Mr. President, on July 30, 1965, President Lyndon B. Johnson stood with President Harry Truman and, together, they delivered the Medicare program. They proudly addressed the American people as President Johnson proclaimed, ``No longer will…
Mr. President, on July 30, 1965, President Lyndon B. Johnson stood with President Harry Truman and, together, they delivered the Medicare program. They proudly addressed the American people as President Johnson proclaimed, ``No longer will older Americans be denied the healing miracle of modern medicine. No longer will illness crush and destroy the savings that they have so carefully put away over a lifetime so that they might enjoy dignity in their later years.'' Today, those words still move me and yet, if I am to be honest, they also haunt me as we consider the Medicare reform legislation before us. I know that this legislation charts a course that will begin to undo the good works of our former Presidents and of a program that is perhaps the single most effective public initiative in our nation's history. Medicare has literally saved the lives of our seniors, keeping them from poverty and providing the peace of mind that comes with security. For this reason, I have a heavy heart and a sense of near dread about this bill. My heart is heavy because I know that this bill to reform and ``improve'' Medicare is deeply, fundamentally flawed. This is not what Presidents Johnson and Truman wanted for the millions of our parents and grandparents who made America strong, and it is not what I want, either.
For many years, we have talked about the need for a prescription drug benefit under Medicare. For a brief moment, I believed we in the Senate were serious about delivering a meaningful benefit. However, I cannot support the Republican Medicare prescription drug bill because it forces seniors to choose between paying more for their own doctor or signing up with an HMO; leaves seniors to pay thousands in out of pocket costs; eliminates employer drug coverage for 2.7 million retirees; prevents efforts to keep drug costs down; and effectively prohibits seniors from importing cheaper drugs from Canada.
I recognize that this bill commits $400 billion to a Medicare prescription drug benefit and truly helps some low income seniors who are without coverage today, and I am glad that it gives a critical boost to rural hospitals and doctors. But the fine print matters and will have very dangerous consequences for how much seniors have to pay for their Medicare benefit, whether this drug benefit really serves seniors, and whether we are strengthening or weakening Medicare for the future. I have always said that a Medicare prescription drug bill must be voluntary, affordable and accessible to all Medicare beneficiaries; must truly help with the high cost of prescription drugs; and must strengthen the Medicare program for the future. This bill fails on all counts.
West Virginians and many of my colleagues know I have been working on Medicare for 20 years. I sat on the Medicare Commission for a year during which we debated the best way to improve Medicare. Before that, I chaired the U.S. Bipartisan Commission on Comprehensive Health Care, which discussed ways to address the problems of the uninsured and the need for long-term care reform in this country. Today, I am the ranking member of the health subcommittee of the Senate Finance Committee. I was a member of the conference committee on this bill--but in name only, not in practice. Nevertheless, my goal has always been, and continues to be, improving Medicare and the quality of health care available to all Americans. This bill does not improve this program. This bill harms this program--actually harms Medicare.
This bill is a tool to force seniors to leave the traditional Medicare program they know and trust in order to obtain the drug benefit they need and deserve. Many people have said that this plan is voluntary and, therefore, if a senior chooses to stay in traditional Medicare and get a drug benefit, he or she can do so. This legislation does not guarantee that in any way. Under this legislation, seniors will have two different options for receiving a drug benefit. The first option is to stay in traditional Medicare for their doctor and hospital services and enroll in a ``drug-only plan'' to receive their drugs. The second option is to give up traditional Medicare and enroll in a HMO or PPO for all of their health care services. You may ask: what is a drug- only plan and how does one work? The answer is that we have no idea because no such entity exists today. It is a completely new concept
which the Administrator of CMS said does not exist in nature and would probably not work in practice. The former head of the Health Insurance Association of America said that drug-only plans are like insuring against haircuts. So, it's completely uncertain whether these plans will emerge, but let's say for a moment that they do. Well, at least seniors should be assured that they can remain in traditional Medicare and get a prescription drug benefit, right? Wrong. There is no limit on what these drug-only plans can charge seniors none at all. These plans could charge seniors $100, $500, or even $1,000 per month. These premiums could be completely prohibitive. West Virginia seniors will certainly not be able to afford premiums that high. If that is the case, seniors will not really have the option to stay in traditional Medicare and get a prescription drug benefit. They will be forced to enroll in an HMO in order to get a drug benefit and that is not what our seniors want.
Again, to be fair, this bill has some provisions, including those affecting physician services and rural hospitals that will be helpful to my home State of West Virginia. I fully recognize that; in fact, I pushed for these because I understand that good care is critical to good health, and that we must adequately reimburse Medicare providers for that good care.
