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Lamar Alexander on Health Care

Republican Sr Senator (TN); previously candidate for President

 


Delay Medicare Rx price increases & keep physician payments

Q: We believe that the Medicare prescription drug benefit law is flawed--we support a simple, easy-to-use drug benefit. Do you support the Prescription Drug Benefit?

A: Recently, I supported the Medicare Improvements for Patients and Providers Act, which became law in July 2008. This bill allows Medicare beneficiaries to continue to receive medications at an affordable price by delaying the Average Manufacturer Price (AMP) until September 2009 and enforcing a prompt payment reimbursement provision for local pharmacists. Additionally, by reversing a 10.6 percent cut in Medicare reimbursements rates for physicians, this bill protects seniors’ access to health care by ensuring that physicians can afford to continue to treat Medicare patients.

Source: Senior Citizens League Guide to the 2008 US Senate Campaigns , Oct 10, 2008

Patient’s bill of rights with four principles; but not suing

    I support a “patient’s bill of rights” which advocates 4 main principles:
  1. Patients should have the right to make decisions about their choice of doctor & health care.
  2. We must eliminate needless bureaucracy, red tape & mandates.
  3. We must lower the cost of health care through reducing waste, fraud & frivolous law suits.
  4. Patients should be involved in the decisions regarding the cost of their care through the adoption of medical savings accounts & the elimination of 3rd party gatekeepers.
    Source: www.LamarAlexander.org/issue , May 25, 1999

    For uninsured: church-based Health Care Networks

    As for those who are currently uninsured, there is a solution and it lies in communities all over America. Right now employment-based coverage is treated as tax-free compensation. We should allow local churches and unions to receive the same tax-free treatment so they can form Health Care Networks for part time workers, those who switch jobs frequently or for individuals who are simply uninsured.
    Source: www.LamarAlexander.org/issue , May 25, 1999

    Medicare provides a menu of plans, some with add-on costs

    Medicare needs to be strengthened by giving people more choices of quality care. I favor giving Medicare recipients the option of choosing from a menu of private insurance plans of remaining in the current government plan. The government portion of the premium would pay for basic coverage and the individual’s cost would go towards more deluxe plans - thus Medicare recipients would get the coverage they need, but would have a strong incentive to pick a cost effective plan.
    Source: www.LamarAlexander.org/issue , May 25, 1999

    Voted YES on the Ryan Budget: Medicare choice, tax & spending cuts.

    Proponent's Arguments for voting Yes:

    [Sen. DeMint, R-SC]: The Democrats have Medicare on a course of bankruptcy. Republicans are trying to save Medicare & make sure there are options for seniors in the future. Medicare will not be there 5 or 10 years from now. Doctors will not see Medicare patients at the rate [Congress will] pay.

    [Sen. Ayotte, R-NH]: We have 3 choices when it comes to addressing rising health care costs in Medicare. We can do nothing & watch the program go bankrupt in 2024. We can go forward with the President's proposal to ration care through an unelected board of 15 bureaucrats. Or we can show real leadership & strengthen the program to make it solvent for current beneficiaries, and allow future beneficiaries to make choices.

    Opponent's Arguments for voting No:

    [Sen. Conrad, D-ND]: In the House Republican budget plan, the first thing they do is cut $4 trillion in revenue over the next 10 years. For the wealthiest among us, they give them an additional $1 trillion in tax reductions. To offset these massive new tax cuts, they have decided to shred the social safety net. They have decided to shred Medicare. They have decided to shred program after program so they can give more tax cuts to those who are the wealthiest among us.

    [Sen. Merkley, D-TK]: The Republicans chose to end Medicare as we know it. The Republican plan reopens the doughnut hole. That is the hole into which seniors fall when, after they have some assistance with the first drugs they need, they get no assistance until they reach a catastrophic level. It is in that hole that seniors have had their finances devastated. We fixed it. Republicans want to unfix it and throw seniors back into the abyss. Then, instead of guaranteeing Medicare coverage for a fixed set of benefits for every senior--as Medicare does now--the Republican plan gives seniors a coupon and says: Good luck. Go buy your insurance. If the insurance goes up, too bad.
    Status: Failed 40-57

    Reference: Ryan Budget Plan; Bill HCR34&SCR21 ; vote number 11-SV077 on May 25, 2011

    Voted NO on regulating tobacco as a drug.

    Congressional Summary:Amends the Federal Food, Drug, and Cosmetic Act (FFDCA) to provide for the regulation of tobacco products by the Secretary of Health and Human Services through the Food and Drug Administration (FDA). Defines a tobacco product as any product made or derived from tobacco that is intended for human consumption. Excludes from FDA authority the tobacco leaf and tobacco farms.

    Opponent's argument to vote No:Rep. HEATH SHULER (D, NC-11): Putting a dangerous, overworked FDA in charge of tobacco is a threat to public safety. Last year, the FDA commissioner testified that he had serious concerns that this bill could undermine the public health role of the FDA. And the FDA Science Board said the FDA's inability to keep up with scientific advancements means that Americans' lives will be at risk.

