[Congressional Record (Bound Edition), Volume 151 (2005), Part 19]
[House]
[Pages 26026-26032]
[From the U.S. Government Publishing Office, www.gpo.gov]




                 MEDICARE PRESCRIPTION PART D DRUG PLAN

  The SPEAKER pro tempore (Mr. Davis of Kentucky). 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, I have an hour as the designee to talk 
about the subject that I want to bring to my colleagues, but I think I 
need to take at least a few seconds of my time from this side of the 
aisle to express my and our heartfelt sympathies to our colleague, the 
gentlewoman from California (Ms. Roybal-Allard), on the death of her 
father.
  I spent the last 15 minutes listening to their special hour and 
learning about that great, great American who represented the State of 
California so well in this body for 30 years; and I want to express my 
sympathy to my colleague from California.
  Mr. Speaker, today, November 15, is a historic day and not just 
because it is my wife Billie's birthday, which it is. Happy birthday, 
honey. But really the historic aspect of today is the roll-out and the 
sign-up today for the first of a 6-month window of opportunity for our 
seniors to voluntarily sign up for the Medicare part D prescription 
drug plan which this Congress made available to them in December of 
2003. So indeed, Mr. Speaker, today, November 15, is indeed a historic 
day.
  I have seen clips of the original signing of the Medicare legislation 
back in 1965 when President Lyndon Baines Johnson signed that bill into 
law. Actually, the very first person to sign up for the other voluntary 
part of Medicare, the part B which is applicable to the physician care 
and outpatient testing, not the hospital part but the voluntary part, 
the first individual to sign up for that was former President Harry 
Truman, that being 40 years ago.
  Here we are now finally, Mr. Speaker, after all of these years, 
offering something that was left out of that original program, I guess 
for a fairly good reason. Maybe back then, I was a freshman in medical 
school, I barely knew who was happening, but there was not quite the 
emphasis then on prescription drug treatment. We had some good 
prescriptions but not nearly what is available to our public and our 
seniors today; and there was much more emphasis on trying to get 
hospital care and needed surgery, emergency room care, indeed long-term 
care, skilled nursing home care for people who had, as an example, 
suffered a stroke.
  So this was all very, very important in the program; and I know my 
colleagues on both sides of the aisle would agree with me it has been a 
great success. There was some concern, though, I remember this much 
about it as I was working as a scrub technician during the summertime 
hearing the doctors at the scrub sink before they went into surgery, 
talking about this new law that was going into effect, this Medicare 
bill. There was some naysayers, no question about it, and some were 
downright opposed to it. But so many seniors were living in poverty and 
not getting needed health care, and it at that time was a Godsend for 
them.
  Mr. Speaker, I will say this. I think today, starting today, November 
15, 2005, some 40 years later another Godsend is coming to our seniors, 
brought to them by this Congress and this President, this 
administration, and that is the Medicare part D prescription drug 
coverage. It is especially a Godsend for those seniors who are living 
at or near the Federal poverty level, and I say that because heretofore 
they have not been able to afford prescription drugs.
  They go to their doctor and get maybe a handful of prescriptions 
because many of our seniors who are living just off of a Social 
Security check are the very ones that have what are called co-
morbidities, more than one disease, maybe high blood pressure, heart 
disease and diabetes; and they need to take four or five or maybe six 
prescriptions a day. They are the very ones who cannot afford it, not 
that they do not want to. They want to take care of themselves, but 
they also want to eat, and they want to have a roof

[[Page 26027]]

over their head, and they have to pay their utility bills, so this 
program is so necessary for them.
  In the past, Mr. Speaker, what has been happening is they would put 
off taking care of themselves because they have could not afford the 
prescriptions. Then, when some catastrophe would occur, they would 
finally get care, whether it was in the emergency room because their 
high blood pressure led to a stroke or whether it was on the operating 
table because their blood sugar, their diabetes was out of control and 
led to a limb becoming gangrenous and needed an amputation or maybe 
even because of high cholesterol they would have to have open heart 
surgery.

