    [Senate Hearing 117-110]
    [From the U.S. Government Publishing Office]

                                                           S. Hrg. 117-110

                        EYES, EARS AND TEETH: EXPANDING
                      MEDICARE TO COVER WHOLE PERSON CARE

    =======================================================================

                                    HEARING

                                   BEFORE THE

                           SPECIAL COMMITTEE ON AGING

                              UNITED STATES SENATE

                        ONE HUNDRED SEVENTEENTH CONGRESS

                                 FIRST SESSION

                                   __________

                                 WASHINGTON, DC

                                   __________

                                AUGUST 30, 2021

                                   __________

                               Serial No. 117-06

             Printed for the use of the Special Committee on Aging

    [GRAPHIC NOT AVAILABLE IN TIFF FORMAT]

            Available via the World Wide Web: http://www.govinfo.gov

                                   __________

                        U.S. GOVERNMENT PUBLISHING OFFICE
    46-330 PDF                 WASHINGTON : 2022

    -----------------------------------------------------------------------------------

                           SPECIAL COMMITTEE ON AGING

                 ROBERT P. CASEY, JR., Pennslyvannia, Chairman

    KIRSTEN E. GILLIBRAND, New York      TIM SCOTT, South Carolina
    RICHARD BLUMENTHAL, Connecticut      SUSAN M. COLLINS, Maine
    ELIZABETH WARREN, Massachusetts      RICHARD BURR, North Carolina
    JACKY ROSEN, Nevada                  MARCO RUBIO, Florida
    MARK KELLY, Arizona                  MIKE BRAUN, Indiana
    RAPHAEL WARNOCK, Georgia             RICK SCOTT, Florida
                                         MIKE LEE, Utah
                                  ----------
                     Stacy Sanders, Majority Staff Director
                     Neri Martinez, Minority Staff Director

                             C  O  N  T  E  N  T  S

                                  ----------

                                                                       Page

    Opening Statement of Senator Robert P. Casey, Jr., Chairman......     1

                               PANEL OF WITNESSES

    Joanne Grossi, President, AARP Pennsylvania, Philadelphia,
      Pennsylvania...................................................     4
    Robin Stelly, Statewide Organizer, Pennsylvania Health Access
      Network, Philadelphia, Pennsylvania............................     6
    Joseph Hollander, CEO, Primary Health, Scranton, Pennsylvania....     8
    Kelly Ranieli, Executive Director, Volunteers in Medicine,
      Wilkes-Barre, Pennsylvania.....................................    10

                                    APPENDIX
                          Prepared Witness Statements

    Joanne Grossi, President, AARP Pennsylvania, Philadelphia,
      Pennsylvania...................................................    25
    Robin Stelly, Statewide Organizer, Pennsylvania Health Access
      Network, Philadelphia, Pennsylvania............................    29
    Joseph Hollander, CEO, Primary Health, Scranton, Pennsylvania....    32
    Kelly Ranieli, Executive Director, Volunteers in Medicine,
      Wilkes-Barre, Pennsylvania.....................................    35

      EYES, EARS AND TEETH: EXPANDING MEDICARE TO COVER WHOLE PERSON CARE

                                  ----------

                            MONDAY, AUGUST 30, 2021

                                           U.S. Senate,
                                    Special Committee on Aging,
                                                        Washington, DC.
        The committee met, pursuant to notice, at 10 a.m., in the
    Luzerne County Courthouse, Wilkes-Barre, Pennsylvania, Hon.
    Robert P. Casey, Jr., Chairman of the Committee, presiding.
        Present: Senator Casey

