11.25.03

Cantwell: Vote Against Sham Medicare Bill is a Vote for Seniors

WASHINGTON, D.C.– This morning the U.S. Senate passed a bill that will change Medicare as we know it. Sen. Maria Cantwell voted against the bill because it leaves too many of Washington's seniors behind.

At least 249,495 seniors will be worse off in Washington state under this bill, than under current law. 91,900 Medicaid beneficiaries making below $8,980 a year will be required to pay co-pays for life saving prescription drugs; 47,000 seniors in Washington will not qualify for low-income protections because of the rigid asset test and lower qualifying incomes; 51,595 seniors will be means-tested for the first time for Part B benefits; and 49,000 retirees may lose their employer-sponsored benefits.

"This bill is not all it is cracked up to be," Cantwell stated. "We aren't actually dealing with the cost of prescription drugs, which is the root of the problem and what we really need to address. This isn't a prescription for Medicare, it is a prescription for problems.

"I cannot support a Medicare prescription drug bill that fails to bring down the cost of prescription drugs for seniors and fails to ensure the future stability of Medicare.

"It fails to keep the promise – a promise made and kept since 1965 – that Medicare be a universal benefit for all seniors over the age of 65. It fails to ensure that low-income beneficiaries won't be hurt. It fails to rein in the astronomical cost increases of drugs. And it fails to add a solid prescription drug benefit to Medicare for seniors.

"In addition, under this bill, between 47,250 and 49,000 retirees in Washington state may lose coverage otherwise provided to them by their employer retiree plans. I find it unacceptable to expect to see nearly 50,000 Washington residents who currently have good, solid insurance coverage that includes prescription drug coverage tossed into a program that I expect to not be nearly so generous.

"The conference bill, for the first time in Medicare's history, will alter this uniform structure over the next five years whereby individuals will pay progressively higher premiums based on their income. In Washington state, that means an estimated 51,595 seniors will see increased Part B premium rates, the rates that pay for visits to the doctor.

"47,000 seniors in Washington will not qualify for low income protections because of the strict asset test in this conference bill and because of the lower qualifying incomes in the conference bill that affords low-income assistance only to those making below 150 percent of the poverty level.

"I also need to weigh in on what I hope is not a death knell for people living with cancer and for the good people caring for them. According to CBO estimates, the total impact of cuts in this bill could amount to $11.5 billion over the next ten years to the cancer care community that is made up of the patients living with cancer and their caregivers.

"Making cuts to cancer care is unacceptable to me; it is unacceptable to the countless nurses I have heard from at Columbia Basin Hematology and Oncology in Kennewick, Washington; and it is unacceptable to the good people at Yakima Valley Memorial Hospital's North Star Lodge who are holistically healing cancer patients. It is also unacceptable to the many people working at Western Washington Oncology serving cancer patients in Olympia, Shelton, Aberdeen, and Centralia, Washington; and most of all, it is unacceptable to the people who are fighting their life-threatening cancers and their families.

"I began this evening talking about how this bill does nothing to rein in the ever-increasing cost of drugs. One of the clearest ways it fails this test, in addition to barring Medicare fromnegotiating for lower drug costs on behalf of its beneficiaries, is to put Pharmacy Benefit Managers (PBMs) in charge of running the new Part D benefit for Medicare beneficiaries.

"A recent study by researchers at the Loyola University Chicago Law School found that the cost to taxpayers from this inherent conflict of interest ranges from $14.5 billion to $29 billion over ten years. That is unconscionable. Putting HMOs together with PBMs in charge of prescription drug coverage is like putting Enron in charge of national energy policy.

"The bill passed by the Senate in June included an amendment I wrote calling for transparency in PBM negotiations and requiring that PBMs provide any savings negotiated with a pharmacy back to seniors.

"My amendment would have strengthened auditing requirements to prevent PBMs from disguising rebates as other fees and to ensure that PBMs are passing savings on to consumers. My amendment also required all PBMs contracting to provide a Medicare benefit to disclose to the Assistant Attorney General for Antitrust of the U.S. Department of Justice and the Health and Human Services Inspector General: (a) information on rebates received from pharmaceutical manufacturers; (b) the amount of rebates received for the top volume 50 drugs; and (c) the percentage differential between the price the PBM pays the pharmacy for a drug and the price it charges the Medicare entity for the same drug for the top 50 volume drugs.

"Unfortunately, my amendment was not included in this final bill before us. Without this protection, prescription drugs will become more expensive, not cheaper, and PBMs will continue to profit at the expense of seniors.

"Throughout this past summer and fall, I had the pleasure of visiting with many seniors in Washington state, discussing the ongoing prescription drug debate. This is what my constituents told me: they want lower drug costs, and they want prescription drug coverage to be comprehensive, simple to administer, guaranteed, stable, and based on the very best medical technology. And most importantly, they want the benefit run through Medicare – a program they understand and upon which they depend.

"Seniors do not want their prescription drug benefit run through an HMO or other private insurance company. Seniors need a comprehensive benefit that covers their total prescription drug needs.

"Furthermore, we know that private plans are not a real choice for seniors living in rural areas – and eighty percent of the 9.3 million Medicare beneficiaries in rural counties live in areas that are not served by any Medicare managed care plan.

"As we debate the legislation before us today, we need to ensure that the traditional Medicare safety net will always be intact. And as we talk about Medicare reform we often fail to highlight that this is a system that has survived for over three decades. In fact, traditional Medicare continues to serve 89 percent of seniors. Had we decided to privatize Medicare over thirty years ago, I wonder if we could say the same.

"No bill is ever perfect. Compromise is an essential part of the legislative process, but that does not mean that we should compromise our core values. I cannot accept the wrongheaded alteration of Medicare as we know it."