Tom Daschle

Mr. DASCHLE

Mr. DASCHLE. Mr. President, I hope we can do as the majority leader has suggested. We have had a good debate. I think this has been an excellent debate. The managers deserve credit for the way they have managed the legislation. We have had 12 rollcall votes today already. It is likely that we will have 16 or 17 by the end of the day, if not more; we had 9 yesterday. More than 50 amendments have now been considered. I think it is time that we bring the debate to a close. There will be many more opportunities to talk about prescription drugs and health care with the array of legislative challenges that we face relating to health. I think we have been able to do a good deal, and I hope we can get cooperation now on both sides of the aisle. I hope the majority leader will hold to the commitment that we finish tonight. That would accommodate people's travel schedules tomorrow. If we are going to do that--it is now 6:30--over the course of the next 4 or 5 hours, we have a lot of work to do even with what we know we have to vote on. I hope everybody will cooperate so we can minimize the time required to consider amendments. I hope those who may have remarks to make will perhaps hold off until after final passage and make those remarks after final passage. That would accommodate our time as well. We will work with the majority leader to see if we can accomplish the schedule he has laid out. I hope we can do so well before the bewitching hour. I yield the floor.

Mr. DASCHLE. Mr. President, I know we are waiting for some completion on negotiations on an amendment. As I understand it, no one is seeking recognition to continue work on other amendments. So I will speak for a couple of minutes until somebody is prepared to come to the floor to continue our work. I don't want to delay the business of the Senate but I want to express myself, as the distinguished Democratic whip has been doing with regard to the legislation. I, too, intend to support this bill. I am thinking of the old joke about a camel being a horse designed by a committee. Oftentimes, I think of that as we work our will on legislation. In many respects, this is the legislative version of a committee horse, a camel. It is not the kind of bill I would write. It is not the kind of bill I would cosponsor. It is not the kind of bill I would enthusiastically endorse. I look at some of the concerns we have about this legislation-- concerns about an unlimited volatility in the premium, uncertainty about the benefit package, uncertainty with regard to the deductible, uncertainty with regard to the backup, uncertainty with regard to the way the provisions can be provided in rural areas. There are many issues. Mostly I think there is far greater confusion than there is understanding with regard to the benefits themselves as seniors attempt to determine whether they will be assisted by this bill. The confusion and the uncertainty will be issues that we have to address at some later date. But having said that, I must say that the rural provisions--the effort made by our two distinguished managers to address the rural needs to overcome the inequities that exist today-- alone merit consideration and I would suggest support for this legislation. The help for low-income seniors--tens of thousands of South Dakotans will get help they are not getting today in part because of this bill. The possibility that seniors could access generic drugs with far more regularly and successfully, and the possibility that we could reimport drugs at a lower price from Canada, all are reasons why I think this bill merits our support. As I look to the balance and look to all of those things I wish were better, my response is that we are going to make them better. It may take months, if not years, but we are going to continue to work to make this a better bill and a better program. There are so many ways that I hope we as Senators--Republican and Democrat--can work together to make this a better bill in future years. There is a warning and a hope as we complete our debate tonight. The warning is that if this legislation comes back from conference in a significantly different form we will not be in the same position we are tonight. This bill will enjoy broad bipartisan support tonight. But if we fail, if we endorse a bill with some of the provisions of the House, then I daresay this legislation may still be in trouble. My hope is that we can do what I have just suggested--that over the course of the next several years we can take a very close look at ways to make this legislation better and that we can address what I would consider to be serious shortfalls, especially the benefits shutdown that exists after a person pays $4,500. We are talking about a sickness penalty that, frankly, cannot be sustained. We have to find a way to address that serious shortcoming in this legislation. I hope it is done sooner rather than later. I come to the floor with my gratitude for the work that has been done. This is the fifth year we have made an effort to pass meaningful prescription drug legislation. We can wait no longer. We simply can't allow the perfect to be the enemy of the good. We have to take what we can do and move to build upon something that we will do in future years to make it more meaningful, make it a better piece of legislation, and make it a law that we can be enthusiastic about someday. I vote tonight with that expectation and that hope. I am hopeful that there will be many on both sides of the aisle who will share that perspective and that expectation. I yield the floor.

Mr. DASCHLE

Mr. DASCHLE. Mr. President, I join with the majority leader in expressing our heartfelt condolences to the family and to the State of Strom Thurmond. In many respects, he was a legend. Many of us had the good fortune to serve with him as a Senator. He was a Governor, a Presidential candidate, a soldier, a father, a citizen. In many respects, he fought, lived, contributed, and legislated in a way that will be written about and commented on for years and decades to come. Much more will be said, but I think as we consider his contribution tonight we can say, as we consider the opportunity that we had to serve with him, Republicans and Democrats, that it was our privilege to do so.

Mr. DASCHLE

Mr. DASCHLE. Mr. President, under the unanimous consent agreement we reached last night, there was scheduled an amendment to be voted upon, the so-called Grassley benchmark amendment, at 10 o'clock. We have not yet had the opportunity to review the amendment. As I understand it, it is still being negotiated. So we are not in a position, obviously, to agree to the amendment at 10 o'clock. We look forward to consulting with both managers of the bill. Certainly I will be talking to the majority leader as we continue to work to bring the amendment to the floor. Given the fact we are not yet at a position to vote, it would not be my expectation that there would be a vote at 10 o'clock. I yield the floor and I suggest the absence of a quorum.

