Patty Murray

Mrs. MURRAY

Mrs. MURRAY. Mr. President, I talked about this amendment earlier today. It provides stopgap coverage for low-income seniors and disabled individuals who may lose their benefits or suffer a gap in coverage due to the implementation of the Medicare Part D prescription drug benefit. I ask unanimous consent that the amendment be set aside and we come back to the amendment to discuss it.

Mrs. MURRAY. Mr. President, I call up amendment No. 2220 and ask for its immediate consideration.

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

Mrs. MURRAY. Mr. President, I ask unanimous consent that amendment No. 2285 be called up and I ask for its immediate consideration.

Mrs. MURRAY. Mr. President, I ask unanimous consent that the pending amendment be set aside.

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 President, I ask unanimous consent that the order for the quorum call be rescinded.

Mrs. MURRAY

Mrs. MURRAY. Mr. President, I am here this morning to talk about a dangerous flaw in the Medicare prescription drug program that is about to take effect. This flaw is a ticking time bomb for more than 6 million Americans, for our communities and our health care providers. That fuse is going to detonate on January 1. We cannot allow low-income seniors and the disabled to lose their direct coverage. We cannot leave our doctors and hospitals and nursing homes unprepared for the biggest change in decades. And we should not be pushing hundreds of thousands of people who need care onto our local communities. We can't wait. We have to fix this problem today. That is why I will be offering an amendment later this morning. I have been working with Senators Rockefeller and Bingaman to address the immediate crisis. I thank them for their leadership. I have also introduced my own bill to protect our most vulnerable. It is the Medicare HEALS Act, S. 1822. I have been traveling around my State. I have been meeting with people in Seattle, Lakewood, Yakima, Aberdeen, and Olympia. I want my colleagues to know, everywhere I go, people are angry and confused. And they are very worried, with good reason. One senior told me: Everyone I have talked to is totally confused--my doctor, my pharmacist, even the Medicare number you are supposed to call. Another one said: If we can't understand this, this whole [Medicare] plan is going to fail. Everywhere I went, people were confused. There were questions that I couldn't answer. When I turned to the doctors sitting next to me, they didn't know the answer. And neither did the pharmacists or the patient advocates. If Senators and doctors and experts do not understand this, how can we expect an 80-year-old person with serious medical problems to understand this complicated new program? We can't. So we need more time and more resources to make this prescription drug plan work. One person I met with said: Please give us more time. Give us the chance to understand this so we don't make a mistake when we sign up. One panelist told me: Taking away something from those that need it the most . . . is not the American way. I couldn't agree more. That is why I am here this morning to talk about this, and that is why I will be offering an amendment shortly after we go to the bill. I have many concerns with the Medicare prescription drug law. I voted against it in 2003 because I believed that seniors deserve better and that America can do better than that. I am concerned about the complexity, the coverage gap, whether needed drugs will be covered. I am concerned about retirees losing the good coverage they have today. And I am concerned about the late enrollment penalty that is going to punish seniors who need more time to pick the right plan. I am working with many other Senators to address all of those concerns. But today the most urgent problem is the way the new law treats our most vulnerable people, people with low incomes, the disabled, and those facing serious medical challenges like AIDS. This law takes away the critical drug coverage these people have today and puts them into a new program that could charge them more money in exchange for less drug coverage. If they don't sign up for a plan, they are randomly assigned one. Either way, the prescriptions they need may not be covered. Because these Americans are living on the financial brink, an interruption of their drug coverage or a new copayment could keep them from getting the drugs they need to live on. The people who are being affected don't know what is going to happen. The doctors and pharmacists, they don't understand it either. This entire mess is going to burst into the open on January 1. We need to take action to prevent this catastrophe now because it is only a few months away. To understand this problem, let's look at how our most vulnerable get their prescription drugs today and how that is about to change. Today, about 