[Congressional Record Volume 143, Number 1 (Tuesday, January 7, 1997)]
[Extensions of Remarks]
[Pages E63-E65]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




IN SUPPORT OF THE MEDICARE DIABETES, EDUCATION AND SUPPLIES ADMENDMENTS

                                 ______
                                 

                     HON. GEORGE R. NETHERCUTT, JR.

                             of washington

                    in the house of representatives

                        Tuesday, January 7, 1997

  Mr. NETHERCUTT. Mr. Speaker, as Co-Chair of the Congressional 
Diabetes Caucus, it is with pleasure that I support the Medicare 
Diabetes Education and Supplies Amendments of 1997, introduced today by 
Representative Elizabeth Furse. Representative Furse and I formed the 
Congressional Diabetes Caucus to promote awareness of diabetes and its 
consequences within Congress. This bill is an important step toward 
providing diabetics with the tools they need to control the negative 
repercussions and cost of diabetes.
  When my daughter, Meredith, was diagnosed with the disease in 1987, I 
became actively involved with learning more about the disease, its 
causes, complications and the cost to American society. Before entering 
Congress, I also served as president of the Spokane chapter of the 
Juvenile Diabetes Foundation.
  Over 16 million Americans suffer from diabetes. The resulting 
financial cost to society is staggering. An estimated $138 billion or 
14 percent of U.S. health care dollars, is spent on diabetes. The last 
several years have been encouraging for those working to find better 
treatments and a cure. Last year, doctors successfully transplanted 
insulin-producing cells into patients with type I diabetes. Researchers 
have also located genetic markers for diabetes, which should make it 
possible to identify patients at high risk. Additionally, the vaccine 
BCG has induced long-term remission of diabetes if given during the 
earliest stage of the disease.
  I am confident that a cure for diabetes is within our reach. In the 
meantime, however, the Federal government must avail itself of advances 
in treatment knowledge. In the private sector, we have seen that 
comprehensive diabetes education reduces both diabetes specific 
complications and overall health care costs. For example, Merck-Medco 
Managed Care, Inc. has realized a total per diabetic patient health 
care cost reduction of $441 since beginning an innovative diabetes 
education program.
  The Medicare Diabetes Education and Supplies Amendments of 1997 will 
employ some of the knowledge learned in the private sector by providing 
diabetes self-management training under Medicare. The bill will also 
expand coverage of blood testing strips to include all people with type 
II diabetes. Self-management training and access to blood testing 
strips are crucial to controlling the high health care costs associated 
with this disease. It is known that when diabetics keep their blood 
glucose level as close to normal as possible, the risk of complications 
can be reduced by as much as 65 percent.
  I encourage my colleagues to support this legislation.
  I am including for the Record the following statements from 
organizations in support of this legislation: The American Diabetes 
Association, the Juvenile Diabetes Foundation, the American Association 
of Diabetes Educators, the American Dietetic Association, the Endocrine 
Society, Eli Lilly and Co., and the Community Retail Pharmacy 
Coalition.

     Statement by the American Diabetes Association in Support of 
   Legislation To Improve Medicare Coverage for People With Diabetes

