STOP LAB CUTS

Medicare payment cuts threaten patient access to clinical laboratory services, which are essential to preventing and diagnosing diseases and conditions, empowering patients and their clinicians to make informed decisions about care. Tell Congress to pass the Reforming and Enhancing Sustainable Updates to Laboratory Testing Services (RESULTS) Act this year.

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Screening and diagnostic tests performed by clinical laboratories inform
life’s most important health care decisions.

Scheduled reimbursement cuts under the Protecting Access to Medicare Act (PAMA) could jeopardize access to many of the clinical laboratory tests that are used to screen, diagnose, monitor, and manage common diseases for all patients, including more than 60 million seniors.

But the threat doesn’t stop there. After three rounds of up to 10 percent cuts, planned payment reductions of up to an additional 15 percent in 2027 could weaken the clinical laboratory infrastructure, making it more difficult to deliver routine health care and respond to the next public health crisis. Strong clinical laboratories are foundational to the U.S. health care system.

Medicare reimbursement cuts also curtail investment in the next generation of diagnostic tests, including those that enable personalized care for diseases like cancer.

IMPACT ON PATIENTS

Clinical laboratory tests play a critical role in health care. Without congressional action, lab tests will face payment cuts next year, with further reductions of up to 15% planned for 2028 and 2029. Learn more about how these tests are used and the potential impact of Medicare cuts on patients:

Diabetes

Heart
Disease

Kidney, Heart and Liver Conditions

Cancers

Chronic Kidney Disease

Viral
Hepatitis

HIV

PAMA cuts could compromise swift access to clinical laboratory tests for many serious conditions, including:

Diabetes

Studies show more than 38 million adults in the United States have diabetes, and 22 percent of them do not know they have it. Almost 30 percent of seniors live with diabetes.
A1C is a routine blood test, typically ordered by a primary care provider, to assess if a patient has or might be at risk of developing diabetes, and it helps health care providers monitor diabetic patients’ average glucose levels over time.
In 2023, more than 36 million hemoglobin A1C tests, which are critical to diagnosing, monitoring, and managing diabetes, were performed for Medicare beneficiaries. Without congressional action, payments made through the Clinical Laboratory Fee Schedule (CLFS) for this test could face a fourth round of cuts in 2027, above and beyond the previous three years of reductions, making it potentially more difficult for seniors to access.

PAMA cuts could compromise swift access to clinical laboratory tests for many serious conditions, including:

Heart Disease

Heart disease is the leading cause of death for Americans aged 65 and older.
In 2023, across the Medicare program, more than 58 million tests were ordered to diagnose and monitor heart disease, including tests to measure cholesterol, triglycerides, and lipids.
Despite the enormous human health and economic burden of this disease, tests to prevent and treat heart disease could face cuts in 2027. This would be on top of three years of prior reductions, in the absence of congressional action.

PAMA cuts could compromise swift access to clinical laboratory tests for many serious conditions, including:

Kidney, Heart, and Liver Conditions

A comprehensive metabolic panel is a widely used routine blood test that helps patients better understand their baseline health and clinicians diagnose, screen for, and monitor certain health conditions.
In 2023, about 80 million comprehensive metabolic panel tests were ordered for all Medicare beneficiaries to assess blood sugar and electrolyte levels, and for indications of how the kidneys, liver, and heart are functioning.
Compounded by three years of prior reductions, Clinical Laboratory Fee Schedule (CLFS) payments for the comprehensive metabolic panel could see additional cuts in 2027 without congressional action.

PAMA cuts could compromise swift access to clinical laboratory tests for many serious conditions, including:

Cancers

Nearly 105,000 commonly ordered tests to diagnose leukemia and hereditary breast and colon cancer in 2023 were ordered for Medicare beneficiaries.
In addition to three years of prior reductions, tests for hereditary colon cancer and leukemia could face another rate reduction in 2027.
Similarly, tests for hereditary breast cancer, that have already taken cuts over the past three years, may be cut under the Clinical Laboratory Fee Schedule (CLFS) in 2027 absent congressional action.

