Democrats push health care screening bills

Democratic legislators, including one whose mother died of ovarian cancer, are carrying several bills this year that would increase efforts at early detection of cancer and other diseases.

These bills have three things in common. First, they seek to require more of insurers in the absence of a large-scale health reform package. Second, they seek to save a lot of money in the future by spending a little money now. Third, they serve to illustrate how medical advances make health insurance a moving target.

On Monday, Assemblywoman Sally Lieber, D-San Jose, introduced AB1774. It would require medical insurers in the state to cover specific annual uterine and ovarian cancer tests. The bill is co-authored by Assemblyman Kevin De Leon, D-Los Angeles, whose mother, Carmen, died of ovarian cancer in 1994 at age 54.

Meanwhile, Susan G. Komen for the Cure, a breast cancer group, is seeking sponsors for a package of four bills. Assemblywoman Patty Berg, D-Eureka, is likely to carry one of these bills, probably one calling for increased use of digital mammography to increase early detection of breast cancer.

Several other bills submitted last year are still on the move.

For instance, AB30 by Assemblywoman Noreen Evans, D-Santa Rosa, passed the Assembly Health Committee on Tuesday. It would require insurers to provide coverage for the testing and treatment of inborn errors of metabolism for newborns; the state would also provide similar coverage for low-income uninsured mothers.

“This is not a new trend,” said Nicole Evans, vice president of communications for the California Association of Health Plans. “We have a long-standing policy of opposing benefit mandate bills because they can increase costs.”

Evans noted several other mandate bills in the current session, such as AB54 from Mervyn Dymally, D-Los Angeles, which calls for insurers to cover acupuncture. In October, Gov. Arnold Schwarzenegger vetoed AB423 from Jim Beall, D-San Jose, which would have mandated increased coverage for mental illness.

The health plans association opposes AB30 but does not yet have a position on AB1774. In a letter sent to members of the Assembly Health Committee ahead of the vote on AB30, the group expressed concern over the “cumulative effects” of the 40 health care benefit mandates already in state law. Evans said this has been one factor driving up health care costs while often providing little in the way of health benefits.

“We’re at the point of an epidemic with breast cancer,” countered Donna Sanderson, executive director of Sacramento-based Komen, saying the group’s proposed bills target tests with well-known benefits. “With early detection, we’ll save the state money.

Other cancers are not so easy to detect.”

The digital mammography bill, Sanderson said, would require insurers to use this more accurate but also more expensive technology in seeking early detection of breast tumors; most insurers cover an older form of mammograms. Komen is also pushing for more testing for the fastest-growing demographic of breast-cancer sufferers, women under 40. It is seeking an extra $12 million in funding to ensure that more women can be screened.

Similarly, Lieber’s bill is seeking to force insurers to use more recently developed tests. Most currently used tests don’t screen for uterine or ovarian cancer.

“There is emerging technology and from a financial perspective, it’s something that insurance companies haven’t been willing to cover,” Lieber said at a news conference in support of the bill on Monday.

Also at that news conference was actress Fran Drescher. The former star of the popular 1990s sit-com “The Nanny” survived a bout with uterine cancer that was diagnosed in 2000. She went on to form the group Cancer Schmancer — a play on her thick Queens accent — to push for better diagnosis and treatment of women’s cancers.

“Too many women are finding out they have cancer when they should have found out yesterday,” Drescher said.

According to figures put out by her group, the five-year survival rate for women diagnosed with stage one breast cancer is nearly 100 percent. It quickly drops from there, with to only 21 percent for women diagnosed at stage four. Fewer than half of women are currently diagnosed in stage one. There are roughly similar diagnosis and survival rates for ovarian, cervical and uterine cancers.
This lack of early diagnosis is both killing people and costing the state money, Lieber and Drescher argued. This is also the argument behind Evan’s newborn screening bill. Her office said that while there are 47 known EIMs that can lead to serious illness and death, insurers are only required to screen for one: phenylketonuria, a condition that has led to warning labels of soft drinks and other products that can trigger a reaction in sufferers. This lack of diagnoses has led to $47 million in annual costs to Medi-Cal, among other costs to the state, they claim.

However, even if tests are covered, treatments may not be, said Gloria Storer, communications director at Komen. In some cases, she said, a diagnosis becomes a condition that a current insurer won’t cover and which prevents a person from getting different coverage.

“A lot of women don’t want to find out if they have breast cancer if they can’t get treatment,” Storer said.

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