                              {time}  2130

  We have finally begun this prescription drug part D sign-up as of 
today, and that is what makes November 15, 2005, so historic.
  I want to spend most of my time then talking about this aspect of the 
Medicare Modernization Act of 2003. There are other things that I think 
are going to be tremendously helpful.
  I will mention just briefly, Mr. Speaker, the fact that with this 
change in the law, for the first time a senior can actually go to his 
or her internist or family practitioner, we call them primary care 
specialist, and get a complete, thorough physical examination when they 
turn 65, if you want to call it an entry-level physical examination. In 
the past, that was not paid for, and a lot of these diseases that I 
have already spoken of in their earlier stages have no symptoms at all, 
and people really do not know, but with this new program, they get an 
opportunity to go have that physical exam.
  Also included in the modernization piece is the coverage for a lot of 
screening tests that were not included in the original Medicare. I am 
talking about things like mammograms, screening for breast cancer 
obviously; colonoscopies, screening for colon cancer; PSA blood 
testing, screening for prostate cancer. I am talking about checking 
blood sugar. I am talking about getting a cholesterol level to see if 
the patient needs to be on one of these statin drugs that do such a 
great job of hopefully preventing heart attacks.
  All of this is now available to our seniors. I am not going to spend 
a lot of time, as I say, Mr. Speaker, on that aspect of the bill 
because I really do want to spend most of the hour talking about the 
prescription drug part because it is so important.
  I have got a few posters here, and we will be referring to them from 
time to time. I also have some of my colleagues that have worked so 
hard and been so supportive of this legislation and are working hard in 
their districts as we roll out this program. As they go home, usually 
we get back into the district on Thursday or Friday morning, and I know 
a lot of our colleagues on both sides of the aisle are holding town 
hall meetings and trying to explain to the seniors and assure them that 
although this is somewhat complicated, there are people there to help 
them through the process and encouraging them, especially the low-
income individuals that I spoke of, to sign up and sign up early.
  They do have 6 months to do it. It starts November 15, today, and 
goes until May 15 of 2006. They have that window of opportunity; but it 
would be a real mistake, particularly for our low-income seniors, not 
to get signed up before the end of the year because the program really 
starts, Mr. Speaker, and I know my colleagues are aware of this, it 
starts on January 1. So if they wait till the last minute into May of 
2006, they will have actually missed 5 months of opportunity, in many 
instances, to get their prescription drugs with hardly any cost, and I 
will repeat that, with hardly any cost except maybe $1 if their 
medication is a generic drug and $3 to $5 if it is a brand-name 
prescription drug.
  So I will have a number of my colleagues joining me, and we will be 
calling on them in just a few minutes. I want them to take as much time 
as they would like to talk about what they are doing in their 
districts, how they feel about this program, what sort of feedback they 
are getting from their seniors, and then maybe we will engage also in a 
little bit of colloquy.
  Let me call my colleagues' attention to this first slide, which I 
think begins to tell the story: ``Helping seniors get the medicine they 
need to stay well.'' That is what it is all about. It is not an 
emphasis on episodic treatment and maybe trying to catch the horse 
after the barn door has been left open when some catastrophe occurs. It 
is so much more difficult, rather, to get the medicine they need to 
stay well. I do not think we can really emphasize that too much.
  Now, Medicare helps seniors prevent disease in addition to treating 
it. I said at the outset, in 1965, all of the emphasis was on treating 
it, and that was good, but not the 21st century medicine. We need to 
emphasize the prevention of disease.
  Medicare part D, it is important that our seniors know that this 
option, prescription drug coverage, really is for all seniors. It is 
not just the low-income. I mentioned them, and we will talk about 
throughout the hour, but no matter what a person's income, if they are 
a Medicare recipient, either because they are 65 years old, and that is 
probably 36 or 37 million in this country, or because of a disability 
at a younger age, and there are probably 6 million or 7 million of our 
citizens who are on Medicare because of a disability, but all of them, 
no matter what their income level, they are eligible for Medicare part 
D.
  As I point out in this next slide, it is a voluntary program. Seniors 
must choose to enroll. They will be getting lots of information and 
have gotten lots of information, whether it is public service 
announcements on television or mail pieces that have come from CMS, the 
Committee on Medicare and Medicaid Services, information maybe they 
obtained from a senior center, from their physician's office or, 
indeed, from their Member of Congress' office, either in Washington or 
in the district, but they do have to make that decision. It cannot and 
will not be made for them.
  There are going to be many plans. Seniors will have a choice of 
plans. We estimate that the monthly premium, and it is premium-based 
just like Medicare part B, Mr. Speaker, is a premium-based and an 
optional program. By the way, I would guess that I am accurate in 
saying that 98 percent, maybe more, of seniors have chosen and will 
continue to choose to enroll in that premium-based part B that covers 
the doctor's expense and outpatient testing and surgery because it is a 
very good deal.
  We will talk a little bit later about what percentage of seniors we 
think will want to sign up for the Medicare part D, the prescription 
drug part; but it will be a substantial number. We are estimating that 
the monthly premiums for that monthly benefit will be about $25 on 
average, some plans less, some plans more, depending on what the 
coverage is.
  All Medicare-approved plans cover both prescription and generic 
drugs, and they are accepted at local pharmacies. That is very 
important because people want to know if they can continue to go to 
that corner druggist. In no way am I suggesting that the chains, the 
Eckerds, the Walgreens, the CVSs that do such a great job, are not a 
wonderful place to go and get prescriptions filled. They are. Many of 
our seniors will choose that type of location, but others who have a 
pharmacist friend that they have known for many years, they call them 
doctor and go to church with them, a lot of times they are able to 
charge their prescriptions and pay a little bit along, the kind of 
service that only a small corner druggist can give. That is very 
important that they know that they will be able to continue as part of 
this program to be serviced by those great pharmacists that we call 
corner druggists.
  Mr. Speaker, before I call on my colleague, the gentleman from Texas 
(Mr. Carter), for his remarks, I want to just present one more poster; 
and, again, I do not think we can emphasize this too much, that is, 
this issue of the dates; and I have already mentioned several times 
that today is the starting date, November 15, for enrollment. This

