[Congressional Record Volume 144, Number 130 (Friday, September 25, 1998)]
[Extensions of Remarks]
[Pages E1809-E1810]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




        NATIONAL BIPARTISAN COMMISSION ON THE FUTURE OF MEDICARE

                                 ______
                                 

                           HON. NANCY PELOSI

                             of california

                    in the house of representatives

                       Friday, September 25, 1998

  Ms. PELOSI. Mr. Speaker, I submit the following testimony.

       Thank you for the opportunity to provide testimony to the 
     National Commission. Your work will have a profound impact on 
     the health care of millions of Americans, and I encourage you 
     to seek broad input from Medicare beneficiaries and providers 
     around the country.
       Medicare is one of our great success stories; it provides 
     quality health insurance to 38 million Americans at a low 
     administrative cost. Today Medicare is serving as a model 
     provider of consumer protections. In the future, it can be 
     the foundation for increased access to health care for all 
     Americans.
       Three months ago, I sponsored two town hall meetings on the 
     future of Medicare in my home district of San Francisco. 
     Hundreds of individuals came to share their thoughts and 
     concerns about Medicare, and to talk about the important role 
     the program plays in their lives.
       The consensus in the San Francisco Bay Area was clearly for 
     Medicare for all. Medicare must be preserved, improved and 
     expanded for future generations. People who came to these 
     meetings urged elected officials to protect the long term 
     financial health of the program. But they also shared their 
     visions of what Medicare can be--a more comprehensive program 
     that better meets the needs of beneficiaries, and provides 
     health insurance to many of those who have difficulty 
     purchasing private insurance.
       To design a Medicare program that improves services as well 
     as meets the financial bottom line, we need to listen to 
     people who are benefiting from Medicare now, and to

[[Page E1810]]

     those who provide needed medical care through the program. So 
     today I am submitting to the Commission the written comments 
     we received at our town hall meetings. Let me briefly 
     summarize these comments for you.


                  Testimony at Two Town Hall Meetings

       The point made most frequently in written comments was that 
     Medicare should not impose stringent limits on home health 
     care services. The logic of providing home health services is 
     clear: seniors are happier and healthier if they can remain 
     in their own homes, with some assistance, and sustain a level 
     of independence. And increased institutionalization obviously 
     means increased long term costs for the program.
       Other frequent comments included the need to provide 
     prescription drug coverage and long term care services 
     through Medicare. One woman noted that, ``Sometimes I have 
     to do without a prescribed medication until I receive my 
     Social Security check at the first of the month.''
       Others voiced their support for an expanded Medicare 
     program in which millions more Americans are eligible for 
     services. It is no secret that if younger and healthier 
     individuals sign up for Medicare and pay premiums, the 
     average cost per beneficiary will fall. Several people who 
     filled out comment forms warned against efforts to privatize 
     Medicare or compromise the program through Medicare savings 
     accounts.
       Others argued for including providing prevention, dental 
     and vision services. The importance of these services 
     requires no explanation. In an era when we are insisting all 
     health care providers deliver more comprehensive prevention 
     services, we should demand the same from Medicare. One woman 
     suggested that Medicare require all HMOs to provide a toll 
     free hotline to consumers.


                    Comments from Medicare Providers

       Medicare providers in my district also spoke at the town 
     hall meetings about the challenges they face in providing 
     care. The interim payment system for home health agencies has 
     imposed a heavy financial burden on providers. Medicare 
     providers have also supported legislative efforts to carve 
     out disproportionate share hospital payments from payments to 
     HMOs, eliminate the 100 bed requirement for qualification as 
     a disproportionate share hospital, and repeal of the 
     financial penalty for hospitals that transfer patients to 
     other care settings before the DRG period has expired.


