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Secretary Hillary Rodham Clinton
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Current Office: U.S. Secretary of State
First Appointed: 01/21/2009
Party: Democratic
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BiographicalVoting RecordIssue Positions
(Political Courage Test)Interest Group RatingsPosition PapersSpeeches and Public StatementsAdditional Biographical InformationCampaign Finances
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Title: Floor Statement of Senator Clinton on Medicare Prescription Drug Proposal
Date: 06/20/2003
Location: Washington, DC
Speech
I believe that this legislation holds tremendous promise and tremendous peril. I applaud the bipartisan effort to work toward a goal many of us share-providing prescription drug coverage to more than 40 million seniors, including 2.7 million in New York-1 million who are living without any coverage today.
While I and so many of my colleagues have been fighting to pass a prescription drug benefit for years, I want to make sure that what we promise is in fact delivered.
Three weeks ago, we learned a real lesson about details and how a small change in a conference report can mean that 12 million children are left our of a child tax credit.
We have to use caution with this legislation because so much is at stake for so many people that we represent. For example, right now the bill excludes the lowest-income seniors who are eligible for Medicare and Medicaid, and 219,000 seniors and disabled New Yorkers fall in that category. We leave them at risk of a state's decisions to curtail or limit Medicaid drug and long-term care coverage.
We are all in a rush to help our seniors, but we do not want to rush through this legislation at the expense of getting it wrong.
We have to go over this bill line-by-line and word-by-word. The details of this legislation are changing every minute. The CBO says one thing and the committee says another. We cannot use arbitrary deadlines and a recess as an excuse to look away from the fine print.
We must address the real problems with this proposal and not gloss over them because we have to vote in ten days or less.
My constituents from the 80-year-old widow in Utica to the 85-year-old man living in a nursing home in the Bronx are counting on me to go about this process with care.
It was the Man from Independence who first raised the possibility of offering medical coverage for our seniors. In 1945 President Truman said, "Millions of our citizens do not now have a full measure of opportunity to achieve and to enjoy good health. Millions do not now have protection or security against the economic effects of sickness. And the time has now arrived for action to help them attain that opportunity and to help them get that protection."
It took two decades to realize President Truman's dream but finally, Medicare and Social Security came to be the embodiment of our country's great ideals: if work you hard all of your life and play by the rules you will not be left to fend for yourself in your golden years.
If you helped make American stronger, smarter, and better, then the nation would help make your retirement years better, healthier, and more secure.
For those who believe in Social Security and Medicare, this social contract was a fundamental agreement between a country and its citizens. It was not the establishment of an entitlement, but the establishment of a responsibility among generations based on individual, family, and national responsibility. And nearly 38 years have passed since President Johnson signed the Medicare bill in 1965. He signed the bill in Independence Missouri, with the Man from Independence to help our seniors maintain their independence.
The times have changed and the medical world has created new treatments, medical cures, and life-saving medications that were unimaginable 30 years ago, a decade ago.
And it is time to strengthen our Medicare system so that is uses the new scientific discoveries and medical advancements of today without losing the values and principles that sparked its creation.
But if I were to take an informal poll of the Senators and the budget scholars who have actually read this bill and asked them, "What is exactly in this bill and how does it work for our seniors?" I bet that I would get 100 different answers.
If my constituents in New York and seniors across America trust us to examine the consequences of this bill and we don't take the time to do so, then how do we know that we are doing the right thing for our seniors and not the right thing for the ballot box in 2004?
I am deeply concerned that in this case-haste really does waste scarce resources.
For starters, why is this so complicated?
Why would we purposefully create a new "Medicare Maze" instead of creating a straight forward and solid foundation for generations to come, leaving the bells and whistles for later? This bill is all bells and whistles, with a big benefit deficit at its core.
Now, I tried to map out the decisions a senior or person with disability would face, and how they would get prescription drug coverage under this plan.
Now here is where a typical senior starts. But seniors, who are low-income or residing in a nursing home and have full Medicaid as well as Medicare eligibility, will not be able to access prescription drugs through this new plan.
Instead, they will need to access their prescription drug coverage through Medicaid. They will be in an entirely different system.
So this plan is for a senior who has to choose between traditional fee for service with a private drug plan, or Medicare Advantage-the private PPO's.
Medicare Advantage is administered by a new agency, the Center for Medicare Choices [point to top of chart] that this bill would create.
Now before any benefits are available, already the bill creates a whole new bureaucracy for seniors.
But the senior must also choose between multiple plans in each category. The premiums are not uniform, and neither are the benefits. So the choice, once again, is complicated.
Year 1:
For those seniors who are not in Medicaid, in Year 1, they will have several choices - assuming that they live in a region of the country that provides them with all the choices available under this plan. Before they make their choice, they will need to research how the prescription drug benefits differ under each of these systems - will the drug they need be covered under the plan.
