[Congressional Record (Bound Edition), Volume 151 (2005), Part 17]
[Senate]
[Pages 23679-23681]
[From the U.S. Government Publishing Office, www.gpo.gov]




                   MEDICARE PRESCRIPTION DRUG PROGRAM

  Mrs. MURRAY. Mr. President, I am here this morning to talk about a 
dangerous flaw in the Medicare prescription drug program that is about 
to take effect. This flaw is a ticking time bomb for more than 6 
million Americans, for our communities and our health care providers. 
That fuse is going to detonate on January 1.
  We cannot allow low-income seniors and the disabled to lose their 
direct coverage. We cannot leave our doctors and hospitals and nursing 
homes unprepared for the biggest change in decades. And we should not 
be pushing hundreds of thousands of people who need care onto our local 
communities. We can't wait. We have to fix this problem today. That is 
why I will be offering an amendment later this morning.
  I have been working with Senators Rockefeller and Bingaman to address 
the immediate crisis. I thank them for their leadership. I have also 
introduced my own bill to protect our most vulnerable. It is the 
Medicare HEALS Act, S. 1822.
  I have been traveling around my State. I have been meeting with 
people in Seattle, Lakewood, Yakima, Aberdeen, and Olympia. I want my 
colleagues to know, everywhere I go, people are angry and confused. And 
they are very worried, with good reason.
  One senior told me:

       Everyone I have talked to is totally confused--my doctor, 
     my pharmacist, even the Medicare number you are supposed to 
     call.

  Another one said:

       If we can't understand this, this whole [Medicare] plan is 
     going to fail.

  Everywhere I went, people were confused. There were questions that I 
couldn't answer. When I turned to the doctors sitting next to me, they 
didn't know the answer. And neither did the pharmacists or the patient 
advocates. If Senators and doctors and experts do not understand this, 
how can we expect an 80-year-old person with serious medical problems 
to understand this complicated new program? We can't. So we need more 
time and more resources to make this prescription drug plan work.
  One person I met with said:

       Please give us more time. Give us the chance to understand 
     this so we don't make a mistake when we sign up.

  One panelist told me:

       Taking away something from those that need it the most . . 
     . is not the American way.

  I couldn't agree more. That is why I am here this morning to talk 
about this, and that is why I will be offering an amendment shortly 
after we go to the bill.
  I have many concerns with the Medicare prescription drug law. I voted 
against it in 2003 because I believed that seniors deserve better and 
that

[[Page 23680]]

America can do better than that. I am concerned about the complexity, 
the coverage gap, whether needed drugs will be covered. I am concerned 
about retirees losing the good coverage they have today. And I am 
concerned about the late enrollment penalty that is going to punish 
seniors who need more time to pick the right plan. I am working with 
many other Senators to address all of those concerns. But today the 
most urgent problem is the way the new law treats our most vulnerable 
people, people with low incomes, the disabled, and those facing serious 
medical challenges like AIDS.
  This law takes away the critical drug coverage these people have 
today and puts them into a new program that could charge them more 
money in exchange for less drug coverage. If they don't sign up for a 
plan, they are randomly assigned one. Either way, the prescriptions 
they need may not be covered. Because these Americans are living on the 
financial brink, an interruption of their drug coverage or a new 
copayment could keep them from getting the drugs they need to live on. 
The people who are being affected don't know what is going to happen. 
The doctors and pharmacists, they don't understand it either. This 
entire mess is going to burst into the open on January 1. We need to 
take action to prevent this catastrophe now because it is only a few 
months away.
  To understand this problem, let's look at how our most vulnerable get 
their prescription drugs today and how that is about to change. Today, 
about 6.4 million Americans with low incomes get help from two 
programs: Medicare at the Federal level and Medicaid at the State 
level. These individuals are sometimes what we call dual eligibles 
because they are eligible for assistance from both Medicare and 
Medicaid. What Medicare does not cover, the States usually cover. For 
example, the Federal program did not cover prescription drugs. The 
State programs filled in that gap. The State coverage is often called 
wraparound coverage, and it is critical for our most vulnerable 
families. As a result, these individuals get the drugs they need, often 
without copayments or deductibles.
  But there is a big problem coming January 1. The new drug program 
prohibits States from providing the extra help they do provide today. 
Instead, what it does is move these people into the Medicare program 
alone, which will require higher out-of-pocket payments and which will 
most likely cover fewer drugs. To me, it doesn't make sense to take 
away the good coverage that vulnerable families have today, force them 
into a program that might not meet their needs, charge them more money 
in the process, and then prohibit our States from helping out these 
most vulnerable people. It doesn't make sense, but that is exactly what 
this new drug program will do unless we fix it before January 1.
  In fact, the new Medicare prescription drug program changes the 
coverage of our most vulnerable in five ways: It imposes higher costs--
those are premiums, copays and deductibles; it covers fewer drugs; it 
blocks States from providing extra help as they do today; it provides 
no transition period to ensure that these low-income residents don't 
face these gaps in coverage; and it penalizes people who need more time 
to pick the right plan for them.
  These are real people we are talking about. I want to introduce two 
of them. Earlier this month in Seattle, I met a woman named Kathryn 
Cole. She is 36 years old. She is disabled, and she is living on Social 
Security disability. She fills about 15 prescriptions each month, and 
her monthly income is $757. She told me:

