Indian Health Care Improvement Act

INDIAN HEALTH CARE IMPROVEMENT ACT

Mr. GRASSLEY. Mr. President, I want to take a few minutes to explain my action today related to S. 1239, a bill to amend the Indian Health Care Improvement Act. Today, with great reluctance, I asked Leader FRIST to inform me before entering any unanimous consent agreements related to consideration of this bill, which the Indian Affairs Committee reported by voice vote this morning.

S. 1239 would pencil the Indian Health Service, IHS, an Indian tribe, a tribal organization, or urban Indian organization to pay the monthly part D premium of eligible Medicare beneficiaries. The bill defines eligible beneficiaries as individuals who are Indian and who are eligible for the part D prescription drug benefit, but who do not receive any additional financial assistance made available under the Medicare Modernization Act of 2003, MMA, to beneficiaries with limited incomes.

I am all for providing assistance in paying premiums for beneficiaries in financial need. We devoted a lot of time to those provisions in the MMA. I am troubled, however, that as currently drafted, S. 1239 would permit the IHS, an Indian tribe, tribal organization, or urban Indian organization to pick and choose who will get premium assistance. Specifically, the bill would allow them to consider an eligible beneficiary's ``expected drug utilization'' and any other factors to determine the cost-effectiveness of paying the beneficiary's premium.

This provision might be an attempt to reflect that the IHS, tribes, and tribal organizations have limited resources. The bill language, however, raises a number of questions. First, how would the IHS and tribes determine expected drug utilization or cost-effectiveness? Would it be based on the number of drugs a person takes or the severity of illness? Second, how would they account for the fact that a beneficiary's drug needs could change dramatically with just one illness? That is the point of having insurance.

When we crafted the MMA, we were keenly aware of the potential for adverse selection--meaning that beneficiaries might wait until they need part D coverage to enroll in part D. This would have the effect of driving up the cost of the part D premium for all beneficiaries. The additional considerations currently included S. 1239 set a dangerous precedent by seemingly promoting adverse selection in the part D program. This is exactly opposite to what we sought to achieve in the MMA.

Mr. President, I welcome the opportunity to work with the sponsors of S. 1239, Senators MCCAIN, DORGAN, and BAUCUS, and with members of the Indian Affairs Committee on this matter. I had hoped to accomplish that before the bill was reported out of committee. Unfortunately, that did not happen. I do not take actions such as these lightly. But I am deeply troubled that as currently drafted, S. 1239 could end up having unintended consequences for the very people it is intended to assist and for all Medicare beneficiaries.

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