[Congressional Record (Bound Edition), Volume 149 (2003), Part 22]
[Senate]
[Pages 30959-30974]
[From the U.S. Government Publishing Office, www.gpo.gov]




   MEDICARE PRESCRIPTION DRUG, IMPROVEMENT, AND MODERNIZATION ACT OF 
                   2003--CONFERENCE REPORT--Continued

  The PRESIDING OFFICER. The Senator from California.
  Mrs. BOXER. Mr. President, this debate so far has been very 
illuminating, in a way fascinating, to see how different Members of the 
Senate view the bill that is before us. I hope that America's seniors 
are watching this debate. I hope they are listening. I hope they will 
make up their own minds.
  There are many groups out there who are going to give their opinions, 
and I respect them all. But I think if you just go to the debate and 
you listen to all sides of it, seniors will come up with their own 
conclusions. As a matter of fact, I also hope people in their fifties 
and forties are watching this debate because many of the changes that 
will be made, if this bill becomes law, are going to impact people in 
their fifties, people in their forties.
  Let's face it, Medicare is a program that impacts all families 
because the children of senior citizens oftentimes bear the burden, if 
there are health problems. Of course, they care deeply about their 
families.
  We know that Medicare is a nationwide health plan for aged and 
certain disabled Americans, and it was created 40 years ago for seniors 
to offer them access to good quality health care. There was a huge 
debate at that time about whether this was the right thing to do. But 
people looked around and saw that our seniors were in trouble. They 
were spending their money on health care, didn't have anything left, 
oftentimes had to move in with their families. Their families had to 
pick up their health care bills, and it was very difficult.
  This program has fulfilled its promise. Is it perfect in every way? 
Of course not. What program is? What corporation is? What person is? 
But Medicare has saved many lives and has made the golden years golden 
for a lot of our seniors. That is why they feel so strongly about it.
  I have been listening to some of the call-in shows. I have heard 
seniors identify themselves as Republicans, Democrats, and 
Independents. They are worried about the changes that are about to hit 
the system, and so am I.
  The one thing I think everyone agrees on is that there ought to be a 
prescription drug benefit. At least I think most of us believe that 
from both sides of the aisle. We know this cost is heavy on our 
seniors. We know drug prices are skyrocketing because, unfortunately 
and very sadly, we don't allow drug reimportation from places like 
Canada and Mexico, although I have to tell you that in my State, people 
are going to Mexico.
  I received a letter from a constituent of mine from San Marcos, CA, 
earlier this year. She told me that her annual cost for prescription 
drugs this year will top $10,000. Think about that, $10,000. How do our 
seniors deal with this when they are retired?
  A retired physician from Marina del Rey told me that a pill he takes 
for his heart disease went up 600 percent, from $15 a month to $85. For 
seniors who have to take an assortment of medicines to manage their 
chronic diseases, the costs really start to add up.
  Very sad to say, in this bill there is virtually no cost containment. 
Even though the House version said reimportation from Canada was a good 
idea, this has not happened. We will continue to pay the highest drug 
prices in the world. It is very sad, indeed. The provisions on generic 
drugs were watered down a bit. We have some in there but not what they 
should be.
  For all the reasons that I talked about--the fact that I feel deep 
compassion for my constituents who have to pay these huge sums for 
medicines--I voted for the Senate bill. The Senate bill left here. I 
thought it made some sense. So let's look at what the Senate bill did 
for our seniors.
  It had about six things that it did that I thought were really 
important.
  First, there was a modest benefit for seniors that were hardest hit 
by the costly prescription drugs. That benefit was a lot better than 
the benefit that is currently before us. I will go into the 
differences. The benefit that is before us is so weak, it barely has a 
pulse. It is barely worth filling out the forms. It is barely worth 
your time. You could probably do better if you become friendly with 
your pharmacy down the road. They will probably give you a better deal.
  The benefit before us, unlike the benefit we voted on, is this: If 
you have $5,100 worth of drug costs, you will pay $4,020 for those 
drugs. In the meanwhile, you will have to figure out what are your 
deductibles, what are your copays, filling out the forms, being 
nervous, getting notified that you no longer have the drug benefit 
because there is a benefit shutdown, which I will get into later. So 
think about it. You have a $5,000 drug bill, and you are paying $4,000. 
And you are going through probably bureaucratic hell to get that 
thousand dollars off.
  So the benefit, when we got the bill, we voted it out. I voted for 
it. I wanted it. It was a modest benefit but a decent benefit. It was 
much better than this one. We will get into that later.
  Secondly, all seniors were guaranteed a Medicare prescription drug 
benefit if they didn't have two private plans in their area. So you had 
a good fallback. If you didn't have two private drug plans competing 
for your business, could you say: Forget this. I can go to Medicare.
  Third, Medicare could have bargained for lower prescription drug 
costs. Now, why is this important? Just look at the Veterans' 
Administration. They can get way lower costs for the drug benefits for 
their veterans because they represent millions of veterans. Therefore, 
they have bargaining power. It is not like if I walked into a pharmacy 
myself and said: Hi, I am a veteran, can you lower my drug prices. And 
the pharmacist looks at me and says: Well, no. But if I bring millions 
of people into the store, the pharmacist is going to say: You know, now 
I can talk to you about some bargain prices.
  That is what we have done with the VA. In the original bill that came 
out of the Senate, Medicare could have bargained. We will talk about 
the current bill in a minute.
  Then, No. 4, there were steps to privatize Medicare, but they were 
minor steps. They were balanced by a $6 billion sum that was added to 
Medicare. So while they gave the private plans $6 billion in the Senate 
bill to ``encourage'' them to stay in the Medicare business, I didn't 
agree with that. When I think about competition, I don't think about 
paying people to compete. I didn't think that is what capitalism is. I 
was a stockbroker. That is news to me. To me competition is what it 
says. You come in, you see you have a chance to make a profit, and you 
compete.
  Well, we were giving them $6 billion. I wasn't happy about it, but I 
felt that, all in all, because we balanced it and gave $6 billion to 
Medicare to add prevention and some other very important benefits, it 
was worth it.
  So just sum that up. I want to be clear here. I supported the 
Medicare prescription drug bill that was before the Senate because it 
was a decent benefit for seniors. It gave them about a third off their 
drugs. So it gave you a third off of your drugs. I thought that was a 
good benefit. You paid two-thirds and you got a third off. Again, I 
thought it should have been better. It was modest. I wasn't thrilled 
with it. I tried to have amendments to close the benefit shutdown, to 
bring the benefit up to 50 percent, but I did not succeed in that 
effort.
  All seniors were guaranteed a Medicare drug benefit, that fallback, 
if they didn't have two private drug plans competing. Frankly, I wanted 
a Medicare fallback for everybody. I remember the debate. But they 
convinced me to compromise. I wasn't thrilled, but I voted for it. 
Medicare could have bargained for lower prices for drugs. I assumed 
that would be part of what we would do. We didn't prohibit it. The

[[Page 30960]]

steps to privatize Medicare, to incentivize HMOs to stay in the 
Medicare business, were balanced by $6 billion added to Medicare for 
some important new benefits.
  The last thing is, for the lowest income seniors, they got 
prescription drugs at no cost. That was a wonderful thing in the Senate 
bill. The poorest of the poor people who worked all their lives and 
found themselves in a horrible situation today would have gotten drugs 
at no cost. For all those reasons, I was very pleased in the end that I 
was able to move that bill forward.
  I want to show you something I hope you can appreciate, as I hold 
this bill up for a minute. The bill itself that has now come back to us 
is very heavy. Here it is. This is the bill that is before us today. 
This bill I am holding is 678 pages. How much of this is the 
prescription drug benefit? It is 181 pages. What does that tell you? It 
tells you that most of this bill has nothing to do with prescription 
drugs. Think about it. We sent a prescription drug bill into the 
conference committee to come back to us, and here it is. This yellow 
tab shows me where it is. This is the prescription drug benefit. It is 
181 pages. The balance of this bill is way more, 5 times more.
  Think about it. If the folks who brought you this bill were sincere 
about giving you a prescription drug benefit, why did they then use 
that as an excuse to begin changing Medicare--changing Medicare in ways 
that are perplexing, that are going to be difficult to understand, and 
the rest?
  Now, I am not, generally speaking, someone who is paranoid about 
things. But I have to tell you, I am when I hear Newt Gingrich, 
praising all 600 pages of this bill, who said in 1995:

       Now, we don't get rid of it [Medicare] in round one because 
     we don't think that that's politically smart, and we don't 
     think that's the right way to go through a transition. But we 
     believe Medicare is going to wither on the vine, because we 
     think people are voluntarily going to leave it.

  Voluntarily. If you mess up Medicare and you make it confusing and 
start doing the things that they do in this bill, Newt Gingrich will be 
proven right. Why do you think he went over to the caucus on the other 
side, in the House, and talked to the Republicans who didn't like the 
bill? Because they thought it was too good to seniors.
  He said: No, it is not. Trust me. Would I lead you astray?
  That is Newt Gingrich. The senior citizens in this country, in my 
view, are the smartest of the folks when it comes to Medicare. They 
know it. They get it. They understand Social Security and they 
understand Medicare. They understand when Newt Gingrich said that 
Medicare should ``wither on the vine,'' and that this isn't something 
they want to see happen.
  Well, folks, please listen. ``We don't have to get rid of it in round 
one,'' Newt said, ``because we don't think it's politically smart.'' So 
what did they do? They take a prescription drug benefit that is 
popular--by the way, it is voluntary, but I will talk about that 
because it is not voluntary if you are on Medicaid, and it is not 
voluntary when you find out that your pension plan has dropped your 
prescription drug coverage because then you will have nothing. You will 
be forced into it. It is not voluntary for those folks.
  But I can tell you that this is just what Newt Gingrich planned. You 
cannot do it all at once. Not in round 1. We have to go through a 
``transition.'' Remember that word because it shows up in this bill--
``transition.'' So here is prescription drugs, and here is the 
withering on the vine.
  A lot of the people who fought Medicare in the beginning are 
embracing this bill. Do you think they had a change of heart? Do you 
think those of us who built our careers on protecting seniors have 
somehow gone wacko on you by saying that this bill does more harm than 
good? Think about the Senators who are standing up here and extolling 
the virtues of this bill. One of them was here before and he said that 
people on the other side are saying we are trying to destroy Medicare. 
How ridiculous, he said. That's crazy. We would never do that. Then he 
launched into a harsh criticism of Medicare and how it needs to change.
  Another, I thought, belied his point of view when he stood up and 
said--it is on the record from this afternoon--we need to get away from 
the ``command and control'' of Medicare.
  Well, I have news for the Senator from Texas, who said that. In 
Medicare, do you know who is in command and control? The senior 
citizens. That senior citizen can go anywhere--to the doctor of choice. 
That is the beauty of the Medicare system. They are in command and 
control.
  What this bill does is start the unraveling of that command and 
control and gives it to a whole new system that is so confusing that I 
would assure you, when you begin to hear the words and the acronyms 
associated with this new system, if you went up to any Senator and 
asked him or her a question about it, not one of them would pass the 
test of understanding every acronym--not even close. So the Senate bill 
benefited seniors. What we have before us is quite different.
  To me, the saddest thing about this bill is that it turned a modest, 
but decent, benefit for seniors into an enormous benefit for the 
largest pharmaceutical companies and HMOs in America. Here is what we 
have now in the bill. This is what we have now. The bill benefits drug 
companies and HMOs.
  First of all, the bill sets up a slush fund of $14 billion for HMOs. 
I have to say something here. The deficit that we are facing in our 
country today is nothing short of an abomination. From the minute this 
President took over until today, we have seen deficits as far as the 
eye can see and balanced budgets turn into $500 billion-a-year deficits 
every year. But the folks in the conference committee found $14 billion 
to give to those profitable corporations in America. Why do you think 
that is the case?
  There is an article today in the Washington Post that tries to 
explain it. This is the headline on the front page:

       2 Bills Would Benefit Top Bush Fundraisers. Executives' 
     Companies Could Get Billions.

  This is the selling of America. I want to quote from this article.

       More than three dozen of President Bush's major fundraisers 
     are affiliated with companies that stand to benefit from the 
     passage of two central pieces of the administration's 
     legislative agenda: the energy and Medicare bills.

  We stopped the Energy bill. I don't know how long we will be able to 
hold that, but the Energy bill is a clear-cut case. We talked about 
that the other day, and now there is the Medicare bill.
  Continuing the quote:

       The energy bill provides billions of dollars in benefits to 
     companies run by at least 22 executives and their spouses who 
     have qualified as either ``Pioneers'' or ``Rangers''--

  That is what they call the big fat cats, Pioneers or Rangers----

       as well as to the clients of at least 15 lobbyists and 
     their spouses who have achieved similar status as 
     fundraisers. At least 24 Rangers and Pioneers could benefit 
     from the Medicare bill--

  Twenty-four Rangers and Pioneers, and those are the people who give 
the most money----

       could benefit from the Medicare bill as executives of 
     companies or lobbyists working for them, including eight who 
     have clients affected by both bills.

