[Congressional Record Volume 150, Number 84 (Thursday, June 17, 2004)]
[Senate]
[Pages S7000-S7003]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. GRAHAM of Florida (for himself and Mr. Durbin):
  S. 2535. A bill to amend title XVIII of the Social Security Act to 
modernize the medicare program by ensuring that appropriate preventive 
services are covered under such program; to the Committee on Finance.
  Mr. GRAHAM of Florida. Mr. President, I am very pleased to introduce 
the Medicare Preventive Services Coverage Act of 2004, and to be joined 
by Senator Richard Durbin.
  This legislation would change the basic charter of Medicare to one 
that not only diagnoses and treats, but also prevents illness.
  On July 30, 1965, Medicare was created under title 18 of the Social 
Security Act to provide health insurance coverage for the elderly.
  The coverage provided through the program was limited to diagnostic 
and treatment services that were considered reasonable and necessary.
  There was little demand to cover preventive services under Medicare 
or any other health plan at that time because we were not yet cognizant 
of the vital role of prevention on the health and quality of human 
life.
  The basic charter of Medicare reflects this lack of understanding.
  However, since Medicare's inception, we have learned a lot about the 
enormous burden of chronic disease on our Nation.
  According to the Centers for Disease Control and Prevention, CDC, 
more than 1.7 million Americans die of a chronic disease each year, 
accounting for about 70 percent of all deaths.
  Not only does chronic disease lead to a majority of deaths and 
disabilities in America, it also accounts for about 75 percent of 
health care costs each year, placing a huge economic demand on our 
Nation.
  Medicare bears a lion's share of this cost. In 2003, Medicare spent 
nearly $7,000 per beneficiary; much of this cost is attributable to 
treating chronic illnesses.
  The percentage of the population over age 65 has increased 
dramatically and will continue to do so. This will place an even 
greater economic burden on Medicare.
  What is the bottom line? In short, Medicare cannot afford this 
spiraling cost.
  The good news is that we now have decades of research demonstrating 
that although chronic diseases are the most common and costly of all 
health problems, they are also the most preventable.
  For example, according to the CDC regular eye exams and timely 
treatment could prevent up to 90 percent of diabetes related blindness.
  Eye chart screening for visual acuity is currently recommended by the 
United States Preventive Services Task Force, USPSTF, but is not 
covered by Meidcare.
  The impact of prevention on chronic disease is well known by the 
President's Secretary for Health and Human Services.
  HHS Secretary Thompson said in September 2003:

       There is clear evidence that the costs of chronic 
     conditions are enormous, as are the potential savings from 
     preventing them, even if there may not always be agreement on 
     the exact amounts of these cost savings.

  He goes on to say:

       . . . the Nation simply cannot afford not to step up 
     efforts to reverse the growing prevalence of chronic 
     disorders. Resources and energy need to be marshaled in all 
     sectors and at all levels of society.

  Partnership for Prevention, a Washington, DC, think tank on health 
policy takes Thompson's comments one step further. A recent Partnership 
report makes the following logical assumption:

       As the primary source of health insurance coverage for 
     millions of older Americans and persons with permanent 
     disabilities, Medicare has the potential to have a 
     substantial impact on the health of beneficiaries by 
     promoting and covering cost-effective preventive services.

