Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, I am thrilled to be on the floor talking about Medicare tonight and certainly thrilled I have a chance to answer some of the comments made by the gentlewoman from Oregon…
Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I am thrilled to be on the floor talking about Medicare tonight and certainly thrilled I have a chance to answer some of the comments made by the gentlewoman from Oregon (Ms. Hooley).
In my district in Florida, I have the fifth largest Medicare eligible population of 435 congressional districts. This is not an issue I take lightly. I would suggest some of our colleagues read the actual bill because what they are asking us to do tonight in their amendment is exactly why we are focused on some of the reforms in the very Medicare package we are talking about.
A physician update, an increase in payment, is in the bill the House Republicans have authored and sent to this floor and now is in conference. There was a mention that there was a fee cut last year of 5.4 percent. I would like to correct the record. As a member of the Committee on Ways and Means who fought to increase physician reimbursement, not only did we eliminate the cut a year ago; we actually increased by 1.5 percent in this bill. In Oregon we have a 1.5 percent update in 2004 and in 2005. We have a 5 percent bonus for those working in rural Oregon to make certain that they are able to see the patients because of the limited access and limited number of physicians. So there is a 16 percent increase in the bill we are talking about today.
Let me also take some exception when it is discussed about this FEHBP competitive-style model for a minute. My district is typical of most districts in the country. In fact, in Florida I represent eight counties: Palm Beach County, St. Lucie, Okeechobee, Glades, Hendry, Martin, and Charlotte. It goes from the east coast on the Atlantic to the west, ending at the Gulf of Mexico. There is almost every demographic mix one can imagine, people moving from the north and east coast; and what they have said to me in town hall after town hall, I want choices like Members of Congress have. They say they want choices like we have in our health care delivery system, and I reach for my wallet because I know somewhere in here is my Federal health benefit plan; and I get a range of options to choose from, whether I want a higher deductible, higher copayment, whether I want a fee-for-service or PPO or a managed care plan.
Seniors in my district are smart enough to know they are able to make choices. The Democrats have been down the street burning AARP cards this afternoon. Rather than engaging in constructive debate on how to fix the most important plan for seniors in this country, they are invoking memories of Jane Fonda burning things in city streets around our country and screaming that AARP has sold them out.
A month ago AARP was, as I was told by some of my colleagues on the other side of the aisle, the gold standard of senior lobbying organizations, and I tend to agree. I meet with AARP in my district in order to have a dialogue to see if we can meet some common ground and common objective. So when AARP indicated that they were supporting our Medicare bill, it was not only refreshing that we were engaged in a bipartisan, constructive conversation, but we were actually modernizing Medicare.
So to eliminate the competitive model in the Medicare plan we are discussing undermines the very notion of what the gentlewoman from Oregon (Ms. Hooley) is debating on the floor today. The update for physicians is in the bill.
Let me also say another thing that is troubling me because I have been somewhat perplexed by this insistence by the other side of the aisle that the trouble with this bill is we do not get after those nasty drug companies.
We do not just let our citizens run across the border and buy drugs from Canada. I just finished a TV interview with one of my colleagues talking about the cost of drugs in America and the cost of drugs in Canada, but let me talk about a more critical concern of mine.
In my district in my county in Florida, the first case of anthrax poisoning occurred in Palm Beach County, Florida, the death of a man who worked for the National Inquirer because he contracted anthrax through the mail that was sent to the National Inquirer.
Why do I bring that up and why do I raise the anthrax attacks and the fear
it invoked in Florida? Because one of the concerns that we have all indicated is we want cheaper prescription drug prices for our seniors, but we wanted a protected chain of custody to make certain that the drugs we are getting for our seniors are not tainted.
Let me read this headline from the National Journal Group American Health Line. It says that Florida laws to prevent the sale of counterfeit or diluted prescription drugs in the State are too weak, according to a report issued Tuesday. The Miami Herald reports the report found that as many as 55 of the 1,458 prescription drug wholesalers licensed in Florida sell counterfeit or diluted medications or treatments illegally imported into the United States. The Office of the Attorney General said the questionable medicines for some wholesalers have reached pharmacies, but the extent of the problem is not known.
So I continue to hear these bottles of pills rattling on the other side of the aisle saying just let us have our chance to be in the debate, and we will get Americans cheaper drugs from Canada. Well, the first person that dies from an anthrax-laced medication or the first person that receives phony or altered cancer drugs and dies because they did not receive the proper dosage, the first person who has a catastrophic incident because somehow that cheaper drug that my colleagues have suggested they will bring to our States has harmed a citizen, I cannot wait to watch the rush for the exit by each of those who have been rattling these pill bottles saying that was not my idea, I certainly did not want any part of it.
