Republican Jr Senator; previously Representative (OK-2)
Voted YES on means-testing to determine Medicare Part D premium.
CONGRESSIONAL SUMMARY:To require wealthy Medicare beneficiaries to pay a greater share of their Medicare Part D premiums.
SUPPORTER'S ARGUMENT FOR VOTING YES:Sen. ENSIGN: This amendment is to means test Medicare Part D the same way we means test Medicare Part B. An individual senior making over $82,000 a year, or a senior couple making over $164,000, would be expected to pay a little over $10 a month extra. That is all we are doing. This amendment saves a couple billion dollars over the next 5 years. It is very reasonable. There is nothing else in this budget that does anything on entitlement reform, and we all know entitlements are heading for a train wreck in this country. We ought to at least do this little bit for our children for deficit reduction.
OPPONENT'S ARGUMENT FOR VOTING NO:Sen. BAUCUS: The problem with this amendment is exactly what the sponsor said: It is exactly like Part B. Medicare Part B is a premium that is paid with respect to doctors' examinations and Medicare reimbursement. Part D is the drug benefit. Part D premiums vary significantly nationwide according to geography and according to the plans offered. It is nothing like Part B.
Second, any change in Part D is required to be in any Medicare bill if it comes up. We may want to make other Medicare changes. We don't want to be restricted to means testing.
Third, this should be considered broad health care reform, at least Medicare reform, and not be isolated in this case. LEGISLATIVE OUTCOME:Amendment rejected, 42-56
Voted YES on allowing tribal Indians to opt out of federal healthcare.
CONGRESSIONAL SUMMARY:TRIBAL MEMBER CHOICE PROGRAM: Members of federally-recognized Indian Tribes shall be provided the opportunity to voluntarily enroll, with a risk-adjusted subsidy for the purchase of qualified health insurance in order to--
improve Indian access to high quality health care services;
provide incentives to Indian patients to seek preventive health care services;
create opportunities for Indians to participate in the health care decision process;
encourage effective use of health care services by Indians; and
allow Indians to make health care coverage & delivery decisions & choices.
SUPPORTER'S ARGUMENT FOR VOTING YES:Sen. COBURN: The underlying legislation, S.1200, does not fix the underlying problems with tribal healthcare. It does not fix rationing. It does not fix waiting lines. It does not fix the inferior quality that is being applied to a lot of Native Americans and Alaskans in this country. It does not fix
any of those problems. In fact, it authorizes more services without making sure the money is there to follow it.
Those who say a failure to reauthorize the Indian Health Care Improvement Act is a violation of our trust obligations are correct. However, I believe simply reauthorizing this system with minor modifications is an even greater violation of that commitment.
OPPONENT'S ARGUMENT FOR VOTING NO:Sen. DORGAN: It is not more money necessarily that is only going to solve the problem. But I guarantee you that less money will not solve the problem. If you add another program for other Indians who can go somewhere else and be able to present a card, they have now taken money out of the system and purchased their own insurance--then those who live on the reservation with the current Indian Health Service clinic there has less money. How does that work to help the folks who are stranded with no competition?
Voted NO on adding 2 to 4 million children to SCHIP eligibility.
Allows State Children's Health Insurance Programs (SCHIP), that require state legislation to meet additional requirements imposed by this Act, additional time to make required plan changes. Pres. Bush vetoed this bill on Dec. 12, 2007, as well as a version (HR976) from Feb. 2007.
Proponents support voting YES because:
Rep. DINGELL: This is not a perfect bill, but it is an excellent bipartisan compromise. The bill provides health coverage for 3.9 million children who are eligible, yet remain uninsured. It meets the concerns expressed in the President's veto message [from HR976]:
It terminates the coverage of childless adults.
It targets bonus payments only to States that increase enrollments of the poorest uninsured children, and it prohibits States from covering families with incomes above $51,000.
It contains adequate enforcement to ensure that only US citizens are covered.
Opponents recommend voting NO because:
Rep. DEAL: This bill
[fails to] fix the previous legislation that has been vetoed:
On illegal immigration: Would the verification system prevent an illegal alien from fraudulently using another person's name to obtain SCHIP benefits? No.
On adults in SCHIP: Up to 10% of the enrollees in SCHIP will be adults, not children, in the next 5 years, and money for poor children shouldn't go to cover adults.
On crowd-out: The CBO still estimates there will be some 2 million people who will lose their private health insurance coverage and become enrolled in a government-run program.
Veto message from President Bush:
Like its predecessor, HR976, this bill does not put poor children first and it moves our country's health care system in the wrong direction. Ultimately, our goal should be to move children who have no health insurance to private coverage--not to move children who already have private health insurance to government coverage. As a result, I cannot sign this legislation.
Reference: Children's Health Insurance Program Reauthorization Act;
Bill H.R. 3963
; vote number 2007-403
on Nov 1, 2007
Voted NO on requiring negotiated Rx prices for Medicare part D.
Would require negotiating with pharmaceutical manufacturers the prices that may be charged to prescription drug plan sponsors for covered Medicare part D drugs.
Proponents support voting YES because:
This legislation is an overdue step to improve part D drug benefits. The bipartisan bill is simple and straightforward. It removes the prohibition from negotiating discounts with pharmaceutical manufacturers, and requires the Secretary of Health & Human Services to negotiate. This legislation will deliver lower premiums to the seniors, lower prices at the pharmacy and savings for all taxpayers.
