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Washington G-2 Reports - Provision for a 20 Percent Co-payment for Laboratory Services Troubling

Obama Hosts Senate Health Bill Check-Up

President Obama and six senators negotiating a bipartisan health overhaul traded views on policy provisions of the legislation Thursday during a White House meeting, and Democrats in the group urged Obama to continue trying to sell the need for an overhaul to the public.

Sen. Kent Conrad, D-N.D., said that Obama asked the group of three Democrats and three Republicans how he could help their negotiations, which have dragged on for nearly two months. “I think the single most important thing he can do is continue to stress how critically important this is for the country,” Conrad said. “Failure is simply not an option.”

The meeting lasted about an hour, with staff asked to leave during the last half, according to Senate Finance Chairman Max Baucus, D-Mont., who is leading the negotiations.

Conrad said that the group talked about several policy areas, including a large Medicaid expansion contemplated as part of the bill; affordability issues, such as how much people can afford to pay in insurance premiums, deductibles and co-payments; and how the legislation should be financed.

Conrad declined to characterize Obama’s positions in detail.

“He made clear his concern about Medicaid expansion being done in a way that was coordinated carefully with the governors,” Conrad said. “And that affordability had to be very sensitive to what the burden is on people. We’ve got to make certain that people are better off because of this than they are before.”

White House Press Secretary Robert Gibbs said that Obama called the meeting to check in with the Finance group. “This was the president continuing to monitor the progress being made,” Gibbs said.

Obama’s overarching message, Conrad said, was: “Keep working.”

Meanwhile, the Finance group came under pressure from AARP on Thursday to drop one potential financing provision it is considering for the legislation: a proposal to require co-payments from seniors for clinical lab tests in Medicare.

An AARP official said that Obama has twice assured them that he would not support cutting Medicare benefits. “To turn around and cut Medicare benefits is going to significantly affect support for health care reform,” said the group’s legislative policy director, David Cerner.

— Drew Armstrong, Adriel Bettelheim and John Reichard contributed to this story.

Source: CQ Today Online News
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© 2009 Congressional Quarterly Inc. All Rights Reserved.

Aug. 6, 2009 – 4:25 p.m.
AARP Pressures Finance Panel to Reject Lab Co-Pays

Senate Finance Committee negotiators are under pressure from the senior lobby AARP and the clinical lab industry to reject the use of Medicare clinical lab co-payments to help pay for a health overhaul.

An AARP official reacted strongly Thursday to reports that the committee would consider charging co-payments. Saying that President Obama has twice assured AARP members that he won’t cut Medicare benefits to pay for an overhaul, AARP legislative policy director David Cerner warned in an interview that “to turn around and cut Medicare benefits is going to significantly affect support for health care reform.”

Assuring senior support for a health overhaul is already a delicate issue for Democrats because of several hundred billion dollars in planned Medicare cuts to hospitals, health plans, and other providers. Arguably those cuts would not affect care to seniors because of improvements in provider efficiency. But AARP is drawing the line at Medicare revisions that would cut benefits or add to out-of-pocket costs.

Democrats also have asserted that a health overhaul will lower cost burdens. But AARP lobbyist John Rother noted that “any requirement that seniors be billed for part of the cost of laboratory services would simply shift costs to beneficiaries, not save costs. Lab services are a function of physician decisions, not patient preferences,” Rother added in an e-mail message.

“Adding the paperwork and additional overhead associated with collections for coinsurance would add costs to the system, not save costs. It would make Medicare less efficient and raise the costs of supplemental insurance coverage. For these reasons, AARP opposes this idea,” Rother said.

In a letter last week to House Energy and Commerce Committee Chairman Henry A. Waxman, D-Calif., AARP CEO Barry Rand wrote, “AARP cannot support any efforts to target Medicare beneficiaries for increased cost-sharing or other benefit cuts,” he said. “In addition, we cannot support backdoor attempts to finance health care reform through increases in beneficiary costs or reductions in benefits, for example, through use of commissions or other process mechanisms.”

A July 31 letter from 26 clinical lab industry groups to the Finance Committee said that “the 20 percent Medicare laboratory co-pay being proposed by the Senate Finance Committee financially burdens both beneficiaries and laboratories and will not accomplish any change in utilization, because laboratory services are ordered by health care professionals, not initiated by patients. 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.”

“It is important to understand that for the majority of the top 100 laboratory procedures, beneficiaries would pay less than $2 in co-payment,” the letter added. “In addition to the burden and confusion these 134 million bills will create for seniors, the cost of collecting $23 billion in these small amounts will exceed the co-pay itself . . . Laboratories do not have a direct relationship with seniors and under Medicare, and by law, labs must make repeated attempts to collect the co-pays.”

An aide to Senate Finance Committee Chairman Max Baucus, D-Mont., declined to address the co-payment issue directly, but said the committee “is absolutely dedicated to protecting seniors and ensuring that care is accessible, affordable and sustainable for all seniors and all Americans.”

Source: CQ HealthBeat News
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© 2009 Congressional Quarterly Inc. All Rights Reserved.

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