However, despite this, I have grave concerns about the compromise produced by the Conference Committee charged with reconciling differences between the House- and Senate-passed Medicare reform bills. I was on the conference committee. I understand the arguments on both sides. And now, more than ever, I believe that the Congress needs to pass a meaningful prescription drug benefit that gives seniors more for their money, not less. I do not want to privatize Medicare, undermine existing retiree coverage, or force seniors to flip-flop between plans. Unfortunately, this bill would do all of that and more. Today, 339,000 seniors live in West Virginia. Nearly 30,000 West Virginia seniors will lose their employer-sponsored prescription drug coverage simply because of the enactment of this bill. As health savings accounts (HSAs) created by this legislation select and cover healthier, younger seniors, employers will be left to cover sicker, older seniors. Employers will see their health care costs rise and they will be priced out of continuing to provide employees or retirees with coverage, leaving remaining retirees with a benefit that is less desirable than they had before. Meanwhile, 70,000 West Virginia seniors will fall into a $2,800 coverage gap, forcing them to bear the total cost of their drug themselves until they reach the end of that gap. In fact, the available benefit will be so stingy that many seniors will pay more for this drug plan than they will receive in actual drug benefits.
At the same time, private insurance plans will be assured even greater profits through a $12 billion ``slush fund'' created by this legislation. Proponents argue that this ``slush fund'' is necessary to bring HMOs into rural areas. The fact is that this additional funding is necessary because HMOs have overhead costs. They have to pay their investors, provide a return to their stockholders and they have to pay for good marketing materials because that's the best way to skim off the healthiest seniors. On average, private plans have administrative costs that are about 15 percent of total spending whereas Medicare's administrative costs are 2 to 3 percent of total spending. There is no way that private plans can be as efficient as Medicare. Yet I am not opposed to allowing them to compete fairly with Medicare. However, we should make them compete on a level playing field. We should make them compete by creating efficiencies. We shouldn't take money away from the highly efficient Medicare program and give it to the HMOs to help them instead of seniors. That is not the free-market at work. That is not real competition. And, while a ``premium support'' demonstration, which effectively allows a voucher system instead of a real Medicare prescription drug benefit, will take place in six metropolitan statistical areas (MSAs) initially, I believe we can safely assume that this demonstration is meant to be standard at some point. This demonstration is expected to raise monthly Medicare premiums by 26 percent.
Perhaps most disturbing, 45,000 ``dual eligible'' beneficiaries will pay more for every prescription drug they receive under this legislation. Dual eligibles are seniors who qualify for Medicaid by virtue of their income. They currently receive drug coverage under Medicaid. In my State of West Virginia, these seniors pay between $0.50 and $2.00 per prescription depending on the total cost of the drug. Under this legislation, they could be required to pay twice that much. I want to be clear on this point because I was among those insisting that the dual eligibles be included under the Medicare benefit and not left in Medicaid. I believe this conference report does the right thing by including these seniors in the Medicare benefit. However, this legislation precludes States from ``wrapping around'' Medicare. In other words, States will not receive any Federal dollars for assisting dual eligible beneficiaries with the costs not covered by Medicare. This is unprecedented. For every other benefit covered by Medicaid but not by Medicare, the states receive a Federal match to provide those benefits to our poorest seniors. For example, Medicaid covers long-term care but Medicare does not. So, for those seniors who are also eligible for Medicaid, the Federal Government provides matching dollars to states to provide long-term care to dual eligibles. This conference report completely twists that concept of protecting our poorest seniors against increased costs in an unprecedented way. This arrangement represents a fundamental change in the relationship between Medicare and Medicaid. Many predict that the individuals affected will choose to forgo the prescription drugs that they need rather than try to pay what they cannot afford.
In my judgment, this bill represents the greatest threat to the Medicare program since its enactment. While numerous opportunities existed to strengthen it, they were wasted. Instead of devoting $12 billion to closing the $2,800 coverage gap, this conference report gives it to HMOs. Instead of protecting the right of our seniors to stay in traditional Medicare and get a prescription drug benefit, this bill protects the rights of the private plans to charge any premium they want. Instead of shoring up retiree coverage for the two to three million beneficiaries across the United States who will lose drug coverage as a result of this bill, this bill includes tax shelters that threaten to undermine the entire employer-based system. This bill is a give-away to special interests, compiled in the dead of night, under wraps. It is shameful. Public policy, like life, is about choices and this bill makes all the wrong choices for our seniors.
While I have painted a bleak picture, I strongly believe that we can avoid disaster. We can do so by putting this bill aside and coming back to the table with a proposal that helps seniors and protects the long- term viability of what is a truly great program. We can take into account the seniors who won't benefit from the low-income provisions in the bill. We can protect retirees, and we can implement positive reform that is productive, not destructive, confusing, or manipulative. It is not too late. It is not too late. I urge my colleagues to reject this bill and to immediately go back to work for the kind of Medicare drug benefit seniors deserve.
Mr. COLEMAN. Mr. President, we stand here today at a historic moment in this country as we begin consideration of the Medicare prescription drug bill. This bill is a triumph not for a party or a President but for America's seniors and their families. This is an incredibly hopeful day for all Americans who long for a national government that can get things done for people.
