Prescription Drug and Medicare Improvement Act of 2003

PRESCRIPTION DRUG AND MEDICARE IMPROVEMENT ACT OF 2003

AMENDMENT NO. 990

Mrs. MURRAY. Mr. President, Congress is about to update Medicare to finally help seniors with prescription drugs, and while I have some real concerns about the way this bill would provide drug coverage, I am convinced that after 5 years of stalemate, it is time to pass a drug benefit now to begin to get seniors the help they need.

Mr. President, I have been working to improve this bill by providing additional funding in the Budget Committee, by supporting various amendments, and by offering my own amendment.

I want to make sure that the drug benefit we create will help as many seniors as possible. Before we add a new benefit to Medicare, we have to remember that there's a serious problem with Medicare today that penalizes seniors based on where they live. The problem is in the payment formula that Medicare uses, and it hurts many seniors.

Today under Medicare, some seniors can get fewer services—and pay higher premiums—just based on where they live. Every senior pays the same amount into Medicare, but some seniors get much fewer benefits based on geography. That's not fair to seniors in my State and in other States.

For the past few years, I've been working to fix that problem. Last year, I introduced the MediFair Act to bring all States up to the national average in Medicare payments. We are still working to fix this disparity in Medicare today. The problem is that this new drug benefit would follow that same old, unfair formula. It means that seniors in States such as Washington will have few choices and pay higher premiums.

That's why I'm offering my amendment today—to give seniors more choices and lower premiums as they get healthcare and prescription drugs.

As we improve Medicare, we shouldn't build on the unfair polices of the past. While I am still working to fix the underlying formula that's hurting seniors in my State, we can at least avoid perpetuating an unfair system in this new benefit. I am proud to report that we have made some progress recently to fix the regional disparity that penalizes many Medicare patients. I am pleased to have joined with Senators GRASSLEY and BAUCUS in closing the rural versus urban gap in reimbursements.

And, earlier this year, the Budget Committee unanimously adopted the Feingold-Murray-Johnson amendment, which modified the Medicare reserve fund to allow legislation to promote geographic equity in Medicare payments.

Back in 1997, when we expanded Medicare+Choice, we took some steps to make it fairer. Since the Medicare+Choice rate was based on the fee-for-service rate, it was important to provide some guaranteed level for states with low reimbursements. We did two things. First, we set a minimum payment—known as a floor—so that no county would fall below a certain level. Second, we tweaked the funding formula to provide greater equity across the country for everyone on Medicare. That approach is known as a "blend" because it takes the regional formula and blends it with the national average. Those were both good steps. There was only one problem: Congress never provided the funding to revise the formula. So we put a fix in the law, but we never funded it. We have not been able to fund it until now because it has to be budget neutral.

Today, my amendment would finally fund that technical correction and give seniors better access to care. Specifically, my amendment fully funds the Medicare+Choice blend formula starting in 2006 for determining the Medicare Advantage benchmark. If we don't fix this problem, we will deny many seniors access to coordinated care.

PPO's and HMO's will only go into those regions already at the higher end of per beneficiary reimbursement. We should—at the very least—try to create a level playing field for all regions of the country. It is unfair to talk about competition when some regions will receive hundreds of dollars more per beneficiary than others.

During this debate, I have listened to my colleagues talk about the benefits of PPO's and HMO's as part of their new Medicare Advantage. Senator FRIST has spoken several times on the benefit of a coordinated care approach for improving disease management and keeping seniors healthier longer. While I still have some concerns about how these new plans will operate, I want to be sure that seniors in Washington State and other States with low Medicare reimbursement can take advantage of Medicare Advantage. I also want to point out that is not about increasing payments to insurance plans. It's about ensuring that seniors in all regions of the country have access to competitive Medicare Advantage plans.

My amendment is similar to language adopted in the House Ways & Means Committee mark. However, I do not fully fund the blend in my amendment until 2006. The House proposes the change starting in 2004. I also point out that my amendment doesn't force plans in any State or region to do anything. If they want to base Medicare Advantage on either the current fee-for-service rate—or the Medicare +Choice rate—they are free to do so. My amendment gives plans a third option that could be more fair and could help more seniors.

Finally—in an effort to truly measure the cost of providing care to all seniors—my amendment directs the Department of Health and Human Services to determine the costs of care provided to Medicare beneficiaries at DoD or VA facilities. Since Medicare assumes the reimbursement, these beneficiaries should be counted in the equation.

Failing to account for the cost of this care has resulted in lower fee for service per beneficiary costs. Those lower fee-for-service rates means significant inequities in Medicare reimbursement. We should correct this existing flaw before we build a new drug benefit around it.

I have been trying to get HHS to take this step since 1997 and supported language in BIP A2000 directing HHS to report to Congress on recommendations for correcting this inequity. Unfortunately, HHS remains unwilling or unable to properly determine the actual cost of care in any given region or State.

SELF-INJECTABLES

Mr. President, I want to take just a moment to update my colleagues on another amendment that I will be offering soon with Senator CONRAD and Senator SMITH. It relates to a new, exciting group of drugs known as self-injected biologics, and it's a chance to give Medicare patients access to the benefits these new drugs offer. Senator CONRAD offered a similar amendment during the Senate Finance Committee mark up and received a commitment from the Chair to work with us on this effort. As a result of this commitment, Senator CONRAD withdrew the amendment. We have been working with CBO and Senator BAUCUS' staff to address any concerns.

Currently, Medicare will only cover biologics if they are administered in a physician's office or clinical setting. That means patients must travel to the physician's office to receive treatment. That's not easy for many patients who have Rheumatoid Arthritis or MS—two diseases that can severely limit a person's mobility.

Fortunately, there are versions of these drugs that a patient can take in their own home. It's a great innovation that will improve a patient's access. Unfortunately, Medicare won't cover biologics that are administered in the home. That just doesn't make sense. I have been working to correct this inequity for the past two Congresses. The Murray-Conrad-Smith amendment would provide two years of coverage, under Part B, for those self injected biologics that replace treatments currently available only in a physician's office. We allow for two-year coverage to bridge the gap to implementation of a Medicare prescription drug benefit.

We have received a CBO score for the two years and believe that we can find room in 2004 and 2005 to provide this important coverage for MS and RA patients. This legislation is strongly endorsed by the Arthritis Foundation and will provide additional coverage to all four MS self-injected or self-administered treatments. For MS, only one treatment is covered under Medicare, provided in a physician's office.

I am hopeful that the managers of this legislation will be able to accept our amendment and end this discriminatory practice in Medicare.

Let me close by returning to the amendment currently before the Senate. For those Senators concerned about the inequities in the current Medicare reimbursement rates, I urge you to support this amendment. Fully funding the blend—as a third option in determining the Medicare Advantage benchmark—will provide greater equity and ensure that all seniors in all regions have access to a competitive, managed and coordinated care approach. Let's finally stop an unfair system and give seniors the access they deserve. It's the right thing to do, and I urge its immediate passage.

I yield the floor.