  Congress has added coverage for some preventive services over the 
last two decades, including the flu vaccine, mammograms, and cancer 
screening.
  As HHS does not have the authority to add preventive services to 
Medicare--despite the growing body of evidence that has proved their 
efficacy--these benefits were only added to Medicare because of 
congressional action.
  The benefits that Congress have added are extremely important, and I 
am glad that we have taken the steps to make them available to our 
seniors.
  However, the congressional process is slow, and subject to political 
winds and influences that are not always based purely in science.
  The legislation I am introducing would change the basic charter of 
Medicare from a program focused on diagnosing and treating illnesses to 
one that also prevents illnesses by giving the Department of Health and 
Human Services the authority to make coverage decisions for preventive 
services.
  Why change the current system of passing legislation each time we 
want to add coverage of preventive service to Medicare? There are some 
very logical reasons.
  The reliance on Congress to cover preventive services has resulted 
in: Coverage for only half of clinical preventive services that experts 
recommend for the 65+ age group; coverage that not only fails to keep 
up with changes in scientific evidence but is often in consistent with 
authoritative recommendations; a confusing array of cost sharing 
requirements across covered preventive services; and lack of coverage 
of some preventive services that provide great health benefits in favor 
of others that do not meet current evidence standards as a result of 
vocal advocacy groups.
  Luckily, the fundamental reform of the program that I am proposing 
does not require extensive statutory or bureaucratic change.
  Medicare already has a process in place for the Secretary of Health 
and Human Services to make coverage decisions on diagnostic, treatment, 
and durable medical equipment options.
  My bill would authorize the Secretary to make coverage decisions on 
preventive services using that same process, based on the 
recommendations of the federally-convened United States Preventive 
Services Task Force, USPSTF, and other groups.
  This authorization would not entail dramatic new administrative 
expenses or a major reorganization of CMS coverage processes and staff.
  My legislation would put preventive services on an equal footing with 
diagnostic and treatment services by allowing the Secretary to make 
coverage decisions for all services needed to prevent, diagnose, and 
treat illness.
  Providing beneficiaries with the most cost-effective and current 
preventive services should no longer require an ``Act of Congress.''
  It should, instead, require the insight of the experts in the field, 
and be based on the same careful process HHS is currently using.
  Let us untie their hands and improve the lives of our Medicare 
beneficiaries by building coverage of preventive services into the 
currently established coverage decision process.
  This legislation is supported by the following groups: American 
College of Preventive Medicine; HealthPartners; Deafness Research 
Foundation; Partnership for Prevention; American Dietetic Association; 
American Public Health Association; Families USA; American Physical 
Therapy Association; American Academy of Family Physicians; United 
Cerebral Palsy Association; National Mental Health Association; 
Campaign for Tobacco-Free Kids, and the Emergency Department Practice 
Management Association.
  If Medicare were created today, it would certainly not exclude 
coverage of preventive services.
  Today we know how important preventive services are; they save money 
and lives. Let us give Medicare the authority to do its job.
  I urge my colleagues to join me in sponsoring this important piece of 
legislation.

[[Page S7001]]

  I ask unanimous consent to print letters of support from the above-
listed groups in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                                   American Public


                                           Health Association,

                                     Washington, DC, June 1, 2004.
     Hon. Bob Graham,
     U.S. Senate, Hart Senate Office Building, Washington, DC.
       Dear Senator Graham: On behalf of the American Public 
     Health Association (APHA), the largest and oldest 
     organization of public health professionals in the country, 
     representing more than 50,000 members from over 50 public 
     health occupations, I write in support of the Medicare 
     Preventive Services Coverage Act of 2004.
       As outlined in position paper 7633, ``Policy Statement on 
     Prevention,'' APHA has long supported measures to 
     increasingly utilize the fund preventive services in federal 
     health programs. In this vein, the Medicare Preventive 
     Services Coverage Act of 2004 demonstrates a significant 
     commitment to addressing the underlying factors responsible 
     for the underutilization of prevention strategies that 
     optimize the health and independence of the elderly by 
     granting the Secretary the authority to approve Medicare 
     coverage of preventive services based on recommendations of 
     the U.S. Preventive Services Task Force and other groups. By 
     allowing decisions about coverage of preventive services to 
     be made in the same timely, evidence-based manner as other 
     services under Medicare, the legislation would enable 
     Medicare to take a vital step towards focusing more on 
     disease prevention, which is cost-effective and has the 
     ability to prevent or delay the occurrence of chronic 
     disease.
       Since the creation of Medicare, the American Public Health 
     Association has supported measures to protect Medicare 
     beneficiaries against significant financial exposure that 
     imposes barriers to the receipt of needed care. The 
     provisions of the Medicare Preventive Services Act of 2004 
     that aim to eliminate co-payments and deductibles from all 
     future preventive benefits serve to ensure that Medicare 
     beneficiaries will not be restricted from accessing needed 
     preventive medical care because of financial hardship.
       Thank you for your attention to and leadership on this 
     important public health issue. We look forward to working 
     with you to move legislation forward this year.
           Sincerely
                                    Georges C. Benjamin, MD, FACP,
     Executive Director.
                                  ____