    Proponent's argument to vote Yes: Rep. HENRY WAXMAN (D, CA-30): The bill before us, the Waxman-Platts bill, has been carefully crafted over more than a decade, in close consultation with the public health community. It's been endorsed by over 1,000 different public health, scientific, medical, faith, and community organizations.

    Sen. HARRY REID (D, NV): Yesterday, 3,500 children who had never smoked before tried their first cigarette. For some, it will also be their last cigarette but certainly not all. If you think 3,500 is a scary number, how about 3.5 million. That is a pretty scary number. That is how many American high school kids smoke--3.5 million. Nearly all of them aren't old enough to buy cigarettes. It means we have as many boys and girls smoking as are participating in athletics in high schools. We have as many as are playing football, basketball, track and field, and baseball combined.

    Reference: Family Smoking Prevention and Tobacco Control Act; Bill HR1256&S982 ; vote number 2009-S207 on Jun 11, 2009

    Voted YES on expanding the Children's Health Insurance Program.

    Congressional Summary:

    Proponent's argument to vote Yes:

    Rep. FRANK PALLONE (D, NJ-6): In the last Congress, we passed legislation that enjoyed bipartisan support as well as the support of the American people. Unfortunately, it did not enjoy the support of the President, who vetoed our bill twice, and went on to proclaim that uninsured children can simply go to the emergency room to have their medical needs met. As the Nation moves deeper into a recession and unemployment rates continue to rise, millions of Americans are joining the ranks of the uninsured, many of whom are children. We can't delay. We must enact this legislation now.

    Opponent's argument to vote No:Rep. ROY BLUNT (R, MI-7): This bill doesn't require the States to meet any kind of threshold standard that would ensure that States were doing everything they could to find kids who needed insurance before they begin to spend money to find kids who may not have the same need. Under the bill several thousands of American families would be poor enough to qualify for SCHIP and have the government pay for their health care, but they'd be rich enough to still be required to pay the alternative minimum tax. The bill changes welfare participation laws by eliminating the 5-year waiting period for legal immigrants to lawfully reside in the country before they can participate in this program. In the final bill, we assume that 65% of the children receiving the benefit wouldn't get the benefit anymore. It seems to me this bill needs more work, would have benefited from a committee hearing. It doesn't prioritize poor kids to ensure that they get health care first.

    Reference: SCHIP Reauthorization Act; Bill H.R.2 ; vote number 2009-S031 on Jan 29, 2009

    Voted YES on overriding veto on expansion of Medicare.

    Congressional Summary:Pres. GEORGE W. BUSH's veto message (argument to vote No):In addition, H.R. 6331 would delay important reforms like the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies competitive bidding program. Changing policy in mid-stream is also confusing to beneficiaries who are receiving services from quality suppliers at lower prices. In order to slow the growth in Medicare spending, competition within the program should be expanded, not diminished.

    Proponent's argument to vote Yes: Sen. PATTY MURRAY (D, WA): President Bush vetoed a bill that would make vital improvements to the program that has helped ensure that millions of seniors and the disabled can get the care they need. This bill puts an emphasis on preventive care that will help our seniors stay healthy, and it will help to keep costs down by enabling those patients to get care before they get seriously ill. This bill will improve coverage for low-income seniors who need expert help to afford basic care. It will help make sure our seniors get mental health care.

    Reference: Medicare Improvements for Patients and Providers Act; Bill HR.6331 ; vote number 2008-S177 on Jul 15, 2008

    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

    Reference: Bill S.Amdt.4240 to S.Con.Res.70 ; vote number 08-S063 on Mar 13, 2008

    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--
    1. improve Indian access to high quality health care services;
    2. provide incentives to Indian patients to seek preventive health care services;
    3. create opportunities for Indians to participate in the health care decision process;
    4. encourage effective use of health care services by Indians; and
    5. 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?

    LEGISLATIVE OUTCOME:Amendment rejected, 28-67

    Reference: Tribal Member Choice Program; Bill SA.4034 to SA.3899 to S.1200 ; vote number 08-S025 on Feb 14, 2008

    Voted YES 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]:

    1. It terminates the coverage of childless adults.
    2. 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.
    3. 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:

    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 YES on limiting medical liability lawsuits to $250,000.

    A "cloture motion" cuts off debate. Voting YEA indicates support for the bill as written, in this case to cap medical liability lawsuits. Voting NAY indicates opposition to the bill or a desire to amend it. This bill would "provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system." It would limit medical lawsuit noneconomic damages to $250,000 from the health care provider, and no more than $500,000 from multiple health care institutions.
    Reference: Medical Care Access Protection Act; Bill S. 22 ; vote number 2006-115 on May 8, 2006

    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.
    Reference: Medicare Part D Amendment; Bill S Amdt 2730 to HR 4297 ; vote number 2006-005 on Feb 2, 2006

    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.
    Reference: Prescription Drug Amendment; Bill S.Amdt. 214 to S.Con.Res. 18 ; vote number 2005-60 on Mar 17, 2005

    Voted YES on $40 billion per year for limited Medicare prescription drug benefit.

