Medicare Prescription Drug, Improvement, and Modernization Act of 2003-Conference Report-Continued

MEDICARE PRESCRIPTION DRUG, IMPROVEMENT, AND MODERNIZATION ACT OF 2003-CONFERENCE REPORT-CONTINUED

Mr. CORNYN. Thank you, Mr. President.

Mr. President, I wanted to speak for a few minutes about this conference report which is before the Senate.

I did not support the Medicare bill voted out of the Senate. I voted against it hoping and praying all along that this bill would be improved as a result of the collaboration of the leadership in the House and the Senate in the conference. Indeed, I believe it has. That is not to say that I believe this is a perfect bill-far from it. But this bill does represent an improvement.

This bill provides coverage for those who need it most. In Texas, nearly 300,000 low-income Medicare beneficiaries who are not eligible for Medicaid and who did not have any prescription drug coverage will be covered under this new bill.

It will increase the percentage of Medicare beneficiaries in Texas with prescription drug coverage from roughly 60 percent to 95 percent.

I would like to express my congratulations to leadership, to Majority Leader Frist, who I know has taken a personal interest in this cause as a medical doctor and as someone who has worked very hard to get us to where we are today; Chairman Chuck Grassley, who has the patience of Job and who I know has worked very closely with Senator Baucus, the ranking member of the Finance Committee, and Senator John Breaux of Louisiana on other side, as well as Senators Nickles and Kyl and others who specifically shared some of the concerns that I had with the Senate bill but which I believe have produced as a result of their collaboration a much improved bill, and one which I am now proud to support.

I do not view this bill as the finished product. I view this as a good start. But I think it would be a mistake to say because we view the glass is half empty as opposed to half full that we ought to vote against this Medicare conference report. I have no confidence the stars will align and the political climate will be such that we could ever get to this point any time in the near future. It is important we deliver on the promise that each Member in this Chamber made when we ran for this office and which the President made when he was elected, that we would strengthen and improve Medicare by providing prescription drug coverage for seniors who need it. The reason I am proud to support this bill today is because this represents delivery on that promise.

In the end, I don't think the American people care very much about demagoguing certain aspects of the bill. They do not care very much about partisan differences. They do not care that much, really, about some of the ideological differences, the competing ideas that now have been melded into this bill and which create, to some extent, a hodgepodge, but on balance, an improvement over the status quo. It is our responsibility to govern. Governing means delivering results and not just criticizing things that are easy enough to criticize.

Frankly, any bit of legislation that comes before this floor has defects that are easy to criticize. We are sent here to get the work of the American people done. This bill represents delivery on a promise we have made.

We spend about $1.4 trillion a year in this country on health care. We know as much money as is spent on health care that still we have large segments of the population that are underserved and who do not have access to good quality health care. Fortunately, since 1965, our seniors have been provided access to good quality health care through the Medicare Program. We also know unless you happen to be among even the most modest means in our society, you would not have coverage. For example, under Medicaid, only those who are of very modest means who fall beneath the poverty level are eligible for that free health care program. Children are provided coverage to health care under the S-CHIP program which has provided coverage for many children who come from families of modest means who would not otherwise have access.

We still have about 45 million people in the United States who do not have health insurance and who have limited access to health care coverage. That is something that we need to address. Fortunately, it is something that has been addressed, at least in part, in this bill.

For example, in my State of Texas, we have many people who are uninsured and, indeed, who are undocumented. In other words, they have come to this country without the benefit of the legal process. But under Federal law, the Federal Government says you must provide free medical care at your emergency rooms and hospitals all across the country.

Finally, rather than to foist that financial burden on the local governments and the local taxpayers and the State government and State taxpayers, this bill starts at least a downpayment to provide for that previously unfunded mandate. Indeed, it provides $250 million a year to be distributed among the States based on their percentage of population of undocumented immigrants. For example, the State of Texas will receive about $50 million a year over the next 4 years to help make good
on that broken promise by the Federal Government.

Indeed, that unfunded mandate will at least be funded to that extent. It is not by any stretch of the imagination enough to make Texas whole, but it is a start, a movement in the right direction.

The other reason I am for this bill is because in 1965 the U.S. Government made a promise to our senior citizens that if you played by the rules, if you worked, if you paid your Medicare taxes, when you turn 65, Medicare would be there for you. While we know there have been enormous changes in the practice of medicine and the delivery of health care since 1965, Medicare has not changed. It is in response to the demands of that passage of time that we see this bill which does actually strengthen and improve Medicare today.

