Senate Majority Leader Harry Reid, Speaker of the House Nancy Pelosi (WDCpix)

The Democrats downplaying the gravity of new recommendations for breast cancer screening have left out an inconvenient fact: their health care bills would automatically adopt them.

Both the House and Senate health reform proposals would force insurance plans to follow the new mammogram guidelines for women ages 50 to 74 as part of a minimum swath of services deemed by the legislation to be medically essential. The recommendations were an unexpected wildcard in the middle of an already contentious health reform debate, and they’ve caused Democrats to de-emphasize their significance at the same time that some in the party are calling for a legislative fix to nullify them.

Image by: Matt Mahurin

The mammogram episode has also revealed the influence of a previously obscure preventive-medicine panel, raised questions about the effectiveness of the Democrats’ reform proposals to weed out unnecessary medical procedures, and highlighted the potential complications when the entrenched habits of patients and providers are called into question by medical science.

“These new recommendations,” breast cancer specialist David Gorski wrote this week, “are a classic example of what happens when the shades of gray that characterize the messy, difficult world of clinical research meet public health policy, where simple messages are needed in order to motivate public acceptance of a screening test.”

The controversy ignited on Monday, when the U.S. Preventive Services Task Force, a federally appointed panel of independent medical experts, released guidelines suggesting that women should not seek routine mammograms before the age of 50 — 10 years later than current protocols dictate. The task force also concluded that annual mammograms are unnecessary for any age group, suggesting biennial screenings instead.

Critics in Congress and the medical community were quick to pounce, arguing that the recommendations would jeopardize the lives of women, particularly those aged 40 to 49. Democrats moved swiftly to divorce their health reform proposals from the new guidelines, maintaining that they merely represent a non-binding data-bank for lawmakers to consider as they craft coverage policies, both public and private.

“I don’t think there’s any general acceptance of what was proposed,” House Speaker Nancy Pelosi (D-Calif.) told NPR Thursday.

“These individuals do not determine federal policy,” Rep. Rosa DeLauro (D-Conn.) added in a statement. “They have simply made recommendations.”

Yet the health reform language moving through Congress tells a different tale. Both the House and Senate bills create an “essential benefits package” which all insurance plans would have to offer. Neither chamber’s proposal specifies what those services would be, instead, empowering the Department of Health and Human Services to make those decisions at a later date. But the bills do outline broad categories of minimum services, including a mandate to cover those recommendations of the task force rated “A” or “B.” The new biennial-screening guidelines for 50 to 74 year-olds are rated “B.”**

The 16 members currently on the panel were all appointed by the Bush administration. None specializes in oncology.

A number of Democrats have blasted the findings. Rep. Debbie Wasserman Schultz (D-Fla.), a breast cancer survivor, said the guidelines are “causing mass confusion” among women accustomed to screening more frequently and earlier in life. Rep. Frank Pallone (D-N.J.), chairman of the Energy and Commerce health subcommittee, has already indicated that he’ll hold a hearing early next month to examine the recommendations. And Rep. Jerrold Nadler (D-N.Y.) is pushing legislation to require insurance companies that cover diagnostic mammograms also to cover routine, annual mammograms to women beginning at age 40.

“Cancers can progress very far in two years,” Nadler said Friday, criticizing the panel’s recommendation for biennial screenings.

The White House has also been wary, quickly indicating that the new recommendations would have no bearing on public policy. In a statement issued Wednesday, HHS Secretary Kathleen Sebelius played down the task force as “an outside independent panel of doctors and scientists who make recommendations.”

“They do not set federal policy,” she added, “and they don’t determine what services are covered by the federal government.”

Yet they certainly can have influence. Indeed, in May, when HHS announced the controversial decision not to pay for virtual colonoscopies under Medicare, the agency leaned heavily on the judgments of the Preventive Services Task Force, which had concluded earlier that the radiation risks outweighed the benefits of the less intrusive cancer-detection procedure.

The HHS declined to comment this week on why the agency was so quick to dismiss the panel’s new mammogram recommendations.

By issuing their report in the middle of a contentious debate over health care reform, the task force didn’t do the Democrats any favors. Republicans are already blasting the reform bills for their funding of comparative effectiveness research, which compares different treatments of the same ailment to discover which work best. The critics fear that the effectiveness data could tempt insurers — both public and private — to deny coverage of certain drugs, devices and other treatments. In the eyes of the GOP, the new mammogram recommendations are just another threat to patients’ access to care.

“This is how rationing starts,” Sen. Jon Kyl (R-Ariz.) said Friday. “Delay of care … then denial of care. At first, it’s guidelines, then the insurance companies … adopt those guidelines with respect to coverage decisions.”

Private insurers, for their part, say they often use the task force recommendations to make coverage determinations. But they deny that the mammogram findings will have any effects — at least not immediately. “Whatever we do today, we’ll continue to do — as far as we can tell,” said Gloria Barone, spokeswoman for Cigna.

