides a huge gap in coverage leaving half of seniors 
without prescription drug coverage for part of every year.
  Further, the bill is sorely lacking in any provision that might 
restrict the skyrocketing costs of the drugs themselves. It does not 
include meaningful reimportation language, strong language ensuring 
access to generic drugs, or the ability to negotiate prices as is done 
currently by the Veterans Administration.
  This legislation relies too heavily on the insurance industry to 
bring drug costs down and does not guarantee seniors access to the 
medicine prescribed by their doctor or that they can get prescriptions 
filled at their local pharmacy. Seniors deserve fair drug prices and a 
real, affordable prescription drug plan.
  Mr. Speaker, for these reasons, I oppose the conference report. I ask 
my colleagues to join me and reject this bill and send it back to the 
committee with instructions to bring the bill back to the floor with a 
real prescription drug plan that guarantees seniors affordable and 
dependable coverage.
  Ms. McCOLLUM. Mr. Speaker, tonight, Republican leaders in Congress 
are poised to pass an overhaul of Medicare that provides a weak 
prescription drug benefit, fails to lower drug costs, and starts the 
process for the privatizing of Medicare--a program that seniors have 
depended upon and trusted for almost 40 years.
  Seniors have been fighting for years for a Medicare prescription drug 
benefit that is affordable; available to all seniors and disabled 
Medicare beneficiaries by providing meaningful benefits within the 
Medicare program.
  However, the legislation Republicans have produced does not make 
prescription drugs affordable, does not offer a guaranteed benefit 
under Medicare and does not sufficiently protect current retiree plans. 
Instead, this bill caters to the pharmaceutical industry, bribes the 
HMOs with $12 billion in subsidies, and allows the AARP to reap $1.56 
billion in profits. This bill threatens the future of Medicare and the 
health of America's seniors.
  Under this Republican Medicare bill: $88 billion in tax credits will 
be given to employers to retain coverage for their retirees, and; 
Despite this windfall, 2 to 3 million seniors will still lose benefits 
from their employer-based coverage; and millions of seniors will pay 
more in Medicare premiums if they refuse to join an HMO.
  The prescription drug plan that Republicans have proposed is a sham. 
Seniors will pay more than 50 percent of their drug costs for coverage 
up to $2,250. Most troubling, the bill leaves a huge ``coverage gap.'' 
Seniors will have zero prescription drug coverage for medication costs 
that run between $2,250 and $5,100--and those beneficiaries will still 
have to pay the monthly premium! Over half of all Medicare 
beneficiaries would fall into this ``coverage gap.'' And this bill will 
scale back coverage for the poorest seniors. Up to 6.4 million low-
income Medicare beneficiaries will get less drug coverage than they 
have now as a result of new low-income thresholds and stringent asset 
testing. Also, seniors will only be eligible for drug coverage through 
private insurance companies that will have wide latitude in setting 
premiums and deductibles. Private insurance companies will also be able 
to make decisions about which drugs are covered, as well as which 
pharmacies seniors can use.
  Today, there are approximately 648,000 Medicare enrollees in 
Minnesota. According to the Minnesota Department of Health, about 46 
percent have no prescription drug coverage. In Minnesota alone, this 
bill that may cause at least 39,480 Medicare beneficiaries to lose 
their coverage from their former employers and 89,800 Minnesotans will 
pay more for prescription drugs.
  And the most outrageous part is that the Republican plan benefits the 
pharmaceutical industry by explicitly prohibiting the Secretary of 
Health and Human Services from negotiating lower drug prices on behalf 
of America's 40 million Medicare beneficiaries. It also blocks the re-
importation of drugs from Canada at lower prices. Additionally, the 
plan will create health savings accounts, which are tax-free savings 
accounts for medical expenditures. This creates an unprecedented tax 
loophole that would undermine existing employer coverage and provide 
$6.7 billion in tax relief for the wealthy.
  Earlier this year, I supported a bill that provides for a voluntary 
prescription drug benefit under Medicare. Medicare would pay 80 percent 
of drug costs after a $100 deductible and no senior will have to pay 
more than $2,000 in costs per year. This plan would cover all Medicare 
beneficiaries, regardless of previous health conditions, and guarantee 
people's choice of medication, pharmacy, doctor and hospital. The plan 
that I supported would also give the Secretary of Health and Human 
Services the authority to use the collective bargaining power of 40 
million beneficiaries to secure lower costs for the most popularly 
prescribed medications to end price gouging by the big drug companies.
  Minnesota seniors and persons with disabilities deserve better than 
the Republican bill that is before us tonight. I will only vote for a 
prescription drug benefit that is affordable and available to all 
seniors and disabled Medicare beneficiaries regardless of geographic 
location or health condition.
  Mr. BISHOP of Georgia. Mr. Speaker, although the massive conference 
agreement over Medicare reform contains some of the provisions the 
country needs and that I support, the overall legislation is deeply 
flawed. Congress can do better. By voting against the agreement, I am 
calling on Congress to correct the flawed provisions that would deny 
many seniors any prescription drug benefit, increase health care costs 
for many lower income citizens, push many seniors into managed care, 
put employer-based prescription drug coverage at greater risk, and 
create an uncertain privatization process that could change the face of 
Medicare forever.
  By voting down this proposal, we could fix the critical flaws and 
still have time to enact a sound Medicare reform bill that the country 
desperately needs before the end of the 2003 session. I am cosponsoring 
a bill introduced Friday (11/21) that would shore up rural providers 
and maintain the integrity of Medicare for rural communities, while 
putting aside the more rancorous issues until later. I urge its 
consideration.
  Among the agreement's provisions that I strongly support are those 
that would provide realistic reimbursements to providers, including 
giving rural hospitals parity with urban hospitals. Many community 
hospitals have shut down, and many are struggling to survive. This puts 
the health of many of our rural citizens, and the vitality of many 
rural communities, at risk. Relief for at-risk hospitals is one of the 
positive things about the agreement, and it should be a part of any 
health care reform enacted by Congress.
  But I cannot overlook the agreement's overwhelming downside.
  Dr. Kenneth Thorpe, a noted health policy authority from Emory 
University, calculates

[[Page 30849]]

that under this agreement 51,450 Georgians would lose employer retiree 
health benefits; 161,300 Georgians would pay more for prescriptions; 
82,000 fewer Georgians would qualify for low-income benefits than under 
the Senate version; and 34,000 Georgians would pay more for Part B 
premiums for doctor and outpatient care.
  There are other sections of this lengthy bill, released the same day 
debate began, that few outside the conference committee have had an 
opportunity to examine. But much of what we know is disturbing.
  There are no measures in this bill to respond to the problem of 
skyrocketing of drug costs. Not only would the government be prevented 
from negotiating drug prices, the possibility of reimportation of less 
expensive medicine from Canada is effectively killed.
  The actual prescription drug benefit is skimpy, with an enormous 
coverage gap and an asset test designed to limit access for thousands 
of truly needy Americans. Moreover, millions of retirees will see the 
superior coverage they now receive from their former employers weakened 
or eliminated. That's nearly 3 million individuals nationally and more 
than 50,000 in the state of Georgia alone.
  One of the biggest concerns is the agreement's push to privatization. 
As drafted, it appears private insurers would tend to pull in the 
healthiest beneficiaries while those with medical problems would remain 
with Medicare, causing Medicare costs to sharply rise. This could 
create what some are calling a `death spiral' of escalating costs in 
traditional Medicare. More and more seniors would be pushed into the 
less-expensive HMOs and PPOs simply because they could not afford the 
higher cost of Medicare.
  From the enormous premium support ``demonstration projects'' to the 
weakened Federal fallback for areas without meaningful access to 
private prescription drug plans, this agreement reveals a poor 
understanding of the needs of rural providers and residents.
  All of these flaws make this agreement unattractive in the short 
term. But if we look just a bit further down the line, the picture 
becomes even bleaker. In 2006, when the prescription drug benefit would 
actually begin, the benefit would be essentially worthless to the 
average citizen. And, when 45 percent of spending on Medicare comes 
from general revenues, extreme measures to curtail Medicare spending 
would be triggered. It's extremely cynical to include such a dramatic 
cost-containment mechanism while excluding responsible measures to 
control Medicare spending.
  There is much that is wrong in this bill, and much less that is 
right.
  Rarely will we consider any legislation that will have a greater 
impact on the well being of the American people.
  Let's get it right!
  Mr. OBERSTAR. Mr. Speaker, Medicare is the most successful health 
initiative in American history--improving the quality of life for 
America's senior citizens, extending their longevity, and relieving 
their anxiety about affording the health care they need.
  For the past several years, Democrats in Congress have worked 
tirelessly for affordable, comprehensive, and guaranteed coverage for 
prescription drugs under Medicare. This week, the Republican majority 
in Congress is poised to pass legislation that will require seniors to 
pay significant out-of-pocket costs for prescription drugs, will 
eliminate employer-provided health care coverage for 2.7 million 
retirees nationwide, and will ultimately undermine the entire Medicare 
program. Simply put, the Republicans brokered a deal that prioritizes 
the pharmaceutical and the insurance industries over providing a 
comprehensive benefit to seniors and the disabled.