  Talk about hitting the lottery. They benefit from the Energy bill and 
this bill. We know where the money is going. It is going out of the 
Federal Treasury to the fat cats. Face it. Unfortunately for the folks 
around here, we know now. We have it.
  How about this?

       Hank McKinnell--

  He may be a lovely man; this is not a personal attack on him----

     chairman and CEO of Pfizer, has pledged to raise at least 
     $200,000 for Bush's reelection, although he is not yet listed 
     as a Pioneer or Ranger. Pioneer Munr Kazmir, who runs a 
     direct-mail drug company called Direct Meds Inc., estimates 
     that he has about 100,000 customers on Medicare who will have 
     more money to buy drugs from his company. ``We know the 
     patients, we know how important this bill is,'' he said.

  Follow the money. Dress it up any way you want. Talk about how great 
this bill is. Follow the money. I hope seniors are watching this 
tonight. They will make up their own minds. They are calling my office. 
My phones are

[[Page 30961]]

overwhelmed. What are they running on this? About 1,000 calls to 200 
calls against this bill. For every 100 yeses, there are 1,000 nos. 
Seniors are smart.
  They trust the AARP. Now they are finding out that the head of the 
AARP wrote the foreword to Newt Gingrich's book. Now they are finding 
out that the AARP gets 60 percent of their funds from selling 
insurance. Now they are finding out that the head of the AARP 
represented big drug companies. Follow the money.
  There is a $14 billion slush fund for HMOs at a time when we don't 
have money to fully fund education. We can't fully fund education, but 
we can find $14 billion for a slush fund for HMOs. They don't call it a 
slush fund. They call it a few other names--a stabilization fund. They 
call it a stabilization fund.
  Over 7 years, HMOs get $14 billion. This includes $10 billion in 
direct subsidies to HMOs handed out at the discretion of the head of 
the agency overseeing Medicare. How would you like to be that guy? At 
his whim, this bureaucrat can write checks to HMOs to bribe them to 
participate in Medicare.
  In addition, there are nearly $4 billion of payments to the HMOs that 
already participate in Medicare just to bribe them to stay in Medicare. 
What kind of capitalism are we living in this country when we have to 
pay the private sector extra money when they went in the business in 
the first place? Things have changed. When I was a stockbroker, it 
wasn't that way. We didn't give corporations the kind of welfare we are 
giving them today. This is corporate welfare. Follow the money to the 
Presidential campaigns and you will get a very interesting story.
  This $14 billion slush fund is particularly egregious when you 
consider that Medicare already pays HMOs more than the per-patient cost 
of traditional Medicare. Let me repeat that.
  HMOs are getting paid more than the traditional Medicare. Do my 
colleagues know why? The overhead in Medicare is very small. Do we know 
exactly--is it 2 or 3 percent? Anyway, we do not pay CEOs millions and 
millions of dollars. They are taking that money right off the top and 
lining their pockets. Oh, but why not? They are nice people, give them 
$14 billion.
  It is not that they are so great, these HMOs. People get the 
runaround. They do not get the care they need. People want their 
traditional Medicare.
  Remember what I said. The bill I voted for in the Senate gave $6 
billion to HMOs. I was not happy with that at all, but at least it gave 
$6 billion to traditional Medicare to help us do more prevention. Guess 
what happened. It is gone. The conference committee took it away. But 
they have added it on to the $6 billion already there. They added $6 
billion that was going to go to Medicare. They put it in the HMOs, and 
they added $2 billion just in case it was not enough money for their 
friends.
  Secondly, this bill benefits drug companies and HMOs. There is a gag 
rule on Medicare price negotiation. I talked a little bit about that 
before. Medicare has all of these clients. Think about the clout 
Medicare could have when they call a drug company and say that their 
drug X, Y, Z is a drug for arthritis and our patients like it; we are 
going to buy a lot of it for our patients; please give us a deal.
  Oh, no, the conferees said, Medicare has a gag rule. Watch out. They 
may do it to the veterans next. The VA can bargain, but Medicare cannot 
bargain. The drug companies and the HMOs can bargain explicitly. They 
can bargain, and they can pocket some of the profits that they bargain, 
but not Medicare. Medicare cannot bargain. There is a gag rule on 
Medicare.
  They will stand up on the other side and say: We are not trying to 
destroy Medicare; we think it is a great program. Just remember Newt 
Gingrich: Let it wither on the vine.
  Seniors are expected to spend $1.6 trillion in prescription drugs 
over the next decade. By the way, there are a lot of pharmaceutical 
companies and a lot of wonderful research companies in my State. I have 
a great relationship with them. I support them getting an R&D tax 
credit; in other words, a tax credit for every penny they put into 
research and development. Why? Because I think that is important. I 
support their patents--reasonably support their patent rights. I 
support research through the NIH very strongly, and a lot of that 
benefits the drug companies as well. So I work very closely with my 
biotech companies, with my pharmaceutical companies, but, by God, I do 
not believe in giving them welfare.
  Fourteen billion dollars? Is that because we have so much money? Is 
our deficit not big enough? It is only up to $500 billion in 2\1/2\ 
years or 3 years. Gee, we could do better. Why do we not make it $600 
billion? Do I hear $700 billion?
  I do not know what has happened, but it is not good. It took us 8 
years to balance that budget. The other side said: We want a 
constitutional amendment to balance the budget. And our side said: 
Let's just balance it. Why do we need to amend the Constitution? Let's 
balance it. And President Clinton did that with us over 8 years.
  Now it is gone. Now we have $14 billion to add to the deficit, and we 
are not going to let Medicare negotiate for us because, for whatever 
reason, they are tying Medicare's hand. I think it is because they want 
Medicare to wither on the vine. That is what Newt Gingrich said. That 
is the only thing I can come up with.
  We know the cost of drugs could be lowered if Medicare negotiated 
those drug prices. One might say, well, maybe, Senator Boxer; that 
would be highly unusual for Medicare to negotiate with the drug 
companies. I would say, not at all. Medicare negotiates payments to 
hospitals. They have done that for years. When the bill left the 
Senate, there was no prohibition, but now there is. Why? Because they 
do not want the Medicare drug plan to be able to offer lower prices. 
They have given the right to negotiate to the private sector. They are 
going to push seniors into those plans.
  Just remember where I started from. Just remember, ``wither on the 
vine,'' and ``follow the money.'' These are some simple concepts. At 
the end of my statement, just put a little ribbon and tie the bow and 
everyone will get the picture as to why we are going down a very 
dangerous path.
  In this bill, we are going to be giving to HMOs payments above their 
stated cost to deliver service. Has anyone ever heard of anything like 
that in their entire life? A firm bids on a contract. They say: We can 
supply you with X number of widgets for a thousand dollars. On the dot, 
you get it. You deliver the thousand widgets, I give you $1,000.
  Here, HMOs are saying: We can deliver health care for patients at a 
cost of X dollars per patient. In this conference committee, they said: 
Well, we are going to give them more money than they say they need. It 
is called a lot of different names, such as premium support. It is 
payment above and beyond what they said it would cost. So put together 
the slush fund and the payments above their cost of service and you are 
scratching your head, saying, maybe I ought to get into this business.
  I say to people all over the country, small businesspeople who work 
hard in their business, be it retail or wholesale, you do not have a 
deal like this. You open up your doors, you go into business, and 
suddenly Uncle Sam is knocking on the door: Hey, I got a check for you 
HMOs, $14 billion over 7 years just to stay in the business; and, by 
the way, we love you so much, we are going to give you dollars above 
and beyond what you say it costs. And, by the way, no one will catch 
on. We are going to call these names different things. We are not going 
to call it a slush fund.
  So the bill left the Senate. It was a good benefit, a decent benefit, 
but a modest benefit. It was not perfect, but at least it was a bill on 
prescription drugs. It came back a benefit for drug companies and HMOs. 
Somebody said to me there was a hostile takeover in the conference 
committee of the Medicare bill, that the Senate passed, by the HMOs and 
the prescription drug companies.
  If we look at Wall Street, follow the money. Look at the prices of 
these stocks. They are going out of sight because people know this is a 
deal of a lifetime, that is for sure.

[[Page 30962]]

  The last point I want to make is that this bill hurts our seniors. I 
am going to be specific. First, it hurts all our seniors, and in the 
end I am going to show you how it hurts my seniors in California, the 
largest State in the Union.
  These are facts. We have gotten them from the staff that worked on 
this conference bill. Six million seniors will pay more for 
prescriptions than they do now. Let me tell you who these people are. 
Six million low-income and disabled beneficiaries currently receive 
prescription drug benefits from the Medicaid Program, which is a 
matching Federal-State program administered by the State. These 
programs are more generous in coverage than the proposed bill that is 
before us because they serve our very sickest Americans.
  For example, a Medicare/Medicaid-eligible person in California can, 
but does not have to, pay a $1 per prescription copayment. The 
copayment is voluntary. A dollar may sound like zero, nothing, to 
people. But if you are an inch away from owning nothing, every dollar 
counts.
  Under the conference bill the same person will now be required to 
make a copayment, maybe, up to $5. Some will pay premiums of $50 and be 
subject to a strict asset test. Studies have shown that even small 
copayments for prescription drugs can make essential medicines 
unaffordable for low-income seniors, resulting in an 88-percent 
increase in hospitalizations and deaths, and a 78-percent increase in 
emergency room visits.
  So they say to my State, now you can't help these poorest of the 
poor. Sorry. They gave that a name, too, which we will get into later. 
They give it a nice name, but the bottom line is the people, the 
poorest of the poor, the States that help them can no longer help them 
once they get into this program.
  The copayments to these poorest of the poor are indexed for 
inflation. So they can and they will go up. Remember, most of these 
people don't make any money. When you get hit with inflation and you 
are on a fixed income, that bites. That takes food off the table. So we 
know there will be an increase in hospitalizations. That was in the 
background information, that 88-percent increase in hospitalizations 
and deaths because people will not take their medicine.
  States are prohibited from covering the out-of-pocket costs of these 
dual eligibles, and the bill prohibits States from establishing more 
expansive drug lists for the mentally ill, disabled, and other groups.
  That is important. They may be taking a drug that isn't covered on 
this formulary.
  I want to talk about people with AIDS. We have a high number in our 
State. People are suffering. Many of them are dual eligibles. They are 
eligible for Medicare disability and Medicaid. For them this bill is 
catastrophic. My phones are ringing off the hook with calls from them, 
their parents, their families. It is likely that they may not have 
access to or be able to afford all the drugs they need. So this is why 
this bill is opposed by the AIDS Medicare Project, San Francisco; AIDS 
Project, Los Angeles; Project Inform, San Francisco; San Francisco AIDS 
Foundation. But let's face it, it is not just AIDS patients who are 
going to be harmed. Anyone with a life-threatening illness runs the 
risk of not having coverage for the drugs they need. If they are denied 
coverage for these drugs under Medicare, they can appeal the decision, 
but this doesn't mean they can afford them.
  So when it comes to my State, I will show you later the numbers of 
people who will be worse off. It goes in the hundreds of thousands--the 
hundreds of thousands.
  Now there is a very cruel asset test. When I voted for the bill in 
the Senate that the Senator from Iowa worked so hard on with the 
Senator from Montana, that was a good bill. That bill would have 
allowed low-income seniors to receive assistance without forcing them 
to sell a car because it was worth over $4,500 or a ring that maybe was 
their most precious possession from their loved one or a family 
heirloom.
  The conference bill imposes a Draconian asset test of $6,000 per 
person, $10,000 per couple, for the poorest of the poor. As a result, 3 
million low-income seniors nationwide, and 300,000 in California, will 
be deprived of assistance that would not only help them with their 
prescription drugs but help them pay the premium so they could receive 
the coverage in the first place.
  In other words, the bill that is before us has some generosity 
towards the poorest of the poor, but they have added an asset test into 
it so if you have a family heirloom or you own a car worth more than 
$4,500 or you have a diamond ring and a gold wedding band that your 
husband may have given you when you were married, you have to sell it. 
You have to get rid of it. Otherwise you don't get the benefit of this 
prescription drug benefit.
  I don't get that. I am sad the conferees didn't go with the bill that 
most of us voted for in the Senate.
  Now you come to seniors who are forced into demonstration projects 
that penalize them for staying in Medicare. That happens in 2010. You 
say we are just in 2003. We are almost in 2004--that is 6 years away, 
big deal. One thing I have learned, as long as I have lived, is that 
time goes fast. Six years will be here. If you are in one of those 
demonstration projects, what is going to happen is plain and simple: 
Your premiums are going to go up if you stay in Medicare--bottom line. 
Even though people say you are not forced into these other plans, the 
costs may force you into these other plans.
  One in six Medicare beneficiaries will be forced to participate in 
this experiment. In California, 12 of its metropolitan statistical 
areas will qualify for these demonstration projects. Let's say two of 
the largest are chosen; one is in L.A. and the other is in San 
Francisco. So what we will have is my seniors in those areas will have 
to make a very tough choice. Do they stay in Medicare and pay more 
money or do they go into an HMO and lose the choice of their doctors?
  We have already had some experimentation. We know the healthy people 
will choose the HMOs because they are cheaper. After all, they are 
healthy so they are not worried about getting messed up by an HMO. If 
they are not sick, you know, it is not a problem.
  But the sicker seniors would be left in Medicare, and we know that we 
will see costs spiral out of control because there will be a sick pool 
of seniors, rather than spreading the risk, which is what insurance is 
all about.
  Now we have a situation where premiums for middle and upper class 
people are going to go up. My colleagues say they are only going to go 
up if you earn $80,000 a year. I understand that is quite a bit. That 
is not that many people. But this is the problem. This number of 
$80,000 a year is not indexed for inflation. So it looks like it is a 
lot now, but in the future it will not look like it is that big.
  For example, if this provision, the one that my colleague from Iowa 
supports, was in place in 1980, the equivalent level of income would be 
$33,000, and the person at that level would have to pay much more for 
their Medicare. So the fact is, they have done an interesting thing: 
They have not indexed this, so in the end you will have people of very 
moderate incomes paying huge premiums to Medicare.
  Now what is going to happen? It will wither on the vine because 
people will say: I don't want anything to do with this. It is too 
costly. I don't need it. I will just go out and buy a catastrophic 
policy elsewhere.
  I will tell you, if you take that fact, along with the fact that this 
bill sets up health savings accounts for the wealthiest people, you are 
going to have middle-income people and wealthy people walk away from 
Medicare, and you will lose the class you have when you have a larger 
pool. That is just a fact of life. That is why we have had a successful 
program--because insurance needs a very big pool.
  I am going to put up a chart that I hope all of you who might be 
crazy enough to be watching this will remember. I know this isn't 
exactly prime-time television. But I want to

