[Congressional Record Volume 141, Number 199 (Thursday, December 14, 1995)]
[Extensions of Remarks]
[Pages E2361-E2362]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




    INTRODUCTION OF THE MEDICARE PREVENTIVE BENEFITS IMPROVEMENT ACT

                                 ______


                        HON. BENJAMIN L. CARDIN

                              of maryland

                    in the house of representatives

                       Tuesday, December 13, 1995

  Mr. CARDIN. Mr. Speaker, today I rise to introduce the Medicare 
Preventive Benefits Improvement Act. This bill seeks to amend Medicare 
by adding new preventive benefits to the program--benefits that not 
only save lives, but improve quality of life, and will save Medicare 
expenditures in the long run.
  My bill would improve Medicare by adding the following new benefits:
  Mammography: The benefit would be expanded so that all women over age 
50 would be eligible for yearly mammographies and the deductible is 
waived.
  Screening pap smears and pelvic exams: Expands the benefit from the 
3-year limitation so that women of childbearing age or at high risk of 
developing cervical cancer are eligible for yearly pap smears and 
cervical exams. The deductible is also waived.
  Colorectal cancer screening: Adds procedures for the purpose of early 
detection of colorectal cancer. These tests would include: screening 
fecal occult blood test, screening flexible sigmoidoscopy, and 
colonoscopy for high risk individuals. The Secretary also would make a 
decision within two years about covering screening barium enemas as an 
alternative to flexible sigmoidoscopy or colonoscopy. In addition, 
changes in technology would be taken into account to update the benefit 
in future years.
  Prostate cancer screening: Adds procedures for the purpose of early 
detection of prostate cancer in men. The tests would include a digital 
rectal examination and a prostate-specific antigen blood test. In 
addition, changes in technology would be taken into account to update 
the benefit in future years.
  Diabetes screening benefits: Adds two new diabetes benefits. First, 
coverage of diabetes 

[[Page E2362]]
outpatient self-management training services which teach people with 
diabetes how to properly care for their disease and avoid unnecessary 
medical complications. Second, Medicare would cover the costs of blood-
testing strips as durable medical equipment.
  Many of you should recognize this package of preventive benefits. It 
is the same as the benefits we included in the Democratic alternative 
Medicare proposal that was considered on the House floor earlier this 
year. In addition, the coalition budget proposal includes a similar 
package of benefits. President Clinton has also included a preventive 
benefits package in his new Medicare proposal.
  Congress is currently facing the daunting task of making the most 
dramatic changes to Medicare ever contemplated. We keep hearing the 
words ``Medicare reform'' in relation to the variety of plans being put 
forth at this time. My contention is that if we are to accomplish real 
Medicare reform, we must make needed improvements to the program

  Medicare is 30 years old and its benefit package shows its age. What 
I am proposing with these new benefits is not a major cost item for the 
program. Of course there will be an upfront investment in these new 
screening procedures--and we expect that cost to be around $2 billion 
over the next 7 years based upon CBO analysis of earlier versions of 
the bill. However, this is a small price to pay at the beginning 
compared to the benefits Medicare will reap in the long run by covering 
such procedures. As we all know, preventive medicine saves money as 
well as lives. Early identification of a disease allows less costly, 
more effective treatment techniques to be used.
  For example, in the area of colorectal cancer, the second deadliest 
cancer in this country, 138,000 new cases will be diagnosed and 53,300 
people will die from this disease this year. Most of these people will 
be Medicare beneficiaries. These patients often suffer through years of 
chemotherapy, surgery and hospitalization. In fact, the most recent 
data has shown that colorectal cancer has led to over 125,000 Medicare 
hospital admissions in one year. Each of these admissions led to costly 
diagnostic, surgical and medical therapeutic interventions. Surely, it 
is both more cost effective and more medically appropriate to prevent 
than to treat this disease.
  To continue using colorectal cancer as the example, this disease is 
one of the most preventable and curable types of cancer when detected 
early. Most colorectal cancers develop from benign polyps. Finding and 
removing these polyps reduces the risk of developing cancer by 90 
percent.
  Screening for colorectal cancer and other preventive services 
included in this bill must be covered by Medicare if we hope to stem 
rising health care costs. We must not continue to be ``penny wise and 
pound foolish'' by covering the expensive treatments and ignoring 
preventive services. These efforts are supported by broad-range of 
organizations representing consumers and health professionals. The 
following organizations have endorsed our bill: the American Cancer 
Society, the American College of Gastroenterology, the American 
Gastroenterological Association, the American Nurses Association, the 
Digestive Disease National Coalition, the American Diabetes 
Association, the American Association of Clinical Urologists, the 
American Foundation for Urologic Disease, the American Urological 
Association, the American Society for Gastrointestinal Endoscopy, the 
Cancer Research Foundation of America, the Association of American 
Cancer Institutes, the Association of Pediatric Oncology Nurses, and 
the United Ostomy Association. I have also attached a letter to the 
congressional leadership signed by 15 organizations supporting the 
identical provisions included in my bill.
  It is my hope that this legislation will be used as a model for the 
preventive benefit package that should be added to Medicare as we seek 
to reform the system. I encourage my colleagues to join me in support 
of this bill and look forward to continuing to work on this important 
issue as Congress grapples with the difficult task of reforming 
Medicare.

