Mr. Speaker, I have an hour as the designee to talk about the subject that I want to bring to my colleagues, but I think I need to take at least a few seconds of my time from this side of the aisle to express my and our heartfelt…
Mr. Speaker, I have an hour as the designee to talk about the subject that I want to bring to my colleagues, but I think I need to take at least a few seconds of my time from this side of the aisle to express my and our heartfelt sympathies to our colleague, the gentlewoman from California (Ms. Roybal-Allard), on the death of her father.
I spent the last 15 minutes listening to their special hour and learning about that great, great American who represented the State of California so well in this body for 30 years; and I want to express my sympathy to my colleague from California.
Mr. Speaker, today, November 15, is a historic day and not just because it is my wife Billie's birthday, which it is. Happy birthday, honey. But really the historic aspect of today is the roll-out and the sign-up today for the first of a 6-month window of opportunity for our seniors to voluntarily sign up for the Medicare part D prescription drug plan which this Congress made available to them in December of 2003. So indeed, Mr. Speaker, today, November 15, is indeed a historic day.
I have seen clips of the original signing of the Medicare legislation back in 1965 when President Lyndon Baines Johnson signed that bill into law. Actually, the very first person to sign up for the other voluntary part of Medicare, the part B which is applicable to the physician care and outpatient testing, not the hospital part but the voluntary part, the first individual to sign up for that was former President Harry Truman, that being 40 years ago.
Here we are now finally, Mr. Speaker, after all of these years, offering something that was left out of that original program, I guess for a fairly good reason. Maybe back then, I was a freshman in medical school, I barely knew who was happening, but there was not quite the emphasis then on prescription drug treatment. We had some good prescriptions but not nearly what is available to our public and our seniors today; and there was much more emphasis on trying to get hospital care and needed surgery, emergency room care, indeed long-term care, skilled nursing home care for people who had, as an example, suffered a stroke.
So this was all very, very important in the program; and I know my colleagues on both sides of the aisle would agree with me it has been a great success. There was some concern, though, I remember this much about it as I was working as a scrub technician during the summertime hearing the doctors at the scrub sink before they went into surgery, talking about this new law that was going into effect, this Medicare bill. There was some naysayers, no question about it, and some were downright opposed to it. But so many seniors were living in poverty and not getting needed health care, and it at that time was a Godsend for them.
Mr. Speaker, I will say this. I think today, starting today, November 15, 2005, some 40 years later another Godsend is coming to our seniors, brought to them by this Congress and this President, this administration, and that is the Medicare part D prescription drug coverage. It is especially a Godsend for those seniors who are living at or near the Federal poverty level, and I say that because heretofore they have not been able to afford prescription drugs.
They go to their doctor and get maybe a handful of prescriptions because many of our seniors who are living just off of a Social Security check are the very ones that have what are called co- morbidities, more than one disease, maybe high blood pressure, heart disease and diabetes; and they need to take four or five or maybe six prescriptions a day. They are the very ones who cannot afford it, not that they do not want to. They want to take care of themselves, but they also want to eat, and they want to have a roof over their head, and they have to pay their utility bills, so this program is so necessary for them.
In the past, Mr. Speaker, what has been happening is they would put off taking care of themselves because they have could not afford the prescriptions. Then, when some catastrophe would occur, they would finally get care, whether it was in the emergency room because their high blood pressure led to a stroke or whether it was on the operating table because their blood sugar, their diabetes was out of control and led to a limb becoming gangrenous and needed an amputation or maybe even because of high cholesterol they would have to have open heart surgery.
We have finally begun this prescription drug part D sign-up as of today, and that is what makes November 15, 2005, so historic.
I want to spend most of my time then talking about this aspect of the Medicare Modernization Act of 2003. There are other things that I think are going to be tremendously helpful.
I will mention just briefly, Mr. Speaker, the fact that with this change in the law, for the first time a senior can actually go to his or her internist or family practitioner, we call them primary care specialist, and get a complete, thorough physical examination when they turn 65, if you want to call it an entry-level physical examination. In the past, that was not paid for, and a lot of these diseases that I have already spoken of in their earlier stages have no symptoms at all, and people really do not know, but with this new program, they get an opportunity to go have that physical exam.
Also included in the modernization piece is the coverage for a lot of screening tests that were not included in the original Medicare. I am talking about things like mammograms, screening for breast cancer obviously; colonoscopies, screening for colon cancer; PSA blood testing, screening for prostate cancer. I am talking about checking blood sugar. I am talking about getting a cholesterol level to see if the patient needs to be on one of these statin drugs that do such a great job of hopefully preventing heart attacks.
All of this is now available to our seniors. I am not going to spend a lot of time, as I say, Mr. Speaker, on that aspect of the bill because I really do want to spend most of the hour talking about the prescription drug part because it is so important.
I have got a few posters here, and we will be referring to them from time to time. I also have some of my colleagues that have worked so hard and been so supportive of this legislation and are working hard in their districts as we roll out this program. As they go home, usually we get back into the district on Thursday or Friday morning, and I know a lot of our colleagues on both sides of the aisle are holding town hall meetings and trying to explain to the seniors and assure them that although this is somewhat complicated, there are people there to help them through the process and encouraging them, especially the low- income individuals that I spoke of, to sign up and sign up early.