                     OPENING STATEMENT OF SENATOR
                     ROBERT P. CASEY, JR., CHAIRMAN

        The Chairman. Good morning, everyone. We're gathered this
    morning here in Wilkes-Barre to convene a hearing of the U.S.
    Senate Special Committee on Aging, and I'm grateful to be with
    you this morning.
        We've gathered here in Luzerne County to discuss a pressing
    need for seniors. That pressing need is to strengthen and
    expand the Medicare program. This field hearing has been a long
    time in coming, and it's a pleasure to be with our witnesses
    today in person, several of whom I've known for a long time.
        This gathering, of course, is after a long and terrible 18
    months for the country because of the ravages of COVID-19. This
    has been, without a doubt, the greatest public health crisis of
    our lifetime. I believe we must increase substantially the
    number of Americans who are vaccinated to help us get past this
    dark chapter in our Nation's history.
        The pandemic brought into sharp focus the longstanding
    challenges that American families face, challenges that they
    confront each and every day of their lives. The American Rescue
    Plan--which was passed back in March with only Democratic
    votes, by the way--just a little side note, Luzerne County got
    $196 million from the American Rescue Plan, when you add up the
    dollars that went to the county itself and then the dollars
    that went to the municipalities.
        That rescue plan did provide a measure of relief to
    families, sometimes directly and sometimes indirectly. That's
    true throughout not just Luzerne County but counties throughout
    northeastern Pennsylvania and throughout our Commonwealth. Many
    families got checks in their pockets, shots in their arms, and
    we had the opportunity, because of funding, to begin to reopen
    more schools safely. I hope we can get greater cooperation in
    this next round of legislating as we go back in the fall.
        I think, overall, what we're trying to do, in addition to
    responding to a pandemic and responding in real time--that's
    why we called it the rescue plan. Next we're also trying to
    continue some of those investments in American families.
        Basically, if you had to boil down what we're trying to do
    in the upcoming reconciliation bill, it's about one basic idea:
    lowering costs for families. That's what it's about. We did
    that in the rescue plan, but we've got more to do in the
    reconciliation bill.
        How do we lower costs? Well, obviously, one of the ways to
    lower costs is to lower the cost of prescription drugs. That's
    true here in northeastern Pennsylvania and around the country
    as well. Second, we lower costs for families by making health
    care premiums more affordable. Third--and not exclusively, but
    at least these three--third, we need to invest in children. You
    do that by helping families raise their children. That's why
    the Child Tax Credit, the Child and Dependent Care Tax Credit,
    are so important.
        In addition to investing in our children, we also need to
    invest in our caregivers, those heroic essential Americans who
    too often are left out of policymaking in Washington. We have a
    long way to go to get that legislation passed, but today we're
    going to focus more intensively on the opportunities that we
    have to strengthen and expand Medicare. That's another way, of
    course, to get costs down for families that are enrolled in
    Medicare or a loved one who's enrolled in Medicare.
        Medicare, of course, is a promise. It's not just a program.
    It's a promise to Americans who have done so much for us: those
    who fought our wars, who worked in our factories, who raised
    all of us, who created the strongest middle class in world
    history, and who gave our country so much. It's a promise to
    them of guaranteed access to health care after a lifetime of
    hard work. It's also not just a program. It's an earned benefit
    in addition to a promise.
        Despite this promise, we know that many seniors, as well as
    people with disabilities, still have trouble affording care and
    still have trouble accessing care. Medicare is not required,
    unfortunately--and that's the purpose of our hearing today--
    Medicare is not required to cover needed dental, hearing, and
    vision services. That's an outrage. There's no reason why that
    should be the case going forward. Poor access to this basic
    care poses serious health risks to older Americans. That's why
    I've introduced a bill to cover dental, vision, and hearing.
        We know that 15 percent of older adults have lost all of
    their teeth due to untreated dental disease. Now, 15 percent
    may not seem like a high number until you apply that to the
    number of seniors. We've got roughly 54 million seniors in
    America. You can do the math. Millions and millions and
    millions of seniors are in that category of having lost all of
    their teeth due to an untreated disease. There's no excuse for
    that in the most powerful country in the world.
        Vision loss as well is associated with an increased risk of
    falls and mobility limitations. Hearing loss can lead to both
    social isolation and cognitive decline. We know that. That's
    what the science and the studies tell us.
        I received numerous letters in my office about this issue,
    letters like those from Dr. Nancy King from Monongahela,
    Pennsylvania, southwestern Pennsylvania. Dr. King's letter
    urges support for Medicare coverage of hearing aids and related
    services. Hearing aids allow Dr. King to work, talk on the
    phone, dance, grocery shop, watch television, and even go fly
    fishing. Most importantly, Dr. King notes in her hearing--in
    her letter that her hearing aids keep her safe.
        Here's what she says as she concludes her letter to me, and
    I'm quoting, ``Without hearing aids, I can't even hear my water
    spigot running, and it has overflowed. Also, without hearing
    aids, I can't hear my phone ring. I cannot hear the cashier. I
    cannot hear my home burglar alarm,'' unquote. That's what one
    Pennsylvanian, Dr. Nancy King, tells us, but I think it's
    emblematic of what we've heard all across the state. It's for
    this reason that we introduced a bill, the Medicare and
    Medicaid Dental, Vision, and Hearing Benefits Act. It's Senate
    Bill 2618. It's why Congress must act to ensure that seniors
    and people with disabilities can access and afford these basic
    needs.
        When I say ``act,'' I'm not talking about acting a few
    years from now. I'm talking about right now. Now, we go back in
    September and October to legislate on a larger bill that, of
    course, goes by the bizarre name ``reconciliation,'' which
    doesn't mean much to many people. It is the legislation, the
    vehicle that will allow us to move forward as a Nation. It may
    be the most important domestic legislation in the history of
    the Nation. One of those component parts should be benefits for
    Medicare and Medicaid recipients.
        We know that we can find story after story about the need
    for dental, vision, and hearing care among our seniors, just as
    we hear story after story about families who can't afford care
    and can't afford prescription drug benefits as well. No person
    should have to choose between buying groceries and taking
    needed medications, but today too many seniors face this
    impossible choice. That's why I support allowing Medicare to
    use its purchasing power to negotiate to bring down the cost of
    prescription drugs. I've introduced legislation, separate
    legislation, to allow for the safe, FDA-inspected importation
    of medications from countries such as Canada.
        This hearing is timely as we discuss these important
    issues. Democrats are working on a bill to enact these historic
    changes to Medicare and Medicaid. These bills, and all under
    the broad heading of ``reconciliation,'' will help seniors and
    will lower costs for families. I look forward to this hearing
    today, and I look forward to learning more about these
    important issues from our great panel of witnesses.
        Before we begin, I want to remind our witnesses to please
    keep their remarks to 5 minutes. In keeping with CDC
    guidelines, I've asked all witnesses to keep their mask on and
    remove them only when speaking. With these final logistical
    notes, we'll turn to the introduction of our witnesses.
        I'll start with Joanne Grossi. Joanne has served as the
    president of AARP of Pennsylvania. She has years of experience
    in the health policy--in health policy and also senior issues.
    Joanne is a caregiver as well to her father. She brings
    personal experience not just by way of policy but by way of her
    work with her dad. Joanne, thank you for being here today and--
    and taking the time to be with us and to share your expertise.
        I'll introduce all of the witnesses, and then we'll go to
    the testimony for each of them. Our next witness is Mr. Joe
    Hollander, who's a resident of my hometown and his, Scranton,
    Pennsylvania. He's the CEO of Scranton Primary Health Care
    Center, a federally qualified health center serving much of
    northeastern Pennsylvania. Joe, as well, has many years of
    experience providing quality health care and dental care to
    Pennsylvanians from throughout northeastern Pennsylvania. If
    you had to look at Lackawanna County itself, it would be from
    Carbondale to Moosic. We're so grateful Joe's with us. Joe,
    thanks for bringing your experience today to this hearing. I
    know personally of the work that you do and the work that gets
    done in your center.
        Witness number three, Robin Stelly. Robin is the statewide
    organizer for Pennsylvania Health Access Network, known as
    PHAN, P-H-A-N. Robin's work has allowed her to listen to
    stories from Medicare consumers, particularly those that
    experience challenges with healthcare affordability. Her
    outreach gives her unique insight regarding how the lack of
    dental, vision, and hearing care benefits directly affects
    older Americans. Robin, I know personally, when we were
    battling back in 2017 to stop the repeal of the Affordable Care
    Act, how effective PHAN has been, and I'm grateful for your
    presence here today.
        Our fourth and final witness is Kelly Ranieli from here in
    Wilkes-Barre, Pennsylvania. She's currently the executive
    director for the Volunteers in Medicine clinic, which serves
    Luzerne County residents and families. This clinic aims to meet
    the needs of Pennsylvanians in the area of--who has no access
    to ongoing health care. I want to thank Kelly for her being
    with us today and for bringing her experience to this hearing
    today.
        We'll start with you, Joanne. You'll be our first witness.
    Then, because I'll stop talking, I'll put my mask back on.
    Joanne, thanks for being with us.

