Saudi Fugitive Declassification Act of 2019

Floor Speech

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Mr. GRASSLEY. Mr. President, the purpose of my speaking today is to remind my colleagues about some history as it relates to the adoption of Part D of Medicare back in 2003 and the importance of considering that history in regard to the importance of passing legislation this year in regard to high drug costs. The reminder goes to my colleagues who are up for election, based on the fact that the history of the elections of 2000 and 2002 had consequences for people who weren't aware of the grassroots support for doing something for prescription drugs and Medicare, as Part D turned out to be.

In this environment today, I don't think there is proper concern that people--the grassroots of America--are expressing the need to do something about prescription drug prices, so I am going to spend my time doing what I just summarized for you going through the history of 20 years ago versus now.

I want to lower the cost of prescription drugs for American seniors. I have spoken on this topic many times before, and in my previous speeches years and years ago, I said that we were delivering on the promises of the last three elections in a bipartisan manner to help seniors who had waited far too long for relief, and that relief came out as Medicare Part D.

That speech was more than 15 years ago. We have been here before. In 2003, I was leading the last piece of bipartisan entitlement reform, the creation of the Medicare Part D Program that was entitled the ``Medicare Modernization Act of 2003.''

Now here we are again on the cusp of meaningful, bipartisan action in regard to prescription drugs. This action would fulfill the promises that I and many of my colleagues and the administration, meaning the Trump administration, made to the American people that we are going to do something about prescription drug pricing. We should be reminded that promises made ought to be promises kept.

I want to remind my colleagues that history does not have to repeat itself. Hopefully, this will help rid the gridlock that delayed us from delivering Medicare Part D nearly two decades ago.

As we all know, the Medicare Modernization Act was signed into law in November of 2003, but the process of creating Part D began long before the President actually signed the bill. We could go back more than a decade--but that is not the most important part of it--but Congress was voting on what would become prescription drug coverage as early as 1988. Obviously, it didn't become law.

Suggestions for how to help seniors with prescription drugs came from every corner throughout the next decade after those 1988 votes. Yet the proposals weren't enacted, so we failed to bring any kind of comprehensive change to Medicare.

Under President Clinton, prescription drug pricing reform gained national attention, just like it has national attention today because President Trump has made it one of his premier goals of reducing drug prices.

So going back to the Clinton administration as part of the Balanced Budget Act of 1997, Congress created a forum to bring more attention to the prescription drug program under Medicare. That was called the National Bipartisan Commission on the Future of Medicare.

After a year's worth of work and research, the Commission voted on three recommendations in 1999, including a prescription drug benefit. However, the recommendations failed to receive the mandated supermajority of members' votes, so no formal recommendations were ever submitted to Congress because that was the rule of the Commission at the time. It had to be a supermajority of the members of the Commission.

Facing mounting pressure from the public in anticipation of the 2000 election, all of the major Presidential candidates presented plans. President Bush had suggested a new Federal subsidy to help low-income beneficiaries purchase drug coverage through private insurers.

Vice President Al Gore, the Democratic candidate, proposed a new voluntary benefit within Medicare to protect chronically ill and low- income beneficiaries against catastrophic expenses. Yet the Congress still couldn't reach a compromise, even though it was very much discussed during that Presidential election, and it was in a lot of discussions in Senate races as well.

At that time, the country was united behind Medicare reform, but Congress was divided on how or even if it should act, and it did not act.

In the Finance Committee, the person that preceded me when I took over the chairmanship of the Finance Committee, a person by the name of Bill Roth of Delaware, proposed two plans to committee members in hopes that a consensus could be reached. The first plan worked to fundamentally change the Medicare Program. The proposal included a universal drug benefit for the Medicare Program with several major contracting reforms. The reforms would have permitted pharmacy benefit managers, insurers, and other qualified firms to compete to manage the government drug benefit in a cost-effective way.

Then-Chairman Roth also proposed a scaled-back plan which would extend prescription drug coverage to low-income seniors and on the State level to those seniors facing catastrophic levels of spending. This second piece of the Roth proposal was meant to be a backstop--just a short-term, bipartisan bandaid on a gaping wound while negotiations continued to find a longer term solution.

Despite the support from then-President Bill Clinton and the Republican majority leader, Trent Lott, compromise was elusive, and the Finance Committee did not act before the November election. So then we had the 2000 election. Prescription drug coverage was a big issue, and it was a big issue probably more for Republicans because we controlled the U.S. Senate. We lost five incumbent Republican Senators because people didn't pay attention to this being a major issue. Hence, to remind you what I opened with, I don't want Senators making that same mistake this year.

