Portland, ME – Senator Susan Collins, who is Chairman of the Senate Special Committee on Aging, gave the keynote address at the 10th Annual Geriatrics Day Conference today at the Maine Medical Center in Portland. Senator Collins’ address updated the Conference on her leadership of the Aging Committee and her work to address the increasing challenges facing older Americans throughout Maine and across our country.
At the request of Senator Collins, Dr. Heidi Wierman, Division Director of Geriatrics at the Maine Medical Center recently testified at a Senate Aging Committee hearing to discuss Alzheimer’s disease and its toll on our nation.
The full text of Senator Collins’ remarks, as prepared for delivery, can be read HERE and below:
Geriatrics Day Conference
Remarks of Senator Susan Collins
April 8, 2015
Thank you, Dr. Wierman, for that very kind introduction. I also want to thank you again for appearing as a witness before the Senate Special Committee on Aging during the recent hearing I called to examine our nation’s fight against Alzheimer’s disease. Your service as a geriatric physician is so crucial to our state, and your insight into caring for patients with Alzheimer’s disease and other forms of dementia, are truly invaluable.
Each one of you is keenly aware that the number of Americans over the age of 65 is projected to double from 40.2 million in 2010 to more than 88.5 million in 2050. And the number of people over age 85 will nearly quadruple in that same period, increasing from 5.8 million to 19 million. With Maine being the oldest state in the nation by median age, your professions could not be more critical to our aging nation.
The fact that this is often a sold-out conference with a waiting list for those who wish to attend, illustrates the importance of the issues you are addressing today.
Maine’s population of older individuals, the rapidly changing demographics of our nation, and the challenges that result from these changes are among the reasons why I pursued a leadership position on the Senate Special Committee on Aging, a Committee on which I have served since 1997. Throughout its history, this committee has spurred Congress to action on issues important to older Americans through its hearings, investigations, and reports.
I appreciate this opportunity to update you on my work on the Aging Committee.
Some of you may know Barbara Smith, also known as “B.”, as a former supermodel who has graced the cover of fashion magazines. She was a restauranteur, author, and radio and television host. In her own words, she now has the “most important job of all,” which is to make a difference in the fight against Alzheimer’s disease. Through very moving and emotional testimony, Ms. Smith recently described her struggles with early onset Alzheimer’s at a hearing before the Senate Aging Committee.
Right by her side, literally and figuratively, is her husband Dan Gasby, who says this cruel disease has taken away a person who was at the peak of her abilities.
During this hearing, we asked this question: “Is our nation on track to finding a treatment for Alzheimer’s disease by 2025?” This is the goal called for in the National Plan to Address Alzheimer’s Disease, as well as by many experts.
As I presided over the hearing, I looked onto a standing-room-only hearing room that was filled with hundreds of Alzheimer’s advocates from throughout the nation, including many from Maine, who wore the color purple to symbolize their support for finding a cure. This “sea of purple” served as another stark reminder that five million Americans suffer from a disease for which there is no cure, no effective treatments, and no means of prevention.
In addition to the human suffering it causes, Alzheimer’s costs the United States more than $226 billion a year, including $153 billion in costs to Medicare and Medicaid.
These costs will skyrocket as the baby boom generation ages. Already our nation’s most expensive disease, Alzheimer’s is projected to cost more than $1.1 trillion in 2050 if nothing is done to change its current trajectory.
It is now estimated that nearly one in two baby boomers reaching 85 will develop Alzheimer’s. As a consequence, chances are that members of the baby boom generation will either be spending their golden years with Alzheimer’s or caring for someone who has it.
It is imperative that we dramatically increase our investment in Alzheimer’s research.
Take a look at this chart on the screen behind me. At a time when the United States is spending $226 billion a year to care for Alzheimer’s patients, we are spending less than three tenths of one percent of that amount less than $600 million a year on research. You can barely see the expenditure on the chart.
Alzheimer’s receives funding that is clearly disproportionately low compared to its human and economic toll.
We currently spend $5.4 billion a year for cancer research, $3 billion a year for research on HIV/AIDS, and $2 billion for cardiovascular research, all investments that have paid dividends.
These investments in research for other diseases have yielded tremendous results: patients have access to new treatments, and death rates for some diseases are decreasing. Yet, at the same time, mortality due to Alzheimer’s is escalating dramatically.
Surely we can do more for Alzheimer’s given its tremendous human and economic price.
Fortunately, there is promising research that holds hope for Alzheimer’s patients and their families. The research community is poised to make important advances through clinical trials and investigating new therapeutic targets.
I recently had the opportunity to visit the Memory Disorders Unit at Massachusetts General Hospital to learn about exciting research being conducted at this facility. Advancements in imaging, for example, hold great promise for more effective and early diagnosis.
During our recent hearing, we also heard from Dr. Ron Petersen, Director of the Mayo Clinic’s Alzheimer’s Disease Research Center. He described encouraging advancements in the effort to better identify so-called “biomarkers” that indicate development of the disease. Identifying the disease as early as possible could help prevent further damage from being done to a patient’s brain.
These research developments hold great promise, but require significantly more funding.
The National Plan to Address Alzheimer’s is a result of legislation I authored with former Senator Evan Bayh.
