[Congressional Record Volume 145, Number 82 (Thursday, June 10, 1999)]
[Senate]
[Pages S6860-S6863]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. GRAHAM:
  S. 1204. A bill to promote general and applied research for health 
promotion and disease prevention among the elderly, to amend title 
XVIII of the Social Security Act to add preventative benefits, and for 
other purposes; to the Committee on Finance.


                 healthy seniors promotion act of 1999

  Mr. GRAHAM. Mr. President, I rise today to announce the introduction 
of the Healthy Seniors Promotion Act of 1999.
  This bill has a clear, simple, yet profoundly important message. That 
message is, ``Preventive health care for the elderly works.''
  Regardless of your age, preventive health care improves quality of 
life. And despite common misperceptions, declines in health status are 
not inevitable with age. a healthier lifestyle, even one adopted later 
in life, can increase active life expectancy and decrease disability.
  The Healthy Seniors Promotion Act of 1999 has a broad base of support 
from across the health care and aging communities, including the 
National Council on Aging, the American Geriatrics Society, the 
American Heart Association, the American Council of the Blind, the 
American College of Preventive Medicine, the National Osteoporosis 
Foundation, and the Partnership for Prevention.
  This bill goes a long way toward changing the fundamental focus of 
the Medicare program from one that continues to focus on the treatment 
of illness and disability--a function which is reactionary--to one that 
is proactive and increases the attention paid to prevention for 
Medicare beneficiaries.
  This bill has 4 main components: First, the bill establishes the 
healthy Seniors Promotion Program. This program will be spearheaded by 
an interagency workgroup within the Department of Health and Human 
Services, including the Health Care Financing Administration, the 
Centers for Disease Control and Prevention, the Agency for Health Care 
Policy Research, the National Institute on Aging, and the 
Administration on Aging.
  This working group, first and foremost, will bring together all the 
agencies within HHS that address the social, medical, and behavioral 
health issues affecting the elderly, and instructs them to undertake a 
series of actions which will serve to increase prevention-related 
services among the elderly.
  A major function of this working group will be to oversee the 
development, monitoring, and evaluation of an applied research 
initiative whose main goals will be to study: (1) The effectiveness of 
using different types of providers of care, as well as looking at 
alternative delivery settings, when delivering health promotion and 
disease prevention services, and (2) the most effective means of 
educating Medicare beneficiaries and providers regarding the importance 
of prevention and to examine ways to improve utilization of existing 
and future prevention-related services.
  Mr. President, this latter point is critical. The fact is that there 
are a number of prevention-related services available to Medicare 
beneficiaries today, including mammograms and colorectal cancer 
screening. But those services are seriously underutilized.
  In a study published by Dartmouth University this spring--The 
Dartmouth Atlas of health Care 1999--it was found that only 28 percent 
of women age 65-69 receive mammograms and only 12 percent of 
beneficiaries were screened for colorectal cancer.
  These are disturbing figures and they clearly demonstrate the need to 
find new and better ways to increase the rates of utilization of 
proven, demonstrated prevention services. Our bill would get us the 
information we need to increase rates of utilization for these 
services.
  A second major portion of this bill is the coverage of additional 
preventive services for the Medicare program. The services that I am 
including focus on some of the most prominent, underlying risk factors 
for illness that face all Medicare beneficiaries. This bill would 
include screening for hypertension, counseling for tobacco cessation, 
screening for glaucoma, and counseling for hormone replacement therapy. 
Attacking these prominent risk factors would reduce Medicare 
beneficiaries' risk for health problems such as stroke, osteoporosis, 
heart disease, and blindness.
  How did we choose these risk factors? We turned to the experts. Based 
on the recommendations of the U.S. Preventive Services Task Force, 
these prevention services represent the recommendations of the Task 
Force which is the nationally recognized body in the area of clinical 
prevention services.
  But simply screening or counseling for a preventive benefit is not 
enough. For example, to tell a 68-year-old woman that she ought to 
receive hormone replacement therapy in order to reduce her risk or 
osteoporosis and bone fractures from falls, and then to tell her you 
won't pay for the treatment makes no sense.
  Since falls and the resulting injuries are among the most serious and 
common medical problems suffered by the elderly--with nearly 80-90 
percent of hip fractures and 60-90 percent of forearm and spine 
fractures among women 65 and older estimated to be osteoporosis-
related--to sit idly by and not take the extra steps needed would be 
irresponsible.
  That is why, Mr. President, we are going the extra mile. The third 
major section of our bill includes a limited, prevention-related 
outpatient prescription drug benefit. This benefit directly mirrors the 
services I just described, plus it provides coverage of outpatient 
prescription drugs for the preventive services added to the Medicare 
program as part of the Balanced Budget Act of 1997--e.g., mammograms, 
diabetes, colorectal cancer.
  For example, if a 70-year-old smoker is counseled by his physician to 
stop smoking, that individual will now have access to all necessary and 
appropriate outpatient prescription drugs used as part of an approved 
tobacco cessation program.
  By linking counseling and drug treatment, we increase the chances of 
success tremendously. For example, there is a 60 percent higher 
survival rate among individuals who quit smoking compared to smokers of 
all ages. And because the number of older people at risk for cancer and 
heart disease is higher, tobacco cessation has the potential to have a 
larger aggregate benefit among older persons.
  Our bill also provides outpatient drugs for the treatment of 
hypertension, hormone replacement therapy, osteoporosis and heart 
disease, and glaucoma. It also provides coverage of drugs stemming from 
the preventive services added by the Balanced Budget Act.
  While many of my colleagues would prefer to see a Medicare 
prescription drug benefit that is comprehensive in nature, the facts 
are that such a benefit is simply not affordable--$20+ billion per 
year--at this point in time. This bill is a down payment to current and 
future Medicare beneficiaries and provides them access to prescription 
drugs that will make a profound impact in their lives.
  Important to note, this bill also states that if the Administration 
moves forward with and prevails in its efforts to sue the tobacco 
industry for the recovery of funds paid by Federal programs such as 
Medicare for tobacco-related illness, that half of those funds would be 
used to add additional categories of drugs to this limited benefit.
  This bill would also instruct the Institute of Medicine to conduct a 
study that would, in part, create a prioritized list of prescription 
drugs that would be used to add new categories of drugs to the program, 
if and when, tobacco settlement funds become a reality in the future.
  Finally, the bill contains two important studies that will be 
conducted on a routine, periodic basis.
  The first study would require MedPAC to report to Congress every two 
years on how the Medicare program is, or is not, remaining competitive 
and modern in relationship to private sector health programs. This will

