Gordon Smith

Mr. SMITH

Mr. SMITH. Mr. President, I rise today with my colleague from North Dakota in support of critical drug coverage for beneficiaries who contend with the debilitating effects of Multiple Sclerosis. This amendment would provide transitional coverage for the four FDA-approved therapies in the 2-year interim until 2006, when the prescription drug plan will take effect. Approximately 400,000 Americans have MS. In my home State of Oregon, it is estimated that there are 5,800 people living with MS. Currently, Medicare covers only one of the four FDA-approved MS therapies and only when administered by a physician. This amendment would cover all four MS therapies, including when they are administered by the patients themselves, providing better coverage and better care for Americans with Multiple Sclerosis. While these therapies do not cure MS, they can slow its course, and have provided great benefit to MS patients. It is critical that MS patients have access to all approved drugs because some MS patients do not respond well to, or cannot tolerate, the one MS therapy that is currently covered. Currently, many Medicare beneficiaries with MS are forced to take the less effective therapy, to pay the costs out of pocket, or forgo treatment. Equally, this amendment is important to rural Medicare beneficiaries with MS. By administering drugs themselves, rural beneficiaries can avoid the costs and hassles of traveling long distances to health care facilities to receive their MS therapy. In the spirit of providing all Medicare beneficiaries with increased choice, MS patients need and deserve the full range of treatment choices currently available and self-administration helps ensure access to needed medications. I urge my colleagues on both sides of the aisle to join me in support of this amendment and to provide adequate and comprehensive drug coverage for MS patients.

Mr. SMITH

Mr. SMITH. Mr. President, I rise today to offer this amendment that will protect the health care safety net and ensure access to quality health care for low-income Medicare beneficiaries who rely on our Nation's community health centers. I am pleased to be joined in this by my colleague from New Mexico, Senator Bingaman, who has been a strong advocate for the medically underserved. It is a privilege to work with him on this amendment. This is an issue that affects the entire country, not just my State of Oregon. We all have community health centers. Health centers are the family doctor to more than 13 million people, more than 5 million of whom are uninsured, and nearly 1 million are low-income Medicare beneficiaries. For many of these individuals, their local health center is the only accessible provider of preventive and primary health care services. While the centers receive Federal Public Health Service Act grant funds to support care for their uninsured patients, they rely on adequate payments from both Medicaid and Medicare for care provided to beneficiaries under both programs. In 1990, Congress recognized the importance of protecting the integrity of the PHSA grant funds and required that health centers receive reasonable cost payments under the traditional Medicare Part B Program. This action on the part of Congress helped both to ensure that the health centers are reimbursed sufficiently for the provision of care to beneficiaries under the traditional Medicare program, and to protect access to health center services for the uninsured. The amendment we are proposing today simply would extend the same requirement to new Medicare Advantage Programs. Specifically, the amendment would ensure that health centers are provided with a wraparound or supplemental payment, equal to the difference between the payments they now receive under Medicare generally and the payments they will receive from Medicare Advantage plans. This is not a new concept. Under current Medicaid law, a health center is reimbursed by a managed care organization the equivalent of what the managed care organization pays any other provider of similar services. In turn, the State Medicaid Program provides a wraparound or supplemental payment for the difference between the managed care organization's payment and the health center's reasonable cost. The absence of a wraparound payment system in the current Medicare managed care program, Medicare+Choice, has left many health centers struggling to provide services to seniors under the program while trying to protect Federal grant funds intended to support care for the uninsured. In 2001, health centers in my home State of Oregon lost more than $55 for each patient's office visit when they were enrolled under a Medicare managed care plan. In the same year, Oregon health centers lost almost as much revenue as they gained from the Medicare managed care patients. It is estimated this new percentage will grow even larger under the new Medicare Advantage Program. In fact, if current estimates are correct, health centers nationwide can expect to experience an average loss of $35 per office visit under the Medicare Advantage Program. Simply put, what this means is that without a wraparound payment system for health care centers contracting with Medicare Advantage plans, these centers will have no choice but to reach deep into their Federal grant funds, money that is supposed to go for care to the uninsured, in order to make up for the loss in Medicare payments. This will only serve to put further strain on health centers as well as the public safety net overall. The President and the Congress have called upon this Nation to double the capacity of health centers and build a stronger primary care infrastructure for America's communities. America's health centers are trying to meet that challenge and still meet the health care needs of the Nation's growing uninsured. In the last 3 years alone, health centers added more than 800,000 new uninsured patients to their roles, raising the number of uninsured Americans served by these centers to one in every eight Americans. Our amendment would protect the vital mission of health centers to provide access to care to underserved rural and inner city communities. It would also bolster the goal of the President and the Congress to strengthen our health care safety net. I have a letter in support of my amendment. I ask unanimous consent the letter be printed in the Record.