                  i. effects on medicare beneficiaries

  I am particularly concerned with the inclusion of ``premium 
support,'' a misguided proposal that will undermine Medicare. Instead 
of providing a Medicare prescription drug benefit for seniors, 
congressional Republicans have embarked on a radical and untested 
social experiment that threatens the future of Medicare. The final 
Medicare bill clearly takes the first step toward privatizing Medicare 
by implementing a ``premium support demonstration project'' in six 
metropolitan areas.
  The bill threatens traditional Medicare because it includes 
provisions designed to stack the deck in favor of the health insurance 
industry. The legislation allots $17 billion to HMOs to lure them into 
the market to provide senior citizens with taxpayer-financed health and 
drug benefits. As the Washington Post recently pointed out, if Medicare 
``privatization is such a good idea, why do the private insurance 
companies need such big subsidies to enter the Medicare market? . . . 
That's not capitalism or competition. That's corporate welfare.'' 
Rather than divert $17 billion from Medicare to prop up private sector 
competition, it would be far better to invest that money in Medicare's 
future.
  Seniors will essentially receive a voucher for services to cover the 
lowest-cost private insurance plan, if such plans are offered, which is 
not at all certain. If this plan does not pay for the services they 
need, seniors will have to cover the difference--which could be a big 
figure--out of their own meager income. Masquerading as increased 
efficiency, this concept disproportionately benefits healthier seniors 
and leaves seniors with more costly health care needs paying an 
estimated 25 percent more for traditional Medicare. Seniors living in 
different regions will also pay different prices for the exact same 
benefit. I believe America's seniors deserve a guaranteed drug plan 
that is available for all Medicare beneficiaries--regardless of where 
they live.


  ii. improved medicare reimbursement for rural health care providers

  I have strongly supported efforts to eliminate disparities in 
Medicare reimbursement for rural areas, and I am very pleased that the 
conference report contains significant improvements for rural health 
care providers. Health care is essential in greater Minnesota. The 
hospitals in many small communities throughout northern Minnesota are 
the major employer in town, and the health care they offer is critical 
for economic development and tourism.
  It is encouraging news that 31 hospitals in my congressional district 
would receive $39 million over 10 years under this bill in improvements 
in Medicare reimbursement, including fourteen Medicaid Disproportionate 
Share Hospitals (DSH) and 12 Critical Access Hospitals (CAHs). Other 
notable changes in the policies for CAHs--albeit not attached to a 
dollar amount--would improve the delivery of mental health services in 
rural northeastern Minnesota by permitting 10 beds to be used for 
psychiatric or rehabilitative services. Physicians would see a payment 
increase of 1.5 percent rather than a 4.5 percent decrease. Teaching 
hospitals would each receive $183,000 spread out over 10 years in 
additional payments for Indirect Medicare Education, which would 
greatly assist the training of medical students at the University of 
Minnesota, Duluth, as they prepare to serve rural Minnesota.


                     iii. prescription drug benefit

  Seniors will be eligible for drug coverage only through private 
insurance companies that will have wide latitude in setting premiums 
and deductibles. Private insurance companies will also be able to make 
decisions about which drugs are covered, as well as which pharmacies 
seniors can use.
  The plan is difficult to explain, but let me try: it begins with 
uncertain private health insurance premiums, estimated to be $35 per 
month, but not specified in statute; then, seniors must pay a $250 
deductible before they receive any assistance, after which they will 
pay a 25 percent co-insurance for up to $2,250 in drug costs. However, 
there is a large coverage gap where no assistance is provided between 
$2,250 and $5,100 in drug spending, the ``hole in the doughnut,'' where 
seniors will be paying premiums but receiving no assistance at all. 
Those seniors with $5,100 in drug costs annually will still pay $4,020 
under this bill. This plan is as unfair as it is complicated and costly 
to older Americans living on fixed incomes.


                       iv. importation/cost issue

  I firmly believe that in order to ensure the continued affordability 
of Medicare benefits for seniors, greater efforts must be made to 
address escalating health care costs, particularly the price of 
prescription drugs. Yet this bill does precious little to contain the 
cost of prescription drugs in the future. The legislation once again 
deceptively appears to permit drug importation from Canada, while 
including a poison pill that the Secretary of the Department of Health 
and Human Services must certify to the Congress that its implementation 
does not present a health risk. During the Clinton Administration, HHS 
Secretary Donna Shalala refused to make such a certification, as has 
the current Secretary, Tommy Thompson. When Americans are paying 30 to 
300 percent more for prescription drugs than Canadians or people in 
other industrialized countries, there must be a concerted effort to fix 
the safety concerns in the legislation rather than jettison the entire 
effort with this poison pill.
  Despite claims that this legislation introduces free market 
principles and competition, I am deeply troubled that the Republican 
Medicare plan prevents federal cost-saving efforts that would reduce 
prescription drug costs for seniors. At a time when many seniors must 
pinch their pennies to afford the basic necessities, this bill--
incredibly--explicitly prohibits the Secretary of the Department of 
Health and Human Services from negotiating lower drug

[[Page 30850]]

