Senate Guarantees Coverage of Mammograms, Other Screenings in Healthcare Reform Bill

December 03, 2009

December 3, 2009 — In a 61 to 39 vote, the US Senate today approved an amendment to its massive healthcare reform bill that would guarantee coverage of much-debated mammograms and other preventive screenings for women without any cost-sharing on their part.

The bill's primary sponsor, Sen. Barbara Mikulski (D-MD), had introduced the measure in response to the US Preventive Services Task Force (USPSTF) announcing last month that it no longer recommends routine mammograms for women aged 40 to 49 years. The USPSTF also stated that mammograms for women aged 50 years and older be performed every 2 years instead of annually. A number of medical societies and expert groups, including the American Cancer Society, have objected to the new recommendations.

Congressional Republicans point to the latest USPSTF guidelines as a preview of healthcare rationing that would occur if Democratic healthcare reform legislation passes. The Senate bill had originally required health plans to cover preventive services such as mammograms that were recommended by USPSTF and several other organizations.

The amendment offered by Sen. Mikulski would require both private and public health plans to cover preventive care and screenings specifically for women that are recommended not only by the USPSTF, but also by the Health Resources and Services Administration, a federal agency charged with expanding access to healthcare for the underserved. As a result, said Sen. Mikulski, the amendment would give all American women the same coverage for preventive care and screenings that female federal employees enjoy. And coverage for mammograms would be guaranteed.

"We don't mandate that you have a mammogram at age 40," she told the Senate earlier this week. "But if your doctor says you need one, you are going to get one."

The Senate accepted an amendment by Sen. David Vitter (R-LA) to the Mikulski amendment to strengthen the guarantee of mammograms. The Vitter amendment states that required coverage of breast-cancer screening and prevention under the Senate healthcare reform bill will reflect USPSTF recommendations prior to those released last month.

Amendment Also Addresses Pap Tests

According to Sen. Mikulski, her amendment also would guarantee coverage of cervical cancer screenings. That promised coverage also addresses fears of healthcare rationing in light of a recommendation last month by the American College of Obstetricians and Gynecologists (ACOG) for less frequent cervical cancer screening. Previous ACOG guidelines had called for annual Pap tests for women ages 21 to 29 years as well as those younger than 21 years who have been sexually active for at least 3 years. ACOG now recommends biennial Pap tests for women starting at age 21 years regardless of sexual history and continuing through age 29 years. In addition, the new guidelines state that low-risk women aged 30 years and older should have Pap test every 3 years as opposed to every 2 to 3 years if they have negative tests 3 years in a row.

Sen. Mikulski said the cost of her amendment, $940 million over 10 years, would be funded from surplus funds in the Senate reform bill.

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