Remarks by Senator Patty Murray on the Medicare Prescription Drug Bill

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Update: Bill Passes Senate – Murray’s Statement

(WASHINGTON, D.C.) – Yesterday afternoon (Sunday), Sen. Murray spoke on the Senate floor about the pending Medicare Prescription Drug bill. Her remarks follow:

“Mr. President, I’ve been fighting for a real prescription drug benefit for years.

• In the 106th Congress, I helped draft the MEND Act.
• Year after year, I’ve used my seat on the Budget Committee to set aside money for a good drug benefit.
• I’ve voted for several Medicare prescription drug bills – including S.1 in June and the Graham-Miller-Kennedy bill in the last Congress.
• I’ve written and introduced legislation to make Medicare more fair for the people of Washington state.
• And I’ve worked to improve healthcare for seniors on the HELP Committee, on the Labor-HHS Appropriations Subcommittee, and here on the Senate floor.

After all these years of work, no one wants a prescription drug benefit more than I do. But I am troubled by the proposal before us.

I am unhappy at the prospect that this plan could force seniors and the disabled into an overly restrictive healthcare rationing regime, where they could lose their choice of a doctor to get a meager drug benefit.

I am unhappy at the prospect that this plan could tell our seniors that they must give up the good retirement health plans that they have worked their lives to earn.

I am unhappy at the prospect that this plan could leave our seniors and disabled at the mercy of ever-increasing premiums.

I am unhappy at the prospect that this plan could tell patients who have complex medical conditions that they can’t get direct access to the specialists they need to see.

I am unhappy at the prospect that this plan could tell patients with MS, Parkinson’s disease, and ALS that they can’t get the drugs they need because their plan will not cover them.

I am unhappy at the prospect that this plan could tell our rural seniors that they will have to roll the dice on how they receive health care coverage because there is not a real choice in their community.

I am unhappy at the prospect that this plan could tell disabled Americans — who are fighting poverty — that the drugs they get today could be off limits tomorrow.

I am unhappy at the prospect that this plan could tell seniors that if their drugs cost more than $2,300, they won’t get a dime of help until they’ve paid $3,600 out of their own pockets.

And Mr. President, I am unhappy at the prospect that this plan could break the promise that Medicare has kept to our seniors and the disabled since 1965.

This isn’t just about plans and formularies and medical service areas. It’s about people. It’s about our parents and grandparents and generations of Americans coming behind us.

I’ve sat down with seniors in my state and heard how badly they need a real drug benefit. Last August I met with more than 200 seniors in Edmonds, Washington at the South County Senior Center. They told me, in their own words, just how important a drug benefit is.

During this debate, I’ve listened to my colleagues. I’ve listened to seniors and the disabled in Washington state. I’ve heard from doctors and hospitals at home. I have read the key provisions in the package, and I have reviewed the C.B.O.’s estimates.

Without a doubt, this is one of the most complex and controversial proposals the Congress has considered.

Partisan Pressure and Unparalleled Tactics in the House

You just have to review what happened in the House Saturday morning to see how controversial – and how political – the vote was. I think that what occurred during the vote speaks volumes — about the failures of this bill, and the lengths the majority will to go to — in order to pass this flawed measure.

At the end of the allotted time the bill had been rejected. But the majority leadership refused to close the vote. They held it open for many more minutes. The minutes turned to hours.

At around six in the morning – after holding the vote open for three hours – the majority managed to pressure a few members to flip their votes.

Medicare is too important to Rush Through a Bad Bill

Mr. President, an issue this important deserves a thorough debate. I am troubled that it appears as though this bill is being railroaded through Congress on twisted arms and backroom pressure.

When I look at Social Security and Medicare, I don’t just see programs. I see a promise. It’s a promise from one generation to the next. It’s a promise from our government to our seniors. And it’s a promise that reflects our values.

Coupled with Social Security, Medicare is the most important anti-poverty program ever. Before Medicare in 1963, 44% of seniors were uninsured. Today it’s just 1%.

In 1966, 29% of seniors lived in poverty. Today it’s down to about 10%.

And since 1960, life expectancy for those over 65 has increased by 25%.