Mr. DASCHLE

Mr. DASCHLE. Mr. President, on July 12, the 5th U.S. Army will demobilize the 129th Mobile Public Affairs Detachment of the South Dakota National Guard. This unit, headquartered in Rapid City, was among more than 20 Guard and Reserve units from my State called to active duty in support of Operation Enduring Freedom/Noble Eagle and Operation Iraqi Freedom. Today, these soldiers and their service become a part of South Dakota's military heritage. Like those who served in the two World Wars, in Korea, in Vietnam and numerous other places, this new generation has answered the call. They have offered to make every sacrifice, including life itself, to protect our freedom and security. We must never forget them or the honor with which they served. This unit participated in a mobilization with few precedents in South Dakota history. Nearly 2,000 Guard and Reserve troops were called to active duty in our State, by far the largest mobilization since World War II. At the time the fighting began, units from more than 20 communities had been called up, from Elk Point in the South to Lemmon in the North, from Watertown in the East to Custer in the West. Indeed, our State's mobilization rate ranked among the highest of all the States on a per-capita basis. These soldiers were proud to serve, and their communities are proud of them. Across the State, thousands of citizens pitched in to participate in send-off parades, to lend a hand for families who suddenly had to get by without a mom or dad, and even to assist with financial hardships caused by the mobilization. This mobilization was a statewide effort, in many ways. In addition to the service of this particular unit, I want to acknowledge the sacrifices and dedication of the families who stayed home. They are the unsung heroes of any mobilization. They motivate and inspire those who are far from home, and they, too, deserve our gratitude. Today, I join these families and the State of South Dakota in celebrating the courage, commitment, and success of the members of the 129th Mobile Public Affairs Detachment, and I honor their participation in this historic event in our Nation's history. Welcome home. Thanks to all of you for your courage, your sacrifice, and your noble commitment to this country and its ideals.

Mr. DASCHLE

Mr. DASCHLE. Mr. President, I am honored today to present to my colleagues in the Senate an essay by Collette N. Roberts of Rapid City, SD. Collette is a student at St. Thomas More High School, and she has been awarded first place in the 16th annual National Peace Essay Contest for South Dakota. ``Justification of War: the Anglo-Zulu and Kosovo Wars'' examines the Anglo-Zulu war of the late 19th century as a paradigm for understanding Kosovo's struggle against the military campaign of Slobodan Milosevic's Serbia. Collette has tackled a vitally important subject with insight and maturity. I can only hope that she continues to share her wisdom with the world, and I commend her essay to my colleagues' attention. I ask unanimous consent that Collette Roberts's essay be printed in the Record.

Mr. DASCHLE

Mr. DASCHLE. Mr. President, I rise today to recognize an outstanding achievement of the town of Eureka, SD. Eureka has the honor of being the only South Dakota town where three students have won the National Discover Card Tribute Award Scholarship. The Discover Card Tribute Award Scholarship is awarded each year to 9 outstanding high school juniors in each state and the District of Columbia. These students are selected based on their leadership skills, special talents, personal obstacles, and commitment to community service. In South Dakota, the state winners for 2003 hail from such cities as Aberdeen, Brookings, Eureka, Milbank, Presho, Salem, Sioux Falls, and Sturgis. Out of these winners, the top three students are selected to compete with students from across the country for 9 national-level scholarships, and it is in this category that the town of Eureka has excelled. Since the award was first created 12 years ago, only 4 South Dakotans have won at the national level, beginning with Lori Heilman Leidholt of Bowdle, South Dakota, in 1994. The other 3 come from Eureka. Sarah Anderson won her scholarship in 2000. Sarah is an award-winning photographer and a tireless advocate for diabetes education. Her renowned kitten calendars sell throughout the state and help raise funds for the Juvenile Diabetes Foundation. As a diabetic herself, she is able to draw from her own experiences as she speaks with adults and children across South Dakota about the disease. In 1999, she successfully lobbied the South Dakota Legislature to enact legislation expanding health insurance coverage for diabetic supplies and equipment. Loni Schumacher was next in 2002. A member of her local chapter of Family, Career and Community Leaders of America, she was selected to visit Japan in 2001 on a 6-week exchange. An only child, she has since adopted ``sisters'' from across the globe. Experiencing a new culture broadened her view of the world, and she has brought those ideals back home to Eureka where she and her family have opened their family farm to exchange students from Brazil and Germany. Loni has also been closely involved in her school's ``Teens Against Tobacco Use'' organization, and teaches elementary school students about the hazards of tobacco use. Amanda Imberi is Eureka's winner for 2003. I had the honor of meeting this young woman when I visited Eureka several weeks ago. Just last week, here in Washington, I presented her with the 2003 Tradition of Caring Jefferson Award. At the age of 9, Amanda lost her mother to cancer. She had to grow up faster than any child should. Even with all of her schoolwork, cooking, and managing the family's finances, she has still found the time to be active with the American Cancer Society, speaking at rallies across the state on the importance of cancer awareness and prevention, as well as producing a variety show style fundraiser at her high school. Two more Eureka students have won the scholarship at the state level--John Ostrowski in 1997 and Alisha Lutz in 1998. For a town of approximately 1,200 people, that is a remarkable achievement. It is not only an indication of the desire to succeed shared by these students, it is also a testament to the quality of teachers and schools that produced such outstanding young adults. I don't know what they are putting in the water in Eureka but, whatever it is, I hope they continue. These young people are an inspiration to their communities and their fellow students. They have proven there is no obstacle you cannot overcome, and that you should always pursue your dreams. I commend them and the entire town of Eureka for their achievement, and hope to see even more Discover Card Tribute Award winners from South Dakota in the future.

