Obamacare vs. women
Beware of what it takes away

Reuters

Bonnary Lek, a manager at Discovery Communications headquarters, signs in for a medical appointment at the Discovery Wellness Center at the company's headquarters in Silver Spring, Maryland December 3, 2009.

Article Highlights

  • Obamacare empowers a host of new boards and committees to arbitrate over what insurance will pay for.

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  • What the US Preventive Services Task Force deems essential is often out of sync with patient preferences and experts.

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  • Dozens of screening tests and treatments that directly benefit women are likely to be dropped from any coverage.

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  • Decisions from the US Preventive Services Task Force will inevitably hew as much to politics as to medical need.

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  • “Women, like all of us under the thumb of ObamaCare, risk losing far more than they’ll gain.” @ScottGottliebMD

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President Obama is campaigning hard on his promise to give women access to free oral contraceptives and surgical sterilization, benefits that are guaranteed under Obamacare. But women should also know about all of the health services they stand to lose.

Obamacare empowers a host of new boards and committees to arbitrate over what insurance will pay for, and what remains uncovered. They’ll rule over not just health plans sold inside the Obamacare exchanges, but even private insurance.

One such board, the US Preventive Services Task Force, will evaluate preventive health services like contraception and decide which benefits must be part of the coverage that insurance plans offer — indeed, which services must be covered in full, with no co-pays.

But requiring first-dollar coverage for those services is expensive, so health plans will have to offset those costly mandates by dropping coverage for things that don’tmake the board’s grade.

Problem is, what the board deems essential is often out of sync with patient preferences, conventional medical practice and even experts like the Centers for Disease Control — which has clashed with the Preventive Services Task Force over recommendations like screening for HIV and hepatitis C.

What health benefits are likely to be nixed from insurance coverage? Well, look at all of the things that the Task Force doesn’t recommend, and therefore won’t be mandated under ObamaCare.

Dozens of screening tests and treatments that directly benefit women are likely to be dropped from any coverage.

Here’s a sampling of what the Preventive Services Task Force dings: chlamydia screening in most women over 25; cervical-cancer screening in those over 65; breast-cancer screening using digital mammography or MRI instead of the traditional plain film.

Screening for ovarian cancer and the genes that raise a women’s risk of breast cancer also don’t make the cut. Same for clinical breast exams in women older than 40.

Even having a doctor teach women how to do a breast self-exam is unlikely to be covered, since the task force says women are rarely the ones to find their breast cancers,

Americans first became familiar with the Preventive Services Task Force in November 2009, when it made the controversial decision to advocate that women ages 40-49 shouldn’t get routine mammograms. More recently, it rebuffed routine use of tests for detecting the viruses that can cause cervical cancer. And now it’s calling the shots for what benefits must be included and what can be nixed from our plans.

This is what happens when benefits are defined in Washington, rather than by a marketplace of competing plans that cater to patient preferences. This is what happens when you put an insular committee of academics in charge, let them meet in secret and devise their own rules — and insulate them from appeals or lawsuits.

Like other Obamacare committees, the Preventive Services Task Force convenes in Washington, so it will be cognizant of the political winds. Decisions will inevitably hew as much to politics as to medical need.

That’s how benefits like full coverage for contraception make their way into the mandates, while other important services are left out. The academicians will find a way to make their economic and clinical analyses line up for the politically popular things, because they know their arrangement depends on it.

At its core, Obamacare is really an exercise of federal power over the regulation of health insurance. The decrees made in Washington will rapidly shape the health plans bought by all Americans, regardless of where we buy our coverage.

As health plans come under tighter regulation of what they must offer, what they can charge for premiums and what they can spend on overhead, insurers will scramble to cut costs by cutting benefits, wherever the feds suggest. Focus groups rather than doctors will start to shape medical benefits.

Women, like all of us under the thumb of Obamacare, risk losing far more than they’ll gain.

Dr. Scott Gottlieb is an American Enterprise Institute resident fellow.

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