[Congressional Record Volume 147, Number 76 (Tuesday, June 5, 2001)]
[Senate]
[Pages S5833-S5836]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. GRAHAM (for himself, Mr. Jeffords, Mr. Kennedy, Mr. Lugar, 
        Mr. Bingaman, Mr. Chafee, Mr. Rockefeller, Mrs. Murray, Mr. 
        Hollings, Mr. Levin, Mr. Corzine, and Mrs. Lincoln):
  S. 982. A bill to promote primary and secondary health promotion and 
disease prevention services and activities among the elderly, to amend 
title XVIII of the Social Security Act to add preventive health 
benefits, and for other purposes; to the Committee on Finance.
  Mr. GRAHAM. Mr. President, I rise today, along with my colleagues 
Senators Jeffords, Kennedy, Lugar, Bingaman, Chafee, Murray, Hollings, 
Rockefeller, Levin, Lincoln, and Corzine, to introduce the Medicare 
Wellness Act.
  For too long, the Medicare approach to health care has been wholly 
reactive. Benefits are designed to treat illness and disability once a 
recipient is already suffering. This approach is outdated. It is time 
for Medicare to become pro-active. It is time to focus on helping 
people to prevent disease in the first place so that they may live not 
just longer, but more fulfilling lives.
  The Medicare Wellness Act shifts the focus of Medicare, changing it 
from a program that simply treats illness to one that promotes 
wellness. For this reason, The Medicare Wellness Act has support from a 
broad range of groups, including the National Council on Aging, the 
American College of Preventive Medicine, the American Heart 
Association, and the National Osteoporosis Foundation.
  Currently, 70 percent of medical spending is the result of 
preventable illnesses, many of which occur in older adults. It does not 
have to be this way. Research shows that declines in health are not 
inevitable with age. In fact, many chronic diseases can be prevented by 
making lifestyle changes such as taking up an exercise program

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or quitting smoking. A healthier lifestyle adopted at any time during 
one's lifetime can increase active life expectancy and decrease disease 
and disability.
  The Medicare Wellness Act helps promote preventive health care among 
older Americans, first by adding to the list of Medicare benefits 
several services that we know to be effective in preventing disease.
  These benefits focus on some of the most prominent, underlying risk 
factors for illness that face all Medicare beneficiaries, including: 
Screening for hypertension, counseling for tobacco cessation, medical 
nutrition therapy services for cardiovascular patients, counseling for 
post-menopausal women, screening for vision and hearing loss, expanded 
screening for osteoporosis, and screening for cholesterol.
  The addition of these new benefits represent the highest 
recommendations for Medicare beneficiaries in the U.S. Preventive 
Services Task Force, recognized as the gold standard within the 
prevention community, and the Institute of Medicine.
  The benefits can help reduce Medicare beneficiaries' risk for health 
problems such as stroke, cancer, osteoporosis, and heart disease.
  Other major components of our bill include the establishment of the 
Healthy Seniors Promotion Program. This program will be led by an 
interagency group within the Department of Health and Human Services, 
which will look at existing preventive benefits and offer suggestions 
to make their use more widespread.
  This 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. A study published by Dartmouth University, The Dartmouth 
Atlas of Health Care 1999, 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.
  Additionally, the Medicare Wellness Act incorporates an aggressive 
applied research effort to investigate new methods of improving the 
health of Medicare beneficiaries and the management of chronic 
diseases.
  Further, our bill would establish a health education and risk 
appraisal program aimed at major behavioral risk factors such as diet, 
exercise, alcohol and tobacco use, and depression.
  This program will target both pre-65 individuals and current Medicare 
beneficiaries and will strive to increase awareness among individuals 
of major risk factors that impact health, to change personal health 
habits, to improve health status, and ultimately to save the Medicare 
program money.
  In addition to new research on prevention among Medicare 
beneficiaries, the Medicare Wellness Act would require several reports 
to assess the overall scientific validity of the Medicare preventive 
benefits package.
  First, our bill would require the Medicare Payment Advisory 
Commission, known as MedPAC, to report to Congress every three years on 
whether the Medicare program needs to change over time in order to 
ensure that Medicare benefits are appropriate for the population being 
served and is as comprehensive as private insurance plans offered.
