[Congressional Record (Bound Edition), Volume 152 (2006), Part 4]
[Senate]
[Pages 4390-4396]
[From the U.S. Government Publishing Office, www.gpo.gov]




                  MEDICARE'S PRESCRIPTION DRUG BENEFIT

  The SPEAKER pro tempore. 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 am proud to be here this evening doing 
this special hour of the Republican majority talking about a great 
success story, and that is the implementation, after a 40-year wait, 
literally, of a benefit under Medicare that our seniors have been 
promised by other administrations, by other Congresses. And finally 
this President, this administration and this Congress, this Republican 
majority, has delivered on the promise to bring a prescription drug 
benefit to our needy seniors.
  I will be joined this evening during this hour by a few of my 
colleagues on this side of the aisle, the gentleman from Minnesota (Mr. 
Kline) and the gentleman from the great State of Texas (Mr. Burgess), a 
fellow OB/GYN.
  But I want to start out talking a little bit about this program and 
why I think it is so beneficial. My colleagues know that in my prior 
life, as recently as 4 years ago, in fact, before getting elected to 
the Congress, I practiced medicine for 30 years. I was there really at 
the infancy of the Medicare program. I was a freshman medical student 
in 1965 when an amendment to the Social Security Act that is the 
original Medicare was signed into law by Lyndon Baines Johnson.
  Something that many people do not know about Medicare part A and part 
B, part B being the optional part, just as part D is, seniors were 
going to have to pay a monthly premium. The very person, the very first 
senior to exercise his option to sign up for part B was none other than 
President Harry S. Truman. If you go to my Web site, you can actually 
see the film clip in black and white.
  I like black and white, which says something about my age and 
television and movies. It is very interesting.
  When you look back at that program today, and we are talking about a 
40-year history, I think most people would say Medicare has been a 
great, great benefit. I think all of my colleagues would agree with 
that, part A and part B, even the optional part B. And over the years, 
of course, that monthly premium has increased to $88.50 a month today, 
and I think it was something like $15 a month in 1965, but it is still 
a deal. It is a good deal because the seniors taking that money 
probably out of their Social Security check are only actually paying 25 
percent of the true cost of part B; 75 percent of it is paid by the 
general taxpayer.
  Again, it is an optional program, but I think today I am right in 
these statistics, 98 percent of seniors when they turn 65, on that 
other voluntary part, part B, the doctor part, the surgery part, the 
outpatient testing part and physical exams, have opted in and certainly 
not opted out.
  So here we are now finally with a great addition to the Medicare 
benefit for our seniors. We passed it, we all remember. We have some 
complaints still from the other side of the aisle that we passed it in 
the middle of the night. Doing things in the middle of the night in my 
profession as an obstetrician is quite routine. You either admit 
patients in labor in the middle of the night and deliver them in the 
daytime; or your admit them in labor in the daytime and deliver them at 
night. I would like to feel as a Member of Congress that I am not 
immune to a 24-hour schedule.
  But back in November of 2003 we did pass this. We had the 
transitional program, the Medicare prescription drug discount card that 
was so beneficial to our neediest seniors because it gave them a $600 
credit per year for 2 years. It was actually a year and a half. They 
got $1,200 worth of credit for purchasing prescription drugs if they 
were low income, and many were.
  Now that program has gone away and we are into the insurance program 
and getting very close to the end of the 6-month sign-up period, May 15 
of this year, just a little less than 6 weeks from now.
  I think my colleagues, I wish on both sides of the aisle, but 
certainly those of us on the majority, even though some of us for what 
we felt they felt were legitimate reasons to be in opposition to this, 
yes, somewhat expensive additional program, they are encouraging our 
seniors to take advantage of it.
  I am, as I say, wanting to talk about this program tonight, and we 
will do that as we continue this hour. But I want to, at this time, 
yield the floor to my colleague from Minnesota who has a lot of 
interesting stories to tell about folks in Minnesota, his constituents 
and how they are saving money and eventually how we are saving lives.
  At this time I yield to the gentleman from Minnesota (Mr. Kline).

                              {time}  2000

  Mr. KLINE. I thank the gentleman for yielding and for his bringing 
this issue to the floor tonight and certainly his leadership over these 
months.
  I just wanted to touch on a couple of points. I think it is 
important, as the gentleman from Georgia said, that we recognize there 
was a spirited debate on this bill, and not everyone in this House 
voted for it. There are still people today who think that it was a 
mistake when we added the prescription drug benefit to Medicare.
  But I think the point to my colleagues, and I know that my good 
friend Dr. Gingrey would agree with me, and I hope that senior citizens 
across the country understand that we need to set that debate aside 
right now. We have a law in place that provides a tremendous benefit 
for our senior citizens, particularly our lower-income senior citizens.
  I think that chart that Dr. Gingrey showed that says a total of 27 
million seniors, 27 million seniors now have coverage under Medicare 
Part D, says an awful lot about the acceptance of this program, 
regardless of the heat and the debate that took place when this bill 
was passed.
  I know that we now have registered for the Medicare prescription drug 
plan in Minnesota, in the Second District, 65,000 senior citizens, and 
that is a very, very good thing. We found early on, and I think my 
colleague probably did, that as we moved from the discount cards, which 
I thought were a tremendous benefit themselves, I know that my mother, 
who lives on Social

[[Page 4391]]

