Mr. President, I rise today with Senators Kerry, Salazar and Stabenow to introduce the Medicare Savings Program Improvement Act of 2007. This legislation would make critical improvements to the Medicare Savings Programs, which provide…
Mr. President, I rise today with Senators Kerry, Salazar and Stabenow to introduce the Medicare Savings Program Improvement Act of 2007. This legislation would make critical improvements to the Medicare Savings Programs, which provide important cost-assistance for low-income Medicare beneficiaries through the Medicaid program and include the Qualified Medicare Beneficiary, QMB, Specified Low-income Medicare Beneficiary, SLMB, and Qualified Individuals-1, QI-1, programs.
One of the most significant improvements within this legislation is to make permanent the QI-1 program, which expires at the end of this month. This program provides vital assistance to low-income Medicare beneficiaries in paying for Medicare Part B premiums. It was established as part of the Balanced Budget Act of 1997 and was authorized for 5 years. Unfortunately, every few years we in Congress
must act to reauthorize this program, providing unnecessary uncertainty for beneficiaries and State Medicaid programs.
Congress should not participate in this annual last minute scramble to try and extend the program for a few months or a year. It is a disservice to the States, who must watch the Congress closely to constantly prepare to send out disenrollment notices and lay off staff, even though they are relatively certain the program will be extended. But, more importantly, it is a disservice to the 185,000 beneficiaries that need this important assistance, as many of those enrolled worry this benefit will be taken away and many of those never enrolled are not told of the benefit since States and advocates are spending their time trying to get the program extended rather than conducting outreach.
While I remain very hopeful that the Congress will pass an extension of the QI-1 program for an additional period in the coming week, I am introducing the Medicare Savings Program Improvement Act of 2007 today in the hope that Congress will end this process of temporary extensions and permanently authorize the program, as provided for in this legislation.
Furthermore, the bill proposes several improvements to the Medicare Savings Programs and application processes that will make these low- income benefits both more efficient to administer and more accessible to the individuals who need them. It would also seek to simplify the process of applying for Medicare Savings Programs and make the Programs more understandable to low-income senior citizens and people with disabilities, as well as State and Federal Government officials.
Rates of enrollment in the Medicare Savings Programs are well below those of other means-tested benefit programs. The Congressional Budget Office estimates that only 33 percent of eligible people are participating in the QMB program, and that the participation rate in the SLMB program is only 13 percent--these figures exclude people who are eligible for full Medicaid benefits. In comparison, participation rates are estimated to be 75 percent in the earned income tax credit, 66 percent to 73 percent for Supplemental Security Income, and 66 percent to 70 percent for Medicaid.
In New Mexico, over 1,500 low-income Medicare beneficiaries receive the QI-1 benefit, which saves them almost $1,000 in Medicare Part B premium out-of-pocket costs annually. Unfortunately, according to estimates made by the Medicare Rights Center using Census Bureau data, over 11,000 are likely to be eligible. Many are completely unaware of the assistance this program offers. This is usually because many eligible individuals are difficult to reach or communicate with because they are isolated, cannot read or speak English, have difficulty seeing or hearing, or lack transportation.
To briefly describe the most critical aspects of the legislation, Section 2 of the bill provides for one unified name for the Federal programs that offer cost sharing and benefit assistance for low income Medicare beneficiaries. Rather than separately referring to the QMB, SLMB, and QI-1 programs, the bill provides one common name for all of these programs, the ``Medicare Savings Programs.'' Aligning these programs under one title helps to establish greater uniformity in income and resource limits, simplifies the application process, makes more people eligible for subsidies and increases the enrollment in programs.
Low enrollment in these assistance programs is in large part due to the lack of knowledge and understanding of the programs or benefits offered. For example, 79 percent of non-enrolled eligible people have ever heard of the Medicare Savings Programs and two thirds of enrollees need assistance in completing the lengthy application form. This simple change has been pilot tested with Medicare beneficiary groups and found to elicit a positive response and interest from Medicare beneficiaries.
Section 3 of the legislation would make permanent the QI-1 category by incorporating these individuals into the SLMB category at 100 percent Federal medical percentage, FMAP, matching rate. In addition to simplifying and making permanent the program, such a change would ensure funding for QI-1 cost-sharing.
Section 5 eliminates the limit on assets, which is set at $4,000 for an individual and $6,000 for a couple and disqualifies millions of Medicare beneficiaries with very low incomes from qualifying for assistance. Many potential beneficiaries do not apply for benefits because they incorrectly assume that they have too many assets to qualify or fear losing their estate. Some States have waived or disallowed the counting of some assets for the purposes of eligibility determination and have seen much higher enrollment rates. The requirements to document one's assets also makes the application process burdensome and deters potential enrollees who might pass the asset test.