They do have 6 months to do it. It starts November 15, today, and goes until May 15 of 2006. They have that window of opportunity; but it would be a real mistake, particularly for our low-income seniors, not to get signed up before the end of the year because the program really starts, Mr. Speaker, and I know my colleagues are aware of this, it starts on January 1. So if they wait till the last minute into May of 2006, they will have actually missed 5 months of opportunity, in many instances, to get their prescription drugs with hardly any cost, and I will repeat that, with hardly any cost except
maybe $1 if their medication is a generic drug and $3 to $5 if it is a brand-name prescription drug.
So I will have a number of my colleagues joining me, and we will be calling on them in just a few minutes. I want them to take as much time as they would like to talk about what they are doing in their districts, how they feel about this program, what sort of feedback they are getting from their seniors, and then maybe we will engage also in a little bit of colloquy.
Let me call my colleagues' attention to this first slide, which I think begins to tell the story: ``Helping seniors get the medicine they need to stay well.'' That is what it is all about. It is not an emphasis on episodic treatment and maybe trying to catch the horse after the barn door has been left open when some catastrophe occurs. It is so much more difficult, rather, to get the medicine they need to stay well. I do not think we can really emphasize that too much.
Now, Medicare helps seniors prevent disease in addition to treating it. I said at the outset, in 1965, all of the emphasis was on treating it, and that was good, but not the 21st century medicine. We need to emphasize the prevention of disease.
Medicare part D, it is important that our seniors know that this option, prescription drug coverage, really is for all seniors. It is not just the low-income. I mentioned them, and we will talk about throughout the hour, but no matter what a person's income, if they are a Medicare recipient, either because they are 65 years old, and that is probably 36 or 37 million in this country, or because of a disability at a younger age, and there are probably 6 million or 7 million of our citizens who are on Medicare because of a disability, but all of them, no matter what their income level, they are eligible for Medicare part
Mr. Speaker, reclaiming my time, I thank the gentleman from Texas for being with me. I appreciate his comments tonight. I welcome him to, if possible, to stay around and maybe we can get involved in a colloquy or I can respond to his questions and yield to him.
Mr. Speaker, the thing that he pointed out, that little anecdote, true story, about that little lady in Round Rock, that is why it is so important. I appreciate Judge Carter mentioning that, because this is real, and the emphasis that he put in his remarks on how important it is to get signed up is real.
Thanksgiving is going to be upon us pretty soon. I think I am correct in saying a week from Thursday. And what comes the day after? Well, I call it ``black Friday,'' Mr. Speaker. That is that big shopping day, the first day of the Christmas season when everybody hits the malls. I think that would be a great day for families, children, grandchildren to sit down with their grandparents, children to sit down with their parents and help them. That would be a wonderful day. It would save money as well, probably. The retailers may not like me very much, Mr. Speaker, for mentioning that, but that would be a great day to just sit down and say, look, I am pretty good at the computer, Mom, Dad, and let us go on-line, let us get on www.Medicare.gov.
If I tried to do that, that computer would start smoking, and everybody in my office knows that. Anytime I need to do anything on the computer, they have to hold my hand. So I understand the need and the fear of computers. But really for the younger people especially, it is a challenge. It is pretty easy for them. They have learned it in high school and college, and some of them even work in the industry. So help is readily available, as Judge Carter said; and it is not that difficult.
I called this morning. I think it was about 8:30, and I decided I was just going to call 1-800-Medicare just to see how long it took to get somebody on the telephone. Mr. Speaker, I had a response in about 3 minutes. The first time I dialed, I got a busy signal, and
so I immediately, within a matter of seconds, dialed again and got right through and began the process.
Now I am not quite 65, and I did not have a card and a number, so at some point I had to quit. I had to hang up. It was a bogus call. But I was very impressed.
Of course, CMS has hired and trained, and that is very important, not just hired but trained probably by a factor of four the number of employees that they normally have responding to these calls. So, as Judge Carter said, that information, that help is there, whether it is by the telephone or on the Web site, and we will get into the specifics of how a senior prepares themselves for this process. There is something called worksheets that are available through CMS. Those are easily obtained, and people just kind of go through that worksheet. We will talk about it a little later in the hour, so that when those questions come up, and, again, they are not difficult, they know the answers, and we can help them through the process.
Mr. Speaker, I see that we have been joined by another of our colleagues and not just any colleague because this is my good friend and fellow physician, indeed a fellow OB-GYN physician who came in in the 108th Congress with Judge Carter and me, the gentleman from Texas.
So I yield to the gentleman from Texas (Mr. Burgess) to give us a little of his insight into this program and what he is doing in his district.
Mr. Speaker, one thing that the gentleman from Texas (Mr. Burgess) mentioned was the fact that if a senior is interested in a mail order opportunity, then as they go through that list, the litany of companies that provide a benefit, they may want to choose one that would allow them to get their drugs in a mail-order fashion. So that option is available.
