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67–864 PDF 2011

S. HRG. 112–93 

PROTECTING THE PROMISE TO OUR SENIORS: 

PRESERVING SENIOR PROGRAMS 

FIELD HEARING 

BEFORE THE

SPECIAL COMMITTEE ON AGING 

UNITED STATES SENATE 

ONE HUNDRED TWELFTH CONGRESS 

FIRST SESSION 

JOHNSTON, RI 

APRIL 27, 2011 

Serial No. 112–5 

Printed for the use of the Special Committee on Aging 

( 

Available via the World Wide Web: http://www.fdsys.gov 

(II) 

SPECIAL COMMITTEE ON AGING 

HERB KOHL, Wisconsin, Chairman 

RON WYDEN, Oregon 

BILL NELSON, Florida 

BOB CASEY, Pennsylvania 

CLAIRE MCCASKILL, Missouri 

SHELDON WHITEHOUSE, Rhode Island 

MARK UDAL, Colorado 

MICHAEL BENNET, Colorado 

KRISTEN GILLIBRAND, New York 

JOE MANCHIN III, West Virginia 

RICHARD BLUMENTHAL, Connecticut 

BOB CORKER, Tennessee 

SUSAN COLLINS, Maine 

ORRIN HATCH, Utah 

MARK KIRK III, Illnois 

JERRY MORAN, Kansas 

RONALD H. JOHNSON, Wisconsin 

KELLY AYOTTE, New Hampshire 

RICHARD SHELBY, Alabama 

LINDSEY GRAHAM, South Carolina 

SAXBY CHAMBLISS, Georgia 

DEBRA WHITMAN, Majority Staff Director 

MICHAEL BASSETT, Ranking Member Staff Director 

(III) 

CONTENTS 

Page 

Opening Statement of Senator Sheldon Whitehouse ............................................ 1 

PANEL OF WITNESSES 

Statement of Edwin Walker, Deputy Assistant Secretary for Program Operations, Administration on Aging, U.S. Department of Health and Human 

Services, Washington, DC ................................................................................... 4 

Statement of Elizabeth Roberts, Lieutenant Governor, Providence, RI .............. 6 

Statement of Christopher F. Koller, Rhode Island Health Insurance Commissioner, Cranston, RI ............................................................................................. 9 

Statement of Kathleen Connell, Senior State Director, AARP–RI, Providence, 

RI ........................................................................................................................... 19 

Statement of Audrey Brett, private citizen, Middleton, RI .................................. 24 

APPENDIX 

Senator Sheldon Whitehouse (D–RI) prepared statement ................................... 30 

WITNESS STATEMENTS FOR THE RECORD: 

Edwin Walker, Deputy Assistant Secretary for Program Operations, Administration on Aging, U.S. Department of Health and Human Services, Washington, DC ............................................................................................................. 34 

Elizabeth Roberts, Lieutenant Governor, Providence, RI .................................... 42 

Christopher F. Koller, Rhode Island Health Insurance Commissioner, Cranston, RI .................................................................................................................. 46 

Kathleen Connell, Senior State Director, AARP–RI, Providence, RI .................. 50 

Audrey Brett, private citizen, Middleton, RI ......................................................... 57 

(1) 

PROTECTING THE PROMISE TO OUR 

SENIORS: PRESERVING SENIOR PROGRAMS 

WEDNESDAY, APRIL 27, 2011 

U.S. SENATE, SPECIAL COMMITTEE ON AGING, Johnston, RI. 

The Committee met, pursuant to notice, at 10:00 a.m., at Johnston Senior Center, 1291 Hartford Avenue, Johnston, Rhode Island, 

Hon. Sheldon Whitehouse, presiding. 

Present: Senator Whitehouse [presiding]. 

OPENING STATEMENT OF SENATOR SHELDON WHITEHOUSE 

Senator WHITEHOUSE. Alright. The hearing will come to order. 

Before we begin, let me thank everyone who is in attendance 

here today. I want to extend my particular gratitude to the staff 

of the Johnston Senior Center, to Tony Zompa and his team for 

hosting us here today. 

And I want to recognize the Mayor of Johnston, who is here 

today, Mayor Polisena, who has been a friend for many years and 

takes second place to no one in his support and advocacy for Rhode 

Island’s senior community. So I am very impressed that he is here. 

And I would also like to thank Deputy Assistant Secretary Edwin 

Walker for rearranging his busy schedule and flying up to Rhode 

Island to be with us here today, as well as Anne Montgomery, who 

is staff to the Senate Aging Committee from Washington, D.C. We 

appreciate very much their efforts, and we look forward to Assistant Secretary Walker’s testimony, as well as that of all of the witnesses who are going to be testifying today. 

It may seem hard to imagine now, but there was a time within 

the last century when more than half of our Nation’s seniors were 

living below the poverty level. It is really an astounding statistic, 

and it should be a sobering reminder of the challenges that seniors 

faced in our country’s not-so-distant past. 

We should be very proud of how far we have come, and we 

should defend that progress. The poverty rate among seniors today 

is lower than any other age group. This is due in no small part to 

the promises we have kept to make the well-being of our seniors 

a national priority. 

I think I have got too much microphone. I feel where I am getting feedback. Thank you. 

That promise began in earnest with the passage of the Social Security Act in 1935, the most successful domestic Government program in our Nation’s history and a critical safety net for seniors 

through good times and bad. Over 200,000 Rhode Islanders rely on 

2 

Social Security to help them make ends meet, and I am committed 

to ensuring that they can count on these benefits. 

The enactment of Medicare in 1965 built upon the promise begun 

by Social Security. At the time, President Johnson said—and I 

quote—‘‘No longer will older Americans be denied the healing miracle of modern medicine. No longer will illness crush and destroy 

the savings that they have so carefully put away over a lifetime so 

that they might enjoy dignity in their later years. No longer will 

young families see their own incomes and their own hopes eaten 

away simply because they are carrying out their deep moral obligations to their parents.’’ 

That is a promise that Medicare has kept and one that we have 

fought to protect and strengthen. Most recently, under the new 

healthcare law, seniors can receive lifesaving preventive care services—like screenings for colon cancer, diabetes, and breast cancer— 

with no copayment. 

In addition, the Affordable Care Act fulfills a promise that I 

made during my campaign in 2006 by moving to close the dreaded 

Medicare prescription drug donut hole completely by 2020, finally 

bringing full prescription drug coverage to Medicare recipients. 

This year, seniors who fall into the coverage gap will receive a 50 

percent discount on brand-name drugs. 

Since the beginning of the year, this new discount has saved nearly 48,800 Medicare beneficiaries $38 million, an average of 

$800 per person. For the thousands of Rhode Islanders who hit the 

donut hole each year, these improvements allow a little more peace 

of mind. 

In July 1965, the same month that Medicare was created, Congress also passed the Older Americans Act. Less well-known than 

Medicare, the OAA has nonetheless supported a wealth of services 

that improve quality of life for seniors—health and wellness programs, transportation services, or Meals on Wheels and other nutrition programs like the ones provided right here at the Johnston 

Senior Center. 

In Rhode Island, the Department of Elderly Affairs, directed by 

Catherine Taylor, has done a great job leveraging Federal funding 

to provide services that so many of our State’s seniors have come 

to rely on. I want to acknowledge Catherine, who is here with us 

today, and thank her and her staff for their important work for our 

Rhode Island community. 

For all of the gains that Social Security, Medicare, and the Older 

Americans Act have made in protecting seniors, each of these critical programs is at a crossroads. The Older Americans Act is set 

to expire later this year. From my position on the Senate Aging 

Committee and on the Health, Education, Labor, and Pensions 

Committee, I pledge to work hard to make sure that the OAA is 

reauthorized and the services it supports for seniors will continue. 

As everyone here knows, Social Security has been a frequent target of attack. In recent weeks, there has been talk about the need 

to change Social Security, even to cut benefits, in order to reduce 

our debt. Let me be very clear. Social Security has paid out every 

dime owed to all eligible Americans without contributing a thing to 

the Federal deficit or debt. It is fully solvent today and is projected 

to remain so for another quarter century. 

3 

If changes are desired to strengthen Social Security, those 

changes should be considered independently from work to reduce 

the deficit. As a founding member of the Defending Social Security 

Caucus, I intend to work to maintain Social Security as America’s 

cornerstone of retirement security. 

Medicare is just as critical. The House of Representatives recently passed a Republican budget which proposes privatizing 

Medicare and requiring seniors to pay the majority of their health 

expenses with their own money. 

In fact, estimates suggest that this proposal would end up forcing a typical 65-year-old senior to pay on average $12,500 each year in 

out-of-pocket expenses, starting in 2022, just a decade from now. 

Here in Rhode Island, where the average senior only gets about 

$13,600 per year from Social Security, that would be a prescription 

for poverty creation. 

Under the Republican budget, seniors would lose the new benefits provided by the healthcare reform law, those preventive services I mentioned earlier. The Republican budget would also reopen 

the Medicare prescription drug donut hole, affecting nearly 17,000 

Rhode Islanders who, in 2012, would pay an additional $9.5 million 

for their prescriptions under the House plan. 

