[Congressional Record (Bound Edition), Volume 155 (2009), Part 10]
[Extensions of Remarks]
[Pages 14122-14123]
[From the U.S. Government Publishing Office, www.gpo.gov]




  INTRODUCTION OF THE MEDICARE SAVINGS PROGRAM IMPROVEMENT ACT OF 2009

                                 ______
                                 

                          HON. XAVIER BECERRA

                             of california

                    in the house of representatives

                         Thursday, June 4, 2009

  Mr. BECERRA. Madam Speaker, I rise today to introduce the Medicare 
Savings Program Improvement Act of 2009 with my colleague Congressman 
Lloyd Doggett (D-TX). Senator Bingaman (D-NM) is introducing similar 
legislation in the Senate. This legislation makes long overdue 
improvements to the Medicare Savings Program by providing additional 
assistance to modest income seniors for their health care out-of pocket 
expenses.
  Numerous advocacy groups have endorsed the bill, including AARP, 
Families USA, Consumers Union, the Center for Medicare Advocacy, the 
Medicare Rights Center, the National Committee to Preserve Social 
Security and Medicare, the National Council on Aging, and the National 
Senior Citizens Law Center.
  Currently, the Medicare Savings Program provides needed financial 
assistance for more than 6.2 million of the sickest and most vulnerable 
Medicare beneficiaries. The program has three major categories of 
beneficiaries: Qualified Medicare Beneficiaries (QMBs), Specified Low-
Income Medicare Beneficiaries (SLMBs) and Qualified Individuals (QI). 
These categories provide varying amounts of benefits to Medicare 
beneficiaries whose annual incomes are less than 135 percent of the 
federal poverty level (annual incomes of $14,623 for an individual and 
$19,670 for couples in 2009) and annual resources are no more than 
$4,000 for individuals and $6,000 for couples.
  Unfortunately, the Medicare Savings Program does not reach many 
eligible beneficiaries because the benefit rules are very restrictive 
and confusing, and it is difficult to apply for the program. The 
Congressional Budget Office estimated that only 33 percent of eligible 
QMBs and 13 percent of eligible SLMBs actually are enrolled in the 
program. This enrollment rate is much lower than other federal benefit 
programs. For instance, 75 percent of eligible beneficiaries receive 
the Earned Income Tax Credit, 66 to 73 percent of eligible recipients 
enroll in the Supplemental Security Income program and 66 to 70 percent 
of eligible beneficiaries enroll in Medicaid.
  The National Academy of Social Insurance found that many potential 
beneficiaries do not apply for these benefits because they incorrectly 
assume that they have too many resources. And for many more modest-
income Medicare beneficiaries, the extremely low asset test of the 
Medicare Savings Program disqualifies them from receiving these 
important benefits. A 2002 Commonwealth Fund study found that only 48 
percent of those who met the income requirements for the Medicare 
Savings Program in effect that year also met the asset requirements.
  This inability to access the Medicare Savings Program benefit has 
real consequences for these seniors and individuals with disabilities. 
MedPAC has cited a study finding that QMB qualifying nonenrollees were 
twice as likely to avoid visiting a physician because of cost than QMB 
enrollees. As a result, QMB qualifying nonenrollees are more likely to 
access hospital emergency rooms than QMB enrollees.
  Both the National Academy of Social Insurance and the Henry J. Kaiser 
Family Foundation in separate studies cite similar reasons for the low 
enrollment in the Medicare Savings Program. They include: enrollment in 
Medicaid offices (welfare stigma), asset reporting, lack of awareness 
(79 percent of unenrolled eligible beneficiaries never heard of the 
program), hard-to-reach population (eligible individuals are older, 
poorer, sicker and often cannot read or speak English), and a 
burdensome application process (two-thirds of enrollees need help with 
the application).
  Recognizing the shortcomings of the current program, Congress did 
make modest, but important modifications in the rules of the program 
last year. As part of ``The Medicare Improvements for Patients and 
Providers Act'' (P.L. 110-275), Congress allowed seniors to begin their 
application process in Social Security offices, modestly increased 
asset limits and eliminated a provision that allowed states to recover 
assets upon a beneficiary's death. These provisions did simplify the 
application process, make more individuals aware of the program and 
increase outreach to hard-to-reach individuals. However, much more 
needs to be done.
  Even with these changes, the Medicare Savings Program's current 
design still makes it difficult for eligible seniors to enroll for the 
benefits and its eligibility requirements are significantly stricter 
than the Medicare low-income drug subsidy program. Recognizing these 
issues in 2008, MedPAC recommended that Congress raise the Medicare 
income and asset criteria to conform to the low-income drug subsidy and 
standardize program requirements so that the Social Security 
Administration could screen low-income drug subsidy applicants for 
federal Medicare Savings Program eligibility.
  In response, the Medicare Savings Program Improvement Act of 2009 
proposes to accomplish three goals. First, the bill aligns the Medicare 
Savings Program with the low-income drug subsidy program by reducing it 
to two beneficiary categories and standardizing the definition of 
income and assets for both programs.
  Second, it would expand access by increasing the income eligibility 
limits for Qualified Medicare Beneficiaries up to 150 percent (an 
annual income level of $16,245 for individuals and $21,855 for families 
in 2009) and Specified Low-Income Beneficiaries up to 200 percent (an 
annual income of up to $21,660 for individuals and up to $29,140 in 
2009) of the federal poverty level. And annual resource limits would be 
raised to $27,000 for individuals and $55,000 for families. 
Representative Doggett has introduced legislation that changes resource 
and income limits for the Medicare low-income drug subsidy program to 
the same levels as this bill.
  Finally, the bill continues to simplify the application process. For 
instance, the legislation makes it easier for non-native English 
speaking Medicare beneficiaries to access enrollment materials.
  Improving the Medicare Savings Program will create increased access 
to health benefits

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for our sickest and poorest seniors and the disabled. I urge my 
colleagues to support this bill and ensure that low-income Medicare 
beneficiaries are able to fully access the important health benefits 
provided by Medicare.

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