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Interview by Marat Moore
Known as a "workhorse, not a showhorse" in Congress, Sen. Chuck Grassley (R-IA) chairs the powerful Senate Finance Committee, one of the most influential health care policy positions on Capitol Hill. The Finance Committee plays a vital role in establishing health care policy and controls the purse strings for the Medicare and Medicaid programs. Grassley has championed the interests of older Americans. He supported ASHA members in strongly opposing the arbitrary Medicare caps on Part B outpatient services and has spearheaded efforts to improve the quality of care in skilled nursing facilities. On a personal note, Grassley is the only working family farmer in Congress. Although his work has profound national impact, he has stayed close to his Iowa roots, commuting home nearly every weekend to meet with constituents and spend time with his family, which now includes nine grandchildren.
What do you consider the most pressing health care issues affecting older Americans?
I believe the increasing cost of health care is the most pressing health care issue affecting older Americans. In 2003, health care costs grew at a rate of 14.7% and are projected to grow 12.6% in 2004. The Medicare program alone had total disbursements of $265.7 billion in 2002, according to the Centers for Medicare & Medicaid Services (CMS) Office of the Actuary. Not only are health care costs rising, but also a growing number of older Americans will be using Medicare in the future. As health care costs continue to escalate, it is important that we strengthen the Medicare program to sustain these benefits into the future.
You have been a true friend to ASHA members and Medicare beneficiaries by opposing the $1,500 Medicare caps on outpatient Part B services, which is currently on hold. What led you to champion this effort?
I believe older Americans should receive rehabilitative services based on their conditions, not on arbitrary payment limits. While many older Americans will not need services that would cause them to exceed the combined $1,500 cap on outpatient Part B speech-language pathology and physical therapy services, others suffering from more serious complications-such as stroke victims-will likely need services beyond what the caps would cover. Therefore, those who most need rehabilitative care would be unnecessarily penalized by being forced to pay the entire cost for the additional services they receive outside a hospital. I want to assure older Americans that the Congress intends to preserve their access to important rehabilitative care.
What do you consider the key issues facing Medicare in the next decade?
Proper implementation of the new bipartisan Medicare Prescription Drug, Improvement and Modernization Act of 2003 will provide a significant challenge to the Congress and CMS. In addition to valuable prescription drug coverage provided in this law, new preventive benefits have been added, such as screenings for cholesterol and diabetes and an initial physical examination. Improvements of this magnitude have not been made since Medicare's inception in 1965, so it will be a monumental task for both the Congress and CMS to successfully implement each provision of this new law.
Are Medicare and Medicaid going to be able to meet the challenges of the coming baby boom? If not, what in your view does the government need to be doing now to prepare?
I'll comment first on the Medicaid program. I understand that nursing homes and other long-term care facilities are increasing as a percentage of Medicaid costs. At the same time, baby boomers need the security of this safety net, and I'll continue to work to ensure the long-term viability of Medicaid for this reason.
As for Medicare, as we continue to implement the new benefits included in the new Medicare law-which will be available to the Baby Boom generation-this process will require careful oversight to ensure every generation continues to maintain the health benefits current beneficiaries enjoy today.
Do you have any suggestions for ways in which ordinary Americans should approach their health care planning?
As far as planning for the future in terms of maintaining access to needed health benefits, the new Medicare law includes a provision to greatly expand the former Medical Savings Accounts into new and innovative Health Savings Accounts (HSAs). This important provision helps individuals save for qualified medical and retiree health expenses on a tax-free basis. Expenses from these new HSAs are tax-free if they are used to pay for qualified medical expenses. These new accounts will allow millions of Americans to properly prepare for the ever-increasing health expenses that we will likely face later in life.
Finally, what is your view on the value of services for people with communication disorders?
The ability to communicate is one of our most fundamental needs. If you have a communication disorder, you need to know that speech-language pathology and audiology services are going to be there when you need them. If you serve those with a communication disorder, you need to know that Congress will support the valuable work that you do.
I like to call the Senate Finance Committee, the committee I chair, the "quality of life" committee because we oversee Medicare, Medicaid, Social Security, international trade, and taxes. Access to communication services ensures quality of life. I even have a certified speech-language pathologist, Jennifer Bell, on my committee staff handling health care policy issues.
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