Mr. DASCHLE

Mr. DASCHLE. Mr. President, today I join Senators Bingaman, Murray, Cantwell and others to introduce the Collaborative Forest Health Act to expedite forest thinning and improve forest health on our national forests and public lands. I thank Senator Bingaman for his leadership on this important issue. Everyone in the Senate wants to do what we can to reduce the threat of catastrophic wildfire. There is agreement on the need to accelerate fuel reduction activities because of the risk of severe fire is so high. Ongoing drought, past fire suppression policies, and past forestry practices have all contributed to the problem. These problems have made fire management much more expensive for American taxpayers. It is important to devote limited resources to proactive efforts to reduce fire risk rather than paying to fight fires once they occur. The risk of damage to human life and property from severe wildfires has increased in areas where rapidly expanding populations are intermingled with forested wildlands, and a primary purpose of the National Fire Plan is to reduce the risks of such fires. Last week, Governors Judy Martz of Montana, Bill Richardson of New Mexico, Janet Napolitano of Arizona, and Dirk Kempthorne of Idaho issued a letter to the Agriculture Committee and the Energy and Natural Resources Committee endorsing this approach stating that ``priority in project selection should be given to projects that reduce fire risk in communities at risk and the watersheds that supply them.'' This comprehensive legislation will assist communities from the threat of wildfire by expediting fuel reduction in high risk areas and target resources near communities and municipal watersheds. We propose to exempt from environmental review and analysis all forest thinning projects located within one-half mile of at risk communities or within certain municipal watershed. While these targeted exemptions from environmental review are warranted, the Senate should proceed with caution in considering any comprehensive changes to judicial review. On May 14, 2003, the General Accounting Office, GAO, issued a report on the Forest Service's fuel reduction activities. For fiscal year 2001 and fiscal year 2002, the GAO found that hazardous fuel reduction activities were conducted on 4.7 million acres. Only 3 percent of all the fuel reduction projects, covering only 100,000 acres, faced any legal challenge during this period. In 2002, the National Academy of Public Administration issued a report recommending the Federal Government conduct fuels reduction treatments near communities and municipal watersheds before treating more distant areas. We also require that 70 percent of forest thinning funds be spent within these critical areas. Our bill authorizes projects on up to 20 million acres over 5 years. The bill also recognizes the role that forest-dependent communities play in restoring our lands by requiring that at least 30 percent of the hazardous fuels reduction funds be spent on projects that benefit small businesses that use hazardous fuels and are located in small, economically disadvantaged communities. It is widely known that approximately 80 percent of the land surrounding homes and communities is non-Federal land. Our legislation provides $100 million annually to States, tribal and private lands to reduce wildfire risk and restore burned areas. In addition, our bill establishes a $25 million research program, in cooperation with colleges and universities, to gather information on insect infestations that can be applied to forest management treatments. Our bill promotes wildfire management activities that maintain the integrity of our national forests and public lands. The bill requires protection of old and large trees, prevents new road construction in roadless areas, and protects municipal watersheds. In conclusion, our bill represents a comprehensive and balanced approach to expedite forest thinning and improve forest health. I urge my colleagues to support this important legislation.

Mr. DASCHLE

Mr. DASCHLE. Mr. President, today I join Senators Bingaman, Murray, Cantwell and others to introduce the Collaborative Forest Health Act to expedite forest thinning and improve forest health on our national forests and public lands. I thank Senator Bingaman for his leadership on this important issue. Everyone in the Senate wants to do what we can to reduce the threat of catastrophic wildfire. There is agreement on the need to accelerate fuel reduction activities because of the risk of severe fire is so high. Ongoing drought, past fire suppression policies, and past forestry practices have all contributed to the problem. These problems have made fire management much more expensive for American taxpayers. It is important to devote limited resources to proactive efforts to reduce fire risk rather than paying to fight fires once they occur. The risk of damage to human life and property from severe wildfires has increased in areas where rapidly expanding populations are intermingled with forested wildlands, and a primary purpose of the National Fire Plan is to reduce the risks of such fires. Last week, Governors Judy Martz of Montana, Bill Richardson of New Mexico, Janet Napolitano of Arizona, and Dirk Kempthorne of Idaho issued a letter to the Agriculture Committee and the Energy and Natural Resources Committee endorsing this approach stating that ``priority in project selection should be given to projects that reduce fire risk in communities at risk and the watersheds that supply them.'' This comprehensive legislation will assist communities from the threat of wildfire by expediting fuel reduction in high risk areas and target resources near communities and municipal watersheds. We propose to exempt from environmental review and analysis all forest thinning projects located within one-half mile of at risk communities or within certain municipal watershed. While these targeted exemptions from environmental review are warranted, the Senate should proceed with caution in considering any comprehensive changes to judicial review. On May 14, 2003, the General Accounting Office, GAO, issued a report on the Forest Service's fuel reduction activities. For fiscal year 2001 and fiscal year 2002, the GAO found that hazardous fuel reduction activities were conducted on 4.7 million acres. Only 3 percent of all the fuel reduction projects, covering only 100,000 acres, faced any legal challenge during this period. In 2002, the National Academy of Public Administration issued a report recommending the Federal Government conduct fuels reduction treatments near communities and municipal watersheds before treating more distant areas. We also require that 70 percent of forest thinning funds be spent within these critical areas. Our bill authorizes projects on up to 20 million acres over 5 years. The bill also recognizes the role that forest-dependent communities play in restoring our lands by requiring that at least 30 percent of the hazardous fuels reduction funds be spent on projects that benefit small businesses that use hazardous fuels and are located in small, economically disadvantaged communities. It is widely known that approximately 80 percent of the land surrounding homes and communities is non-Federal land. Our legislation provides $100 million annually to States, tribal and private lands to reduce wildfire risk and restore burned areas. In addition, our bill establishes a $25 million research program, in cooperation with colleges and universities, to gather information on insect infestations that can be applied to forest management treatments. Our bill promotes wildfire management activities that maintain the integrity of our national forests and public lands. The bill requires protection of old and large trees, prevents new road construction in roadless areas, and protects municipal watersheds. In conclusion, our bill represents a comprehensive and balanced approach to expedite forest thinning and improve forest health. I urge my colleagues to support this important legislation.