  Currently, there is no regular assessment to ensure that Medicare is 
providing a healthcare package that is up-to-date with either the 
current needs of seniors or current scientific findings. Quite frankly, 
Medicare hasn't kept up with the rest of the health care world, we need 
to do better.
  A second study that our bill would require is one in which the 
institute of Medicine, IOM, would assess, every three years, the 
scientific validity of the entire Medicare preventive benefits package.
  The study will be presented to Congress in a manner that mirrors The 
Trade Act of 1974. The Institute of Medicine's recommendations would be 
presented to Congress in legislative form. Congress would then have 60 
days to either accept or reject the recommendations. But Congress could 
not change the recommendations themselves.
  This ``fast-track'' process is a deliberate effort to get Congress 
out of the business of micro-managing the Medicare program allowing 
science to dictate the medical needs of seniors in America.
  In the aggregate, the Medicare Wellness Act represents the most 
comprehensive legislative proposal in the 107th Congress for the 
Medicare program focused on health promotion and disease prevention for 
beneficiaries. It represents sound health policy based on sound 
science.
  However, at a time when there is concern over the solvency of 
Medicare and concern that it won't be able to provide future seniors 
with the health care that they are promised, one may question whether 
it is wise to expand upon benefits already offered. And one is wise to 
do so.
  However, the issue of prevention is different.
  Benjamin Franklin was truly on the mark when he first said that ``an 
ounce of prevention is worth a pound of cure''. Offering preventive 
care under Medicare, or the ``ounce of prevention,'' will definitely 
cost the government money up front. However, this initial outlay of 
dollars will be returned in terms of costs saved in the long run by 
avoiding long-term, cost intensive treatments, or the ``pound of 
cure''.
  And, just as important, although unmeasurable, will be the enhanced 
quality of life for seniors. Prevention helps us all to live more 
healthy lives in the long run which translates into more productive and 
fulfilling lives as well.
  Today, many people continue to work beyond the age of 65 contributing 
to the workforce and the economy. However, they are only able to do so 
if their health allows.
  When considering the future of Medicare, the question really comes 
down to this. Is the value of improved quality of life for seniors and 
their ability to maintain healthy, functional and productive lives 
worth the expenditure?
  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 
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 our children and 
grandchildren.
  I encourage my colleagues to join us on this important bill and to 
work with us to ensure that the provisions of the bill are reflected in 
any Medicare reform legislation that is debated and voted on this year 
in the Senate.
  I ask unanimous consent that a list of groups supporting this bill be 
printed in the Record.
  There being no objection, the list was ordered to be printed in the 
Record, as follows:

          Groups Supporting the Medicare Wellness Act of 2001

       American Cancer Society.
       American College of Preventive Medicine.
       American Dietetic Association.
       American Geriatrics Society.
       American Heart Association.
       American Lung Association.
       American Physical Therapy Association.
       American Public Health Association.
       American Speech-Language Hearing Association.
       Campaign for Tobacco Free Kids.
       Families USA.
       National Campaign for Hearing Health.
       National Osteoporosis Foundation.
       National Committee to Preserve Social Security and 
     Medicare.
       National Council on Aging.
       National Chronic Care Association.
       National Mental Health Association.
       Partnership for Prevention.
       Strong Women Inside and Out.
       United Cerebral Palsy Associations.

  Mr. JEFFORDS. Mr. President, I am pleased to join Senator Graham 
today in introducing the Medicare Wellness Act of 2001. Our Nation's 
rapidly growing senior population and the ongoing search for cost-
effective health care have led to the development of this important 
legislation. The goal of the Medicare Wellness Act is to increase 
access to preventive health services, improve the quality of life for 
America's seniors, and increase the cost-effectiveness of the Medicare 
program.
  Congress created the Medicare program in 1965 to provide health 
insurance for Americans age 65 and over.

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 From the outset, the program has focused on coverage for hospital 
services needed for an unexpected or intensive illness. In recent 
years, however, a great escalation in program expenditures and an 
increase in knowledge about the value of preventive care have forced 
policy makers to re-evaluate the current Medicare benefit package.
