[Congressional Record (Bound Edition), Volume 151 (2005), Part 17]
[House]
[Pages 23042-23047]
[From the U.S. Government Publishing Office, www.gpo.gov]




                              {time}  2000
                            MEDICARE PART D

  The SPEAKER pro tempore (Mr. Jindal). Under the Speaker's announced 
policy of January 4, 2005, the gentleman from Georgia (Mr. Gingrey) is 
recognized for 60 minutes as the designee of the majority leader.
  Mr. GINGREY. Mr. Speaker, we just heard from the other side, the 30-
Something Democrats. I have been listening, as I know my colleagues 
have, to the 30-Something Democrats for about a year and a half now a 
couple or three times a week. It is the same old same old. Now they 
have pledged to come back tomorrow night with some positive information 
voice, and I look forward to that. In fact, I am going to listen very 
closely, because all I have heard from my three colleagues on the other 
side, the 30-Something Democrats, the two from Florida, the one from 
Ohio, very intelligent, very well spoken, very articulate, and very, 
very negative.
  So before we get into our special hour talking about something 
positive, a Medicare prescription drug benefit for our needy seniors, I 
just want to suggest to my colleagues who spent the last hour talking 
negative we look forward to hearing from them tomorrow night maybe on 
something positive for a welcomed, welcomed change.
  Mr. Speaker, it kind of reminds me of the fall of 2003, my first year 
in the 108th Congress, when we worked so very hard on trying to bring 
to our seniors finally, after almost 38 years, a prescription drug 
benefit under Medicare. What we heard from our colleagues on the other 
side of the aisle was very similar to what we just listened to in this 
Chamber over the last hour from the 30-Something Democrats. It was all 
negative. There was no plan, there was no alternative. It was just: 
Seniors in my Democratic district, you men and women who have supported 
me and let me represent you in the Congress, this is what I suggest 
that you do, you take out your AARP card and you cut it to shreds 
because that is what I, your Congressman or your Congresswoman on the 
Democratic side of the aisle, plan to do.
  Yet, Mr. Speaker, what we did was an historic benefit. In fact, for 2 
years now, and it will continue until January 1 of 2006 when the 
official Medicare Part D prescription benefit plan is available, we had 
an almost a 2-year transition plan of a Medicare prescription drug 
discount card which would allow our neediest seniors actually to have 
$600, a debit card if you will, not a credit card, but $600 each of 
those 2 years if they were at or near Federal poverty level low income, 
below about $11,000 a year for an individual or below $14,000, $15,000 
a year for a couple, basically men and women, our seniors who are on 
Medicare and essentially living off of their Social Security benefit 
and very, very little else.
  I think it was a tremendously compassionate thing for this Congress, 
this leadership, this Republican majority and this President, George W. 
Bush, to finally deliver on a promise that had been made by prior 
Congresses, prior Presidents. I will not get into naming names or 
saying who was in charge at what period of time.
  The fact is Medicare was first passed in 1965. Medicare was a very 
good program then, it is a very good program now, but it desperately 
needed modernization when we have come to realize, especially over 
these last few years, how important it is to have an opportunity to 
have that prescription drug benefit to go along with Part A and Part B.
  Part A of course, Mr. Speaker, you understand is a hospital part and 
the nursing home part. There is a pretty high deductible for that as 
well, today something like $850 out of pocket before there is any 
coverage for Part A. And Part B, if God forbid a person end up in a 
nursing home after 100 days, there are no benefits in any period or 
episode of illness. Everything else is out of pocket, and that is why 
so many of our seniors who do end up in a nursing home pretty quickly 
become dependent, wards of the State almost, and Medicaid, which is 
strapping our States so badly now across this country, pays about 85, 
90 percent of all skilled nursing home bills, is paid by Medicaid 
because people literally are going broke and they cannot afford it.
  So here again, as I waited of course to have this opportunity to 
speak on the Republican side, the aisle where we have dedicated, Mr. 
Speaker, to explain and talk about something positive. We are a 
positive party. We want to do things that are for the benefit of the 
people and not just stand around and criticize like we heard over this 
last hour.
  I do not hear a plan from the other side, yet they voted almost 
overwhelmingly, thank goodness there were a few in a bipartisan fashion 
did vote in favor of the Medicare prescription drug modernization plan 
Part D, and it should not have been a partisan issue. It should have 
been not about the next election, but doing something that is going to 
help the most treasured part of our society, really, that being our 
senior citizens, and particularly those who are in greatest need. So, 
Mr. Speaker, it is a pleasure to be asked by the leadership tonight to 
lead this hour as a physician Member of the body.
  There are actually 10 M.D. physicians in this congressional body of 
435 Members. There are other Members who are health care professionals, 
be they psychologists or pharmacists or registered nurses and physical 
therapists, veterinarians, people that have worked in health care, and 
I think we all owe it to our colleagues and to the American people to 
get behind and to support this legislation which will in fact go into 
effect January 1, 2006.
  Mr. Speaker, it is important for each one of us on both sides of the 
aisle not to discourage our constituents, our seniors from signing up 
for this prescription drug benefit, but to explain it to them and let 
them know and to particularly let those know who are at a low income 
level.
  We mentioned just a few seconds ago about that amount, about $11,800 
for an individual, a single person, a widow or a widower, or about 
$15,000, $16,000 for a couple, that they are eligible for supplemental 
help. We anticipate, Mr. Speaker, that the deductible for the Medicare 
Part D prescription drug benefit would be about $250 a year and that 
the monthly premium would be about $35 a year, $32 to $35 a year. That 
is what we predicted a year and a half ago. Now that these plans are 
rolling out and are being offered to our seniors, the marketplace is 
working. Competition, that competitive entrepreneurial spirit is 
working without government price controls, and many of these plans are 
going to be offered or

