Chuck Grassley

Mr. GRASSLEY

Mr. GRASSLEY. I agree. repeal of therapy caps

Mr. GRASSLEY. Mr. President, parliamentary inquiry. Are we now ready for third reading?

Mr. GRASSLEY. Mr. President, I ask unanimous consent that following passage of S. 1, the bill be held at the desk; further, when the Senate receives from the House the companion measure to S. 1 the Senate proceed to its consideration, all after the enacting clause be stricken, and the text of S. 1 as passed be inserted in lieu thereof; the bill then be read a third time and passed with the motion to reconsider laid upon the table; further, that the Senate then insist on its amendments and request a conference with the House, and the Chair be authorized to appoint conferees with a ratio of 5 to 4; finally, with that action, I ask unanimous consent that passage of S. 1 be vitiated and the bill be placed back on the calendar.

Mr. GRASSLEY. Mr. President, we are about to take a historical vote. Since 1965, Medicare hasn't covered prescription drugs. Now, 38 years later, we're changing that--on a strong bipartisan basis. Because of this bill, on January 1, 2004, seniors across America will have immediate help with prescription drug costs. Moreover, on January 1, 2006, seniors will have access to affordable, comprehensive drug coverage as a permanent part of Medicare. No longer will seniors have to make hard choices when it comes to paying for prescription drugs. This bill also strengthens and improves Medicare, giving seniors more choices and better benefits than they have today. At the same time, it brings long overdue Medicare equity to the people of Iowa and to other rural States. We are on the verge of a major victory. I urge my colleagues to support S. 1.

Mr. GRASSLEY. Yes, this is true, and I apologize for the inaccurate information and misunderstanding provided to you and your staff from the Finance Committee on this issue. The language included in the base bill instead is based on Senator Santorum's bill.

Mr. GRASSLEY. Mr. President, I move to reconsider the vote.

Mr. GRASSLEY

Mr. GRASSLEY. Mr. President, I ask unanimous consent that the pending amendments be temporarily set aside and that the following amendments be called up en bloc: No. 1014, by Senator Bond, study of pharmacy services; No. 1015, by Senator Dodd, study of blind and disabled; No. 1059, by Senator Hatch, HHS review; No. 1106, by Senator Hatch, citizens councils; No. 1086, by Senator Murkowski, pharmacy access; No. 1067, by Senator Lincoln, kidney disease; No. 1033, by Senator Mikulski, municipal health services; No. 935, by Senator Lincoln, geriatric GME; No. 959, by Senator Lincoln, physical therapy demo; No. 1038, by Senator Jeffords, critical access hospital; No. 1095, by Senator Johnson, therapy management. I further ask unanimous consent that these amendments be agreed to en bloc and the motion to reconsider be laid upon the table en bloc.

Mr. GRASSLEY

Mr. GRASSLEY. I withdraw the reservation.

Mr. GRASSLEY. Madam President, I move to reconsider the vote.