Susan Pisano, spokeswoman for America’s Health Insurance Plans, the industry lobby group, pointed out that the task force recommendation against routine screenings for 40-somethings is hardly an outright moratorium, instead leaving the decision to women and their doctors. “I don’t see this as limiting coverage,” Pisano said.

Under Medicaid, states have leeway to set their own coverage rules. Ann Kohler, director of the National Association of State Medicaid Directors, said state officials use the task force guidelines “often.” “However in this case,” she added, “I think they will not change their historical policy.”

Julius Hobson, former lobbyist for the American Medical Association and now a senior policy analyst at the Washington law firm Bryan Cave, suggested that the members of the task force had crunched their numbers without consideration of the broader effects of their recommendations. “They missed the psychological and social impact of what they were saying,” Hobson said.

Their timing, he added, was also a bit suspect. “You’d have to be deaf, dumb, blind and crazy not to know that Congress has spent the whole year working on health reform.”

**Clarification: An early version of this story implied that the recommendations for 40- to 49-year olds would also be adopted by the Democrats bill. That would not be the case. That recommendation is rated “C.”

Benjamin was unanimously approved by the Health, Education, Labor and Pensions Committee on Oct. 7, but Senate Republicans are holding up all [Department of Health and Human Services] nominees over a so-called gag order on insurance companies that have been critical of Democratic efforts to reform health care.

“We’ve not received any recent calls from the administration about their nominee,” a senior Republican aide said. “There won’t be any time agreements for confirmation of HHS nominees until their actions have been fully reviewed.”

At issue is an investigation of insurance companies by the Centers for Medicare and Medicaid Services, a division of the HHS, which announced the probe last month after a letter surfaced from Humana to seniors critical of the Senate Finance Committee’s health care bill.

CMS officials charged that the letter contained misleading information, a claim Republicans have disputed.

That’s it. Because of that, HHS is working without a surgeon general during the H1N1 outbreak. Local newspapers in the deep South have noticed, and called for Benjamin to get an up-or-down vote, but this issue really hasn’t gotten anywhere in the beltway.

While Benjamin has waited in limbo, Democrats — who ostensibly run the Senate — have held two hearings on whether the president is appointing too many czars.

In a letter to the White House, Republican leaders have threatened to block confirmation of 10 White House nominees to various posts in the Health and Human Services Department unless the “gag-order” is rescinded. Senate Minority Leader Mitch McConnell (R-Ky.) reiterated that threat today on Fox News.

“None of those people will get through the Senate easily until they lift the gag order,” McConnell said.

None of these people make it through the Senate without extensive debate until they lift the gag order and allow the First Amendment to function for everyone in this country, including people who just happen to be doing business with the federal government.

The ruckus began last week when the federal Medicare agency announced an investigation into Humana for letters the insurance giant had mailed to seniors warning that the Democrats’ health reform plans were threatening their private insurance coverage, called Medicare Advantage. The letters urged the seniors to contact their lawmakers opposing the legislation.

The Centers for Medicare and Medicaid Services claim those letters represent a breach of contract, because CMS requires MA sponsors to screen such mailings through the agency. CMS has barred all MA sponsors from sending similar messages to their customers. Republicans, though, say the First Amendment trumps the CMS guidelines.

This might have been just a minor footnote in the debate over health reform. But the GOP holds on the HHS nominees mean it could grow into something much bigger.

Yesterday, President Obama stood before the nation’s largest doctors’ group and made his strongest case yet for the creation of a government-backed insurance plan to compete with private companies. Such an option is necessary, Obama told members of the American Medical Association, “[to] force waste out of the system and keep the insurance companies honest.”

Today, Kathleen Sebelius, head of the Department of Health and Human Services, tempered the president’s remarks, telling The Associated Press that passing a health reform bill is more important than including a public plan.

“It’s way too early to say ‘This is absolutely in, this is absolutely out,’” she said when asked about [the public option]. “I mean, what he’s trying to do is get a bill passed.”

At what point does political savvy become waffling?

Sebelius, who will step down from her current job as the governor of Kansas, had come under fire from the right because of her support for abortion rights. On Twitter, Sen. John McCain (R-Ariz.) announced he had another reason for opposing her nomination:

SenJohnMcCainvoted against Sebelius – already moving towards socialized auto companies, we don’t need socialized medicine!

“Some people think that declaring a state of emergency about the flu was a political thing to push the Sebelius nomination through,” said Wright. She pointed to news stories that ask whether the slow-walking of the Sebelius choice will hurt the response to the flu. “If there’s even a hint that [Department of Homeland Security] is manipulating the health situation to push a political appointee through, well, it almost defies imagination that they’d be willing to that.”

