[Congressional Record Volume 155, Number 51 (Wednesday, March 25, 2009)]
[Senate]
[Pages S3791-S3792]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BINGAMAN (for himself, Mr. Brown and Ms. Collins):
  S. 700. 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 along with my colleagues, 
Senators Brown and Collins, to introduce bipartisan legislation 
entitled Ending the Medicare Disability Waiting Period Act of 2009. 
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 an April 2007 report from the Commonwealth Fund, it is estimated 
that over 1.5 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.'' Nearly 39 percent of 
these individuals do not have health insurance coverage for some point 
during the waiting period and 26 percent have no health insurance 
during this period.
  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 five 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 several 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. The consequences are unacceptable and are, in fact, dire.
  The majority of people who become disabled were, before their 
disability, working full-time jobs and paying into Medicare like all 
other employed Americans. At the moment these men and women need 
coverage the most, just when they have lost their health, their jobs, 
their income, and their health insurance, Federal law requires them to 
wait 2 full years to become eligible for Medicare. Many of these 
individuals are needlessly forced to accumulate tens-of-thousands of 
dollars in healthcare debt or compromise their health due to forgone 
medical treatment. Many individuals are forced to sell their homes or 
go bankrupt. Even more tragically, more than 16,000 disabled 
beneficiaries annually, about 4 percent of beneficiaries, do not make 
it through the waiting period. They die before their Medicare coverage 
ever begins.
  Removing the waiting period is well worth the expense. According to 
the Commonwealth Fund, analyses have shown providing men and women with 
Medicare at the time that Social Security certifies them as disabled 
would cost $8.7 billion annually. This cost would be partially offset 
by $4.3 billion in reduced Medicaid spending, which many individuals 
require during the waiting period. In addition, untold expenses borne 
by the individuals involved could be avoided, as well as the costs of 
charity care on which many depend. Moreover, there may be additional 
savings to the Medicare program itself, which often has to bear the 
expense of addressing the damage done during the waiting period. During 
this time, deferred health care can worsen conditions, creating 
additional health problems and higher costs.
  Further exacerbating the situation, some beneficiaries 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 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 possibly think this makes any sense.
  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 to note that there will be 
some 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.

[[Page S3792]]

  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 to Medicaid, often 
have a different set of providers, 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.
  Finally, private-sector employers and employees in those risk-pools 
would also benefit from the passage of the bill. As the Commonwealth 
Fund has noted, ``. . . 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 to individuals with amyotrophic 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.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                 S. 700

         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 2009''.
         (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 2010, 18 months;
         ``(2) for 2011, 16 months;
         ``(3) for 2012, 14 months;
         ``(4) for 2013, 12 months;
         ``(5) for 2014, 10 months;
         ``(6) for 2015, 8 months;
         ``(7) for 2016, 6 months;
         ``(8) for 2017, 4 months;
         ``(9) for 2018, 2 months; and
         ``(10) for 2019 and each subsequent year, 0 months.''.
         (c) Conforming Amendments.--
         (1) Sunset.--Effective January 1, 2019, 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, 2010).

     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'' after ``amyotrophic lateral 
     sclerosis (ALS)''; and
         (B) in subparagraph (B) (as redesignated by paragraph 
     (1)), by striking ``(rather than twenty-fifth month)''; and
         (4) 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--
         ``(A) 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; and
         ``(B) annually review the compassionate allowances list 
     of conditions of the Social Security Administration.''.
         (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, 2010).

     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 2010 and 2011.
                                 ______