September 4, 2021

The Honorable Nancy Pelosi                                               
U.S. House of Representatives
Washington, DC 20515

The Honorable Kevin McCarthy
Minority Leader
U.S. House of Representatives
Washington DC 20515

The Honorable Chuck Schumer                                         
Majority Leader
U.S. Senate
Washington, DC 20510

The Honorable Mitch McConnell
Minority Leader
U.S. Senate
Washington, DC 20510

Dear Speaker Pelosi, Minority Leader McCarthy, Majority Leader Schumer, and Minority Leader McConnell,

On behalf of the National Committee to Preserve Social Security and Medicare’s millions of members and supporters, I am writing to urge you and your colleagues to prioritize the needs of older Americans and people with disabilities as you negotiate an agreement on budget reconciliation legislation.  We support:

  • Medicare drug pricing and Medicare Advantage payment reforms to offset the cost of adding long overdue hearing, dental and vision coverage to Medicare;
  • Investments in home- and community-based services that enable seniors and people with disabilities to stay in their homes;
  • Expansion of low-income protections that help vulnerable beneficiaries access their existing and new Medicare benefits;
  • Improvement of the Supplemental Security Income (SSI) program for the eight million low-income seniors and people with disabilities — including over a million children — who depend on it for basic income support; and
  • Creation of a paid leave program that enables family members to care for elderly and disabled loved ones without imposing an additional workload burden on the underfunded Social Security Administration (SSA).

Reform Prescription Drug Pricing

Drug pricing reform must include a strong drug negotiation provision that will provide Medicare with the flexibility to negotiate prescription drug prices.  We oppose efforts to narrow the scope of negotiation authority in ways that would make it too easy for drug companies to evade meaningful cost reductions.

The National Committee supports an out-of-pocket cap on Part D costs if it is coupled with provisions that reduce underlying drug costs for the Medicare program.  To this end, we urge you to include language in the agreement to restructure the program to shift more costs to private Medicare plans and drug manufacturers in the catastrophic phase and place limits on the ability of manufacturers to raise drug costs above the rate of inflation for drugs used under Medicare Part B and Part D.

Fill the Gaps in Medicare Coverage

Congress should reinvest Medicare drug savings into the Medicare program in the form of benefit improvements that will be broadly shared by beneficiaries including hearing, dental and vision coverage and an overall out-of-pocket cap for beneficiaries.

Providing basic dental, hearing and vision coverage will fill a gap in Medicare coverage that will help to keep seniors and people with disabilities out of hospitals and nursing homes, lengthen their lifespans and improve their quality of life.

Just to provide one example, there is growing evidence being gathered by Dr. Frank Lin’s research through the National Institutes of Health that untreated hearing loss accelerates cognitive decline including dementia and Alzheimer’s disease.  Currently, Medicare and Medicaid spending to treat people with Alzheimer’s is $305 billion a year.  By 2050, that cost is expected to jump to $777 billion a year.  But if a higher percentage of seniors with age-related hearing loss had hearing aids, the skyrocketing cost of treating people with Alzheimer’s disease and dementia could drop significantly.  Not to mention that children and grandchildren might get to spend more years of quality time with their parents and grandparents.

In addition, we support other program enhancements included in the House-passed H.R 3, such as Medigap reforms and improved low-income subsidies in Part D and the Medicare Savings Programs.

Improve Protections for Low Income Beneficiaries Without Means Testing or Vouchers

In pursuing these vital Medicare improvements, we ask that the budget reconciliation agreement ensures that Medicare’s integrity as a social insurance program be retained and provides low-income seniors with guaranteed access to Medicaid programs that assist with Medicare’s out-of-pocket costs.  The National Committee supports making the new hearing, dental and vision benefits more affordable by expanding the Medicare Savings Program and opposes the use of vouchers or means testing the new benefits.

Reduce Overpayments to Private Medicare Advantage Plans

In addition to cost savings from reforming Medicare drug pricing, we urge you to include in the agreement a reduction in overpayments to Medicare Advantage (MA) plans to help pay for benefit improvements.  Private MA plans continue to draw down larger reimbursements than they should receive by using inappropriate diagnostic coding for enrollees’ medical conditions. To address this problem, the budget reconciliation agreement should require the Centers for Medicare and Medicaid Services to use a specific and even-handed method of computing coding intensity. A statutory formula for measuring coding intensity would bring payments to MA plans more in line with payments for other providers.

Invest in Home- and Community-Based Services

The National Committee also strongly support robust investments in home- and community-based services. We reject the notion that we can’t update Medicare’s antiquated benefit package and make long needed improvements to our long-term care infrastructure.  The catastrophic loss of life in nursing homes during the COVID pandemic underscores the imperative to transition our long-term care system away from its current bias toward institutional care and toward safer and more cost-effective care that allows seniors and people with disabilities to live where they want, in their homes and in their communities.

Restore Supplemental Security Income

We urge you to include H.R. 3824/S. 2065, the Supplemental Security Income Restoration Act of 2021, in the reconciliation agreement. During the 50-year history of the program, Congress has failed to keep SSI up to date for the 8.3 million low-income seniors and people with disabilities that depend on the program for basic income support. The SSI Restoration Act rights this wrong by increasing the SSI federal maximum benefit level; updating and indexing the resource limits and the income disregards; eliminating the marriage penalties and the In-Kind Support and Maintenance provisions. We urge you to enact these needed SSI improvements.

Create a Paid Leave Program Without Overburdening the Underfunded SSA

The National Committee supports a paid family, parental, and caregiver leave program that provides caregiving and medical leave in addition to parental leave. With 10,000 baby boomers turning 65 every day – and the number of seniors projected to double by 2050 – it is clear America needs a paid family leave program that addresses the needs of older adults and people with disabilities for their own illness or to serve as a caregiver for family members, such as a parent, spouse, adult children, or grandchildren or others of any age.

To be successful, we urge Congress to ensure that a paid leave program is given sufficient administrative resources — especially during development and implementation, but also over the long term — to preclude burdens to the implementing agency and negative results for their customers.  The Social Security Administration (SSA), for example, has been operating with insufficient resources to carry out its existing core functions for the past decade. This has led to diminished service, including longer wait times for disability claims and phone services and prevented SSA from strengthening its existing core programs to meet the needs of its expanding customer base.  Inadequate customer service has real-life consequences for disabled Americans as thousands die each year while waiting for a decision on their claim.

Restoring the ability of the Agency to handle its current and projected workload will take a significant investment of resources, both in funding and staff competencies.  Adding the burden of administering a new program at this time is likely to result in further deterioration in services for the SSA’s existing constituency while at the same time providing inadequate attention needed for a successful launch of the new program.   For these reasons, the National Committee does not believe SSA is the agency best suited to successfully administer this important new program.  If it is ultimately selected, we strongly urge Congress to ensure the Agency has sufficient funding, not only to administer the new program, but also to successfully eliminate all of the backlogs that have impeded the Agency’s ability to provide the services that America’s seniors have earned through their working lives.


In the budget reconciliation agreement you and your colleagues are currently negotiating, the National Committee urges you to include the policy priorities described in this letter to improve the health and economic security and caregiving of all Americans and to add needed reforms to prescription drug pricing and payments to Medicare Advantage plans.


Max Richtman
President and CEO