September 27, 2007

STATEMENT ON THE MEDICARE PREVENTIVE SERVICES COVERAGE ACT

Mr. CARDIN. Mr. President, I rise to introduce the Medicare Preventive Services Coverage Act of 2007. It has been ten years since Congress enacted the first comprehensive package of preventive services for Medicare beneficiaries. At the time Medicare was created in 1965, it was modeled closely after the indemnity health insurance policies of the time. As such, Medicare only covered the treatment of illnesses, and it paid for tests only when a symptom was present, but it did not cover preventive services. Over the next 3 decades, the medical community learned a great deal about the importance of preventive care. Although as early as the 1970s, health maintenance organizations had begun to cover cancer screenings and other wellness services, traditional Medicare had not kept pace.

The Balanced Budget Act of 1997 changed that. Working across the aisle, I introduced legislation that year to provide coverage for lifesaving screenings to Medicare beneficiaries. With strong bipartisan support, Congress added our language to BBA 1997, ensuring coverage for preventive services, including: an annual screening mammography for women over age 39; screening pap smear and pelvic examination for cervical cancer; prostate cancer screening; colorectal cancer screening; bone mass measurement for osteoporosis; and diabetes testing supplies and self-management training services.

Congress expanded this list of benefits in subsequent Medicare legislation. Now traditional Medicare also covers cardiovascular screenings to help prevent heart attacks and strokes; diabetes screenings; flu shots to help prevent influenza, glaucoma screening, medical nutrition therapy services, Hepatitis B vaccine, and ultrasound screening for aortic aneurysm.

Medicare also now covers a one-time Welcome to Medicare Visit'' within the first 6 months of Part B enrollment. This is an initial physical examination where beneficiaries can receive education and counseling about their medical history and needs, have some preventive screenings performed, and get referrals for other services.

Yes, over the past decade, Medicare has indeed made great strides toward helping our seniors get screened for diseases. But we have far to go.

The participation rate for Medicare preventive benefits is low. One key obstacle is financial. America's seniors still have the highest out-of-pocket costs of any age group. A 2007 Kaiser Family Foundation study compared out-of-pocket health care spending among age groups. For nonprescription drug expenses, it found that average spending for the over-65 population was nearly twice that for under-65 group. It also showed that on average, seniors in one-person households are spending 12.5 percent of their incomes on health care, versus 2.2 percent of those under 65. This means that excluding prescription drug costs, despite Medicare Part D, seniors will have very high medical bills that stretch their fixed incomes. It is no wonder that preventive services that require cost-sharing will be delayed or not received at all.

Over the years, we have also improved the benefits . We have waived the deductible for mammograms and colorectal cancer screenings. But cost sharing is still an obstacle for many seniors. They still must satisfy the deductible before getting reimbursed for the physical exam and most other services, and they must pay coinsurance for all other services except laboratory tests.

The bill that I am introducing today will waive the cost sharing for all preventive screenings and the Welcome to Medicare physical examination. It will also grant the Secretary of Health and Human Services the authority to add additional benefits as he or she determines to be reasonable and necessary for the prevention or early detection of an illness or disability.'' These determinations would take into account evidence-based recommendations by the U.S. Preventive Services Task Force and other organizations. Finally, my bill would extend eligibility for the Welcome to Medicare Visit from its current time frame of 6 months to 1 year.

This bill will mean the difference between early screening and delayed diagnosis and treatment. It will mean the difference between detecting a serious illness and providing hundreds of thousands of dollars of services later.

Let me explain why. Preventive services such as mammography and colonoscopy are important tools in the fight against serious disease. The earlier they are detected, the greater the chances of survival. For example, when caught in the first stages, the 5-year survival rate for breast cancer is 98 percent. But if the cancer has spread, that rate declines to 26 percent. Similarly, if colorectal cancer is detected in its early states, the survival rate is 90 percent, but only 10 percent if found when it is most advanced.

Our seniors are at particular risk for cancer. The greatest single risk factor for colorectal cancer is being over the age of 50, when more than 90 percent of cases are diagnosed. In addition to increasing survival rates, identifying diseases early reduces Medicare costs. In the case of colorectal cancer, Medicare will pay $207 for a screening colonoscopy in a medical facility, but if the patient is not diagnosed until the disease has metastasized, the cost of care can exceed $60,000 over the patient's lifetime. Medicare pays $98 for a mammogram, but if breast cancer is not detected early, treatment can cost tens of thousands of dollars more, depending on when the cancer is found and the course of treatment used. One drug used to treat late stage breast cancer can cost as much as $40,000 a year. There can be no doubt that these services are both life saving and cost saving. But if seniors cannot afford the copayments for these services, they may delay getting them.