Security and Medicare, has saved literally thousands of dollars with 
that interim program. When we moved from those cards to the sign up for 
Medicare Part D there was certainly confusion. Seniors were confused. 
Pharmacists were confused. Doctors were confused. It was not what we 
would call a smooth start.
  Having said that, we have now moved past that rocky start, and 
seniors that have had the chance to look at this understand that it is 
really an important benefit for them.
  We wanted to help, in my office, and I know many of my colleagues did 
this on both sides of the aisle. They held town hall meetings and 
workshops. We chose to have what we call sign-up workshops. We got some 
tremendous support from the Minnesota Board of Aging Senior Linkage 
Line provided volunteers to come and help us, help the senior citizens 
in Minnesota's Second District understand what their options were. We 
advertised the workshops. We had seniors call my office to make an 
appointment to come in for one-on-one counseling. And as these seniors 
came in and they sat down with experienced volunteers and members of my 
staff who have become quite expert on this, and they looked at the 
program that was offered in front of them and they looked at their list 
of medications that they are taking and that the options that were 
there, in case after case after case, they were able to make wise 
choices, and I don't know anyone who came to our workshops who didn't 
leave feeling that they had gotten the information they needed and were 
able to make a wise choice.
  I have some quotes here that I just thought I would share with my 
colleagues here, and I know that Dr. Gingrey can empathize with this, 
and he experienced much of the same, I am sure, when he was working 
with the folks in Georgia. But just a couple of quotes. There is a man 
from Shakopee came to the workshop and he said, quote, ``I got an 
honest comparison and found out the plan I was leaning toward would 
cost twice what I could get. Now I can save $2,000 on a different 
plan.'' That is quite a bit.
  Lady from Eagan said: It was wonderful. I wouldn't have known what to 
do or where to begin without that session. The woman that worked with 
me was very knowledgeable and did all the computer work for me. She 
printed up the nine cheapest prescription drug coverages for me, and I 
can see already that I am going to save $100 a month. I was very, very 
pleased. And so forth.
  Lady from Inver Grove Heights said: They were wonderful. They were 
extremely informative. In 45 minutes, they probably saved 8 hours of 
work and confusion.
  These programs, if you just take the time to sit down with somebody 
who knows what they are doing, it is actually pretty easy to decide 
what plan is best for you. And we have seen that in case after case 
after case. And I very much regret that there are, in fact, some of our 
colleagues who are still perhaps upset over the bill itself and are not 
providing this kind of help and encouragement to the seniors in their 
district.
  I know my mother, as I mentioned before, she was a beneficiary of the 
interim plan with the cards, and now we have got her signed up for this 
Medicare Part D and she is going to save thousands of dollars a year.
  You can save a lot of money, and I hope that our colleagues will help 
the constituents in their districts, the senior citizens, understand 
the value of this program, set aside the bitterness of the debate that 
took place over the bill itself and recognize that this is a tremendous 
benefit, it can save their senior citizens hundreds and sometimes 
thousands of dollars, and help those seniors to sign up.
  I don't know if the gentleman from Georgia is continuing with his 
workshops. I know we are. We have a couple more scheduled next month. 
We are looking at the schedule deadline. May 15 is the deadline for 
signing up for this prescription drug benefit, the Part D, without 
paying a penalty, suffering a penalty. So we are encouraging our 
seniors to sign up. We are scheduling some more of these workshops and 
encouraging them to come. The wonderful volunteers from Senior Linkage 
Line are going to be there to help us again. We hope that every senior 
will take a look at this option and decide whether it is for them or 
not. If they have any questions, we would love to help. I will yield 
back to the gentleman from Georgia here. I know that he has spent a lot 
of time helping seniors in his district in much the same way.
  Mr. GINGREY. Well, if the gentleman would yield.
  Mr. KLINE. I am happy to yield.
  Mr. GINGREY. Actually, just for a question. And I wanted to ask the 
question, if he has had an experience really similar to what I have. We 
have been working on this program, like I say, for a year and half 
during the transitional phase, and Representative Kline has held a lot 
of town hall meetings; I have certainly held a lot of town hall 
meetings. You sort of lose count after a while.
  But what I wanted to ask Mr. Kline, Colonel Kline, is, in your 
experience, when you first started doing these programs, and there was 
so much angst and rhetoric and doom and gloom possibly from certain 
Members of the body, did you feel that what you heard then and what you 
are hearing now was a little bit different? Has that changed a little 
bit?
  Mr. KLINE. If the gentleman would yield. I think it is fair to say 
so. We took a different approach in how we were going to reach out to 
the seniors. We sent them mail to alert them to what they were doing. 
We invited them to call our office and make appointments so they could 
get that one-on-one attention. But I am sure the gentleman will agree 
that back in January and early February, when there was a great deal of 
confusion, many seniors were afraid to get started. They didn't know 
where to start. And we found that by continually offering the 
opportunity for seniors to come in and get one-on-one help, that we 
moved through that. And I know that the gentleman from Georgia and most 
of my colleagues who have been working on this issue for some time have 
seen a change in the understanding and the attitude of not just 
seniors, but I think many of us who are at that stage in life where we 
are helping to take care of seniors.
  You know, the gentleman from Georgia, I don't know if he has 
advertised what his age is. It is a matter of public record, as you 
know. But those of us that are in our 50s, many of us are in the 
position of having parents who are not as able to take care of 
themselves, and we are anxious to make sure that we are providing the 
best for them. And so I found that not just the seniors, but a lot of 
times, their children, I hesitate to think of myself as a child 
anymore, but those people who are responsible for the health care for 
their parents and elderly relatives have also come to understand that, 
with just a little bit of attention to this, it has proven to be a very 
good program that can save them hundreds and sometimes thousands of 
dollars. And I know that Dr. Gingrey knows that not only is it saving 
individuals money, but this whole process, the competition in this 
process, which was hotly debated and much discussed, has actually 
started to drive down the cost of those prescription drugs and the cost 
of the whole program to the taxpayer. So we are seeing competition work 
in the large scheme of things, a sort of macro economics. But we are 
also seeing a payoff in these examples that I read from constituents in 
my district of where it is helping the individual seniors, the elderly 
couple and those who are helping to take care of them. So a change in 
attitude, I think we are seeing everybody who has come to our workshop, 
whether they have signed up on the spot or just taken the information 
and gone home, has left very relieved that this is a program that can 
help them, and it is not nearly as scary as they thought a few months 
ago. And I will yield back to the gentleman.
  Mr. GINGREY. I thank the gentleman. And that really is an experience, 
Mr. Speaker and my fellow colleagues, that I have had as well. Early 
on, we, almost every town hall meeting on the subject it seemed like 
there was someone there that was reading the

