[Congressional Record Volume 149, Number 39 (Tuesday, March 11, 2003)]
[Senate]
[Pages S3548-S3549]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mrs. LINCOLN (for herself, Ms. Collins, and Mr. Bingaman):
  S. 599. A bill to amend title XVIII of the Social Security Act to 
provide coverage under the medicare program for diabetes laboratory 
diagnostic tests and other services to screen for diabetes; to the 
Committee on Finance.
  Mrs. LINCOLN. Mr. President, I rise today to introduce the ``Access 
to Diabetes Screening Services Act of 2003'' with my friends Senators 
Collins and Bingaman. This bill will help to bring the epidemic of 
diabetes under control by providing Medicare coverage for laboratory 
diagnostic tests and other services which are used to screen for 
diabetes. Medicare cannot currently provide these screening services 
because they are prohibited to do so by Federal law.
  Diabetes has reached epidemic proportions among adults in the United 
States. The latest figures published by the Centers for Disease 
Control, CDC, in the January 1, 2003, edition of the ``Journal of the 
American Medical Association'' show that 7.9 percent of the American 
population has diabetes. The CDC believes that if trends continue, more 
than 10 percent of all Americans will have diabetes by the year 2010. 
Even today our Nation is feeling the effects of this disease--diabetes 
is the Nation's sixth leading cause of death.
  Diabetes strikes even harder in our nation's minority and emerging 
majority populations. Today, the CDC estimates that 11.9 percent of the 
African American population and nine percent of the Hispanic population 
has diabetes. Without a doubt, diabetes is now truly the epidemic of 
our time.
  These rising rates are especially evident among our Nation's aging 
population. Currently almost seven million Americans age 65 and older, 
or over 20 percent of seniors, have diabetes. Roughly 20 percent of 
seniors age 65 and older have a newly identified condition called pre-
diabetes, which if left untreated will develop into diabetes. An 
additional 40,000 people living with diabetes and end-stage renal 
disease under the age of 65 participate in the Medicare program.
  Even more distressing is the fact that approximately one third of the 
7 million seniors with diabetes, or 2.3 million people, are 
undiagnosed. They simply do not know that they have this very serious 
condition--a condition whose complications include heart disease, 
stroke, vision loss and blindness, amputations, and kidney disease.
  My own home State of Arkansas has had first-hand experience with the 
rising diabetes rates. Arkansas ranks

[[Page S3549]]

fifth in the Nation for diabetes incidence. Recent studies show that 
8.9 percent of all Arkansas adults had diagnosed diabetes, and over one 
million Arkansans are at risk for undiagnosed diabetes.
  Our Nation is not yet doing enough to manage this preventable and 
controllable disease. Last week, the National Institutes of Health, the 
CDC and the American Diabetes Association announced that the direct 
costs of treating diabetes grew by more than 50 percent between 1997 
and 2002, from $44 billion to $91.8 billion. One of every ten dollars 
spent on healthcare in America is now spent on diabetes, and the 
average per capita cost of healthcare for a person living with diabetes 
is $13,243 versus $2,560 for a typical American without diabetes.
  Those in the medical community and the federal government are only 
too aware of the rising prevalence and serious nature of diabetes. The 
Centers for Disease Control, National Institutes of Health, and the 
Department of Health and Human Services recently joined together in a 
national education campaign to inform people about diabetes and 
encourage people age 45 and older to get screened for diabetes.
  Unfortunately, current law does not allow Medicare to reimburse for 
diabetes testing, even if a patient presents serious risk factors for 
diabetes such as obesity, high blood pressure, or high cholesterol. 
Most shockingly, even if a patient is experiencing early evidence of 
diabetes complications, such as blindness or kidney disease, Medicare 
still cannot reimburse a physician for diabetes testing.
  This nonsensical omission of diabetes screening coverage is even more 
shocking in light of the fact that about 25 percent of the Medicare 
budget currently is devoted to providing medical care to seniors living 
with diabetes. In 1999, Arkansas spent $1.6 billion on direct and 
indirect costs of diabetes. The amount Arkansas spent on diabetes in 
2002 is undoubtedly higher in light of the cost data available. Why are 
we continuing to react to diabetes and its complications instead of 
proactively screening our Medicare beneficiaries for this common and 
costly disease? This screening can identify the disease, even before 
any symptoms have appeared, and has the potential to save and improve 
thousands of lives. In addition, this screening will potentially help 
prevent countless cases of end-stage renal disease, blindness and 
amputations--preventable complications of the diabetes that are 
draining Medicare of vital resources.