[[Page 30963]]

show you a chart of ``Fear and Confusion.'' This is a Barbara Boxer 
homemade chart. This is the chaos and confusion that our seniors are 
going to be facing.
  If any of you are watching this tonight, I am telling you to take 
note. I am telling you to call the AARP. Senator Durbin gave you the 
number. I do not know it. I want you to take notes and ask them to 
explain each of these concepts they have endorsed in this bill. Then I 
want you to call everyone who votes for this bill, if this bill passes, 
and call your Senators and ask them to explain what all of this means. 
I am not going to tell you what it means tonight because we would be 
here all night. These are the terms that have been thrown around in 
this bill. You are going to have to understand this if you are going to 
understand what Congress is about to do to you. You will have to 
understand this.
  Confusion and fear--some of them you know; HMO, you know that one. 
There is fear there, but it has nothing to do with the fact you don't 
know what Health Maintenance Organization stands for.
  Risk corridors: I want you to learn what risk corridors mean; 
copayments, plan retention funding, MA-prescription drug plans, or MA-
PD plans; donut hole. No, it is not what you buy in the store that is 
so good. I am on a diet. I haven't had one of them in a while. But a 
donut hole is something you had better understand because it is going 
to cost you when you get to it.
  Here is another one: MA-Regions; catastrophic, premium support, 
assets test. I explained that one to you. That is one where you have to 
sell your wedding band, if you are poor, in order to qualify for 
getting your drugs free.
  Average weighted premium; MSP, Medicare Secondary Payment; 
coordination requirements; initial coverage limit; CMS, you had better 
know that because the man who is the head of it is the one who is going 
to control the slush fund for HMOs.
  Here is one which is kind of my favorite because I actually 
understand it: Claw back. That is a new word for you. That expresses 
what happens if you are a State and you have helped your poorest people 
pay for their Medicaid. You no longer can help them, but you can't keep 
the money. You have to send it to Uncle Sam. That is a claw back.
  Transitional assistance, MSA. That stands for Metropolitan 
Statistical Area. If you are in one of those, you are forced into a 
demonstration project even if you do not want to be.
  Benefit shutdown: This is one I know very well. After you buy a 
certain amount of drugs--around $2,000--you get a letter in the mail 
from your company that is giving you this drug benefit, and they say: 
Sorry, sir, your benefits shut down until you go past $5,100. Benefit 
shutdown is not a good thing.
  Risk adjustment premiums--you all know what that means; Part D, 
income relating, SA-wraparound; national bonus payment. But don't get 
excited. It doesn't go to you. Comparative Cost Adjustment Program; 
Stabilization Fund--that sounds as if it is a good thing. If you are an 
HMO, that is the money you get to keep you in business.
  I tell you, if something happens to me and I am not back here after 
my next election, which could happen to anybody, I am going to consider 
helping one of these big HMOs. I understand half of this. I may help 
them.
  Medicare advantage competition, wraparound--we did that--MA-regional 
plans; MA-prescription drugs; annual out-of-pocket threshold. Watch out 
for that one. Annual out-of-pocket threshold is what you have paid for 
your drugs out-of-pocket before you can get the benefit. However, if 
your drug isn't on the formulary, it doesn't count. So don't count on 
it too soon.
  Return disclosure: This has to do with your tax return. You are going 
to have your tax return sent to the IRS from the Health and Human 
Services Department if you are an upper income senior. They want to 
know what you earn. Before, Medicare never asked that because it is an 
insurance program. Now, do you know in this bill that the people who do 
not like taxes are making sure the IRS receives from the Health and 
Human Services Department information about your tax return?
  Deductible: Again, very tricky. You have to understand that.
  PDP sponsors, Prescription Drug Plan sponsors; monthly benchmarks. I 
am not sure about that one myself. But monthly benchmarks, we have to 
be careful about those.
  Fallback: The fallback is in the prescription drug plan. In the 
Senate bill that I voted for, if you didn't have two plans come in to 
compete, you could always fall back to Medicare. Now it is basically 
one plan.
  I told you about fallback. I went over all of it. MSP; average 
weighted premium--I think I pretty well went over this; coverage gap; 
plan retention funding.
  The way I have done this chart, it looks kind of chaotic. It is to 
make a point. I don't even have half of the terms that are in this 
bill. I am going to work on this so that after the cloture vote when we 
have a little more debate, I will be able to get a better list.
  But there is no secret why seniors are calling up our offices. They 
are smart. They are the smartest folks around. They have lived a long 
time. They are smart. They know what Newt Gingrich said: Let it wither 
on the vine. And then he endorses this. They weren't born yesterday.
  The one thing I was interested in with C-SPAN is the people who were 
calling were Republicans and Democrats, and they all sounded alike. One 
out of 10 said they liked the deal. So this bill hurts seniors. We know 
that for sure.
  Confusion and fear, large benefit shutdown, which is daunting and 
penalizes innocent seniors.
  I told you before. You get to a certain point, and your benefits 
stop. A couple of thousand dollars, and then it starts up again at 
$5,000. Name for me one other drug program that does that. I checked it 
out. There are hundreds of them. Maybe there was one other that had a 
small benefit. I have never seen it. We don't have that in our plan. We 
just go in the pharmacy and give them our Senator's health card. We get 
a good deal. They never shut us down. Why should we shut you down? It 
is a bad thing. It is not right. If I was a local pharmacist, I would 
say to my seniors, I can do better than this plan. Come into my store, 
buy your drugs here, and I will give you a discount card.
  Seniors will have to worry about filling out this form, filling out 
that form, is this drug on the formulary, and so on--fear and 
confusion. The bill hurts seniors.
  Now we will look at what it does to my State's seniors. This is the 
direct impact on my State's seniors: 867,000 sick low-income seniors 
will have worse Medicaid prescription drug coverage. Boom. This starts 
in 2006 when 867,000 sick low-income seniors will have worse Medicaid 
prescription drug coverage than now.
  Mr. President, 250,000 retirees will lose their more generous 
prescription drug coverage even after we give payments to the 
employers. I supported that. That was a good move. But even with that, 
they are dropping coverage once they know their retirees have another 
option. Wait until those people get the clue that is happening.
  Years ago we passed a catastrophic medical bill and I remember 
seniors were attacking Congress people. Wait until they hear they get 
dropped--retirees who worked all their life, who like their plan and 
they get dropped. They do not have a choice. If they want prescription 
drugs they have to come with this plan. Wait until they have to deal 
with benefit shutdowns.
  Mr. President, 296,000 fewer low-income seniors will qualify for low-
income protections than under the Senate bill because of the assets 
test that I talked about and lower-qualifying income levels. The 
poorest of the poor--when compared to what we did in the Senate, the 
bill I voted for--are worse off. These numbers are huge because I 
represent a big State. And 230,000 Medicare beneficiaries will pay 
higher Part B premiums because they are upper middle income and 
wealthy. That will happen to them.
  Also, because they are in the MSA or metropolitan statistical area, 
that

[[Page 30964]]

demonstration project, 1.4 million could be forced into them as we 
projected because we have the big metropolitan areas, or be penalized 
for staying in traditional Medicare because the people who are healthy 
will go into those private plans and the people who are sick will stay 
in Medicare and the costs will go up.
  We have fear and confusion. I don't know how many of these figures 
are double-counted, so I cannot just add them up. Some of these figures 
may fit into more than one category, but I can state with certainty a 
couple of million of my 4 million people on Medicare are going to be 
worse off with this bill, much worse off. That is a very bad thing to 
do.
  I don't know where the votes are. I think they have the votes to pass 
this. But if seniors across this country got a couple of days--there 
are about 48 hours to pick up your phone, call your Senator and say: 
Senator, maybe you are right. But this thing is confusing. I am 
fearful. Give me a little more time.
  The bill was just printed and we saw it for the first time the day 
before yesterday. This bill is bigger than I am, and we got it the day 
before yesterday.
  I have shared some of the new bureaucratic ``wordspeak'' in the bill 
and I have just had a couple of days to look it over. At the least, we 
should say to our colleagues, put this thing off. We are going to come 
back in January. This Congress goes 2 years. That is the beauty of it. 
If it was next year, the legislation would die. But we have 1 more year 
of this session. What is the rush? Tell your Senator, maybe Senator 
Boxer is wrong when she says this will hurt me. I am not sure, but she 
has raised some issues.
  Change, if it is positive change, is something we all want. But 
change could be negative, could be disruptive, could cause us to be 
confused or fearful. What is the problem in taking a little while 
longer? To be honest, I would love to have the Christmas holiday recess 
to read every line of this bill. I started to do that. That is how I 
came up with all of these words, by reading the bill and trying to 
understand all of this. I did not even scratch the surface.
  This Senate voted down an Energy bill which I felt, frankly, was in 
many ways a giveaway for a lot of special interests. And the good that 
was in it--and there were good things in it--was outweighed by the 
special interest provisions. We should be here for the public 
interests, for the people we represent.
  I remember one of my colleagues saying to me, when someone asked a 
question about oncology, because there has been some concern about how 
the oncologists are being treated--someone in the room said, just look, 
there is a company being traded, a health care company that deals with 
oncology, and the stock is shooting up. It must be that oncologists are 
being treated fairly.
  I used to be a stockbroker. It is not of any interest to me to do 
things that make the stock of a company go up. Do you know what I want 
to go up? The stock of the American people, the lives of the American 
people, the quality of life of the American people, the quality of life 
of grandmas and grandpas and their families.
  This is truly not a partisan issue. It is an issue of how do we give 
a prescription drug benefit to our senior citizens and keep Medicare 
strong and not make this bill a giveaway to the largest HMO and 
pharmaceutical companies and insurance companies in the country. They 
are doing very well. This debate has been a good debate so far. We have 
serious disagreement. I am sure I will be back in the Senate after we 
have a cloture vote, one way or the other, just to add more terminology 
to my fear and confusion chart.
  I know my colleagues on the other side of the aisle are waiting with 
bated breath to see my next version of this fear and confusion chart 
because I know they understand every single one of these terms. It is 
interesting to look at these terms and to realize how far reaching and 
how bureaucratic this new bill is.
  I will say one last thing and then I will leave the floor, much to 
the delight of the Senator from Iowa and the Senator from Montana. I 
say to any senior citizen, any human being who is within the reach of 
my voice, and there may be a few at this late hour, if you feel we need 
more time to see whether Senator Boxer is right or Senator Grassley is 
right or Senator Baucus is right or Senator Kennedy is right or Senator 
Durbin is right or Senator Hatch is right, if you think you need more 
time to take a look at this bill, to get this bill analyzed, this bill 
that weighs a lot, this bill that is over 600 pages, call your Senator, 
e-mail your Senators and tell them to take some more time, to put this 
thing over until after the first of the year and we can come back here 
and have the whole year to work on this bill, which is really rewriting 
the Medicare Program.
  Thank you very much, Mr. President. I yield the floor.
  The PRESIDING OFFICER. The Senator from Iowa.
  Mr. GRASSLEY. Mr. President, I think the place for me to start is 
where the Senator from California left off; that is, the impression 
that is left that this bill is going to confuse the seniors of America, 
and almost that the purpose of it might be to confuse seniors.
  But let me make very clear to all the seniors who are listening, and 
everybody else who is listening, one of the keystones of this 
legislation is to say to the seniors of America: If you do not want to 
do anything, if you do not want anything to do with this, you do not 
have to have it. This is strictly voluntary.
  For any senior in Iowa or California who comes to their respective 
Members of Congress and says: Congressman so and so, or Senator so and 
so, just leave my Medicare alone; I am satisfied, each of us can say to 
them: If you do not want to worry about all this that we are talking 
about--prescription drugs or anything new about Medicare--you do not 
have to because you can keep traditional Medicare as you have known it 
for the last 35 years. Just keep it as is, if you are satisfied with 
it.
  But for those who might not be satisfied, we give them several 
options. They have a right to choose. They have a right to keep 
traditional Medicare with a prescription drug program that they can 
choose to go into, or they also have the right to choose a new 
Medicare--preferred provider organizations--that is very close to what 
baby boomers now have in the workplace. They can choose that with an 
integrated drug benefit plan.
  So we are not trying to confuse anybody. We are trying to give 
seniors the right to choose. We are trying to give seniors who are 
totally satisfied with what they have right now an opportunity to just 
stay where they are right now. It is the right of seniors to choose.
  I think I better be very clear because so much of the opposition to 
this bill today has come from the other side of the aisle, mostly 
Democratic Members of the Senate.
  We are here today with a piece of legislation because over the years 
2001 and 2002--after Senator Jeffords switched from being a Republican 
to being an independent and casting his lot with the Democrats, so they 
were a majority during the remainder of 2001 and all of 2002--there was 
an effort early on to develop a bipartisan approach to a drug benefit 
during the last Congress.
  When that was developing, there was a fear that there might be a 
bipartisan bill reported out of the Senate Finance Committee, a year 
ago, and the then-majority leader, now the minority leader, Senator 
Daschle, decided that this was an issue that ought to be brought to the 
Senate floor, not worked out in committee.
  Remember, you develop bipartisanship in the Senate in the committee. 
You do not do it very often here on the floor of the Senate. You build 
coalitions.
  Remember, nothing gets done in the Senate that is not bipartisan--
unlike the House of Representatives, where partisan things can be 
done--because, remember, the Senate of the United States is that only 
institution in our political system where minority rights are 
protected.

