Medicare benefits for mammograms added in last hours

October 31, 1990|By Knight-Ridder

WASHINGTON -- In a development expected to save thousands of women's lives, Congress has added mammography benefits to Medicare that will pay for breast cancer screening for people 65 and older and the disabled beginning next year.

The new benefits, which will cover women and men, were agreed to during the final hours of budget negotiations last Friday by an all-male committee meeting in secret. But the committee worked under a warning from leaders of the 140-member congressional women's issues caucus, who said they would oppose any budget that failed to include mammography benefits, according to lawmakers involved in the negotiations.

"I told them I would not vote for it, and I would get votes against it," said Rep. Mary Rose Oakar, D-Ohio, who worked for eight years to get the cancer-screening benefit added to Medicare. "I think they got the message."

The addition of the mammography benefits to Medicare is seen as extraordinary because they were struck from the House budget package on Oct. 16, and were never included in the Senate budget package.

"I though it was amazing. . . . It just came out of nowhere," said Marsha Simon, legislative director of Families USA, a lobbying group. She attributed the victory to the clout of the women's caucus.

In a bit of political rough and tumble, Oakar took to the floor Oct. 22 to say that the same budget negotiators who said there was no money for mammography "were the same good ole boys [who] have taken care of their special interests," including tax breaks for wineries and cigar makers. In another floor speech, Oakar said that "a lot of people are dead" because Congress removed mammography from a package of proposed Medicare add-ons two years ago.

Breast cancer is the most common form of cancer to strike women, and mammograms are the best method of detecting it at its earliest, most curable stage. The American Cancer Society estimates there will be 150,900 new cases diagnosed in the United States in 1990, and about 44,000 women and 300 men will die of the disease.

A mammogram is a low-level X-ray exam that can reveal cancers too small to be felt by hand. A baseline mammogram, performed when women are about 35, sets a norm for doctors to compare against in later years. Under the new provisions, Medicare will pay up to $55 for a mammogram every other year for Medicare beneficiaries 65 and older. Additional out-of-pocket expenses billed to the patient cannot exceed 25 percent of the cost of the mammogram, or a maximum of $13.75 per exam.

Disabled Medicare beneficiaries can get one baseline mammogram between the ages of 35 and 39. Between ages 40 and 49, disabled beneficiaries qualify for one screening every two years unless they are determined to be at high risk for breast cancer, in which case they qualify for annual exams. Disabled Medicare beneficiaries between 50 and 64 qualify for annual exams.

The new benefits are expected to cost about $1.3 billion over five years, according to the Congressional Budget Office. But backers of the legislation say the estimate does not account for savings from detecting cancer earlier, thereby avoiding more expensive treatments.

"The consequences of not [getting a mammogram] can be radical mastectomy and chemotherapy," said Joan Kuriansky, executive director of the Older Women's League, an advocacy and education group.

"We see [the new benefit] as a potential savior for many women's lives," Kuriansky said. "As women get older they are more likely to get breast cancer, and yet older women are less likely than younger women to get a mammogram. We believe one of the primary reasons is cost."

Medical authorities estimate that deaths due to breast cancer could be reduced 30 percent if women follow the guidelines recommended by the American Cancer Society, which include one baseline mammogram for women 35 and older and annual mammograms after 50.

If all women who are eligible took advantage of the mammogram benefit, 14,000 cases of breast cancer would be detected, according to estimates from Oakar's office.

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