Mr. DASCHLE

Mr. DASCHLE. Mr. President, I yield 3 additional minutes of my leader time to Senator Dorgan.

Mr. DASCHLE. Mr. President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. DASCHLE. Mr. President, I wish to alert my colleagues this morning to an important new study that has just been published by the Institute of Medicine entitled ``Hidden Costs, Value Lost: Uninsurance in America.'' According to the Institute's findings, the United States economy loses between $65 billion and $130 billion each year because of the cost of the undiagnosed or untreated illnesses of those Americans who lack insurance. In short, the report found that the cost of not providing insurance is higher than the cost of providing insurance. If these findings are borne out, this would represent an astonishing fact that should force the Congress to rethink our approach to the health care and insurance, policies in the country today. The report also examined the effect being uninusured has on individuals and their families. It states: Unisured individuals and families bear the burden of increased financial risk and uncertainty as a consequence of being uninsured. Although the estimated monetary value of the potential financial losses that those without coverage bear is relatively small, the psychological and behavioral implications of living with financial and health risks and uncertainty may be significant. Recently, I was home in South Dakota meeting with citizens. I saw first-hand the effect that the lack of insurance and the fear of losing insurance has on the people of my State. Day after day, too many South Dakotans know that they are one layoff, one bad crop, one accident, or one illness away from being totally unprotected. I met with veterans who are picking up a greater share of their health care costs, because cuts to their health benefits are causing longer waits and worse care in the VA system. I met with self-employed people, small business owners and farmers, who buy their own insurance and as a result face premium costs as high as $20,000 a year. I met with the families of National Guard members who just a few weeks ago were afraid that their loved ones might get hurt in the line of duty in Iraq. Today, they were worried that their husbands or wives will lose their health coverage when they return home. And I met with citizens from all walks of life who can't afford the high cost of insurance and live in constant fear that an illness or an injury could throw them and their family into bankruptcy. I recently heard from a couple in Springfield, SD, who own a small business, but who do not have insurance. The husband is a veteran and he has been on the waiting list to receive benefits for himself through Veterans Health Administration for a year-and-a-half. In the meantime, he has looked for health insurance for both for he and his wife. But, the only policy they could find had monthly premiums of $800 and deductible of $2,500. In addition, the insurance would not cover the couple's pre-existing conditions. This policy was too expensive, so they are forced to live without coverage of any kind until the Veterans Administration is able to provide it. They may wait for as long as 2 years. To bring resources for Veterans health more in line with the overwhelming need, many of us introduced a bill, S. 19, that would change the funding process for the Veterans Health Administration. The bill would mandate increased funding to correspond to any increase in the number of patients. This section, which is identical to S. 50, the Veteran Health Funding Guarantee Act introduced by Senator Johnson, would help ensure that the VA can provide medical services to every eligible veteran. Our failure to provide coverage to veterans is one of the most glaring examples of the unfairness in our health care system. But the problem extends throughout our entire country. Forty-one million Americans lack health insurance today, and high costs are driving that number even higher. With the release of the Institute of Medicine's report, we learn that doing what's right is in fact less costly for our country than doing nothing. We can do better. This is a national problem and it demands national leadership to fix it. We have an obligation to focus on the troubles of our economy and the Americans who are struggling to work and raise families. We certainly want to do everything we can to keep the Senate's attention focused on the crisis in health care. Our citizens are asking for our leadership, and we have an obligation to answer their call. I yield the floor.

