Free mammograms: Women's health in reform

You might have thought that all the sports news this week revolved around Tiger Woods and his “transgressions.” 

But of course politics is something of a sport as well, and there was plenty of gamesmanship on display this week, from President Obama’s decision to both send 30,000 more troops to Afghanistan and outline a timeline for withdrawal by 2011; to reminding the American public that the government is still focused on a jobs stimulus despite everything else that's going on; to the football-like grappling in the U.S. Senate over the health reform bill.

Senators locked horns over costs, and also women’s health—namely, mammograms.

Free mammograms
A couple weeks ago a government panel said women who aren’t predisposed to breast cancer should get mammograms starting at age 50 rather than 40, setting off a firestorm. So the Senate passed an amendment to its version of the health bill (they pass many amendments to revise the bill that came out of committee beforevoting on the whole bill) that would require insurance companies to cover mammograms before age 50 and also make them—and other types of screenings and preventative services—FREE. The amendment passed 61-39.

Fear of rationing
Exactly why they should be free and not subject to some kind of a co-pay is not entirely clear. 

The cost of the amendment is $940 million over 10 years. In part it may be due to fear that women would put off mammograms even when recommended if insurance didn’t cover them.

Another fear is “rationing,” which you likely are hearing thrown around a lot these days. Basically this refers to either an insurance company or the government choosing to not cover certain procedures, often because scientific research doesn’t support its need or shows it to be ineffective, and usually in the name of profit or cost savings. If the new guidelines recommended by the panel were followed, the fear is that mammograms might be “rationed.”

Another reason might be because women are considered key health care decision makers for families, and Democrats want to court them with female-friendly legislation.

Discussions surrounding women and the Senate health bill are not over. At issue is the use of public funds to pay for abortion. Senator Ben Nelson, a Blue Dog Democrat from Nebraska (we wrote about Blue Dogs back in July), is expected to submit language–- similar to what they passed in the House—that would prohibit any government insurance plans from covering abortion.

In 2000, 57% of women who received abortions were “low income,” meaning they likely did not have health insurance coverage. The restrictions were a big fight in the House and are expected to be so in the Senate. With 60 votes in the Senate, the Democrats need all of them to pass the full bill. But Nelson says he’ll oppose the overall bill if the abortion restrictions aren’t included, meaning Democrats will need at least one Republican to vote with their team.

The big picture
Creating safeguards for women in health reform is particularly important following a revealing report issued last year by the National Women’s Law Center that found that women who purchase individual insurance plans (not through an employer) face higher insurance premiums than men (called gender rating) and are at risk of being rejected for coverage due to female-related conditions such as a cesarean section.

As the author of the Senate amendment on mammograms put it, “The insurance companies take being a woman as a pre-existing condition.” The fact that the mammogram amendment adds to the cost of an otherwise expensive bill likely means we haven’t heard the last of this discussion, especially when the bill moves to the full floor for a vote, which may or may not happen before the end of the year.