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December 12, 2009

By Misty Watson

Some local health officials say the debate over how often women should get mammograms shows how health decisions become political battles when the government gets involved. Will these battles grow if the government gets even more involved in health care?”

“I really think it is going to be that way,” said state Sen. Don Thomas, R-Dalton, a practicing physician and chairman of the Senate Health and Human Services Committee.

“I don’t know that it will. But it’s a scary proposition,” said Jeff Myers, CEO designate of Hamilton Health Care System. Myers was named CEO of Hamilton earlier this year and will replace current CEO John Bowling on Jan. 1, 2010.

In November, a federal task force said women should generally start getting routine regular mammograms at 50, not 40 as had been previously recommended, and should get them every other year, not annually as had been the previous advice. The task force’s recommendations were not federal policy, but Medicare and Medicaid often rely on recommendations from it.

Those recommendations started a maelstrom of debate and criticism by some doctors and other health officials. Health and Human Services Secretary Katherine Sebelius quickly said those new guidelines would not affect federal policies.

About three weeks later, the U.S. Senate, having seen how unpopular the new guidelines were, directed the government to set aside those guidelines. The Senate also passed an amendment requiring government and private health insurance plans not only to cover mammograms and pap smears but not to charge patients for them. If the Senate passes a health care bill, those amendments would be part of it.

Thomas said he believes medical decisions, such as when to do tests such as mammograms, should be made by doctors and patients.

Dalton physician John Antalis, a director of the Medical Association of Georgia, agrees.

“Politics should not be in the exam room,” Antalis said.

But Thomas said he’s also wary of the government mandating that insurance cover particular procedures.

“A person should be able to have whatever private insurance they like, and if we start putting mandates on insurance it runs the costs up,” Thomas said.

In fact, all 50 states now mandate that private insurance cover different tests and treatments. More than a dozen states require health insurance to cover marriage counseling and acupuncture, according to the National Center for Policy Analysis. More than half the states require health insurance to pay for contraceptives. And seven require coverage for wigs and toupees. The industry-funded Council for Affordable Health Insurance estimates these mandates may increase insurance costs by up to 50 percent.

According to Alliant Health Plans, a not-for-profit health plan based in Calhoun, the state of Georgia has around 30 mandates on private insurers, requiring group plans to cover everything from infertility treatment to contraceptives to chiropractors to chlamydia screening. Those mandates increase the costs of premiums 11 to 19 percent, according to data provided by Alliant.

Myers says the explosion of state mandates in the 1990s is one of the factors that drove up the costs of health insurance.