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Richard D.
Democrat IL

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  • Statements on Introduced Bills and Joint Resolutions

    by Senator Richard J. Durbin

    Posted on 2013-02-28

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    DURBIN (for himself, Mr. Reed, and Mr. Whitehouse): S. 408. A bill to amend title XVIII of the Social Security Act to deliver a meaningful benefit and lower prescription drug prices under the Medicare program; to the Committee on Finance.



    Mr. DURBIN. Mr. President, last week TIME Magazine published an extensive piece that took a close look at the hidden costs within our health care system and how the Medicare program, which is widely disparaged these days, is effective in controlling costs.

    We as a nation will spend $2.8 trillion this year on health care. That is on average 27 percent more than what is spent per capita in other developed countries.

    According to the TIME article, many hospitals routinely overcharge patients and reap profits at the expense of American families. As one former hospital billing officer put it, ``hospitals all know the bills are fiction.'' Too many families are put on the path to financial ruin because of hospital bills.

    Another thing the TIME piece highlighted was that Medicare is much more effective at controlling costs than private sector providers, whether non-profit or for-profit.

    Because Medicare sets the prices it is willing to pay providers in advance, patients with Medicare coverage are charged substantially less than patients with private health insurance who have received the same services.

    In fact, projected Medicare spending over the 2011-2020 period is more than $500 billion lower since late 2010 than CBO projected.

    But we can do more. Every day, 10,000 Americans turn 65 and become eligible for Medicare. In 11 years, Medicare's hospital insurance fund will start paying out more in benefits than it takes in.

    Meaningful reforms that lead to better health care at lower costs are good for America's seniors--and for our entire health care system. And that should start with changes to Part D.

    Today, I am introducing with Senators Whitehouse and Jack Reed the Medicare Prescription Drug Savings and Choice Act.

    Our bill would save taxpayer dollars by giving Medicare beneficiaries the choice to participate in a Medicare Part D prescription drug plan run by Medicare, not private insurance companies.

    Seniors want the ability to choose a Medicare-administered drug plan, so let's give them this option.

    In 2010, Americans spent approximately $260 billion on prescription drugs. That figure is projected to double over the next decade. However, patients in the United States spend 50 percent more than other developed countries for the same drugs.

    The average monthly price of cancer drugs has doubled over the past 10 years, from about $5,000 to more than $10,000.

    Of the 12 new cancer drugs approved by the FDA last year, 11 were priced above $100,000 a year.

    About 77 percent of all cancers are diagnosed in persons 55 years of age and older.

    As these people enter the program, Medicare should be allowed to control how much it pays for these prescription drugs.

    While the Affordable Care Act does a lot to control costs in the private insurance market, current law handcuffs Medicare beneficiaries from obtaining competitive prices for their prescription drugs.

    For all other Medicare programs, beneficiaries can choose whether to receive benefits directly through Medicare or through a private insurance plan.

    The overwhelming majority of seniors choose the Medicare-run option for their hospital and physician coverage.

    Our bill requires the Secretary of HHS to develop at least one nationwide prescription drug plan.

    Why? Because we should take advantage of the Federal Government's purchasing power.

    The Veterans Administration uses this type of negotiating authority and has cut drug prices by as much as 50 percent for our Nation's veterans.

    [[Page S1016]] Savings from negotiating on behalf of seniors in Medicare could be used to further reduce costs in the program and ensure the program is there for future generations.

    America's health care system is burdening families and hindering our ability to invest in the future.

    The Affordable Care Act takes important steps to begin bringing down costs in the private market and in Medicare, but there is more we can do. This proposal is a simple and common sense option that should be available for seniors.

    Allowing Medicare to manage a prescription drug plan and negotiate prices, taxpayers will save money and seniors will get high quality drug coverage.

    Mr. President, I ask unanimous consent that the text of the bill and letters of support be printed in the Record.

    There being no objection, the material was ordered to be printed in the Record, as follows: S. 408 Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicare Prescription Drug Savings and Choice Act of 2013''.

    SEC. 2. ESTABLISHMENT OF MEDICARE OPERATED PRESCRIPTION DRUG PLAN OPTION.

