[Congressional Record Volume 153, Number 145 (Thursday, September 27, 2007)]
[Senate]
[Pages S12291-S12292]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. CARDIN:
  S. 2115. A bill to amend title XVIII of the Social Security Act to 
extend for 6 months the eligibility period for the ``Welcome to 
Medicare'' physical examination and to provide for the coverage and 
waiver of cost-sharing for preventive services under the Medicare 
program; to the Committee on Finance.
  Mr. CARDIN. Mr. President, I rise to introduce the Medicare 
Preventive Services Coverage Act of 2007. It has been ten years since 
Congress enacted the first comprehensive package of preventive services 
for Medicare beneficiaries. At the time Medicare was created in 1965, 
it was modeled closely after the indemnity health insurance policies of 
the time. As such, Medicare only covered the treatment of illnesses, 
and it paid for tests only when a symptom was present, but it did not 
cover preventive services. Over the next 3 decades, the medical 
community learned a great deal about the importance of preventive care. 
Although as early as the 1970s, health maintenance organizations had 
begun to cover cancer screenings and other wellness services, 
traditional Medicare had not kept pace.
  The Balanced Budget Act of 1997 changed that. Working across the 
aisle, I introduced legislation that year to provide coverage for 
lifesaving screenings to Medicare beneficiaries. With strong bipartisan 
support, Congress added our language to BBA 1997, ensuring coverage for 
preventive services, including: an annual screening mammography for 
women over age 39; screening pap smear and pelvic examination for 
cervical cancer; prostate cancer screening; colorectal cancer 
screening; bone mass measurement for osteoporosis; and diabetes testing 
supplies and self-management training services.
  Congress expanded this list of benefits in subsequent Medicare 
legislation. Now traditional Medicare also covers cardiovascular 
screenings to help prevent heart attacks and strokes; diabetes 
screenings; flu shots to help prevent influenza, glaucoma screening, 
medical nutrition therapy services, Hepatitis B vaccine, and ultrasound 
screening for aortic aneurysm.
  Medicare also now covers a one-time ``Welcome to Medicare Visit'' 
within the first 6 months of Part B enrollment. This is an initial 
physical examination where beneficiaries can receive education and 
counseling about their medical history and needs, have some preventive 
screenings performed, and get referrals for other services.
  Yes, over the past decade, Medicare has indeed made great strides 
toward helping our seniors get screened for diseases. But we have far 
to go.
  The participation rate for Medicare preventive benefits is low. One 
key obstacle is financial. America's seniors still have the highest 
out-of-pocket costs of any age group. A 2007 Kaiser Family Foundation 
study compared out-of-pocket health care spending among age groups. For 
nonprescription drug expenses, it found that average spending for the 
over-65 population was nearly twice that for under-65 group. It also 
showed that on average, seniors in one-person households are spending 
12.5 percent of their incomes on health care, versus 2.2 percent of 
those under 65. This means that excluding prescription drug costs, 
despite Medicare Part D, seniors will have very high medical bills that 
stretch their fixed incomes. It is no wonder that preventive services 
that require cost-sharing will be delayed or not received at all.

  Over the years, we have also improved the benefits. We have waived 
the deductible for mammograms and colorectal cancer screenings. But 
cost sharing is still an obstacle for many seniors. They still must 
satisfy the deductible before getting reimbursed for the physical exam 
and most other services, and they must pay coinsurance for all other 
services except laboratory tests.
  The bill that I am introducing today will waive the cost sharing for 
all preventive screenings and the Welcome to Medicare physical 
examination. It will also grant the Secretary of Health and Human 
Services the authority to add additional benefits as he or she 
determines to be ``reasonable and necessary for the prevention or early 
detection of an illness or disability.'' These determinations would 
take into account evidence-based recommendations by the U.S. Preventive 
Services Task Force and other organizations. Finally, my bill would 
extend eligibility for the Welcome to Medicare Visit from its current 
time frame of 6 months to 1 year.
  This bill will mean the difference between early screening and 
delayed diagnosis and treatment. It will mean the difference between 
detecting a serious illness and providing hundreds of thousands of 
dollars of services later.

[[Page S12292]]

