[Congressional Record Volume 163, Number 155 (Wednesday, September 27, 2017)]
[Senate]
[Pages S6180-S6181]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                            Chronic Care Act

  Mr. WYDEN. Mr. President, often late at night when the Senate passes 
a piece of legislation by unanimous consent, people often don't get a 
chance to understand what it really means, and usually there is a sense 
of, well, this maybe won't be the most important thing coming down the 
road, and everybody just said OK, and so it passed the Senate.
  Last night, the Senate took action on Medicare. At a time when 10,000 
people will turn 65 every day for years and years to come, Medicare is 
something millions of older people rely on, and their kids and 
grandkids make plans to make sure their grandparents are taken care of, 
but also they want to know what their future is going to be all about.
  What the Senate did last night--Democrats and Republicans coming 
together--is, in my view, transformational for seniors today and the 
beginning of an effort that is going to evolve in the days ahead for 
kids and their parents and their grandparents to, in effect, benefit 
from an updated Medicare guarantee that will stand the test of time for 
many years to come. The reason I say ``updated Medicare guarantee'' is 
that Medicare is not a voucher. It is not a piece of paper. It is not 
something you get and then, well, maybe it will do you some good, but 
if your healthcare costs go above your vouchers, you are going to get 
buried in costs. Medicare is a guarantee that vital services are going 
to be available to those over 65.
  Last night, all Senators voted to send to the House of 
Representatives a bipartisan effort that was years in the making to 
update the Medicare guarantee to start focusing on chronic illnesses, 
such as cancer, diabetes, heart disease, and Alzheimer's.
  Mr. President, I am going to make this a little bit personal. I am so 
grateful to Chairman Hatch, Senator Isakson, Senator Warner--the 
bipartisan group in the Senate that has been working on this.
  What I can tell the Senate tonight is that back when I was director 
of the Gray Panthers and ran the legal aid services for older people, 
Medicare was a very different program. Back in the 1970s when we were 
getting the Gray Panthers off the ground, it was a very different 
program than it is in 2017. Medicare really consisted of two parts. 
There was Part A. If a senior broke their ankle or needed surgery for a 
broken hip, they went to the hospital, and Medicare Part A would be 
there to cover a senior's surgery. If a senior had an awful bout of the 
flu, he or she visited the doctor and they used Part B. That is not 
Medicare in 2017. Medicare in 2017 is not primarily about treating the 
flu or a broken ankle. It is there for those conditions, and we are 
very glad that it is, but more than 90 percent of the Medicare dollars 
go to treat

[[Page S6181]]

older people with two or more chronic conditions. I will tell you, 
until the Senate Finance Committee, on a bipartisan basis, began to 
deal with this problem--and fortunately, we had a couple of colleagues 
in the House who picked up on it as well--my sense is that, basically, 
both political parties had missed it. They really missed the fact that 
most of the Medicare dollars--90 percent--go to seniors who have two or 
more of these chronic conditions. They might, for example, deal with 
diabetes and heart problems.

  But today's seniors really face the kinds of conditions that didn't 
dominate the program back in the days when the Gray Panthers were 
getting off the ground. Today, seniors get their care in a variety of 
different ways. It is not just fee-for-service medicine. We have the 
Medicare Advantage Plan, Accountable Care Organizations, and other new 
systems under development.
  So keeping up with those changes--updating the Medicare guarantee--
ought to be a real priority for policymakers. That is why the Finance 
Committee has put so much effort over several years to get the bill 
that passed late last night across the finish line. There are still 
more steps before the policies reach the President's desk with strong 
bipartisan backing of the entire Senate. I am confident the job will 
get done.
  The CHRONIC Care Act means more care at home and less in 
institutions. It will expand the use of lifesaving technology. It 
places a stronger focus on primary care. It gives older people--however 
they get their Medicare--more tools and options to receive care 
specifically targeted to address chronic illnesses and to keep them 
healthy. These, in my view, are a whole set of building blocks that you 
have to set in place to update the Medicare guarantee. Still to come is 
ensuring that every older person with multiple chronic conditions has 
an advocate to help them navigate through the Byzantine healthcare 
system in America.
  I just want to highlight that point. If you have two or more of these 
chronic conditions--I guess the physicians call them comorbidities--you 
can be drowning, especially if you are not part of a coordinated 
Medicare program or Medicare Advantage or something like that. You can 
just be drowning in forms and processes and procedures. Lots of times, 
over the years, I have gotten calls from a child who is a lawyer or an 
engineer and they said: Ron, help me out in trying to get through all 
of this maze of bureaucracy to try to get help for my parents. So I 
want it understood that what the Senate has done as of last night is an 
extraordinarily important beginning, but there is a lot more to do.
  I want to wrap up my comments on this subject and, then, turn briefly 
to one other, by handing out some very appropriate thank-yous. I think 
the Finance Committee has handled this bill, in my view, as a model to 
work on a bipartisan basis. I want to thank Chairman Hatch. He and I 
put together the bipartisan chronic care working group two years ago, 
and Senators Warner and Isakson did a first-rate job of leading it.
  There is an awful lot of sweat equity put in by staff. A lot of staff 
worked on these issues while they were dealing with weddings. We had 
three children born in the process, and there were job changes.
  Big thanks go to Karen Fisher, Hannah Hawkins, Kelsey Avery, Leigh 
Stuckhardt, Liz Jurinka, Beth Vrabel, and Matt Kazan on our team.
  Chairman Hatch and his team really stepped up to work with us and all 
the Senators: Jay Khosla, Brett Baker, Jen Kuskowski, Katie Meyer-
Simeon, and the chronic care lead, Erin Dempsey. Big thanks also go to 
Senators Warner and Isakson for lending us Marvin Figueroa and Jordan 
Bartolomeo.
  I close this portion of my remarks by saying that I think what 
happened last night--while certainly not something everybody is talking 
about this evening--is something that is going to be extraordinarily 
important in the years ahead. It is an issue that I know the President 
of the Senate and I have talked about--this whole question of 
healthcare and Medicare and the like. This was an important step to 
take and an important step we can build on. I hope the other body in 
the House will take action quickly.