      STATEMENT OF JOANNE GROSSI, PRESIDENT OF AARP PENNSYLVANIA,
                       PHILADELPHIA, PENNSYLVANIA

        Ms. Grossi. Well, thank you, Senator Casey. Good morning,
    everyone. My name is Joanne Grossi, and I am the volunteer
    State president of AARP Pennsylvania. AARP is a nonpartisan
    nonprofit nationwide organization with nearly 38 million
    members in all 50 states, D.C., and the U.S. territories,
    including 1.8 million members here in Pennsylvania.
        For more than 30 years, I have been involved in public
    health, including serving for 7 years as the regional director
    of the United States Department of Health and Human Services
    during the administration of President Obama, and as Deputy
    Secretary of Health for the Commonwealth of Pennsylvania for 5
    years during the Rendell administration. Thank you for the
    opportunity to participate in today's field hearing
    highlighting the importance of access and affordability of
    expanded Medicare coverage for dental, hearing, and vision
    benefits.
        Fifty-six years ago, President Lyndon Johnson signed the
    Social Security Amendment Act of 1965 and thus created
    Medicare. Serving as a Federal health insurance program for
    people aged 65 and older regardless of income or medical
    history and for people under age 65 with permanent
    disabilities, Medicare currently provides guaranteed affordable
    coverage for more than 60 million Americans, including 2.8
    million Pennsylvanians. AARP's founder, Dr. Ethel Percy Andrus,
    played an active and important role in championing health
    insurance for older Americans. She helped craft Medicare into a
    successful program, and today AARP remains one of Medicare's
    strongest advocates.
        AARP has a long support--has long supported closing the
    gaps in health coverage by including dental, hearing, and
    vision coverage in the Medicare program. The lack of coverage
    for these important health benefits leads to worse health
    outcomes for older Americans and can actually cause higher
    Medicare spending.
        We know the majority of Medicare spending is on the
    fraction of beneficiaries with chronic conditions such as
    diabetes and heart disease. Meanwhile, Medicare does nothing to
    prevent infections originating in the mouth. It does nothing to
    help people retain or replace their teeth in order to eat and
    be properly nourished. It does little to help people speak,
    smile, or build relationships to fight off loneliness. It does
    little to help people hear and see obstacles, which, as you
    mentioned, Senator, can result in falls. In fact, 3 million
    people are treated each year in emergency rooms in America due
    to falls, costing the health care system $50 billion of which
    Medicare and Medicaid cover 75 percent of those costs.
        In short, Medicare will cover the expensive aftermath but
    not the less expensive prevention. A recently released Kaiser
    Family Foundation report which analyzed dental coverage and
    costs for people with Medicare shows that many people enrolled
    in Medicare go without dental care, especially beneficiaries of
    color. Almost half of all Medicare beneficiaries did not have a
    dental visit within the past year, with higher rates among
    those who are Black or Hispanic. Rates were also higher among
    those who have low incomes or are in fair or poor health.
        One reason Medicare beneficiaries do not seek care is a
    lack of insurance. Nearly half of all people with Medicare do
    not have dental coverage. The others get this coverage through
    Medicare Advantage, private insurance, and Medicaid. While
    these programs recognize the value of dental, hearing, and
    vision in keeping people healthier longer, their coverage is
    inconsistent and not nearly robust enough.
        In order to achieve the best possible health outcomes and
    the greatest value, Medicare should cover the entire person
    from head to toe. I'd like to give a little more context about
    how the lack of a dental benefit stands in stark contrast to a
    positive development in health care: thinking and acting
    holistically to keep a person healthy and not just treating the
    symptom or disease.
        The lack of the dental benefit worsens the problems of
    social isolation. As you mentioned, Senator, in your remarks,
    the lack of a dental benefit worsens the problem of social
    isolation. Helping older adults build stronger social
    connections is a top priority for AARP. One respective study
    has found that the impact of prolonged social isolation is
    equivalent to smoking 15 cigarettes a day. We have to ask: Why
    continue a policy that ignores oral health, that leaves so many
    older adults with tooth loss, that makes them embarrassed about
    their smile and makes it harder for them to communicate? We
    could help prevent the social isolation that comes with losing
    your self-confidence and ability to connect with family and
    loved ones.
        Simply put, Medicare should cover dental care; vision care,
    including eyeglasses; and hearing care, including hearing aids.
    Medicare beneficiaries want, need, and deserve these services
    and are often surprised when they learn Medicare doesn't cover
    them. It is time for Congress to take action to add in these
    essential benefits. AARP is fighting hard to make sure this
    happens, and we appreciate your leadership in this phase. Thank
    you.
        The Chairman. Joanne, thank you for your statement. We'll
    move now to Robin Stelly. You may begin.

            STATEMENT OF ROBIN STELLY, STATEWIDE ORGANIZER,

                  PENNSYLVANIA HEALTH ACCESS NETWORK,

                       PHILADELPHIA, PENNSYLVANIA

        Ms. Stelly. Good morning. Thank you. My name is Robin
    Stelly. Thank you, Senator Casey, for convening this hearing to
    discuss an important issue that's on the minds of seniors and
    disabled people, as you mentioned, across Pennsylvania and the
    country: expanding Medicare to include dental, vision, and
    hearing services. I'm an organizer with PHAN. We're the only
    statewide consumer-led organization focused on achieving
    quality accessible, equitable, and affordable health care for
    all Pennsylvanians.
        Every year we talk to over 10,000 Pennsylvanians from 62 of
    67 counties. We assist people in enrolling in health insurance
    coverage. We also help with problems of accessibility and
    affordability of health care including unaffordable medical
    bills, problems accessing providers, long travel or wait times
    for care, denials of medically necessary care, and other
    similar issues. All of these personal interactions shows how
    much Pennsylvania's families, seniors, disabled people, and
    small business owners struggle to access health care, as we
    have--and we have numbers to back that up.
        Recently, PHAN was fortunate to partner with Altarum's
    health value--Healthcare Value Hub to do the first ever
    Pennsylvania-specific survey on health care affordability in
    the Commonwealth. Among other findings, and the findings were
    legion, but to talk about today, the results showed that 42
    percent of residents involved in Medicare were concerned about
    being able to afford coverage in the near future. The premiums
    for Part D, Part B, and Medigap plans add up. Something we hear
    more--about more frequently is the struggle to pay for services
    that aren't covered by Medicaid--Medicare, and that's vision,
    hearing, and dental.
        As I mentioned, through our work at PHAN, we're lucky to be
    able to hear firsthand from consumers. In addition to reaching
    out through the telephone and in person, we also engage
    consumers online via surveys. Last week we conducted an
    informal online survey on this topic. In fewer than 24 hours,
    we had over 200 comments, and we have almost 500 comments
    this--by this morning. People from all over the State responded
    to this question: What would expending Medicare to include
    vision, dental, and hearing services mean to you? I'm just
    going to share a few.
        This is Joanne in Mechanicsburg: ``I haven't been to the
    dentist in 5 years. I can't hear in my right ear, and unless
    people look straight at me so I can make out what they're
    saying, I have no idea what they said. I'm 72 and on Social
    Security, which everyone knows is below the poverty level. This
    is horrific considering I worked for 42 years.''
        This is Rochelle from Philadelphia: ``Over the past few
    years, I've had severe dental issues and my vision has
    deteriorated. My Social Security benefits barely cover my
    monthly mortgage, utility, groceries, and prescription drug
    pills. In order to cover the dental and vision bills, I need to
    dip into what little savings I had. I'm now dealing with new
    serious dental problems that will be--likely be very costly,
    along with needing new glasses immediately and the likelihood
    of eye surgery in the near future. Unlike many of my peers, I
    no longer have savings to pay for serious household or other
    emergencies. Expansion of Medicare to include vision, dental,
    and hearing services is vital to my well-being.''
        Catherine from Harwick: I would be able to get dentures and
    eyeglasses. I now stay home, avoid get-togethers because I'm
    embarrassed to see old friends and my family in current''--I'm
    sorry--``old friends and family in my current toothless State.
    I also would be able to eat healthier foods, which is a
    priority for me being diabetic. I could get an eye exam, which
    is critical when you have diabetes.''
        Last, Karen Anne, who's a nurse practitioner in Lewisburg:
    The importance of dental, vision, and hearing to the health of
    older adults is well noted in the medical literature. The lack
    of dental care and poor dentition is known to increase heart
    disease and frailty among older adults. Poor vision and hearing
    is highly correlated with loneliness, depression, and injuries
    such as falls. Few older adults can afford out-of-pocket costs
    for both glasses and hearing aids. I paid $6,000 for my hearing
    aids, and I dread coming up with the money for the next pair as
    I live on a meager retirement.''
        That was a small sampling of the nearly 500 comments we've
    collected. The stories were all different, but the common
    themes definitely emerged. We repeatedly heard about the lack
    of economic security, living on a fixed income, going without
    or delaying care, digging into retirement to pay for care,
    isolation in the community and in the family, a reduced quality
    of life, seeking pain from pain--seeking relief from pain and
    embarrassment, feeling like a burden to one's family, and the
    fact that this problem is something that medical providers,
    family members, and business owners see around them.
        It's not hidden or difficult to understand. People age.
    It's natural, and they deserve care for their entire body, not
    only selected parts. In closing, thanks again to Senator Casey
    for taking the time to have this hearing on this critical
    problem. I want to thank you for your commitment to affordable
    health care for seniors, disabled people, and all
    Pennsylvanians. I'm happy to answer any questions you have.
    Thank you.
        The Chairman. Robin, thanks very much. We'll next turn to
    Joe Hollander.

