Mr. President, this debate so far has been very illuminating, in a way fascinating, to see how different Members of the Senate view the bill that is before us. I hope that America's seniors are watching this debate. I hope they are…
Mr. President, this debate so far has been very illuminating, in a way fascinating, to see how different Members of the Senate view the bill that is before us. I hope that America's seniors are watching this debate. I hope they are listening. I hope they will make up their own minds.
There are many groups out there who are going to give their opinions, and I respect them all. But I think if you just go to the debate and you listen to all sides of it, seniors will come up with their own conclusions. As a matter of fact, I also hope people in their fifties and forties are watching this debate because many of the changes that will be made, if this bill becomes law, are going to impact people in their fifties, people in their forties.
Let's face it, Medicare is a program that impacts all families because the children of senior citizens oftentimes bear the burden, if there are health problems. Of course, they care deeply about their families.
We know that Medicare is a nationwide health plan for aged and certain disabled Americans, and it was created 40 years ago for seniors to offer them access to good quality health care. There was a huge debate at that time about whether this was the right thing to do. But people looked around and saw that our seniors were in trouble. They were spending their money on health care, didn't have anything left, oftentimes had to move in with their families. Their families had to pick up their health care bills, and it was very difficult.
This program has fulfilled its promise. Is it perfect in every way? Of course not. What program is? What corporation is? What person is? But Medicare has saved many lives and has made the golden years golden for a lot of our seniors. That is why they feel so strongly about it.
I have been listening to some of the call-in shows. I have heard seniors identify themselves as Republicans, Democrats, and Independents. They are worried about the changes that are about to hit the system, and so am I.
The one thing I think everyone agrees on is that there ought to be a prescription drug benefit. At least I think most of us believe that from both sides of the aisle. We know this cost is heavy on our seniors. We know drug prices are skyrocketing because, unfortunately and very sadly, we don't allow drug reimportation from places like Canada and Mexico, although I have to tell you that in my State, people are going to Mexico.
I received a letter from a constituent of mine from San Marcos, CA, earlier this year. She told me that her annual cost for prescription drugs this year will top $10,000. Think about that, $10,000. How do our seniors deal with this when they are retired?
A retired physician from Marina del Rey told me that a pill he takes for his heart disease went up 600 percent, from $15 a month to $85. For seniors who have to take an assortment of medicines to manage their chronic diseases, the costs really start to add up.
Very sad to say, in this bill there is virtually no cost containment. Even though the House version said reimportation from Canada was a good idea, this has not happened. We will continue to pay the highest drug prices in the world. It is very sad, indeed. The provisions on generic drugs were watered down a bit. We have some in there but not what they should be.
For all the reasons that I talked about--the fact that I feel deep compassion for my constituents who have to pay these huge sums for medicines--I voted for the Senate bill. The Senate bill left here. I thought it made some sense. So let's look at what the Senate bill did for our seniors.
It had about six things that it did that I thought were really important.
First, there was a modest benefit for seniors that were hardest hit by the costly prescription drugs. That benefit was a lot better than the benefit that is currently before us. I will go into the differences. The benefit that is before us is so weak, it barely has a pulse. It is barely worth filling out the forms. It is barely worth your time. You could probably do better if you become friendly with your pharmacy down the road. They will probably give you a better deal.
The benefit before us, unlike the benefit we voted on, is this: If you have $5,100 worth of drug costs, you will pay $4,020 for those drugs. In the meanwhile, you will have to figure out what are your deductibles, what are your copays, filling out the forms, being nervous, getting notified that you no longer have the drug benefit because there is a benefit shutdown, which I will get into later. So think about it. You have a $5,000 drug bill, and you are paying $4,000. And you are going through probably bureaucratic hell to get that thousand dollars off.
So the benefit, when we got the bill, we voted it out. I voted for it. I wanted it. It was a modest benefit but a decent benefit. It was much better than this one. We will get into that later.
Secondly, all seniors were guaranteed a Medicare prescription drug benefit if they didn't have two private plans in their area. So you had a good fallback. If you didn't have two private drug plans competing for your business, could you say: Forget this. I can go to Medicare.
Third, Medicare could have bargained for lower prescription drug costs. Now, why is this important? Just look at the
Veterans' Administration. They can get way lower costs for the drug benefits for their veterans because they represent millions of veterans. Therefore, they have bargaining power. It is not like if I walked into a pharmacy myself and said: Hi, I am a veteran, can you lower my drug prices. And the pharmacist looks at me and says: Well, no. But if I bring millions of people into the store, the pharmacist is going to say: You know, now I can talk to you about some bargain prices.
