Insurance and Real Estate Committee

JOINT FAVORABLE REPORT

Bill No.:

SB-848

Title:

AN ACT CONCERNING BREAST ULTRASOUND SCREENINGS.

Vote Date:

2/8/2011

Vote Action:

Joint Favorable

PH Date:

2/3/2011

File No.:

12

SPONSORS OF BILL:

Insurance and Real Estate Committee

REASONS FOR BILL:

Some women need breast ultrasound screening because they are at increased risk for breast cancer due to having dense breast tissue. In addition, dense tissue is known to make detecting breast tumors more difficult due to a masking effect on mammograms (both dense tissue and tumors show up white on a mammogram). Therefore, the use of ultrasound screening, in addition to a mammogram, can be the difference between an early and an advanced cancer diagnosis.

Most insurance companies treat ultrasound screening differently than mammography screening, and require co-payment, deductible, co-insurance, or other out-of-pocket fees for breast ultrasound screening. Because of these fees, there is a barrier to participation in this lifesaving measure, depending on a woman's ability to pay.

This bill will eliminate out-of-pocket fees for breast ultrasound screening so that more women have access to finding cancer at its earlier stage, when it is most treatable and the chance for survival is highest.

RESPONSE FROM ADMINISTRATION/AGENCY:

CT Insurance Department submitted written testimony, stating, “When considering the enactment of new or additional health insurance mandates, the Department respectfully urges members of the legislature to take into account the future financial obligations that may be placed on the State and taxpayers. The federal Patient Protection and Affordable Care Act requires by January 2014 that each State establish an exchange for the purchase of qualified health plans. The Insurance Department states, “Qualified health plans will be required to offer an essential benefits package as determined by the Secretary of Health and Human Services.” The State may require benefits in addition to the essential benefits, but if it does “the State must assume the costs of the additional benefits.” They state in addition, “Essential benefits have yet to be defined by HHS; therefore, there is no mechanism for determining if” the benefits in this bill “will fall within the definition of essential benefits or not.” However, should this bill be passed and these benefits “be determined to exceed the essential benefit requirements, the State will have an immediate financial obligation to pay the cost” in 2014.

NATURE AND SOURCES OF SUPPORT:

Nancy M. Cappello, Ph.D., resident of Woodbury, CT, testified in support of the bill, stating, “In 2005, the Connecticut legislature unanimously supported the first bill in the nation for whole-breast ultrasound screening to be covered by insurance companies for women with dense breast tissue. Since the additional passage of the breast density inform bill in 2009, ultrasound screening has been routinely used across the state as an adjunct to mammography for women with dense breast tissue.”

She stated, “Research informs us that even digital mammography can miss up to 40 percent of cancers in women with dense breast tissue and analog mammography as high as 60 percent -- as density appears white on a mammogram and so does cancer -- thus there's no contrast to 'see' through the density. Screening ultrasound increases detection of small node-negative cancers that mammography miss. Dr. Kevin Kelly's research in 2010 using automated ultrasound in addition to mammogram doubled the detection rate.”

She also stated that there has been “a solid and continuing line of research finding a correlation between tissue density and risk for breast cancer. This risk factor is seldom shared with the patient. Connecticut has changed that fatal flaw in early detection and is recognized as a leader in the nation in breast density information. There are three pending bills in other states right now -- New York, Florida and Texas -- to inform women of their breast density and provide access to reliable screening tools. In addition, we have pending action in four additional states -- Massachusetts, California, Missouri and Kansas -- and we are also working with our own Congresswoman, Rosa DeLaura, on a federal bill.

Concluding her testimony, she stated, “Because of the risk factors and the masking effect of dense tissue, women with dense tissue need increased surveillance. Access to supplemental ultrasound screening can be the difference between an early and an advanced cancer diagnosis, as in my case. Most insurance companies treat ultrasound screening differently than mammography screening, as it is not part of the well-care package. Therefore, women must first exhaust their copayments and deductibles before the exam is fully covered. So depending on a woman's ability to pay, there is uneven participation in this lifesaving measure.” She thanked legislators for their continued support and stated, “This bill will reduce the burden of this copayment so that all women have access to finding cancer at its earlier stage when it is most treatable and survival is high.”

Nancy Traver, resident of Waterbury, CT, submitted written testimony in support of the bill, stating that her doctor has recommended that she have ultrasound breast screening in addition to a mammogram due to the fact that she has dense breast tissue. She also stated that the cost of her mammogram “was covered 100% under routine preventive screening but the ultrasound was not considered 'preventive' and as a result, I had to pay $129.22” out of pocket. She stated, “We know that breast density is one of the strongest predictors of mammography missing cancers and that, when supplementing a mammogram with an ultrasound screening, cancer detection rates can increase from 30 to 50 percent.” She concluded her written testimony by stating, “Having ultrasound as part of a patient's 'well-care' package will increase the likelihood of breast cancer found at its earliest stage, when it is most treatable and the survival odds are the highest.”

NATURE AND SOURCES OF OPPOSITION:

Christine Cappiello, Director of Government Relations for Anthem Blue Cross Blue Shield of Connecticut, testified against the bill, stating that it would “add a new mandate for all individual and group policies, including the State Employee Health Insurance Plan. “Mandating benefits takes away the flexibility insurers have in developing products in response to the needs of the marketplace. The cost of mandates may cause the purchasers of healthcare, specifically employers, to stop offering health insurance all together,” she stated. She concluded her written testimony by stating concern that the bill “could conflict with the provisions of the Patient Protection and Affordable Care Act” with regard to the definition of preventive care because the bill's “lack of co-pay etc. is based on family history, etc. not as a preventive measure.”

Eric George, Associate Counsel for CT Business and Industry Association, submitted testimony stating that for the business community, the rising cost of health insurance causes some companies to no longer be able to provide coverage for their employees. He stated, “Connecticut's health insurance mandates impact smaller employers in the state to a greater degree than larger employers. When the legislature either creates a new mandate or expands an existing mandate, it is making health insurance less affordable for those small companies that can least afford to shoulder these cost increases.” He concluded his written testimony by stating, “In essence, by prohibiting copayments for breast ultrasound screening [the bill] will effectively shift those costs onto the rest of the healthcare system and all healthcare consumers.”

CT Association of Health Plans, submitted testimony stating that while the intent is laudable of any mandate under consideration, the cost impact must be weighed, especially in context of the impact of federal health care reform. They stated, “In simple terms, all mandated coverage beyond the required essential benefits (as will be determined by HHS) will be at the State's expense. Those costs may not be delegated to the individual purchaser of insurance or the insurer.”

Reported by: Sheila McCreven

Date: March 9, 2011