Ted Kennedy

Mr. KENNEDY

Mr. KENNEDY. Will the Senator yield on my time?

Mr. KENNEDY. You included the assets test. And it is just as I identified it.

Mr. KENNEDY. I will go back. You yielded the time. I will go back. And I hope you have read your book because----

Mr. KENNEDY. What about personal property?

Mr. KENNEDY. Excuse me, Senator. Excuse me, Senator. For money over the $4,500--up to $4,000--the value of the car and above that, it works to disqualify them from the coverage.

Mr. KENNEDY. We are not talking about taking the car from them. We are talking about disqualifying them for all of the funds over $4,500.

Mr. KENNEDY. He does not choose to yield--on my time--to explain it?

Mr. KENNEDY. Will the Senator yield on that point?

Mr. KENNEDY. According to the CBO--this isn't our estimate; it is a CBO estimate--3.5 million seniors who are getting decent drug coverage through employers will be dropped from the list. They wonder why the senior groups are not in support of this. This is an enormously important debate and discussion that we will have. We will have an opportunity to have an expression on the proposal. As Senator Graham and Senator Miller have pointed out, we have what is called the first-dollar coverage. We do not have the doughnut, the loophole, that exists there. It will be within the ability of our seniors. It will be dependable. It will be affordable. It will be reliable. And it will be built upon existing programs, programs which have the confidence of our seniors and on which they can rely. It will be a very effective program. It will meet the kind of human needs that we believe our seniors need and deserve. I reserve the remainder of our time.