Mr. GRASSLEY. Mr. President, I yield myself such time as I might consume to address the issue of the amendment by the Senator from North Dakota and his attempt to take money from the $12 billion that is the bipartisan compromise that is a major compromise on this amendment between Republicans and Democrats. The $12 billion is being divided: $6 billion to make the marketplace provider organizations more competitive, to save money, and to get people into organizations that will manage particularly chronic disease; and the other $6 billion to go for Medicare demonstration projects to do the same, have about the same result, to have chronic disease management. The reason for this compromise is both approaches deal with the issue that 5 percent of the sick people under Medicare are responsible for about 50 percent or 55 percent of the cost of Medicare. It is a small segment of people. If we were in business and we found 5 percent of our employees, or a certain problem we had with our business that was just 5 percent of it, but it was 50 percent of the cost of our business, we would hone in on that problem with the particular business. The Federal Government is in the business of providing health care for our seniors. If we have 5 percent of our senior population who, for various reasons, are the cause of 50 percent of the costs of Medicare, then quite obviously we ought to concentrate on that 5 percent. We have plans to do that. This is how we use this $12 billion, and we do it in a bipartisan way. Honestly, the Senator from North Dakota is very open about it; he has a better idea how to use that money. He would take it to lower the monthly premium paid by beneficiaries in the new Part D prescription drug program. I have at least two problems with that. First of all, the Congressional Budget Office's rule of thumb is that it costs around $5 billion to lower the estimated $35-a-month premium by just $1. You spend $5 billion and reduce the monthly premium from $35 down to $34. So if you take the $12 billion that is available in the Grassley-Baucus amendment and use that to lower the premium for the people he wants to lower the premium for, instead of paying $35 a month they will be paying $32.50 a month. My colleagues have to weigh that against the use of this money where we want to focus in on fee for service as well as the new Medicare Program, zeroing in on trying to save Medicare money by managing the chronic disease situations of the 5 percent of the most sick people under Medicare. So the underlying Grassley-Baucus amendment, I remind my colleagues, authorizes the Secretary to establish a number of projects in fee-for- service Medicare Programs that would provide these enhanced services and benefits for beneficiaries. These enhanced services or benefits include preventive services, chronic care coordination, and disease management services. These are very worthwhile projects and have the potential to help many beneficiaries get better care and considerably reduce the cost in the Medicare Program. I don't know how many Members on the other side of the aisle have worked with this issue we are trying to put $6 billion toward, chronic disease management. A lot of people who have the same political philosophy as the Senator from North Dakota are very concerned about doing that. We are concerned on this side about doing it as well. That is why it is a bipartisan piece of legislation. I don't know how, in good conscience, the Senator from North Dakota can take money that would reduce a monthly premium by $2.50, still costing $32.50, away from chronic disease management and a lot of other things that people on his side of the aisle are very concerned about. It would not be possible to do these projects that we have in the underlying amendment. It seems to me that the Grassley-Baucus amendment with this bipartisan compromise of $6 billion enhanced membership in PPOs as well as $6 billion for chronic disease management in the older fee-for-service Medicare Program is preferable to the second-degree amendment offered by the Senator from North Dakota. I urge my colleagues to not support the amendment by the Senator from North Dakota. This is the second or third time I have heard that seniors have voted on whether they like fee for service or Medicare+Choice, the argument being 89 percent of the people in this country are in fee for service. Eleven are in managed care, Medicare+Choice, HMO, whatever you want to call it. That is true for the Nation as a whole. But remember that in the vast geographical part of America HMOs are not available. In the State of Iowa, only 1 county out of 99 has an HMO for our seniors to join. We have 4,000 Iowans in Medicare+Choice. No place else in Iowa can my citizens get it. The Des Moines Register is always editorializing why more of Iowa cannot have Medicare+Choice so the seniors of our country have that opportunity. But what is unfair about the 89 percent versus the 11 percent, and Senators making statements that it is so overwhelming that seniors do not like Medicare+Choice, is the fact that if more had that choice more would take it. I use, as a basis for my statement, that in the larger cities of America a much higher percentage of seniors have decided to join Medicare+Choice. They do it voluntarily. They can go in one year and get out the next, if they don't like it. They have voted by a much higher percentage in favor of Medicare+Choice. They like it because they get more for their money. First, they do not have to pay Medigap insurance. Second, they might get things such as eye glasses and a better deal on prescription drugs than people who are in traditional Medicare fee for service. Where they have had a chance to have that option, a much higher percentage of seniors than 11 percent will join. All you have to do is talk to people in my State who go to Arizona, California, and Florida for maybe the winter and find out about what people in those States have when they join Medicare+Choice. They ask, Why can't we have that in more places in the country? A couple of speakers on the other side of the aisle have talked about wasting money with Medicare+Choice. I think you ought to ask the seniors who join and who like it. That is a much higher percentage than 11 percent in a lot of the cities. It is not a fair comparison to imply that since only 11 percent of the people in the country have it and because such a high percentage can't get it that Medicare+Choice is not desired by seniors of America. Our underlying legislation, the Grassley-Baucus bill, is going to make that opportunity more available for people down the road as we bring in new options. What we want to do in the underlying bill is give our seniors the right to choose. Not enough of them have a right to choose. They have a right to choose prescription drugs. They don't want to join for prescription drugs if they don't have to. They have a right to choose between traditional Medicare. If seniors say they are satisfied with what they have, I can say to those seniors that they can keep what they have. It is their choice. But it you want to go over here and join something that has more options, you will have that right to choose. You should have that right to choose. One of the complaints people made about the President's program was that if you were going to get prescription drugs you had to go over to a new type of Medicare. In traditional Medicare, you could not get prescription drugs--or at least not much of a program; at least not equal to what you could get over here in the new program. That is where Senator Baucus and I disagree with the President of the United States. We believe in equal benefits. If you want prescription drugs, if you want to join it voluntarily, and if you want to stay in traditional Medicare fee for service, you can have prescription drugs. If you want to go over here and choose a new form and have prescription drugs with it, that is your choice. The right to choose and fairness and equality and no pressure is the basis for this bipartisan Grassley-Baucus legislation. That is the basis for the compromise amendment that is before us which the Senator from North Dakota wants to detract from and use the money someplace else. I think we need to keep this balanced approach. We need to keep the fairness, the equality, and no pressure and the right to choose. Seniors should have options just as other people have. I yield the floor.