    (a) In General.--Subpart 2 of part D of title XVIII of the Social Security Act is amended by inserting after section 1860D-11 (42 U.S.C. 1395w-111) the following new section: ``medicare operated prescription drug plan option ``Sec. 1860D-11A. (a) In General.--Notwithstanding any other provision of this part, for each year (beginning with 2014), in addition to any plans offered under section 1860D- 11, the Secretary shall offer one or more Medicare operated prescription drug plans (as defined in subsection (c)) with a service area that consists of the entire United States and shall enter into negotiations in accordance with subsection (b) with pharmaceutical manufacturers to reduce the purchase cost of covered part D drugs for eligible part D individuals who enroll in such a plan.

    ``(b) Negotiations.--Notwithstanding section 1860D-11(i), for purposes of offering a Medicare operated prescription drug plan under this section, the Secretary shall negotiate with pharmaceutical manufacturers with respect to the purchase price of covered part D drugs in a Medicare operated prescription drug plan and shall encourage the use of more affordable therapeutic equivalents to the extent such practices do not override medical necessity as determined by the prescribing physician. To the extent practicable and consistent with the previous sentence, the Secretary shall implement strategies similar to those used by other Federal purchasers of prescription drugs, and other strategies, including the use of a formulary and formulary incentives in subsection (e), to reduce the purchase cost of covered part D drugs.

    ``(c) Medicare Operated Prescription Drug Plan Defined.-- For purposes of this part, the term `Medicare operated prescription drug plan' means a prescription drug plan that offers qualified prescription drug coverage and access to negotiated prices described in section 1860D-2(a)(1)(A). Such a plan may offer supplemental prescription drug coverage in the same manner as other qualified prescription drug coverage offered by other prescription drug plans.

    ``(d) Monthly Beneficiary Premium.-- ``(1) Qualified prescription drug coverage.--The monthly beneficiary premium for qualified prescription drug coverage and access to negotiated prices described in section 1860D- 2(a)(1)(A) to be charged under a Medicare operated prescription drug plan shall be uniform nationally. Such premium for months in 2014 and each succeeding year shall be based on the average monthly per capita actuarial cost of offering the Medicare operated prescription drug plan for the year involved, including administrative expenses.

    ``(2) Supplemental prescription drug coverage.--Insofar as a Medicare operated prescription drug plan offers supplemental prescription drug coverage, the Secretary may adjust the amount of the premium charged under paragraph (1).

    ``(e) Use of a Formulary and Formulary Incentives.-- ``(1) In general.--With respect to the operation of a Medicare operated prescription drug plan, the Secretary shall establish and apply a formulary (and may include formulary incentives described in paragraph (2)(C)(ii)) in accordance with this subsection in order to-- ``(A) increase patient safety; ``(B) increase appropriate use and reduce inappropriate use of drugs; and ``(C) reward value.

    ``(2) Development of initial formulary.-- ``(A) In general.--In selecting covered part D drugs for inclusion in a formulary, the Secretary shall consider clinical benefit and price.

    ``(B) Role of ahrq.--The Director of the Agency for Healthcare Research and Quality shall be responsible for assessing the clinical benefit of covered part D drugs and making recommendations to the Secretary regarding which drugs should be included in the formulary. In conducting such assessments and making such recommendations, the Director shall-- ``(i) consider safety concerns including those identified by the Federal Food and Drug Administration; ``(ii) use available data and evaluations, with priority given to randomized controlled trials, to examine clinical effectiveness, comparative effectiveness, safety, and enhanced compliance with a drug regimen; ``(iii) use the same classes of drugs developed by the United States Pharmacopeia for this part; ``(iv) consider evaluations made by-- ``(I) the Director under section 1013 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003; ``(II) other Federal entities, such as the Secretary of Veterans Affairs; and ``(III) other private and public entities, such as the Drug Effectiveness Review Project and State plans under title XIX; and ``(v) recommend to the Secretary-- ``(I) those drugs in a class that provide a greater clinical benefit, including fewer safety concerns or less risk of side-effects, than another drug in the same class that should be included in the formulary; ``(II) those drugs in a class that provide less clinical benefit, including greater safety concerns or a greater risk of side-effects, than another drug in the same class that should be excluded from the formulary; and ``(III) drugs in a class with same or similar clinical benefit for which it would be appropriate for the Secretary to competitively bid (or negotiate) for placement on the formulary.

