Health lobbyists focus on a once-obscure group
For years, an obscure federal task force sifted through medical literature on colonoscopies, prostate-cancer screening and fluoride treatments, ferreting out the best evidence for doctors to use in caring for their patients. But now its recommendations have financial implications, raising the stakes for patients, doctors and others in the health-care industry.
Under the new health-care overhaul law, health insurers will be required to pay fully for services that get an A or B recommendation from the U.S. Preventive Services Task Force, a volunteer group made up of primary care and public health experts.
That's good news for patients, who will no longer face cost sharing for these services, but it puts the group in the cross hairs of lobbyists and disease advocates eager to see their top priorities -- routine screening for Alzheimer's disease, diabetes or HIV, for example -- become covered services.
"It's a wide-open door for lobbying," says Robert Laszewski, a health insurance industry consultant.
On Wednesday, first lady Michelle Obama; Jill Biden, the wife of Vice President Biden; and Health and Human Services Secretary Kathleen Sebelius discussed the importance of preventive care at a news conference to unveil regulations for implementing the provisions, which include coverage of immunizations and additional services for women and children.
"Too many Americans don't get the preventive care they need to stay healthy and keep health-care costs down for all of us," Sebelius said. "Our challenge is to remove the barriers."
The preventive-services task force will guide that effort. Founded in 1984, it has 16 members -- many of whom are doctors. The group meets three times a year and is staffed by officials at the Agency for Healthcare Research and Quality.
Under the new law, the task force could become a political lightning rod. If it doesn't recommend a service, insurers might not pay for it, and advocates might argue the decision is a barrier to care. If the panel does back a service, it might increase patients' access, as well as create new business opportunities.
The requirement applies only to plans created after Sept. 23. The Obama administration estimates that 31 million people in new employer plans, and 10 million people in new individual plans, will benefit next year. By 2013 the number of people in employer plans who will benefit is projected to reach 78 million, for a total of 88 million. Health department officials expect the provision will boost insurance premiums by about 1.5 percent.
The increased interest of advocates may conflict with the task force's tradition of scholarly dedication to the science of randomized medical trials.
"If you want to be evidence-based, lobbying just doesn't fit," said Ned Calonge, the panel's chairman and the chief medical officer for the Colorado Department of Public Health and Environment. "My charge to members would be to stay true to the methods and the evidence."
But sticking to the science hasn't always been popular. The task force set off a firestorm in November 2009 when, seemingly oblivious to the politically charged health-care debate, it recommended that women begin getting routine mammograms at 50, rather than at 40.