That is what we have done with the VA. In the original bill that came out of the Senate, Medicare could have bargained. We will talk about the current bill in a minute.
Then, No. 4, there were steps to privatize Medicare, but they were minor steps. They were balanced by a $6 billion sum that was added to Medicare. So while they gave the private plans $6 billion in the Senate bill to ``encourage'' them to stay in the Medicare business, I didn't agree with that. When I think about competition, I don't think about paying people to compete. I didn't think that is what capitalism is. I was a stockbroker. That is news to me. To me competition is what it says. You come in, you see you have a chance to make a profit, and you compete.
Well, we were giving them $6 billion. I wasn't happy about it, but I felt that, all in all, because we balanced it and gave $6 billion to Medicare to add prevention and some other very important benefits, it was worth it.
So just sum that up. I want to be clear here. I supported the Medicare prescription drug bill that was before the Senate because it was a decent benefit for seniors. It gave them about a third off their drugs. So it gave you a third off of your drugs. I thought that was a good benefit. You paid two-thirds and you got a third off. Again, I thought it should have been better. It was modest. I wasn't thrilled with it. I tried to have amendments to close the benefit shutdown, to bring the benefit up to 50 percent, but I did not succeed in that effort.
All seniors were guaranteed a Medicare drug benefit, that fallback, if they didn't have two private drug plans competing. Frankly, I wanted a Medicare fallback for everybody. I remember the debate. But they convinced me to compromise. I wasn't thrilled, but I voted for it. Medicare could have bargained for lower prices for drugs. I assumed that would be part of what we would do. We didn't prohibit it. The steps to privatize Medicare, to incentivize HMOs to stay in the Medicare business, were balanced by $6 billion added to Medicare for some important new benefits.
The last thing is, for the lowest income seniors, they got prescription drugs at no cost. That was a wonderful thing in the Senate bill. The poorest of the poor people who worked all their lives and found themselves in a horrible situation today would have gotten drugs at no cost. For all those reasons, I was very pleased in the end that I was able to move that bill forward.
I want to show you something I hope you can appreciate, as I hold this bill up for a minute. The bill itself that has now come back to us is very heavy. Here it is. This is the bill that is before us today. This bill I am holding is 678 pages. How much of this is the prescription drug benefit? It is 181 pages. What does that tell you? It tells you that most of this bill has nothing to do with prescription drugs. Think about it. We sent a prescription drug bill into the conference committee to come back to us, and here it is. This yellow tab shows me where it is. This is the prescription drug benefit. It is 181 pages. The balance of this bill is way more, 5 times more.
Think about it. If the folks who brought you this bill were sincere about giving you a prescription drug benefit, why did they then use that as an excuse to begin changing Medicare--changing Medicare in ways that are perplexing, that are going to be difficult to understand, and the rest?
Now, I am not, generally speaking, someone who is paranoid about things. But I have to tell you, I am when I hear Newt Gingrich, praising all 600 pages of this bill, who said in 1995:
Now, we don't get rid of it [Medicare] in round one because
we don't think that that's politically smart, and we don't
think that's the right way to go through a transition. But we
believe Medicare is going to wither on the vine, because we
think people are voluntarily going to leave it.
Voluntarily. If you mess up Medicare and you make it confusing and start doing the things that they do in this bill, Newt Gingrich will be proven right. Why do you think he went over to the caucus on the other side, in the House, and talked to the Republicans who didn't like the bill? Because they thought it was too good to seniors.
He said: No, it is not. Trust me. Would I lead you astray?
That is Newt Gingrich. The senior citizens in this country, in my view, are the smartest of the folks when it comes to Medicare. They know it. They get it. They understand Social Security and they understand Medicare. They understand when Newt Gingrich said that Medicare should ``wither on the vine,'' and that this isn't something they want to see happen.
Well, folks, please listen. ``We don't have to get rid of it in round one,'' Newt said, ``because we don't think it's politically smart.'' So what did they do? They take a prescription drug benefit that is popular--by the way, it is voluntary, but I will talk about that because it is not voluntary if you are on Medicaid, and it is not voluntary when you find out that your pension plan has dropped your prescription drug coverage because then you will have nothing. You will be forced into it. It is not voluntary for those folks.
But I can tell you that this is just what Newt Gingrich planned. You cannot do it all at once. Not in round 1. We have to go through a ``transition.'' Remember that word because it shows up in this bill-- ``transition.'' So here is prescription drugs, and here is the withering on the vine.
