House Committees Mark Up Medicare Payments That Goal for Enhancements, however Have Unintended Penalties

This week, the House Ways and Means and Energy and Commerce Committees met to evaluate payments that goal to cut back protection restrictions and prices for choose providers for sure Medicare beneficiaries. These essential objectives are, nevertheless, undermined by some parts of the payments.  

Increased Free Screening, however Only for Some

One of the items of proposed laws thought of, H.R. 842, would offer protection with out cost-sharing for rising blood-based most cancers screening providers. But solely folks below 68 in 2028 could be eligible for that protection. This limitation isn’t based mostly on scientific components—certainly, the age restrict will increase over time.  Medicare Rights strongly opposes such arbitrary limitations on entry to cheap and crucial providers and urges Congress to as a substitute work to make sure that everybody with Medicare can get the suitable, high-quality providers they want.  

Breakthrough Device Access, Without Brakes

Another invoice thought of, H.R. 5343, would require Medicare to mechanically cowl all Food and Drug Administration (FDA)–designated medical breakthrough gadgets throughout a four-year transitional interval, bypassing Medicare’s obligation to find out what providers are “reasonable and necessary” below what circumstances, for Medicare beneficiaries. This analysis is important for shielding affected person security, client integrity, and programmatic integrity.  

Importantly, the Centers for Medicare & Medicaid Services (CMS) has, as of 2024, established a particular, accelerated pathway for the analysis and protection of breakthrough gadgets that retains Medicare’s essential function in guaranteeing that coated gadgets meet the statutory “reasonable and necessary” customary.

We applaud Congress’s consideration to the problems Medicare beneficiaries face, together with protection restrictions and affordability challenges that stop folks from accessing the providers and drugs they should construct and preserve well being. But efforts to cut back these issues should not create synthetic divisions between Medicare beneficiaries or undermine key affected person security and fraud-prevention capabilities.