The attack on Medicare also overlooks the most basic fact of 

healthcare, which is that all healthcare costs are skyrocketing, irrespective of who the insurer is. There is a problem in healthcare, 

but attacking Medicare misdiagnoses the problem. 

As we get today’s hearing underway, I hope that my message is 

clear. We will protect our promises to our seniors. I look forward 

to the testimony today and to working with you to protect these important programs. 

With that, it is my pleasure to begin the introductions of the first 

panel of witnesses. Our first witness is Edwin Walker, the Deputy 

Assistant Secretary for Program Operations at the Department of 

Health and Human Services Administration on Aging. In this role, 

he promotes the development of home- and community-based longterm care programs, policies, and services designed to improve the 

quality of life for older people and improve effectiveness for caregivers. 

Edwin is recognized as an expert on the Older Americans Act 

legislation, and he serves as the primary liaison for the Administration on Aging on legislation related to aging services and programs. He has over 25 years of experience with aging services and 

programs, previously serving as director of the Missouri Division 

on Aging. 

After Edwin, we will hear from our Lieutenant Governor Elizabeth Roberts. Prior to taking office, Lieutenant Governor Roberts 

spent over a decade distinguishing herself as an advocate for quality affordable healthcare for every family and built a State-wide 

reputation as a tireless leader on health and medical issues. 

I should add that years ago, when I was the policy chief for Governor Sundlun, my two top staffers were Elizabeth Roberts, who is 

now our Lieutenant Governor, and Keith Stokes, who is now our 

director of economic development. So if you wonder why I did a 

good job in that position, you have to look no further than my staff. 

[Laughter.] 

4 

Lieutenant Governor Roberts is the chair of the Long-Term Care 

Coordinating Council, where she is pushing to expand communitybased care for seniors and for people with disabilities. In addition, 

she has shown great leadership in forming and heading the 

Healthy Rhode Island Implementation Task Force and serving as 

chair of the Rhode Island Healthcare Reform Commission, where 

she leads the State’s health reform efforts. 

Lieutenant Governor Roberts served in the Rhode Island State 

Senate from 1997 to 2007, is a graduate of Brown University, and 

earned an MBA in healthcare management from Boston University. 

The first panel will conclude with testimony from Chris Koller, 

Rhode Island’s first health insurance commissioner. He took over 

this role in 2005. The Office of the Health Insurance Commissioner 

is responsible for health insurance consumer protection, the financial solvency of Rhode Island’s health insurers, and directing policies that improve the accessibility, affordability, and quality of 

Rhode Island’s healthcare system. 

The office is nationally recognized for its rate review process and 

its efforts at improving the primary care infrastructure in the State 

and the readability of health insurance contracts. Prior to taking 

this position, Mr. Koller was the CEO of Neighborhood Health Plan 

of Rhode Island, a nationally recognized community health centerbased Medicaid health plan. In this role, he was the founding chair 

of the Association of Community-Affiliated Plans. 

Mr. Koller has a bachelor’s degree from Dartmouth College and 

a master’s degree in management and religion from Yale University. 

So it is a wonderful panel, and I ask Assistant Secretary Walker 

to lead it off. Please, sir? 

[The prepared statement of Senator Sheldon Whitehouse appears 

in the Appendix on page 30.] 

STATEMENT OF EDWIN WALKER, DEPUTY ASSISTANT SECRETARY FOR PROGRAM OPERATIONS, ADMINISTRATION ON 

AGING, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Mr. WALKER. Thank you so very much, Senator Whitehouse. It 

is a pleasure to be here. 

Over the past year, the Administration on Aging has conducted 

the most open process for seeking input on the reauthorization of 

the Older Americans Act in its history. I am pleased to discuss the 

input we have received and to learn more about the perspectives 

from Rhode Island. 

At the outset, however, I would like to commend you for your 

leadership as a member of the Senate Special Committee on Aging 

and other key committees which have jurisdiction over important 

senior issues, including the Older Americans Act. We are grateful 

for the support you have provided, as well as your strong leadership in improving the quality of care for families, for protecting 

against consumer fraud, and supporting elder rights. 

I am very impressed by the level of commitment and dedication 

of Rhode Island’s Aging Services Network, and I had the pleasure 

of meeting your director of the Department of Elderly Affairs, 

5 

Catherine Taylor, this morning. And I am impressed by the interest and the enthusiasm of your older citizens and their families. 

Rhode Island is one of the highest per capita populations of seniors in the country and plays a large role as a leader in many aspects related to the health and well-being of seniors and the soonto-be seniors. By winning a number of competitive Federal grant 

awards, the Department of Elderly Affairs has taken full advantage of opportunities which seek to more efficiently support the 

needs of frail seniors and their families. We have much to learn 

from the insights and perspectives of your citizens, and I am quite 

honored to be here today. 

As you indicated, Senator, in 1965, President Johnson signed the 

Older Americans Act into law, followed by Medicare and Medicaid. 

These three programs, along with Social Security, have served as 

the foundation for economic, health, and social support for millions 

of seniors, individuals with disabilities, and their families. 

For more than 45 years, the Older Americans Act has quietly but 

effectively provided nutrition and community support to millions of 

people across the Nation and here in Rhode Island. It has also protected the rights of seniors and been a key to their independence. 

Annually, nearly 11 million, or 1 in 5, older Americans and their 

family caregivers are supported through the Older Americans Act 

network. These services complement medical and healthcare systems, help prevent hospital readmissions, provide transport to doctor’s appointments, and support some of life’s most basic functions. 

The assistance is especially critical for the nearly 3 million seniors 

who receive intensive in-home services, half a million of whom 

meet the disability criteria for nursing home admission, but who 

are able to remain in their own homes due to these community 

supports. 

What is more, the need for this support is growing very rapidly. 

Every day the equivalent of a small town, or more than 9,000 

babyboomers, turn 65. Also rapidly increasing is the number of 

seniors with severe disabilities who are at greatest risk of nursing 

home admission and Medicaid eligibility. 

The reauthorization of the Older Americans Act provides us with 

the opportunity to strengthen and to build upon a long record of 

success in serving our families and communities and to help meet 

that growing need. Over the past year, the Administration on 

Aging received input and reports from reauthorization listening 

sessions held throughout the country. This input represented the 

interests of thousands of consumers. 

During the process, we heard a number of themes, and I would 

like to mention two of them today. First, improve program outcomes and do this by embedding evidence-based interventions in 

disease prevention programs, by encouraging comprehensive person-centered approaches, by providing flexibility to respond to local 

nutrition needs, and by increasing efforts to fight fraud and abuse. 

Second, we heard remove the barriers and enhance access by extending caregiver supports to parents caring for their adult children with disabilities; by providing ombudsman services to all 

nursing facility residents, not just older residents; and by utilizing 

aging and disability resource centers as single access points for 

long-term care information and to public and private services. 

6 

Senator Whitehouse, three brief examples of areas that we would 

like to discuss with the Congress as you consider legislation include 

the following. Number one, ensuring that the best evidence-based 

interventions for helping older individuals manage chronic diseases 

are utilized. These have been effective in helping people adopt 

healthy behaviors, improve their health status, and reduce their 

use of hospital services and emergency room visits. 

Number two, improving the Senior Community Service Employment Program by integrating it with other seniors programs. The 

President’s 2012 budget proposes to move the program from the 

Department of Labor to the Administration on Aging. We would 

like to discuss adopting new models of community service, including having seniors assist other seniors so they can remain independent in their homes. 

And number three, combating fraud and abuse in Medicare and 

Medicaid by converting the Senior Medicare Patrol Program to an 

ongoing consumer-based fraud prevention and detection program 

and by continuing to use the skills of retired professionals as volunteers to conduct community outreach and education so that seniors 

and families are better able to recognize and report fraud and 

abuse. 

The Older Americans Act has historically enjoyed widespread bipartisan support. Based in part upon this extensive public input 

process, we think that reauthorization can strengthen the Older 

Americans Act and put it on a solid footing to meet the challenges 

of a growing population, as well as to carry out its important mission of helping elderly individuals maintain their health and independence in their own homes and communities. 

Thank you again, Senator, for your leadership in these important 

issues and for the invitation to be here today. I would be happy to 

take any questions. 

[The prepared statement of Edwin Walker appears in the Appendix on page 34.] 

Senator WHITEHOUSE. Thank you, Deputy Assistant Secretary 

Walker. 

I appreciate that you are here, and I look forward to working 

with you to reauthorize this important legislation. I think what we 

will do is defer questions until all of the witnesses have testified, 

and then we can do Q&A as a panel. 

So that takes us to our exceptional Lieutenant Governor Elizabeth Roberts. 

STATEMENT OF ELIZABETH ROBERTS, LIEUTENANT 

GOVERNOR, PROVIDENCE, RI 

Ms. ROBERTS. Thank you very much, Senator, and good morning. 

I am here today in two capacities, as chair of both the Rhode Island Healthcare Reform Commission and as chair of the Rhode Island Long-Term Care Coordinating Council. These are forums for 

Rhode Islanders to actively participate in health policy and have a 

real impact on issues that will profoundly affect seniors, those who 

are nearing retirement and, indeed, all of us. 

And I want to thank you for bringing this hearing here today. 