[[Page 23043]]

are being offered right now to our seniors at as low as $20 a month 
premium, not $32, not $35, but $20 a month. So already the predicted 
cost is coming down, and as a result of that I think the number of 
seniors who sign up and take advantage, sure, there will be, Mr. 
Speaker, some seniors who will realize that they already have coverage. 
Maybe they are a retired State employee, possibly a teacher, maybe they 
are a retired Federal employee, possibly they work for a company like 
in the State of Georgia, Lockheed Martin or Coca-Cola or Home Depot, 
some of these strong companies that seniors have worked for 30 or 40 
years, and that was not atypical with the great generation, they stuck 
with the job and with the company and they have been promised health 
care benefits and benefits that do include prescription drug coverage.
  In this bill, by the way, we have done everything we could to make 
sure that companies do not drop those plans, that those promises made 
are promises kept. That is in addition part of this Medicare 
modernization. So some people, Mr. Speaker, some seniors will decline 
to sign up for Medicare Part D because they already have a plan and 
they have a good plan and they stick with it, and that is perfectly 
understandable. But for those seniors who do not have anything, who get 
to go to their doctor, maybe their family practitioner, their general 
internist for that annual physical, and lo and behold they find out 
that their cholesterol is elevated, their blood sugar is elevated, 
their blood pressure is elevated and they have that need to be on 
medication and they go to the drug store with a fistful, literally a 
fistful of prescriptions, maybe four or five. You talk about sticker 
shock. Currently our seniors in that situation, they are maybe not part 
of an HMO and they do not get any discount because of volume, it is 
just them trying to fill a prescription.
  I know that recently I went to the drugstore and happen to be on a 
statin to lower my cholesterol and ordered a 3-month supply, and only 
to find out that my part of the prescription, I think 25 percent of the 
true cost, was going to be $110. When I asked the pharmacist what it 
really cost, the cost per pill, and I will not mention the pill in 
fairness to the company, but it was something like $5.25 for each pill, 
and it is necessary that I take that every day, and my health is pretty 
good. But you take a lot of our seniors, Mr. Speaker, they do not have 
one thing wrong, a lot of times it just almost like you might say is 
multi-system diseases. They may have three things that impact each 
other. What has happened in the past of course is this: They maybe were 
too embarrassed to say they could not afford the prescription, and 
maybe they turned around and walked out and said they would be back but 
never came back. Or possibly they asked the pharmacist, instead of a 
month's supply, just give me a 2-week supply, and then they would go 
home and they start breaking those pills and trying to stretch it just 
like we oftentimes have to stretch the budget when things are tight.
  But the problem is, of course, that is when these diseases get out of 
control. That is when the elevated cholesterol results in plaque 
formation in the coronary arteries, or the blood sugar gets elevated 
and all of a sudden there is a problem with blindness and loss of limb 
or a patient ending up on renal dialysis.
  I hope my colleagues would listen carefully to this. We heard at the 
outset a lot of Members, and very legitimately and honestly and 
sincerely, oppose this bill and the vote was a very close vote, and 
indeed it was. I am very proud that I voted yes, and I think most if 
not all of the physician Members as a body also voted yes on both sides 
of the aisle. But there were men and women of good faith who voted no. 
In some instances they were voting no because they did not think that 
we were doing enough. You even hear that today, the hole in the 
doughnut is too big and the plan is not good enough. It might be okay 
for some people, but for the typical average senior who is a Medicare 
beneficiary or someone who is on Medicare because of a disability, it 
is just not good enough. We want to do more, we want to close down, 
shrink down that hole in the doughnut, so they voted no. And I can 
understand that line of reasoning.
  There were Members mostly on this side of the aisle who felt that we 
cannot do this because we cannot afford to do it. We have got a 
deficit, we have got a debt that is far too big by everybody's 
admission. Although we would like to do this, we cannot do it because 
we cannot afford really to do anything. We are in a war in the Middle 
East trying to bring democracy. I think we are succeeding there. I 
think the light at the end of the tunnel is beginning to shine brighter 
and brighter with the success and the 60 percent plus turnout here 
recently in the new constitution and then hopefully parliamentary 
elections a month from now.