Wright said that she’d heard the speculation “on talk radio,” and wanted to be skeptical, but “there’s too much of a basis in that argument to easily dismiss it.”

–

TWI is on Twitter. Please follow us here.

From the statement from Collins office, via Politico’s Glenn Thrush:

As Ranking Member of the Senate Homeland Security Committee, Senator Collins has led hearings on pandemic flu preparedness, worked on “bioshield” legislation and funding, and helped strengthen our nation’s preparedness for a pandemic flu.

Claims that she is opposed to increased funding for pandemic flu research are blatantly false and politically motivated. In fact, in December 2008, Senator Collins joined in a letter to Senate leaders requesting a $905 million increase for the Public Health and Social Services Emergency Fund at the Department of Health and Human Services.

There is no evidence that federal efforts to address the swine flu outbreak have been hampered by a lack of funds. Senator Collins does, however, believe that it is a problem that the Centers for Disease Control and the Department of Health and Human Services still do not have top positions filled. She hopes the Senate will move promptly to confirm Governor Sebelius for HHS Secretary.

Two bills introduced in Congress recently stake out rival positions on a key issue related to health care reform. Which approach ultimately prevails will help determine whether the pharmaceutical industry maintains the support that Pfizer CEO Jeffrey Kindler voiced Wednesday for President Obama’s plan’s to overhaul the nation’s health care system.

Reps. Anna Eshoo (D-Calif.), Jay Inslee (D-Wash.) and Joe Barton (R-Texas) introduced a bill Tuesday that would give manufacturers of new drugs up to 14 years of market exclusivity before generic versions could come onto the market. Earlier this month, Rep. Henry Waxman (D-Calif.) introduced legislation providing five years market exclusivity. Big Pharma hailed the Eshoo bill while the Obama administration has indicated it prefers the Waxman approach.

Can the drug companies live with shorter exclusivity, which cuts into the big profits margins of popular drugs?

Maybe, says Kindler, who heads the world’s largest pharmaceutical manufacturer. He told CNN, “My guess is that, assuming there is comprehensive health care reform and it’s passed, there will be elements of any bill that any number of participants won’t like, because everybody will undoubtedly have to make compromises and contributions. And I’m sure we will be no exception, nor should we be, by the way.”

In an op-ed that appeared today in The Washington Post, former House Speaker Tom Daschle (D-S.D.) — who withdrew his nomination to be President Obama’s secretary of health and human services earlier this month amid a tax scandal –  said the prospect for comprehensive health care reform has never been better, in part, because “reformers have some new and unlikely allies,” including the insurance and pharmaceutical industries.

Since his bid to become HHS secretary failed, Daschle has become more of a cheerleader, not a czar. But that doesn’t mean he’s wrong.

–

The prospect for following TWI on Twitter has also never been better. Please do so here.

Daschle was also supposed to take an additional policy post in the White House as the administration’s “health care czar.” Today, Obama announced Clinton administration veteran Nancy-Ann DeParle will fill the position — which is officially known as “Counselor to the President and Director of the White House Office for Health Reform.” Whew!

Finally, in case you were wondering when some of this stimulus money will be released to start work on “shovel-ready projects,” Obama announced the release of $155 million alotted in the stimulus bill for the “support of 126 new health care centers” to provide primary and preventative care to an estimated 755,000 uninsured Americans. According to a White House statement, the funds will create 5,500 jobs.

One quick note on the Sebelius nomination: One story that is currently flying under the radar nationally is the radical impact that Obama’s elevation of former Arizona Gov. Janet Napolitano’s to secretary of homeland security has had on her home state. With Napolitano gone and a new conservative Republican governor in place, there is little check on the Republican-controlled state legislature. Arizonans are seeing the results, such as the legislature’s easy passage of dramatically increased restrictions on abortion in the state — which, not incidentally, is very similar to legislation twice vetoed by Napolitano.

Unlike their brethren in Arizona, Kansas Democrats may have a bit of breathing room — at least temporarily. If Sebelius is confirmed by the Senate, Lt. Gov. Mark Parkinson — a Republican-turned-Democrat who was Sebelius’ running mate in 2006 — will take over for the remainder of her term, which ends in January 2011 . However, Parkinson has pledged not to seek another term — while Sen. Sam Brownback (R-Kans.), an anti-abortion zealot and creationist, has already thrown his hat in the ring. With its state legislature long dominated by Republicans, Kansas may find itself in Arizona’s position soon enough.

Sentiment in favor of a Dean promotion is pretty much universal on the right: Dean is viewed as a bumbler who’d wreck relations between the White House and Congress and doom health care reform. It’s a little curious, considering that in 2005, Republicans mocked Dean’s election as Democratic National Committee chair and proceeded to drop election after election to the Democrats. But it’s true that Democrats don’t think as highly of Dean as a manager of delicate White House-Congress relations, and that he’s not really on the HHS shortlist.