On the December 2 edition of Fox News' Special Report, correspondent Shannon Bream advanced the Republican argument that recommendations like the mammogram screening guidelines recently released by the U.S. Preventative Services Task Force “will enable insurance companies to ration care and deny reimbursement for various procedures,” suggesting that insurance companies don't already ration care. Indeed, many insurance companies already keep patients from getting the medical treatments they need and the recommendations are not legally binding.
Bream: Republicans say “recommendations by this kind of group will enable insurance companies to ration care”
From the December 2 edition of Fox News' Special Report with Bret Baier:
BREAM: While today's Capitol Hill hearing [on the new mammogram guidelines] was quickly scheduled with the primary goal of getting an explanation and guidance from the task force, it rapidly morphed into a renewed debate over the health care reform bill passed weeks ago by the House with a number of Republicans saying recommendations by this kind of group will enable insurance companies to ration care and deny reimbursement for various procedures.
Fact: Task force recommendations “do not set federal policy”
Sebelius: Recommendations are from “an outside independent panel,” “do not set federal policy.” From HHS Secretary Kathleen Sebelius's November 18 press release:
“There is no question that the U.S. Preventive Services Task Force Recommendations have caused a great deal of confusion and worry among women and their families across this country. I want to address that confusion head on. The U.S. Preventive Task Force is an outside independent panel of doctors and scientists who make recommendations. They do not set federal policy and they don't determine what services are covered by the federal government.
” There has been debate in this country for years about the age at which routine screening mammograms should begin, and how often they should be given. The Task Force has presented some new evidence for consideration but our policies remain unchanged. Indeed, I would be very surprised if any private insurance company changed its mammography coverage decisions as a result of this action.
“What is clear is that there is a great need for more evidence, more research and more scientific innovation to help women prevent, detect, and fight breast cancer, the second leading cause of cancer deaths among women.
” My message to women is simple. Mammograms have always been an important life-saving tool in the fight against breast cancer and they still are today. Keep doing what you have been doing for years -- talk to your doctor about your individual history, ask questions, and make the decision that is right for you."
Fact: Recommendations are not legally binding
Task force recommendations not legally binding. The task force's recommendations are not legally binding, and the task force encouraged policymakers to include additional considerations and “individualize decision making to the specific patient or situation.”
NBC's Snyderman: “It's important to remember that these new recommendations from this independent task force are just that -- they're recommendations.” In a Nightly News report on the task force recommendations, NBC chief medical correspondent Dr. Nancy Snyderman stated, “It's important to remember that these new recommendations from this independent task force are just that -- they're recommendations. They don't mandate any changes in who should get mammograms and when.” [NBC's Nightly News with Brian Williams, 11/17/09]
Task force previously recommended against certain preventive cancer screenings under Bush, undermining efforts to connect guidelines, “rationing” charge to Democrats. For example, in 2004 the task force recommended against screening for ovarian cancer, routine screening for testicular cancer in “asymptomatic adolescent and adult males,” and routine bladder cancer screening in adults; in 2005, it recommended against routine screening for peripheral arterial disease; in 2006, it recommended against routine genetic screening of the asymptomatic general population for hereditary hemochromatosis; and in 2007, it recommended against screening the general adult population for asymptomatic carotid artery stenosis.
Fact: Insurance companies already ration care
Insurance companies acknowledge rationing care. Insurance companies acknowledge that they ration care, restricting coverage of procedures and tests like MRIs and CAT scans and denying coverage for pre-existing medical conditions.
Sanjay Gupta: “I can tell you, as a practicing physician ... who deals with this on a daily basis, rationing does occur all the time.” As Dr. Sanjay Gupta, CNN's chief medical correspondent, explained: "[P]eople always say, 'Is there going to be rationed care?' And I can tell you, as a practicing physician, as someone who deals with this on a daily basis, rationing does occur all the time. I mean, I was in the clinic this past week. And I -- you know, at the end of clinic, I get all this paperwork that basically says, 'Justify why you're doing such and such procedure. Justify why you're ordering such and such test.' And if the justification is inadequate, the answer comes back, 'Well, that's not going to be covered.' Which basically is saying that the patient is going to have to pay for it on their own, which is, in essence, is what rationing is, in so many ways."
Insurance companies ration care by rescinding coverage. As former senior executive at CIGNA health insurance company Wendell Potter explained in June 24 Senate testimony, insurance companies restrict or deny coverage by rescinding health insurance policies on the grounds that people had undisclosed pre-existing conditions. President Obama cited one such example in an August speech, noting that "[a] woman from Texas was diagnosed with an aggressive form of breast cancer, was scheduled for a double mastectomy. Three days before surgery ... the insurance company canceled the policy, in part because she forgot to declare a case of acne. ... By the time she had her insurance reinstated, the cancer had more than doubled in size."