    ``(C) Consideration of ahrq recommendations.-- ``(i) In general.--The Secretary, after taking into consideration the recommendations under subparagraph (B)(v), shall establish a formulary, and formulary incentives, to encourage use of covered part D drugs that-- ``(I) have a lower cost and provide a greater clinical benefit than other drugs; ``(II) have a lower cost than other drugs with the same or similar clinical benefit; and ``(III) drugs that have the same cost but provide greater clinical benefit than other drugs.

    ``(ii) Formulary incentives.--The formulary incentives under clause (i) may be in the form of one or more of the following: ``(I) Tiered copayments.

    ``(II) Reference pricing.

    ``(III) Prior authorization.

    ``(IV) Step therapy.

    ``(V) Medication therapy management.

    ``(VI) Generic drug substitution.

    ``(iii) Flexibility.--In applying such formulary incentives the Secretary may decide not to impose any cost-sharing for a covered part D drug for which-- ``(I) the elimination of cost sharing would be expected to increase compliance with a drug regimen; and ``(II) compliance would be expected to produce savings under part A or B or both.

    ``(3) Limitations on formulary.--In any formulary established under this subsection, the formulary may not be changed during a year, except-- ``(A) to add a generic version of a covered part D drug that entered the market; ``(B) to remove such a drug for which a safety problem is found; and ``(C) to add a drug that the Secretary identifies as a drug which treats a condition for which there has not previously been a treatment option or for which a clear and significant benefit has been demonstrated over other covered part D drugs.

    ``(4) Adding drugs to the initial formulary.-- ``(A) Use of advisory committee.--The Secretary shall establish and appoint an advisory committee (in this paragraph referred to as the `advisory committee')-- ``(i) to review petitions from drug manufacturers, health care provider organizations, patient groups, and other entities for inclusion of a drug in, or other changes to, such formulary; and ``(ii) to recommend any changes to the formulary established under this subsection.

    ``(B) Composition.--The advisory committee shall be composed of 9 members and shall include representatives of physicians, pharmacists, and consumers and others with expertise in evaluating prescription drugs. The Secretary shall select members based on their knowledge of pharmaceuticals and the Medicare population. Members shall be deemed to be special Government employees for purposes of applying the conflict of interest provisions under section 208 of title 18, United States Code, and no waiver of such provisions for such a member shall be permitted.

    ``(C) Consultation.--The advisory committee shall consult, as necessary, with physicians who are specialists in treating the disease for which a drug is being considered.

    ``(D) Request for studies.--The advisory committee may request the Agency for Healthcare Research and Quality or an academic or research institution to study and make a report on a petition described in subparagraph (A)(i) in order to assess-- ``(i) clinical effectiveness; ``(ii) comparative effectiveness; ``(iii) safety; and [[Page S1017]] ``(iv) enhanced compliance with a drug regimen.

    ``(E) Recommendations.--The advisory committee shall make recommendations to the Secretary regarding-- ``(i) whether a covered part D drug is found to provide a greater clinical benefit, including fewer safety concerns or less risk of side-effects, than another drug in the same class that is currently included in the formulary and should be included in the formulary; ``(ii) whether a covered part D drug is found to provide less clinical benefit, including greater safety concerns or a greater risk of side-effects, than another drug in the same class that is currently included in the formulary and should not be included in the formulary; and ``(iii) whether a covered part D drug has the same or similar clinical benefit to a drug in the same class that is currently included in the formulary and whether the drug should be included in the formulary.

    ``(F) Limitations on review of manufacturer petitions.--The advisory committee shall not review a petition of a drug manufacturer under subparagraph (A)(i) with respect to a covered part D drug unless the petition is accompanied by the following: ``(i) Raw data from clinical trials on the safety and effectiveness of the drug.

