Possible Medicare Lab Fee In Health Bill Sees Criticism
13 Agosto 2009 - 2:30PM
Dow Jones News
A proposal under consideration by a Senate panel to impose a
co-pay fee for common medical lab procedures has aroused protest
from laboratory industry groups and the nation's top seniors'
group, which argue that it would amount to a cut in Medicare
services.
The groups say that the Senate Finance Committee is discussing a
proposal to raise $23 billion to help pay for a broad health-care
legislation through a 20% co-insurance fee for laboratory
procedures undergone by Medicare beneficiaries.
Lab tests help diagnose and track a broad range of health
problems, from high cholesterol to diabetes to kidney problems. The
small co-pay for patients receiving the tests could be as low as $2
for some tests under the co-pay proposal, but laboratory companies
suggest the co-payments would also be expensive to collect from
patients.
A bipartisan group of six Finance Committee members is currently
negotiating the bill, which is considered a key piece of the
efforts from Congress and the White House to expand health
insurance coverage. If the Finance panel included the co-pay
proposal as part of a larger health-care bill, political fallout
from floating the co-pay fee could be heavy.
A July 31 letter signed by more than two dozen companies and
groups, including divisions of Roche Holding AG (RHHBY) and Siemens
AG (SI), as well as Quest Diagnostics Inc. (DGX), sounded alarms
about the proposal that cite its effect on Medicare
beneficiaries.
"The result of this proposed policy is not a cost savings to our
health care system, but rather, a staggering new $23 billion cost
shift to seniors," the letter states.
AARP, the nation's largest advocacy group for older people, has
also registered concerns. David Certner, legal counsel and
legislative policy director for the group, indicated that the AARP
would oppose legislation that included the co-pay proposal.
"While we are supportive of some of some of the savings they're
trying to get from the Medicare program...we have told them that we
cannot support a bill that basically cuts benefits for our
beneficiaries," Certner said. "Any additional co-payment on
services would be considered a cutback in benefits."
Sen. Kent Conrad, D-N.D., in July said that the co-pay proposal
is "on the table" in the committee's discussions, but a committee
aide said Wednesday that members of the Finance panel "are still
discussing a wide range of provisions and have not finalized or
agreed to any policies or scores."
Medicare is the country's largest purchaser of clinical
laboratory services and paid $7.1 billion for lab tests in 2008.
The co-pay would represent a major step by the federal government
to reduce the costs of lab services, which rose an average of 9%
between 1999 and 2006.
Many services under Medicare Part B, which covers doctors'
visits and medical equipment, are already subject to a 20% co-pay
requirement. The Congressional Budget Office in a December 2008
report said that one rationale for imposing a lab co-pay is that it
"would make cost-sharing requirements under [Medicare Part B] more
uniform and therefore easier for enrollees to understand."
The CBO report also suggested that some Medicare beneficiaries
"might be less likely to request or undergo laboratory tests of
little expected benefit if they had to pay part of the costs
themselves." If fewer tests were ordered, Medicare's costs for the
procedures would presumably fall or at least grow at a less
staggering rate.
But Alan Mertz, president of the American Clinical Laboratory
Association, argued that unlike consumers deciding between generic
and brand-name pharmaceutical drugs, patients told to get lab tests
have little choice but to receive the tests.
"I've never been to a doctor where they say, 'Let's go over
which test you need,'" Mertz said.
And some industry observers say that, proportionally, lab
companies would be harder hit than other medical sectors that
negotiated cost-cutting initiatives with the Senate Finance
panel.
"I think it goes beyond fair and reasonable if you look at
comparable deals by the hospital groups and [pharmaceutical
companies]," said Ipsita Smolinski, a senior analyst at Capitol
Street in Washington, which advises investors.
-By Patrick Yoest, Dow Jones Newswires; 202-862-3554;
patrick.yoest@dowjones.com