Nearly 20 years ago, I had the privilege of working alongside lawmakers, health experts, and patient advocates to help pass one of the most consequential reforms to Medicare in its history: the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.
That law was built on the simple, but powerful, principle that Medicare should empower seniors to access the best available care, not settle for less. I am proud of that work. Which is why I am deeply concerned about what the Centers for Medicare and Medicaid Services is proposing today.
The CMS has put forward a coverage framework for colorectal cancer screening tests that, while well-intentioned, sets the bar in the wrong place. The proposed performance thresholds focus primarily on whether a test can detect cancer after it has already developed. What they fail to meaningfully account for is whether a test can find the precancerous polyps that cause cancer in the first place. That is where the real opportunity to save lives lies.
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This distinction matters enormously. The evidence proves that the long-term mortality benefit from colorectal cancer screening comes not from catching cancer early, but from finding and removing precancerous lesions before they ever become cancer. A coverage standard that ignores this reality is a coverage standard that accepts more cancer deaths among Medicare beneficiaries. That should be unacceptable to everyone.
Consider a simple analogy. Imagine two smoke detectors, one alerts you when your house is already engulfed in flames, and the other detects the first wisp of smoke before the fire starts. While both technically detect fire, only one saves your home. The CMS is proposing to cover both detectors equally, even though one gives seniors a fighting chance and the other may simply confirm that the damage is already done.
I have spent decades fighting for Medicare to work better for the seniors who depend on it. I have seen firsthand how coverage decisions made in Washington ripple out to affect real people managing serious diagnoses, navigating complex treatment decisions, and counting on their government to point them toward the most effective care available. This proposed rule does not do that.
I am also a strong supporter of the Trump administration’s commitment to rooting out waste and inefficiency in Medicare. Administrator Mehmet Oz has shown real leadership in pushing the CMS to think more critically about what it covers and why. But covering screening tests that are largely blind to precancer, while equivalent or superior alternatives exist, is not a path to greater efficiency. It is a path to worse patient outcomes down the road, when cancers that could have been prevented must instead be treated. Medicare must invest in prevention today, not advanced cancer treatment for America’s seniors tomorrow.
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The good news is that the CMS can get this right. The fix is straightforward: Coverage standards should require that any screening test, regardless of the underlying technology, demonstrate it can detect advanced precancerous lesions, not just cancer. This is a technology-neutral standard that rewards genuine performance and ensures Medicare dollars are directed toward tests that deliver the greatest preventive benefit for seniors.
The stakes here are straightforward. Medicare’s promise to seniors is not just to find disease, but to help prevent it. The CMS has an opportunity to honor that promise by setting coverage standards that reflect the full body of scientific evidence and demand the highest level of preventive performance from every test seeking Medicare reimbursement. I helped build this program to protect seniors. I hope the CMS will rise to that standard.
Jim Martin is the founder and chairman of the 60 Plus Association, the American Association of Senior Citizens.