  The American Association of Clinical Endocrinologists strongly 
believes that patients with diabetes should be identified as early as 
possible in their illness. We have the technology to do this through 
screening.
  I cannot overstate the need for this legislation. When faced with the 
rising prevalence of diabetes, the high percentage of seniors who 
already have the disease, the alarmingly high number of seniors who 
have diabetes but do not know it yet, the growing number of seniors 
living with preventable diabetes complications, and the high cost 
associated with diabetes treatment, it is obvious that Medicare should 
provide coverage for diabetes screening.
  Our Nation must do more to battle the epidemic of diabetes through 
prevention, detection and treatment. This legislation will make 
detection of a deadly disease available to all Medicare enrollees. The 
American Diabetes Association has identified Medicare screening 
coverage as a top legislative priority, and I have worked closely with 
them to craft this legislation. I urge all of my colleagues to give 
serious consideration to cosponsoring and actively supporting the 
Diabetes Screening Act of 2003.
  Ms. COLLINS. Mr. President, I am pleased to join my colleague from 
Arkansas, Senator Lincoln, in introducing this important bill to 
provide Medicare coverage for laboratory diagnostic tests and other 
services used to screen for diabetes.
  As the founder and co-chair of the Senate Diabetes Caucus, I have 
learned a great deal about this serious disease and the difficulties 
and heartbreak that it causes for so many Americans and their families. 
Diabetes is a devastating, lifelong condition that disproportionately 
affects the elderly, children and minorities. It is one of our Nation's 
most costly diseases in both human and economic terms, and is the 
leading cause of kidney failure, blindness in adults, and amputations 
not related to injury. Moreover, it is a major risk factor for stroke, 
heart disease and other chronic conditions. According to a new study 
released by the American Diabetes Association, diabetes cost our Nation 
$132 billion last year, and health care spending for people with 
diabetes is almost double what it would be if they did not have 
diabetes.
  Unfortunately, diabetes frequently goes undiagnosed. Of the more than 
17 million Americans who have diabetes, 7 million of whom are 65 and 
older, it is estimated that as many as one third don't know it. They 
simply do not know that they have this very serious condition that 
places them at increased risk of developing devastating and costly 
complications such as blindness, kidney failure and amputations.
  Moreover, an additional 16 million Americans have a newly identified 
condition known as ``pre-diabetes,'' an increasingly common condition 
in which blood glucose levels are higher than normal, but not yet 
diabetic. Pre-diabetes dramatically raises the risk for developing Type 
2 diabetes and increases the risk of heart disease by 50 percent. 
According to research supported by the Department of Health and Human 
Services, most people with pre-diabetes are likely to develop diabetes 
within a decade unless their condition is diagnosed and they make the 
lifestyle changes necessary to reduce their risks for the disease.
  Secretary of Health and Human Services Tommy Thompson has made 
diabetes prevention and management a key part of the Bush 
Administration's broader efforts to encourage a healthier America. As a 
part of this effort, the Centers for Disease Control and Prevention, 
the National Institutes of Health and the Department of Health and 
Human Services have joined together in a national education campaign to 
inform people about diabetes and encourage people age forty-five and 
older to get screened for diabetes.
  Unfortunately, however, current law does not allow Medicare to pay 
for diabetes testing, even for patients with serious risk factors for 
diabetes, such as obesity, high blood pressure, or high cholesterol. 
Astoundingly, even if a patient is experiencing early evidence of 
diabetes complications such as blindness or kidney disease, Medicare 
will not pay for diabetes testing.
  This coverage omission is particularly irrational given the fact that 
one out of every four Medicare dollars is currently spent on medical 
care for seniors who are living with diabetes.
  Early detection and treatment are essential if we are to improve the 
quality of life for people with diabetes and prevent or delay the onset 
of the costly and sometimes deadly complications associated with the 
disease. We have the technology to identify diabetes even before the 
onset of any symptoms. These tests have the potential of improving and 
saving thousands of lives, not to mention countless Medicare dollars. 
It only makes sense that Medicare should cover them.
  Both the American Diabetes Association and the American Association 
of Clinical Endocrinologists support our legislation, and I encourage 
all of our colleagues to join us as cosponsors.
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