The plan calls for prevention and an effective treatment of Alzheimer’s disease by 2025. To meet that goal, the Chairman of the federal Alzheimer’s Advisory Council says we need to devote $2 billion a year to Alzheimer’s research. Increasing our nation’s investment in Alzheimer’s research to just one percent of what we are currently spending on Alzheimer’s would lead to better treatments and ultimately a means of prevention or a cure for this awful and expensive disease.
Among my highest priorities as Chairman of the Senate Aging Committee is to ensure that the goals set forth in the National Plan to Address Alzheimer’s disease are achieved.
That is why I recently authored a bipartisan amendment to the Senate Budget Resolution that calls for an increase in our federal investment in Alzheimer’s research. I have also been joined by my colleague, Senator Amy Klobuchar, in introducing a resolution declaring that that the goal of preventing and effectively treating Alzheimer’s by 2025 is an “urgent national priority.” Our resolution calls on the Senate to double the amount of funding the United States spends on Alzheimer’s in fiscal year 2016 and develop a plan to meet the target of $2 billion.
According to Alzheimer’s Association, if the federal government were to invest this amount, it would recoup its investment within the first three years a treatment or means of prevention becomes available.
The color purple currently represents support for Alzheimer’s research, the patients and their families. I hope that someday the color purple will be worn by Alzheimer’s survivors.
Another disease that I know takes a tremendous toll on far too many of your older patients is diabetes.
As the co-chair of the Senate Diabetes Caucus, I have learned a great deal about this terrible disease that affects 29 million Americans. It also has a cost to our nation of $174 billion as well as one out of three Medicare dollars.
Fortunately, we have seen some encouraging breakthroughs and are on the threshold of a number of important new discoveries.
This is particularly true for the estimated 1.2 million Americans living with type 1 diabetes. Advances in technology, like continuous glucose monitors, are helping patients control their blood glucose levels, which is key to preventing costly and sometimes deadly diabetes complications. We are also moving closer and closer to our goal of an artificial pancreas, which would control blood glucose levels automatically and revolutionize diabetes care.
The NIH and FDA have been extremely supportive of these innovations in diabetes care. I was therefore surprised and troubled to learn that insulin-dependent Medicare beneficiaries are being denied coverage for continuous glucose monitors, or CGMs, because CMS has determined that they do not meet the Medicare definition of durable medical equipment and do not fall under any other Medicare category.
As a consequence, we are seeing situations similar to what we saw with insulin pumps in the late 1990s B where individuals with type 1 diabetes have had coverage for their continuous glucose monitor on their private insurance, only to lose it when they age into Medicare.
CGM are an effective, and in some cases, life-saving way to help manage Type I diabetes. It is no wonder that about 95 percent of commercial insurers provide coverage for CGM devices.
The ironic thing is that it is only because of advances in diabetes care like the continuous glucose monitor that people with type 1 diabetes can expect to live long enough to become Medicare beneficiaries.
I recently joined my colleague from New Hampshire, Senator Jeanne Shaheen, in introducing the Medicare CGM Access Act of 2014 to create a separate benefit category under Medicare for the continuous glucose monitor and to require coverage of the device for individuals meeting certain medical criteria.
It simply makes no sense that Medicare does not provide coverage for CGMs, and I am working to change this policy.
Finally, I want to touch on issues affecting home care and hospice.
I need not tell any of you that the challenges facing our nation’s health care system are driven by demographics. Our health care system now stands directly in the path of a tidal wave of aging baby boomers who will be retiring at the rate of 10,000 a day for the next 20 years. That system will clearly have to adapt and change if it is to survive the impact.
One of the most important things we can do is to shift our orientation from institutional to community and home-based care. Advances in technology and medical practice have made it possible for older adults who previously would have been forced to move to a hospital or nursing home to stay just where they want to be, in the comfort, privacy and security of their own homes.
Yet, Medicare beneficiaries continue to face unnecessary barriers in getting home health services. To ensure that our Medicare patients get the home care they need, when they need it, I have introduced the Home Health Care Planning Improvement Act to allow advance practice nurses and physician assistants to order home health care for their Medicare patients.
These health care professionals are playing increasingly important roles in the delivery of health care services, particularly in rural and medically underserved areas of our country where physicians are in short supply. Medicare already pays them to provide physician services that are within their scope of practice. They can also certify that a Medicare patient is eligible for skilled nursing services. Nurses and health care practitioners should be able order less costly home health services for their patients.
I have also introduced legislation to extend the modest increase in payments for home health services in rural areas that otherwise will expire on January 1 of next year. The delivery of home health services in rural areas can be as much as 12 to 15 percent more costly because of the extra travel time required to cover long distances between patients, higher transportation expenses, and other factors.
If this rural payment is not extended, agencies may be forced to make decisions not to accept rural patients with greater care needs.
I recently had the opportunity to participate in a National Action Conference on End-of-Life Care, hosted by the Institute of Medicine. This can be a difficult topic for many families to address. Too many Americans fail to plan for their inevitable demise, and, as a result, their care may not be what they would have chosen.
Working with former Senator Jay Rockefeller, I authored the law to include a discussion regarding advance care planning during the initial “Welcome to Medicare” physician visit to which all Medicare beneficiaries are entitled.
We must do more, however, to encourage families to have these important discussions, difficult as they may be.
The changing demographics of our nation will affect every facet of our society. But at the heart of it all is the work that all of you do day in and day out.
Thank you again for inviting me to speak today.
I would be happy to now answer some of your questions.