Chuck Grassley

Mr. GRASSLEY

Mr. GRASSLEY. Mr. President, I ask unanimous consent that the Subcommittee on Antitrust, Competition Policy and Consumer Rights be authorized to meet on Wednesday, March 15, 2006 at 2:30 p.m. to conduct a hearing on ``Hospital Group Purchasing: Are the Industry's Reforms Sufficient to Ensure Competition?'' in Room 226 of the Dirksen Senate Office Building. Witness List Panel I: Richard J. Bednar, Coordinator, Healthcare Group Purchasing Industry Initiative, Washington, DC; Mark B. Leahey, Executive Director, Medical Device Manufacturers Association, Washington, DC; S. Prakash Sethi, Professor, Baruch College, The City University of New York, New York, NY; and Mina Ubbing, President and CEO, Fairfield Medical Center, Lancaster, OH.

Mr. GRASSLEY. Mr. Enzi. Mr. President, I ask unanimous consent that the Committee on Health, Education, Labor and Pensions be authorized to meet on Wednesday, March 15, 2006, at 9 a.m. on legislative items.

Mr. GRASSLEY. Mr. President, I ask unanimous consent that the Select Committee on Intelligence be authorized to meet during the session of the Senate on March 15, 2006 at 2:30 p.m. to hold a closed briefing.

Mr. GRASSLEY. Mr. President, I ask unanimous consent that the Committee on Foreign Relations be authorized to meet during the session of the Senate on Wednesday, March 15, 2006, at 9:30 a.m. to hold a hearing on Post-Palestinian Election Challenges in the Middle East.

Mr. GRASSLEY. Mr. President, I ask unanimous consent that the Subcommittee on Readiness and Management Support be authorized to meet during the session of the Senate on March 15, 2006, at 9:30 a.m., in open session to receive testimony on ground forces readiness in review of the Defense authorization request for fiscal year 2007.

Mr. GRASSLEY. Mr. President, I ask unanimous consent that the Committee on Armed Services be authorized to meet during the session of the Senate on March 15, 2006, at 9:30 a.m., in open session to continue to receive testimony on the Joint Strike Fighter F136 Alternative Engine Program in review of the Defense Authorization request for fiscal year 2007 and the future years Defense Program.

Mr. GRASSLEY. Mr. President, I ask unanimous consent that the Committee on the Judiciary be authorized to meet to conduct a markup on Wednesday, March 15, 2006, at 9 a.m. in The Mansfield Room, S-207 The Capitol. Agenda I. Nominations: Norman Randy Smith, to be U.S. Circuit Judge for the Ninth Circuit; Patrick J. Schiltz, to be U.S. District Court Judge for the District of Minnesota; Steven G. Bradbury, to be an Assistant Attorney General for the Office of Legal Counsel; John F. Clark, to be Director of the United States Marshals Service. II. Bills: S. , Comprehensive Immigration Reform; Chairman's Mark; S. 1768, A bill to permit the televising of Supreme Court proceedings: Specter, Leahy, Cornyn, Grassley, Schumer, Feingold, Durbin; S. 829, Sunshine in the Courtroom Act of 2005: Grassley, Schumer, Cornyn, Leahy, Feingold, Durbin, Graham, DeWine, Specter; S. 489, Federal Consent Decree Fairness Act: Alexander, Kyl, Cornyn, Graham, Hatch; S. 2039, Prosecutors and Defenders Incentive Act of 2005: Durbin, Specter, DeWine, Leahy, Kennedy, Feinstein, Feingold; S. 2292, A bill to provide relief for the Federal judiciary from excessive rent charges: Specter, Leahy, Cornyn, Feinstein, Biden. III. Matters: S.J. Res. 1, Marriage Protection Amendment: Allard, Sessions, Kyl, Hatch, Cornyn, Coburn, Brownback.

Mr. GRASSLEY. Mr. President, I ask unanimous consent that the Committee on Energy and Natural Resources be authorized to meet during the session of the Senate on Wednesday, March 15 at 11:30 a.m. The purpose of this meeting is to consider pending nominations and any other pending calendar business of the Committee which may be ready for consideration.