Mr. KENNEDY. We have 90 minutes. I thank the Chair. Mr. President, tomorrow in the early afternoon the Senate will have an opportunity to vote on which vision is the best vision for our seniors and for others who need prescription drugs. This will be the first opportunity we have had in the Senate to take that vote. The absence of a prescription drug benefit from the Medicare Program is a glaring failure of the Medicare Program that every family understands in America today. It is not the fact that we have not had prescription drug programs that have been advanced to the Senate--we have. But they have been kept bottled up in the committees over the period of recent years. I introduced, more than 5 years ago, prescription drug coverage into the committee. It was referred to the Committee on Finance, and it never saw the light of day. We heard last week, and have heard now that somehow the majority leader has circumvented the Finance Committee and now we have the legislation out here. I applaud his efforts. So should all seniors applaud those efforts. We hear now the committee was prepared to move-- but we waited and waited. Our friends on the other side of the aisle had control of the Senate for 4 of the last 5 years. They controlled the Finance Committee for 4 of the last 5 years, and we never had an opportunity to have a debate on the issue of prescription drugs. Now we do. Now we will have a vote. I think it is important for the American people to understand that we have been denied that opportunity for the past 5 years. Now we will have that opportunity. It is a tribute to leadership of Senator Daschle, who understands the importance of this issue to families in this country. We are enormously grateful to him for his leadership, and we are extremely hopeful that we will have a strong vote tomorrow that will reflect what is in the best interests of our seniors. I was here in 1965 when we actually passed Medicare. We passed physicians' services and hospitalization but not prescription drugs. Now we all know that if the Medicare Program had been considered on the floor of the U.S. Senate, we would have included prescription drugs. It is as important as physicians' services and hospitalization. It is perhaps even more important in a number of different instances. The fact remains that this is going to become even more important because we are now in the life sciences century. We are going to see extraordinary breakthroughs. We now see the mapping of the human genome and progress in so many important areas of research. It is virtually unlimited in what we will be able to achieve over a period of years. It should be important to find ways of taking the progress being made in the labs and getting it to the patients who need it. They need it today. And we have a program that will do it. I have listened with interest to those who support the Republican proposal, as they outlined at least what they consider to be the advantages of the Republic proposal and the disadvantages of our proposal. I hope in the 50 minutes they have remaining today or in the time prior to the vote tomorrow they will cite at least one, two, three, or four senior citizen groups that support their program. Because there are not any. Do we understand that? There are not any. The senior citizen groups that know the importance of prescription drugs have gone through these various programs in careful detail for those they are representing. And do you know what? They endorse the Graham-Miller proposal. They are behind the Graham-Miller proposal. They support it completely and wholeheartedly. They appreciate the fact that our Republican friends over here are at least giving lip service to a prescription drug program. But if we are talking about which particular version is best for senior citizens, there is no competition. There is no question about it. You never heard in the earlier claims this afternoon the senior citizen groups that support their program because they are not there. This is one of the key reasons this is so important, and--I am hopeful--what this tomorrow vote is about. I listened to my friend and colleague from Utah talk about premiums. On page 26 of the Graham-Miller proposal, our premium is listed at $24; for 2005, $25. I searched all weekend to find out where the $24 premium was in their bill that they have been talking about for the past few days. You can't find it in there. It is an estimate. Ours is printed right here. Every senior citizen knows what that premium is going to be. Theirs is an estimate. They all say: We have one that is $24--lower than the Miller program. But that is an estimate of what they are going to charge the insurance companies over a period of time. That is the difference. I want to take just a few minutes to review with our colleagues what this program does not do and why the seniors have been so distressed about their program. Actually, between 2005 and 2012 the seniors in this country are going to spend $1.6 trillion on prescription drugs. Their program is $330 or $340 billion. It is a lot of money. But if you figure that out, that is only about 20 cents on the dollar. They are trying to say they are really going to be able to do something for the seniors. It just doesn't measure up. I want to take a few moments of the Senate's time to go through the facts of the program itself. This chart over here is the Republican program, and this line is the percent of seniors. The next line is the drug costs; beneficiary payments; Medicare benefits; and then the percent of costs paid by the senior citizen. That is what we are concerned about. The fact is, to address the extraordinary escalation of the costs of prescription drugs, we have an underlying proposal which will create momentum to get a handle on that escalation of prescription drugs--the excellent proposal introduced by our colleagues, Senators Schumer and McCain. It was reported out of our committee with bipartisan support, which we welcome. But 18 percent of seniors spend $250; the beneficiary payments will be $538. That is what they are going to pay in terms of their premium and their deductible in order to sign up for this program. For 18 percent of our senior citizens, they turn out to be losers, because 100 percent is going to be paid by senior citizens. We take what the premiums are going to be, estimated by the Republicans, and also add the deductibles and the copays. You have another 18 percent that spend $1,000. Again, you add up the premium, deductibles, and copays. It will be $913 and beneficiary payments of $87. The senior citizen, 91 percent--some help and assistance. Together, 36 percent of all the seniors, and one part of them, are going to pay 100 percent. They are not going to get any help, and the other group will pay 91 percent of the cost. You come down here to the $2,000. This is where you really begin to get some help. The seniors are still going to spend 71 percent. If you come into the $3,000 to $4,000 range, 23 percent, they are going to be spending 67 percent. Finally, 7 percent at the very high end. They will still be paying 74 percent. These are the figures that are the expression of the program advanced by the Republicans. If you are a senior citizen and are hard-pressed today, you will find that your help and assistance in this program is a lot of rhetoric and very little action. That is what the result will be. This is why, perhaps more than any other reason, seniors do not support the Republican proposal. And there are features in the Republican proposal that we find absolutely extraordinary. I have heard a great deal from those on the Republican side talking about how this is going to help really the poorest of the poor of the seniors. We know the extraordinary average income is maybe $14,000. You can mention the handful of people who we read about who are billionaires. But the fact is, when you are talking about a group of our fellow citizens, the people who fought in the wars and brought us through the Depression, you are talking about this group here-- basically, about $14,000 in income. What is really in the Republican program are assets tests for the very, very poor. We heard from the other side, well, if they really fall down to 135 percent of poverty, they are going to have their premiums taken care of, and they won't have to worry about anything else. Right? Wrong. Wrong. Wrong. They will get them taken care of, if they don't have anything more than $4,000 in savings because we have an assets test, a pauperization test, for our seniors. If they have more than $2,000 in furniture and personal property-- maybe a wedding ring, an heirloom, something that has been passed on-- if it is worth more than $2,000, they are in real trouble. If they have burial assets of more than $1,500, it counts against them, and if they have a car worth more than $4,500. What do we have for $4,500 for our seniors in our part of the world, the Northeast, where it is cold in the wintertime; or how about in other parts of the country, where it is steaming hot in the summertime? Do we want them to risk their car breaking down, as they are trying to get their prescription drugs? Go down to most of the car lots and find out what you can get for $4,500 and how dependable that car would be, whether you would want your mother or grandmother riding around in it in the cold of the winter or the heat of the summer, wondering if they can get to their destination. If there are any more of those values, it adds up. And when it hits $4,000, they are excluded from the program. Think of the demeaning aspects of this for our senior citizens, who are part of the greatest generation, who fought in World War II and lifted this country out of the Depression. They are in their golden years and have a few bucks--not very many--and they have to go down and fill out that form in order to qualify. It seems to me that is such a demeaning requirement. I am surprised. I am surprised that our Republican friends have included that--saving the few bucks that it would--in their particular program. I am deeply surprised. Our seniors deserve much better treatment. There are ways of making an evaluation as to what the assets are. No one is talking about trimming on this. We do not want people to trim--and they should not trim--but there are better ways of doing it than this particular way. Finally, because of the time, I will mention one other feature that I am very perplexed about. I do not understand why they developed this kind of program. Their program is going to effectively take 3.5 million senior citizens who are now receiving a good drug program through their employers and drop them back to this program, which will provide a lesser benefit than they are now receiving, by and large, from their employers. This aspect of their program is very different from the Graham-Miller which would help and assist the small businesses and the medium-sized businesses continue to fund a good program. I yield myself 3 more minutes.