  The Medicare Wellness Act adds to the Medicare program those benefits 
recommended by the Institute of Medicine and the U.S. Preventive 
Services Task Force. These include: screening for hypertension, 
counseling for tobacco cessation, counseling for hormone replacement 
therapy, screening for vision and hearing loss, cholesterol screening, 
expanded screening for osteoporosis, and nutrition therapy counseling 
or seniors with cardiovascular disease. These services address the most 
prominent risk factors facing Medicare beneficiaries.
  In 1997 and again in 2000, Congress added several new preventive 
benefits to the Medicare program through the Balanced Budget Act and 
the Beneficiary Improvement and Protection Act. These benefits included 
annual mammography, diabetes self-management, prostate cancer 
screening, pelvic examinations, glaucoma screening, and colorectal 
cancer screening. Congress's next logical step is to incorporate the 
nine new screening and counseling benefits in the Medicare Wellness 
Act. If these symptoms are addressed regularly, beneficiaries will have 
a head start on fighting the conditions they lead to, such as diabetes, 
lung cancer, heart disease, blindness, osteoporosis, and many others.
  Research suggests that insurance coverage encourages the use of 
preventive and other health care services. The Medicare Wellness Act 
also eliminates the deductibles and coinsurance for new and current 
preventive benefits in the program. Because screening services are 
directed at people without symptoms, this will further encourage the 
use of services by reducing the cost barrier to care. Increased use of 
screening services will mean that problems will be caught earlier, 
which will permit more successful treatment. This will save the 
Medicare program money because it is cheaper to screen for an illness 
and treat its early diagnosis than to pay for drastic hospital 
procedures at a later date.
  However, financial access is not the only barrier to the use of 
preventive care services. Other barriers include low levels of 
education or information for beneficiaries. That is why the Medicare 
Wellness Act instructs the Secretary of Health and Human Services to 
coordinate with the Centers for Disease Control and Prevention and the 
Health Care Financing Administration to establish a Risk Appraisal and 
Education Program within Medicare. This program will target both 
current beneficiaries and individuals below the age of 65 who have high 
risk factors. Outreach to these groups will offer questions regarding 
major behavioral risk factors, including the lack of proper nutrition, 
the use of alcohol, the lack of regular exercise, the use of tobacco, 
and depression. State of the art software, case managers, and nurse 
hotlines will then identify what conditions beneficiaries are at risk 
for, based on their individual responses to the questions, then refer 
them to preventive screening services in their area and inform them of 
actions they can take to lead a healthier life.
  The Medicare Wellness Act also establishes the Healthy Seniors 
Promotion Program. This program will bring together all the agencies 
within the Department of Health and Human Services that address the 
medical, social and behavioral issues affecting the elderly to increase 
knowledge about and utilization of prevention services among the 
elderly, and develop better ways to prevent or delay the onset of age-
related disease or disability.
  Now is the time for Medicare to catch up with current health science. 
We need a Medicare program that will serve the health care needs of 
America's seniors by utilizing up-to-date knowledge on healthy aging. 
Effective health care must address the whole health of an individual. A 
lifestyle that includes proper exercise and nutrition, and access to 
regular disease screening ensures that proper attention is being paid 
to the whole individual, not just a solitary body part. It is time we 
reaffirm our commitment to provide our Nation's seniors with quality 
health care.
  It is my hope that my colleagues in Congress will examine this 
legislation and realize the inadequacy of the current package of 
preventive benefits in the Medicare program. We have the opportunity to 
transform Medicare from an out-dated sickness program to a modern 
wellness program. I want to thank Senator Bob Graham and all the other 
cosponsors of the Medicare Wellness Act who are supporting this bold 
step towards successful Medicare reform.
  Mr. KENNEDY. Mr. President, it's a privilege to join Senator Graham 
and Senator Jeffords in introducing the Medicare Wellness Act of 2001, 
Medicare reform for the 21st century. This important legislation will 
make it easier for senior citizens to take advantage of the preventive 
benefits to them, while strengthening Medicare at the same time.
