Ms. Linda Furlong using a catheter. She is able to fed herself and eats well, but is very frail, weighing about eighty-five pounds. This causes many injuries, sprains, bruises, etc. This I cannot transport her anywhere, unless by ambulance. makes medical care next to impossible, except to go to the hospital. As it stands now, our family life suffers because we cannot leave her alone. We cannot afford to hire someone to come in. Trained people cost at least ten dollars an hour. Not many people are comfortable caring for someone like her. She cannot make her needs known and she doesn't understand what people say to her. She is very senile! I have six hours a week of homemaker service and have been unable to get any more hours of help. I have not applied for welfare as I was told her Social Security check it too high. She has no savings. I am unable to work outside of the home to meet rising costs-of-living. I still have two teenage boys at home and really need to work. My grandmother's expenses for things not covered by Medicare are using up most of her monthly check. Examples of her out-of-pocket costs include: Heat, year round; diapers; bed and chair pads; bandages; sterile gloves; special lotions, powders, shampoos, etc.; hospital nightgowns; nutrition drink, $45.00 per case; hospital feeding table; caregiver, sitter; and transportation by ambulance. When she was in the hospital for a broken hip, we had to pay $10.00 an hour for a special nurse's aid to sit and watch her at night so she wouldn't fall. Family stayed during the day, but were not allowed to stay at night and we could not hire someone cheaper hospital rule. Her doctor is very good, he even makes house calls, but he would sometimes rather admit her to the hospital instead of helping me care for her at home. She is not safe in hospital settings. She is like a baby, but is not treated with the same protective care. It is a real personal hardship for me and her when she is admitted. She has been injured as a result of one emergency room visit. When she had pneumonia and was almost ready to come home, someone (nursing staff) caused her to aspirate food and get pneumonia in her other lung. They were too short handed and hurried her till she choked. I observed this on several occasions. Of course this was denied. Ms. Linda Furlong Hospitals are short of help. They cannot take the time needed for people like my grandmother. Not one listens to the family's pleas for help. The supervisor makes excuses that they are short handed. They don't give the patient a discount for below quality care. They can't make up for the emotional pain of seeing a loved one in a out-of-control situation. I had to watch my grandmother beg to use the bathroom for two days. She was in a gerry chair in the hall by the nurse's station. They didn't have time to take her. We were not allowed to take her. She was not able to understand why she just couldn't get up and go. I signed her out of the hospital just so she could use the bathroom when she had to go. This may not seem important, but to her and to us it was very upsetting and should not ever happen to people. There are many other things that happened during her three hospital trips. My point is when a person has someone to care for them at home, hospital care could be shortened if help were provided at home. These helpless elderly people deserve dignity and respect. Unless you have money, you can't receive adequate care nor can you have the basic things you need. To improve services, each case must be treated individually. It seems there is a new definition of who qualifies for care money. Just being old isn't enough. Some people fall through the cracks. Please change the guidelines to fit each case so that home caregivers can get help to fit the needs of the person and the family, for example: A 24 hour phone hotline for support; A 24 hour phone hotline to have medical answers A support group is fine, but not all people cat get to it; Provide funds to set up home-care initially for nursing type care; Yearly allowance for non-medical, but necessary items; and Home care would still cost less than nursing home care and the person would be with loved ones. Mr. PALLONE. Thank you, Ms. Furlong. I wanted to say that I really appreciate all three of you being here. I know it's difficult because you're talking about your own personal experiences. And I want to ask some questions. Obviously, it's important that we get into some more details about your cases if it's going to be valuable to the committee. But I know it's difficult because you're talking about your own lives, and that's never that easy. Two of the people who spoke, Mr. Vergano and Ms. Furlong, basically were talking, in my opinion, about the need to expand Medicare, about the fact that the current health care programs do not really provide for enough coverage. You talked, Ms. Furlong, about respite care, which is very limited coverage under Medicare, at least the way I understand it. And Mr. Vergano mentioned prescription drugs. Of course, the PAAD program that we have in New Jersey is State-funded. In most States, we would not have a program and certainly Medicare would not cover prescription drugs. We're fortunate in New Jersey, it's income-based and there are restrictions on it but at least there is a PAAD program which is-I guess not many of you know-funded with casino revenue funds. One of the reasons why in New Jersey we do have some coverage beyond just your basic Medicare coverage is because of the financing that comes in from the casino revenue fund. But again, it goes back to what I was saying before, which is in the current climate, as much as we would like to see expansion, there is the need for expanding Medicare to cover a lot of things that aren't covered now. If anything, our battle has been to try to keep what we have. And that doesn't mean that I don't want to hear about the need to expand it, because I do and that's why I'm here in part. But I just thought that I needed to mention that. And, Mr. Sperling, I wanted to zero in on your case a little bit if you don't mind because I'm not sure I really understood all the details of what the problems were. You said that you had to wait a considerable period of time? Explain that to me. Mr. SPERLING. My problem stems from the fact that I suffered a heart attack in March. In March, I verbally contacted Social Security. Social Security told me that I would have to wait 5 months before I could be eligible for any kind of benefits. Mr. PALLONE. If I could interrupt-in other words, you had a heart attack and it wasn't covered? In other words, you owed the doctor bill, the hospital bill, as a result of that heart attack? Is that what you're making reference to? Mr. SPERLING. The problems were that I was