prices on behalf of America's seniors. Unlike the Department of 
Veterans Affairs, which does have such authority, the Secretary of HHS 
would not be allowed to leverage the market power of 40 million 
Medicare beneficiaries to reduce prices.
  In my view, the big winners are the drug and insurance companies, at 
the expense of our nation's seniors. In addition to providing $17 
billion to HMOs and prohibiting the Secretary of the Department of 
Health and Human Services from negotiating lower prices, the final 
Medicare bill will eventually undermine community pharmacies. Pharmacy 
benefit manages (PBMs), charged with administering the prescription 
drug benefit, will be able to contract out and establish an unequal 
playing field whereby mail order companies can sell larger quantities 
for lower co-pays than community pharmacies can. There is no 
transparency for PBMs--just a conflict of interest; PBMs are not held 
responsible to report rebates or kick-backs they might receive from the 
pharmaceutical industry for selling specific drugs--that provision was 
stripped from the conference report. I am continually dismayed that 
Republicans go to great lengths to serve special interests rather than 
the public good.
  I have voted many times this year in support of a strong prescription 
drug program that would strengthen the Medicare program. However, I am 
not willing to cast a vote to undermine a program that seniors and the 
disabled have trusted for nearly 40 years, in exchange for an atrocious 
prescription drug benefit that directs formidable sums of money to 
special interests. Congress can do better; our seniors certainly 
deserve better.
  Mr. DAVIS of Illinois. Mr. Speaker, it is said that the cruelest lies 
are often told in silence--in what you don't say. If that's the case, 
then the silence is deafening as the Medicare prescription drug 
legislation looms ever closer to final passage.
  We promised the American people we would protect and strengthen 
traditional Medicare. This legislation does the opposite--it begins 
coercing millions of seniors out the common Medicare insurance pool 
into private HMOs.
  It creates huge new tax shelters for the ultra wealthy with the 
ironic name of ``Health Savings Accounts.''
  Meanwhile the very poorest seniors, those who also qualify for 
Medicare, will see their benefits slashed.
  The bill places draconian new caps on future Medicare services and 
spiraling new tax burdens on middle income working families.
  The bill inaugurates the process of means-testing and asset-testing 
seniors before providing them benefits--of checking their wallets 
before checking their health.
  It would also add heavy new financial burdens to state budgets 
already strained to bursting by federal cutbacks.
  All this in return for a pathetically inadequate prescription drug 
benefit and skyrocketing drug company prices and profits as far as the 
eye can see.
  Fool me once, shame on you. Fool me twice, shame on me. Fooling our 
seniors shame on all of us.
  Mr. Speaker, this Medicare prescription drug bill is not what it is 
advertised to be. It is a cruel hoax and a danger to the health and 
well-being of America's seniors.
  As Representatives of the American people, we have a special moral 
responsibility to be honest with the people.
  This legislation breaks that sacred trust. This bill deceives and 
dispossesses America's seniors.
  I'm with Will Rogers: I'd rather be the man who bought the Brooklyn 
Bridge than the man who sold it.
  Mr. VAN HOLLEN. Mr. Speaker, with regret, I rise in opposition to the 
Medicare conference report now before us. Rather than giving seniors 
the simple, comprehensive and affordable prescription drug benefit they 
deserve, this bill recklessly undermines the Medicare program, 
threatens many seniors' existing drug coverage and fails to bring down 
skyrocketing drug costs.
  Let's be clear: This is not about whether we ought to add a 
prescription drug benefit to Medicare. Democrats--including myself--
have been calling for a meaningful Medicare prescription drug benefit 
for years. Now that the Republican party has dropped its historic 
opposition to modernizing Medicare, there is broad consensus--at least 
rhetorically--on the importance of this goal.
  Additionally, this is not about whether doctors should receive a 
positive payment update for services rendered under Medicare. I think 
everyone in this chamber understands we could pass a free-standing 
positive payment update for physicians today--and by a wide margin. 
Frankly, I would be first in line--because I don't think you can ask 
providers to participate in a program without adequate reimbursement. 
But if we were really interested in giving doctors a fair reimbursement 
rate, we would end this untenable ritual of dodging the next round of 
scheduled payment cuts with stop-gap, band-aid measures and finally get 
around to fixing the obviously flawed Medicare reimbursement formula 
once and for all. Unfortunately, that's not what we are doing here 
today.
  Instead, after months of secretive negotiations and much highly 
publicized bickering, the majority is now presenting this House with a 
prescription drug bill that blatantly violates the first tenet of 
responsible medicine: Do No Harm.
  If this conference report is enacted into law, as many as 7 million 
seniors will be forced to pay more for Medicare--unless they agree to 
give up their doctor and join an HMO, according to analysis done by the 
House Ways and Means and Energy and Commerce Committee minority staff. 
Additionally, over 2 million retirees who already have private 
prescription drug coverage stand to lose that coverage, according to 
the same report.
  That is also the conclusion reached by the former Republican Majority 
Leader of the House Dick Armey, who called on Congress to reject this 
misguided bill in today's Wall Street Journal, saying in part: ``(T)his 
bill is going to cost millions of seniors their current prescription 
drug coverage.''
  In my home state of Maryland, an estimated 60,000 Medicare 
beneficiaries could lose their existing private prescription drug 
benefits, according to analysis based on CBO data prepared by the 
Senate Health, Education, Labor and Pension Committee minority staff. 
Moreover, similar analysis from the Senate HELP Committee minority 
staff using CRS data projects that 75,000 Maryland Medicaid 
beneficiaries will pay more than they do now for the prescription drugs 
they need.
  This legislation puts seniors with existing coverage--and the future 
of the entire Medicare program--at risk. And for what? A prescription 
drug benefit that--after all the premiums and deductibles and co-pays 
and coverage caps and out-of-pocket costs are accounted for--provides 
$1 of assistance for every $4 that seniors with significant drug costs 
will still have to pay themselves.
  There are smarter, more efficient ways to spend $400 billion on a 
Medicare prescription drug plan. For starters, we should eliminate the 
$12 billion subsidy being offered the private insurance industry as an 
inducement to participate in the Medicare market. If PPOs and HMOs are 
really more efficient than traditional than traditional Medicare in 
delivering high quality care at a lower cost, they don't need a $12 
billion taxpayer handout to do it. Additionally, we should scrap the 
Administration's ill-conceived and deceptively named ``Health Security 
Accounts'', which amount to little more than a $6 billion tax break for 
the wealthy. And finally, we should get serious about making drugs 
affordable for seniors and for all Americans--through such common sense 
steps as permitting re-importation from our industrialized trading 
partners and allowing the federal government to negotiate for lower 
drug prices on behalf of Medicare's 41 million beneficiaries--something 
the bill before us today actually forbids the government to do.
  The ultimate value of allowing the Center for Medicare and Medicaid 
Services (CMS) to negotiate for lower prices will obviously turn on the 
outcome of those particular negotiations. But we know from the 
experience of the Veterans Administration--which does currently have 
the ability to negotiate for lower prices--that the savings can run 
upwards of 60 percent. In the absence of meaningful steps to curb the 
exorbitant cost of drugs, this bill does more for the pharmaceutical 
industry than it does for consumers.
  I believe seniors deserve a real Medicare prescription drug benefit 
plan; one that is comprehensive, affordable and easy to understand; one 
that will strengthen Medicare rather weaken it; and one that will not 
reduce the benefits of seniors who already have prescription drug 
coverage.
  Mr. Speaker, we should defeat this fatally flawed conference report, 
come together on a bipartisan basis and give seniors the meaningful 
prescription drug assistance they are asking for and need.
  Mr. CUMMINGS. Mr. Speaker, I rise today to speak against the woefully 
inadequate Medicare prescription drug conference bill being considered 
today.
  Mr. Speaker, this report is an insult to our seniors. Instead of a 
bill that helps our seniors, we have a bill that makes an untenable 
trade-off. A meaningless prescription drug benefit and the dismantling 
of the Medicare ``healthcare'' program for 40 million seniors and 
disabled Americans as we know it today. Quality healthcare coverage 
should come along with a prescription drug benefit, which

[[Page 30851]]

Democrats have been fighting for over the past six years, not at the 
expense of it. But that is what this bill does. So today, what we have 
to consider is a bill that will do more harm than good--one that 
represents a giant first step in privatizing and the emasculation of 
Medicare--a program that our seniors and disabled know and love.
  Under this disastrous plan:
  Gone are retiree benefits. Because it gives employers no incentive to 
maintain prescription drug coverage for their retirees two or three 
million retirees will lose their current private drug coverage. In my 
home state of Maryland this includes 59,640 retirees.
  Gone are wrap-around services. Six million low-income beneficiaries 
will pay more for their prescription drugs. Those who are dually 
eligible to receive both Medicare and Medicaid--seniors who are so poor 
that they need what we call wrap-around services to have healthcare 
coverage--will pay more for their prescription drugs under this plan. 
To add insult to injury this bill does not allow states to use their 
federal Medicaid monies to supplement them. This includes 75,800 
seniors in Maryland.
  Gone is the traditional Medicare Program as we know it. They say fee-
for-service stays intact. Well if you as a beneficiary want to be 
nickeled and dimed to death--and pay almost 80 percent out of pocket 
for Medicare and prescription drug coverage up to $5,044, then it stays 
intact. Let me explain, that means that after a senior or disabled 
person has paid almost $4,000 out-of-pocket in premiums, deductibles 
and contributions, then the traditional Medicare coverage kicks back 
in.
  Soon to be gone is traditional Medicare. Traditional Medicare is most 
threatened by what has been termed premium support. Beginning in 2010, 
about 7 million beneficiaries will be forced into a premium support 
demonstration that will make them pay more for Medicare if they don't 
give up their doctors and join an HMO. This also means that there will 
be tremendous premium variation from region to region even in the same 
state when this plan is fully rolled-out. While it may be just 7 
million seniors in 2010, now make no mistake the goal is to end 
Medicare as a social compact, where eventually, Medicare will indeed 
``wither on the vine'' and private insurance and pharmaceutical 
companies will rule the day. Unfortunately, passage of this legislation 
will mean that many of our seniors will wither right along with the 
Medicare program--which will no longer be seen as a guaranteed 
benefit--a concept our nation embraces.
  Here to stay are vouchers for Medicare beneficiaries--to take to an 
HMO which will give these folks what they want them to have--there will 
be little real choice. Seniors want stability--knowing who their 
doctors will be, who will be able to fill their prescriptions, which 
drugs will be covered, and in which hospital they can receive services. 
I have not ever been told by a single senior that they want to be able 
to choose between profit-driven private insurer providers which may or 
may not want to have them as clients.
  Here to stay is assets testing. What's good about this bill is that 
those beneficiaries who are 15 percent below the poverty level are able 
to forego paying the monthly premiums of $35 and the yearly deductible 
of $275, and to escape the donut hole in coverage from $2,200 to 
$5,044. But again our compassionate conservative friends give with one 
hand and take with the other.
  In order to qualify as low-income, seniors have to go through the 
degradation of proving that they are poor enough to receive it--meaning 
all of their assets, not just incomes are tested. The one saving grace 
of this bill is poisoned by the lack of compassion. This means that low 
income seniors will be kicked out of receiving the low-income benefits 
of the plan depending on their assets--simply because they have been 
able to squirrel away a few thousand dollars into a savings account. 
This affects 53,000 seniors in Maryland, many in my district.
  I ask, who is going to invade their privacy and check their assets--
isn't it sufficient that they're already living off of meager means 150 
percent below the poverty level, should they too have to pay $4,000 to 
receive both Medicare and prescription drug coverage? What a trade-off. 
How despicable. I think my colleagues can agree that this is a very 
troubling proposition and a totally unfair result.
  Here to stay is big money to the drug companies and HMOs. In fact, 
this bill overpays the private insurance plans by $1,920 per 
beneficiary at the expense of traditional Medicare by creating a $12 
billion slush fund for these companies just to take on these 
beneficiaries. Mr. Speaker, our seniors do not need a hand-out, but a 
hand-up--use that $12 billion to give to our current providers and 
hospitals who already give outstanding care to our seniors, along with 
a meaningful prescription drug benefit.
  Here to stay are HMOs that seniors will feel coerced into joining 
because they will not be able to pay for the traditional Medicare they 
enjoy today.
  Additionally, with the establishment of the Voluntary Prescription 
Drug Benefit Program, beneficiaries again lose because of the lack of 
negotiated prices for the prescription drugs. Why not leverage the 
power of the 40 million Medicare beneficiaries? Why not mandate 
containment of drug costs in this bill? Why give seniors and the 
disabled a prescription discount card they cannot use until 2006 while 
the drug companies still get to determine the cost? Why enact health 
savings accounts that only the well-off can afford? Why include a 
poison-pill that kills any chance of reimportation of affordable 
medicines? Why include an artificial budget cap on general revenues 
funding for Medicare that triggers a fast-track legislation procedure 
that would allow immediate cuts in benefits, cut payments to nursing 
homes and home health care providers and increase cost-sharing? Why 
leave our seniors and disabled powerless?
  I know the answers. It's because this bill is not a reform bill, but 
a rewards bill--and the pharmaceutical and the private insurance 
companies are the winners.
  Mr. KIND. Mr. Speaker, I rise in reluctant opposition to the bill 
before us today. It was my hope that the conference committee would 
work in a bicameral, bipartisan manner and produce a bill focused on 
providing prescription drug coverage to seniors and improving Medicare. 
Instead, House Democrats were shut out of the discussion completely, 
and special interest groups were given more information than members of 
Congress. Even more troubling than the process, however, was the 
legislation that came out of this conference. This bill is a bad deal 
for American seniors and an even worse deal for our children and 
grandchildren. Estimated at $400 billion, this bill is not paid for 
and, without basic cost containment measures, like price negotiation or 
drug reimportation from Canada, will leave a legacy of debt for our 
children and grandchildren to inherit. The easiest thing to do in 
politics is pass a bill and don't pay for it.
  Certainly, there are portions of this bill which I support--portions 
which generously and correctly bring aid and equity to hospitals, 
especially those in rural areas like western Wisconsin. For far too 
long, rural hospitals and critical access hospitals have been treated 
as second-best, and I have long been a champion of bringing equity to 
these hospitals which do such important work throughout our country. 
This bill will at last begin to equalize the base inpatient payment 
rate, increase the cap for Medicare disproportionate share hospitals, 
and bring the hospital update to full market basket. Providers also 
benefit a great deal from this bill, and I am pleased that instead of 
receiving a cut, Medicare providers would receive a 1.5% update for the 
next two years. Furthermore, the assistance to our providers is paid 
for with offsets in the budget, so it does not add to the historically 
large federal deficit. If these provisions were separate from the bill, 
I could support them in a heartbeat, and I am confident that such a 
bill would pass overwhelmingly in Congress. In fact, just today my 
colleagues and I have introduced a bill that is identical to the rural 
health care package included in the Medicare Conference Report. We 
could still pass such a bill if the Republican leadership wanted to, 
but they do not. Instead, they are holding the rural provisions hostage 
to all ill-advised and costly prescription drug program to be delivered 
to private insurance companies after we bribe them with billions to do 
it, even after they have told us they do not want to do this.
  As important as it is to sustain our hospitals and our doctors, 
aspects of the bill which will hurt our seniors, our pharmacists, and 
our states make it impossible to support this bill. Too many seniors in 
my district in western Wisconsin have told me stories of skipping meals 
in order to afford prescription drugs or cutting their pills in half to 
make their expensive prescriptions last longer. I came to Washington to 
work towards a real solution to this problem, and I have championed the 
New Democratic Coalition's plan, which is simple, progressive, and 
affordable. I would be proud to stand on this floor today and support 
the Dooley prescription drug plan. I would have been able to compromise 
and support a bill that was close to the Senate's bipartisan bill. But 
I am unable to support a bill that will do relatively little to provide 
seniors with drug coverage, that bribes insurance companies, that 
threatens to destabilize existing coverage for retirees, that 
undermines Medicaid, and that has no reasonable measures to contain 
costs.

