Chuck Grassley

Mr. GRASSLEY

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 President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. GRASSLEY. Mr. President, I ask unanimous consent that amendment No. 990, previously adopted, be modified with language I send to the desk.

Mr. GRASSLEY. I ask unanimous consent that the pending amendment be temporarily set aside, amendment No. 1096 be called up, adopted, and the motion to reconsider be laid on the table.

Mr. GRASSLEY. I am sorry, No. 1041.

Mr. GRASSLEY

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 President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. GRASSLEY. Mr. President, what is the business before the Senate?

Mr. GRASSLEY. I urge adoption of the amendment.

Mr. GRASSLEY. Mr. President, I have a unanimous consent request to correct a previous unanimous consent request. In a previous unanimous consent request, I referred to amendment No. 990 when I meant to refer to the previously adopted Murray amendment No. 961. I ask unanimous consent to make that change. I referred to the Kyl amendment No. 1128 when I meant to refer to Kyl amendment No. 1121. I also ask unanimous consent to make that change.

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 President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. GRASSLEY. Mr. President, I send an amendment to the desk.

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

Mr. GRASSLEY. Mr. President, is there no discussion necessary on the amendment?

Mr. GRASSLEY. Yes, that is my understanding, as well.

Mr. GRASSLEY. I will be happy to work with both of you and our staffs to rectify this problem. Adult day care is an important issue, and being that the Senate and House of Representatives will have different language on this issue, it must be conferenced in a way to ensure that all with interests in this matter, including interested provider and senior organizations, are involved and approving of the final adult day care language. I am looking forward to further working with both of you on this matter.

Mr. GRASSLEY. I thank both the Senator from Nevada and the Senator from Arkansas for their comments and for withdrawing the amendment. As you may know, I asked CMS Administrator Scully at the Finance Committee markup to further delay implementation of these beneficiary caps. Unfortunately, as a result of the Senate Budget Resolution constraints, I do not have Medicare dollars to repeal the beneficiary cap on therapy services. I agree that this arbitrary limit does not make sense and have sought to address this issue in the past. I will work in conference to enact a therapy cap moratorium and appreciate your hard work and passion on this issue.

Mr. GRASSLEY. Yes, Senator Bunning, I remember your submitted language regarding Adult Day Care.

Mr. GRASSLEY

Mr. GRASSLEY. Mr. President, first of all, let me make very clear that we know that Medigap is very important as part of Medicare. We leave that untouched as it relates to 1965 model Medicare. In fact, many of my Iowa constituents want to keep that. But we as a policy matter have made it a very conscious choice to prevent the sale of wraparound Medigap plans for the new Part D drug benefit. This policy makes sense considering drug plans could be different everywhere else in the United States. It is impossible to standardize Medigap policies like we did about 15 years ago so that seniors don't get ripped off. But the Congressional Budget Office tells us this new Medigap plan that is before us now will increase the cost of our bill. The cost of this amendment is $1.5 billion over 10 years, according to the Congressional Budget Office. That is because of the increased utilization that comes from having additional insurance. I share the Senator's concern with gaps in coverage. I wish we didn't have any. But we believe participating drug plans--especially drug plans delivered by PPOs--will offer benefits in a comprehensive fashion, lessening the need for expensive supplemental policies. I urge my colleagues to reject this amendment.

Mr. GRASSLEY. I move to reconsider the vote.

Mr. GRASSLEY

Mr. GRASSLEY. Mr. President, I send a modification to Senator Lincoln's amendment No. 1067 on kidney disease to the desk and ask unanimous consent that it be modified.

Mr. GRASSLEY. Mr. President, I send a modification of Senator Mikulski's amendment to the desk on municipal health services and ask unanimous consent that it be modified.

Mr. GRASSLEY. Mr. President, I ask unanimous consent that we delay the vote so I can do some amendments that have been agreed to--a bipartisan list of amendments--to get them out of the way at this time.

Mr. GRASSLEY. Mr. President, I rise in opposition to this amendment. In S. 1, beneficiaries who are enrolled in both Medicaid and Medicare will continue to receive the generous drug coverage that they currently know through the Medicaid program. Some of my colleagues have argued that by having dual eligibles remain in the Medicaid program, Congress is treating these vulnerable seniors as second-class citizens and subjecting them to a lower quality benefit. This is not the case. In fact, this letter from the Long Term Care Pharmacy Alliance applauds S. 1 for keeping the duals in Medicaid. Specifically, the letter states, ``This approach will preserve the time-tested safeguards designed to prevent medication errors and ensure quality care for the majority of these beneficiaries in the institutional setting.'' The policy decision to cover the drug cost for dual eligibles in Medicaid was not made in vacuum. These vulnerable citizens deserve the best benefit available, which is the benefit provided through Medicaid. I also remind my colleagues that the intent of this legislation is to expand prescription drug coverage to our senior citizens who do not have access to prescription drugs or who are faced with paying a large share of their income for their drug coverage. This does not describe the current coverage experienced by those who are dually eligible. These seniors currently have a drug benefit through the Medicaid program. In fact, many advocates and beneficiaries describe and know this benefit to be very generous. Medicaid was created to assist individuals who do not have the means to pay for their share of health care costs. That is a responsibility shared between the Federal Government and the States. Medicaid pays for many benefits that Medicare does not. We all know that the purpose of S. 1 is to provide prescription drugs to seniors that do not currently have access to drugs or are paying extremely high drug costs. However, recognizing the costs associated with covering the cost of providing prescription drug coverage to the dual eligible population, S. 1 does provide nearly 18 billion in new Federal dollars to compensate States for some of these costs. This is because S. 1 provides minimum standards that ensure that every aspect of the benefit provided through Medicaid is the same high quality that is provided through part D of the Medicare program. I remind my colleagues that adoption of this amendment will not expand coverage at all; it will simply shift the cost to the Federal Government and in time to the other Medicare beneficiaries. In closing, I remind my colleagues that S. 1 helps to deliver care that is consistent with current law and is familiar to vulnerable beneficiaries. I urge my colleagues to defeat this amendment. I ask unanimous consent to print the letter to which I referred in the Record.

Mr. GRASSLEY. Yes, $12 billion is a lot of money; $6 billion of that $12 billion he wants to take away from this provision, this bipartisan provision, that would be used for things he stands for. He has been talking about chronic disease management. He has been talking about managing to a better extent people with chronic diseases. We have put $6 billion into demonstration projects like that to save the taxpayers' money. Why? Because 5 percent of the seniors cause 50 percent of the costs to Medicare. That is why those demonstration projects are very important. That is why I hope you will vote against this amendment.

Mr. GRASSLEY

Mr. GRASSLEY. Mr. President, I understand the concerns of the Senators from Oregon, and look forward to working with them to reauthorize the TANF program in the coming months. I appreciate their concern for the need for Oregon to retain flexibility in TANF. I hope the Senator from Montana will agree that the Finance Committee, on both sides of the aisle, should discuss this issue as we move to reauthorize the TANF program.

Mr. GRASSLEY

Mr. GRASSLEY. Madam President, I suggest the absence of a quorum.