How Obamacare Could Affect Laboratories and PAs

This past Thursday the Supreme Court made a landmark decision to uphold the individual mandate of Obamacare or more formally known "The Patient Protection and Affordable Care Act." Although I have my own opinions about the moral implications of this ruling, I will try to leave aside the politics and analyze how the Affordable Care Act could affect the future of the field of pathologist's assistants as well as its affect on clinical laboratories.

Of course, this is all contingent on President Obama becoming reelected in November. Mitt Romney has vowed to repeal Obamacare if elected, so all of these musings by myself could be for naught.

The following predictions are my own personal hypotheses and if I have used incorrect information, then please correct me.

Predictions:

-Pathology Laboratories will receive more specimens.
The individual mandate of course means that there will be many more people required to have health insurance. It has been estimated that as many as 34 million new people will now gain health insurance through Obamacare. The rule of subsidies follows the slogan, "If you subsidize it, you will get more of it." With more people becoming covered, I expect that these people will want to have more tests done. Whereas before a person might have ignored that strangely growing brown spot on their arm, now they will be more inclined to get it checked and have a biopsy done. This will be a great step forward in preventative care. More people will be getting their diseases checked out early before they become bigger problems later on.
Effect on PAs: Slightly Positive. More specimens means that laboratories will be busier and there will be a greater demand for PAs. Laboratories may have to hire more PAs so the job market should be favorable.

-Pathology Laboratories will receive slightly more biopsies. The number of complex specimens should stay relatively constant. The type of complex specimens may change slightly.
Because more people will be able to get their ailments checked out early, I would expect the number of biopsy specimens to increase. If these biopsies lead to the early detection of disease then the disease can be managed before having to visit the surgeon. As more people become covered by health insurance, the cost of health care is shifted to the insurance companies who will in turn raise premiums. When individuals are not responsible for their own expenses, then they will utilize the service more. However, we have a positive feedback loop here. Because higher utilization will increase the costs to insurance companies and lead to higher premiums, people will be impelled to use the service even more to "get their money's worth."
Earlier detection of diseases will lead to fewer complex specimens, but it should be countered by the increased number of prophylactic complex specimens. Tumors and so forth that would have gone undiagnosed (but would most likely have stayed benign) will now be caught. (For example, think of all of the prostatectomies that are occurring due to prostate cancer as a preventative measure. Most people with small foci of prostate cancer will die due to other causes, but nonetheless many still undergo the prostatectomy procedure. Another example would be mastectomies and hysterectomies.)
Effect on PAs: Neutral. The beneficial role of having a PA work in a laboratory is that PAs are certified by law to perform high complexity testing. I expect that complex specimens due to patients ignoring their health to decrease (lung cancers, large skin cancers, etc...), but I expect the number of prophylactic and non-life threatening complex specimens to increase (prophylactic mastectomies, prophylactic prostatectomies, hysterectomies, etc...).  I expect biopsies to increase, so I would expect that the demand for laboratory technicians, who are cheaper to hire than PAs, will increase.

-Small Pathology Laboratories will struggle to stay in business. Hospital Laboratories and Large Pathology Laboratories will be able to weather the increased costs.
When I write 'increased costs' what I really am talking about is the decreased reimbursement that laboratories will receive under Obamacare. It seems that laboratories always bear the brunt of cuts. They are an easy, out-of-sight target and patients don't ever visit clinical laboratories. A letter written by the American Clinical Laboratory Association (ACLA) states that the combined effects of the Middle Class Tax Relief and Job Creation Act of 2012, Obamacare, and anticipated future sequestration cuts calls for a total 23% slash in Medicare reimbursements to clinical laboratories over the next 10 years. (Imagine what it will be after you account for inflation!) Clinical laboratories only make up 1.6% of Medicare spending but will bear 15% of the Medicare cuts.
In addition, most smaller laboratories aren't reimbursed the same as some large hospitals and laboratories due to Section 508 of the Medicare Prescription Drug, Improvement, and Modernization Act. It has been around for a while; it passed in 2003. But, it puts further strain on smaller laboratories that are not a part of the 'in-group'. You may have thought that reimbursement rates for Medicare specimens was the same throughout the country, but that is a fallacy. Larger hospitals and laboratories located in areas with high costs of living are reimbursed a greater percentage than smaller laboratories. Reimbursement rates are basically tied to a cost of living index. The already smaller reimbursement rates will cause small laboratories to buckle even more.
Effect on PAs: Negative or slightly positive. The effect will be largely dependent on whether you work at a small community laboratory versus a hospital laboratory/large laboratory. Lower reimbursement rates could cause many smaller laboratories to go out of business or refuse to accept Medicare patient specimens. If the smaller laboratory can weather the loss of reimbursements, then it will put a strain on laboratory personnel salaries. If the smaller laboratory can't weather the loss of reimbursements and chooses to refuse Medicare patients, a large percentage of their specimen volume will be gone, leading to lower demand for PAs. 
Of course, hospitals will be more than happy to take on the Medicare specimens that smaller laboratories don't take. Classically, tests done at hospitals cost more money and hospitals/larger laboratories are reimbursed more for Medicare specimens. If nearby smaller laboratories close, hospitals and larger laboratories could see an increase in specimen volume. 
It should be noted that the other people who will be hurt are unsurprisingly Medicare patients. Some nursing homes may no longer have access to their local, low-cost, small clinical laboratory and will have to rely on the more expensive hospitals which are farther away.

I am sure that I have missed other important details regarding the effect that Obamacare will have on PAs. If there is anything else that you can think of or would like to add, please leave a comment!

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Update July, 4th 2012

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I have an additional prediction that I have thought up of.

-Laboratories will receive slightly more complex specimens. This goes in contrast to what I wrote above, that "the number of complex specimens should stay relatively constant". We know that with up to 34 million new people receiving healthcare and not a new doctor being trained to take on this increased load, waiting lines and appointments will take longer. How much longer it will take to see a doctor and how much longer it will take to see a specialist remains to be seen. However, the increased waiting times (whether it be weeks or months) could give certain cancers just enough time to become more invasive, metastatic or complex. It is a sad development for patient care, but a very real possible outcome of increasing patient load without increasing the number of doctors. A minority of Americans may be able to afford traveling abroad for instant healthcare (medical tourism), but the vast majority of Americans will have to compete with each other to be seen by the same number of doctors, or just give up altogether due to the increased waiting time.

Effect on PAs: Slightly positive. I would never want someone to develop a disease for the sake of providing a living, just like I would never want someone to pass away so that I could do an autopsy. A slightly increased load of complex specimens means that PAs will be in slightly higher demand.