S.1193/A.7161 – Coverage for Ovarian Cancer Screening

This legislation would require coverage of genetic testing for ovarian cancer for patients with a personal or family medical history of ovarian cancer. While well intentioned, this bill is unnecessary, as health plans currently provide this benefit to individuals. Further, establishing new health insurance mandates results in increased costs for individuals and employers purchasing health insurance in New York. Accordingly, the New York Health Plan Association (HPA) opposes this bill.

In structuring benefits, health insurers seek to align benefits with the most up-to-date clinical guidelines and recommendations. The United States Preventative Services Task Force (USPSTF) recommends that individuals with a personal or family history of breast, ovarian, tubal, or peritoneal cancer have access to a genetic risk assessment and BRCA1/2 mutation testing. These tools can be used by clinicians to support referrals to genetic counseling, which is another benefit accessible to members. Concurrently, when deemed necessary, plans provide access to Lynch Syndrome and coding exons analysis associated with ovarian cancer to members. Mandating into statute specific treatments or levels of coverage fails to take into account when the science changes or guidelines evolve, requiring health plans to cover services that are outdated and, potentially, harmful to patients.

Moreover, mandating coverage of specific services or treatments disproportionately affect small and medium-sized employers. Forcing employers to include benefits they and their workforce may not want or need exacerbates the challenge they face to find affordable health care options.  Mandated benefit bills pertain only to fully-insured policies, which are generally those purchased either by individuals who buy coverage on their own or receive it through a small or medium-sized business.  Large companies typically “self-insure,” providing employee health benefits by directly paying health care claims to providers. These plans are governed by the Federal Employee Retirement Income Security Act (ERISA) and therefore not subject to state mandated benefits.  This exemption offers self-insured employers greater control over the particular benefits they cover for their employees.

Today, more than 50 percent of the commercial market in New York is covered under a self-insured plan.  As more employers self-insure, state laws mandating specific types of benefits and services affect an increasingly smaller portion of the privately insured marketplace, with the costs of mandates falling largely on small and medium-sized employers.

For all these reasons, HPA opposes S.1193/A.7161.