If a senior looked for the lowest premium, they would choose the HMO, but this HMO doesn't cover the senior's primary care doctor.
So the senior turns to the plan with the next lowest premium, private plan 2. But lo and behold, the formulary in private plan 2 does not cover a drug that the senior finds out she must take to treat her [cholesterol].
So the senior can file a grievance, and get a hearing, and the needed drug may then get approved, but in the meantime, this process has consumed valuable time, and left a long paper trail in its wake.
Year 3
But these private plans are new-they have not refined their business models, and at the end of 2 years when the plan's contract expires, it may decide to drop out, just like Medicare HMO's have dropped.
As we have all heard from our constituents, the number of Medicare + Choice plans decreased by over half in the last 5 years, leaving thousands of seniors in the lurch when they pull out of markets. Those who didn't pull out have changed and cutback benefits, and raised premiums, 15.5% last year alone.
Now, let's say our senior waited it out, finally got the prescription drug she needed, but then after two years, the plan did not find the market profitable and choose to pull out of the market. The government would have to be sure that there was a Federal fallback in place so our senior might then go into the Federal fall back.
BUT, this would be for only a limited time - only until the new government agency could negotiate with private plans, potentially subsidizing up to 99.9% of their risk, and get two plans to re-enter the market.
Year 4
Our senior would then be forced to move plans YET AGAIN. At this point our senior, may choose to enter a HMO, but find that her needed drug was again not in the formulary. This time the process might not be so kind to her and she could be left with the HMO but with no drug coverage.
Last year, I along with a majority of my colleagues voted for Graham-Miller, but it failed because of a procedural hurdle. It was simple. It had the same premiums, deductibles, and copays and there were no drop-offs. It was over 50% more generous than the bill before us today. It was a better plan and better for seniors and I was proud to support it.
I know that some of my colleagues have expressed support for this bill because of their strong belief in a competition.
I too believe strongly in competition, but none of us champion competition for its own sake-we champion it for the sake of consumers and patients. And competition on a skewed playing field, that excludes certain plans from staying in the market and creates inefficient administrative and transaction costs, could actually leave consumers less informed, less well-off, and spend scarce health care dollars for bureaucracy and administration costs.
Drug plans should not compete for profits by attracting only the healthiest, and dumping the seniors they consider "bad risks." They should not compete by cutting corners in quality.
They should compete on a level playing field when it comes to prescription drug coverage. That means a uniform premium across the country, a uniform benefit, which allows seniors to discern which plans can really deliver better value, rather than simply delivering different packaging.
The Senate bill has taken some steps to address these issues, and I hope we can improve it still further. But the House bill lacks a fallback to protect seniors and disabled individuals, and it voucherizes Medicare in later years. These are grave flaws that sacrifice seniors and dismantle Medicare, and I oppose those measures.
Competition, if it can produce lower premiums and better prices, is a noble endeavor. But we must guarantee our seniors that competition with not compromise the quality of care and the health of Americans in Medicare
As I mentioned before, New York State has 219,000 low-income seniors who qualify for Medicaid and Medicare. And under this bill it excludes those seniors, and puts at grave risk others who may have access to drug coverage through a state run program, or an employer's retiree program-CBO states a third of Medicare retirees with drug benefits would lose coverage under this bill.
And when I add up the number of New Yorkers who are low-income, the 365,000 who might lose their retiree benefits, and the 317,000 who are enrolled in the state's EPIC prescription drug program, that's nearly 900,000 New York Medicare patients-one in three-who are disadvantaged or outright excluded by this bill.
Never in the history of the Medicare program has a Medicare beneficiary been denied access to a covered benefit, and this is particularly troubling that this exclusion is aimed at the lowest income beneficiaries. Why would we alter history now? How does limiting access modernize and strengthen Medicare?
Even Governor George Pataki has asked that Medicare cover the drug costs of these seniors and New Yorkers with disabilities. Our states are facing budget deficits not seen in a generation, and places like New York need more help with health care, not less.
And I ask unanimous consent for the Governor's letter to be put in the record as an explanation of the importance of extending the Medicare benefit to everyone including the low-income dual eligibles.
Furthermore, we should eliminate the penalty against retirees. By refusing to count retiree benefits as out of pocket expenses, 365,000 New Yorkers alone will never make it through the gap in coverage. And we should support states like New York that do the right thing and offer a drug program
I have heard from so many New Yorkers, terrified that this bill will discourage employers from continuing coverage, and New York from continuing EPIC. They fear the bill will leave them worse off, and so do I.
Once seniors navigate their way through the Medicare Maze, they will discover that the benefits that are offered are not that beneficial to their bank accounts.
The gap in coverage is very disconcerting. This is not just a gap in coverage, but a brick wall in the path to benefits.
