Statement of Congressman John D. Dingell, Ranking Member
Committee on Energy and Commerce

SUBCOMMITTEE ON HEALTH
HEARING ON "KEEPING SENIORS HEALTHY: NEW PREVENTIVE
BENEFITS IN THE MEDICARE MODERNIZATION ACT"

September 21, 2004

The Medicare program has been providing quality care for seniors and individuals with disabilities for nearly four decades. Medicare’s original charter provides coverage for illness and disability, but not prevention. Yet medical care has evolved since the program’s inception, and much of our health care is based upon early detection and prevention of illness.

For over 20 years, Congress has added preventive benefits in a piecemeal fashion, often spurred on by efforts of interest groups and beneficiaries to expand coverage. The new benefits added last year are a small but positive step in the right direction. Before we pat ourselves on the back for the new benefits, however, we should recognize that adding appropriate benefits is only part of what needs to be done. If the Medicare coverage, or the benefits offered, cost too much for the beneficiaries, we won’t be helping anyone. For example, unlike many other preventive benefits, the new benefit of an initial "Welcome to Medicare" physical is subject both to the $110 deductible -- that was recently increased in the Medicare bill -- and co-insurance. And, coupled with the record premium increase, also as a result of the Medicare bill, the cost of these benefits could be a problem.

It is a challenge for Congress and the Centers for Medicare and Medicaid Services (CMS) to ensure beneficiaries are receiving these prevention services. We have a good deal of work to do in this area.

The use of Medicare’s existing preventive benefits varies depending on a number of factors. Racial, ethnic, geographic, and income disparities affect the ability to obtain critical services such as mammograms, colon and prostate cancer screening, and flu and pneumonia vaccinations. This should not and need not be the case. Medicare’s Quality Improvement Organizations (QIOs) are doing excellent work with providers to improve rates of immunizations, stroke treatment and prevention, cancer screening, and other preventive services. Activities like these should be encouraged and fully supported, but these alone are not enough. We must also look at system changes to assure incentives for providers are designed to focus on prevention and reward improved outcomes and health.

We need fresh approaches for Medicare and its beneficiaries. I have cosponsored legislation with Ranking Member Brown that would amend Medicare’s charter to add services to prevent and detect illness and disability. The bill would grant the HHS Secretary discretion to add such services based on recommendations of the

U.S. Preventive Services Task Force. This change would be a genuine improvement to the program that so many seniors and individuals with disabilities depend upon for their healthcare, and for the taxpayers who would realize savings as a result of better health outcomes.

I thank the Chairman for holding this hearing, and I hope that this Subcommittee will be holding more hearings on implementation of the entire Medicare bill. Topics such as that legislation’s true cost, the undermining of employer-sponsored retiree coverage, restrictive drug formularies, gaps in coverage, and low income assistance are all worthy of this Subcommittee’s detailed attention. I also hope and expect that this Subcommittee will proceed in an open and fair manner, that the Subcommittee Chairman will not deny Members’ rights, under longstanding bipartisan interpretations of Committee rules, to make opening statements, and that Members’ rights to participate fully will be respected.

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(Contact: Jodi Seth, 202-225-3641)