Thank you very much for being here. We have colleagues that will be joining us. I think we will go ahead and get started as they come.
I'm very pleased that Senator Mikulski and other colleagues will be joining me as we talk about this very important debate on Medicare and expanding Medicare to cover prescription drugs.
We feel very strongly that as women we understand that women are very much involved and care about this debate because the majority of people on Medicare are women. We know that starting at the age 65 that 57 percent of the beneficiaries are women, but by age 85, because at least at the moment we are living longer, that we, in fact, comprise almost three out of four of the Medicare beneficiaries that we are talking about during this next two weeks.
So when we talk about health care for older Americans, we talk about Medicare, we are talking about the health of older women. And that makes it a particular concern to all of us as we debate the right way to do this.
We come with different perspectives about the right approach in terms of strengthening Medicare, but I think there is a general feeling, certainly in our caucus, that we need to have an option of Medicare coverage under Medicare as one of the options that is available for seniors to choose from.
Because of that, I'll be offering an amendment -- it will be the first amendment that we offer this afternoon -- that will do just that. Right now, unfortunately, under this plan that's been put forward, we have the first option being only private insurance companies for anyone under Medicare. You don't have the choice of choosing to stay in traditional Medicare and receive help with your prescription drugs. You are forced, if there are private plans -- at least two private plans in your area, to choose one of those plans.
And then, as we know, there is a process that would require you to go in and out potentially, have one insurance plan; the next year something changes, you're back to something else; then you may be back again; back and forth and back and forth.
I find it interesting that many colleagues have said that seniors under Medicare should receive the same kind of prescription drug coverage that we receive through our federal employees health system. I can assure you, no one in the federal employees health system is required to change health insurance companies every year. No one is required to pick from one group without having the total selection of options.
If someone wants to pick Blue Cross and Blue Shield and stay there forever, they can. If they want to choose an HMO, some other managed care system, they have the opportunity to do that.
We are not providing that for our seniors under this plan. They do not have the full range of choices because they don't have the choice that, in fact, 89 percent of them already have selected, which is to stay in traditional Medicare.
So when we talk about Medicare we are talking about older women of this country. When we talk about providing choices, we are talking about providing choices for older women, as well as men, in this country. And we intend to fight to make sure this plan is the best it can be. Our seniors have waited long enough. We've got to be able to provide them with the best possible plan we can and that's really what we're fighting for in the next two weeks.
Very pleased to have the dean of our delegation, the women of the Senate, as well as one of the cardinals in the Senate, Senator Barbara Mikulski from Maryland, with us, who is a constant champion on the issues of Medicare and Social Security.
I'm very pleased today to join my colleague Senator Debbie Stabenow, as well as Senator Boxer, in standing up for a prescription drug benefit and for doing it now. Senator Boxer and I have served in both the House and the Senate together, and have long been advocates in the area of women's health.
My colleague Senator Stabenow also has a Master's degree in social work. So do I. So Senator Stabenow and I are the only licensed, certified, born-again do-gooders in the United States Senate. So I'm proud to stand them with today to talk about a prescription drug benefit for seniors.
I think as we look at the debate we need to look at certain principles. Number one, we must have a sense of urgency. A prescription drug benefit is absolutely needed and it is needed now. Too often in the Senate when all is said and done, more gets said than gets done. You can't talk your way into being able to get your insulin.
You can't talk your way into being able to get your Lipitor. You can't talk your way into being able to get the much- needed drugs if you have blood cancer or lung cancer or breast cancer.
So now, talk is cheap, but a prescription drug benefit might not. But we need to be able to pay the cost and share the responsibility, because the seniors of this country are in absolute desperation to have a prescription drug benefit. So a sense of urgency.
Number two, we need to make sure that we do not privatize Medicare and that we keep Medicare as Medicare.
The other is that we have to look at it as a woman's issue. Women tend to have greater health needs and lower incomes. Senior women spend a greater share of their income on prescription drugs, because 70 percent of the women on Medicare are over the age of 85, they tend to have multiple chronic conditions, they have to have those that are absolutely necessary to be managed by a prescription drug -- diabetes, hypertension, and heart disease -- and they have paid a mommy tax.
Very often, women, because they have stepped back because of child-rearing responsibilities, their Social Security is far lower than men or if they have a pension benefit at all, it is often skimpy and Spartan.
But we can't skimp on what we're going to do for them. So we need to be able to look at them as one of the greatest utilizers of prescription drugs who also come to the doctors examining room with the least disposable income.