6.4 million Americans with low incomes get help from two programs: Medicare at the Federal level and Medicaid at the State level. These individuals are sometimes what we call dual eligibles because they are eligible for assistance from both Medicare and Medicaid. What Medicare does not cover, the States usually cover. For example, the Federal program did not cover prescription drugs. The State programs filled in that gap. The State coverage is often called wraparound coverage, and it is critical for our most vulnerable families. As a result, these individuals get the drugs they need, often without copayments or deductibles. But there is a big problem coming January 1. The new drug program prohibits States from providing the extra help they do provide today. Instead, what it does is move these people into the Medicare program alone, which will require higher out-of-pocket payments and which will most likely cover fewer drugs. To me, it doesn't make sense to take away the good coverage that vulnerable families have today, force them into a program that might not meet their needs, charge them more money in the process, and then prohibit our States from helping out these most vulnerable people. It doesn't make sense, but that is exactly what this new drug program will do unless we fix it before January 1. In fact, the new Medicare prescription drug program changes the coverage of our most vulnerable in five ways: It imposes higher costs-- those are premiums, copays and deductibles; it covers fewer drugs; it blocks States from providing extra help as they do today; it provides no transition period to ensure that these low-income residents don't face these gaps in coverage; and it penalizes people who need more time to pick the right plan for them. These are real people we are talking about. I want to introduce two of them. Earlier this month in Seattle, I met a woman named Kathryn Cole. She is 36 years old. She is disabled, and she is living on Social Security disability. She fills about 15 prescriptions each month, and her monthly income is $757. She told me: Even if the copay were only $5, that adds up to $75 a month. I don't have the kind of extra money to squeeze out of my budget. Kathryn asked me: Which week am I supposed to not eat? People like Kathryn are living on the financial edge. They cannot afford to pay more for their medication. They need our help. In Olympia, WA, I met a man named William Havens. He is 50 years old, living with HIV/AIDS. He takes 43 pills a day. William told me: For the first time [in my life], I realize I'm going to have to make a choice between pills and food. It is outrageous that this new law is going to make life so much harder for people like Kathryn and William. In addition to hurting people, the new drug program is going to hurt our health care system. It is going to have a costly impact on nursing homes, doctors, pharmacists, and hospitals. Many of these dual-eligible individuals live in nursing homes. Now nursing homes are going to have to navigate all these new plans out there. In my State of Washington, there are at least 14 of these new plans. Some States have as many as 40 or more, all with different costs and different formularies. Nursing home managers are going to have to see which plan each resident has been assigned to and if their needed drugs are covered. In Olympia, I met with a Dr. David Fairbrook. He is in private practice, and he is also the medical director of two skilled nursing facilities which care for 150 people. He was very concerned about his patients being randomly assigned to plans that don't meet their medical needs. He said patients may be denied drugs. They may be forced to change their medications, and they could face a time-consuming, stressful appeals process. He predicts there will be ``chaos for nursing staff regarding coordination of multiple suppliers. It further duplicates paperwork and documentation requirements.'' That is a tremendous new administrative burden for understaffed and underfunded nursing homes and care providers who care for people we know--our parents, grandparents, sisters, and brothers. That is who is going to be affected by this new law if we don't take action. Unless we act, the new program is going to make the work of our pharmacists across the country much harder. They are literally going to be on the front lines. They may well be forced to deny coverage to seniors. And by the way, each one of these pharmacists has to go in contract with each of these new drug plans in their States. Now CMS is telling us that pharmacists will be able to look up and see what plan someone has been assigned to. But frankly, I have to say, given the error and the mistakes CMS has made so far, I don't have a lot of confidence that this is going to be a flawless situation in transition. Remember, the people who will be hurt have no financial