Governor Cuomo’s deal with legislative leaders on expanded access to breast cancer screening falls squarely within three unfortunate Albany traditions: It micromanages the health-care industry in ways that add red tape and drive up costs. It singles out a high-profile disease for special treatment. And it accomplishes less than what’s promised by the press release.
The bill announced Sunday by Cuomo, Assembly Speaker Carl Heastie, and Senate Majority Leader John Flanagan (S. 8093/A. 10679) has three provisions.
First and most consequentially, it requires hospitals and clinics that perform screening mammograms to offer morning, evening, or weekend hours, which is meant to make it easier for working women to schedule appointments.
But many such facilities already do have extended hours. Of 105 facilities surveyed by the New York City Council in 2009, 39 percent offered evening hours, and 50 percent were open on weekends.
Second, the deal bars insurance companies from charging copayments or coinsurance for either screening mammograms or follow-up diagnostic imaging. But for small group and individual policies, copayments and coinsurance are already banned for screening mammograms because of how New York implemented the Affordable Care Act. And it’s not clear that this bill will apply at all to health plans offered by companies who “self-insure,” which cover the majority of New Yorkers with employer-sponsored coverage.
Plus, this policy makes no distinction between truly needy women and those who could easily afford a copayment. Nor does it affect copayments and coinsurance for treating breast cancer, as opposed to screening for it.
Third and most gratuitously, the bill grants New York City’s employees four hours a year of breast cancer screening leave (expanding a policy that already covers all other state and municipal workers). But if all mammography centers are to be open on weekends and evenings, where is the urgent need for extra time off? The policy even applies to teachers and other school employees whose work schedules include long blocks of vacation.
Assuming the Legislature approves this bill—which is virtually guaranteed by Cuomo, Heastie, and Flanagan’s three-way agreement—it will be layered on top of decades’ worth of previous mandates specific to breast cancer.
This includes a 1990 law requiring insurance companies to pay for at least one “baseline” mammogram for women who are 35 or older, then at least annual mammograms for women over 40.
This goes far beyond the guidelines of the U.S. Preventive Services Task Force, which, for women at average risk, recommends mammograms every other year starting at age 50. The panel of medical experts did not consider cost; its research-based analysis weighed the benefits of screening against the risks of false positives and over-treatment.
Not all experts accept those findings. The American Cancer Society’s guidelines say women ages 40 to 44 “should have the choice to start annual breast cancer screening with mammograms if they wish to do so”; women from 45 to 54 “should get mammograms every year”; and women 55 and older “should switch to mammograms every 2 years, or have the choice to continue yearly screening.” The ACS guidelines make no mention of a “baseline” screening at 35.
In announcing the agreement on Sunday, the governor cited the experience of his girlfriend, Sandra Lee, who underwent a double mastectomy last year.
“When Sandy was diagnosed with breast cancer, she was lucky to have caught it early,” Cuomo said. “But not all women are that lucky, and many are not fortunate enough to have the flexibility in their schedule or the resources to fight this disease head on. By expanding screening hours and removing insurance barriers, this agreement will give our wives, daughters and sisters better access to life-saving health services so they too can get ahead of this disease.”
Left unexplained is why state government should intervene so heavily regarding one deadly disease while taking a hands-off approach to so many others.
According to the Health Department, about 15,000 New York women are diagnosed with breast cancer each year, and 2,600 die from it. It’s the second leading cause of cancer death in women, and appropriate screening is a proven strategy for saving lives.
Routine screening is also crucial for combating colorectal cancer, which annually kills 3,200 New Yorkers of both sexes. Yet state law includes no extended hours for colonoscopy facilities, no colon-specific insurance mandates, and no special time off.
New York’s screening rate for breast cancer is 75 percent, compared to 70.7 percent for colorectal cancer. Both rates are better than national averages.
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