Medicare

More than forty years ago, our nation created the Medicare system and entered into an agreement with every single American- if you work hard and pay into the system, you are entitled to Medicare benefits when you turn 65 or become disabled. Today, more than 47 million people receive Medicare benefits- nearly 50% of who earn less than $23,000 each year. Congresswoman Speier considers this system to be absolutely sacred and is committed to doing all she can to ensure that it is here for decades to come. That said, Medicare is certainly on the firing line these days.

The Republicans, under the leadership of Paul Ryan, introduced a Medicare plan which would replace traditional Medicare with a voucher system beginning in 2022. The voucher would grow more slowly than health care costs leaving seniors at the mercy of insurance companies and facing higher out of pocket costs. In fact, the non-partisan Congressional Budget Office estimates that by 2030, seniors would be paying nearly 70% of their health care costs with the voucher only picking up 30% of the tab. A 54 year old today will need to have an additional $182,000 in their IRA or 401(k) just to cover these additional expenses. This is not want seniors have worked for and deserve, nor what Congress envisioned when it created the program decades ago. That is why Speier proudly cast her against the plan when it reached the House floor in April 2011. She was pleased that the Senate subsequently rejected the measure when it reached its chamber in May 2011.

That said, Speier believes we must do more to protect the Medicare system. As the baby boomers age, there are fewer contributing workers for each eligible Medicare recipient. Currently, there are nearly 4 workers paying Medicare taxes for every American receiving services but only 2.4 workers will be contributing by 2030. Furthermore, while health reform extended the solvency of the Medicare trust fund by seven years, it will still face funding challenges by 2024.

This is why Speier is committed to implementing common sense reforms that will ensure adequate access to care, increased efficiency and a Medicare system that is available for decades to come. She believes we must do more to eliminate Medicare fraud which costs our nation nearly $60 billion each year, reduce medical errors and infections which not only cost our system $45 billion annually but lead to 100,000 deaths each year, and build on the measures included within health reform which ensure that doctors operate more efficiently while continuing to make quality patient care their number one priority.

One reform Speier is championing is the end to self-referrals. She has introduced Integrity in Medicare Advanced Diagnostic Imaging Act of 2011, legislation that will cut wasteful Medicare spending and protect patients from dangerous and unnecessary exposure to radiation. Current law bars physicians from referring Medicare patients for certain health care services in which they have a financial interest, but the in-office ancillary services exception allows physicians to be reimbursed for CT, MRI and PET scans that they purchase and use within their own offices. Today, physicians purchase these machines because with a fee for service payment system, they know that they are big profit drivers. The exception was originally created so that physicians could continue to render non-complex services, like X-Rays, within their offices at the same time as the patient’s visit, and was never intended to include complex and costly advanced imaging services. Instead, this exception has created perverse incentives and led to overutilization:

• Doctor-owned imaging machines have been used four times more than those used by radiologists since 2000.

• Self-referring non-radiologist physicians perform up to eight times as many imaging studies as physicians who refer their patients to radiologists.

• Between 1998 and 2005, the number of physicians referring patients for radiological testing within their own practices grew at triple the rate of the same exams in other settings.

• Only 10% of advanced imaging services are performed on the same day as an office visit.

• Imaging has ballooned into a $100 billion industry- $14 billion of which is absorbed by Medicare. Medicare data shows that 2/3 of these machines are within physician offices.

These scans are not making our country healthier. According to a recent study, between 20 to 50 percent of medical imaging is unnecessary because the results do not help diagnose ailments. According to MedPAC, between 1980 and 2006, per-capita radiation dosage for clinical imaging exams increased almost 600% in the United States. Although CT scan machines make up only 12% of all medical radiation procedures, they deliver almost half of the estimated collective dose of radiation exposure in our country and are relatively unregulated.

