A new KFF Health Tracking Poll shows healthcare costs are now the top economic worry for U.S. households—raising concerns that patients may skip screenings or shop more aggressively for lab tests, reshaping utilization and revenue patterns in 2026.
Healthcare costs are now the top economic concern for US households—and that anxiety is likely to ripple directly into clinical laboratories, according to a new KFF Health Tracking Poll released January 29.
Roughly one-third of the public (32%) say they are “very worried” about their ability to afford healthcare, a higher share than those most concerned about food, housing, utilities, or transportation. More broadly, 56% expect healthcare to become less affordable for their families in the coming year, signaling sustained pressure on patients’ willingness and ability to engage with the health system.
For clinical laboratories, that concern translates into two distinct, and potentially competing, patient behaviors.
Rising Costs Could Reshape Patient Testing Behavior
In one scenario, patients worried about out-of-pocket costs may delay or skip preventive screenings and fail to follow through on physician-ordered diagnostic testing. KFF found that about one in five respondents said their healthcare costs have risen faster than basic necessities like utilities or groceries. That perception alone can be enough to discourage patients from completing tests they view as optional, even when those tests are clinically indicated.
In another scenario, cost-conscious patients may still pursue testing but do so more selectively. Rather than abandoning care altogether, these patients may “shop around,” comparing prices, turnaround times, and service offerings across clinical laboratories. This trend could increase demand for clearer test pricing, stronger patient-facing communication, and more transparent billing practices—areas where some labs may find both challenges and opportunities.
The poll also suggests that cost concerns are not confined to any single demographic or political group. Healthcare costs ranked as the top economic worry among Democrats, independents, and Republicans alike. More than four in ten voters (44%) say healthcare costs will have a “major impact” on whether they vote in the upcoming midterm elections, underscoring how personally felt the issue has become.
Policy Shifts Add New Pressure to Coverage and Affordability
Recent policy changes may be amplifying these anxieties. Congress allowed enhanced Affordable Care Act (ACA) tax credits to expire, a move that two-thirds of the public (67%) say was “the wrong thing” to do. The expiration is expected to increase premium payments for many marketplace enrollees, potentially leaving patients with less discretionary income for lab testing and other medical services.
While most Americans still view the ACA favorably—58% overall—that support has softened since last fall, reflecting ongoing uncertainty about coverage stability and affordability. For labs, fluctuations in insurance coverage can complicate reimbursement, increase patient self-pay balances, and add friction to pre-test counseling and billing workflows.
Taken together, the findings point to a year in which clinical laboratories may see uneven test utilization patterns. Some patients may disappear from the testing pipeline altogether, while others arrive armed with questions about cost, necessity, and alternatives.
As financial anxiety increasingly shapes patient decision-making, labs that can clearly communicate value—clinical relevance, quality, speed, and cost transparency—may be better positioned to maintain trust and test volume in an environment where affordability is front of mind.
Researchers report that treatment resistance in advanced prostate cancer is driven by epigenetic lineage plasticity rather than genetic mutations, raising new possibilities for combination therapies and biomarker development in clinical laboratories.
Scientists at the Herbert Irving Comprehensive Cancer Center (HICCC) at Columbia University have identified a molecular mechanism that helps explain why advanced prostate cancers often become resistant to modern hormone-based therapies—and, importantly, how that resistance may be reversed. The findings, published in Nature, describe how prostate tumor cells evade treatment through epigenetic reprogramming rather than genetic mutation, and present preclinical evidence for a drug strategy that could restore treatment sensitivity.
For clinical laboratory professionals, the study highlights the growing relevance of epigenetic regulation, lineage plasticity, and biomarker-driven therapeutic strategies in oncology.
From Hormone Therapy to Lineage Switching
Over the past decade, androgen receptor (AR) inhibitors have become the standard of care for advanced prostate cancer. While initially effective, these therapies frequently drive tumors to adopt a neuroendocrine-like state, a highly aggressive phenotype that no longer depends on androgen signaling and is largely resistant to existing drugs. This transition has posed a longstanding puzzle for cancer biologists and clinicians alike, as it occurs without obvious DNA mutations.
