Important CRC Access Bill Introduced in Senate

Friday, May 23, 2014
Judy Behm & Eric Auslander
Preventing Colorectal Cancer

On May 15, 2014, Senator Sherrod Brown (D-OH) introduced legislation that would improve access to colorectal cancer (CRC) screenings for seniors who receive health coverage through Medicare. This legislation, if enacted, would eliminate cost sharing regarding Medicare beneficiaries receiving a routine colonoscopy screening in which a polyp was removed.

Under the Affordable Care Act (ACA), many preventive medical services, including colorectal cancer screenings, must be offered with no cost-sharing to a patient. The goal of this new policy is to encourage all Americans to undergo important screenings that will detect potential illnesses such as cancer before they become dangerous and avoid the costs associated with more intense treatment. An individual’s colonoscopy is therefore covered by private health insurance as well as Medicare.

A question that has arisen, though, is whether the removal of polyps that are found during a colonoscopy is considered preventive service, and therefore covered without cost-sharing. The U.S. Centers for Medicare and Medicaid Services (CMS) has previously said that commercial insurance plans must cover polyp removal with no cost-sharing, since the removal is an integral part of the screening. This was an important victory in the fight against cancer. Without it, many patients would have been saddled with the costs of removing potentially cancerous tissue.

However, the ruling did not apply to Medicare. Because colonoscopies are recommended mostly for people over age 50, many of those who need colonoscopies most are enrolled in Medicare. Sen. Brown’s bill would eliminate the coinsurance associated with a polypectomy. This bill would give patients more financial peace of mind, and likely prevent many from avoiding the screening for fear of the potential costs.

S. 2348 has a companion bill in the U.S. House of Representatives, H.R. 1070, which was introduced by Rep. Charles Dent (R-PA), titled “Removing Barriers to Colorectal Cancer Screening Act.” Rep. Dent introduced the House legislation on March 12, 2013, and it has bipartisan support.