[[Page S6862]]

give the Congress [information it doesn't now have] the ability to 
assess, on an ongoing basis, how Medicare is faring in its efforts to 
modernize over time.
  The second study will again be conducted by the Institute of 
Medicine. The Institute of Medicine, with input from new, original 
research on prevention and the elderly that we will be funding through 
the National Institute on Aging, will conduct a study every 5 years to 
assess the preventive benefit package, including prescription drugs. 
The study will determine whether or not the preventive benefit package 
needs to be modified or changed based on the most current science. A 
critical component of this study will be the manner in which it is 
presented to Congress.
  To this end, I have borrowed a page from our Nation's international 
trade laws (The Trade Act of 1974) and developed a fast track proposal 
for the Institute of Medicine's recommendations. This is a deliberate 
effort, Mr. President, to finally get Congress out of the business of 
micro-managing the Medicare program and the medical and health care 
decisions within it. While limited to the preventive benefits package, 
this will offer a litmus test on a new and creative approach to future 
Medicare decision making. This provision would put the substantive 
decision making authority where it belongs, in the hands of the real 
experts, not the politicians and not the lobbyists who come to our 
offices every day. Congress, after some deliberation, would either have 
to accept or reject the Institute of Medicine's recommendations. A 
change, in my view, that would be a major, positive change in how we do 
business in this body.
  A few final thoughts. There are many here in Congress who argue that 
at a time when Medicare faces an uncertain financial future, this is 
the last time to be adding benefits to a program that can ill afford 
the benefits it currently offers. Normally I would agree with this 
assertion. But the issue of prevention is different. The old adage of 
``an ounce of prevention is worth a pound of cure'' is very relevant 
here. Do preventive benefits ``cost'' money in terms of making them 
available? Sure they do. But the return on the investment, the 
avoidance of the pound of cure and the related improvement in quality 
of life is unmistakable.
  Along these lines, a longstanding problem facing lawmakers and 
advocates of prevention has been the position taken by the 
Congressional Budget Office, as they evaluate the budgetary impact of 
all legislative proposals, that only costs incurred by the Federal 
government over the next ten years can be considered in weighing the 
``cost'' of adding new benefits. From a public health and quality of 
life standpoint, this premise is unacceptable.
  Among the problems with this practice is that ``savings'' incurred by 
increasing the availability and utilization of preventive benefits 
often occur over a period of time greater than 10 years. And with the 
average lifespan of individuals whom are 65 being nearly 20 years--and 
individuals 85 and older are the fastest growing segment of the elder 
population--it only makes sense to look at services and benefits that 
improve the quality of their lives and reduce the costs to the Federal 
government for that 20-year lifespan and beyond.
  In addition to increased lifespan, a ten-year budget scoring window 
doesn't factor into consideration the impact of such services on the 
private sector, such as productivity and absenteeism, for the many 
seniors that continue working beyond age 65.
  The bottom line is, the most important reason to cover preventive 
services is to improve health. As the end of the century nears, 
children born now are living nearly 30 years longer than children born 
in 1900. While prevention services in isolation won't reduce costs, 
they will moderate increases in the utilization and spending on more 
expensive acute and chronic treatment services.
  I want to leave you with these last thoughts, Mr. President. As 
Congress considers different ways to reform Medicare, several basic 
questions regarding preventive services and the elderly must be part of 
the debate.
  (1) Is the value of improve quality of life worth the expenditure?
  (2) How important is it for the Medicare population to be able to 