Mr. DASCHLE

Mr. DASCHLE. Madam President, if we can get consent, which I will offer in a moment, I intend to offer an amendment which would address one of the concerns I have with the current bill; that is, the uncertainty with regard to the premium itself. Under the bill, it is anticipated the monthly premium paid for by beneficiaries, the beneficiary obligation, would be $35, but there is no guarantee that beneficiary figure of $35 is going to be what our beneficiaries are going to pay; it is only an average. The Congressional Budget Office that gave the $35 figure cannot state what the range will be that will be charged to beneficiaries. It could be lower. Most likely, it could be higher. I am told last year the Medicare+Choice plans increased by 15.5 percent. That was just last year alone. If Medicare+Choice premiums increased by 15.5 percent, there is no telling what the figure could be. It could be $40 or $50, and I will get into that in a moment. Even the so-called Medicare fallback, available when private plans choose not to serve a community, provides no guarantee. So you do not have any guarantee in the private sector options that will be made available. And if those cannot be made available in a region, the Medicare fallback does not offer any guarantee with regard to what the premium will be either. Initially, we were told by the bill's authors that the fallback plan would have a uniform premium, but in fact it does not have even a uniform premium. So not only do we anticipate that it will not be $35, we do not know what it will be. We also know it could be different in different areas. We know that Alaska or South Dakota could be forced to pay a much higher premium than someplace where price and utilization figures could be different; say, Florida. We actually see that right now with Medicare+Choice. Medicare+Choice HMOs offer prescription drug coverage today. According to a report provided to the Congress recently, the premiums in Connecticut, under a Medicare+Choice plan, today are $99 per month. That same premium is $16 in Florida. So with the experience we have already had in the private sector, the Medicare+Choice option, we have seen a dramatic variation in the price of the premium for beneficiaries. I fear we are going to see exactly the same thing with the private plans offered through this bill as soon as the legislation is implemented. We have two issues: First, we do not know what the premium will cost because we just have an estimated national average; second, even if there is a national average, we are concerned that there could be a dramatic variation from one part of the country to the other. It is that variation, as well as that uncertainty with regard to the premium itself, that we are trying to address with the amendment we are offering. The way the bill is written, I will state what will likely happen. There are two terms with which I hope people will become more familiar. The first term is the national weighted average premium. That is the overall premium cost that must be achieved in order to pay for the private sector coverage as well as the Medicare backup when the bill is implemented. In other words, the prescription drug companies will determine, given what the benefit package is, given the utilization rates, given the actuarial tables, it will take so much money, divided up per person, to pay for the plan once it is implemented. There will be two payments. One will be from the Government and the other is from the beneficiary. The second part of this term, the beneficiary obligation, is what the senior citizen is going to pay. That is the so-called $35. But the overall premium could be $100. In fact, we think it might be in the $100 range. So, under that example, $65 would be paid by Government, $35 would be paid for in the premium by the beneficiary, the beneficiary obligation. Assume the average is $100 and assume, then, the payment is over by $10. Assume the premium is not $100 but it is $110. Under this bill, that $10 extra in the premium is paid all by the beneficiary. That will be added to the beneficiary obligation. So instead of a $35 payment, it could be $45, a 30 percent increase in the premium the Medicare beneficiary will have to pay. That is why there could be a significant variation. So we have these two calculations: The national weighted average premium, which we estimate could be around $100; the beneficiary obligation, which is $35, roughly, give or take. And of course, as I said, we do not know what it will be like in some parts of the country. It could be dramatically different, as we have seen with Medicare+Choice right now. Amendment No. 939

Mr. DASCHLE. I ask unanimous consent that the pending amendments be set aside and that this amendment be considered at this time.

Mr. DASCHLE. Madam President, I ask unanimous consent that the reading of the amendment be dispensed with.

Mr. DASCHLE. Madam President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. DASCHLE. Madam President, yesterday the committee offered a modified version of the bill before us. My amendment does not conform to the modified version in terms of page and line numbers. I ask unanimous consent that a modified amendment be offered and substituted for the amendment I offered earlier this morning.

Mr. DASCHLE. Mr. President, I ask for the yeas and nays.

Mr. DASCHLE. Madam President, basically what our amendment does is simply say: We understand there will be variance. We understand we cannot pinpoint with any precision exactly what the cost to the beneficiary is going to be. Why don't we put a cap on what that senior citizen is going to be required to pay, within some reason. If we say the beneficiary obligation is going to be $35 a month, put a 10 percent cap on that premium. It can be below to whatever extent. If it comes down to $15, we all ought to celebrate. But if it is going to be more than $35, say that it cannot exceed 10 percent of the average beneficiary obligation. This would give some assurance to senior citizens that they are not going to be facing dramatically varied costs or facing this extraordinary uncertainty with regard to what the premium will be. But within a 10 percent range, give or take, they will know what their premium obligation will be as they make their decision from one year to the next as to what that premium will cost them. This is exactly what we do with Medicare Part B. Right now with Medicare Part B, beneficiaries pay $58.70 a month for their physician and outpatient care. I might add, that is a consistent figure. It is the same in Alaska and South Dakota as it is in New York and California. That has worked. No one has complained. I don't know that any amendment has ever been offered to suggest South Dakota ought to pay a different Medicare Part B premium than someone else. No one has said that having an actual figure every year that seniors can know will be a given cost is something that does not work for physicians. If it works for Medicare Part B, if it works for physicians and outpatient costs, why wouldn't it work for prescription drugs? We are actually giving more latitude. We are not saying it has to be $35. What we are saying, simply, is let's make sure there is some certainty. Even if it cannot be with the same precision--which, frankly, I think it could be--but if it cannot be the same precision as we expect with Medicare Part B, let's at least say: Give or take 10 percent, it has to be in that $35 range. I don't think that is too much to ask, with all the uncertainty people are facing today as they consider this. I was just talking on a radio station a few minutes ago, trying to explain what a senior would have to pay. The question was, What does this mean for a senior? Here is what I had to say. I said we think the premium is going to be $35. We think the deductible is going to be $275. We think the copay is going to be 50/50 between the program and the beneficiary with all the charges up to $4,500, and after that we know the benefits are cut off until you reach about $5,800, and then it kicks on at a 90-percent reimbursement rate at $5,800. If I was a 87-year-old citizen listening to the radio, I would say: Holy cow, call my accountant. And this is for a drug benefit. But that is what we are doing. We are asking the senior citizen somehow to make sense of all this, and then we have to say we don't even know if two companies are going to come into your region to provide the benefits in the first place. If they do not, there will be a Medicare backup and we will give you the details on that later. This just provides a modicum of additional certainty, some degree of confidence that they have some idea, with one of those calculations, of the premium itself, that it is not going to be $45, $55, $65 a month; that it is going to be $35 a month, give or take 10 percent. I do not think that is too much to ask. We had a debate about this legislation in the committee. I was disappointed the amendment was not adopted in committee. I feel so strongly about it I think it is important for the Senate to have an opportunity to reconsider the amendment. We got a letter from the National Committee to Preserve Social Security and Medicare. Let me read this letter: On behalf of the millions of members and supporters of the National Committee . . . I am writing in support of your ``Guaranteed Premium'' amendment to S. 1. The current Senate prescription drug bill, S. 1, does not limit the premium increases, which could potentially subject seniors to dramatic fluctuations in premium costs. Seniors want assurance that their costs will not suddenly skyrocket. Over the past year, premiums for Medicare Plus Choice plans increased 15.5 percent. Seniors need to know what costs they can expect in order to receive a drug benefit. Most seniors are on fixed incomes and even the slightest increase could impose a huge burden on their ability to afford a drug benefit or other necessities, such as food and shelter. We understand your amendment would limit premium increases . . . preventing dramatic changes in price. We agree that seniors have the right to know what they will be paying today and in the future for a drug benefit. . . . I will just add one other thought. The letter notes that a slight increase could impose a huge burden on their ability to afford a drug benefit. I have talked literally to hundreds of seniors--maybe even thousands by now. I know it is hard for a United States Senator to be fully appreciative of what it means to live on Social Security but many seniors do. That is their only source of income. We are now telling them in addition to the $58.70 they pay for Medicare Part B, there is going to be added to that at least $35, probably more, for a prescription drug benefit. So now we are talking about, not $58, but probably $100, out of whatever Social Security check they get each month. I have talked to many seniors who have said: For me, it is a choice between drugs and rent, drugs and groceries. I think we overlook that. I think people minimize the extraordinary financial impact these charges, these costs have in their daily lives. What they want is a little more certainty. What they want is a little more assurance that they can make ends meet with these extraordinarily limited budgets within which they live. That is what our amendment does. I am hopeful the Senate will consider it. My hope is that, on a bipartisan basis, we can adopt it later today. I yield the floor and I suggest the absence of a quorum.