[[Page 30965]]

  So a year ago, the then-majority party decided that this ought to be 
debated on the floor. But they also knew that it would be impossible to 
get the bipartisan majority that it takes to get things done. They 
gambled that they needed an issue for the last election rather than a 
product. They gambled on an issue that we would not do anything last 
year, and the way they maneuvered this, nothing was done because 
nothing in a partisan way, even by majority Democrats, can be produced 
out of this body that is not somewhat bipartisan.
  Then there was an election, and they found out that issue did not 
work for them; that Republicans were put in a majority. This gave, in 
this new majority, in this new Congress, Senator Baucus and I, the top 
Democrat and the top Republican on the committee, an opportunity to do 
our magic and put together a bipartisan bill. That bill came to the 
Senate floor and was passed 76 to 21. It went to conference, and came 
out of conference in a bipartisan way. And we are here because the 
majority Republicans and some sensible Democrats want to produce a 
product and not have an issue for the next election. I happen to think, 
from the comments I have heard today--all the fault that can be found 
with this bipartisan product--that there are still too many people on 
the other side of the aisle who have not learned a lesson: No. 1, how 
do you get anything done in the Senate? It has to be bipartisan. And, 
No. 2, they did not learn from the mistakes of the last election when 
they thought they needed an issue. Do they think if it did not work in 
2002, it is going to work in 2004?
  So that is why we are where we are because there are Democrats who 
know that you do not get anything done in the Senate if there is not a 
bipartisan coalition. There are Republicans who have understood that 
for a long period of time.
  So that is background to what I want to tell the people of America 
and my colleagues about why this bill should be adopted. During this 
process, I am going to correct some of the statements made by my 
colleagues so far today.
  I want to correct what my colleague from Iowa said earlier about this 
bill's impact on rural America and on our State of Iowa in particular.
  The rural health provisions of this bill go further and wider than 
any other legislation that this Congress has ever considered. It enjoys 
the strong support of the Nation's doctors and hospitals, and it is 
also strongly endorsed by the Iowa Medical Society and by the Iowa 
Hospital Association, two of the strongest advocates for rural equity 
in my State and my colleague's State.
  I will read an excerpt from each and then ask unanimous consent that 
both letters be printed in the Record.
  This is from the Iowa Medical Society president, Tom Evans, M.D.: 
``[P]assage of the bill,'' meaning the bill before us, ``is critical 
for rural states like Iowa.'' ``He said: ``In addition to providing 
seniors with prescription drug coverage''--and I want to emphasize this 
part of his statement--``this legislation fixes many of the 
reimbursement issues that have unfairly penalized rural States. 
Congress must pass this legislation before the Thanksgiving [Day] 
recess.''
  Now, I go to the Iowa Hospital Association, which in 2001 circulated 
statistics, already referred to, showing Iowa in last place in per-
beneficiary spending. The Iowa Hospital Association: ``The Iowa 
Hospital Association strongly endorses passage of this legislation.'' 
``In an evaluation of the per-beneficiary increase, this legislation 
provides Iowa hospitals with the second largest percentage increase per 
Medicare beneficiary of any state in the Union. This amounts to a per-
beneficiary increase of $583, which is the thirteenth highest increase 
of any state in the Union.
  Mr. President, beyond those quotes, I could give a lot of evidence, 
but I think those quotes speak volumes about our rural package. That 
package in this legislation speaks for itself. It brings real 
improvements and equitable payments to hospitals and doctors in Iowa 
and way beyond.
  I ask unanimous consent to have these letters printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                     Iowa Hospital Association

                                    Des Moines, IA, Nov. 20, 2003.
     Hon. Charles Grassley,
     U.S. Senator, Hart Senate Office Building Washington, DC.
       Dear Senator Grassley: Congratulations in reaching an 
     agreement on a conference report that directly and 
     significantly impacts the issue of equity and fairness for 
     hospitals and physicians in rural America and particularly 
     for Iowa. Just this morning, the entire Iowa Hospital 
     Association Board was briefed on the impact of your Medicare 
     legislation and on a unanimous vote endorsed the pending 
     legislation.
       In an evaluation of the per-beneficiary increase, this 
     legislation provides Iowa hospitals with the second largest 
     percentage increase per Medicare beneficiary of any state in 
     the Union. This amounts to a per-beneficiary increase of 
     $583, which is the thirteenth highest increase of any state 
     in the Union.
       The Iowa Hospital Association strongly endorses passage of 
     this legislation and will today ask its entire membership to 
     weigh-in on behalf of the legislation with the entire 
     congressional delegation of Iowa in an effort to support your 
     work to achieve passage of this legislation before the 
     Thanksgiving holiday. It is our hope that when Congress 
     completes its work and you return to Iowa for the holidays, 
     that all Iowa providers will have an opportunity to 
     congratulate you for successful passage of this historic 
     legislation.
           Sincerely,
     Kimberly A. Russel,
       IHA Board Chair.
     Kirk Norris,
       President/CEO.
                                  ____


   Iowa Medical Society Strongly Supports Passage of Medicare Reform 
                              Legislation

       The Iowa Medical Society (IMS) announced today its strong 
     support for the Medicare Prescription Drug and Modernization 
     Act of 2003 conference report.
       IMS President Tom Evans, MD, said passage of the bill is 
     critical for rural states like Iowa. ``In addition to 
     providing seniors with prescription drug coverage, this 
     legislation fixes many of the reimbursement issues that have 
     unfairly penalized rural states,'' he said. ``Congress must 
     pass this legislation before the Thanksgiving recess.''
       Evans said the bill protects Iowans' access to physicians 
     by replacing a 4.5 percent payment cut scheduled for 2004 
     with two years of modest payment increases. The bill also 
     fixes a component of the reimbursement formula that deals 
     with geographic practice cost adjustors that causes huge 
     reimbursement swings from state to state.
       ``If this legislation isn't passed, the American Medical 
     Association estimates that a 4.5 percent cut in reimbursement 
     will take $30 million away from Iowa's health care system in 
     2004,'' he said. ``Now add to this the fact that Iowa already 
     receives among the lowest payment rates in the country, and 
     you can see how Medicare is threatening our ability to care 
     for our patients.''
       Evans also thanked Senator Charles Grassley for his work on 
     this bill as Chair of the Senate Finance Committee, and he 
     urged Iowa Senator Tom Harkin and Iowa's Congressional 
     Representatives to support the Medicare conference report.
       The Iowa Medical Society is the professional association 
     representing over 4,600 MDs and DOs. The IMS core purpose is 
     to assure the highest quality health care in Iowa through its 
     role as physician and patient advocate.

  Mr. GRASSLEY. Now let me speak to what this bill does for Iowa's 
seniors. The bipartisan agreement provides all of the 485,042 
beneficiaries in Iowa with access to Medicare prescription drug 
benefits, as I have stated previously, on a voluntary basis. It does it 
for the first time in the history of the Medicare Program. That begins 
January 2006. Beginning in 2006, the bipartisan agreement will give 
142,297 Medicare beneficiaries in Iowa access to drug coverage they 
would not otherwise have and will improve coverage for many more.
  Within 6 months after this bill is signed--in other words, during the 
year 2004--Iowa residents will be immediately eligible for Medicare 
approved prescription drug discount cards which will provide them with 
savings between 10 percent and 25 percent off the retail price of most 
drugs. Beneficiaries with incomes of less than $12,123, or $16,362 for 
couples, who lack prescription drug coverage, including drug coverage 
under Medicaid, will get up to $600 in annual assistance to help them 
afford their medicine along with a discount card. That is a total of 
$100,840,345 in additional help for 84,034 Iowa residents during these 
years of 2004 and 2005, as this interim program is in place, helping 
Medicare recipients with drugs

[[Page 30966]]