Then when we look at this, we need to make sure that the benefit is universal. If we are truly one nation under God, there should be one universal benefit under Medicare.
Second, it should be affordable to the senior and to the taxpayer.
Also, it needs to be meaningful. It means that we need to have a prescription benefit that covers drugs based on what the doctor says the patient needs rather than what an insurance says the patient should have.
So I'm for passing a prescription drug benefit. And I want to pass it before the 4th of July. But I want a benefit that is for the benefit for the seniors and not for a benefit for the insurance companies.
Thank you so much.
I'd like to now turn it over to Senator Barbara Boxer, another champion on issues of health care and women's health.
I wanted to give my colleagues and you out there an idea of why this means so much to me in California, and a lot of these percentages will reflect other states.
I've got 4 million Californians on Medicare. That's five states of Delaware, all right? That's five states of Delaware. Those are just my people on Medicare. So what we do here isn't a matter of affecting a few, but many.
Fifty-six percent of them are women. Forty percent of Medicare beneficiaries are low income. And by the way, women average one half the retirement income of men.
This just gives a picture of why you see the Democratic women of the Senate, or a good group of us here, and it is because we understand the reality of these people. We know what their life is like. We've seen our own parents and so on.
Now I'm just going to make a couple of quick points. Senator Stabenow has, I believe, the most important amendment of all, although there will be many important amendments. Because what she is saying in her amendment is that, when it comes to a prescription drug benefit, Medicare must be an option not just a fallback for times where you don't have two companies competing. Why is it so important?
First of all, our seniors like Medicare. And we know many from the other party don't like it, from Newt Gingrich who said it's going to let it wither on the vine to others who say it's over and our own president uses the term "reform." What that really means in my mind is repeal. I've been around here long enough to know when they say "reform" they mean "repeal."
So we really have to make a stand, and I hope we'll win this vote.
Senator Stabenow's amendment -- it's crucial that Medicare be the way. Why? Because underlying this whole problem is the high cost of prescription drugs. I'm sure that Senator Stabenow talked about that. And if you have Medicare out there negotiating, bargaining for the best price, you're going to see the cost of drugs go down. If you don't, Katie bar the door.
You know, there's no set premium here. It's suggested at $35 a month, but if you look at Medicare Plus Choice -- our colleague Chuck Schumer was explaining that this morning at the leadership meeting -- there's no end to what they can charge.
I'm going to have an important amendment as well. You know there is a benefit shutdown in this plan. The benefits just shut down, they stop cold when you get up to around $4,500 of drug costs and they don't resume again until you get way up to $5,800. You do the math. That's a lot of money for seniors who are poor.
So we say, "End the benefit shutdown."
The way I calculated it last night sitting on the plane, and I can't swear that it's accurate, but if someone has about a $5,000 drug bill their benefit after all is said and done -- paying the premiums, doing the paperwork, getting the mail, figuring it all out -- is 20 percent. They'd be better off buying their drugs from Canada, friends.
But the bottom line is we have an opportunity here. This is a chance to get something in place. And we're going to work as hard as we can to make it the best that it can be.
And I just want to say in closing that Senator Stabenow has been just unrelenting on this. And I just want to personally say to her how much appreciate what she has done.
I don't have a degree in -- what is it, social work? I do have a degree in economics and you put together social work and economics and you say, we got to do better than what we've got in front of us.
Senator Maria Cantwell from Washington state, another strong advocate with us?
Thank you, Senator Stabenow. And I also want to give my thanks to you for your perseverance and hard work on this issue and for your amendment, which I think is critically important to this legislation.
When Congress first created Medicare, it designed a program, as I quote, "Make the best of modern medicine more readily available to the agent," end quote. We're not making the best of modern medicine available when millions of senior can't afford access to the prescription drugs that they need. This is especially important, as my colleagues have said, to older women who find that their health care demand may take them longer in years.
Medicare is not typically thought of as a woman's program, but it does have a disproportional effect. Almost six in 10 of those in Medicare at 65 are women, and by age 85 women outnumber men in the program by more than two to one. In Washington state, 58 percent of Medicare beneficiaries are women. And women on Medicare spend 20 percent more on prescription drugs than their male counterparts, because women live longer and typically have more chronic illnesses. In fact, in 2003 female Medicare beneficiaries spent a total of $2,418 on prescription drugs; nearly $1,100 of that was out-of-pocket expenses. But their male counterparts spent much less.
