Commentary

Sen. Manchin, others should listen to the compelling case for hearing aid coverage in Medicare

November 10, 2021 12:20 am

Mature man at medical examination or checkup in otolaryngologist’s office. Getty Images.

An older fellow who’s hard of hearing can get pretty anxious when he reads that hearing loss is the biggest treatable risk factor for dementia. The good news is that it’s treatable. The bad news is that most people can’t afford the main treatment, hearing aids.

Peer-reviewed studies have confirmed a link between hearing loss and accelerated cognitive decline. This is a particular issue for the population with the most hearing loss, older adults.

U.S. Sen. Joe Manchin, D-West Virginia, and other lawmakers should be aware of this – that millions of older Americans on Medicare suffer from hearing loss (including a significant portion of his state’s population). He ought to know that people who don’t hear well are more vulnerable to slipping memory, awkward pauses, more mental faux pas (some potentially dangerous) than those without a hearing impairment.

In the evenly split U.S. Senate, Manchin’s vote can make or break President Biden and the Democrats’ agenda. That’s why his preferences for what’s in and what’s out of legislation carry so much weight.

During the ongoing negotiations over the Democrats’ social spending/climate-change bill, one of the red lines drawn by Manchin is a proposal to expand Medicare to pay for hearing aids for older adults. Proposals for dental and vision coverage under Medicare previously were cut from the draft legislation after opposition from Manchin.

The senator cites concerns about the long-term viability of Medicare’s financial underpinning with any costly expansions to the program. Yet, Manchin also opposes raising taxes on very wealthy people and corporations to help pay for the variety of social programs in the Build Back Better Bill.

In opposing any and every possible method to pay for the Medicare expansion and other popular benefits in the social-spending legislation, the West Virginia senator has shoved overboard a founding principle of the political party to which he belongs – asking wealthier citizens and corporations to contribute a fair proportion of their income to help society at large. Currently, many of these folks are paying few if any taxes.

That being the case, it’s difficult to respect Manchin’s supposedly principled concern about Medicare’s future. This senator is refusing to consider reasonable ways to protect that future while still paying for a vitally needed expansion of services.

It seems to me – someone at higher risk of dementia because of mild to moderate hearing loss – that this very serious health concern is at least as urgent as many – perhaps even most – of the healthcare costs that Medicare and private insurance do cover. It’s something that a sizable percentage of older adults can’t afford to address without help from their insurance and/or Medicare.

WHEN FIRST DIAGNOSED with hearing loss last spring, I was stunned to learn about the links with cognitive decline. As a 66-year-old Ohioan, I assumed that the worst effects of my hearing loss involved having to use closed captioning on TV and engaging in comedic loud and quizzical exchanges with my spouse, a la Morty and Helen, Jerry’s parents on “Seinfeld.”

Assumptions like these have kept hearing aid coverage out of Medicare since its inception: That “losing your hearing is a normal part of aging”; that older adults can remain more or less functional despite being “a little deaf.”

Two peer-reviewed studies, one published in 2013 and another in 2019, confirmed links between hearing loss and cognitive impairment. The second study, published in JAMA Otolaryngology – Head and Neck Surgery, found that connection at virtually any level of hearing loss above zero.

An article in the New York Times Magazine in February 2020, headlined, “Can Hearing Aids Prevent Dementia?,” summarized those studies.

The 2013 study, “Hearing Loss and Cognitive Decline in Older Adults,” according to the article, “discovered that a subject’s likelihood of developing dementia increased in direct proportion to the severity of his or her hearing loss at the time of the initial test. The relationship seems to be ‘very, very linear,’ (the study’s lead author Frank) Lin says, meaning that the greater the hearing deficit, the greater the risk a person will develop the condition.”

In 2017, the article added, Lancet, a respected medical journal, appointed a commission to examine all published research on dementia risk factors “that might be modified to prevent or delay the onset of symptoms.” Hearing loss won that dubious competition, accounting for 9 percent of dementia diagnoses.

What’s less certain, as the NYT Magazine headline suggests, is how much (if any) hearing aids and other treatments for hearing loss reduce the risk of dementia in older adults. (They probably would not alter the risk of Alzheimer’s disease, which results from pathology in the brain likely unrelated to hearing loss.)

Still, Lin told the NYT Magazine that considering the main hypotheses for the link between hearing loss and cognitive decline, “there’s every reason to think if you treat hearing loss, that those interventions could directly modify those (neural) pathways,” reducing the linkage.

To be overly simplistic, if being hard of hearing is damaging your ability to think, wouldn’t fixing the hearing stop the damage?

The problem is that “fixing the hearing” by the primary available means, hearing aids, is prohibitively expensive for most people.

According to the NYT Magazine story, two-thirds of adults 70 and older suffer from hearing loss. Yet, in the United States, just 14 percent of adults with hearing impairment actually use hearing aids.

The latter statistic is likely due to a mixture of the old assumptions (“hearing loss is a normal and acceptable part of aging”) and the exorbitant cost of a pair of hearing aids. Though much cheaper, no-frills options are available, the cost can easily exceed $6,000 if the price includes expert assessment and testing, higher-quality hearing aids, follow-ups, regular cleaning and multi-year warrantees.

They don’t last forever, so if you buy a pair of hearing aids when you’re 65, you may need to buy another one or two pairs before you die. Not many retirees can comfortably produce several thousand dollars for what they’re conditioned to consider as a discretionary purchase.

It’s no wonder that faced with that major expense – equal to several months’ rent or house payments, or groceries for half a year – most people just accept the fact that they can’t hear very well. They go on with their lives, unaware that their hearing impairment is hastening cognitive decline that adversely affects quality of life and family relations on many levels.

Helping these people seems a worthy candidate for help from the federal government, certainly as worthy as the panoply of health conditions that do qualify for reimbursement from Medicare and/or private insurance.

AFTER READING ABOUT THE LINKS between hearing loss and cognitive decline, I bit the bullet and last week spent a chunk of my retirement savings on hearing aids. It’s more than a year too early to benefit from a Medicare expansion for hearing aids, which wouldn’t go into effect until 2023.

With my new hearing aids, so far so good. Everything seems sharper and crisper when I’ve got them in, and the tinnitus sounds more like a soft spring night than full-on cicada summer. I’m hoping they will help hold off mental decline.

Clearly, this plausible remedy to a frightening and debilitating affliction should be available to more people than the relatively small number willing and able to afford several thousand dollars out of pocket.

Thus far, Sen. Manchin has refused to hear the compelling case for expanding Medicare to pay for hearing aids. Maybe if enough people shout in his ears, he will.

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Terry Smith
Terry Smith

Terry Smith in May 2020 left The Athens NEWS in Athens, Ohio, after editing that award-winning publication for 34 years. His columns and editorials have placed first in the Ohio News Media Association’s annual weekly newspaper awards in recent years. Before returning to Athens and his alma mater, Ohio University, in 1986, Smith reported for newspapers in Ohio, Arizona, Idaho, Colorado and West Virginia. He is currently freelance editing and writing from his home in Athens.

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