[[Page 26028]]

little icon, if you will, shows an hourglass, and that means that 
starting today the sands of time, that 6 months, is ticking away. Of 
course, the program, if you get signed up right away, you reap the 
benefits starting January 1. Then if you sign up before May 15, that 6-
month window, then you incur no penalties; but after that, there are 
some penalties for signing up late. Again, I am sure some of my 
colleagues will talk about that.
  At this time, I am very happy to see the gentleman from Texas (Mr. 
Carter) with me again to share one of these hours on health care 
issues. The judge knows a lot about legal issues and the judiciary, but 
he also knows a lot about health care. So I am honored at this time to 
yield to the gentleman from Texas (Mr. Carter).
  Mr. CARTER. Mr. Speaker, I thank my colleague, the gentleman from 
Georgia (Mr. Gingrey), my good friend, for yielding to me; and I 
actually came down here because, Mr. Speaker, the gentleman from 
Georgia (Mr. Gingrey) is probably one of the people that has dedicated 
more time and effort to the health care issues that affect the American 
public than any other Member of this Congress.
  On many occasions, he has educated me on health care issues and given 
me good advice and good counsel on how we need to make health care 
available, because the health of our Nation is very important to the 
gentleman from Georgia (Mr. Gingrey) and all Members of this House on 
both sides of the aisle. We battle and toil with how exactly we are 
going to address health care issues.
  I really wanted to start and come down here and share with the 
gentleman from Georgia (Mr. Gingrey) an absolutely true event that 
happened to me personally; I guess by now it is probably almost 2 years 
ago or maybe even better. It was right after I was blessed to join this 
august body.
  I was back home in my district, and I was back at my pharmacy, that I 
am not going to advertise for, but where I regularly buy my 
prescription drugs. I was standing in line for my turn to get 
prescription drugs, and I am sure people have told this story that I 
never had actually experienced, a story like this, until I heard the 
story.
  There was a lady that was at that time being waited on by the 
pharmacist there at the counter and getting her prescription drugs, and 
they brought them to her. She was getting two prescriptions as I 
recall, one for herself and one for her husband. I do not know how old 
this lady was, but she was clearly on Social Security because she said 
so. This was when we were still working on trying to come up with a 
prescription drug benefit that would help our senior citizens.
  She asked the pharmacist how much the two prescriptions were going to 
be. The price was very expensive for both of the drugs that she was 
going to have to pay, and between the two drugs, it was going to add up 
to, as I recall, over $500 for these prescriptions. She told the 
pharmacist, well, I cannot get these two prescriptions and continue to 
feed my husband and me on what we have to live on; I am just not going 
to be able to do it. Would it be possible that I could get half of the 
prescription?
  The pharmacist said, well, ma'am, the one for you was obviously for 
something that had come upon her. The other was an ongoing prescription 
for her husband, the way I understood it. He said, your doctor has a 
reason he wants you to have this whole prescription. It may have been 
an antibiotic or something like that. I am not in the medical 
profession, but the pharmacist clearly said you need to take all of 
this prescription; you just cannot take half. Well, she said, ma'am, I 
just cannot spend that kind of money and take care of my family.
  When you heard that, when you actually heard that from a human being, 
you said to yourself, we have got to do something to get some relief 
for people like this lady that was standing there. I was two people 
back from her in line, and what I heard that day from that lady touched 
my heart to where I really felt like I had seen the crisis firsthand.

                              {time}  2145

  We have now put together Medicare part D, as my colleague from 
Georgia has been explaining and will be able to explain in far better 
detail than I can as to what the benefits are for this, but we have now 
got a solution for that lady who was standing in line, and it is now 
time for people to start going out and getting signed up for Medicare 
part D. That is why I wanted to come join my colleague tonight in the 
hopes that people in my district and people across this entire country 
will hear our message that the time is here. We have arrived at the 
time when they need to go down and register to get involved in Medicare 
part D. And benefits will actually start, as Mr. Gingrey has explained, 
in January of 2006.
  Now, I have traveled my district and I hold town hall meetings, and a 
lot of our senior citizens are concerned about, well, this seems so 
complicated, I do not know whom to turn to. And we are here to let the 
people know this is important to them and their loved ones. There are 
people there to assist them.
  I would ask the families of those Medicare recipients that need help, 
sometimes as we grow into our later years, little things become big 
things to folks like my parents, who now are deceased, but I can 
remember when they become big things for them as we grow older. And I 
would hope that the families of these people along with these folks 
will encourage them to go look into getting registered, getting set up 
in a plan.
  There are multiple plans that are offered. There are people there to 
help them understand those plans. There are people to tell them what 
fits their life, their life-style, where they come from, and I would 
hope not only those people who are going to be eligible for the program 
but those people who have folks in their family that will be eligible 
for the program will encourage them to go down and talk to folks, get 
the help, get signed up.
  It is not as complicated as people think it is. There is a lot of 
fear that is unwarranted fear of this program. It happens on everything 
we do. When we deal with the government in many areas in our lives, 
dealing with the government is a frightening thing, dealing with plans 
and paperwork. This is cut down to where it is not going to be that 
hard to understand the plans.
  There are people there to look at what people's circumstances are and 
tell them and show them which plans offer them the best options. Every 
State except Alaska has a State plan, as I recall. There are regional 
plans, and there are 10 nationwide plans that are available. There are 
multiple options that they can talk to them about. People can talk to 
their pharmacists. Medicare has people that will help them.
  Call that number, 1-800-Medicare, and they will explain how to sign 
up. It is so important to your family. Do not let a little fear or a 
new world attitude that you do not understand keep you from getting 
signed up for a benefit. Because this is going to be able to assist all 
Americans in their health care needs, and it is especially going to be 
of great assistance to those people who are in the lower economic 
sector of our country. In most instances, those people who make, I 
think, $11,500 as an individual and $22,000 as a couple, they are 
basically not going to have hardly any Medicare costs for drugs. So it 
is important that you not let the fear of a new program or something 
you might have seen on television or some political rhetoric that was 
in some campaign somewhere that got you concerned that you would not be 
able to understand what the program is about to keep you from getting 
what you need so that you never have to be like that lady who stood in 
line in front of me and have to make a decision as to whether you took 
your medicine.
  Does my colleague know what was really loving about that story? There 
was no question she was going to buy her husband's medicine. She never 
even blinked on that. She was saying, I will give up so we can live our 
life here what I need, but of course there is no question I am buying 
the medicine for my husband.
  That kind of love permeates American society, and I think we have a