[[Page 4392]]

talking points from the opposition in regard to oh, you know, you have 
done nothing but let the pharmaceutical industry write a bill, or this 
is just a giant giveaway to the drug companies. And you heard that kind 
of rhetoric almost every time. But what I am hearing, and I think 
Representative Kline as well, that people now understand that in this 
process that we go through, nothing that we do, no bill, Mr. Speaker, 
is perfect. I wish that it were. But that the product that we delivered 
in November of 2003 is a very, very good product, and our seniors are 
beginning to understand that. They are seeing through a lot of this 
negative rhetoric, mostly from the other side of the aisle. And what is 
said is they are even in the last throes of the implementation of this 
program, we are down to the last 5 or 6 weeks, it is my understanding, 
and I know this because I have actually seen this, Members are holding 
town hall meetings and in some instances discouraging people, 
continuing to discourage them.
  Mr. KLINE. If the gentleman would yield.
  Mr. GINGREY. I will be happy to yield to the gentleman from 
Minnesota.
  Mr. KLINE. I thank the gentleman for yielding. You know I find that 
absolutely remarkable. I was just thinking, I could not help but smile 
to myself when the gentleman was pointing out that there is no such 
thing as a perfect bill. And I would argue that many times there is a 
perfect bill. It is perfect to me, but it is not perfect to my 
colleagues on the other side of the aisle, or I dare say sometimes not 
even to the gentleman from Georgia and vice versa. So we work these 
things out. We try to do the very best we can. Every large bill is 
going to have a flaw in it from one of our perspectives. There are some 
flaws in this bill from my perspective and I am sure from the 
gentleman's and from our colleagues. But I think what is very 
important, that we all understand, that our constituents understand and 
that our colleagues here understand is that debate is for now behind 
us. What we have now is the opportunity, with a deadline of May 15, for 
our constituents to see what is available to them and see if it can't 
save them money. And we are seeing in case after case after case of the 
now hundreds of people in Minnesota's Second District that it can save 
them money. It is saving them money. And if you are discouraging one of 
your constituents from looking into this program because you are 
unhappy with the bill, I would argue that you are doing them a great 
disservice. And I would argue that you are not doing your job as their 
Member of Congress because that debate may come again another day. 
There will no doubt be changes in Medicare legislation as we go down 
the road. But for now, it is very important that we set that acrimony 
aside and make sure that our constituents know that they have a program 
here that can save them an awful lot of money. And I will be happy to 
yield back.
  Mr. GINGREY. If the gentleman would yield. And the gentleman said, 
you know, doing your job, and that is exactly what we should be doing. 
In fact, I think what we are hearing from the other side as they 
continue to oppose everything that this majority has tried to do in the 
109th Congress, and of course the rhetoric gets worse and worse as we 
approach November, and we all know it is an election year. But it is 
not only, I think, not doing your job for your constituents, but it is 
kind of like one of my favorite Garth Brooks songs, it's shameless. It 
is absolutely shameless to think that someone would hold a town hall 
meeting and discourage, as the gentleman from Minnesota said, seniors 
from signing up for something that is going to save everybody some 
money, but it is an absolute Godsend to those of our seniors who are 
low income, low assets, the very neediest in our society. And I think 
most of the legislation that we try to pass, and I think the attitude 
should be the same whether we are Republicans or Democrats, is to try 
to help those in the greatest need who really can't help themselves 
through no fault of their own.

