[Congressional Record Volume 151, Number 76 (Thursday, June 9, 2005)]
[Senate]
[Pages S6320-S6322]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BINGAMAN (for himself, Mr. DeWine, Mr. Corzine, Mr. 
        Durbin, Mr. Schumer, Mr. Johnson, Ms. Cantwell, Mr. Lautenberg, 
        Ms. Stabenow, Mr. Kennedy, Mrs. Clinton, Mr. Kerry, Ms. 
        Mikulski, Mr. Akaka, Mr. Salazar, and Mr. Sarbanes):
  S. 1217. A bill to amend title II of the Social Security Act to phase 
out the 24-month waiting period for disabled individuals to become 
eligible for medicare benefits, to eliminate the waiting period for 
individuals with life-threatening conditions, and for other purposes; 
to the Committee on Finance.
  Mr. BINGAMAN. Mr. President, I rise today to introduce bipartisan 
legislation entitled ``Ending the Medicare Disability Waiting Period 
Act of 2005'' with Senators DeWine, Corzine, Durbin, Schumer, Johnson, 
Cantwell, Lautenberg, Stabenow, Kennedy, Clinton, Kerry, Mikulski, 
Akaka, Salazar, and Sarbanes. This legislation would phase-out the 
current 2-year waiting period that people with disabilities must endure 
after qualifying for Social Security Disability Insurance (SSDI). In 
the interim or as the waiting period is being phased out, the bill 
would also create a process by which the Secretary can immediately 
waive the waiting period for people with life-threatening illnesses.
  When Medicare was expanded in 1972 to include people with significant 
disabilities, lawmakers created the 24-month waiting period. According 
to a July 2003 report from the Commonwealth Fund, it is estimated that 
over 1.2 million SSDI beneficiaries are in the Medicare waiting period 
at any given time, ``all of whom are unable to work because of their 
disability and most of whom have serious health problems, low incomes, 
and limited access to health insurance.''
  The stated reason at the time was to limit the fiscal cost of the 
provision. However, I would assert that there is no reason, be it 
fiscal or moral, to tell people that they must wait longer than 2 years 
after becoming severely disabled before we provide them access to much 
needed health care.
  In fact, it is important to note that there really are actually three 
waiting periods that are imposed upon people seeking to qualify for 
SSDI. First, there is the disability determination process through the 
Social Security Administration, which often takes many months or even 
longer than a year in some cases. Second, once a worker has been 
certified as having a severe or permanent disability, they must wait an 
additional 5 months before receiving their first SSDI check. And third, 
after receiving that first SSDI check, there is the 2-year period that 
people must wait before their Medicare coverage begins.
  What happens to the health and well-being of people waiting more than 
2\1/2\ years before they finally receive critically needed Medicare 
coverage? According to Karen Davis, president of the Commonwealth Fund, 
which has conducted 2 important studies on the issue, ``Individuals in 
the waiting period for Medicare suffer from a broad range of 
debilitating diseases and are in urgent need of appropriate medical 
care to manage their conditions. Eliminating the 2-year wait would 
ensure access to care for those already on the way to Medicare.''
  Again, we are talking about individuals that have been determined to 
be unable to engage in any ``substantial, gainful activity'' because of 
either a physical or mental impairment that is expected to result in 
death or to continue for at least 12 months. These are people that, by 
definition, are in more need of health coverage than anybody else in 
our society. Of the 1.2 million people stuck in the 2-year waiting 
period at any given time, it is estimated that one-third, or 400,000, 
are left completely uninsured. The consequences are unacceptable and 
are, in fact, dire.
  In fact, various studies show that death rates among SSDI recipients 
are highest during the first 2 years of enrollment while waiting to be 
covered by Medicare. For example, the Commonwealth Fund report, 
entitled ``Elimination of Medicare's Waiting Period for Seriously 
Disabled Adults: Impact on Coverage and Costs,'' 4 percent of these 
people die during the waiting period. In other words, it is estimated 
that of the estimated 400,000 uninsured disabled Americans in the 
waiting period at any given time, 16,000 of them will die awaiting 
Medicare coverage. Let me repeat . . . 16,000 of the 400,000 uninsured 
disabled in the waiting period at any given moment will die while 
waiting for Medicare coverage to begin.
  Moreover, this does not factor in the serious health problems that 
others experience while waiting for Medicare coverage during the 2-year 
period. Although there is no direct data on the profile of SSDI 
beneficiaries in the 2-year waiting period, the Commonwealth Fund has 
undertaken a separate analysis of the Medicare Current Beneficiary 
Survey for 1998 to get a good sense of the demographic characteristics, 
income, and health conditions of this group.
  According to the analysis, ``. . . 45 percent of nonelderly Medicare 
beneficiaries with disabilities had incomes below the Federal poverty 
line, and 77 percent had incomes below 200 percent of poverty. Fifth-
nine percent reported that they were in fair or poor health; of this 
group, more than 90 percent reported that they suffered from one or 
more chronic illnesses, including arthritis (52 percent), hypertension 
(46 percent), mental disorder (36 percent), heart condition (35 
percent), chronic lung disease (26 percent), cancer (20 percent), 
diabetes (19 percent), and stroke (12 percent).''
  To ascertain the impact the waiting period has on the lives of these 
citizens, the Commonwealth Fund and the Christopher Reeve Paralysis 
Foundation conducted a follow-up to ``gain insight into the experiences 
of people with disabilities under age 65 in the Medicare 2-year waiting 
period.'' According to that second report entitled ``Waiting for 
Medicare: Experiences of Uninsured People with Disabilities in the Two-
Year Waiting Period for Medicare'' in October 2004, ``Most of these 
individuals must invariably get by with some combination of living one 
day at a time, assertiveness, faith, and sheer luck.''
  One person in the waiting period with a spinal cord injury from 
Atlanta, Georgia, seeking medical treatment for their condition was 
told to simply ``try not to get sick for 2 years.'' As the individual 
said in response, ``None of us TRIED to become disabled.''
  The people that we have spoken to in the waiting period, since the 
introduction of this legislation last year, talk about foregoing 
critically needed medical treatment, stopping medications and therapy, 
feeling dismayed and depressed about their lives and future, and 
feeling a loss of control over their lives and independence while in 
the waiting period.
  These testimonials and appeals in support of this legislation are 
often emotional and intense. Some describe the waiting period as a 
``living nightmare'' and appropriately ask how it is possible that 
their government is doing this to them.
  In fact, some have had the unfortunate fate of having received SSI 
and Medicaid coverage, applied for SSDI, and then lost their Medicaid 
coverage because they were not aware that the change in income, when 
they received SSDI, would push them over the financial limits for 
Medicaid. In such a case, and let me emphasize this point, the 
government is effectively taking their health care coverage away 
because they are so severely disabled.
  Therefore, for some in the waiting period, their battle is often as 
much with the government as it is with their medical condition, 
disease, or disability.
  Nobody could possible think this makes any sense.
  House Ways and Means Chairman Bill Thomas questioned the rationale of 
the waiting period in a press conference on April 29, 2005.
  As the Medicare Rights Center has said, ``By forcing Americans with 
disabilities to wait 24 months for Medicare coverage, the current law 
effectively sentences these people to inadequate health care, poverty, 
or death . . . Since disability can strike anyone, at any point in 
life, the 24-month waiting period should be of concern to everyone, not 
just the millions of Americans with disabilities today.''
  Although elimination of the Medicare waiting period will certainly 
increase Medicare costs, it is important