Mr. GRASSLEY. I move to lay that motion on the table. The motion to lay on the table was agreed to. Amendment No. 1052

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

Mr. GRASSLEY. Madam President, I send to the desk a modification of the Grassley benchmark amendment filed last night. I ask that I have a right to modify my amendment.

Mr. GRASSLEY. Madam President, I ask that the pending amendments be set aside and that the Senator from Washington be recognized for an amendment.

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

Mr. GRASSLEY. I ask unanimous consent to proceed as in morning business.

Mr. GRASSLEY. Reserving the right to object, have we seen this? We do not seem to know about this.

Mr. GRASSLEY. Reserving the right to object, we do not know about the modification--or do we? We do not seem to.

Mr. GRASSLEY

Mr. GRASSLEY. Mr. President, I ask unanimous consent that the Senate proceed to the immediate consideration of Calendar No. 166, S. 312.

Mr. GRASSLEY. Mr. President, I ask unanimous consent that the managers' amendment be agreed to; that the bill, as amended, be read a third time and passed; that the motion to reconsider be laid upon the table; and that any statements relating to the bill be printed in the Record.

Mr. GRASSLEY

Mr. GRASSLEY. Mr. President, I send an amendment to the desk for myself and Senator Baucus and ask for its immediate consideration.

Mr. GRASSLEY. And the Senator from Pennsylvania on our side.

Mr. GRASSLEY. Yes.

Mr. GRASSLEY. Let me say to the Senator from Pennsylvania, this is just for the purpose of a unanimous consent request. Then I will yield the floor. Madam President, I ask unanimous consent that at 6:30 the Senate proceed to a vote in relation to Durbin amendment No. 994, to be followed by a vote in relation to the Clinton amendment No. 1000, with no second-degree amendments in order to the amendments prior to the votes, and with 2 minutes equally divided for debate prior to each vote after the first; further, that following those votes, the Senator from Iowa--me--be recognized to offer an amendment.

Mr. GRASSLEY

Mr. GRASSLEY. Madam President, I have to ask my colleagues to vote against this amendment because it costs $200 billion. We are working within a $400 billion package. I wish we could eliminate the gap, as well. What we are trying to do is help the most people who have the most need with the money we have. Most seniors will not be affected by the gap in coverage. Most seniors will not have drug spending in a year that exceeds the benefit limit. According to the CBO, about 88 percent of the seniors will not even have prescription drug spending that exceeds the $4,500 limit. The Senator from Florida calls the benefit limit a ``sick tax'' because he believes that seniors should not pay a premium for coverage for catastrophic costs. This is as if to say you should not pay for fire insurance if your house is not going to be on fire. Of course, that is not how insurance works. People purchase insurance to protect them against an unfortunate accident.