These issues are very much on the minds of the people in this room 

7 

and the minds of the people you and I talk to every day in our 

work. 

I want to thank the Mayor for this exceptional senior center and 

an exceptional community. I said to the Mayor every time I come 

to Johnston there are several hundred people here to greet me, and 

it really says something about this community. And I will commend 

to you that Rhode Island is one big community, and we look after 

our seniors and recognize and respect the needs of our seniors and 

will not leave them behind. 

I want to recognize Director Catherine Taylor, and I want to take 

a moment to recognize Tony Zompa, who is the director of this very 

good senior center, where it is our privilege to come so often. 

And particularly Senator Whitehouse, he commented that I had 

the privilege to work for him many years ago. He certainly had 

more dark hair. I had a little more dark hair. 

[Laughter.] 

But that I think we in Rhode Island are remarkably fortunate at 

this time in the debate going on in Washington to have someone 

with the depth of understanding of healthcare, of Medicare, of the 

needs of seniors, but also the depth of commitment, and we are 

going to be very well served during what will be a very tough budget fight. And I am glad he has brought this discussion here to 

Rhode Island to hear directly from the people of this community. 

As changes to vital programs like Medicare, Medicaid, and Social 

Security are being discussed at the national level, it is important 

that Rhode Islanders are here today to contribute to this dialogue. 

And I want to thank you again for this opportunity. 

Let me first talk about national health reform, the Affordable 

Care Act, because there has been so much misinformation about 

this law and its impact on Medicare and seniors. And I want to 

take a moment to set that record straight. 

First of all, health reform, national health reform does not cut 

benefits for seniors. In fact, it improves those benefits, and I want 

to reiterate something that Senator Whitehouse said a few minutes 

ago. The donut hole—and believe me, when I am campaigning, 

when I am working with seniors, I hear about the donut hole all 

the time. It will be gradually filled in over time so that we will 

never again have seniors who cannot afford their medications. 

There will now be free annual wellness visits. As somebody who 

is a—and you will hear more from our health insurance commissioner—but have a deep belief in the importance of maintaining 

our health and preventing illness and managing chronic illness, 

having those wellness visits and a strong relationship with a family 

physician is vital. 

And that they will no longer have to pay deductibles and copayments, things that keep people from getting important preventive 

care. These reforms are part of an effort to focus on keeping people 

healthy instead of waiting until they get sick. Now, none of us 

wants to get sick, but it is also more expensive for all of us if we 

do get ill. 

The health reform law also provides incentives for healthcare 

providers to work together to improve the quality of care and reduce costs. There is no doubt that we need to reduce healthcare 

costs so that the Government can afford its promises to seniors, as 

8 

well as invest in other priorities like education. But we now face 

a stark choice as to how to do that, and that choice will have a profound effect on seniors today, but also the seniors of tomorrow. 

And I looked across the breakfast table at my husband, who I 

will confess is a little older than I am, and I said, ‘‘Well, if the Republicans win, you are going to have a good Medicare program, but 

not me.’’ And I don’t think there is any resident of Rhode Island 

who wants to have one family member have the protection and 

good care that Medicare has provided and have another deprived 

of that. 

Instead, do we reform the way we pay for healthcare to encourage better care instead of more care, or do we radically restructure 

programs to simply make seniors pay more out of their pockets? 

And do we tie our hands by fragmenting insurance even further by 

privatizing Medicare, hampering reform, making effective cost containment very difficult, and also making consumer protection very 

difficult? 

As chair of the Rhode Island Healthcare Reform Commission, I 

can assure you we are working hard to reform the way we pay for 

and deliver healthcare in this State. We are looking hard at how 

to be cost effective and cost conscious, but while maintaining quality and access to care. We have been a national leader in improving 

the care of chronic disease by developing patient-centered medical 

homes here, primary care providers that know you and help coordinate your care. 

And as we move forward in implementing the health reform law, 

I want to continue to encourage all Rhode Islanders to participate 

in the dialogue about how do we improve care and do it in a costeffective way? Real change cannot happen unless everyone in this 

room, along with physicians, hospitals, nurses, small business owners, and patients are involved, just as we are here today. 

My other role that brings me here is as chair of the Long-Term 

Care Coordinating Council, a group of policymakers and providers 

of services to the elderly and persons with disabilities and also consumers of those services. Many of the people who participate in 

that council are here in this room today. 

We meet monthly to discuss State policies, as well as the impact 

of Federal programs and the impact of budget. A small change in 

how Medicare pays for certain services can have a large impact on 

all of the people who sit at that table, trying to do the best for 

Rhode Islanders. And one of the most important reasons for us to 

all work together to safeguard and strengthen Medicare is that 

some of the most important reforms will be possible through the 

significant purchasing power and benefit coverage of Medicare and 

its ability to work effectively with our Medicaid programs, which 

provide so much care to seniors in long-term care, both in the community and in nursing homes. 

The value of the Long-Term Care Council is that it represents an 

open forum for some of the most well-informed and knowledgeable 

participants in the long-term care arena. It is the forum where all 

facets of the long-term care system are at the same table discussing the common areas of interest and concern. 

This coordinated approach allows for thoughtful dialogue and 

creates an environment that fosters the use of best practices and 

9 

information sharing. It makes sure that the services for aging, that 

the services of Medicaid, that the services of Medicare fit together 

to serve the people of our State. 

So that is a lot about Government policy and how we need to coordinate Government policy, but one of the pleasures of being an 

elected official is I am also out every day in so many different ways 

talking to people in the community. And there isn’t a person that 

I talk to who doesn’t care deeply about the future of our State and 

our country, who doesn’t want to be responsible with taxes and taxation and with fraud and abuse, but who also wants to make sure 

that our family members, our parents, our husbands and wives, 

and our children are going to benefit from the very strong Social 

Security and Medicare programs that we have in our country 

today. 

You know, it seems a long time ago those days when half of our 

seniors lived in poverty. You know, it was when my father was 

born, for example, was that time. But I have no doubt that it would 

not take us very long to go back there, and I do not see a State 

or a country that is willing to do that to the people that we share 

a community with. 

So the Republican budget that was put out for discussion a few 

weeks ago, to me, absolutely breaks that promise for the future, 

and I, as a public official, will fight as hard as I can and certainly 

support Senator Whitehouse in his effort to fight that so that all 

of us, looking forward, can have a security for our family, for those 

we love, and for ourselves that we can stay independent, healthy, 

in our communities throughout our lives. 

Thank you very much. 

[The prepared statement of Elizabeth Roberts appears in the Appendix on page 42.] 

Senator WHITEHOUSE. Thank you, Lieutenant Governor. 

And before we switch to Chris Koller, I just want to say that the 

Affordable Care Act provided very significant tools to States to improve the quality of care and to save money not by cutting people’s 

benefits or taking things away from them, but by improving the 

quality of care, by coordinating the care better, by eliminating 

some of the waste and some of the foolishness that is now endemic 

in our healthcare system. 

But we can’t do that if there aren’t local leaders who are willing 

to step up and wield those tools and figure out how to make this 

work in their local communities. And Lieutenant Governor Roberts’ 

leadership on this, recognized by Governor Chafee, is really significant and worthy of note before I turn to our health insurance commissioner, Chris Koller. 

Chris, please proceed. 

STATEMENT OF CHRISTOPHER F. KOLLER, RHODE ISLAND 

HEALTH INSURANCE COMMISSIONER 

Mr. KOLLER. Great. Thank you very much, Senator Whitehouse 

and honored guests. 

I have to add to the chorus. I want to particularly recognize my 

colleague Catherine Taylor and all the great work that she and her 

staff do at the Department of Elderly Affairs. 

10 

And Mayor Polisena, I want to note this is a great senior center, 

and this crowd is a little bit different from one of the last times 

I was here, which is when we were debating the Affordable Care 

Act. And what a difference a few years makes is what I would say. 

But regardless, it is important to have these community resources where people can come and be informed and engage in discussions as a part of what makes our country what we are. And 

it is because of, as Lieutenant Governor said, communities that can 

come together to work on these things. 

So in my role, I am responsible for overseeing the actions of commercial health insurance companies, including the rates they 

charge. And I believe that Senator Whitehouse wanted me to speak 

to that a little bit and this issue of rising costs. So I am going to 

take lessons from my religion background and tell you what I am 

going to say and then say it and then tell you what I said. 

The messages are rising medical costs are not unique to Medicare. They are a problem across the entire system. And the reasons 

for these increases are because of the way we organize and pay for 

our care. 

And the third point is that the Affordable Care Act, as Senator 

Whitehouse and the Lieutenant Governor said, gives us some great 

tools to address these costs, and the urgency is only going to increase in the coming years. Because if we get this wrong, then we 

have no choice but to take the options that are being put forward 

by other folks around vouchers and things like that. So the onus 

is on us to use these tools and make them work. 

The first part with rising costs, there are lots of ways to state 

this problem as it goes to Medicare. The Medicare trust fund is 

scheduled to go bankrupt in 2029. Medicare now consumes a full 

15 percent of the budget, and Medicare costs are increasing at two 

or three times rates of inflation. We can’t afford to keep paying 

taxes—we don’t want our taxes to go up two or three times what 

our Social Security, our wages are going up. 

