Mr. President, I begin by complimenting my colleagues from the Finance Committee: Senator Grassley, our chairman; the ranking member, Senator Baucus; and all of the other members on the committee who have really focused on what is most…
Mr. President, I begin by complimenting my colleagues from the Finance Committee: Senator Grassley, our chairman; the ranking member, Senator Baucus; and all of the other members on the committee who have really focused on what is most important to the American people, and that is to get a good, commonsense product out of the Senate that encourages our seniors and lets them know that we do understand that this is a critical issue. It is critical not only in terms of the quality of life for our seniors but also in regard to economics. We want them to understand we can provide cost savings not only to our Nation but to our aging families by providing a prescription drug package which will allow them to be healthier individuals; to not cause or create greater costs for this country and for the other parts of the health care system in this great Nation through acute care or difficulties in long-term care, in nursing homes and emergency rooms, but being able to have a quality of life and providing a good economic way to deal with the aging process.
As we went through this bill in committee, we talked an awful lot about ways that we could improve Medicare; looking at coordination of care, at how we could provide a better, commonsense way of administering health care to our elderly in this country not only through a prescription drug package but recognizing that disease management is an enormous part of what we are doing for our elderly, and that with the multiple diseases they are dealing with, if we can manage that disease management of multiple diseases and have a coordination of care, we are going to get a better bang for our buck in Medicare.
I am excited about the possibilities and want to compliment my colleagues on a lot of hard work that has been done, particularly recognizing that rural areas of our Nation also have great needs. I certainly applaud the chairman and the ranking member on that.
Today I bring up several of the amendments I have to offer. Many of these amendments we discussed in the committee. In my approach in the committee I was willing to visit with the chairman and the ranking member and say I hoped we could work through whatever we needed to in order to get these passed and get them in part of the bill. Those discussions are ongoing and I compliment my colleagues for working with me on these critical issues.
Hopefully we can resolve them without going to a vote, but I want these amendments placed and filed and in the queue so my colleagues have an opportunity to comment on them and work with me in order to get them done.
Amendment No. 934, as Modified
First is amendment 934 which has already been filed. Medicare Part B does not currently cover insulin or syringes used to inject insulin for the majority of enrollees in the Medicare Program. This is a horrific oversight in a program that should be designed to deal with our elderly but, more importantly, dealing with, again, some of these diseases that are predominantly in our aging population, especially when we see that of the 7 million or so Americans over 65 with diabetes, 40 percent inject insulin every day to control their diabetes.
Providing syringes for insulin will go a long way to helping seniors keep their diabetes in control. It is a fabulous preventive measure. It is obviously a critical area of need for our seniors. The management of blood glucose levels for diabetes helps prevent long-term complications like kidney failure, blindness, amputation, and a multitude of other chronic illnesses and problems that arise when diabetes is not kept in check.
Syringes are required to inject insulin because there is no oral or inhaled form of insulin. The lack of coverage for syringes means syringe purchases will not count toward their yearly maximum out-of- pocket expenses and their copayments. This will lead to the reuse of syringes that are not FDA approved for more than one use. We recognize it is a very minimal cost to the overall package and makes a huge difference.
I encourage my colleagues to take a look at this amendment. I compliment the ranking member and the chairman for being willing to work with me as we go through this process. I hope it is something we can get accepted. If it is not, I hope my colleagues will recognize for this very small amount of money we can make an enormous difference in a huge population of our elderly who are suffering from diabetes. I look forward to working with my colleagues on that.
I call up amendment 934 as modified.
I ask unanimous consent to lay that amendment aside to proceed to the next amendment.
I ask unanimous consent that amendment be laid aside for my next amendment.
The next amendment is amendment numbered 959. I am offering this amendment that authorizes a 3-year, five-State demonstration project of direct access to outpatient physical therapy services within the Medicare Program without the sometimes burdensome requirement of seeking a physician referral.
This is not a new concept. Several health professionals currently enjoy practice without referral under Medicare for their respective scopes of practice--dentists, podiatrists, chiropractics, optometrists, nurse practitioners. They all practice independent physician referral.
Non-Medicare citizens in my State of Arkansas and 36 other states, including Iowa, Utah, Maine, Arizona, Wyoming, Pennsylvania, the home State of our Presiding Officer, Tennessee, Oregon, Kentucky, Montana, West Virginia, South Dakota, North Dakota, Florida, New Mexico, and Massachusetts, all of which have Senators represented on this committee, allow direct access to licensed physical therapists as authorized by their State law.
However, Medicare requires its beneficiaries in my home State and yours to obtain a referral in order to access the services of a physical therapist. I certainly believe it is time to study the example of the States in a demonstration project to see if the referral requirement is indeed necessary. We are talking about seniors who are striving so diligently to claim the final years of quality of life. Physical therapy, occupational therapy, vocational therapy, all of these therapies are the tools that allow these individuals to go back into their home and to live their life, with the quality of life, with the dignity they want in their end-of-life years. It is so critical they can get the necessary access to these services in order to be able to do that.
I encourage my colleagues and certainly the ranking member, Senator Baucus, and our chairman, Senator Grassley, to work with me on this program. I believe it is budget neutral. It simply is moving forward on the concept that many of our States have already embarked on. It is very practical on behalf of the aging community that we are working on right now.