So let us debate Medicare and let us debate it on the floor, not in the AARP lobby, not in the newspapers, and not on TV, but for seniors like my parents and in the memory of my grandmother, whose one wish was that Social Security and Medicare would sustain her for her life. The one check she would wait for was Social Security, and the one thing she wanted more than ever was not to be a burden on her children or grandchildren. She wanted to be self-sustaining. It is in her memory I have worked 9 years on Medicare and want to make certain this proposal works. So I reject this motion.
We will continue to have discussions on it, but the things that have been raised in this motion today on H.R. 1 are just not accurate. They just do not apply. If they read the bill, they will see that physicians are getting compensated properly. They will see the competitive model is not going to undermine Medicare. It has no effect on entitlement. There is continued entitlement to defined benefits under current law. There is continued access to traditional FFS Medicare through the fee- for-service Medicare throughout the country, and all payments to plans, including traditional fee-for-service Medicare based on the demographic and health risks of employees. We have provisions in this bill that deal with most of the problems raised.
Mr. Speaker, I reserve the balance of my time.
Mr. Speaker, I yield myself such time as I may consume.
It is indeed appropriate that there be a doctor in the House sitting in the well presiding as we discuss this important project, a doctor who happens to be a Republican. The notion that we want to destroy Medicare is patently false. It is interesting, I am on the Committee on Ways and Means, so this is something we deal with quite frequently, how many letters I get urging us to increase the fee payments to Medicare+Choice organizations, Blue Cross and Blue Shield of New Jersey, Blue Cross and Blue Shield of Florida. From my colleagues on the other side of the aisle who somehow find those Medicare+Choice, which are popular with their constituents, we should increase reimbursements to those plans. But if they listened to the argument they just made about privatization, then those Medicare+Choice panels would not even operate. They would not even exist.
So it seems like there is a number of Members here that seem to trust the private health insurance industry when it suits the political goals of allowing their constituents to have access to prescription drugs, to eyeglasses, to other remedial services, that is okay. That is not really privatization. That is kind of a sort of an experiment, I guess. But that is in fact what is happening today. There are managed care plans that President Clinton supported and endorsed and increased funding for, community health care organizations, a number of things that we have done in our communities to make certain health care is delivered.
We know they are losing the debate when they have to bring up Newt Gingrich on the floor and rather than talk about substantive debate here, many of us have read the bill numerous times because we had it on the floor, we all had a vote, I think nine Democrats joined us in supporting that bill. I know it was not in its entirety. I am sure there are some new additions, some new conference report language, some different things, but we are not talking about whole new territory here, we are not going over new ground. But I would caution when we start accusing the entirety of the Republican Party as being opposed to Medicare that that is somewhat of a hurtful statement to this Member because I take seriously the responsibility I have representing seniors, I take seriously the fact that my parents are on Medicare, enrolled in Medicare, my father is suffering today with cancer who is being treated by great physicians in Palm Beach County who are being reimbursed by Medicare, who seem to be not only caring for him, but obviously thrilled with their work and happy with the reimbursements being offered.
The current Medicare system is a sickness model. I am hopeful that the party on the other side of the aisle comes back to the roots of Claude Pepper from Florida and Lyndon Johnson who would have recognized a fabulous program but one that needs to reflect today's technologies.
In our bill we have wellness incentives to look for dietetic screenings to see if we can prolong the life of someone suffering from diabetes. Medicare today will reimburse to amputate your limb, they will watch you go blind, they will put you on dialysis, but we will not reimburse a dietician to come in and see if we can properly construct a diet to minimize the onset of the disease. That is a plan that they want to sit here and defend? New technologies that can indicate a cancer in the body early and detect it and cause, hopefully, the cure of that cancer. Cardiovascular screening that I have worked on with Senator Bob Graham from Florida.
This Medicare bill we are bringing to the floor has a lot more to offer than some of the criticism would indicate. But I still have to snicker when I see a group of people standing outside of AARP burning cards. It harkens back to an earlier day. I just somewhat humorously look at how quickly they turn on that organization whom they held in such high esteem up to 48 hours ago and now is being vilified here on the floor. We are happy AARP weighed in. They said it was a first step. They did not say this was a panacea, nor did any Member of this body ever suggest that this is the last thing we will ever do on Medicare. We will learn as we go along, we will add, we will try and increase the opportunities for preventive health care, we will increase reimbursement to hospitals in every Members' district, a bill that I authored. We are doing the drug discount card, another provision that I authored that will be in this bill. I think we are on the right track.