       Even if the copay were only $5, that adds up to $75 a 
     month. I don't have the kind of extra money to squeeze out of 
     my budget.

  Kathryn asked me:

       Which week am I supposed to not eat?

  People like Kathryn are living on the financial edge. They cannot 
afford to pay more for their medication. They need our help. In 
Olympia, WA, I met a man named William Havens. He is 50 years old, 
living with HIV/AIDS. He takes 43 pills a day. William told me:

       For the first time [in my life], I realize I'm going to 
     have to make a choice between pills and food.

  It is outrageous that this new law is going to make life so much 
harder for people like Kathryn and William. In addition to hurting 
people, the new drug program is going to hurt our health care system. 
It is going to have a costly impact on nursing homes, doctors, 
pharmacists, and hospitals. Many of these dual-eligible individuals 
live in nursing homes. Now nursing homes are going to have to navigate 
all these new plans out there.
  In my State of Washington, there are at least 14 of these new plans. 
Some States have as many as 40 or more, all with different costs and 
different formularies. Nursing home managers are going to have to see 
which plan each resident has been assigned to and if their needed drugs 
are covered.
  In Olympia, I met with a Dr. David Fairbrook. He is in private 
practice, and he is also the medical director of two skilled nursing 
facilities which care for 150 people. He was very concerned about his 
patients being randomly assigned to plans that don't meet their medical 
needs. He said patients may be denied drugs. They may be forced to 
change their medications, and they could face a time-consuming, 
stressful appeals process. He predicts there will be ``chaos for 
nursing staff regarding coordination of multiple suppliers. It further 
duplicates paperwork and documentation requirements.''
  That is a tremendous new administrative burden for understaffed and 
underfunded nursing homes and care providers who care for people we 
know--our parents, grandparents, sisters, and brothers.
  That is who is going to be affected by this new law if we don't take 
action.
  Unless we act, the new program is going to make the work of our 
pharmacists across the country much harder. They are literally going to 
be on the front lines. They may well be forced to deny coverage to 
seniors. And by the way, each one of these pharmacists has to go in 
contract with each of these new drug plans in their States.
  Now CMS is telling us that pharmacists will be able to look up and 
see what plan someone has been assigned to. But frankly, I have to say, 
given the error and the mistakes CMS has made so far, I don't have a 
lot of confidence that this is going to be a flawless situation in 
transition. Remember, the people who will be hurt have no financial 
cushion. They are living on fixed incomes and they don't have an extra 
$20 or $30 for copayments or premiums. If they are turned away at the 
pharmacy counter, they do not have the money to pay for those drugs now 
and get reimbursed later when all the paperwork is sorted out.
  Doctors are going to be on the front line in this, too. Doctors are 
going to have to know which drugs are on the formulary. They may have 
to help patients appeal any denials, and they will have to treat 
patients who have gone without their medicine.
  One doctor told me, ``Doctors don't have the information they need on 
this yet. If patients pick the wrong plan and their medicine is not 
covered, it can have serious medical harm.''
  Hospitals are also going to be affected. They are going to have to 
navigate all of these new plans. They are going to have to deal with 
patients who haven't been able to get their prescriptions. In fact, for 
many poor families, the only place to get these medicines will be the 
emergency room, and that is going to increase the cost of health care 
for every single one of us.
  So as you can see, this new drug law is going to impose an expensive 
and very confusing administrative burden on our doctors, on our 
pharmacists, on our hospitals, and our nursing homes. In this country I 
think we can do a lot better than that.
  The amendment I will be offering today says let's fix this problem 
before people realize they can't get the prescriptions they need. My 
amendment simply provides emergency funding to prevent this disaster.
  First, it ensures that our most vulnerable don't lose their current 
drug coverage. It will provide $2 billion in emergency funding to make 
sure our low-income seniors do not lose their benefits or suffer a gap 
in coverage.

