The Treatment

Will the Government Really Start “Rationing” Mammograms?

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Conservatives have already begun stoking fears that the new mammography recommendations that screenings should begin at 50 years instead of 40 will inevitably lead to “rationing,” particularly if Obama’s health-care reform bill passes. “I absolutely believe this could be a form of rationing," Representative Phil Gingrey told Fox News yesterday. “It scares me.” A private physician quoted in the story said the guidelines issued by the federal task force were “at the top of a slippery slope toward rationing,” claiming that “the government-run insurance companies are definitely going to be using these federal guidelines.”

But to what extent will recommendations from the U.S. Preventative Services Task Force actually dictate what’s covered under the new reform bill? Over at FireDogLake, Daniel Dayen flags the White House’s attempt to push back against the “rationing” meme. On the White House blog yesterday, Dan Pfeiffer explained why the government and insurers weren’t automatically going to adopt the task force’s findings:

The USPTF would have no power to deny insurance coverage in any way…They are an independent scientific body that makes recommendations based on scientific evidence; however they do not set official policy for the federal government. Under health reform, their recommendations would be used to identify preventive services that must be provided for little or no cost.

To clarify: in its effort to regulate the insurance market and expand preventative coverage, the health-care legislation would require insurance companies to provide a certain set of preventative services for free or at little cost, according to a minimum benefits package determined by the Department of Health and Human Services. Medical treatments outside of this prescribed set of preventative services could be subject to cost-sharing--i.e. a co-pay that the patient has to contribute--but would hardly be automatically excluded from coverage. As Dayen concludes, findings by the USPTF--an independent group compromised of medical authorities and primary-care experts--would serve as a guide for HHS to determine which treatments should be part of preventative services and which are subject to co-pays, but coverage is by no means limited to what the task force recommends.

Moreover, an amendment that Senator Barbara Mikulski introduced into the Senate HELP Committee bill explicitly includes women’s preventative health care within the minimum set of preventative servicesa measure that neither the House nor the Finance Committee bills contains. Mikulski’s amendment would include preventative services for women in benefits packages, mammograms possibly among them, though it would still be up to the discretion of HHS to decide which benefits would be covered and for what age brackets. The provision could arguably lessen, not increase, the cost of mammograms for women: while every state except for Utah requires insurance companies to cover the screenings for women, insurance companies can still charge co-pays for the service. If the amendment makes it to the final bill, insurers would be prohibited from charging high co-pays.

To be sure, the USPTF’s recommendations could still influence what kind of coverage women between 40 and 50 years old receive for mammograms, if public and private authorities decide that they’re medically unnecessary. But it’s quite obvious that the debate about the new guidelines is far from being settled, having attracted heated opposition from medical advocacy groups, doctors, patients, and, yes, Democratic legislators. And HHS Secretary Kathleen Sebelius made it clear this afternoon that the administration is currently distancing itself from the task force’s findings. The idea that the government will blindly adopt these recommendations to ration care under their reform billand force private insurers to do the sameis simply a conservative myth.

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