    ``(ii) Any data from clinical trials conducted using active controls on the drug or drugs that are the current standard of care.

    ``(iii) Any available data on comparative effectiveness of the drug.

    ``(iv) Any other information the Secretary requires for the advisory committee to complete its review.

    ``(G) Response to recommendations.--The Secretary shall review the recommendations of the advisory committee and if the Secretary accepts such recommendations the Secretary shall modify the formulary established under this subsection accordingly. Nothing in this section shall preclude the Secretary from adding to the formulary a drug for which the Director of the Agency for Healthcare Research and Quality or the advisory committee has not made a recommendation.

    ``(H) Notice of changes.--The Secretary shall provide timely notice to beneficiaries and health professionals about changes to the formulary or formulary incentives.

    ``(f) Informing Beneficiaries.--The Secretary shall take steps to inform beneficiaries about the availability of a Medicare operated drug plan or plans including providing information in the annual handbook distributed to all beneficiaries and adding information to the official public Medicare website related to prescription drug coverage available through this part.

    ``(g) Application of All Other Requirements for Prescription Drug Plans.--Except as specifically provided in this section, any Medicare operated drug plan shall meet the same requirements as apply to any other prescription drug plan, including the requirements of section 1860D-4(b)(1) relating to assuring pharmacy access.''.

    (b) Conforming Amendments.-- (1) Section 1860D-3(a) of the Social Security Act (42 U.S.C. 1395w-103(a)) is amended by adding at the end the following new paragraph: ``(4) Availability of the medicare operated prescription drug plan.--A Medicare operated prescription drug plan (as defined in section 1860D-11A(c)) shall be offered nationally in accordance with section 1860D-11A.''.

    (2)(A) Section 1860D-3 of the Social Security Act (42 U.S.C. 1395w-103) is amended by adding at the end the following new subsection: ``(c) Provisions Only Applicable in 2006 Through 2013.--The provisions of this section shall only apply with respect to 2006 through 2013.''.

    (B) Section 1860D-11(g) of such Act (42 U.S.C. 1395w- 111(g)) is amended by adding at the end the following new paragraph: ``(8) No authority for fallback plans after 2013.--A fallback prescription drug plan shall not be available after December 31, 2013.''.

    (3) Section 1860D-13(c)(3) of the Social Security Act (42 U.S.C. 1395w-113(c)(3)) is amended-- (A) in the heading, by inserting ``and medicare operated prescription drug plans'' after ``Fallback plans''; and (B) by inserting ``or a Medicare operated prescription drug plan'' after ``a fallback prescription drug plan''.

    (4) Section 1860D-16(b)(1) of the Social Security Act (42 U.S.C. 1395w-116(b)(1)) is amended-- (A) in subparagraph (C), by striking ``and'' after the semicolon at the end; (B) in subparagraph (D), by striking the period at the end and inserting ``; and''; and (C) by adding at the end the following new subparagraph: ``(E) payments for expenses incurred with respect to the operation of Medicare operated prescription drug plans under section 1860D-11A.''.

    (5) Section 1860D-41(a) of the Social Security Act (42 U.S.C. 1395w-151(a)) is amended by adding at the end the following new paragraph: ``(19) Medicare operated prescription drug plan.--The term `Medicare operated prescription drug plan' has the meaning given such term in section 1860D-11A(c).''.

    SEC. 3. IMPROVED APPEALS PROCESS UNDER THE MEDICARE OPERATED PRESCRIPTION DRUG PLAN.

    Section 1860D-4(h) of the Social Security Act (42 U.S.C. 1305w-104(h)) is amended by adding at the end the following new paragraph: ``(4) Appeals process for medicare operated prescription drug plan.-- ``(A) In general.--The Secretary shall develop a well- defined process for appeals for denials of benefits under this part under the Medicare operated prescription drug plan. Such process shall be efficient, impose minimal administrative burdens, and ensure the timely procurement of non-formulary drugs or exemption from formulary incentives when medically necessary. Medical necessity shall be based on professional medical judgment, the medical condition of the beneficiary, and other medical evidence. Such appeals process shall include-- ``(i) an initial review and determination made by the Secretary; and ``(ii) for appeals denied during the initial review and determination, the option of an external review and determination by an independent entity selected by the Secretary.

