By LAURIE KELLMAN, Associated Press Writer Laurie Kellman, Associated Press Writer – 1 hr 4 mins ago



WASHINGTON – Republicans are seizing on this week's recommendations for fewer Pap smears and mammograms to fuel concern about government-rationed medical care — and to try to chip away support by women for President Barack Obama's proposed health care overhaul.

"This is how rationing starts," declared Jon Kyl of Arizona, the party's second-in-command in the Senate, during a news conference. "This is what we're going to expect in the future."

Said Sen. Lisa Murkowski of Alaska: "Those recommendations will be used by the insurance companies as they make a determination as to what they're going to cover."

Democrats said the recommendations had nothing to do with the big health care bill. And besides, they said, the recommendations, especially one that women start mammograms at 50 rather than 40, were deeply flawed.

"It's entirely possible that this panel got it wrong, and I think they did," said Illinois Sen. Dick Durbin, the vote-counting Democratic whip. Fears that the government is going to run health care have not come up during negotiations for Saturday's crucial procedural vote, Durbin added.

But the recommendations have given Republicans something new to talk about in making their case that the 2,074-page bill amounts to government-rationed health care.

The timing of the release of both sets of guidelines this week, though apparently coincidental, couldn't have been worse for majority Democrats. The bill faces its first survival test Saturday, when it must win 60 votes to advance to the next step. In recent days, Democratic leaders have struggled to placate three holdouts from their caucus but appeared Friday night to be winning them over.

One Democrat wasn't taking chances on whether the recommendations had jeopardized access to affordable mammograms. Sen. Barbara Mikulski, D-Md., said she would introduce an amendment that would limit the costs of the breast cancer tests for women 40 and older.

"Otherwise, insurance companies may use this new recommendation as yet another reason to deny women coverage for mammograms," Mikulski said.

That was unlikely, the White House said.

"Under health insurance reform, recommendations like these cannot be used to dictate coverage," said presidential spokesman Reid Cherlin.

The guidelines themselves stress that they're general recommendations for routine screening, not a replacement for the one-on-one health advice that women with various risk factors for breast or cervical cancer get from their doctors in choosing how often to get a Pap or mammogram.

"So, what does this mean if you are a woman in your 40s? You should talk to your doctor and make an informed decision about whether a mammography is right for you based on your family history, general health and personal values," said Dr. Diana Petitti, vice chair of the task force that made the mammogram recommendations.

Still, the new guidelines generated enough confusion and raised enough questions to force proponents of the health care overhaul on the defensive.

Health and Human Services Secretary Kathleen Sebelius has said the mammogram recommendation "does not determine what services are covered by the federal government."

Senate Finance Committee Chairman Max Baucus said the Senate health care bill he authored "doesn't do one single thing to change current law related to the way coverage decisions are made."

"Those decisions will be based only on science and thorough review, just as they are today," said Baucus, D-Mont. "Research comparing the effectiveness of different treatments for different patients cannot be used for rationing care."

"We're not rationing anything," said Rep. Lynn Woolsey, D-Calif. "It's a decision between a woman and her doctors."

The specter of the government making deeply personal medical decisions for millions of Americans — in this case, women — has been propelled in part by the Republican drive to stymie the Democratic bill.

The legislation would require most people to buy health insurance, and the House version would create a government plan that would compete with those offered by private insurers.

This week's recommendations from two different groups called for less-frequent cancer tests for women.

On Monday, 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 on Friday, 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. The ACOG's recommendations are aimed at its own members.

The Democratic bill would set up an independent institute to conduct studies. It would not authorize the health secretary to deny coverage solely based on the institute's research.

There are other safeguards. All states except Utah make insurers cover mammograms, and 20 states require coverage that starts at age 40, according to 2007 data compiled by the Washington-based National Women's Law Center.

___

Associated Press writers Stephanie Nano in New York and Lauran Neergaard in Washington contributed to this report.

http://news.yahoo.com/s/ap/20091121/ap_on_bi_ge/us_health_care_women_s_tests

1st Senate vote looms on health legislation
By ERICA WERNER, Associated Press Writer Erica Werner, Associated Press Writer – 2 hrs 47 mins ago

WASHINGTON – A crucial first Senate vote on President Barack Obama's health care overhaul in a rare Saturday night session looms as a test of Democratic unity and the president's prestige.