[[Page 30852]]

  Sadly, for all the excitement over a prescription drug benefit, this 
bill would bring little relief to struggling seniors. The drug benefit 
does no start until 2006, leaving struggling seniors a few more years 
before they receive any help in paying for their prescription drugs. 
Once 2006 rolls around, many seniors will find a drug benefit far less 
generous than the one they expected. In fact, a senior who spends 
slightly over $5,000 per year on prescription drugs will have to spend 
over $4,000 of his or her own money, meaning the consumer still pays 80 
percent of drug costs. This is hardly the relief from expensive 
prescription drugs that seniors have been promised and that they 
deserve.
  Also of concern is the effect this bill will have on seniors who 
currently have drug coverage. Astoundingly, an estimated 58,170 
Medicare beneficiaries in Wisconsin will lost their retiree health 
benefits because of this bill. And they are not the only seniors who 
will suffer. Wisconsin's Seniorcare program is a shining example of the 
great work that can be done to aid our nation's seniors when federal 
and state governments cooperate. The bill before us would punish 
Wisconsin's leadership on this issue; Wisconsin would most likely lose 
the matching funds it receives for Seniorcare and be forced to 
drastically scale back the program. Wisconsin's Seniorcare participants 
currently pay a nominal enrollment fee, low drug co-payments, and a 
modest deductible, with those seniors below 160 percent of the poverty 
level paying no deductible whatsoever.
  The Wisconsin Medicaid program, as well as the 110,200 seniors who 
are dual eligibles, will see a significant risk in their drug costs as 
a result of this legislation. The bill purports to do good things for 
low-income seniors, but in my state, it will have exactly the opposite 
effect. For the 99 percent of seniors in my state who already have 
health insurance, the introduction of a new prescription drug plan 
means a confusing new benefit with higher costs to the state and 
beneficiaries and less coverage than many Wisconsin seniors already 
enjoy.
  All of this speculation over a prescription drug plan assumes, of 
course, that drug-only plans will be around to offer this less than 
substantial coverage. Currently, there are no drug-only insurance 
plans, and representatives of the industry have maintained they do not 
want to start such plans. Because of this reluctance, the bill bribes 
private insurance companies, pouring billions into the industry in an 
attempt to entice the companies to create drug-only plans. Clearly, 
$400 billion is just a floor, costs will explode, and the insurance 
companies will return to Congress in the future to ask for more money 
or they will drop coverage of our seniors, just as many Medicare plus 
Choice plans are doing today.
  The $400 billion price-tag is only the beginning of spiraling costs 
to the federal government; we have no idea what costs might be in the 
future for this benefit. Incredibly, even the original $400 billion is 
not paid for, and there are no attempts at cost control in this 
measure. The government, for both Medicaid and the Veterans 
Administration, negotiates drug prices. The 40 million Americans 
covered by Medicare constitute an immense and potentially powerful 
purchasing pool. Great savings could be realized by negotiation, yet 
this bill specifically prohibits the government from negotiating with 
drug companies. Another potential for savings is reimportation from 
Canada; once again, this cost-cutting measure is prohibited, as the 
Secretary of Health and Human Services would have to approve 
reimportation, and the agency has already indicated no such approval 
will be granted.
  Finally, Mr. Speaker, I would like to speak of a group that has 
received little attention in a debate focused on seniors--our children 
and grandchildren. While I fully support providing seniors with a 
prescription drug benefit, I do not believe it is right to shift the 
costs of this benefit to future generations. We must devise a way to 
pay for these benefits now; we cannot and must not rely on future 
Congresses and future taxpayers to fix a problem of our creation. The 
party in power in Washington today wants tax cuts for the wealthy and 
pays no attention to fiscal responsibility. It is wrong to create a 
larger deficit than the one we already face. To protect seniors, to 
protect our children and grandchildren, I am opposing this bill, and I 
urge my colleagues to reject the flawed proposals contained in this 
bill. We can and must do better.
  Mrs. DAVIS of California. Mr. Speaker, I support providing our 
seniors with prescription drug benefits under Medicare. It is one of 
the most important efforts we have undertaken this session, and, I 
believe, one of the most attainable. This is why I rise, with regret, 
to oppose this Medicare Conference Report. The legislation before us 
fails our seniors and places them at the mercy of private plans and 
insurance companies.
  There are some good items in this legislation. For example, the 
increased funding for hospitals and hard-working physicians is greatly 
needed in our communities. Unfortunately, the overall bill does not 
accomplish what our seniors need.
  When I reviewed this legislation, I needed to answer the following 
questions: ``What are the benefits for our seniors?'' and ``What do the 
changes mean in the long run?''
  In the very limited amount of time I had to review this legislation, 
I have concluded that, in reality, this Medicare bill will hurt seniors 
by making health care less reliable and more costly.
  We needed a prescription drug bill. We received, instead, legislation 
that has been called a ``Medicare monstrosity.'' It mandates huge 
changes to Medicare, but evades the underlying issue of providing 
seniors with a comprehensive prescription drug benefit.
  This legislation ends Medicare's guarantees to seniors. It gives 
billions for managed care, for tax shelters, and for many other special 
interests unrelated to prescription drugs. It significantly worsens 
current levels of coverage for millions of Medicare beneficiaries with 
increased Part B premiums and threats of disappearing employer 
benefits.
  Are all of these changes worth a weak drug benefit that will 
disappoint millions of seniors? No.
  Mr. Speaker, our seniors deserve better!
  At townhall meetings and in thousands of letters, phone calls and 
emails, seniors have told me that they want a prescription drug benefit 
that is affordable, comprehensive, and guaranteed, and they would like 
the coverage provided in the current Medicare system. The bill before 
us meets none of these standards.
  Instead this bill will make our seniors anxious--anxious about 
substantial cost increases; anxious about having to switch doctors; and 
anxious about losing he security that Medicare has provided for almost 
40 years.
  The Conference Report before us is a missed opportunity. I hope 
Congress does the right thing by going back to the drawing board, and 
giving seniors a reliable and affordable prescription drug benefit. We 
can do better or our seniors--and we must!
  Join me in defeating this bill and working to pass legislation that 
truly addresses our seniors' needs.
  Mr. RAMSTAD. Mr. Speaker, I rise in strong support of the Medicare 
Prescription Drug, Improvement and Modernization Act.
  This is truly a historic day. After years of hard work, Congress is 
finally on the verge of delivering on our commitment to America's 
seniors. The bill before us will honor our promise to create a 
meaningful and long overdue prescription drug benefit for Medicare 
beneficiaries.
  This legislation means seniors will no longer have to choose between 
purchasing life-saving drugs or the basic necessities of food and 
housing.
  In addition to this important new prescription drug benefit, the bill 
modernizes and improves Medicare to give seniors better choices and 
greater access to state-of-the-art health care.
  I am grateful for the many important provisions in this package from 
the bill I sponsored, the Medicare Innovation Responsiveness Act (H.R. 
941), which will increase seniors' access to lifesaving medical 
technology. These provisions provide long needed reforms that will 
bring the Medicare program into the 21st Century.
  As founded and co-chair of the Medical Technology Caucus, I have 
witnessed first-hand the remarkable advances that lifesaving and life-
enhancing medical technology has made to treat and cure debilitating 
conditions. The current Medicare system is antiquated because of its 
failure to incorporate modern day advances in technology.
  Currently, seniors face unconscionable delays of up to 5 years before 
Medicare grants access to new technology. This delay can literally be a 
matter of life or death for many seniors.
  The legislation before us incorporates many of the reforms I proposed 
that will vastly improve medicare's coverage, coding and payment 
process. These reforms will remove barriers to FDA-approved, lifesaving 
technology for millions of seniors. The result will not only improve 
lives, but in many cases save lives as well.
  Thanks to this legislation, we are finally eliminating the barriers 
that discourage innovation and deny America's seniors the medical 
technologies they desperately need. Seniors have waited too long for 
access to the same treatment options that other Americans routinely 
enjoy.
  I am also pleased the bill includes legislation I introduced with Mr. 
Cardin to break down regulatory barriers facing specialized 
Medicare+Choice plans that serve the frail elderly.

