January saw the start of both a new Administration and the 117th Congress. The Biden Administration has announced its focus will be actions to mitigate the spread of the coronavirus and the effective distribution of vaccines. And, while stopping a pandemic that has killed more than 400,000 Americans and wreaked havoc on our economy must be the top priority, other health policy issues critical for people with colorectal cancer and other chronic conditions also must be addressed. The Colorectal Cancer Alliance will be increasing our advocacy work in 2021 to make sure the concerns and needs of our community are clear to the Administration and our legislators.
One of our top priorities for the past five years has been to fix the colonoscopy loophole. By law, screening is provided without co-pay, but there is a glitch that results in patients having to pay if the doctor removes one or more polyps. This loophole was closed recently, but with a phase-in period, as the legislation introduced by Representative Donald Payne Jr. from New Jersey was included in the spending bill passed by Congress at the close of 2020. The phase-in was apparently necessary to address the concerns of some legislators over costs. Over a nine-year period, the patient co-pay portion will decrease every three years until it goes away completely in 2030.
Our advocacy work must be both timely and flexible as issues often arise with little notice. It is therefore important to begin the year with identified priority goals and positions. Here are several of the key items the Alliance will address in 2021:
- Screening at age 45: The incidence of colorectal cancer at age 45 now approximates the same rate as age 50. The Alliance has aggressively advocated that the recommended screening age be lowered to at least 45. Recently, we were thrilled to see that the US Preventive Services Task Force (USPSTF) issued updated draft recommendations generally consistent with our position and we have strongly advocated that these be finalized. Under the Affordable Care Act (ACA) all group health plans issued after 2010 must cover colorectal cancer screenings which have an A or B rating from USPSTF with no co-pay or co-insurance. Assuring screening will be available at no cost beginning at age 45 would be a huge win in our efforts to reduce the incidence of colorectal cancer.
- Cost of Cancer Care: The cost of cancer care has increased 34% in the last five years, more than three times the rate of inflation; in fact, a cancer diagnosis more than doubles the odds a family will have to declare bankruptcy. A key priority for the Alliance in 2021 will be to advocate for legislation that will lower the cost of care. Last year the House passed legislation and the President issued Executive Orders attempting to lower the cost of prescription drugs. For 2021, the Alliance will advocate that Congress pass legislation that takes a comprehensive approach to addressing the cost of care. Drug prices are but a part of the high cost of health care; prescription drugs are between 15% to 20% of our health care spending depending on which study you choose. In addition to drug costs, patient’s pay premiums, deductibles, co-pays, co-insurance, out-of-network costs.
- Access to Affordable Health Insurance: Lowering the cost of cancer care is vital for patients that have health insurance, but 25 million Americans did not have health insurance before the virus, and as millions lost their job in the pandemic, they lost coverage as well. The average Medicare cost of a colorectal cancer diagnosis is $39,000 and later stage cancer can be $150,000 or more – very few American families can afford that kind of expense without insurance. In 2021, the Alliance will advocate for legislation that both reduces the cost of health insurance and expands the number of Americans covered.
- Maintain critical ACA protections: For people with colorectal cancer, the single most important protection in the ACA is that insurers cannot discriminate against you because you have a pre-existing condition. The ACA is now before the Supreme Court as a group of Republican state attorneys general, having failed once, are again challenging the Constitutionality of the law, this time based on Congress having zeroed out the individual mandate. Although Supreme Court prognosticators tend to think the Court will again uphold the law, it is dangerous to try to predict Court decisions based on the questions Justices’ ask in oral arguments.
If the ACA is overturned there must be immediate action to maintain key protections. Millions of Americans that lost their job during the pandemic now do not have health insurance and, if they have a pre-existing condition, they may not be able to get insurance that covers it without this vital Federal protection.