There is a clear need for a prescription drug benefit. We've heard that here and we join our colleagues in that. But seniors do not want their prescription drug benefit run through an HMO or a private insurance company. A study that was done in June 2002 by the Kaiser Family Foundation and the Kennedy School of Government found that 67 percent of American people believe that we should expand Medicare to pay for part of prescription drugs. But when asked, only 26 percent said we should help seniors pay by private insurance to pay for their prescription drug costs. So 67 percent wanted Medicare, 26 percent said, "OK, you can have a private insurer."
So Congress needs to take a reasoned and rational approach to integrating a new prescription drug benefit into Medicare and that's why I will be supporting the Stabenow amendment. As women senators, we must pay special attention to this because of the needs of women in the Medicare program. And I have many conversations with seniors in my state and constituents and they tell me that they want a prescription drug benefit that is simple, but comprehensive and based on the very best medical technology. And most important, they want that system run through Medicare. And that's what we're going to be continuing to fight for.
I wonder if my colleagues will indulge me for a minute to just say that I followed the president's remarks this morning in Virginia at a work force training summit at a community college and was surprised to hear the president's comments on work force and how important it was, given that the president's own budget request was a 12 percent cut from the 2002 level. And he mentioned the one-stop- shop program -- a program that he pretty much is decimating in his budget proposal -- and leaves a big question mark whether we will fund those effective programs.
I was successful in getting a budget amendment on the budget resolution to keep the 2002 level, something that we fought hard for and we're joined by Senators Snowe and Collins to keep that.
So if the president had gotten new religion on work force, glad to hear it. I hope he'll guarantee as we come to the appropriations bill money for work force. Otherwise I invite him to Washington state to help us deal with our 7.4 percent unemployment and understand how critical the work force issues really are to this country.
One other point: I will be offering an amendment to this legislation on PBMs to make sure that benefit managers of prescription drugs are more forthcoming with their accounting and their records, and to make more transparent the profits that they get so that consumers understand where the costs and prescription drug benefits are going.
Let me just conclude by saying again that women have a major stake in this debate. And that's why we are here today.
And secondly, while we understand and we completely agree with the incredible sense of urgency to move forward on behalf of seniors to help them with their prescription drug coverage, we have a responsibility to get this right, to be able to provide what it is they are really asking for.
And as my colleagues have said, what seniors overwhelmingly are asking for is that we update Medicare -- simply update Medicare. Eighty-nine percent of the seniors under Medicare, when given a choice between an HMO and traditional Medicare, have chosen Medicare.
That's what my amendment does.
My colleagues, I appreciate their cosponsorship and support. We will be offering that. If we want true choice, my amendment provides true choice so that people have the option of receiving prescription drug help where they choose to do it. That's all this is about.
And I'm very hopeful that my colleagues will join us in truly providing choice for the seniors of America.
Yes. Essentially if seniors were to have -- much like we have through the federal employee system -- a range of choices, but one would be traditional Medicare, to be able to administer the program, one would be HMOs, PPOs, other kinds of managed care.
So it would be available to everyone. You wouldn't be penalized by choosing Medicare.
Right now, if you don't choose to go into an HMO or a PPO, you are penalized because you're forced into this very confusing system where you have to take private insurance if two or more plans are available. If one is dropped, then you can go back, you can take a Medicare plan, but the next year, if there are two or more plans, you have to drop Medicare and you have to go back and wade through insurance forms.
So can you imagine -- I mean, someone who every year or every other year gets this wonderful prize mailed to their house which is reams and reams of insurance paperwork that they get to choose from every year potentially, or every other year, in terms of their insurance? That is certainly not what we do for federal employees. Senators would never tolerate that.
And by the way, I should say that we are only spending half of what we spend on ourselves, in terms of the federal employee system in this particular plan.
There's no gap in coverage for senators or for other federal employees. There is no gap. There is no structure like we have set up. This is not what we provide to ourselves. There's a benefit shut-down. There's not true choice.
And so we gladly step up and urge our colleagues to join with us, to truly provide both the choice that senators have, as well as the benefit level that senators have, and the seniors of our country would be very pleased by that.
There is no cost. What I'm doing in my amendment is no difference in cost. We're not dealing with the other critical issue that Senator Boxer raised. In my amendment we simply say that within the dollars and the benefit structure that has been defined by the committee, we will have a real choice of traditional Medicare or other private plans.
I just wanted to say as someone who's -- my mother passed away when I got to the Senate, but she was ill for quite a while. And most of us in real life, unless someone can really afford to have a full-time accountant seriously at your every wish, it is really confusing to go through life, period.