[[Page 30853]]

  I also worked diligently to ensure that seniors suffering from 
serious mental illness will have the necessary access, under the new 
drug benefit, to the psychotropic medication they desperately need. I 
am pleased that this legislation addresses this critical need.
  Mr. Speaker, this package of reforms will improve the lives of 
today's seniors and seniors for generations to come. I urge my 
colleagues to support this landmark legislation and deliver on our 
promise to preserve, protect and strengthen Medicare.
  Mr. CANTOR. Mr. Speaker, tonight is a truly historic night. Tonight 
we will reform and modernize the Medicare system to reflect the needs 
of seniors. This legislation will save Medicare for our children while 
allowing seniors access to affordable prescription drugs starting next 
year.
  One important feature of this legislation that allows seniors to have 
more control of their health care is the inclusion of new Health 
Savings Accounts (HSAs). These tax-preferred savings accounts work like 
IRAs and allow individuals, not the government, to make choices that 
best suit their needs. HSAs, will put individuals back in the driver's 
seat when it comes to their own health care.
  The success of 529 college-savings plans and Roth IRAs proves that 
HSAs will work. I am glad that we were able to add this conservative 
and common sense proposal to the bill.
  Tonight for the first time in Medicare's history, we will provide 
nearly 1-million Virginians with access to affordable prescription drug 
coverage. I am proud to deliver this much-needed and past-due 
assistance to my fellow Virginians.
  Mr. Speaker, I support the Medicare legislation before us. It is a 
critical step in the right direction, and I encourage my colleagues on 
both sides of the aisle to support this bill.
  The SPEAKER pro tempore (Mr. Hastings of Washington). Without 
objection, the previous question is ordered on the conference report.
  There was no objection.


           Motion To Recommit Offered By Mr. Turner Of Texas 

  Mr. TURNER of Texas. Mr. Speaker, I offer a motion to recommit.
  The SPEAKER pro tempore. Is the gentleman opposed to the conference 
report?
  Mr. TURNER of Texas. Yes, I am, Mr. Speaker.
  The SPEAKER pro tempore. The Clerk will report the motion to 
recommit.
  The Clerk read as follows:

       Mr. Turner of Texas moves to recommit the conference report 
     on the bill H.R. 1 to the committee of conference with the 
     following instructions to the managers on the part of the 
     House:
       (1) Strike the provisions of section 1860D-11(i) of the 
     Social Security Act, as added by section 101(a) of the 
     conference substitute and relating to noninterference of the 
     Secretary of Health and Human Services with the negotiations 
     between drug manufacturers and pharmacies and PDP sponsors.
       (2) Substitute the provisions of title I of the Senate 
     amendment to the bill for title I of the conference 
     substitute recommended by the committee of conference, but 
     provide for medicare as primary payor for prescription drug 
     coverage for low-income individuals (as contemplated by the 
     House bill), and permit State medicaid programs to provide 
     wrap-around coverage (as contemplated by the Senate 
     amendment).
       (3) Substitute the provisions of title II of the Senate 
     amendment to the bill for title II of the conference 
     substitute recommended by the committee of conference with 
     the following changes:
       (A) Omit the provisions of section 231 of the Senate 
     amendment (relating to establishment of alternative payment 
     system for preferred provider organizations in highly 
     competitive regions).
       (B) Omit the provisions of subtitle E (relating to the 
     establishment of a National Bipartisan Commission on Medicare 
     Reform).
       (4) Within the scope of conference and to the maximum 
     extent possible, take up and reconsider title VIII of the 
     conference substitute.
       (5) Strike section 1123 of the conference substitute 
     (relating to a study and report on trade and 
     pharmaceuticals).
       (6) Within the scope of conference and to the maximum 
     extent possible, take up and reconsider the issue of 
     importation of prescription drugs.
       (7) Within the scope of conference and to the maximum 
     extent possible, take up and reconsider the issue of special 
     rules for employer-sponsored programs, including qualified 
     retiree prescription drug plans.

  Mr. TURNER of Texas (during the reading). Mr. Speaker, I ask 
unanimous consent that the motion to recommit be considered as read and 
printed in the Record.


                             Point of Order

  Mr. THOMAS. Mr. Speaker, I make a point of order.
  The SPEAKER pro tempore. The gentleman will state his point of order.
  Mr. THOMAS. Mr. Speaker, do we have the motion to recommit in written 
form?
  The SPEAKER pro tempore. The Clerk is reading the motion now.
  Mr. THOMAS. Mr. Speaker, are we allowed to have the motion?
  The SPEAKER pro tempore. The gentleman submitted his motion to the 
desk.
  The Clerk will read.
  The Clerk concluded the reading of the motion to recommit.
  The SPEAKER pro tempore. The motion to recommit is not debatable.
  Without objection, the previous question is ordered on the motion to 
recommit.
  There was no objection.
  The SPEAKER pro tempore. The question is on the motion to recommit.
  The question was taken; and the Speaker pro tempore announced that 
the noes appeared to have it.