until we get the permanent program put in place. Then beginning in the 
year 2006, all 485,042 Medicare beneficiaries living in Iowa will be 
eligible to get prescription drug coverage through a Medicare approved 
plan.
  In exchange for a monthly premium of about $35, seniors who are now 
paying the full retail price for prescription drugs will be able to cut 
their drug costs roughly in half. In many cases, they will save more 
than 50 percent on what they pay for their prescription medicines. One 
hundred thirty-three thousand beneficiaries in Iowa who have limited 
savings and low incomes--and this would generally be those below 
$12,000 for individuals and $16,000 for couples--will qualify for even 
more generous coverage. They will pay no premiums for their 
prescription drug coverage, and they will be responsible for a nominal 
copayment. That copayment would be no more than $2 for generic drugs 
and $5 for brand name drugs.
  We have 41,300 additional low-income beneficiaries in Iowa with 
limited savings, and incomes below $13,500 for individuals and $18,000 
for couples, qualifying for reduced premiums and a reduced deductible 
of $50 and a Medicare that will cover 85 percent of their prescription 
drug costs with no gap in coverage.
  Additionally, Medicare, instead of Medicaid, will now assume the 
prescription drug cost of 50,000 Iowa beneficiaries who are eligible 
for both Medicare and Medicaid. These seniors generally will pay $1 and 
$3 per prescription and those in nursing homes will pay zero dollars 
for their prescriptions. This will save Iowa $175 million over 8 years 
on prescription drug coverage for its Medicaid populations.
  I have tried to address for my colleagues, but particularly for my 
residents and constituents in Iowa, how this program will impact them 
as individual beneficiaries of the prescription drug part of our bill. 
And I have tried to inform my colleagues and my residents of Iowa how 
the rural equity package will help provide quality care for Iowans 
because we are increasing the reimbursement for our hospitals and for 
our doctors in rural America.
  Now I will address several of the most egregious misconceptions about 
the bill that have been spoken on the floor of the Senate today. First, 
I will address the issue of protecting retiree drug coverage. This 
would be those people who have, for the most part, coverage from places 
where they used to work that also continue to cover people with health 
benefits and prescription drugs after they leave employment.
  During the debate on S. 1, when this bill passed the Senate the first 
time in June of this year, it passed by a 76-to-21 bipartisan vote. At 
that time, even though we had that high bipartisan majority, my 
colleagues raised concerns about what they referred to as the high 
level of employers that would drop their retiree prescription drug 
coverage should we enact the prescription drug benefit into the 
Medicare Program.
  At that time, the Congressional Budget Office told us that 37 percent 
of the seniors who have drug coverage--that is roughly one-third of the 
seniors under Medicare--would lose that coverage if we passed the bill. 
I think I ought to say that there was another group, the Employer 
Benefit Association, that studied the same issue and said it would be 3 
percent to 9 percent who would lose coverage. So we probably have an 
intellectually honest difference of opinion by the Congressional Budget 
Office on the one hand and the Employer Benefit Association on the 
other hand. But we in the Congress are stuck, as we determine the cost 
of programs, with what the Congressional Budget Office says. We would 
rather--and it would be easier--if we could just go by what the 
Employer Benefit Association says, but we go by CBO because they are 
God when it comes to saying what something costs. So we had to live 
with that 37 percent.
  Well, as we all know, however, employers have been dropping or 
reducing prescription drug coverage for many years. So this is really 
nothing new. If we were not even talking about this bill today, some 
board of directors of some corporation in America could come to the 
conclusion that they couldn't afford to cover their retirees anymore 
and drop them. What could Congress do about that? Nothing. But it is 
nice to have a program when that happens for people to fall back on. 
That is one of the reasons for this legislation.
  Of course, we want to take care that we can do everything possible to 
make sure that corporation X doesn't do that. In just the past 2 years, 
retiree health care coverage has dropped by 22 percent. That was with 
this Congress not doing anything, not considering this legislation.
  We know these days employers are finding it harder and harder to 
continue to voluntarily provide health insurance coverage. That is due 
to a lot of factors, including rising health care costs overall. Now, 
as we were in conference between the House and the Senate, we took this 
marketplace dynamic of company XYZ, ABC, or whatever corporation--that 
they could do this. This is a dynamic we had to take very seriously. So 
we went to great lengths to improve employer participation in drug 
benefits to keep employers in the game; to keep their retirees covered, 
as retirees would expect to be covered, but sometimes they are 
surprised when they are not.
  Our conference report reflects this. It includes remarkably better 
policies for employers than those that were in either the bill that 
passed in the Senate 76 to 21 or that passed the House in June as well. 
So I am saying to you we brought back a conference report that was 
better in regard to employee-retiree coverage than either passed the 
Senate or the House in the first place.
  So what happens when we do that good work? The policies in this 
conference report have led to major corporate plans endorsing our 
conference report. So the people on the other side of the aisle, with 
their charts, who are saying bad damage is being done by this 
legislation, what would they have us do? Pass nothing? If corporation X 
decides to drop, and there is nothing there for their employees, do you 
think those same people are better off if Congress does zilch? Where 
were they when they voted in the first place, complaining about S. 1 or 
H. 1, the House bill, when we passed them in June?
  Here we are bringing back a conference report that is being endorsed 
by these corporate plans. Doesn't that mean anything to any of you? 
Under this conference report, employers will be given an enormous 
amount of flexibility and options--employers that already provide 
retiree benefits beyond Medicare coverage. This legislation will help 
make it more affordable for these employers to continue providing these 
benefits. We do that by a direct subsidy worth 28 percent of their drug 
spending between deductibles and the coverage gap.
  I should add, too, this conference report makes this 28 percent 
completely excludable from taxation, so that instead of doing 65 
percent good because of a 35 percent tax bracket that corporations are 
in, it does 100 percent good, bringing down the number of people who 
might lose coverage.
  Now, some people would say, what is this corporate welfare all 
about--Congress giving money to corporations to do something they have 
been doing forever. Some people might say, well, when you buy a 
Chevrolet, you pay for these retirement plans. How many times do you 
have to pay for them? You pay for them when you buy a car and when you 
pay a 28 percent subsidy. We are cautious about the fact that some do 
that.
  So I tell my colleagues over there--each of them who are complaining 
about this--this 28 percent subsidy is something you ought to be glad 
to have. Sometimes when we give corporations something, you condemn us 
for giving corporations something; but you cry when we do it and you 
cry when we don't do it because they might dump their retirees. In the 
final analysis, we are also doing it to protect the taxpayers and the 
Medicare Program because it is better to encourage these employers to 
keep their retirees in these plans at a 28 percent subsidy, which is 
about $750 per person, instead

[[Page 30967]]

of having those corporations dump those plans on the Medicare Program, 
and it is going to cost about $1,250. So that is why we do that.
  Now, besides this 28 percent help, we also say that employers can use 
the flexibility this legislation provides to structure plans that 
complement Medicare's new drug benefits and provide them even enhanced 
benefits for their retirees. They can even do better than they are 
presently doing because of this flexibility we have in the legislation.
  These new choices and options will do much more to help and, 
consequently, not threaten employer-sponsored health care coverage for 
those who currently receive it.
  In fact, the Congressional Budget Office now estimates that the so-
called drop rate--in other words, the rate by which corporations will 
drop their retirees--is now 17 percent because of the changes that were 
made in conference. In other words, we listened to our colleagues over 
there complain about a 37 percent potential drop rate because of the 
way S. 1 was written. But it goes to conference and it comes back from 
conference with, instead of 37 percent, 17 percent, and you folks are 
still complaining. I don't understand it. And these 2.7 million 
retirees will still be better off with Medicare coverage, likely paid 
for by their former employees. In other words, the 2.7 million people 
who would have been dropped, according to CBO, because of what we did 
in the conference--that is better than either bill when first passed in 
June; 2.7 million people are still going to be in their corporate 
retiree plan.
  So I say to my colleagues--I hope you hear this--we have come a long 
way since June, when 76 people, in a bipartisan way, voted for this. 
Half of you over there voted for it. I believe company plans have a lot 
to be happy about under this conference agreement.
  All seniors deserve health care benefits. All seniors deserve access 
to prescription drug programs. This compromise between the House and 
Senate provides that, and it makes certain that good sources of 
existing coverage remain intact. I urge my colleagues to embrace the 
strong employer provisions we have agreed to and vote for this 
conference report.
  We have also heard from a lot of them over there that somehow we are 
trying to privatize Medicare. How many times do I have to say it? This 
program is voluntary. Nobody has to go into anything in this bill if 
they don't want to. If they want to keep traditional Medicare, keep it. 
But this issue has been brought up. Do you know why? Because these 
folks over there, my colleagues over there--every one of them--like to 
scare seniors. You know, it is called Medicare, but you like to make 
Medicare into ``medi-scare.''
  You know, it is easy to scare seniors. I have my town meetings around 
Iowa. I hold town meetings in each of the 99 counties every year so I 
can keep in touch with my constituents. There are people--the older, 
the more so--but seniors come up to me and they actually believe what 
is said on that side of the aisle when people say somebody is going to 
take their Medicare away from them. They believe that ``medi-scare.''
  They are really nervous. Some of them even have tears in their eyes. 
I tell them, if you just knew as seniors how you have a hook on 
Congress, that Congress is scared to death of you, you would be 
laughing at me instead of being scared of something we might do. That 
is how the concerns of the seniors of America are taken into 
consideration by people in the Congress of the United States.
  Maybe we ought to have a little more of an independent view than be 
so concerned about the electoral power of the seniors, but they have 
tremendous influence on Congress. Maybe some people say too much 
influence. Regardless, it is wrong for people over here to ``medi-
scare'' our seniors.
  I wish to address this issue of privatization, but the easiest answer 
is that if you are satisfied with what you have--traditional Medicare--
don't worry. Also, if you like other provisions in this bill, they are 
voluntary. You don't have to do them.
  This bill before us today brings Medicare into the 21st century 
practice of medicine. It does not privatize traditional fee-for-service 
Medicare. Overall, this conference agreement relies on the best of the 
private sector to deliver drug coverage, supported by the best of the 
public sector to secure consumer protections and important patients' 
rights. This combination of public and private resources is what 
stabilizes the benefits and helps keep costs down.
  Seniors will be able to purchase prescription drug coverage on a 
voluntary basis as part of Medicare's traditional fee-for-service 
program or be part of a new Medicare-approved private plan where the 
drug benefit is integrated into broader medical coverage. These 
Medicare-approved plans have the advantage of offering the same 
benefits of traditional Medicare, including prescription drugs, but on 
an integrated, coordinated basis. This creates new opportunities for 
chronic disease management and access to innovative new therapies.
  Let me comment on chronic disease management. That is very important 
if we are going to keep costs down in the future. We won't have to 
squeeze seniors at all. In fact, seniors will have a better quality of 
life under chronic disease management because 5 percent of the seniors 
are responsible for 50 percent of the cost of Medicare. The reason for 
that is that we only pay doctors to make people well after they get 
sick. We never pay enough to keep them well in the first place.
  We can concentrate on this 5 percent in chronic disease management, 
and by so doing, we are going to provide a better quality of life 
because they will not be in and out of the hospital as much, and we 
save money there. But also their quality of life is going to be better, 
and it protects the taxpayers in the process and preserves the 
longevity of Medicare.
  Unlike Medicare+Choice, we set up a regional system where plans will 
bid in a way that doesn't allow them to choose the most profitable 
cities and towns. Cherry-picking cannot take place. Systems like this 
work well for Federal employees, such as the postmaster in New 
Hartford, IA, my hometown. He has a choice of several plans. We want to 
give that same choice to his parents who today only have traditional 
Medicare. They have no right to choose.
  We provide an alternative plan for people who want to try something 
new, something that is probably close to what baby boomers have for 
health plans where they work. We have set up preferred-provider 
organizations. Are they right for everyone? We give seniors the right 
to choose. Our bill sets up a playing field for preferred-provider 
organizations to compete for beneficiaries. We believe preferred-
provider organizations can be competitive and offer a stronger, more 
enhanced benefit than traditional Medicare, assuming seniors want to 
choose that. They have that choice.
  Let me be clear, no senior has to go into a preferred-provider 
organization. My policy has always been to let seniors keep what they 
have if they like it with no changes. All seniors, regardless of 
whether they choose a PPO or not, can still choose prescription drug 
coverage if they want to, to go along with their traditional Medicare, 
but it is their right to choose.
  I can't mention preferred-provider organizations without correcting 
the record regarding the preferred-provider organization stabilization 
fund that the other side has called a slush fund. It is no slush fund. 
It is something that those of us who live in rural America know we have 
to have. We learned a lesson from Medicare+Choice because in 1997, I 
worked hard to bring greater reimbursement to rural America through 
Medicare+Choice so that people in Iowa would have the same options that 
40 percent of the people in Miami have chosen: to go into an HMO. It is 
a voluntary choice. If they don't like it, they can get out tomorrow. 
Get in today; get out tomorrow. In rural America, we enhanced greatly 
the reimbursement for them, but they have not come because of cherry-
picking.
  We want the preferred provider organizations to serve all of America, 
rural

[[Page 30968]]

