Report from Capitol Hill: High Risk Women and Health Insurance Reform

The average woman has a one in 71 chance of developing ovarian cancer. Some women, however, are at increased risk due to genetic mutations or a family history of the disease. Many of these women are interested in ways to reduce their risk, and whether those preventive measures will be covered by their insurance.

There are two primary ways for a woman to reduce her risk of ovarian cancer: 1) prophylactic risk reducing bilateral salpingo-oophorectomy (RRSO) and 2) oral contraceptives. Both RRSO and oral contraceptives have been shown to significantly reduce the risk of ovarian cancer. For oral contraceptives, the reduction in risk is approximately 50 percent if taken for five or more years.

The Patient Protection and Affordable Care Act—the health reform bill—included a provision requiring insurance companies to cover women’s preventive services without co-pay. A committee organized by the Institute of Medicine (IOM) was charged with researching which services should be covered as preventive care for women. The committee then passed its recommendations on to the Department of Health and Human Services (HHS). Because of their impact on ovarian cancer, especially for women at increased risk, the Ovarian Cancer National Alliance urged the government to include both oral contraceptives and RRSO in the list of preventive services covered under the act.

This summer, the IOM committee released its recommendations regarding women’s preventive health services. Shortly thereafter, HHS issued regulations defining the services that will be covered as preventive care for women under the Patient Protection and Affordable Care Act. Covered services will include all forms of birth control, HPV testing, counseling for sexually transmitted infections, well-woman visits, breastfeeding support and screening for domestic violence and HIV.

The recommendations are mixed with respect to ovarian cancer. While birth control is included, the rationale for this decision did not mention the known risk-reducing effects for this disease. Preventive surgeries, including both RRSO and mastectomy, were not included. Their inclusion would have benefited women at high risk of developing ovarian cancer, as preventive surgeries are not covered by Medicare and are covered by only some insurance companies.

The Alliance continues to fight for coverage of preventive surgery for women at high risk of developing ovarian cancer. We are working with Medicare, champions on the Hill and advocates to require coverage for preventive surgeries when medically appropriate.