A lot of the people who fought Medicare in the beginning are embracing this bill. Do you think they had a change of heart? Do you think those of us who built our careers on protecting seniors have somehow gone wacko on you by saying that this bill does more harm than good? Think about the Senators who are standing up here and extolling the virtues of this bill. One of them was here before and he said that people on the other side are saying we are trying to destroy Medicare. How ridiculous, he said. That's crazy. We would never do that. Then he launched into a harsh criticism of Medicare and how it needs to change.
Another, I thought, belied his point of view when he stood up and said--it is on the record from this afternoon--we need to get away from the ``command and control'' of Medicare.
Well, I have news for the Senator from Texas, who said that. In Medicare, do you know who is in command and control? The senior citizens. That senior citizen can go anywhere--to the doctor of choice. That is the beauty of the Medicare system. They are in command and control.
What this bill does is start the unraveling of that command and control and gives it to a whole new system that is so confusing that I would assure you, when you begin to hear the words and the acronyms associated with this new system, if you went up to any Senator and asked him or her a question about it, not one of them would pass the test of understanding every acronym--not even close. So the Senate bill benefited seniors. What we have before us is quite different.
To me, the saddest thing about this bill is that it turned a modest, but decent, benefit for seniors into an enormous benefit for the largest pharmaceutical companies and HMOs in America. Here is what we have now in the bill. This is what we have now. The bill benefits drug companies and HMOs.
First of all, the bill sets up a slush fund of $14 billion for HMOs. I have to say something here. The deficit that we are facing in our country today is nothing short of an abomination. From the minute this President took over until today, we have seen deficits as far as the eye can see and balanced budgets turn into $500 billion-a-year deficits every year. But the folks in the conference committee found $14 billion to give to those profitable corporations in America. Why do you think that is the case?
There is an article today in the Washington Post that tries to explain it. This is the headline on the front page:
2 Bills Would Benefit Top Bush Fundraisers. Executives'
Companies Could Get Billions.
This is the selling of America. I want to quote from this article.
More than three dozen of President Bush's major fundraisers
are affiliated with companies that stand to benefit from the
passage of two central pieces of the administration's
legislative agenda: the energy and Medicare bills.
We stopped the Energy bill. I don't know how long we will be able to hold that, but the Energy bill is a clear-cut case. We talked about that the other day, and now there is the Medicare bill.
Continuing the quote:
The energy bill provides billions of dollars in benefits to
companies run by at least 22 executives and their spouses who
have qualified as either ``Pioneers'' or ``Rangers''--
That is what they call the big fat cats, Pioneers or Rangers----
as well as to the clients of at least 15 lobbyists and
their spouses who have achieved similar status as
fundraisers. At least 24 Rangers and Pioneers could benefit
from the Medicare bill--
Twenty-four Rangers and Pioneers, and those are the people who give the most money----
could benefit from the Medicare bill as executives of
companies or lobbyists working for them, including eight who
have clients affected by both bills.
Talk about hitting the lottery. They benefit from the Energy bill and this bill. We know where the money is going. It is going out of the Federal Treasury to the fat cats. Face it. Unfortunately for the folks around here, we know now. We have it.
How about this?
Hank McKinnell--
He may be a lovely man; this is not a personal attack on him----
chairman and CEO of Pfizer, has pledged to raise at least
$200,000 for Bush's reelection, although he is not yet listed
as a Pioneer or Ranger. Pioneer Munr Kazmir, who runs a
direct-mail drug company called Direct Meds Inc., estimates
that he has about 100,000 customers on Medicare who will have
more money to buy drugs from his company. ``We know the
patients, we know how important this bill is,'' he said.
Follow the money. Dress it up any way you want. Talk about how great this bill is. Follow the money. I hope seniors are watching this tonight. They will make up their own minds. They are calling my office. My phones are overwhelmed. What are they running on this? About 1,000 calls to 200 calls against this bill. For every 100 yeses, there are 1,000 nos. Seniors are smart.
They trust the AARP. Now they are finding out that the head of the AARP wrote the foreword to Newt Gingrich's book. Now they are finding out that the AARP gets 60 percent of their funds from selling insurance. Now they are finding out that the head of the AARP represented big drug companies. Follow the money.
There is a $14 billion slush fund for HMOs at a time when we don't have money to fully fund education. We can't fully fund education, but we can find $14 billion for a slush fund for HMOs. They don't call it a slush fund. They call it a few other names--a stabilization fund. They call it a stabilization fund.
