Congressional Black Caucus demands briefing over Medicare changes

Originally published in The Hill.

The Congressional Black Caucus (CBC) is calling for an immediate halt to new policy changes from the Centers for Medicare and Medicaid Services (CMS) that it says will disproportionately affect Black and brown Americans. 

In a letter sent to the CMS and the Department of Health and Human Services, Rep. Steven Horsford (D-Nev.) addressed a March decision made by the Molecular Diagnostic Services Program (MolDX) that restricts access to noninvasive post-transplant testing for patients with a heart, lung or kidney transplant.

MolDX said the change, known as a billing article, went into effect after it became aware of improper billing and over-utilization of the tests.

But Horsford, the CBC chair, said there is an “urgent concern” for how this change will impact patients of color.

“As a result of this change, thousands of Black and Brown individuals covered by Medicare who have received an organ transplant but are not currently having clinical signs of rejection are no longer able to regularly access a non-invasive blood test able to detect rejection months in advance,” Horsford said in his letter. 

The policy change, he added, “disproportionately impacts transplant recipients in minority, marginalized, and under-resourced populations — exacerbating racial disparities that have long impacted these communities and contradicting this Administration’s commitment to health equity.” 

Horsford pointed to statistics that show Black individuals are four times more likely to develop kidney failure than white people but less likely to receive a kidney transplant. Black Americans also experience the highest rates of heart failure but receive heart transplants at lower rates than white individuals.

These disparities have been labeled as “tragic inequities” by the Association of American Medical Colleges. 

“Against this backdrop, the March 2023 MolDX coverage decision has forced many marginalized patients lucky enough to receive a lifesaving transplant to live with the fear of not knowing if these organs will be rejected by their immune systems and that, if they are, it may be too late to save them,” Horsford wrote.

Now, Horsford and the CBC are calling for an immediate briefing on the topic, demanding that billing article be immediately rescinded and asking that no further policy changes be made without input from Congress, clinicians and the transplant community. 

“This abrupt change in policy is a step backwards for health equity, with potentially fatal consequences for organ recipients — many of them low-income and underserved patients,” said Horsford. 

He added that the Biden administration has made a commitment to addressing racial disparities in the healthcare system, and the CBC stands with that mission. 

“All of us sit in government because we believe a better future is possible in which the children and grandchildren of our constituents have fair access to care,” wrote Horsford. 

The CBC is not the only leading Black organization to express concern over the Medicare change. 

In November, the Rev. Al Sharpton partnered with musician Al B. Sure! to launch a new health equity coalition to combat the policy change. 

“These blood tests are especially important to transplant patients in the Black, Hispanic, Latino, and underserved transplant communities,” said the musician, who received a life-saving liver transplant in summer 2022. 

The issue has also become a larger bipartisan concern in Congress. 

Last August, 14 members of the House, led by Reps. Anna Eshoo (D-Calif.) and Michael Burgess (R-Texas), signed a letter expressing concerns about the rollbacks. A follow-up letter was sent in October. 

CMS confirmed it received Horsford’s letter and would respond.