[Congressional Record (Bound Edition), Volume 145 (1999), Part 8]
[Extensions of Remarks]
[Page 11201]
[From the U.S. Government Publishing Office, www.gpo.gov]



INTRODUCTION OF MEDICARE MODERNIZATION NO. 6: MEDICARE PREVENTIVE CARE 
                        IMPROVEMENT ACT OF 1999

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                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                        Wednesday, May 26, 1999

  Mr. STARK. Mr. Speaker, I am very pleased today to introduce the 
sixth bill in my Medicare modernization effort: the ``Medicare 
Preventive Care Improvement Act of 1999.'' This bill carries forward 
the overall theme of modernization: to improve the quality of health 
services for Medicare beneficiaries, and achieve potential savings for 
the program.
  Medicare should provide state-of-the-art health services to its 
beneficiaries. But in order to achieve this, Medicare needs more 
flexibility to adapt and change with today's ever-changing health 
sciences. Currently, Medicare relies on Congressional decision-making 
for too many of its day-to-day operations. For example, my colleagues 
and I have often been asked to consider whether or not to include 
additional services in Medicare's benefits package. In order to do 
this, we have to weigh the costs and benefits of highly technical 
information that we know virtually nothing about. Often, our decisions 
are based more on political motivations than sound scientific analysis. 
This is no way to run a health insurance plan.
  Fortunately, we have experts in the Department of Health and Human 
Services who are qualified to make these decisions. Now we just need to 
give them the authority to do so. The ``Medicare Preventive Care 
Improvement Act of 1999'' would allow the Secretary of Health and Human 
Services to make decisions about whether or not to cover new preventive 
health measures. If the Secretary determines that covering a new 
preventive service would be cost effective, she may implement that 
coverage without seeking an Act of Congress. Granting such 
administrative flexibility is the cornerstone of my modernization 
effort.
  In 1997, Congress passed a series of preventive health initiatives 
for Medicare including: Yearly Mammography Screening; Increased 
coverage of Screening Pap Smear and Pelvic Exams; Prostate Cancer 
Screening; Colorectal Cancer Screening; Diabetes Self Management and 
Training Services (and coverage of blood test strips and glucose 
monitors); and Bone Mass Measurement tests (osteoporosis screening).
  Recognizing the importance of preventive health care to the Medicare 
population, the BBA also provided for a study to analyze the potential 
expansion or modification of preventive and other services covered 
under Medicare. Unfortunately, the BBA did not take this commitment to 
preventive care one step further by allowing the Secretary to implement 
preventive services that are found to be cost effective. This bill 
leaves the technical, medical, cost-benefit analysis issues up to the 
Secretary and the expert doctors in the Department to resolve.
  If we want Medicare beneficiaries to avail themselves of preventive 
services, we must make it simple and affordable for them to do so. This 
bill also makes two necessary improvements in that regard. Currently, 
some preventive services are subject to the $100 Part B deductible 
while others are specifically exempted from the application of the 
deductible. The Medicare Preventive Care Improvement Act would 
standardize the policy so that all preventive benefits are exempt from 
the deductible. In addition, under current Medicare rules, providers 
can balance bill for some preventive services, but not others. This 
legislation would firmly establish in law that balance billing for all 
preventive services is prohibited.
  What type of preventive care services might be allowed under the bill 
I am introducing today? In recent years, I have received a number of 
letters and reports from kidney disease specialists saying that if 
Medicare were more flexible in providing care to those approaching end-
stage renal disease, we could in many cases delay the onset of ESRD and 
the need for dialysis by months or even years.
  Each year a person is on dialysis with terminal ESRD, it costs 
Medicare and the taxpayer $40,000 to $60,000. ESRD patients are 
consistently the most expensive patients enrolled in the program. Yet 
experts have said that dietary consultation, occasional dialysis, and 
early placement of dialysis access, are all tools which can save money, 
pain, and improve the quality of life of ESRD patients. I do not know 
if these claims are valid. I am not a doctor. But HHS has the experts, 
and if the Department's physicians and researchers find these claims 
are true, of course we should start to cover those preventive services. 
The Secretary should have the flexibility to provide these services 
when she finds that the evidence supports their use as cost-saving, 
quality-improving actions, without requiring an Act of Congress.
  Another example of a qualified preventive service is independent 
living services for the blind. When someone is stricken with blindness, 
they can access several training programs that help them learn to live 
independently. Without this training, blind persons risk becoming 
institutionalized. Until this bill, if the Secretary determines that 
rehabilitation such as this would prevent a blind person from having to 
move to a more intensive setting, she may cover such services.
  Modern medicine keeps developing new miracles to delay or prevent 
terrible illnesses. If Medicare is to be a modern health insurance 
plan, it must be able to cover these preventive care services quickly. 
Forward looking treatments like those included in the BBA take the 
position that a disease prevented is a dollar saved. Logically, if we 
prevent diseases from occurring, Medicare will save money in the long 
run. In the case of Medicare, the savings can be considerable. The bill 
I am introducing today gives the Medicare Administrator the tools to 
use modern health advances to save lives and money.
  The BBA of 1997 was a good first step, but did not go far enough 
toward improving the overall service available to Medicare 
beneficiaries. The ``Medicare Preventive Care Improvement Act of 1999'' 
provides for greater flexibility to adopt preventive health measures 
without having Members of Congress play doctor.

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