[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                     
          
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                       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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