United States Senator Daniel K. Akaka (D-Hawaii) opposed invoking cloture on the conference report to accompany H.R. 1, the Medicare Prescription Drug and Modernization Act, and announced his intention to vote against the legislation. In a Senate speech this morning, Senator Akaka outlined his concerns with the $400 billion package.
"This bill is a false promise to our seniors," Akaka said. "The conference report contains too many flaws to warrant passage. It lacks appropriate prescription drug coverage for seniors and weakens the existing Medicare entitlement program. Indeed, many seniors will be worse off under this proposal. Many people, particularly seniors, will eventually come to the conclusion that I have reached on the legislation and Congress will regret this rush to judgment.
"For too many seniors in Hawaii and across the nation, prescription drug coverage will be worse under the provisions in the conference report. Seniors who are currently provided prescription drugs through their state's Medicaid programs will have federally mandated copayments imposed on them. For example, Hawaii's low-income seniors who get their medications through Hawaii's Medicaid program will be worse off under this plan. They will now have to pay copayments to get their prescription medication. Hawaii's seniors are not alone. Most of the 6.4 million individuals that have dual eligibility for Medicare and Medicaid will be charged more under the conference agreement for medication than under existing law."
Senator Akaka cited data indicating that millions of retirees will lose their existing coverage. "Over the past few years this has been a disturbing trend of reducing benefits for retirees," Akaka noted. "Creating this voluntary benefit will only accelerate this trend. The intent of the legislation is to expand prescription drug coverage for seniors, not merely to shift the financial burden of existing coverage to the federal government. Many seniors will be forced to rely on Medicare, which will provide a less generous benefit than what they currently enjoy." It is estimated that 17,850 Medicare beneficiaries in Hawaii will lose their retiree health benefits as a result of the enactment of this legislation. If Medicare beneficiaries lose their employer-based coverage, they may have to pay more for a Medicare drug benefit that provides less comprehensive coverage. Despite the subsidies included in the conference report to encourage the continuation of existing coverage, it is estimated that approximately 2.5 million Americans will lose their coverage.
Akaka also voiced concern that federal civil service retirees could face a reduction in their prescription drug coverage. Conferees rejected his request that the final package include legislation (S. 1369) he introduced to ensure that present and future federal retirees receive the same level of prescription drug coverage as federal employees in the report. "The government health care plan stands as a model employer-sponsored health care plan, and my bill protects the nation's federal annuitants and their survivors," Akaka said. "My legislation sends a message to other employer-sponsored plans that the federal government stands behind its commitment to retired workers."
Akaka objected to the means tests for Medicare Part B premiums and for low-income subsidies for the prescription drug benefit imposed by the conference report. "This is the beginning of the end of Medicare as a universal benefit," Akaka warned. "This is the first step towards means testing other parts of the existing Medicare program. Means tests place greater burdens on seniors.
"Even more objectionable is the assets test used to determine the low-income subsidies for the prescription drug benefit. The assets test is completely unrealistic. Asset testing will deny subsidies to 2.8 million very low-income seniors if they have even a small amount of assets. Medicare is an entitlement and participants should not be subjected to these demeaning means tests. Additional assistance should not be denied because they happen to have set a small amount of money aside for future expenses."
Akaka also expressed disappointment that the conference report did not include a Senate-passed amendment he authored which would have allowed Hawaii to benefit from the $6.35 billion increase in Medicaid disproportionate share hospital (DSH) payments included in the bill. Medicaid DSH payments are designed to provide additional support to hospitals that treat large numbers of Medicaid and uninsured patients. The 1997 Balanced Budget Act created specific DSH allotments for each state based on their actual DSH expenditures for fiscal year 1995. In 1994, the State of Hawaii implemented the QUEST program to reduce the number of uninsured and improve access to health care. The Medicaid DSH program was incorporated into QUEST. As a result of the demonstration program, Hawaii did not have DSH expenditures in 1995 and was not provided a DSH allotment.
Congress made further changes to the DSH program in 2000, which included the establishment of a floor for DSH allotments. However, states without allotments were again left out. Other states that have obtained waivers similar to Hawaii's waiver have retained their DSH allotments. Only two states, Hawaii and Tennessee, do not have DSH allotments.
The conference report provides that states without DSH allotments could receive additional assistance if their waiver was terminated or removed. While this may possibly benefit Tennessee, this language will prevent Hawaii from obtaining any additional Medicaid DSH support that is included in this bill. "Hawaii's hospitals are struggling to meet the healthcare needs of the uninsured" Akaka said. "All fifty states need to have access to this additional Medicaid DSH support."
Akaka concluded, "Some have argued that this measure is an important step forward in the Medicare program. I disagree. This conference report takes too many elderly Americans backwards in terms of their benefits to constitute forward progress or forward thinking. After reviewing the provisions in this legislation, I am disappointed that this bill is a false promise that undermines the existing Medicare program."
