March 1, 2011
States Urged to Pass and Defend Patient Protection Laws Requiring Insurers to Cover Costs of Colon Cancer Screening
National Colorectal Cancer Legislation Report Card Shows Passage of New Preventive Screening Legislation Stalled, Leaving Many Without Coverage Options
WASHINGTON – March 1, 2011 – Passage of laws requiring insurance providers to cover the costs of colon cancer screenings has stalled over the past two years and advocates are bracing to protect existing legislation in states that currently guarantee access to these lifesaving tests, a coalition of public health associations and medical professional societies reported today. The progress made in passing state-mandated coverage of colon cancer screening tests according to accepted medical guidelines has come to a near halt as state legislatures reconsider their role in the wake of the passage of the federal Affordable Care Act.
Only one state, Hawaii, passed coverage legislation in 2010. Combined with Vermont’s legislation passed in 2009, only two states have improved their grade in the past two years as reported by the annual Colorectal Cancer Legislation Report Card – the slowest improvement since the report card launched seven years ago.
“The facts are clear – in states with laws mandating coverage of colon cancer screening, more people get screened and more lives are saved,” said Lisa Paulsen, CEO of the Entertainment Industry Foundation, the 501(c)(3) non-profit organization of which the National Colorectal Cancer Research Alliance is a part. "State legislatures need to move to ensure that everyone who needs colorectal cancer screening has access to it. We know that the prevention or early detection that can result from screening saves lives, and will save health care dollars for the states in the long run.”
With the addition of Hawaii in 2010, 23 states and the District of Columbia now require insurance coverage of colonoscopies and other procedures that follow accepted medical guidelines, earning them the grade of “A.” Ten other states require varying degrees of coverage, with scores of B, C or D, while 17 states score an “F” for failing to mandate any coverage of the cost of colon cancer screening.
As of September 23, 2010, all new health plans are required to cover colorectal screening tests as part of the Patient’s Bill of Rights in the federal Affordable Care Act (ACA). The coverage rules follow guidelines established by the U.S. Preventive Services Task Force, which require that insurance companies cover some colorectal cancer screening tests for those ages 50-75. However, those guidelines still leave high-risk populations under 50 without coverage options. In addition, grandfathered plans (those existing health plans in which a person was enrolled on the date of enactment of ACA), are not required to cover the tests.
Starting in 2014, as part of the ACA, all plans participating in state exchange programs will be required to provide coverage based on a federally mandated “essential benefits” package. It is expected that the package will also follow the U.S. Preventive Services Task Force guidelines – potentially leaving high risk populations that fall outside the guidelines without coverage options.
In the 17 states that currently do not guarantee screening coverage, many people will continue to fall through the cracks unless patient protections are established. In addition, many of the states that currently have guaranteed coverage have benefits that go above and beyond the U.S. Preventive Services Task Force guidelines and advocates do not want to see any of those guarantees rolled back.
“We have made tremendous strides in moving states to take action to protect the health and lives of their citizens by ensuring that colorectal cancer screenings are covered for all who need them,” said John R. Seffrin, PhD, CEO, American Cancer Society Cancer Action Network (ACS CAN), the advocacy affiliate of the American Cancer Society. “While the essential benefits package in the Affordable Care Act will go a long way in 2014 to guarantee coverage, the best way to ensure that everyone who needs screening tests have access to them is for states to continue to enact patient protections and maintain the strong laws they already have in place.”
Colorectal cancer (also known as colon cancer) is the second-leading cause of cancer deaths for men and women combined in the United States. However, the disease can often be prevented entirely through the early identification and removal of pre-cancerous polyps. When colorectal cancer is diagnosed at an early stage, the five year survival rate is 90 percent. However, when it is not diagnosed until it has spread to distant organs, the five year survival rate is only 11 percent. In 2010, the American Cancer Society reported that the colorectal cancer death rate has continued to decline. Down approximately 3.9 percent per year in men from 2002 to 2006 and 3.4 percent per year in women from 2001 to 2006, colorectal cancers saw one of the largest declines in death rates of all leading cancers.
Research has shown that regular screening is crucial for all those over 50, as well as those under 50 at increased risk.
Despite widespread awareness about the importance of colon cancer screenings, insurance coverage is still a barrier to screening according to a 2009 survey undertaken by Harris Interactive on behalf of ACS CAN and the Entertainment Industry Foundation’s National Colorectal Cancer Research Alliance (EIF’s NCCRA).
In fact, 70 percent of all survey respondents, including two-in-three (62 percent) of those 50 and older, said that if they knew that their insurance covered the entire cost of colonoscopy, they would be somewhat to much more likely to have the procedure at age 50, or earlier if their doctor recommended.
About the Report Card Coalition
Launched in 2004, the Colorectal Cancer Legislation Report Card initiative is supported by a coalition that includes American Cancer Society Cancer Action Network, American College of Gastroenterology, American Gastroenterological Association, American Society of Colon and Rectal Surgeons, American Society for Gastrointestinal Endoscopy, the Cancer Support Community, C3: Colorectal Cancer Coalition, Colon Cancer Alliance, Hadassah, Prevent Cancer Foundation, The Colon Club, The Jay Monahan Center for Gastrointestinal Health, and the Entertainment Industry Foundation's National Colorectal Cancer Research Alliance (EIF's NCCRA).
Now entering its eighth year, the Colorectal Cancer Legislation Report Card initiative continues to make an impact, providing an effective tool for influential organizations in the fight against colon cancer in their work to generate awareness of screening's importance and encourage the enactment of state legislation requiring insurers to cover the costs of colorectal cancer tests. When the Report Card Initiative began in 2004, 18 states had passed screening legislation. As of 2010, 30 states and the District of Columbia now have such laws.