Medicare's Prescription Drug Benefit (Part 1)

MEDICARE'S PRESCRIPTION DRUG BENEFIT
House of Representatives
March 29, 2006

The SPEAKER pro tempore. Under the Speaker's announced policy of January 4, 2005, the gentleman from Georgia (Mr. Gingrey) is recognized for 60 minutes as the designee of the majority leader.

Mr. GINGREY. Mr. Speaker, I am proud to be here this evening doing this special hour of the Republican majority talking about a great success story, and that is the implementation, after a 40-year wait, literally, of a benefit under Medicare that our seniors have been promised by other administrations, by other Congresses. And finally this President, this administration and this Congress, this Republican majority, has delivered on the promise to bring a prescription drug benefit to our needy seniors.

I will be joined this evening during this hour by a few of my colleagues on this side of the aisle, the gentleman from Minnesota (Mr. Kline) and the gentleman from the great State of Texas (Mr. Burgess), a fellow OB/GYN.

But I want to start out talking a little bit about this program and why I think it is so beneficial. My colleagues know that in my prior life, as recently as 4 years ago, in fact, before getting elected to the Congress, I practiced medicine for 30 years. I was there really at the infancy of the Medicare program. I was a freshman medical student in 1965 when an amendment to the Social Security Act that is the original Medicare was signed into law by Lyndon Baines Johnson.

Something that many people do not know about Medicare part A and part B, part B being the optional part, just as part D is, seniors were going to have to pay a monthly premium. The very person, the very first senior to exercise his option to sign up for part B was none other than President Harry S. Truman. If you go to my Web site, you can actually see the film clip in black and white.

I like black and white, which says something about my age and television and movies. It is very interesting.

When you look back at that program today, and we are talking about a 40-year history, I think most people would say Medicare has been a great, great benefit. I think all of my colleagues would agree with that, part A and part B, even the optional part B. And over the years, of course, that monthly premium has increased to $88.50 a month today, and I think it was something like $15 a month in 1965, but it is still a deal. It is a good deal because the seniors taking that money probably out of their Social Security check are only actually paying 25 percent of the true cost of part B; 75 percent of it is paid by the general taxpayer.

Again, it is an optional program, but I think today I am right in these statistics, 98 percent of seniors when they turn 65, on that other voluntary part, part B, the doctor part, the surgery part, the outpatient testing part and physical exams, have opted in and certainly not opted out.

So here we are now finally with a great addition to the Medicare benefit for our seniors. We passed it, we all remember. We have some complaints still from the other side of the aisle that we passed it in the middle of the night. Doing things in the middle of the night in my profession as an obstetrician is quite routine. You either admit patients in labor in the middle of the night and deliver them in the daytime; or your admit them in labor in the daytime and deliver them at night. I would like to feel as a Member of Congress that I am not immune to a 24-hour schedule.

But back in November of 2003 we did pass this. We had the transitional program, the Medicare prescription drug discount card that was so beneficial to our neediest seniors because it gave them a $600 credit per year for 2 years. It was actually a year and a half. They got $1,200 worth of credit for purchasing prescription drugs if they were low income, and many were.

Now that program has gone away and we are into the insurance program and getting very close to the end of the 6-month sign-up period, May 15 of this year, just a little less than 6 weeks from now.

I think my colleagues, I wish on both sides of the aisle, but certainly those of us on the majority, even though some of us for what we felt they felt were legitimate reasons to be in opposition to this, yes, somewhat expensive additional program, they are encouraging our seniors to take advantage of it.

I am, as I say, wanting to talk about this program tonight, and we will do that as we continue this hour. But I want to, at this time, yield the floor to my colleague from Minnesota who has a lot of interesting stories to tell about folks in Minnesota, his constituents and how they are saving money and eventually how we are saving lives.

At this time I yield to the gentleman from Minnesota (Mr. Kline).

Mr. KLINE. I thank the gentleman for yielding and for his bringing this issue to the floor tonight and certainly his leadership over these months.

I just wanted to touch on a couple of points. I think it is important, as the gentleman from Georgia said, that we recognize there was a spirited debate on this bill, and not everyone in this House voted for it. There are still people today who think that it was a mistake when we added the prescription drug benefit to Medicare.

