Clinical laboratories and the shape of Medicare reform

July 1, 2003

This year has been, and will continue to be, a very busy one for legislators in our nations capital. There are many international and domestic issues on the congressional agenda, ranging from the Middle East and the war on terrorism to a stalled economy and a growing budget deficit. Add to this mix the upcoming presidential campaign and congressional elections, and what you have is a very short window of opportunity for legislative action on key policy initiatives. Now that tax relief is out of the way, the focus will be on developing a comprehensive Medicare prescription drug and reform bill.

The fight over the shape of the Medicare package will be intense as Republicans seek to expand the role of the private sector in the management and delivery of health services, while the Democrats argue for greater government involvement and a more generous benefits package. Most of these issues will be beyond the scope of the laboratory communitys interest or expertise, but parts of the debate will engage laboratory-related professional associations and commercial concerns.

Foremost to American Association for Clinical Chemistry (AACC) and the Clinical Laboratory Coalition (an ad hoc coalition of laboratory and industry groups and manufacturers) will be legislative efforts to cut laboratory reimbursement. At one point, the recent tax bill that was enacted included a 20% Medicare copayment and deductible for laboratory services. Although this provision was later removed, there is a real danger that it could re-emerge as one of the ways to pay for the larger Medicare package. The adoption of a copay would significantly increase laboratories costs and burden associated Medicare patients.

Other laboratory payment issues that could arise include competitive bidding for laboratory services or a reduction in the laboratory consumer price index, or CPI, update. These items, along with copayment, are always on the table when Congress is looking to cut reimbursements to its providers. AACC urges you to monitor the progress of this legislation through your various associations and publications and, if these provisions or others arise, to contact your congressional representatives to voice your opinion on these matters. To find your congressional representatives, use the congressional website, THOMAS, at and select either the House or Senate directories. Then select your representatives offices and send them messages opposing these measures.

The comprehensive nature of the package is likely to mean that there will be other items of interest to the laboratory community in the bill, since legislators will also try to use this bill to enact other healthcare initiatives. Among the more positive items that could be included are: contractor reform; a voluntary national reporting system for medical errors; expanded coverage for preventive testing (possibly cholesterol and diabetes); and provisions streamlining the regulatory review process for new medical technologies, among others.

Congress hopes to complete action on this legislation by the July recess. This means that lawmakers in the House and Senate will need to work quickly in drafting and passing their bills. The challenge in the Senate will be to pass a bill with strong bipartisan support, since a filibuster is always a potential threat in this closely divided chamber. Then, assuming the House passes its version of the measure, the two bodies will need to work out a compromise, which may not be an easy task, before it can go to the President. If Congress fails to reach agreement this summer, the chances of enacting a prescription drug benefit will become far more remote. At press time, the congressional panels are only just beginning to do their work. Although it is an ambitious time frame, an impending election can be a strong force for swiftness.

There are a number of websites where you can get updates on the progress of the Medicare package as it goes though the legislative process, such as:

If you have any questions or need additional information, you can reach me at (202) 835-8721 or e-mail me at [email protected]. l

Vince Stine is AACCs director for government affairs.He is responsible for the associations legislative and regulatory activities, as well as drafting the monthly Government Affairs Update. Prior to joining AACC, Mr. Stine worked four years on Capitol Hill as a legislative aide.

As has been the history of MLOs Washington Report, this space will be
devoted in 2003 to keeping readers abreast of ongoing issues and new legislation affecting the clinical laboratory and its professional managers and technicians. If there is a particular legislative question or a legislative topic of special interest to your organization, please e-mail:
[email protected].

2003: Vol. 35, No. 7

© 2003 Nelson Publishing, Inc. All rights reserved.