The American people were obviously disappointed in the lack of action back in 2000, and it showed, but as we have to do when there is grassroots support like there was then, we marched on to find a path forward, but building consensus was not easy.

I was chairman during part of that time between the years 2000 and 2003. I wasn't chairman all that time because the Senate flipped to a Democratic majority when Senator Jeffords of Vermont changed from Republican to Democrat. Between the years 2000 and 2003, we held countless meetings and hearings on the status of Medicare and how we could come to an agreement to add Part D and bring Medicare into the 21st century. The gridlock seemed inescapable.

In 2002, the budget allowed for $350 billion to reform the Medicare Program, most of that going toward the prescription drug reform that we were proposing. Partisan discord led to three separate proposals being sent to the Senate from House Republicans that were subsequently voted down.

As a result of the 2002 elections, Republicans were back in the majority, and I retook the gavel as chair of the Finance Committee. I promised at that time legislation that would address seniors' concerns and be bipartisan so it would pass an almost evenly split Senate. That was my goal. In the Finance Committee, we went through the important and wide-ranging process of creating what eventually became the Medicare Modernization Act of 2003.

I worked across the aisle, across the Capitol, and down Pennsylvania Avenue to make sure the prescription drugs and Medicare improvement bill struck the right balance, spending the money allocated to us by President Bush to be done in a fair and equitable way. A lot had changed in the practice of medicine since Medicare had been signed into law 40 years before, in 1965, and we needed to recognize that the practice of medicine had changed. My friend Senator Baucus, who was at that time the Democratic ranking member of my committee, and I were able to thoughtfully pull together a Medicare package by closing a big coverage gap and doing that in the right way. The Part D marketplace offered consumers better choice, better coverage, and better value. Of course, it was about time that Congress had taken this action demanded by the grassroots of America in a serious way. I said in 2003, ``We all know seniors don't want politics, they want prescription drugs,'' and that holds true today as we consider this issue.

It is important to note that just like in the 2000 election, the country took notice, but this time it was for our accomplishments, and Republicans gained four Senate seats in that 2004 election.

I am now standing here again, more than 15 years later, to make the very same point. It seems like deja vu. American seniors don't care about party politics any more now than they did in 2003. When it comes to almost any issue, but particularly healthcare issues, what they care about is having access to affordable medication.

Once again, I am leading a bipartisan effort to enact much needed entitlement reform, and once again some of my colleagues on both sides of the aisle are resisting compromise. Once again, medicine has changed since the last entitlement reform I led. Let me remind you, prescription medication was not much of a part of the cost of medicine in 1965 when Medicare was passed. By 2003, it had become a significant portion of the cost of medicine. That is why people needed Medicare Part D. Pharmaceuticals are even more a part of the practice of medicine today. Scientific advances have led to many new and more effective treatments. However, they are often accompanied by very high costs. That means prescription drug prices have skyrocketed, and Americans want Congress to act now so they can afford their lifesaving medications.

Our seniors deserve better than the over 5-year delay in action we put them through last time--in other words, 5 years before we finally passed something in 2003 called Part D of Medicare. They shouldn't have to wait 5 years this time. Congress has been here before. We want to make sure history doesn't repeat itself. I want to make sure it doesn't repeat itself. I personally have been here before. I have watched the opportunity to help patients slip away. Now, just like in 2003, Americans want action on entitlement reforms. Now, just like in 2003, the President supports action. Now, just like back then in 2003, numerous proposals were floated and ultimately fell short of the finish line.

We have another opportunity to deliver meaningful reforms to help the Part D program adapt to new innovations in the healthcare world. The bill that came out of my committee 19 to 9, titled the ``Prescription Drug Cost Reduction Act of 2019,'' builds on the successful programs we created in 2003. It will lower beneficiary premiums by $6 billion and lower out-of-pocket costs by $25 billion. The bill will implement an out-of-pocket cap, eliminate excess payments, cap taxpayer subsidies, and permanently repeal the doughnut hole in Medicare Part D. It uses market forces. Those market forces will incentivize manufacturers to lower list prices and report more accurate calculations of their rebate obligations.

In short, this is the right bill at the right time. We should seize this opportunity to support actions that Americans need now, not 5 or 10 years from now.

I want to give credit to Senator Wyden of Oregon, the ranking Democrat on my committee and my partner on this issue.

Thank you for working with us in the tradition of the Finance Committee in the same way that Senator Baucus and I worked together 15 years ago on Part D legislation.

I ask all of my colleagues to join Senator Wyden and me in our bipartisan effort to lower the cost of prescription drugs.

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