Bill Overview
Title: Saving Access to Laboratory Services Act
Description: This bill modifies provisions relating to Medicare payment rates for clinical diagnostic laboratory services, including by requiring payment rates for certain widely available clinical diagnostic laboratory tests to be based on a statistical sampling of private sector rates.
Sponsors: Rep. Pascrell, Bill, Jr. [D-NJ-9]
Target Audience
Population: Medicare beneficiaries
Estimated Size: 64000000
- The bill pertains specifically to Medicare, a national health insurance program in the United States.
- Medicare primarily serves individuals who are 65 or older, younger people with disabilities, and individuals with End Stage Renal Disease (ESRD).
- Clinical diagnostic laboratory services are essential for diagnosing diseases and are utilized widely by Medicare beneficiaries to manage and monitor health conditions.
- Adjustments in payment rates for lab tests can impact access to testing services for Medicare beneficiaries, influencing healthcare outcomes.
- The number of Medicare beneficiaries is approximately 64 million as of 2023.
Reasoning
- The budget constraint of $150,000,000 for year 1 and $1,680,000,000 over 10 years means that the policy can be expected to make a significant impact on costs associated with Medicare’s clinical diagnostic lab services.
- The policy primarily affects Medicare enrollees, who are generally older adults, adults with disabilities, or individuals with specific life-threatening conditions like ESRD.
- Simulated interviews will include people mostly aged 65 and above, given the demographics of Medicare users.
- Various impacts, from high to none, will be simulated to encompass different scenarios intercepted by the policy.
- Medicare’s effect on personal finances and access to health services means that any changes to coverage or payment strategies can have substantial effects on wellbeing, both financial and personal health. Thus, the simulation focuses on these aspects of wellbeing before and after the policy.
Simulated Interviews
Retired (Florida)
Age: 68 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 20.0 years
Commonness: 15/20
Statement of Opinion:
- I think any changes to how Medicare handles payments for lab tests can be worrying, but if this helps reduce out-of-pocket costs, I am all for it.
- Lab tests are a constant part of my life due to diabetes management, so affordability matters a lot.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 8 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 8 | 4 |
Retired factory worker (Ohio)
Age: 74 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 5.0 years
Commonness: 14/20
Statement of Opinion:
- I am concerned about making ends meet with my medical expenses, so anything that helps reduce costs would help.
- The policy sounds beneficial if it adjusts rates to be more reasonable.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 5 | 4 |
| Year 3 | 5 | 3 |
| Year 5 | 5 | 3 |
| Year 10 | 4 | 3 |
| Year 20 | 4 | 2 |
Retired teacher (California)
Age: 82 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 10.0 years
Commonness: 12/20
Statement of Opinion:
- I hope the changes make necessary health services more accessible for people my age.
- Affordability and the ability to get timely tests are crucial.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 5 |
| Year 5 | 8 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 7 | 4 |
Artist (New York)
Age: 58 | Gender: other
Wellbeing Before Policy: 5
Duration of Impact: 20.0 years
Commonness: 10/20
Statement of Opinion:
- As someone relying on Medicare, it’s important the payments are fair because I am constantly in and out of the hospital.
- I support anything that keeps healthcare costs down.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 4 |
| Year 10 | 7 | 3 |
| Year 20 | 6 | 3 |
Retired engineer (Texas)
Age: 60 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 15.0 years
Commonness: 13/20
Statement of Opinion:
- I am going for regular tests for my kidneys, so precise rates are important.
- Policy changes should reflect real market values to avoid discrepancies in charges.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 8 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 7 | 4 |
Retired (Georgia)
Age: 66 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 11/20
Statement of Opinion:
- As a retiree paying for frequent lab work, keeping costs down will help me maintain my care routines.
- I think statistically sampling private sector rates will ensure fairness.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 4 |
| Year 10 | 7 | 4 |
| Year 20 | 6 | 3 |
Retired technician (Michigan)
Age: 70 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 3.0 years
Commonness: 10/20
Statement of Opinion:
- I’ve been able to manage my condition with regular treatments and tests, and I think consistent fees are critical.
- Changes in rates need careful consideration.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 6 | 6 |
| Year 3 | 6 | 5 |
| Year 5 | 6 | 5 |
| Year 10 | 6 | 5 |
| Year 20 | 5 | 4 |
Disabled (Illinois)
Age: 59 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 8.0 years
Commonness: 11/20
Statement of Opinion:
- Managing my condition is heavily dependent on test results; thus, affordable access is crucial.
- Appropriate survey of private rates for tests is a good approach.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 5 | 4 |
| Year 3 | 5 | 4 |
| Year 5 | 6 | 4 |
| Year 10 | 6 | 3 |
| Year 20 | 5 | 3 |
Retired accountant (Colorado)
Age: 72 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 5.0 years
Commonness: 12/20
Statement of Opinion:
- Not looking forward to any increase in costs, but change is crucial if implemented well.
- Any reasonable reduction is a step in the right direction.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 5 |
| Year 2 | 5 | 4 |
| Year 3 | 5 | 4 |
| Year 5 | 5 | 4 |
| Year 10 | 5 | 4 |
| Year 20 | 5 | 3 |
Retired lawyer (Washington)
Age: 68 | Gender: male
Wellbeing Before Policy: 7
Duration of Impact: 10.0 years
Commonness: 11/20
Statement of Opinion:
- Ensuring lab tests are affordable is crucial for my ongoing health checks.
- I support private sector rate sampling to bring parity.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 8 | 7 |
| Year 3 | 8 | 7 |
| Year 5 | 8 | 6 |
| Year 10 | 8 | 6 |
| Year 20 | 7 | 5 |
Cost Estimates
Year 1: $150000000 (Low: $100000000, High: $200000000)
Year 2: $155000000 (Low: $105000000, High: $205000000)
Year 3: $160000000 (Low: $110000000, High: $210000000)
Year 5: $170000000 (Low: $115000000, High: $220000000)
Year 10: $180000000 (Low: $120000000, High: $230000000)
Year 100: $250000000 (Low: $200000000, High: $300000000)
Key Considerations
- The balance between increasing payment rates to meet market levels and maintaining the sustainability of Medicare expenses.
- Impact on beneficiaries who rely on clinical diagnostic tests and the potential effects on their healthcare outcomes.
- Administrative complexities and costs associated with implementing a data-driven payment adjustment process.
- Overall effect on the growth of the medical labs sector and the competitive landscape.