     STATEMENT OF JOSEPH HOLLANDER, CEO, SCRANTON PRIMARY HEALTH,
                         SCRANTON, PENNSYLVANIA

        Mr. Hollander. Good morning, Chairman Casey. Thank you for
    the opportunity to testify this morning on the need to expand
    dental coverage for seniors.
        My name is Joseph Hollander. I'm proud to say for the last
    seven and a half years I've been the CEO of Lackawanna County's
    only federally qualified health center, Scranton Primary Health
    Care. We have three offices located in Lackawanna County, and
    they have been providing care to the community for over 42
    years.
        Scranton Primary Health Care provides care to everyone
    regardless of their ability to pay. We offer pediatrics; family
    medicine; internal medicine; women's health; gynecology;
    perinatal care, with over 253 deliveries last year alone;
    infectious disease care; behavioral health care; and general
    dentistry, which includes diagnosis, treatment and management
    of overall oral health care needs, including preventive
    education, dental hygiene and cleanings, fluoride varnish,
    sealants, gum care, fillings, root canals, extractions, crowns,
    bridges, partials, full dentures, and mouth guards. All of our
    providers are board certified and employees of the health
    center.
        We also assist members of the community in the navigating
    and making application to the insurance marketplace. Our
    patient base ranges from newborns to a senior who still lives
    alone and will be celebrating her 104th birthday in November. I
    think it is important to understand our patient demographics.
    Sixty-one percent of our patients are at or below 200 percent
    of the Federal poverty level. When we combine all of our
    services, 14 percent of our patients are uninsured. I'm
    certain, when it comes to dental, that number grows beyond 20
    percent.
        Sixty percent of our patients are covered by Medicare or
    Medicaid, 9 percent by Medicare, 2 percent by the Children's
    Health Insurance Program, and the balance have private
    insurance. We take our mission very seriously, and, as a result
    of that, never closed at any time during the pandemic. We
    literally spent hundreds of thousands of dollars installing
    HEPA filtration and UV-C filtration systems in an attempt to
    keep our staff and patients safe.
        We also purchased special equipment to control aerosols
    generated during dental procedures in an effort to keep our
    dental clinic open and safely operating throughout the pandemic
    fully understanding the emergency departments in the area were
    overwhelmed and not in the position to see dental emergencies.
    We invested over a quarter of a million dollars in COVID-19
    rapid-test equipment when the systems became overloaded and we
    were literally waiting 10 to 14 days for test results. We now
    have results in less than 14 minutes.
        When vaccinations became available, we immediately pivoted
    and added vaccinations to our already taxed health care
    delivery system. Since December, we have delivered over 10,000
    vaccinations and we were honored to vaccinate the Scranton fire
    and police departments and many of the area's first responders
    and health care workers as well as our own patients.
        Now that you know a little bit about us, I would like to
    talk about the purpose of today's hearing: expanding Medicare
    to include dental coverage. I cannot stress to you how
    important it is, the link between good oral health and good
    physical health. Common sense tells us that if your diet is
    severely limited because you're unable to chew your food and
    eat a healthy diet, you can't get the nutrients and nourishment
    you need. For some reason, this is stressed to us over and over
    when we are young and ignored when it comes time to care for
    our seniors.
        We've always been taught to do whatever is necessary to
    preserve your teeth. Extractions should be a last resort. Most
    individuals, by the time they qualify for Medicare, have had
    many of their teeth restored multiple times, leaving little
    choices but the expensive option of root canals and/or crowns,
    or the less costly and more common option of extractions.
        As you can imagine, extractions cause their diet and
    nutrition to suffer. This can also affect their speech as well
    as their appearance, which can affect their mental health and
    cause anxiety and depression. Every one of these factors
    affects their physical health and well-being and ultimately
    drives up the cost of medical care.
        In the recent report by the Kaiser Family Foundation
    mentioned earlier, it was disclosed that 40 percent--47 percent
    of Medicare beneficiaries do not purchase dental coverage. That
    same percentage did not have a dentist visit during the past
    year, with minorities and those with low incomes at a much
    higher rate. One in five Medicare beneficiaries who do visit
    the dentist spend in excess of a thousand dollars for out-of-
    pocket dental care.
        In closing, please indulge me and allow me to read a social
    media post from a gentleman who received care from our dental
    clinic. In an effort to protect the individual's privacy, I
    will call him ``George.'' ``I am a 68-year-old veteran of the
    U.S. Navy and have been a patient of the dental clinic for the
    past several months. I have been dealing with dental problems
    almost my entire life, which finally culminated in the loss of
    most of my teeth, which made it almost impossible to chew most
    foods. Since my dental problems were not 100 percent service-
    related, the Navy would not cover the cost of treatment.
        ``I searched far and wide for help when I came across
    Scranton Primary. They were a godsend. Dr. DellAglio started my
    treatment, and now I am so excited. I am just a few months away
    from getting my dentures and being able to eat again. The
    greatest thing about the dental clinic was they worked hard to
    set up a payment--a payment plan I could afford and didn't make
    me pay in advance. After they learned more about my personal
    financial situation, they actually forgave my remaining debt
    and thanked me for my service to our country.
        ``I have never been so touched in my life. Thank you, thank
    you, thank you, thank you. I cannot recommend these guys
    enough. With today's news being filled with man's inhumanity to
    man, it's nice to know there's still people who care.'' George,
    U.S. Navy, 1970 to 1974.
        Thank you very much for this morning and the opportunity to
    testify before you, Senator, and thank you, in general, for
    caring about our seniors.
        The Chairman. Joe, thanks very much for your testimony.
    We're grateful you're here. Finally, Ms. Ranieli. Thank you
    very much, Kelly, for being here.