as well as urban. The stabilization fund is so those of us in rural 
America have an opportunity to get the same benefits as people in New 
York City or Los Angeles or Miami.
  The bipartisan agreement on a final Medicare bill establishes this 
stabilization fund. It was not in the Senate bill. Some people say the 
Kyl provisions were similar to that, but Senator Kyl will tell you he 
had a whole different idea in mind. His idea is not even in this bill, 
but we did take a stabilization fund to accomplish something he wants 
to accomplish. He wants his entire State of Arizona to be served by 
PPOs, not just Phoenix. We did this in an effort to expand access to 
private health plans in all areas of the country and, additionally, to 
maintain existing health care choices in areas where health plans face 
particularly difficult challenges.
  My colleagues on the other side who find fault with this conference 
report are always talking about this slush fund as benefiting some 
organization's profit motive.
  Every one of them has rural areas. My colleagues ought to want the 
people in the rural parts of their State to be served the same way as 
people in the urban parts of the State.
  The reality is that this is not a slush fund, but it is to help 
beneficiaries have equal services, whether they live in rural America 
or urban America, and that will be helped by this stabilization fund. 
It is targeted and its plans are held accountable. Resources will be 
distributed from the stabilization fund only when specific conditions 
are met. Moreover, in instances where these conditions are met, then 
health plans will be accountable for using these funds only to promote 
affordable health coverage to beneficiaries, not for profit. Under no 
circumstances will plans then be permitted to use these funds to pad 
their bottom line.
  It expands choices and ensures access in rural areas. The fund is 
designed to expand and preserve beneficiary choices and benefits in 
areas where it is most difficult to provide private health plans and to 
get them to participate in this program.
  The stabilization fund will ensure that millions of additional 
beneficiaries, including many in rural areas, will have access to 
health plans offering high quality, comprehensive benefits, and low 
out-of-pocket costs. If the stabilization fund is not successful, the 
worst case scenario is that the funds will be returned to the U.S. 
Treasury.
  Now I will speak about the accurate explanation of how this bill 
helps low-income seniors. We did something in the conference report 
that the House did so the Senate receded to the House on this point, 
and that is where we in the Senate decided to leave dual eligibles who 
were covered by Medicaid. That is the way it passed the Senate. The 
House wanted to have one program for seniors, a totally Federal 
program, so dual eligibles in the House bill were taken away from 
Medicaid and put in Medicare. We accepted what the House wanted to do, 
as a matter of equality I suppose. We had other motivations for doing 
it in the Senate.
  In fact, most of the support for doing that--that was one of the 
shortcomings that Democrats said about the Senate bill in June. Now we 
are hearing complaints from them about aspects of this dual eligible, 
how it impacts seniors, particularly on asset tests. That is one of the 
reasons we tried to avoid putting dual eligibles under Medicare in the 
Senate bill, because we wanted asset tests to be the same for this 
group. Now they are complaining, I think inaccurately, which I will 
prove in a minute, about it negatively impacting people with less 
coverage than they presently have.
  We have heard from the other side how 6 million low-income eligible 
seniors will be worse off under this conference report. That is 
inaccurate. It is a lot of talk, and I want to tell the American public 
the truth about this issue. Beneficiaries are not hurt by this bill. 
They are helped. This bill provides generous predictable coverage to 
6.4 million dual eligibles, but it does not stop there. It provides 
coverage to an additional 7.7 million low-income seniors. Madam 
President, 14.1 million seniors are eligible for low-income subsidy, 
nearly 36 percent of Medicare beneficiaries.
  So who are these dual eligibles? They are the 6.4 million who are 
enrolled in both Medicare and Medicaid.
  This conference report for the first time provides drugs to dual 
eligibles through Medicare rather than Medicaid. This is a great help 
for the States that have budget problems, and Medicaid is a growing, 
biggest part of State budgets.
  As I said, the Senate bill left dual eligibles in Medicaid. That 
policy allowed the Senate to provide generous coverage for low-income 
seniors. S. 1 focused on providing drug coverage to seniors who did not 
have any coverage whatsoever, and duals did have that coverage. So in 
the spirit of compromise, the Senate conferees changed the policy in 
the Senate bill.
  The conference report provides prescription drugs for dual eligibles 
through Medicare. It is not exactly the same, but in general policy it 
is the same way they were treated in the House bill. Providing drugs 
for dual eligibles through Medicare was a cornerstone issue for House 
conferees.
  The conference report covers duals in the Medicare Program. The 
coverage is designed to benefit as many low-income seniors, including 
duly eligibles, as possible, given the budget constraints of $400 
billion in our budget.
  This bill comes out at about $395 billion. Blanket statements about 
the reduction of benefits for the dual eligibles in the conference 
report are not accurate. We have heard some of those inaccurate 
statements this Saturday as we have debated this bill. This bill is 
generous and does not leave 6.4 million seniors worse off. I will bet 
tomorrow those over on the other side will be putting those signs up 
again that say that. Well, don't do it.
  For instance, unlike the Senate bill or the current Medicaid Program, 
the conference agreement does not have cost sharing above the 
catastrophic limits for the dual eligibles. That is right. There is no 
cost sharing. I hope my colleagues on the other side get that.
  I will put this in perspective, then, from the State level. According 
to the Kaiser Family Foundation, the Commonwealth of Massachusetts 
currently charges $2 for every prescription filled by dual eligibles. 
There is no catastrophic limit for duals in that Medicaid Program in 
that State, just a requirement for beneficiaries to pay $2 for every 
single prescription.
  Like many Medicaid Programs, this bill establishes copayments for a 
majority of the dual eligibles who are either equal to or less than 
those required by most State Medicaid Programs. So let's get that 
straight. These copayments are no more than, and in some cases less 
than, those required in most State Medicaid Programs.
  More specifically, today 25 States have copayment levels for generic 
and brand-name drugs set at $1 or higher for dual eligibles enrolled in 
their Medicaid Programs. In this conference agreement, dual eligibles 
with incomes below 100 percent of poverty will be responsible only for 
a copayment between $1 and $3 for their Medicare drug benefit. Taking a 
step back, it seems to me that this level of cost sharing is very 
similar to what the duals pay for in Medicaid coverage.
  In fact, in South Dakota, duals pay $2 per prescription. That policy 
is on par with the coverage offered through this bill. This conference 
report contains a generous drug benefit, then, for dual eligibles. 
There is no donut, or no loss of coverage, no gap in coverage, for low-
income Medicare beneficiaries. But my colleagues on the other side 
would lead us to believe otherwise.
  The bill guarantees all 6 million dual eligibles access to 
prescription drugs. Under the conference report, dual eligibles will 
have better access through Medicare than they do today, specially since 
State Medicaid Programs are increasingly imposing restrictions on 
patients' access to drugs because of budget problems that 45 of our 50 
States have.
  Further, States have the flexibility to provide coverage for classes 
of drugs, including over-the-counter

[[Page 30969]]

medicines that might not even be covered by the Medicare Program.
  This bill ensures appeal rights for dual eligibles. Under the 
agreement, duals will maintain appeal rights, such as those that they 
presently have in the Medicaid Program. The dual eligibles are a 
fragile population and are well taken care of in this bill. The 
conference report recognizes and provides generous coverage to these 6 
million beneficiaries and in fact goes further by providing full drug 
coverage to 7.7 million more low-income seniors.
  So I turn now to highlighting what this bill does to protect Medicare 
in the long run. I have heard some Members trying to assert that this 
$400 billion expansion of one of the most successful social programs in 
our country's history is going to destroy traditional Medicare; you 
have said it, ``Medicare as we know it.'' That is another one of your 
``medi-scare'' tactics.
  I know Members are tired. I know we are nearing the closing of our 
first session of the 108th Congress. Many Members are using these 
wornout lines because they would rather not take a serious look at the 
bipartisan Medicare agreement we put together and really assess whether 
or not those scare tactics are true. I am here to tell all my 
colleagues and the people of this country that the allegations that 
this Medicare bill destroys traditional Medicare are falsehoods.
  This Medicare bill strengthens and improves traditional Medicare in a 
number of ways. We are not talking about just Medicare as it has been 
for the last 38 years. We are talking about some improvements we made 
in traditional Medicare that seniors will have the choice, the right to 
choose to stay in if they want to. I will discuss just three.
  First, we add new preventive program benefits. For the first time 
ever, every new Medicare enrollee will receive a ``Welcome To 
Medicare'' physical; they go to the doctor when they go into Medicare, 
get a benchmark physical. Hopefully, nothing is wrong. But if something 
is wrong, we know about it right away and it is part of our effort to 
see that we zero in on keeping people well, as opposed to waiting until 
they get sick and it costs a heck of a lot more. It is part of our 
program, of a quality of life for our seniors. It is part of our 
program of zeroing in on the 5 percent of the people who, because of 
not having chronic care management, are costing us 50 percent of the 
total costs.
  Seniors are going to have physicals that will help them--maybe their 
lifestyle, like getting their weight checked, but more seriously, the 
heart; receive cancer, diabetes, and bone mass screenings. It is very 
important to have an initial physical because, as we say in Iowa, an 
ounce of prevention is worth a pound of cure.
  Consider these statistics. In 2000, 6.2 percent of the U.S. 
population had diabetes. Heart disease and stroke are the first and 
third leading causes of death in the United States. In 2003, 1.1 
million Americans will have a heart attack. Diabetes, heart disease, 
and other chronic conditions exact an awful toll on our seniors. By 
getting an initial physical, seniors can get valuable information on 
their health status. They can enroll in weight loss programs, start a 
blood pressure medicine, or know whom to call if something goes wrong.
  We have also eliminated the deductibles and the copays on screening 
tests for heart disease and diabetes, so beneficiaries do not incur any 
costs. There is an extent to which that cost today may inhibit them or 
divert them from having needed tests, so this is an additional 
incentive, particularly for those with limited resources who might not 
otherwise access these benefits. Adding preventive benefits is just one 
way we have improved traditional Medicare.
  A second way we have improved the fee-for-service program is by 
providing access to disease management. It is a common option available 
to younger people in health insurance. If you have a chronic health 
condition such as heart disease, diabetes, asthma, you can get extra 
help managing your condition. You may be taking a lot of medications 
and seeing several doctors. Disease management programs help patients 
take responsibility for their health care and better control of their 
lives, but they also involve health professionals in that process, to 
aid you.
  When this Medicare bill becomes law, seniors with access will have 
access to these services. It will be a voluntary program and one that 
will improve the quality of life for millions of Medicare 
beneficiaries.
  Another improvement is this bill provides an additional $25 billion 
for rural health care providers. That is new money to strengthen our 
Nation's hospitals, physicians, ambulance riders, and dialysis clinics, 
just to name a few. This is the biggest funding boost Congress has ever 
passed for our rural health care system. This is going to help fee-for-
service, traditional Medicare because in some places in this country 
there is not an adequate number of health care providers. Providers in 
rural States such as mine, Iowa, practice some of the lowest cost 
medicine in the country. Yet health care providers in rural areas lose 
money on every Medicare patient they see. This Medicare bill takes 
historic steps toward correcting geographic disparities that penalize 
rural health care providers.
  So when I hear people in Washington say this bill is going to destroy 
traditional Medicare, I suggest that each of them take a closer look at 
this legislation. Providing new preventive benefits, allowing seniors 
to access state-of-the-art disease management programs, and mending the 
rural health care safety net will help millions of seniors with these 
three important ways we are strengthening Medicare.
  I would like to turn now to a subject that is important to me, to the 
taxpayers, and to the seniors, and that is the issue of curbing waste, 
fraud, and abuse. You just read in your news releases from HHS, $11.5 
billion of waste, fraud, and abuse within health care. If we can save 
that money, we are going to make Medicare strong for a long time in the 
future.
  When it comes to reimbursements for many of the items and services 
that Medicare covers, the price, historically speaking, has not been 
right. That goes, for instance, for doctors and hospitals in rural 
areas who are paid too little, and some drugmakers and equipment 
suppliers, to name a few, who are paid too much.
  This conference agreement makes great strides toward correcting both 
the underpayment and the overpayment that plague the Medicare Program. 
I have already talked about the underpayments to rural States such as 
Iowa and how this bill corrects that through the $25 billion of new 
money we are injecting into making Medicare reimbursements equitable.
  But I want to talk now about just the opposite. There are 
overpayments in Medicare. Overpayments eat away at Medicare's reserves, 
eating away at its solvency slowly, like a cancer. Overpayments are bad 
for taxpayers, they are bad for beneficiaries, both of whom deserve to 
pay a fair price. In certain areas of Medicare, in many payment systems 
there are few fair prices.
  Fee schedules pay too much, providers play games with complex rules 
and regulations, and beneficiaries pay a higher copay as a result. The 
sad fact is that Medicare's price is often far higher than the 
marketplace price. This conference agreement begins to change that in 
significant ways.
  My colleagues should read title III of the conference report, and 
that is entitled, ``Combating Waste, Fraud, and Abuse.''
  Our bipartisan initiative in this bill will end overpayments, reduce 
fraud, and cut down on opportunities for abuse to the tune of $31.3 
billion as scored by the Congressional Budget Office. That is 
significant.
  These measures in this bill directly reduce Medicare's spending on 
overpriced, wasteful, fraudulent items, and services to the tune of 
$31.3 billion over 10 years.
  Throughout my time in Congress, I have worked hard to combat fraud 
and waste in Federal programs. In 1986, I successfully passed False 
Claims Act improvements that give whistleblowers new rights and 
protections under Federal law. In just the last year alone,

[[Page 30970]]