Mr. GRASSLEY. Mr. President, I ask unanimous consent that the Committee on Indian Affairs be authorized to meet on Wednesday, March 15, 2006, at 9:30 a.m. in Room 485 of the Russell Senate Office Building to conduct a hearing on S. 1899, the Indian Child Protection and Family Violence Prevention Act Amendments of 2005.

Mr. GRASSLEY. Mr. President, I ask unanimous consent that the Committee on Commerce, Science, and Transportation be authorized to meet on Wednesday, March 15, 2006, at 1:30 p.m., on Innovation and Competitiveness.

Mr. GRASSLEY. Mr. President, I ask unanimous consent that the Subcommittee on Oversight of Government Management, the Federal Workforce and the District of Columbia be authorized to meet on Wednesday, March 15, 2006, at 2:30 p.m., for a hearing entitled, ``The GAO High-Risk List: An Update.''

Mr. GRASSLEY. Mr. President, I ask unanimous consent that the Special Committee on Aging be authorized to meet tomorrow, March 15, 2006 from 10 a.m.-12 p.m. in Dirksen 106 for the purpose of conducting a hearing.

Mr. GRASSLEY

Mr. GRASSLEY. Mr. President, I have some points I would like to make. Before I do that, I will respond to a couple of points that the Senator from Florida made. One was his speaking about the bewilderment among seniors about the program. I would say that a great deal of the bewilderment comes from the confusion that people have because of the rhetoric of people who don't like this plan and have tried to kill it with rhetoric because they didn't have the votes on the floor of the Senate. That has not created a very good environment. On the other hand, I can say that at my town meetings--I held 16, Monday through Thursday, during our last break--people who came expressed some wonderment about exactly what program to get into. But people who also had already selected a program gave very positive comments about the benefit of the program to them. The other point I would like to make, Mr. President, is the point that was made that maybe the cost is coming in less than what was anticipated because not enough seniors are coming in. I think it is very clear that the reason this is costing $8 billion less than what 3 years ago CBO estimated it would be for this year is because of the competition. As a conferee, as I was going through ironing out the differences between the House and Senate on this bill, we were very nervous that our anticipation of the premium being $37 a month, on average, might end up being much higher. And we, as writers of this legislation, would be embarrassed about that. Competition has brought that premium down to $25. Instead of $37, the average premium is $25. We were estimating that there would be all sorts of savings from competition because we were patterning this program after what the Federal Employees Health Benefits Plan had been for 4 years. It worked so well for Federal employees, we felt it would work very well for seniors, and it is working very well in this respect for seniors. But we estimated there would be certain savings. Quite frankly, we were nervous about whether these savings would materialize. But they did materialize--to the point of adding up to that $8 billion that I have referred to. But with specific drugs--we have drugs and pharmacists coming in under these plans--brand-name drugs are coming in on an average of 18 percent less than otherwise in a pharmacy. If it is mail order, it is about 26 percent less. In the case of generics bought at a pharmacy, it is 55 percent less, and for mail order it is 66 percent less. So I suggest to the Senator from Florida that enrollment has nothing to do with it. The savings are coming because competition is working. Now, another confession we have to make is that as we were writing this bill, we wondered whether we would have enough plans sign up so we would have this competition that works so well in the Federal Employees Health Benefits Plan--even to the point where we decided we needed a backup plan. Just in case only one plan signed up, we would make sure the Government set up a competitive plan so that there would be some choice for our seniors. We ended up with lots of plans, and we hear from the other side there are too many plans. Well, the marketplace brought plans in and drove down the price. Some of these plans are going to get out because the marketplace is going to drive them out. Hopefully, we still have plenty of choice when this all happens. But competition is working. Now, also, I hear the rhetoric about too many plans being confusing. I just read in the newspaper in a whole other area, but to throw it out for comparison, I heard that in regard to people signing up for health savings accounts--HSAs--you have to have a catastrophic insurance policy go with it. There are 96 companies selling catastrophic policies. Yet we have had 3 million Americans sign up in less than a year for catastrophic policies. I don't know whether it is confusing to them or not, but they are joining. That is twice as many plans that are available. We don't hear people complaining about too many plans out there for health savings accounts. So I don't know why--except for rhetoric to gain political advantage--we talk about too many plans out there for seniors. The more plans, the more choice. Do you think Congress has the ability to write one plan that is going to fit the needs of 44 million seniors and disabled people? First of all, if you did that, it would have to be mandatory. If you make it mandatory, it would be evidence that you never learned a lesson from the last time we tried to extend