                              {time}  2015

  The point I wanted to make, Mr. Speaker, in regard to the cost, the 
cost was calculated based on the fact that you would continue to spend 
in the Medicare program in this country the same amount, maybe 
increasing depending on, as the population of seniors increased for 
part A, you would have the same situation for part B; it would increase 
because of an increase in population of seniors.
  And then you would have this added expense. We were told initially 
that that was about $400 billion over 10 years, and then there was a 
recalculation and maybe it was going to be as much as $600 billion. The 
fact, Mr. Speaker and my colleagues, is this. We get no credit for the 
fact that taking prescription medications, when our seniors can go to 
the drug store and get those prescriptions filled, and they can in a 
very timely fashion lower that blood pressure, lower that blood sugar, 
lower that cholesterol, and guess what, we do not end up spending money 
on them for part A or part B, do we except maybe for an annual check-up 
on an outpatient basis by one of our wonderful primary care physicians 
who work so hard and such long hours? No. We keep them out of the 
hospital.
  Before the Medicare modernization, before December of 2003, you could 
not even go to your doctor and get a routine thorough physical and have 
it paid for under Medicare. You could not get a blood test for 
cholesterol, you could not get a mammogram, you could not get a PSA 
blood test screening for prostate cancer, you could not get a 
colonoscopy.
  In this bill, in addition to the prescription drug benefit, all of 
those things are now available and paid for. This is what we call, Mr. 
Speaker, preventative medicine. Not waiting until somebody is eligible 
for coverage under part B because they show up in the emergency room 
having had a stroke because their blood pressure could not be treated, 
or they ended up on the operating table getting the coronary bypass or 
even worse, having a leg amputated because they never had the money to 
treat their diabetes.
  We save money, Mr. Speaker, on part B because of part B. And even if 
we did not, it is the compassionate thing to do. It is the 
compassionate thing to do. Who wants to end up spending the rest of 
their life in a nursing home after a stroke no matter who is paying for 
it?
  But as I said earlier, those days are limited to 100, and then after 
that, mom or dad or grandmom or granddad exhausts every bit of their 
savings, everything that they have worked their whole lives for, maybe 
they wanted to send a grandchild to college, an opportunity that they 
never had when times were tougher, and all of a sudden they lose it all 
simply because we did not, Congress did not, give them this coverage, 
this Medicare prescription drug benefit.
  So I say, Mr. Speaker, to my colleagues, to anybody who will listen, 
that this was the right thing to do. This is not something that we can 
afford to put off. You cannot. I have heard people say, well, gee, you 
know, the seniors have waited 3 years, surely because now we are in a 
bind, and we are trying to figure out a way to pay for the restoration 
of the gulf coast and rebuild that infrastructure, certainly we need to 
do that and we need