With that, I call up amendment 959.
I ask unanimous consent that amendment be laid aside so I can bring up my final amendment.
Before I get to my final amendment, I want to touch on one other issue and that is the issue of our rural ambulance providers. I see my colleague, Senator Thomas. He and many others who are in the rural health caucus have done a tremendous job in working through this bill and providing great access issues for our rural areas. I am encouraging my colleagues, as well as the ranking member and the chairman, to work with us on the issue of the rural ambulance providers.
We do not have an amendment as of yet and I am hoping we can work through some of those details as we move forward in this piece of legislation. I encourage them to work with us and hopefully we can finish that on Monday and move expeditiously on a piece of legislation that will benefit all of the seniors across the Nation.
Amendment No. 963
My last amendment is an amendment we have brought on the fallback issue, which is a critical piece of this bill. I think it is absolutely essential, as we look toward making sure private industry can play a role in providing a Medicare prescription drug package. We have seen, over the course of many past years, where private industry has certainly the option, even today, to participate in Medicare and the application of it. In some of our areas across this great Nation they are reluctant to do so because the profitability is not there for them.
We want to make sure there is every opportunity for private industry to come in and provide a product for everyone across this Nation. But if, in fact, in the time it takes to implement this program certain areas of our Nation find themselves in the same predicament they are today, which is private industry does not find it quite profitable enough to come in there, we want to make sure there is a fallback. We don't want anyone left behind. We think all seniors in this great Nation are equally important. We are going to make sure, across this great Nation, if for some reason there is an area that does not meet the test for private industry, there is a fallback.
In that fallback we want to make sure they have the same contract benefit the private industry does. We have talked a little about this issue in the past. We want to make sure, as we move forward on all these issues, again, that the fallback measure that is going to be there in some of our less populated areas is going to have that 2-year contract ability.
In the Finance Committee, when we brought the bill up, we found in many instances it primarily affects our rural States, and primarily rural areas. We want to make sure we offer them the same opportunity we do in private industry.
It improves stability, provides a more stable benefit by reducing year-to-year variability in premiums and cost sharing, and provides better assurances that needed medications and local pharmacists will be covered. It improves choice. After all, that is what we are here to do, to provide our seniors with as much choice as we possibly can.
It provides that once seniors are in a fallback plan, they have the option to remain in that plan for 2 years. One of the concerns we have had in our State is that when we have seen private plans come in, they come in and then they leave and then they come back. Seniors do not know what they can depend on. They have to make different decisions. Each year, because there is no standard design here, their choices are going to be different. They are going to have different premiums, different formularies, different pharmacies they can go to. So we want to make this the least confusing possible. Providing them the ability to have the same stability in the fallback as they do in the private plans I think is very important. And I think it is fair. Therefore, we do improve on fairness, providing the seniors in the fallback plan the same rights given to seniors who are in a drug-only plan, the opportunity to stay in for that same 2 years.
Continuing the first bidding rights for drug-only plans--maintaining first bidding rights for the drug-only plans, allowing fallback plans to enter a region only after it has been determined the two private drug-only plans will not be available--I encourage my colleagues to look at this. If there are two private plans, there is no fallback. You do not have to worry about a 2-year contract. You do not have to worry about a 1-year contract. That is because the fallback doesn't even exist. These are just emergency measures, to make sure individuals in rural areas are going to get the same benefit and they are going to be covered. We are not asking anything more of a Government fallback plan than we are of private industry. If private industry is there, you do not have to worry about it because the fallback is not going to exist.
I encourage my colleagues to take a look at this. It comes at a very minimal cost. It adds substantial stability to the system and, certainly, by not costing much more in dollars.
We again plead with our colleagues to make sure those seniors in rural States will have the same benefit there as have other seniors across this great country. We look forward to working with them if there are any concerns they have.
Mr. President, I appreciate your patience in allowing me to bring before the Senate my amendments to this very important bill and to encourage my colleagues. These are probably some of the most important policy decisions we will be making. As we embark on this journey to provide a critical component of health care to an enormous population in our Nation, as far as I am concerned, one of the most important as well as the most vulnerable, I think it is critical for all of us to look at ways we can improve this bill. Once this bill is passed, once it is signed into law, are changes going to be easy to make? No, they are not. So it is critical for each of us to take the time and recognize where we can make these slight changes and improvements in a bill. It is going to make a remarkable difference in the lives of the elderly of this Nation.
I encourage my colleagues to take a look at these very simple amendments that I think will be improving amendments to a bill that is moving down the pathway, something we encourage everyone to support in the coming days as we come to completion on a remarkable piece of legislation and a remarkable help to the seniors of this Nation.
I thank the Chair and my colleagues for their indulgence today and for being able to offer these amendments.
I do so now.
I yield the floor.
Mr. President, I ask unanimous consent that the order for the quorum call be rescinded.
Mr. President, there seems to be some confusion as to the last amendment which I submitted. At this point, I ask unanimous consent to withdraw that amendment, and I will reintroduce it on Monday.
Thank you, Mr. President.