                      Concerns of People with AIDS

       The AIDS epidemic has taken a devastating toll in my 
     district, and Medicare plays a significant role in provision 
     of health care to individuals affected by this epidemic. It 
     is estimated that between 6% and 20% of people with HIV/AIDS 
     rely on Medicare for some or all of their health care 
     services. The Centers for Disease Control has estimated that 
     between 10,565 and 22,927 Medicare beneficiaries are 
     diagnosed with AIDS.
       A recent report published by the Academy for Educational 
     Development documents several concerns about HIV-related 
     health care services under Medicare. First, because the 
     program does not cover the costs of prescription drugs, 
     beneficiaries are forced to find other means of acquiring the 
     expensive but promising new drug treatments for HIV 
     infection. These drugs can cost $12,000 per year or more.
       The report notes several other problems for people with HIV 
     including, ``the lack of guaranteed availability of 
     individual supplemental insurance for the disabled under the 
     age of 65, the lack of guaranteed availability of HIV 
     specialists in Medicare managed care plans, the inadequacy of 
     community-based and home care services to address the ongoing 
     chronic nature of the HIV disease process, and the 
     limitations of the hospice benefit for addressing the acute 
     treatment needs of people in the terminal stage of HIV 
     disease.'' I am submitting a copy of this report with the 
     town hall meeting testimony noted above.


                            Recommendations

       A number of recommendations for reform of Medicare follow 
     from the testimony and policy research presented above. Below 
     is a list of recommendations. In some cases, I have noted 
     legislation I have cosponsored that is consistent with these 
     recommendations.

                  Expand sevices available in Medicare

       Medicare should provide comprehensive and cost effective 
     care to those who are eligible for the program. The program 
     should provide reimbursement for needed drug therapies, long 
     term care services, dental and vision care, and prevention 
     services. The Medically Necessary Dental Care Act (H.R. 1288) 
     would provide coverage for outpatient dental procedures.

                    Expand eligibility for Medicare

       Medicare can serve as the foundation for increased access 
     to health care for all Americans. I urge the Commission to 
     identify ways in which eligibility for the program can be 
     expanded. The Medicare Early Access Act (H.R. 3470) is 
     consistent with this proposal. The bill would allow many of 
     the ``near elderly'' to buy in to Medicare. We need to build 
     upon this legislation to ensure that any buy in is affordable 
     for all those who need health insurance coverage.

           Address legitimate concerns of Medicare providers

       The interim payment system for home health agencies 
     threatens to put many providers out of business. Congress and 
     the Commission must urgently address the need to develop a 
     more equitable payment system for home health care. The 
     Medicare Home Health Beneficiary Protection Act (H.R. 4339) 
     places a moratorium on the interim payment system for home 
     health care.
       The Commission should also take steps to protect 
     reimbursement to disproportionate share hospitals. H.R. 2701 
     would ``carve out'' disproportionate share hospital (DSH) 
     payments from the payment we give HMOs.
       In addition, the 100 bed requirement for qualification as a 
     DSH should be repealed.
       The disincentive for early hospital discharge should be 
     eliminated. The Common Sense Hospital Payment Act (H.R. 2908) 
     repeals the financial penalty for hospitals that transfer 
     patients to other care settings before the DRG payment period 
     has expired.

      Address concerns of People with AIDS and other disabilities

       As people with AIDS live longer lives, more will become 
     eligible for Medicare. The Commission should make several 
     changes in the program to address the needs of this growing 
     population, including: guaranteed availability of 
     supplemental Medicare insurance for disabled individuals; 
     guaranteed access to an HIV expert as a primary care provider 
     and for specialist services; and elimination of the 
     limitation on hospice benefits that bars people from 
     receiving some needed acute care treatments while in hospice 
     care.
       In addition, I encourage the Commission to study the 
     interaction between Medicare, Medicaid, and Ryan White CARE 
     program services, particularly in the provision of community 
     based support services.
       I look forward to working with the Commission to build a 
     fiscally sound and expanded Medicare program. Thank you again 
     for the opportunity to present these perspectives.

     

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