                                                     June 2, 2004.
     Hon. Bob Graham,
     U.S. Senate,
     Washington, DC.
       Dear Senator Graham: Congratulations on the introduction of 
     your new legislation to provide a permanent solution to 
     Medicare's long-standing failure to cover appropriate 
     preventive health services. Families USA, the health consumer 
     advocacy organization, strongly endorses your effort.
       Currently, life-saving and life-improving preventive 
     screening services have been covered only by an act of 
     Congress--and usually only after long and difficult debates. 
     Your proposal will place this basic scientific and technical 
     issue in the excellent medical staff of the Centers for 
     Medicare and Medicaid Services, where decisions can be made 
     on a more timely, professional and scientific basis. We 
     believe that this will help ensure that important preventive 
     care services will be implemented in a more timely and 
     rational way. The result will be an improvement in the 
     quality of life of Medicare beneficiaries.
       Congratulations again on this proposal--one of a long-line 
     of creative and helpful health initiatives that you have 
     championed in your outstanding Senate career.
           Sincerely,
                                                Ronald F. Pollack,
     Executive Director.
                                  ____

                                                 American Physical


                                          Therapy Association,

                                     Alexandria, VA, June 2, 2004.
     Hon. Bob Graham,
     U.S. Senate, Senate Hart Office Building, Washington, DC.
       Dear Senator Graham: On behalf of the 64,000 members of the 
     American Physical Therapy Association (APTA), I commend you 
     for your efforts to promote the full continuum of health care 
     for our nation's seniors and persons with disabilities served 
     by the Medicare program. APTA appreciates the introduction of 
     your legislation, the Medicare Preventative Services Coverage 
     Act of 2004 and fully supports its enactment by the 108th 
     Congress. Prevention services are an essential part of the 
     health care continuum that needs better integration into the 
     Medicare program, and your legislation goes a long way toward 
     achieving that objective.
       Physical therapists provide prevention services that 
     forestall or prevent functional decline and the need for more 
     intense care. Through timely and appropriate screening, 
     examination, evaluation, diagnosis, prognosis, and 
     intervention, physical therapists frequently reduce or 
     eliminate the need for more costly forms of care and also may 
     shorten or even eliminate institutional stays. Physical 
     therapists are actively involved in promoting health, 
     wellness and fitness initiatives, including the provision of 
     services and education of patients that stimulate the public 
     to engage in healthy behaviors. An example of physical 
     therapist involvement in preventive services is the use of 
     therapeutic interventions to improve strength, mobility, and 
     balance to reduce falls that often lead to more costly health 
     care and disability under Medicare.
       Thank you for your commitment to improving the Medicare 
     program. The addition of appropriate preventative services to 
     the Medicare program will help our nations' seniors and 
     persons with disability lead more healthy and productive 
     lives within our communities. Please feel free to contact 
     Justin Moore on APTA's Government Affairs staff at 
     [email protected] or 703/706-3162, if you have any 
     questions or need additional information.
           Sicnerely,
                                       Ben F. Massey, Jr., PT, MA,
     President.
                                  ____