                              {time}  2015

  We need to put some wind beneath their wings to kind of uplift them.
  And I know there may be a few in the gentleman from Minnesota's 
district and I know there are some in the 11th of Georgia who still 
need to get the message, and maybe they do not know and they do not 
realize. They have not gone to the Social Security Web site and found 
out that they qualify because their income is only $14,450, or if they 
are married, $19,250 a year; and they do not have assets worth more 
than $11,500 if they are single, or $23,000 if they are married.
  We need to get them signed up, and I know the gentleman would agree 
with me on that.
  Mr. KLINE. If the gentleman would yield, I think that is an excellent 
point. We sometimes forget that when we passed that bill, the one we 
have been discussing which was debated with some spirit, it was 
designed, it was designed to help seniors who are low income first; and 
I think that the implementation of this part D is showing that to be 
true. When we have low-income seniors come to one of our workshops and 
they are taking sometimes a passel of prescription drugs, they are 
saving thousands of dollars. That is what the bill was designed to do.
  I remember a lot of the debate and discussion, and we talked about 
seniors who were forced into the terrible position of choosing whether 
to take a prescription drug or having the next meal or paying rent or 
perhaps arbitrarily choosing to cut their tablets in half. This part D 
for low-income seniors removes that. There is no low-income senior who 
should not be getting their prescription drugs with tremendous savings, 
virtually free in some cases, but saving lots and lots of money.
  What we are finding very interesting is that there are thousands of 
middle-income seniors who, when they come to our workshop and look at 
the choices and they sit in front of that computer terminal where you 
can very quickly rate the different choices, they are seeing that they 
can save an awful lot of money and it is to their benefit.
  If it is not to their benefit, certainly they can choose some other 
form. Perhaps they have private insurance or they have VA benefits or 
something. It may not be for them. But many are finding out that they 
can save money.
  And so it goes back to the point the gentleman was making earlier. It 
is incumbent upon all of us, certainly the administration; some 
organizations like the AARP are working very hard to get this word out, 
and Members of Congress, our colleagues, to make sure that the citizens 
know that this is something that they ought to investigate.
  And I know that we found early on and even last year when we were 
looking at the interim discount card that there are seniors who are not 
comfortable, frankly, sitting in front of a computer and going on line. 
Many are and I am always very heartened to see that. Some of them, in 
fact, are much more computer literate than I am. But in many cases they 
are intimidated, and that is why it is important that this help be 
offered to them, either in one of our workshops or yours, or there are 
other ways that you can get help.
  Medicare, CMS itself, will be happy to provide help. Seniors can call 
1-800-Medicare. There are ways that they can get help without having a 
computer and without having to sit down by themselves and try to figure 
this out.
  So I encourage all of my colleagues to do everything they can to make 
sure that their constituents, their senior citizens, know that even if 
they are not low income, this is a program they ought to investigate.
  Mr. GINGREY. I appreciate the gentleman's being with me tonight 
describing this program in greater detail.
  I wanted to point out a couple of slides based on the information 
that he just gave us, and hopefully he can continue to be with us for a 
little while longer in this time. But Representative Kline was talking 
about the fact that it is certainly not just beneficial to the low-
income seniors. We know that they get the greatest benefit. But 
certainly

[[Page 4393]]