Mr. Speaker, I reserve the balance of my time.
Mr. Speaker, I reserve the balance of my time.
Mr. Speaker, I yield myself such time as I may consume.
Of course I respect very much my colleague from Florida, and I appreciate his words tonight. I do want to at least add that at the current program we have on Medicare, just to correct any record, there is zero prescription drug coverage in Medicare. So for the very seniors they are talking about tonight, the veterans they are talking about tonight, citizens watching us tonight, they have zero coverage from Medicare for prescription drugs. Yes, there is a $275 deductible, and there is a monthly premium. The average American spends about $2,000 on drug costs annually. Under our plan they will probably save anywhere from $900 to $1,100 that will now be provided through Medicare to them. So anyone who is spending money on drugs today with this bill will have a benefit.
The drug discount card that I authored along with Senator Hagel that is now part of this global bill includes for low-income families a $600 credit much like their ATM card that they can use at drug stores to not only achieve a discount off the retail price of the pharmaceutical but also have money to purchase and back up that purchase.
So, yes, I am pleased with the progress we are making. I am pleased that we have things in this bill to provide new remedies for situations for ailing seniors, and I am encouraged by the fact that we have been able to increase reimbursements to hospitals, increase reimbursements to physicians. We are able to do some of the diagnostic tests necessary to improve and enhance the quality of life. So I feel very comfortable, as we continue the debate, that more changes probably can be made if we deal in a constructive fashion.
I yield to the gentleman from New Jersey.
Mr. Speaker, reclaiming my time, actually 6 months from enactment, we will start with a discount card that will provide an immediate $600 in the plan. A number of the wellness provisions we are talking about will become instantaneous, the increase to physicians, the increase to hospitals, the increase to managed care.
Mr. Speaker, reclaiming my time, there will be a number of things that will take place up until 2006. The big fundamental prescription drug will be 2006, the gentleman is correct. Because we have to get plans up and running. We have to implement the delivery system. We have to get plans concurrent. We have to do the pharmacology. So there are a number of things that will require some time.
Maybe. That may be possible as we move forward. With some cooperation, we may be able to actually expedite the time frame. That is this gentleman's wish. The sooner, the better. But within 6 months of enactment, we will have the first phase of this. We will have a number of the components already implemented. As to the prescription drug plan, I think our leadership will move more quickly than 2006.
Mr. Speaker, I reserve the balance of my time.
Mr. Speaker, I yield myself such time as I may consume.
It is almost comical on the floor for people who claim they have never seen this bill, they know every aspect of it and can criticize it with great flourish and abundance.
We just heard about the rural health care network, and I absolutely represent a lot of rural communities. Mr. Speaker, $30 billion additionally to fund rural health. Standardized amount for payments. A labor share to help with the labor index in rural communities. The disproportionate share program is increased in our bill. Low-
volume hospitals receive additional payments based on their discharges. Critical-access hospitals have additional benefits. A wage index. Graduate medical education programs. Sole-community hospitals qualify based on some data.
These are all incorporated in this new Medicare reform proposal that will benefit constituents in the gentlewoman from California's district.
Bonus payments for physician, an increased 5 percent add-on if you are in the rural component. Clinics pay separately for professional services. Rural health care clinics, federally qualified. Low-volume rural ambulance, targets higher payments for ambulances in rural communities. Home health care adds an additional 5 percent.
So these are all funded by our program, including community health centers.
Now, it came up about the $2,200, the doughnut that they continue to describe. The median recipient on Medicare uses approximately $2,000 annually in drug utilization costs. That is why we came up with the $2,200 to cover the majority of Americans. After $3,600 of drug expenditures, we then pick up 95 percent of the tab for the catastrophically ill.
Now, what the Democrats fail to continue to mention, and I wish they would put their price tag alongside their lofty ideas, is to give drugs to every senior in an unlimited amount without payment, without copayment, without deductible, would be about $900 billion, almost $1 trillion. Please, somebody on the other side, advise me where that money comes from, and I will be willing to listen to their proposal.
But in the abstract and failing to offer concrete solutions, they criticize a bill that has been worked on by the Committee on Ways and Means. They should contact some of their Democratic colleagues who serve on the committee with me. They are probably not happy with every aspect of the bill, but they have seen it. We have debated it. We have discussed it. This bill has been around for about 4\1/2\ years, no shocks, no nuances, no changes. It has all been part of the debate. Yes, they may object to portions of it, but to claim that somehow we just popped this bill up in the middle of the night belies the 4\1/2\ years I have been on the committee working on this and shows little of the knowledge of the very important components that provide relief to a number of their constituents, Democrat, Republican, and Independent alike.