Medicare is a success story. It promises our seniors that they will have health care security – regardless of their ability to pay, regardless of where they live, and regardless of their medical condition.

Not only has Medicare helped seniors, but it forms the foundation of all healthcare. Medicare helps train our doctors. Medicare payments help keep rural hospitals open. And Medicare helps keep emergency rooms and neonatal units operating.

Medicare is open to every doctor and hospital. It doesn’t force providers into restricted networks. It lets doctors make decisions based on what their patients need — not on some cost-saving mandate from an accountant. It’s troubling to think of where rural America would be today — and where inner city trauma centers would be today — without Medicare. Let’s not forget, the reason we created Medicare in the first place. The market failed our seniors.

So I approach this debate with a clear understanding of the importance of Medicare to our seniors and to our entire health care system.

A Bad Bill for Washington’s Seniors in 5 Ways

When I look at this bill, I want to know: What does it mean for the seniors I represent? So far, I’ve found five big dangers for Washington’s seniors.

First, this plan jeopardizes the health benefits that retirees have earned during their working years. In Washington state, 47,250 seniors could lose their retiree health benefits. In return, they will get much less coverage, and they will pay far more than they had planned. This plan is an unpredictable benefit that requires huge out-of-pocket costs and has massive gaps in coverage. This bill changes the ground rules on seniors in the middle of their Golden Years, and that’s not right.

Second, seniors could be forced into an overly restrictive healthcare rationing regime if they want a drug benefit. On paper, it looks like seniors will have a choice. That’s what the proponents keep repeating. But when you take a closer look, you see what’s really going on. Supporters claim that seniors can stay in traditional Medicare, but that’s only if insurance companies decide to offer “drug only” plans. Now they could offer “drug only” plans, but the affordability of those plans is unknown and unknowable. That’s because there is no limit on how much a plan can charge, so seniors will not be protected from price gouging.

On paper, it may look like seniors get a choice. But in reality, many will face a new system that rations their healthcare in exchange for a small drug benefit.

Third, seniors could get fewer choices and less coverage than they have today. They will face fewer choices because an imposed system of rationing may not let them pick their own doctor.

And they’ll have less coverage because the plans they’ll be forced into don’t need to cover every drug that is medically-necessary. So if you’ve got a chronic, life-threatening disease like cancer or AIDS, you are not guaranteed the drugs you need.

Here’s what one client of the Lifelong AIDS Alliance in Washington state had to say – quote – “The current bill as it is written will affect me personally as it limits the drugs I can have access to because it only allows for up to 2 drugs under the prescription part of the bill. Since I’m on a multiple drug regimen, I would not have access to other life saving drugs that I have to take to stay HIV healthy.”

Mr. President, those are chilling words of one of my constituents who is HIV-positive and who understands what this bill could mean for him. That’s why AIDS service providers in my state oppose this bill.

In addition, if you need access to a clinical trial, forget it – this bill does not require any plan to give you access to experimental treatments. So this plan will mean fewer choices and less coverage for millions of seniors.

Fourth, this bill is especially bad for seniors and disabled Americans who are fighting poverty. Today, about 6 million Americans are eligible for both Medicare and Medicaid. Through these two programs, they get coverage for the drugs they need.

But this new bill strips away what’s known as “wrap-around” coverage. In Washington state, it means about 92,000 people will get less coverage than they have today. And these are the most vulnerable among us — the very people that Medicare and Medicaid were designed to protect.

Fifth, there is a huge gap in coverage. For many seniors, there will be a big hole in your coverage. Your payments won’t stop — but your coverage will. If your drugs cost more than $2,250, you’ll get zero help until you’ve spent a total of $3,600 out of your own pocket. So you get no coverage but you still have to pay your premium.

And when you look at what the average Medicare beneficiary spends for drugs, this coverage gap gets even worse. According to the Kaiser Family Foundation, in 2003 the average Medicare beneficiary paid $2,322 for prescription drugs. So if you just spend the average, you’re already in the coverage gap.

These figures were included in a Los Angeles Times article that appeared in the Seattle Times on November 21st. They show that the average senior will end up with a gap in coverage – from which few seniors will ever emerge.

So when I ask – What does this bill mean for the seniors I represent? – I’m deeply troubled by the answers.