                                                November 16, 1995.
     Hon. Robert Dole,
     Majority Leader U.S. Senate, Washington, DC.

     Hon. Newt Gingrich,
     Speaker, U.S. House of Representatives, Washington, DC.
       Dear Senator Dole and Speaker Gingrich: In crafting the 
     future Medicare system, the 104th Congress would be remiss to 
     overlook the most significant key to the future health status 
     of our nation's citizens--preventive health services. The 
     undersigned organizations urge you to include preventive 
     services coverage for Medicare recipients during the 
     Reconciliation Conference.
       When details of the draft Republican health plan first 
     became known this summer, we applauded the foresight of 
     Congressional policymakers for including Medicare payments 
     for a small number of proven preventive health services. 
     While we recognize the fiscal constraints dominating this 
     first round of Budget Reconciliation decisionmaking, we urge 
     your reconsideration of the critical omission of colorectal 
     cancer screening, mammography expansions, pap smears and 
     pelvic examinations, prostate cancer screening and 
     reimbursement for diabetes care and education. We believe 
     strong bipartisan support exists for including these limited 
     preventive benefits under Medicare.
       In revamping Medicare, now is the time to provide 
     reimbursement for:
       Annual mammography screening services for all women over 
     the age of 49, without a twenty percent copayment.
       Pap smear and pelvic exam screenings as well as clinical 
     breast examinations for female Medicare beneficiaries, 
     without copayments.
       Colorectal screening services for Medicare beneficiaries, 
     including screening of fecal-occult blood testing, flexible 
     sigmoidoscopies and colonoscopies.
       Prostate cancer screening for men.
       Diabetes care and education, specifically the coverage of 
     outpatient self-management training services and blood 
     testing strips for diabetics.
       We strongly urge that you include the above screening 
     services as part of the revamped Medicare program. In the 
     long run, providing preventive services to Medicare 
     beneficiaries will save not only money, but more importantly 
     lives. The Senate and House are uniquely poised to better the 
     lives of millions of Medicare beneficiaries who stand so much 
     to lose or gain from this historic legislative opportunity.
       We respectfully request the opportunity to meet with you at 
     your earliest convenience to discuss including these 
     preventive benefits in the final package.
           Sincerely,
         American Cancer Society, American College of 
           Gastroenterology, American Diabetes Association, 
           American Foundation for Urologic Disease, American 
           Public Health Association, Cancer Research Foundation 
           of America, Digestive Disease National Coalition, 
           Families Against Cancer Terror (FACT).
         National Breast Cancer Coalition, National Coalition for 
           Cancer Survivorship, The Oncology Nursing Society, The 
           Association of Pediatric Oncology Nurses, The Susan G. 
           Komen Breast Cancer Foundation, United Ostomy 
           Association, The V Foundation.

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