cushion. They are living on fixed incomes and they don't have an extra $20 or $30 for copayments or premiums. If they are turned away at the pharmacy counter, they do not have the money to pay for those drugs now and get reimbursed later when all the paperwork is sorted out. Doctors are going to be on the front line in this, too. Doctors are going to have to know which drugs are on the formulary. They may have to help patients appeal any denials, and they will have to treat patients who have gone without their medicine. One doctor told me, ``Doctors don't have the information they need on this yet. If patients pick the wrong plan and their medicine is not covered, it can have serious medical harm.'' Hospitals are also going to be affected. They are going to have to navigate all of these new plans. They are going to have to deal with patients who haven't been able to get their prescriptions. In fact, for many poor families, the only place to get these medicines will be the emergency room, and that is going to increase the cost of health care for every single one of us. So as you can see, this new drug law is going to impose an expensive and very confusing administrative burden on our doctors, on our pharmacists, on our hospitals, and our nursing homes. In this country I think we can do a lot better than that. The amendment I will be offering today says let's fix this problem before people realize they can't get the prescriptions they need. My amendment simply provides emergency funding to prevent this disaster. First, it ensures that our most vulnerable don't lose their current drug coverage. It will provide $2 billion in emergency funding to make sure our low-income seniors do not lose their benefits or suffer a gap in coverage. That money will allow our States to help the low-income residents they have, people who currently get help from State drug assistance programs, and people being helped by AIDS drug assistance programs. My amendment will protect our most vulnerable, including any beneficiary with income below 150 percent of the Federal poverty level and any beneficiary currently eligible for Medicaid through ``spend down'' requirements. It is going to give our States the flexibility to protect the people who live in those States. States could provide coverage through Medicaid or as a separate drug assistance program. And importantly, my amendment provides accountability. States will be required to notify CMS of their plan for ensuring no lapse in benefits for low-income beneficiaries. Secondly, my amendment ensures that everyone knows about the changes that are coming. It requires States to notify those currently eligible for Medicaid and Medicare assistance. I can't tell you how many people I talked to when I was in my State who said: I have not been notified that I need to make a change. No one has told me. And yet we are 2 months away from them being assigned a plan. States would also notify pharmacists. They would notify community health centers, rural health clinics, hospitals, critical access hospitals, doctors, and other Medicaid-eligible providers that assistance is available. Providers will be allowed to seek reimbursement for any uncompensated costs associated with providing medically necessary drugs to these people. In summary, my amendment simply protects our most vulnerable and makes sure that everyone involved knows what is happening. This new Medicare prescription drug plan that has been passed has a lot of problems, but the most urgent one is what is going to happen to our most vulnerable patients and the difficulty it will cause our health care providers such as hospitals, nursing homes, doctors, and pharmacists. Time is running out. As of January 1, millions of vulnerable Americans are going to be forced into a new system they haven't been told about, they don't understand, and it will not meet their needs. We can avoid this train wreck. Senators who are concerned about the health and well-being of their own constituents but who are concerned about the costs have other options. We can support efforts on the reconciliation to provide additional time to transition into this plan and we can make changes to the Medicare Modernization Act to let the States provide coverage they have available through Medicaid during this transition. No matter what, this is a problem. Either we spend the money now to prevent this crisis, I warn my colleagues, or we are going to have to push back the deadline so we can make this transition smoothly. People's lives are hanging in the balance. I urge my colleagues to stand up today for those who don't have a voice, and for the doctors, hospitals, pharmacists, and nursing homes, and give them the relief and protection my amendment provides. I will be offering this amendment in the Chamber today and I urge my colleagues' support. I thank the Chair. I yield the floor.