Mr. Speaker, I reserve the balance of my time.
Mr. Speaker, I yield myself such time as I may consume.
I would just ask Members who are so comfortable with the insurance provided to them through Blue Cross Blue Shield, it is a PPO, it is made out to me, it is a government-wide benefit plan that has a retail pharmacy carrier; it has a mail order if I want; there is a customer service number; I can use it at most hospitals for admission and medical doctors. But surprisingly, it is not the Federal Government, it is Blue Cross and Blue Shield. So if this is so onerous and a disaster waiting to happen, then maybe my colleagues ought to turn in their card. I think they probably would not go without the coverage, and that is what my constituents have been asking for: give me what you have. Let me have choices. Let me have options. Let me decide for myself.
Now, they may be outraged at AARP, but up until last week they were always throwing it in our faces that this was the legitimate group that negotiated for seniors, and now all of a sudden they have racked up this alleged racketeering, mob-style pharmaceutical alliance with big PhRMA. It is just interesting, when they change their viewpoint and decide to support something we are doing, this is evil incarnate. A week ago they were the gold standard of senior care and consideration; today we are going to burn our cards.
So I ask my colleagues to be the judge: is it politics, or is it process? Is it results, or is it claiming credit? As a Member of the Committee on Ways and Means, yes, there is a lot more I would like to do to this bill. But part of the process I have learned is compromise, negotiation, and meaningful steps forward to make results achievable for citizens, the people that pay our salary that send us to work.
When I go home after reviewing this bill and looking at its contents, I know in my heart I can look at seniors, whether they live in Lake Worth, Port St. Lucie, Punta Gorda, Okeechobee; whether they are wealthy or poor, whatever their ethnic background, whatever their family composition, that I will be able to look them in the eye and say, this is a better program than it was last month and last year.
Mr. Speaker, with that I know the hour is late, and I sincerely appreciate, as I have worked with the gentlewoman from Oregon on a number of issues, and we care deeply about health care; we share common objectives and common goals. But I think the characterization of this bill is overstated in its demagoguery. I think if we look at what is being provided and the full range of services, people should come
away from this bill knowing this is an important, critical first step to providing prescription drug coverage for our seniors. Today, at this hour, seniors have absolutely zero coverage by the Federal Government for prescription drugs.
If there is any indication that what we are about to embark on by those who suggest this is not a benefit, then they have not read the calculation. Just do the math along with me. From $3,600 to $5,000, the example used by the gentleman from California, if you spent $5,000, you are only paying $900; well, do the math. From $3,600 to $5,000 is $1,400. Your obligation is a 5 percent copay of that. So it does not take rocket science to figure out that is $70. That means you have $1,330 of a benefit there alone. If you take the front end, if you take the front end and you look at the deductible and the $2,200 amount, you are talking about roughly $900 to $1,100. So if you add those two together, there is about $2,430 of benefit for a person that spends $5,000, not counting the $600 and the discount card, plus the discounts achieved. So if we reflect on all of those numbers and you hear these numbers thrown around, get out a calculator, we will supply the numbers. It is not that difficult.
My final statement will be to those who say our seniors do not understand enough of what they are doing to be able to figure these new processes or new bills out. Well, do my colleagues know what? The generation I am talking about managed their way through the depression, they survived World War II, they taught us how to ride our bikes and drive our cars. They raised us. They fought wars. They have been able to succeed in life on their own without the Federal Government dumbing them down and acting like they cannot make choices.
The Medicare bill we are about to bring to this floor represents significant, important, fundamental change. It represents increasing opportunity to gain wellness care. It represents prescription drug coverage for the first time in this Nation's history.
The Congress was controlled by the Democrats in 1965, when Medicare was introduced, to 1995 when the Republicans took over and, in that span of time, no prescription drugs were added. So I ask the basic question. I have been working on it since I came to Congress in 1995. We finally have a product on the floor in 2003, a lot later than I would have liked to, but under our majority, with President Bush and the Senate majority in Republican hands, we are about to embark on a wellness Medicare program for the 21st century.
So I appreciate the time of the gentlewoman from Oregon (Ms. Hooley), and I appreciate the House's indulgence.
Mr. Speaker, I yield back the balance of my time.