maintain healthy, functional and productive lives?
  (3) Do we, as a Nation, accept the premise that quality of life for 
our elderly is as important as any other measure of health?
  (4) If we can, in fact, delay the onset of disease for the Medicare 
population by improving access to preventive services and compliance 
with these services, how important is it to ensure that there is an 
overall saving to the system?
  These are just some of the questions we must answer in the coming 
debate over Medicare reform. While improving Medicare's financial 
outlook for future generations is imperative, we must do it in a way 
that gives our seniors the ability to live longer, healthier and valued 
lives. I believe that by pursuing a prevention strategy that addresses 
some of the most fundamental risk factors for chronic illness and 
disability that face seniors, we will make an invaluable contribution 
to the Medicare reform debate and, more importantly, to current and 
future generations of Medicare beneficiaries.
  I urge colleagues to support the Healthy Seniors Promotion Act of 
1999.
  Mr. President, I ask unanimous consent that additional material be 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:


                                   Partnership for Prevention,

                                    Washington, DC, June 10, 1999.
     Hon. Bob Graham,
     U.S. Senate,
     Washington, DC.
       Dear Senator Graham: I am writing on behalf of Partnership 
     for Prevention to express support for ``The Healthy Seniors 
     Promotion Act of 1999.'' Partnership is a national non-profit 
     organization committed to increasing the visibility and 
     priority for prevention within national health policy and 
     practice. Its diverse membership includes leading groups in 
     health, business and industry, professional and trade 
     associations.
       We believe prevention does work for all ages--a decline in 
     health status is not inevitable with age. A healthier 
     lifestyle adopted later in life can increase active life 
     expectancy and decrease disability. This is the time for 
     greater emphasis on health promotion and disease prevention 
     among older Americans. By delaying the onset of disease, we 
     expect to have a healthier elderly population living longer 
     lives and ultimately embracing Medicare's financial 
     stability.
       In this bill, your focus on specific prevention measures is 
     well supported by the existing literature. For individuals 
     over 65, the United States Preventive Services Task Force 
     recommends tobacco cessation counseling with access to 
     appropriate nicotine replacement or other appropriate 
     products to help the individual combat nicotine addiction; 
     hormone replacement therapy and hypertension screening with 
     access to the appropriate drug therapy for both conditions.
        A case can be made that dollar for dollar, prevention 
     services offer an invaluable return on the investment for the 
     Medicare eligible population especially when compared to 
     treatment costs. We need more information on these issues and 
     hope to work closely with the Institute of Medicine to 
     determine additional changes to the Medicare system in the 
     future.
       I would like to highlight one additional issue. Partnership 
     for Prevention supports using a significant portion of any 
     funds recouped by the Federal Government from the tobacco 
     industry for tobacco control and prevention. Public and 
     private direct expenditures to treat health problems caused 
     by tobacco use total more than $70 billion annually and 
     Medicare pays more than $10 billion of that amount.
       Applying a significant portion of this money will decrease 
     tobacco use and reduce the cost to the Medicare program in 
     the future.
       Prevention services may moderate increases in health care 
     use and spending. We believe this country should be able to 
     reach a consensus around the importance of maintaining the 
     quality of life and social contribution of our seniors and we 
     applaud your initiative in moving this issue forward.
           Sincerely,
                                        William L. Roper, MD, MPH,
     Chairman.
                                  ____