Mrs. MURRAY

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

Mrs. MURRAY

Mrs. MURRAY. Mr. President, I rise today in memory of Paul and Sheila Wellstone. It is hard to believe that on this date 3 years ago, the lives of Paul and Sheila Wellstone, and others, were taken in a plane crash in Minnesota. On that day, I lost a good friend, the Senate lost a leader, and the American people lost an advocate who was never afraid to stand up and speak for those who had no voice. Today I honor my friend and colleague, Senator Paul Wellstone, who inspired so many people to speak up and to serve. Even as I stand here today, I cannot imagine that when I turn around I won't see Paul standing at his desk, his arms flailing in the air, making his point with great passion. Paul inspired me to run for the U.S. Senate. His brilliant example reminded me that you don't need to be powerful or rich to make a difference. You just need to have an honest concern for others, an optimistic spirit, and the courage to act. Paul embodied these traits. I am grateful for the time we had with Paul. He and I worked on everything from domestic violence and education to providing health care to veterans and protecting families from asbestos. As the month of October, which is Domestic Violence Awareness Month, draws to a close, there is much the Senate has accomplished on this issue. The Violence Against Women Act reauthorization, which contains many improvements to the current law, has passed the Senate. But the absence of the Wellstones has truly been felt. Paul and Sheila were such champions for victims of domestic violence, especially in the area of economic security. Paul knew that it is important to address the economic barriers that trap women in violent homes or relationships. That is why he and I worked together to introduce bills to provide economic protections for victims. I am proud to carry on the legacy of Paul and Sheila Wellstone, and in their honor I have introduced the Security and Financial Empowerment, SAFE Act, which will protect and even save the lives of victims of domestic or sexual violence and their families. We are all poorer for the loss of Paul Wellstone, his wife Sheila, his daughter Marcia, the members of his staff, and the pilots who were taken from us on this day 3 years ago. But I continue to hope that each one of us who are here will take on part of Paul's legacy--for example, the spirit to speak out for the underprivileged or for the woman on welfare because of domestic violence who is trying to get back on her feet. If we can remember to fight for all Americans no matter what challenges they face, and do so with respect and dignity, then Paul's legacy will live on in the Senate, as it lives on in our hearts and minds. In the name of Paul and Sheila Wellstone, I pledge to carry on their legacy throughout my time in the Senate.

Mrs. MURRAY

Mrs. MURRAY. Mr. President, I wanted to take a minute, as we finish this bill, to again thank my colleague from Missouri for his tremendous work on this bill. I know he has been under personal duress today and had a late night last night, but his team won despite what it appears to be. I think he has done a tremendous job and I wish to thank him. I also wish to thank all of the majority staff, John Kamarck Paul Doerrer, Cheh Kim, Lula Edwards, Josh Manley, and Matt McCardle for their help in working with us for many months along the way, and also our minority staff, Peter Rogoff, Kate Hallahan, Diana Hamilton, Bill Simpson, Meaghan McCarthy, as well as my personal staff, especially Casey Sixkiller. I also want to thank all of the floor staff who have been diligent in working with us as we have moved this bill through and again thanks to my colleague from Missouri for his tremendous work on this bill.

Mrs. MURRAY. I agree with the distinguished Senator from Missouri and request that the needs of the U.S. Court for the District of New Mexico be considered by the Administrative Office of the Courts. I have also been made aware of these concerns earlier in the year by the other Senator from New Mexico, Mr. Bingaman.

Mrs. MURRAY. Mr. President, I appreciate the Senator bringing this issue to our attention and she can be sure that her concerns will be given every consideration in conference.

Mrs. MURRAY

Mrs. MURRAY. Mr. President, we are working our way quickly toward final passage. I just wanted to take a minute and thank our chairman, Senator Bond, from Missouri, who has done a remarkable job with a very complex bill that has numerous agencies with it, the first time the Senate has considered a bill with Transportation and HUD and Judiciary. I wish to compliment him and his staff and thank all of our staffs for the tremendous work they did in moving this bill forward. I thank the Chair.

Mrs. MURRAY. I move to lay that motion on the table. The motion to lay on the table was agreed to.

Mrs. MURRAY. Mr. President, this amendment makes small revisions to the provision in the bill mandating the continued operation of the emergency landing field at Midway Island Atoll in the Pacific. The bill before us, for the third consecutive year, requires a cost- sharing agreement between the appropriate Federal agencies for the continued operation of this critical airfield. This amendment would clarify that among the costs that must be covered by the Federal agencies are the necessary capital costs for the replacement of the aged fuel farm on the island. I am not aware of any objection on either side. I ask for adoption of the amendment.

Mrs. MURRAY. I move to lay that motion on the table. The motion to lay on the table was agreed to. Amendment No. 2180

Mrs. MURRAY. I move to lay that motion on the table. The motion to lay on the table was agreed to. Amendments Nos. 2175 and 2176 En Bloc

Mrs. MURRAY. I move to lay that motion on the table. The motion to lay on the table was agreed to. Amendment No. 2146, as Modified

Mrs. MURRAY. I move to lay that motion on the table. The motion to lay on the table was agreed to.