[[Page 26029]]

duty to our loved ones who are eligible for Medicare to help them and 
encourage them to go get signed up for this. Because Americans do care 
about their elderly. Americans do care about those senior citizens who 
have given all that they had for us today. It is time for us to give 
them the benefits that they need so they do not ever have to have the 
kind of experience that that sweet lady did who was standing in front 
of me at the drugstore.
  That is why I came down here tonight, to join Congressman Gingrey and 
speak directly to the American people and say, get out there and help, 
get out there and get yourself registered, or get somebody to help you 
get registered, because these benefits are important. There are 
occasions now where people say, right now, prescription drug benefits 
do not mean much to me. One never knows what is right down the road, 
and it is important that people get registered now and have those 
benefits available. Because in the month of May, they may come down 
with something where they have got a permanent situation where for the 
rest of their life they are going to be taking medicine, and if they 
had not gotten registered, then they would be in a scramble trying to 
get registered. So it is important to look at it now.
  Mr. Speaker, one of the things that I think is most important as we 
sit here this evening is to encourage our seniors and their families to 
assist our seniors to get out and learn about the program and get 
signed up. Getting signed up is what it is all about. Trained 
professionals are available 24 hours a day, 7 days a week at 1-800-
Medicare.
  They have got a Web site, and I am reading from Congressman Gingrey's 
sign, www.Medicare.gov, for those high-tech seniors, who are probably 
better at that than I am, to get out there and do this on-line. There 
is a lot of help available.
  I hope that that lady who was standing in line in front of me in the 
drugstore in Round Rock, Texas, I hope she hears, by accident or 
whatever, channel surfing, and tunes into this show tonight and will 
say ``I had better go do that.''
  I think our colleagues on both sides of the aisle are going to be out 
in our districts talking to people and saying do not let something new 
keep you away. Get out there and get involved and get signed up.
  Mr. GINGREY. Mr. Speaker, reclaiming my time, I thank the gentleman 
from Texas for being with me. I appreciate his comments tonight. I 
welcome him to, if possible, to stay around and maybe we can get 
involved in a colloquy or I can respond to his questions and yield to 
him.
  Mr. Speaker, the thing that he pointed out, that little anecdote, 
true story, about that little lady in Round Rock, that is why it is so 
important. I appreciate Judge Carter mentioning that, because this is 
real, and the emphasis that he put in his remarks on how important it 
is to get signed up is real.
  Thanksgiving is going to be upon us pretty soon. I think I am correct 
in saying a week from Thursday. And what comes the day after? Well, I 
call it ``black Friday,'' Mr. Speaker. That is that big shopping day, 
the first day of the Christmas season when everybody hits the malls. I 
think that would be a great day for families, children, grandchildren 
to sit down with their grandparents, children to sit down with their 
parents and help them. That would be a wonderful day. It would save 
money as well, probably. The retailers may not like me very much, Mr. 
Speaker, for mentioning that, but that would be a great day to just sit 
down and say, look, I am pretty good at the computer, Mom, Dad, and let 
us go on-line, let us get on www.Medicare.gov.
  If I tried to do that, that computer would start smoking, and 
everybody in my office knows that. Anytime I need to do anything on the 
computer, they have to hold my hand. So I understand the need and the 
fear of computers. But really for the younger people especially, it is 
a challenge. It is pretty easy for them. They have learned it in high 
school and college, and some of them even work in the industry. So help 
is readily available, as Judge Carter said; and it is not that 
difficult.
  I called this morning. I think it was about 8:30, and I decided I was 
just going to call 1-800-Medicare just to see how long it took to get 
somebody on the telephone. Mr. Speaker, I had a response in about 3 
minutes. The first time I dialed, I got a busy signal, and so I 
immediately, within a matter of seconds, dialed again and got right 
through and began the process.
  Now I am not quite 65, and I did not have a card and a number, so at 
some point I had to quit. I had to hang up. It was a bogus call. But I 
was very impressed.
  Of course, CMS has hired and trained, and that is very important, not 
just hired but trained probably by a factor of four the number of 
employees that they normally have responding to these calls. So, as 
Judge Carter said, that information, that help is there, whether it is 
by the telephone or on the Web site, and we will get into the specifics 
of how a senior prepares themselves for this process. There is 
something called worksheets that are available through CMS. Those are 
easily obtained, and people just kind of go through that worksheet. We 
will talk about it a little later in the hour, so that when those 
questions come up, and, again, they are not difficult, they know the 
answers, and we can help them through the process.
  Mr. Speaker, I see that we have been joined by another of our 
colleagues and not just any colleague because this is my good friend 
and fellow physician, indeed a fellow OB-GYN physician who came in in 
the 108th Congress with Judge Carter and me, the gentleman from Texas.
  So I yield to the gentleman from Texas (Mr. Burgess) to give us a 
little of his insight into this program and what he is doing in his 
district.
  Mr. BURGESS. Mr. Speaker, I thank the gentleman for yielding to me, 
and I thank him for once again bringing this subject to the floor of 
the House.
  It is a timely subject. Here we are celebrating Medicare's 40th 
birthday; and, Mr. Speaker, as the Members will recall, 2 years and 1 
week ago we actually passed this legislation, on November 22 of 2003, 
which now has become the Medicare Modernization Act and with it the 
prescription drug plan.
  Mr. Speaker, I have been doing town hall events and informational 
group-
ings throughout my district, and my district is pretty diverse. I have 
been very fortunate. I have had someone there from CMS with me, and 
together I think we have been able to answer a lot of the questions 
that come up. I do not want to get ahead of the program that Dr. 
Gingrey has proposed for this evening, but the concept of the 
worksheet, the concept of prearranging some of the information in an 
organized fashion, is a critical one. It is so important because we are 
coming up on a time of year of celebration of holidays, Thanksgiving 
and Christmas holiday, when families are going to be together. It is a 
great opportunity for them to talk, after they have had all the 
football and turkey that they can handle, to sit down and talk about 
what are the changes that are coming up in this Medicare program.
  The gentleman alluded to calling 1-800-Medicare. I must admit I have 
not had the courage to do that myself, but I do go on the Internet, and 
we can go into the plan selector part on www.Medicare.gov. They do ask 
for their Medicare number, but if they scroll down that page just a 
little bit, they can actually fill out the plan finder information 
without giving up any information, if they just want to check and see 
what is available.
  I have done this for Texas. We have got in excess of 40 plans 
available to seniors in the Lone Star State, and they are good plans. 
Some of them come in with less of a premium and less of a deductible 
than what Medicare proposes. In fact, I have seen premiums as low as 
$10 and $20, and I have seen some programs with a zero dollar 
deductible.
  A lot has been made about the so-called gap in coverage that occurs 
at some levels. And do remember, Mr. Speaker, we passed this 
legislation 2 years ago, and what were we trying to do? We knew we 
could not cover every last single person in this country, so