Medicare and make it mandatory when we put a catastrophic program in in 1988 or 1989, which passed this body-- I don't know--it was a closer vote than it was repealed. But when you go home to the grassroots of Iowa, and every other State in the Nation, there is an uproar because it was mandatory and people had to pay for something they didn't want to use. And in a year or two it was almost unanimously repealed by this body. So we believed it ought to be voluntary, and it is voluntary. So if you don't want to join, you don't have to join. But if you want to join, everybody has different needs and desires and you ought to have some choice, just like Federal employees have. If it has worked 40 years for Federal employees, it seems to me that it is a pattern that we ought to have enough respect for the seniors of America to give to them. Mr. President, I would like to go to the issue before us, an issue that we have discussed before, not an issue that I entirely disagree with the Senator from Florida on because I don't know what the situation is going to be by May 15. But I know if you had an amendment up to extend the deadline for filing income tax on April 15 and you moved it to May 15, everybody would be going to the post office on May 15 to drop in their income tax forms, and I would be one of them. Americans procrastinate until the last minute. Some are going to procrastinate until the last minute on joining one of these plans. The extent to which people benefit from this plan, particularly lower income people, because it is highly subsidized--up to 98 percent--it seems to me the extent to which you want to give them more leeway, you are not being very humane to them if they can benefit from the program today instead of tomorrow. So you may be right, but today you are not right. You may be right on May 1. Maybe your timing is off. Maybe I am conceding too much. My staff will probably tell me when I am done I was too good to you, that you are too right. But there are other ways of doing what you want to do, and I am going to suggest a way. You are probably going to disagree with it. Before I get to that point, I want to give some background. The amendment by Senator Nelson is going to extend the open enrollment period. Information on the Medicare prescription drug benefits first became available last October, and then the open enrollment period began November 15. So today the open enrollment period has been going on for 4 months, and there are still 2 months left before open enrollment ends on May 15. I personally think that enrollment is going well. About a quarter million people--250,000 beneficiaries, in other words--enroll each week. Enrollment in stand-alone plans in my State of Iowa increased by 71 percent between January and February. At this rate, Medicare is on a track to reach the goal of 28 million to 30 million beneficiaries with coverage by May 15. I think making decisions about one's health care can, in fact, be difficult. That is why information about the available plans went out way back in October. That is why beneficiaries have 6 months to make a decision. That is why there are many resources to help beneficiaries learn about their options and make their decisions. That is why beneficiaries can change their plan choice once before May 15. But that said, I know there is concern that beneficiaries may need more time. So the amendment I am offering would grant the Secretary of Health and Human Services the authority to extend the enrollment period. We are just 2\1/2\ months into this new benefit--the first expansion of Medicare in 40 years. Personally, I think it is premature to change this date. So I offer this amendment as a compromise. The amendment would grant the Secretary definitive authority to extend the enrollment period. It would waive the application of the late enrollment penalty, and it would extend beneficiaries' rights to change their plan, and to change it once. Despite the rhetoric that we constantly hear around here, I hope everyone wants this benefit to be successful. I know there have been some disappointing startup problems, especially for some of our Nation's most frail and vulnerable beneficiaries. But what would you expect when, on January 1, you have 44 million people rushing into a brand new Government program? There are obviously going to be some roadblocks, when people sign up on December 31 and go to the drugstore on January 2 to get drugs under a plan that you are trying to squeeze 44 million Americans into. It is quite obvious that there would be some problems. I think the administration has made great progress in getting these problems solved. The Secretary of HHS has sat down with our committee on three occasions to hear both Republicans and Democrats, to listen to what the problems are. I think it is mutually agreed that there were about seven areas where there were problems. The question I asked three times was: Is there any change in law that is necessary for the Secretary of HHS in order to grapple with these problems? And the Secretary said, no, he had ample authority to do that. He pointed out to us the seven problems. He pointed out to us how he was going to solve those problems. Between meetings, he gave us updates on progress being made toward solving those problems. So I think we have a Secretary of Health and Human Services and we have a director of CMS who are working more than full time, and a lot of these problems, quite frankly, are simply the technicians it takes to make sure the computer software is working right. What is the problem?