I am troubled that this could force 47,000 seniors in Washington to give up the retiree health benefits that they’ve worked for their entire lives.

I am troubled that this could force seniors in Washington state into overly restrictive healthcare rationing to get a limited drug benefit and to lose their choice of doctor.

I am troubled that this could force patients with cancer, AIDS and other life-threatening diseases into a system that will deny them the drugs they need.

I am troubled that this could force 92,000 low-income seniors or disabled Washingtonians out of Medicaid and into a market where they will lose access to the drugs they get today.

And I am troubled that this could force millions of seniors into a coverage gap where they have to spend more than $3,600 out their own pocket without getting any coverage or benefits.

Mr. President, those are some of the ways this bill is bad for seniors and the disabled.

A Bad Bill for Washington State

This bill is also bad for Washington state in seven ways.

• It could result in unequal benefits throughout Washington.
• It could force providers and seniors to re-evaluate their participation every year, and they will get very little in return for this added unpredictability.
• It could encourage seniors who are healthier and financially secure to leave traditional Medicare.
• It could undermine Medicaid in Washington state.
• It could require my state to send to the federal government a large chunk of the savings it realizes.
• It could force Washington state to manage new bureaucracies to test the assets of seniors in my home state.
• And it could push Washington state even further down the list in Medicare reimbursements per beneficiary.

How It Works

Let me walk through how this program would work so that you can see why it’s bad for my home state. Under this plan, the country will be divided into as many as 50 regions. States like Washington could be divided into as many as three regions. Within these new, undefined regions, private insurance plans would be able to run the Medicare program — not just the drug benefit, but Part A and Part B as well.

Washington state will be an attractive market for PPO’s and HMO’s. That’s because we have areas that have healthier and wealthier seniors and a tradition of efficient care delivery. Currently, Washington state has one of the highest Medicare+Choice participation rates in the country. 18% of Medicare beneficiaries in Washington state receive Medicare through a Medicare+Choice plan. Washington state also has a long tradition of managed and efficient care, so we will be a prime target for new PPO’s and HMO’s.

Different Benefits in Different Parts of Washington

This system will mean that Medicare benefits will vary from region to region and from county to county. In theory, seniors in Washington state may have more choices, but they give up the guarantee of a defined benefit.

More Uncertainty for Providers and Seniors Every Year

Providers in Washington state could also face the same changes and uncertainty. Every year, seniors in Washington state would have to evaluate each insurance plan to find the one that best meets their needs.

Here are some of the things seniors will have to figure out every year:

• While not knowing what medical conditions they may confront, they’ll have to figure out how much they’ll pay out of pocket?
• Without knowing what the future holds they will have to predict what providers they’ll be able to see?
• What doctors have dropped out of their plan?
• What restrictions there will be on drug coverage?
• What their co-payments will be?
• Will their plan’s formulary include their expensive new drugs?
• And what hospitals will be in their network?

That’s a lot to figure out – especially since health plans are never written in plain English and no one knows what medical conditions they may confront in their future.

Today Medicare provides predictability. Under the Medicare+Choice plan, seniors got more than they gave up. Mr. President, I do want to note that there have been some managed care success stories in Washington state.

We have some great providers in Washington state, which have led the way in providing innovative, comprehensive care that puts the focus on patients not profits.

But overall, we need to think about how this plan would expand the Medicare+Choice model. Medicare+Choice has worked in limited parts of Washington state. A total of 131,391 seniors in Washington state participate in these plans. But, they are not open to all seniors, and they are limited to a few select regions. But even in this limited program, we have seen significant changes and instability in Washington state.

I am not convinced this is a model we should expand for all seniors and the disabled.

Wealthy, Healthy Seniors Will Be Tempted to Leave Traditional Medicare

If new plans attract higher income, healthy seniors, what will be left of traditional Medicare? I’m afraid that traditional Medicare will look more and more like Medicaid. The prospects for this plan are deeply troubling, and they could have a massive financial impact on Washington state.

It Could Hurt Medicaid in Washington State

Next, I’d like to turn to how this plan will affect Washington state’s Medicaid program. I received a letter from the Democratic Governors Association. This letter is signed by three Governors, including Governor Locke of Washington. Mr. President, I ask unanimous consent to include this letter in the Record at the conclusion of my remarks.