                                       American Heart Association,


                        Office of Communications and Advocacy,

                                    Washington, DC, June 10, 1999.
     Hon. Bob Graham,
     U.S. Senate, Washington, DC.
       Dear Senator Graham: The American Heart Association 
     applauds your efforts in the ``Healthy Seniors Promotion 
     Act'' to modernize the Medicare system by addressing both 
     coverage for preventative screening and counseling, as well 
     as access to prescription drugs for senior citizens.
       Science continues to demonstrate the effectiveness of 
     preventative care. Because it has not kept pace with the 
     changing science, Medicare is an antiquated system to treat

[[Page S6863]]

     the sick, rather than a modern healthcare system to maintain 
     the health of the elderly. Counseling and drug therapy for 
     smoking cessation, hypertension screening and drug treatment 
     and counseling for hormone replacement therapy are important 
     services that the American Heart Association believes ought 
     to be included in a modern healthcare benefits plan. The 
     association believes that hormone replacement therapy 
     counseling is important because the science related to HRT 
     and cardiovascular risk is still evolving.
       As you know, the American Heart Association is dedicated to 
     reducing death and disability from heart disease and stroke. 
     Each year, cardiovascular disease claims more than 950,000 
     lives. In 1999, the health care and lost productivity costs 
     associated with cardiovascular disease are estimated to total 
     $286.5 billion.
       To achieve our mission of reducing the burden of this 
     devastating disease, we are committed to ensuring that 
     patients have access to quality health care, including the 
     medical treatment necessary to effectively prevent and 
     control disease. For too long, senior citizens have had to 
     work with an outdated healthcare delivery system.
       Thank you for your leadership in the fight to modernize 
     Medicare. The American Heart Association looks forward to 
     continuing to work with you to ensure that senior citizens 
     have access to preventive services and affordable 
     prescription drugs.
           Sincerely,
                                               Diane Canova, Esq.,
     Vice President, Advocacy.
                                  ____



                              The American Geriatrics Society,

                                       New York, NY, June 9, 1999.
     Hon. Bob Graham,
     U.S. Senate,
     Washington, DC.
       Dear Senator Graham: The American Geriatrics Society (AGS) 
     strongly supports your bill, the Healthy Seniors Promotion 
     Act of 1999. The AGS thanks you for introducing this 
     important legislation that will provide comprehensive 
     preventive health benefits to the elderly.
       The AGS is comprised of more than 6,000 physicians and 
     other health professionals that treat frail elderly patients 
     with chronic diseases and complex health needs.
       As you know, preventive health care for the elderly can 
     improve quality of life and delay functional decline. 
     However, the current Medicare program does not cover 
     substantive preventive health services. Your bill authorizes 
     Medicare coverage of new preventive services as well as a 
     prevention-related outpatient drug benefit. In this way, your 
     bill would change the Medicare program from one that treats 
     illness and disability to one that focuses on health 
     promotion and disease prevention for Medicare beneficiaries. 
     As the organization that represents physicians that treat 
     only the elderly, we believe that this is a long overdue and 
     critical program reform.
       We applaud your long interest in Medicare prevention and we 
     look forward to working with you on legislation that will 
     enable the elderly to live longer, more productive, and 
     healthier lives.
           Sincerely,
                                          Jospeh G. Ouslander, MD,
     President.
                                  ____