                                               American Academy of


                                            Family Physicians,

                                     Washington, DC, June 9, 2004.
     Hon. Robert Graham,
     Hart Senate Office Building,
     U.S. Senate, Washington, DC.
       Dear Senator Graham: Thank you for the opportunity to 
     review the draft of your legislation, the Medicare Preventive 
     Services Coverage Act. On behalf of the 93,700 members of the 
     American Academy of Family Physicians, I am pleased to inform 
     you that the AAFP strongly endorses the bill, and we 
     congratulate you for your efforts on behalf of the nation's 
     seniors.
       This legislation would help make Medicare more responsive 
     to the people that it directly serves. By allowing CMS to 
     cover preventive services that are based on evidence and 
     current science and that have been reviewed and approved by 
     the United States Preventive Services Task Force and other 
     appropriate organizations, the bill helps direct Medicare 
     toward proven health care services that will keep seniors 
     healthier. The AAFP commends your commitment to evidence-
     based measures that will prevent accidents and illness and 
     provide more effective health care. We believe that sound 
     science should always be the basis of medical decisions.
       The Academy would urge you and your colleagues in Congress 
     to consider giving CMS the authority to review current 
     preventive services in the light of the U.S. Preventive 
     Services Task Force recommendations and to alter 
     reimbursement accordingly. And we would also suggest that 
     Congress might want to make more explicit the agency's 
     authority to review and revise payments as the evidence of 
     previously approved services changes.
       Thank you, Senator Graham, for your commitment to the 
     health of Medicare patients and for your leadership in 
     improving this important program that serves them.
           Sincerely,
                                       James C. Martin, MD, FAAFP,
     Board Chair.
                                  ____

                                               American College of


                                          Preventive Medicine,

                                                     June 4, 2004.
       The American College of Preventive Medicine (ACPM) is very 
     pleased to support Senator Bob Graham's bill granting the 
     Secretary of Health and Human Services the authority to 
     approve Medicare coverage of preventive medical services from 
     the recommendations of the United States Preventive Services 
     Task Force (USPSTF) and other appropriate organizations.
       As the representative organization for preventive medicine 
     physicians, ACPM understands the potential long-term benefits 
     from clinical preventive services supported by evidence to 
     have a beneficial impact on survival and quality of life. As 
     the population of the United States ages, preventive services 
     will become the best strategy to keep people healthy and to 
     conserve medical expenditures.
       Therefore, the ACPM offers its full support of Senator 
     Graham's proposed legislation to include preventive services 
     under Medicare coverage.
                                                       Mike Barry,
     Deputy Director.
                                  ____



                                American Dietetic Association,

                                        Chicago, IL, June 2, 2004.
     Hon. Bob Graham,
     U.S. Senate,
     Washington, DC.
       Dear Senator Graham: The American Dietetic Association 
     (ADA) is the largest organization of food and nutrition 
     professionals in the U.S. We promote optimal nutrition and 
     well being of all people, by relying on evidence-based 
     practices and policies. To that end, ADA is pleased to 
     support the Medicare Preventive Services Coverage Act of 
     2004.
       Nutrition is a critical element to any comprehensive health 
     care program and in particular preventive services. According 
     to the Department of Health and Human Services, 40 percent of 
     Americans age 40 to 74 suffer from pre-diabetes. The evidence 
     shows that proper nutrition and physical activity can prevent 
     many, if not most of these Americans from developing type II 
     diabetes. In cardiovascular care, the evidence shows that 
     proper preventive nutrition intervention can slow or reverse 
     conditions such as hypertension or dyslipidemia. 
     Unfortunately, Medicare does not recognize the importance of 
     preventive care in general and preventive nutrition therapy 
     specifically.
       When Congress passed the Medicare Modernization Act last 
     year, it included a new provision for preventive care under 
     Sec. 611,

[[Page S7002]]

     the Initial Preventive Physical Examination. While referral 
     to medical nutrition therapy is specifically mentioned in the 
     bill, CMS is interpreting this new language as limited to 
     only those diseases (diabetes and renal) that are already 
     eligible for MNT. As a result of this interpretation, 
     patients diagnosed during the initial preventive physical 
     exam as having pre-diabetes, must wait until their conditions 
     progress to type II diabetes before Medicare will cover 
     nutrition therapy.
       Such an approach to preventive care is poor health policy 
     and poor fiscal management of the program. Your Medicare 
     Preventive Services Coverage Act if enacted, will promote 
     preventive care within Medicare to the status it deserves. 
     ADA commends your efforts and foresight.
           Sincerely,
                                                  Ronald E. Smith,
     Director of Government Relations.
                                  ____

