William Roth

Mr. ROTH

Mr. ROTH. I yield 2 minutes off the bill.

Mr. ROTH. I yield 5 minutes to the Senator from Oklahoma.

Mr. ROTH. Mr. President, I yield 5 minutes off the bill to the Senator from North Dakota.

Mr. ROTH. Yes.

Mr. ROTH. Mr. President, I yield 3 minutes to the Senator from Pennsylvania.

Mr. ROTH. I yield 5 minutes off the regular time to the Senator from Nebraska.

Mr. ROTH. I yield a total of 5 minutes with 1 minute being off the bill.

Mr. ROTH. How many minutes?

Mr. ROTH. Four minutes.

Mr. ROTH. I yield 5 minutes to the Senator.

Mr. ROTH

Mr. ROTH. I move to reconsider the vote.

Mr. ROTH. Mr. President, as you can imagine, drafting a piece of legislation this large in such a short timeframe and having to incorporate over 50 amendments resulted in some technical errors and omissions. The items contained in this amendment are those which are technical in nature, and replace inadvertent omissions or are necessary to bring the legislation into compliance with the committee's budget instructions. The amendments accepted or adopted in the committee markup were done so with the proviso they would not bring the committee out of compliance with its instruction. Therefore, now that the Congressional Budget Office has completed scoring of the entire package, certain revisions to these amendments are necessary. A description of the items contained in this amendment is located on each Senator's desk. I ask this amendment be adopted and be considered original text for the purpose of amendment. The question is on agreeing to the amendment.

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

Mr. ROTH. Mr. President, I send an amendment to the desk on behalf of Senator Moynihan and myself and ask for its immediate consideration.

Mr. ROTH. Mr. President, I ask unanimous consent that we set aside temporarily the motion before us to consider a technical amendment that has been cleared on both sides.

Mr. ROTH. I yield 5 minutes to the distinguished Senator from Texas.

Mr. ROTH. Mr. President, I yield myself 3 minutes. Mr. President, I asked for a waiver because I oppose the point of order on the age of eligibility in the bill. What we are proposing to do is to make the age of eligibility for Medicare conform with Social Security. The age of eligibility will change from 65 to 67, which will be phased in over a 24-year period beginning in 2003 and ending in 2027. This is a very, very modest approach to an extremely serious problem. What we are concerned about is the solvency of Medicare. The solvency of Medicare is of critical importance as part A is seen going bankrupt by the year 2001. By the year 2007, if we do not make significant change, the program is at a loss of one-half trillion dollar. What we are seeking to do here, by making the age of eligibility for Medicare reform conform with Social Security, is to take a modest step forward to assure the solvency of this most important program. The bipartisan Commission on the Future of Medicare will be required to analyze and report back the feasibility of allowing individuals between age 62 and Medicare eligibility the option to buy into Medicare. As I said, our provision will help us extend solvency in the program. It is, I think, the very least we should do. The average life expectancy for a man or a woman over age 65 has been steadily improving. People are living longer, they are leading more vibrant lives, and this means that changing the eligibility age for Medicare will follow our natural demographic progression. In fact, around the time Medicare was enacted, the average life expectancy for men at age 65 was about 13 years, for women about 16 years. In 2030, when this provision is fully phased in, average life expectancy at age 65 for men is anticipated to be about 17 years, and 20.5 years for women. This is a very modest step to bring about significant reform. It is critically important that we show that we have the courage to take these steps on behalf, not only of our senior citizens of today, but the increasing number that will join this group in 2010 and later. It is, in a way, very ironic that a point of order was made on this matter, because while it is true that it will not have a significant impact on revenue in the early years because of the very, very compassionate way we are introducing changing the age of eligibility, the fact is that this very modest approach will do a very, very great deal in the long term in helping the solvency of this program. I cannot emphasize too much the importance of this change. As I pointed out, it merely conforms to what already has taken place in respect to Social Security. It is a change that will make the program significantly more solvent in the long term, and I hope the Senate will assure that this language continues as part of the agreement. I yield the remainder of my time.

Mr. ROTH. We want the half hour.

Mr. ROTH. I would like to have a vote before we recess for lunch.

Mr. ROTH. I move to lay that motion on the table. The motion to lay on the table was agreed to. Mr. SARBANES addressed the Chair.

Mr. ROTH. Mr. President, I move to table the Kennedy amendment and ask for the yeas and nays.

Mr. ROTH. I yield the Senator from Rhode Island 5 minutes.

Mr. ROTH. I yield to the Senator from Texas such time as he may require.

Mr. ROTH. I yield such time as is required by the Senator from Oklahoma.

Mr. ROTH. Mr. President, as I said, the purpose of the $5 copayment fee is to bring some balance into this program. I obviously cannot support the Kennedy amendment. I do not believe that the home health care copayment is a barrier to care nor that it is unreasonable. As I have already pointed out, from 1988 to 1996, spending on home health care grew an average of 37 percent per year. That is a growth that cannot be sustained if we are going to maintain Medicare as a program not only for those on it now but for the future. Medicare is going bankrupt. And this rate of growth is without question unsustainable. I cannot say too loud nor too clear that we need to assure that Medicare is preserved and protected. It is our responsibility to make certain that costs do not run out of control. Under current law, all Medicare benefits, except for home health and laboratory services, are subject to some form of beneficiary cost- sharing. Let me reemphasize that. Under current law, all Medicare benefits, except home health and laboratory services, are subject to some form of beneficiary cost-sharing. The $5 home health copay will have beneficiary share--in some degree, financial responsibility for services with the program. Five dollars is not an unreasonable amount to ask beneficiaries to pay for a visit. The Prospective Payment Assessment Commission, which advises Congress on Medicare policy, supports--I underscore the word ``supports''--a modest beneficiary copay subject to an annual limit. That is exactly what this bill proposes to do. I also point out that a report recently issued by the Commonwealth Fund supports the idea of a $5 copay. The report claims there is a sensible approach--a sensible approach which would make beneficiaries sensitive to use but not form a barrier to care. That is exactly what we want. We want this program to be used on a prudent basis; a sensible basis. But, of course, we do not want it to be a barrier to those who need this form of care. As I have already indicated, those who cannot afford the $5 copay, those who are under 100 percent of Federal poverty, will be covered by Medicaid. They will not have to pay the $5 copay. Medicaid will pay it. So they are protected. Beneficiaries will not have to pay any copay for the first 100 home health cares after a hospital stay. Only those visits in excess of 100, or that do not follow a hospitalization, will have a copay. And the amount is limited every year to the hospital deductible, which is what beneficiaries who have home health after a hospital stay would have to pay the hospital. Mr. President, this is a modest proposal where according to the Congressional Budget Office only about one-third of home health users-- that is about 1.2 million beneficiaries--are likely to be subject to more than $100 in copays in a year. And only about 11 percent of home health users--that is roughly 380,000 beneficiaries--are likely to reach the annual cap. The copay for home health is not an untested idea. Until 1972, Medicare required a 20-percent copay for all part B home health visits. During health care reform, President Clinton's Health Security Act included a 20-percent copay on home health care. So the proposal that we have in the legislation before us is far more modest. Mr. President, I yield the floor.