The research builds on decades of work by Michael Shen, PhD, co-leader of the tumor biology and microenvironment program at HICCC, who studies “lineage plasticity”—the ability of cancer cells to change identity under therapeutic pressure. Prior work from Shen’s lab showed that this lineage shift is driven by epigenetic changes rather than permanent genetic alterations, pointing to reversible factors.
To identify the epigenetic drivers, Shen partnered with other Columbia researchers. The team homed in on NSD2, a gene that regulates cellular processes but can also cause cancers during abnormal activity. (Photo credit: Columbia University)
Targeting an “Undruggable” Enzyme to Restore Drug Sensitivity
NSD2 had long been considered “undruggable,” complicating efforts to translate the discovery into a therapeutic strategy. However, recent advances in small-molecule inhibitor development changed that outlook. Using a newly developed NSD2 inhibitor, the researchers demonstrated in prostate cancer models that blocking NSD2 caused neuroendocrine tumors to lose their resistance to therapies.
While NSD2 inhibition alone did not kill tumor cells, its impact was dramatic when combined with other inhibitors. The combination therapy restored sensitivity to standard hormone treatments, effectively resensitizing previously resistant cancers.
For the clinical laboratory community, these findings underscore the importance of epigenetic markers in cancer diagnostics. The ability to distinguish lineage states—and potentially monitor transitions between them—could influence future testing strategies, companion diagnostics, and treatment selection.
More broadly, the study provides one of the clearest demonstrations to date that epigenetically driven treatment resistance can be reversed. Because lineage plasticity is common across multiple tumor types, including small cell lung cancer, the NSD2 pathway may represent a broader therapeutic and diagnostic target.
As these findings move toward clinical testing, laboratories may play a central role in translating epigenetic insights into actionable oncology care.
The Theranos case continues to resonate in the lab community, reminding professionals of the importance of validation, transparency, and accountability.
Elizabeth Holmes, the former CEO of Theranos whose company became synonymous with laboratory fraud, has formally requested an early release from federal prison, renewing attention on one of the most consequential scandals in modern diagnostics.
According to filings with the US Department of Justice’s Office of the Pardon Attorney, Holmes has asked President Donald Trump to commute her sentence, a request that remains under review. If granted, the commutation could shorten her 11-year sentence by nearly six years.
Holmes was convicted in 2022 on multiple counts of wire fraud and conspiracy for misleading investors about Theranos’ blood-testing technology. She began serving her sentence in 2023 at a minimum-security federal prison camp in Bryan, Texas, and is currently scheduled for release on December 30, 2031. Both CNN and ABC News report that a federal appeals court last year upheld Holmes’ conviction, sentence, and a $452 million restitution order that she shares with former Theranos President Ramesh “Sunny” Balwani.
When Hype Outruns the Science
For clinical laboratory professionals, the case remains a stark reminder of the consequences when scientific validation is subordinated to hype.
Theranos claimed it could run hundreds of diagnostic tests using only a few drops of blood—assertions that, if true, would have dramatically reshaped laboratory workflows, patient access, and cost structures. Instead, investigations revealed that the company relied heavily on conventional analyzers while misrepresenting the performance and use of its proprietary technology.
Elizabeth Holmes is currently serving an 11-year sentence at the Federal Prison Camp in Bryan, Texas, for defrauding investors in her company, Theranos; she began her sentence in May 2023 and is eligible for release in December 2031, though she recently asked President Trump to commute her sentence for early release. (Photo credit: Wikimedia Commons.)
The appeals court ruling reinforced a critical principle for the diagnostics industry: financial success, celebrity boards, and political connections do not insulate companies from accountability when analytical validity and transparency are lacking. Judges rejected arguments that legal errors tainted the trial and upheld restitution based on the full amount investors lost, underscoring how severely courts view deception tied to medical testing claims.
