[Congressional Record (Bound Edition), Volume 152 (2006), Part 14]
[House]
[Pages 18790-18791]
[From the U.S. Government Publishing Office, www.gpo.gov]




              ADDRESSING THE MEDICARE PART D DOUGHNUT HOLE

  Mr. BURGESS. Mr. Speaker, I ask unanimous consent to claim the time 
of the gentleman from Nebraska.
  The SPEAKER pro tempore. Without objection, the gentleman from Texas 
is recognized for 5 minutes.
  There was no objection.
  Mr. BURGESS. Mr. Speaker, we heard a lot last spring about the 
voluntary Part D prescription drug program that seniors had available 
to them for the first time. We haven't heard much about it recently, 
but it is important to revisit the concept because of two aspects.
  One is the open enrollment period, which is going to begin the middle 
of November and run through the end of the year; and the other is to 
address the fact that some seniors are coming upon what is called the 
coverage gap. They have received enough help in the prescription drug 
program, and they have come into a period of spending where they are 
expected to cover the whole cost of their prescription drug components 
until they get up to a catastrophic level, after which they will only 
be responsible for 5 percent of their drug expenditures.
  Mr. Speaker, last spring when we talked about the Medicare 
prescription drug program back home, I would tell my constituents to 
focus on cost, coverage and convenience. If cost is your biggest 
driver, then look for the plan that has the lowest cost. That is pretty 
easy to do if you have got a computer and can go to Medicare.gov and 
scroll through the various computer screens of the plans out there.
  In my State in Texas, there were some 48 different plans and 
combinations of plans that were available, but it is pretty easy to 
pick out the ones that are the lowest cost. If cost was the main 
driver, that is what I would encourage people to do, and then focus in 
on those three or four that were the lowest-cost plans.
  If coverage was the main driver, there was a column devoted to 
coverage as well. You can certainly pick and choose from plans that 
covered 95, 98 percent or even 100 percent of the drugs in the Medicare 
formula.
  Finally, convenience. If you want to use mail order, make sure that 
the program that you are looking at conforms to that expectation. If 
you want to use the Wal-Mart pharmacy, if you want to use the mom-and-
pop drugstore down on the corner, make certain that that dispensing 
entity is available on the drug plan.
  But by focusing on cost, coverage and convenience, then this rather 
daunting prospect of looking at 48 different drug plans became a whole 
lot easier.
  Remember, Mr. Speaker, when we passed the Medicare drug prescription 
program, the idea was with the finite number of dollars we had 
available we were going to cover the people most in need. That meant 
the people who had the most trouble with illness, who were on the most 
medications, and those people who were the least well off. The sickest 
and the poorest received the greatest amount of help from the Medicare 
prescription drug program. And that indeed has been borne out. But of 
necessity, those of us who are more well off or perhaps not as ill will 
find ourselves exposed to some expenditure for prescription drugs in 
the so-called coverage gap.
  Well, 92 percent of the people who signed up for Medicare are not 
affected by the coverage gap. That is, 45 percent of all Medicare 
beneficiaries will be eligible. Some fall into a category where they 
are eligible for low-income subsidies and therefore not affected by the 
gap. They have annual drug expenditures well below the $2,250 level and 
will never reach the gap, or they have chosen an enhanced Part D plan 
that provides some coverage in the coverage gap. An additional 47 
percent have prescription drug coverage from plans outside of Part D, 
government plans, veterans plans or another Federal program, or an 
employer-sponsored program. Or there are those 9 percent who just said, 
I don't get sick, I don't need drugs, I don't take drugs, and I am not 
going to sign up. Forty-seven percent of Americans fall into that 
group. So 92 percent of people will never be affected by the coverage 
gap.
  But of those 8 percent who are, and this is the most important part, 
they need to concentrate on one of the enhanced plans when the open 
enrollment period comes up on the 15th of November.
  Every Medicare beneficiary, every single Medicare beneficiary, 100 
percent are covered for catastrophic.
  What I would like to do with the balance of the time is to focus on 
the individuals who would benefit from being on an enhanced drug 
program.
  Mr. Speaker, I have just taken a random page from some of the plans 
that are available in my State of Texas. This is what will appear on 
someone's computer screen. You have the company name, the plan name, 
monthly drug premium, the annual deductible, the cost-sharing coverage 
in the gap, the formulary percentage of drugs covered, and a checkmark 
for whether or not someone is enrolled in that plan.
  If the plan you are in leaves you exposed in the coverage gap, I 
encourage people to go back to the computer screen or have their 
grandchild go to the computer for them and scroll through the plans 
available.
  If you look down, Mr. Speaker, you will find that some of the plans, 
albeit they are more expensive from the standpoint of the monthly 
premium, but look, here is one with a zero dollar annual deductible. 
Yes, it has some cost sharing, between $2 and $40. Coverage in the gap, 
yes. Generic only, but

[[Page 18791]]

if a person is on a blood pressure medicine, cholesterol-lowering 
medication or reflux medication, this may be a very valuable plan. And 
then the one right below it, again no deductible, but generic and 
branded.
  This is the type of coverage someone needs to focus on if they found 
themselves having the expenditures in the so-called coverage gap.

                          ____________________