Deficit Reduction Omnibus Reconciliation Act of 2005

DEFICIT REDUCTION OMNIBUS RECONCILIATION ACT OF 2005 -- (Senate - November 02, 2005)

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Mrs. MURRAY. Mr. President, I have some serious concerns about the budget that is now before us. To make our country strong again, we need to invest at home. What I see in this budget is a $35 billion cut from America's priorities, and I see that it will burden our children with a massive debt.

I am especially concerned this afternoon about what this bill will do to our most vulnerable in this budget and in the new Medicare prescription drug plan that is going to be implemented very soon.

This budget cuts $27 billion from Medicaid. That is a health care program, and it is a safety net for our country's most vulnerable and sickest. I think that cutting their health care is the wrong thing to do.

As I look ahead to this new Medicare prescription drug law, I see a time bomb that is ticking for more than 6 million Americans. A time bomb is ticking for our communities and for our health care providers. That fuse is set to detonate on January 1, 2006, in a few short months. We cannot stand by and let low-income seniors and the disabled lose their drug coverage. We cannot leave doctors, hospitals, and nursing homes unprepared for the biggest change in decades, and we cannot push hundreds of thousands of people who need care on to our local communities.

We cannot wait. We need to fix this problem today. That is why I am offering this amendment. I have been working with Senators ROCKEFELLER, BINGAMAN, and NELSON to address this immediate crisis, and I want to thank them for their leadership.

I have also introduced my own bill to protect our most vulnerable. It is called the Medicare HEALS Act, S. 1822. I have been traveling around my home State of Washington this past month and meeting with people in Seattle, in Lakewood, Yakima, out in Aberdeen, and Olympia. Everywhere I have gone they have been angry, confused, and very worried and with good reason. Here are some of the concerns I heard. One senior told me:

Everyone I have talked to is totally confused--my doctor, my pharmacist, even the Medicare number you are supposed to call.

Another said:

If we can't understand this, this whole plan is going to fail.

Everywhere I went, people were confused. There were questions I could not answer. When I turned to the doctors sitting next to me, they did not know the answer and neither did the pharmacists or the patient advocates that were there with us.

If Senators, doctors, and experts do not understand this bill, how can we expect an 80-year-old person with serious medical problems to understand this complicated new Medicare prescription drug plan? We cannot. So I believe we need more time and more resources to make this work.

One person I met with said:

Please give us more time, give us the chance to understand this so we don't make a mistake when we sign up.

One panelist said to me:

Taking something away from those that need it the most ..... is not the American way.

I could not agree more, and that is why today I am offering this amendment on this budget bill.

I have a lot of concerns with the Medicare prescription drug law. I was one of those who voted against it in 2003 because I think seniors deserve better, and I think America can do better for our seniors. I am very concerned about the complexity. I am concerned about the coverage gap, and I am concerned about whether needed drugs will actually be covered. I am concerned about the retirees who are losing the good coverage they have today, and I am concerned about the late enrollment penalty that is going to punish seniors who need more time to pick the right plan for themselves.

I am working with many other Senators to address those specific concerns. Today, the most urgent problem is the way that this new Medicare prescription drug law treats our most vulnerable: People with low incomes, the disabled, and those who face serious medical challenges such as AIDS.

This Medicare prescription drug law takes away the critical drug coverage that these people have today and puts them into this new program that could charge them more money in exchange for less drug coverage. If they do not sign up for a plan, they are going to be randomly assigned one. Either way, the prescriptions they need may not be covered. Because these are Americans who are living on the financial brink, an interruption of their drug coverage or a new copayment could keep them from getting the drugs they need to live. These people who are being affected do not know this is even going to happen to them. Their doctors and their pharmacists do not understand it and this entire mess is going to burst into the open on January 1, a few short weeks away.

This Senate needs to take action now so we can prevent this catastrophe, which is just a few months away. To understand this problem, let us look at how our most vulnerable are getting their prescription drugs today and how that is about to change.

