[Congressional Record Volume 145, Number 112 (Tuesday, August 3, 1999)]
[Extensions of Remarks]
[Pages E1736-E1737]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


       THE INTRODUCTION OF THE OMNIBUS LONG-TERM CARE ACT OF 1999

                                 ______
                                 

                         HON. EDWARD J. MARKEY

                            of massachusetts

                    in the house of representatives

                        Tuesday, August 3, 1999

  Mr. MARKEY. Mr. Speaker, I am pleased to join my good friend Pete 
Stark today as we introduce a comprehensive long-term care bill. Pete 
and I have been concerned about the long-term care needs of seniors, 
near-seniors, and the disabled for quite some time--and Pete has been a 
real leader on this issue in the Congress. In the remarks Rep. Stark 
has made for the Record, he gives an excellent summary of our bill. We 
hope that our bill begins to get Congress and the American people 
focused on the issue of long-term care because doing something about 
people's long-term care needs will be one of our Nation's biggest 
challenges in the next century.
  This bill contains a number of important provisions. It's got a 
$1,000 refundable tax credit for family caregiver expenses. The 
legislation

[[Page E1737]]

makes some changes to Medicare which will result in the program being 
more useful to beneficiaries with chronic care needs that are best met 
in the home or in adult day care and other community-based settings. We 
clarify the definition of homebound. We've got provisions to enhance 
and ensure that our Nation's nursing homes are top-notch. We also 
incorporate President Clinton's proposal permitting Federal employees 
to buy long-term care insurance at group rates through the Office of 
Personnel Management and require that a plan be developed to allow all 
Americans to buy these types of policies--all the while paying special 
attention to the highest consumer protection standards. We have adopted 
the President's proposal to create a family caregiver support program 
through grants to the States. Our bill will extend Medicare eligibility 
to family caregivers who are qualified to receive the tax credit. And 
finally, we protect family caregivers who must leave the workforce to 
care for a loved one by making them eligible for Social Security 
credits to protect their retirement income.
  This legislation is not perfect. We will need to iron out some kinks 
along the way. But it is a beginning. It will be expensive and we don't 
specify from where the money will come. Earlier this year, I proposed 
the 2 Percent Solution--using 2 percent of the projected future budget 
surplus to fund a long-term care program for in-home and community-
based chronic care and respite care. I offered the proposal as an 
amendment in the Budget Committee and every Republican voted against 
it--a party line vote. The Republicans needed every penny they could 
find to pay for $800 billion in tax cuts. Surely, we can do better. 
This problem is not going to go away.
  One of the greatest American achievements of the 20th century has 
been our ability to increase life expectancy. From the dawn of time to 
the year 1900, the average life expectancy in the United States was 47 
years. Over the last 99 years, we have nearly doubled the life 
expectancy of Americans. We have done so with a massive infusion of 
Federal research dollars, and through thoughtful and compassionate 
programs that provide health care for millions of Americans--Medicaid 
and Medicare.
  What of the quality of that longer life however? I believe we have a 
moral obligation to ensure that people who are living longer are not 
living sicker and poorer.
  Today, Alzheimer's Disease is on track to wreak havoc on our nation's 
health care system and leave millions of American families in emotional 
and financial ruin. The disease affects over 4 million people 
nationwide and will affect as many as 14 million by 2050. Alzheimer's 
patients will symptomatically lose ability to perform routine tasks, 
and suffer impaired judgment, personality change and loss of language 
and communication skills. More than 7 out of 10 people with this 
disease live at home. Their caregivers are not wealthy, yet they spend 
on average $12,500 per year to support the person with Alzheimer's they 
are caring for. They work hard, but often must leave, reduce, or change 
employment to care for their loved ones. Ninety percent of Alzheimer's 
caregivers are giving care to a relative, and an overwhelming majority, 
75 percent, of caregivers are women. Studies have shown that the 
typical family caregiver is in her 70's and has two chronic health 
problems.
  Of course, the real tragedy of Alzheimer's is the human cost 
associated with the disease--it ravages patients and caregivers. For 
millions, being an Alzheimer caregiver means giving up more hours for 
more years and more money. It means less time, less energy, and fewer 
resources for other family members, for dear friends, and for the 
caregivers themselves.
  Alzheimer's is now the third most expensive disease in our country 
after heart disease and cancer, and yet the federal commitment to 
Alzheimer's research is three to five times less than the commitment 
the government has made to research on those other diseases. Last year, 