This isn’t sustainable for the Federal Government, but this is not 

unique to Medicare. In Rhode Island, commercial insurance rates, 

in spite of our office’s activities, are rising the last few years at an 

average of 9 percent a year. Medicaid is the fastest-growing part 

of the State budget, and that is in spite of the work that Secretary 

Costantino and his staff continue to do around reducing those 

costs. And soon, Medicaid is going to be even larger than Medicare 

nationally. 

Now you would think that if we spend 75 percent more per person than any other country that we would get better healthcare as 

a result, but we don’t. Anyone who says that we have the greatest 

healthcare system in the world I think isn’t looking at the numbers 

that says that we have people who die earlier. We have poor infant 

mortality. We have more obese people. 

We can do better. We don’t get a whole lot for all this money that 

we spend, but it is not a problem that is unique to Medicare. 

So where does all this money go? If you look at some of the data, 

really what we are getting is a lot more services, but particularly, 

we are paying more people for those services. If you look, compared 

to other countries, we pay more to our hospitals, to our specialists, 

to almost every provider at the high end per unit of service. 

11 

We actually use less services, I was surprised to find out, than 

some of the other countries. But we pay more for them. But I want 

to point out that we don’t have to look overseas for solutions. There 

actually are communities that do better, where costs are 40, 50 percent lower than the averages. It is not just in Medicare. It is across 

Medicare, commercial, Medicaid. There are communities that get it 

right. 

And the researchers say that those communities that get it right 

across everybody—Medicare, Medicaid, commercial, uninsured— 

they have lots of primary care. They have physicians who are organized as groups rather than individuals. 

You know, one of our proudest things that we have nationally, 

and it is sort of one of our best hidden secrets is the Veterans Administration care system, which actually delivers better outcomes 

and lower costs because the physicians work together as a group. 

And that is run by the Government. Can you imagine that? 

[Laughter.] 

These communities have nonprofit hospitals that both compete, 

but they collaborate. They don’t advertise for their latest toy. They 

advertise for how they are working to reduce costs of care and keep 

people healthy. These communities have a strong public focus on 

improving quality, like some of what the Lieutenant Governor has 

done with flu vaccinations, something that we are very good at in 

Rhode Island. And they have employers who care and who are willing to go to hospitals and providers and say this is what we want. 

So we can become a community like that, through the leadership 

of Senator Whitehouse, Lieutenant Governor, and other folks working in the State, if we are willing to look at the community as a 

whole. And how do we put these things together? How do we have 

lots of good primary care? How do we have medical homes where 

people can go to get all their services? How do we have community 

supports that keep people out of hospitals, keep people out of nursing homes unless they have to be there, keep people from being readmitted to the hospitals? 

This sort of looking at broader than medical care but thinking 

about it as healthcare. If we can get our medical providers to work 

together through things like health information technology and the 

way that we pay our providers. 

So what I want to close with is what the implications are for 

Medicare because—bring this back down to Medicare. First of all, 

we have to acknowledge that change is going to have to happen, 

that the status quo, it is bad for private industry. They can’t afford 

these medical care costs. And it is bad for the Federal Government, 

as it pays for Medicare. 

But we have control over how that change happens, and I think 

what we are saying is that change can be different than just handing individuals a check and say, ‘‘Good luck and God bless, and 

navigate the system.’’ But the onus is on us. 

The second thing is that if we are going to do this, the Federal 

Government and the State governments have to use the power, the 

leverage that they have. If you combine Medicare and Medicaid 

that means $1 out of every $2 that gets spent in this country is 

spent by public folks. They can pay for what works and not pay for 

what doesn’t work. 

12 

And I want to recognize the work that Senator Whitehouse has 

been doing consistently to try to get Medicare and Medicaid to be 

better purchasers of things like health information technology, of 

primary care, the things that we know work, as opposed to paying 

for things that don’t work. 

And the last thing I want to say is that the Federal Government 

has this leverage where it is really on us if we don’t want to have 

the kind of choice that the Lieutenant Governor is talking about is 

that the Federal Government has to learn how to have the independence to make these sorts of decisions. And I want to call something—it might be really detailed, but it is a good example. 

Buried within—and Senator Whitehouse worked hard for this. 

Buried within the Affordable Care Act was something called the 

Independent Payment Advisory Board that was a panel of independent experts, not part of Congress, not part of Health and 

Human Services. They would make recommendations to Medicare 

and Medicaid to pay for the things that work. 

Why is it that we in Rhode Island have more MRIs than in the 

entire country of Canada? Why is it that children’s psychiatrists 

are scarce as hen’s teeth? Well, it is because of the way Medicare 

pays. And Medicare makes MRIs really, really profitable. 

And why does it do that? Because the radiology folks have very 

good lobbyists who lobby Congress about how MRIs should be paid, 

and therefore, we are advertising for them in the New England Patriots games. ‘‘Come, get your MRI.’’ 

[Laughter.] 

That isn’t going to help keep us healthy, but if we want to 

change that, we have to make those decisions independently from 

political interference. 

And the Independent Payment Advisory Board was not a death 

panel. It is not about rationing care. It is about making some decisions about what it—it is frankly doing the kind of things that we 

are doing here, trying to pay more for primary care, trying not to 

pay for hospitals to get you sick and then to pay to cure you, which 

is the way that Medicare pays right now. 

So, and if we don’t figure out politically how to set up those 

things, the Senator knows politics is not a bad word. If we don’t 

figure out politically how to set up those things, then we are left 

with vouchers. We are left with all the Government can do is give 

you a check and say, ‘‘Good luck, navigate out there.’’ And I think 

we can expect more from ourselves. I think we can expect more 

from the Government than simply to do that for our seniors, for our 

parents, for us. 

I think it is only through the hard work of people here, the citizens, that we can put this sort of thing together. Because if we 

don’t this is the kind of future that we are talking about. And as 

I said, I think we can do better. 

Thank you very much. 

[The prepared statement of Christopher F. Koller appears in the 

Appendix on page 46.] 

Senator WHITEHOUSE. Thank you very much, Chris. 

Let me start with a question for Deputy Assistant Secretary 

Walker. You made an interesting point in your testimony that a 

great number of seniors are able to remain in their own homes deVerDate Nov 24 2008 10:24 Sep 16, 2011 Jkt 067864 PO 00000 Frm 00016 Fmt 6633 Sfmt 6633 C:\DOCS\67864.TXT SHAUN PsN: DPROCT
13 

spite meeting the disability requirements for entry into a nursing 

home. 

Now, presumably, that is better for the seniors because they are 

more independent. Presumably, it is also less expensive for the system. 

Before we got underway here, Director Taylor told me that they 

have information at the Department of Elderly Affairs that seniors 

who engage with the Department of Elderly Affairs on a regular 

basis and get involved in their programs actually, on average, last 

17 months longer before they end up in a nursing home. They have 

much longer periods of independence. 

So could you talk a little bit about what the things are that seem 

to be most effective in supporting people to make—first of all, is 

it a win-win? It looks like it. Is it, in your experience, really a winwin? And if so, how can we get more of it? 

Mr. WALKER. Thank you for the question, and the answer is absolutely. 

That is really the beauty of the Older Americans Act as the complement to the other systems we have. The mission of the Older 

Americans Act is very simple. It is to help older people, by giving 

them supports, do what they want to do, do what they prefer to do, 

which is to remain independent, to live with dignity, to maintain 

their health, and to keep them at home and in their own communities for as long as possible. 

We clearly understand that, at some point, many seniors will 

have to go to a nursing facility because they may not have the supports in the community. They may not have family caregivers to 

provide them support in their own homes. And at that point, the 

Older Americans Act provides an array of protections to speak on 

their behalf, to look after their interests, to ensure that the facility 

is providing the highest quality of care for that older individual. 

But our services are low-cost services, nonmedical services that 

complement the services in a facility, and I have to, again, publicly 

applaud Rhode Island. What we have done at the Administration 

on Aging is we have studied what works, what are the things that 

really are the most effective and the most efficient solutions. And 

then we have put out discretionary grants—because the Congress 

has enabled us to do that—encouraging States to try new things, 

to test new models, to find out what really works within the State 

and within each community. 

And Rhode Island has actively sought those grants, positively 

competed and won, and has put in place a number of innovative 

approaches, working with hospitals to reduce readmissions, ensuring that individuals know what the doctor said at the point of discharge, know what supports can be put together within the community so that you avoid having to return to the hospital. 

I recently saw a statistic, and I will have to get you the exact 

figure, but it was startling. It was something like within 30 days 

of a hospital discharge, 24 percent or 2.6 million of Medicare beneficiaries are readmitted—it was incredible. And the costs are startling—in excess of $2.6 billion each year. 

And so, as part of coordinating care, using the Older Americans 

Act premise of we don’t have to fund everything through the Older 

Americans Act, but the responsibility of a State unit on aging and 

14 

an area agency on aging and a tribal organization is to coordinate 

the services in the community on behalf of the older individual, 

making it easy for them to access those services, making it effective 

and efficient. 

Senator WHITEHOUSE. So the role of States and particularly of 

State officials like Lieutenant Governor Roberts and Director Taylor and Commissioner Koller in working together to have a coordinated strategy on this is really central to the success of this program and to allowing seniors these opportunities? 