[[Page 23044]]

to look for so-called offsets. And they are there.
  We talk about maybe taking a little haircut and cutting 1 to 2 
percent of the growth in every Department. I think we can find those 
cuts, and I think we can do that. But to ask the seniors to wait 
another year or two or three, that would be the cruelest of ironies on 
our part.
  And I, Mr. Speaker, am not willing to do that. And I would beg my 
colleagues, let us not go down that road. We are about to do something 
that is really good for our seniors. It may be not unlike what we have 
done in the Middle East. We hear, whether it is from the 30-Something 
Democrats or in the editorial pages from our liberal newspapers in this 
country, the constant, constant negative criticism and naysayers, and 
this talk about what is your exit strategy.
  I have been hearing that, Mr. Speaker, for 2 years. What is your exit 
strategy? I mean, you know, you are in the early part of the fourth 
quarter of a football game, and you are winning, but the going is 
getting a little tough. If you pull your team off the field, you do not 
win; you forfeit.
  And all of those lives, 2,000 dead, and four times that many injured, 
are for naught. What a disgraceful thing that would be if we did not 
follow through. So the analogy then is the light is at the end of the 
tunnel, it is shining brightly, I think, as I stand here tonight, Mr. 
Speaker, in the Middle East.
  And I think that is absolutely true in regard to health care for our 
seniors as we go forward. And to all of a sudden snuff out that light 
because we have this natural disaster, this catastrophe which nobody 
could prevent or predict, and we have to respond to it, but as Thomas 
Payne once said, when he was serving at Valley Forge with George 
Washington, these are the times that try men's souls.
  But we, thank God, Mr. Speaker, can walk and chew gum at the same 
time. This Republican leadership can deal with both of these issues, 
and it would be a terrible mistake to turn our backs on our seniors at 
this critical time where we are seeing light at the end of the tunnel 
and providing for them a benefit that they well, well deserve and have 
needed for so long.
  The thing about this bill that excites me, Mr. Speaker, I guess one 
of the things that I am the most excited about, is the fact that the 
benefit is the greatest for those with the greatest need. Yes, there is 
a hole in the donut, and it is true that for some people the benefit 
would not be great if they were not spending anything on prescription 
drugs.
  And there are those in our society who are very fortunate. Sometimes 
in medical parlance we refer to this as having the Methuselah gene: 
they enjoy long life and good health, and other members of their family 
the same. And, you know, maybe they will go see the doctor every year 
or two; but everything is always fine, and so they are not spending any 
money on prescription drugs.
  So they may look at it and say, gee, $250 deductible if I have to 
spend anything, that is out of my pocket. And if I am spending $30 a 
month, you know, that is another almost $400, and I am not currently 
spending that. So, you know, I look at that and I have spent $700 the 
first year of the prescription drug benefit that I have got, and last 
year I did not spend anything on prescription drugs, so I have lost 
$700. Well, that is true. That is true.
  But what that individual needs to realize, and I hope that my 
colleagues in the Congress on both sides of the aisle will make sure 
that they in a very fair way explain this to their constituents, you 
beware that next year or next month or next week or even tomorrow, do 
not all of a sudden have a little chest pain and end up being that 
person that needs to be on four or five prescription drugs, and then 
your bill could be 3 or $4,000 or $6,000 or $8,000 dollars a year.
  And it does not take long for that to put one in the poor house, if 
they can afford it at all. So for everybody, for every senior there is 
something that we call catastrophic coverage. So if they spend, an 
individual on Medicare, spends in any year up to $3,600 on prescription 