                             Recorded Vote

  Mr. TURNER of Texas. Mr. Speaker, I demand a recorded vote.
  A recorded vote was ordered.
  The vote was taken by electronic device, and there were--ayes 211, 
noes 222, not voting 2, as follows:

                             [Roll No. 668]

                               AYES--211

     Abercrombie
     Ackerman
     Alexander
     Allen
     Andrews
     Baca
     Baird
     Baldwin
     Ballance
     Becerra
     Bell
     Berkley
     Berman
     Berry
     Bishop (GA)
     Bishop (NY)
     Blumenauer
     Boswell
     Boucher
     Boyd
     Brady (PA)
     Brown (OH)
     Brown, Corrine
     Burton (IN)
     Capps
     Capuano
     Cardin
     Cardoza
     Carson (IN)
     Carson (OK)
     Case
     Clay
     Clyburn
     Conyers
     Cooper
     Costello
     Cramer
     Crowley
     Cummings
     Davis (AL)
     Davis (CA)
     Davis (FL)
     Davis (IL)
     Davis (TN)
     DeFazio
     DeGette
     Delahunt
     DeLauro
     Deutsch
     Dicks
     Dingell
     Doggett
     Dooley (CA)
     Doyle
     Edwards
     Emanuel
     Emerson
     Engel
     Eshoo
     Etheridge
     Evans
     Farr
     Fattah
     Filner
     Ford
     Frank (MA)
     Frost
     Gephardt
     Gonzalez
     Gordon
     Green (TX)
     Grijalva
     Gutierrez
     Gutknecht
     Harman
     Hastings (FL)
     Hill
     Hinchey
     Hinojosa
     Hoeffel
     Holden
     Holt
     Honda
     Hooley (OR)
     Hoyer
     Inslee
     Israel
     Jackson (IL)
     Jackson-Lee (TX)
     Jefferson
     John
     Johnson, E. B.
     Jones (NC)
     Jones (OH)
     Kanjorski
     Kaptur
     Kennedy (RI)
     Kildee
     Kilpatrick
     Kind
     Kleczka
     Kucinich
     Lampson
     Langevin
     Lantos
     Larsen (WA)
     Larson (CT)
     Lee
     Levin
     Lewis (GA)
     Lipinski
     Lofgren
     Lowey
     Lucas (KY)
     Lynch
     Majette
     Maloney
     Markey
     Marshall
     Matheson
     Matsui
     McCarthy (MO)
     McCarthy (NY)
     McCollum
     McDermott
     McGovern
     McIntyre
     McNulty
     Meehan
     Meek (FL)
     Meeks (NY)
     Menendez
     Michaud
     Millender-McDonald
     Miller (NC)
     Miller, George
     Mollohan
     Moore
     Moran (VA)
     Murtha
     Nadler
     Napolitano
     Neal (MA)
     Oberstar
     Obey
     Olver
     Ortiz
     Owens
     Pallone
     Pascrell
     Pastor
     Paul
     Payne
     Pelosi
     Peterson (MN)
     Pomeroy
     Price (NC)
     Rahall
     Rangel
     Reyes
     Rodriguez
     Ross
     Rothman
     Roybal-Allard
     Ruppersberger
     Rush
     Ryan (OH)
     Sabo
     Sanchez, Linda T.
     Sanchez, Loretta
     Sanders
     Sandlin
     Schakowsky
     Schiff
     Scott (GA)
     Scott (VA)
     Serrano
     Sherman
     Skelton
     Slaughter
     Smith (WA)
     Snyder
     Solis
     Spratt
     Stark
     Stenholm
     Strickland
     Stupak
     Tanner
     Tauscher
     Taylor (MS)
     Thompson (CA)
     Thompson (MS)
     Tierney
     Towns
     Turner (TX)
     Udall (CO)
     Udall (NM)
     Van Hollen
     Velazquez
     Visclosky
     Wamp
     Waters
     Watson
     Watt
     Waxman
     Weiner
     Wexler
     Woolsey
     Wu
     Wynn

                               NOES--222

     Aderholt
     Akin
     Bachus
     Baker
     Ballenger
     Barrett (SC)
     Bartlett (MD)
     Barton (TX)
     Bass
     Beauprez
     Bereuter
     Biggert
     Bilirakis
     Bishop (UT)
     Blackburn
     Blunt
     Boehlert
     Boehner
     Bonilla
     Bonner
     Bono
     Boozman
     Bradley (NH)
     Brady (TX)
     Brown (SC)
     Brown-Waite, Ginny
     Burgess
     Burns
     Burr
     Buyer
     Calvert
     Camp
     Cannon
     Cantor
     Capito
     Carter
     Castle
     Chabot
     Chocola
     Coble
     Cole
     Collins
     Cox
     Crane
     Crenshaw
     Cubin
     Culberson
     Cunningham
     Davis, Jo Ann
     Davis, Tom
     Deal (GA)
     DeLay
     DeMint

[[Page 30854]]


     Diaz-Balart, L.
     Diaz-Balart, M.
     Doolittle
     Dreier
     Duncan
     Dunn
     English
     Everett
     Feeney
     Ferguson
     Flake
     Fletcher
     Foley
     Forbes
     Fossella
     Franks (AZ)
     Frelinghuysen
     Gallegly
     Garrett (NJ)
     Gerlach
     Gibbons
     Gilchrest
     Gingrey
     Goode
     Goodlatte
     Goss
     Granger
     Graves
     Green (WI)
     Greenwood
     Hall
     Harris
     Hart
     Hastert
     Hastings (WA)
     Hayes
     Hayworth
     Hefley
     Hensarling
     Herger
     Hobson
     Hoekstra
     Hostettler
     Houghton
     Hulshof
     Hunter
     Hyde
     Isakson
     Issa
     Istook
     Janklow
     Jenkins
     Johnson (CT)
     Johnson (IL)
     Johnson, Sam
     Keller
     Kelly
     Kennedy (MN)
     King (IA)
     King (NY)
     Kingston
     Kirk
     Kline
     Knollenberg
     Kolbe
     LaHood
     Latham
     LaTourette
     Leach
     Lewis (CA)
     Lewis (KY)
     Linder
     LoBiondo
     Lucas (OK)
     Manzullo
     McCotter
     McCrery
     McHugh
     McInnis
     McKeon
     Mica
     Miller (FL)
     Miller (MI)
     Miller, Gary
     Moran (KS)
     Murphy
     Musgrave
     Myrick
     Nethercutt
     Neugebauer
     Ney
     Northup
     Norwood
     Nunes
     Nussle
     Osborne
     Ose
     Otter
     Oxley
     Pearce
     Pence
     Peterson (PA)
     Petri
     Pickering
     Pitts
     Platts
     Pombo
     Porter
     Portman
     Pryce (OH)
     Putnam
     Quinn
     Radanovich
     Ramstad
     Regula
     Rehberg
     Renzi
     Reynolds
     Rogers (AL)
     Rogers (KY)
     Rogers (MI)
     Rohrabacher
     Ros-Lehtinen
     Royce
     Ryan (WI)
     Ryun (KS)
     Saxton
     Schrock
     Sensenbrenner
     Sessions
     Shadegg
     Shaw
     Shays
     Sherwood
     Shimkus
     Shuster
     Simmons
     Simpson
     Smith (MI)
     Smith (NJ)
     Smith (TX)
     Souder
     Stearns
     Sullivan
     Sweeney
     Tancredo
     Tauzin
     Taylor (NC)
     Terry
     Thomas
     Thornberry
     Tiahrt
     Tiberi
     Toomey
     Turner (OH)
     Upton
     Vitter
     Walden (OR)
     Walsh
     Weldon (FL)
     Weldon (PA)
     Weller
     Whitfield
     Wicker
     Wilson (NM)
     Wilson (SC)
     Wolf
     Young (AK)
     Young (FL)

                             NOT VOTING--2

     Ehlers
     Gillmor
       


                Announcement by the Speaker Pro Tempore

  The SPEAKER pro tempore (Mr. Hastings of Washington) (during the 
vote). Members are advised 2 minutes remain in this vote.

                              {time}  0301

  Mr. SHADEGG, Mrs. BONO and Mrs. JO ANN DAVIS of Virginia changed 
their vote from ``aye'' to ``no.''
  So the motion to recommit was rejected.
  The result of the vote was announced as above recorded.
  Stated against:
  Mr. EHLERS. Mr. Speaker, on rollcall No. 668 I was delayed on the way 
to the floor to vote, and the vote ended just as I walked in the door. 
Had I been present, I would have voted ``no.''
  The SPEAKER pro tempore (Mr. Hastings of Washington). The question is 
on the conference report.
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.
  Mr. DINGELL. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to rule XX, this 15-minute vote on 
adoption of the conference report will be followed by a 5-minute vote 
on the motion to suspend the rules on S. 877.
  The vote was taken by electronic device, and there were--yeas 220, 
nays 215, not voting 0, as follows:

                             [Roll No. 669]