Mr. WALKER. Absolutely. And we look to common sense solutions. 

The Older Americans Act also has the beauty of ensuring that consumers, older people themselves, are active participants in designing systems, in providing input in terms of what works, what 

doesn’t work well. 

You have a number of coordinating councils here in Rhode Island—the Lieutenant Governor is heading those—in terms of how 

do we constantly look at improving what we have, ensuring that 

it works well? Living within our means, but making sure that we 

can do the best we can for the citizens of this State and of this 

country. 

Senator WHITEHOUSE. Let me ask the Lieutenant Governor or 

the commissioner, both of you used the term ‘‘patient-centered 

medical homes.’’ That is a known piece of terminology in healthcare 

jargon. 

But I think it would be good for the people here in the room and 

for the record of the hearing, describe that in kind of human terms. 

What is the experience of a patient who gets into one, and what 

does it mean in somebody’s own life when they have a good operating, patient-centered medical home? 

Ms. ROBERTS. Senator, I was going to suggest—I just suggested 

to the health insurance commissioner that he describe the structure, and then I will actually tell a personal story about how it has 

worked. 

Mr. KOLLER. So if you look at a typical insurer’s costs, and the 

same would be true for Medicare, 5 percent of the people drive 50 

percent of the costs in the system. And if you think about who that 

5 percent are, they are people with chronic illnesses. They are 

probably people who are too sick or too disengaged to come to a day 

like today. 

And how do those people get their medical care? They get it all 

over the place. They go see a foot doctor. They go see a lung doctor. 

Because they don’t have a single disease, they have a bunch of diseases. They have diabetes, and with their diabetes, they are overweight. And that starts to affect their heart. And so, what they are 

seeing is a bunch of doctors with no one coordinating it. 

And the best example is they have got a huge bag of pills, and 

they don’t quite know what to do with it. But every doctor said, 

‘‘Take this. I think it will be good, and give me a call back in a 

few weeks and see how it goes.’’ 

No one is looking to say, ‘‘Well, do those pills interact with one 

another?’’ No one is calling up to say, ‘‘Did the pills work? Did you 

finish them?’’ And chances are they might be sitting on a medicine 

cabinet or something like that. And it is not just that those pills 

are expensive. They are. But it is that there is no quarterback. 

15 

So the idea, Senator, you are right. It is kind of jargon. But the 

idea of a patient-centered medical home is pretty simple. It is to 

have a medical care provider, a place where you can go who can 

coordinate your care. And often, it is not the Marcus Welby doctor. 

It is actually a nurse working for the Marcus Welby doctor. 

And the nurse is the one who knows what is going on, who calls 

you up afterwards and say, ‘‘Did you go to your visit? How did it 

feel? Did it work for you? Let us try something else.’’ And then she 

goes, or he, and puzzles through with the doc to say what is happening with that, and when should we try something different? 

And the problem is that, once again, Medicare, Medicaid, the 

commercial insurers, they don’t pay for that. They don’t pay the 

doc to spend 45 minutes with you or your parent to figure out what 

is going on and put together a plan, or a nurse. They don’t pay for 

the nurses at all. 

They pay for the docs to do a 15-minute visit. Next, next, next, 

next. Prescribe a pill. Let us go on. 

And so, to change that requires public action. Believe me insurers aren’t going to do it. The market isn’t going to do it. It takes 

Medicare and the local insurance regulators to sit down and say, 

hey, you know what? Pay for something different. 

If a primary care doc has a nurse care manager, if a primary 

care doc has an electronic health record, if they work as a team, 

then we want you to pay for them differently. Pay for them to coordinate that care. That is the principle behind a patient-centered 

medical home. 

Before the Lieutenant Governor talks about it, I have got to say 

something we are very proud of in Rhode Island. We actually have 

more of those per capita than any other State in the country because of the really hard work that the primary care docs have been 

doing for a while with the insurers. 

So that is sort of it in theory. But in practice—— 

Ms. ROBERTS. So it is a little bit of back to the future, I like to 

say. You know, it is about having an office where they know you, 

where they have a range of people—because I think about it, you 

know, most of us take this for granted with our pediatricians. 

If your kids are well, I remember even when I was a kid, but 

with my kids, they would see the nurse for their shots and this and 

that. I think my children, who are now slightly above the pediatrician, didn’t see the pediatrician for the last 5 years because they 

weren’t sick. They just needed somebody to check in, did their 

physical. And the doctor would see them if they needed to. 

But let me tell you a story about my dad. And my dad has a 

number of chronic illnesses, but my dad has a doctor who he has 

had for 30 years, who coordinates his care and who also knows him 

and knows his personality, knows his medical history, and has that 

information background that helps make a difference. 

And my dad had a serious health crisis. Of course, there was a 

big snowstorm when it happened. So they were having trouble getting to the hospital. His doctor had trouble getting to the hospital. 

And his doctor came to see him and looked at my dad and said, 

you know, you are not a candidate for surgery, which, if you were 

younger, we would do. And I am not going to admit you to the hospital. I am going to send you home. 

16 

And we are then going to have people come, and this goes back 

to that continuum of care, people are going to come and help care 

for you at home. And he said to my dad, honestly, I can’t tell you 

you are going to live. You may not live. But he knew my dad to 

know to send him home because I don’t think my dad would have 

lived if he had stayed in the hospital. 

So my dad went home. He is living with my brother because he 

is a widower, and they coordinated hospice services. And you know 

what? It is a year and half later. My dad is living with my brother, 

doing quite well. You know, he has still got chronic conditions, but 

it is what the potential is on a very practical level, on a personal 

level. 

And when you think about it and you are not his daughter, you 

also think about the fact that that just saved Medicare tens of 

thousands of dollars and did the right thing for my father. 

So medical homes have the ability to know you, know your living 

situation, have a range of providers integrated in. If you maybe 

need some mental health counseling as part of recovering, they 

have access to those services. It helps you navigate. 

And for those of us who are children of people who are ill, that 

bag of pills and that list of 10 doctors is just as overwhelming, and 

how do we help our seniors and all of us navigate this complex system? That medical home can be our partner and a very powerful 

partner. 

Senator WHITEHOUSE. Let me ask one final question before we 

go on to the second panel. We have talked about the so-called medical home, which is really something as simple and human and 

practical as a go-to person who knows you and who knows what 

care you are receiving and can help you organize what is going on, 

understand what is going on, and navigate your way through the 

system. That is the most kind of low-tech possible thing. 

At the other end is the high-tech aspect of health information 

technology. And when I first started looking into this, I was astounded to read that there had been fortunes saved in retail, in 

banking, in financial services, and all these different American industries, but it hadn’t really penetrated into healthcare in any significant way. Indeed, the article said that the healthcare industry 

had about as much information technology going on in it as the 

mining industry. 

And then I ran into—the human stories started to come out. I 

remember a person I know whose daughter was so ill that she had 

to be basically medically evacuated up to a Boston hospital. And in 

the rush to get her into the ambulance and up to the Boston hospital where the specialists were waiting to treat her, her paper 

records got left behind at the Rhode Island hospital. 

And so, they got up there, and they didn’t know what to do. And 

they couldn’t go the way you could go in every other aspect of your 

lives and find it electronically. They had to send a car, take a call 

down there, and send a car up with the records. 

In the meantime, she was in real extremis, and they started 

needing to redo the tests that had already been done on her so they 

could know what to do up there while the car was racing up with 

the records, put her life at risk, cost an absolute fortune in unnecessary tests. 

17 

And you can imagine the fear of the father with his daughter 

going through all this. ‘‘You are kidding me. You forgot the records, 

and there is no way to—’’ 

So could you just comment for a bit, Lieutenant Governor and 

then Commissioner, on what you think the value is down the road 

if we can get a really robust health information infrastructure 

going here in Rhode Island? 

Ms. ROBERTS. Well, this is a great example of where reform does 

exactly what it should. It improves quality and lowers cost and lowers inefficiency. 

It is amazing that we don’t even have to go to Boston. I work at 

the State House. So if you think about it, if I fell down the stairs 

at the State House and really badly hurt myself, I would probably 

go to the Miriam Hospital emergency room—it is sort of the closest 

one—to get whatever care I needed. 

And if I then went home, and I live about 4 miles from there in 

Cranston, and things weren’t going right and I ended up at Kent 

Hospital, they would have no idea what had happened. And heaven 

forbid I was ill enough that I couldn’t tell them. I didn’t have my 

husband with me who could tell them about me. They have to start 

from scratch. 

And it is amazing to me that I can go anywhere in the world and 

look at every single banking transaction in the last 12 months of 

my Citizens Bank account here in Rhode Island, but I can’t go into 

a doctor’s office that is not my doctor’s office and have them know 

anything about me. It just makes sense in terms of quality, in 

terms of cost, in terms of simplifying. 

Like that human navigator we want to have help us with the 

system, to have our information travel through the system—our 

history, our medications, all of those things—so that people aren’t 

duplicating services, but they also know quickly about your medical 

history. 

For those of you who don’t know—and I am going to give Senator 

Whitehouse, we will have a little mutual admiration society here— 

we are really leading the country in many respects in this effort. 

