House committee marks Medicare bills designed to improve but unintended consequences

This week, the House's Ways, Means, Energy and Commerce Committee met to review the coverage limits and costs of services designed to reduce certain Medicare beneficiaries. However, these important goals are undermined by some components of the bill.

Added free filters, but only for

One of the proposed legislation, HR 842, will provide coverage without sharing emerging blood-based cancer screening services. However, only those under the age of 68 in 2028 are eligible for the report. This limitation is not based on clinical factors, but age limitations increase over time. Medicare rights strongly oppose arbitrary restrictions on access to reasonable and necessary services and urge Congress to work to ensure that all those with Medicare have access to the appropriate, high-quality services they need.

Breakthrough device access, no brakes

Another bill considered is HR 5343, requiring Medicare to automatically cover all Food and Drug Administration (FDA) designated medical breakthrough equipment over a four-year transition period, bypassing the obligations under which Medicare determines which services are “reasonable and necessary” for Medicare to use for Medicare beneficiaries. This assessment is critical to protecting patient safety, consumer integrity and procedural integrity.

Importantly, as of 2024, the Medicare & Medicaid Service Center (CMS) has established a specific, accelerated pathway for evaluating and covering breakthrough devices that retain the important role of Medicare in ensuring Medicare is in ensuring that the equipment covered meets statutory “reasonable and necessary” standards.

We commend Congress for its concern about the issues facing Medicare beneficiaries, including coverage limitations and affordability challenges to prevent people from accessing the services and medicines they need to build and maintain health. However, efforts to reduce these issues must not establish artificial divisions among health insurance beneficiaries, or undermine critical patient safety and fraud prevention functions.