Over 7 years, HMOs get $14 billion. This includes $10 billion in direct subsidies to HMOs handed out at the discretion of the head of the agency overseeing Medicare. How would you like to be that guy? At his whim, this bureaucrat can write checks to HMOs to bribe them to participate in Medicare.
In addition, there are nearly $4 billion of payments to the HMOs that already participate in Medicare just to bribe them to stay in Medicare. What kind of capitalism are we living in this country when we have to pay the private sector extra money when they went in the business in the first place? Things have changed. When I was a stockbroker, it wasn't that way. We didn't give corporations the kind of welfare we are giving them today. This is corporate welfare. Follow the money to the Presidential campaigns and you will get a very interesting story.
This $14 billion slush fund is particularly egregious when you consider that Medicare already pays HMOs more than the per-patient cost of traditional Medicare. Let me repeat that.
HMOs are getting paid more than the traditional Medicare. Do my colleagues know why? The overhead in Medicare is very small. Do we know exactly--is it 2 or 3 percent? Anyway, we do not pay CEOs millions and millions of dollars. They are taking that money right off the top and lining their pockets. Oh, but why not? They are nice people, give them $14 billion.
It is not that they are so great, these HMOs. People get the runaround. They do not get the care they need. People want their traditional Medicare.
Remember what I said. The bill I voted for in the Senate gave $6 billion to HMOs. I was not happy with that at all, but at least it gave $6 billion to traditional Medicare to help us do more prevention. Guess what happened. It is gone. The conference committee took it away. But they have added it on to the $6 billion already there. They added $6 billion that was going to go to Medicare. They put it in the HMOs, and they added $2 billion just in case it was not enough money for their friends.
Secondly, this bill benefits drug companies and HMOs. There is a gag rule on Medicare price negotiation. I talked a little bit about that before. Medicare has all of these clients. Think about the clout Medicare could have when they call a drug company and say that their drug X, Y, Z is a drug for arthritis and our patients like it; we are going to buy a lot of it for our patients; please give us a deal.
Oh, no, the conferees said, Medicare has a gag rule. Watch out. They may do it to the veterans next. The VA can bargain, but Medicare cannot bargain. The drug companies and the HMOs can bargain explicitly. They can bargain, and they can pocket some of the profits that they bargain, but not Medicare. Medicare cannot bargain. There is a gag rule on Medicare.
They will stand up on the other side and say: We are not trying to destroy Medicare; we think it is a great program. Just remember Newt Gingrich: Let it wither on the vine.
Seniors are expected to spend $1.6 trillion in prescription drugs over the next decade. By the way, there are a lot of pharmaceutical companies and a lot of wonderful research companies in my State. I have a great relationship with them. I support them getting an R&D tax credit; in other words, a tax credit for every penny they put into research and development. Why? Because I think that is important. I support their patents--reasonably support their patent rights. I support research through the NIH very strongly, and a lot of that benefits the drug companies as well. So I work very closely with my biotech companies, with my pharmaceutical companies, but, by God, I do not believe in giving them welfare.
Fourteen billion dollars? Is that because we have so much money? Is our deficit not big enough? It is only up to $500 billion in 2\1/2\ years or 3 years. Gee, we could do better. Why do we not make it $600 billion? Do I hear $700 billion?
I do not know what has happened, but it is not good. It took us 8 years to balance that budget. The other side said: We want a constitutional amendment to balance the budget. And our side said: Let's just balance it. Why do we need to amend the Constitution? Let's balance it. And President Clinton did that with us over 8 years.
Now it is gone. Now we have $14 billion to add to the deficit, and we are not going to let Medicare negotiate for us because, for whatever reason, they are tying Medicare's hand. I think it is because they want Medicare to wither on the vine. That is what Newt Gingrich said. That is the only thing I can come up with.
We know the cost of drugs could be lowered if Medicare negotiated those drug prices. One might say, well, maybe, Senator Boxer; that would be highly unusual for Medicare to negotiate with the drug companies. I would say, not at all. Medicare negotiates payments to hospitals. They have done that for years. When the bill left the Senate, there was no prohibition, but now there is. Why? Because they do not want the Medicare drug plan to be able to offer lower prices. They have given the right to negotiate to the private sector. They are going to push seniors into those plans.
Just remember where I started from. Just remember, ``wither on the vine,'' and ``follow the money.'' These are some simple concepts. At the end of my statement, just put a little ribbon and tie the bow and everyone will get the picture as to why we are going down a very dangerous path.