    ``(B) Consultation in development of process.--In developing the appeals process under subparagraph (A), the Secretary shall consult with consumer and patient groups, as well as other key stakeholders to ensure the goals described in subparagraph (A) are achieved.''.

    Alliance for a Just Society, February 28, 2013.

    Reduce Pharmaceutical Prices--Do Not Cut Benefits Dear President Obama and Senator/Representative: We have noted with great concern that federal budget discussions have included the possibility of cuts to Medicare and Medicaid. We wish to be clear: We strongly oppose such an approach and believe it to be both unnecessary and a no-growth policy for an economy that remains stagnant.

    Medicare and Medicaid not only provide critical protections against the economic deprivation caused by illness, especially for older Americans; they also create jobs and boost an economy that is slumbering. Cutting these programs leads this country in the wrong direction.

    We cannot continue to unravel these critical programs for working families, the elderly, and the poor. If the Congress is unable to move forward without some compromise that reduces our national commitment to quality Medicare and Medicaid programs, there is a source for reductions that will not harm beneficiaries: the cost of prescription drugs.

    The U.S. pays more for prescriptions than any nation in the world. Medicare and Medicaid beneficiaries pay more for medicines than do our veterans and the clients of the National Indian Health Service. Why do these differences in cost persist? They do so because other countries, the VA, and the IHS negotiate the prices for prescriptions, while Medicare and Medicaid programs do not.

    According to the Center for Economic and Policy Research, savings to the federal government over the next decade would be as high as $541.3 billion. The saving to the states would be as high as $72.7 billion, and beneficiaries would save $112.4 billion. These amounts are far in excess of the demand for expenditure reductions being suggested by the most strident deficit reduction advocates.

    We are more than 275 national and state organizations, and we are opposed to cutting health care benefits for the elderly and the poor. However, saving money by negotiating drug prices would be beneficial to the entire health care system, in addition to saving money for the federal government and the states. We urge you to pursue this policy as a major part of efforts to reduce health care costs.

    Sincerely, National 9to5, AFL-CIO, AFSCME (American Federation of State, County and Municipal Employees), Alliance for a Just Society, Alliance for Retired Americans, Association of Asian Pacific Community Health Organizations, Campaign for America's Future, Campaign for Community Change, Center for Popular Democracy, Coalition on Human Needs, Community Action Partnership, Community Organizations in Action, Grassroots Policy Project, HCAN (Health Care for America Now!), Institute for Policy Studies, Break the Chain Campaign, Jobs With Justice, Leadership Center for Common Good, National Domestic Workers Alliance, National Education Association.

    National Legislative Association on Prescription Drug Prices--20 signers (see attached letter): Rep. Sharon Engle Treat (ME), Rep. Nickie Antonia (OH), Rep. Sheryl Briggs (ME), Sen. Capri Cafaro (OH), Rep. Michael Foley (OH), Sen. Dede Feldman (NM), Assemblyperson Richard N. Gottfried (NY), Sen. Jack Hatch (IO), Sen. Karen Keiser (WA), Sen. Sue Malek (MT), Sen. Kevin Mullin (VT), Rep. Don Perdue (WV), Rep. Elizabeth B. Ritter (CT), Rep. Cindy Rosenwald (NH), Rep. Linda Sanborn (ME), Rep. Shay Shual-Berke (MD), Sen. Michael J. Skindell (OH), Rep. Peter Stuckey (ME), Rep. Roy Takumi (HI), Rep. Joan Welsh (ME).

    National Health Care for the Homeless Council, National Health Law Program, National Korean American Service & Education Consortium, National People's Action, National Women's Health Network, New Bottom Line, PICO National Network, [[Page S1018]] Progressive Democrats of America, Racial and Ethnic Health Disparities Coalition, Raising Women's Voices for the Health Care We Need, Rights to the City, Service Employees International Union, Social Security Works, UAW (United Auto Workers), Universal Health Care Action Network, USAction, Working America, AFL-CIO, Working Families Party.