                                                      Campaign for


                                            Tobacco-Free Kids,

                                                    June 14, 2004.
     Hon. Bob Graham,
     U.S. Senator, Hart Senate Office Building, Washington, DC.
       Dear Senator Graham: The Campaign for Tobacco-Free Kids is 
     pleased to lend its support to your bill, The Medicare 
     Preventive Services Coverage Act of 2004.
       This bill will help provide the scientific foundation and 
     evidence-based decisions that are critical for ensuring that 
     the Medicare program provides the most effective preventive 
     services to all Medicare beneficiaries. This bill will help 
     shift the emphasis of the Medicare program from treating 
     illness to one where the focus is more on wellness, health 
     promotion and prevention. With nearly three-quarters of all 
     illnesses in this country related to preventable conditions 
     such as tobacco use, lack of proper nutrition and physical 
     fitness, obesity and diabetes, it makes perfect health and 
     fiscal sense to enact such changes into the Medicare program.
       With the recent inclusion of prescription drug coverage to 
     the Medicare program, including coverage for prescription 
     tobacco use cessation medications such as nicotine nasal 
     spray and bupropion SR, this bill represents a tremendous 
     opportunity to enhance and compliment this new coverage 
     through the provision of tobacco use cessation counseling 
     services. According to the U.S. Preventive Services Task 
     Force, next to childhood immunizations, tobacco cessation 
     counseling is the most clinically effective preventive 
     service that we have. Furthermore, we know that counseling 
     services double the number of successful quit smoking 
     attempts versus people who try to quit ``cold turkey''. And 
     when combined with medications, there is nearly a four-fold 
     increase in successful quit attempts. With about 10 percent 
     of all Medicare beneficiaries still smoking, about 4.5 
     million people, such a benefit would have a tremendous impact 
     on the health and quality of life of our nation's seniors.
       Again, the Campaign for Tobacco-Free Kids is proud to 
     support this important piece of public health legislation.
           Sincerely,
                                                 Matthew L. Myers,
     President.
                                  ____



                                   Partnership For Prevention,

                                     Washington, DC, June 2, 2004.
     Hon. Bob Graham,
     U.S. Senator, Hart Senate Office Building, Washington, DC.
       Dear Senator Graham: Thank you for requesting Partnership 
     for Prevention's comments on Medicare policy concerning 
     disease prevention and health promotion.
       Partnership strongly recommends that Congress modernize 
     Medicare by directing the Centers for Medicare and Medicaid 
     Services to make coverage decisions for disease prevention 
     and health promotion services based on evidence-based 
     recommendations such as those of the U.S. Preventive Services 
     Task Force and the Advisory Committee on Immunization 
     Practices. This was one of the principal policy 
     recommendations in Partnership's 2003 report, A Better 
     Medicare for Healthier Seniors: Recommendations to Modernize 
     Medicare's Prevention Policies. We understand that you plan 
     to introduce legislation that would bring about such a policy 
     change.
       When Congress created Medicare in 1965, it designed the 
     program based on the knowledge of health, medicine and health 
     care at that time. Thus, Medicare focused on hospitalization 
     and visits to doctors' offices to treat or diagnose seniors 
     who were already showing signs of illness. Medicine has made 
     great progress since then, including development of proven 
     ways to prevent disease and promote longer, healthier lives. 
     But Medicare has consistently lagged behind the curve, 
     failing to cover proven disease prevention and health 
     promotion services or providing coverage years later than 
     private insurers.
       Allowing Medicare coverage decisions for preventive 
     services to be made following a similar process as diagnosis 
     and treatment decisions is an important step in modernizing 
     Medicare. It is also critical that these coverage decisions 
     be informed by systematic reviews of evidence conducted by 
     independent experts, such as the U.S. Preventive Services 
     Task Force. We understand that your bill would address these 
     issues and enable Medicare to keep pace with progress in 
     preventive medicine and health promotion.
       Partnership's Better Medicare report also noted that use 
     rates for most preventive services that are covered by 
     Medicare fall short of national targets, in part because of a 
     confusing array of cost sharing requirements, such as 
     deductibles and co-payments for these services. We understand 
     that your bill would eliminate these impediments for 
     preventive services covered in the future.
       Most Americans understand that it is preferable to help 
     people stay healthy instead of waiting to treat them after 
     they become sick. It is in our nation's interest for seniors 
     to be healthy instead of infirm, active instead of 
     hospitalized, productive instead of costly, independent 
     instead of dependent. Cost-saving and cost-effective disease 
     prevention and health promotion are sound investments for our 
     country.
       Thank you again for requesting our comments on these 
     important facets of Medicare policy.
           Sincerely,
                                                   John M. Clymer,
     President.
                                  ____