     STATEMENT OF KELLY RANIELI, EXECUTIVE DIRECTOR, VOLUNTEERS IN
                  MEDICINE, WILKES-BARRE, PENNSYLVANIA

        Ms. Ranieli. Thank you for the opportunity to share my
    personal insight and experience as executive director of a
    nonprofit healthcare facility.
        Volunteers in Medicine, VIM, is a 501(c)(3) community-based
    nonprofit organization established to provide free medical,
    dental, and behavioral health services to the working uninsured
    and underinsured populations in northeastern Pennsylvania. The
    clinic is not federally funded, and it does not charge for
    services, so it operates solely from donations, grants, and
    proceeds from special events. Individuals eligible for free
    services work with an income at or below 200 percent of the
    Federal poverty guidelines and has no access to affordable
    health insurance or medical care.
        In March 2021, approximately 7 percent of the population in
    Pennsylvania was uninsured, and it's estimated that almost
    three times that amount have no dental insurance. VIM is
    experiencing an influx of new patients due to the pandemic. Due
    to the need in the community, with the help of over a hundred
    volunteers, the VIM in Wilkes-Barre began seeing patients in
    June 2008. We've accomplished many milestones, including the
    transition into a national certified patient medical home,
    which validates the quality care.
        Free services include not only primary but many specialty
    services. VIM dispenses medications with a value of
    approximately $50,000 a month free to those that can't afford
    them. A hundred percent of patients are offered preventative
    services. Lab work and imaging testing is also provided free to
    the patient but a cost to the clinic to ensure continuity of
    care. Translation program is also available to our non-English-
    speaking patients. The behavioral health program at VIM
    includes psychiatric evaluations, counseling, case management,
    and resource navigation. The health equity program assists
    patients with resolving transportation, housing, jobs, and food
    disparities.
        The VIM dental clinic was established in January 2011 and
    quickly became a high-demand community resource. Many patients'
    oral hygiene needs require a minimum of three appointments to
    relieve the pain. Our goal is to get them out of pain, educate
    on oral hygiene, and on a biannual cleaning schedule. Due to
    the complexity of treatments required, we have an extensive
    waiting list of those desperately needing dental services. We
    have found many patients and caregivers aren't educated on
    proper oral hygiene. If the adult isn't aware, then the
    children in the household most likely aren't learning at a
    young age.
        We recently had a hardworking father of two have numerous
    visits in the dental clinic for cavities. After talking with
    him, he had no understanding that all the energy drinks, soda,
    and packets of sugar in his coffee throughout each and every
    day were causing tooth decay. In 2015, we created a healthy
    smile program to educate children on good oral hygiene as well
    as provide evaluations and program supplies.
        Our main mission is to keep our community healthy, well,
    and working. We partner with our health care systems to keep
    uninsured patients out of the emergency rooms for non-emergent
    issues, annually saving the hospitals millions.
        According to the United Healthcare, the average cost of an
    ER visit in the United States is $2,200. Research conducted by
    Texas A&M, patients that go to the ER to treat preventable
    dental conditions cost taxpayers, hospitals, and the government
    about 2 billion a year. Uninsured patients that visit both
    local emergency rooms with dental abscesses are immediately
    referred to VIM for care.
        The clinic is a critical community resource. In the last 6
    months, we provided free health care to employees at 136
    businesses in Luzerne County, and students from ten local
    universities are hosted for their official internships. A
    patient is eligible for free dental services at VIM if they
    have Medicare and still are working, even if it's limited part-
    time, and meet our income guidelines. Our primary population is
    the working uninsured, but VIM currently has 275 registered
    patients over the age of 65 receiving dental services. Most
    older patients are in need of extractions and dentures. We have
    had patients come into VIM because they previously had
    removed--teeth removed and couldn't afford dentures. Many have
    extreme difficulty eating solid food.
        One patient had numerous health issues, needing medications
    to combat her problems. After she finished her dental treatment
    plan to rid her mouth of numerous infections, her medical
    provider at VIM was amazed at the positive changes. Her
    appearance was healthier and basically cured from her medical
    symptoms, therefore able to stop taking some of her
    medications. We also provided dentures to a patient a couple
    days before her wedding. The patient said it was the first time
    she ever smiled.
        VIM staff and volunteers hear on a daily basis the
    struggles from all ages and races, the challenges in finding
    affordable health insurance, medical care, behavioral health,
    and dental care. The services provided at--that--VIM are
    otherwise unattainable to the low income population. The VIM
    clinic offers a unique healthcare model that benefits the
    entire community. It's important to understand that in order to
    heal the entire well-being, medical, dental, and behavioral
    health care needs to be provided, especially to the low income
    underserved populations. Everyone benefits from a healthy
    community.
        Thank you, Senator Casey.
        The Chairman. Kelly, thanks so much. I'll stay with you for
    our first question, and then I'll go from Kelly to Robin and
    then go to this side of the room. Kelly, thanks very much for
    that testimony.
        It's especially noteworthy and, I think, significant and
    helpful that each of you provided the--us with the benefit of
    your experience in the organization that you represent, but you
    also brought to bear on this conversation the voices of real
    people who have struggled without--without the kind of health
    care that they should--they should benefit from.
        Let me start, though, Kelly, with you on the question of
    dental coverage. We know that the majority of people with
    Medicare don't have dental coverage. It's still hard to
    comprehend that, but that's actually the case. We're told that
    as recently as the year 2016, 49 percent of people with
    Medicare did not go to the dentist. Many older adults report
    being embarrassed about their teeth. They, as you mentioned
    just a moment ago, avoid smiling, and even reduce social
    participation due to the condition of their mouth and their
    teeth. Additionally, people with disabilities often struggle to
    find dentists willing to treat them because of lack of
    training.
        Kelly, I'd ask you, how can we make sure that seniors and
    people with disabilities are able to get access to the dental
    care that they need?
        Ms. Ranieli. Well, in 2019, 4.9 million over 65 years of
    age fall at or under 200 percent of the Federal poverty
    guidelines. Dental benefits are not covered by traditional
    Medicare, as you mentioned. In 2021, it's reported that more
    than 26 million people are enrolled in a Medicare Advantage
    plan. The key to Medicare and these supplemental programs is it
    must be affordable. It must be affordable for the most
    vulnerable, which includes the elderly.
        At VIM, we hear many seniors State they can never--they
    can't sign up for Medicare due to the costly penalty that would
    be incurred by not signing up at 65. Preventative dental
    coverage, including an oral exam, cleanings, dental, X-rays and
    even fluoride treatments, are critical. Restorative services,
    which would include fillings, are necessary to prevent
