[Congressional Record Volume 145, Number 69 (Thursday, May 13, 1999)]
[Senate]
[Pages S5274-S5275]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. AKAKA (for himself, Ms. Snowe, Mrs. Murray, and Ms. 
        Collins):
  S. 1034. A bill to amend title XVIII of the Social Security Act to 
increase the amount of payment under the Medicare program for pap smear 
laboratory tests; to the Committee on Finance.

[[Page S5275]]

                INVESTMENT in WOMEN's HEALTH act of 1999

  Mr. AKAKA. Mr. President, today marks the 116th birthday of Dr. 
George Papanicolaou, who developed one of the most effective cancer 
screening tests in medical history--the Pap smear. Cervical cancer was 
one of the leading causes of cancer deaths in women in the United 
States 50 years ago and it is still a major killer of women worldwide. 
I rise today to introduce the Investment in Women's Health Care Act, a 
bipartisan bill to increase the reimbursement for Pap smear laboratory 
tests under the Medicare program. I am pleased to be joined by my 
colleagues--Senators Snowe, Murray and Collins.
  The inadequacy of current lab test reimbursement was brought to my 
attention by pathologists who alerted me to the significant cost-
payment differential for Pap smear testing in Hawaii. According to the 
American Pathology Foundation, Hawaii is one of the 23 States where the 
cost of performing the test greatly exceeds the Medicare payment. In 
Hawaii, the cost ranges between $13.04 and $15.80. Yet the Medicare 
reimbursement rate is only $7.15.
  The large disparity between the reimbursement level and the actual 
cost of performing the test may force labs in Hawaii and around the 
Nation to discontinue Pap smear testing. The below-cost reimbursement 
may compel some labs to process tests faster and in higher volume to 
improve cost efficiency. This situation increases the risk of 
inaccurate results and can severely handicap patient outcomes.
  This bill would increase the a reimbursement rate for Pap smear 
labwork from its current $7.15 to $14.60--the national average cost of 
the test. This rate is important because it establishes a benchmark for 
many private insurers.
  Last year, we were successful in having language included in the 
omnibus appropriations conference report recognizing the large 
disparity between the costs incurred to provide the screening tests and 
the amount paid by Medicare. The conferees noted that data from 
laboratories nationwide indicates that the cost of providing the test 
averages $13.00 to $17.00, with the costs in some areas being higher. 
Accordingly, conferees urged the Health Care Financing Administration 
to increase Medicare reimbursement for Pap smear screening. Although 
HCFA has indicated a willingness to increase this payment, I am 
concerned that the adjustment the agency is considering may be 
significantly less than the costs incurred by most laboratories in 
providing this service. Therefore, my colleagues and I are compelled to 
reintroduce legislation that would implement what we believe to be an 
appropriate increase.
  Mr. President, no other cancer screening procedure is as effective 
for early detection of cancer as the Pap smear. Over the last 50 years, 
the incidence of cervical cancer deaths has declined by 70 percent due 
in large part to the use of this cancer detection measure. Evidence 
shows that the likelihood of survival when cervical cancer is detected 
in its earliest stage is almost 100 percent, if treatment and follow-up 
is timely. If the Pap smear is to continue as an effective cancer 
screening tool, it must remain widely available and reasonably priced 
for all women. Adequate payment is necessary to ensure women's 
continued access to quality Pap smears.
  I urge my colleagues to support this important bipartisan 
legislation. Mr. President, I also ask consent the text of my bill be 
included in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record as follows:

                                S. 1034

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Investment in Women's Health 
     Act of 1999''.

     SEC. 2. INCREASE IN PAYMENT AMOUNT FOR PAP SMEAR LABORATORY 
                   TESTS.

       (a) In General.--Section 1833(h) of the Social Security Act 
     (42 U.S.C. 13951(h)) is amended by adding at the end the 
     following:
       ``(7) In no case shall payment under the fee schedule 
     established under paragraph (1) for the laboratory test 
     component of a diagnostic or screening pap smear be less than 
     $14.60.''.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply with respect to laboratory tests furnished on or 
     after January 1, 2000.

  Ms. SNOWE. Mr. President, I rise today to join my colleague from 
Hawaii, Senator Akaka, in introducing the Investment in Women's Health 
Act.
  Today we celebrate the 116th birthday of Dr. George Papanicolaou, the 
physician who developed the Pap smear. In the 50 years since Dr. 
Papanicolaou first began using this test, the cervical cancer mortality 
rate has declined by an astonishing 70 percent. There is no question 
that this test is the most effective cancer screening tool yet 
developed. The Pap smear can detect abnormalities before they develop 
into cancer. Having an annual Pap smear is one of the most important 
things a woman can do to help prevent cervical cancer.
  Congress has recognized the incomparable contribution of the Pap 
smear in preventing cervical cancer and nine years ago directed 
Medicare to begin covering preventive Pap smears. Medicare 
beneficiaries are eligible for one test every three years, although a 
more frequent interval is allowed for women at high risk of developing 
cervical cancer. And through the Balanced Budget Act of 1997, Congress 
expanded the Pap smear benefit to also include a screening pelvic exam 
once every 3 years.
  But the Medicare reimbursement rate is artificially low and does not 
accurately reflect the true cost of providing this vital test. The 
current Medicare rate of reimbursement is $7.15, though the mean 
national cost of the test is twice that amount: $14.60 per test. The 
bill we introduce today, The Investment in Women's Health Act, will 
raise the Medicare reimbursement rate for Pap smears to at least $14.60 
per test.
  Women understand the usefulness and life-saving benefit of the Pap 
smear. The U.S. Centers for Disease Control and Prevention reported 
last year that 95 percent of women age 18 years old and over have 
received a Pap smear at some point in their lives. And 85 percent of 
women age 18 years and older across the country have received a Pap 
smear within the last 3 years.
  Unfortunately, the artificially low reimbursement rate threatens both 
our country's local clinical laboratories and the health of women 
across the country. Pathologists are increasingly concerned that low 
Medicare reimbursement for Pap smears will force them to stop providing 
the service and to ship the slides to large out-of-state laboratories. 
Shipping the slides to non-local, large-scale laboratories--``Pap 
mills''--reduces quality control, brings up continuity of care issues, 
and puts women at risk of higher rates of ``false positives'' or 
``false negatives.''
  Providing Pap smears locally facilitates the likelihood of follow-up 
by a pathologist, comparison of a patient's Pap smear to cervical 
biopsy, and facilitates better communication and consultation between 
the patient's pathologist and attending physician or clinician. When 
Pap smears are shipped out of the local community these vital 
comparisons are much more difficult to complete and are more prone to 
inconsistencies and error.
  Inadequate reimbursement for Pap smears provided through Medicare 
threatens not only a woman's health but the financial stability of the 
laboratory as well. If a lab is forced to continue to subsidize 
Medicare Pap smears they will eventually either stop providing the 
Medicare service or go out of business--and neither option is 
acceptable. Finally, local laboratories have a proven track record of 
providing better service for the patients. A Pap smear is less likely 
to get lost in a local lab than among the tens of thousands of other 
tests in a ``Pap mill'' and cytotechnicians have better supervision by 
a pathologist in smaller laboratories than in large volume operations.
  The Pap test has contributed immeasurably to the fight against 
cervical cancer. We cannot risk erasing our advancements in this fight 
because of low Medicare reimbursement. I urge my colleagues to join us.
                                 ______