drugs out of their own pocket, that of course would include the 
deductible and the copay and then, yes, the gap or the hole in the 
doughnut; but beyond that, if there are still costs for prescription 
drugs, the Medicare part D insurance program pays 95 percent of 
everything above that.
  That is a wonderful benefit, what we call catastrophic coverage. I 
hope most people will not get into that situation. But clearly they 
could. They could get into that situation. So what I am saying, Mr. 
Speaker, is this is a good benefit for everybody; and everybody is 
eligible, from the lowest income to the highest income. If they do not 
have coverage in some other way for prescription drugs, then they are 
eligible for this benefit.
  Of course, those who are living off of Social Security and they have 
very little assets, not much stuff, we all, I think, Mr. Speaker, have 
too much of a desire for stuff, stuff that really in some instances is 
not very important. Certainly more stuff does not necessarily make you 
happier.
  But a person can own their home, they can own it free and clear. They 
can own up to 50 acres of land that may have been in the family for 
some time and they do not want to sell. They can certainly own an 
automobile. But they cannot have much stuff beyond that. Much assets.
  But if they meet that means test, then the deductible is covered. The 
monthly premium is covered. There is no copay up to the first $2,250 or 
25 percent as it is to everybody else, and there are no holes in the 
donut, there is no gap in the coverage. Everything is catastrophic 
coverage almost from day one, maybe a dollar copay for a generic 
prescription, and up to a maximum of $5 for the most expensive.
  Remember I talked, Mr. Speaker, earlier about that statin that I was 
taking that cost $5 a pill. For our needy seniors, a 3-month supply, 
100 pills, you do the math, that is over $500. They might have a $5 
copay for a prescription like that.
  Mr. Speaker, I see that one of my physician colleagues has joined us, 
and I thank him for taking time out of his busy schedule to be with us 
during this leadership hour to talk about this Medicare part D 
prescription drug benefit that we talked about.
  He was very much a part of that, Mr. Speaker, and he was in the 
108th, my classmate, my friend. I yield to the gentleman from Texas 
(Mr. Burgess).
  Mr. BURGESS. Mr. Speaker, I thank the gentleman for yielding to me. I 
could not help but see as the leadership hour progressed you were doing 
an excellent job of covering all of the things that I think are so 
important to tell our constituents and our seniors about this plan.
  Of course, it is an optional plan. There is no requirement that 
anyone take this plan. But still I think it is worthwhile for families 
to sit down, perhaps the day after Thanksgiving, while everyone is at 
home and thinking about things, to sit down and look at these plans and 
decide if it might not be a good idea for the Medicare beneficiary in 
your family.
  I would stress that the first date that the benefits will be 
available will not be until January 1, but the first day that a senior 
can sign up for a plan is November 15. So that Friday after 
Thanksgiving or the Saturday after Thanksgiving after you have had 
enough leftover turkey and pumpkin pie and football, maybe it would be 
a good idea to sit down and decide if this is not worth a little closer 
scrutiny.
  I took the liberty of going to the Medicare.gov Web site. If anybody 
has not been there recently, I would encourage them to do so. If you 
are unable to use a computer, ask your son or daughter or your 
grandchild to do it for you. I promise you they know how.
  But looking on the Medicare.gov Web site for my State, Texas, there 
are some interesting figures available there. And perhaps one of the 
most interesting there, it is too small to show on the television, but 
there are a variety of plans that are available in the State of Texas.
  Just going down the list here, we see one that has a monthly premium 
of $28, which is lower than the premium that was originally designated 
as $37, the

