As I mentioned in my last post, health insurers—and legislators sympathetic to insurers—don't like the insurance requirement in S6769/A9586. They're trying to amputate that arm of the bill.

Even the American Congress of Obstetricians and Gynecologists (ACOG) claims to oppose the bill because it has an insurance requirement. They say it's unnecessary: "Currently, ACOG is unaware of cases whereby women are unable to get additional breast imaging if her physician believes the mammography result warrants further investigational study."

ACOG, you're about to get schooled. But before I school ya, let me tell you why ACOG's argument smells.

In California, similar legislation died last year (only to come back from the dead...only to be murdered at the governor's desk...only to be resurrected yesterday but I'll get to all this in another post.) The difference between the California bill and the New York bill is that the California bill does not have an insurance requirement.

The California Medical Association (CMA) fought hard against the bill last year because it did not require insurers cover additional screening. The chairwoman of CMA's legislative council, Ruth Haskins, complained that women requesting additional screening would end up frustrated because insurance wouldn't cover these screenings: "The problem with this bill is that it gives a boatload of power to a lot of women who then become powerless to use that information."

So in California, doctors' orgs oppose the bill because insurance won't cover additional screenings, and that will frustrate women. In New York, doctors' orgs oppose the bill because it requires additional screenings and you can't prove that's necessary.

There's a saying for this: damned if you do and damned if you don't. In fact, there's a word for this: catch-22.

It's Kill da Bill, East Coast Style vs. West Coast Style.

The truth is, these doctors' orgs don't care if insurers cover additional screenings or not. (Note that ACOG is not arguing that the insurance requirement be removed from the bill; they just cite it as a reason to oppose the bill in its entirety.) ACOG would oppose this bill regardless, and will come up with whatever they can think of to oppose it.   Because this is all about control of information for them.  Doctors reflexively chafe at being told what to do by legislators. ACOG opposes requiring doctors to share vital information with their patients, even if doing so will save patients' lives.

(Note that there are good gynecologists and obstetricians out there. There are even good local orgs representing these specialties. However, their national organization stinks.)

But as long as they've put this bogus argument out there, let me address it. It's the same thing you'll hear if you call Assembly Insurance Chair Joe Morelle's office: do you know of a single case where a woman has been denied coverage for a screening sonogram? It's kind of a trick question, because at present there's no insurance code for a screening sonogram--only a diagnostic sonogram. That means if a woman has dense breasts and wants a sonogram, she (possibly with her doctor in cahoots) has to lie fib and claim there's an irregularity so she can get a diagnostic sonogram.

So we had no evidence that insurers wouldn't cover a screening sonogram because to date there's no such thing as a screening sonogram. We had nothing to give them.

Until a day ago. A lady in Poughkeepsie--and I don't know who she is or how we found her--had dense breasts and requested a sonogram. Her doctor ordered one. And her claim was rejected by her health insurer. She forwarded it to supporters of the bill.

This documentation was forwarded to Joe Morelle's office. Word on the street is that it was a hot topic of discussion in Morelle's office yesterday.  But not everyone in his office got the memo, because a constituent of Morelle's who called his office today was told "we have no cases of a woman being denied access to additional tests when the doctor has determined that they're necessary."

You do now.

Right now, we're so down to the wire that I will be relieved if the bill makes it out of Morelle's office at all, even if the insurance arm is amputated. We're really short on time here.

(That doesn't mean I will be happy. It will be a shame if the insurance requirement is removed from the bill--a shame on the insurance committee.)

However,  if the bill leaves Morelle's office with the insurance arm intact, we can thank that lady in Poughkeepsie...and the dumb bureaucrat who denied her sonogram claim. P.S. ACOG, you've been schooled.

Greetings. This is a blog about sausagemaking, as they sometimes call lawmaking.  It's actually about a particular sausage: bipartisan New York Bill S6769/A9586 (Breast Density Disclosure and Insurance) which is in the process of being both made and unmade in Albany. It's a bipartisan bill requiring that women with dense breasts be notified by mammographers that their breasts are difficult to read by mammogram, and that they should discuss additional screening options with their doctors. Right now, women with dense breasts are not informed that they are in danger of misdiagnosis. Women like Joann Pushkin, whose cancer grew for five years undetected by mammogram.

A similar law that passed in Connecticut has doubled the detection rate for women with dense breasts who received sonogram screening. So we know this bill will save lives of New York women.

In its current incarnation, the joint senate/assembly bill calls for insurance coverage for sonograms as a follow-up screening tool for women with dense breasts. (Health insurers are trying to amputate this part of the bill before it leaves committee. I will go into more detail in a subsequent post.)

The bill has broad bipartisan support. If it comes to a vote, it is certain to pass.

If. 

The bill may never make it to the assembly floor. There is less than a month left in the legislative session, and it's still stuck in committee, where lobbyists and legislators are quibbling over the language of the bill. Among them are people who would like to kill this bill without leaving fingerprints. They can do it by running out the clock. With all the procedural hurdles this sausage has to go through, it may not make it to the assembly floor. That's why I started this blog. This sausage can only be cured with some sunlight.

Right now the joint bill is stuck in Assemblyman Joe Morelle's office (he's the assembly insurance chair) and Senator James L. Seward's office (he's the state senate insurance chair). When will it leave Morelle's committee? Will it leave? Time is of the essence.

There are some heroines/heroes in this story: Republican State Senator James Flanagan (Senate sponsor), Democratic Assemblywoman Ellen Jaffee (Assembly sponsor) and their many colleagues from both sides of the aisle who have signed on as co-sponsors of this bill. Also, JoAnn Pushkin, the tireless driving force behind the New York bill. Like many of the advocates behind this bill (including myself), JoAnn is fighting for this bill's survival even as she fights for her own survival.

But there are villains in this story too. At the end of the month, we'll know who the biggest villain is. The winner will get the "boob of the month" award from this blog.

In the meantime, I have a lot to fill you in on.  So stay tuned.

p.s. New Yorkers, call your state senator and your assembly member and tell them to support the bill and that you want to see this bill pass this session. Find your state senator here and your assembly member here.