Senate Approves Women's Preventive Care Amendment to Health Reform Bill

December 4, 2009 — On Thursday, the Senate voted 61-39 to approve an amendment to its health care reform bill that would require insurance companies to offer women's preventive care services at little or no cost to patients, the New York Times reports. The amendment, introduced by Sen. Barbara Mikulski (D-Md.), would task the HHS Health Resources and Services Administration with developing "comprehensive guidelines" recommending preventive care and screening services for women, and insurers would be required to provide the services without any cost-sharing by patients (Pear/Herszenhorn, New York Times, 12/4). Republican Sens. Susan Collins (Maine), Olympia Snowe (Maine) and David Vitter (La.) voted for the amendment, while Democratic Sens. Ben Nelson (Neb.) and Russ Feingold (Wis.) voted against it (Ethridge, CQ Today, 12/3). Snowe was a co-sponsor of the amendment.

Mikulski said the covered preventive services could include screenings for cancer, diabetes and heart disease, as well as domestic violence and postpartum depression (New York Times, 12/4). Abortion services would not be included, CQ Today reports. The Congressional Budget Office estimates that the amendment would cost $940 million over 10 years, which Mikulski said would be offset by surplus funds in the bill (CQ Today, 12/3).

Although the underlying bill would eliminate many copayments and deductibles for preventive services, Mikulski said the "unique needs" of women were not adequately addressed in the legislation. The amendment "would eliminate one of the major barriers to care by getting rid of high copayments and deductibles," potentially saving lives, Mikulski said (New York Times, 12/4).

Senators approved by voice vote a provision by Vitter that would bar the U.S. Preventive Services Task Force's recent recommendations on breast cancer screening from being used for coverage determinations. Vitter's amendment states that the task force's recommendations, which were released in November, would not be considered the most current and that recommendations made prior to November would be used instead. The USPSTF guidelines generated controversy over the recommendation that most women in their 40s do not need annual screening mammograms.

The Senate also voted 41-59 to reject a more restrictive amendment by Sen. Lisa Murkowski (R-Alaska) that would have required the HHS secretary not to use any recommendations or rankings by USPSTF in deciding to deny coverage. Nelson joined Republicans in voting for the amendment, CQ Today reports (CQ Today, 12/3).

According to the Times, the vote on Mikulski's amendment "broke a logjam" on how to handle debate on amendment votes to the Senate reform legislation. Senate Democrats "still face a long road ahead" as they grapple with other contentious issues in the health reform bill, including the public plan option, the Times reports. The vote also signals how difficult it will be for Democrats to sway Nelson, who sided with Republicans in three of the four roll-call votes on Thursday (New York Times, 12/4). Democratic leaders in the Senate have said they want to pass the chamber's final bill by the end of the month, but Republicans would like to extend the debate into the 2010 election campaign season, Reuters reports. If the Senate passes its bill this month, it would have to be reconciled with the House version in January before being sent to President Obama for his signature (Whitesides, Reuters, 12/3).