    Alabama Federation Of Child Care Centers of Alabama.

    Arkansas Arkansas Community Organizations.

    California 9to5 California, Alliance of Californians for Community Empowerment, Center for Third World Organizing, People Organized for Westside Renewal, PICO California, San Diego Organizing Project, California Childcare Coordinators Association, California PIRG, Children's Defense Fund-- California, Community Health Council, Elsdon, Inc., Greenlining Institute, Molina Healthcare of California, National Association of Social Workers, CA Chapter.

    Colorado 9to5 Colorado, Colorado Progressive Coalition, Colorado Organization for Latina Opportunity and Reproductive Rights, Together Colorado.

    Connecticut Connecticut Citizen Action Group.

    Florida Central Florida Jobs with Justice, Community Business Association, Florida CHAIN, Florida Chinese Federation, Florida Civic Rights Association--Asian American Affairs, Florida Coalition on Black Civic Participation (FCBCP), Florida Consumer Action Network, Florida Consumer Action Network Foundation, Florida Institute for Reform & Empowerment, Florida New Majority, Florida Watch Action, Labor Council for Latin American Advancement of Central Florida (LCLAA of CF), National Congress of Black Women, Organization of Chinese Americans--South Florida Chapter, Organize Now, South Florida Jobs with Justice, United Chinese Association of Florida.

    Georgia 9to5 Atlanta, Georgia Rural Urban Summit.

    Hawaii Faith Action for Community Equity.

    Idaho Idaho Community Action Network, Idaho Main Street Alliance, Indian People's Action, United Action for Idaho, United Vision for Idaho.

    Illinois AFSCME Council 31, Chicago Federation of Labor, AFL-CIO, Citizen Action Illinois, Coalition of Labor Union Women (CLUW), Illinois Alliance for Retired Americans (IARA), Illinois Indiana Regional Organizing Network, Jane Addams Senior Caucus, Lakeview Action Coalition, Northside P.O.W.E.R., Public Action Foundation.

    Indiana Northwest Indiana Federation of Interfaith Organizations.

    Iowa Iowa Citizen Action Network, Iowa Citizen Action Network Foundation, Iowa Citizens for Community Improvement, Iowa Main Street Alliance.

    Louisiana Micah Project--New Orleans, PICO Louisiana.

    Maine Consumers for Affordable Healthcare, Maine Equal Justice Partners, Maine People's Alliance, Maine People's Resource Center, Maine Small Business Coalition, MSEA-SEIU Local 1989, Prescription Policy Choices.

    Maryland Maryland Communities United.

    Massachusetts Disability Policy Consortium.

    Michigan Harriet Tubman Center--Detroit, Metropolitan Coalition of Congregations, Metro Detroit, Michigan Citizen Action, Michigan Citizen Education Fund, Michigan Organizing Collaborative.

    Minnesota AFSCME Council 5, CWA Minnesota State Council, Health Care for All--Minnesota, ISAIAH, Jewish Community Action, Minnesota AFL--CIO, Minnesotans for a Fair Economy, Moveon.org Twin Cities Council, Physicians for a National Health Plan--Minnesota, SEIU Local 284, SEIU Minnesota State Council, Take Action Minnesota, UFCW Local 1189, Universal Health Care Action Network--Minnesota.

    Missouri Communities Creating Opportunity, GRO (Grass Roots Organizing), Metropolitan Congregations United, Missouri Progressive Vote Coalition, Missouri Citizen Education Fund, Missouri Jobs with Justice, Missourians Organizing for Change, Missourians Organizing for Reform and Empowerment, Missouri Rural Crisis Center, Progress Missouri.

    Montana AFSCME Council 9, Big Sky CLC--Helena, Greater Yellowstone CLC--Billings, Indian People's Action, MEA-MFT, Missoula Area CLC, Montana Alliance for Retired Americans, Montana Organizing Project, Montana Small Business Alliance, MT AFL- CIO State Federation, MT-HCAN, SEIU Healthcare 775 NW, Southcentral Montana CLC--Bozeman, Southwestern Montana CLC-- Butte.