       There are few, if any, issues facing the nation that have 
     stronger bipartisan support than the diabetes Medicare reform 
     legislation being introduced today by Representatives 
     Elizabeth Furse and George Nethercutt. There are none, in our 
     opinion, for which there is a greater need.
       Diabetes is a prevalent, serious and costly disease and is 
     increasing at a shocking rate. Since the '60s the number of 
     cases has tripled to 16 million. Since 1992, the direct costs 
     of caring for people with diabetes have doubled to its 
     current sum of $91.1 billion a year. This figure does not 
     begin to account for the staggering losses in productivity 
     for our economy and well-being to Americans. When indirect 
     costs are included, diabetes costs our economy nearly $138 
     billion a year, more than any other single disease.
       Medicare alone spends one-quarter of its budget, nearly $27 
     billion a year, treating people with diabetes. Approximately 
     half of all diabetes cases occur in people older than 55 
     years of age. However, the complications and hospitalizations 
     associated with the disease (blindness, amputation, kidney 
     failure, heart disease and stroke) can be delayed or avoided 
     altogether with proper care. Our nation is only now coming to 
     this realization.
       The improvement in diabetes care embodied in this 
     legislation represents the only preventive care measure ever 
     scored (analyzed for its economic implications) by the 
     Congressional Budget Office (CBO) to save money. According to 
     the CBO analysis, each day Congress waits to enact these 
     Medicare reforms costs taxpayers an additional $500,000.
       This legislation, which incorporates two bills introduced 
     in the 104th Congress, H.R. 1073 and H.R. 1074, has 
     widespread support on both sides of the aisle. H.R. 1073 had 
     250 cosponsors in the last Congress. Of the more than 4,000 
     bills introduced in the 104th Congress, only 12 had more 
     cosponsors.
       During the fall election campaign, 180 members of the 
     incoming 105th Congress demonstrated support for improving 
     diabetes coverage by completing the American Diabetes 
     Association's Diabetes '96 Candidate Survey. Two hundred and 
     eighty-nine (289) Members of the 105th Congress either 
     cosponsored legislation or signed the Candidate survey. Of 
     the 289 supporters, 116 (40.1%) are Republicans and 173 
     (59.9%) are Democrats.
       Leaders of both political parties have stated their strong 
     support for this legislation. This legislation was included 
     in President Clinton's FY '97 budget proposal and according 
     to the White House, will be included in

[[Page E64]]

     FY '98. Minority Leader Gephardt has noted that the 
     provisions of the bill, if enacted, ``would help every 
     individual and family coping with diabetes and save billions 
     of dollars in future Medicare spending.''
       Speaker Gingrich cosponsored identical legislation (H.R. 
     4264) in the 104th Congress and has said that addressing 
     diabetes is one of his top four legislative priorities. 
     During the fall election campaign, Presidential candidate 
     Robert Dole noted that ``improved Medicare and private 
     insurance coverage of necessary diabetes supplies and 
     education would save lives and reduce the cost of diabetes-
     related illnesses to both the taxpayer and the private 
     sector.''
       The growing awareness of the seriousness of diabetes, along 
     with the strong support of President Clinton, Speaker 
     Gingrich and Congress, is crystal-clear mandate for immediate 
     action to improve Medicare coverage for diabetes. There is no 
     reason to wait. Any delay necessarily risks the health of the 
     3 million seniors diagnosed with diabetes and will waste 
     millions of taxpayers dollars.
                                  ____


   JDF Supports Legislation to Expand Medicare Coverage for Diabetes-
                            Related Services

       The Juvenile Diabetes Foundation International (JDF), which 
     gives more money directly to diabetes research than any other 
     non-profit health agency in the world, strongly supports 
     expedited passage of legislation which would make available 
     to millions of older Americans the diabetes self-management 
     training and critical testing equipment needed to attain 
     better control of blood glucose levels, thereby helping to 
     delay debilitating and life-threatening complications. It is 
     imperative that, while we pursue the longer-term objective of 
     a cure for diabetes through research, all people battling 
     this insidious and devastating disease have access to the 
     most advanced, proven diabetes management regimens and 
     technologies available. This additional Medicare coverage 
     makes tremendous economic sense for the country as well, 
     given the fact that treatment for diabetes-related 
     complications accounts for more than 27 percent of the total 
     Medicare budget.
       Despite medical and technological advances, people with 
     diabetes continue to die and suffer life-threatening 
     complications as a result of the disease. JDF believes that 
     ultimately, through research advances, a cure for diabetes 
     and its devastating complications will be found, resulting in 
     millions of lives and billions of dollars saved. The public 
     and private sector support for diabetes research has led to 
     substantial progress. The Congress' steadfast support for 
     medical research funding through the National Institutes of 
     Health has not only brought us closer to a cure for diabetes, 
     it has also produced new and better management techniques 
     which would have been unimaginable only two decades ago. 
     Recent studies show that U.S. health expenditures for people 
     with diabetes exceed $130 billion per year, or one out of 
     every seven health care dollars. Clearly, increased public 
     and private support for medical research is critical to 
     controlling health care costs.
       The Juvenile Diabetes Foundation International (JDF) is 
     dedicated to supporting research to find a cure for diabetes 
     and its complications, and to improving the lives of people 
     with diabetes through research progress. JDF is a not-for-
     profit, voluntary health agency with over 100 chapters in the 
     U.S. alone.
                                  ____