incurring bills and after going through the trauma of the heart attack and being in the hospital and realizing that bills—and having no insurance, nowhere to go, not much money, laying there realizing that I was incurring bills of some $1,200 a day wasn't helping me to recover. I was forced by economics to go out and go back to work, which worsened my condition. In April, I went through a cardiac catheritization at the hospital. They found that I had many occluded arteries and so forth and they couldn't do what they call angioplasty, it had to be open heart surgery. So I had to wait until August 22nd to have the surgery. The period of time that lapsed between the heart attack and after going into the hospital for surgery, I wasn't allowed to work. I forced myself to work because I had issues like child support to pay, things like that. But without an income, I was sunk. And, again, looking for help from the system, the system wasn't there for me. Mr. PALLONE. And I know it's tough to talk about it, I'm just trying to get to the bottom of what the problem was and how we could correct it. You're not eligible for Medicare? You're too young? Mr. SPERLING. What I found out recently is that they're going to apparently use the date of the surgery as a jumping off point which is ludicrous. I got a piece of paper in the mail that says they're going to hold the case-they're going to table the case until November 22nd, when they will have enough medical evidence. They've already gotten medical evidence. They've gotten post and preoperative reports. They've gotten the psychiatrist's reports. I was asked to go a psychiatrist and I find out now that if these psychiatrists had found some mental instability I would have gotten benefits right away but no mental instability was found so I've got to wait. Mr. PALLONE. Mr. Sperling, what I'm just trying to find out, just from a point of view of the coverage, the problem was that you probably were not covered by Medicare, at least, correct? Because you're not old enough? If you don't mind my asking, how old are you? Mr. SPERLING. I'm 43. Mr. PALLONE. Okay. That's what I thought. So you're an example of a person, it seems to me, what we call the uninsured. In other words, you're not old enough to be eligible for Medicare. At the same time, you were, for whatever your financial reasons, at least until some point, not eligible for Medicaid. And so basically, you were in this category of people we estimate at as many as 25 million Americans who are working but who do not have any kind of health insurance. In addition to that, there are people who are not working who don't have health insurance, but are not eligible for Medicaid. So that's what I was trying to get to the bottom of and that's what I understand. Now, at some point, did you become eligible for Medicaid and did they end up paying some of the bills? Is that what happened? Or is all of this still being paid privately by you to the best of your ability? Mr. SPERLING. No. Retroactive, Medicaid said that they would take care of those back to a certain point. And I was given presumptive benefits for a 3-month period. In that 3-month period, all the evidence was presented to Social Security disability determinations. I still suffer from those problems but I don't have the benefits. I can't go back to work. I don't have anything to turn into cash. What happens now? That's the question. Mr. PALLONE. Okay. I think I'm starting to understand now. So are you now eligible for Social Security disability? Still not? Mr. SPERLING. They claim that they don't have enough information which I know not to be true. Mr. PALLONE. So you're actually totally in a state of limbo. You're one of these people that has totally fallen through the crack, so to speak, because you're not eligible for Medicare, you're not old enough; you haven't qualified for Social Security disability; and you have no private insurance and you have no insurance through your employer because you aren't working. I guess it's obvious to a lot of people, but basically this first example seems to me to be of a person who just has fallen through the cracks and this is, of course, an example-and there are a lot of people like that—of the problems, a very good example of the problems with the system. I don't want to keep dwelling on it, but I think that it's very valuable to have you here today because I think people don't realize that there are just a lot of people-one in eight Americans—that just are not eligible in any way and so your situation now is that you still can't work, right? And you still have all these bills and you're not qualifying for any kind of Government program as such. At least right now. Mr. SPERLING. According to the adjudicator in Newark. They, again, have tabled everything until November 22nd. And they have enough information. They have all the reports. They have the report from the psychiatrists. And, again, had I been found mentally incapable, I would have had my benefits. Mr. PALLONE. Well, we could talk for a long time about what the answer is. Frankly, there are a lot of possibilities out there in terms of what we need to do. Obviously, some people advocate a national health insurance program so that nobody falls through the cracks; or the other option, which is something that I've talked about a lot is to provide some sort of national program which would not be national health insurance per se but rather require the employers, either through tax incentives or subsidies, to provide for health insurance; or, alternatively, if a person is not working that the Government would take up the slack. I mean, those are the types of things that we have to investigate in order to deal with your situation. There are a lot of people out there that are like you. Mr. SPERLING. Let me just clarify and give you all the information. Prior to the time that I suffered the heart attack, I had a business. The business, because of the economy, people not paying their bills, the business went. In January, I went into a job. I joined the labor force and took a job. The heart attack came 2 weeks before the insurance kicked in. That was the killer. Mr. PALLONE. Okay. Well, thanks a lot. I really appreciate your testimony because I think it indicates a lot about the problems with the system. Mr. Vergano, I just wanted to ask you a couple of questions because you basically raise the whole issue of prescription drugs and how the whole issue of providing drugs relates to Medicare or current health insurance. Now, you said you'd spent-how much on drugs this year? Basically? Mr. VERGANO. I take six different pills a day, some two, three and four times a day. Two heart pills, potassium, water pills and persantine-it's a blood thinner. I average, like I said, about $150 a |