Mandate foe, not medicine’s

By J. Patrick Coolican (contact), Sam Skolnik (contact)

Wednesday, Sept. 24, 2008 | 2 a.m.

State Sen. Joe Heck is one of the Legislature’s strongest voices on health care, which isn’t surprising given that he’s a physician. What is surprising, however, is that on some key issues he’s an ally of the health insurance industry — surprising because doctors often view insurance companies like some virulent bacterium.

Heck’s relationship with the insurance industry and his views on health care issues have come into sharp relief in recent weeks — he’s fighting for his political life in a tough reelection campaign against Democratic challenger Shirley Breeden for Senate District 5.

The state Democratic Party has spent tens of thousands of dollars on tough — and often misleading — mail pieces accusing Heck of not caring about women’s health care issues, and particularly cervical cancer. One flier featuring pictures of suffering cancer patients falsely accuses him of voting against cervical cancer screenings.

In fact, last year Heck voted against a different health care bill mandating that most insurance companies include in their coverage the vaccine for the sexually transmitted human papillomavirus (HPV), often a precursor to cervical cancer.

Heck, of Henderson, told a 2007 state Senate committee that he had “philosophical” objections to mandating coverage of the vaccine because there were preventable risk factors, including multiple sex partners, that sometimes lead to HPV transmission and then cancer.

Here’s what Heck said at the 2007 committee meeting: “I do have a bit of a philosophical issue with this vaccine in that this type of cancer is, ah, three of the major types of risk factors are behavioral for this type of cancer.”

He compared it to a vaccine for lung cancer.

“I wonder if it opens the door that, should some great day we develop a vaccine for the type of cancer that’s caused by smoking, are we then going to mandate that everybody who smokes needs to have an insurance-paid or government-paid vaccine?”

Democratic script writers drew an inference, fairly or not: Heck believes women shouldn’t be granted a vaccine to allow them to engage in risky sexual behavior.

The HPV vaccine bill, sponsored by state Sen. Dina Titus, eventually passed. Heck’s detractors, including the National Organization for Women, accused him of being an ideologue hostile to women.

Not so, Heck said in an interview Tuesday, noting that he has a wife and two daughters and is as interested in the vaccine as anyone.

The first-term senator said his real opposition is to forcing insurance companies to take on more and more mandates, which, he said, will merely drive up the cost of insurance. (Heck has not received significant campaign contributions from the health insurance industry despite claims made in Democratic mailers.)

Heck reiterated his point about forcing insurance companies or the government to provide a vaccine to smokers, thus allowing them to puff with impunity.

“I wasn’t trying to say women are bringing this on themselves. I was saying, ‘Do you say to someone who’s smoking tobacco, we’re going to mandate the insurance company cover a vaccine for lung cancer, and then you can smoke with impunity?’ ”

Heck also said the vaccine is new to the market and faces lingering questions about its effectiveness.

For Heck, the issue of insurance mandates is not a small matter. And his explanation doesn’t appear to be an effort to distract from his arguably impolitic comments about HPV.

Rather, Heck says, “private health insurance has to become more affordable. We are one of the most heavily mandated states in the union. Every mandate needs to be analyzed on a cost-benefit analysis. You can’t give in to every special interest group,” he said.

Insurers should be allowed to offer less expensive basic plans, which could be accomplished by eliminating 40 of the 50 current mandates, he said.

Each mandate adds between 0.25 percent and 1 percent to health insurance premiums, Heck said, citing data from a health insurance trade group. He posited that the cost of a basic health insurance package could be reduced 10 percent to 15 percent if Nevada reined in its mandates.

The problem with this approach, according to some health care analysts, is that it doesn’t address the real problem.

Stan Dorn, a health care analyst for the Urban Institute, a Washington, D.C. think tank, said the leading causes of the high rates of uninsured are lots of low-wage jobs and a flimsy health care safety net, not regulatory issues.

For instance, Alabama has a particularly weak regulatory structure with few mandates, but its rate of residents without health insurance is roughly equal to the national average.

Dorn points out that employers whose workers make $20,000 a year can’t economically justify providing employees a $10,000-per-year insurance policy. Reducing mandates and taking the cost down to $9,000, as Heck proposes, won’t change the equation, Dorn said.

Henry Aaron, a health care policy analyst for the Brookings Institution, noted the relatively low cost of the HPV vaccine Gardasil — about $360 per patient — and said it could offer long-term savings because it’s so much cheaper than treating cancer.

Heck agreed a stronger health care safety net is needed. He opposes any health care budget cuts that would threaten Nevada’s ability to receive federal matching funds, including for Medicaid.

Heck acknowledged Nevada’s health care system is in disrepair, lamenting the inability of many residents to afford quality care, or get treated even if they can afford it. He proposed loosening restrictions on some programs, such as Nevada’s version of the federal COBRA, which allows employees to take their health insurance with them when they leave their job.

A key problem, Heck noted, is the shortage of nurses and doctors. He proposed making it easier for board-certified doctors from other states to get licensed here, assuming they have a clean record.

Breeden, whose campaign has kept tight control of her interactions with the media, did not reply to requests for an interview about health care issues.