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

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

Ms. COLLINS. Mr. President, the Senate will soon have an historic opportunity to pass landmark legislation to make affordable prescription drug coverage available to all of our Nation's seniors, as well as to people with disabilities who receive Medicare benefits. This legislation, which represents the largest expansion of Medicare in the program's 38-year history, is long overdue, and it deserves our support. Prescription drugs are as important to the health of our seniors today as a hospital bed was back in 1965 when the Medicare Program was first created.

I have long been a supporter of providing a prescription drug benefit as part of an effort to strengthen the Medicare Program, and I believe that were prescription drugs as important back in the 1960s as they are today the creators of the Medicare Program undoubtedly would have provided for that coverage. But back then the focus was on covering hospitalization.

While I continue to have reservations about some of the conference agreement's provisions, we simply cannot allow the perfect to become the enemy of the good. This historic opportunity may never come again, and we cannot afford to let it pass. We cannot allow yet another year to go by without taking action to help our seniors with the soaring cost of prescription drugs. Millions of older Americans and their families will be helped by this legislation. Millions more will be helped in the future. I, therefore, will cast my vote in favor of the conference report, and I want to take a moment to commend the majority leader, the chairman of the Senate Finance Committee, Senator Grassley, Senator Baucus, Senator Breaux and, indeed, all of the conferees who have worked so hard to craft a compromise and to bring this bill before us.

With recent advances in research, prescription drugs can literally be a lifeline for many patients. They reduce the need to treat serious illness through hospitalization and surgery. They allow our seniors to live longer, healthier, happier lives. Soaring prescription drug costs, however, have placed a tremendous financial burden on millions of our disabled citizens and senior citizens who must pay the full retail price for these essential drugs out of their pockets. Monthly drug bills of $300 or even $400 or even more dollars per month are not at all uncommon for older Mainers living on very limited incomes.

Lorraine White, of Winthrop, ME, wrote to tell me that she and her husband spend about $400 each month on vital prescription drugs. They live on limited income and they have had to draw down their savings to make ends meet. They wonder what they are going to do when their savings are depleted.

Time and again, seniors in Maine have come up to me to tell me they simply cannot afford the essential prescription drugs their physicians have prescribed. I remember an elderly woman coming up to me in a grocery store in Bangor and telling me she could only get 12 of the 36 pills for which her doctor had written a prescription. None of our seniors should be faced with those kinds of decisions. They should not be choosing between paying their bills and buying the pills that they need to stay healthy.

The legislation that is before us today will make affordable prescription drug coverage available to seniors such as the Whites, like so many seniors with whom I have talked in Maine, and it will protect them from these high out-of-pocket costs that are such a burden.

Under this legislation, the Whites' drug costs would be cut by more than half, and the savings would be even greater for this couple if they qualify for the low-income subsidies provided under this legislation.

The legislation before us today makes prescription drug coverage a permanent part of the Medicare Program, and it provides a benefit that will be available to all seniors and disabled individuals on Medicare, regardless of where they live.

It is also crafted in a way that, if a senior citizen is very happy with their health care insurance, the drug coverage that that senior already has, he or she does not have to take this additional benefit under the Medicare Program. It is a voluntary benefit.

Beginning in 2006, all seniors will be eligible to get both upfront and catastrophic protection for an average premium of $35 a month. Moreover, low-income seniors, those who are most burdened with the high cost of prescription drugs, will receive generous subsidies and get additional protections. The more than 12 million older and disabled Americans nationwide, including 75,000 Mainers, with incomes below 135 percent of poverty will not have to pay any premiums at all to secure comprehensive prescription drug coverage, and they will have only minimal cost sharing. An additional 18,500 low-income Mainers will qualify for reduced premiums, lower deductibles, and coinsurance rates, and no gaps in coverage.

The senior Senator from Maine spoke earlier today about this legislation, and I agree wholeheartedly with her contention that our Medicare beneficiaries will, indeed, be far better off once this legislation is signed into law. Clearly, we are providing meaningful and realistic help to our seniors, particularly those who are struggling the most-low-income seniors and those with very high drug costs.