[[Page 23681]]

That money will allow our States to help the low-income residents they 
have, people who currently get help from State drug assistance 
programs, and people being helped by AIDS drug assistance programs.
  My amendment will protect our most vulnerable, including any 
beneficiary with income below 150 percent of the Federal poverty level 
and any beneficiary currently eligible for Medicaid through ``spend 
down'' requirements.
  It is going to give our States the flexibility to protect the people 
who live in those States. States could provide coverage through 
Medicaid or as a separate drug assistance program. And importantly, my 
amendment provides accountability. States will be required to notify 
CMS of their plan for ensuring no lapse in benefits for low-income 
beneficiaries.
  Secondly, my amendment ensures that everyone knows about the changes 
that are coming. It requires States to notify those currently eligible 
for Medicaid and Medicare assistance. I can't tell you how many people 
I talked to when I was in my State who said: I have not been notified 
that I need to make a change. No one has told me. And yet we are 2 
months away from them being assigned a plan.
  States would also notify pharmacists. They would notify community 
health centers, rural health clinics, hospitals, critical access 
hospitals, doctors, and other Medicaid-eligible providers that 
assistance is available.
  Providers will be allowed to seek reimbursement for any uncompensated 
costs associated with providing medically necessary drugs to these 
people.
  In summary, my amendment simply protects our most vulnerable and 
makes sure that everyone involved knows what is happening.
  This new Medicare prescription drug plan that has been passed has a 
lot of problems, but the most urgent one is what is going to happen to 
our most vulnerable patients and the difficulty it will cause our 
health care providers such as hospitals, nursing homes, doctors, and 
pharmacists. Time is running out. As of January 1, millions of 
vulnerable Americans are going to be forced into a new system they 
haven't been told about, they don't understand, and it will not meet 
their needs. We can avoid this train wreck. Senators who are concerned 
about the health and well-being of their own constituents but who are 
concerned about the costs have other options. We can support efforts on 
the reconciliation to provide additional time to transition into this 
plan and we can make changes to the Medicare Modernization Act to let 
the States provide coverage they have available through Medicaid during 
this transition.
  No matter what, this is a problem. Either we spend the money now to 
prevent this crisis, I warn my colleagues, or we are going to have to 
push back the deadline so we can make this transition smoothly. 
People's lives are hanging in the balance.
  I urge my colleagues to stand up today for those who don't have a 
voice, and for the doctors, hospitals, pharmacists, and nursing homes, 
and give them the relief and protection my amendment provides.
  I will be offering this amendment in the Chamber today and I urge my 
colleagues' support.
  I thank the Chair. I yield the floor.
  The PRESIDENT pro tempore. The Senator from Idaho is recognized.

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