    S. 1 As Amended; Prescription Drug and Medicare Improvement Act of 2003. Vote to pass a bill that would authorize $400 billion over 10 years to create a prescription drug benefit for Medicare recipients beginning in 2006. Seniors would be allowed to remain within the traditional fee-for-service program or seniors would have the option to switch to a Medicare Advantage program that includes prescription drug coverage. Private insurers would provide prescription drug coverage. Private Insurers would engage in competitive bidding to be awarded two-year regional contracts by the Center for Medicare Choices under the Department of Health and Human Services.Enrolled seniors would pay a $275 deductible and an average monthly premium of $35. Annual drug costs beyond the deductible and up to $4,500 would be divided equally between the beneficiary and the insurer. Beneficiaries with incomes below 160 percent of the poverty level would be eligible for added assistance.
    Reference: Medicare Prescription Drug Benefit bill; Bill S.1/H.R.1 ; vote number 2003-262 on Jun 26, 2003

    Rated 0% by APHA, indicating a anti-public health voting record.

    Alexander scores 0% by APHA on health issues

    The American Public Health Association (APHA) is the oldest and largest organization of public health professionals in the world, representing more than 50,000 members from over 50 occupations of public health. APHA is concerned with a broad set of issues affecting personal and environmental health, including federal and state funding for health programs, pollution control, programs and policies related to chronic and infectious diseases, a smoke-free society, and professional education in public health.

    The following ratings are based on the votes the organization considered most important; the numbers reflect the percentage of time the representative voted the organization's preferred position.

    Source: APHA website 03n-APHA on Dec 31, 2003

    Religious exemption from ObamaCare individual mandate.

    Alexander co-sponsored H.R.631 & S.352

    Congressional Summary: To provide an additional religious exemption from the individual health coverage mandate. This Act may be cited as the 'Equitable Access to Care and Health Act' or the 'EACH Act'. The 'Religious Conscience Exemption' exempts individuals who are members of a recognized religious sect which relies solely on a religious method of healing, and for whom the acceptance of medical health services would be inconsistent with their religious beliefs.

    Supporters reasons for voting YEA: (TheHill.com weblog, April 29, 2013): "We believe the EACH Act balances a respect for religious diversity against the need to prevent fraud and abuse," wrote Reps. Aaron Schock (R-IL) and William Keating (D-MA). "It is imperative we expand the religious conscience exemption now as the Administration is verifying the various exemptions to the individual mandate," they wrote. Religious exemption from ObamaCare has come up before, including contraception. The EACH Act, however, deals only with exemptions from the insurance mandate.

    Opponents reasons for voting NAY: (CHILD, Inc. "Children's Healthcare Is a Legal Duty", Dec. 2014): The Christian Science church is pushing hard to get another religious exemption through Congress. The EACH Act exempts everyone with "sincerely held religious beliefs" from the mandate to buy health insurance. We are particularly concerned about uninsured children: hundreds of American children have died because of their family's religious objections to medical care. The EACH Act increases the risk to children in faith-healing sects and the cost to the state if the children do get medical care. Some complain that their church members should not have to pay for health care that they won't use. But insurance works on the assumption that many in the pool of policyholders will not draw from it. Most people with fire insurance don't have their homes burn, for example.

    Source: EACH Act 15_S352 on Feb 3, 2015

    Establishment of Office of Health Care Fraud Prevention.

    Alexander signed establishing of Office of Health Care Fraud Prevention

    SPONSOR'S INTRODUCTORY REMARKS:

    Sen. LeMIEUX. The current proposal for health care is a $1 trillion proposal. If we spent as much time caring about the money we are spending now, as opposed to the money some in this Chamber want to spend, I suspect we could find plenty of money to either return to the people or to find money for these new programs.

    Today, I wish to talk about just such an idea, an idea to recover some of the waste, fraud, and abuse that is currently happening in our current provision of health care--in Medicare and Medicaid. Estimates are that some $60 billion to a staggering $226 billion a year to waste, fraud, and abuse.

    This health care proposal that we are discussing in the Senate is $1 trillion over 10 years. That is about $100 billion a year. We may be wasting $226 billion a year. If we captured just half of that, we might be able to pay for this program.

    Why can't we do the same thing the credit card companies are doing for health care? Why can't we use a predictive modeling system that says a health care claim is not going to be paid when a red flag comes up? Right now we are on a pay-and-chase system. If we put this predictive modeling system in, it stops the fraud before it happens. The credit card industry benchmark is 0.1% while fraud losses in the health care business run from 3% to 14%.

    Source: Prevent Health Care Fraud Act of 2009 (S.2128 & H.R.4222 ) 2009-S2128 on Oct 29, 2009

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