[[Page 26030]]

we wanted to provide the greatest amount of coverage to those who were 
the poorest and those who were the sickest, and I think we did a good 
job in accomplishing that. But it does leave a gap in coverage, or at 
least the Medicare proposal, the proposal for the Medicare prescription 
drug plan, was to leave a gap. But, actually, there are some plans in 
Texas where, if they are willing to accept generics, there is, in fact, 
no gap in coverage. So there is complete coverage from the first dollar 
spent up and to the so-called catastrophic ranges.
  I have had some people complain about the time frame that is 
available to sign up for this program. It starts today, and for the 
next 6 months people can sign up for any of the Medicare-eligible 
programs. Those who have not signed up by May 15, right now Medicare is 
proposing a 1 percent penalty per month. That will be 32 cents penalty 
the first month of June of 2006, and it will continue at a 1 percent 
per month increase thereafter.

                              {time}  2200

  But realistically, this should be thought of as insurance and not an 
entitlement. That is what I have tried to explain to my constituents 
when they say they do not like the idea that you are forcing me to sign 
up. It is a voluntary program. If you decide it is not for you, you are 
absolutely free not to sign up.
  But when I was a physician and I offered health insurance to my 
employees, they would be expected to pay a small part of it. If they 
chose not to pay that part, they could opt not to take the insurance. 
But they could not just wait until they got sick and then say, I would 
like to sign up for the insurance. Otherwise, it would not be fair to 
the rest of the people who have been paying their premiums all along. 
The program is structured to look like commercial insurance. It is on 
purpose not scheduled to look like an entitlement, because it is not. 
It is insurance coverage for seniors who need help with paying for 
their prescription drugs.
  Mr. Speaker, I would just stress as a last point that when people 
evaluate these plans for their families or for themselves, that they 
look at cost, coverage, and they look at convenience. Many of the plans 
cost less than what Medicare has proposed.
  The coverage part is important. You want to be certain that you pick 
a plan that covers the medicines that you are actually taking. Talk it 
over with your doctor. If your doctor is watching a problem like a 
mildly elevated blood pressure, be sure that those medications would 
likely be covered. Every plan lists on the Web site how many of the top 
100 prescriptions covered by Medicare that particular plan covers. Most 
are in the high-90 range. I have not seen one less than 82 or 83 of the 
top 100 prescriptions covered by Medicare. But check out the coverage.
  Finally, convenience. They will provide a pharmacy that is close by. 
If your neighborhood pharmacy is the one you want to use because they 
have a delivery boy you like, use that tool to help you decide which 
one of those pharmacies you want to use. There is also mail order.
  There is a lot of flexibility in these plans. Yes, it is complicated. 
Health care is complicated in the 21st century. These are not easy 
decisions. Yet at the same time, Tom Brokaw called you the Greatest 
Generation. You beat the Nazis, solved the problems of the Great 
Depression, and solved a lot of the problems related to civil rights. 
Seniors can solve these problems as well.
  This program will become streamlined over time. I am happy about 
things like disease management and physicals that will be offered now. 
It is good legislation. Mr. Speaker, it is good medicine.
  Mr. GINGREY. Mr. Speaker, one thing that the gentleman from Texas 
(Mr. Burgess) mentioned was the fact that if a senior is interested in 
a mail order opportunity, then as they go through that list, the litany 
of companies that provide a benefit, they may want to choose one that 
would allow them to get their drugs in a mail-order fashion. So that 
option is available.
  I had mentioned earlier in the evening talking about the worksheet 