The governors’ letter urges Congress to give the states time to determine the impact on their Medicaid programs before enacting sweeping changes in — how we treat Medicaid beneficiaries, and how states pay for coverage for low income seniors and the disabled.

Washington State Will Have to Surrender Savings to the Federal Government

Under this plan, if states save money by shifting drug costs from Medicaid to Medicare, states would have to give a portion of those savings to the federal government every year. Many states like Washington stepped up to the plate and tried to fill the gap in Medicare by providing affordable comprehensive prescription drug coverage through Medicaid for people who are eligible for both programs.

Over the past 10 years — as drug costs rapidly increased — this burden has become overwhelming. Many states are being forced to scale back coverage and access. In 2002, Washington state spent an estimated $212.8 million on drug costs for people who are eligible for both Medicare and Medicaid. This was a huge strain on our state.

Under this plan, the states will see some relief by shifting Medicaid beneficiaries to Medicare for drug coverage. Unfortunately, the plan gives with one hand, but takes back with the other.

Washington state will be forced to surrender much of its savings to the federal government. This could reduce Washington state’s federal Medicaid dollars by almost $2 billion from 2006 to 2013.

This could devastate the entire program and result in further Medicaid reductions for low income children and families. This could also force the state to again implement reductions in provider payments for doctors, hospitals and nursing homes.

A $2 billion give-back will mean more uninsured, lower provider payments, and more children losing any health care safety net.

It Imposes Massive Administrative Burdens on Washington State

And let’s not forget that states will be handed a massive new administrative burden. Washington state will now have to administer new asset tests to determine who qualifies under Medicare for low income assistance. These tests are extremely restrictive and will result in many low income seniors being pushed into higher income categories.

Under the conference agreement, assets will be limited to $6,000 for a single person and $9,000 for a married couple. In order to get any additional financial assistance under this plan, many seniors and the disabled will be forced to impoverish themselves and give up almost everything they’ve worked to earn. Even if the states wanted to provide a more humane benefit or assistance, they will not be allowed to do so.

Many of us fought to provide relief to states this year by temporarily increasing the federal Medicaid match. This was a critically important fight to save Medicaid and prevent massive Medicaid cuts on doctors and hospitals. Our success in achieving a small measure of relief, is now being undone by imposing an even greater burden on the states.

Finally, this bill will punish Washington state even further in Medicare payments.

For several years, I’ve been working to address the geographic disparities that punish providers and seniors in Washington state. For years, Washington state has received unfair treatment.

Today, Washington state ranks 41st in the nation in Medicare payments per beneficiary. We are being penalized because we have a tradition of low cost, efficient healthcare and healthy seniors. Medicare should reward that.

Instead, its outdated reimbursement formulas are causing doctors to leave our state or close their practices to new Medicare patients. I’ve spoken about this at length on the Senate floor, and I’ve introduced legislation to correct this inequity.

Under this bill, the situation would be even worse. Washington state would fall from 41st in the nation today to 45th in the nation. Even though there would be a slight increase in payments to Washington, because of what happens to other states, we end up falling even further behind.

This is a fundamental shift in the Medicare entitlement – in exchange for a weak benefit.

Philosophically, this plan goes in the wrong direction. We should be strengthening the foundation of Medicare – not experimenting with imposing a new healthcare system on seniors. This plan undermines the role of the federal government in ensuring that every senior can live with the dignity, respect, and stability that they deserve.

It could force seniors into an overly restrictive, ever-changing health care system.

Let’s not forget why Medicare was enacted in the first place. It was created because the private insurance market had failed seniors and the disabled. Coverage was sporadic, expensive and unpredictable. Medicare changed all of this for our nation’s seniors. Now I’m afraid, we’re flirting with that original failed model.

Seniors Deserve an Affordable, Comprehensive Drug Benefit

I believe we can do better.

During my time in the Senate, I’ve been proud to work on prescription drug coverage – from helping to draft the MEND Act in the 106th Congress – to working on the Budget Committee over the past four years to fund prescription drugs.