But I think the point to my colleagues, and I know that my good friend Dr. Gingrey would agree with me, and I hope that senior citizens across the country understand that we need to set that debate aside right now. We have a law in place that provides a tremendous benefit for our senior citizens, particularly our lower-income senior citizens.

I think that chart that Dr. Gingrey showed that says a total of 27 million seniors, 27 million seniors now have coverage under Medicare Part D, says an awful lot about the acceptance of this program, regardless of the heat and the debate that took place when this bill was passed.

I know that we now have registered for the Medicare prescription drug plan in Minnesota, in the Second District, 65,000 senior citizens, and that is a very, very good thing. We found early on, and I think my colleague probably did, that as we moved from the discount cards, which I thought were a tremendous benefit themselves, I know that my mother, who lives on Social Security and Medicare, has saved literally thousands of dollars with that interim program. When we moved from those cards to the sign up for Medicare Part D there was certainly confusion. Seniors were confused. Pharmacists were confused. Doctors were confused. It was not what we would call a smooth start.

Having said that, we have now moved past that rocky start, and seniors that have had the chance to look at this understand that it is really an important benefit for them.

We wanted to help, in my office, and I know many of my colleagues did this on both sides of the aisle. They held town hall meetings and workshops. We chose to have what we call sign-up workshops. We got some tremendous support from the Minnesota Board of Aging Senior Linkage Line provided volunteers to come and help us, help the senior citizens in Minnesota's Second District understand what their options were. We advertised the workshops. We had seniors call my office to make an appointment to come in for one-on-one counseling. And as these seniors came in and they sat down with experienced volunteers and members of my staff who have become quite expert on this, and they looked at the program that was offered in front of them and they looked at their list of medications that they are taking and that the options that were there, in case after case after case, they were able to make wise choices, and I don't know anyone who came to our workshops who didn't leave feeling that they had gotten the information they needed and were able to make a wise choice.

I have some quotes here that I just thought I would share with my colleagues here, and I know that Dr. Gingrey can empathize with this, and he experienced much of the same, I am sure, when he was working with the folks in Georgia. But just a couple of quotes. There is a man from Shakopee came to the workshop and he said, quote, ``I got an honest comparison and found out the plan I was leaning toward would cost twice what I could get. Now I can save $2,000 on a different plan.'' That is quite a bit.

Lady from Eagan said: It was wonderful. I wouldn't have known what to do or where to begin without that session. The woman that worked with me was very knowledgeable and did all the computer work for me. She printed up the nine cheapest prescription drug coverages for me, and I can see already that I am going to save $100 a month. I was very, very pleased. And so forth.

Lady from Inver Grove Heights said: They were wonderful. They were extremely informative. In 45 minutes, they probably saved 8 hours of work and confusion.

These programs, if you just take the time to sit down with somebody who knows what they are doing, it is actually pretty easy to decide what plan is best for you. And we have seen that in case after case after case. And I very much regret that there are, in fact, some of our colleagues who are still perhaps upset over the bill itself and are not providing this kind of help and encouragement to the seniors in their district.

I know my mother, as I mentioned before, she was a beneficiary of the interim plan with the cards, and now we have got her signed up for this Medicare Part D and she is going to save thousands of dollars a year.

You can save a lot of money, and I hope that our colleagues will help the constituents in their districts, the senior citizens, understand the value of this program, set aside the bitterness of the debate that took place over the bill itself and recognize that this is a tremendous benefit, it can save their senior citizens hundreds and sometimes thousands of dollars, and help those seniors to sign up.

I don't know if the gentleman from Georgia is continuing with his workshops. I know we are. We have a couple more scheduled next month. We are looking at the schedule deadline. May 15 is the deadline for signing up for this prescription drug benefit, the Part D, without paying a penalty, suffering a penalty. So we are encouraging our seniors to sign up. We are scheduling some more of these workshops and encouraging them to come. The wonderful volunteers from Senior Linkage Line are going to be there to help us again. We hope that every senior will take a look at this option and decide whether it is for them or not. If they have any questions, we would love to help. I will yield back to the gentleman from Georgia here. I know that he has spent a lot of time helping seniors in his district in much the same way.

Mr. GINGREY. Well, if the gentleman would yield.

Mr. KLINE. I am happy to yield.