                            The National Council on the Aging,

                                     Washington, DC, June 7, 1999.
     Hon. Bob Graham,
     Hart Senate Office Building
     Washington, DC.
       Dear Senator Graham: On behalf of the National Council on 
     the Aging (NCOA), I write to express our organization's 
     support for the Healthy Seniors Promotion Act of 1999.
       NCOA strongly believes that increased attention must be 
     focused on actions and techniques intended to prevent illness 
     or disability. It is easier to prevent disease than it is to 
     cure it. The time has come to take action that would broaden 
     and further coordinate federal programs such as Medicare 
     related to health promotion.
       Disease prevention, including access to health promotion 
     activities, protocols, and regimens for older and disabled 
     persons--should be included as an essential component 
     throughout the continuum of care.
       NCOA supports expanding the Medicare program to include 
     coverage of a full range of preventive services, prevention 
     education, and counseling, as well as prescription drugs. 
     Your proposal is a significant step in achieving these 
     objectives on a cost effective basis, in a manner which will 
     dramatically improve the quality of the lives of millions of 
     older Americans.
       We deeply appreciate your strong leadership in the area of 
     preventive care. NCOA looks forward to working with you and 
     your staff to pass the Healthy Seniors Promotion Act.
           Sincerely,
                                                    Howard Bedlin,
     Vice President, Public Policy and Advocacy.
                                  ____



                                American Council of the Blind,

                                     Washington, DC, June 9, 1999.
     Senator Robert Graham,
     Hart Senate Office Building
     Washington, DC.
       Dear Senator Graham. The American Council of the Blind is 
     pleased to have the opportunity to support the Healthy 
     Seniors Promotion Act. This legislation contains provisions 
     for expanded Medicare coverage that are needed by a large 
     number of visually impaired persons in this country, namely, 
     coverage for glaucoma screening and medications.
       The American Council of the Blind is a national 
     organization of persons who are blind and visually impaired. 
     Many of our members are seniors who have lost their vision 
     due to glaucoma, diabetes or macular degeneration. In fact, 
     this is the fastest growing segment of our membership. The 
     expansion of Medicare coverage proposed in this bill would 
     benefit these individuals by alleviating some of the 
     financial burdens faced by those who have already developed 
     conditions that cause vision loss, and giving peace of mind 
     to those who can still take measures to prevent the onset of 
     vision loss. We congratulate you for your foresight in 
     proposing these measures and look forward to working with you 
     to see that this legislation is approved by both houses of 
     congress and signed into law by the president.
       Thank you very much.
           Respectfully,
                                                  Melanie Brunson,
     Director of Advocacy and Governmental Affairs.
                                  ____



                             National Osteoporosis Foundation,

                                     Washington, DC, June 9, 1999.
     Hon. Bob Graham,
     U.S. Senate,
     Washington, DC.
       Dear Senator Graham: The National Osteoporosis Foundation 
     is pleased to offer its support for ``The Healthy Seniors 
     Promotion Act of 1999''. We applaud your foresight regarding 
     preventive health care and support your efforts to reduce, 
     for example, stroke, osteoporosis, heart disease, and 
     blindness.
           Sincerely,
                                             Bente E. Cooney, MSW,
     Director of Public Policy.
                                  ____

                                               American College of


                                          Preventive Medicine,

                                     Washington, DC, June 9, 1999.
     Senator Bob Graham,
     U.S. Senate,
     Washington, DC.
       Dear Senator Graham: The American College of Preventive 
     Medicine is pleased to express its enthusiastic support for 
     the ``Healthy Seniors Promotion Act of 1999.'' Your 
     introduction of this bill underscores what preventive 
     medicine professionals have known for many years, namely, 
     that the benefits of preventive services for older Americans 
     are just as great as for younger Americans. For many seniors, 
     access to high quality preventive services can add years to 
     life and life to years.
       Your bill adds to the list of services covered by Medicare 
     several services that we know to be effective in preventing 
     serious disease. After an exhaustive and rigorous review of 
     the scientific literature, the U.S. Preventive Services Task 
     Force--considered by many to be the gold standard in 
     determining the effectiveness of clinical preventive 
     services--has identified a number of services for older 
     Americans that are effective in preventing disease. These 
     include tobacco cessation counseling, hypertension screening, 
     and counseling on the benefits and risks of hormone 
     replacement therapy--all of which would be covered under the 
     ``Healthy Seniors Promotion Act of 1999.''
       Your bill also helps ensure that important research gaps 
     concerning preventive services for seniors are filled. It is 
     incumbent upon the Congress to ensure that Medicare's 
     preventive benefit package reflects the latest scientific 
     research on the effectiveness of preventive services.
       Basing coverage decisions on what the science tells us is 
     effective is sound national health care policy. The American 
     College of Preventive Medicine, which represents physicians 
     concerned with health promotion and disease prevention, 
     stands ready to assist you in working toward passage of this 
     forward-looking and important bill.
           Sincerely,
                                      George K. Anderson, MD, MPH,
                                                        President.
                                 ______