Statement by the American Association of Diabetes Educators in Support 
 of Legislation To Improve Medicare Coverage for People With Diabetes 
            and To Support Diabetes Self-management Training

       The American Association of Diabetes Educators, which has 
     more than 10,000 health care professionals who teach people 
     with diabetes how to manage their disease, supports the 
     diabetes reform legislation being introduced today by 
     representatives Elizabeth Furse and George Nethercutt.
       This legislation, which incorporates two bills introduced 
     in the 104th Congress, H.R. 1073 and H.R. 1074, would provide 
     diabetes outpatient self-management training services under 
     Part B of the Medicare program and uniform coverage of blood-
     testing strips for individuals with diabetes.
       We know the critical role diabetes education plays in the 
     treatment of this disease. Each day we help people with 
     diabetes lead healthy, productive lives. Each day we help to 
     prove that diabetes education saves lives and potentially 
     billions in Medicare expenditures each and every year.
       While difficult for some, these modifications can 
     dramatically reduce some of the more serious and expensive 
     complications which result from untreated diabetes.
       There are many case studies that prove the importance of 
     diabetes education and self-management. Take for instance the 
     case of Mr. H.L.
       H.L. is a 72-year old Medicare subscriber who has had 
     insulin-treated diabetes for the past 17 years. Six years 
     ago, H.L. averaged two hospital admissions per year for 
     uncontrolled diabetes. He was at high risk for cardiovascular 
     disease because of cholesterol levels 1\1/2\ times normal. 
     And, tragically, his right leg was amputated below the knee.
       You see, H.L. had walked for a day in wet shoes. Because he 
     had a lack of feeling in his feet, he didn't realize an ulcer 
     had developed on his foot until it was many days later--much 
     too late for treatment.
       H.L. had never been taught to monitor his blood glucose 
     levels--and he hadn't been told that he needed to regularly 
     examine his feet and legs for any abnormalities.
       Now, six years later, H.L. tests his own blood glucose 
     levels each day. His cholesterol levels are within the normal 
     range. And, despite having an increased risk of another 
     amputation, H.L. has his left leg and has not been admitted 
     to the hospital for uncontrolled diabetes since he began 
     self-management training.
       We cannot win the fight against diabetes without empowering 
     individuals with the skills to manage this disease. Because 
     no cure is currently available for diabetes, diabetes 
     education is one of our only and most potent weapons.
       Armed with this weapon, H.L. has prevented the amputation 
     of his left leg--as well as the frequent and costly 
     hospitalizations when this disease became uncontrollable.
       Now is the time to make a dramatic impact on the Medicare 
     system--and more imporantly--on the lives of people with 
     diabetes. Now is the time to recognize that diabetes 
     education pays for itself over a relatively short period of 
     time--and will save billions in Medicare expenditures each 
     year.
       How is this possible? Consider that for an average $50 
     visit to a diabetes educator, people like H.L. can learn how 
     to eliminate $1,000 per day hospital stays.
       For an average $50 visit to a diabetes educator, people can 
     save the hundreds of thousands of dollars spent each year 
     treating cardiovascular disease and kidney disease associated 
     with diabetes.
       For an average $50 visit to a diabetes educator, $30,000 
     amputations, like H.L.'s, can be prevented not only saving 
     the money spent on the procedure, but the costs of further 
     treatment and rehabilitation.
       Today, on behalf of the 10,000 diabetes educators from 
     around the country, the American Association of Diabetes 
     Educators strongly supports congressional action on this 
     important diabetes legislation to benefit the more than 16 
     million Americans afflicted with this disease.
                                  ____


 Statement of the American Dietetic Association in Support of Diabetes 
                        Self-Management Training