Mr. GINGREY. Actually, just for a question. And I wanted to ask the question, if he has had an experience really similar to what I have. We have been working on this program, like I say, for a year and half during the transitional phase, and Representative Kline has held a lot of town hall meetings; I have certainly held a lot of town hall meetings. You sort of lose count after a while.

But what I wanted to ask Mr. Kline, Colonel Kline, is, in your experience, when you first started doing these programs, and there was so much angst and rhetoric and doom and gloom possibly from certain Members of the body, did you feel that what you heard then and what you are hearing now was a little bit different? Has that changed a little bit?

Mr. KLINE. If the gentleman would yield. I think it is fair to say so. We took a different approach in how we were going to reach out to the seniors. We sent them mail to alert them to what they were doing. We invited them to call our office and make appointments so they could get that one-on-one attention. But I am sure the gentleman will agree that back in January and early February, when there was a great deal of confusion, many seniors were afraid to get started. They didn't know where to start. And we found that by continually offering the opportunity for seniors to come in and get one-on-one help, that we moved through that. And I know that the gentleman from Georgia and most of my colleagues who have been working on this issue for some time have seen a change in the understanding and the attitude of not just seniors, but I think many of us who are at that stage in life where we are helping to take care of seniors.

You know, the gentleman from Georgia, I don't know if he has advertised what his age is. It is a matter of public record, as you know. But those of us that are in our 50s, many of us are in the position of having parents who are not as able to take care of themselves, and we are anxious to make sure that we are providing the best for them. And so I found that not just the seniors, but a lot of times, their children, I hesitate to think of myself as a child anymore, but those people who are responsible for the health care for their parents and elderly relatives have also come to understand that, with just a little bit of attention to this, it has proven to be a very good program that can save them hundreds and sometimes thousands of dollars. And I know that Dr. Gingrey knows that not only is it saving individuals money, but this whole process, the competition in this process, which was hotly debated and much discussed, has actually started to drive down the cost of those prescription drugs and the cost of the whole program to the taxpayer. So we are seeing competition work in the large scheme of things, a sort of macro economics. But we are also seeing a payoff in these examples that I read from constituents in my district of where it is helping the individual seniors, the elderly couple and those who are helping to take care of them. So a change in attitude, I think we are seeing everybody who has come to our workshop, whether they have signed up on the spot or just taken the information and gone home, has left very relieved that this is a program that can help them, and it is not nearly as scary as they thought a few months ago. And I will yield back to the gentleman.

Mr. GINGREY. I thank the gentleman. And that really is an experience, Mr. Speaker and my fellow colleagues, that I have had as well. Early on, we, almost every town hall meeting on the subject it seemed like there was someone there that was reading the talking points from the opposition in regard to oh, you know, you have done nothing but let the pharmaceutical industry write a bill, or this is just a giant giveaway to the drug companies. And you heard that kind of rhetoric almost every time. But what I am hearing, and I think Representative Kline as well, that people now understand that in this process that we go through, nothing that we do, no bill, Mr. Speaker, is perfect. I wish that it were. But that the product that we delivered in November of 2003 is a very, very good product, and our seniors are beginning to understand that. They are seeing through a lot of this negative rhetoric, mostly from the other side of the aisle. And what is said is they are even in the last throes of the implementation of this program, we are down to the last 5 or 6 weeks, it is my understanding, and I know this because I have actually seen this, Members are holding town hall meetings and in some instances discouraging people, continuing to discourage them.

Mr. KLINE. If the gentleman would yield.

Mr. GINGREY. I will be happy to yield to the gentleman from Minnesota.

Mr. KLINE. I thank the gentleman for yielding. You know I find that absolutely remarkable. I was just thinking, I could not help but smile to myself when the gentleman was pointing out that there is no such thing as a perfect bill. And I would argue that many times there is a perfect bill. It is perfect to me, but it is not perfect to my colleagues on the other side of the aisle, or I dare say sometimes not even to the gentleman from Georgia and vice versa. So we work these things out. We try to do the very best we can. Every large bill is going to have a flaw in it from one of our perspectives. There are some flaws in this bill from my perspective and I am sure from the gentleman's and from our colleagues. But I think what is very important, that we all understand, that our constituents understand and that our colleagues here understand is that debate is for now behind us. What we have now is the opportunity, with a deadline of May 15, for our constituents to see what is available to them and see if it can't save them money. And we are seeing in case after case after case of the now hundreds of people in Minnesota's Second District that it can save them money. It is saving them money. And if you are discouraging one of your constituents from looking into this program because you are unhappy with the bill, I would argue that you are doing them a great disservice. And I would argue that you are not doing your job as their Member of Congress because that debate may come again another day. There will no doubt be changes in Medicare legislation as we go down the road. But for now, it is very important that we set that acrimony aside and make sure that our constituents know that they have a program here that can save them an awful lot of money. And I will be happy to yield back.