Mr. DASCHLE. I suggest the absence of a quorum.

Mr. DASCHLE. Mr. President, the amendment that is now pending before the Senate addresses a concern that many of us have with regard to the volatility of the premium. As everyone knows, currently, the Medicare Part B premium is $58.70. That is across the board, across the country. Regardless of where you live, regardless of the circumstances, a senior pays $58.70. We do not know what the premium for this prescription drug benefit will be. We are told the average cost is anticipated to be $35. But there is the average national weighted premium that is supposed to be about $100, which comprises both what the beneficiary pays and what the Government pays. If that is off by $10, if it is going to be $110 rather than $100, that $10 is going to be added to the $35, requiring a 30-percent increase in the cost of the premium for the beneficiary. So we are very concerned, first, about the unpredictability of the premium, and, secondly, about the volatility of the premium because we really do not know what the national weighted average is going to be. We also know because of utilization, there could be dramatic changes from region to region. Currently, in a Medicare+Choice program, including prescription drug benefits, a benefit package in Florida costs $16 and a package costs $99 in Connecticut. So you get a wide- ranging variance with regard to regions of the country. This amendment simply says: Look, of all the factors you have to be concerned about; at least on the premium you are going to have some understanding that it is not going to vary as dramatically and as wildly as it might because there will be a cap of 10 percent over that national average for the beneficiary's contribution. If the national average is $35, it cannot exceed 10 percent more in any 1 year. It might exceed more than that year after year, but each year it would be within 10 percent of the average. It can go below that, but it just cannot go above 10 percent. When you look at all of the concerns that seniors have with regard to the unpredictability of this plan, the co-pay, the coverage gap, the stop loss, the benefits package itself--all of those concerns, in addition to the variance of the premium--we are simply saying, let's do, at least in part, what we do with Medicare Part B. If Medicare Part B can be $58.70, let's say the prescription drug benefit can be $35 plus 10 percent regardless of what circumstances may be out there. Let's give a little more certainty, a little more stability to seniors as they begin to pay their premiums. As it as a result of this bill, they are going to be paying $100 a month now for Part B as well as for this new prescription drug benefit per month. I think we have to be concerned about how high those costs can go and how much economic challenge these seniors are going to have to take on as they face the real prospect of being in a position of not being able to afford the benefit at all. Mr. President, I yield to my dear friend and colleague from Nebraska, Senator Nelson.

