Mandated Coverage for Cancer-Screening Services: Whose Guidelines Do States Follow?

Abstract

Am J Prev Med 2000;19:71–8 Insurance departments in 50 states, the District of Columbia, and Puerto Rico were contacted to identify mandatory coverage for cancer screening services by private insurers. Mandates for guidelines were compared to guidelines from the American Cancer Society (ACS) and US Preventive Services Task Force. No coverage of cervical cancer screening was required by 28 states and Puerto Rico, ACS guidelines were used by 14 states and the District of Columbia, and nonspecific or nonconforming guidelines were required by seven states. Ohio mandated that consumers be offered screening, and Wyoming required disclosure when screening was not covered. Breast and cervical cancer screening mandates appear to have leveled off during the past 5 years, while prostate screening mandates are increasing; colorectal screening mandates were first implemented in 1999. Interviews with state insurance analysts suggest that decisions to enact mandatory screening legislation were politically driven, balancing the proven benefits of cervical and breast cancer screening against the controversial benefits of prostate cancer screening to avoid charges of gender bias. Comment: The use of cervical cancer screening services and the development of cervical cancer have been linked to private health insurance, but this link may not be valid if Pap smears are not covered. The majority of states do not require coverage, but this study is limited by its failure to determine the proportion of women with private health insurance across the United States who are covered for screening despite the absence of state mandates. As the authors point out, screening mandates may be ineffective if screening rates are high despite the absence of mandates, and they may paradoxically decrease screening rates if they force premium costs higher because it may decrease access for poor women, who are especially at risk for cervical cancer. The assessment of the impact of these mandates on public health is ongoing, as the authors briefly describe. (LSM)