Mr. KENNEDY. Mr. President, how much time--how much time remains between now and 6 o'clock?

Mr. KENNEDY. I yield myself 15 minutes.

Mr. KENNEDY. Both times? I had 22 minutes.

Mr. KENNEDY. We had additional time.

Mr. KENNEDY. I thank my friend and colleague from Maine. Mr. President, I ask that she be entitled to whatever additional time she needs.

Mr. KENNEDY. That is why we have such strong support from seniors and why it is justified.

Mr. KENNEDY. I thank the Senator. That is why I agree with the Senator.

Mr. KENNEDY. Just so we understand this, on page 37 of the tripartisan bill, in the formulary determinations, they say: An individual who is enrolled in a Medicare Prescription Drug plan offered by an eligible entity may appeal to obtain coverage for a covered drug that is not on a formulary of the eligible entity if the prescribing physician determines that the formulary drug for treatment of the same condition is not as effective for the individual or has adverse effects for the individual. But there is no price limit on this, as I understand it. There is no price mentioned in here, in contrast to the Senator's provisions that have been included in his legislation. His legislation provides what is medically necessary and then goes on to indicate what the costs will be, to ensure that they are reasonable. In the other bill, seniors may have the ability to get what is medically necessary, but there is no indication about what the cost would be, as I understand it.

Mr. KENNEDY. So they have no idea today. It will be left up to the insurance companies. They will make that decision. This is an estimate--and a favorable estimate--that they are making on this side; whereas under the Graham proposal, it is explicit. I would like to move on to another area that was talked about by the Senator from Mississippi and others regarding the formulary issue. Let me see if I understand what is in the Graham proposal. In the Graham proposal, it says that all generics included in the therapeutic class must be on the formulary, and at least one brand-name drug but no more than two in the therapeutic class must be in the formulary. It is designed, obviously, to obtain the deepest discounts. That is obvious. But if you need a drug that is not in the therapeutic class, you can still get it at a formulary price, as I read on page 29 of the Graham bill. I thought the Senator from Mississippi missed this element. It says: The eligible entity shall treat a nonformulary drug as a preferred brand-name drug, if such nonformulary drug is determined to be medically necessary. The cost of that drug would then be $40. If it is medically necessary under the Graham proposal, seniors will be able to get it. This is what was missing from the debate and discussion with our friend from Mississippi earlier.

Mr. KENNEDY. I couldn't agree with the Senator more. Let me get to the issue of cost of the program. I have listened with great interest to the debate from the other side about their $24 monthly premium. Yet, I have great difficulty in reviewing their proposal and finding where that $24 is even mentioned. Of course, it is not mentioned, because it is an estimate, as they indicated. But the premium is written right into the law on page 26 of the Senator's bill. Then on page 28, the cost of generics, $10, is listed and then the cost for the preferred, $40, is listed. It is written right into that bill. Has the Senator, in his examination of the alternative, seen any statement or indication of that kind of precision reflected in the Republican bill?