Mr. DASCHLE

Mr. DASCHLE. Mr. President, I will use my leader time. I am not sure what the allocation of time is right now. I commend the distinguished Senator from Michigan and the Senator from Illinois for their work on this particular amendment. I think I can say for most, if not all, of our caucus members, this is the most important amendment as it relates to this bill, in large measure because it goes to the essence of what it is we believe we need to do. What we have said from the very beginning is let's build on what we have achieved in the Medicare system now for the last 38 years. Obviously, we know there are ways in which the program needs to be updated and reformed. I think there is common agreement among Republicans and Democrats that if we are to reform Medicare, the single most important priority is to ensure that we recognize that health care delivery has changed dramatically in the last 40 years. Health care delivery now is largely outpatient. Far more people get their health care in an outpatient setting than they do inpatient. With that recognition, we made a decision in the 1960s that was wrong. We said we would reimburse drug costs in a hospital but we would not reimburse drug costs outside of a hospital or doctor's office. Well, had we decided back then that we would reimburse drug costs regardless, we would not be here today. So we made a decision based on, I am sure, a lot of different factors--cost was probably important--that we wish now we could have reversed a long time ago. But that, in essence, is what we are talking about with reform. It is a recognition that health care delivery itself has changed. The real question is, What will be the mechanism by which seniors acquire these prescription drugs? There are those who have suggested that seniors ought to have choice. I have heard the distinguished Senator from Michigan say so eloquently that if you are in favor of choice, you will be in favor of this amendment because that is basically what we are proposing--choice. We are saying to seniors, if you think you can find a better plan out there somewhere, offered within your region, take it. This is a voluntary program. We are not mandating that you do anything. But if you think Medicare has provided a good service and if you think, in order to be consistent with the spirit and the concept of Medicare to begin with, that it ought to be offered through the Medicare system, you ought to have a right to choose that as well. Why in Heaven's name would we deny a senior the right to stay within Medicare when they get their doctor and hospital benefits through Medicare? They ought to get prescription drugs through Medicare. So that is, in essence, what the Senator from Michigan is suggesting with her amendment. Let's allow choice; let's allow consistency. But I think it goes beyond the choice of the senior citizens. The reason it ought to be our choice occurred again last night to me as I listened to some of the debate in the House Committee. The question was asked last night: Can you tell us what the administrative costs will be for the private sector systems providing this new prescription drug benefit? On record last night during that debate the answer was given: 25 percent. The administrative costs for the private sector plans is anticipated to be 25 percent. That means out of the $400 billion we are committing to the drug program under this legislation, $100 billion could go to paperwork. We have asked what is the administrative cost of the Medicare system, and we are told by CBO and others that the administrative cost today for Medicare is between 3 and 4 percent. So we could save upwards of 20 percent if we had an opportunity for seniors to use the Medicare system. That is another reason that choice would make sense to us--to keep administrative costs down. We only have to look to the Veterans Administration to see how effectively they have controlled costs, not only administratively but on drug acquisition costs. The drug acquisition cost through the Veterans Administration is dramatically lower, ranging anywhere from 15 to 30 percent below what is done in the private sector through private insurance companies. We could save in Medicare as well. From a cost containment point of view, an administrative point of view, and a choice point of view, this amendment ought to pass. I think it is key to sending the right signal not only to our seniors about what kind of services we want to provide, about what kind of consistency, what kind of choice we want to offer, but it ought to be a message to the taxpayer. We are going to do it through the most efficient, most administratively simple concept to which we can subscribe. Extending Medicare, providing drug benefits through Medicare, is the way to do it. Again, I commend the distinguished Senator from Michigan for her efforts and for her amendment. I hope it will enjoy broad bipartisan support. I yield the floor.

