If the most recent U.S. Preventive Services Task Force (USPSTF) breast cancer screening guidelines are finalized, 17 million women between the ages of 40 and 49 could lose insurance coverage for mammography screening exams, according to a new report released by consulting firm Avalere Health.
Why? Because under the Affordable Care Act (ACA), private insurers are only required to cover preventive services if they have an "A" or "B" rating from USPSTF. The new guidelines would give a "C" rating to screening for women ages 40 to 49. (Screening of women in the Medicare program would continue to be covered under a separate federal statute.)
Avalere used health insurance results and demographic data from the 2014 American Community Survey to identify how many women in employer and individual markets would be affected by USPSTF's new guidelines. The company also estimated how the recommendation would affect women covered under Medicaid and determined ACA exchange demographics from U.S. Centers for Medicare and Medicaid Services (CMS) data.
Reimbursement for screening would be cut for a total of 17 million women, Avalere found.
| No. of women affected by USPSTF guidelines | |
| Insurance market | Estimated No. of women |
| Employer | 13.4 million |
| Individual | 1.3 million |
| Exchanges | 1.2 million |
| Medicaid | 1.1 million |
| Total | 17 million |
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USPSTF's 2009 guidelines gave breast cancer screening for women in this age group a grade C rating as well. But Health and Human Services Secretary Kathleen Sebelius reaffirmed the agency's backing for the younger screening age, and ACA's coverage for breast cancer screening was guided by the task force's 2002 recommendation -- which gave the exam a grade of B.
When USPSTF released new draft breast screening recommendations in April, it hewed to its 2009 dictum, stating that the net benefit of screening younger women is small. If these guidelines are finalized, they will become the new ACA standard, eliminating coverage for women in this age group, Avalere wrote in its analysis.
"USPSTF's final recommendation will determine how breast cancer screenings are covered for millions of women," said Avalere Director Sung Hee Choe in the report. "Policymakers and women's health groups need to take a close look at the implications of the draft guidelines."
USPSTF is taking public comment on the proposed recommendations through May 18.