       The American Dietetic Association, the world's largest 
     organization of nutrition professionals, strongly supports 
     legislation which would provide coverage of diabetes 
     outpatient self-management training services under Part B of 
     the Medicare program. Dietitians recognize that self-
     management training--which includes medical nutrition 
     therapy--is essential if individuals with diabetes are to 
     successfully manage their disease.
       Numerous studies, such as the Diabetes Control and 
     Complications Trial, have shown that control of blood sugar 
     levels can help patients prevent or delay diabetes-related 
     complications. A study conducted in 1994 by the International 
     Diabetes Center in Minneapolis, MN, for The American Dietetic 
     Association showed that persons with non-insulin dependent 
     diabetes mellitus--also known as type II diabetes--can better 
     control their blood sugar levels, weight and cholesterol with 
     medical nutrition therapy. Medical nutrition therapy is the 
     use of specific nutrition services to treat a chronic 
     condition, illness or injury. At all phases of the six-month 
     study, medical nutrition therapy provided by a registered 
     dietitian resulted in improvements in patients' fasting 
     plasma glucose (FBG) and glycated hemoglobin levels (HBA1c) 
     compared to levels at the onset of the study.
       Medical nutrition therapy is a cornerstone of self-
     management training and has been proven to significantly save 
     health care costs by reducing the incidence of 
     complications--including lower extremity amputations, kidney 
     failure, blindness, heart attacks and frequent 
     hospitalization. An internal analysis of nearly 2,400 case 
     studies submitted by American Dietetic Association members 
     show that on average more than $9000 per case can be saved in 
     type I diabetes (insulin-dependent) cases with the 
     intervention of medical nutrition therapy. Intervention in 
     type II diabetes cases showed a savings of nearly $2000 per 
     case.
       Enactment of legislation providing coverage for diabetes 
     self-management training will correct a monumental oversight 
     in Medicare coverage by providing the essential training and 
     nutrition services that have been recognized as critical to 
     the treatment of diabetes. The nearly 70,000 members of The 
     American Dietetic Association strongly support action by the 
     congressional leadership to enact this important legislation 
     immediately.
                                  ____


Statement of P. Michael Conn, Ph.D., President, the Endocrine Society, 
                on Bill for Diabetes Management Programs

       ``The Endocrine Society applauds the efforts of Reps. 
     Elizabeth Furse and George Nethercutt, whose goal is to 
     improve the quality of life for patients with diabetes. And 
     as a constituent of the Congresswoman from Oregon, I extend 
     special recognition to her for her bill.
       ``The state of diabetes care in the U.S. calls for the kind 
     of reform proposed in this

[[Page E65]]

     legislation. In too many instances, people with diabetes do 
     not have access to the management programs and equipment 
     necessary to properly care for their illness. Without these 
     management tools, diabetic patients face higher risks of the 
     long-term complications that rob them of their sight and 
     mobility.
       ``Diabetes is a chronic illness, but one that can be 
     controlled--even reversed--when patients have access to and 
     follow appropriate management programs under the care of an 
     endocrinologist. Medical science has shown that complications 
     of diabetes do not have to happen. Costs associated with 
     chronic illnesses have been identified as a significant 
     health care crisis that we will face in the future, according 
     to a study released in November 1996 by the Robert Wood 
     Johnson Foundation. An earlier taxpayer-funded study has 
     already proven that management programs reduce complications 
     from diabetes.
       ``Fewer complications means a greater quality of life for 
     the 16 million Americans with diabetes and a lower health 
     care bill for all Americans. Our Medicare program needs the 
     common-sense, cost-saving reform proposed in this bill. As 
     soon as it is passed, we will begin to invest in economical 
     diabetes prevention programs that improve patients' lives and 
     save the country's health care dollars.''
                                  ____


