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

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

Mr. INOUYE. Mr. President, I have voted today to oppose the termination of debate on the Medicare Conference Report because I have carefully analyzed the report and come to the conclusion that far from being a bipartisan compromise on prescription drug benefits, the report is nothing short of an attempt to compromise the integrity of the Medicare and Medicaid system as we know it.

When it comes to health care in America, there are many parties in interest-providers, patients, care facilities, and pharmaceutical suppliers, to name a few. These groups have interests that may, at times, be in conflict, but I believe one overwhelming interest unites them all: providing the American public with the health care services and treatment that it needs. Regrettably, I find that the report we have been asked to consider has abandoned this powerful unifying principle.

Worse than abandoning our commitment to the health of our Nation, when viewed as a whole, the report strikes at the foundation of the Medicare and Medicaid system. Rather than buttressing the system of comprehensive care for our senior citizens and disabled persons, the report actually sows the seeds of its demise by undermining its ability to provide a prescription drug benefit, subsidizing competing private health plans, and increasing Medicare premiums without increasing the benefits provided.

The overwhelming drive to reconsider the Medicare and Medicaid systems came from listening to our constituents and their frustration with the ever-increasing cost of the medicines they needed. From blood thinners, to antibiotics, to state-of-the-art pharmaceuticals for cancer and HIV/AIDS, the cry for help was clear: the cost of prescription drugs was breaking the backs of the Americans who were paying for these expensive, but life-saving therapies.

Far from addressing these needs, however, the report actually makes the problem worse. On the administrative level, the report dilutes the Medicare systems's purchasing power by mandating the purchase of necessary medications by individual Medicare regions, rather than as a whole system. With more individual buyers, pharmaceutical companies are more able than ever to raise their prices, because the individual regions will have less bargaining power.

The report will also impact average beneficiaries by potentially depriving them of the specific drugs they need by providing coverage for only one or two of each class of drug. In a world where antibiotic resistant strains of common ailments are on the rise, this could be a very expensive proposition, if the drug you need is not one of the covered drugs in the antibiotic class. Difficulties only escalate in medically complex cases where patients' individual responses to pharmaceutical may vary dramatically, as in treatments for high blood pressure, high cholesterol, cancer, and HIV/AIDS.

Even worse, what flexibility there is in the report to tailor the limited drug benefit to the needs of individual patients must now be requested and petitioned for by the patients themselves. Placing the paperwork burden on seniors and the disabled only shifts the burden to the people least able to bear it, and I would not be surprised to learn that as a result, more and more beneficiaries will lose access to the medicines they need.

Finally, the report strikes a further blow to more than 6 million of our neediest citizens, those who are eligible for both Medicare and Medicaid. At present, States have the statutory flexibility to make any copayments for persons who are "dual eligible." Under the report, however, persons with dual coverage will face increased out-of-pocket expenses because States will lose this flexibility. As a result, Americans who are already below the poverty level would be expected to make copayments between $1 and $3-a great hardship for single persons with incomes of less than $8980 per year, and couples with incomes of less than $12,120 per year.

More than failing to provide the promised prescription drug benefit, however, the report actually paves the way for eventually dismantling Medicare and Medicaid altogether. The report establishes a demonstration project for "premium support" in six metropolitan areas. "Premium support" does not mean, as one might think, additional Federal support for areas where costs are especially high, and premiums are not sufficient to cover all expense. Just the opposite, it is a way of increasing the Medicare premiums Americans pay in order to compensate for rising health care costs. Moreover, with a "demonstration project" such as this in place, it would be a simple step to broaden the "project" to include the entire United States-and with an estimate average 25 percent increase in premiums, the costs to American citizens would be substantial.

The report would also provide a $12 billion subsidy to private Health Maintenance Organizations and Preferred Provider Organizations-HMOs and PPOs. With a massive subsidy such as this, there will be no question but that HMOs and PPOs will have a competitive edge over Medicare because they will receive more money per plan participant than Medicare will-and with more money, subsidized insurers will be able to provide more benefits.

"Premium support" and a $12 billion subsidy for private insurers look suspiciously like a one-two punch aimed at Medicare. On the one hand, "premium support" will increase the cost of Medicare without raising benefit levels, while on the other, a multi-billion dollar subsidy will allow HMOs and PPOs to slash premiums and provide more services. Add to this a prescription drug benefit that actually leaves millions of Americans worse off than they are now, and it is difficult to see how this conference report responds to the simple unifying principle of our health care system: providing Americans with the health care they need.