Mr. KENNEDY

Mr. KENNEDY. Mr. President, today the Senate considers long-needed legislation to address the worsening crisis in nursing care across the country. We all know the importance of nurses in delivering good health care. A nurse is often the first person that patients see after waking in the morning and the last person they see at night. Nurses are the backbone of an effective health care system--yet the nation now faces a crisis in nursing due to the shortages of trained nurses. The Nurse Reinvestment Act we are considering today takes significant steps to address the shortage by improving nurse training, reducing the barriers to a nursing education through loan repayment programs and scholarships, and improving working conditions. The bill we consider today owes much to the skill and dedication of many of our colleagues on both sides of the aisle and on both sides of the Capitol. The legislation contains major provisions to improve nurse training sponsored by our colleague from Maryland, Senator Mikulski, who has been tireless in her support for nurses. Her energy and skill were indispensable in the Senate's approval of this important legislation earlier this year. She is a champion for nurses, and this bill is a fitting tribute to her dedication. The legislation we consider today also owes a great deal to the commitment of our colleagues, Senator Kerry and Senator Jeffords. In the legislation they introduced in the Senate last year, they outlined a vision for a National Nurse Service Corps to serve in areas with a nursing shortage. This proposal is part of the legislation we are considering today. The provisions on the National Nurse Service Corps will provide scholarships and loan repayment agreements for nursing students who agree to practice nursing in areas with a critical shortage of nurses. This corps of nurses can be effective in easing the most critical shortages that exist in so many communities. The challenge we face is clear. It is becoming increasingly difficult for hospitals and other health facilities to obtain the nurses they need to properly care for patients. Today, about 125,000 nurse positions remain vacant. This shortage will become more severe in the years ahead as nurses reach retirement and as the demand for nursing care increases because of the nation's aging population. A major part of the problem is that nurses often leave the practice of nursing because of poor working conditions. Senator Clinton has sponsored important provisions in the bill to improve working conditions for nurses and improve the retention of trained nurses. Her proposals will provide effective incentives for hospitals to involve nurses in clinical decision-making and to improve communication among nurses and other health professionals. A clear example of the benefits of these programs is shown by the success of hospitals designated as ``magnets'' for quality nurses. These leading institutions provide higher quality patient care because they are successful in retaining trained nurses. The source of their success is very clear--they value the professional role of nurses in patient care. I also commend the distinguished ranking member of our committee, Senator Gregg, and the distinguished ranking member of our subcommittee, Senator Frist, as well as many other members of our committee for their contributions to this legislation. This legislation will also attract more students to the practice of nursing through public service announcements, advertisements and outreach programs to demonstrate the value of a career in nursing to young persons in all parts of the country. Nurses have an indispensable role in our health care system. They are the ones who provide much of the direct care to patients and monitor how patients are recovering. Studies confirm that nursing care is critical to improving patient outcomes, and that a shortage of nurses can hurt patient care. We cannot have a quality health care system without quality care by nurses. The legislation the Senate considers today will alleviate the severe shortage the nation faces in trained nurses. It will improve the quality of care for millions of patients in communities throughout the Nation. I thank my colleagues for their dedication to this important issue, and I urge the Senate to approve this needed legislation.

Mr. KENNEDY

Mr. KENNEDY. I think, for the benefit of the Members, the time for the vote will be at 5:40.

Mr. KENNEDY. Madam President, what is the order now? We were allocated time to different individuals, and then at the conclusion of that we were going to recognize the Senator from Michigan to make final comments. I think Senator Gregg is here.

Mr. KENNEDY. That was my understanding as well. I think the Senator was recognized for 5 minutes and then when they extended the time of the Senator from Michigan, I think they extended the time of the Senator from New Hampshire as well. I would ask that he be accorded the 12 minutes.

Mr. KENNEDY

Mr. KENNEDY. Mr. President, I ask unanimous consent to have printed in the Record this letter to Mr. Carl Feldbaum of the Biotechnology Industry Organization.