Does insurance have to pay for hospital stay after breast cancer surgery?

WASHINGTON (Reuters) – A congressional panel on Wednesday said it has bipartisan support for a bill requiring health insurers to pay for a minimum 48-hour hospital stay after breast cancer treatment, to combat what critics call “drive-through” surgeries.

About 20 U.S. states have such a minimum insurance requirement for women undergoing mastectomies or lumpectomies to treat breast cancer. Advocates of the bill say federal legislation is needed to equalize coverage across the nation.

“Having access to appropriate medical care should not be dependent on the state you live in,” said Rep. Frank Pallone, the New Jersey Democrat who chairs the health subcommittee of the Energy and Commerce Committee.

Breast cancer is the most common form of cancer among women after skin cancer, killing more than 41,000 women a year in the United States, according to the Centers for Disease Control and Prevention.

The bill has bipartisan support and 219 co-sponsors in the House of Representatives. A companion bill in the Senate has 19 co-sponsors thus far.

Women with breast cancer often undergo a mastectomy, in which the entire breast is completely removed, or a lumpectomy, a less drastic surgery that is followed by radiation therapy. About two-thirds of the 125,000 women who undergo mastectomies in the U.S. annually leave the hospital a few hours after surgery, without regard to their health, because their insurance will not pay for a longer stay, according to testimony from Dr. Kristen Zarfos, a fellow at the American College of Surgeons.

But America’s Health Insurance Plans, an industry group for most major health plans such as UnitedHealth Group and WellPoint Inc , called the bill unnecessary. “We do not think that it is a good idea on the state level or the federal level to be putting clinical guidelines into statute,” group spokeswoman Susan Pisano said.

Most health insurers treat each case on a “medical necessity” basis. “We think there are women who are satisfied with shorter lengths of stay,” she said.

DISEASE WINNERS AND LOSERS

Singer-songwriter and breast cancer survivor Sheryl Crow also testified at the House panel’s hearing, expressing support for a second bill that would provide $40 million annually for five years for federal research into environmental factors linked to breast cancer.

“There is little financial incentive for anyone else to do this research,” Crow told lawmakers. She added: “I have no idea why I got breast cancer or what I can say to others on how to prevent it.”

Some Republicans and a federal health official said the research bill would tie the government’s hands and interfere with science.

“In general, prescribing a specific way of conducting federal research could have the unintended consequence of narrowing the field of inquiry and promoting an unwise use of precious resources,” said Deborah Winn, associate director of epidemiology and genetics at the National Cancer Institute.

Because the bill establishes a panel to set research priorities, it could hamper current efforts, Winn said.

A Senate companion bill includes changes related to the peer review process that could make a compromise possible, Winn said.

The committee’s top Republican, Rep. Joe Barton of Texas, said he is worried that Congress is too susceptible to the power of disease groups.

For example, advocates for breast cancer are among the most organized and best funded advocacy groups, Barton said. If Congress responded to their entreaties, it would be “picking winners and losers in terms of who gets the most research. Where does that leave liver cancer? … What about autism …diabetes?” he asked.

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