Today, about 6.4 million Americans with low incomes get help from two programs: Medicare at the Federal level and Medicaid at the State level. These individuals are what we call in Washington, DC, dual eligible because they are eligible for assistance from both Medicaid and Medicare.

What Medicare does not cover, States cover. For example, since the Federal program did not cover prescription drugs, the State programs filled that gap. This State coverage is often called wraparound coverage, and it is very critical for these vulnerable families. As a result, these individuals got the drugs they need, often without copayments or deductibles.

Now there is a big problem coming on January 1. The new prescription drug bill will prohibit States from providing this extra help these people need. Instead, what it does is take these people and move them into this new Medicare Program alone, which will require of them higher out-of-pocket payments and will probably cover fewer drugs.

To me, it does not make sense to take away the good coverage these vulnerable families have today, force them into a program that might not meet their needs, charge them more money in the process and then prohibit our States from helping out these most vulnerable residents. It does not make sense, but that is exactly what this new drug program will do, unless we fix it before January 1.

In fact, the new Medicare prescription drug program changes the coverage for our most vulnerable families in five ways: First, it is going to impose higher costs, higher premiums, copayments, and deductibles. These are our low-income families. They do not have the extra dollars.

Secondly, it is going to cover fewer drugs. Those drugs that they rely on right now for their health care, their mental health, may not be covered in the plan they are randomly assigned to.

Third, it blocks our States from providing extra help as they do today, and our States are the end here. They are the ones who are going to see the fallout if these people do not get the prescriptions they need.

Fourth, it provides no transition period to make sure that these low-income residents do not face gaps in their coverage.

Finally, it penalizes people who simply need more time to understand and pick the right plan for them. These are real people that we are talking about. I am going to introduce two of them.

Earlier this month in Seattle, I met a woman named Kathryn Cole. She is 36 years old. She is disabled, and she is living on Social Security disability. She fills about 15 prescriptions every month. Her monthly income is $757. That is what she lives on. Well, she told me: Even if this copay were only $5, that adds up to $75 a month out of her $757. She said:

I don't have that kind of extra money to squeeze out of my budget.

Kathryn looked at me and she said, which week am I not supposed to eat?

People like Kathryn across this country today are living on the financial edge. They cannot afford to pay more for their medication. That is what America is about, making sure that the least among us are able to succeed in this country. Kathryn is one of those people.

In Olympia, in my State, I met a man named William Havens. He is 50 years old, and he is living with HIV/AIDS. He takes 43 pills a day. William told me:

For the first time I realize I'm going to have to make a choice between pills and food.

It is outrageous that this Medicare prescription drug law is going to make life so much harder for these people that I have met, such as Kathryn and William.

In addition to hurting these people, this new drug program, if enacted the way it is right now, is going to hurt our health care system. It is going to have a costly impact on our nursing homes, our doctors, our pharmacists, and our hospitals.

Many of these dual-eligible individuals live in nursing homes. Nursing homes are going to have to navigate through all of these new plans. In my home State of Washington, there are at least 14 of these new plans that the dual eligibles are going to be assigned. Each one of these plans has different costs and different formularies. Nursing home managers are going to have to see which plan their patient has and if the needed drugs are covered.

In Olympia, I met with a doctor named David Fairbrook. He is in private practice, and he is also the medical director at two of these skilled nursing facilities. He cares for about 150 patients. He is very concerned about his patients being randomly assigned to plans that do not meet their medical needs. He said patients may be denied needed drugs. They could be forced to change their medications, and they could very well face a time-consuming, stressful appeals process.

Dr. Fairbrook predicted to me that there is going to be chaos for nursing staff regarding coordination of multiple

suppliers, further duplicating their paperwork and documentation requirements. Chaos, he called it. There is a tremendous new administrative burden for understaffed and underfunded nursing homes and care providers.