I was proud to support the Graham/Miller/Kennedy bill in the 107th Congress that world have provided an affordable, reliable, and comprehensive prescription drug benefit as part of Medicare. We had a chance to do much better.

The Right Way to Update Medicare

I believe a prescription drug benefit must be a seamless part of Medicare. It should be treated just like a doctor’s office visit or an outpatient surgical procedure.

By implementing a seamless affordable benefit as part of Medicare — as we did when we added the Part B benefit — we would guarantee that all seniors have access to the same level of care — regardless of their health status, their age, their income, their assets or where they live.

That access would be stable and predictable.

I know we can do this. Many of us in this chamber — on both sides of the aisle — have worked to significantly boost our investment in NIH funding. We have fought to reform and modernize the FDA to ensure timely approval of new, life-saving drug treatments.

I want all of my seniors and disabled constituents to benefit from this investment. Under the plan today, I cannot be sure they will reap the rewards of this federal investment.

We should be on the floor today debating a prescription drug benefit package, not a proposal to radically alter Medicare. This should be a fight about providing good, affordable, stable coverage — not about experimenting with Medicare.

I Appreciate Senator Baucus’s Efforts

Before I close, I want to thank my friend and colleague, Senator Baucus for his efforts. I know he worked to do the very best he could. Senator Baucus understands the importance of Medicare for seniors and the disabled. I know he fought against incredible odds.

He was sitting across the table from Members of Congress who have tried before to privatize Medicare and many who still hope to turn Social Security over to Wall Street. He faced an impossible task. I know he did all he could, and I thank him for his fight. There have been many Medicare fights when I have stood arm-in-arm with the senior Senator from Montana

In many ways, this package is a victory for those of us who have fought against drastic cuts in Medicare. It is a victory because the Majority is now proposing a $400 billion expansion in Medicare.

We have forced quite a turnaround from 1995 — when we were fighting Medicare cuts of well over $260 billion proposed by many of these same members. This $400 billion threshold is also a huge improvement on the $190 billion proposal that passed the House of Representatives in the last Congress.

Some Parts of the Bill Are Helpful

I want to note that I fought to include some very important features in this bill.

This bill will prevent additional cuts in payments to doctors that are scheduled to take effect early next year. The scheduled reduction of 4.5% is unacceptable. I worked hard to prevent the scheduled reduction of 4% in 2003, and I applaud the conferees for meeting our demands on this issue.

The package also provides additional relief for our rural hospitals, home health care agencies, and rural health care providers. This relief is truly a lifeline for saving rural health care. I have always supported these provisions and will continue to fight for fair and equitable rural payments. I can promise health care providers and patients in Washington state that regardless of the outcome of this legislation, I remain committed to stabilizing Medicare payments.

The bill provides limited help for the next 24 months, but because of the changes contemplated by this bill starting in 2006, health care providers in Washington state may not have the opportunity to remain part of Medicare as they know it today.

I know that many organizations representing doctors and hospitals think we can come back in 2006 and correct the mechanisms in this bill that undermine Medicare, but I fear that this could be a dangerous gamble.

Not only that, but we don’t know what the people who put this flawed bill together will demand — down the road — in exchange for changes. Will they demand:

• Premiums support or vouchers in all 50 states?
• More state Medicaid dollars?
• A larger gap in coverage?
• More co-payments?
• More restrictions on access?
• More tax cuts for the few in order to allow them to opt out of Medicare?
• More deals on the House floor in the middle of the night?

We don’t know what the price tag will be to undo the damage that this bill will impose, but I assure you it will not be easy.

Mr. President, I had looked forward to the day when the Senate would pass a Medicare prescription drug benefit. The day is upon us, but the price of this benefit is far too high.

In the coming months and years we will see the theory behind this bill put to practice. As more and more people discover what this Congress and this President have done to their healthcare – I am confident that we will hear from seniors as we never have before.

This is a difficult decision – the $400 billion in this bill does represent a step forward – the provider payments contained in this bill are needed in my state – and seniors deserve the prescription drug coverage they have been asking for.

Passage of this bill, and its being signed into law is not the end of this story. A tremendous amount of work will be required to fix the deficiencies in this bill. And I will be there – as I have been all these years – working the best I can to do the right thing for my state and our country.”