This week, the House Ways and Means and Energy and Commerce Committees met to review bills that aim to reduce coverage restrictions and costs for select services for certain Medicare beneficiaries. These important goals are, however, undermined by some components of the bills.
Increased Free Screening, but Only for Some
One of the pieces of proposed legislation considered, H.R. 842, would provide coverage without cost-sharing for emerging blood-based cancer screening services. But only people under 68 in 2028 would be eligible for that coverage. This limitation is not based on clinical factors—indeed, the age limit increases over time. Medicare Rights strongly opposes such arbitrary limitations on access to reasonable and necessary services and urges Congress to instead work to ensure that everyone with Medicare can get the appropriate, high-quality services they need.
Breakthrough Device Access, Without Brakes
Another bill considered, H.R. 5343, would require Medicare to automatically cover all Food and Drug Administration (FDA)–designated medical breakthrough devices during a four-year transitional period, bypassing Medicare’s obligation to determine what services are “reasonable and necessary” under what circumstances, for Medicare beneficiaries. This evaluation is essential for protecting patient safety, consumer integrity, and programmatic integrity.
Importantly, the Centers for Medicare & Medicaid Services (CMS) has, as of 2024, established a specific, accelerated pathway for the evaluation and coverage of breakthrough devices that retains Medicare’s important role in ensuring that covered devices meet the statutory “reasonable and necessary” standard.
Efforts to reduce these problems must not create artificial divisions between Medicare beneficiaries.
We applaud Congress’s attention to the issues Medicare beneficiaries face, including coverage restrictions and affordability challenges that prevent people from accessing the services and medications they need to build and maintain health. But efforts to reduce these problems must not create artificial divisions between Medicare beneficiaries or undermine key patient safety and fraud-prevention functions.