I campaigned on a promise to get things done--deliver to the American people what they need to live better lives and what they are looking to Congress to accomplish to make America a stronger country. Prescription drugs, energy, partial-birth abortion were all at the top of the list of issues that most Americans were looking for Congress to take action. Their seemingly simple request was for us here in Washington to put politics aside and do what is right for the American public.
I am proud to say we are seeing that happen with this Medicare bill. This is a bipartisan effort that, although not
perfect, makes a good start at addressing the needs of Minnesota's seniors and health care providers as well as those across this country.
This is the largest and most comprehensive rural health care improvement package ever contemplated by this body. Last year, as I campaigned across Minnesota and spent many hours talking to our rural health care providers, it was apparent to me that most of our hospitals and doctors had given up hope for fair Medicare reimbursement.
Thanks to the strong leadership of Chairman Grassley, we have a bill before us that has $26 billion--or $2.6 billion each year for 10 years--for rural providers, something that one short year ago seemed nearly impossible.
Quality rural health care is one of the foundations of our rural communities--this isn't simply about making sure our rural hospitals are adequately reimbursed. This is about preserving a way of life in America.
Without rural hospitals and physicians, it is tough to raise a family and hard to attract new businesses to rural communities. Without access to health care, many of our out-state towns simply couldn't exist.
This bill seeks to eliminate many of the disparities in reimbursement rates that have existed too long and crippled the rural health system. Hospitals, physicians, and ambulances, as well as all of those health professionals who work within these systems will not see Medicare reimbursement rates that better reflect the realities of the costs of providing care in rural communities.
As I look back on the accomplishments of the first session of the 108th Congress, addressing the rural health care payment disparity under the Medicare program will undoubtedly be one of the most meaningful achievements to Minnesotans. Many said it couldn't be done, and today I have the great opportunity to come to the Senate floor and tell my constituents that we will be voting on a bill that takes a major step in providing equality with urban payments that will significantly improve their ability to provide quality care.
Minnesota has a long tradition of providing high quality care, but many of our seniors have not had access to this care because of the lack of prescription drug coverage under the Medicare program.
Again, I have the great honor coming here and announcing to the seniors back home that help is on the way.
Beginning in 2006, the 677,400 Medicare beneficiaries in Minnesota will have access to drug coverage for the first time in the history of the Medicare program, and 187,356 of these people would not otherwise have access to drug coverage.
That means access to new drug therapies that could never been imagined in 1965 when Medicare was created. It is time to bring this program in line with current medical practices. A 1965 Cadillac is a classic. A 1965 health care benefit is a travesty.
This bill will provide prescription drug coverage for 41 million people in this country--41 million people! Is this the perfect benefit? I'm not sure what the perfect benefit realistically looks like. But I do know that the average senior's drug costs will be cut roughly in half under this proposal. That is meaningful assistance for all seniors and the bill provides even more assistance for those low-income seniors who need us to shoulder even more of the burden.
Let's not let perfect be the enemy of good. In the words of the AARP, one of the largest senior associations, ``Millions of Americans can't afford to wait for perfect.''
And we know that drugs are most effective when used to prevent the onset of a health condition. Right now almost 93 percent of our health care dollars go to treat a person who is sick. While we have amazing screening and early detection capabilities, we have a program that waits for people to develop dangerous and costly conditions before they can receive care.
It appears to me that this is a 1965 model of care, not a model that belongs in a 2003 health care system. This bill for the first time includes a ``Welcome to Medicare'' physical that will allow beneficiaries to get an assessment of their health condition and possibly detect conditions that could possibly escalate over time. It also includes cardiovascular screening, blood tests and diabetes screening that will be available without deductibles or co-pays to encourage seniors to take advantage of these benefits.
I want to stop for a moment at the word ``encourage.'' It is absolutely critical for every senior to know that they don't have to take advantage of the preventive screenings, they are not required to participate in the prescription drug plan, and most importantly, no seniors under this proposal are forced into a private health plan. Every senior who chooses to remain in traditional Medicare has that equally important option under this bill.
This bill is about expanding choice. Time and time again I hear from seniors who have said they want to receive the same benefits that my colleagues and I here and in the House of Representatives enjoy. This bill is about giving seniors the option to participate in a plan that looks very close to the benefits that I and most individuals in the private sector enjoy.
This bill is good for our seniors, it is good for health providers, and it is good for the American public who are tired of the partisan battles that have characterized this Congress. I thank Senators Grassley and Baucus and the members of the conference committee who have crafted this bipartisan Medicare package. This is a truly historic time in this body's history.
As we look toward completing our work for this first session, I am hopeful that the spirit of cooperation that has led to this bill will be extended to the many important issues we will leave unresolved this year.
The Thanksgiving season is upon us. Our work in this session is nearing completion. But our work will not be done until and unless we seize this historic opportunity and bring a prescription drug benefit and hopes for a better and healthier life and make this a Thanksgiving to remember for all the right reasons for our senior citizens and their families.