                                 Deafness Research Foundation,

                                     Washington, DC, June 2, 2004.
     Hon. Bob Graham,
     U.S. Senate,
     Washington, DC.
       Dear Senator Graham: On behalf of the Deafness Research 
     Foundation and World Council on Hearing Health, we fully 
     support the Amendment to Title XVII of the Social Security 
     Act to modernize the Medicare program so as to ensure 
     preventive services be covered under the program.
       The Deafness Research Foundation and its public education 
     and advocacy arm, called the World Council on Hearing 
     Health's mission is to make a lifetime of hearing possible 
     for all people through quality research, public education and 
     advocacy. We espouse the program platforms of detection, 
     prevention, intervention and research about hearing loss. 
     Therefore, we fully support your draft bill that will allow 
     for the Secretary of Health and Human Services be granted the 
     authority to approve Medicare coverage of preventive services 
     based on recommendations of the U.S. Preventive Services Task 
     Force and other organizations if enacted.
       Early detection of hearing loss through regular hearing 
     checkups (at least once every two years) from childhood to 
     adulthood is a key to early intervention as needed. For 
     babies and children it is especially important so their 
     educational, emotional and social development is not halted 
     nor compromised. In adults, early detection of hearing loss 
     is the best prevention against further damaging one's hearing 
     not to mention the impact hearing loss can have on one's 
     career and quality of life. In the elderly, the ability to 
     diagnose hearing loss early on is an imperative to combat 
     misdiagnoses of dementia and senility.
       We commend you on taking the initiative to propose this 
     bill and we will tell the 40,000 donors and members of 
     Deafness Research Foundation to fervently follow its 
     progress.
           Sincerely,
                                                      Susan Greco,
     Executive Director.
                                  ____

                                                     June 3, 2004.
     Hon. Robert Graham,
     Hart Senate Office Building,
     Washington, DC.
       Dear Senator Graham: I am writing on behalf of 
     HealthPartners in support of the ``Medicare Preventive 
     Services Coverage Act of 2004''. HealthPartners is a 
     consumer-governed family of nonprofit Minnesota health care 
     organizations focused on improving the health of its members, 
     its patients and the community. HealthPartners and its 
     related organizations provide health care services, insurance 
     and HMO coverage to more than 670,000 members. The key 
     features of this bill would go far in helping to improve the 
     health of Medicare enrollees.
       This bill would put disease prevention on a level playing 
     field with disease detection and treatment under Medicare. It 
     would also permit preventive service coverage decisions to be 
     based on evidence. We believe strongly that appropriate 
     preventive services should be included in the Medicare 
     benefit set and that those benefits should be evidence-based. 
     Using the United States Preventive Services Task Force (and 
     other appropriate organizations') recommendations as a guide 
     for the addition of preventive services is an excellent step.
       We encourage the Secretary and Congress to continue to 
     focus benefits in both the Medicare and Medicaid programs on 
     evidence based medicine. Evidence based care provides the 
     structure for the right services to be delivered at the right 
     time in the right location for enrollees of all ages. This, 
     in turn, supports achieving the six aims for care as outlined 
     by the Institute of Medicine: care that is patient-centered, 
     timely, effective, efficient, equitable and safe. We support 
     your efforts to achieve these ends.
           Sincerely,

                                           George Isham, M.D.,

                                              Medical Director and
     Chief Health Officer.
                                  ____

             Emergency Department Practice Management Association,
                                        McLean, VA, June 16, 2004.
     Hon. Senator Graham,
     Hart Senate Office Building,
     U.S. Senate, Washington, DC.
       Dear Senator Graham: Thank you for the opportunity to 
     review your draft legislation, the Medicare Preventive 
     Services Coverage Act. On behalf of the Emergency Department 
     Practice Management Association's members, we congratulate 
     you on your efforts in

