Insurance and Real Estate Committee

JOINT FAVORABLE REPORT

Bill No.:

SB-10

Title:

AN ACT CONCERNING INSURANCE COVERAGE FOR BREAST MAGNETIC RESONANCE IMAGING.

Vote Date:

2/24/2011

Vote Action:

Joint Favorable Substitute

PH Date:

1/27/2011

File No.:

SPONSORS OF BILL:

Insurance and Real Estate Committee

REASONS FOR BILL:

The bill provides coverage for breast Magnetic Resonance Imaging (MRI) when an annual mammogram demonstrates a woman has dense breast tissue.

Women with dense tissue are at an increased risk for breast cancer. 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 MRI screening, in addition to a mammogram, can be the difference between an early and an advanced cancer diagnosis.

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. The Department concludes its written testimony by stating that the bill “by mandating coverage for preventative services without cost sharing, will unnecessarily duplicate federal law which already has addressed this issue.”

The Permanent Commission on the Status of Women (PCSW), submitted written testimony in support of the bill, stating that passage will benefit 40% of Connecticut's population – the 1.4 million Connecticut women over the age of 18 who are at risk of being diagnosed with breast cancer. The state ranks 26th in the nation for the number of deaths from breast cancer. In 2002, there were 2,802 women diagnosed with malignant breast cancer. Women with high density breast tissue are four to five times more likely to develop cancer than women with low density. Women with high density tissue often need more than a regular mammogram. Providing alternate screening tools would assist women to discover and treat breast cancer earlier.”

NATURE AND SOURCES OF SUPPORT:

Collin O'Connor Udell, testified in support of the bill stating that the story of her breast cancer diagnosis underscores the importance of the bill. She stated, “In the summer of 2009, I had an unusual symptom that was very unlike the usual lump we're taught to look for. I woke up with a red flush on my left breast. I went to one of the top breast surgeons in Hartford, and she did an ultrasound, which showed nothing. [But after researching on the Internet myself] I learned that a red flush like that could potentially be the sign of inflammatory breast cancer. I had several other symptoms on the checklist, and the material I read advised I should get an MRI to figure out what was going on. The next morning, I called the doctor and [was told] that an insurance company would not cover the costs of an MRI. I said that I absolutely needed an MRI and that I would pay for it if necessary. The next morning, I had the MRI, and [it] showed a large mass in my left breast. The doctor performed a biopsy that day that turned out not only my left breast but a lymph node was affected. Diagnosis: Stage 3 breast cancer.” She concluded her testimony by stating, “If I had been given an MRI earlier in the process due to my dense breast tissue, I could have been diagnosed at Stage 1 or even earlier and the anguish that wracked my family last year could have been avoided. And it's terrifying to think what would have happened if I had listened to the nurse's statement that the insurance company wouldn't pay for the MRI and had succumbed to the considerable pressure not to have one. My understanding is that [an MRI costs] somewhere between three and six thousand dollars. And I'm an attorney, so I'm just blessed that I could afford to pay, but there are lots of women out there who can't. I'm speaking in support of this bill because I feel passionately that other women should not have to go through this experience.”

Marc Glickstein, medical doctor practicing the subspecialty of radiology, and representative of the Radiology Society of Connecticut, testified in support of the bill. He stated that this bill is, “a natural progression of the steps that have been taken in recent years to increase the knowledge of, and access to, imaging tests that detect breast cancer, particularly for women who have dense breast tissue. [The bill] would add MRI to the list of procedures covered by the law, and this is a very good thing.” He stated that the technology to discover even the smallest of cancers continues to develop rapidly. He also stated, “Mammograms are considered a baseline procedure, but other tests are now available to evaluate the possibility of breast cancers through the use of breast ultrasound or MRI. There's no doubt about the utility of these additional procedures. The Radiology Society believes that women should know all the options that are available in the way of safe and effective breast examinations. MRI plays an important role in this regard. It's very important. He stated that there would be substantial “cost saved for people who have early detection versus later-stage breast cancer [which can develop into] metastatic disease that can involve lungs, with breathing difficulties, central nervous system, with everything attendant from that, bone metastases where you have somebody who can develop pathological fractures, who can require surgery, orthopedic surgery for fractures, involvement of the liver, the kidneys. A whole variety of things, you know, can be involved with the spread of the disease. As far as treatment, there's the initial surgery. Generally surgery is going to be one or two stages. And at a certain point, there's really not much more to do once you get to the point where a patient has had their lymph nodes removed and total mastectomy. Chemotherapy can be quite varied and depending on the stage can be more or less toxic to the patient. Early detection prevents all this.”

Nancy M. Cappiello, Ph.D., Woodbury, CT, testified in support of the bill. She stated, “Insurance companies often deny coverage of screening MRIs even for women at high risk of breast cancer. In Connecticut, 36 percent of newly diagnosed breast cancers are at an advanced stage where the cancer has traveled to the lymph nodes and beyond. That's 997 women in Connecticut. Many of these late-stage diagnoses occur because of lack of access to appropriate screening tools to find cancer at its earliest stage when it is most treatable.

She described her personal story, stating “Despite a decade of normal mammograms, including a normal mammogram one month before my diagnosis, it was actually seven years ago today, February 3, 2004, when I heard those dreaded words: You have breast cancer, and it's at an advanced stage. Unknown to me at the time, my mammograms kept failing me because of dense breast tissue. When cancer is present, it is more unlikely to go undetected on a mammogram when a tissue is dense, even with digital mammography. Breast density is one of the strongest predictors of the failure of mammography screening to detect cancer and is emerging as one of the strongest risk factors. And we know that ultrasound and MRI when combined with mammogram increases the detection of small node-negative cancers. In my case, a pathology report uncovered 13 lymph nodes, [yet with] a normal mammogram weeks before. That's not early detection.”

She concluded her testimony by stating, “This bill will ensure that there's another reliable screening tool to find cancer early, when it's most treatable. These life-altering decisions must be determined by the patient and her healthcare provider to increase the survival odds of the 2700 women who are diagnosed with breast cancer in Connecticut each year.”

NATURE AND SOURCES OF OPPOSITION:

Eric George, Associate Counsel for the CT Business and Industry Association, submitted written testimony in opposition to the bill, 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, “Every health benefit mandate, while providing a benefit to the individuals who utilize those services, increases health insurance premiums for all state-regulated group and individual policies.”

Susan Halpin, CT Association of Health Plans, submitted written 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.”

Christine Cappiello, Director of Government Relations for Anthem Blue Cross and Blue Shield, submitted written testimony in opposition to 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.

Edward J. Donahue, Jr., Regional Director and Counselor for Aflac, submitted written testimony stating, “It is our position that mandates for specific medical procedure in health insurance policies should exempt supplemental health insurance products.”

The CT Conference of Municipalities (CCM), submitted written testimony in opposition to the bill, stating, “The expansion of insurance coverage will increase insurance costs and thus premiums, which will eventually be borne by policy holders – municipalities to name one. This would result in increased insurance costs statewide.”

Reported by: Sheila McCreven

Date: March 17, 2011