I led the effort to have Congress increase Alzheimer's funding at NIH 
by $100 million--we got $50 million. This year I'm working to increase 
that funding by $100 million again.
  Alzheimer's Disease is only part of the problem, however. We have a 
chronic care crisis in our country today. Without a coherent and 
comprehensive approach to care for people with disabling chronic 
conditions, this situation will only worsen. People with chronic 
diseases and disabilities will continue to suffer the consequences of 
deteriorating health if a strategy is not implemented to meet their 
long-term care needs.
  As part of that strategy, we must recognize that there are thousands 
of spouses and other family members struggling to provide care for 
their loved ones in their homes each year. A new study in the latest 
issue of Health Affairs estimates the current market value of unpaid 
caregiving to adults who are disabled or chronically ill to be nearly 
$200 billion a year.
  These family caregivers are heroes--they fill a virtual ``no care 
zone'' where loved ones have no chronic care coverage but still have 
chronic care needs that require monitoring, oversight, and assistance.
  The cuts passed as part of the Balanced Budget Act have had a 
devastating impact on real people's lives. In my district, one hospital 
has closed and two have been radically altered--one of them became a 
``hospial without beds'' performing only outpatient day surgeries and 
closing its emergency room and maternity ward. Home health agencies and 
community health centers are closing. And the community hospital system 
serving my hometown of Malden and the surrounding communities has 
slashed its home health visits from 470,000 in 1997 to 332,000 in 1998 
and they estimate only 260,000 for 1999. 1,400 patients have been cut 
from the system's home health care roster.
  The Congressional Budget Office is having a hard time explaining the 
remarkably slow rate of growth in Medicare. At the same time, the CBO 
has drastically miscalculated the level of Medicare cuts attributable 
to the Balanced Budget Act. The CBO now predicts that the BBA will 
result in $207 billion in ``Medicare savings'' over the 1997-2002 
period, nearly double its August 1997 estimate of $112 billion. The 
collapse of Medicare growth will result, in budget terms, in over $63 
billion in unanticipated savings in the next three years. These 
unanticipated savings should be redirected to their unintended victims.
  Our plan will help to alleviate some of the pain caused by the BBA 
and ease the burdens of patients and families affected by conditions 
like Alzheimer's, Parkinson's, Congestive Heart Failure, Multiple 
Sclerosis, Cerebral Palsy, Spinal Cord Injury, Muscular Dystrophy, and 
Stroke to name a few.
  Our bill will help these caregivers in many different ways--through 
refundable tax credits, and a change in Medicare to better meet 
beneficiaries' chronic care needs at home or in adult day care and 
other community-based settings to name just a few.
  This legislation is not perfect. But it is a beginning. It will be 
expensive--but I think there is a compelling argument to be made that 
long-term care needs to be at the top of our priority list. In 1995, 
Republicans were prepared to let Medicare ``wither on the vine.'' In 
1997, in the mad rush to pass the BBA the Republicans said Medicare is 
too expensive, and by the way, we need to cut it to pay for a tax cut. 
So in 1997 they chose Millionaires over Medicare. Earlier this year, I 
proposed the 2 percent Solution--using 2 percent of the projected 
future budget surplus to fund a long-term care program for in-home and 
community-based chronic care and respite care. I offered the proposal 
as an amendment in the Budget Committee and every Republican voted 
against it--they said covering long-term care through Medicare is too 
expensive, and by the way, we need every penny to pay for $800 billion 
in tax cuts. So, despite a soaring economy that's filling the pockets 
of the wealthy, and despite the fact that the Republicans gave them a 
Balanced Budget Bonus in 1997, the 1999 atrocity is their choice of 
Billionaires over Beneficiaries.
  What's worse, in 10 years, just as the first wave of baby boomers is 
set to retire--the price tag for the second 10 years of this year's 
Republican tax cut will explode to nearly $3 trillion. Surely, we can 
do better.
  We have entered a new era in Washington--an era with surplus as far 
as the eye can see--an era when the stock market is soaring, 
unemployment is at record lows, and American prosperity is unparalleled 
in the world. We can afford to give America's caregiver heroes help--
Pete Stark and I have a plan which will send the message to these 
heroes that help is on the way.
  I am pleased to join in introducing this bill today. Rep. Stark and I 
will be devoting a lot of time and energy recruiting members who care 
deeply about the long-term care crisis in our country--together we will 
be working on solutions for patients, for caregivers, and for families 
managing the impact of chronic and disabling conditions on their 
everyday lives. We look forward to working with our colleagues in the 
weeks and months to come building the coalition and passing legislation 
to bridge the gap between need and coverage for people suffering from 
chronic illness and disability in our country.

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