and what a senior would need to have if they are dialing the 1-800 
Medicare number or dialing the Web site with or without assistance at 
www.Medicare.gov, or coming to one of the congressional offices to get 
help, they need that work sheet and that work sheet should include and 
should already be filled out.
  Again, it is information that the seniors know. First and foremost, 
it should include a list of the prescription drugs that you are 
currently taking, including the dosage, the milligram, the strength, if 
you will, and how often you are taking those drugs.
  Secondly, information about any prescription drug coverage you 
currently have, be it employer or union-sponsored or a Medigap policy. 
Or maybe you are a veteran and have TRICARE for Life, or possibly you 
are retired State or Federal employee and you have coverage that 
includes a prescription drug benefit. You need to have that information 
so we can put that into the formula and help you decide whether you 
want to continue with that program or opt for the Medicare part D 
program, whichever is better, whichever really is the best deal, unique 
to your situation.
  And of course the name and address, as Mr. Burgess and Mr. Carter 
both said, the name of the local pharmacy that you use to fill 
prescriptions. So we will need your ZIP Code as well and the out-of-
pocket amount you spend on prescription drugs each year currently. 
Again, I know our seniors know that because they are real good 
accountants. They have to watch every dollar, and it is important that 
we know that. And then last but not least, your Medicare enrollment 
information, your Medicare number and your address and all of those 
particulars, whether you are on traditional Medicare or Medicare 
Advantage under an HMO or PPO-type program.
  Mr. Speaker, I see that we are joined by another health care 
professional, the gentleman from Pennsylvania (Mr. Murphy). Mr. Murphy 
has been with us on just about all of these hours that we have done on 
health care and this particular issue.
  Mr. MURPHY. Mr. Speaker, I thank the gentleman from Georgia for 
yielding to me. I thought it would be helpful to point out a couple of 
things. When an individual contacts 1-800 Medicare or Medicare.gov, 
when they have their name, address, medications and dosage level, and 
what they are paying for it and their ZIP Code, they can find out a 
number of things. They will be able to compare the cost of medications. 
Because with the 75 percent discount, 75 percent paid by their tax 
dollars and other folks' taxes for the first couple thousand, and then 
after $5,000, 95 percent is paid for by the government, but from this 
it is important to be able to compare medications.
  I have a chart here. This is Pennsylvania, my home State. I want to 
point out something, and that is savings for seniors with multiple 
chronic conditions for someone in Pennsylvania, this is comparing the 
savings in the best plan and savings in an average plan. Let me read. 
Jane is a hypothetical medical beneficiary taking the following 
medications: Celebrex, 200 milligrams; Fosamas, 70 milligrams; Nexium, 
40 milligrams; Singulair, 10 milligrams; Zoloft, 50 milligrams; and 
metroprolol tartrate, 50 milligrams.
  What comes out of this is in the best plan it appears there is about 
a 60 percent savings, or $3,797. In the average plan, about a 32 
percent savings, being $2,036 of what they will pay. I am not sure what 
sort of medical condition this is, and perhaps you can diagnose based 
upon the medications alone, but I am just interested in your comments 
on this because it becomes a matter, it is one of the reasons when 
somebody calls and says how much is my discount going to be, it gets 
complex. In each case, you have to look at the individual's 
prescriptions.
  I wonder if my physician friends here can tell just what this tells 
them and why it is a matter that deals with the discussions of 
Medicare.
  Mr. GINGREY. Mr. Speaker, I call on the gentleman from Texas (Mr. 
Burgess) and enter into a colloquy with you on that issue.

[[Page 26031]]