Mr. SMITH. Senator Bingaman and I are convinced that this amendment goes a long way toward answering the concerns of health centers about how the Medicare Advantage Program will impact their ability to continue to provide high-quality health care services to their patients. I thank my distinguished colleague from New Mexico for his efforts and his cosponsorship of this amendment and I urge all our colleagues to support it. I yield the floor.

Mr. SMITH

Mr. SMITH. Mr. President, on behalf of myself and my colleagues Mr. Biden of Delaware and Mr. Durbin of Illinois, I ask unanimous consent that the full text of the bill be printed in the Record.

Mr. SMITH

Mr. SMITH. Mr. President, on behalf of myself and my colleagues Mr. Biden of Delaware and Mr. Durbin of Illinois, I ask unanimous consent that the full text of the bill be printed in the Record.

Mr. SMITH

Mr. SMITH. Mr. President, I rise today to speak about the need for hate crimes legislation. On May 1, 2003, Senator Kennedy and I introduced the Local Law Enforcement Act, a bill that would add new categories to current hate crimes law, sending a signal that violence of any kind is unacceptable in our society. I would like to describe a terrible crime that occurred at Fort Campbell, KY. A little after 3 in the morning on July 5, 1999, PFC Barry L. Winchell was forced outside his barracks where he was stationed and brutally beaten with a baseball bat by another Army private. Winchell died of his injuries the following day. Army officials and sources close to Winchell believe that his death was motivated by antigay bias. I believe Government's first duty is to defend its citizens, to defend them against the harms that come out of hate. The Local Law Enforcement Enhancement Act is a symbol that can become substance. I believe that by passing this legislation and changing current law, we can change hearts and minds as well.

Mr. SMITH

Mr. SMITH. Mr. President, today I am introducing legislation to provide the Bureau of Reclamation, an agency of the Department of the Interior, with limited off-site mitigation authority in the Columbia River Basin. This legislation, if enacted, would enhance Reclamation's ability to comply with the provisions of the December 2000 biological opinion for operations of the Federal Columbia River Power System. This legislation is similar to an Administration proposal that was submitted to the Congress on October 30, 2002, but never introduced during the 107th Congress. Prior to the introduction of this bill, I have sought comments from numerous stakeholders in the Pacific Northwest and have addressed any concerns raised whenever possible. While there has been a recent court ruling on the 2000 biological opinion that found certain aspects of the opinion to the arbitrary and capricious, it is important to move forward with the reasonable and prudent alternatives, including fish passage improvements. The Administration is currently working to address the deficiencies in the biological opinion. I remain committed to working with my colleagues, the Northwest governors, and the Administration to keep salmon recovery on track, while preserving the multiple benefits for the Pacific Northwest of the Federal Columbia River Power System. The good news in our region is that over the past few years there have been robust salmon runs on the Columbia and Snake Rivers. Promising new technologies, such as removable spillways, have also been tested in recent years. I know that the Administration remains committed to taking actions throughout the salmon's life cycle to recover salmon runs in the Columbia and Snake Rivers. This important legislation, if enacted, will provide yet another tool in addressing the complex issues of salmon recovery. I urge my colleagues to join me in supporting this legislation, and will press for its consideration in a timely manner.