PAMA cuts could compromise swift access to clinical laboratory tests for many serious conditions, including:

Chronic Kidney Disease

Laboratory tests that allow early diagnosis of chronic kidney disease are key to preventing kidney failure.
Across the Medicare program, these critical laboratory tests were performed for Medicare beneficiaries more than 3.2 million times in 2023. Unless Congress steps in, Medicare payments under the Clinical Laboratory Fee Schedule (CLFS) for these renal function panels could face a fourth cut in January 2027 – adding onto three years of prior reductions.

PAMA cuts could compromise swift access to clinical laboratory tests for many serious conditions, including:

Viral Hepatitis

Several viruses can cause hepatitis, or inflammation of the liver, that can lead to a reduction in liver function, cancer, and death.
Over 3.2 million clinical laboratory tests for Hepatitis B and C are ordered for Medicare beneficiaries each year in line with screening and diagnostic guidelines.
Absent congressional action, various tests paid through the Clinical Laboratory Fee Schedule (CLFS) for Hepatitis B and C could face a fourth round of cuts—on top of three years of prior reductions—in January 2027.

PAMA cuts could compromise swift access to clinical laboratory tests for many serious conditions, including:

Human Immunodeficiency Virus (HIV)

The number of Medicare beneficiaries with HIV has tripled since the 1990s and includes many who are dual-eligible for Medicare and Medicaid.
Hundreds of thousands of screening and diagnostic tests are conducted each year for Medicare beneficiaries at increased risk for HIV.
Without congressional action, Clinical Laboratory Fee Schedule (CLFS) payments for commonly used clinical laboratory tests for HIV could face another round of cuts in 2027. This would be on top of three years of prior reductions.

THE PROBLEM

Congress passed the Protecting Access to Medicare Act (PAMA) in 2014. The legislation was designed to align Medicare payment for clinical laboratories with commercial market rates across the country. Unfortunately, the commercial market data collected to inform Medicare payment rates was incomplete and not representative of the broader laboratory ecosystem, leading to deeper than expected payment cuts to laboratories. In three consecutive years, hundreds of laboratory tests experienced up to 10 percent cuts, almost $4 billion in total and far greater than Congress intended. A fourth round of up to 15 percent cuts is scheduled for January 2027, with further reductions of up to 15% planned for 2028 and 2029.

Without congressional intervention this year, laboratories across the country will face tough decisions potentially reducing services offered to patients and curbing investment in the next generation of diagnostic tests. Physician offices may stop offering essential laboratory tests, and independent laboratories could be forced to close. This could result in slower tests results or fewer test offerings. These cuts could jeopardize access to essential laboratory tests that guide clinical decision-making for patients with heart disease, diabetes, cancer, and many other common and complex conditions. In short, these scheduled Medicare cuts will undermine laboratory infrastructure essential for day-to-day care and critical to public health emergencies, while also stifling investment to advance innovative new screening and diagnostic tests.

Congress has acted on a bipartisan basis six times to “press the brakes” on harm caused by PAMA, and now is the time to put laboratory payment policy on the right trajectory for the long-term, with congressional action needed this year – before the next round of cuts go into effect in January 2027. The outcome of these cuts is predictable: Delayed and disrupted care could lead to poorer health or worse health outcomes for at-risk and vulnerable seniors.

THE SOLUTION

Congress must take action this year to fix the broken payment system and prevent further, deep cuts to clinical laboratories. The RESULTS Act would:

Preserve patient access to life-saving diagnostic tests that are foundational to informed clinical decision-making,

Provide payment stability and predictability for the Medicare program and clinical laboratories,

Facilitate long-term R&D of innovative diagnostics that will advance the next generation of personalized care,

Ensure comprehensive, up-to-date data is used to set Medicare rates, and

Protect clinical laboratory infrastructure for day-to-day care and in times of public health emergency.

The RESULTS Act has the support of more than 60 leading patient / consumer and provider advocacy organizations that recognize the role of clinical laboratories in providing crucial healthcare information.

TAKE ACTION

Tell Congress to stop Medicare cuts to clinical laboratory testing.

StopLabCuts.org is a campaign of the American Clinical Laboratory Association.