[Congressional Record Volume 155, Number 48 (Thursday, March 19, 2009)]
[Senate]
[Pages S3565-S3566]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BUNNING (for himself and Ms. Mikulski):
  S. 654. A bill to amend title XIX of the Social Security Act to cover 
physician services delivered by podiatric physicians to ensure access 
by Medicaid beneficiaries to appropriate quality foot and ankle care; 
to the Committee on Finance.
  Mr. BUNNING. Mr. President, today I am reintroducing an important 
piece of legislation that I have worked on for several years with 
Senator Mikulski from Maryland. I am pleased that she is joining me in 
introducing this bill today, and I look forward to working with her to 
get it passed.
  The bill we are introducing today, the Equity and Access for 
Podiatric Physicians Under Medicaid Act, will ensure that Medicaid 
beneficiaries in all States have access to the services of top-quality 
podiatric physicians.
  Having healthy feet and ankles is critical to keeping individuals 
mobile, productive and in good long-term health. This is particularly 
true for individuals with diabetes.
  According to the Centers for Disease Control and Prevention, CDC, 
over 23 million Americans have diabetes, which amounts to over seven 
percent of the total population. Diabetes is the seventh leading cause 
of death in this country.
  If not managed properly, diabetes can cause several severe health 
problems, including eye disease or blindness, kidney disease and heart 
disease. Too often, diabetes can lead to foot complications, including 
foot ulcers and even amputations. In fact, the CDC estimates that in 
2004, about 71,000 people underwent an amputation of a leg, foot or toe 
because of complications with diabetes.
  Proper care of the feet could prevent many of these amputations.
  The bill we are introducing today recognizes the important role 
podiatrists can play identifying and correcting foot problems among 
diabetics. The bill amends Medicaid's definition of ``physicians'' to 
include podiatric physicians. This will ensure that Medicaid 
beneficiaries have access to foot care from those most qualified to 
provide it.
  Under Medicaid, podiatry is considered an optional benefit. However, 
just because it is optional, does not mean that podiatric services are 
not needed, or that beneficiaries will not seek out other providers to 
perform these services. Instead, Medicaid beneficiaries will have to 
receive foot care from other providers who may not be as well trained 
as a podiatrist in treating lower extremities.
  Also, it is important to note that podiatrists are considered 
physicians under the Medicare program, which allows seniors and 
disabled individuals to receive appropriate care.
  I urge my colleagues to give careful consideration to this important 
bill. It will help many Medicaid beneficiaries across the country have 
access to podiatrists that they need.
  Finally, I want to thank the Senator from Maryland for helping me 
reintroduce this legislation today. I hope that by working together we 
can see this important change made.
  Ms. MIKULSKI. Mr. President, I rise today to join Senator Bunning to 
introduce the Equity and Access for Podiatric Physicians Under Medicaid 
Act. I am proud to introduce this legislation that will ensure Medicaid 
patients have access to care provided by podiatric physicians.
  This bill adds podiatric physicians to Medicaid's definition of 
physicians. Currently, podiatric physicians are defined as physicians 
under Medicare but not under Medicaid. Medicaid treats podiatric 
physicians as optional providers. This is a simple, commonsense bill 
that will treat podiatric physicians the same in Medicare and Medicaid. 
In this economic tsunami, with shrinking budgets and less to go around 
for Medicaid with more people in need, states are looking for ways to 
trim budgets and cut costs--one way to do that could be ending 
reimbursements to providers on Medicaid's ``optional list.'' That means 
diabetics who need foot and ankle care but cannot afford to pay out of 
pocket will not get preventive care from a podiatrist that literally 
can save life and limb.
  In fact, covering podiatric physicians may be a cost-effective 
measure. Ensuring Medicaid patients access to podiatric physicians will 
save Medicaid funds in the long term. Seventy-five percent of Americans 
will experience some type of foot health problem during their lives and 
foot disease is the most common complication of diabetes leading to 
hospitalization. Foot care programs with regular examinations could 
prevent up to 85 percent of these amputations. We must focus more on 
prevention on our health care system, and podiatrists are important 
providers of this preventive care.

[[Page S3566]]

  Podiatric physicians are the only health professionals specially 
trained to prevent wounds and amputations in the lower limbs in people 
with chronic conditions like diabetes. Conditions that can devastate 
feet and ankles. With obesity and diabetes reaching epidemic 
proportions in the U.S., the work of podiatrists is more important now 
than ever before. Over 23 million people in this country have diabetes, 
that is 8 percent of the U.S. populations. Approximately 82,000 people 
have diabetes-related Leg-,foot or toe amputations each year. Both the 
CDC and American Diabetes Association recommend that podiatric 
physicians are a part of the care plan for people with diabetes. 
Medicaid covers necessary foot and ankle services, so the program 
should allow podiatric physicians who provide these services to get 
reimbursed for them. I want Medicaid patients around the country, and 
the over 600,000 Medicaid patients in Maryland, to have access to these 
services.
  I know how important the care provided by podiatric physicians can be 
from my own personal experience. Dr. Vince Martorana, a podiatrist 
practicing in Baltimore did great things for my mother. He handled 
everything from health maintenance to unique challenges facing my 
mother, who lived for many years with adult onset diabetes. My severely 
diabetic mother could walk on her own two feet until she passed away 
because of Dr. Martorana. My Uncle Tony was also a podiatric physician 
who practiced in Baltimore for more than 40 years. He was there helping 
Rosie the Riveters stay on the job during World War II. These were 
hardworking people who had to stand on their own two feet to make a 
living and Uncle Tony was going to make sure it happened.
  Podiatric physicians need to be recognized for the important role 
they play in health care and be reimbursed for their services. This 
bill makes sure that happens and ensures Medicaid patients have access 
to essential medical and surgical foot and ankle care. The bill is 
strongly supported by the American Podiatric Medical Association and I 
urge my colleagues to cosponsor this important legislation.
                                 ______