In this bill, we are going to be giving to HMOs payments above their stated cost to deliver service. Has anyone ever heard of anything like that in their entire life? A firm bids on a contract.
They say: We can supply you with X number of widgets for a thousand dollars. On the dot, you get it. You deliver the thousand widgets, I give you $1,000.
Here, HMOs are saying: We can deliver health care for patients at a cost of X dollars per patient. In this conference committee, they said: Well, we are going to give them more money than they say they need. It is called a lot of different names, such as premium support. It is payment above and beyond what they said it would cost. So put together the slush fund and the payments above their cost of service and you are scratching your head, saying, maybe I ought to get into this business.
I say to people all over the country, small businesspeople who work hard in their business, be it retail or wholesale, you do not have a deal like this. You open up your doors, you go into business, and suddenly Uncle Sam is knocking on the door: Hey, I got a check for you HMOs, $14 billion over 7 years just to stay in the business; and, by the way, we love you so much, we are going to give you dollars above and beyond what you say it costs. And, by the way, no one will catch on. We are going to call these names different things. We are not going to call it a slush fund.
So the bill left the Senate. It was a good benefit, a decent benefit, but a modest benefit. It was not perfect, but at least it was a bill on prescription drugs. It came back a benefit for drug companies and HMOs. Somebody said to me there was a hostile takeover in the conference committee of the Medicare bill, that the Senate passed, by the HMOs and the prescription drug companies.
If we look at Wall Street, follow the money. Look at the prices of these stocks. They are going out of sight because people know this is a deal of a lifetime, that is for sure.
The last point I want to make is that this bill hurts our seniors. I am going to be specific. First, it hurts all our seniors, and in the end I am going to show you how it hurts my seniors in California, the largest State in the Union.
These are facts. We have gotten them from the staff that worked on this conference bill. Six million seniors will pay more for prescriptions than they do now. Let me tell you who these people are. Six million low-income and disabled beneficiaries currently receive prescription drug benefits from the Medicaid Program, which is a matching Federal-State program administered by the State. These programs are more generous in coverage than the proposed bill that is before us because they serve our very sickest Americans.
For example, a Medicare/Medicaid-eligible person in California can, but does not have to, pay a $1 per prescription copayment. The copayment is voluntary. A dollar may sound like zero, nothing, to people. But if you are an inch away from owning nothing, every dollar counts.
Under the conference bill the same person will now be required to make a copayment, maybe, up to $5. Some will pay premiums of $50 and be subject to a strict asset test. Studies have shown that even small copayments for prescription drugs can make essential medicines unaffordable for low-income seniors, resulting in an 88-percent increase in hospitalizations and deaths, and a 78-percent increase in emergency room visits.
So they say to my State, now you can't help these poorest of the poor. Sorry. They gave that a name, too, which we will get into later. They give it a nice name, but the bottom line is the people, the poorest of the poor, the States that help them can no longer help them once they get into this program.
The copayments to these poorest of the poor are indexed for inflation. So they can and they will go up. Remember, most of these people don't make any money. When you get hit with inflation and you are on a fixed income, that bites. That takes food off the table. So we know there will be an increase in hospitalizations. That was in the background information, that 88-percent increase in hospitalizations and deaths because people will not take their medicine.
States are prohibited from covering the out-of-pocket costs of these dual eligibles, and the bill prohibits States from establishing more expansive drug lists for the mentally ill, disabled, and other groups.
That is important. They may be taking a drug that isn't covered on this formulary.
I want to talk about people with AIDS. We have a high number in our State. People are suffering. Many of them are dual eligibles. They are eligible for Medicare disability and Medicaid. For them this bill is catastrophic. My phones are ringing off the hook with calls from them, their parents, their families. It is likely that they may not have access to or be able to afford all the drugs they need. So this is why this bill is opposed by the AIDS Medicare Project, San Francisco; AIDS Project, Los Angeles; Project Inform, San Francisco; San Francisco AIDS Foundation. But let's face it, it is not just AIDS patients who are going to be harmed. Anyone with a life-threatening illness runs the risk of not having coverage for the drugs they need. If they are denied coverage for these drugs under Medicare, they can appeal the decision, but this doesn't mean they can afford them.
So when it comes to my State, I will show you later the numbers of people who will be worse off. It goes in the hundreds of thousands--the hundreds of thousands.
