Recently the Senate passed Sen. Barbara Mikulski's Women's Health Amendment, which requires health insurance companies to provide free mammograms and other preventive health services for women. Sounds good, doesn't it? Women's health needs have traditionally been underserved by the insurance system. But, ironically, the Senate's excise tax will force many women to pay indirectly for these "free" services.

Here's how: For one thing, the cost of the services mandated in the Mikulski Amendment will cause even more health plans to exceed the cost cap for the excise tax. And it's expected that 20% of plans will already be over the limit when the tax takes effect. In practical terms, any added costs for new services provided by these plans (like those mammograms) will be taxable. So, in one very real sense, the Senate plans to tax some of this preventive care for women - at a staggering 40% of cost.

The Mikulski Amendment looks like a step forward, but many women will pay for these services indirectly - in the form of higher premiums or increased out-of-pocket costs. One hand giveth and the other taketh away. And speaking of irony ...

Guess who voted for the Mikulski amendment? Some Senators who haven't even committed themselves to voting for the final bill, including Lieberman, Landrieu, and Snowe (who even cosponsored the amendment. Here's an idea: They can make sure these women's services really remain "free" by supporting the Sanders-Franken-Brown Amendment, which would replace the excise tax with a tax on the extremely wealthy (the way the house does it.)

That would remove the irony in the Senate's actions and replace it with fairness.