BY SCOTT GOTTLIEB | FEBRUARY 22, 2012
Meet the ObamaCare Mandate Committee
Think the contraception decision was bad? Wait until bureaucrats start telling your insurer which cancer screenings to cover
Offended by President Obama's decision to force health insurers to pay for contraception and surgical sterilization? It gets worse: In the future, thanks to ObamaCare, the government will issue such health edicts on a routine basis—and largely insulated from public view. This goes beyond contraception to cancer screenings, the use of common drugs like aspirin, and much more.
Under ObamaCare, a single committee—the United States Preventative Services Task Force—is empowered to evaluate preventive health services and decide which will be covered by health-insurance plans.
The task force already rates services with letter grades of "A" through "D" (or "I," if it has "insufficient evidence" to make a rating). But under ObamaCare, services rated "A" or "B"—such as colon cancer screening for adults aged 50-75—must be covered by health plans in full, without any co-pays. Many services that get "Cs" and "Ds"—such as screening for ovarian or testicular cancer—could get nixed from coverage entirely.
That's because mandating coverage for all the "A" and "B" services will be very costly. In 2000, the Congressional Budget Office estimated that the marginal cost of similar state insurance mandates was 5 percent-10 percent of total claims. Other estimates put the cost of mandates as high as 20 percent of premiums.
Health plans will inevitably choose to drop coverage for many services that don't get a passing grade from the task force and therefore aren't mandated. Insurance companies will need to conserve their premium money, which the government regulates, in order to spend it subsidizing those services that the task force requires them to cover in full.
Americans first became familiar with the task force in November 2009, when it made the controversial decision to recommend that women ages 40-49 shouldn't get routine mammograms. More recently, it rebuffed routine prostate-cancer screening and the use of tests that detect the viruses that can cause cervical cancer.
The task force relishes setting a very high bar. Like the Food and Drug Administration in approving new drugs, it usually requires a randomized, prospective trial to "prove" that a diagnostic test or other intervention improves clinical outcomes and therefore deserves a high grade of "A" or "B."
This means its advice is often out of sync with conventional medical practice. For example, it recommended against wider screening for HIV long after such screening was accepted practice. As a result, many of its verdicts are widely ignored by practicing doctors.
The task force is a part-time board of volunteer advisers that works slowly and is often late to incorporate new science into its recommendations. Only in 2009 did it finally recommend aspirin for the prevention of stroke and heart attack among those at risk—decades after this practice was demonstrated to save lives and had become part of standard medical practice.
The task force is also the only federal health agency to have the explicit legal authority to consider cost as one criterion in recommending whether patients should use a medical test or treatment.
Over time, the task force will surely recommend against many services that patients now take for granted, while mandating full insurance coverage for things that they'd be just as happy paying for. Among the interventions that it plans to consider in 2012 are screening for hepatitis C in adults, for osteoporosis in men and for depression in children; counseling for obesity in adults and for alcohol use in adolescents; and daily aspirin for heart-attack and stroke prevention in people over 80.
The task force's problems are compounded by the fact that it is deliberately exempted from the rules that govern other government advisory boards and regulatory agencies. Thus it has no obligation to hold its meetings in public, announce decisions in draft form or even consider public comments. Consumers have no way to directly appeal its decisions. And health providers or product developers affected by its decisions can't sue it for recourse.
To begin addressing these problems, Congress should make the task force subject to the Federal Advisory Committee Act, which would at least require it to hold its deliberations in public. Congress could also make it a full-fledged part of the Agency for Healthcare Research and Quality, which already convenes its meetings. That would make the task force subject to the Administrative Procedures Act and all the rules that bind other regulatory bodies, including the legal requirement to consider public comments and provide avenues for appeal.
Better still, Congress could let private health plans—and their members—decide on their own how preventive tests and treatments should be covered. If not, Americans will soon be surprised by all the important tests and treatments that become more costly, and all the less relevant stuff that's suddenly free.
It's all a reminder that President Obama's decision on contraception isn't a one-off political intervention but the initial exploit of an elaborate new system.
Dr. Gottlieb, a physician and resident fellow at the American Enterprise Institute, has served as deputy commissioner of the Food and Drug Administration and senior policy adviser to the Centers for Medicare and Medicaid Services. He consults with and invests in health-care companies.