[[Page S6321]]

to note that there will be some corresponding decrease in Medicaid 
costs. Medicaid, which is financed by both Federal and State 
governments, often provides coverage for a subset of disabled Americans 
in the waiting period, as long as they meet certain income and asset 
limits. Income limits are typically at or below the poverty level, 
including at just 74 percent of the poverty line in New Mexico, with 
assets generally limited to just $2,000 for individuals and $3,000 for 
couples.
  The Commonwealth Fund estimates that, of the 1.26 million people in 
the waiting period, 40 percent are enrolled in Medicaid. As a result, 
the Commonwealth Fund estimates in the study that Federal Medicaid 
savings would offset nearly 30 percent of the increased costs. 
Furthermore, States, which have been struggling financially with their 
Medicaid programs, would reap a windfall that would help them better 
manage their Medicaid programs.
  Furthermore, from a continuity of care point of view, it makes little 
sense that somebody with disabilities must leave their job and their 
health providers associated with that plan, move on the Medicaid to 
often have a different set of providers, to then switch to Medicare and 
yet another set of providers. The cost, both financial and personal, of 
not providing access to care or poorly coordinated care services for 
these seriously ill people during the waiting period may be greater in 
many cases than providing health coverage.
  And finally, private-sector employers and employees in those risk-
pools would also benefit from the passage of the bill. As the 2003 
report notes, ``. . . to the extent that disabled adults rely on 
coverage through their prior employer or their spouse's employer, 
eliminating the waiting period would also produce savings to employers 
who provide this coverage.''
  To address concerns about costs and immediate impact on the Medicare 
program, the legislation phases out the waiting period over a 10-year 
period. In the interim, the legislation would create a process by which 
others with life-threatening illnesses could also get an exception to 
the waiting period. Congress has previously extended such an exception 
to the waiting period for individuals with amyothrophic lateral 
sclerosis (ALS), also known as Lou Gehrig's disease, and for hospice 
services. The ALS exception passed the Congress in December 2000 and 
went into effect July 1, 2001. Thus, the legislation would extend the 
exception to all people with life-threatening illnesses in the waiting 
period.
  I would like to thank Senator DeWine and the other original 
cosponsors, including Senators Corzine, Durbin, Schumer, Johnson, 
Cantwell, Lautenberg, Stabenow, Kennedy, Clinton, Kerry, Mikulski, 
Akaka, Salazar, and Sarbanes, for supporting this critically important 
legislation. Furthermore, I would like to commend Representative Gene 
Green of Texas for his introduction of the companion bill in the House 
of Representatives and for his work, diligence, and commitment to this 
issue.
  I urge passage of this legislation and ask unanimous consent that a 
fact sheet, which includes a list of original supporting organizations 
for the legislation, and the text of the bill be printed in the Record.
  There being no objection, the materials were ordered to be printed in 
the Record as follows:

