Prescription Drug and Medicare Improvement Act of 2003

PRESCRIPTION DRUG AND MEDICARE IMPROVEMENT ACT OF 2003

Ms. COLLINS. Mr. President, today the Senate begins a truly historic debate on landmark legislation that will make affordable, comprehensive prescription drug benefits available to our Nation's seniors as well as to people with disabilities who receive Medicare benefits. This legislation is long overdue, but I am confident the Senate will, in fact, approve it before the Fourth of July. That is good news for our Nation's seniors.

The Prescription Drug and Medicare Improvement Act that the Finance Committee approved last week represents the most significant expansion of the Medicare Program in its 38-year history. I commend the chairman, the ranking member, and the other members of the Finance Committee, including my senior colleague, Senator Snowe, for their hard work in devising and developing this important package.

We now have an unprecedented opportunity to make the improvements necessary to ensure that the Medicare Program can provide peace of mind to our Nation's seniors and true health security, not only to the 40 million American seniors who rely on Medicare today but to future generations as well. We want a strong Medicare Program that meets the needs of our grandparents, our parents, and our children's generation.

With recent advances in research, prescription drugs can become literally a lifeline for patients whose drug regimen protects them from becoming sicker. Prescription drugs reduce the need to treat serious illness through hospitalization and surgery.
Soaring prescription drug costs, however, have placed a tremendous financial burden on millions of our seniors who must pay for these necessary drugs out of their own pockets. Monthly drug bills of $300, $400, or even $500 are not at all uncommon for older seniors living on limited incomes.

For example, Emery Jensen of Gorham, ME, has an annual drug bill of about $4,600. That is about one-quarter of the entire income he and his wife receive from Social Security. Another constituent from coastal Maine sent me a 2-page list of the medications her husband took over an 8-month period before he died. The total cost: Nearly $4,000. More and more, I am hearing disturbing accounts of older Americans who are running up huge high-interest credit card bills in order to buy medicine they could not otherwise afford. Even more alarming are the accounts of patients who are either skipping doses to stretch out their prescriptions or forced to choose between paying the bills or buying the pills that keep them healthy.

I will never forget an elderly woman coming up to me in the grocery store in Bangor and saying to me she was only able to get half the number of pills her doctor had prescribed because otherwise she would not be able to buy the food she needed.
No senior in our country should be forced to choose between putting food on their table and buying the pills they need to remain healthy.

It is critical we bring Medicare into line with most private sector insurance plans and expand the program to include coverage for prescription drugs. The legislation before the Senate today will make prescription drug coverage a permanent part of Medicare. This is an important improvement over previous versions of this bill which had sunset dates which would have created tremendous anxiety for our seniors on whether this would be only a temporary program.

This bill will make this coverage permanently part of Medicare. It provides a comprehensive prescription drug benefit that will be available to all seniors in Medicare, regardless of where they live. Moreover, that benefit will be equal for everyone, both for those who choose to stay in the traditional program as well as for those seniors who elect one of the new programs, the new plan options available in the Medicare Advantage Program which is modeled after the Federal Employees Health Benefits Program.

Beginning in 2006, seniors will be able to get comprehensive prescription drug coverage, including both upfront and catastrophic protection, for $35 a month premium. Moreover, low-income seniors will receive generous subsidies and get additional protections and assistance. The more than 9 million seniors nationwide, including 60,000 seniors living in Maine, who have incomes below 135 percent of the poverty level will not have to pay any premium to secure coverage. That 135 percent of poverty equals $12,120 for a single person and $16,360 for a couple. It is important we provide that extra assistance for these very low income elderly people who would be hard pressed even to afford that $35 a month.
Unfortunately, this is not going to happen overnight. It will take some time for this new benefit to come online.

To provide some interim assistance, starting next year seniors will get prescription drug discount cards that will save them between 15 and 25 percent on each drug purchase. Lower income seniors will receive a benefit of $600 on top of that starting next year.

There are also some other significant features in this bill. Medicare's reimbursement systems have historically tended to favor large urban areas and failed to take into account the needs of more rural States. This simply is not fair to States such as New Hampshire, which the Presiding Officer represents so ably, or my home State of Maine.

Ironically, Maine's low payment rates are also the result of its long history of providing cost effective high-quality care. We have a strange system where, if you delivered care in a low-cost manner, the formula actually penalizes you for doing so. In the early 1980s, lower than average costs in Maine were used to justify lower Medicare payments to doctors and hospitals. Since then, Medicare's payment policies have only served to widen the gap between low- and high-cost States.

This is an issue on which I have been working my entire time in the Senate. I remember in the previous administration meeting with the head of what was then called the Health Care Financing Administration and her telling me that in fact the State of Maine ranked dead last in Medicare reimbursements. Since that time, I have worked hard to improve the reimbursements to Maine, and now we are up to about 46, but that still represents a tremendous inequity.

I am, therefore, particularly pleased the legislation before the Senate takes steps to strengthen the health care safety net by increasing Medicare payments to physicians and hospitals in rural States such as Maine to help even out the reimbursement and eliminate the inequities that have hurt rural States.

According to the American Hospital Association, the provisions in this bill will increase Medicare payments to hospitals in Maine by approximately $63 million over the next 10 years. That is a step in the right direction. It will be particularly helpful for our small community hospitals which are struggling to make ends meet. Those same hospitals tend to serve a population that is older, poorer, and sicker, so they particularly suffer when Medicare reimbursements are unfair because they simply do not cover the cost of treating this older, poorer, sicker population.

This legislation also restores funding to some extent for home health. That benefit has been cut far more deeply and abruptly than any benefit in the history of the Medicare Program. Earlier this month, 54 Senators, at my request, joined me in sending a letter to the chairman and the ranking member of the Finance Committee asking that they avoid any further cuts in home health care and extend the additional payment for home health services in rural areas that expired on April 1 of this year.

I am pleased the legislation before the Senate does provide for a full inflation update for home health agencies and also extends the rural add-on that is vital to sustaining home health care in rural areas of our country. Surveys have shown the delivery of home health services in rural areas can be as much as 12 to 15 percent more costly because of the extra travel time required to cover long distances between patients, higher transportation expenses, and other factors.

While I am disappointed the Finance Committee reduced the add-on payment from 10 percent to 5 percent, at least it has been extended, and that will help to ensure that Medicare patients in rural areas continue to have access to home health care services.

The Prescription Drug and Medicare Improvement Act was approved by the Finance Committee by a strong 16 to 5 bipartisan vote. I think that bodes very well for the future of this legislation. At long last, this legislation holds out real hope to our seniors that they will finally receive an affordable, comprehensive Medicare prescription drug benefit.

Since the cost of providing a meaningful drug benefit will only increase as time passes, it is imperative that we act now. I am pleased the majority leader has scheduled this legislation and set a goal of its passage before we adjourn for the July 4 recess.

Our senior citizens deserve no less from us. We must act. I am confident we will act to provide a long overdue prescription drug benefit.

I yield the floor and I suggest the absence of a quorum.