Mr. GRASSLEY. Mr. President, I think we have a Secretary who is working hard on it. There are problems, but at the same time, we are writing a million prescriptions a day without incident. Beneficiaries are saving a lot of money. I spoke with the Senator from Florida about how the average premium is now $25 a month, 20 percent lower than we first projected. I spoke with the Senator from Florida about the lower drug costs, saving the taxpayers dollars as well. Just this year, the benefit, as I said, will cost $8 billion less than originally thought. The 10-year cost has dropped by $180 billion. I heard from a couple in Iowa who are saving nearly $2,800 a year. Another Iowan is saving $1,750 a year. And here is another one. A person from Massachusetts is saving $17,000--$17,000--a year on medicine because they are participating in this program. Getting this level of savings depends on strong competition among the plans, and we have that. Many people will remember the skepticism on whether many plans would participate at all. Some would say that we have too many choices and that is why beneficiaries need more time. Those choices, in fact--let me put it this way: It is not just choices, but because of choice, we have competition keeping premiums low, and they are letting people pick the plan that best suits their medical needs. My amendment strikes an effective compromise, I believe, to Senator Nelson's amendment, which is before us. Senator Nelson's amendment calls for a unilateral extension of the enrollment deadline right now, and it would extend it until the end of the year and into the enrollment period of next year. As I said, I think it is premature to make that decision now. Some people think 6 months is not enough time to make a decision on a plan. Yet millions are enrolling even now. Many people are also concerned about the late enrollment penalty. This penalty is modeled after the way Medicare Part B has worked since its origination in 1966. There is a late enrollment penalty in Part B that anybody who doesn't sign up for it when they get to be 65 will pay, and that is there to encourage people to enroll early and to think of Part B as not some Government program, just a Government program, but to see all of this--whether it is Part B or it is Part D, as in drugs--as an insurance policy. People who are 65 today thinking about signing up for the Part D drug program under Medicare may be very healthy and may think they have never taken a pill in their life and that they will never take a pill, but that is today when they are 65. They are not going to know what their health needs are when they are 70 and maybe get sick and have to take a lot of medication. It is a little bit as if you were never going to have a car accident, you would never buy car insurance. If you were never going to have a fire in your house, you would never buy fire insurance. But Americans see insurance as a very useful tool, a necessary tool to manage their risks, and our seniors and disabled people ought to see this as an insurance policy, maybe not needed today, but that will be needed some day, and they ought to be enrolled. Obviously, if you didn't have that penalty in Part B and now in Part D, the drug part, then who would ever sign up until the day before they have to buy their first pill, just as you would not buy your car insurance policy until the day before you were going to have a car accident. So I hope people see it as a good investment, as an insurance policy, as it has been for Federal employees for the last 40 years. The late enrollment penalty is designed to encourage enrollment, and as with other coverage of insurance, it spreads these costs across many enrollees. The more people enroll, the lower the costs are for everyone. So if the Senator from Florida wants to keep these costs continually low, get more people under the umbrella, sell an insurance policy, as he has been so successful selling people on the importance of keeping Senator Nelson in the Senate. The open enrollment creates an enrollment deadline. The deadline that is involved in the open enrollment period encourages people to act, to get the protection against unexpected drug costs. We all know that people sometimes wait until they need coverage to get it. It would be the same as if only people with a burning house get fire insurance. If you waited until the day before your house was going to burn down to buy fire insurance, fire insurance would be awfully expensive. That leads to higher costs for everyone. For the same reasons then, there is an enrollment period and a late enrollment penalty under Medicare Part B, not at all a new idea. The premise of the Nelson amendment is that Congress needs to override that 6-month open enrollment period and make it even longer. The Nelson amendment would do that today even though enrollment is on track. It would extend the open enrollment period now even though we don't know whether it will be necessary 2 months from now. It presupposes a bad outcome to the enrollment of Part D of Medicare. It plans for failure, and I think this plan, particularly with how successful the competition is, for failure is wrong. Frankly, I think Senator Nelson's amendment has the potential to do more harm than good, regardless of his good intentions. Without the pressure of that May 15 deadline, many beneficiaries may forgo savings by putting off their decision. Now, it may turn out that the enrollment period needs to be extended, as I said in my first remark to my colleague from Florida. And if that is the case, then my amendment would give the Secretary the authority to do that right away. No further congressional action would be needed. Under my amendment, if in 2 months the Secretary determines the enrollment period should be extended, if enrollment is lagging, for example, then he has clear authority to do that. My amendment would also automatically delay the late enrollment penalty if the enrollment period is extended by the Secretary of HHS. My amendment would provide the funding needed to continue the open enrollment period. This funding is needed to continue the round-the- clock operations of the 1-800 Medicare number, and the expanded operations for that open enrollment period. I close this debate by reading an editorial from the New York Times in 1966. This was an editorial about the implementation of the original Medicare Program we have had on the books since 1966. A quote from the New York Times: But as Medicare gets underway, the danger is that the strains on it will generate pressures for unsound change. They will come from those who will be disappointed because they have been led to expect too much as well as from those who see failure in every shortcoming. Changes will come in time, but they should be made on the basis of Medicare's own experience. This great new experiment must be given ample time to get over its growing pains. Those growing pains for Part D Medicare are now just 2\1/2\ months old. So I go back to the first sentence, for the consideration of my friend from Florida, ``that the strains on the system will generate pressures for unsound change.'' I think his is an unsound change. This quote speaks volumes about our current situation with Part D Medicare. I urge my colleagues to support my amendment and to oppose the Nelson amendment. Mr. President, do I have to ask to have a previous amendment set aside in order to send my amendment to the desk?

