The Senate began debate on the Patient Protection and Affordable Care Act (H.R.3590) this week. Senators on both sides of the aisle offered amendments to Senate Majority Leader Harry Reid’s huge, 2074 page health care bill. The first votes to take place concerned preventative services for women. As Senators weigh in on this vital topic, Americans have yet another opportunity to examine their actions rather than just their promises and talking points.

Bureaucratic Control over Health Benefits. This week, Senator Barbara Mikulski (D-MD) offered an amendment that would extend the preventative services that women and children receive without co-payments or other forms of cost-sharing with insurance companies.

Though most Senators agree with Sen. Mikulski’s goal, her amendment would require micromanagement of Americans’ health benefits by the federal government. Insurance companies would be forced to cover, at no charge, all preventative services recommended by the United States Preventative Services Task Force, all immunizations relevant to a given patient, all preventative care and screenings for children as defined by the Health Resources and Services Administration. In addition, any benefits not recommended by the United States Preventative Services Task Force that were recommended by the guidelines of the Health Resources and Services Administration( an agency within HHS) would also be required to be fully covered by insurance companies. The breadth of this federal power to set benefits has incurred the formal opposition of the National Right to Life Committee, inasmuch as HHS would have “sweeping power” to define “preventive care,” including abortion as a medical procedure.

Because it prohibits out of pocket costs, the Mikulski amendment will increase Americans’ health premiums, and will also affect the range of choices available to women. As Senator Mike Enzi (R-WY) put it, “I think we agree [with] Senator Mikulski’s goal that all Americans should be able to get preventive benefits, but we disagree that her amendment achieves that stated goal”.

Government control of health benefits and medical procedures can be unpopular and have adverse consequences. The United States Preventative Services Task Force’s recent decision to downgrade the necessity of mammograms for women between the ages of 40 of 50 was controversial. But if federal officials control health benefits, that kind of controversy would likely become routine.

In the case of the Mikulski amendment, all insurance companies would be required to cover all benefits ranked “A” or “B” by the Task Force, but they would be unlikely to cover as many benefits that are ranked lower in order to keep costs down.  Mammograms for women between the ages of 40 and 50 are now ranked “C”. This means that they would more likely be unavailable to women under the age of 50 because of the regulations that would follow from Mikulski’s amendment. The reason: the incentives to offer benefits in addition to those recommended by the Task Force would be scant. According to Senator Lisa Murkowski (R-AK), “…according to the Mikulski amendment, those women who are younger than 50 years of age will not be eligible or will not be covered under the mandatory screening requirement that she has set forth in her amendment”.

Among other things, Sen. Mikulski’s amendment would dramatically strengthen the role of the federal bureaucracy in determining what health benefits Americans can get in their health coverage. According to Sen. Coburn, “…a bureaucracy looking at numbers, not patients, never putting their hand on a patient, will make a decision about what is good for them and what is not.” Nonetheless, Sen. Mikulski’s amendment was passed.

Safeguarding the Patient-Doctor Relationship. Sen. Lisa Murkowski (R-AK) also offered an amendment to improve patients’ access to preventative health benefits. Under Sen. Murkowski’s proposal, the Secretary of Health and Human Services (HHS) would be prohibited from using recommendations made by the U.S. Preventative Services Task Force to deny coverage of medical services. Under the Murkowski amendment , insurers would be required to consult guidelines and recommendations made by professional medical organizations that were relevant to specific preventative services, not recommendations made by federal officials.. As Senator Tom Coburn, M.D. (R-OK) asked the Senate, “…do we have the government decide based on cost or do we have the professional caregivers who know the field decide based on what’s best for that patient? That’s the difference.”

The amendment would have also prohibited the use of Comparative Effectiveness Research (CER) as a basis for denying coverage. CER would not override the needs of each unique patient. Sen. Murkowski’s amendment would make such an override unlawful.

Moreover, referencing the issue of women under 50 not getting mammograms as a covered benefit, as recently specified by a government task force, insurers would be unable to deny coverage based on the recommendations of bureaucrats, instead rather than medical professionals. Nonetheless, Sen. Murkowski’s amendment was defeated.

Foreshadowing Federal Micromanagement of Health Benefits. Before adjourning on Wednesday night, Senator David Vitter (R-LA) offered an amendment that provides that women under the age of 50 cannot be denied coverage for mammograms based on the recent recommendation of the U.S. Preventative Services Task Force. The Vitter amendment passed.

The Senate debate highlighted a crucial problem with the Senate bill: if federal officials are given unprecedented control over the benefits and medical services that all insurance must provide, it is likely that the Congress would be voting on measures like Sen. Vitter’s constantly. This is a tart foretaste of what Americans can expect if Congress insists on transferring such immense power to federal officials.

Kathryn Nix currently is a member of the Young Leaders Program at the Heritage Foundation. For more information on interning at Heritage, please visit: