HOUSE BILL REPORT

HB 1074

BYRepresentatives Haugen, Walker, Winsley, Leonard, Cole, Hankins, S. Wilson, Ferguson, Nutley, Scott, Belcher, Anderson, Basich, Dellwo, Spanel, Braddock, Brough, Horn, Todd, Nelson, Brekke, Rector, Appelwick, Hine, Heavey, Baugher, Kremen, Cooper, Zellinsky, K. Wilson, Wood, Rayburn, Jesernig, Jacobsen, R. Fisher, R. King, Rust, Pruitt, Wang, Grant, Jones, Moyer, Cantwell, Locke, Inslee, H. Myers, G. Fisher, Morris, Patrick, Miller, Wolfe, O'Brien, Rasmussen, Walk, May, Doty, Phillips, Betrozoff and Ballard

Requiring health insurance to cover mammograms.

House Committe on Financial Institutions & Insurance

Majority Report:  The substitute bill be substituted therefor and the substitute bill do pass.  (12)

      Signed by Representatives Dellwo, Chair; Chandler, Ranking Republican Member; Anderson, Baugher, Beck, Crane, Day, Dorn, Inslee, Nutley, K. Wilson and Winsley.

Minority Report:  Do not pass.  (1)

      Signed by Representative Schmidt.

House Staff:John Conniff (786-7119)

Rereferred House Committee on Appropriations

Majority Report:  The substitute bill by Committee on Financial Institutions & Insurance be substituted therefor and the substitute bill do pass.  (20)

      Signed by Representatives Locke, Chair; Grant, Vice Chair; H. Sommers, Vice Chair; Appelwick, Belcher, Bowman, Brekke, Bristow, Brough, Dorn, Ebersole, Hine, Padden, Peery, Rust, Sayan, Spanel, Valle, Wang and Wineberry.

Minority Report:  Do not pass.  (6)

      Signed by Representatives Silver, Ranking Republican Member; Braddock, May, McLean, Nealey, and Sprenkle.

House Staff:      Randy Acker (786-7136)

AS REPORTED BY COMMITTEE ON APPROPRIATIONS MARCH 4, 1989

BACKGROUND:

Health insurance policies, health care contracts, and health maintenance agreements provide coverage for mammograms used for detection of breast cancer. However, some insurers do not provide coverage for mammograms used as a method of "preventive medicine" e.g., routine mammograms, whether or not a patient is suspected of having breast cancer.  Some health care service contractors and health maintenance organizations do utilize mammograms as a part of a preventive medicine program; but, the contractor or organization controls access to such programs.

SUMMARY:

SUBSTITUTE BILL:  After January 1, 1990, all health insurance policies, health care contracts, health maintenance agreements, and health plans administered by the state must provide coverage for routine mammograms in accordance with specified guidelines.

Insurance policy or contract provisions governing health care benefits apply equally to required coverage for routine mammograms including the application of co-payments and deductibles to such coverage.

SUBSTITUTE BILL COMPARED TO ORIGINAL:  State health benefit plans must cover mammograms.  The effective date is changed and a technical amendment is made.

CHANGES PROPOSED BY COMMITTEE ON APPROPRIATIONS:  None.

Fiscal Note:      Requested February 28, 1989.

Effective Date:This bill applies to each group disability insurance policy issued or renewed after January 1, 1990, that provides coverage for hospital or medical expenses.

House Committee ‑ Testified For:    (Financial Institutions & Insurance)  Ronald P. Smith, M.D., Olympia Radiological Associates; Marie Lee, M.D., Washington State Radiological Association; Jonelle Dedrick, R. N., Breast Health Specialist, Northwest Hospital; Gail Toraason, Washington State Nurses Association; Ann Simons, National Organization for Women.

(Appropriations)  Representative Mary Margaret Haugen, Prime Sponsor.

House Committee - Testified Against:      (Financial Institutions & Insurance)  Joan Gaumer, Association Washington Business; George Schneider, M.D., Washington State Medical Association; and Jim Halstrom, Health Care Purchasers Association.

(Appropriations)  Mel Sorensen, Washington Physicians Service; and Ken Bertrand, Group Health Cooperative.

House Committee - Testimony For:    (Financial Institutions & Insurance)  Routine mammograms save lives and should be encouraged.  Requiring insurance companies to provide coverage for routine mammograms will save costs in the long run as women avoid extensive and expensive treatment for breast cancer.

(Appropriations)  Breast cancer is the prime cause of death in women.  Routine mammograms save lives.

House Committee - Testimony Against:      (Financial Institutions & Insurance)  Any mandated benefit, however desirable, drives up the cost of health insurance and places private insurers at a competitive disadvantage with self-insured plans that need not comply with the mandate.  Furthermore, the costs associated with routine mammograms may exceed the costs of treating breast cancer.  If the Legislature mandates coverage of mammograms, such a mandate should not be so rigid as to specify how and when such testing should be performed.

(Appropriations)  Mandated benefits raise the cost of health benefits.  The self-funded market is not affected by this legislation.  Utilization will drive costs up and the benefit/cost ratio does not support mammograms.