Mr. SMITH

Mr. SMITH. Mr. President, I rise today to speak about the need for hate crimes legislation. On May 1, 2003, Senator Kennedy and I introduced the Local Law Enforcement Act, a bill that would add new categories to current hate crimes law, sending a signal that violence of any kind is unacceptable in our society. I would like to describe a terrible crime that occurred in Farwest, WA. On September 13, 2001, a Sikh cab driver was stopped by a 21-year- old man who had hailed his cab. Once inside the cab, the passenger verbally accosted the driver accusing him of being a terrorist and that he had no right to be in the United States. The passenger subsequently grabbed the driver around the neck and choked him. Before the driver was able to escape, the passenger punched the victim in the face, grabbed fistfuls of his beard and ripped off parts of his turban. The attacker was eventually arrested by a passing police officer. I believe that government's first duty is to defend its citizens, to defend them against the harms that come out of hate. The Local Law Enforcement Enhancement Act is a symbol that can become substance. I believe that by passing this legislation and changing current law, we can change hearts and minds as well.

Mr. SMITH

Mr. SMITH. Mr. President, today I am introducing legislation to provide the Bureau of Reclamation, an agency of the Department of the Interior, with limited off-site mitigation authority in the Columbia River Basin. This legislation, if enacted, would enhance Reclamation's ability to comply with the provisions of the December 2000 biological opinion for operations of the Federal Columbia River Power System. This legislation is similar to an Administration proposal that was submitted to the Congress on October 30, 2002, but never introduced during the 107th Congress. Prior to the introduction of this bill, I have sought comments from numerous stakeholders in the Pacific Northwest and have addressed any concerns raised whenever possible. While there has been a recent court ruling on the 2000 biological opinion that found certain aspects of the opinion to the arbitrary and capricious, it is important to move forward with the reasonable and prudent alternatives, including fish passage improvements. The Administration is currently working to address the deficiencies in the biological opinion. I remain committed to working with my colleagues, the Northwest governors, and the Administration to keep salmon recovery on track, while preserving the multiple benefits for the Pacific Northwest of the Federal Columbia River Power System. The good news in our region is that over the past few years there have been robust salmon runs on the Columbia and Snake Rivers. Promising new technologies, such as removable spillways, have also been tested in recent years. I know that the Administration remains committed to taking actions throughout the salmon's life cycle to recover salmon runs in the Columbia and Snake Rivers. This important legislation, if enacted, will provide yet another tool in addressing the complex issues of salmon recovery. I urge my colleagues to join me in supporting this legislation, and will press for its consideration in a timely manner.

Mr. SMITH

Mr. SMITH. I suggest the absence of a quorum.

Mr. SMITH. Mr. President, I rise in support of this amendment. I commend Senators Gregg, Schumer, McCain, and Kennedy for their work on this carefully crafted and bipartisan amendment. Improved access to generic drugs is a policy that is, frankly, long overdue. Last year I voted in favor of this amendment, and I am pleased to say I believe today's vote will be on an improved amendment. The bill's sponsors have worked with the FDA, the drug industry, and the generics to reach the compromise that is before the Senate today. The result is a bill that will bring generics to the market in a timely way without stifling or shifting the process. Innovations that are vital to the American public and to health care consumers around the globe are, I believe, contained within this bill. By closing the loopholes that have allowed both the brand name drug companies and the generics to keep more affordable drugs off the market, all Americans win. I urge my colleagues to support this amendment. I yield the floor.

