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Preventive Care: How Do Unfunded Mandates Affect the Insurance Industry?

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In November 2009, a little-known advisory group of the federal government — the U.S. Preventive Services Task Force — set off a political firestorm when it announced new guidelines for breast cancer screening, recommending against routine mammograms for most women in their 40s and saying women should consider having the screening test every other year instead of annually.

The timing of the announcement — right in the middle of Congress’ consideration of far-reaching health care reform legislation — instantly turned it into one of the top media story of the day. Physician organizations, patient advocacy groups, and politicians all railed against the Preventive Services Task Force.

Immediately, accusations flew from all sides, looking to score political points from this emotionally charged atmosphere. From one side, this was an example of how the Obama Administration would cut health care costs. From another side, this was an example of government bureaucrats were making decisions for patients and excluding doctors from consideration. Still another accusation was that these guidelines would serve as an excuse for insurance companies to reduce coverage for breast cancer screening.

In truth, the U.S. Preventive Services Task Force is an unlikely source of such a political maelstrom. The task force was created in 1984, at a time when screening methods — whether for cancer, cholesterol, or diabetes — were in their infancy and consequently were rarely paid for by insurers. The task force was set up by the Department of Health and Human Services (HHS) to evaluate how well such methods worked. Although financed by HHS, the group works without much oversight from the Department. The intent behind the task force was to put together medical experts who could evaluate evidence and to protect it from any political pressures so they could produce objective assessments. And, while the guidelines issued by the USPSTF are taken seriously, they are only guidelines and are not regulations

What made the cancer screening guidelines so white-hot is that they arrived in the middle of an intense political debate over the health care reform legislation, a debate which included extensive discussions about the treatment implications of cost-cutting and whether reform would lead to a government-run system and rationing of treatment.

In any policy battle, there are angels and demons. Which are which entirely depends on your perspective on the policy. For those who believe that the existing system has problems, but does not require a reformation, the demons are the image of nameless and faceless government bureaucrats making health care decisions. For those who believe in the need for a single-payer, government-run health insurance system, private insurance companies are the devil incarnate.

When the USPCTF recommendations on breast cancer screening came out, it’s no surprise that supporters of single-payer suggested that insurance companies would use the Preventive Care Task Force’s guidelines as an excuse to reduce coverage for mammograms. In fact, because they are so demonized in Washington, DC, insurance companies must be very careful to keep up with the various gyrations of the health care reform legislation, so that they can anticipate the impact the legislation will have on patients and coverage. Regardless of what the eventual health care reform package looks like, insurance companies will have a spotlight focused on them.

The USPCTF recommendations give some insight as to how health care reform could affect patients and insurance companies, in part because Congress reacts with little regard for long-term implications. Breast cancer awareness and screening is perhaps more visible than any other disease in America, and has been for nearly 20 years. It is a very emotional issue in part because it has been personalized and highlighted, but also because of the dramatic increase in survivor stories.

The guidelines drew a lot of attention, and one of the first responses was for a U.S. Senator to offer an amendment to the health reform bill that would “guarantee women access to preventive health care screenings and care at no cost … [by requiring] all health plans to cover comprehensive women’s preventive care… with no copayments.” That amendment passed in the Senate bill.

And now it will be a mandated part of any coverage issued by an insurance company. Along with how many other mandates tucked away in the 2,000 page health reform legislation? Inevitably, when Congress lards on mandates, they leave it to someone else to consider the costs. That will mean insurance companies will have to raise their premiums, and will have to take the heat for it.

Don Hannaford is Senior Vice President and Chair of the Public Affairs Practice at Levick Strategic Communications and a contributing author to Bulletproof Blog. He can be reached at [email protected].


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