  Mr. BURGESS. Mr. Speaker, my understanding is you will be offered the 
top three plans based on cost to evaluate. Then you can go to the next 
three plans and the next three plans. So the information is given in 
those sorts of segment. My understanding is cost, since cost is one of 
the principal concerns in people's minds, cost is one of the parameters 
upon which the three plans are picked. Here are the top three plans in 
your area based on cost, covering some portion of these medications, 
and whether there would be a stand-alone prescription drug plan or one 
of the PPO- or HMO-type products that would include a prescription drug 
plan, those are also included in the choices as they are given.
  We have some 47 prescription drug plans in Texas that are recognized 
by Medicare as being good products. You cannot evaluate all 47. So give 
me the top three based on cost, and let me figure out the coverage and 
convenience aspect of those. If you have expanded the search to include 
a HMO or PPO product, let me make the decision based on can I see any 
doctor I want or would I have to see a select panel of doctors.
  Those are the kinds of decisions, the same kinds of decisions people 
would make in starting a new job, when they went and met with their 
employee benefits manager. Just like we did when we started in the 
House 3 years ago, they asked, do you want a HMO, PPO product, and went 
through the litany of things that might be available to us.
  This would be the type of information that would be given to someone. 
And again, this may be too much for an individual 85 years of age to 
deal with three plans that are somewhat different in their construct. 
That is why it is going to be helpful to have a child, a nephew, a 
grandchild to be able to help make those decisions. Probably the person 
who helps arrange for those prescription purchases on a regular basis 
would be the best person to advocate for that particular senior and 
help them make those choices.
  Mr. MURPHY. Mr. Speaker, when you are comparing plans, my 
understanding is if you look at the most commonly prescribed drugs for 
seniors, and not every drug may be covered by every plan, there is 97 
to 95 percent overlap.
  Mr. BURGESS. That is correct, and that information is listed on the 
Web site.
  Mr. MURPHY. And the reason a person wants to compare different plans 
is to make sure that not only their drug is covered, but different 
plans may have different costs for those individual drugs. So the 
person can actually shop around on the Internet or on the phone.
  Mr. BURGESS. That is correct. The Internet would provide some 
transparency that probably is not available to that senior today.
  Mr. MURPHY. Mr. Speaker, I was in the grocery store the other day, 
and I wanted to buy a loaf of bread. I had not been in this store 
before. This store must have had 30 or 40 different types of bread. 
Every roll, shape, flat, cut, everything. I said I just want some whole 
wheat bread. They helped me find it.
  I thought this sort of reminds me with some of the choices with the 
Medicare plan. If anything, yes, there are many choices, but it is 
important to keep in mind that by working with somebody on the Web site 
or on the phone, and many pharmacies and senior centers offer this. 
Ultimately the issue is this: that a person should not just compare the 
cost of a drug, what is this drug going to cost, but what is it going 
to cost me over a year's period of time.
  We looked, for this hypothetical person Jane, what does it cost for a 
year because in some cases people may say if there is coverage up to 
$2,250, and if my drugs cost $3,000, they may ask, do I have to pay 
$3,000? And the answer to that is?
  Mr. BURGESS. The answer is, if it is over $2,250, it would be $750.
  Mr. MURPHY. But the rest is covered. That is part of the confusion 
that takes place. We need to make sure that our colleagues and America 
understands this is a matter of looking at the overall cost of 
medications for your year, and that is why it is important the person 
writes down all those numbers, and have those annual costs ready, or 
even your monthly costs, so you can compare.

                              {time}  2215

  But it is, I think, the most valuable way that seniors can look at 
the overall cost of the Medicare plan.
  Mr. GINGREY. If the gentleman from Pennsylvania would yield for just 
a second in regard to that issue. As you go through the Web site, it is 
important that our colleagues know to let their seniors understand that 
there is a page there, and Mr. Murphy was referencing that, where you 
are able to compare the different plans. Let us say you have several in 
your community that are available to you, and you narrow it down by the 
process of whether or not they allow mail order, if they have good 
discounts for all of the drugs you are on or three out of the four, and 
then you finally narrow it down maybe to three or four that you want to 
choose from.
  As you go through this process, and again there is someone right 
there to guide you through it, you can see really what your cost per 
year, as Mr. Murphy was referring to, what each plan would be and then 
make that intelligent choice, based on a lot of factors, but not the 
least of which, of course, is that cost factor.
  Mr. MURPHY. I thank the gentleman for explaining that. It is such a 
critically important thing here. And this is where, when you look at 
the cost, a couple of elements that I consider very important, as a 
health care practitioner myself, that one of the things we recognize is 
for the most part, when a physician prescribes medication, I am sure 
the gentleman has seen this too in his practice, prescribe medications, 
sometimes patients will not fill that prescription. Sometimes, even if 
they fill it, they may not take it all. They may take it in part and 
discontinue it, or they may find if they feel they cannot afford it, 
they stretch it out. Under such circumstances, when a patient does not 
take a medication that the physician feels is needed, it can actually 
worsen their health and cost more.
  One of the things about this Medicare plan, when the critics were out 
there saying this is going to cost more, we have to remember the CBO, 
the Congressional Budget Office, does not score savings. And between 
the entry physical, between the case management, where there will be 
pharmacists and others who will work with the physician to make sure 
they are not getting duplicate drugs, there is not confusion, just 
checking the dosage and following through, plus the idea that the drugs 
are more affordable, lifesaving, life enhancing, the kind of things 
that are so important for people's health are more affordable, that 
means people will take them. And part of this effect is people will be 
staying out of the hospitals and staying out of emergency rooms with 
that as well.
  Mr. GINGREY. If the gentleman will yield, Mr. Murphy hit the nail, I 
think, right on the head. And as we talk about this, the gentleman from 
Texas (Mr. Carter) is still with us. He may want to weigh in and share 
some of his thoughts on this subject. But there is no question that 
this program has the potential to significantly lower prices across the 
board, maybe not just for our seniors, but to everybody for some of 
these heretofore very expensive pharmaceutical drugs. And we anticipate 
that this program, and again, we talked about participation level. 
Remember, I said at the outset of the hour that Medicare part D, that 
other optional part of Medicare, probably got a 98 percent 
participation rate because it is such a good deal.
  We will not have that higher participation rate with the part D 
because many of our seniors already have prescription drug coverage. We 
mentioned some of those categories. But this program, we anticipate 
across the board about a 50 percent savings, maybe 11 or $1,200 a year 
on average, and that of course includes people that are low-income. It 
includes people that are high-income; but on average, we anticipate, is 
that not right, Mr. Carter, about a 50 percent reduction.
  Mr. CARTER. That is right. And if the gentleman would yield once 
again.

