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The Affordable Care Act: What’s Not Being Reported About Preventive Screening Benefits

One part of the health care law that took effect this week is widely reported as “establishing a menu of preventive procedures, such as colonoscopies, mammograms and cholesterol screening, that must be covered without co-payments.” For example, one of my local papers, the [St. Paul, Minnesota] Star Tribune, wrote: “Some people will no longer have to pay for copays, coinsurance or meet their deductibles for preventive care that’s backed up by the best scientific evidence.” (emphasis added)

That phrase should always include a huge asterisk, like the one hung on Roger Maris’ 61st home run. The best scientific evidence according to whom?

Time magazine reports, “Procedures, screenings and tests that are considered ‘preventive’ will be determined by the U.S. Preventive Services Task Force, the Centers for Disease Control (for vaccines) and the Health Resources and Services Administration.” As written, that is incorrect and inaccurate at worst and misleading at best.

The Associated Press came closer to the truth, reporting: “Of note to women: Those in their 40s and at average risk for breast cancer can get a mammogram every one to two years as part of the free preventive care. That’s in line with American Cancer Society advice. But it’s more generous than the Preventive Services Task Force, which says most women don’t need mammograms in their 40s.” However, the AP fell into the same un-asterisked trap, leading with the line, “New health insurance policies beginning on or after Sept. 23 must cover — without charge — preventive care that’s backed up by the best scientific evidence.”

Don’t forget: independent experts volunteering on the US Preventive Services Task Force last November stated:

“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, including the patient’s values regarding specific benefits and harms.”

The task force’s “Grade C” recommendation means it recommends against routinely providing the service. “There may be considerations that support providing the service in an individual patient. There is at least moderate certainty that the net benefit is small.”

The task force page has a little box at the bottom that reads:

The Department of Health and Human Services, in implementing the Affordable Care Act under the standard it sets out in revised Section 2713(a)(5) of the Public Health Service Act, utilizes the 2002 recommendation on breast cancer screening of the U.S. Preventive Services Task Force.

In other words, the 2009 review was ignored because special interests and politicians didn’t like it. So a review done 7 years prior was used instead because it was more politically acceptable.

This appears to be a clear political concession on the part of the Department of Health & Human Services to people like Senator David Vitter of Louisiana, who boasted on his website:

December 3, 2009
Senate Approves Vitter Breast Cancer Amendment

(Washington, D.C.) – U.S. Sen. David Vitter today announced that the U.S. Senate approved his amendment to the Senate health care bill that would prevent the new United States Preventive Service Task Force recommendations from restricting mammograms for women. In November, the USPSTF released a series of recommendations that stand in stark contrast to common-held cancer prevention practices.

Politics won.

Expert analysis by members of the USPSTF was ignored, disregarded and overruled.

You are free to disagree with the USPSTF. But it is wrong to say that the new law’s recommendations are based on the USPSTF recommendations – without including a line like “based on only some of the USPSTF recommendations” or “based on older USPSTF recommendations in the case of mammography” or “based on the more politically acceptable USPSTF recommendations.”

Some news organizations — and probably many Americans — may still not understand what happened. But there’s an obligation to report the facts – whether you like them or not.

It is particularly ironic that the day before the law’s changes went into effect, a study was published in the New England Journal of Medicine that was reported in the New York Times, for example, under the headline, “Mammograms’ Value in Cancer Fight at Issue.

More evidence. But the law — driven by politics and special interests — went in a different direction.

*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*

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3 Responses to “The Affordable Care Act: What’s Not Being Reported About Preventive Screening Benefits”

  1. What’s under-reported are the flaws in the new paper on mammography and, more generally, progress in treatments and survival among women with early stage BC. See Medical Lessons post –

  2. Mammogate was a shameful intrusion of politics into medical policy. The USPSTF is known for it caution and medical conservativism. It is widely respected for its apolitical approach. This debacle is but a glimpse of what awaits us when comparative effectiveness research begins. Even colonoscopy, which I perform, hasn’t been validated to save lives in randomized controlled trials. But,at least it has the imprimatur of the USPSTF and is based on sound medical evidence.

  3. I think it’s critical that we not conflate discussions regarding the data for different tumor types, as is happening now by some journalists and many readers. Breast cancer refers to a set of diseases that are not the same as colon cancers.

    Whether a government panel should set policy on what’s covered is an issue apart from deciphering the data, except that if you think the government should set policy, as I do, there’s even more reason for scientists, doctors and journalists to get the facts straight.

    Mortality from breast cancer is down by roughly a third since 1980. That progress, in breast cancer and not in other cancers, is due to the combined effects of mammography, improved surgical techniques to remove tumors once found, new pathology methods, and adjuvant therapy of early-stage disease.

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