"Last week, I joined House Democrats in introducing the Medicare Prescription Drug Benefit and Discount Act.  I am a lead sponsor of that plan because I truly believe it is the answer to the problems our seniors face in struggling to pay for their medicine and improve or maintain their health.  As a small town family pharmacy owner, I have seen this problem first hand, and have worked hard in Congress to correct it. 

"When it comes to this issue, House Republicans seem to be working to protect the big drug companies that help to keep them in office. The Republican bill will not guaranteet hat seniors will have affordable drug coverage.  Instead, seniors must obtain coverage through private insurers, who may not participate and can offer vastly different benefits and premiums.  The Republican bill will cover less than a quarter of Medicare beneficiaries' estimated drug costs over the next ten years, and under their plan, seniors will only be covered for medicines and pharmacies that have been placed on their private insurer’s formulary. 

"On the other hand, the Democrats’ plan is a plan for seniors.  Under this 'seniors plan,' Medicare will not force seniors into HMO’s or private insurance.  Rather, Medicare will cover the cost of prescription drugs just as it covers a visit to the doctor or a hospital.  Our bill specifies that for a $25 monthy premium and a $100 deductible, Medicare will cover 80 percent of the cost of seniors’ prescription medication.  For low-income seniors, coverge will be even more generous.  Our plan will lower the cost of drugs for all seniors and ensure that seniors can get the drug their doctor prescribes at the pharmacy of their choice. 

"Debates over this issue will grow more intense over the next few weeks as these plans progress through Congress, and I have challenged my colleagues in the House of Representatives to do the right thing.  I have encouraged them to go back to their districts and speak with seniors about the details of these plans, to put party politics aside, and to fix this problem once and for all by uniting behind the plan that works – the 'seniors plan.'"

“Insurance companies often don’t differentiate between surgeries that are reconstructive and those that are cosmetic,” Ross said.  “Unfortunately, for those suffering from rare diseases or conditions which require rare procedures, falling into the wrong category means denial of coverage for their medical needs.” 

Wendelyn Osborne of Arkadelphia was the 16th person ever documented to be born with a rare bone disease, Craniometaphyseal Dysplasia, which causes an overgrowth of her craniofacial bone that never deteriorates.  Now in her mid-thirties, Wendelyn had her first of 14 surgeries when she was 6 years old and was not expected to live to adulthood.  Her condition requires these periodic surgeries to correct the growth and abnormalities caused by the disease.  She is currently in need of another orthognathic surgery. 

Unfortunately, since the advent of managed care, Wendelyn has had to fight for any type of disease-related procedure as well as getting “qualified” physicians.  Most insurance plans do not recognize congenital conditions such as hers, and those that do generally have an age limitation.  These plans often stop covering congenital conditions once the beneficiary has passed age 21, whereas the congenital condition never goes away.  Wendelyn’s condition is rare, but her experience in seeking care is not. 

“I have fought a very hard battle and have no more avenues to take,” wrote Wendelyn in a June 2001 letter to Ross.  “At this time, my insurance policy covers congenital conditions through the age of 12.  When you are born with a congenital condition, most likely you’ll die with it.  I feel as if I’m being punished for being born with a rare disease.” 

Last fall, Ross drafted legislation to help Wendelyn and the thousands like her receive the care they need, and Wendelyn came to Washington to meet with members of Congress and to help announce the bill on September 12, 2001.  Unfortunately, due to extraordinary events of September 11, 2001, the introduction of the bill and Wendelyn’s meetings had to be cancelled.    This week, Wendelyn has returned to Washington, D.C., to help Congressman Ross introduce this legislation and to meet with other members of Congress and the White House to explain her condition and to promote this important measure. 

“Wendelyn suffers from a rare disease, but she joins countless others in suffering from a lack of coverage for what is medically necessary for her survival,” Ross said.  “To classify surgeries which would allow her to eat normally as ‘cosmetic’ is unacceptable.  The Reconstructive Surgery Act of 2002 will ensure that people like Wendelyn whose needs are simply misunderstood or mislabeled are taken care of.” 

The bill defines medically necessary reconstructive surgery as surgery “performed to correct or repair abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infections, tumors, or disease, to: (1) improve functions; or (2) give the patient a normal appearance, to the extent possible, in the judgment of the physician performing the surgery.  It specifically excludes “cosmetic” procedures defined as “surgery that is performed to alter or reshape normal structures of the body in order to improve appearance.” 

Examples of medically necessary procedures that would be covered under this legislation include:  injuries from accidents, cleft lips and palates, burns, skull deformities, benign tumors, vascular lesions, missing pectoral muscles that cause chest deformities, Crouson’s syndrome (failure of the mid-face to develop normally), and others. 

The Reconstructive Surgery Act of 2002 (HR 4959) is co-sponsored by Reps. Vic Snyder (D-AR) and Robert E. Andrews (D-NJ) and has been endorsed by the National Organization for Rare Disorders, National Foundation for Facial Reconstruction, Easter Seals, and the March of Dimes.  A companion bill, S. 576, has been introduced in the United States Senate by Sen. Dianne Feinstein (D-CA).