    complications such as oral infections. Dentures, of course, are
    a core service for the elderly population.
        The Chairman. All right. Just, when you think about it in
    your own life, I just--just can't imagine not having access to
    a dentist when--if--especially if you have pain. All of us, I
    think, at one time or another, have experienced that.
        Robin, I'll move to you next. I wanted to talk to you about
    the connection between hearing or hearing loss and cognition.
        We know that nearly one in four people ages 65 to 74, and
    one in two people over the age of 75, have hearing loss. At a
    minimum, if you're not able to hear well, you can't participate
    in the conversations around you, obviously. In your testimony
    today, you shared stories from individuals who talked about
    this issue. We know that there's a direct connection or
    association between hearing loss and poor cognition. Many
    seniors with hearing loss will--would benefit from hearing
    aids, obviously. Yet at thousands of dollars per pair, they're
    far too costly for most people with Medicare.
        Robin, I was going to ask you, could you share with us what
    you've heard from Pennsylvania consumers regarding the cost of
    hearing aids, No. 1, and why they would benefit from hearing
    coverage under Medicare?
        Ms. Stelly. Sure. When we did our survey, we heard from,
    like I said, almost 500 seniors. They didn't all talk about the
    same things. We had people who talked about hearing issues, and
    they could be split up into a small group of people who could
    afford the hearing aids and then a larger group of people who
    could not afford hearing aids or even going to an audiologist.
    They just live with the problem.
        I don't know. I mean, I'm in my 50's, so you just--it
    doesn't--it isn't like you wake up 1 day and you can't hear. It
    sort of stops, right, and you kind of acclimate to it. They
    have hearing losses. From the people that are telling us that
    they have profound hearing losses, they are profound hearing
    losses. Other people are simply not knowing that they're losing
    their hearing and need to see an audiologist but just--that
    isn't something that they can afford to do.
        The hearing aids are also a problem, and they're so
    expensive. You heard from Karen Anne, who said that she had
    $6,000 to pay for hearing aids, and already she's starting to
    worry about how am I going to afford to pay for them again.
    They're machines. They wear out, and they need to be replaced,
    so this cost is recurring. The people who can't afford care at
    all, they're impacted financially, emotionally, and physically.
    They do. They have the falling issues. They have the constant
    stress of the isolation, being left out of their family. This
    is the most heartbreaking to me personally, being left out of
    family interactions, falling by the wayside within one's own
    family because they can't hear what's going on.
        I think you really have to--if you haven't had it happen to
    you, you have to kind of think hard about imagining what that
    would be like. I implore people who are thinking on the fence
    about this to try to go without this sense for 10 minutes.
    You're unable to hear what the cashier is saying, what your
    attorney is saying to you, what your doctor is saying to you.
        Try it. Try it for 10 minutes, and then come back and let
    us know that these are not vital services that should be
    provided for, for our seniors and our disabled community, who
    have paid into this for all their lives.
        The Chairman. That's a good point. Walking in their shoes,
    even for a few minutes, might be the best way to get the point
    across.
        Joe, I wanted to ask you as well about dental coverage.
    Your testimony is full of references to all the work that
    you've done. I noted on the first--or second full paragraph of
    your testimony, where you outlined all of the ways that
    Scranton Primary has provided help on dental issues, whether
    it's hygiene and cleaning, sealants, fluoride, varnish,
    fillings, root canals. It goes on and on. I wanted to ask you
    about that.
        You indicated, also, in your testimony, about the long wait
    that many seniors face when seeking dental services and that
    many clinics in northeastern Pennsylvania are booking 6 months
    to 1 year out for appointments. Obviously, that's too long for
    someone to wait, especially when they're in pain and in need of
    care. We know that both good oral health is important in and of
    itself, but it also has a direct connection, as you know better
    than I from your experience, has a direct connection to
    physical health. Could you share with us examples from your
    patients where their poor oral health negatively impacted their
    physical health and their mental health?
        Mr. Hollander. Thank you, Senator.
        As you said, poor oral health does cause oral bacteria
    issues that can lead to several medical consequences, including
    but not limited to poorly controlled diabetes, increased risk
    of pneumonia, and endocarditis, which is an infection of the
    inner lining of the heart. This can further lead to
    cardiovascular disease and vascular plaque buildup.
        Over the years, we have encountered several of our diabetic
    patients with poor dentition and difficult-to-control blood
    sugars. For example, we had a female patient, approximately 65
    and a half years old who required high doses of insulin, who
    said she could not afford to see a dentist. We referred her to
    our dental clinic. After treatment by the dental clinic, which
    resulted in her ability to see--to eat an improved diet, we
    were able to correct her blood sugar levels and saw a 2 point
    drop in her HbA1c.
        As I stated in my testimony earlier, poor dentition also
    affects personal well-being, mental health, and confidence.
    More importantly in the elderly, an inability to chew properly
    due to missing teeth or ill-fitting dentures can lead to
    malnutrition.
        Recently we had a patient, one of our elderly patients, who
    had lost a significant amount of weight. Only after speaking
    with one of our behavioral health counselors did we find that
    he had diabetes and dentures that did not fit well. He would
    take them out to eat and therefore could not tolerate any solid
    foods. Once treated, his overall weight and health improved
    dramatically.
        Finally, we had a third senior who had been treating for
    years who suddenly, when he came in for his physical health
    appointment, seemed different and didn't appear to be himself.
    No abnormalities were found on the physical side. During a
    conversation with one of our licensed clinical social workers,
    we discovered he was experiencing malaise and a lack of energy
    with night sweats. When we learned he had not been to a dentist
    in years, we scheduled him for a cleaning and exam. Our dentist
    discovered the gentleman had a fluid connection--fluid
    collection with a low-grade infection under a cracked molar.
    Upon repair of the molar, the nightsweats and the mood changes
    went away, and he's now once again a happy and functioning
    senior.
        The Chairman. Well, that--that tells it all when you just
    recite those conditions, one after another, from diabetes to
    pneumonia to malnutrition to weight loss and infection. It
    makes the point of how important this change in policy could be
    for people.
        Joanne, I'll move to you on the question of disparity. One
    thing that became plainly evident to most Americans in this
    pandemic is not only our healthcare system but so many other
    aspects of our lives, even structures within society, have
    different application depending on who you are. We--if we knew
    about racial disparities before, we knew a lot more after the
    pandemic was upon us. Those significant disparities among
    people reporting trouble with vision problems or hearing
    problems or dental problems become even more--become even more
