THE TREATMENT NOVEMBER 30, 2009
In the first amendment offered on the opening day of the Senate health-care debate, Senator Barbara Mikulski proposed to restore a provision for women’s preventative services that had originally been in the Senate HELP bill. The amendment would provide “additional preventative care and screenings…as provided for in comprehensive guidelines supported by the Health Resources and Services Administration” (HRSA), prohibiting insurance companies from charging women any co-pays for these services.
Mikulski’s amendment has taken on particular urgency given the current controversy over the US Preventative Services Task Force’s new mammogram guidelines—and the concern that women won’t be able to get the screenings when they need them. The GOP has already latched onto the new recommendations as a clear example of “government rationing” that will be surely be in store if the bill passes. Mikulski has pushed back by saying her amendment likely to provide preventative coverage for “cervical cancer screenings for a broad group of women, annual mammograms for women under 50,” as well as a host of other health screenings for conditions like heart disease and diabetes, according to a press release from her office. In other words, the amendment will “guarante[e] screenings for breast cancer,” Mikulski said on the floor today. “If your doctor says you need one, you’re going to get one.”
But will relying on HRSA instead of the USPSTF for guidance necessarily result in different guidelines? It’s not entirely clear, but the HHS agency—designed increase access to “medical undeserved” children, mothers, and rural communities—appears rely on a similar decision-making process to create policy: it examines the evidence and consults with a broad range of external groups and scientific research. For example, in developing guidelines for newborn screening, HRSA consulted with—horrors!—an external task force, drawing upon the opinions of medical experts as well as “disease-specific advocacy organizations.” While HRSA is more broad-ranging in its mission than the USPSTF, which operates according to a fairly narrow mandate, its research- and decision-making process doesn’t appear to be radically different.
Conservatives are bound to label the agency as just another government bureaucracy that can ration health care at the whim of government-selected medical experts. And though Mikulski insists that any woman under 50 will receive mammogram coverage without co-pays if her doctor recommends it, it’s conceivable that HRSA’s “women’s health experts” could later decide to change its guidelines about which women will be covered, as guidelines are determine by the agency and not pre-determined in the legislative language of the amendment.
But would this necessarily be such a bad thing? In truth, having the flexibility to reconsider coverage based on mounting medical evidence isn’t a weakness—it’s a sign that the government recognizes that knowledge isn’t static, and that scientific discoveries can sometimes warrant an upheaval of the status quo. The fact is that guidelines for screenings do change (quite frequently) over time based on continuing research. To have some means to continue such deliberation is to recognize the value of evidence-based medicine.