                               Fact Sheet


       ending the medicare disability waiting period act of 2005

       Senators Jeff Bingaman (D-NM) and Mike DeWine (R-OH) are 
     preparing to introduce the ``Medicare Disability Waiting 
     Period Act of 2005.'' The bill would, over 10 years, 
     completely phase-out the two-year waiting period which 
     Americans with disabilities must endure before receiving 
     Medicare coverage. The legislation also creates a process by 
     which the Secretary can immediately waive the waiting period 
     for people with life-threatening illnesses.
       When Medicare was expanded in 1972 to include people who 
     have significant disabilities, lawmakers created a ``Medicare 
     waiting period.'' Before they can get Medicare coverage, 
     people with disabilities must first receive Social Security 
     Disability Insurance (SSDI) for 24 months. Generally, SSDI 
     begins five months after an individual's disability has been 
     certified. As a result, people with disabilities face three 
     consecutive waiting periods prior to getting health coverage: 
     (1) a determination of SSDI approval from the Social Security 
     Administration; (2) a five-month waiting period to receive 
     SSDI; and, (3) another 24-month waiting period to get 
     Medicare coverage.
       Because of the 24-month Medicare waiting period, an 
     estimated 400,000 Americans with disabilities are uninsured 
     and many more are underinsured at a time in their lives when 
     the need for health coverage is most dire, Dale and Verdier, 
     The Commonwealth Fund, July 2003. In fact, various studies 
     show that death rates among SSDI recipients are highest 
     during the first two years of enrollment, Mauney, AMA, June 
     2002. For example, according to the Commonwealth Fund, 4 
     percent of these people die during the waiting period.
       There is an important exception to the 24-month waiting 
     period and that is for individuals with amyothrophic lateral 
     sclerosis (ALS), also known as Lou Gehrig's disease, and for 
     hospice services. The ALS exception passed the Congress in 
     December 2000 and went into effect July 1, 2001.
       ``Ending the Medicare Waiting Period Act of 2005'' would, 
     over 10 years, phase-out the waiting period and would also, 
     in the interim, create a process by which others with life-
     threatening illnesses, like ALS, could also get an exception 
     to the waiting period.
       As the Medicare Rights Center has said, ``By forcing 
     Americans with disabilities to wait 24 months for Medicare 
     coverage, the current law effectively sentences these people 
     to inadequate health care, poverty or death. . . . Since 
     disability can strike anyone, at any point in life, the 24-
     month waiting period should be of concern to everyone, not 
     just the millions of Americans with disabilities today.''
       If you have any questions or need additional information, 
     please contact Bruce Lesley in Senator Bingaman's office at 
     202-224-5521 or Abby Kral in Senator DeWine's office at 202-
     224-7900.


