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Health Care Reform and Mammogram Guidelines

November 23, 2009 - by Donny Shaw

When the U.S. Preventive Services Task Force issued recommendations last week that women start screening for breast cancer at age 50, not 40, and that women above 50 get screening less frequently, congressional Republicans were quick to use it to bolster their argument against the Democrats’ health care reform legislation. “This is how rationing starts,” Sen. Jon Kyl [R, AZ], the second ranking Republican in the Senate, said during a press conference. “This is what we’re going to expect in the future,” he added. Igor Volsky at the Wonk Room documents a similar and more overt claim from Sen. John Barrasso [R, WY].

Democrats have dismissed the charges. “Let’s be clear: the task force’s recommendation will have absolutely no impact on the bills we in the Senate write, debate or vote on,” Majority Leader Harry Reid [D, NV] said in a press release. “Secretary Sebelius has also assured me there that nothing in Medicare or Medicaid will change as a result of the recommendation, and that’s the way it should be.”

The fact of the matter is that the Democrats’ health care bills are somewhat vague on the extent to which the task force’s guidelines could affect insurance coverage of mammograms. Both the Senate and House health care bills contain new consumer protections and minimum standards for health care plans including things like hospitalization, prescription drugs, maternity care and mental health coverage. But they both also include this language that would require health plans to cover U.S. Preventive Services Task Force recommendations that are rated either A or B. The task force’s recommendation that women between the age of 50 and 74 get mammograms every other year rather than the previous recommendation that they get them annually, is rated B.

Here are links to the exact section of text regarding coverage of task force recommendations rated A or B in the House bill and in the Senate bill.

To be clear, neither of the Democrats’ bills would require health insurance plans to cover mammograms for women aged 50 to 74 only every two years. The bills’ guidelines establish floors for minimum service coverage that insurers could go beyond if they so choose. In that respect, the bills are an improvement to the status quo with no requirements for minimum mammogram coverage. On the other hand, there is some concern that mandating the minimum coverage level would result in some insurers that are currently in compliance with the current recommendations of annual mammograms to scale back their coverage.

Interestingly, there is a stand-alone bill in Congress that was introduced in February that basically predicted this whole issue. The bill — known as the Mammogram and MRI Availability Act of 2009 — would require any plan that covers mammograms at all to cover them annually for women aged 40 and older. It would also require coverage of annual magnetic resonance imaging for women with genetic mutations making put that at high risk for breast cancer. The bill was introduced by Rep. Jerry Nadler [D, NY-8] and so far has not advanced in the committee process. To date, it has attracted 79 co-sponsors, all Democrats. SO far, there’s been no indication that it will be rolled into the broader health care bills.

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