Virginia finds itself at the center of an important health care debate, and Southwest Virginia’s own U.S. Rep. Morgan Griffith, R-Salem, is in the driver’s seat as chair of the House Energy and Commerce Subcommittee on Health.
Here’s the problem: Medicare beneficiaries can wait years — sometimes averaging half a decade — between when the FDA greenlights breakthrough medical technologies and when Medicare actually covers them. Private insurers often move quickly on new innovations, but Medicare patients end up waiting, unable to access treatments their doctors are recommending.
There’s growing bipartisan support to change this. The House Ways and Means Committee already passed the Ensuring Patient Access to Critical Breakthrough Products (EPIC) Act, which creates a four-year coverage window for FDA-designated breakthrough devices while giving Medicare a clear roadmap for making permanent coverage decisions. It’s a practical policy that works for both patients and the program.
Now the ball is in the Energy and Commerce Committee’s court. Rep. Griffith’s Health Subcommittee recently held a productive hearing on the bill and will play a key role in moving it toward markup and passage. Here’s what makes this especially important: the Energy and Commerce version includes diagnostic tests — something that was left out of the Ways and Means bill.
That’s a big deal. Diagnostics are where health care often starts. Blood tests that catch cancer early. Lab work that spots heart disease before it becomes a crisis. Tests that identify Alzheimer’s or other conditions while there’s still time to intervene effectively. If we’re going to reform breakthrough coverage, leaving out diagnostics doesn’t make much sense.
Medical technology has transformed what’s possible in health care. Hospital stays are down 38%, breast cancer deaths have dropped 43% and heart disease fatalities have fallen 49%. None of that happened by accident — it’s the result of continuous innovation across devices, diagnostics and surgical tools.
Virginia plays a real role in this ecosystem. Our medical technology sector generates $1.4 billion and supports 4,100 jobs. From medical device manufacturing to surgical instruments to diagnostic products, Virginia companies are part of the infrastructure that delivers advanced health care nationwide. When Medicare coverage lags years behind FDA approval, it creates uncertainty for patients and for the people developing these innovations.
The support for this reform is remarkably broad. Virginia Biotechnology Association joined dozens of similar state organizations and major patient groups — the Alzheimer’s Association, American Cancer Society Cancer Action Network, National Health Council and many others — in pushing for action. When that many different voices line up behind something, it’s worth paying attention.
Rep. Griffith’s subcommittee has the chance to keep diagnostic coverage in the bill as it moves forward. His questions during the recent hearing showed he understands what’s at stake. As the subcommittee works toward markup, maintaining those diagnostic provisions will mean the legislation actually solves the whole problem instead of just part of it.
The Centers for Medicare and Medicaid Services (CMS) could also step in through rulemaking to streamline the path from FDA approval to Medicare coverage, including diagnostics from the start. There’s no reason the legislative and regulatory approaches can’t work together.
Medical innovation keeps moving forward. Rep. Griffith can help ensure Medicare coverage keeps up by advancing the Energy and Commerce bill through his subcommittee with diagnostic coverage intact. That would be a win for Virginia seniors and Medicare beneficiaries everywhere.
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