[[Page S7003]]

     this area and strongly support this legislation as it 
     reflects sound health policy.
       EDPMA members work with their hospital partners to provide 
     quality patient care in the emergency departments across the 
     country. As you know, overcrowding in emergency departments 
     is a serious problem. By expanding Medicare's coverage of 
     preventative services, we believe that Medicare patients will 
     have incentives to get treatment in less acute settings.
       Emergency departments are a key element of the nation's 
     safety net. While we support expansion of Medicare benefits, 
     we believe it is of critical importance that Medicare's 
     physician fee schedule appropriately capture emergency 
     physician's uncompensated care costs. We look forward to 
     working with you to address this problem.
       Like you, EPDMA is dedicated to providing quality care to 
     Medicare's patients. We join you in support of this 
     legislation and appreciate your on-going leadership in health 
     policy.
           Sincerely,
                                                  Emily R. Wilson,
     Managing Director.
                                  ____

                                                   National Mental


                                           Health Association,

                                    Alexandria, VA, June 16, 2004.
     Hon. Bob Graham,
     U.S. Senate, Hart Senate Office Building, Washington, DC.
       Dear Senator Graham: On behalf of the National Mental 
     Health Association (NMHA), I am writing to commend you for 
     introducing the Medicare Preventive Services Coverage Act of 
     2004. Prevention and early detection of mental illness are 
     critical components to ensuring overall well-being that have 
     long been overlooked, particularly with regard to Medicare 
     beneficiaries. Your bill represents a major step forward in 
     recognizing that mental illness can be prevented and 
     successfully treated, especially if detected early. 
     Prevention services provided through this legislation will 
     undoubtedly lead to improved access to and utilization of 
     mental health treatment among a population in which mental 
     illness has been severely under-diagnosed.
       NMHA is the nation's oldest and largest advocacy 
     organization addressing all aspects of mental health and 
     mental illness. With more than 340 affiliates nationwide, we 
     work to improve the mental health of all Americans through 
     advocacy, education, research, and service. Prevention of 
     mental illness is a key element of our mission, and we are 
     heartened by your efforts to ensure that Medicare 
     beneficiaries receive a full complement of preventive 
     services, including mental health services.
       As you know, mental illness affects a very large segment of 
     the Medicare population, but few receive the treatment they 
     need. According to the Surgeon General's 1999 Report on 
     Mental Health, some 20 percent of those 55 and older 
     experience specific mental disorders that are not part of 
     normal aging, including phobias, obsessive-compulsive 
     disorder, and depression, and 40 percent of those on Medicare 
     because of a disability, face mental illness. Major 
     depression is particularly prevalent among older Americans: 
     in primary care settings, 37 percent of seniors display 
     symptoms of depression.
       However, all too often seniors and people with disabilities 
     struggle with mental illness alone and without treatment and 
     support. It is estimated that only half of older adults who 
     acknowledge mental health problems actually are treated. A 
     very small percentage of older adults--less than 3 percent--
     report seeing mental health professionals for treatment. This 
     lack of care has tragic consequences as illustrated by the 
     fact that Americans 65 and older have the highest rate of 
     suicide in the country, accounting for 20 percent of suicide 
     deaths.
       The President's New Freedom Commission on Mental Health 
     found that ``[t]he number of older adults with mental 
     illnesses is expected to double to 15 million in the next 30 
     years [and that] [m]ental illnesses have a significant impact 
     on the health and functioning of older people and are 
     associated with increased health care use and higher costs.'' 
     New Freedom Commission on Mental Health, Achieving the 
     Promise: Transforming Mental Health Care in America. Final 
     Report, p. 59. The Commission recommended that ``[a]ny effort 
     to strengthen or improve the Medicare and Medicaid programs 
     should offer beneficiaries options to effectively use the 
     most up-to-date [mental health] treatments and services.'' 
     Id., p. 26.
       Early detection and intervention services are essential for 
     preventing mental health problems from compounding and for 
     lessening long-term disability that can result from mental 
     illness. The President's Commission stated that early 
     assessment and treatment are critical across the life span 
     and found that ``[n]ew understanding of the brain indicates 
     that early identification and intervention can sharply 
     improve outcomes and that longer periods of abnormal thoughts 
     and behavior have cumulative effects and can limit capacity 
     for recovery.'' Id., p. 57. Numerous studies have indicated 
     that prevention and early intervention services for seniors 
     result in improved mental health conditions, positive 
     behavioral changes, and decreased use of inpatient care.
       Thank you again for introducing the Medicare Preventive 
     Services Coverage Act of 2004. By incorporating preventive 
     mental health services into the Medicare program, this bill 
     will substantially improve access to treatment for a 
     population with tremendous mental health needs.
           Sincerely,
                                          Michael M. Faenza, MSSW,
     President and CEO.
                                  ____