  Let me explain why. Preventive services such as mammography and 
colonoscopy are important tools in the fight against serious disease. 
The earlier they are detected, the greater the chances of survival. For 
example, when caught in the first stages, the 5-year survival rate for 
breast cancer is 98 percent. But if the cancer has spread, that rate 
declines to 26 percent. Similarly, if colorectal cancer is detected in 
its early states, the survival rate is 90 percent, but only 10 percent 
if found when it is most advanced.
  Our seniors are at particular risk for cancer. The greatest single 
risk factor for colorectal cancer is being over the age of 50, when 
more than 90 percent of cases are diagnosed. In addition to increasing 
survival rates, identifying diseases early reduces Medicare costs. In 
the case of colorectal cancer, Medicare will pay $207 for a screening 
colonoscopy in a medical facility, but if the patient is not diagnosed 
until the disease has metastasized, the cost of care can exceed $60,000 
over the patient's lifetime. Medicare pays $98 for a mammogram, but if 
breast cancer is not detected early, treatment can cost tens of 
thousands of dollars more, depending on when the cancer is found and 
the course of treatment used. One drug used to treat late stage breast 
cancer can cost as much as $40,000 a year. There can be no doubt that 
these services are both life saving and cost saving. But if seniors 
cannot afford the copayments for these services, they may delay getting 
them.
  In addition to cancer, diabetes is another prevalent disease among 
seniors. The statistics associated with diabetes are staggering. Nearly 
20 million Americans are estimated to have diabetes. Approximately half 
know they have diabetes and another half have diabetes but do not know 
it. But once diagnosed, the co-morbidities associated with diabetes can 
be avoided. It is estimated that 90 percent of diabetes-related 
blindness is preventable, 50 percent of kidney disease requiring 
dialysis is preventable, 50 percent of diabetic-related amputations are 
preventable and 50 percent of diabetic-related hospitalizations are 
preventable.
  Diabetes and its complications are not only disabling, but costly to 
Medicare as well. The cost of medical care of people with diabetes is 
about $150 billion a year, according to data from the Department of 
Health and Human Services. In its direct costs, diabetes was the most 
costly of the 39 diseases reported. Despite the fact that 9 percent of 
the Medicare population is diagnosed with diabetes, about 27 percent of 
the Medicare budget is used to treat their diabetes.
  Most of the cost for medical care of people with diabetes is for the 
treatment of the complications, which are largely preventable with 
modern treatment including blood sugar control. Clearly, prevention of 
the complications of diabetes would reduce the costs of diabetes in 
lives and in dollars.
  Numerous studies have found that once diabetes management training is 
provided, populations see a nearly 50 percent reduction in emergency 
room visits. In addition, the number of outpatient visits, doctor 
office visits, and other medical expenses all decline. Diabetes can 
lead to amputations, blindness, heart disease, and stroke, all of which 
can be prevented with training and management.

  This bill also gives the Secretary of Health and Human Services the 
authority to add new preventive services based on the recommendations 
of the U.S. Preventive Services Task Force. As we have seen, it can 
take a very long time for Congress to change health policy in this 
country. In order to add new preventive services to Medicare, it now 
requires legislative action. Under current law, as our researchers 
discover new, more efficient, and more accurate screening methods to 
detect disease, Congress would have to pass new legislation authorizing 
coverage for each one. This provision would enable Medicare to provide 
coverage for new types of screenings based on up-to-date scientific 
evidence.
  The Preventive Services Task Force has a long and distinguished 
record. It dates back to 1984, when the U.S. Public Health Service 
convened a panel of primary and preventive health care specialists to 
develop guidelines for preventive services. From this panel, the U.S. 
Preventive Services Task Force's Guide to Clinical Preventive Services 
was born. While many other respected professional and research 
organizations have issued their own recommendations, the Task Force's 
publication is regarded as the ``gold standard'' reference on 
preventive services. In December of 1995, a new Task Force released an 
updated and expanded second edition of the Guide which includes 
findings on 200 preventive interventions for more than 70 diseases and 
conditions. The Task Force employed a rigorous methodology to review 
the evidence for and against hundreds of preventive services, assessing 
more than 6,000 studies. The Task Force recommended specific screening 
tests, immunizations, or counseling interventions only when strong 
evidence demonstrated the effectiveness of preventive services. My bill 
will give the Secretary the authority to use this gold standard to 
expand Medicare's basic benefit package to include the tests that 
studies have shown to be effective.
  The newest benefit is the Welcome to Medicare Visit, an initial 
physical examination for new beneficiaries. We know that large numbers 
of people in the 55 to 64 age group lack health insurance, so it is 
particularly important for them to get a baseline examination and 
screenings for diseases that affect elderly people But as of July 2006, 
only 2 percent of all new beneficiaries, or about 8,000 people, have 
received this physical exam. Uptake has been slow for a number of 
reasons. You must get the exam within 6 months of enrolling in Medicare 
Part B. But many seniors don't learn about the benefit until they have 
been enrolled for a while, and even then it can take several months to 
schedule a physical examination with a doctor. So the vast majority of 
our seniors are missing out on this important benefit. My bill extends 
eligibility from 6 months after enrolling in Part B to 1 year.
  Finally, I want to address the matter of cost, and that is the 
appropriate thing to do under our budget scoring principles. The 
elimination of cost sharing for preventive services has been scored by 
the Congressional Budget Office at $1.1 billion over 5 years. Based on 
CBO estimates from the 2003 Medicare law, extending the eligibility 
period for the Welcome to Medicare Visit from six months to one year 
will cost approximately $1.2 billion over years. But I believe that the 
members of this body also understand that, although dynamic scoring is 
not used by CBO, preventive health care will save money. If we detect 
diseases earlier, the overall cost to our society will be less. Our 
seniors will save out of pocket costs and all taxpayers will save 
money.
  This bill is supported by the American Cancer Society's Cancer Action 
Network, the American Federation of State, County and Municipal 
Employees, the Center for Medicare Advocacy, the Colorectal Cancer 
Coalition, C3, and the Society of Vascular Surgeons. I urge my 
colleagues to join me in this effort to get improve seniors' access to 
lifesaving preventive services.

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