And there have been big Federal grant opportunities to help us invest in this system and creating that network so that medical information can be privately and safely shared between our different 

physicians and a hospital if we walk in the door. 

We have benefited from all three of the—we are a three-for-three 

State in terms of Federal investment here. And you now have the 

opportunity to sign up as an individual in what is called 

currentcare, where your medical information, your lab reports— 

think about it, MRIs. How many people—as the head of health purchasing for IBM said, ‘‘My goal in buying health insurance for my 

employees is never to pay for an MRI twice in one day.’’ 

And how many people have had a problem and had a test duplicated because you went someplace else because they sent you somewhere else or they couldn’t get access to your past? It is really an 

exciting thing. It is a great opportunity, and we have to do it. 

Now when Senator Whitehouse says we were behind, it was partly because so much of healthcare we have been struggling with 

each other. We fight with our health insurance company. Our 

18 

health insurance companies fight with the doctors and physician offices. We haven’t been on the same page. 

And in order to make investments like that, which sometimes 

benefit one group financially and sometimes another, you don’t 

want to invest. It is like, ‘‘Oh, it is his benefit. He needs to pay for 

it.’’ We need to be focused on the common good of the health of our 

community, and then we invest. 

And I really give a lot of credit to our Federal leaders for giving 

us the resources to move this issue forward in our State, and we 

need to really make it work well for the broad community. 

Mr. KOLLER. You took all my lines. 

[Laughter.] 

I think I would just add a couple of things. One, most of the research indicates that 20 to 30 percent of medical care is duplicative, just of absolutely no value. And the best example is what happens when someone goes to the emergency room. The emergency 

room is kind of like our symbol for everything that is messed up 

in our healthcare system because we are asking highly trained docs 

to take care of kids with earaches, as well as trauma victims. 

It makes no sense, and they have no information. It is like they 

are being asked to fly an airplane with the shades down over it because they have to invent everything all over again because they 

have no information on you when you come in. 

What I want to—and the other point I would make is after Hurricane Katrina, the patients who were evacuated, the citizens who 

were evacuated, the ones who were the most medically secure were 

the veterans because they could land at any place, walk into any 

VA facility, and someone would look and say, ‘‘Oh, here is your 

problem list.’’ 

Imagine having to recreate that if you were coming out of 

Katrina or someplace. The last thing you are going to pick up is 

your chart on your way out. And yet, for the VA, it was all there. 

So what I would—so making this real is real hard in Rhode Island. Money helps, but it is also kind of personal change. So I 

would encourage every one of you to have a conversation with your 

primary care physician, your medical home, to say how do I sign 

up for currentcare? To ask yourself what would it take for me to 

feel comfortable signing in for this? 

And if you are not comfortable because you are concerned about 

security of information, if you are concerned about someone having 

access to it, then you have to tell us what it would take to make 

you comfortable. Because until each of us makes that commitment 

to change, to be part of the system or to say what it is going to 

take for them to do it, then we are going to be left with ER docs 

who are giving us tons of tests and two MRIs a day. 

And so, that is how we move from talking about it in theory to 

getting the money to making it actually happen so that we have 

got—our clinicians have the information so they can make the right 

decisions for us at each point. 

Senator WHITEHOUSE. It is a little bit out of the traditional order 

for an official Senate hearing. But this is Rhode Island. So I get 

to do it my way, not the Washington way. 

And what I would like to do is to ask for our Lieutenant Governor, for Assistant Secretary Walker, and for our healthcare comVerDate Nov 24 2008 10:24 Sep 16, 2011 Jkt 067864 PO 00000 Frm 00022 Fmt 6633 Sfmt 6633 C:\DOCS\67864.TXT SHAUN PsN: DPROCT
19 

missioner a round of applause for their wonderful testimony, for 

the great work that they do. 

[Applause.] 

And we will take just a moment while we call up the second 

panel. So if you want to stretch for a second? 

[Pause.] 

Alright. The hearing will come back to order. 

I hope that the first panel helped demonstrate how important 

and how realistic some of the practical alternatives are to simply 

throwing people off of Medicare or throwing people off of Social Security because of cost issues. Whether it was Deputy Assistant Secretary Walker talking about the ways you can keep seniors at 

home longer by working with the Department of Elderly Affairs 

and with Director Taylor and save money that way or whether you 

are talking about having a medical home that coordinates your 

care with a nurse who knows who you are and what you are doing, 

what your situation is, to having an electronic record that follows 

you wherever you go, there are things that can be done that can 

improve our system and make it less expensive. 

And we now have witnesses who can talk a little bit about the 

personal cost and the problems that can ensue if we don’t choose 

to go that way, but instead choose just to cut and take things away 

from people. 

And first, we will hear from Kathleen Connell. She is the senior 

State director of AARP Rhode Island. Kathy joined AARP Rhode Island in 2001, following a long and distinguished career in public 

service, education, and healthcare. Her career in public service included three terms as Rhode Island Secretary of State, a term in 

the Rhode Island Senate, and 16 years elected to local town offices 

in Middletown. 

During that time, she was also a leader in numerous education 

and healthcare issues and in issues affecting women. She currently 

serves on the board of directors of Quality Partners of Rhode Island. Kathleen holds a master’s degree in international relations 

and a bachelor’s degree in nursing, both from Salve Regina University in Newport, Rhode Island. 

Our final witness will be Audrey Brett, who is a senior living in 

Middletown, Rhode Island, where she has retired after a career in 

State and local government in nearby Connecticut. She currently 

receives Social Security and Medicare benefits. She has two sons, 

seven grandchildren, and two great-granddaughters. 

We will begin with Kathy Connell. 

STATEMENT OF KATHLEEN CONNELL, SENIOR STATE 

DIRECTOR, AARP RHODE ISLAND 

Ms. CONNELL. Thank you, Senator, and it is a pleasure and an 

honor to be here and a challenge to follow the previous panel. 

All of them have shown and I am sure, Deputy Assistant Secretary Walker, that you observe that Rhode Island has a tradition 

of leadership in healthcare that exists today more strongly than 

ever. It is a tradition that we take great pride in, beginning with 

our Congressmen Fogarty and Forand and the OAA and Medicare. 

And we are pleased, more than pleased, that our Senator is taking 

a leadership role in the challenges in this particular area. 

20 

I am here today as the State director of AARP. And as I said, 

it is a challenge to follow that panel. In fact, Audrey said as we 

were called up, ‘‘Okay, we are the also-rans.’’ 

[Laughter.] 

So she clearly has a sense of humor about this, and I am looking 

forward to hearing her testimony, too. 

But it is as a representative of AARP that I am here, and let me 

address that. AARP is a nonprofit, nonpartisan, social mission organization representing some 37 million members age 50 and older 

across the country. Here in Rhode Island, we serve some 135,000 

members, which is a significant number in a State this size. 

This morning, AARP Rhode Island had an executive council 

meeting scheduled, but when the Senator’s office called, the executive council agreed that there is nothing more important on our 

plates than the issues we discuss today. So we changed the meeting, and the executive council are here with us today. Would you 

people all raise your hands, please? 

And these are dedicated individuals that are out there, working 

on the issues AARP takes positions on and backs up with research 

and efforts in the field. 

Our members are Democrats, Republicans, moderates, independents, people who align with other parties, and some who aren’t 

sure where they stand politically. But what they have in common 

is that they seek a healthy, secure future, a life of independence, 

dignity, and purpose. In short, the American dream. Among the 

ways AARP helps to fulfill this expectation here in Rhode Island 

and across the country is through education and information, advocacy, and community service. 

So let me begin by addressing concerns about Social Security. 

Seniors, along with just about everyone else, are nervous about potential changes in Social Security and what the debate in Congress 

holds for their future. I want to assure you that AARP on both the 

national and State levels will be a strong and tireless participant 

in this watershed discussion, and we know you will be, too. 

First, let me tell you where we stand. Social Security must be 

protected for current beneficiaries and strengthened so future generations get the benefits they have earned. But Social Security 

changes should only be considered if these changes make retirement more secure, not less. And it is important to understand some 

key points. 

Social Security is strong and can pay Americans 100 percent of 

the benefits they have earned for the next 25 years and approximately 75 percent of promised benefits thereafter without any 

changes at all. But to make sure the program will be strong for future generations, we need to make gradual, modest changes sooner 

rather than later. 

Social Security is not only a lifeline for the most vulnerable. It 

is a critical source of income for the middle class. Do not let it be 

turned into a welfare program. In other words, if Social Security 

is fundamentally altered so that it is no longer an earned benefit 

for all who contribute, then the long-term result will be many middle-class wage earners retiring without the critical income support 

provided by Social Security. For most middle-income earners, Social Security remains their largest source of income in retirement. 

21 

Americans have earned their Social Security benefits by paying 

into the system their whole working lives. Social Security is earned 

by the money you contribute from your paycheck and what your 

employer contributes on your behalf. 

Social Security has not contributed to the Nation’s debt and 

should not be used to balance the budget. Instead of putting our 

children and grandchildren’s retirement in jeopardy, Congress 

should find ways to solve our Nation’s budget problems without 

making damaging cuts to Social Security. 