    Nebraska Nebraska Urban Indian Health Clinic.

    Nevada Dream Big Las Vegas, Nevada Immigration Coalition, PLAN Action, Progressive Leadership Alliance of Nevada, Uniting Communities of Nevada.

    New Hampshire Granite State Organizing Project, New Hampshire Citizens Alliance, New Hampshire Citizens Alliance for Action.

    New Jersey New Jersey Citizen Action, New Jersey Citizen Action Education Fund, PICO New Jersey, New Jersey Communities United.

    New Mexico Organizers in the Land of Enchantment (OLE).

    New York Center for Independence of the Disabled--NY, Citizen Action of New York and Public Policy and Education Fund, Community Service Society of New York, Health Care for All New York, Institute of Puerto Rican/Hispanic Elderly Inc. Make the Road New York, Medicaid Matters New York, Metro New York Health Care for All Campaign, New York Communities for Change, New Yorkers for Accessible Health Coverage, Professional Staff Congress at CUNY Local 2334--AFT, Public Policy and Education Fund of New York, Small Business United, Syracuse United Neighbor.

    North Carolina Action North Carolina, Disability Rights NC, North Carolina Fair Share, North Carolina Justice Center, Unifour OneStop Collaborative.

    Ohio Communities United for Action, Contact Center, Fair Share Research and Education Fund, Mahoning Valley Organizing Collaborative, Ohio Alliance for Retired Americans Educational Fund, Ohio Organizing Collaborative, Progress Ohio, Progressive Democrats of America--Ohio Chapter, The People's Empowerment Coalition of Ohio, Toledo Area Jobs with Justice & Interfaith Worker Justice Coalition, UHCAN Ohio.

    Oregon Asian Pacific American Network of Oregon, Center for Intercultural Organizing, Fair Share Research and Education Fund, Main Street Alliance of Oregon, Oregon Action, Oregon Women's Action for New Directions, Rural Organizing Project, Portland Jobs with Justice, Urban League.

    Pennsylvania ACHIEVA, ACTION United, Be Well! Pittsburgh, Beaver County NOW, Consumer Health Coalition, Lutheran Advocacy Ministry of Pennsylvania, Maternity Care Coalition, New Voices Pittsburgh: Women of Color for Reproductive Justice, Pennsylvania Alliance for Retired Americans, Philadelphia Unemployment Project, Women's Law Project.

    Rhode Island Ocean State Action, Ocean State Action Fund.

    Tennessee Tennessee Citizen Action, Tennessee Citizen Action Alliance.

    Virginia SEIU Virginia 512, Virginia AFL-CIO, Virginia New Majority, Virginia Organizing.

    Washington AFGE Local 3937, Asian Pacific Islander Americans for Civic Empowerment, FUSE Washington, Health Care for All Washington, Main Street Alliance of Washington, OneAmerica, Physicians for a National Health Program--Western Washington, Puget Sound Advocates for Retirement Action, SEIU Healthcare 1199NW, SEIU Local 6, SEIU Local 775, SEIU Healthcare 775NW, Spokane Peace and Justice Action League, Washington CAN! Education and Research Fund, Washington CARE Campaign, Washington Community Action Network Education, Washington Fair Trade Coalition, Washington State Labor Council AFL-CIO, Working Washington.

    West Virginia West Virginia Citizen Action Group, West Virginia Citizen Action Education Fund.

    Wisconsin 9to5 Wisconsin, Citizen Action of Wisconsin, Citizen Action of Wisconsin Education Fund, Coalition of Wisconsin Aging Groups, M&S Clinical Services Assessment Center, Milwaukee Teachers Education Association (NEA), SEIU Healthcare Wisconsin, SOPHIA--Stewards of Prophetic, Hopeful, Intentional Action (Gamaliel), Wisconsin Federation of Nurses and Health Professionals (AFT).

    ____ National Committee To Preserve Social Security & Medicare, Washington, DC, February 28, 2013.

    Hon. Dick Durbin, U.S. Senate, Hart Office Building, Washington, DC.

