PAMA Reform Gains Momentum: Inside the Fight to Protect Clinical Labs
Congress included lab relief in its latest funding bill, signaling growing awareness of PAMA’s impact. Here’s what lab leaders should do next.
During a Nov. 12 webinar hosted by Dark Daily, the discussion centered on why a small laboratory provision ended up in the massive continuing resolution (CR) to reopen the federal government, and what it signals about congressional awareness of the urgent issues surrounding PAMA.
Panelists Susan Van Meter, president, American Clinical Laboratory Association (ACLA) and Jay Weiss, PhD, president and co-owner, Allermetrix explained that the inclusion reflects years of coordinated, persistent advocacy by ACLA, NILA, laboratorians, and industry partners, who have made the case that impending cuts on January 1 would be devastating. Although Congress has repeatedly delayed PAMA cuts and reporting requirements—five and six times respectively—stakeholders emphasized that this should never be taken for granted.
Both speakers highlighted that many lawmakers were initially unaware that laboratories were facing up to 15% reductions on roughly 800 codes beginning in 2026, with ripple effects extending to private insurers because their rates are indexed to Medicare. As Congress searched for a bipartisan path to reopen the government, advocates successfully argued that a short-term delay of the PAMA “cliff” needed to be included in the CR. That delay now runs only until January 30.
“We have been working very deliberately around the clock since the beginning of this year to encourage Congress to move forward legislation that would reform PAMA and address the reductions. It’s been a complicated legislative year,” said Susan Van Meter, president, ACLA. (Photo credit: ACLA)
RESULTS Act
The panel then outlined the RESULTS Act, a bipartisan proposal intended to fix structural flaws in PAMA. Its main provisions include:
- Replacing lab-reported commercial rates with data from a nonprofit claims database for widely available tests
- Requiring labs to report only for low-volume codes (100 or fewer labs)
- Reducing reporting burden significantly
- Eliminating three years of up to 15% cuts
- Capping future reductions at 5% annually
- Ensuring Medicare rates are based on actual, adjudicated claims instead of outdated 2016 data.
Speakers noted that commercial plans already submit claims data to independent entities such as FAIR Health, so the framework is neither novel nor untested. Claims would be reported only after full adjudication, typically six months post-submission.
On timing, the panel acknowledged that passing the RESULTS Act before Jan. 30 is ambitious, especially after weeks of congressional inaction during the shutdown fight. Still, they characterized the inclusion of lab relief in the CR as a strong signal that lawmakers view PAMA reform as legitimate and urgent. A Congressional Budget Office score has not yet been issued for the RESULTS Act, though preliminary scoring requests have been made.
What Lab Leaders Can Do
Both speakers urged labs to prepare dual budgets—one assuming RESULTS Act passage, another reflecting full PAMA implementation. Contingency planning may include staff reductions, automation investments, operational cuts, and pursuing non-payer revenue streams. They also emphasized that PAMA cuts would affect far more than Medicare because commercial payers peg rates to the CLFS.
Finally, both panelists stressed that advocacy in the next few weeks is critical. They encouraged labs to contact lawmakers through email, phone, or in-person visits—and especially to invite members of Congress to tour their laboratories. The StopLabCuts.org campaign has already generated 150,000 messages to Capitol Hill; speakers urged the audience to double that volume. With strong bipartisan sponsorship in both chambers, they said the RESULTS Act has momentum—but is not guaranteed without significant grassroots pressure.
If you missed the live webinar, view it on demand, here.
This article was created with the assistance of Generative AI and has undergone editorial review before publishing.
—Janette Wider