Mrs. MURRAY. I move to lay that motion on the table. The motion to lay on the table was agreed to.

Mrs. MURRAY. Mr. President, I rise today to join Senator Bond in strongly opposing the Coburn amendment and the numerous other amendments he has filed with the same type of philosophy, as he calls it, in the Senate. I join with my colleague from Missouri, the chairman of this committee. I, like him, go home every single weekend to Washington State, which is 2,500 miles away from the Nation's Capital. I, like the Senator from Missouri, do not believe the bureaucrats sitting in Washington, DC, know what is happening on the ground in my home State 2,500 miles away from here. I am out there. I am out in every community, talking to people, listening to them, knowing what their concerns are, knowing what they are developing within their own communities, within their own cities, within their own capabilities, to help stimulate the economy and to do good things. It is my job to be their partner in that. I tell them that all the time. You get it going on the ground here, you develop the projects, you get the consensus within your own communities, and I will do what I can to get some small part of help from the Federal Government. That is how I, like most Senators in the Senate, am sent projects. Last year, I was in Yakima Valley and talked to our farmers out there. This is a remote community. They are struggling with putting together a clinic. I talked to them. They developed the ideas at the local level and put together a building, a job training center, to assist our State's large farmworker community to help further their education and acquire some critical new skills. This was an important project for them. I was able to come back here and partner with $500,000 from the Federal Government to help stimulate that project to make sure it was going to succeed. Another time, I was traveling in King County, talking to community leaders there who were working to fund a Greenbridge community center in the heart of an exciting Hope VI project that is bringing affordable housing and economic development to one of the poorest communities in King County. I came back here. It is my job to represent a State that is thousands of miles away from here, and I flew back and said I will do my part to help with this important project. And we were able to get $500,000. Today, the Senator from Oklahoma has targeted another project that I sat down and discussed with local community leaders. I didn't come up with this. This came from the heart of my local community because they are working very hard in an urban core in the city of Seattle to turn a brownfield into a hub of activity. It is a project that is stimulating jobs and investments. That is exactly what this EDI program is intended to do. We didn't need to cut investments to clean up brownfields to produce jobs. We need more projects like this. If the Senator from Oklahoma wants to look for a culprit for the fiscal situation in this country, he should look into the billions and billions of dollars in tax cuts that have been granted to multimillionaires in this country, and he should look at additional tax cuts his party wants to implement in future years if he wants to find incredible savings. To take apart a Senator's projects, who worked very hard, as I have and as the Senator from Missouri has, the Senator from Rhode Island, the Senator from Mississippi, and the Senator from Nebraska have done with their projects and numerous other Senators who have gone home like we have, listened to the leadership in their communities, heard their projects, filtered through them as we have had to because we do not have a lot of money in these accounts, and said these are the ones we will partner with you at the Federal level and put into this bill. The Subcommittee on Transportation, Treasury, the Judiciary, Housing and Urban Development, and Related Agencies, under the leadership of my capable colleague from Missouri, Senator Bond, has been respectful and responsive to requests of Senators who have come up with projects. Contrary to the representation that some Members have made in the Senate, these EDI projects we are talking about are not the centerpiece of our efforts of community development in this bill. In fact, they are far from it. The funding for these EDI projects that the Senator from Oklahoma is targeting amounts to less than 8 percent of the overall funding we provide in this bill for HUD's community development fund. In fact, my colleagues should remember that President Bush's budget looked to take the Community Development Block Grant Program out of this bill and fund it in the Department of Commerce while cutting its funding by more than a third. Senator Bond and I fought to continue the funding for the CDBG Program in our bill because we all heard from our local communities how important these funds were for development across the country. The Senator from Oklahoma now comes to the Senate with a series of amendments targeting a few States to pick out individually named projects and eliminate those projects' funding. We are not going to go down that road. There are criteria that pertain to the funding for the project that I have, for the