As noted by The Dark Report during Holmes’ trial in 2021, testimony provided a series of lessons about how directors of a CLIA-certified labs can be held accountable for violations of federal and state laws.
Why Theranos Still Matters
Holmes’ renewed online visibility has also drawn renewed attention within the laboratory and diagnostics community. According to the CNN article, in recent months, posts have reappeared on her X account, including messages praising Trump’s healthcare affordability efforts and asserting her innocence. While the White House does not comment on pending clemency petitions, the optics of a high-profile fraud case intersecting with presidential pardons, particularly in a second Trump term marked by several controversial commutations, has revived debate about accountability in healthcare innovation.
For laboratories navigating patient expectations, evolving regulatory oversight, and the growth of direct-to-consumer testing, the Theranos case remains a relevant point of reference. The case is frequently cited by regulators and payers as justification for stricter oversight of laboratory-developed tests, more aggressive enforcement actions, and heightened expectations for data integrity.
Regardless of whether Holmes’ sentence is ultimately commuted, her request serves as a reminder that trust in laboratory medicine is hard-won and easily lost. For professionals, the case underscores the importance of scientific rigor, transparent validation, and strong governance in maintaining credibility and trust.
Clinical laboratories face renewed Medicare payment uncertainty as a congressional funding impasse threatens to derail temporary PAMA relief, with new CLFS cuts scheduled to take effect in days unless lawmakers act.
Clinical laboratories are once again facing near-term Medicare payment uncertainty as congressional negotiations over a must-pass spending package stall, putting temporary relief from PAMA-driven cuts at risk just days before new reductions are scheduled to take effect.
The American Clinical Laboratory Association (ACLA) is closely tracking bipartisan, bicameral negotiations tied to a broader government funding deal that includes provisions to delay further cuts to the Medicare Clinical Laboratory Fee Schedule (CLFS). The proposal would push back additional PAMA-related reductions until Jan. 1, 2027, and update the private payor data CMS uses to set future Medicare rates. Without action, lab test reimbursement rate cuts are scheduled to go into effect on Jan. 31.
ACLA Backs PAMA Relief but Warns Structural Flaws and Imminent CLFS Cuts Remain
ACLA President Susan Van Meter said lawmakers appear increasingly aware of the structural flaws baked into PAMA’s rate-setting framework.
“ACLA appreciates that lawmakers on both sides of the aisle recognize the serious and ongoing problems posed by PAMA,” Van Meter said in a statement provided by the organization. (Photo credit: ACLA)
She emphasized that shifting the data collection period to more recent market information would represent a meaningful, though incomplete, step forward.
Under the legislative language outlined in the bill, Congress would revise the PAMA phase-in schedule by extending payment reduction caps through 2029, rather than allowing steeper cuts to resume sooner. The bill would also replace the 2019 private payor data CMS is currently set to rely on with data from 2025, addressing longstanding concerns from laboratories that Medicare rates are being calculated using outdated and unrepresentative commercial payment information.
“Updating the data collection period from 2019 to 2025 would move Medicare payment rates away from reliance on seven-year-old market data that would otherwise be used to set 2027 rates,” Van Meter said, according to the statement from ACLA. However, she cautioned that even with updated timelines, “CMS is unlikely to receive comprehensive and representative commercial data needed to set accurate Medicare rates.”
The stakes for laboratories are immediate. Without congressional action, new CLFS cuts of up to 15 percent on roughly 800 tests are scheduled to take effect on Jan. 31, adding to what ACLA described as “three previous rounds of reductions.” Lab professionals have repeatedly warned that cumulative cuts threaten the sustainability of community-based testing and could restrict patient access, particularly in rural and underserved areas.
PAMA Relief Tied to High-Stakes Funding Fight, Leaving Labs in Legislative Limbo
The PAMA provisions are embedded in a larger government funding package that now faces political headwinds. As reported in The Washington Post, Senate Democrats have indicated they will block the broader spending deal unless it is restructured, raising the possibility of a partial government shutdown. While the dispute centers on Department of Homeland Security (DHS) funding, failure to advance the package would also stall health-related provisions, including laboratory payment relief. There has been discussion about separating votes for DHS and Health and Human Services (HHS) spending, but it is not clear yet whether that will happen. The PAMA delays are tied into the HHS spending package.
