Health lobbyists focus on a once-obscure group

Ned Calonge, chairman of the Preventive Services Task Force, said he'll ask the group to "stay true to the methods and the evidence." (Susan Biddle For The Washington Post)

Critics pounced on the proposal, saying the government would engage in health-care rationing. Breast cancer activists also protested. The result: Sen. Barbara A. Mikulski (D-Md.) inserted an amendment in the health-care law to explicitly cover regular mammograms for women between 40 and 50.

Groups including the American Diabetes Association and General Electric, which manufactures equipment for mammography, also lobbied Congress on task force issues. The diabetes group won a requirement that the task force include in its reviews of evidence the guidelines drafted by specialty groups -- language intended to help preserve diabetes coverage.

In response to the backlash over the mammography recommendation and other calls for transparency, the task force recently adopted a new policy of accepting public comment before finalizing its recommendations.

Calonge said the task force was "willing to take on such challenges as increased scrutiny may bring forward." He said that while the panel wouldn't change its recommendations just because of criticism, it also would not be "immune" to input that might add perspective." But, he added, "the science needs to come first."

In addition to the task force, other scientific bodies and government groups will also help determine the services that must be covered. For instance, plans must also cover a set of standard vaccines recommended by the Advisory Committee on Immunization Practices, as well as screening practices for children that have been developed by the Health Resources and Services Administration in conjunction the American Academy of Pediatrics. Health plans will also be required to cover additional preventative care for women recommended under new guidelines that the Department of Health and Human Services is expected to issue by August 2011.

Several disease groups are going directly to HHS to make their cases.

The diabetes association, for instance, is arguing to the department that the current task force guidelines, which call for screening for diabetes only when a patient has elevated blood pressure, could become a barrier to care and that insurers should be required to provide broader coverage.

Lobbyist Tekisha Everette called the guideline "a shark in the water" and said her group has pressed Sebelius to include a broader diabetes screening requirement in regulations.

The HIV Medicine Association is making a similar argument. A two-page memo it delivered to the staff of the preventive services task force explains that one reason 20 percent of people with HIV don't know they are infected is that testing isn't reimbursed by most insurers.

Calonge said his panel's recommendation would only be used to set minimum coverage requirements and that insurers are free to cover additional services. The panel revisits its recommendations every five years.

Many commercial insurers already cover preventive services without cost sharing, often based on the task force's advice, according to Robert Zirkelbach, a spokesman for America's Health Insurance Plans, a trade group based in Washington. "There's broad recognition that prevention is essential," he said.

Weaver is a reporter for KHN (www.kaiserhealthnews.org), an editorially independent news service and a program of the Kaiser Family Foundation, a nonpartisan health-care policy organization that is not affiliated with Kaiser Permanente. Washington Post staff writer N.C. Aizenman contributed to this report.