pink-ribbon-14306811601dc-222x300-5897610State legislators have taken their mania for insurance mandates to a new extreme: They’ve passed a bill that arguably accomplishes nothing other than covering unnecessary mammograms.

Unless vetoed by Governor Andrew Cuomo, this mandate would not only waste millions, but possibly do more harm than good for the women it’s supposed to help.

The bill in question, sponsored by Senator Joseph Griffo of Rome and Assemblywoman Rebecca Seawright of Manhattan, adds “breast tomosynthesis,” a high-tech form of mammography, to the long list of procedures that state-regulated health plans must pay for.

Approved by the Food and Drug Administration in 2011, the technique generates a 3-D X-ray image of the breast, and shows promise of more accurately identifying signs of cancer, especially in the roughly half of women who have dense breast tissue.

However, the U.S. Preventive Services Task Force and other experts say there is not yet enough clinical evidence to show that the technique improves health outcomes in women of average risk, as has been proven with traditional mammograms.

In the face of this scientific uncertainty, Governor Cuomo announced in February that regulators at the Department of Financial Services were ordering health plans to cover tomosynthesis “when medically necessary.” The order seemed largely symbolic, since the state Health Plan Association said its members already covered tomosynthesis when medically necessary.

But the DFS rule left plans with sensible discretion to limit coverage – such as covering the procedure only for women with dense breast tissue or a family history of breast cancer, or simply requiring a doctor’s recommendation.

Had the Legislature simply codified the same rule as law, that would be bad enough. Writing medical guidelines into statute is a dangerous business, especially when the science remains unsettled.

But the Griffo-Seawright mandate bill goes well beyond the DFS rule. It includes no mention of medical necessity, family history, dense tissue, or a doctor’s recommendation. Instead, it expands the state’s existing mammography mandate to include tomosynthesis, effectively adding it as a routine procedure for all women.

Since the DFS has previously mandated coverage of medically necessary tomosynthesis screens, the only practical impact of Griffo-Seawright is to require coverage, by law, for unnecessary ones.

Already, the state’s existing screening law, written years ago, goes beyond the current guidelines of expert organizations. For women of average risk, it requires coverage of a baseline mammogram as young as 35, then yearly screens starting at 40 with no upper age limit.

The Preventive Services Task Force, by contrast, recommends every-other-year mammograms from 50 to 74 for average women, and starting at age 40 for women at high risk.

The task force based its guidelines not on cost, but on the potential harm of excessive screening – including the anxiety and unnecessary biopsies and treatments that result from false alarms.

But of course mammograms of all kinds cost money, and requiring payment for unnecessary procedures will only add to the high cost of healthcare in New York State.

Despite these concerns, the Assembly approved Griffo-Seawright unanimously on March 30, and the Senate did the same on Thursday.

As Trudy Lieberman of Health News Review wrote earlier this year, regarding the DFS order: “Breast cancer is good politics, and when votes are at stake, inconvenient or nuanced science gets overlooked.”

About the Author

Bill Hammond

As the Empire Center’s senior fellow for health policy, Bill Hammond tracks fast-moving developments in New York’s massive health care industry, with a focus on how decisions made in Albany and Washington affect the well-being of patients, providers, taxpayers and the state’s economy.

Read more by Bill Hammond

You may also like

The state puts a pricey condition on its approval of a heart transplant center

In a provocative flex of executive power, the state Health Department is requiring a hospital system to spend $50 million on health care in Brooklyn and Queens if it wants to open an $8.4 million heart transplant center in Manhattan. Read More

The Essential Plan’s accumulated surplus balloons to $8 billion, with no fix in sight

The state's Essential Plan has generated billions in surpluses as the program automatically drew pandemic relief money that it did not need Read More

New federal health funding is headed for Essential Plan limbo in New York

Washington's newly enacted climate, health and tax package harbors an only-in-New York glitch: It pours even more money into the state's Essential Plan, which is sitting on a multi-billion-dollar surplus that officials have Read More

New York’s health insurance price controls are not working

In what has become a rite of summer, the state Department of Financial Services on Wednesday approved substantially higher health insurance premiums for 2023 Read More

State Budget Back in the Red

Historically large budgetary surpluses inherited by Governor Hochul are now just a memory with New York facing projected gaps of $13.7 Billion Read More

New York’s health insurance affordability problem gets worse

New York's health insurance affordability gap surged to a new high last year, with state residents paying an average of 16 percent more. Read More

New York Doesn’t Need the Build Public Renewables Act

Assembly Speaker Carl Heastie called for a special hearing this Thursday to get more input on the Build Public Renewables Act. Read More

The dangers of Governor Hochul’s endless ’emergencies’

Last week, Governor Hochul extended one of her two pandemic-related emergency orders into its ninth month – an action so routine and non-urgent that her office issued no press release. Five days later, an expose in the Times Union showed why casually overusing emergency powers can be a bad idea. Read More

Subscribe

Sign up to receive updates about Empire Center research, news and events in your email.

CONTACT INFORMATION

Empire Center for Public Policy
30 South Pearl St.
Suite 1210
Albany, NY 12207

Phone: 518-434-3100

General Inquiries: Info@EmpireCenter.org

Press Inquiries: Press@EmpireCenter.org

About

The Empire Center is an independent, non-partisan, non-profit think tank located in Albany, New York. Our mission is to make New York a better place to live and work by promoting public policy reforms grounded in free-market principles, personal responsibility, and the ideals of effective and accountable government.

Empire Center Logo Enjoying our work? Sign up for email alerts on our latest news and research.
Together, we can make New York a better place to live and work!