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Women's Advocates See Health Reform Problem : Medicine: They say preventive procedures such as mammograms and Pap smears are underfunded. The White House is eager to win them over.

October 06, 1993|EDWIN CHEN | TIMES STAFF WRITER

WASHINGTON — The health care reform agenda developed for the Administration by First Lady Hillary Rodham Clinton has come under increasing criticism from women's health advocates who argue that it would cover fewer mammograms, Pap smears and other preventive procedures than current guidelines.

"The plan's preventive health coverage must be improved," Rep. Nita M. Lowey (D-N.Y.), a member of the congressional Women's Caucus, said Tuesday in an interview.

The critics, while welcoming most aspects of Clinton's proposals, are upset because the comprehensive benefits package would provide free mammograms only to women 50 and older--and only at two-year intervals. In contrast, the National Cancer Institute and the American Cancer Society recommend mammograms for women after 40, either annually or every other year, and yearly mammograms after 50.

"We feel that the standards for mammograms should be in accordance with the American Cancer Society. The same goes for Pap smears and pelvic exams," Lowey said.

Administration health officials insist that women deemed at high risk may have mammograms--or any other preventive procedure--at more frequent intervals if their primary care physicians prescribe such tests. In these cases, the women would have to pay a fee, probably in the form of a $10 co-payment, or 20% of the cost of the procedure, depending on the health plan they join.

But Lowey was not assuaged. "A health care plan that doesn't cover yearly screening mammograms for women over 50 would leave millions needlessly at risk," she said. "We're going to have to continue discussing this issue with the Administration."

The White House is particularly eager to win over women on the issue of health care reform because numerous polls and private Administration-sponsored focus groups have shown that women, far more than men, are the "decision-makers" when it comes to health care.

That concern was underscored Tuesday when Mrs. Clinton spent an hour talking about women's health issues during a satellite broadcast. She repeatedly stressed that the President's plan has much to offer women--including preventive screening procedures.

The First Lady confirmed that the government-designed benefits package in effect will pay for fewer mammograms than experts recommend. But she dwelt instead on the larger benefits of guaranteeing all women some measure of preventive services.

"For the first time ever, every woman will be insured for those things that really matter for her--like Pap smears and mammograms, and for those things that really matter for her family--like well-child care and vaccinations and prenatal care, as well as other tests like cholesterol screening that will affect men as well as women," Mrs. Clinton said.

She also disclosed that obstetricians and gynecologists will be considered primary care physicians, thus giving women direct and inexpensive access to such providers.

Mrs. Clinton also made a broader pitch for women's support for the Administration's reform agenda, which she said would reverse a historic bias against women.

"I think it's fair to say, unfortunately, that women's needs have been subordinated. We haven't had the kind of attention paid to diseases that are particularly afflicting women," she said.

The First Lady also reaffirmed that abortions will be covered under Clinton's plan, under the rubric of "pregnancy-related services."

The President's proposals would group consumers into large insurance-purchasing alliances that shop among doctors and hospitals for the best price and quality. Each alliance would be required to offer at least three insurance plans, including a traditional fee-for-service plan and a less expensive health maintenance organization. All insurance plans would have to be at least as generous as the government-designed benefits package.

The President's plan would provide free Pap smears and pelvic exams every three years after the onset of menstruation through age 49; women between 50 and 64 would be provided such procedures every two years.

Current government guidelines suggest that women over 40 have pelvic exams annually and that women between 18 and 40 get them every one to three years, depending on the results.

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