[Congressional Record Volume 143, Number 140 (Thursday, October 9, 1997)]
[Extensions of Remarks]
[Pages E2002-E2003]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




            THE SENIOR CITIZEN RESPIRATORY CARE ACT OF 1997

                                 ______
                                 

                       HON. CHRISTOPHER H. SMITH

                             of new jersey

                    in the house of representatives

                       Thursday, October 9, 1997

  Mr. SMITH of New Jersey. Mr. Speaker, today I am introducing 
legislation to restore Medicare coverage for ultrasonic nebulizers--
medical devices used to treat patients with severe asthma, cystic 
fibrosis, chronic obstructive pulmonary disease [COPD], and other 
respiratory diseases.
  In April 1997, the Durable Medical Equipment Carriers [DMERC's], 
under the authority of the Health Care Financing Administration [HCFA], 
made a significant change in Medicare reimbursement policy that will 
put senior

[[Page E2003]]

citizens and disabled persons with respiratory illnesses at serious 
risk. My legislation is very simple. It restores Medicare coverage for 
ultrasonic nebulizers to the same terms and conditions that existed 
prior to this change.
  The device in question uses ultrasonic sound waves to turn medicine 
into a fine mist that is inhaled by the patient into the lungs. 
Ultrasonic nebulizers are extremely efficient at delivering medication 
where it is needed--the lungs--and in the optimum particle sizes.
  Without any clinical justification and without any public notice or 
comment, the DMERC's have either eliminated Medicare coverage for 
ultrasonic nebulizers entirely, or reduced reimbursement rates so 
drastically that suppliers will no longer provide them.
  The DMERC's decision was made despite the fact that ultrasonic 
nebulizers have been considered safe, effective, and medically 
necessary for years, and notwithstanding a large body of evidence that 
ultrasonic nebulizers are more efficient at delivering medication than 
the most similar alternative, the jet nebulizer or pneumatic 
compressor.
  Furthermore, beneficiaries are being forced to switch to a metered-
dose inhaler [MDI], which is not covered by Medicare. This has led to a 
significant increase in the out-of-pocket-costs of Medicare 
beneficiaries. I am particularly concerned that the additional costs 
borne by senior citizens may cause some to forego needed treatments--an 
outcome which could put their lives in jeopardy.
  Mr. Speaker, in addition to the increased costs to seniors, the lack 
of openness and public accountability, the new ``one-size fits all'' 
Medicare respiratory care policy is downright dangerous. While metered-
dose inhalers [MDI's] are wonderful devices, they are not the 
appropriate therapy for every person.
  Indeed, a number of well-controlled studies suggests that up to 50 
percent of senior citizens do not use MDI's properly--even after 
repeated instruction. What these studies imply is that if HCFA does not 
reverse the decision of the DMERC's and restore Medicare coverage for 
ultrasonic nebulizers, there will be seniors, forced to switch to 
MDI's, who could require hospitalization because they cannot use their 
MDI properly.
  Asthma and cystic fibrosis are not diseases to be taken lightly--if a 
person does not have the proper medicine, they can die. It is that 
simple. In fact, of the nearly 5,000 people who die every year from 
asthma, most deaths resulted from patients who failed to take their 
medication.
  For those with severe arthritis or poor hand-eye coordination, they 
cannot use an MDI at all. They will be the real victims of the new 
HCFA/DMERC policy on ultrasonic nebulizers. The HCFA/DMERC decision to 
deny ultrasonic nebulizer coverage is a clear case of a policy that is 
``penny wise and pound foolish.'' If a single inpatient hospital 
admission results from improper MDI usage, it will cost Medicare tens 
of thousands of dollars in increased costs.
  Lastly, Mr. Speaker, I am concerned about the impact on seniors if 
the Food and Drug Administration [FDA] is allowed to begin banning 
metered-dose inhalers that contain chlorofluorocarbons [CFC's], as they 
proposed on March 6, 1997. If HCFA removes coverage for ultrasonic 
nebulizers, forcing seniors to use metered-dose inhalers, and FDA in 
turn removes most metered-dose inhalers from the market, seniors will 
be left with a dramatically reduced range of therapeutic options at 
significantly higher prices.
  This outcome is completely unacceptable, and that is why my good 
friend and colleague from Florida, Mr. Cliff Stearns, and I have joined 
in introducing the Senior Citizen Respiratory Care Act of 1997. 
Congress must act soon to reverse HCFA's ``stealth'' coverage change, 
and restore Medicare reimbursement to devices which are safe and 
effective therapeutic options for seniors with serious respiratory 
illnesses.

                          ____________________