Mikulski Amendment Aims to Prevent Insurers From Scaling Back Mammogram Coverage
One of the biggest fears surrounding contentious new breast-cancer screening guidelines, which were unveiled last month by the U.S. Preventive Services Task Force, was that private insurers would use them as justification for scaling back coverage of routine mammograms. Now Sen. Barbara Mikulski (D-Md.) is pushing legislation to ensure that that won’t happen.
Among the thorniest of the recommendations, the task force suggested that routine screenings begin at age 50 instead of 40, and occur biennially rather than every year. Democrats were quick to distance their health reform bills from the guidelines, yet both the House and Senate bills specify that certain task-force findings would automatically become a part of new minimum coverage requirements for all insurers. The biennial screening recommendation, for one, fell into this category.
That certainly wouldn’t prohibit insurers from offering broader coverage that includes routine annual screenings, and many states have their own requirements that guarantee such coverage. But it also wouldn’t require that they do so, again stirring concerns that private companies searching for ways to enhance profits (or states searching ways to balance budgets) could change policies to cover only diagnostic tests more frequently, as the task force recommends. [A quick note: Routine screenings, under current protocols, refer to the annual tests gotten by asymptomatic women aged 40 and up because another year has passed -- not to be confused with diagnostic mammograms, performed after a lump is detected or a screening turns up an abnormality.]
Mikulski yesterday offered her version of a legislative fix, introducing an amendment to the Senate health-reform bill that would prohibit insurance companies from using the task force recommendations to restrict mammogram coverage at any age or any frequency if a doctor recommends the test.
“We don’t mandate that you have a mammogram at age 40,” Mikulski said yesterday on the Senate floor. “What we say is discuss this with your doctor. But if your doctor says you need one, you are going to get one.”
Specifically, the provision would ensure that, under an essential benefits package to be offered by all insurers, women would be covered — at no extra cost — for “additional preventive care and screenings … supported by the Health Resources and Services Administration” — a branch of the HHS that aims to improve access to health-care services, particularly for the nation’s uninsured and under-insured populations. Aside from breast cancer, the provision is designed to encourage screenings for other prominent diseases, such as diabetes, cervical cancer and heart disease.
“Women often pay more and get less,” Mikulski said. “For many insurance companies, simply being a woman is a preexisting condition.”
Mikulski said the provision, as scored by the Congressional Budget Office, would cost the government $1 billion over the next decade.
Also of note, while Mikulski’s amendment retains the bill language automatically adopting A- and B-graded task-force recommendations as part of the minimum-coverage package, it also adds a clarifier that appears aimed at nullifying the recent, B-graded task-force recommendation for biennial routine screenings:
Nothing in this subsection shall be construed to prohibit a plan or issuer from providing coverage for services in addition to those recommended by United States Preventive Services Task Force or to deny coverage for services that are not recommended by such Task Force.
Mikulski spokeswoman Rachel MacKnight said Tuesday that she wasn’t sure if that language was added as a specific response to the new task-force recommendations. But it wasn’t a part of the original Mikulski amendment that passed the Senate health committee over the summer.