[[Page 23045]]

premium that we originally designated on Medicare, and there is no 
deductible incurred with that expense. So that is a straight monthly 
expense.

                              {time}  2030

  Mr. Speaker, I would argue that that is a heck of a deal. And again, 
there are several plans like this, and they are all available for you 
to see in your State at the Medicare.gov Web site. Furthermore, for 
people who want to look into using one of the Medicare HMOs or PPOs, 
one of the Medicare advantage plans that will be available, there are 
several in my State of Texas; there are several in the counties that I 
represent. There is a PPO plan with basically a zero drug premium, and 
there is an HMO plan with a zero drug premium and zero drug deductible, 
so these are significant savings for people who are on Medicare who do 
spend money on drugs.
  I would stress, and I have had constituents call me, and they looked 
at the plan and they say particularly when looking at the concept of a 
$37-a-month premium with a $250 deductible, they will say this is of no 
benefit to me. That may be true, in which case do not do it, but look 
at some of the plans that are available in your State, in your county 
and see if there is not one there.
  Have a family discussion. Involve your children or your grandchildren 
in the discussion, because doggone it, we take good health for granted. 
It is something, though, that can change year by year and that is, 
after all, why we buy insurance, not to save us money on our current 
expenditures, but to protect us from those very hefty expenditures that 
may be incurred in the future.
  I must tell the gentleman from Georgia (Mr. Gingrey) he has done a 
very thorough job about discussing Medicare. I agree with him 
completely about the need for cutting the deficit this year. I think 
that is critical that we do so, but this plan is not the place to make 
that cut. And for anyone who has heard a story or a rumor that the 
Medicare prescription drug part D roll out may be delayed because of 
problems with the deficit, that is simply not true. This program will 
roll out on time. And as we always like to say, it is on time and under 
budget.
  With that, I yield back to my good friend from Georgia.
  Mr. GINGREY. Mr. Speaker, I thank the gentleman from Texas (Mr. 
Burgess), and I thank him so much for being with us tonight. I would 
welcome, if time would permit, for him to stick around with us and 
possibly get into a little bit of a colloquy regarding some other 
salient points of this bill. Certainly, I appreciate him being here and 
giving us this time this evening.
  I was earlier, Mr. Speaker, talking about that statin that I bought a 
3-month supply of just last week and that the cost was going to be, the 
true cost, I paid 25 percent according to my plan, the prescription 
drug plan that I have, but the true cost was over $500. Well, a senior 
who maybe has no prescription drug coverage under any plan, they are 
not part of an HMO, they are not retired from a company or they are but 
the company is not providing prescription drug coverage as part of the 
health care benefit, if you multiplied 3 months times four which would 
give you 12, if my Georgia Tech math serves me well, then that cost 
would be $2,000 for that one prescription.
  Well, that is getting pretty darn close, Mr. Speaker, to the $2,250 
that we were talking about, that the gentleman from Texas (Mr. Burgess) 
was talking about. And the savings on that you would not have to have 
too many more prescriptions, maybe an antihistamine or two or an 
antibiotic here or there during the course of a year to get up to at 
least $250, if you have got one very expensive drug like that statin I 
mentioned. The senior who was enrolled in that scenario, they would 
actually save about $1,100 a year. That is how much the coverage would 
give them.
  Of course, if they had prescriptions above that and they got into the 
gap or the hole in the doughnut, certainly there would be more out-of-
pocket expenses. But I think it is very important for people to 
understand when they hear these naysayers, some of whom we heard from 
earlier tonight during their leadership hour, that this is a waste of 
time and effort, and it is not any good. And now that you have torn up 
your AARP card, and by the way, the reason they made that 
recommendation when we came out with the transitional prescription drug 
discount card when we first passed this bill, knowing it would take 
almost 2 years to get the prescription drug part B insurance program 
part up and running, AARP had the audacity to support a Republican 
proposal, Mr. Speaker.
  I think the other side must have felt that that organization was 
always their best friend or, as the saying goes, in their hip pocket. 
And they could not stand the fact that AARP, and I am a member, have 
been since age 50. I will not tell you how many years I have been a 
member. It is a wonderful organization of 37 million seniors in this 
country. AARP serves them very well. And AARP as far as partisan 
politics, we are blind to whether it was an R or a D proposal. When 
they saw a good thing they supported it, and that is what they should 
have done, and that is what our colleagues on the other side of the 
aisle should do.
  When you see a good thing, do not constantly say no, no, no, just 
because you are afraid that the majority party or this President is 
going to get credit for a job well done and a promise made and a 
promise delivered. Get on board. Join the team for the benefit of our 
seniors and to support a good program when you see one.
  It is a time now for all of us to work with our seniors to make sure 
that they understand the program, that they know how to contact 
Medicare, www.Medicare.gov or dial 1-800-Medicare. There are 
organizations in every State, the CMS, Committee on Medicare-Medicaid 
Services, has contracted with Medicare to explain this benefit.
  I know in my own office, Mr. Speaker, we are going to put computer 
terminals in the main office and have someone there that can be online 
with seniors who just drop in and say, I have gotten the brochures; I 
have seen the public service spots on television, but I am still a 
little bit confused and would you help us out. I know that I am going 
to do that. I know that the gentleman from Texas (Mr. Burgess) is going 
to do that.
  I know that my physician colleagues and my health care provider 
colleagues in this body and hopefully all 435 of us will take that 
opportunity, because there is a wonderful program and as the gentleman 
said, and I am so glad that he reassured our colleagues and anybody who 
might be listening to us this evening during this leadership hour, that 
we are not going to delay this program. We cannot afford to do that to 
our seniors. They have waited too long. And as I said earlier, this is 
a compassionate program, and it would be cruel to pull that rug out 
from under them when they have waited so long for this opportunity.
  With that, my colleague from Texas (Mr. Burgess), if he would like to 
make a few more comments and possibly we can have a little bit of 
dialogue back and forth with the remaining time that we have this 
evening. And I will turn it back over to the gentleman from Texas at 
this point.
  Mr. BURGESS. Again, I think you have done an excellent job of laying 
out the case for the prescription drug benefit. We have a saying back 
in Texas when something is a really good deal, we say it does not cost, 
it pays. I kind of feel that way about the part B Medicare benefit.
  There are three ways that the Medicare part B benefit could, in fact, 
result in a costs savings for the Medicare program. One was by 
introducing competition. The second was by the more timely treatment of 
disease with appropriate medications. And the third way was by 
intervening far earlier in the disease process before it gets to the 
more costly end-state of the disease.
  Well, guess what, we will not know about the latter two for some 
time, but we do know about the competition aspect. And competition 
works. Competition has driven down the cost of premiums. Competition 
has driven down the cost of the deductible for many of