In addition to cancer, diabetes is another prevalent disease among seniors. The statistics associated with diabetes are staggering. Nearly 20 million Americans are estimated to have diabetes. Approximately half know they have diabetes and another half have diabetes but do not know it. But once diagnosed, the co-morbidities associated with diabetes can be avoided. It is estimated that 90 percent of diabetes-related blindness is preventable, 50 percent of kidney disease requiring dialysis is preventable, 50 percent of diabetic-related amputations are preventable and 50 percent of diabetic-related hospitalizations are preventable.

Diabetes and its complications are not only disabling, but costly to Medicare as well. The cost of medical care of people with diabetes is about $150 billion a year, according to data from the Department of Health and Human Services. In its direct costs, diabetes was the most costly of the 39 diseases reported. Despite the fact that 9 percent of the Medicare population is diagnosed with diabetes, about 27 percent of the Medicare budget is used to treat their diabetes.

Most of the cost for medical care of people with diabetes is for the treatment of the complications, which are largely preventable with modern treatment including blood sugar control. Clearly, prevention of the complications of diabetes would reduce the costs of diabetes in lives and in dollars.

Numerous studies have found that once diabetes management training is provided, populations see a nearly 50 percent reduction in emergency room visits.

In addition, the number of outpatient visits, doctor office visits, and other medical expenses all decline. Diabetes can lead to amputations, blindness, heart disease, and stroke, all of which can be prevented with training and management.

This bill also gives the Secretary of Health and Human Services the authority to add new preventive services based on the recommendations of the U.S. Preventive Services Task Force. As we have seen, it can take a very long time for Congress to change health policy in this country. In order to add new preventive services to Medicare, it now requires legislative action. Under current law, as our researchers discover new, more efficient, and more accurate screening methods to detect disease, Congress would have to pass new legislation authorizing coverage for each one. This provision would enable Medicare to provide coverage for new types of screenings based on up-to-date scientific evidence.

The Preventive Services Task Force has a long and distinguished record. It dates back to 1984, when the U.S. Public Health Service convened a panel of primary and preventive health care specialists to develop guidelines for preventive services. From this panel, the U.S. Preventive Services Task Force's Guide to Clinical Preventive Services was born. While many other respected professional and research organizations have issued their own recommendations, the Task Force's publication is regarded as the gold standard'' reference on preventive services. In December of 1995, a new Task Force released an updated and expanded second edition of the Guide which includes findings on 200 preventive interventions for more than 70 diseases and conditions. The Task Force employed a rigorous methodology to review the evidence for and against hundreds of preventive services, assessing more than 6,000 studies. The Task Force recommended specific screening tests, immunizations, or counseling interventions only when strong evidence demonstrated the effectiveness of preventive services. My bill will give the Secretary the authority to use this gold standard to expand Medicare's basic benefit package to include the tests that studies have shown to be effective.

The newest benefit is the Welcome to Medicare Visit, an initial physical examination for new beneficiaries. We know that large numbers of people in the 55 to 64 age group lack health insurance, so it is particularly important for them to get a baseline examination and screenings for diseases that affect elderly people But as of July 2006, only 2 percent of all new beneficiaries, or about 8,000 people, have received this physical exam. Uptake has been slow for a number of reasons. You must get the exam within 6 months of enrolling in Medicare Part B. But many seniors don't learn about the benefit until they have been enrolled for a while, and even then it can take several months to schedule a physical examination with a doctor. So the vast majority of our seniors are missing out on this important benefit. My bill extends eligibility from 6 months after enrolling in Part B to 1 year.

Finally, I want to address the matter of cost, and that is the appropriate thing to do under our budget scoring principles. The elimination of cost sharing for preventive services has been scored by the Congressional Budget Office at $1.1 billion over 5 years. Based on CBO estimates from the 2003 Medicare law, extending the eligibility period for the Welcome to Medicare Visit from six months to one year will cost approximately $1.2 billion over years. But I believe that the members of this body also understand that, although dynamic scoring is not used by CBO, preventive health care will save money. If we detect diseases earlier, the overall cost to our society will be less. Our seniors will save out of pocket costs and all taxpayers will save money.

This bill is supported by the American Cancer Society's Cancer Action Network, the American Federation of State, County and Municipal Employees, the Center for Medicare Advocacy, the Colorectal Cancer Coalition, C3, and the Society of Vascular Surgeons. I urge my colleagues to join me in this effort to get improve seniors' access to lifesaving preventive services.