[[Page 26032]]

As we talk about this, let us reemphasize again to our seniors the 
importance of getting registered and signed up for the program. You 
know, as the gentleman was talking about these drugs, and we read the 
list off, of those drugs I am familiar with and some of them I am not.
  But I thought about how much medicine has changed. And you are the 
doctors. I am just an old lawyer and trial judge. But I can recall that 
my father almost died from bleeding ulcers. As a younger man, I was 
working my way down that road, and, in fact, at one point in time had 
an ulcer. But Tagamet, I am not plugging any particular brand, but that 
is the name I know of because that is what I took when Tagamet came on 
the market; and with that drug, I have never had any more problems 
whatsoever with ulcers, where my father almost died. They had to give 
him 7 pints of blood, and he had to be cut from stem to stern like he 
had been in a knife fight to try to save his life and they had to 
remove two-thirds of his stomach.
  Medicine now can stop a condition that we used to solve with major 
surgery with prescription drugs. This tool is now available to our 
Medicare recipients. It is critical that they understand, do not be 
frightened even by what we have tried to make simple here tonight. Some 
could even be frightened by that. Do not be frightened by that. Make 
the effort to save your life. Make the effort to go out there and have 
every tool that you can be one of those blessings to our country, and 
that is a senior citizen with long life and good wisdom to pass on to 
future generations. And you can only be that way if you take care of 
yourself.
  And part of taking care of yourself is getting signed up so that 
modern medicine can care for you, because with no offense to the great 
work that our surgeons do, in the long haul, having had a couple of 
those surgeries myself, I will take that pill all day long and into the 
night before I want them to cut me wide open because I think modern 
medicine has been proven over and over, that good preventive medicine, 
which we now have in this plan, meaning going to get your checkups, get 
your tests for which you are now covered, do those things that were not 
available but are now available to you to make sure you are maintaining 
a look at your health.
  And the prescription drug plan along with the other normal medical 
benefits that have been available before make this a better future for 
our senior citizens, a better, healthier, longer future. I cannot 
impress it upon our people enough. This is so, so life changing in the 
world. It is not perfect, and we all would love for the world to be 
perfect. But you know what? When we came in here, somebody hit on it 
tonight, when we came in here and signed up for Congress and they 
dropped those half a dozen or a dozen plans in front of me, it might as 
well have been written in Greek. And I sat there and stumbled and 
fumbled and said I am sticking with my Texas plan and stayed right 
where I was. And that is my own fault. And I am confessing it right 
here in front of God and everybody that that is what I did. But in fact 
I thought I had a better plan in Texas anyway. But that is a different 
story. But I understand their frustration because it is a frustrating 
thing. But that is the world we deal with right now.
  Mr. GINGREY. Well, as usual, the gentleman is right on target. And I 
think it is important that we remember that the plan, typically, if I 
could describe a typical plan for the typical senior, would be about a 
$30 a month premium, would be a $250 deductible, would be a 25 percent 
copay, that is, the senior has to pay 25 percent of the cost of the 
prescription drugs after the 250 out of pocket, up to a total of 
$2,250. Then there is this issue of the hole in the doughnut, or the 
gap, where any cost above $2,250, up to about $5,100, is 100 percent on 
the back of the senior. A lot of people have been concerned about that. 
They tend to forget, though, that above that you have this catastrophic 
coverage. If you have spent in any one year on Medicare part D 
prescription drugs, if you have spent more than $3,600 out of your 
pocket, then anything above that is covered at the 95 percent level.
  And, really, there are situations like that. Maybe for some seniors 
today before they sign up for this program, they already know that they 
are spending $3,600 or more, maybe $6,000 a year on prescription drugs. 
Now, they very well may want to choose a plan. This slide that I have 
in front of me now sort of goes over that, talks about the premium and 
the deductible and the gap in the coverage. Well, seniors can choose. 
They can literally, if they want, particularly, and I would recommend 
this, if they are on a number of drugs already and they have high costs 
already and they know that, then they may want to pick a plan that the 
monthly premium is a little bit higher than the average of 25 or $30, 
maybe it is $50 a month. But it does not have any gap in the coverage. 
Those plans are available, and that information of course is what they 
will obtain from the Web site.
  I know we are getting close to the exhaustion of our time, and I 
wanted to call again on my colleague from Pennsylvania to see if he had 
any closing remarks before we wrap up this hour. And I want to, before 
I run out of time, express my appreciation to Mr. Carter, to Mr. 
Murphy, and Mr. Burgess for joining us during this hour.
  Mr. MURPHY. Actually, I think we are out of time, so I yield back the 
floor here and thank the gentleman for leading this.
  Mr. GINGREY. I thank my colleagues. Thank you, Mr. Speaker. I yield 
back whatever remaining time we have and look forward to the next 
session.

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