There's the average $275 deductible, a $35 monthly premium that could vary widely and be much higher in certain regions-a 50 percent subsidy until $4,500, and then after that nothing until you hit the catastrophic threshold at $5,813 in drug costs.
Many of us have heard from our constituents about how this new benefit will or will not cover their prescription drug costs. I just want to share one story from Arlene Francis, a Buffalo-area senior, actually now living in Orchard Park, New York, who was married to a Bethlehem Steel Retiree who passed away.
Arlene takes Fosamax for her osteoarthritis which costs $68 a month, she has a hormone replacement patch, and takes antibiotics as needed. Her drug costs total $998 dollars a year. She now relies on the New York State's EPIC program, which covers seniors on a sliding scale up to $35,000 for singles, and $50,000 for a couple. Under EPIC her annual fee is $36, and her copays are $3, and her share of her yearly $998 drug expenses totals $336.
But watch how her expenses change under the Grassley-Baucus proposal. She'll pay at least $420 in premiums, a $276 deductible, and a 50 percent copay. Her total costs for coverage of her $998 in drug expenditures--$1,157.
Not only is Arlene going to get nothing from this bill, but New York State gets left out as well. The federal government isn't lifting the state's costly burden of prescription drugs, and it even adds some administrative burdens on state Medicaid offices.
The bill gives states an incentive to cut back on their programs, or even end them altogether. This would be bad news for the 316,000 seniors like Arlene who rely on EPIC and could be much worse off under the Grassley-Baucus deal.
Again, we must do our best to ensure that this prescription drug proposal delivers on its promise. How can we say this plan delivers with this large benefit gap? Or when the CBO states that seniors with prescription drug costs of $1,115 or less would end up paying more through premiums, deductibles, and cost-sharing than they receive in return from this bill?
But this bill falls short for patients with high drug costs as well. Even seniors who spend $5,000 or more will get only $1700, and have to manage 66 percent of the costs on their own.
Let's eliminate the gaps in coverage and take the time and care to ensure that we follow that basic medical principle-do no harm.
One of the most important ways to assure that competition is helpful rather than harmful is to assure that plans compete to improve, rather than cut corners, on quality. I am pleased that the bill includes a measure that I have supported, along with Senator Hatch and others, to commission the Institute of Medicine (IOM) to develop quality standards that everyone can use to make informed apples-to-apples comparisons and informed choices among health plans
We must also help consumers make meaningful comparisons about the quality and efficacy of medicines as well.
That is why I propose an amendment that will help consumers in 2 ways.
First, it would ensure research comparing the efficacy and cost-effectiveness of the top drugs used by Medicare and Medicaid beneficiaries. Often there are a number of competing drugs to treat the same condition. But which is more effective? Since drug companies don't always have an incentive to do head-to-head trials of their drug against their competitors, oftentimes, we just don't know. But we need to know that we are getting the value for each of our $400 billion.
And second, if want seniors to make informed choices as consumers, then we should make these comparison studies available to seniors. Drug ads should contain this information, so they don't mislead seniors. We should put this information on the Internet, and we should guarantee that funding for consumer counseling is adequate.
We cannot let ourselves get consumed with the need to complete this bill by sundown next Friday so that we bypass protecting the consumer or fail to keep seniors' lab costs down or shortchange our nursing homes or neglect our teaching hospitals. In the next two decades, these needs will only grow as more and more people from my generation find old age knocking at their door.
At the end of this debate, we may mend every problem and fix every provision that does more harm than good for our seniors.
I believe that is possible if we lengthen the time of this debate and approach this landmark piece of legislation with care and precision. But if we do not, then I believe that many of us will face a very difficult decision.
Do we support legislation that we know is not the best for our seniors, but view it as a step in the right direction and a foundation to build on. Or do we vote it down because it fails to deliver more promise than perils for our seniors.
I know that what the House passed is something I cannot support on behalf of New Yorkers. But I hope that we can do the hard work here in the Senate.
Fix the problems now so that later we can focus our efforts on doing more to bring Medicare into the 21st century. Our system of helping those in need is itself in need of help.
Not by privatization, but by building upon the social contract President Johnson strengthened nearly 38 years in Independence.
When he signed Medicare into law, President Johnson said, "There is another tradition that we share today. It calls upon us never to be indifferent toward despair. It commands us never to turn away from helplessness. It directs us never to ignore or to spurn those who suffer untended in a land that is bursting with abundance."
We cannot forget about the larger issue at hand. We must fulfill our responsibility as a nation to provide seniors who contributed to this great nation all of their lives with a health care system that is reliable and comprehensive.
That is our collective goal-not just choice or competition-but coverage for all who need it. We have the rare bipartisan opportunity to do this; let's get it right the first time.
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