Mr. GINGREY. If the gentleman would yield. And the gentleman said, you know, doing your job, and that is exactly what we should be doing. In fact, I think what we are hearing from the other side as they continue to oppose everything that this majority has tried to do in the 109th Congress, and of course the rhetoric gets worse and worse as we approach November, and we all know it is an election year. But it is not only, I think, not doing your job for your constituents, but it is kind of like one of my favorite Garth Brooks songs, it's shameless. It is absolutely shameless to think that someone would hold a town hall meeting and discourage, as the gentleman from Minnesota said, seniors from signing up for something that is going to save everybody some money, but it is an absolute Godsend to those of our seniors who are low income, low assets, the very neediest in our society. And I think most of the legislation that we try to pass, and I think the attitude should be the same whether we are Republicans or Democrats, is to try to help those in the greatest need who really can't help themselves through no fault of their own.

We need to put some wind beneath their wings to kind of uplift them.

And I know there may be a few in the gentleman from Minnesota's district and I know there are some in the 11th of Georgia who still need to get the message, and maybe they do not know and they do not realize. They have not gone to the Social Security Web site and found out that they qualify because their income is only $14,450, or if they are married, $19,250 a year; and they do not have assets worth more than $11,500 if they are single, or $23,000 if they are married.

We need to get them signed up, and I know the gentleman would agree with me on that.

Mr. KLINE. If the gentleman would yield, I think that is an excellent point. We sometimes forget that when we passed that bill, the one we have been discussing which was debated with some spirit, it was designed, it was designed to help seniors who are low income first; and I think that the implementation of this part D is showing that to be true. When we have low-income seniors come to one of our workshops and they are taking sometimes a passel of prescription drugs, they are saving thousands of dollars. That is what the bill was designed to do.

I remember a lot of the debate and discussion, and we talked about seniors who were forced into the terrible position of choosing whether to take a prescription drug or having the next meal or paying rent or perhaps arbitrarily choosing to cut their tablets in half. This part D for low-income seniors removes that. There is no low-income senior who should not be getting their prescription drugs with tremendous savings, virtually free in some cases, but saving lots and lots of money.

What we are finding very interesting is that there are thousands of middle-income seniors who, when they come to our workshop and look at the choices and they sit in front of that computer terminal where you can very quickly rate the different choices, they are seeing that they can save an awful lot of money and it is to their benefit.

If it is not to their benefit, certainly they can choose some other form. Perhaps they have private insurance or they have VA benefits or something. It may not be for them. But many are finding out that they can save money.

And so it goes back to the point the gentleman was making earlier. It is incumbent upon all of us, certainly the administration; some organizations like the AARP are working very hard to get this word out, and Members of Congress, our colleagues, to make sure that the citizens know that this is something that they ought to investigate.

And I know that we found early on and even last year when we were looking at the interim discount card that there are seniors who are not comfortable, frankly, sitting in front of a computer and going on line. Many are and I am always very heartened to see that. Some of them, in fact, are much more computer literate than I am. But in many cases they are intimidated, and that is why it is important that this help be offered to them, either in one of our workshops or yours, or there are other ways that you can get help.

Medicare, CMS itself, will be happy to provide help. Seniors can call 1-800-Medicare. There are ways that they can get help without having a computer and without having to sit down by themselves and try to figure this out.

So I encourage all of my colleagues to do everything they can to make sure that their constituents, their senior citizens, know that even if they are not low income, this is a program they ought to investigate.

Mr. GINGREY. I appreciate the gentleman's being with me tonight describing this program in greater detail.