                        Supporting Organizations

       Acid Maltase Deficiency Association
       AIDS Foundation of Chicago
       The AIDS Institute
       AIDS Project Los Angeles
       Air Compassion America
       Alzheimer's Association
       American Academy of Audiology
       American Academy of HIV Medicine
       American Congress of Rehabilitation Medicine (ACRM)
       American Congress of Community Supports and Employment 
     Services (ACCSES)
       American Dance Therapy Association
       American Gastroenterological Association
       American Network of Community Options and Resources
       American Occupational Therapy Association
       American Psychological Association
       Angel Flight Mid-Atlantic
       The Arc of the United States
       Association for Community Affiliated Plans
       Association of University Centers on Disabilities (AUCD)
       Benign Essential Blepharospasm Research Foundation
       Brian Tumor Action Network
       California Health Advocates
       Center for Medicare Advocacy, Inc.
       Coalition for Pulmonary Fibrosis
       Community Action New Mexico
       Disability Service Providers of America (DSPA)
       Empowering Our Communities in New Mexico
       Families USA
       Family Voices
       Gay Men's Health Crisis
       Harm Reduction Coalition
       Hereditary Hemorrhagic Telangiectasia (HHT) Foundation 
     International
       HIV Medicine Association
       HIVictorious, Inc., Madison, WI
       Medicare Rights Center
       Mercy Medical Airlift
       Miami, ACT UP
       National Alliance for the Mentally Ill (NAMI)
       National Alliance of State and Territorial AIDS Directors 
     (NASTAD)
       National Association of Children's Behavioral Health
       National Association of Councils on Developmental 
     Disabilities (NACDD)
       National Association of Protection and Advocacy Systems 
     (NAPAS)
       National Ataxia Foundation
       National Health Law Program (NHeLP)
       National Kidney Foundation
       National Mental Health Association
       National Minority AIDS Council
       National Organization for Rare Disorders (NORD)
       National Patient Advocacy Foundation
       National Women's Law Center
       New Mexico AIDS Services
       New Mexico Medical Society
       New Mexico POZ Coalition
       New Mexico Public Health Association
       North American Brain Tumor Coalition
       Paralyzed Veterans of America
       Power Mobility Coalition
       Reflex Sympathetic Dystrophy Syndrome Association of 
     America
       Senior Citizens Law Office, New Mexico
       Southern New Hampshire HIV/AIDS Task Force
       Special Olympics
       The Title II Community AIDS National Network
       United Cerebral Palsy
       United Spinal Association
       Utah AIDS Foundation
       Visiting Nurse Associations of America
       Von Hippel-Lindau Family Alliance

[[Page S6322]]

                                S. 1217

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Ending the 
     Medicare Disability Waiting Period Act of 2005''.
       (b) Table of Contents.--The table of contents of this Act 
     is as follows:

Sec. 1. Short title; table of contents.
Sec. 2. Phase-out of waiting period for medicare disability benefits.
Sec. 3. Elimination of waiting period for individuals with life-
              threatening conditions.
Sec. 4. Institute of Medicine study and report on delay and prevention 
              of disability conditions.

     SEC. 2. PHASE-OUT OF WAITING PERIOD FOR MEDICARE DISABILITY 
                   BENEFITS.

       (a) In General.--Section 226(b) of the Social Security Act 
     (42 U.S.C. 426(b)) is amended--
       (1) in paragraph (2)(A), by striking ``, and has for 24 
     calendar months been entitled to,'' and inserting ``, and for 
     the waiting period (as defined in subsection (k)) has been 
     entitled to,'';
       (2) in paragraph (2)(B), by striking ``, and has been for 
     not less than 24 months,'' and inserting ``, and has been for 
     the waiting period (as defined in subsection (k)),'';
       (3) in paragraph (2)(C)(ii), by striking ``, including the 
     requirement that he has been entitled to the specified 
     benefits for 24 months,'' and inserting ``, including the 
     requirement that the individual has been entitled to the 
     specified benefits for the waiting period (as defined in 
     subsection (k)),''; and
       (4) in the flush matter following paragraph 
     (2)(C)(ii)(II)--
       (A) in the first sentence, by striking ``for each month 
     beginning with the later of (I) July 1973 or (II) the twenty-
     fifth month of his entitlement or status as a qualified 
     railroad retirement beneficiary described in paragraph (2), 
     and'' and inserting ``for each month beginning after the 
     waiting period (as so defined) for which the individual 
     satisfies paragraph (2) and'';
       (B) in the second sentence, by striking ``the `twenty-fifth 
     month of his entitlement' refers to the first month after the 
     twenty-fourth month of entitlement to specified benefits 
     referred to in paragraph (2)(C) and''; and
       (C) in the third sentence, by striking ``, but not in 
     excess of 78 such months''.
       (b) Schedule for Phase-out of Waiting Period.--Section 226 
     of the Social Security Act (42 U.S.C. 426) is amended by 
     adding at the end the following new subsection:
       ``(k) For purposes of subsection (b) (and for purposes of 
     section 1837(g)(1) of this Act and section 7(d)(2)(ii) of the 
     Railroad Retirement Act of 1974), the term `waiting period' 
     means--
       ``(1) for 2006, 18 months;
       ``(2) for 2007, 16 months;
       ``(3) for 2008, 14 months;
       ``(4) for 2009, 12 months;
       ``(5) for 2010, 10 months;
       ``(6) for 2011, 8 months;
       ``(7) for 2012, 6 months;
       ``(8) for 2013, 4 months;
       ``(9) for 2014, 2 months; and
       ``(10) for 2015 and each subsequent year, 0 months.''.
       (c) Conforming Amendments.--
       (1) Sunset.--Effective January 1, 2015, subsection (f) of 
     section 226 of the Social Security Act (42 U.S.C. 426) is 
     repealed.
       (2) Medicare description.--Section 1811(2) of such Act (42 
     U.S.C. 1395c(2)) is amended by striking ``entitled for not 
     less than 24 months'' and inserting ``entitled for the 
     waiting period (as defined in section 226(k))''.
       (3) Medicare coverage.--Section 1837(g)(1) of such Act (42 
     U.S.C. 1395p(g)(1)) is amended by striking ``of the later of 
     (A) April 1973 or (B) the third month before the 25th month 
     of such entitlement'' and inserting ``of the third month 
     before the first month following the waiting period (as 
     defined in section 226(k)) applicable under section 226(b)''.
       (4) Railroad retirement system.--Section 7(d)(2)(ii) of the 
     Railroad Retirement Act of 1974 (45 U.S.C. 231f(d)(2)(ii)) is 
     amended--
       (A) by striking ``, for not less than 24 months'' and 
     inserting ``, for the waiting period (as defined in section 
     226(k) of the Social Security Act); and
       (B) by striking ``could have been entitled for 24 calendar 
     months, and'' and inserting ``could have been entitled for 
     the waiting period (as defined is section 226(k) of the 
     Social Security Act), and''.
       (d) Effective Date.--Except as provided in subsection 
     (c)(1), the amendments made by this section shall apply to 
     insurance benefits under title XVIII of the Social Security 
     Act with respect to items and services furnished in months 
     beginning at least 90 days after the date of the enactment of 
     this Act (but in no case earlier than January 1, 2006).