    apparent when we examine them from the question of--from the
    vantage point of racial disparities.
        We know that a greater share of both Black and Hispanic
    seniors and people with disabilities on Medicare went without a
    dental visit in the last year, that number is a lot higher than
    those Americans who happen to be white beneficiaries of
    Medicare. As we've heard today about forging--or, I'm sorry,
    foregoing this type of care can result in poorer health
    outcomes more broadly.
        Can you tell us, from the vantage point of what you know
    from the work that AARP does and the initiatives that you've
    undertaken to reduce these disparities, how would including
    dental, hearing, and vision benefits under Medicare help to
    advance not only the health issues that we talked about today
    but to advance health equity goals?
        Ms. Grossi. Yes, well, thank you, Senator. I appreciate
    that question. You're right. AARP cares a great deal about
    health equity. In fact, recently AARP Pennsylvania partnered
    with the Drexel University College of Nursing and Health
    Professionals, and we both conducted a study and released a
    study on health disparities. It showed, not surprisingly, that
    ethnic, economic, and geographic location played a significant
    role in your access to health care.
        As you mentioned a moment ago and as you heard in my
    testimony and Joe's testimony, you know, about half the
    Medicare--only about half the Medicare beneficiaries had a
    dental visit last year. Well, but if you--but that number was
    61 percent, though, if you're Hispanic; 68 percent if you're
    African American; or 73 percent for people with low income, so
    you can see, you know, as you were mentioning in your comments
    and your question a moment ago, it made a big difference about
    health disparities. That's actually why, you know, AARP cares
    so much about this issue, about, you know, hearing, vision, and
    dental access. We know that if we can--we can improve health
    equity and decrease health disparities if those benefits are
    included in Medicare. Other--obviously, that will--you know,
    evens the playing field. It gives everyone more access to care
    and improves health outcomes, as Joe was talking about a moment
    ago. We actually believe it reduces the costs to the Medicare
    program in the long run. We're very committed to including
    these benefits for all of those reasons.
        The Chairman. We appreciate that. I think those--when you
    consider those numbers that you've cited, as high as they are
    for the population overall, they get even higher for those
    Americans who happen to be Black or Hispanic. I think it makes
    a--it puts an emphasis on how grave this problem is across the
    board.
        I wanted to ask--it may be a question for our whole panel,
    and each of you, if you can, just take a moment to add your
    response. We know that with hearing loss or loss of vision or
    lack of dental care, that each of them, in some way or another,
    have been considered part of the aging process. They also
    greatly affect people's contributions to society and their
    ability to engage socially.
        I believe we've got to do a lot better for our seniors, for
    people with disabilities, and for their families. The way we do
    better is by passing legislation, not just talking about it.
    We've got to ensure that people with Medicare are able to take
    on more active roles in their communities, and they could do
    that only with this kind of help.
        I'd ask each of you to share, based on your experience and
    expertise, how would coverage of dental, hearing, and vision in
    Medicare impact the quality of life for seniors and people with
    disabilities. I know you've all spoken to this in one way or
    another, but maybe as kind of a wrap-up. Kelly, maybe we'll
    start with you.
        Ms. Grossi. Senator, I was going to volunteer to start, but
    to start, but
        The Chairman. Oh, go ahead. Go ahead.
        Ms. Grossi. Well, if you don't mind, actually
        The Chairman. Yes.
        Ms. Grossi [continuing]. Senator, I would like
        The Chairman. Sure.
        Ms. Grossi [continuing]. to tell you my own personal story.
        The Chairman. Sure.
        Ms. Grossi. As you mentioned in your introduction of me,
    I'm a caregiver for my 90-year-old father, who actually turns
    91 this week. He has experienced everything everyone has talked
    about today. A number of years ago, he had significant hearing
    loss. As you heard about from some of your opening comments, he
    couldn't hear the telephone. He couldn't have a conversation
    with his family. He couldn't go to church. He couldn't watch
    TV. All the things you heard mentioned, you know, were really
    lost to him until we went and got him hearing aids.
        Of course, he had to pay out of pocket for those hearing
    aids. At the time, it cost him $5,000 out of pocket.
    Subsequently for, you know, visits since then to the
    audiologist and, you know, additional batteries and things like
    that, he's had additional expenses. Just the initial expense
    was $5,000, which, fortunately, my father could afford. That's
    with hearing.
        Then last year my father was having significant teeth
    problems and, in fact, in consultation with the dentist, it was
    determined that he had to have all of his bottom teeth removed
    and to get dental implants. This was a 9-month process of
    pulling out teeth at, you know, a number of visits, and then
    having the gums heal, and then finally getting the implants and
    finally getting the teeth. By the way, that cost him $15,000
    out of pocket. In those ensuing 9 months, it's what you heard
    people talk about today.
        I was worried about his nutrition. He couldn't eat
    properly. He was embarrassed. You know, he didn't want to go
    out. Obviously, it was the pandemic, but he didn't want to be
    with people. He didn't want to have a conversation. He was
    embarrassed. He was hard to hear.
        You know, if it weren't for, you know, close family members
    around, I think he would have been very isolated. Again, as I
    mentioned already, really worried about his nutrition because
    he just couldn't eat hardly anything except something like
    Ensure or soup. Again, you know, my father had the means to pay
    those $15,000. He's in the minority because in fact we know
    that 75 percent of Medicare beneficiaries who need a hearing
    aid haven't been able to get one because of the cost.
        Seventy, you know, percent of the people who have had
    problems with their teeth and eating also, you know, haven't
    done anything about it because, again, of the cost. You know,
    my dad's in the minority of those being lucky enough to afford
    it, but just those two issues were over $20,000.
        Like you were saying, my dad, you know, devoted a lifetime
    to this country in service and raising a good family, and it's
    not fair that people like him have to pay that kind of money.
    It should be one of the services we include in Medicare. Again,
    lucky my dad's fortunate enough to pay for it, but I appreciate
    that you're taking on this case for the Americans and
    Pennsylvanians who can't afford to pay this out of pocket.
        The Chairman. Well, Joanne, thanks for bringing your story
    to this discussion, because sometimes that's the only way for a
    lot of us to relate to an issue is what's our own personal
    experience.
        As you were--as you were talking, I was reminded that as
    much as a problem--a dental problem or a hearing problem or a
    vision problem is about something physical and related to your
    physical health, it's also about your dignity as well.
        Ms. Ranieli. Mm-hmm.
        The Chairman. It's your ability to participate, to be
    engaged.
        I think it was your testimony that had a number I've seen
    before about the connection between if someone doesn't--isn't
    able to engage and is isolated, prolonged isolation can lead to
    terrible health problems. The one number--and I'll find in here