Now you have a situation, if the Stabenow amendment passed, we have a whole new world here because you said, "Is there cost?" It's going to save money for seniors right away because Medicare will have so many people signing up that they will be able to negotiate the best prices. So it's going to be cost saving for the individual and certainly no added burden -- it's paid for in the bill.
But I'm just trying to get through here the human touch here. I want you all to think about the most elderly person you know, whether it's a grandma, an aunt, an uncle, think about it and think about that person at that age dealing with a circumstance where they could have a changing insurance company. You know, every few months somebody could go out of business, somebody comes in. They have to keep a running calculation of how much they've spent until they hit the benefit shutdown, because what if the insurance company says, "You hit the benefit shutdown." "No, I didn't. I only spent $3,000." "No, you spent $4,800 on the drugs." And it's going to be huge nightmares.
So I just hope that people will take into account what happens on the ground to real people, real families, and think about the fact that a lot of our seniors are living longer. It's a wonderful thing, and they need that medication. They don't deserve to have a benefit shutdown. They don't deserve to be faced with a nightmare of paperwork.
Somebody told me yesterday that his mother was dealing with some HMO and she was crying because she couldn't do anything about it, and her two sons got on the phone and they couldn't do anything. "Oh, call the other person, the other person."
So we have a great opportunity here. We have agreement that there ought to be a benefit, but let's not just forget about the fine print here.
Well, here's what it says to seniors. It says, "It's more important that you get a plan that will work for you, that will really have benefits for you, and let's have it sunset and the year before it sunsets, let's take a look and see if it's working."
See, my view is, sort of, like the Republican view on things. As you know, they sunset -- in order to get bigger tax cuts they sunsetted the tax cuts. And then their idea is, "Well, when that sunset comes, everyone is going to be afraid."
Well, you know what? I want to sunset this, but I want to make it a better bill that doesn't have a benefit shutdown. You know, it's really a sickness penalty when you really think about it. Suppose that benefit shutdown kicks in because you've got cancer and you're on expensive chemotherapy. Now all of a sudden you have a benefit shutdown.
I would rather have a bill that works well for a shorter period of time that seniors like than to have a total fiasco. And so I think it's a great idea to have a better plan, sunset it. You're going to have to look at this anyway. This is a new benefit. This isn't something that's not going to have quirks in it, and that's what I'm going to offer so there will be no added costs. We're just going to say, it sunsets a little sooner.
Let me just add that I hope as you describe this you will include the tax cuts in order to be fair and look at the whole system. When we have a $350 billion tax cut that passed that was only $350 billion because of sunsets in order to squeeze and move that into a particular time period to be able to get the level of cuts.
If that is legitimate public policy for tax cuts, then it is certainly legitimate to provide the kind of benefit that seniors needs and deserve, and do it within a timeframe that will allow us to fully provide that benefit.
And then to come back when we are nearing the conclusion of the time period and extend it, that is no different than any other approach. I've been here just in the Senate two and a half years and have seen this happen many, many times.
So we really are talking about a choice of values, a choice of priorities in our minds, providing real help for seniors to pay for their medicine. Life-saving medicine is equally as important as the tax cuts that were passed for the privileged few of this country.
Well, let me just tell you why it makes more sense here, way more sense. This is a new benefit, never been done. This bill is complicated. We don't know how the private sector will respond. We don't know even whether they will respond. From what we hear, a lot of these HMO companies don't offer a standalone drug benefit, because they can't make it work, they can't get enough profit in it.
So if ever there was a case where, yes, make it a better plan, sunset it out, then in that year before it sunsets out, take a look at how you can save money, how you can make it better, how it can work. Let's hear from the seniors.
Tax cuts, that's nothing to do with a new program. So when you're talking about a program -- for example, the Violence Against Women Act. We sunsetted that out. We sunset out a lot of our programs because they need to be reviewed.
And this one, with all its controversy, as you know, to get a bit -- look, I give Max and Chuck Grassley credit for getting a bill out. I look at it as a way for us to now weigh in as women of the Senate and people who are concerned to make it better. But the fact is, this was -- there were a lot of tough choices made here that could come back, frankly, to haunt some of the folks unless we make it better. So why not sunset it out? It's not a tax cut. Tax cuts are tax cuts. This is a new program. And I've got to go.
It's a few years, it's a few years sooner. I'm working on it. I haven't got the score from CBO, but I'll let you know as soon as we have it.
Great, well, thank you very much.