Is Controversy Over Mammograms Looming?
The issue of mammogram coverage is about to return to the Washington agenda.
A draft recommendation from the U.S. Preventive Services Task Force last month echoes a similar recommendation made in the fall of 2009. Namely, the task force recommends mammogram screening every two years for women ages 50 to 74 but does not recommend universal screening before age 50: “The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account.”
That contradicts guidelines issued by the American Cancer Society and other groups for women in their 40s and is part of a long-standing debate about whether the benefits of early detection and treatment offset the costs, including false positives and additional radiation exposure.
Obamacare moved that debate from the clinical realm into the policy world by giving the task force jurisdiction over which preventive services insurers must cover. The law references the task force more than a dozen times. Any preventive service the task force grades “A” or “B” must be covered by private insurers, Medicare, and Medicaid without cost-sharing such as co-pays or deductibles. Because the draft recommendations give a “B” grade only to biennial screening between ages 50 to 74, insurers would not be required to cover mammograms for women younger than 50 or screenings more frequent than the every-two-years regimen recommended by the task force.
When the task force issued its recommendations during the fall of 2009—at the height of the Obamacare debate—critics of the bill questioned the task force’s role in the proposed regime. Sarah Palin wondered whether cutting costs played a role in the recommendations, and a group of Republican congresswomen called them a “slippery slope” on the way to rationing. Then-Health and Human Services Secretary Kathleen Sebelius issued a statement and said that the task force had no policy-making role—statements belied by the text of the bill before Congress.
In the end, the law explicitly instructed the Department of Health and Human Services to disregard the controversial 2009 guidelines, reverting instead to a prior series of recommendations that allowed for annual coverage of mammograms for all women 40 and older. If, however, the task force re-issues the same recommendations later this year—as its April draft suggested–that would supersede all its prior reports, again raising questions about coverage of annual mammograms.
A bipartisan group from Congress has already written to HHS, asking that the draft mammogram recommendations be disregarded. Congress may in time take more explicit action to overrule the task force. But the controversy in 2009 showed that the final recommendations issued by the U.S. Preventive Services Task Force are not likely to go unnoticed—in Washington or around the country.
This post was originally published at the Wall Street Journal Think Tank blog.