The one drawback that I see in the way this benefit is structured, that I want to discuss right now, is that, unfortunately, it takes time for this new benefit to come on line. I fear many of our seniors believe this benefit is going to be available immediately and, unfortunately, that is not the case. But there is still help, immediate help, in this bill for our seniors. To provide some interim assistance, starting next year seniors will receive discount cards that will save them between 15 and 25 percent on each prescription drug purchase. Moreover, low-income beneficiaries will receive a $600 credit on that card, in both 2004 and 2005, that they can apply to the purchase of their drugs. This subsidy in conjunction with the discount card will give our most vulnerable seniors immediate assistance in purchasing drugs that they otherwise might not be able to afford.

In addition to the prescription drug benefit, there are other significant features in this bill that I strongly support. For example, the bill takes major steps to make Medicare payments more equitable. This is an issue I have been working on since my first year in the Senate. The bill tracks very closely legislation that Senator Feingold and I introduced earlier this year.

Medicare's reimbursement systems have historically tended to favor large urban areas and failed to take into account the special needs of rural States. This simply is not fair. Ironically, in Maine the low payment rates are also the result of the State's long history of providing high-quality, cost-effective care.

In the early 1980s, Maine's lower than average costs were used to justify lower payment rates to doctors and hospitals. Since then, Medicare's payment policies have only served to widen the gap between low-cost and high-cost States. I am, therefore, particularly pleased that the chairman of the Finance Committee worked so hard to include in the conference report significant steps to strengthen the health care safety net by increasing Medicare payments to physicians and hospitals in rural States such as Maine.

According to the American Hospital Association, these provisions will increase Medicare payments to Maine's rural hospitals by more than $125 million in the next 10 years.

Moreover, they will increase payments to physicians in Maine by an estimated $7 million a year.

I can't tell you how important these rural provisions are to my State. Maine ranks near the bottom in the rate of Medicare reimbursement despite the cost of survival care in my State and despite the fact that the providers in Maine give very high quality care. This inequity has only worsened as additional payments under the Medicare system have gone to large urban hospitals.

I am very pleased that the rural health care package will help relieve some of the stress on our rural hospitals which are so important to rural States such as Maine. It will help ensure that there is more equity in the Medicare reimbursement system.

I also include a special thanks to the conferees for including a provision at my request that will ensure continued Medicare graduate medical education funding for Maine's family residency programs. These family practice residency programs are absolutely essential in training physicians who tend to stay in Maine and serve. They practice in underserved areas of the State.

I am also pleased that the legislation restores the rural add-on; that is, the enhanced reimbursement for Medicare home health payments that is vital to sustaining home health care in the rural areas of our country.

The Presiding Officer, the Senator from Missouri, and I have worked very hard over the years to sustain and revitalize home health care. We are well aware that many of our elderly citizens would prefer to receive the health care they need in the privacy and security of their own home. But Medicare reimbursement rates, particularly in rural areas, have been so lacking that that home health care has been in jeopardy. I wish the bill went further. I think we should have had a 10-percent rural add-on in order to compensate for the additional costs in terms of travel time, long distances between patients, and other factors that come into play when home health care is provided to seniors and disabled citizens in rural areas.

In fact, surveys have shown that the delivery of home health services in rural areas can be as much as 12 to 15 percent more costly. But certainly the extension of a 5-percent rural add-on is a major step in the right direction.

I am also very relieved that the conferees rejected an ill-advised proposal to have our seniors have a copay for the cost of home health care. I am convinced that had that been included in this package and signed into law, it would have discouraged many of our most vulnerable sick seniors from getting the home health care they need. The conferees made a wise decision, indeed, in dropping that provision which was included in the House version of this bill.

The conference report will also make prescription drugs more affordable for all consumers by closing loopholes in our patent laws that some of the large brand name pharmaceutical companies have exploited in order to delay consumers access to lower priced generic drugs. According to the Congressional Budget Office, these provisions will help to reduce our Nation's drug costs by some $60 billion over the next decade.