I had mentioned earlier in the evening talking about the worksheet and what a senior would need to have if they are dialing the 1-800 Medicare number or dialing the Web site with or without assistance at www.Medicare.gov, or coming to one of the congressional offices to get help, they need that work sheet and that work sheet should include and should already be filled out.
Again, it is information that the seniors know. First and foremost, it should include a list of the prescription drugs that you are currently taking, including the dosage, the milligram, the strength, if you will, and how often you are taking those drugs.
Secondly, information about any prescription drug coverage you currently have, be it employer or union-sponsored or a Medigap policy. Or maybe you are a veteran and have TRICARE for Life, or possibly you are retired State or Federal employee and you have coverage that includes a prescription drug benefit. You need to have that information so we can put that into the formula and help you decide whether you want to continue with that program or opt for the Medicare part D program, whichever is better, whichever really is the best deal, unique to your situation.
And of course the name and address, as Mr. Burgess and Mr. Carter both said, the name of the local pharmacy that you use to fill prescriptions. So we will need your ZIP Code as well and the out-of- pocket amount you spend on prescription drugs each year currently. Again, I know our seniors know that because they are real good accountants. They have to watch every dollar, and it is important that we know that. And then last but not least, your Medicare enrollment information, your Medicare number and your address and all of those particulars, whether you are on traditional Medicare or Medicare Advantage under an HMO or PPO-type program.
Mr. Speaker, I see that we are joined by another health care professional, the gentleman from Pennsylvania (Mr. Murphy). Mr. Murphy has been with us on just about all of these hours that we have done on health care and this particular issue.
Mr. Speaker, I call on the gentleman from Texas (Mr. Burgess) and enter into a colloquy with you on that issue.
If the gentleman from Pennsylvania would yield for just a second in regard to that issue. As you go through the Web site, it is important that our colleagues know to let their seniors understand that there is a page there, and Mr. Murphy was referencing that, where you are able to compare the different plans. Let us say you have several in your community that are available to you, and you narrow it down by the process of whether or not they allow mail order, if they have good discounts for all of the drugs you are on or three out of the four, and then you finally narrow it down maybe
to three or four that you want to choose from.
As you go through this process, and again there is someone right there to guide you through it, you can see really what your cost per year, as Mr. Murphy was referring to, what each plan would be and then make that intelligent choice, based on a lot of factors, but not the least of which, of course, is that cost factor.
If the gentleman will yield, Mr. Murphy hit the nail, I think, right on the head. And as we talk about this, the gentleman from Texas (Mr. Carter) is still with us. He may want to weigh in and share some of his thoughts on this subject. But there is no question that this program has the potential to significantly lower prices across the board, maybe not just for our seniors, but to everybody for some of these heretofore very expensive pharmaceutical drugs. And we anticipate that this program, and again, we talked about participation level. Remember, I said at the outset of the hour that Medicare part D, that other optional part of Medicare, probably got a 98 percent participation rate because it is such a good deal.
We will not have that higher participation rate with the part D because many of our seniors already have prescription drug coverage. We mentioned some of those categories. But this program, we anticipate across the board about a 50 percent savings, maybe 11 or $1,200 a year on average, and that of course includes people that are low-income. It includes people that are high-income; but on average, we anticipate, is that not right, Mr. Carter, about a 50 percent reduction.
Well, as usual, the gentleman is right on target. And I think it is important that we remember that the plan, typically, if I could describe a typical plan for the typical senior, would be about a $30 a month premium, would be a $250 deductible, would be a 25 percent copay, that is, the senior has to pay 25 percent of the cost of the prescription drugs after the 250 out of pocket, up to a total of $2,250. Then there is this issue of the hole in the doughnut, or the gap, where any cost above $2,250, up to about $5,100, is 100 percent on the back of the senior. A lot of people have been concerned about that. They tend to forget, though, that above that you have this catastrophic coverage. If you have spent in any one year on Medicare part D prescription drugs, if you have spent more than $3,600 out of your pocket, then anything above that is covered at the 95 percent level.
And, really, there are situations like that. Maybe for some seniors today before they sign up for this program, they already know that they are spending $3,600 or more, maybe $6,000 a year on prescription drugs. Now, they very well may want to choose a plan. This slide that I have in front of me now sort of goes over that, talks about the premium and the deductible and the gap in the coverage. Well, seniors can choose. They can literally, if they want, particularly, and I would recommend this, if they are on a number of drugs already and they have high costs already and they know that, then they may want to pick a plan that the monthly premium is a little bit higher than the average of 25 or $30, maybe it is $50 a month. But it does not have any gap in the coverage. Those plans are available, and that information of course is what they will obtain from the Web site.
I know we are getting close to the exhaustion of our time, and I wanted to call again on my colleague from Pennsylvania to see if he had any closing remarks before we wrap up this hour. And I want to, before I run out of time,
express my appreciation to Mr. Carter, to Mr. Murphy, and Mr. Burgess for joining us during this hour.
I thank my colleagues. Thank you, Mr. Speaker. I yield back whatever remaining time we have and look forward to the next session.