The Integrity in Medicare Advanced Diagnostic Imaging Act will eliminate certain advanced diagnostic imaging services, including diagnostic MRI, CT, PET and other diagnostic imaging services from the in-office exception. The Act does not include imaging services performed for the purposes of radiation therapy treatment planning or in conjunction with interventional radiological procedures.

Healthcare Reform

In March 2009, Speier proudly cast her vote in favor of the Patient Protection and Affordable Care Act, a historic measure that was nearly 60 years in the making. Ensuring that Americans have access to affordable, quality health care is one of the main reason Speier’s constituents sent her to Washington. Many of the provisions in the Act took effect shortly after passage in 2010. Once the entire measure is completely implemented by 2014, 94% of Americans will have access to coverage. Since the law's passage, in Speier’s district alone:

• 97,000 Medicare beneficiaries have experienced improved benefits including free preventive and wellness care and improved primary and coordinated care

• Of these, 11,300 patients who fall into the Part D prescription drug donut hole each year are already experiencing much needed relief. In 2010, these beneficiaries all received a $250 rebate and are purchasing their brand name drugs at a 50% discount this year. Further, the bill will close the donut hole within a decade.

• 44,000 young adults can now remain on their parents’ policies until they turn 26

• The 472,000 residents who receive coverage from their employer or through policies purchased on the individual market cannot lose their coverage should they become sick with a costly disease or condition or be limited by lifetime benefit limits. Further, their insurance companies are now limited in how much of the premiums dollars received can be spent on administrative expenses, profits and other overhead.

The benefits of this bill are only just being realized. Not only did it improve the Medicare system and extend the trust fund solvency by over seven years, it reduces the deficit by over $1.3 trillion in the next two decades. Given the numerous positive changes Americans are already experiencing as a result of the bill, Speier has forcefully opposed efforts to dismantle the law entirely. She cast her vote in opposition to the repeal measure that was brought to the House floor in January 2011 and will continue to should the challenges continue.

Childhood Cancer

Each year, 13,500 children in the United States are diagnosed with cancer. Over the past 40 years we have made progress in combating the disease. In the 1960s, a child born with the most common form of childhood cancer -- acute lymphoblastic leukemia -- had less than a 10 percent chance of surviving. Today, 90 percent of those diagnosed will be cured. But this is not enough. Speier believes we can’t rest until there is an effective cure for every child diagnosed with cancer and every survivor must have access to the care they need. She has introduced the Pediatric, Adolescent and Young Adult Cancer Survivorship Research and Quality of Life Act of 2011 because every child who bravely struggles with and conquers cancer must have the resources they need for their long term medical needs. Improvements and advances in the treatment of childhood cancer mean that more than 300,000 children are now living as cancer survivors. In fact, the 5-year cancer survivor rate for children has improved from just 56% in 1974 to almost 80% today. For many of these children, however, the fight does not end with remission. According to the Institute of Medicine (IOM), more than two-thirds of childhood cancer survivors experience 'late effects' of the disease or its treatment as they grow older. The most common late effects include long-term complications, disabilities, or other adverse outcomes, and up to one-fourth are serious or life-threatening.

For many cancer survivors and their families, geographic distance from cancer centers is a barrier to receiving appropriate specialized care. Her bill adopts many of the IOM recommendations for improving follow-up care for cancer survivors. It also expands cancer control programs, including surveillance and comprehensive control programs within the CDC that will support states’ efforts in this area. In addition, it establishes grants at the National Institutes of Health so that research can be conducted on disparities in survivorship and the development of systems to monitor and care for cancer survivors. Of particular importance, it creates grants to establish and operate childhood cancer clinics so that comprehensive long-term follow up services are available for a larger number of childhood cancer survivors.

While we are making progress towards the elimination and more effective treatment of children's cancer, we must also dedicate greater effort towards effectively addressing the long-term effects of these conditions. This bill would help ensure that those who have bravely struggled and conquered cancer as children have access to the resources and infrastructure they need as the longer term consequences of their illness surface, sometimes years down the road.