Mr. SMITH

Mr. SMITH. Mr. President, I rise today to speak about the need for hate crimes legislation. On May 1, 2003, Senator Kennedy and I introduced the Local Law Enforcement Act, a bill that would add new categories to current hate crimes law, sending a signal that violence of any kind is unacceptable in our society. I would like to describe a terrible crime that occurred in Hamilton, NJ. On September 16, 2001, an Arab-American man and his son were verbally accosted and attacked by a man shouting ethnic slurs and wielding a knife. The victim was able to use his cane to protect himself and his son until he was able to wrestle the knife away from the attacker. The perpetrator was eventually arrested by the police. I believe that Government's first duty is to defend its citizens, to defend them against the harms that come out of hate. The Local Law Enforcement Enhancement Act is a symbol that can become substance. I believe that by passing this legislation and changing current law, we can change hearts and minds as well.

Mr. SMITH

Mr. SMITH. Madam President, I rise today to speak about the need for hate crimes legislation. On May 1, 2003, Senator Kennedy and I introduced the Local Law Enforcement Act, a bill that would add new categories to current hate crimes law, sending a signal that violence of any kind is unacceptable in our society. I would like to describe a terrible crime that occurred in San Jose, CA. On October 12, 2001, a pregnant Yemini woman wearing a hijab and a long dress was beaten by a group of angry teenagers. After the attack, the woman needed to be hospitalized and remained in guarded condition until she delivered her baby. I believe that Government's first duty is to defend its citizens, to defend them against the harms that come out of hate. The Local Law Enforcement Enhancement Act is a symbol that can become substance. I believe that by passing this legislation and changing current law, we can change hearts and minds as well.

Mr. SMITH

Mr. SMITH. I have no objection.

Mr. SMITH. I thank my colleague for his amendment. I think the Enzi- Reed amendment will clearly improve beneficiaries' access to long-term prescriptions at their local pharmacies, as well as to increased disclosure requirements for participating plans. Community pharmacists play an integral and active role in health care delivery by providing programs that help patients manage their disease, prevent dangerous drug interactions and educate and counsel on the proper use of their medications. Any prescription drug program will rely heavily on community pharmacists. Under S. 1, the underlying bill, entities eligible to offer a Medicare prescription drug plan would be required to ensure that beneficiaries have convenient access to community pharmacies in both rural and urban areas. Additionally, no eligible plan would be allowed to offer prescription drug coverage solely through mail order pharmacies. The Enzi amendment builds on the provisions already included in S. 1 and would ensure that beneficiaries who enroll in prescription drug plans and Medicare Advantage plans that offer mail order benefits would also have the option to fill long-term prescriptions in community pharmacies. This amendment also would provide beneficiaries flexibility, convenience, and increased corporate reporting requirements for Medicare prescription drug plans. This should promote, not stifle, competition and improve choice. So let's be clear. There are efficiencies inherent in mail order pharmacies and beneficiaries would continue to benefit financially by purchasing drugs through the mail, but this amendment would provide them with yet another choice, another option, as well. It is certainly my intention to vote for the Enzi-Reed amendment. I am not in a position to say that the chairman is saying that yet, but I suspect he will. I understand Senator Enzi will speak for a few more minutes.

Mr. SMITH. Mr. President, I ask unanimous consent that the vote in relationship to the pending amendment No. 931 occur at 3:15 today with no amendments in order to the amendment prior to the vote and 5 minutes for debate equally divided prior to the vote. I further ask unanimous consent that at 2:15 today the amendment be set aside and Senator Enzi then be recognized to offer an amendment.

Mr. SMITH. I suggest the absence of a quorum.

Mr. SMITH. Madam President, it is my understanding that CBO has evaluated the information just provided them by the Senator from Michigan, and they are standing by their opinion that her amendment will cost an additional $50 billion over 10 years. So while the Stabenow amendment does violate the budget, which allocates $400 billion, it is my understanding the leadership on this side does not want to raise a point of order and would like to take this vote just straight up on its merits. The provisions of this bill offer Senators a choice between a new way or the old way. I ask my colleagues: Do you want to go the way of Government price control in which you put a bureaucrat between you and your medicine cabinet regardless of Medicare's terrible experience in evaluating market prices on prescription drugs? If you believe this is the way Medicare's future is best provided, then you should vote for the Stabenow amendment. If you want to try a new way, if you want to see if the marketplace actually works to provide more choices, more cost control, and even better quality and innovation, then you should vote with the bipartisan agreement that has the support of, I believe, a majority of Senators. This bill presents a choice between the past and the future, between Government, central planning, price controls, and a marketplace that can evolve. But that marketplace will not evolve if Government comes in and says, on a permanent basis: we are going to be the other choice. I can promise you capital will not follow, and there will be no marketplace developed. I think seniors of this country are due a prescription drugs package that can pass and that the President will sign. The President is not going to sign a Medicare and Prescription Drugs bill that comprises the Stabenow amendment. I yield the floor.

