Examining Policies to Enhance Seniors’ Access to Breakthrough Medical Technologies

Health Care Costs and Drug PricingHouse Energy and Commerce Subcommittee on Health · 2025-09-18 · 119th Congress
The House Energy and Commerce Subcommittee on Health held a legislative hearing to examine four bills: H.R. Begins at 0:15:55
Transcript
Highlights

Title

Legislative hearing on Medicare coverage of breakthrough devices and cancer screening

Purpose

The House Energy and Commerce Subcommittee on Health held a legislative hearing to examine four bills: H.R. 842, the Nancy Gardner Sewell Medicare Multi-Cancer Early Detection Screening Coverage Act; the Ensuring Patient Access to Critical Breakthrough Products Act, which would create a four-year transitional Medicare coverage pathway for FDA-designated breakthrough devices; a bill reforming Medicare's national and local coverage determination (NCD/LCD) processes; and the Expanding Access to Diabetes Self-Management Training Act. Five witnesses — an industry scientist, a health policy researcher, an innovation-policy analyst, a patient advocate, and a Medicare-beneficiary advocate — testified on the "valley of death" between FDA approval and Medicare coverage, the accuracy of multi-cancer blood tests, and proposed age limits in H.R. 842, while Democrats used the hearing to press concerns about NIH/CDC funding cuts, ACIP changes, and expiring ACA subsidies. Begins at0:15:55

Who spoke

Chairman Morgan Griffith (R-VA), Subcommittee Chair0:15:55: Opened the hearing, summarized all four bills including H.R. 842's multi-cancer screening pathway0:17:18 and the Breakthrough Products Act's response to the "valley of death" between FDA approval and Medicare coverage0:18:40; later voiced concern about H.R. 842's age-67 cutoff1:04:24 and questioned Ezell on false negatives1:05:42 and Brinton on the reconsideration comment process0:20:201:20:53.

Rep. Diana DeGette (D-CO), Ranking Member0:22:00: Argued the committee should be examining Trump administration cuts to NIH, FDA, and CDC rather than "fiddling while Rome burns"0:22:00, citing halted funding for the Pediatric Brain Tumor Consortium0:23:05 and only 4% of NCI grant applications being funded this year0:24:13; later highlighted NIH's ~$2.8 billion contribution to Keytruda's development1:11:47 and pressed witnesses on support for full NCI funding1:13:31.

Rep. Frank Pallone (D-NJ), Full Committee Ranking Member (statement read by Dr. Ruiz)0:29:51: Statement argued Republicans' "big, ugly law" cuts over $1 trillion from health care and strips coverage from 15 million people0:30:46, citing a Georgia hospital closing its maternity unit and enhanced ACA tax credits covering 24.3 million Americans0:31:050:32:30; later, in person, questioned witnesses on the Breakthrough Products Act's effect on CMS's reasonable-and-necessary standard1:35:56 and H.R. 842's age eligibility1:40:01.

Rep. Brett Guthrie (R-KY), Full Committee Chair0:27:11: Praised the committee's prior work on breakthrough technology access0:27:38 and questioned Brinton on Edwards' experience with the TCET pilot pathway1:14:55 and the 510(k) review process1:16:57.

Rep. Raul Ruiz (D-CA), Vice Ranking Member0:29:51: Delivered Pallone's opening statement; later described a Coachella Valley farmworker whose delayed care led to metastatic renal cancer1:25:33 and asked witnesses about the impact of research funding cuts on innovation1:29:19.

Dr. Todd Brinton, Edwards Lifesciences0:36:39: Described Edwards' EVOKE tricuspid valve device going through the TCET pilot, a 13-month process from FDA authorization to coverage0:38:061:15:23; recommended a two-year look-back period, Medicare Advantage parity, and dedicated CMS funding0:39:041:16:30; noted TAVR's NCD still excludes asymptomatic patients despite new supportive data1:22:08.

Stephen Ezell, ITIF0:41:37: Cited over 600,000 cancer deaths annually and 70% of cancer deaths from cancers with no proven screening test0:42:040:43:22; said Medicare will spend $1 trillion on cancer care over the next decade0:42:34; warned China filed as many new drug applications with FDA as the U.S. last year2:10:12 and opposed cutting the NIH budget in half2:11:08.

Roger Royce, patient advocate0:46:53: Described being diagnosed with stage II pancreatic cancer via a 2022 liquid biopsy despite no symptoms, giving him a 44% five-year survival rate versus 4% at stage IV0:47:412:35:37; contrasted his outcome with his brother, who died nine months after a late-stage lymphoma diagnosis0:49:430:50:41.

