Medicare bill would require co-pays for seniors' lab tests

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Medicare bill would require co-pays

for seniors' lab tests

By Susan Jaffe and Stephen Koff

Cleveland Plain Dealer, July 2, 2003

Congress wants to add prescription drug coverage to Medicare, but it also might trim a benefit that could cost seniors billions of dollars.

Buried deep inside the hundreds of pages of the Senate's Medicare bill is a provision requiring Medicare patients to pay 20 percent of the costs of their clinical lab work, such as blood tests and urinalysis. Seniors would have to start paying in January.

Some physicians predicted many of their patients would be unable to pay the new fees and wouldn't get the tests they need.

"Every time you add co-payments, you limit service for people who can't afford it," said Dr. Peter DeGolia, medical director for long-term services at Metro Health Medical Center. "It's an other way of rationing care."

The Senate measure, now being reconciled with the House version, would reverse a 1984 decision in which doctors, hospitals and labs agreed, with a nod from Congress, not to charge patients co-payments for lab tests.

Fees for blood tests to check cholesterol levels, electrolytes for dehydration and glucose for diabetes and to make dozens of other checks for chemicals, anti bodies or bacteria typically run $25 to $40, said Mark Birenbaum, a microbiologist.

Birenbaum is the administrator of the American Association of Bioanalysts.

Nationwide, the co-payments could total $18.6 billion over the next 10 years, said the Clinical Laboratory Coalition, which is campaigning against the provision.

Co-payments for seniors on Medicare, the health insurance plan for 40 million elderly and disabled Americans, would be $5 to $8 a test.

But seniors who need regular tests could quickly see those fees add up.

"Medicare is supposed to be helping us, but we're paying more and more out of our own pockets," said Anne McKinley, 78, who lives in Lake County. "Somewhere it has to stop."

Blood tests are especially important to monitor the condition of older patients, who are more likely to have multiple chronic health problems, said Dr. Robert Palmer, director of geriatric medicine at the Cleveland Clinic.

The tests can detect adverse side effects of the many medications older patients rely on.

"There's a rational reason for these tests," he said. "I might as well be practicing in a jungle if I don't have a laboratory."

In the case of about 185,000 low-income Ohio seniors who are also covered by Medicaid, the state-run program for the poor, the state would have to make the new co-payments.

The prospect of additional expenses worries state officials struggling to keep up with rising health-care costs.

Medicaid is already the fastest- growing portion of the state bud get, and program officials have been looking for ways to cut costs, said Dennis Evans, a spokesman for the Ohio Department of Job & Family Services, which runs the Medicaid pro gram.

"If we're required to do it, we've got to come up with the money," he said.

Bill Hoagland, director of bud get and appropriations for Sen ate Majority Leader Bill Frist, Re publican of Tennessee, said the co-payments would provide money to help pay for other benefits for seniors.

But Robert Hayes of the Medicare Rights Center said, "It obviously defeats the purpose of pro viding a drug benefit if you pay for it by picking the pockets of senior citizens."

The House version of the Medicare prescription-drug bill, which like the Senate bill also passed last week, does not contain that provision.

Lawmakers will start resolving differences between the two bills this month. But senior staffers in both chambers don't expect a final bill to be ready for a vote until fall.