Although the Senate seems to have been debating healthcare reform proposals for months, it only had its first health insurance-related vote on Thursday. Democratic Sen. Barbara Mukulski's women's health amendment passed with a solid majority. The legislation has the potential to improve the care many women receive from their health insurance plans. However, there are detractors--some who are surprising.

The Mukulski amendment presents a mandate to health insurance companies. They will now be required to provide preventative female health services, such as mammograms and OB-GYN visits for free, without charging any deductible or co-payment. She is worried that many women will neglect their care for financial reasons; for example, if they can only afford one co-pay, a mother may pay for her kids to visit a doctor and forgo her own appointment. Even though the main healthcare reform bill eliminates out-of-pocket costs for many preventative health care services, the senator believed that it didn't go far enough to alleviate the unique challenges women face with their health insurance plans.

Women have generally had to pay higher premiums for their health insurance plans, regardless of whether maternity coverage was included. The disparity is due to the fact that diseases such as ovarian and cervical cancer (which the amendment covers) necessarily impact women as a function of their biology. KISS drummer Peter Criss nonwithstanding, the vast majority of breast cancer patients are female. It also covers conditions that, while not specific to women, strike them at high rates: diabetes, lung cancer, and heart disease; the latter is the little-publicized #1 cause of death for American women. In addition, counseling and treatment related to domestic violence must also be provided at no cost to the patient.

For those worried about the recent mammogram recommendations from a federal task force, the amendment offers some peace of mind. It tells doctors and health insurance plans to disregard the new guidelines, which suggest that annual mammograms should begin 10 years later (at 50 rather than at 40 years old) for the average woman without other risk factors. Still, the amendment does not lack controversy. It would charge the federal Health Resources and Services Administration with developing the guidelines insurers will have to follow in their health insurance plans. Some have objections to that level of federal involvement on principle, and others worry that issues such as rationing will occur.

The bill passed in a 61-39 vote. Surprisingly, it wasn't split by party lines. A handful of Democrats voted against the Maryland senator's amendment; their objections varied. Conservative Democrat Bill Nelson wasn't satisfied that the bill did not specifically exclude abortion from the mandatory coverage, although it wasn't included, either. Russ Feingold's opposition was driven more by budget concerns: it did not include any provisions describing how the estimated $940 million cost would be paid.

Republican proponents included Senator Olympia Snowe, who co-sponsored the amendment and is known for being liberal-leaning--she even expressed approval of a public option among health insurance plans, albeit one that only took effect if "triggered". Fellow Maine Senator Susan Collins also voted in favor, as did Louisiana's David Vitter. Better known for a prostitution scandal, Vitter took pains to make sure that women in the 40-49 age group also had access to free breast cancer screenings. Joe Lieberman, independent who caucuses with the Democrats but has been a loose cannon on healthcare reform votes, was another supporter of the amendment.