I wanted to point out a couple of slides based on the information that he just gave us, and hopefully he can continue to be with us for a little while longer in this time. But Representative Kline was talking about the fact that it is certainly not just beneficial to the low-income seniors. We know that they get the greatest benefit. But certainly a lot of middle-income seniors have no coverage under Medicare. They have part A and part B, but they have no prescription drug coverage. They may even have a Medigap policy that fills in the deductibles and the copay for part A and part B, but does not have a prescription drug part.

And I wanted to point out in this slide to my colleagues, Medicare part D helps working Americans. In fact, half of women on Medicare without drug coverage are middle income. That is represented here on the right, and these people are above 150 percent of the Federal poverty level. They are not going to qualify for any low-income supplement.

But this program, my mom is in this category, and on average we are talking almost a 50 percent savings on the cost of their prescription drugs. And so that is why it is important for people to understand that while the benefit for the lowest-income seniors is the greatest, and Representative Kline mentioned that, in many of those instances the only payment is a little copay for a prescription drug, maybe $1 if it is generic or possibly up to $5 if it is a brand name.

If their doctor feels that they, for some particular reason, need to be on that brand name, or if there is no generic equivalent available, Medicare, the insurance program, the part D covers the deductible. It covers the monthly premium. It covers the copay of the first $22,050. And guess what. There is no doughnut hole. There is no lack of coverage at any point for those neediest seniors.

But it is important that our colleagues understand this and also understand that even the seniors who get no supplement because maybe their income is a little bit higher, as I say, my mom, Mr. Speaker, Helen Gannon Gingrey, 88 years old, she is going to be mad at me, Mr. Speaker, for telling her age, but if you could see her, you would never guess. She is young at heart and very energetic and yet was spending $4,000 or $5,000 a year out of pocket to purchase about five prescription drugs.

And I was able to work with her and, as Congressman Kline says, together we were able to go through the www.medicare.gov Web site, and Mom today is saving about $1,100 a year, and that really means a lot to her.

I wanted to also point out, Mr. Speaker, in this slide, this kind of gives a breakdown of how our seniors paid for prescription drugs before part D. We are talking about 41 million, about 41 million, and maybe 6 million of those are people under 65 that are on Medicare because of a disability, but this is the population we are talking about, and I think this slide is so instructive to show, before this program, what was happening.

Now, my mom, Helen Gingrey, was in this group of something like 40 percent of these 41 million seniors who were paying for prescription drugs out of their own pocket, and that is really the population that we are trying to address. And I would say a third of this group, a third of this 40 percent, are the low income, the ones for whom this program is an absolute Godsend.

Now, as we were talking earlier, some people in their Medigap policy also have prescription drug coverage, and that amounted to about 3 percent. Employment-based plans, 26 percent. Now, we are talking about retirees, people who have worked for a company, a big company, a small company, but a company that has not reneged on their promise, as a retirement benefit, to provide health care with prescription drug coverage. And as part of this program, we built in an incentive to those companies to encourage them to continue to provide health care for their retirees, in many cases who have worked for the company 30 or 40 years, who had earned this benefit, and to encourage them to continue it and continue the prescription drug coverage. So about 26 percent were in that category.

Medicaid, 12 percent; they will all now be covered under this Medicare part D.

State-based programs and other sources, 6 percent.

But this is pretty much how it breaks down. And as we get closer to that sign-up deadline without paying a penalty, Mr. Speaker, beyond May 15, we do not want that to happen, and I would hope our colleagues on the Democratic side would join us in the majority in the realization that to discourage is a dreadful thing, of course, for those who are going to literally get the benefit with minimal, if any, cost, but those who have to pay the monthly premium, which is quite a number, to discourage them and then have them get beyond that May 15 deadline, and then all of a sudden they realize that they have been fed a bill of goods and some bad information and then they hurriedly sign up, but they fall into that penalty phase. That is something that we do not want to happen. I do not think Members on either side of the aisle want that to happen, and I hope that we will work toward this goal.

I see, Mr. Speaker, that we have been joined by another of my colleagues. I mentioned him at the outset of the hour, and that is the gentleman from Texas, not only my colleague in this great body, the House of Representatives but also a fellow physician and a fellow OB/GYN specialist, Dr. Mike Burgess.

I would like to yield to him at this time.

BREAK IN TRANSCRIPT (cont. Part 2)