Now there is a very cruel asset test. When I voted for the bill in the Senate that the Senator from Iowa worked so hard on with the Senator from Montana, that was a good bill. That bill would have allowed low-income seniors to receive assistance without forcing them to sell a car because it was worth over $4,500 or a ring that maybe was their most precious possession from their loved one or a family heirloom.
The conference bill imposes a Draconian asset test of $6,000 per person, $10,000 per couple, for the poorest of the poor. As a result, 3 million low-income seniors nationwide, and 300,000 in California, will be deprived of assistance that would not only help them with their prescription drugs but help them pay the premium so they could receive the coverage in the first place.
In other words, the bill that is before us has some generosity towards the poorest of the poor, but they have added an asset test into it so if you have a family heirloom or you own a car worth more than $4,500 or you have a diamond ring and a gold wedding band that your husband may have given you when you were married, you have to sell it. You have to get rid of it. Otherwise you don't get the benefit of this prescription drug benefit.
I don't get that. I am sad the conferees didn't go with the bill that most of us voted for in the Senate.
Now you come to seniors who are forced into demonstration projects that penalize them for staying in Medicare. That happens in 2010. You say we are just in 2003. We are almost in 2004--that is 6 years away, big deal. One thing I have learned, as long as I have lived, is that time goes fast. Six years will be here. If you are in one of those demonstration projects, what is going to happen is plain and simple: Your premiums are going to go up if you stay in Medicare--bottom line. Even though people say you are not forced into these other plans, the costs may force you into these other plans.
One in six Medicare beneficiaries will be forced to participate in this experiment. In California, 12 of its metropolitan statistical areas will qualify for these demonstration projects. Let's say two of the largest are chosen; one is in L.A. and the other is in San Francisco. So what we will have is my seniors in those areas will have to make a very tough choice. Do they stay in Medicare and pay more money or do they go into an HMO and lose the choice of their doctors?
We have already had some experimentation. We know the healthy people will choose the HMOs because they are cheaper. After all, they are healthy so they are not worried about getting messed up by an HMO. If they are not sick, you know, it is not a problem.
But the sicker seniors would be left in Medicare, and we know that we will see costs spiral out of control because there will be a sick pool of seniors, rather than spreading the risk, which is what insurance is all about.
Now we have a situation where premiums for middle and upper class people are going to go up. My colleagues say they are only going to go up if you earn $80,000 a year. I understand that is
quite a bit. That is not that many people. But this is the problem. This number of $80,000 a year is not indexed for inflation. So it looks like it is a lot now, but in the future it will not look like it is that big.
For example, if this provision, the one that my colleague from Iowa supports, was in place in 1980, the equivalent level of income would be $33,000, and the person at that level would have to pay much more for their Medicare. So the fact is, they have done an interesting thing: They have not indexed this, so in the end you will have people of very moderate incomes paying huge premiums to Medicare.
Now what is going to happen? It will wither on the vine because people will say: I don't want anything to do with this. It is too costly. I don't need it. I will just go out and buy a catastrophic policy elsewhere.
I will tell you, if you take that fact, along with the fact that this bill sets up health savings accounts for the wealthiest people, you are going to have middle-income people and wealthy people walk away from Medicare, and you will lose the class you have when you have a larger pool. That is just a fact of life. That is why we have had a successful program--because insurance needs a very big pool.
I am going to put up a chart that I hope all of you who might be crazy enough to be watching this will remember. I know this isn't exactly prime-time television. But I want to show you a chart of ``Fear and Confusion.'' This is a Barbara Boxer homemade chart. This is the chaos and confusion that our seniors are going to be facing.
If any of you are watching this tonight, I am telling you to take note. I am telling you to call the AARP. Senator Durbin gave you the number. I do not know it. I want you to take notes and ask them to explain each of these concepts they have endorsed in this bill. Then I want you to call everyone who votes for this bill, if this bill passes, and call your Senators and ask them to explain what all of this means. I am not going to tell you what it means tonight because we would be here all night. These are the terms that have been thrown around in this bill. You are going to have to understand this if you are going to understand what Congress is about to do to you. You will have to understand this.
Confusion and fear--some of them you know; HMO, you know that one. There is fear there, but it has nothing to do with the fact you don't know what Health Maintenance Organization stands for.
Risk corridors: I want you to learn what risk corridors mean; copayments, plan retention funding, MA-prescription drug plans, or MA- PD plans; donut hole. No, it is not what you buy in the store that is so good. I am on a diet. I haven't had one of them in a while. But a donut hole is something you had better understand because it is going to cost you when you get to it.