a lot of middle-income seniors have no coverage under Medicare. They 
have part A and part B, but they have no prescription drug coverage. 
They may even have a Medigap policy that fills in the deductibles and 
the copay for part A and part B, but does not have a prescription drug 
part.
  And I wanted to point out in this slide to my colleagues, Medicare 
part D helps working Americans. In fact, half of women on Medicare 
without drug coverage are middle income. That is represented here on 
the right, and these people are above 150 percent of the Federal 
poverty level. They are not going to qualify for any low-income 
supplement.
  But this program, my mom is in this category, and on average we are 
talking almost a 50 percent savings on the cost of their prescription 
drugs. And so that is why it is important for people to understand that 
while the benefit for the lowest-income seniors is the greatest, and 
Representative Kline mentioned that, in many of those instances the 
only payment is a little copay for a prescription drug, maybe $1 if it 
is generic or possibly up to $5 if it is a brand name.
  If their doctor feels that they, for some particular reason, need to 
be on that brand name, or if there is no generic equivalent available, 
Medicare, the insurance program, the part D covers the deductible. It 
covers the monthly premium. It covers the copay of the first $22,050. 
And guess what. There is no doughnut hole. There is no lack of coverage 
at any point for those neediest seniors.
  But it is important that our colleagues understand this and also 
understand that even the seniors who get no supplement because maybe 
their income is a little bit higher, as I say, my mom, Mr. Speaker, 
Helen Gannon Gingrey, 88 years old, she is going to be mad at me, Mr. 
Speaker, for telling her age, but if you could see her, you would never 
guess. She is young at heart and very energetic and yet was spending 
$4,000 or $5,000 a year out of pocket to purchase about five 
prescription drugs. And I was able to work with her and, as Congressman 
Kline says, together we were able to go through the www.medicare.gov 
Web site, and Mom today is saving about $1,100 a year, and that really 
means a lot to her.
  I wanted to also point out, Mr. Speaker, in this slide, this kind of 
gives a breakdown of how our seniors paid for prescription drugs before 
part D. We are talking about 41 million, about 41 million, and maybe 6 
million of those are people under 65 that are on Medicare because of a 
disability, but this is the population we are talking about, and I 
think this slide is so instructive to show, before this program, what 
was happening.
  Now, my mom, Helen Gingrey, was in this group of something like 40 
percent of these 41 million seniors who were paying for prescription 
drugs out of their own pocket, and that is really the population that 
we are trying to address. And I would say a third of this group, a 
third of this 40 percent, are the low income, the ones for whom this 
program is an absolute Godsend.
  Now, as we were talking earlier, some people in their Medigap policy 
also have prescription drug coverage, and that amounted to about 3 
percent. Employment-based plans, 26 percent. Now, we are talking about 
retirees, people who have worked for a company, a big company, a small 
company, but a company that has not reneged on their promise, as a 
retirement benefit, to provide health care with prescription drug 
coverage. And as part of this program, we built in an incentive to 
those companies to encourage them to continue to provide health care 
for their retirees, in many cases who have worked for the company 30 or 
40 years, who had earned this benefit, and to encourage them to 
continue it and continue the prescription drug coverage. So about 26 
percent were in that category.
  Medicaid, 12 percent; they will all now be covered under this 
Medicare part D.
  State-based programs and other sources, 6 percent.
  But this is pretty much how it breaks down. And as we get closer to 
that sign-up deadline without paying a penalty, Mr. Speaker, beyond May 
15, we do not want that to happen, and I would hope our colleagues on 
the Democratic side would join us in the majority in the realization 
that to discourage is a dreadful thing, of course, for those who are 
going to literally get the benefit with minimal, if any, cost, but 
those who have to pay the monthly premium, which is quite a number, to 
discourage them and then have them get beyond that May 15 deadline, and 
then all of a sudden they realize that they have been fed a bill of 
goods and some bad information and then they hurriedly sign up, but 
they fall into that penalty phase. That is something that we do not 
want to happen. I do not think Members on either side of the aisle want 
that to happen, and I hope that we will work toward this goal.
  I see, Mr. Speaker, that we have been joined by another of my 
colleagues. I mentioned him at the outset of the hour, and that is the 
gentleman from Texas, not only my colleague in this great body, the 
House of Representatives but also a fellow physician and a fellow OB/
GYN specialist, Dr. Mike Burgess.
  I would like to yield to him at this time.
  Mr. BURGESS. Mr. Speaker, I thank the gentleman for yielding.
  I am sure my colleagues have pointed out tonight we have less than 60 
days left on the open enrollment period for the Medicare prescription 
drug enrollment plan, and we were informed this morning that they have 
currently signed up 28 million people on the Medicare prescription drug 
plans.
  When this started last November 15, the target sign-up was 30 
million. So, Mr. Speaker, it seems pretty likely that CMS is going to 
meet that target or likely exceed that target.
  Just to carry on with numbers a little bit more, there are 42 million 
senior Americans enrolled in Medicare. Six million of those have 
coverage from other sources such as the VA or a private retiree plan. 
If 28 million are covered in the new Medicare prescription drug 
benefit, that leaves about 7 or 8 million left that is the target 
population that we really want to reach over the next 60 days. Half of 
those individuals are, in fact, low income who will receive a 
significant benefit from the Medicare prescription drug plan.
  Well, a big question that has come up certainly on the floor of this 
House and in some of the newspaper articles you read is, is the benefit 
worthwhile? Well, the average Medicare recipient will see a 55 percent 
savings on their prescription drug bill or about $1,100 a year. That is 
the typical amount. For a senior who is low income, that savings may be 
more in line with $3,700 a year because of the extra help that someone 
who is low income will receive.
  We have had a lot of negative publicity about the Medicare plan, but 
the fact of the matter is that as people investigate this plan and sign 
up for it, the number of problems markedly decrease. Those without 
coverage currently, the 7 to 8 million, are the target groups that we 
want to reach over the next 60 days.
  There are going to be a number of events that I will be doing back in 
my district. In fact, I think the President is scheduled to do several 
events around the country over the next couple of weeks to help get 
people focused on this.
  And one consideration for someone who has kind of been sitting on the 
sidelines and wondering whether or not to sign up, there was a lot of 
pressure on the sign-up right after the first of the year when a lot of 
people showed up to enroll in the Medicare prescription drug plan, and 
there was some confusion and there were some hurt feelings. But bear in 
mind there will be additional pressure as we get to that May 15 date.
  So do yourself a favor. Do the work required to investigate what plan 
would be best for you and try to make that sign-up occur during the 
month of April and do not leave it until the last minute when there may 
be additional pressure on the system that will tax computer systems and 
tax phone lines. Do not put yourself in that position. Do not wait 
until the night before the test to start studying.

[[Page 4394]]