If there is one fundamental reason I am for this bill it is because I think it is the best this body and our counterparts across the Rotunda are able to come up with at this time. It would be unconscionable to leave our seniors without prescription drug coverage, especially after all Members in this Chamber and elsewhere have campaigned on that issue, year after year after year, and left perhaps too many people skeptical or maybe even cynical about whether we actually intended to follow through on our campaign promises. This bill represents the kind of results I think they deserve and the kind of results that make good those promises we have made.

As I say, I believe this is a good start. This is not a finished product. One of the best aspects of this bill is it changes the nature of Medicare to some extent by turning at least to some small degree from the command and control model that says the Federal Government knows best, which provides no choice, no alternatives, no opportunities for seniors to actually get better service or better health care by having some competition in the marketplace. Now, 38 years after Medicare was first passed in 1965, we see better coverage under this bill. We see more choice. We see coordination of medical therapies because, of course, many people are on multiple types of therapies, even drugs that may interact. This bill provides for a coordination of those medical therapies in a way that will enhance and protect the health of our seniors, not damage them.

This bill places an important emphasis on prevention. This is one of the areas on which we need to do a lot more work. Frankly, it is much more humane and much cheaper and, indeed, much more compassionate to prevent disease than to wait until it has occurred and then try to treat it, perhaps with some or no success. This bill does provide for screening for cardiovascular disease, for diabetes, for greater access to mammography so that breast cancer can be diagnosed earlier, and it will provide an opportunity for every senior, as they go into Medicare, to get a complete physical examination so that if there is some way we can prevent them from becoming ill or perhaps address that illness much more effectively and efficiently by getting to it earlier, we can improve the quality of life and also save the taxpayers money when it comes to treating full-blown illnesses as they run amok.

This bill is a vast improvement over the status quo because it has strong provisions for prevention of fraud, waste, and abuse. It is inevitable in a bill this big, some $400 billion over the next 10 years, that there is potential for fraud, waste, and abuse. I congratulate Chairman Grassley and the conference committee for writing into this bill important protections that will allow for the detection, indeed, for the investigation and hopefully for the prosecution of fraud, waste, and abuse when it comes to the taxpayers' dollars.

I know the chairman of the Finance Committee shares a passion for protecting people in the rural parts of his State, and certainly across the United States. I share that passion with him.

I still remember when I was campaigning up in the panhandle of Texas, a place where there is low-population density, in a rural part of our State where the county judge, who is the chief administrator for the county government, came up to me. She was concerned about her mother. She said the doctor for her mother, who was 80 years old, had refused to continue to accept Medicare patients. And this individual's mother had no other way to pay for her health care other than Medicare. So literally she lost access to the only doctor she had ever had and that she had ever known, at least during that period of her life.

This bill addresses that concern, too, by providing greater access to health care in rural parts of our country, and it imposes reimbursement rates for doctors and hospitals. Frankly, I have always thought it was wrong for us to try to balance the budget on the backs of health care providers because, frequently, these people provide free health care out of the goodness of their heart, for which they have no hope of compensation. I think it is only just and it is only right that we provide for fair and adequate reimbursement for treatment of Medicare patients. Frankly, that is the only way we are going to continue to see ready access for our seniors to the health care they need.

There were two reasons I was very concerned about the bill as it left the Senate. One was because it lacked any means testing; in other words, the young man or young woman who earns minimum wage would be expected, out of their Medicare taxes, to pay for the prescription drugs of Bill Gates or Ross Perot from my State, someone who is more than capable of paying for their prescription drugs. I, frankly, thought it was unfair to foist that on the minimum-wage worker.

Then the other concern I had was that I wanted to make sure we were not providing incentives for employers who maintain health insurance coverage for their employees after they retire, to simply drop them and create a greater burden on taxpayers.

I think both of those issues have been addressed.

Finally, Mr. President, I think the provision of health savings accounts represents a tremendous victory for those of us who believe that individuals ought to have greater choice, greater opportunity to manage their health care costs, by taking pretax dollars to pay for medical costs that are not otherwise covered by insurance.

So for all those reasons, I congratulate again Chairman Grassley and those who have worked so hard on this bill. I know it
has not been easy. It is not perfect, but, again, I do not think we should let the best be the enemy of the good. So I will proudly support it and work with Chairman Grassley and others to see that this gets to the President's desk for signature as soon as possible.

Mr. President, I yield the floor.