Mr. SMITH. I move to reconsider the vote.

Mr. SMITH. I ask for the yeas and nays.

Mr. SMITH. Madam President, have the yeas and nays been ordered?

Mr. SMITH. Mr. President, I rise to respond to the Senator from Michigan. I think she makes a number of points that are worth our consideration. I think this can be done through the Government route. But the grand experiment here is predicated on a belief that the marketplace can actually work. If we were to adopt the Stabenow amendment, it would clearly undermine the private sector from forming plans and offering prices which have the potential of very real savings for our seniors and providing us with some very real reforms which seniors are counting on; that is, that we provide this benefit without undermining the financial integrity of Medicare. We need to make up our minds. We can either go the Government route or we can go the market route. The Government route can work but it comes at a cost that is, frankly, hard to calculate. Even as we speak, right now on Part B Medicare, the Government is looking at gross overpayments already on prescription drugs and is having to make reimbursements because of that. Imagine all of the inefficiencies that would be infused into the system if we relied upon the Federal Government to manage every prescription drug for every senior in this country. If they are overpaying on one and wasting money at the same time, I hate to think of the bill the Federal Government would have to foot if we did this for every senior on the basis that the Senator is describing. Moreover, the Congressional Budget Office has just announced an initial estimate of what the Stabenow amendment would cost, which is an additional $50 billion over 10 years. Without a doubt, with the budget that provides $400 billion over 10 years, this would exceed that by $50 billion. I am sure at some point a manager of the bill will make a budget point of order. It has come at a significant additional cost of $50 billion. Again, I return to the point that we can either let the marketplace work or we can let the Government do it. But if you have a permanent Government backup as opposed to a fallback provision until the marketplace develops, you will retard, if not destroy, the marketplace from ever developing. It is that simple. The predicate of the compromise between Republicans and Democrats that has been a result of the prescription drug benefit coming to our seniors is that we are going to have a fallback. But we are going to give the marketplace a chance. We are going to see which one works. As for me and my money, I am placing my bet on the marketplace, if we provide an economic structure for it to develop. If it develops, it will give real hope and a real renewed life to Medicare, and it will give our seniors the benefit they need of a prescription drug immediately. I think that is the better vote. I think it is the better way. I think we know how Government works. When it is necessary for a Government bureaucrat to be between you and your medicine cabinet, I shutter, frankly, at the inefficiencies that can come from that; whereas, if you allow the marketplace to work--as with PPOs which the Presiding Officer and I have as Federal employees--frankly, they can take a holistic approach to your health by including prescription drugs. It gives us a very real chance to give our seniors a program that includes prescription drugs, which includes holistic health care, and which doesn't rely on a Government formulary and Government price setting to determine what drugs you can have and what they are going to cost. I urge my colleagues to vote no on the Stabenow amendment because it undermines entirely the bipartisan agreement that has been arrived at in the Finance Committee. I yield the floor.

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

Mr. SMITH

Mr. SMITH. I believe that is true.

Mr. SMITH. Mr. President, I ask the Chair to lay before the Senate a message from the House with respect to H.R. 1308; that the Senate disagree to the House amendments to the Senate amendments, agree to the request for a conference with the House on the disagreeing votes of the two Houses, and that the Chair be authorized to appoint conferees on the part of the Senate.