     SEC. 3. ELIMINATION OF WAITING PERIOD FOR INDIVIDUALS WITH 
                   LIFE-THREATENING CONDITIONS.

       (a) In General.--Section 226(h) of the Social Security Act 
     (42 U.S.C. 426(h)) is amended--
       (1) by redesignating paragraphs (1), (2), and (3) as 
     subparagraphs (A), (B), and (C), respectively;
       (2) in the matter preceding subparagraph (A) (as 
     redesignated by paragraph (1)), by inserting ``(1)'' after 
     ``(h)'';
       (3) in paragraph (1) (as designated by paragraph (2))--
       (A) in the matter preceding subparagraph (A) (as 
     redesignated by paragraph (1)), by inserting ``or any other 
     life-threatening condition identified by the Secretary'' 
     after ``amyotrophic lateral sclerosis (ALS)''; and
       (4) in subparagraph (B) (as redesignated by paragraph (1)), 
     by striking ``(rather than twenty-fifth month)''; and
       (5) by adding at the end the following new paragraph:
       ``(2) For purposes of identifying life-threatening 
     conditions under paragraph (1), the Secretary shall compile a 
     list of conditions that are fatal without medical treatment. 
     In compiling such list, the Secretary shall consult with the 
     Director of the National Institutes of Health (including the 
     Office of Rare Diseases), the Director of the Centers for 
     Disease Control and Prevention, the Director of the National 
     Science Foundation, and the Institute of Medicine of the 
     National Academy of Sciences.''.
       (b) Effective Date.--The amendments made by this section 
     shall apply to insurance benefits under title XVIII of the 
     Social Security Act with respect to items and services 
     furnished in months beginning at least 90 days after the date 
     of the enactment of this Act (but in no case earlier than 
     January 1, 2006).

     SEC. 4. INSTITUTE OF MEDICINE STUDY AND REPORT ON DELAY AND 
                   PREVENTION OF DISABILITY CONDITIONS.

       (a) Study.--The Secretary of Health and Human Services (in 
     this section referred to as the ``Secretary'') shall request 
     that the Institute of Medicine of the National Academy of 
     Sciences conduct a study on the range of disability 
     conditions that can be delayed or prevented if individuals 
     receive access to health care services and coverage before 
     the condition reaches disability levels.
       (b) Report.--Not later than the date that is 2 years after 
     the date of enactment of this Act, the Secretary shall submit 
     to Congress a report containing the results of the Institute 
     of Medicine study authorized under this section.
       (c) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section $750,000 for the 
     period of fiscal years 2006 and 2007.
                                 ______