HR-8749-119
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Sponsored by Maxwell Frost (D-FL)
What it does
This bill would add a new category of Medicare coverage called "home resiliency services" for beneficiaries who are determined to be medically at-risk during a climate or manmade disaster. Covered items would include heat pumps, batteries for medical equipment, and energy-efficient storage for medical supplies. Coverage would be limited to cases where these services are deemed medically necessary.
Who benefits
Medicare beneficiaries (primarily adults 65 and older, plus younger people with qualifying disabilities) who are medically at-risk during disasters — such as those dependent on powered medical equipment like ventilators, oxygen concentrators, or refrigerated medications. Manufacturers and retailers of heat pumps, batteries, and energy storage equipment who would gain a new federally reimbursed customer base. Home health and durable medical equipment suppliers who may administer or install covered items. Caregivers and family members of at-risk beneficiaries who would have greater assurance of continuity of care during emergencies.
Who is hurt
Medicare trust funds and federal taxpayers, who would bear the cost of the new benefit category. Private insurers and Medigap plan providers, who may face pressure to offer comparable coverage. Medicare beneficiaries who are not classified as "medically at-risk" and would not qualify, potentially creating disparities in access. Competing durable medical equipment suppliers not positioned to provide the newly covered items, who may face market displacement.
Supporters argue
Supporters argue that medically vulnerable Medicare beneficiaries — such as those relying on powered ventilators, oxygen equipment, or refrigerated insulin — face life-threatening risks during power outages caused by hurricanes, wildfires, and extreme heat events, which are increasing in frequency. They contend that covering home resiliency equipment is a logical extension of Medicare's existing durable medical equipment benefit, preventing costly emergency hospitalizations and deaths that occur when at-risk patients lose access to essential medical technology during disasters.
Opponents argue
Opponents argue that Medicare was designed to cover direct medical treatment, not home infrastructure improvements like heat pumps and energy storage systems, and that expanding it to cover such equipment sets a broad precedent that could significantly increase program costs. They contend that disaster preparedness is primarily a state and local responsibility, and that federal funding for home equipment upgrades — even for at-risk patients — is better addressed through FEMA, HUD weatherization programs, or targeted grants rather than by expanding an already financially strained entitlement program.
Constitutional context
Congress has broad authority to create and modify Medicare under the Taxing and Spending Clause (Art. I, §8, cl. 1), which permits spending for the general welfare. NFIB v. Sebelius (2012) affirmed Congress's wide latitude to structure benefit programs, though post-Loper Bright (2024), any agency rules implementing the new "medically at-risk" or "medically necessary" determinations would face independent judicial scrutiny rather than automatic deference.
Checks and balances
Congress would expand Medicare's benefit categories; HHS and CMS would gain authority to define "medically at-risk" and "medically necessary" for disaster-related equipment, subject to independent judicial review under Loper Bright.
Historical precedent
Medicare's existing durable medical equipment (DME) benefit covers powered wheelchairs, home oxygen, and ventilators for medically necessary use, but no prior federal law has extended Medicare coverage to home energy infrastructure such as heat pumps or battery storage systems.