civil fraud recoveries have tallied a record $2.1 billion, the Justice 
Department announced just last week. This is a 75-percent increase over 
the prior years' recoveries of $1.1 billion, and brings total 
recoveries to over $12 billion since I got that bill passed. Of the 
$2.1 billion, $1.4 billion is associated with suits initiated by 
whistleblowers.
  While the False Claims Act is one of our best weapons in the war on 
fraud and abuse, our policies in this new language of the title III 
conference agreement adds still more weapons to our arsenal.
  First, we make important technical clarifications to existing law 
that strengthen and improve what is known as the secondary payer 
statute. The purpose of the statute is to ensure that Medicare pays 
first for seniors' medical needs when other sources should be, in fact, 
paying instead of the taxpayer paying.
  These other sources include, for instance, employer coverage. In 
addition, when a Medicare beneficiary is injured by wrongful conduct of 
another entity, that entity's liability insurance or the entity itself, 
if it has no insurance, or it might be self-insured, is always required 
to pay first instead of having the taxpayers pay. The provisions in 
title III do not change existing law in this area but, in fact, clarify 
the intent of Congress in protecting Medicare's resources.
  According to the Congressional Budget Office, these clarifications 
alone promise to restore Medicare over $9 billion out of that $31 
billion.
  Second, we change the way Medicare pays for durable medical 
equipment, first by slowing the spending growth in these areas for 3 
years, and then by instituting a competitive mechanism that will 
deliver a fair market price for seniors.
  While I have concerns about the impact of such a new system on very 
many small businesses across America, the supply of high-quality 
equipment especially in rural areas, I am confident that good 
protections are in this conference agreement for small business and for 
our seniors as well.
  The Congressional Budget Office estimates that these changes will 
save Medicare $6.8 billion out of that $31 billion.
  Next, title III institutes what we call market pricing mechanisms for 
drugs administered in the doctors' offices that both the Office of 
Inspector General and the GAO have concluded are priced far higher than 
their actual costs.
  In addition to the financial toll these overpayments take on the 
taxpayers, they also affect Medicare's beneficiaries who are often 
required to pay dramatically higher copayments for the drugs they rely 
on. In some instances, these copayments can even exceed the actual 
prices the doctors paid for the drug.
  In recommendations to Congress, the GAO urged Medicare to take steps 
to begin paying doctors for Part B-covered drugs and related services 
at levels that reflect the doctor's actual acquisition costs--not some 
inflated cost. And they use information about actual market 
transactions prices to bring that about.
  I am pleased that our conference agreement accomplishes this first by 
reducing the so-called average wholesale price by 10 percentage points, 
and then instituting a new payment system based on manufacturers' 
reported average sale price--or ASP reporting--which will be closely 
scrutinized by the inspector general on an ongoing basis ensuring its 
accuracy.
  Errors or abuse of the system will be corrected swiftly so that 
Medicare will never again pay an unfair price.
  These changes result in Medicare savings of approximately $11 billion 
out of that $31 billion total.
  Finally, title III takes similar steps to correct overpayments for 
respiratory medicine which the Office of Inspector General has said are 
priced far in excess of their actual costs. These drugs will be reduced 
by 10 percentage points in 2004, and then priced on a similar average 
sale price system, as others I just mentioned, and that will begin in 
the year 2005.
  The Congressional Budget Office says that this policy alone will save 
Medicare $4.2 billion of that $31 billion total.
  I have listed three or four examples of how you save that $31 
billion.
  I believe all of these changes have been carried out in a 
compassionate fashion with twin goals of protecting both the Medicare 
Program's resources and our senior citizens' access to those services. 
We have done both.
  Our market-based improvement Part B drug payments are accompanied by 
sweeping changes in payments for clinical services associated with 
delivering them.
  We worked closely with oncologists to ensure that access to cancer 
care was not harmed.
  Similarly, we went to great lengths to ensure that seniors who rely 
on medical equipment supplies will be able to rely on them as they do 
today.
  Finally, to my colleagues who talk about cost containment and the 
need for Medicare to curtail its spending, I say this: It starts right 
here. Cost containment begins by ensuring that the costs to Medicare 
and to the taxpayers who finance it are, in fact, fair.
  The conference agreement starts us down the road. The sum total of 
$31.3 billion of savings, and the market prices we are imposing on 
future spending in this area, are in my view, the most significant cost 
containment policies in this conference agreement.
  In the months and years ahead as Medicare spending increases with the 
expansion of benefits that we are going to pass here shortly, our focus 
on cost containment will obviously increase. The best thing that 
Congress can do is to be vigilant. We all need to watch Medicare's 
outlays closely, and to listen to whistleblowers who are patriotic 
citizens telling us when there is fraud and crying for government to do 
something about it.
  We also need to pay attention to other private individuals who have 
inside information on wrong doing. We need to heed the warnings of the 
Office of Inspector General, and, most of all, insist that Medicare 
never pay more than market price. Taxpayers, on the one hand, and the 
seniors' Medicare services, on the other hand, deserve nothing less.
  I want to conclude by talking about the views of very many 
organizations that support the conference report.
  Mr. GRASSLEY. Madam President, I want to quote from some.
  As you know, I have a chart up here talking about the AARP. All of 
you colleagues on that side of the aisle have been saying to me all day 
how dastardly it is that the AARP is backing this legislation. Some 
Members have even spoken of them becoming a political organization. 
They cannot become a political organization or they will lose their 
tax-exempt status. But you accuse them of being a tax-exempt 
organization.
  It is funny, last year when they did not come out for the bipartisan 
bill that several Members brought out, that the Democrat majority did 
not want to let pass because they wanted an issue in the last election 
instead of a product, the AARP was not backing what I, Senator Snowe, 
Senator Jeffords, Senator Breaux, and Senator Hatch wanted to do. Ours 
was a bipartisan effort, or a tripartisan effort, with Senator Jeffords 
being an Independent, to get a bill through because you cannot get 
through anything in this body if it is not bipartisan. The AARP did not 
like what we were doing. They did not discourage us but they did not 
help us. They actually sent letters out to support what Senator Kennedy 
was trying to do a year ago.
  I did not accuse the AARP of being a tool of the Democrat Party like 
Members on the other side are accusing the AARP of being in bed with 
the Republicans. They are not in bed with the Republicans. They are in 
bed with a bipartisan group of this body who want to do something for 
seniors of America. It is funny how the AARP is OK when they are 
helping Senator Kennedy but they are not OK if they are helping a 
bipartisan group led by Senator Grassley and Senator Baucus.
  I would say they are discretionary in what they do. They may not be 
consistent, but thank God they are not consistent because they would 
not be representing the diverse group they represent.

[[Page 30971]]

  Here is what the AARP says in their endorsement:

       AARP believes that millions of older Americans and their 
     families will be helped by this legislation.

  They continue:

       This bill provides 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.

  The last sentences I will read:

       An unprecedented $88 billion will encourage employers to 
     maintain existing health retiree benefits. The legislation 
     will help speed generic drugs to market and add important new 
     preventive and chronic care management services. This 
     legislation protects poor seniors from future soaring 
     prescription drug costs.

  All the Members complaining about the AARP, put that in your pipe and 
smoke it.
  Then we have the National Council on the Aging:

       . . . we find it too difficult to again say to millions of 
     vulnerable seniors in need: Sorry, come back in a few years 
     and maybe there will be some help for you then.

  Another sentence:

       We urge Congress to pass the Medicare bill so that millions 
     of seniors with greater needs will receive long-awaited and 
     badly-needed prescription drug coverage.

  Are Members trying to tell me the National Council on the Aging does 
not know what is good for seniors when they see it? Put that in your 
pipe and smoke it.
  The Alzheimer's Association says:

       This is a historic accomplishment that may potentially 
     provide meaningful relief to the 4.5 million Americans 
     dealing with Alzheimer's disease--many of whom also suffer 
     other health issues.

  That is from Sheldon Goldberg, president and CEO of the Chicago-based 
national organization for the Alzheimer's Association.
  Are Members telling me the Alzheimer's Association cannot make a 
judgment if this bill is good for their members? Go put that in your 
pipe and smoke it.
  From the American Diabetes Association:

       . . . contains important improvements to the Medicare 
     Program that will benefit many people living with or at risk 
     for diabetes.
       . . . the prescription drug package assists seniors living 
     with diabetes by providing coverage for insulin and syringes, 
     a critical component for seniors that take insulin to manage 
     their diabetes.
       . . . the American Diabetes Association supports passage 
     of--and strongly urges Congress to enact--the Medicare 
     package as a way to improve the lives of millions of seniors 
     living with diagnosed and undiagnosed diabetes.

  Are Members trying to tell me the American Diabetes Association does 
not know a good piece of legislation when they see it? Put that in your 
pipe and smoke it.
  We have a statement by Advancing Health in America, AHA, saying:

       It provides prescription drug benefits to the elderly and 
     provides needed Federal relief to hospitals, particularly 
     rural hospitals.
       The legislation includes important provisions that help 
     patients by providing hospitals the resources necessary to 
     continue caring for America's seniors.

  Tell me an organization called Advancing Health in America does not 
know what is good for their Members.
  From the American Medical Association:

       Congress listens to America's patients and physicians who 
     serve it.
       The status quo is unacceptable to patients and their 
     physicians. The Medicare conference agreement includes 
     numerous provisions that will improve seniors' access to 
     medical services.

  Tell me the American Medical Association does not know what is good 
for their members or what is good for their members' patients.
  The Arthritis Foundation says:

       The Arthritis Foundation supports a Medicare Prescription 
     Drug, Improvement, and Modernization Act for 2003 that for 
     the first time would provide coverage for prescription drugs 
     and biologicals for persons with arthritis.

  Can Members tell me the Arthritis Foundation does not know what is 
good for their members, know a good piece of legislation when they see 
it?
  We have the American Pharmacists Association:

       . . . APhA supports this as an important, long-overdue step 
     toward providing Medicare beneficiaries greater access to 
     medications and critical pharmacist services.
       The proposal creates a comprehensive benefit that provides 
     coverage for drug products and pharmacist services, and 
     provides seniors their choice of pharmacists and ensures any 
     willing pharmacist can participate in a plan and incorporates 
     important administrative efficiencies.

  Those Members who oppose this bill, are you trying to tell the people 
of America that the American Pharmacists Association does not know a 
good piece of legislation when they see it and that they cannot speak 
for not only their membership but also their patients and clients they 
serve?
  From the College of American Pathologists:

       This legislation will improve Medicare coverage for seniors 
     and protect access to the physicians and services upon which 
     they rely for quality of care.
       The conference agreement also preserves critical health 
     care services provided by independent laboratories in to 
     hospital patients, especially in smaller and rural 
     communities.

  Are Members telling me, as they criticize this legislation, that the 
College of American Pathologists would support legislation that is not 
good for their patients and the people they serve?
  The Federation of American Hospitals:

       This agreement does more to improve Medicare coverage for 
     seniors than any legislation since its program inception.

  That is 38 years.

       The Federation of American Hospitals commends President 
     Bush, the Congressional leadership, and members of the 
     Medicare Conference Committee for their great efforts in 
     bringing these vital improvements to the Medicare to 
     fruition.
       H.R. 1 would greatly enhance the ability of hospitals to 
     provide necessary care medical care to Medicare 
     beneficiaries. It would make important strides in ensuring 
     that all hospitals have sufficient funding to meet the 
     medical needs of this nation's seniors and would particularly 
     aids though hospitals that serve seniors in rural areas.

  Every Member has rural areas in their State. And we have a major 
hospital association supporting this legislation because it is 
particularly going to serve seniors in rural America.
  Now, tell me that they do not know a good bill when they see it.
  Here is something that answers complaints that were heard late this 
morning or early this afternoon. One of the first speakers on the other 
side of the aisle, the Senator from Illinois, was complaining about 
this not doing enough for generics. But here we have the Generic 
Pharmaceutical Association:

       The Generic Pharmaceutical Association today called the 
     Medicare Conference compromise on generic drugs a tremendous 
     victory for all consumers that will ensure timely access to 
     affordable pharmaceuticals. . . .
       The House and Senate conferees have met the challenge of 
     eliminating some of the most serious barriers to generic 
     competition by closing loopholes that have unnecessarily 
     delayed the timely introduction of affordable 
     pharmaceuticals--and American consumers, young and old alike, 
     will be the winners.

  Now, how many of you speaking today have complained about this 
legislation not doing anything about the cost of drugs? And we know 
that putting generics on the market sooner is one of the ways to bring 
down tremendous drug costs.
  Now, the Generic Pharmaceutical Association supports this 
legislation, and yet you do not recognize that they understand a good 
piece of legislation when they see it.
  We have the United Seniors Association:

       We commend the Senate and House Conferees on their historic 
     step to benefit every senior in America. Partisan politics 
     and rhetoric-without-results on prescription drugs are simply 
     unacceptable. Years of hard work by many in Congress and 
     years of heartache for America's seniors have led us to this 
     point. The whole senior world is watching and Congress must 
     not collapse so near the finish line.

  Are you trying to tell me that the United Seniors Association looks 
at this legislation and sees it is good for their members, and yet you 
cannot see that?
  We have The 60 Plus Association:

       The bill makes available much needed assistance to millions 
     of seniors who lack any

[[Page 30972]]

     prescription drug coverage. Significantly, those who can 
     least afford to pay will get the most help [from this 
     legislation].

  From the Rural Hospital Coalition:

       We support your efforts to modernize Medicare and give 
     senior citizens a prescription drug benefit that they 
     deserve. . . . [T]his bill strengthens health care in rural 
     America.

  From the National Rural Health Association:

       This bill is a big boost for the rural healthcare system. . 
     . . A stronger healthcare system will help revitalize rural 
     economies which will positively impact rural Americans 
     throughout the country.

  We have the National Hospice and Palliative Care Organization:

       NHPCO strongly supports these provisions and believes these 
     changes will improve the quality and timeliness of hospice 
     and palliative care for seniors and their families.

  From the Mayo Clinic, 150 miles from my home in Iowa:

       Mayo Clinic supports the compromise Medicare reform 
     legislation that has emerged from a congressional conference 
     committee.
  We have NAMI, The Nation's Voice on Mental Illness:

       This conference agreement does represent an improvement for 
     Medicare beneficiaries living with mental illness. . . . NAMI 
     feels strongly that it is time for Congress to end partisan 
     stalemate over this issue and take advantage of the $400 
     billion available this year to spend on a new drug benefit.

  This is kind of a partisan statement I am going to read to you, but 
it does represent a group of people who are impacted by what we do here 
with dual eligibles. It is from the Republican Governors Association:

       Medicare will provide first-time access to prescription 
     drug coverage to many of our seniors. The agreement also 
     assists states with the costs related to the dual eligible 
     population. Assistance to low income persons as well as 
     critical protection against high out-of-pocket drug costs are 
     essential components of this legislation. . . . [T]he 
     preventive benefits found in this measure will keep our 
     constituents healthier.