Here is another one: MA-Regions; catastrophic, premium support, assets test. I explained that one to you. That is one where you have to sell your wedding band, if you are poor, in order to qualify for getting your drugs free.
Average weighted premium; MSP, Medicare Secondary Payment; coordination requirements; initial coverage limit; CMS, you had better know that because the man who is the head of it is the one who is going to control the slush fund for HMOs.
Here is one which is kind of my favorite because I actually understand it: Claw back. That is a new word for you. That expresses what happens if you are a State and you have helped your poorest people pay for their Medicaid. You no longer can help them, but you can't keep the money. You have to send it to Uncle Sam. That is a claw back.
Transitional assistance, MSA. That stands for Metropolitan Statistical Area. If you are in one of those, you are forced into a demonstration project even if you do not want to be.
Benefit shutdown: This is one I know very well. After you buy a certain amount of drugs--around $2,000--you get a letter in the mail from your company that is giving you this drug benefit, and they say: Sorry, sir, your benefits shut down until you go past $5,100. Benefit shutdown is not a good thing.
Risk adjustment premiums--you all know what that means; Part D, income relating, SA-wraparound; national bonus payment. But don't get excited. It doesn't go to you. Comparative Cost Adjustment Program; Stabilization Fund--that sounds as if it is a good thing. If you are an HMO, that is the money you get to keep you in business.
I tell you, if something happens to me and I am not back here after my next election, which could happen to anybody, I am going to consider helping one of these big HMOs. I understand half of this. I may help them.
Medicare advantage competition, wraparound--we did that--MA-regional plans; MA-prescription drugs; annual out-of-pocket threshold. Watch out for that one. Annual out-of-pocket threshold is what you have paid for your drugs out-of-pocket before you can get the benefit. However, if your drug isn't on the formulary, it doesn't count. So don't count on it too soon.
Return disclosure: This has to do with your tax return. You are going to have your tax return sent to the IRS from the Health and Human Services Department if you are an upper income senior. They want to know what you earn. Before, Medicare never asked that because it is an insurance program. Now, do you know in this bill that the people who do not like taxes are making sure the IRS receives from the Health and Human Services Department information about your tax return?
Deductible: Again, very tricky. You have to understand that.
PDP sponsors, Prescription Drug Plan sponsors; monthly benchmarks. I am not sure about that one myself. But monthly benchmarks, we have to be careful about those.
Fallback: The fallback is in the prescription drug plan. In the Senate bill that I voted for, if you didn't have two plans come in to compete, you could always fall back to Medicare. Now it is basically one plan.
I told you about fallback. I went over all of it. MSP; average weighted premium--I think I pretty well went over this; coverage gap; plan retention funding.
The way I have done this chart, it looks kind of chaotic. It is to make a point. I don't even have half of the terms that are in this bill. I am going to work on this so that after the cloture vote when we have a little more debate, I will be able to get a better list.
But there is no secret why seniors are calling up our offices. They are smart. They are the smartest folks around. They have lived a long time. They are smart. They know what Newt Gingrich said: Let it wither on the vine. And then he endorses this. They weren't born yesterday.
The one thing I was interested in with C-SPAN is the people who were calling were Republicans and Democrats, and they all sounded alike. One out of 10 said they liked the deal. So this bill hurts seniors. We know that for sure.
Confusion and fear, large benefit shutdown, which is daunting and penalizes innocent seniors.
I told you before. You get to a certain point, and your benefits stop. A couple of thousand dollars, and then it starts up again at $5,000. Name for me one other drug program that does that. I checked it out. There are hundreds of them. Maybe there was one other that had a small benefit. I have never seen it. We don't have that in our plan. We just go in the pharmacy and give them our Senator's health card. We get a good deal. They never shut us down. Why should we shut you down? It is a bad thing. It is not right. If I was a local pharmacist, I would say to my seniors, I can do better than this plan. Come into my store, buy your drugs here, and I will give you a discount card.
Seniors will have to worry about filling out this form, filling out that form, is this drug on the formulary, and so on--fear and confusion. The bill hurts seniors.
Now we will look at what it does to my State's seniors. This is the direct impact on my State's seniors: 867,000 sick low-income seniors will have worse Medicaid prescription drug coverage. Boom. This starts in 2006 when 867,000 sick low-income seniors will have worse Medicaid prescription drug coverage than now.
Mr. President, 250,000 retirees will lose their more generous prescription drug coverage even after we give payments to the employers. I supported that. That was a good move. But even
with that, they are dropping coverage once they know their retirees have another option. Wait until those people get the clue that is happening.