Mr. GRASSLEY. You mean the time I used off the bill.

Mr. GRASSLEY. Mr. President, I ask unanimous consent that time be charged to my amendment.

Mr. GRASSLEY. I send my amendment to the desk.

Mr. GRASSLEY. Mr. President, I have 35 seconds?

Mr. GRASSLEY. Mr. President, I only want to clarify two things. One, if I said there were no complaints at my town meetings about the program, there were, but I found a great deal of people who had enrolled very satisfied and also satisfied with the process. The second thing is, it has to be a policy decision by Congress to do what I want to do, so it is still up to Congress to make this decision. I would be willing to make this decision if it was made first, but your amendment is up today. So it is still a choice we are making. I yield the floor.

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

Mr. GRASSLEY. Let me get a copy of my amendment.

Mr. GRASSLEY. Mr. President, I will yield to whatever the Senator wants me to listen to.

Mr. GRASSLEY. Mr. President, to the Senator from Florida, Mr. Nelson, if the Secretary extends the period, it automatically then waives the penalty for that period of time.

Mr. GRASSLEY. The purpose of my amendment is--I think I am answering the Senator's question. Let's say May 14 comes and the Secretary decides we need more time and he makes a decision to extend that period of time. Let's say he extends it from May 15 to September 15. During the period of May 15 to September 15, there would be no penalty.

Mr. GRASSLEY. Could I have 1 more minute?