  Greater investment in the health of the nation's elderly is long 
overdue. Although we have made significant progress in reducing chronic 
disability among older Americans, we still have a long way to go. 
According to the World Health Organization, the United States ranks 
behind 23 other nations in ``healthy life expectancy.'' Surely, we can 
do better than that.
  Each year, chronic disability adds $26 billion to the nation's health 
care costs. Unless we act, the burden of these costs will become 
increasingly unbearable for countless senior citizens. In the next 30 
years, Medicare will be under even heavier pressures as the baby boom 
generation retires. Nearly one fifth of the population will be 65 and 
older by 2025, which means that a larger number of beneficiaries will 
be supported by a smaller number of workers. To avoid hard remedies 
such as benefit cuts or tax increases, we should do all we can to 
reduce future Medicare costs by improving the health of senior 
citizens.
  According to a study at Duke University, if the 1.3 percent decline 
in disability achieved over the last 12 years can be raised to 1.5 
percent, we can potentially save enough in Medicare to avoid any 
substantial long-term increase in Medicare tax or reduction in 
benefits. The Medicare Wellness Act attempt to do that. It waives cost-
sharing for a series of preventive benefits, provides individual health 
risk appraisals, encourages a falls prevention campaign, and funds 
pilot projects and new research on the most effective ways to encourage 
senior citizens to adopt healthier lifestyles.
  Prevention saves lives and saves money. Screening can often be the 
difference between a successful battle with cancer and a failed one. 
Colorectral cancers, for example, have a five-year survival rate of up 
to 90 percent if detected at an early stage--but currently only 37 
percent of these cancers are actually diagnosed early. Unfortunately, 
screening tests are significantly under-used by Medicare beneficiaries. 
Only approximately a third of men and women at-risk for these cancers 
are currently being screened.
  Our bill helps to combat this problem by eliminating cost-sharing and 
deductibles for a wide range of preventive services, such as screening 
for colorectral cancers, mammography, screening for glaucoma, bone mass 
measurement, medical nutrition therapy services, and screening for 
cholesterol problems and hypertension.
  The Medicare Wellness Act also creates a national ``falls 
prevention'' education and awareness campaign to reduce these injuries. 
Older Americans are hospitalized for fall-related injuries five times 
more often then they are for other types of injuries. This awareness 
campaign will educate senior citizens about precautions they can take 
to reduce the likelihood of such injuries.
  Clinical depression also takes a heavy toll on the nation's elderly. 
Compared to all other age groups, senior citizens have the highest 
suicide rate in the nation. Twenty percent of persons age 55 and older 
suffer from a mental disorder that is not part of the normal aging 
process. As with so many other illnesses, depression is under-diagnosed 
among the elderly. This bill provides needed funding for demonstration 
projects to screen for depression, so that elderly persons suffering 
from this problem can be diagnosed and referred to specialists for the 
treatment they need.

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  The Medicare Wellness Act also encourages senior citizens to improve 
their health and reduce the risks of illness in other ways. Typical 
factors leading to poor health include smoking, physical inactivity, 
and excessive use of alcohol. A health risk appraisal initiative under 
the Act will given senior citizens the individual attention they need 
to make the changes in lifestyle necessary to improve their health.
  In addition, the Medicare Wellness Act encourages research to explore 
the most effective ways to improve Medicare's role in preventing 
disease and improving health. Pilot programs are authorized to 
experiment with innovative ways to promote healthier lifestyles and 
reach out to senior citizens in various settings.
  Federal agencies will undertake particular research programs on these 
issues. The Medicare Payment Advisory Commission is asked to evaluate 
Medicare benefits in relation to private sector benefits. The National 
Institute on Aging is asked to report on ways to improve the quality of 
life for the elderly. The Institute of Medicine is asked to make 
recommendations to Congress about the medical and cost effectiveness of 
existing Medicare benefits and the potential benefit of preventive 
services.
  I urge my colleagues to support this important legislation. The 
Medicare Wellness Act can be a significant contribution to healthier 
senior citizens and a healthier Medicare.
                                 ______