The fight for healthcare justice in America has recently experienced another setback as a result of the senior official for Medicare evading questioning from members of Congress.
Late in April, Chiquita Brooks-LaSure, the administrator of the Centers for Medicare and Medicaid Services (CMS), testified before the House Energy and Commerce Committee’s Health Subcommittee to explain why the Medicare program rejected a request to fully cover a recently approved Alzheimer’s therapy that had been shown to slow the progression of the disease.
Medicare’s Role in Perpetuating Privilege
It should come as no surprise that many who support Alzheimer’s have vehemently opposed the decision.
Elderly people in rural regions and communities of color who are living with early-onset Alzheimer’s are disproportionately harmed by the regulatory strategy used by Medicare.
A little-known regulatory method called coverage with evidence development, or CED, is at the heart of the Alzheimer’s verdict. Except for therapies delivered in a very tightly constructed clinical research, Medicare does not pay reimbursement for products or services that have received FDA approval under CED.
Ironically, CMS, not Congress, established the CED designation in 2005 to facilitate faster patient access to some of the most recent medical device treatments. But recently, CMS has exploited CED by using it to ration senior care.
There are currently 22 various therapies needing CED, including procedures for sickle cell disease, treatments for colorectal cancer, and even cochlear implants for individuals with hearing loss.
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Impact of CED on Underserved Populations
The agency’s misuse of the CED paradigm is problematic, however, because it disproportionately affects communities of color and other underserved populations.
First, keep in mind that many of the treatments that become stuck in CED limbo are for diseases that disproportionately affect minorities.
For instance, Black Americans are more likely to have the genetic disorder sickle cell anemia. In contrast, Black people have a 1.5–2 times higher risk of developing Alzheimer’s disease than White people.
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