   Lilly Supports Medicare Coverage Improvement for Diabetes Patients

       Representatives Elizabeth Furse (D-1st-OR) and George 
     Nethercutt (R-5th-WA) will introduce a bill requiring 
     Medicare coverage of self-management training services and 
     blood testing strips, important preventive measures for 
     people with diabetes who want to stay healthy and avoid 
     complications. Eli Lilly and Company vigorously supports the 
     Furse-Nethercutt diabetes bill.
       More than 16 million Americans have diabetes, a serious 
     disease that affects the body's ability to produce or respond 
     properly to insulin, a hormone that allows blood sugar to 
     enter the cells of the body and be used for energy. 
     Approximately half of all diabetes cases occur in people 
     older than 55.
       Studies show that providing coverage for diabetes supplies, 
     and self-management training directly helps people with 
     diabetes avoid devastating and costly complications like 
     kidney failure, heart attack, stroke, blindness and 
     amputations.
       According to the American Diabetes Association, diabetes 
     costs the U.S. $138 billion a year in health costs. About 
     one-fourth of the Medicare budget (nearly $30 billion a year) 
     is devoted to treating diabetes and its complications. People 
     on Medicare are one-and-a-half times more likely to have 
     diabetes and its complications than other persons. Yet 
     Medicare does not cover the tools to properly manage their 
     disease.
       Two-thirds of diabetes expenditures are related to the 
     complications of the disease. The American Diabetes 
     Association estimates that up to 85 percent of the 
     complications associated with diabetes can be prevented. Yet 
     today, only 30 percent of all patients receive any type of 
     diabetes self-management training.
       Lilly is a leader in diabetes care, celebrating 75 years of 
     lifesaving Lilly insulin in 1996. In addition to providing 
     disease treatments, Lilly specializes in diabetes education, 
     teaching patients about the roles of diet, exercise, 
     medication and monitoring their blood glucose levels to best 
     manage their disease. Through our PCS subsidiary's 
     Information Warehouse of 1.2 billion pharmacy records, Lilly 
     helps physicians and health care providers identify 
     particularly vulnerable points in the progression of 
     diabetes.
       Lilly believes the Furse-Nethercutt bill will prove to be 
     extremely valuable as a prevention measure for people with 
     diabetes, while helping reduce future Medicare costs.
                                  ____

                                                  Community Retail


                                           Pharmacy Coalition,

                                  Alexandria, VA, January 7, 1997.
     Hon. Elizabeth Furse,
     House of Representatives,
     Washington, DC.
       Dear Representative Furse: The Community Retail Pharmacy 
     Coalition is writing to indicate its support for your bill to 
     improve Medicare coverage of outpatient self management 
     training and blood testing strips for diabetics. The 
     Coalition consists of the National Community Pharmacists 
     Association (NCPA), representing independent retail pharmacy, 
     and the National Association of Chain Drug Stores (NACDS). 
     Collectively, the 60,000 retail pharmacies represented by the 
     Coalition provide 90 percent of the 2.3 billion outpatient 
     prescriptions dispensed annually in the United States.
       This program will help reduce the relatively high 
     percentage of Medicare expenditures which result from caring 
     for Medicare's significant diabetic population. We understand 
     that this program will save Medicare $1.6 billion over the 
     next six years. Allowing Medicare beneficiaries to use their 
     local retail pharmacy provider to obtain this education and 
     training makes sense. The nation's community retail 
     pharmacies already provide a convenient location for Medicare 
     beneficiaries to obtain the supplies that they need to help 
     manage their diabetes, such as insulin and test strips.
       The Coalition supports this bill, but asks that you assure 
     that pharmacists meeting the educational requirements to 
     participate in the program are, in fact, eligible for payment 
     for these services under Medicare. The bill defines a 
     ``provider'' as an individual or entity that provides other 
     items or services to Medicare beneficiaries for which payment 
     may be made. Pharmacies already provide such items and would 
     appear to qualify as a ``provider'' under this bill. However, 
     pharmacies are not currently classified as ``suppliers'' 
     under the Medicare program, and we urge that your bill do so 
     to assure that pharmacies qualify under this important 
     program.
       We believe that similar programs to increase quality and 
     reduce costs could be developed for other disease states that 
     are common in the Medicare population, such as asthma and 
     high blood pressure. We would be very willing to work with 
     you on developing such programs. We acknowledge and applaud 
     your leadership in increasing the quality of care for 
     diabetics who are covered by Medicare.
           Sincerely,
                                                Ronald L. Ziegler,
                     President and Chief Executive Officer, NACDS.
                                                Calvin N. Anthony,
     Executive Vice President, NCPA.

                          ____________________