In addition, unless we act, this new program is going to make the work of our pharmacists across the country a lot harder. Pharmacists, as we all know, are literally going to be on the front lines. They are going to be forced to deny coverage to these patients. CMS is telling us that pharmacists will be able to look up and see what plan someone has randomly been assigned to so when one of these patients comes into their pharmacy and says, I do not know who is covering me now, they are supposed to be able to look it up and tell them.

Frankly, given all the errors and mistakes that CMS has made so far, I do not have a lot of confidence that this is going to be a flawless transition. Remember, these people whom we are talking about do not have a financial cushion. So if they go into the pharmacy and all of a sudden they find out, much to their surprise, that they have to have a copay of $5 per prescription or more, they are living on fixed incomes, they do not have an extra $20 or $30 to say, fine, okay, I will pay this. They will turn away from the pharmacy counter, and they are not going to have the funds to pay for their drugs now and get reimbursed later when some kind of paperwork system gets sorted out. So we are going to see a huge impact at our pharmacies, and we are already hearing about it from them.

Doctors are going to be on the front line. Doctors are going to have to know which drugs are on the formulary, and they may need to help their patients appeal any denials. I remind my colleagues, most of the plans out there right now do not have a formulary. So people who are looking at this and making conscious decisions about which prescription drug plan they are going to sign up for cannot make a reasoned decision yet because they do not even know which plans cover what drugs. So doctors are telling us that they are going to have a real challenge as they try to help their patients work their way through these plans to make sure that their plan covers the prescriptions that are actually given to them.

One doctor I met with told me if doctors do not have the information they need on this yet, if their patients pick the wrong plan and their medicine is not covered, it can have serious medical harm.

Hospitals are also going to be impacted by this. They are going to have to navigate all of these new plans that are being offered. They are going to have to deal with patients who have not been able to get their prescriptions. In fact, for many of these poor families, the only place to get needed medicine is going to be the emergency room, and that is going to increase the cost of health care for all of us.

So this new drug law is going to impose an expensive and confusing administrative burden on doctors, on pharmacists, on hospitals, and on nursing homes. I think we can do a lot better than this. My amendment simply says let us fix this problem before people realize that they cannot get the prescriptions that they need.

The Murray-Rockefeller-Bingaman amendment simply provides a 6-month transition for low-income, dual-eligible beneficiaries. It does not delay the implementation of the Medicare Part D Program. It simply gives States, CMS, and the Social Security Administration 6 more months to ensure that all of those who currently have access to prescription drugs through Medicaid or who are eligible for Medicaid assistance are not lost in this transition.

Surely we can at least do that for these people.

According to CBO, this amendment could cost $130 million over 5 years. I say that is a very small price to pay when we are talking about the lives of 6.4 million Americans. In this budget, we are being asked to cut $27 billion from health care for the poor. I think it is worth spending less than 1 percent of that amount to make sure our most vulnerable do not lose their drug coverage in this transition.

Today we got another example of how easily our most vulnerable can fall through these cracks. Just today, CMS announced it is going to be sending a mailing to 86,169 dual eligibles in my home State of Washington. But according to the numbers I got from my State, there are actually 95,000 of these dual-eligible patients. So somehow 8,831 vulnerable people are not being counted. They are not going to get a letter. They are not going to get signed up for a plan. They are going to get lost in this transition, and on January 31 they will have no drug coverage. That is exactly why I am offering this amendment and telling my colleagues that we need to have a transition period to allow this to work.

I urge my colleagues to support this amendment and give our most vulnerable a few extra months to make sure they do not get lost in this transition.

This is a life-or-death issue for many people. We cannot rip away the last remaining safety net for these people. We owe them at least this one very small fix. Time is running out. On January 1, millions of vulnerable Americans are going to be forced into a new system they do not understand and that does not meet their needs. I believe we can avoid this train wreck. People's lives are hanging in the balance, and I urge my colleagues to at least allow these people who are dual eligible a transition period so they are not lost as this plan is implemented.

I retain the remainder of my time.

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