                              {time}  2030

  Early this year in August through my district, Secretary Leavitt and 
Administrator McClellan came to town in the Medicare bus. We had a big 
event at one of my hospitals. Some people came out, but it was hard to 
generate much interest or enthusiasm. But people were a little bit 
curious about what was going on.
  During the fall we heard about the fact that the people were confused 
because there was too much choice associated with the plan, and I think 
that has now evolved into genuine enthusiasm for what this plan may 
provide the seniors of America.
  Pharmacists are of special consideration, particularly the community 
pharmacists. There have been some issues that the pharmacists have had 
to deal with that perhaps weren't anticipated at that time, front end 
of Medicare. I think it is incumbent upon us, as Members of Congress, 
and the pharmacists, community pharmacists who are constituents, to 
help the Medicare plans realize that the distributive network that the 
community pharmacist provides for the Medicare beneficiary is extremely 
valuable; and they do need to work together so that those community 
pharmacists are able to continue to provide the benefit for Medicare 
recipients and Medicare beneficiaries.
  Clearly, the community pharmacist has value added, particularly in 
rural communities, and I know this to be true in many areas of west 
Texas, just west of where I am from.
  Mr. GINGREY. If the gentleman would yield.
  Mr. BURGESS. Yes, sir.
  Mr. GINGREY. Because I wanted to ask the gentleman on that point 
about the independent pharmacists, what we call the corner druggists 
back in Georgia and maybe also in Texas. I would love for the gentleman 
maybe to elaborate a little bit on some of the concerns that I know a 
lot of the Members have heard from the community. Independent 
pharmacists, not the big chain, but the moms and pops, if you will, God 
bless them, have some concerns and have had some concerns, and we have 
been talking about that.
  In fact, as the gentleman knows, Mr. Speaker, just this morning, we 
had conversations with Secretary Leavitt and Dr. Mark McClellan, the 
director of CMS. They are aware of these concerns, and we may want to 
discuss that for a moment or two and how we plan to continue to work 
really closely with those corner druggists that a lot of our patients 
call, they call them ``doctor''----
  Mr. BURGESS. Yes.
  Mr. GINGREY. Because of the work they do.
  Mr. BURGESS. That is a good point. We had a hearing on the Energy and 
Commerce Committee about this issue just a couple of weeks ago. I asked 
the Secretary, I asked the Administrator to consider having a follow-up 
hearing in our community when we get to the first week of May. I hope 
there will be time to do that. This is an issue in which we need to be 
sensitive.
  To be certain, no one person on this planet is irreplaceable. If the 
only place to get drugs turns out, the only place to get prescription 
drug benefit turns out to be the mail order, well, people will 
accommodate to that. We will lose value if we lose the corner 
pharmacist, we lose the corner druggist. They do provide so much in the 
way of expertise and guidance, even to the point of being concerned 
whether or not the patients are actually taking the medicine, which has 
been dispensed, always being certain that they get the right medication 
dispensed in the right dosage.
  It does become difficult for these small businessmen to maintain 
their businesses when the accounts receivable stream has been disrupted 
a bit, as it was when we made the switch to the Medicare prescription 
drug benefit.
  But as these problems work out, as the accounts receivable stream 
accommodates to that change, I am hopeful that a good many of these 
pharmacists, in fact, I have had phone calls from some who explain the 
difficulties they are encountering, but also always will end up with 
the comment that I feel like this is a good plan. If you give it time 
to work, and if you work with us and help us, this is going to be a 
good deal for our patients and for your constituents.
  I did want to point out some of the things that were happening in 
Texas. I know Texas is not unique, but it is a big State, and there are 
a good number of Medicare beneficiaries, about 2.5 million out of the 
43 million Medicare beneficiaries do live in Texas.
  The standard benefit that we are all aware of here, that is provided 
for by law, the law that we passed 12 years ago, includes a $250 
deductible, 75 percent coverage up to $2,250 annually, and catastrophic 
coverage, 95 percent, paid above $3,600 per year for out-of-pocket drug 
costs. That is not the end of the story.
  One of the things that we were criticized for 2 weeks ago, or 2 years 
ago when we passed the bill was, no drug company is going to come in 
and sign up to provide this prescription drug benefit. It will, by 
default, become a Federal system. But the reality is, we have got 47 
plans in Texas.
  In those 47 plans, when you look at how much drugs cost, those that 
are just stand-alone prescription drug plans, there are 47 of them in 
Texas, on average the monthly premium is $37, 12 plans, only one-
quarter cost less than $30 per month.
  Of those prescription drug plans that are associated with a Medicare 
Advantage or a Medicare Plus Choice account, those beneficiaries may 
choose among 64 Medicare Advantage plans with prescription drug 
coverage. On average, the drug, the monthly drug premium is $19.44. 
Nineteen plans could not charge any additional premium for drug 
coverage for people who are receiving their Medicare on one of those 
Medicare Advantage plans.
  To sum up, the average premium is $37 a month, but drops to $19 a 
month for patients on Medicare Advantage and prescription drug plans. 
Of those patients that are just on a prescription drug plan, if they 
take a plan with no deductible, their monthly out-of-pocket expense is 
going to be $40. If they have a $250 deductible, their average monthly 
out-of-pocket expense is under $30.
  One of the things that I have stressed when I have done these events 
in my district, when people tell me that they have trouble making 
choices because there are too many choices, try to separate the plans 
and look at it from the standpoint of cost, coverage and convenience. 
Know the drugs that you are taking.
  This is very important. Before anyone calls any of the Medicare 
hotlines or goes online to try to decide what drug coverage they need, 
they need to know what drugs they are on and the dosage and the dosage 
schedule. It doesn't do any good to purchase a Medicare prescription 
drug plan that doesn't cover the medicines that you are taking.
  My colleague and I heard this morning from another Member that for a 
husband and wife who are both on prescription drugs, but not 
necessarily on the same prescription drugs, what is a good plan for the 
one spouse may not be a good plan for the other spouse. Each spouse 
needs to look at that individually. In this situation, it is not 
necessary nor sometimes even desirable for both to buy the same plan.
  Mr. GINGREY. If the gentleman would yield.
  Mr. BURGESS. Yes, be happy to yield, my friend.
  Mr. GINGREY. I would point out that although a couple, for the 
reasons that you just so clearly explained, might have signed up for 
different prescription drug plans, they can get their medication filled 
at the same pharmacy.
  Mr. BURGESS. That brings up the convenience part of that formula that 
I was talking about. If you wish to get your drugs through the mail 
order house, by all means make that selection. But if you wish to get a 
prescription at your chain drugstore, that decision can be made at the 
time you sign up.
  If you wish to receive it from the corner druggist, from the 
community pharmacist, you can cost compare what would be the best deal 
or what

