Tuesday, June 26, 2018


For more than five decades, Medicare has been the bedrock of health security for tens of millions of Americans. Before the program’s creation in 1965, only half of seniors were enrolled in health coverage; today, the uninsured rate among older Americans is 2 percent. Elder poverty has declined by more than two-thirds over that period, and Medicare has been crucial to this historic progress.

As we look to the future of Medicare, many seniors are rightly worried about the direction that the Trump administration and congressional Republicans want to take the program. Just last week, House Republicans unveiled yet another budget resolution that would end Medicare as we know it by instituting a radical voucher scheme, limiting eligibility and cutting more than $500 billion from the program. This comes on the heels of a recent report by the Medicare Trustees finding that the Republican tax law and attacks on the Affordable Care Act (ACA) have weakened Medicare’s Hospital Insurance Trust Fund.

The ACA showed us that Medicare can be strengthened without cutting benefits — through commonsense efforts to increase revenues and reduce overpayments, while expanding innovative payment models and improving access to preventive benefits. In fact, thanks to the changes made by the ACA, the solvency of the Hospital Insurance Trust Fund was extended by more than a decade, while seniors’ benefits were strengthened, not cut.

A continued step in strengthening evidence-backed practices that improve the overall health of seniors would be to include dental, vision and hearing care into Medicare’s benefit package.

In 2011, the Institute of Medicine released a landmark report that documented the devastating consequences of inadequate access to dental care on overall health. Finding numerous links between poor oral health and systemic conditions, such as diabetes, cardiovascular disease and malnutrition, the report noted that “there is mounting evidence that oral health complications not only reflect general health conditions but also exacerbate and even initiate them.”

Unfortunately, the state of oral health care among the elderly reflects a widespread unmet need. Approximately 70 percent of older Americans suffer from periodontal disease, nearly 20 percent live with untreated tooth decay and one in four are edentulous — meaning they have no teeth at all.

Similarly, lack of access to eye care has placed tremendous burdens on older Americans. Vision impairment is the third leading chronic condition among the elderly in the United States. Untreated vision loss is closely associated with social isolation, depression and cognitive impairments, such as dementia. Moreover, vision loss is a major contributor to falls — a leading cause of costly hospitalizations and preventable death among the elderly.

Yet the majority of older adults lack vision coverage to offset the costs of eye exams, eyeglass frames and lenses, and low-vision magnifying devices to assist with severe vision impairments.

Likewise, numerous studies of the hearing health of older Americans reveal a number of troubling facts. Seniors are disproportionately affected by hearing loss, including nearly two-thirds of individuals over age 70. A 2016 report published by the National Academies of Sciences documented the extensive links between untreated hearing loss and other serious health problems, including poorer mental health, cognitive impairments, balance problems and increased risk of falls among the elderly.

Unfortunately, of the millions of older Americans who could benefit from hearing aids only 30 percent have ever used one.

As Republicans and the Trump administration continue to call for ideological policies to slash benefits and shift more costs onto patients, they increasingly find themselves on the wrong side of the evidence that tells us that dental, vision and hearing care are closely linked to overall health. Rather than ideological proposals to end Medicare as we know it, we should work to strengthen program benefits to meet these needs.

To that end, I and a number of my Democratic colleagues at the Committee on Ways and Means have introduced legislation that would provide comprehensive dental, vision and hearing coverage to all beneficiaries as part of the basic Part B benefit package.

This is a long-overdue reform backed by evidence, not ideology. It will expand access to necessary care, improve overall health and make Medicare a stronger program for generations to come.

Rep. Sander M. Levin, Michigan Democrat, is Ranking Member on the House Ways and Means Subcommittee on Health.

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