Finally, section 8 eliminates some of the critical barriers to enrollment. As I noted earlier, rates of enrollment in the Medicare Savings Programs are well below those of other means-tested. benefit programs. This section provides for several important enrollment simplification procedures, such as allowing self-certification of income and continuous eligibility, and expanded outreach efforts. For instance, instead of requiring people to apply for benefits at the state Medicaid office, the Social Security Administration took applications and forwarded them to Medicaid offices for processing and increased enrollment by 10 percent. Perhaps with more outreach efforts provided within this bill, even more low-income Medicare beneficiaries will receive the health care for which they are eligible.
I urge the Congress to pass a temporary extension of the QI-1 program early next week, but then to immediately begin work to permanently authorize the QI-1 program and to simplify and streamline all the Medicare Savings Programs. Our Nation's low-income Medicare beneficiaries and the States deserve nothing less.
Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.
Mr. President, I rise today to introduce bipartisan legislation entitled ``Ending the Medicare Disability Waiting Period Act of 2007 with Senators Obama, Salazar, Brown, Kerry, Stabenow, Cantwell, and Clinton. 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 a 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, Mr. President, I would assert that there is no reason, be it fiscal or moral, to tell people that they must wait longer than two years after becoming severely disabled before we give 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 two 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 by Medicaid, 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 possible 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 corresponding 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.
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 individuals with amyothrophic 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.
Mr. President, I rise today with Senators Obama, Salazar, Collins, and Lieberman to introduce the Medicare Independent Living Act of 2007. This legislation would eliminate Medicare's ``in the home'' restriction for the coverage of mobility devices, including wheelchairs and scooters, for those with disabilities and expected long-term needs. This includes people with multiple sclerosis, paraplegia, osteoarthritis, and cerebrovascular disease that includes acute stroke and conditions like aneurysms.
As currently interpreted by the Centers for Medicare and Medicaid Services, CMS, the ``in the home'' restriction only permits beneficiaries to obtain wheelchairs that are necessary for use inside the home. As a result, seriously disabled beneficiaries who would primarily utilize a wheelchair outside the home are prevented from receiving this critical and basic equipment through Medicare. For example, this restriction prevents beneficiaries from receiving wheelchairs to access their work, the community-at-large, place of worship, school, physician's offices, or pharmacies.
On July 13, 2005, 34 senators wrote Secretary Leavitt asking the Department of Health and Human Services, or HHS, to modify the ``in the home'' requirement so as to ``improve community access for Medicare beneficiaries with mobility impairments.'' Unfortunately, CMS continues to impose the ``in the home'' restriction on Medicare beneficiaries in need of mobility devices.
As the Medicare Rights Center in a report entitled ``Forced Isolation: Medicare's `In The home' Coverage Standards for Wheelchairs'' in March 2004 notes, ``This effectively disqualifies you from leaving your home without the assistance of others.''
Furthermore, in a Kansas City Star article dated July 3, 2005, Mike Oxford with the National Council on Independent Living noted, ``You look at mobility assistance as a way to liberate yourself.'' He added that the restriction ``is just backward.''
In fact, policies such as these are not only backward but directly contradict numerous initiatives aimed at increasing community integration of people with disabilities, including the Americans with Disabilities Act, the Ticket-to-Work Program, the New Freedom Initiative, and the Olmstead Supreme Court decision.
According to the Medicare Rights Center update dated March 23, 2006, ``This results in arbitrary denials. People with apartments too small for a power wheelchair are denied a device that could also get them down the street. Those in more spacious quarters get coverage, allowing them to scoot from room to room and to the grocery store. People who summon all their willpower and strength to hobble around a small apartment get no help for tasks that are beyond them and their front door.''
In New Mexico, I have heard this complaint about the law repeatedly from our State's most vulnerable disabled and senior citizens. People argue the provision is being misinterpreted by the administration and results in Medicare beneficiaries being trapped in their home.
The ITEM Coalition adds in a letter to CMS on this issue in November 25, 2005, ``There continues to be no clinical basis for the `in the home' restriction and by asking treating practioners to document medical need only within the home setting, CMS is severely restricting patients from receiving the most appropriate devices to meet their mobility needs.''
My legislation would clarify that this restriction does not apply to mobility devices, including wheelchairs, for people with disabilities in the Medicare Program. The language change is fairly simple and simply clarifies that the ``in the home'' restriction for durable medical equipment does not apply in the case of mobility devices needed by Medicare beneficiaries with expected long-term needs for use ``in customary settings such as normal domestic, vocational, and community activities.''
This legislation is certainly not intended to discourage CMS from dedicating its resources to reducing waste, fraud, and abuse in the Medicare system, as those efforts are critical to ensuring that Medicare remains financially viable and strong in the future. However, it should be noted that neither Medicaid nor the Department of Veterans Affairs impose such ``in the home'' restrictions on mobility devices.
Mr. President, I ask unanimous consent that the text of the bill and a letter sent to Secretary Leavitt be printed in the Record.