[[Page 4395]]

would be the best price for that individual consumer. Again, it may be 
different for a husband and wife, if they are, indeed, on different 
medicines.
  Also, look at the coverage, look at the lists of what medicines are 
covered under that drug plan. In Texas, for example, our first-tier 
plans cover, on average, 730 drugs on the first tier and 399 drugs on 
the second tier. That means, on average, the plans in Texas cover over 
1,100 different drugs in the plans.
  But look at the plan to be certain that the medicines that you are on 
are, in fact, covered, because that is going to create difficulties if 
your particular medicine is not covered on the drug plan that you 
select.
  Finally, I do want people to remember that this is a little bit 
different from standard Medicare in that this plan, this prescription 
drug program, is not an entitlement. It is insurance. It is insurance 
with premium support. This is exactly what was recommended by the 
commission that was set up under President Clinton in the 1990s, 
premium price support and insurance coverage, rather than a pure 
entitlement. I have heard from some of my constituents, who are 
concerned that the cost will go up if they miss the deadline.
  Well, that is true, but that would happen with regular insurance as 
well. Please approach this as insurance coverage and price it as 
insurance coverage and recognize that what the Federal Government is 
bringing to the table is price support for that premium. The premium 
will not be as high as it otherwise would be if Medicare were not a 
participant.
  Well, the gentleman from Georgia has been very generous with his 
time. I am not sure what time remains with the hour. I will be happy to 
stay and participate if he would like me to, but I have pretty much 
concluded the remarks that I had prepared to say this evening.
  Mr. GINGREY. I thank the gentleman. I hope he can stay. We may be 
able to engage in a little bit of a colloquy on some of these points. 
But in any regard, I thank the gentleman so much for his tireless 
insight and his understanding, of course, as a physician in making sure 
that our seniors get the right information so that they do get signed 
up.
  He was talking a few minutes ago about the couple where the husband 
and the wife may have signed up, need to sign up, really, for a 
different prescription drug plan because they are on different drugs. 
But the fact that they can go to that same, same pharmacist, maybe it 
is a corner druggist in their neighborhood, right down the street, I 
mean, it could be Corley's Pharmacy in La Grange, Georgia. It could be 
Kim Curl's drugstore up in Hiram in Paulding County, or Steve Wilson's 
Carter drugstore in Smyrna, Georgia. All of these wonderful independent 
pharmacists are in my district, and I know the gentleman, Dr. Burgess 
from Texas, has a similar situation.
  You know, I think it is so important, as we do approach this deadline 
for signing up without a penalty, that our colleagues understand that. 
There was a lot of effort, I think, almost as much effort on the side 
of resistance as has been on the side of encouragement. I think the 
encouragement has won out, is continuing to win out over resistance and 
negativity. But we need to work toward achieving a goal of a full 
implementation of this program.
  But here are the encouraging statistics, while the program, as Dr. 
Burgess said, may have started out a little slow, as people were 
confused by all of the political rhetoric that was going on, as of last 
week, Mr. Speaker, as of last week 27 million seniors now have 
prescription drug coverage under Medicare.
  Now, when you think about the fact that we are talking about a 
population of about 41 million, and 27 million now have this coverage 
under Medicare, and probably 8 million or so, 8 or 12 million, even of 
those that are not signed up, they already have something. They already 
have, if they are veterans, TRICARE, TRICARE For Life; if they are 
retired Federal employees, if they have a prescription drug coverage 
under the Federal health benefit plan; same thing with State retired 
teachers.
  We are getting pretty darn close to 100 percent implementation. In 
fact, signing up 380,000 new beneficiaries each week, and 1.9 million 
additional beneficiaries have signed up for prescription drug coverage 
since mid-February. This represents a 25 percent increase over last 
month and the number of people who have selected a plan.
  A lot of our opposition has said over and over, well, new people are 
not signing up, this is just automatic enrollment for the dual 
eligibles, the low-income seniors who have both Medicare and Medicaid. 
Well, that is absolutely not true.

                              {time}  2045

  Of the 27 million who have signed up, 7.2 million are folks that are 
not low income, and they had no prescription drug coverage so we are 
getting there. And as I say, we are going to continue to work right up 
until the last day, May 15, 2006.
  Now, our colleagues on the other side of the aisle, Mr. Speaker, are 
trying to make political hay in saying that we ought to extend that 
deadline. We ought to push it out another 6 months, but in a way, that 
is just a cruel hoax because the longer we delay, the longer our needy 
seniors delay, the more they are either not going to get that 
supplemental help that they are eligible for, for if they are not 
eligible for supplemental help because of their income, they are going 
to continue to pay sticker price for their prescription drugs, more 
than anybody else in our population.
  These younger people that are covered under an HMO or possibly an 
insurance company that has negotiated a low price, they get the 
discount; and that has been part of the problem, Mr. Speaker, why it is 
so important that we do this program. It is so unfair for our seniors 
to have to pay more than anybody else. So we want to encourage them, 
and I hope my colleagues on both sides of the aisle will continue to do 
that.
  Mr. BURGESS. Mr. Speaker, one of the things that I find really 
exciting about the Medicare Advantage Plus Prescription Drug Coverage 
those plans, many of them do away with the so-called gap in coverage 
that occurs above expenditures of $2,250 up until you get to that upper 
limit of $3,600 whatever it is.
  Obviously, as a clinician, and the gentleman from Georgia knows this, 
you don't want your patient stopping and starting their medication as 
the coverage becomes available and then perhaps they move into the 
interim period or the gap period where the coverage would not be 
available, and they just decide to not buy their medicine again. But 
many of the plans in Texas I have noted will eliminate that gap in 
coverage so long as the patient is willing to accept the issuance of a 
generic medication. And I think that is one of the really exciting 
things about this. It gives the patient an incentive to consider or try 
a generic medication which is going to cost the government less and the 
health plan less. It provides them their medicine throughout the year 
with no break in their medication, and that is what this program is all 
about when you get down to it.
  Gone are the days where we just want to treat things where the crisis 
happens. Timely treatment of disease, access to prescription drugs, 
access to preventative therapy, this is the Medicare of the 21st 
century. Not in the hospital for the pneumonia, in the hospital for the 
surgery, in the hospital for the pancreatitis or the uncorrected 
elevated blood lipids or any of these things that would have caused 
problems in the past. Prevent those. Maintain to that person's health 
throughout the year, and it is going to cost us less.
  In fact, we found some cost savings just with the competition part on 
the prescription drug plan. We will begin to see the cost savings from 
the timely treatment of disease and providing prescription drugs to 
prevent the catastrophic events of untreated chronic disease will begin 
to reap those benefits 2 years, 3 years, 4 years, 5 years from now. And 
I for one will be anxiously awaiting hearing about those savings.
  Mr. GINGREY. Mr. Speaker, I thank him for bringing that up because it 
is

