Mr. Speaker, we have heard from the Democrats that this is a plan that will not work and is a fraud. We had 2 days of hearing, and I never heard a plan from the gentleman from Michigan (Mr. Dingell) or the gentleman from Ohio (Mr. Brown).…
Mr. Speaker, we have heard from the Democrats that this is a plan that will not work and is a fraud. We had 2 days of hearing, and I never heard a plan from the gentleman from Michigan (Mr. Dingell) or the gentleman from Ohio (Mr. Brown). We had 64 amendments.
Parliamentary Inquiry
Mr. Speaker, I do not yield.
Mr. Speaker, what we have here is a plan that the Republicans have been on their knees trying to come up with to try and solve this problem. It is voluntary. It brings choice, everything that the Federal employees health benefit plan has, the same program that all these folks have.
Joshua Hammond wrote a book called ``The 7 Cultural Forces,'' which defines who we are as Americans; and one of those cultural forces is we are ready, fire, aim. That is, sometimes we do not get it perfect. We do the best we can, and that has been our history for 230 years. Is this bill perfect? No. In fact, the people on this side will argue back and forth, but all of us know this bill is not perfect. However, we have carefully balanced the needs and resources from home health to physical therapy.
This bill contains the long-overdue addition of a prescription drug benefit. Our seniors and disabled beneficiaries have waited many years, particularly true in Florida; and I am pleased to be part of the solution and part of that markup that we did for 2 days.
Now the folks on this side of the aisle say they have a bill. Their bill is for $1 trillion. Ours meets the budget demands of $400 billion. If we could spend all we want in the world, that would be the Democrat's plan.
But at long last Medicare beneficiaries will have available the same options that the President of the United States has, the Senate and the House and the staff here in Congress, a choice to choose the plan that best meets their needs.
Mr. Speaker, I am very happy that part of this plan that we have here has a demonstration project in consumer directed care for chronic conditions such as folks with diabetes. It is analogous to the successful consumer-directed care demonstration and evaluation projects, known as cash and counseling in Florida, Arkansas and New Jersey. It is consumer-directed, and in fact this type of plan is part of the American Postal Workers Union. It has a consumer-directed option. So what we have with Medicaid, we are going to have with Medicare. I am glad that is part of the solution we have.
So I would conclude by saying to my colleagues who are wondering what to do on this side of the aisle, come along with us. It is a start. It is not perfect. We can move it to the Senate, have a conference on it, and improve it. In fact, the gentleman from Louisiana (Mr. Tauzin) in the markup amended the bill with a GAO study of the impact of this new cost regime. It is my hope that this will provide an objective, balanced approach and give us a proper understanding of how much this whole thing is going to cost. I commend the chairman every step of the way trying to be balanced, listening to the Democrats' amendments, many of which were accepted, many we defeated.
Mr. Speaker, thank you for bringing this package of Medicare additions, updates and reforms here to the Floor today. There is much here to applaud. We have carefully balanced needs and resources varying from home health to the physical therapy cap. Most significantly, this bill contains the long-overdue addition of a prescription drug benefit to Medicare. Our seniors and disabled beneficiaries have waited for this for many years now, and I am pleased to be part of the solution. At long last, Medicare's beneficiaries will have available to them the same options that we, and the Senators, and all of our staff and employees have: a choice of selections from which to choose the plan that best meets their needs.
Leading off with ``choice,'' I am pleased that my provision for a voluntary, small-scale, controlled demonstration project in consumer- directed care for Medicare beneficiaries with chronic conditions, my particular interest is diabetes, is included in H.R. 1 as Section 736.
This would be an analog to the successful Consumer-Directed Care Demonstration and Evaluation Projects, known nationally as ``Cash and Counseling,'' in Medicaid in Florida, Arkansas, and New Jersey. the Energy and Commerce Committee held a hearing June 5 on Consumer- Directed Care, and every single Member praised that demonstration's progress, but many cautioned not to overreach expanding its application. I agree. To that end, at markup I agreed to language from my friend, the ranking Member of the Committee, the gentleman of Michigan, Mr. Dingell, tightening some boundaries for the demonstration project. The Consumer-Directed Care demo is working, let's expand the elements of Consumer-Directed Care that have been successful in a voluntary, incremental fashion and see how the demonstration in Medicare might be evaluated down the road.
Section 736 will direct the Secretary to design a demonstration project allowing for participating Medicare beneficiaries to cash out the value of certain services. They then, with the assistance of a designated ``counselor'' of their choosing, and government-provided fiscal intermediary, would have some flexibility in making decisions directing care for their condition.
Furthermore, Consumer-Directed Care type models are now offered in major health plans in the private sector: in 2003, the American Postal Workers Union (APWU-AFL-CIO) are the very first Federal employee group with a Consumer-Directed Care plan available to them. Do our Medicare beneficiaries deserve any less choice?
At the June 5 hearing, the National Director of Cash and Counseling, Dr. Kevin Mahoney, outlined that there are generally three characteristics of a condition that make it a good fit for the consumer-directed care model. Disabilities fit these three, and I believe diabetes does, too: (1) It is chronic, and one of the most self-managed diseases; (2) it follows a relatively predictable course of treatment; and (3) there is room for choice, in tailoring a treatment plan to the individual.
I remind my colleagues that under the Medicaid demonstration, satisfaction has been in the high 90 percentage, no adverse health outcomes have occurred (in some measures it has improved), and fraud has been virtually zero.
From that, I must turn to other provisions of the bill. I do not stand here without some reservations. For example, the reform of reimbursement for oncologists. No one, no Member, no oncologist, and no patient wishes for the accounting mismatch of Average Wholesale Price (AWP), to perpetuate, and we should never let dialogue about AWP degrade into accusations about gaming the system. It is true that H.R. 1 eliminates the current overpayment on Medicare-covered drugs, while concurrently increasing the practice expense reimbursement to appropriate levels that reflect their costs. But my understanding is that this is still a net decrease for the practice. I ask that the negotiations continue in good faith. In Energy and Commerce, Chairman Tauzin amended the bill with a GAO study of the impact of this new cost regime, and it is my hope that this will provide an objective, accepted arbiter on true proper costs of administering total community-based cancer care.
Further, I harbor concerns that this bill not become a runaway money train. We have budgeted $400 billion over 10 years: is that a ceiling, or a floor? It is a logical modernization to add prescription drug coverage to the Medicare program; none of us would choose a health plan in FEHBP (Federal Employee Health Benefits Program) that lacked drug coverage. And, through economies of scale, both the traditional fee- for-service program and the participating private sector plans will have the purchasing power to contain costs. However, there always runs the risk of this exploding beyond our control. We have a responsibility for the fiscal health of this nation, and it is essential that proper cost containment be addressed in conference, as I understand the Speaker has assured.
Mr. Speaker, if the Democrats' plan is for $1 trillion and our is for $400 billion, we cannot say they offered a plan that met the budget requirements. I would like to ask the Democrats tonight: Do you have a plan that is under $400 billion like the Republicans?