Years ago we passed a catastrophic medical bill and I remember seniors were attacking Congress people. Wait until they hear they get dropped--retirees who worked all their life, who like their plan and they get dropped. They do not have a choice. If they want prescription drugs they have to come with this plan. Wait until they have to deal with benefit shutdowns.
Mr. President, 296,000 fewer low-income seniors will qualify for low- income protections than under the Senate bill because of the assets test that I talked about and lower-qualifying income levels. The poorest of the poor--when compared to what we did in the Senate, the bill I voted for--are worse off. These numbers are huge because I represent a big State. And 230,000 Medicare beneficiaries will pay higher Part B premiums because they are upper middle income and wealthy. That will happen to them.
Also, because they are in the MSA or metropolitan statistical area, that demonstration project, 1.4 million could be forced into them as we projected because we have the big metropolitan areas, or be penalized for staying in traditional Medicare because the people who are healthy will go into those private plans and the people who are sick will stay in Medicare and the costs will go up.
We have fear and confusion. I don't know how many of these figures are double-counted, so I cannot just add them up. Some of these figures may fit into more than one category, but I can state with certainty a couple of million of my 4 million people on Medicare are going to be worse off with this bill, much worse off. That is a very bad thing to do.
I don't know where the votes are. I think they have the votes to pass this. But if seniors across this country got a couple of days--there are about 48 hours to pick up your phone, call your Senator and say: Senator, maybe you are right. But this thing is confusing. I am fearful. Give me a little more time.
The bill was just printed and we saw it for the first time the day before yesterday. This bill is bigger than I am, and we got it the day before yesterday.
I have shared some of the new bureaucratic ``wordspeak'' in the bill and I have just had a couple of days to look it over. At the least, we should say to our colleagues, put this thing off. We are going to come back in January. This Congress goes 2 years. That is the beauty of it. If it was next year, the legislation would die. But we have 1 more year of this session. What is the rush? Tell your Senator, maybe Senator Boxer is wrong when she says this will hurt me. I am not sure, but she has raised some issues.
Change, if it is positive change, is something we all want. But change could be negative, could be disruptive, could cause us to be confused or fearful. What is the problem in taking a little while longer? To be honest, I would love to have the Christmas holiday recess to read every line of this bill. I started to do that. That is how I came up with all of these words, by reading the bill and trying to understand all of this. I did not even scratch the surface.
This Senate voted down an Energy bill which I felt, frankly, was in many ways a giveaway for a lot of special interests. And the good that was in it--and there were good things in it--was outweighed by the special interest provisions. We should be here for the public interests, for the people we represent.
I remember one of my colleagues saying to me, when someone asked a question about oncology, because there has been some concern about how the oncologists are being treated--someone in the room said, just look, there is a company being traded, a health care company that deals with oncology, and the stock is shooting up. It must be that oncologists are being treated fairly.
I used to be a stockbroker. It is not of any interest to me to do things that make the stock of a company go up. Do you know what I want to go up? The stock of the American people, the lives of the American people, the quality of life of the American people, the quality of life of grandmas and grandpas and their families.
This is truly not a partisan issue. It is an issue of how do we give a prescription drug benefit to our senior citizens and keep Medicare strong and not make this bill a giveaway to the largest HMO and pharmaceutical companies and insurance companies in the country. They are doing very well. This debate has been a good debate so far. We have serious disagreement. I am sure I will be back in the Senate after we have a cloture vote, one way or the other, just to add more terminology to my fear and confusion chart.
I know my colleagues on the other side of the aisle are waiting with bated breath to see my next version of this fear and confusion chart because I know they understand every single one of these terms. It is interesting to look at these terms and to realize how far reaching and how bureaucratic this new bill is.
I will say one last thing and then I will leave the floor, much to the delight of the Senator from Iowa and the Senator from Montana. I say to any senior citizen, any human being who is within the reach of my voice, and there may be a few at this late hour, if you feel we need more time to see whether Senator Boxer is right or Senator Grassley is right or Senator Baucus is right or Senator Kennedy is right or Senator Durbin is right or Senator Hatch is right, if you think you need more time to take a look at this bill, to get this bill analyzed, this bill that weighs a lot, this bill that is over 600 pages, call your Senator, e-mail your Senators and tell them to take some more time, to put this thing over until after the first of the year and we can come back here and have the whole year to work on this bill, which is really rewriting the Medicare Program.
Thank you very much, Mr. President. I yield the floor.