Democratic leaders are optimistic of success, but they need every Democrat and both independents to vote "yes," and two moderates remained uncommitted ahead of the roll call, which is expected around 8 p.m. The vote will determine whether debate can go forward on Majority Leader Harry Reid's 2,074-page bill to dramatically remake the U.S. health care system over the next decade.

Most everyone would be required to purchase insurance under Reid's legislation, and billions in new taxes would be levied on insurers and high-income Americans to help extend coverage to 30 million uninsured. Insurance companies would no longer be allowed to deny coverage to people with medical conditions or drop coverage when someone gets sick.

The two holdouts are Sens. Blanche Lincoln of Arkansas and Mary Landrieu of Louisiana. A third centrist, Ben Nelson of Nebraska, announced Friday that he'd be supporting his party on the test vote, while cautioning that it didn't mean he'd be with them on the final vote.

"It is not for or against the new Senate health care bill," Nelson said. "It is only to begin debate and an opportunity to make improvements. If you don't like a bill, why block your own opportunity to amend it?"

If that same reasoning holds with Lincoln and Landrieu, Reid, D-Nev., will have the 60 votes he needs to prevail in the 100-seat Senate. The 40 Republicans are unanimously opposed.

Landrieu has made comments suggesting she'll support the move to debate, but Lincoln, who faces a difficult re-election next year, carefully avoided taking any public position Friday.

Republicans used their weekly radio and Internet address to slam the legislation, calling it a government takeover of health care that would increase taxes and raise medical costs.

"This 2,000-page bill will drive up the cost of health care insurance and medical care, not down," Sen. Mike Crapo, R-Idaho, said in the address. "This is not true health care reform, and it is not what the American people want. This bill will result in higher premiums and higher health care costs for Americans — period."

Democrats said their legislation could make historic and necessary improvements in the country's social safety net.

"Prices of health care are marching relentlessly upwards, and so too many people don't have coverage," said Sen. Byron Dorgan, D-N.D. "The purpose of all of this is to try to get a handle on it somehow."

The White House issued a statement late Friday praising the Senate measure. "This bill provides the necessary health reforms that the administration seeks — affordable, quality care within reach for the tens of millions of Americans who do not have it today, and stability and security for the hundreds of millions who do," the statement said.

The action in the Senate comes two weeks after the House approved a health overhaul bill of its own on a 220-215 vote. After the vote Saturday night, senators will leave for a Thanksgiving recess. Upon their return, assuming Democrats prevail on the vote, they will launch into weeks or more of unpredictable debate on the health care bill, with numerous amendments expected from both sides of the aisle and more 60-vote hurdles along the way.

Senate leaders hope to pass their bill by the end of the year. If that happens, January would bring work to reconcile the House and Senate versions before a final package could land on Obama's desk.

The bills have many similarities, including the new requirements on insurers and the creation of new purchasing marketplaces called exchanges where self-employed individuals and small businesses could go to shop for and compare coverage plans. One option in the exchanges would be a new government-offered plan, something that's opposed by private insurers and business groups.

Differences include requirements for employers. The House bill would require medium and large businesses to cover their employees, while the Senate bill would not require them to offer coverage but would make them pay a fee if the government ends up subsidizing employees' coverage.

Another difference is in how they're paid for. The Senate bill includes a tax on high-value insurance policies that's not part of the House bill, while the House would levy a new income tax on upper-income Americans that's not in the Senate measure. The Senate measure also raises the Medicare payroll tax on income above $200,000 annually for individuals and $250,000 for couples. Both bills rely on more than $400 billion in cuts to Medicare.

The Senate bill was written by Reid in private negotiations with White House officials, combining elements of two committee-passed bills and making additional changes with an eye to getting the necessary 60 votes.

Along the way, Reid sweetened the pot for individual senators, adding federal funds for Louisiana and agreeing to support an amendment written by Sen. Ron Wyden, D-Ore., that would expand eligibility for the purchasing exchanges.

http://news.yahoo.com/s/ap/20091121/ap_on_bi_ge/us_health_care_overhaul