That linkage is raising concern across the laboratory sector, where advocates argue that PAMA relief has long enjoyed bipartisan support and should not become collateral damage. Van Meter urged lawmakers to move quickly, calling the proposal “a down payment toward lasting PAMA reform” and pressing Congress to advance the bipartisan RESULTS Act this year.
For lab professionals, the outcome of the funding negotiations will determine whether temporary relief materializes—or whether another round of PAMA cuts proceeds as scheduled, further reshaping the Medicare testing landscape just as laboratories continue to adapt to tightening margins and rising operational costs.
Federal health officials have updated cervical cancer screening guidelines to add HPV self-collection and require insurer coverage starting in 2027, a shift that could significantly impact testing volumes and workflows for clinical laboratories.
In a move that could significantly reshape testing volumes, workflows, and access strategies for clinical laboratories, the US Health Resources and Services Administration (HRSA) said in a press release that it has issued updated cervical cancer screening guidelines that formally introduce patient self-collection as a new screening option..
Under the updated guidance, high-risk human papillomavirus (hrHPV) testing—using either clinician-collected or patient-collected samples—is now the preferred screening method for average-risk women ages 30 to 65, while Pap testing remains an option. For women ages 21 to 29, Pap testing continues to be recommended.
The guideline also includes a major payer-facing provision that lab leaders should note. HRSA said most insurance plans will be required to cover not only the screening itself, but also any additional testing needed to complete the diagnostic process following an abnormal result. That coverage requirement takes effect January 1, 2027, reducing patient cost barriers that have historically limited follow-up testing volumes.
“These updates represent a significant step forward in cervical cancer screening and will improve screening rates and save lives,” HRSA Administrator Tom Engels said, adding that expanded options and reduced financial barriers allow more women to “take an active role in protecting their health and their future.” (Photo credit: HRSA)
HRSA Update Sets Stage for Insurer-Covered At-Home Testing Starting in 2027
An article from ABC News said the HRSA update aligns federal preventive guidance with recent FDA approvals that now allow both in-clinic and at-home self-collection for HPV testing. The January 2027 deadline for private insurers is expected to accelerate adoption of home-based and alternative specimen collection models.
“The addition of self-collection really empowers women to make this choice for themselves,” Ann Sheehy, MD, HRSA’s chief medical officer, told ABC News. “We do retain the option for Pap smear … this is just an additional choice for women.”
ABC News stated the preferred screening cadence for women ages 30 to 65 is now primary hrHPV testing every five years, whether the sample is collected by a clinician or by the patient. Alternative pathways—co-testing every five years or Pap testing every three years—remain in place if HPV testing is unavailable, preserving flexibility for labs at different stages of HPV test adoption.
HRSA officials emphasized that the goal is expanded access, not replacement of existing workflows. Engels told ABC News that self-collection could help reach women who have “been falling through the cracks,” adding, “By doing that, we’re going to save lives.”
ABC News noted the guidance also clarifies insurer obligations for follow-up diagnostics, including Pap testing, biopsy, and laboratory work, a move designed to prevent cost-sharing from disrupting care pathways. Separate HRSA rules now also require coverage of patient navigation services, which may further increase completed diagnostic testing after abnormal screens.
The American Cancer Society’s (ACS) December 2025 guideline update helped shape the federal move, ABC News said, citing evidence that self-collection improves access without sacrificing accuracy. “The combination of good evidence of the benefits of self-collection, which include increased access to cervical cancer screening, combined with FDA approval, led the ACS and HRSA to include self-collection,” said Robert Smith PhD, senior vice president of early cancer detection science at the ACS.
For lab professionals, HRSA’s announcement underscores a coming shift: broader HPV test demand, increased importance of validated self-collection workflows, and potentially higher follow-up testing volumes as cost barriers fall and screening gaps narrow.
