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Editor's Note: The House released a merge version of the "Affordable Healthcare for America Act," HR 3962, last week. Debate on the bill may begin as soon as Nov. 5.
Every parent traveling with a child in the car knows the first question that is going to come out of their mouth: Are we there yet? The same could be asked about healthcare reform. Are we there yet? While the debate seems to drag on endlessly, we are getting closer.
The Senate Finance Committee recently passed its version of healthcare reform-the last of the five health panels to do so. Congressional leaders are hoping to build on this momentum and move forward with final votes in the House and Senate within the next month. This may be ambitious given the difficult compromises still remaining. Congressional leaders realize, however, that time is not on their side. The longer it takes to broker a deal, the more time opponents have to derail the legislation.
Still to be resolved are 'hot button' issues, such as whether to include a public insurance option, whether or not to require individuals to purchase health coverage or be subject to fines, and the amount to tax small businesses that don't insure their employees. Each of these issues, and many others, need to be addressed before a bill can be passed. Plus, now that the parameters of a final package are becoming more apparent, each health sector, including clinical laboratories, is evaluating the various options under consideration and their potential impact.
The Bright Side
The basic health package that is emerging in the House and Senate is generally favorable to clinical laboratories. The expectation is that an increase in the number of insured will translate into an increase in overall testing, particularly since laboratory services will be part of any minimum benefits package that insurers will be required to offer. Also, the emphasis on preventive testing is likely to lead to increases in cholesterol and diabetes testing and other services recommended by the United States Preventive Services Task Force.
Also of interest to clinical laboratories is the emphasis on comparative effectiveness research (CER). This evidence-based approach can play a key role in assisting healthcare professionals to evaluate which tests or methods are most appropriate for specific health conditions and subpopulations. Researchers may also use laboratory testing as a means of evaluating various treatment options, thereby further highlighting the value of laboratory testing.
On the Other Hand.
The downside for clinical laboratories is that any final agreement is going to include cuts in laboratory payments. It appears that laboratories will face two cuts in their consumer price index (CPI) update-one permanent and one for a set period of time. The first is a reduction in the Update by a 'productivity factor,' which is expected to average between 1.1 - 1.4 percent over the next few years. This, in conjunction with a cut of 1.75 percent in each of the next five years, brings the laboratory contribution for reform to $10 billion over ten years.
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