Legislation in the U.S. Senate could threaten insurance coverage for mammograms and other cancer prevention and treatment services by allowing private health insurance plans to skirt state consumer protections.
The ostensible goal of the bill, the Health Insurance Marketplace Modernization and Affordability Act (S. 1955), is to allow small businesses to purchase more affordable health insurance for their employees, such as by enabling businesses to form associations to purchase health insurance plans.
But a section of the bill would allow insurance companies to ignore state mandates that certain screening procedures be covered. For example, under current law, 49 states have requirements that medical insurers cover mammography screening. These requirements could be waived for insurance plans if S. 1955 becomes law.
This bill would cover all private health insurers, whereas a measure that passed the House last summer would affect only smaller plans. But even that aspect of the legislation has its critics. The insurance carriers would only need to offer a plan that includes the same protections as any one of the plans offered to state employees in one of the five most populous states.
The Senate bill's sponsors are Sen. Mike Enzi (R-WY), chairman of the Senate Health, Education, Labor and Pensions Committee, and Sen. Ben Nelson (D-NE). The bill could be voted on today or tomorrow.
If passed, the legislation could be a major step backward in offering preventive healthcare services, according to Gerald Kolb, chief development officer for Breast Health Management, a large mammography provider with centers in several states.
"When you look at the bill itself, it serves as a rollback for all of the state provisions that mandate certain levels of coverage. Like for pregnancy, for mammography, preventive healthcare," he said. "On a national basis it's a retrograde step. It took a long time to get to where we have in this country what is effectively a national mammography screening program. What I fear is that whenever there is any kind of a rollback like this, it ends up being a foot in the door."
In place of state coverage mandates, S. 1955 would enable employers to choose less comprehensive and less expensive health plans -- so long as the plans matched the coverage of any one of the health insurance plans available to state government employees of any of the five most populous states -- California, New York, Illinois, Texas, or Florida.
Forty-nine states currently require coverage for mammograms in health insurance programs -- coverage that would be in jeopardy if S. 1955 becomes law. Only Utah does not mandate mammogram coverage.
A growing number of states require coverage of colorectal, prostate, and cervical cancer screenings. This coverage could also be threatened by passage of S. 1955, as it would enable health insurance plans, including those formed through business associations known as small-business health plans (SBHPs), to bypass state consumer protections as long as they also offer a plan that includes the same protections as any one of the plans offered to state employees in the five most populous states.
"If insurers can find a way not to cover something, they are going to take advantage of it," said Dr. Kathleen Gundry, a radiologist in the division of breast imaging at Emory University in Atlanta. "Anything that decreases the access to mammography is significant. We've proven that mammography saves lives. In the long term, the cost of doing the screening mammogram is far less than the cost of treating someone with an advanced breast cancer."
Alternative legislation has been introduced in the Senate. The bill (S. 2510), sponsored by senators Richard Durbin (D-IL) and Blanche Lincoln (D-AR), would create a program based on the Federal Employees Health Benefits Program (FEHBP), which has provided benefits to members of Congress and federal employees for many years. The American Cancer Society is backing this legislation. S. 2510 would be limited to businesses with 100 or fewer employees.
In addition to eliminating guaranteed access to cancer screenings, S. 1955 would also remove coverage guarantees for clinical trials, off-label prescription drug use, and smoking-cessation services.
As of this writing, a proposed amendment to S. 1955 would protect insurance guarantees in place in at least 26 states, but would still threaten to eliminate state benefit protections such as colon cancer screenings, participation in clinical trials, and other cancer screenings and treatments.
S. 1955 is opposed by more than 200 organizations, including the American Medical Association, AARP, AFL-CIO, the American Academy of Pediatrics, the American Cancer Society, C3: Colorectal Cancer Coalition, the League of Women Voters, the National Women's Law Center, the National Women's Health Network, the Service Employees International Union, 19 state insurance commissioners, and 40 state attorneys general.
Bill Thiel, who founded Maureen's Mission to promote early diagnosis of breast cancer after his wife died due to what he said was a failed early diagnosis, believes S. 1955 is a dangerous piece of legislation. "Many women and men will die because of delayed diagnosis if this bill is passed," Thiel said.
By Robert Bruce
AuntMinnie.com contributing writer
May 11, 2006
Related Reading
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Breast cancer survivors often forgo annual mammography, April 24, 2006
Aetna offers retrospective mammo CAD reimbursement, April 24, 2006
Mammography rates tied to ethnic disparities in breast cancer outcomes, April 18, 2006
Global lifestyles, immigration patterns bring changes in breast cancer screening, April 14, 2006
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