Dr. Diana Zuckerman, National Center for Health Research0:51:36: Said fewer than 5% of medical devices are tested in clinical trials, with more than 95% cleared via the less-stringent 510(k) pathway0:52:29; found only 5 of roughly 49 "breakthrough" 510(k) devices would likely meet Medicare's reasonable-and-necessary standard0:55:12; cited a study showing one multi-cancer test's positive result was correct only 4% of the time0:56:39 and urged deleting H.R. 842's age restrictions0:58:01.

David Lipschutz, Center for Medicare Advocacy0:58:32: Said his organization has no concerns about the NCD/LCD or diabetes training bills but opposes H.R. 842's age phase-in, which would permanently exclude everyone currently over 650:59:511:40:25; said Medicare Advantage plans are overpaid by at least $84 billion a year per MedPAC due to upcoding1:02:57.

Rep. Marc Molinaro / Rep. Diana Harshbarger (R-TN), Vice Chair0:20:28: Asked Brinton about GAO-identified NCD delays and recommendations to shorten the reconsideration comment period from roughly 9-10 months1:20:531:22:58; asked about gaps in Medicare Advantage coverage of breakthrough therapies1:24:10.

Rep. Buddy Carter (R-GA)1:40:55: Asked Ezell to quantify Medicare savings from earlier cancer detection, citing an estimated $1 trillion decade-long cancer cost and $6.5 trillion in economic gains from past screening expansions1:42:541:43:48.

Rep. Kim Schrier (D-WA),1:46:27: A pediatrician and Type 1 diabetic, discussed her own diabetes training bill1:46:27 and pressed Zuckerman on the risks of false positives leading to unnecessary "cascade" testing1:47:301:48:22; warned of administration cuts to the U.S. Preventive Services Task Force and ACIP downgrading hepatitis B and HPV vaccination1:50:071:51:22.

Rep. Neal Dunn (R-FL)1:52:09: Noted over 1,400 Medicare beneficiaries are diagnosed with advanced cancer daily1:52:09 and asked Ezell whether H.R. 842 appropriately balances speed and safety1:54:24.

Rep. Greg Landsman (D-OH)1:56:28: Argued Republicans are cutting NIH funding while "let[ting] this secretary of health and human services run unchecked"1:56:28; asked Ezell about the impact of cuts on U.S. biomedical leadership relative to China1:57:27; later argued for restoring the $1 trillion in health-care cuts and protecting ACA premium subsidies2:51:19.

Rep. Yvette Herrell (R-NM) [misidentified as "Mr. VC" in transcript]1:56:28: (Note: transcript speaker at this point is ambiguous; see Landsman above.)

Rep. Jake Ellzey / unnamed member questioning on Cowboys screening example1:58:21: Cited Dak Prescott-funded screenings catching an executive's neck cancer early and asked Ezell how H.R. 842 balances patient safety with timely access1:59:49.

Rep. Troy Balderson / Rep. specific to Ohio recognized as subcommittee chair pro tem2:22:24: Asked Brinton why "breakthrough" is the right eligibility criteria2:22:24 and asked Ezell about risks of inaction on MCED coverage2:25:41.

Rep. Dan Crenshaw (R-TX)2:01:41: Pressed Ezell and Zuckerman on federal R&D funding's link to innovation, asked whether cutting NIH funding in half is wise (no)2:11:08, and questioned Brinton about a CMS/DOGE official's alleged conflict of interest with Medicare Advantage insurers2:08:522:09:21.

Rep. John Joyce (R-PA)2:13:05: A physician, asked Brinton about patient-care impact of the "valley of death" delay, noting an average 5.5-year gap between FDA authorization and coverage2:14:31; asked Royce how early detection changed his outcome versus his brother's2:16:31.

Rep. Robin Kelly (D-IL)2:18:08: Noted H.R. 842's leading tests have false-positive rates below 1% and it is the most-endorsed health care bill in Congress2:19:01; criticized Secretary Kennedy's removal of all 17 ACIP members2:21:25.

Rep. Troy Carter (D-LA)2:38:48: Cited 40% of Americans receiving a cancer diagnosis in their lifetime and 600,000 annual deaths2:38:48; asked Ezell about the effect of federal research cuts on U.S. biomedical leadership2:41:26 and Royce about MCED filling screening gaps for cancers like pancreatic2:43:13.