project the Senator from Oklahoma has, the project from Nebraska, the project from Missouri, the project from Mississippi, the project from Rhode Island, and the other projects on which he has amendments. There are criteria for these. They are not random. These funds have to be used for capital expenses rather than operating costs. None of the funds are dedicated to for-profit entities. The vast majority are dedicated to projects in underprivileged communities. I don't care if it is my project, Senator Bond's project, Senator Nelson's project, Senator Chafee's project, or the other projects that the Senator from Oklahoma has randomly picked to target, the Senators that have EDI projects in this bill--and that, by the way, is almost every Senator in this Senate--are going to have to stand together. We are not going to watch the Senator pick out one project and make it into a whipping boy. Now, it is true that Senator Bond and I allow Senators to allocate EDI funds to those projects in their States that they think make best use of the funds. We do not make any apology for that practice. As the Senator from Missouri has said--which I agree with, I do not think the bureaucrats at the Department of Housing and Urban Development know better than I do--a Senator from a State thousands of miles away from here, who goes home every single weekend and is on the ground talking to community leaders in every county and every city in my State, and hearing from them what they think is important. We do not choose these projects randomly sitting on high from back here. We go out and talk to our community leaders. They tell us this project, the one the Senator has decided to target, is a project, as I said, that is turning a brownfield into a hub of an urban center, into a center of activity, and it is critical for their economic development. When the community leaders come together, and they have a consensus for it, and they have built the funding for it in the State, it is my job, I believe, to represent my State, which is thousands of miles away from here, and to come back and be an advocate for them. I don't know that the bureaucrats at the Department of Housing and Urban Development ever take the opportunity to go out and sit on the ground in my State. It is my job to do that. I take it seriously. And I am happy to come back here and fight for them, such as most of the other Senators have done who have given us EDI projects in this bill this year--next year or the following year. There is not a lot of money in these accounts. We allocate them correctly. I sat across the table from the Senator from Missouri in the Budget Committee for many years, and I can vouch for him that he is not someone who spends money randomly. He and I have disagreed, in fact, on budgets and spending over the years, but I do know that he takes his job seriously, to make sure we spend the taxpayers' dollars wisely. He votes, every time, for a budget where most of the time I say I am willing to spend more than he does. He cuts those budgets. And we have done so this year. It is a very tight budget year. Our committee is operating within the confines of that budget. I commend my colleague from Missouri for doing so because I know how many requests we got for funding within this bill. It was a tough year. I watched him work his way through a bill, telling Members of the Senate that he could not fund all their projects. But he has moved this bill forward under the confines of that budget. It is our job to make sure that every Senator has the ability we have to go home to their States, listen to their community leaders, and then be their partner in the Senate for this small amount of EDI funding that is available. These projects in this bill have to fall under the criteria that the EDI funds do so, and we make sure they do. I hope the Senate will not go down the road of cherry-picking individual projects that Senators have come to us and have championed on behalf of their constituents who do not live here in Washington, DC. I hope we do not go down the road deciding we know better than home State Senators about the merits of the projects they bring to us. As the old saying goes: What is good for the goose is good for the gander. And I tell my colleagues, if we start cutting funding for individual projects, your project may be next. So, Mr. President, when Members come down to the floor to vote on this amendment, they need to know if they support stripping out this project, Senator Bond and I are likely to be taking a long, serious look at their projects to determine whether they should be preserved during our upcoming conference negotiations. We must not and we will not go down the road of picking on one Senator or another on the floor of the Senate. I urge a no vote on this amendment. Mr. President, I yield the floor.

Mrs. MURRAY. I move to lay that motion on the table. The motion to lay on the table was agreed to.

Mrs. MURRAY. Madam President, we are able to accept this amendment on our side as well.

Mrs. MURRAY. I move to lay that motion on the table. The motion to lay on the table was agreed to.

Mrs. MURRAY. Madam President, this amendment is acceptable on our side as well. We are ready to go forward at this time.