It is equally important to understand that this legislation does not do certain things. HR4 does not preclude private plans from getting additional discounts on medicines they offer seniors and people with disabilities. HR4 does not establish a national formulary. HR4 does not require price controls. HR4 does not hamstring research and development by pharmaceutical houses.
HR4 does not require using the Department of Veterans Affairs' price schedule.
Opponents support voting NO because:
Does ideological purity trump sound public policy? It shouldn't, but, unfortunately, it appears that ideology would profoundly change the Medicare part D prescription drug program, a program that is working well, a program that has arrived on time and under budget. The changes are not being proposed because of any weakness or defect in the program, but because of ideological opposition to market-based prices. Since the inception of the part D program, America's seniors have had access to greater coverage at a lower cost than at any time under Medicare.
Under the guise of negotiation, this bill proposes to enact draconian price controls on pharmaceutical products. Competition has brought significant cost savings to the program. The current system trusts the marketplace, with some guidance, to be the most efficient arbiter of distribution.
Status: Cloture rejected Cloture vote rejected, 55-42 (3/5ths required)
Reference: Medicare Prescription Drug Price Negotiation Act;
Bill S.3 & H.R.4
; vote number 2007-132
on Apr 18, 2007
Voted NO on expanding enrollment period for Medicare Part D.
To provide for necessary beneficiary protections in order to ensure access to coverage under the Medicare part D prescription drug program. Voting YES would extend the 6-month enrollment period for the Prescription Drug Benefit Program to the entire year of 2006 and allows beneficiaries to change plans once in that year, without penalty, after enrollment. Also would fully reimburse pharmacies, states and individuals for cost in 2006 for covered Medicare Part D drugs.
Voted NO on increasing Medicaid rebate for producing generics.
Vote on an amendment that removes an increase in the Medicaid deduction rebate for generic drugs from 11% to 17%. The effect of the amendment, according to its sponsor, is as follows: "This bill eliminates the ability of generic drugs to be sold using Medicaid. Over half the prescription drugs used in Medicaid are generic. Because we have raised the fees so dramatically on what a generic drug company must pay a pharmacy to handle the drug, pharmacies are not going to use the generic. In the long run, that will cost the Medicaid Program billions of dollars. My amendment corrects that situation." A Senator opposing the amendment said: "This bill has in it already very significant incentives for generic utilization through the way we reimburse generics. Brand drugs account for 67% of Medicaid prescriptions, but they also account for 81% of the Medicaid rebates. This is reasonable policy for us, then, to create parity between brand and generic rebates. This amendment would upset that parity."
Reference: Amendment for Medicaid rebates for generic drugs;
Bill S Amdt 2348 to S 1932
; vote number 2005-299
on Nov 3, 2005
Voted NO on negotiating bulk purchases for Medicare prescription drug.
Vote to adopt an amendment that would allow federal government negotiations with prescription drug manufactures for the best possible prescription drug prices. Amendment details: To ensure that any savings associated with legislation that provides the Secretary of Health and Human Services with the authority to participate in the negotiation of contracts with manufacturers of covered part D drugs to achieve the best possible prices for such drugs under Medicare Part D of the Social Security Act, that requires the Secretary to negotiate contracts with manufacturers of such drugs for each fallback prescription drug plan, and that requires the Secretary to participate in the negotiation for a contract for any such drug upon the request of a prescription drug plan or an MA-PD plan, is reserved for reducing expenditures under such part.
Voted NO on subsidizing private insurance for Medicare Rx drug coverage.
HR 4680, the Medicare Rx 2000 Act, would institute a new program to provide voluntary prescription drug coverage for Medicare beneficiaries through subsidies to private plans. The program would cost an estimated $40 billion over five years and would go into effect in fiscal 2003.
Reference: Bill sponsored by Thomas, R-CA;
Bill HR 4680
; vote number 2000-357
on Jun 28, 2000
Voted YES on banning physician-assisted suicide.
Vote on HR 2260, the Pain Relief Promotion Act of 1999, would ban the use of drugs for physician-assisted suicide. The bill would not allow doctors to give lethal prescriptions to terminally ill patients, and instead promotes "palliative care," or aggressive pain relief techniques.
Reference: Bill sponsored by Hyde, R-IL;
Bill HR 2260
; vote number 1999-544
on Oct 27, 1999
Voted YES on establishing tax-exempt Medical Savings Accounts.
The bill allows all taxpayers to create a tax-exempt account for paying medical expenses called a Medical Savings Account [MSA]. Also, the measure would allow the full cost of health care premiums to be taken as a tax deduction for the self-employed and taxpayers who are paying for their own insurance. The bill would also allow the establishment of "HealthMarts," regional groups of insurers, health care providers and employers who could work together to develop packages for uninsured employees. Another provision of the bill would establish "association health plan," in which organizations could combine resources to purchase health insurance at better rates than they could separately.
Reference: Bill sponsored by Talent, R-MO;
Bill HR 2990
; vote number 1999-485
on Oct 6, 1999
Expand medical savings accounts for employers & individuals.
Coburn co-sponsored expanding medical savings accounts for employers
To expand the availability of medical savings accounts. Amends the Internal Revenue Code with respect to medical savings accounts to:
repeal the limitation on the number of accounts;
make all employers (currently limited to small employers) eligible to offer accounts;
increase contribution deduction amounts;
permit employer and employee contributions;
reduce high deductible health plan deductibles; and
permit accounts to be offered under cafeteria plans.
Source: Medical Savings Account Effectiveness Act (H.R.614) 1999-H614 on Feb 8, 1999
