When Cost-Cutting Threatens Care: The Fight Over Medicare's Supply Bidding

MOUNT LAUREL TOWNSHIP, N.J. – October 28, 2026 — For most Americans, the intricate mechanics of Medicare procurement policy are a distant abstraction. But for the millions of individuals living with an ostomy or managing urinary dysfunction, these bureaucratic decisions dictate the very boundaries of their daily lives. The deeply personal nature of this care has now collided with federal cost-cutting measures, prompting a fierce pushback from frontline healthcare workers and a bipartisan coalition in Congress.

Today, the Wound, Ostomy, and Continence Nurses Society (WOCN) formally threw its considerable weight behind the Access to Medical Supplies Act (H.R. 10787). The legislation, introduced earlier this month by Representatives Greg Murphy, M.D. (R-NC), and Brad Schneider (D-IL), aims to hit the brakes on a controversial Centers for Medicare & Medicaid Services (CMS) rule. That rule, finalized in November 2025, mandates that ostomy and urological supplies be folded into Medicare's Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program starting in January 2028.

The proposed legislation would carve out a five-year exclusion for these specific items, delaying their inclusion until at least December 31, 2032. More importantly, it mandates the creation of a technical expert panel and a demonstration project to study exactly what happens when highly individualized medical supplies are subjected to a lowest-bidder procurement model.

The Quality vs. Cost Conundrum

At the heart of this legislative battle is a fundamental disagreement over the nature of the products in question. CMS views ostomy pouches, skin barriers, and urinary catheters as "medical equipment items" suitable for commoditization. The agency's competitive bidding programs are historically designed to protect the Medicare Trust Funds and lower beneficiary copays by awarding regional or national contracts to suppliers who can offer the lowest prices.

However, specialized nurses and patient advocates argue that this approach fundamentally misunderstands the clinical reality of continence care. These are not one-size-fits-all commodities like standard walkers or basic bandages. A poorly fitting ostomy appliance doesn't just cause discomfort; it leads to severe skin breakdown, dangerous infections, and a loss of personal independence.

"Nurses see firsthand how access to the right supplies affects a patient's health, independence, and daily life," said Christine Berke, MSN, APRN-NP, AGPCNP-BC, CWOCN-AP, WOCN Society President. "We have spent years educating policymakers about the clinical needs of the patients who rely on these products. This legislation represents an important step toward protecting their access, and we urge our members to help Congress understand why these protections matter."

Advocacy groups have consistently argued that these supplies functionally act as prosthetic devices—restoring a lost bodily function—rather than standard durable medical equipment. By restricting the pool of available products and vendors, clinicians fear that patients will be forced to use substandard or ill-fitting alternatives, ultimately driving up healthcare costs through preventable emergency room visits and hospital readmissions.

At-Home Care and the Threat of Market Consolidation

The financial mechanics of the upcoming CMS rollout further complicate the landscape. The 2028 bidding round for these supplies is structured as a National Remote Item Delivery (RID) program. CMS estimates it will award contracts to approximately eight national suppliers for the entire country's urological and ostomy needs.

This aggressive market consolidation threatens to decimate the ecosystem of local, specialized suppliers who currently guide patients through the overwhelming process of product selection. A recent industry survey revealed that nearly half of all current durable medical equipment suppliers face significant business viability risks under the RID model. For many small-to-medium businesses, ostomy and urological supplies represent up to half of their revenue. If they fail to secure one of the few national contracts, widespread closures and layoffs are imminent.

Historical data from previous competitive bidding rounds offers a cautionary tale. When CMS applied competitive bidding to diabetes testing supplies, payment rates plummeted by roughly 50 percent. While this achieved the agency's goal of reducing upfront Medicare spending, independent analyses painted a troubling picture of the aftermath. Some academic studies tracking the diabetes supply rollout observed disrupted access, reduced utilization of necessary testing strips, and a doubling of inpatient hospital admissions among affected beneficiaries. Government watchdog reports have also previously criticized internal monitoring methods for failing to adequately track whether beneficiaries actually received needed equipment on time or if their health outcomes deteriorated.

Bipartisan Pushback on Bureaucratic Rulemaking

The introduction of H.R. 10787 represents a rare moment of bipartisan consensus, uniting lawmakers across the aisle against executive branch rulemaking that they argue prioritizes short-term ledger balancing over long-term patient stability.

Partnering organizations have quickly rallied behind the bill, recognizing the immediate threat to their patients' quality of life. The Society of Urologic Nurses and Associates (SUNA), which represents professionals caring for patients with urologic conditions across the lifespan, has joined the national nursing community in a vocal campaign to secure congressional cosponsors.

"SUNA members care for the patients who rely on urinary catheters and ostomy supplies every day, and we see what is at stake when access to the right product is put at risk," said Nicole Zhang, PhD, RN, FAUNA, President of the Society of Urologic Nurses and Associates (SUNA). "For our patients, the right supply is not a preference. It is what keeps them independent, out of the emergency department, and living their lives. SUNA stands with WOCN in urging Congress to cosponsor H.R.10787, so that access to clinically appropriate urological and ostomy supplies is protected while the evidence is gathered."

The legislation effectively demands that CMS prove its case before dismantling the current supply chain. By requiring a demonstration project and a specialized technical panel, the bill shifts the burden of proof back onto the regulatory agency, forcing a comprehensive evaluation of clinical outcomes rather than just projected financial savings.

Measuring the True Cost of Care

As the debate moves through the halls of the Capitol, it highlights a persistent tension in American healthcare policy: the friction between macroeconomic cost-efficiency and the microscopic, deeply human realities of patient care.

Federal efforts to rein in Medicare spending are undeniably necessary as the population ages. Yet, the strategy of applying bulk-purchasing logic to highly sensitive, individualized medical necessities exposes a critical flaw in how we calculate healthcare costs. If saving pennies on a specialized catheter results in a severe urinary tract infection that requires a multi-day hospital stay, the system has not saved money; it has merely shifted the financial burden to a more expensive, more dangerous setting.

For the millions of aging and disabled Americans relying on these essential daily supplies, the outcome of this legislative standoff will determine far more than their monthly copays. It will dictate their ability to leave their homes with confidence, maintain their dignity, and participate fully in their communities without the looming fear of a catastrophic medical complication. The Access to Medical Supplies Act asks lawmakers to pause and consider whether the pursuit of a lower bid is worth the ultimate cost to patient well-being.