  From the Alliance For Aging Research:

       With this act the millions of Medicare beneficiaries will 
     no longer have to wait from 15 months to 5 years for access 
     to new state-of-the-art medicines and life-saving and life-
     enhancing technologies. In addition, and most importantly, it 
     targets those with the greatest need by providing significant 
     low-income subsidies for prescription drugs that will assist 
     millions of Medicare beneficiaries living longer and 
     healthier lives. . . . This will be a giant step toward 
     expanding and modernizing Medicare, while preserving the 
     power of science and technology to improve and enhance the 
     lives of our people in the future.

  Lastly, we have the American Benefits Council, a news release. The 
headline: ``Medicare, prescription drug reform bill represents 
historic, positive achievement.''

       We urge swift enactment of the legislation. . . .

  I have quoted these statements from these outstanding organizations 
for the Record because they speak louder than any Member of this Senate 
can about what is good about this legislation.
  I would hope that you folks on the other side of the aisle would take 
these statements into consideration, particularly tomorrow, when I am 
told 15 of you are going to speak, probably most of you against this 
legislation. I would appreciate you taking into consideration what 
these major groups have said.
  Madam President, I yield the floor and suggest the absence of a 
quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Ms. MURKOWSKI. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER (Mr. Grassley). Without objection, it is so 
ordered.
  Ms. MURKOWSKI. Mr. President, I realize the hour is late. This body 
has been discussing the issue of Medicare legislation for close to 12 
hours now on this Saturday.
  I want to speak briefly this evening about the legislation that is 
under consideration in the Senate and its impact on senior citizens in 
my home State of Alaska as well as around the Nation.
  We have heard a great deal today on the floor about the need for 
reform, about what we need to provide for our senior citizens.
  We must keep in perspective what we owe our seniors. This is the 
generation of Americans who paid most dearly to protect the freedoms we 
enjoy. Many of our older Americans today went through the Depression 
and have very personal, truly gut-wrenching memories of the hunger that 
they perhaps went through at the time. They were the generation who 
settled the frontier areas of America, including my State of Alaska. 
They remember the horror and the stories from Pearl Harbor. We owe this 
generation of Americans many things, not the least of which is honesty.
  Since Medicare was enacted in 1965, it has provided health security 
to millions of America's seniors and people with disabilities. Medicare 
is that promise of health security we must always keep.
  Many of my colleagues on the other side of the aisle would like 
Americans to believe that the bill in front of us today is designed to 
kill those promises made in 1965. I remind my colleagues that Americans 
deserve more than the rhetoric and the scare tactics we have heard 
saturating the airwaves from here. Earlier this evening in listening to 
the debate, one of my colleagues made reference to the fact that 
seniors are going to have to sell their wedding rings in order to meet 
certain levels for low-income subsidies for Medicare beneficiaries.
  I thought, wait a minute, that can't be true. That is not a part of 
this legislation. Seniors will not have to do that. So I said: Show me. 
Let me know for sure that, in fact, this is not the case.
  We pulled it out and looked at the application of the asset test. It 
very clearly states those resources that are not counted for an asset 
test, excluded resources, include, and No. 3 on the list is memorabilia 
such as a wedding ring. For us to stand here on the Senate floor and 
suggest to a senior citizen that in order to meet certain requirements 
to keep your Medicare benefits you might have to give up your wedding 
ring, I sure hope my 84-year-old next-door neighbor was not hearing 
that because I know she wouldn't sleep well knowing that that could be 
true.
  We have to be real. We have to be honest with our statements, and we 
have to talk the truth about what is and is not contained in the 
legislation before us.
  Americans deserve to know that this bill, while not perfect--I don't 
think any of us would suggest it is perfect--will provide good drug 
coverage for any senior citizen who wants to enroll. Americans deserve 
to know that this bill doesn't force seniors to join HMOs to get 
prescription drugs.
  This legislation is designed to provide choice, not coercion. If 
seniors want to add prescription drug coverage to the Medicare plan 
that they have right now, they would have that option. Their benefits 
would not be reduced, would not be taken away. If they don't want the 
drug coverage or if they are happy with the coverage they have now 
through their retirement plan, they don't have to accept the voluntary 
Medicare benefit.
  The incentives for employers to keep offering their own prescription 
drug benefits: The Employer Benefit Research Institute indicates that 
they expect between 97 percent and 99 percent of beneficiaries won't 
have any change in benefits. We need to clearly repeat these 
provisions.
  The bottom line is this: If you like Medicare the way it is today, 
you can keep it that way because it is designed to be a voluntary 
benefit.
  The problem is for many Americans, including those in Alaska, 
Medicare has not been living up to its promises. It will only pay for 
your drugs if you have been hospitalized. And for many, it does not pay 
for the health care professionals. Essentially, this program is still 
stuck in the 1960s mindset of reactive care rather than the kinds of 
proactive care we expect today.
  Several months back I had an individual up in the State who was 
meeting with me and going out to senior centers. We were talking about 
the Medicare legislation in front of us at that time. She made the 
analogy that Medicare is like the telephone. In 1965, the

[[Page 30973]]

telephones that we had in our homes were the black rotary dial. They 
came in one color and one style, and that was it. And that was how we 
talked.
  Now in the year 2003, we talk on cell phones, by fax, e-mail, on 
colored phones. The technology has changed incredibly, but we are still 
doing the talking.
  Medicare is essentially the rotary dial system of health care that 
just hasn't been ramped up.
  Americans need to know that Medicare still doesn't provide full 
coverage for preventive care, including cancer, diabetes screenings. It 
doesn't offer protection against catastrophic medical costs, these 
things that can rob our seniors of their hard-earned savings. There has 
been a lot of rhetoric about the drug benefit. But if you cut all 
through it, if you do the number crunching, you get to the indisputable 
fact that the average senior citizen, after paying their premium, is 
going to see a savings in the cost of their drugs--we estimate about a 
63-percent savings in the cost of drugs.
  For those seniors with limited income and limited savings, which is 
about half of Alaska's senior citizens, half of Alaska's senior 
citizens are in this lower income bracket, they will have closer to 90 
percent of their drug costs covered, and this is not a skimpy benefit.
  The bill also adds important preventive benefits that are many years 
overdue. In order to combat our Nation's No. 1 and No. 3 killers, which 
are heart disease and stroke, Medicare would be required to cover 
screening blood tests with no cost to the senior. This bill helps the 
millions of Americans who struggle daily with the chronic diseases such 
as asthma and diabetes. The bill adds principles of disease management 
to Medicare which will help the seniors navigate the oftentimes 
confusing health care system and get them the access to vital specialty 
care and educational resources.
  While we all seem to agree that it is important to add preventive 
benefits to Medicare, there has been a lot of discussion about whether 
to allow government-regulated private plans to offer these Medicare 
benefits. I have to step back a little and wonder if perhaps I am the 
only one who finds it ironic that we would use taxpayer-funded 
subsidies to give each one of us in Congress a choice of health plans, 
but yet we would deny our senior citizens that same choice.
  The bill before us rejects this philosophy of ``big Government knows 
best,'' and tells our seniors: You have the right to select a benefit 
that meets your needs. If you don't need drug coverage, you don't have 
to enroll. You can keep Medicare the way it is today. If you don't want 
to join a private plan, you don't have to. If you don't want to change 
anything about Medicare, you don't have to.
  I also want to address a comment that a number of Members--primarily 
on the other side of the aisle--have made characterizing Medicare as 
good the way it is now. I have even heard a number claiming that the 
Medicare Program today gives seniors such things as a choice of 
doctors. While I agree with them that Medicare is a good program, and I 
believe we need to make sure it still exists for our children's 
children, I need to let my colleagues know that the way the current 
Medicare Program does business, it hurts those in my State who have 
been promised care.
  Every week, Senator Stevens, Congressman Young, those in the Alaska 
delegation, and I come to work and we are faced with a huge stack of 
mail, e-mail, phone calls, and the like from Alaskans about the 
problems they are having with Medicare. I mentioned earlier that this 
summer, back in my State, I held a senior citizen forum in the 
community of Chugiak. What I learned may actually surprise some of my 
colleagues who seem particularly enamored with the way Medicare is 
today. Seniors in Alaska are not only being denied a choice of doctors, 
but in many cases they don't have the ability to see a doctor at all. 
This is because doctors, or health care providers, in Alaska are paid 
just about 37 cents on the dollar for the care they provide to seniors 
on Medicare. Medicare is a price-fixer. So what we have is somebody in 
Baltimore sitting in a cubical, and they are deciding how much to pay 
for medical care in the community of Delta Junction, in Alaska; or take 
the community of Bethel, not on the road system, completely cut off 
from the rest of the world. If the payment the folks in Baltimore have 
said we are going to be charging is less than the cost of actually 
providing the care, Medicare basically tells our doctors: Tough, you 
are out of luck. This price-fixing causes problems not only in the 
rural areas of the State--as I mentioned, in a place such as Bethel or 
Delta, where you would expect these problems--but the sad truth is that 
even seniors in the urban centers of Alaska, in Anchorage and 
Fairbanks, cannot find a doctor who will accept new Medicare patients.
  Perhaps I need to go a little further in explaining to my colleagues 
how much of a problem this is in my State. When a senior in the lower 
48 cannot find a doctor in their community to help them, they can hop 
into their car and drive to the next town and find a doctor--just go to 
the city. But when seniors cannot find a doctor in Fairbanks--and the 
whole State knows seniors in Anchorage are having the same problem--
there are two options for them. The first one is that there are few 
things you can do. Second, there are bad things you can do.
  The simple fact is that for many of my constituents, their choice for 
a doctor is limited to those who are practicing in the emergency room. 
Who is the doctor on call that night? That is their choice of doctors.
  The only other choice is--and this is probably a choice only for a 
few--to fork over the $1,400, or whatever the price of the airplane 
ticket is, to make the 8-hour roundtrip flight to Seattle and try their 
luck with doctors there.
  Just 2 weeks ago, I had a constituent in my office who told me she 
flies to Virginia every year to see her doctor. She lives in Alaska. 
She flies to Virginia to see her doctor. She does this because she 
cannot find one in Anchorage who will accept new Medicare patients. The 
cost for the ticket alone, not counting her lodging and meals while she 
is there, is about $1,500. Unfortunately, these situations in Alaska 
right now are not the exception; they are the rule.
  We have somewhere between 1,000 and 2,000 senior citizens in 
Anchorage alone who cannot find a doctor who is willing to treat them. 
The situation in Fairbanks is not much better. We recently called up 
the State to one of the larger clinics there that accepts Medicare 
patients. We asked them: Are you accepting new Medicare patients, and 
when would the first available appointment be? We were told mid-July. 
This is not choice when it comes to your doctor.
  How is this situation keeping the promise we made to our senior 
citizens in 1965 when we established Medicare? What kind of treatment 
are you advocating for when you keep Medicare the way it is? We can 
come up with grand plans here in Washington and we can talk about 
Medicare reform, but if we don't have doctors who can write the 
prescriptions, if we don't have access to physicians, we have not done 
anything to fix the problem with Medicare.
  Keeping Medicare as we know it in Alaska means Alaskans will go to 
the emergency room for primary care. It means making Alaskans pay to 
fly across the country by themselves to go find a doctor, and it means 
making Alaskans go without preventive screening.
  Medicare as we know it doesn't give patients a choice of providers or 
access to the care of their choice, as some of my colleagues have 
stated. Medicare isn't working perfectly and desperately needs reform. 
I believe the legislation we have in front of us is a good compromise. 
It includes provisions that will ensure that senior citizens around the 
Nation and in Alaska will be able to find a doctor somewhere other than 
in the emergency room.
  We owe our seniors a little more honesty in this debate. They deserve 
to know clearly that the prescription drug is voluntary. They deserve 
to know they will not be forced to join a program they don't want to 
join. They deserve to know the average senior citizen who joins will 
save somewhere

[[Page 30974]]

around 63 percent on the cost of their prescription drugs. They deserve 
to know low-income seniors will pay no deductible, no monthly premium, 
and have no gap in coverage; and Medicare will pay about 90 percent of 
their drug costs. They deserve to know the group purchasing power we 
are giving to seniors is going to make the drug companies work for 
their business.
  Mr. President, those who stood defending our freedom deserve more 
than the partisan rancor that has been sailing around this Chamber. 
They deserve to know more than some of the half-truths that have been 
told. Medicare, as we know it, should provide seniors with access to 
vital health care services and the physician of their choice. I believe 
this bill does those things, and I believe it will meet the needs of my 
constituents.
  We have come a long way toward making good on our promise to our 
senior citizens, and that is to the credit of the administration and to 
the leadership of this Congress, certainly to the leadership of the 
Senator who is presiding this evening. We do need to strengthen 
Medicare, and seniors do need access to vital prescription drugs.
  Many who are now on Medicare fought for the freedom that we enjoy 
today, and Monday we will, hopefully, have the opportunity to keep our 
promise to seniors and to fight on their behalf by providing them with 
a voluntary prescription drug benefit.
  I urge my colleagues to support this legislation.

                          ____________________