     Hon. Bob Graham,
     U.S. Senate, Hart Office Building, Washington, DC.
       Dear Senator Graham: United Cerebral Palsy would like to 
     lend our wholehearted support to the Medicare Preventive 
     Services Coverage Act of 2004 that would amend the Social 
     Security Act and the Medicare Prescription Drug Improvement 
     and Modernization Act of 2003 to make a broad array of 
     preventive health care services a standard part of Medicare. 
     To date, the Congress has added selected preventive services 
     to Medicare but has not included other services that are 
     proven effective; nor has it encouraged Medicare to take a 
     comprehensive approach to disease prevention and health 
     promotion for American seniors and people with disabilities. 
     Passage of this legislation would mean that, for the first 
     time and to the benefit of millions of Americans, prevention 
     would be placed on a level playing field with disease 
     detection, diagnosis and treatment under Medicare.
       We thank you for recognizing that prevention is a good 
     investment, diminishing disability and discomfort, leading to 
     less time spent in hospitals and in nursing homes and more 
     time spent at home and in the community. In many cases, 
     effective preventive services will generate cost savings for 
     Medicare, as well as providing beneficiaries with more 
     productive years of life.
       About one in eight of Medicare's 40+ million beneficiaries, 
     about 5 million people, are people with disabilities under 
     age 65, people who have worked and become disabled, or who 
     are the adult dependents or survivors of eligible workers. 
     According to the National Economic Council, these 
     beneficiaries are 35 percent less likely to have any sort of 
     employer-based coverage, compared to elderly beneficiaries 
     who sometimes have coverage through retiree health plans. 
     Thus, access to any prevention benefits outside their 
     Medicare coverage is severely limited.
       For individuals with disabilities, prevention is truly no 
     less important than medical treatment. A primary disability 
     can often mean that a person is extremely at risk for, or 
     susceptible to, secondary health or disabling conditions. 
     Compounding this fact is the fact that many of these 
     secondary conditions may be low-incidence conditions that 
     affect only a small population and would, therefore, not 
     necessarily be those that come to the attention of Congress 
     when new coverage decisions are made.
       Additionally, as people with a wide range of disabilities 
     grow older, the impact of their disability may lead to 
     premature occurrence of age-related conditions. Clearly, the 
     Medicare Preventive Services Coverage Acts of 2004 would be 
     of great assistance to these beneficiaries by allowing 
     decisions about coverage of preventive services to be made in 
     the same manner as coverage decisions for other services, 
     making preventive service coverage decisions more timely, 
     individualized and evidence-based.
       We are also pleased that the bill would eliminate co-
     payments and deductibles from all future preventive benefits. 
     There is currently a confusing array of cost-sharing 
     requirements across Medicare's covered preventive benefits, 
     and Medicare beneficiaries with disabilities are more likely 
     to have lower incomes. By definition, people receiving 
     disability insurance often are unable to engage in full-time 
     work due to their conditions, and more than three-fourths of 
     these beneficiaries have income below 200 percent of the 
     poverty level, compared to half of elderly beneficiaries.
       United Cerebral Palsy wishes you the best and offers our 
     support in gaining passage of this critical legislation.
           Sincerely,

                                              Stephen Bennett,

                            President and Chief Executive Officer,
                                            United Cerebral Palsy.
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