[[Page 23046]]

the plans that are going to be available in my State, in my 
congressional district, and many other areas across the country.
  How soon will we know about whether or not the timely treatment of 
disease results in a lowered cost for treating the disease? I cannot 
tell you that. But the fact that the emphasis is going to be not only 
on the timely treatment of disease but on prevention, identifying those 
individuals who are at risk, using the disease management tools that 
are available in the Medicare program, how powerful is it that someone 
would have the knowledge that a patient's weight had gone up day over 
day so that they need to go to their doctor's office and get their 
congestive heart failure treated, get their medications adjusted on 
Friday morning rather than coming into the emergency room late on 
Sunday night and incurring 4 or 5 days in the intensive care unit at 
who knows the figure, 6, 7, 8, $9,000 a day.
  That is the kind of cost difference we are talking about from the 
timely treatment of disease. As far as intervening early in the 
processes so perhaps that person never gets to the stage of heart 
disease where they develop congestive heart failure, incalculable the 
amount of dollars that could be saved. Just by increasing exercise, 
modifying the diet to reduce that risk of type 2 diabetes. Disease 
management will be a powerful tool for holding down costs in the 
future.
  Again, the gentleman from Georgia (Mr. Gingrey) has done a great job 
in outlining the benefits of this plan, and I certainly thank him for 
taking time out of his schedule to come and explain this to his 
constituents and the American people at large.
  I am happy to enter into a colloquy if there is any time left; but I 
honestly think, Mr. Speaker, that the gentleman from Georgia (Mr. 
Gingrey) has done a wonderful job, and I will yield to him for whatever 
his pleasure is at this point.
  Mr. GINGREY. Mr. Speaker, I thank the gentleman so much. I appreciate 
his being with us in talking about this issue.
  The gentleman and I are not only colleagues of course here in the 
Congress, but we are, as I said earlier, fellow physicians; but I think 
most of our Members realize we are both OB-GYN specialists so we share 
so much in common. And I would guess that the situation in Texas is 
very, very similar to the situation in Georgia. Maybe there are some 
figures that you would want to mention in regard to Texas; but, Mr. 
Speaker, in Georgia we have got a State maybe a little smaller than the 
State of Texas population-wise and certainly geography-wise, but we are 
a State of almost 9 million people now.
  There are approximately 85,500 Medicare beneficiaries; 16,700 of 
those live below 135 percent of the Federal poverty level. These are 
the folks that are going to benefit the most, and that is why I felt so 
strongly and passionately about this compassionate program. It is those 
16,710 who are at or below 135 percent of the Federal poverty level, 
Mr. Speaker. There are another 7,000 in Georgia, that brings it up to 
about 25,000 people in Georgia who are at or below 150 percent of the 
Federal poverty level. All of these individuals, all of these 
individuals will be eligible to receive supplemental benefit.
  Earlier in the discussion in the hour we talked about the numbers, 
and I need to correct it a little bit. I think I may have given numbers 
that were a little bit on the low side. But you may qualify, listen to 
this, seniors may qualify if you are single and have income below 
$14,355 and resources are less than $11,500. That does not include your 
possibly paid-for home and homestead and your automobile. And married 
couples who have income below $19,200 and resources less than $23,000. 
Again, excluding their homestead their home and their automobiles.
  These individuals and those at or about the Federal poverty level, 
again, no deductible, no co-pay, no monthly premium; and you get that 
prescription filled for $1 on generic or maybe as much as $3 or 
possibly $5 for one of those very expensive drugs that I talked about 
earlier.

