Bill Overview
Title: Lymphedema Treatment Act
Description: This bill provides for Medicare coverage of lymphedema compression treatment items. Specifically, the bill provides for coverage of standard and custom fitted gradient compression garments and other approved items that are prescribed by a physician or other specified health care professional to treat lymphedema.
Sponsors: Rep. Schakowsky, Janice D. [D-IL-9]
Target Audience
Population: Individuals with lymphedema
Estimated Size: 4000000
- Lymphedema is a condition affecting a significant number of individuals worldwide, often arising as a consequence of cancer treatment, surgeries, infection, or genetics.
- Compression garments are a primary treatment intervention for managing lymphedema symptoms.
- The bill focuses on providing Medicare coverage, indicating a positive impact predominantly on populations eligible for Medicare, including primarily U.S. citizens over the age of 65 or those with certain disabilities.
- The global population affected by lymphedema extends beyond the U.S. and includes people in countries with varying levels of medical coverage.
- The impact of the bill is directly on Medicare beneficiaries but the concept of insurance coverage for lymphedema care could influence wider health insurance practices.
Reasoning
- The target population of Americans with lymphedema who might be affected by this policy is estimated to be between 3-4 million. However, only a portion of these individuals will be covered by Medicare, as the policy is specifically aimed at providing Medicare coverage. This means the population actually impacted by this new policy would likely be those already eligible or soon to be eligible for Medicare benefits.
- Within the simulated interviews, individuals across a range of ages and geographical locations will be included to represent both directly impacted Medicare beneficiaries and other citizens for context.
- People with lymphedema under 65 or those not covered by Medicare will not feel the direct effects of this policy unless there are significant changes in non-Medicare insurance markets or if Medicaid programs start adopting similar coverage, which is not guaranteed in the short term.
Simulated Interviews
Retired teacher (Florida)
Age: 67 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 20.0 years
Commonness: 15/20
Statement of Opinion:
- The cost of compression garments is high, and not covered by my current Medicare plan.
- This bill would greatly ease my financial burden and improve my quality of life.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 8 | 5 |
| Year 5 | 8 | 5 |
| Year 10 | 9 | 5 |
| Year 20 | 9 | 4 |
Software developer (California)
Age: 45 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 0.0 years
Commonness: 12/20
Statement of Opinion:
- Medicare coverage won't directly benefit me as I am not eligible.
- However, I hope this sets a precedent for other insurers to offer similar coverage.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 6 | 6 |
| Year 3 | 6 | 6 |
| Year 5 | 6 | 6 |
| Year 10 | 6 | 6 |
| Year 20 | 6 | 6 |
Freelance writer (Texas)
Age: 62 | Gender: other
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 10/20
Statement of Opinion:
- I'm approaching Medicare eligibility, so this policy will soon apply to me.
- Having these costs covered will significantly reduce my financial stress.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 8 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 7 | 4 |
Retired engineer (Ohio)
Age: 74 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 15.0 years
Commonness: 13/20
Statement of Opinion:
- With Medicare, I struggle to afford the necessary compression garments.
- The new coverage would improve my mobility and everyday life.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 7 | 4 |
| Year 5 | 7 | 4 |
| Year 10 | 8 | 3 |
| Year 20 | 8 | 3 |
Medical student (New York)
Age: 29 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 0.0 years
Commonness: 10/20
Statement of Opinion:
- I'm young and healthy, but see the impact of such policies on elderly patients I study.
- Providing coverage reduces a significant stressor for older adults.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 7 | 7 |
| Year 5 | 7 | 7 |
| Year 10 | 7 | 7 |
| Year 20 | 7 | 7 |
Truck driver (Colorado)
Age: 52 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 5.0 years
Commonness: 8/20
Statement of Opinion:
- Not on Medicare yet, but this policy highlights what might be possible for private insurance too.
- Hopeful for broader change, but changes won’t affect me immediately.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 5 |
| Year 2 | 5 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 6 | 5 |
| Year 10 | 6 | 5 |
| Year 20 | 5 | 4 |
Retired nurse (Illinois)
Age: 70 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 20.0 years
Commonness: 12/20
Statement of Opinion:
- This policy would be a relief, helping cover expenses for compression garments.
- I believe it will improve my daily life and mental health significantly.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 8 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 9 | 6 |
| Year 10 | 9 | 6 |
| Year 20 | 9 | 5 |
Research scientist (Washington)
Age: 30 | Gender: other
Wellbeing Before Policy: 8
Duration of Impact: 0.0 years
Commonness: 10/20
Statement of Opinion:
- Although I'm not impacted directly, I study how policies improve equality.
- Medicare’s support of lymphedema treatment sets an important standard.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 8 |
| Year 2 | 8 | 8 |
| Year 3 | 8 | 8 |
| Year 5 | 8 | 8 |
| Year 10 | 8 | 8 |
| Year 20 | 8 | 8 |
Office manager (North Carolina)
Age: 55 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 11/20
Statement of Opinion:
- My mother relies on these garments extensively; this will reduce our financial pressures.
- Her wellbeing and mine are tied to ease of her care.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 8 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 7 | 4 |
Retired farmer (Georgia)
Age: 68 | Gender: male
Wellbeing Before Policy: 3
Duration of Impact: 15.0 years
Commonness: 14/20
Statement of Opinion:
- With this coverage, I could access quality compression garments more easily.
- It would significantly improve my lifestyle and reduce my pain.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 4 | 3 |
| Year 2 | 5 | 3 |
| Year 3 | 6 | 3 |
| Year 5 | 7 | 3 |
| Year 10 | 8 | 3 |
| Year 20 | 8 | 2 |
Cost Estimates
Year 1: $380000000 (Low: $250000000, High: $500000000)
Year 2: $400000000 (Low: $260000000, High: $520000000)
Year 3: $420000000 (Low: $270000000, High: $540000000)
Year 5: $450000000 (Low: $290000000, High: $580000000)
Year 10: $500000000 (Low: $320000000, High: $640000000)
Year 100: $800000000 (Low: $500000000, High: $1200000000)
Key Considerations
- This policy directly increases Medicare expenses but aims to improve health outcomes for individuals with lymphedema, potentially reducing long-term healthcare costs.
- Compression garments are a widely recognized treatment, which indicates a potentially large uptake among eligible populations.
- The policy sets a precedent for Medicare coverage, which could pressure other insurers to follow suit, potentially broadening coverage for other types of medical supplies.