Health carriers are now in the middle of a medical battle between those who believe women should have regular mammograms and those who believe regular checkups are unnecessary for most women and also pose their own health risks.
According to analysis by Avalere Health, the Department of Health and Human Services will soon release guidance that supports those opposed to biennial mammograms. An independent medical panel will recommend against the regular exams. And that means carriers will no longer have to cover them for women 50 years old and younger, as currently required by the Patient Protection and Affordable Care Act.
According to Avalere, the guidance could deny coverage of biennial mammograms to some 17 million women, most of whom are covered by employer-sponsored plans. Whether the department has the stomach to take on the issue again remains to be seen.
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"The [United States Preventive Services Task Force] is working to balance the life-saving benefits of breast cancer screening against the potential risks for over-diagnosis and unnecessary treatment of lower-risk women," said Caroline Pearson, senior vice president at Avalere. "By linking the ACA rules to USPSTF decisions, coverage for preventive services will continue to evolve as new research and evidence becomes available."
News outlet The Hill reported that a replay of a similar effort in 2009 could be in store. Then, opposition to such guidance was so strong HHS dropped the matter.
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Dan Cook
Dan Cook is a journalist and communications consultant based in Portland, OR. During his journalism career he has been a reporter and editor for a variety of media companies, including American Lawyer Media, BusinessWeek, Newhouse Newspapers, Knight-Ridder, Time Inc., and Reuters. He specializes in health care and insurance related coverage for BenefitsPRO.