[[Page 4396]]

so important. A lot of the concern over this Medicare part D addition 
was the cost. And some Members on our side of the aisle, fiscal 
conservatives, and I understand that, voted against the prescription 
drug part D because they did not think we could afford it. Some of our 
friends on the other side of the aisle voted against it because they 
did not think we were doing enough. And, of course, if we had done more 
and there was no doughnut hole, then it would have cost, who knows, $3 
trillion maybe instead of the estimated $750 billion over 10 years.
  But Dr. Burgess brought up an excellent point, Mr. Speaker, and I 
think we need to elaborate on it a bit. Even if it does cost $750 
billion or $75 billion a year over the next ten, what Dr. Burgess is 
saying, Mr. Speaker, you are going to shift costs from part A and part 
B onto part D. So what we are saying is, let's pay for the prescription 
drugs so that we can keep people out of the emergency rooms, off the 
operating table, off of renal dialysis, out of the nursing homes, maybe 
in some instances because they have had a stroke. They did not have the 
medicine to treat the high blood pressure. Now we are paying, either on 
Medicare or Medicaid, 20 years of skilled nursing home care. What a 
false economy that is. It is a compassionate thing to do to shift some 
of that cost from part A to part B.
  I know, Mr. Speaker, we are getting close to the end of the hour and 
I thought that what would be good maybe is to quote some stories. In 
fact, I have one patient from Texas and while the gentleman is still 
here I wanted to give this to our colleagues, this Medicare D success 
story.
  Barbara L. from Kemp, Texas, and Kemp, Texas, is possibly in the 
gentleman's district, but in any regard, it is Texas. In 2005, Barbara 
spent $2,100 on prescription drugs. She enrolled in an AARP Part D 
plan. I know that the support of the AARP, that great senior 
organization, its 35 million members, gives a little angst and 
heartburn to our colleagues on the other side of the aisle that they 
are used to having blanket support from the AARP and all of the sudden 
this great senior organization that is supporting this program and that 
causes them a little discomfort.
  Barbara signed up for a plan that they offered, and in 2006, she 
expects to pay not $2,100 but $360, a total savings of $1,740.
  Listen to what Barbara said: ``I found the drug plan confusing at 
first, but I called Medicare today.'' One of the organizations that is 
helping to explain on a contractual basis the plan. ``I called Medicare 
today, got the information I needed, then I signed up. It is 
glorifying,'' Barbara says. ``I'm beside myself with the drug cost 
savings.''
  Mr. Speaker, Barbara W. from El Mirage, Arizona, I want to give these 
testimonials from across this great country because it is not just 
Texas. It is not just Georgia. It is not just Minnesota. Barbara W. 
from El Mirage, Arizona, had no prescription drug coverage, like my 
mom, spent more than $2,600 a year on medications, wanted an 
inexpensive plan with a low premium. She enrolled in a part D plan 
where the monthly premium was only $6.14 on a monthly basis. In 2006, 
she will save $1,800. Nearly $200 a month. And that is Barbara from the 
great State of Arizona.
  Here is another, Mr. Speaker. Thomas P. from Providence, Rhode 
Island. Thomas is 77 years old, spending more than $3,000 a year on 
prescription drugs. He probably is not low income, didn't have a 
Medigap coverage or not a veteran, and out of his pocket spending 
$3,000 a year. He found out from Social Security that he did qualify 
for extra help with his monthly premium. He did not know it but 
realized that he qualified. Now he expects to spend not $3,000 a year, 
but $400 a year on prescriptions. Do the math. That is a total savings 
of $2,700 a year, and that is not peanuts as they say in Georgia.
  Thomas says, ``It's worth the time to save all that money.'' Indeed.
  I think we are getting close to the witching hour. I had one more 
that I wanted to point out, but, Mr. Speaker, we thank you for the 
opportunity to bring this hour from the majority to explain this 
program. I thank Dr. Burgess. I thank Mr. Kline. And I want to 
encourage my colleagues on both sides of the aisle. Let's support this 
program. Let's give our seniors what they really need. They deserve it, 
and they deserve our support.

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