We believe Social Security is a guarantee. When you pay in, you 

get the benefit you earned when you retire. Social Security benefits 

should keep up with inflation so seniors, many of whom are kept 

out of poverty by Social Security, can continue to afford basic necessities when costs rise. We believe that Social Security benefits 

were always intended to be there in both good times and bad. 

It is also important to note that the next generation has paid 

into Social Security for decades and deserves to get the retirement 

benefits they have already earned. With shrinking pensions, dwindling savings, diminished assets, and longer life expectancies, future generations will depend on Social Security even more. It goes 

without saying your urgent attention to strengthening Social Security for the long term is necessary and greatly appreciated. 

Let me next mention the Medicare program and some recent proposals being considered by Congress. Medicare was created in 1965 

and plays a vital role in ensuring health and retirement security 

of older Americans and people with disabilities in current and future generations. 

Medicare covers persons age 65 and older, regardless of their income or medical history, and now covers 47 million Americans, 

helping individuals pay for needed healthcare services. Nearly half 

of all people on Medicare, 47 percent, live on incomes below 

$21,600 as individuals and $29,140 for couples. 

According to the most recent data available, Medicare beneficiaries spent a median of $3,103 a year of their own money on 

healthcare in 2006. Ten percent of beneficiaries, more than 4 million people, spent more than $8,300 a year. The oldest and poorest 

beneficiaries spent about one-quarter of their incomes on 

healthcare. 

As you know, AARP supported the Affordable Care Act last year 

because it will improve and strengthen Medicare and provide 

Americans who currently lack health insurance access to affordable 

comprehensive health insurance. President Obama recently suggested that the Independent Payment Advisory Board, IPAB, established under the new law, be expanded. AARP agrees with 

many of the Independent Payment Advisory Board’s original goals, 

that being extending Medicare solvency, slowing cost growth, and 

improving quality without reducing benefits or increasing cost 

sharing for people in Medicare. 

However, we remain concerned about the spending targets the 

IPAB must meet in its second 10 years and the unintended impact 

these savings targets might have on beneficiaries’ access to or quality of care. We have strong concerns with expanding the role of this 

unelected, unaccountable board. We will carefully monitor how 

22 

these proposals move forward to ensure that Medicare is protected 

and strengthened for the millions of people who depend on it. 

Other proposals being considered in Congress that would greatly 

expand the cost sharing on beneficiaries, significantly increasing 

their out-of-pocket cost for Medicare, we do not believe the answer 

is to simply shift costs onto Medicare beneficiaries and increase the 

health and economic insecurity of millions of Americans. Increasing 

the out-of-pocket costs for people on Medicare would especially penalize the sick. 

The House-passed Fiscal Year 2012 budget resolution. Before it 

left for recess, the House passed this resolution, which, among 

other things, would eliminate the current Medicare program for 

those turning 65 in the year 2022 and after and replace it with a 

defined contribution premium support program, with the Government’s contribution growing each year by the rate of inflation. We 

find the direction of this House-passed budget disturbing and in 

some cases misguided. 

First, we are concerned that a premium support system would 

dramatically increase costs for Medicare beneficiaries while removing the promise of secure health coverage, a guarantee that future 

seniors have contributed to through a lifetime of hard work. Under 

this proposal, premium payments to private plans would be sharply 

reduced, capped at levels well below medical inflation. 

Therefore, Medicare beneficiaries would bear a larger and larger 

share of the high cost of medical inflation. According to the calculations based on the Congressional Budget Office analysis, the 

House-passed budget would more than double the beneficiary costs 

in 2022 from about $5,500 to $12,500, an increase of roughly 

$7,000 per year in beneficiary premiums and coinsurance. 

The legislation would also increase the age of Medicare eligibility 

from 65 to 67 by 2033. Those who enter Medicare before 2022 

would continue under the current program, with the option to 

switch to the new program. AARP opposes raising the age of eligibility for the Medicare program because, according to research, it 

would increase the cost burden for 65- to 66-year-olds; increase premiums and cost sharing for Medicare enrollees; raise costs for 

States, employers, and for people under 67 purchasing coverage; 

and produce relatively little in savings to the Federal Government. 

And the House-passed budget repeals key improvements in the 

Affordable Care Act. The two I would like to speak to today are closure of the coverage gap or donut hole in Medicare Part D and 

eliminating the Community Living Assistance Services and Supports, CLASS, program. 

AARP fought to close the donut hole because it provides millions 

of seniors with access to lower out-of-pocket costs for their prescription drugs. Repealing the donut hole provision would immediately 

increase the prescription drug costs for nearly 4 million Medicare 

beneficiaries. 

The CLASS program is a national voluntary insurance program 

to help individuals pay for some of the costs of services and supports to help them live in their homes and communities. It has the 

potential to provide savings in Medicaid, support family caregivers 

in their caregiving roles, and help to give eligible consumers choice 

and control and a flexible benefit to help them meet their needs. 

23 

Abandoning relief from the donut hole and taking away an option 

to help people live in their homes does not bode well for older 

adults. The added burden of higher health costs would put more 

seniors at risk, especially those who are most vulnerable. 

As for Medicaid, under the House-passed budget resolution, all 

Federal Medicaid payments to States would be converted to a block 

grant, beginning in 2013, with constrained annual growth. Now 

Rhode Island is operating in a special environment when it comes 

to Medicaid because we have what is known as the global waiver 

that puts more money to work here, creating some flexibility in 

how the State allocates Federal funds and, we hope, helping us to 

rebalance the health and long-term services and support system toward more community-based care, which research shows over and 

over again is the preference of the people who use it. 

We are watching this closely because oversight is absolutely critical and because it remains to be seen what happens down the road 

when we are apt to see a reduction in the original Federal contribution. What we do know is that the notion of replacing Medicaid as it is presently constituted with a block grant system is a 

move in the wrong direction. 

There are limited financing options currently available to pay for 

long-term services and supports, and individuals typically exhaust 

their own assets before turning to Medicaid. Block granting Medicaid would put both current and future seniors in need of these 

services at risk. For those who are already in nursing homes or receiving home- and community-based services, cutbacks could lead 

to reduced access and inadequate care. 

For those who do not yet need long-term services and supports 

or can still pay for those services themselves, if the time comes and 

they have exhausted their savings, may be turned away or offered 

insufficient care that neither meets their needs nor maintains their 

dignity. 

While AARP appreciates that the budget resolution recognizes 

the importance of Social Security to older Americans, we remain 

concerned that across-the-board cuts to Medicare, Medicaid, and 

other critical Federal programs could also have a detrimental impact to the lives of many seniors who depend on these programs 

for their health and retirement security. We urge you to consider 

the impact of these proposed cuts on real people here in Rhode Island and across the country and to look to less draconian ways to 

achieve savings. 

Across-the-board cuts could include reductions in Medicare and 

Medicaid and other healthcare spending. The House-passed budget 

resolution proposes enacting this hard spending cap as a law, and 

it could not be waived regardless of need or economic circumstances, even by a supermajority of votes in Congress. 

The budget contemplates enacting this spending cap as part of 

the debt ceiling debate that will begin when you return to Congress 

next week. This is a frightening scenario for everyone. 

The Older Americans Act provides essential programs, information, and services to meet the needs of a growing older population. 

These programs provide vital support for those older adults who 

are at significant risk of losing their ability to remain in their own 

24 

homes and communities who need support and protection in longterm care facilities. 

Pending formal legislative language, our interest is to ensure 

that the act maintains critical service and information roles and 

promotes greater responsiveness to the needs of mature and older 

Americans. In this period of economic downturn, AARP is most concerned that programs, authorities, and partnerships that have already proven effective in meeting the needs of vulnerable older 

Americans be maintained and strengthened. 

We believe that the most important legislative objective to better 

serve older persons is to promote and improve efficiency in the delivery of core services. Better coordination of existing OAA programs with other Federal programs holds great promise and merits 

the support of the Administration and Congress. 

AARP’s 135,000 members in Rhode Island hope that the Special 

Committee on Aging is listening. We hope you will not turn away 

from the great needs of a generation that has made America great 

and millions of others who have paid into a system based on the 

promise of greater health and financial security in retirement. 

We know that creative solutions are necessary. All we ask is that 

you carefully measure the human consequences of your decisions 

and that you remember the greatest wealth of this Nation is the 

way we show the world the respect we have for our older citizens. 

Thank you. 

[The prepared statement of Kathleen Connell appears in the Appendix on page 50.] 

Senator WHITEHOUSE. Thank you very much, Kathy, and thank 

you to AARP. 

And now we will turn to our final witness, Audrey Brett. Please 

proceed. 

STATEMENT OF AUDREY BRETT 

Ms. BRETT. Hi. I don’t know how to use this. Is this right? Okay. 

I really don’t know why I am here. I feel very flattered, and I 

thank you for having me. I am not of the caliber of the professional 

people who are speaking. I am just an old Yankee tobacco farmer 

from Connecticut. 

[Laughter.] 

But us Yankees have pretty good logic, I want you to know that. 

Also, speaking last, I don’t have to speak long, and I can be comic 

relief. 

[Laughter.] 

It delights me to hear all this talk about 65-year-olds. I have a 

son that age. He is very old for my age. 

[Laughter.] 