                               YEAS--220

     Aderholt
     Alexander
     Bachus
     Baker
     Ballenger
     Bartlett (MD)
     Barton (TX)
     Bass
     Beauprez
     Bereuter
     Biggert
     Bilirakis
     Bishop (UT)
     Blackburn
     Blunt
     Boehlert
     Boehner
     Bonilla
     Bonner
     Bono
     Boozman
     Boucher
     Boyd
     Bradley (NH)
     Brady (TX)
     Brown (SC)
     Brown-Waite, Ginny
     Burgess
     Burns
     Burr
     Buyer
     Calvert
     Camp
     Cannon
     Cantor
     Capito
     Carson (OK)
     Carter
     Castle
     Chocola
     Coble
     Cole
     Collins
     Cox
     Cramer
     Crane
     Crenshaw
     Cubin
     Cunningham
     Davis (TN)
     Davis, Jo Ann
     Davis, Tom
     Deal (GA)
     DeLay
     Diaz-Balart, L.
     Diaz-Balart, M.
     Dooley (CA)
     Doolittle
     Dreier
     Duncan
     Dunn
     Ehlers
     English
     Everett
     Ferguson
     Fletcher
     Foley
     Forbes
     Fossella
     Franks (AZ)
     Frelinghuysen
     Gallegly
     Gerlach
     Gibbons
     Gilchrest
     Gillmor
     Gingrey
     Goode
     Goodlatte
     Goss
     Granger
     Graves
     Green (WI)
     Greenwood
     Hall
     Harris
     Hart
     Hastert
     Hastings (WA)
     Hayes
     Hayworth
     Hefley
     Hensarling
     Herger
     Hobson
     Hoekstra
     Houghton
     Hulshof
     Hunter
     Hyde
     Isakson
     Issa
     Istook
     Janklow
     Jenkins
     John
     Johnson (CT)
     Johnson (IL)
     Johnson, Sam
     Keller
     Kelly
     Kennedy (MN)
     King (IA)
     King (NY)
     Kingston
     Kirk
     Kline
     Knollenberg
     Kolbe
     LaHood
     Latham
     LaTourette
     Leach
     Lewis (CA)
     Lewis (KY)
     Linder
     LoBiondo
     Lucas (OK)
     Manzullo
     Marshall
     Matheson
     McCotter
     McCrery
     McHugh
     McInnis
     McKeon
     Mica
     Miller (MI)
     Miller, Gary
     Murphy
     Myrick
     Nethercutt
     Neugebauer
     Ney
     Northup
     Nunes
     Nussle
     Osborne
     Ose
     Otter
     Oxley
     Pearce
     Peterson (MN)
     Peterson (PA)
     Petri
     Pickering
     Pitts
     Platts
     Pombo
     Pomeroy
     Porter
     Portman
     Pryce (OH)
     Putnam
     Quinn
     Radanovich
     Ramstad
     Regula
     Rehberg
     Renzi
     Reynolds
     Rogers (AL)
     Rogers (KY)
     Rogers (MI)
     Rohrabacher
     Ros-Lehtinen
     Royce
     Ryan (WI)
     Saxton
     Schrock
     Scott (GA)
     Sensenbrenner
     Sessions
     Shaw
     Shays
     Sherwood
     Shimkus
     Shuster
     Simmons
     Simpson
     Smith (NJ)
     Smith (TX)
     Souder
     Stearns
     Stenholm
     Sullivan
     Sweeney
     Tauzin
     Taylor (NC)
     Terry
     Thomas
     Thornberry
     Tiahrt
     Tiberi
     Turner (OH)
     Upton
     Vitter
     Walden (OR)
     Walsh
     Weldon (FL)
     Weldon (PA)
     Weller
     Whitfield
     Wicker
     Wilson (NM)
     Wilson (SC)
     Wolf
     Wu
     Young (AK)
     Young (FL)

                               NAYS--215

     Abercrombie
     Ackerman
     Akin
     Allen
     Andrews
     Baca
     Baird
     Baldwin
     Ballance
     Barrett (SC)
     Becerra
     Bell
     Berkley
     Berman
     Berry
     Bishop (GA)
     Bishop (NY)
     Blumenauer
     Boswell
     Brady (PA)
     Brown (OH)
     Brown, Corrine
     Burton (IN)
     Capps
     Capuano
     Cardin
     Cardoza
     Carson (IN)
     Case
     Chabot
     Clay
     Clyburn
     Conyers
     Cooper
     Costello
     Crowley
     Culberson
     Cummings
     Davis (AL)
     Davis (CA)
     Davis (FL)
     Davis (IL)
     DeFazio
     DeGette
     Delahunt
     DeLauro
     DeMint
     Deutsch
     Dicks
     Dingell
     Doggett
     Doyle
     Edwards
     Emanuel
     Emerson
     Engel
     Eshoo
     Etheridge
     Evans
     Farr
     Fattah
     Feeney
     Filner
     Flake
     Ford
     Frank (MA)
     Frost
     Garrett (NJ)
     Gephardt
     Gonzalez
     Gordon
     Green (TX)
     Grijalva
     Gutierrez
     Gutknecht
     Harman
     Hastings (FL)
     Hill
     Hinchey
     Hinojosa
     Hoeffel
     Holden
     Holt
     Honda
     Hooley (OR)
     Hostettler
     Hoyer
     Inslee
     Israel
     Jackson (IL)
     Jackson-Lee (TX)
     Jefferson
     Johnson, E. B.
     Jones (NC)
     Jones (OH)
     Kanjorski
     Kaptur
     Kennedy (RI)
     Kildee
     Kilpatrick
     Kind
     Kleczka
     Kucinich
     Lampson
     Langevin
     Lantos
     Larsen (WA)
     Larson (CT)
     Lee
     Levin
     Lewis (GA)
     Lipinski
     Lofgren
     Lowey
     Lucas (KY)
     Lynch
     Majette
     Maloney
     Markey
     Matsui
     McCarthy (MO)
     McCarthy (NY)
     McCollum
     McDermott
     McGovern
     McIntyre
     McNulty
     Meehan
     Meek (FL)
     Meeks (NY)
     Menendez
     Michaud
     Millender-McDonald
     Miller (FL)
     Miller (NC)
     Miller, George
     Mollohan
     Moore
     Moran (KS)
     Moran (VA)
     Murtha
     Musgrave
     Nadler
     Napolitano
     Neal (MA)
     Norwood
     Oberstar
     Obey
     Olver
     Ortiz
     Owens
     Pallone
     Pascrell
     Pastor
     Paul
     Payne
     Pelosi
     Pence
     Price (NC)
     Rahall
     Rangel
     Reyes
     Rodriguez
     Ross
     Rothman
     Roybal-Allard
     Ruppersberger
     Rush
     Ryan (OH)
     Ryun (KS)
     Sabo
     Sanchez, Linda T.
     Sanchez, Loretta
     Sanders
     Sandlin
     Schakowsky
     Schiff
     Scott (VA)
     Serrano
     Shadegg
     Sherman
     Skelton
     Slaughter
     Smith (MI)
     Smith (WA)
     Snyder
     Solis
     Spratt
     Stark
     Strickland
     Stupak
     Tancredo
     Tanner
     Tauscher
     Taylor (MS)
     Thompson (CA)
     Thompson (MS)
     Tierney
     Toomey
     Towns
     Turner (TX)
     Udall (CO)
     Udall (NM)
     Van Hollen
     Velazquez
     Visclosky
     Wamp
     Waters
     Watson
     Watt
     Waxman
     Weiner
     Wexler
     Woolsey
     Wynn
  Mr. MILLER of Florida and Mr. CULBERSON changed their vote from 
``yea'' to ``nay.''
  Messrs. ISTOOK, FRANKS of Arizona, OTTER, MARSHALL, DOOLEY of 
California, and SCOTT of Georgia changed their vote from ``nay'' to 
``yea.''

                              {time}  0553

  So the conference report was agreed to.
  The result of the vote was announced as above recorded.
  The SPEAKER pro tempore (Mr. Hastings of Washington). Without 
objection, the motion to reconsider is laid on the table.
  Mr. FRANK of Massachusetts. Mr. Speaker, I object.
  The SPEAKER pro tempore. Objection is heard.

[[Page 30855]]


  Mr. FRANK of Massachusetts. Mr. Speaker, I move reconsideration. I 
move reconsideration, thanks to your arm-twisting.
  The SPEAKER pro tempore. The gentleman will suspend.
  Did the gentleman vote on the prevailing side?
  Mr. FRANK of Massachusetts. I was until the game started.
  The SPEAKER pro tempore. The motion to reconsider may be entered only 
by someone who voted on the prevailing side.


                         Parliamentary Inquiry

  Mr. FRANK of Massachusetts. Mr. Speaker, parliamentary inquiry.
  The SPEAKER pro tempore. The gentleman will state his inquiry.
  Mr. FRANK of Massachusetts. After all the razzle-dazzle, exactly what 
was the prevailing side?
  The SPEAKER pro tempore. The yeas have it. Without objection, the 
motion to reconsider is laid on the table.
  Mr. HOYER. Mr. Speaker, reserving the right to object, and I am not 
going to object, I am not going to put people to the purpose of voting; 
but I will again say the democratic process is that we come to this 
floor. I will remind you that you said we had 17 minutes to vote. You 
made it very clear. You sent us a notice, and you said come with 15 
minutes; we will give you 2 more minutes.
  This vote has now been held open longer than any vote that I can 
remember. I have been here 23 years. Perhaps some of you have been here 
longer. The outrage that was discussed when Speaker Wright held the 
vote open for far less time than this was palpable on your side of the 
aisle. Democracy is about voting. But just as you cannot say on Tuesday 
of Election Day, we will keep the polls open for 15 more hours until we 
get the result we want, you ought not to be able to do it here, Mr. 
Speaker. We have prevailed on this vote. Arms have been twisted and 
votes changed. And I will continue to reserve.
  The SPEAKER pro tempore. Is there objection to tabling the motion to 
reconsider?
  Mr. FRANK of Massachusetts. Objection.
  Mr. THOMAS. Mr. Speaker, I move to reconsider the vote just taken.


