[Congressional Record Volume 155, Number 16 (Tuesday, January 27, 2009)]
[Extensions of Remarks]
[Page E153]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




 INTRODUCTION OF THE SOCIAL SECURITY AND MEDICARE IMPROVED BURN INJURY 
                      TREATMENT ACCESS ACT OF 2009

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                          HON. RICHARD E. NEAL

                            of massachusetts

                    in the house of representatives

                       Tuesday, January 27, 2009

  Mr. NEAL of Massachusetts. Madam Speaker, I rise today to introduce 
the Social Security and Medicare Improved Burn Injury Treatment Access 
Act of 2009. This legislation provides a waiver of the 24-month waiting 
period now required before an uninsured individual becomes eligible for 
Medicare coverage for disabling burn injuries, as well as the five-
month waiting period for Social Security disability benefits.
  Each year an estimated 500,000 people are treated for burn injuries. 
Of these 500,000 injuries, about 40,000 require hospitalization. Fire 
and burn deaths average about 4,000 per year.
  Burn care is highly specialized. While there are thousands of trauma 
centers in the United States, there are only 125 burn centers with a 
total burn-bed capacity of just over 1,800. These specialized burn 
centers treat about 25,000 patients annually, or on average, 200 
admissions per year for each center. U.S. hospitals without burn 
centers treat the remaining patients and average less than three burn 
admissions per year.
  Medical care for serious burn injuries is very expensive, which 
places a great financial strain on burn centers, about 40 percent of 
whose patients are uninsured. Because of these financial challenges, 
burn centers in Pennsylvania, Mississippi, Iowa and South Carolina have 
closed in just the past two years.
  This is occurring at a time when the Federal Government is asking 
burn centers to expand their capacity to deal with mass casualty 
scenarios. The Departments of Health and Human Services and Homeland 
Security have included burn centers in the Critical Benchmark Surge 
Capacity Criteria in the funding continuation requirements for State 
plans administered through the Health Resources and Services 
Administration (HRSA). HSS, in conjunction with the American Burn 
Association, has created a real-time, web-based burn bed capacity 
system in the national emergency preparedness center and funded 
Advanced Burn Life Support (ABLS) and clinical, on-site burn nurse 
training for 200 public health service nurses as a reserve capacity for 
potential mass burn casualty incidents, as well as supporting more than 
20 ABLS courses with over 600 first-responders in 10 key areas of the 
country.
  The 9/11 terrorist attacks on New York City and Washington, DC, and 
major accidents like the Rhode Island nightclub fire and North Carolina 
chemical plant explosions demonstrate the substantial number of burn 
injuries that can result from such events. Over one-third of those 
hospitalized in New York on 9/11 had severe burn injuries. The 
Department of Homeland Security has recognized that there would be mass 
burn casualties in terrorist acts, and there is a need for appropriate 
preparedness activities. For example, if the United States should 
suffer further terrorist attacks using explosions, incendiary devices 
or chemical weapons, most victims would suffer severe burn injuries.
  Even a relatively modest number of burn injuries can consume large 
segments of the Nation's burn bed capacity. For example, the victims of 
the Rhode Island nightclub fire absorbed the burn bed capacity of most 
of the northern East Coast of the United States. Mass burn casualties 
that reach into the hundreds or thousands would strain the system to 
the breaking point.
  It is clear that burn centers are a national resource and a critical 
link to public health emergency preparedness. Medicare coverage for 
serious, disabling burn injuries would enable these burn centers to 
remain financially viable and preserve an essential component of our 
public health emergency infrastructure.
  This legislation follows an approach already taken with respect to 
End Stage Renal Disease (ESRD) and amyotrophic lateral sclerosis (ALS 
or Lou Gehrig's disease), both of which result in waivers of the 24-
month waiting period for Medicare eligibility. While these 2 diseases 
tend to be progressive in nature, the very initial phase of a serious 
burn injury is when things are most acute.
  This legislation is similar to H.R. 685, which I introduced in the 
110th Congress, except for the inclusion of some important cost 
containment provisions. No one with either public or private insurance 
at the time of their burn injury will be eligible for the 24-month 
waiver. Nor will State public insurance programs be permitted to 
restrict coverage for burn patients so as to place the burden solely on 
Medicare. The legislation also requires that the individual's 
disability status be reevaluated at least once every 3 years to ensure 
that those patients who have fully recovered from their burn injuries 
will not be able to stay on Medicare indefinitely.
  Providing immediate Medicare coverage for uninsured patients 
suffering serious, disabling burn injuries is fully justified and a 
necessary step. Although not all hospitalized burn injuries would 
qualify as ``disabling'' and thus result in immediate Medicare 
coverage, this legislation is about providing coverage for the many 
uninsured patients suffering from serious burn injuries and ensuring 
the survival of a vital national resource that already is in jeopardy, 
a situation we cannot accept as we seek to prepare the nation to deal 
with potential mass casualty terrorist events.

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