Mr. DASCHLE

Mr. DASCHLE. Madam President, I commend the distinguished majority leader for his statement and for the effort he has made to bring the debate on prescription drugs to the floor over the course of the next 2 weeks. I share his hope and his goal that by the end of this period, we can have achieved what I think all Senators want--a good, vigorous debate about what is the best approach to take with regard to a prescription drug benefit under Medicare--and complete that debate prior to the July 4 recess. I have indicated to him personally that it would be my intention to work with him to accommodate that goal. I do hope we can move to the amendment phase of the debate sooner rather than later, preferably this afternoon. I also commend Senators Grassley and Baucus for their effort in the Finance Committee. The vote of 16 to 5 was an indication of their success in accommodating the concerns and the ideas of many of our colleagues. They have worked on this for a long period of time and I think deserve our commendation for the effort they have made on a bipartisan basis. During the committee process, I indicated it would be my hope that I could work as vigorously as they did in achieving the bipartisan tone that was accomplished during the markup last week. I must say, I do not share the enthusiasm for the legislation that some of my colleagues do, and I wish to talk about that this morning. We may have a different perspective on how close this may be, but I also recognize that we have made the perfect the enemy of the good at times, and I do not want to do that in this case. I hope we can make a good down payment. I hope we can achieve a start. I have been concerned about how shaky a start this may be, but it is a start. If we are going to commit $400 billion over the next 10 years to provide meaningful drug benefits, I hope we can do so maximizing the use of those resources, providing the most efficient utilization, and a mechanism, an infrastructure, for prescription drugs that will accommodate many of the goals and hopes we have for at long last modernizing Medicare in a way we know must be done. I hope we do not overpromise. It is so easy to make proclamations about how good this accomplishment is, and I think we may create false expectations, high expectations, for this legislation that just will not be realized once the full impact of the bill is felt in the countryside. Some have said, for example, that this is just like FEHBP, the Federal Employees Health Benefits Plan, for Senators. It is not. There is about a $1,000-a-year difference in the value of benefits between what Senators get and what seniors are going to get. To do what Senators get, we are told by economic analysts, it would take about $800 billion over a 10-year period, not $400 billion. So this is not FEHBP. This is something substantially below FEHBP. We also must acknowledge that a senior who has $5,000 of drug costs will get a benefit of about $1,700; $3,300 will still come out of pocket out of that $5,000. So people need to be aware this is not FEHBP; that this is not going to address all of the concerns and needs that seniors have with regard to their drug costs. Having said that, I believe we put down a marker, we set a foundation, and we should work with the administration and with especially the Department of Health and Human Services to address some of these concerns, and over time I believe we can make this an even better bill. Whether it is in the next 2 weeks, the next 2 months, 2 years, or 2 decades, we are going to make this a better bill, a better program. There are a number of concerns I have with regard to how we can make it better that I hope we can address through amendments. The first amendment Democrats will offer is simply to give seniors more choice; to say to them: You can pick a private sector plan if you wish, but we also think you ought to be able to pick a plan that is strictly a Medicare plan; that you can simply extend your current Medicare benefits for doctors and hospitals to prescription drugs as well, and that should be an option for you as you make your decision with regard to what choices may be right for you. That will be one of our key amendments. As I said, it will be our first amendment. I am concerned as well about the volatility of premiums. There are those who suggest there will not be much variation, and yet in testimony we were given just last week during the markup, the experts told us they could not guarantee there would not be great volatility. We are concerned about the past example of Medicare+Choice, the premium for such plans can cost $16 in Florida and cost $99 today in Connecticut. That variation is what we are afraid could be part of this plan unless we do something about it. Seniors are going to have four cost issues about which to be concerned. The first is the premium. The second is the initial cap on benefits and the stop-loss; that is, at what point do they lose all coverage and at what point do they get catastrophic coverage--and I will get to that in a minute, the gap when they pay all of the costs. They will also have co-payments and the deductible. All four of those variables could change dramatically. The deductible is currently $250, thereabouts, in the bill, but it could go up. The co-payments are 50- 50, but it could go up. The stop loss is around $3,700 out-of-pocket. That could change. And you have, of course, the premium itself which is estimated to be $35, but there is no guarantee. There is no defined benefit. One plan could have a lot more benefit than another. And seniors in their late eighties or early nineties are, I think, going to find it very confusing with all these variables with regard to their costs and also extremely different options and variables when they get to their benefits. So there is no defined benefit. As I say, there is still a large issue with regard to the benefit falloff, the initial benefit cap for the package overall. It has been described as a donut hole, a coverage gap, but the benefit cap, the benefit stop that kicks in at about $4,500 in drug spending, will mean that seniors between $4,500 and at least $5,800 are going to have to pay all of the premium costs and get no benefit whatsoever during that period of time. So we are going to have to deal with that as well, it seems to me, and that is a function of cost. We also have another issue about which we are concerned. We are told by CBO that 37 percent of beneficiaries--this is CBO--37 percent of beneficiaries with retiree prescription drug coverage will lose it under this bill; 37 percent, one out of three retirees, one out of three at least. I guess you could not say necessarily it is one out of three employees; it could be more than that. Thirty-seven percent of beneficiaries with retiree coverage today will lose that prescription drug coverage when this bill kicks in. There is only one way to stop that from happening: To incent employers, to try to discourage them in as many ways not to drop that coverage, and we are going to try to do that. The way we write the language on how retirees can be dropped, the way we incent employers by providing them with benefits to keep that coverage--we are going to try to do that as well. To provide 100 percent of the incentive it is going to take for companies not to drop their employees would cost more money. This bill currently has some. So we are going to see if we can get closer to that full amount to ensure that we do not find any more companies than absolutely necessary or possible that will drop their employee benefits. So we have a number of significant concerns about the way this is written, about the benefits, about the uncertainty, about the costs, about whether or not Medicare can play more of an upfront role. We have one other issue, the volatility of the benefit itself. South Dakota is a good example of a concern that many of us have. In South Dakota we do not have any Medicare+Choice. Companies do not want to serve the rural areas. So we are concerned about what it is going to take to bring companies into South Dakota to compete for the benefit plan to be provided in our region. If we cannot find anybody, under the bill, Medicare kicks in for 1 year. Once Medicare has kicked in, at the end of 1 year's time, these private companies can come back in and the Medicare plan that seniors had counted on for that year no longer would exist and there would be competition again for the private sector plans competing if they wish to serve that particular area. So there is this constant change. If there is anything seniors do not like, it is change and this uncertainty that comes with change. Not only that, we learned last week another disconcerting aspect of this. A decision would be made sometime in September on whether plans would exist for the coming year. If it can be determined by September that the plans cannot be put into effect for that coming year in a given region, then what happens is Health and Human Services establishes a Medicare plan, but they have to contract with a private company to provide that Medicare plan for the following year beginning in October. So what happens under the bill between October and January is this: They find out first that no two plans can compete, so the Medicare plan is supposed to kick in. They contract for the Medicare plan, decide what the premium, the benefits, the stop loss, and the deductible are going to be. They somehow notify all the seniors in the region. They begin to try to implement the plan between October and December and make all of these decisions with regard to plans, benefits, notification, implementation, and administration. Technically it is supposed to kick in on January 1. Now, if my colleagues have seen Government work that fast in any other area than perhaps a military intervention somewhere, I would like to see where it is. I am very concerned--frankly, extremely concerned-- about whether or not that is even humanly possible. Keep in mind, this is not going to be a one-time experience. We are going to repeat this every single year perhaps. We are going to make a decision in every region whether or not these plans can compete. Whether it is Alaska or South Dakota, my guess is they will not find them. They will then say, okay, we are going to have 3 months to fully implement a Medicare fallback even though we do not know who the contractor for that Medicare fallback will be on October 1. So I have to say, as we walk through a lot of these concerns, my colleagues will understand why many of us worry about setting these high expectations and then find out how seniors will deal with them and address them in a way that does not cause confusion, fear, anxiety, frustration that is so unnecessary if we would just do this right.

Mr. DASCHLE. I am happy to yield.

Mr. DASCHLE. I would certainly agree with that, and before the Senator came on the floor I commended those responsible for making this a better bill and bringing us to this point. I think that while perhaps it is a shaky start, it is a very important start and we can deal with all of these other issues. Those are two issues we have dealt with, and I am grateful for the fact that we have made progress.