As a young woman, I worked full time. And during my years, I 

paid payroll taxes, and when I retired, I applied for Social Security. 

Women’s wages at that time were a small percentage of what men 

earned, another one of my women’s rights things. And so, my Social Security check was quite minimal. 

And I never thought much about it until my husband died and 

my check stopped. His was transferred to me, and that was really 

a godsend. He died suddenly. I not only lost him, I lost one check, 

the supplemental income he brought in as a manufacturer’s rep. 

25 

I still had the same rent, maintenance, medical costs, car maintenance, food, and no income except for the Social Security check, 

which enabled me to go on living simply, but adequately, and without being a burden on my sons and losing my dignity as well. Like 

me, many friends are experiencing the same Social Security that 

has succeeded in keeping millions of widows, senior citizens, children, and disabled out of poverty. 

I am reminded of an old political saying, as I listen and read a 

lot. Because I spent all of my adult years in Connecticut in the political arena and 50 years in the vineyard, I learned a lot of good 

stuff. And one thing I learned was, ‘‘Figures don’t lie, but liars figure.’’ 

The Preamble of our Constitution describes that document as 

providing for the common defense and promoting the general welfare. We go all the way back to that. And I am disturbed and troubled that there are those who would destroy our basic democratic 

principles for their own political aggrandizement. I worry for me. 

I worry for my children. 

That grand old lady standing in New York Harbor who welcomed 

all of those who came to this country, the land of the free, where 

all men are created equal, to find a good life, she stands in the harbor and weeps. 

When I crossed the border into Rhode Island, one of the first 

things I did was to establish myself with a medical provider. That 

is my old Girl Scout training, ‘‘Be prepared.’’ I quickly learned that 

although Medicare is always accepted, certain Medigap insurances 

are not. I have never had a complaint with Medicare. It has always 

been available and always delivers what it has committed to do. 

In the privatized area, however, actions are very different. In the 

private sector, companies have used the process known as rescission for many years. It is well documented that tens of thousands 

of Americans lose their health insurance after being diagnosed with 

life-threatening, expensive medical conditions. And once you lose it 

and have an existing condition, you can’t get insurance. 

Again, political expediency, I greatly fear the change for Medicare to privatization. The Federal Medicare program has changed 

the lives of millions of Americans, but our roots of Medicare go 

back to our Nation’s early efforts to achieve health coverage for its 

elderly and poor citizens. 

For all those Americans who worked, paid their taxes, added to 

the betterment of this country, served in the military and civil 

service, we cannot let them live and die in poverty. We owe them 

the final days of security and dignity. 

If I had to move out of Connecticut, I think I am glad I came 

to Rhode Island because I am impressed with the gentleman of intelligence, understanding, and caring who represents this State in 

the Senate. And Senator Whitehouse, for your tireless efforts in resisting the actions that threaten the good and welfare of your constituents in the Nation, I thank you very much. 

[The prepared statement of Audrey Brett appears in the Appendix on page 57.] 

Senator WHITEHOUSE. Thank you, Audrey, very much. 

26 

It is always good to have some testimony that keeps it real, and 

you have more than accomplished that goal. And I really appreciate 

that you testified here today. 

I want to note one thing in Audrey’s testimony that I thought 

was particularly significant, and it is a very touching phrase that 

she used. And that was, ‘‘My Social Security check enabled me to 

go on living simply, but adequately without being a burden on my 

sons.’’ And it reminds me of the statement that President Johnson 

made way back when Medicare was founded. 

He said, ‘‘No longer will young families see their own incomes 

and their own hopes eaten away simply because they are carrying 

out their deep moral obligations to their parents.’’ And I think that 

testimony helps remind us that Medicare and Social Security is not 

just about the seniors who are the immediate beneficiaries. 

Franklin Roosevelt talked about freedom from want, freedom 

from fear, and the freedom from want and fear that these programs 

provide, knowing that people can have a secure and dignified old 

age, isn’t just a freedom that seniors enjoy. It is a freedom that all 

Americans enjoy. It is a worry that regular working families out 

there now, going to the second or third job, Americans have a lot 

to worry about. 

And knowing that they are not going to be—what was President 

Johnson’s phrase here? They are not going to see their own incomes and their own hopes eaten away because of their moral obligation to their parents, that they are not going to have to prepare 

to take on that burden, that risk, that chance that something terrible goes wrong in their parents’ healthcare, and suddenly, they 

have to stop everything. Suddenly, they have to lose everything in 

order to support them. That is an important freedom that allows 

our children to pursue their own dreams, to travel if necessary to 

where jobs are for them, to have a sense of what—I mean, that is 

really part of what America has been about. 

And I think that was a very important point that you made. I 

just wanted to recognize that. 

The other thing I would like to do is to ask Kathy Connell about 

the question of the prescription costs in Medicare and Medicaid. 

We had testimony from the earlier panel about the buying power 

that Medicare and Medicaid have, that $1 out of every $2 goes 

through those systems. 

As you know, when the prescription drug Part D plan was put 

together, a group of people, I assume driven by the interests of the 

pharmaceutical industry, insisted on a requirement in the bill that 

the Federal Government is not allowed to negotiate for the price 

of the pharmaceuticals that it pays for through these programs. 

And we have all heard the stories about the drugs that are $88 in 

the United States, and you go up over the Canadian border, and 

there they are for $22. 

We have all seen the difference between what the VA can buy 

drugs for because they are not limited by that restriction. They can 

use the lesser buying power that they have. What is the position 

of AARP on trying to particularly in an environment in which potentially slashing Medicare benefits, giving it up as a benefits program and having it just be a voucher that goes to an insurance industry, and as for the rest, ‘‘You are on your own, pal.’’ 

27 

In that context, does it make it even more important that we 

fight to try to make sure that the buying power of Medicare and 

Medicaid are brought to bear on the increasing costs of prescription 

drugs? What is AARP’s position here? 

Ms. CONNELL. Our position is to do whatever is necessary to help 

to contain costs, and we did support buying power for the negotiation in Medicare for cost of drugs. That part of the issue has not 

been on the front burner recently that I have noticed, but it certainly is one that warrants the attention of those who want to 

make sure that this program does serve. 

We know that the costs of drugs have been increasing far beyond 

the rate of inflation. And oftentimes, there are new and wonderful 

drugs coming on the market, but there are also old ones that have 

been kicking around forever whose costs have gone up exponentially. 

So that is a whole area that needs to be carefully looked at and 

addressed. And hopefully, that is part of what will happen as they 

seek to get these costs under control. 

Senator WHITEHOUSE. Well, let me thank both of you for your 

testimony, and let me thank everyone for staying through this 

hearing. I want to particularly acknowledge again Mayor Polisena, 

who, despite the very, very busy schedule of a Mayor in a Rhode 

Island city, has taken the time to stay through the entire hearing 

and to hear all the testimony. 

As I said, I have never met anybody in Rhode Island government 

or politics who is a stronger fighter for seniors, particularly for his 

Johnston seniors, than Mayor Polisena. And that is shown in the 

quality of this wonderful senior center that we are here. 

[Applause.] 

It is shown in the wonderful work of Tony Zompa and the staff 

who are here. And I appreciate it very much. 

I think the witnesses have been very helpful and instructive. And 

if there is a single point that I think we can take away from this 

hearing, it is that there is a terrible cost to real Rhode Islanders 

and to real Americans if we degrade Social Security and Medicare, 

if we change them from being cornerstones of what it means to be 

an American and to have that security and dignity and hand it 

over to, in particular in Medicare’s case, the insurance industry. 

But in the Social Security case, if we are going to go back to 

privatizing that as was tried a few years ago, hand that over to 

Wall Street. 

So there are powerful interests here, and there are real harms 

that could take place. But what was important to me in today’s 

hearing was to hear so many different solutions that can be 

brought to hear in a win-win way to improve these programs, to 

lower the costs, particularly in healthcare, in ways that actually 

improve our experience of the healthcare system, how well the 

healthcare system serves us, our safety while we are in the hands 

of the healthcare system, and the results that we, as a society, get 

from our healthcare system. 

And I will do one last recognition. She probably doesn’t want me 

to do it, but I see in the back of the room a friend and former State 

senator who served in public life with great distinction for many 

28 

years, Catherine Graziano. And so, I want to make sure I recognize 

her as well. 

[Applause.] 

So do we keep the hearing open for a week? Okay. So under the 

Senate rules, the record of this hearing can stay open for 2 weeks, 

if anybody wishes to add any further testimony. So we will keep 

it open for the full 2 weeks. If anybody has any additional comment 

or testimony that they would like to add, then that will go into the 

official Senate record of this hearing. 

And I will thank again the wonderful panel of witnesses who 

came out. The wonderful panels, both panels of witnesses were 

really extraordinary, and thank all of you for attending. 

And let you know that we are at the beginning of a very long and 

active discussion about these programs, but I think it is pretty 

clear where I stand, and I can assure you that the entire Rhode 

Island congressional delegation stands with me in this area. 

So, again, thanks to those who are here, recognition again to our 

Department of Elderly Affairs director Catherine Taylor, and thank 

you all so very much. 

The hearing will be adjourned. 

[Whereupon, at 11:36 a.m., the hearing was adjourned.] 

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APPENDIX 

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