    in your testimony, but it can be the equivalent of 15
    cigarettes a day are the adverse impact, that social isolation
    can have a physical impact that's equivalent to smoking 15
    cigarettes a day, or whatever that number is in that study.
    That just shows you the gravity of this problem for people.
    Your father's circumstance is, unfortunately, all too--all too
    emblematic of that.
        I want to open it up for anyone else. Kelly or Robin or
    Joe?
        Ms. Ranieli. At Volunteers in Medicine, we witness how
    important it is for comprehensive or holistic care. It's
    necessary for the well-being and overall health of the patient.
        The low income population, which is who we serve,
    especially those that are uninsured or underinsured, are
    historically sicker than those with insurance because those
    that are uninsured have no access to preventative services.
        According to Harvard Medical School, one in five adults
    ages 65 or older have untreated tooth decay. Tooth decay and
    gum disease leads to serious health problems, as Joe mentioned.
    Lack of dental care can exasperate chronic medical conditions
    such as diabetes and cardiovascular disease.
        We at the clinic have potential new clients walking in with
    swelled faces due to abscesses. This is at any age. The elderly
    population who have multiple teeth extracted come to VIM
    malnutritioned because they haven't been able to afford, you
    know, dentures. We witness this on a regular basis. Of course,
    increasing dental, hearing, and vision coverage would be, you
    know, critical for older adults, absolutely critical.
        The Chairman. Thanks.
        Robin?
        Ms. Stelly. I think you hit the nail on the head. You said
    that word. That word has escaped me from the beginning of when
    I was putting testimony together and doing research. It's
    dignity. That was it. That's it. For the consumers. Right? It's
    a loss of dignity.
        For their families, it's increased stress that they don't
    need to go through. When is the next hearing aid? Got Mom's
    hearing aid but, you know, it's--you know, I got another one
    coming up. It's only going to be three to 5 years. That's
    expected. Start saving now. I also need a car, but I've got a
    kid in college. Maybe she can make her hearing aid stretch.
        This is not a conversation that people should have to have
    around their--talking about their families. You can tell the
    stress. Just imagining this is stressful. For society, it's
    just lost capacity. Why are we throwing these people away? 65
    is not old. It's old, but it's not done. We're throwing them
    away.
        A lot of the people that completed our survey and people
    that we know in our own experience work. They can't work as
    well if they're not fully functioning. You know, they work and
    they have Medicare, so--and then, of course, there's people who
    don't work--who want to retire and find out that all of this is
    now lost to them and that they are lost to us. It's just not
    acceptable.
        Thank you.
        The Chairman. No, I appreciate that. You're right. It's
    that stress and that--that loss to all of us. It really does
    diminish all of us in one way or another. I appreciate you
    making that point.
        Joe, you'll have the final word.
        Mr. Hollander. Thank you, Senator.
        While Medicare recipients generally have a higher risk for
    medical problems simply because of age, most of their daily
    quality of life and well-being revolves around dental, hearing,
    and vision. When you think about it, these affect every one of
    us. Seniors are no different. Not addressing these issues
    adequately can lead to a number of problems. Poor communication
    due to a loss of hearing can result in misdiagnosis or poor
    understanding of instructions. We also see an increase in falls
    due to poor vision. Of course, we've spoken earlier about poor
    dental outcomes leading to or causing physical disease, all of
    which can be linked to the higher cost of medical care.
        During a meeting earlier this week with my medical
    director, I learned we just lost a patient at the health center
    last week who had severe hearing loss and an inability to
    afford hearing aids. When he described her, I remembered her
    well because she had been dropped off by county transportation
    last week, and I happened to be walking by at the time and saw
    her struggling in her wheelchair.
        I assisted her and helped her get to the waiting room and
    distinctly remember, no matter how loud I spoke to her, she
    couldn't understand me. This is generally not a problem I have.
    Most of the time, people are asking me to speak softer. She
    would simply put her head down out of frustration as I tried to
    speak with her. My medical director told me while she had a
    number of serious health issues, he had seen her in the office
    2 days before she passed away and, in retrospect, is convinced
    if he had been able to communicate with her more effectively,
    he may have been able to help her and present--and prevent her
    demise.
        Avoiding these coverages as preventive measures has the
    potential of saving Medicare money in the long run much more
    than the initial cost to the system. Senator, thank you very
    much for sponsoring this Senate bill.
        Thank you very much for taking the time to hold this very
    important hearing and inviting us to participate.
        The Chairman. Well, Joe, thanks for sharing that hearing--
    or sharing that story. That's as good an example as any of what
    can happen in one instance where someone can't communicate,
    that you have a medical professional saying they might have
    been able to save her life if she was able to communicate.
        I know we have to wrap up, but I just want to thank each of
    our witnesses. Joe, I want to thank you and Joanne for being
    with us today as well as Kelly and Robin for taking the time to
    be with us in bringing, as I said, both your experience and
    expertise as advocates and as experts, but also to inject into
    this conversation the voices of--of Pennsylvanians all across
    the board. Couldn't be more important as we try to pass this
    bill, the Medicare and Medicaid Dental, Vision, and Hearing
    Benefits Act, Senate Bill 2618.
        We all believe, I think, as Americans, that no one should
    be forced to choose between affording their medication and
    keeping the lights on. No one should be asked to deplete their
    life savings in order to receive the dental care--the dental
    care they need to be able to eat and share a meal with their
    family.
        No senior and no person with a disability should have to
    miss out on a gathering with friends or loved ones, family
    members, because they can't afford to purchase a hearing aid
    that will let them participate in those conversations. As our
    witnesses told us today, this is all too often the case. As
    Americans, we can and we must do better. Now Congress can do
    better by passing this legislation, Senate Bill 2618, to
    provide these kinds of benefits to ensure this kind of care is
    provided to so many millions of Americans who are not receiving
    it today.
        To our witnesses, I want to say thanks for being here with
    us today. Your experiences and your testimony will be top of
    mind as we continue to fight for these policies in the next--
    especially the next 2 months. I'll continue to fight to protect
    Medicare from cuts, and I'm working with Democrats in the house
    and the Senate to make these benefits possible. Thanks for
    being with us today, and thanks for being such strong advocates
    for these benefits. Thank you.
        With that, our hearing is adjourned.
        [Whereupon, at 11:10 a.m., the hearing was adjourned.]

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                                    APPENDIX

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                          Prepared Witness Statements

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