Under the new health care overhaul law, insurers will be required to pay fully for services that get an "A" or "B" recommendation from the U.S. Preventive Services Task Force. That's good news for patients, who will no longer face cost-sharing for these services, but it puts the group in the crosshairs of lobbyists and disease advocates eager to see their top priorities – including routine screening for Alzheimer’s disease, domestic violence, diabetes or HIV – become covered services.
"It's a wide-open door for lobbying," says Robert Laszewski, a health insurance industry consultant.
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 – such as it did earlier this month when it suggested wider screening for osteoporosis – it might increase patients' access, as well as create new business opportunities.
The increased interest of advocates may conflict with the task force's tradition of scholarly dedication to the science. "If you want to be evidence-based, lobbying just doesn't fit," said Dr. Ned Calonge, the panel's chairman and the chief medical officer of the Colorado Department of Public Health and the Environment.
But, sticking to the science hasn’t always been popular. The task force set off a political firestorm in November when -- seemingly oblivious to the political issues swirling around the health care debate – it said women should wait until 50, rather than 40, to begin getting routine mammograms.
Critics pounced on the proposal, saying the government would engage in health care rationing. Breast cancer activists also protested the change. The result: Sen. Barbara 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 for changes in the way the task force does business. The diabetes group won, for instance, a requirement in the law 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 began accepting public comment before finalizing its recommendations. The comments may provide one tool for "people who are eager to figure out ways to influence the task force," said Paul Bonta, associate executive director of the American College of Preventive Medicine.
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 would also not be "immune" to input that might add perspective to recommendations. But, he added, "the science needs to come first."
In the meantime, 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 if insurers aren't required to provide even broader coverage. 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 the service isn't reimbursed by most insurers. The task force could help with that problem, the memo said, by recommending routine screening, which insurers would have to cover. Currently the task force recommends tests only for people who are at risk. The requirements would not apply to some existing employer-based plans that that are exempted from many requirements of the health law.