                  Motion to Table Offered by Mr. DeLay

  Mr. DeLAY. Mr. Speaker, I move to lay the motion on the table.
  The SPEAKER pro tempore. The question is on the motion to table the 
motion to reconsider. That is not debatable.
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.
  Mr. FRANK of Massachusetts. Mr. Speaker, on that I demand the yeas 
and nays.
  The yeas and nays were ordered.
  The vote was taken by electronic device, and there were--yeas 210, 
nays 193, not voting 32, as follows:

                             [Roll No. 670]

                               YEAS--210

     Aderholt
     Akin
     Bachus
     Baker
     Barrett (SC)
     Bartlett (MD)
     Barton (TX)
     Bass
     Beauprez
     Bereuter
     Biggert
     Bilirakis
     Bishop (UT)
     Blackburn
     Blunt
     Boehlert
     Boehner
     Bonilla
     Bonner
     Bono
     Boozman
     Bradley (NH)
     Brady (TX)
     Brown (SC)
     Brown-Waite, Ginny
     Burgess
     Burns
     Burr
     Burton (IN)
     Buyer
     Calvert
     Camp
     Cannon
     Cantor
     Capito
     Carter
     Castle
     Chabot
     Chocola
     Cole
     Collins
     Cox
     Crane
     Crenshaw
     Cubin
     Culberson
     Cunningham
     Davis, Jo Ann
     Davis, Tom
     Deal (GA)
     DeLay
     Diaz-Balart, L.
     Diaz-Balart, M.
     Doolittle
     Dreier
     Duncan
     Dunn
     Ehlers
     English
     Feeney
     Ferguson
     Flake
     Foley
     Forbes
     Fossella
     Frank (MA)
     Franks (AZ)
     Frelinghuysen
     Gallegly
     Garrett (NJ)
     Gerlach
     Gilchrest
     Gingrey
     Goode
     Goodlatte
     Goss
     Granger
     Graves
     Green (WI)
     Greenwood
     Gutknecht
     Harris
     Hart
     Hastert
     Hastings (WA)
     Hayes
     Hayworth
     Hensarling
     Herger
     Hobson
     Hoekstra
     Hostettler
     Houghton
     Hulshof
     Hunter
     Hyde
     Isakson
     Issa
     Istook
     Janklow
     Jenkins
     Johnson (CT)
     Johnson (IL)
     Johnson, Sam
     Keller
     Kelly
     Kennedy (MN)
     King (IA)
     King (NY)
     Kingston
     Kirk
     Kline
     Knollenberg
     Kolbe
     LaHood
     Latham
     Leach
     Lewis (CA)
     Lewis (KY)
     Linder
     LoBiondo
     Lucas (OK)
     Manzullo
     McCotter
     McCrery
     McHugh
     McInnis
     McKeon
     Mica
     Miller (FL)
     Miller (MI)
     Miller, Gary
     Murphy
     Musgrave
     Myrick
     Nethercutt
     Neugebauer
     Ney
     Northup
     Nunes
     Nussle
     Osborne
     Ose
     Otter
     Pearce
     Pence
     Peterson (PA)
     Petri
     Pickering
     Pitts
     Platts
     Pombo
     Porter
     Portman
     Pryce (OH)
     Putnam
     Quinn
     Radanovich
     Ramstad
     Regula
     Rehberg
     Renzi
     Reynolds
     Rogers (AL)
     Rogers (KY)
     Rogers (MI)
     Rohrabacher
     Ros-Lehtinen
     Royce
     Ryan (WI)
     Ryun (KS)
     Saxton
     Schrock
     Sensenbrenner
     Sessions
     Shadegg
     Shaw
     Shays
     Sherwood
     Shimkus
     Shuster
     Simmons
     Simpson
     Smith (MI)
     Smith (NJ)
     Souder
     Stearns
     Sullivan
     Sweeney
     Tancredo
     Tauzin
     Taylor (NC)
     Terry
     Thomas
     Thornberry
     Tiberi
     Toomey
     Turner (OH)
     Upton
     Vitter
     Walden (OR)
     Weldon (FL)
     Weldon (PA)
     Weller
     Whitfield
     Wicker
     Wilson (NM)
     Wilson (SC)
     Wolf
     Young (FL)

                               NAYS--193

     Abercrombie
     Ackerman
     Alexander
     Allen
     Andrews
     Baca
     Baird
     Baldwin
     Ballance
     Becerra
     Bell
     Berkley
     Berman
     Berry
     Bishop (GA)
     Bishop (NY)
     Blumenauer
     Boswell
     Boyd
     Brady (PA)
     Brown (OH)
     Brown, Corrine
     Capps
     Capuano
     Cardin
     Cardoza
     Carson (IN)
     Carson (OK)
     Case
     Clyburn
     Cooper
     Costello
     Crowley
     Cummings
     Davis (AL)
     Davis (CA)
     Davis (FL)
     Davis (IL)
     DeFazio
     DeGette
     Delahunt
     DeLauro
     Deutsch
     Dicks
     Dingell
     Doggett
     Doyle
     Edwards
     Emanuel
     Emerson
     Engel
     Eshoo
     Etheridge
     Evans
     Farr
     Fattah
     Filner
     Frost
     Gonzalez
     Gordon
     Green (TX)
     Grijalva
     Gutierrez
     Hall
     Harman
     Hastings (FL)
     Hill
     Hinchey
     Hinojosa
     Hoeffel
     Holden
     Holt
     Honda
     Hooley (OR)
     Hoyer
     Inslee
     Israel
     Jackson (IL)
     Jackson-Lee (TX)
     Jefferson
     John
     Johnson, E. B.
     Jones (OH)
     Kanjorski
     Kaptur
     Kennedy (RI)
     Kildee
     Kilpatrick
     Kind
     Kleczka
     Kucinich
     Lampson
     Langevin
     Larsen (WA)
     Larson (CT)
     Lee
     Levin
     Lewis (GA)
     Lipinski
     Lofgren
     Lowey
     Lucas (KY)
     Lynch
     Majette
     Maloney
     Markey
     Marshall
     Matheson
     Matsui
     McCarthy (MO)
     McCarthy (NY)
     McCollum
     McDermott
     McGovern
     McIntyre
     McNulty
     Meek (FL)
     Meeks (NY)
     Menendez
     Michaud
     Millender-McDonald
     Miller (NC)
     Miller, George
     Mollohan
     Moore
     Moran (VA)
     Murtha
     Nadler
     Napolitano
     Oberstar
     Obey
     Olver
     Ortiz
     Owens
     Pallone
     Pascrell
     Pastor
     Paul
     Payne
     Pelosi
     Peterson (MN)
     Pomeroy
     Price (NC)
     Rahall
     Rangel
     Reyes
     Rodriguez
     Ross
     Rothman
     Roybal-Allard
     Ruppersberger
     Rush
     Ryan (OH)
     Sabo
     Sanchez, Linda T.
     Sanders
     Sandlin
     Schakowsky
     Schiff
     Scott (GA)
     Scott (VA)
     Serrano
     Sherman
     Skelton
     Slaughter
     Snyder
     Solis
     Spratt
     Stenholm
     Strickland
     Stupak
     Tanner
     Tauscher
     Taylor (MS)
     Thompson (CA)
     Thompson (MS)
     Tierney
     Towns
     Turner (TX)
     Udall (CO)
     Udall (NM)
     Van Hollen
     Velazquez
     Visclosky
     Waters
     Watson
     Watt
     Waxman
     Weiner
     Wexler
     Woolsey
     Wu
     Wynn

                             NOT VOTING--32

     Ballenger
     Boucher
     Clay
     Coble
     Conyers
     Cramer
     Davis (TN)
     DeMint
     Dooley (CA)
     Everett
     Fletcher
     Ford
     Gephardt
     Gibbons
     Gillmor
     Hefley
     Jones (NC)
     Lantos
     LaTourette
     Meehan
     Moran (KS)
     Neal (MA)
     Norwood
     Oxley
     Sanchez, Loretta
     Smith (TX)
     Smith (WA)
     Stark
     Tiahrt
     Walsh
     Wamp
     Young (AK)

                              {time}  0613

  Mr. FRANK of Massachusetts changed his vote from ``nay'' to ``yea.''
  So the motion to table was agreed to.
  The result of the vote was announced as above recorded.
  A motion to reconsider was laid upon the table.

                          ____________________