Mammogram Coverage Under Medicare Won't Change, Sebelius Says

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On Wednesday, HHS Secretary Kathleen Sebelius said that federal health insurance programs will not alter their mammogram coverage policies following new recommendations from the U.S. Preventive Services Task Force, the New York Times report.

The guidelines, released earlier this week, promote mammogram screening every two years for most women starting at age 50. They also say that doctors should not instruct women on how to examine their breasts on a regular basis.

Medicare -- which primarily covers U.S. residents ages 65 and older but also insures some younger people with disabilities -- pays for annual mammograms beginning at age 40.

Medicaid coverage policies are set by states (Sack/Kolata, New York Times, 11/19).

Sebelius acknowledged that the new guidelines have "caused a great deal of confusion and worry among women and their families across this country," but she emphasized that the task force is "an outside independent panel of doctors and scientists who ... do not set federal policy and ... don't determine what services are covered by the federal government" (Stein/Eggen, Washington Post, 11/19).

Sebelius said the government's policies concerning mammogram coverage "remain unchanged," adding, "I would be very surprised if any private insurance company changed its mammography coverage decisions as a result of this action" (New York Times, 11/19).

Insurers React to Recommendations

Susan Pisano -- a spokesperson for America's Health Insurance Plans, which represents 1,300 insurance companies -- said that private insurers have not yet proposed altering their mammogram coverage policies (Szabo, USA Today, 11/19).

Several companies -- including WellPoint, Aetna, CIGNA, Kaiser Permanente and UnitedHealth Group -- said that their coverage decisions are based on a variety of research guidelines from different groups, including organizations that have not endorsed the task force's new recommendations.

According to a statement from Kaiser Permanente, the insurer believes "that focusing on prevention and early detection is critical in improving women's health and saving lives." The statement added that Kaiser does "not currently plan on making any changes to our coverage or treatment practices" in response to the task force's recommendations (Singer/Abelson, New York Times, 11/19).

Political Debate

The guidelines continued to draw bipartisan criticism on Wednesday.

Coming in the midst of Democrats' push for health care reform -- which includes an emphasis on using science-based protocols to rein in costs and reduce the number of unnecessary procedures -- Republicans seized on the guidelines as an example of the health care rationing that they say would occur if current reform legislation is passed.

Rep. Marsha Blackburn (R-Tenn.) said, "This is the little toe in the edge of the water ... where you start getting a bureaucrat between you and your physician."

Rep. Debbie Wasserman Schultz (D-Fla.) said, "At a time when we are working to reform our health care system to provide greater access to preventive care, these guidelines and the fact that they conflict with many of the recommendations from leading cancer organizations only adds to the confusion that so many women have when it comes to breast health" (Sack/Kolata, New York Times, 11/19).

Sebelius attempted to downplay any link between the task force's recommendations and Democrats' reform efforts. Sebelius noted that the task force members were appointed by President George W. Bush and that -- according to task force chair Ned Calonge -- most of the group's work was completed years before the 2008 presidential election and the current drive for reform (Washington Post, 11/19).

Still, James Thrall, a member of the American College of Radiology's board of chancellors, said that because reform legislation cites the task force as playing a role in determining which preventive services merit coverage, Sebelius should urge the panel to rescind its new guidelines. ACOR has condemned the task force's findings (Steenhuysen, Reuters, 11/18).

Not everyone criticized the guidelines, however.

Fran Visco -- president of the National Breast Cancer Coalition, which supports the recommendations -- said, "This should not be an issue of political pressure or public pressure." She added, "It should be an issue of what the science says and what's best for women. We're not rationing care; we're doing what's best for the health of women."

In a statement, Rep. Rosa DeLauro (D-Conn.) said, "If we can cut through the Republicans' political gamesmanship on this issue, the new breast cancer recommendations, as always, were an attempt to put the best possible evidence in the hands of women and their doctors, so they can assess their own risk and benefit" (Washington Post, 11/19).

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