    Hon. Janice Schakowsky, House of Representatives, Rayburn House Office Building, Washington, DC.

    Dear Senator Durbin and Representative Schakowsky: On behalf of the millions of members and supporters of the National Committee to Preserve Social Security and [[Page S1019]] Medicare, I am writing to express our support for the Medicare Prescription Drug Savings and Choice Act. We applaud this effort because it would improve the Medicare program for beneficiaries and reduce federal spending on prescriptions drugs.

    We understand that your legislation would create one or more Medicare-administered drug plans with uniform premiums, providing seniors with the opportunity to purchase drugs directly through the Medicare program. In addition, your legislation would require the federal government to use its purchasing power to negotiate lower prices on prescription drugs for beneficiaries who enroll in the Medicare- administered plan. The Department of Veterans Affairs and many state governments are able to deliver lower drug prices because of price negotiation, and we believe that the federal government should be able to receive the best price available for Medicare prescription drugs. Finally, we appreciate that your legislation establishes an advisory committee to assess a public formulary and streamlines the Medicare Part D appeals process, which will help all beneficiaries.

    Thank you for your continued leadership on Medicare, particularly for identifying ways to reduce Medicare spending without shifting costs to beneficiaries. We look forward to working with you to enact this important legislation.

    Sincerely, Max Richtman, President and CEO.

    ______ By Mr. ROCKEFELLER (for himself, Mr. Crapo, Mr. Wyden, and Mr. Moran): S. 411. A bill to amend the Internal Revenue Code of 1986 to extend and modify the railroad track maintenance credit; to the Committee on Finance.

    Mr. ROCKEFELLER. Mr. President, today I am joining my colleagues Senators, Crapo, Wyden, and Moran in introducing the Short Line Railroad Rehabilitation and Investment Act of 2013, legislation to extend for 3 years the Section 45G short line freight railroad tax credit.

    In the 112th Congress, I introduced a 6-year extension of this credit. Despite the often contentious atmosphere of the 112th Congress, during which my colleagues found little they could agree on, the short line rail credit was a bipartisan success story, with my legislation attracting more than 50 bipartisan cosponsors.

    ``Short line'' railroads are small freight rail companies responsible for bringing goods to communities that are not directly served by large, trans-continental railroads. Supporting small railroads allows the communities surrounding them to attract and maintain businesses and create jobs. The evidence of the success of this credit can be found in communities across America.

    This credit has real impact for the people of my state. West Virginia is the second biggest producer of railroad ties in the country. Since the credit was enacted, it is estimated 750,000 railroad ties have been purchased above what would have otherwise been purchased with no incentive. Those railroad ties translate directly into jobs. This credit does not create just West Virginia jobs though. The ties, spikes, and rail this credit helps fund are almost entirely American made.

    Over 12,000 rail customers across America depend on short lines. This credit creates a strong incentive for short lines to invest private sector dollars on private-sector freight railroad track rehabilitation and improvements. Unfortunately, it is now scheduled to expire at the end of 2013.

    We were unable to enact a full 6-year extension of this important tax credit last Congress, but I was pleased that this credit was extended through the end of 2013 as part of the December 31st fiscal cliff deal.

    This Congress I want to do more. This credit, and the short line railroads that serve all of our constituents, deserve a meaningful extension. If this credit is allowed to expire at the end of the year, private-sector investments in infrastructure in our communities will fall by hundreds of millions of dollars.

    This bill would extend the 45G credit through 2016, providing the important long-term planning certainty necessary to maximize private- sector transportation infrastructure investment. Over 50 members of this body sponsored legislation in the last Congress extending this credit and I hope there will be similar support again this year. I ask my colleagues to join me in supporting this important legislation.

    ______ By Mr. CORNYN (for himself, Mr. Blumenthal, Mr. Portman, and Ms. Klobuchar): S. 413. A bill to amend the Omnibus Crime Control and Safe Streets Act of 1968 to include human trafficking as a part 1 violent crime for purposes of the Edward Byrne Memorial Justice Assistance Grant Program; to the Committee on the Judiciary.

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