                              {time}  2045

  And, Mr. Speaker, here again my colleague may want to talk about the 
situation in Texas, because I suspect it is very similar.
  Mr. BURGESS. Well, Mr. Speaker, the gentleman has caught me without 
having done my homework as well as he has, so I do not have those 
figures at hand. But when my colleague was going through that it 
reminded me of the times we were on this floor over the last 18 months 
talking about the Medicare prescription drug discount card. And of 
course in the hour before us there were some individuals who were 
fairly negative about anything that might be offered from the 
Republican side of the aisle and they spoke very harshly against that 
prescription drug discount card for the past 18 months. And that was so 
pernicious, so pernicious to people who may have benefited from that 
prescription drug discount card; the $600 a year subsidy and the 
discount rates that were available on that card.
  What a shame. What a shame that their constituents did not get to 
participate in that because their representatives came back and told 
them, no, this is a bad plan. It is a Republican plan and it is not 
good for you.
  Well, this is a compassionate plan. This is a bipartisan plan, 
because there were Democrats who supported the bill, I am grateful to 
say, the night that we took that vote in November of 2003.
  So I urge people, regardless of their party affiliation, to look at 
the benefits that are available to you in your State, in your area. 
Look at it with your loved ones. Look at it with your children or 
grandchildren because there may be some significant savings, some 
significant benefit to you.
  There is also a benefit to the program at large. If you treat your 
disease more effectively, if you prevent disease effectively overall, 
that disease process is going to cost less, and that is good for the 
country as a whole.
  I have to tell the gentleman from Georgia that I just cannot let this 
hour go by without asking one additional time for some type of sane 
liability reform in this country. We have had good liability reform in 
Texas, so why does it matter to me with the rest of the country? Why do 
I even care, since Texas is taken care of? The reason I care is because 
the cost of defensive medicine in this country in the Medicare program 
alone probably approaches $30 billion a year. That is almost the cost 
of this prescription drug program.
  If we could reform our liability system, this program costs us 
nothing. It is the right thing to do and we should do that this year. 
And I yield back to the gentleman.
  Mr. GINGREY. I thank the gentleman from Texas for his leadership not 
only on the Medicare Modernization and Prescription Drug Act, but also 
on medical liability. He has been a stalwart supporter of the Health 
Act that we have passed in this body so many times over the last few 
years.
  Mr. Speaker, in the remaining time that we have I wanted to make a 
couple of additional comments. We got some good news here recently in 
regard to the COLA, the Social Security COLA, which is about a 4.6 
percent increase next year because of the Consumer Price Index. That is 
good news for our seniors. That is about a $40 per month, typically, 
increase in that Social Security paycheck.
  Now, it is true that the premium for Medicare part B, even though 
that premium only covers 25 percent of the true cost, will also have an 
increase next year of about $10. That $10 from $40 leaves $30 still 
remaining in that COLA. And even for the seniors who get no 
supplemental help, that $30 will pretty much cover the premiums for 
Medicare part B. In fact, it may more than cover them, because, as I 
said earlier, because of the marketplace, because of competitiveness, 
pharmacy benefit managers and companies that are going to offer the 
Medicare prescription drug discount program, we are hearing premiums as 
low as $20 a month.
  And another thing, Mr. Speaker, that we need to say before we 
conclude the hour, because we have heard so much negative rhetoric 
about this tremendous gap in coverage, the hole in the

[[Page 23047]]

donut and the program not being nearly good enough, is that we will 
have an opportunity to reduce those costs by some companies now with a 
slightly increased premium, maybe as much as $40, possibly $50 a month, 
so that there will be no gap in coverage. It will close that hole in 
the donut completely. So people will have the option of paying a little 
bit more and having coverage without any gap.
  Mr. Speaker, in conclusion, I want to again remind our seniors and 
ask our colleagues to remind their constituents that beginning November 
15 through May 15, 2006, a 6-month window of opportunity will be the 
time to sign up for the Medicare part D prescription drug benefit. Look 
at the program and compare. If you have something else, make a 
comparison, and then make a decision. And make that decision early. 
Because if you do, then that coverage starts January 1. If you wait 
until after the program starts there may be a month gap before that 
coverage kicks in. And if you wait beyond May 15, then there will be a 
surcharge. So it is very important to do it in a timely fashion.
  I thank my colleagues for their attention, and I thank the leadership 
for giving me this opportunity to discuss something as vitally 
important as this Medicare prescription drug benefit for our needy 
seniors.

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