Women's insurance amendment gets first Senate vote

WASHINGTON (AP) - A bipartisan amendment to increase insurance benefits for women through yearly screenings gets the first Senate vote Tuesday on health care overhaul legislation.

The amendment - co-sponsored by Sens. Barbara Mikulski, D-Md., and Olympia Snowe, R-Maine - would require policies to include a variety of yearly screenings and was inspired in part by controversial recommendations last month that women undergo fewer mammograms and Pap smears to test for cancer.

"My amendment guarantees screening for breast cancer, yes, mammograms," Mikulski said. "We don't mandate that you have a mammogram at age 40. What we say is discuss this with your doctor, but if your doctor says you need one, my amendment says you are going to get one." A vote was expected Tuesday afternoon.

The Congressional Budget office said the amendment would cost $940 million over a decade.

Mikulski has said that her amendment was aimed at preventing insurance companies from using a pair of recommendations for cancer testing in women to deny coverage. Republicans, too, insisted that the recommendations could result in rationing of health care, a charge President Barack Obama's White House has heatedly denied.

Last month, a government-appointed but independent panel of doctors and scientists said women generally should begin routine mammograms in their 50s, rather than their 40s. Then, in an apparent coincidence, the American College of Obstetricians and Gynecologists said that most women in their 20s can have a Pap test every two years - instead of annually - to catch slow-growing cervical cancer.

Neither the task force, which provides advice to government officials who may or may not act on it, nor the ACOG set federal policy.

But the recommendations could not have come at a worse time for majority Democrats, especially Senate leaders trying to hold together the 60 votes required to advance the health care overhaul.

The legislative struggle is expected to last for weeks in a test that pits GOP senators determined not to give ground against Senate Democrats determined to deliver on Obama's signature issue.

The 10-year, nearly $1 trillion legislation includes a first-time requirement for most Americans to carry insurance, greatly expands the Medicaid federal-state insurance program for the poor, and would require insurers to cover any paying customer regardless of their medical history or condition.

On Monday each side offered the first of what are likely to be dozens of amendments, with the measures seemingly designed as much to court a skeptical public as to reshape Senate Majority Leader Harry Reid's 2,074-page bill.

Sen. John McCain, R-Ariz., attacked the legislation as a "monstrosity" that employs "Bernie Madoff accounting, Enron accounting" as he offered the first GOP amendment. McCain's amendment would strip out more than $400 billion in Medicare cuts to home health providers, hospitals, hospices and others - a pitch to seniors, who polls show have deep concerns about the legislation.

Democrats planned to go on the offense on the same issue Tuesday with an amendment underscoring benefits to seniors and guaranteeing that basic Medicare benefits would not be touched.

The Congressional Budget Office has estimated that 31 million uninsured individuals would receive insurance if the bill were enacted, many of them assisted by federal subsidies. The legislation would be paid for through a combination of cuts in projected Medicare payments, a payroll tax on the wealthy and taxes on drug makers, medical device manufacturers, owners of high-cost insurance and others.

It has taken months to advance the legislation to the floor, as Democrats struggled with their own internal divisions as well as Republican opposition.

Democrats control 60 seats in the Senate, precisely the number needed to trump a promised Republican filibuster, and Reid's ability to steer the bill to passage will depend on finding ways to finesse controversial provisions within the measure, such as a proposal for the government to sell insurance in competition with private firms.

Despite the public jousting, significant action was occurring behind the scenes as Reid, D-Nev., and Finance Committee Chairman Max Baucus, the bill's author, huddled Monday with top White House and Cabinet officials. The group included Chief of Staff Rahm Emanuel, Interior Secretary Ken Salazar and Health and Human Services Secretary Kathleen Sebelius, along with former Senate Democratic Leader Tom Daschle, Obama's first pick for HHS secretary before his nomination was derailed.

Liberals favor the government insurance plan; moderate and conservative Democrats oppose it. As drafted, the bill establishes a so-called government option, although each state can block it. Legislation passed earlier by the House also has a a government option, with no state opt-out provision; it would have to be reconciled with any Senate-passed measure before a final bill could go to Obama's desk.


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