Rep. Jay Obernolte (R-CA)2:44:13: Raised concerns about false positives detecting indolent precancerous lesions that might never progress2:45:20; asked Brinton about AI's potential to improve CMS efficiency2:48:08.

Rep. Lizzie Fletcher (D-TX)2:27:41: Cited Baylor College of Medicine and UT Health layoffs from federal funding cuts and $1.8 billion in canceled NIH grants over nine months2:29:29; asked Ezell about the "brain drain" of scientists leaving the U.S.2:30:37.

Rep. Mariannette Miller-Meeks (R-IA)2:32:53: A physician and H.R. 842 co-author, cited Medicare's projected $1 trillion cancer spending over the next decade2:33:15; asked Royce to compare stage 1 versus stage 4 colorectal cancer survival rates (over 90% versus ~15%)2:35:07.

Rep. Kat Cammack (R-FL)2:54:12: Criticized CMS's slow, "arbitrary" coverage processes2:55:06; asked Ezell how rural communities can gain access to breakthrough technologies, citing the UK's mobile phlebotomy program for the Galleri test2:58:46.

Key moments

Royce testified that his multi-cancer blood test, taken with no symptoms, detected pancreatic cancer at stage II, giving him a 44% five-year survival rate versus 4% at stage IV, while his brother — diagnosed late with lymphoma — died nine months later of a "mostly curable" cancer0:47:410:49:432:35:37.

Zuckerman testified that of roughly 49 "breakthrough" devices cleared via the 510(k) pathway, only 8 were studied in clinical trials, and at most 5 would meet Medicare's reasonable-and-necessary standard for coverage0:54:180:55:33; she cited a study showing one MCED test's positive result was correct only 4% of the time0:56:39.

Lipschutz and Pallone argued H.R. 842's age-based phase-in (coverage starting at 68 in 2028, rising one year annually) means no one currently over 65 would ever become eligible, calling this an arbitrary, cost-driven rather than clinical criterion1:00:151:40:01.

Brinton said the average time from FDA authorization to Medicare coverage is about 5.5 years, and that even after TAVR's NCD was updated in 2019, new England Journal data show asymptomatic patients benefit from earlier treatment but remain uncovered2:14:311:22:08.

Crenshaw pressed Brinton on whether it would concern him that former CMS/DOGE lead Brad Smith simultaneously ran a company backed by Medicare Advantage insurers that received reimbursement increases during his tenure; Brinton said it "raises a lot of red flags"2:08:522:09:21.

Ezell said Chinese applicants filed as many new drug applications with the FDA as U.S. companies for the first time last year, and China's share of global biopharmaceutical value has grown fourfold in 20 years, while opposing proposed 50% cuts to NIH funding2:10:122:11:08.

DeGette and Ruiz repeatedly tied support for H.R. 842 to opposition to administration cuts, citing halted Pediatric Brain Tumor Consortium funding, only 4% of NCI grant applications funded this fiscal year, and Secretary Kennedy directing endorsement of "ideological" ACIP recommendations0:23:050:24:130:24:40.

Lipschutz cited MedPAC data showing Medicare Advantage plans are overpaid by at least $84 billion annually due to upcoding and a flawed quality bonus program1:02:57.

Obernolte raised the unresolved question of whether MCED tests might detect indolent, never-progressing "precancerous" lesions as false positives, a concern Ezell and Brinton both deferred to clinicians to resolve2:44:532:46:59.

Schrier warned that ACIP was simultaneously meeting to restrict childhood vaccines, including disparaging hepatitis B vaccination for newborns, and that the administration proposed eliminating the CDC's National Diabetes Prevention Program1:50:360:25:45.

Metadata

CommitteeHouse Energy and Commerce Subcommittee on Health
Chamber / CongressHouse · 119th Congress
Date2025-09-18
TypeHearing
Witnesses
Mr. Roger Royse — Patient Advocate and Partner, Haynes and Boone, LLP
Dr. Diana Zuckerman — President, National Center for Health Research
Dr. Todd Brinton — Corporate Vice President, Advanced Technology, and Chief Scientific Officer, Edwards Lifesciences
Mr. David Lipschutz — Co-Director of Law and Policy, Center for Medicare Advocacy
Mr. Stephen Ezell — Vice President, Global Innovation Policy, and Director, Center for Life Sciences Innovation, Information Technology and Innovation Foundation
Videoyoutube
Transcript378 caption blocks · 26,758 words · 3:00:53 runtime
EventCongress.gov 118632