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

Location: Washington, DC


Mr. CHAMBLISS. Mr. President, I rise today to voice my concerns with the conference agreement on H.R. 1, the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.

My original intentions were to work with this body to create and provide a fiscally responsible prescription drug benefit for seniors who are in need. My primary responsibility and obligation through this process was to make sure that Medicare beneficiaries with the lowest monthly income and the highest monthly drug bill were taken care of. That obligation has been fulfilled by this agreement.

This bill will provide almost 1 million Georgia seniors with completely voluntary access to a Medicare prescription drug benefit for the first time in the history of the Medicate program. Starting next year, low-income seniors will get drug cards that provide $600 worth of assistance for prescription drugs. Seniors will be covered with access to an initial physical and other new preventive benefits such as cholesterol and diabetes screenings. This legislation creates new Health Savings Accounts, HSAs, to pay for qualified medical expenses, available to all beneficiaries with contributions allowed from employers and family members.

Beginning in 2006, all Medicare beneficiaries will be eligible to get prescription drug coverage though a Medicare-approved plan. In exchange for a monthly premium of about $35, seniors who are now paying full retail price for prescription drugs will be able to cut their drug costs roughly in half. Lower-income seniors could qualify for more generous benefits, including reduced premiums, lower deductibles and coinsurance, with no gaps in coverage.

With Medicare beneficiaries receiving access to a prescription drug benefit, Medicare instead of Medicaid will be assuming the prescription drug cost of roughly 172,000 beneficiaries in Georgia. This could equal $469 million in added savings over the next eight years for the State of Georgia.

The bill also would increase Medicare funding for doctors, hospitals and other health care providers, particularly in rural areas, where reimbursement levels are far below what is paid in urban areas of the country. Additionally, the bill provides cost incentive to encourage companies to retain the health coverage they provide their retirees. I want to voice my support for all of these provisions.

Following my review of the conference report, however, I can't help but feel that this is not the best we could do. I feel like we missed the mark on trying to ensure Medicare's solvency. While we are trying to ensure that prescription drug coverage is provided for those seniors who need them, we should also ensure that future generations are not overburdened by the costs of this expanded entitlement program.

Attempts to cap the bill's cost have been diluted. Instead of putting cost containment provisions in the legislation, there is a vague transfer of power from today's lawmakers to future lawmakers to handle the cost when it becomes a problem. In 2007, the Congressional Budget Office has estimated that the bill will cost $40.2 billion. By 2013, that price tag hits $65.2 billion. I am not comfortable leaving these problems to be dealt with in the future. If we cannot logically solve them now, how do we expect future Congresses to tackle cost containment while this program is spiraling out of control?

Helping today's seniors with access to prescription drugs must be balanced with our responsibility to future generations, our own children and grandchildren. These generations will have to pay, literally, for our miscalculations. They will be able to look back and see clearly when and where we made mistakes. Today, future generations are a main concern of mine because I think this bill lacks some common sense regarding fiscal restraint. It has the potential to expand our budget deficit for years to come. Placing the cost burden of an entitlement program on the shoulders of our children's generation seems very unfair. Shouldn't it be possible for this legislative body to create a prescription drug benefit plan that is fiscally responsible? Have we successfully done this? With a cost containment trigger we could have done just that and we have missed the opportunity.

In addition to the looming fiscal problems of this measure, I am also very concerned with cuts for the reimbursement of drugs for cancer treatment. Community oncology practices in Georgia and nationwide will be at risk of closing their doors because of these cuts. When approximately 1.4 million people are diagnosed with new cases of cancer each year and approximately 550,000 people die from cancer each year, why are we decreasing these drug reimbursements?

Our small town pharmacists may also experience financial risk as a result of the passage of this bill. They play a fundamental role in delivering these benefits to our seniors. Pharmacy Benefit Managers, PBMs, should be required to report all financial concessions they receive from manufacturers such as discounts, rebates, and indirect subsidies and should be audited to ensure accountability. I want to ensure that these pharmacists will be able to compete on the same level as the PBMs and purchasing by mail so that they can continue serving their patients. We also need to acknowledge and protect the role of medication counseling services provided by our pharmacists as this is a valuable benefit to the patient.

Another concern is the lack of flexibility within the Medicare program. Competition among private healthcare plans in Medicare will help ensure more up-to-date coverage and gives seniors the ability to choose the healthcare plan that best meets their personal health needs rather than a one-size-fits-all government plan. A Medicare-approved private healthcare plan needs flexibility in designing benefits so that seniors can have the option to choose the coverage that makes the most sense to them and best suits their health needs. Seniors deserve choice and flexibility within their benefits, and this bill does not give seniors the full extent of flexibility they deserve.

Lastly, the means testing provisions included in this bill are positive but are not strong enough. Our goal should be to help those seniors who cannot afford life saving drugs and currently have to make the difficult choice between putting food on their table and buying the prescriptions they need. We should not waste taxpayer money on subsidizing wealthy seniors who can easily afford to pay for their own medicines.

Individuals who fall into the category of 150 percent of Federal poverty level or those with a total income of $13,470 or less will receive great benefits. However, the gaps in coverage for the middle class will make this legislation somewhat effective or possibly even more costly for certain beneficiaries. Protecting those most in need is imperative, but we cannot sacrifice those folks that fall in the middle.

The decisions we will make today by voting for this measure will affect the health of every American and significantly impact future taxing and spending of generations to come. I stand before you today burdened by trying to make the best decision for America's seniors, for Medicare solvency, and for the financial security of our children and their future generations.

This bipartisan agreement is a necessary step to completing the promise we made to seniors, and that is to provide prescription drug coverage. It is for this reason only that I will vote for this conference report, but I will continuously seek ways to improve this program by seeking stronger cost containment provisions and increasing the flexibility for the plans.

Thank you, Mr. President. I yield the floor.

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