Proposed Medicare rule ignores what we got right

OPINION:

Nearly 20 years ago, I had the honor of working alongside lawmakers, health experts and advocates to pass one of the most significant reforms to Medicare in its history: the Medicare Modernization Act of 2003. It was a bipartisan effort to bring Medicare into the 21st century by expanding coverage for prescription drugs and ensuring that our country’s seniors had greater access to the tools they need to live longer, healthier lives.

That law did more than add benefits. It also drew a firm line around the kinds of medical supplies that could be subjected to government-run competitive bidding. Urological, ostomy and tracheostomy supplies were deliberately excluded from competitive bidding for one simple reason: The seniors who rely on these products need individualized, clinically appropriate care that cannot be reduced to the lowest bidder.

Unfortunately, the Centers for Medicare & Medicaid Services now seems determined to reverse that protection. In its proposed rule for 2026, CMS has floated a plan to include urological and ostomy products in the Medicare Competitive Bidding Program. As someone who was there when Congress made the opposite decision on competitive bidding two decades ago, I believe this is a serious mistake.

Let me be clear. I fully support the administration’s goal of rooting out waste, fraud and abuse from the Medicare system. We have seen far too many cases where bad actors exploit seniors and taxpayers for personal gain. The recent revelations around a $10.6 billion catheter fraud scheme were shocking. The Justice Department was absolutely right to crack down on the criminals responsible, and CMS should be applauded for working to protect Medicare’s integrity.

Still, punishing patients, particularly our most vulnerable seniors, is not the way to fight fraud.

Urological and ostomy supplies are internal-use prosthetics, chosen with a physician’s guidance, that help seniors recover from surgery, manage chronic conditions and avoid life-threatening infections. When CMS forces these products into a bidding war, the result will not be smarter spending. It will be lower-quality products, reduced access and unnecessary suffering.

I have heard from countless seniors who spent months working with their doctors and suppliers to find the devices that work best for them, including a catheter that would not cause pain or infection. Others depend on ostomy supplies that must be fitted to their exact body shape and skin type. If this rule goes forward, those seniors could be told their preferred supplies are no longer available or that they must wait weeks to receive an inferior product from a distant contractor.

Seniors are rightfully concerned. Inferior products that may not fit correctly will likely lead to rehospitalization, increasing the costs to our health care system and defeating the entire purpose of competitive bidding.

We saw this happen before. In the early 2000s, CMS ran a demonstration project in Polk County, Florida, that applied competitive bidding to urological supplies. The results were predictable: Supplier participation dropped, product availability shrank, and patient care suffered. That experience helped persuade Congress to draw a clear boundary in 2003. CMS’s new proposal ignores that history and puts seniors back at risk.

We would be remiss to ignore the broader implications of this rule. Many suppliers that provide these products are small businesses specializing in serving seniors. They know their customers by name. They offer education, follow-up services and support. If they are squeezed out of the market by a lowest-cost bidding model, seniors will be left with fewer choices and lower-quality service.

The Medicare Modernization Act was designed to protect seniors, not expose them to unnecessary risk. It recognized that some products are too important, too personal and too clinically sensitive to be thrown into a cost-cutting contest. That principle still holds today.

My Medicare roots began 60 years ago, on July 30, 1965, when the program was enacted. At the time, I was chief of staff to Rep. Edward J. Gurney, Florida Republican, who voted for its passage. I know Medicare (and its programs) well. I was deeply involved in its creation. Because of this, I know CMS should stay focused on the real sources of fraud — shell companies, identity theft and false billing — and leave alone the critical medical products on which our seniors rely. This is not a time to go backward. It is a time to uphold what we got right.

• Jim Martin is the founder and chair of 60 Plus, the American Association of Senior Citizens.