Medicare for Environmental Health Hazards?

UPDATE: Hat tip goes out to Jeremy Koulish, of Carrots and Sticks, for running down the CBO numbers and giving us a rough estimate of how many people would likely be covered by this provision of the bill. That number is in the thousands, a few thousand or so. As Jeremy said, "Yeah, not particularly earth-shattering, but obviously great for those 3,000 people." We will be doing some more analysis of this, and should it pass, we will check back to see how this provision is being implemented.

There is something interesting in the new health care amendment, Section 1881A.

MEDICARE COVERAGE FOR INDIVIDUALS EXPOSED TO ENVIRONMENTAL HEALTH HAZARDS.

We have still got a lot of reading left to do on this section of the amendment, but it has raised some very interesting questions.

I will start with what, as my reading leads me to believe, this section of the amendment does. This section allows for certain individuals, deemed affected by environmental health hazards, to be eligible for Medicare in the event that the individual is not eligible for necessary care under other public or private programs. It also allows for the creation of a pilot program to determine eligibility and to provide necessary benefits.

First and foremost, this is not restrictive by age. Meaning, regardless of how old you are, if you are deemed affected by environmental health hazards, you may be eligible for Medicare.

The first question this raises, who is considered an "environmental exposure affected individual"

(e) ENVIRONMENTAL EXPOSURE AFFECTED INDIVIDUAL DEFINED.—

(1) IN GENERAL.—For purposes of this section, the term ‘environmental exposure affected individual’ means—

(A) an individual described in paragraph (2); and
(B) an individual described in paragraph (3).

(2) INDIVIDUAL DESCRIBED.—
(A) IN GENERAL.—An individual described in this paragraph is any individual who—

(i) is diagnosed with 1 or more conditions described in subparagraph (B);
(ii) as demonstrated in such manner as the Secretary determines appropriate, has been present for an aggregate total of 6 months in the geographic area subject to an emergency declaration specified in sub- section (b)(2)(A), during a period ending—

(I) not less than 10 years prior to such diagnosis; and
(II) prior to the implementation of all the remedial and removal actions specified in the Record of Decision for Operating Unit 4 and the Record of Decision for Operating Unit 7;

(iii) files an application for benefits under this title (or has an application filed on behalf of the individual), including pursuant to this section; and
(iv) is determined under this section to meet the criteria in this subparagraph.

(B) CONDITIONS DESCRIBED.— For purposes of subparagraph (A), the following condi- 13 tions are described in this subparagraph:
(i) Asbestosis, pleural thickening, or pleural plaques as established by—

(I) interpretation by a ‘B Read-er’ qualified physician of a plain chest x-ray or interpretation of a computed tomographic radiograph of the chest by a qualified physician, as determined by the Secretary; or
(II) such other diagnostic standards as the Secretary specifies, except that this clause shall not apply to pleural thickening or pleural plaques unless there are symptoms or conditions requiring medical treatment as a result of these diagnoses.

(ii) Mesothelioma, or malignancies of the lung, colon, rectum, larynx, stomach, esophagus, pharynx, or ovary, as established by—

(I) pathologic examination of bi- opsy tissue;
(II) cytology from bronchioalveolar lavage; or
(III) such other diagnostic standards as the Secretary specifies.

(iii) Any other diagnosis which the Secretary, in consultation with the Com- missioner of Social Security, determines is an asbestos-related medical condition, as established by such diagnostic standards as the Secretary specifies.

(3) OTHER INDIVIDUAL DESCRIBED.—An individual described in this paragraph is any individual who—

(A) is not an individual described in paragraph (2);
(B) is diagnosed with a medical condition caused by the exposure of the individual to a public health hazard to which an emergency declaration applies, based on such medical conditions, diagnostic standards, and other criteria as the Secretary specifies;
(C) as demonstrated in such manner as the Secretary determines appropriate, has been present for an aggregate total of 6 months in the geographic area subject to the emergency declaration involved, during a period deter- mined appropriate by the Secretary;
(D) files an application for benefits under this title (or has an application filed on behalf of the individual), including pursuant to this section; and
(E) is determined under this section to meet the criteria in this paragraph.

That is a lot of language to say that, essentially, an "environmental exposure affected individual" is someone affected by asbestos or someone in the geographic area where an "emergency declaration aplies."

I am going to ignore the part about asbestos, for now (it comes back up at the end). How do we define whether or not an "emergency declaration applies?"

(2) EMERGENCY DECLARATION.—The term emergency declaration’ means a declaration of a public health emergency under section 104(a) of the Comprehensive Environmental Response, Compensation, and Liability Act of 1980.

In other words, a Superfund site that has been deemed an emergency. So this amendment would make it so anyone affected by a health hazard, who lives in an area designated a Superfund site under an emergency declaration, would be eligible for Medicare if they are not already eligible for the needed care through other public or private entities.

Not a huge deal. Especially considering how rarely a Superfund site is deemed an emergency.

But there was one part that caught my eye, when I came across the section on pilot programs:

(b) PILOT PROGRAM FOR CARE OF CERTAIN INDIVIDUALS RESIDING IN EMERGENCY DECLARATION AREAS.—
(1) PROGRAM; PURPOSE.—

(A) PRIMARY PILOT PROGRAM.—The Secretary shall establish a pilot program in accordance with this subsection to provide innovative approaches to furnishing comprehensive, coordinated, and cost-effective care under this title to individuals described in paragraph (2)(A).
(B) OPTIONAL PILOT PROGRAMS.—The Secretary may establish a separate pilot program, in accordance with this subsection, with respect to each geographic area subject to an emergency declaration (other than the declaration of June 17, 2009), in order to furnish such comprehensive, coordinated and cost-effective care to individuals described in subparagraph 15 (2)(B) who reside in each such area.

"Other than the declaration of June 17, 2009." What declaration was that? None other than the first, and only, emergency declaration by the EPA under the Environmental Response, Compensation, and Liability Act of 1980.

And now is when I will bring back the asbestos stuff that I chose to ignore at the beginning. This emergency declaration happens to revolved around problems with, you guessed it, asbestos. So, now I am confused.

Does this bit about excluding the declaration of June 17th exclude all these people from being eligible for Medicare, or are they included by the bits about asbestos?

We are working on getting in touch with Senator Baucus's office (given that it is the weekend, and a crazy one at that, we may have to wait for Monday) to help us tackle some of these questions. I hope you will join us in trying to figure out this peculiar section of the amendment. Check back for updates.