Healthcare Reform & CRC

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As a colorectal cancer survivor, advocate, caregiver, or family member, it is important that you understand how the Affordable Care Act (ACA) will affect access to colorectal cancer screening. The ACA extends not only to the health insurance industry, but also to prevention and wellness programs throughout the country.

Both the expansion of health coverage and the funding of colon cancer prevention programs have potential to significantly impact the screening and treatment of colorectal cancer. At Fight Colorectal Cancer, we believe that colorectal cancer is a national priority, and screening access should reflect that.

Expanded Coverage

Currently, lack of health insurance among the adult population is a key reason that just over half of Americans over age 50 are routinely screened. That number decreases to 15 percent among the uninsured population.

Due to the ACA mandate that all Americans must have healthcare coverage either through a private policy or a government program, millions of additional individuals will gain health insurance coverage, which will likely lead to more people undergoing routine colorectal cancer screenings.

Fewer Expenses

One of the most significant barriers Americans face in receiving screening for colorectal cancer is the cost associated with colonoscopy. Insurance often brings down the cost of procedures like colonoscopy, and the previsions of the ACA provide additional financial support to encourage screenings. The ACA requires all self-funded and commercial health insurance policies to cover colorectal cancer screening tests at no out-of-pocket cost to the consumer. With regard to Medicaid, the ACA expands program eligibility and encourages states to provide preventive services. Additionally, the Federal Medical Assistance Percentages, which determine how much money the federal government gives to states for programs like Medicaid, is increased by 1% to states that offer preventive services (including colorectal cancer screenings) without cost-sharing to Medicaid beneficiaries.

Polyp Detection and Removal

Despite the fact that a colonoscopy is a preventive measure, some argue that once a polyp is found during the procedure, it becomes a polypectomy and therefore goes beyond “preventive” medicine. Therefore, some commercial insurers and self-funded, third party administrators could require out-of-pocket cost-sharing. It was recently ruled that for self-funded plans and commercial insurance policies, polyp removal is an integral part of a colonoscopy and is not subject to cost-sharing. This makes clear that both screening for colorectal cancer and removal of polyps are fully covered; the assurance that patients will incur no costs will likely lead to a rise in colonoscopy screening incidences.

Negative Consequences

The massive shock to the healthcare industry can lead to unintended consequences such as the increased shortage of gastroenterologists. In addition to the GI shortage, there could also be a shortage of propofol, a drug used to sedate patients undergoing colonoscopies. As more Americans have access to insurance, these shortages may increase unless circumstances in the healthcare environment change. For now, this remains a serious problem in the healthcare industry at large and for colorectal cancer screening in particular.

What now?

Fight Colorectal Cancer will continue to advocate to protect and increase health insurance mandates that guarantee coverage for colorectal screening tests; fight for state and federal funding for colorectal cancer screening and treatment programs; and work with Congress and the Secretary of Health and Human Services to ensure that all Americans have access to evidence-based prevention, early detection, and treatment services critical to colorectal cancer patients.

Join us in making colorectal cancer a national priority. Become an Advocate and get behind a cure.

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