I am very pleased to have played a role in drafting this legislation with leaders on the bill-Senator Schumer, Senator McCain, Senator Edwards, and Senator Gregg. All of us worked very hard to bring this about. This is a really significant provision. It is going to help reduce the cost of drugs in State Medicaid programs. It will help to control the cost of drugs in the Medicare Program as we are adding this benefit. It will help uninsured individuals because it will lower the cost of drugs for them. It will help employers who are providing prescription drug coverage as part of a health insurance plan. This is a very important provision and one I advocated very strongly to be included in this conference report.

In addition, the conference report includes the provision which I offered, and which the Presiding Officer cosponsored, to the Senate bill to establish a pilot program to help modernize the outdated "homebound" definition that has impeded access to needed home health services for many of our elderly and disabled Medicare beneficiaries.

I know that when we start talking about the definition of "homebound" in the Medicare Act it may sound esoteric, but in fact it is vitally important for so many disabled and elderly citizens who, because of the interpretation of the law by some of the fiscal intermediaries in the Medicare Program, have literally become prisoners in their own homes fearful of leaving in that they will jeopardize their ability to continue to receive essential home health care.

I particularly thank David Jayne, the courageous advocate who inspired this legislation, a truly heroic individual, and also Senator Bob Dole who has been such an outstanding advocate for disabled Americans for so many years. They worked very hard to ensure that this provision was retained in the final version of the bill.

Overlooked in much of the discussion of this Medicare bill are other very important provisions that will provide better coordinated care for seniors with chronic conditions such as diabetes. As the cochair, along with Senator Breaux and the founder of the Senate Diabetes Caucus, I believe these provisions will greatly improve the quality of care for individuals suffering from diabetes. I am very pleased that these provisions have been included in this bill.

I have talked now at some length about the many provisions in this conference report that I strongly support. I do, however, have reservations about other provisions.

The House bill included provisions based on a premium support model that would have called for direct competition between private plans and traditional Medicare. I have serious concerns about the implications of this proposal, particularly that it could result in driving up premiums in the traditional Medicare Program. That would be particularly problematic in a rural State such as Maine where seniors are not likely to have a host of insurance companies competing for their business because of the small size of the market.

Moreover, the House bill could have resulted in sharply different premiums for seniors in different parts of the country and even within a single State. Those health provisions really troubled me because I did not think that a senior living in Fort Kent, ME, should be paying a different rate for the same coverage as a senior who is living in San Francisco, CA. I therefore joined a number of my colleagues in sending a letter to the majority leader expressing concern about the inclusion of this controversial policy in the Medicare bill.

The final bill, while it still causes me a lot of concerns in this area, is different from what was in the original House proposal. The original proposal was significantly downsized to a limited pilot project that would not begin until the year 2010 and that would provide significant protections for those seniors who are remaining in the traditional Medicare Program.

While I continue to have reservations about even the demonstration project, I urge my colleagues to look at the package as a whole. I agree with the AARP and the National Council on the Aging that its strengths clearly outweigh its weaknesses. When I hear some say that somehow this legislation spells the end of the traditional Medicare Program, I know that is not true. I know it is not true because I have carefully studied this bill. I also am convinced it is not true because the AARP, the Nation's largest seniors organization, would never endorse a bill that spelled the end of the Medicare Program. That is just not conceivable.

This conference report represents the last real hope of getting an affordable Medicare prescription drug benefit anytime in the foreseeable future. Our seniors have already waited too long for this benefit. We cannot delay; we cannot continue to push this issue off to the future. Since the cost of providing a meaningful drug benefit will only increase as time passes, it is imperative we act now. Our seniors have waited too long for this coverage. We cannot push this off another year, another month, another week. Let's act now. Let's not let the perfect be the enemy of the good.

This package is worth supporting despite its flaws. I urge my colleagues to join me in voting yes on the conference agreement.

I yield the floor.