Archibald: Medicare For All Could Mean Medical Delays For All

By Janan Archibald, NH Journal

Over 10 years ago, I traveled to Washington with diabetes advocates to ask New Hampshire’s congressional delegation to pass the Medicare CGM Access Act. I went because it was personal. This device saves lives.

A CGM, or continuous glucose monitor, is a small sensor worn on the body. It tracks blood sugar around the clock and sounds an alarm when it falls dangerously low, including in the middle of the night, when a person with type 1 diabetes may not wake up on their own. I believe that alarm saved my family member’s life more than once.

At the time, our CGM was covered by private insurance. Private insurers had recognized its value years earlier. Medicare had not. A person with type 1 diabetes who relied on a CGM through an employer plan could lose it the day they turned 65, just as the risk of severe low blood sugar tends to rise.

The reason was not that the device didn’t work. Medicare ruled that early CGMs did not fit its legal definition of medical equipment because users still had to confirm readings with a fingerstick. The first real-time CGMs were approved by the Food and Drug Administration in 2006. Medicare did not cover them until 2017, more than a decade later. Medicare’s own process was not moving, so Congress had to step in. Sens. Susan Collins and Jeanne Shaheen introduced a bipartisan bill to push Medicare to cover CGMs. It took that bill, years of advocacy, and families like mine walking the halls of Congress before Medicare changed course.

We will never know how many seniors had a dangerous low during those years with no alarm to warn them. That is part of the problem.

And the waiting continues. This month, the New England Journal of Medicine published a large clinical trial showing CGMs help people with type 2 diabetes who don’t take insulin. Some private insurers have already started covering CGMs for these patients. Medicare still doesn’t cover them for most, and the companies that make the devices are still waiting on a decision.

What my family learned is that when Medicare said no, we still had options. Private insurance had already said yes. That coverage kept the device in our hands, and it gave advocates proof to bring to Washington. Patients and doctors could point to families like mine and ask Medicare why it was falling behind. Having more than one decision-maker is what eventually moved the one that was stuck.

That is why I worry about putting every coverage decision in one place.

Here in New Hampshire’s First Congressional District, Stefany Shaheen is running for Congress on a promise of Medicare for All, a single government plan that would replace private insurance. She knows this fight personally. Shaheen openly discusses the advocacy she has done for her daughter who has type 1 diabetes. We have both seen how hard it can be for patients to get the care they need, and private insurers have real shortcomings of their own: denials, prior authorizations, and paperwork that wears families down. But our experiences have led us to different answers. Hers is to put one government program in charge of everyone’s coverage. Mine is that the agency that made families wait more than a decade should not be the only one deciding.

In the CGM story, private insurers went first. Under Medicare for All, that check would largely disappear. When the next breakthrough arrives, nearly every patient would be waiting on the same agency’s answer. If that answer is no, or not yet, patients would have far fewer places to turn.

This question is bigger than one candidate or one election. It is not whether Medicare has made mistakes. Every insurer has. It is whether taking a system with a documented history of delays and making it the only system would turn those delays into everyone’s delays.

That matters more today than ever. Artificial intelligence is helping researchers discover new drugs, design new devices, and detect disease earlier. Advances that once took decades may soon arrive in a few years. Medicare’s coverage process was not built for that pace. Despite recent incremental improvements, it still moves too slowly to keep up with new technology, so Congress has had to keep pushing it along. It should not take an act of Congress every time Medicare needs to cover something new. Under Medicare for All, every American’s access to new treatments would depend on that same slow process.

Disease does not wait for rulemaking. Neither do the people living with it. Before we put every coverage decision in the hands of one agency, we should remember the families who waited more than a decade for Medicare to say yes and ask who will be waiting next.

Janan Archibald is a Republican activist who lives in Kensington. She wrote this for NHJournal.com.

This story was originally published by the NH Journal, an online news publication dedicated to providing fair, unbiased reporting on, and analysis of, political news of interest to New Hampshire. For more stories from the NH Journal, visit NHJournal.com.