111th Congress, Vote 355; Senate #3590

Preventive Services Coverage Requirements

Official Title: An act entitled The Patient Protection and Affordable Care Act.

S Amdt 2791: Preventive Services Coverage Requirements
Amendment adopted Dec. 3, 2009, 61-39

This amendment to health care reform requires that health insurers provide first-dollar coverage (without co-pays or deductibles) for:

• preventive services that are recommended by the U.S. Preventive Services Task Force with an 'A' or 'B' rating such as mammograms,
• Immunizations recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention;
• preventive health care and screenings for infants, children and adolescents as provided for in guidelines supported by the Health Resources and Services Administration; and
• preventive health care and screenings for women as provided for in guidelines supported by the Health Resources and Services Administration.

Why supporters pushed for this bill

• The amendment focused on the need for first-dollar coverage of preventive services for women. As Senator Dianne Feinstein explained: "Women of childbearing age spend 68 percent more in out-of-pocket health care costs than men. Most people don't know that, but it is actually true. So we believe all women – all women – should have access to the same affordable preventive health care services as women who serve in Congress, no question.
  
  "The amendment offered by Senator Mikulski … will ensure that is, in fact, the case. It will require insurance plans to cover at no cost basic preventive services and screenings for women. This may include mammograms, Pap smears, family planning, screenings to detect postpartum depression, and other annual women's health screenings …
  
  "Nothing in our bill would address abortion coverage. Abortion has never been defined as a preventive service. The amendment could expand access to family planning services – the type of care women need to avoid abortions in the first place."
• Supporters argued that the bill could be funded by cutting Medicare waste.

Why opponents tried to stop it

Opponents said the Senate should have found a way to pay the cost of Sen. Mikulski’s proposal, estimated at $940 million over 10 years. They warned that otherwise, Medicare funds would be raided to pay for the bill.

Some said the amendment should have explicitly excluded abortion from the definition of preventive care. Others believed that the bill should have required insurers to inform patients of screening guidelines issued by professional groups like the American College of Obstetricians and Gynecologists, which recommends that average-risk women have a mammogram only every 1-2 years starting at age 40.

Since mammograms in younger women produce a relatively high rate of false-positive results (when the test falsely indicates breast cancer), there is a risk of radiation exposure and potentially unnecessary biopsies or surgeries if average-risk women under 40 undergo mammograms.

12/03/2009

Status: Senate amendment agreed to

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