Five States Passed Laws in 2007, but 26 Still Earn D's or F's on Legislation Report Card

WASHINGTON, D.C. (March 11, 2008) — For the first time, more than half of the U.S. population is now covered by state laws that require insurance providers to cover the cost of colon cancer screening tests, according to a new report card issued by a coalition of 11 leading public health groups. The enactment of new coverage laws in five states during 2007 also increased to 19 the number of states receiving an "A" grade on the 2008 Colorectal Cancer Legislation Report Card. Despite the gains, 26 states still have failing marks of "D" or "F."

Nebraska, New Mexico and Washington all joined the "A" list since last year's report card with new laws that require insurance carriers to pay for the full range of colon cancer screening tests, including colonoscopy. The report card gave states "A" grades based whether the laws embraced the screening guidelines of the American Cancer Society, American Gastroenterological Association (AGA), American College of Gastroenterology (ACG) and American Society for Gastrointestinal Endoscopy (ASGE) that were current at the time of evaluation in 2007. "A" level legislation also takes into account future advances, which is particularly crucial this year as screening guidelines have recently been updated for 2008.

Alaska, which enacted comprehensive legislation in 2006, was added to the "A" list in March 2007 shortly after enacting its new law. The state received an "A" grade in the 2007 report card, which was released shortly after the law became effective. A new Minnesota law requiring coverage for preventative screening raised that state's grade from "F" to "C." Minnesota missed out on a higher grade because the law is somewhat vague and does not specifically define which types of screening must be covered. (To view the report, visit www.nccra.org).

Despite Gains, 26 States Do Not Assure Screening Coverage
Thanks to the new laws, 54 percent of the U.S. population is now covered by laws that require insurance coverage for colon cancer screening, compared to 49 percent at the end of 2006.

"We made real progress this past year in the fight against colon cancer. The new laws enacted will give more Americans the opportunity to stop colon cancer before it starts through early detection tests that can remove growths before they turn into cancer," said Daniel E. Smith, president of the American Cancer Society Cancer Action Network (ACS CAN), the American Cancer Society's sister advocacy organization. "Still, we can't rest until every state requires insurers to cover the cost of colon cancer screening so that it's accessible to everyone who needs it."

Commonly known as colon cancer, colorectal cancer is the second leading cause of cancer death among American men and women combined, but — according to the Centers for Disease Control — if everyone aged 50 years or older were screened regularly, as many as 60 percent of deaths from colorectal cancer could be avoided. The Society recommends that average-risk adults should begin colorectal cancer screening at age 50 years with one of several options, including a once-a-decade colonoscopy that not only detects cancerous growths, but can remove polyps before they become cancerous. Studies show that screening rates rise and death rates decline substantially when states require insurance coverage for these potentially lifesaving procedures.

Screening Rates and Cancer Survival Rise When States Require Coverage
A May 2006 analysis by the American Cancer Society found that screening rates in states with "A" level coverage laws had risen 40 percent faster than the rates in states without such laws.(1)

When detected early, colon cancer is among the most treatable of all cancers and has a five-year survival rate of 90 percent. That survival rate drops to only 10 percent when people are diagnosed with the most advanced stage of the disease (once it has spread from the colon to other organs such as the liver and lungs). Early detection and prevention through screening is extraordinarily cost effective.

Screening is Cost Effective
A study commissioned by the American Cancer Society in 2003 shows that colon cancer screening tests are less costly than equally-important annual screening for breast cancer, for which coverage is protected by law in 49 states. The PMPM cost of screening mammography is 75 cents -- 9 cents more PMPM than flexible sigmoidoscopy and FOBT combined and 20 cents more than colonoscopy.(2)

Early detection also produces overall savings in health care expenditures by reducing treatment costs. A recent report commissioned by ACG estimated average per patient treatment costs of $30,000 when early stage cancers are detected early, compared to $120,000 for a patient with late-stage colon cancer.

While screening is cost-effective on an aggregate basis, the out-of-pocket costs can strain the finances of uninsured and underinsured individuals and discourage them from taking advantage of screening technology. Medical practitioners recommend regular screening for colon cancer once individuals reach the age of 50, but in 2003, fewer than one half of Americans in this group reported getting screened regularly. By comparison, data from that year shows that more than 57 percent of men over 50 reported being screened for prostate cancer in the last year, and 69.7 percent of women over 40 reported being screened for breast cancer within the past two years.

Studies have shown that limits on covered benefits impede an individual's ability to benefit from early detection of or screening for cancer, in particular colorectal cancer.(3,4) The less extensive the coverage, the less likely a person is to get screened. Furthermore, doctors often do not refer people for tests if they believe those tests are not covered by insurance. (5)

Many Insurance Plans Limit Coverage
A recent Health Insurance Association of America (HIAA) report found that many health plans do not currently provide coverage for the full range of screening tests when not required by law. The report states: "Most private insurers will only cover colonoscopies for high risk populations" and affirms that health insurance coverage is a factor in low screening rates.(6)

"Getting people to seek a colon cancer screen is difficult enough; adding insurance barriers makes it almost impossible," said Dr. David Johnson, immediate past president of the American College of Gastroenterology. "But 26 states allow insurance companies to make getting a colonoscopy a chore."

About the Report Card Coalition
Launched in 2004, the Colorectal Cancer Legislation Report Card initiative is supported by a coalition that includes the 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, 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 fifth year, the Colorectal Cancer Legislative Report Card initiative continues to make an impact - galvanizing the most influential organizations in the fight against colon cancer in order to generate crucial awareness of the importance of early screening, and to impact the legislative landscape in a long list of states. The Report Card has become an important tool used by advocates at the state level in the effort to enact legislation requiring insurers to cover CRC screening. When the Report Card Initiative began in 2004, 18 states had passed screening legislation. As of 2008, 24 states and the District of Columbia have passed legislation, and there is legislation pending in a number of other states.

"We are making progress, but we are not there yet," said Lisa Paulsen, CEO of the Entertainment Industry Foundation. "The evidence shows that colonoscopies cost less and save lives. The states that do not yet require insurance coverage can help their citizens live longer and healthier lives by enhancing access to lifesaving colonoscopy screening."

Contact:
Jennifer Burke
Burke PR
203-405-1479
burkepr@gmail.com

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1 March 2006 ACS analysis of Behavioral Risk Factor Surveillance System Public Use Data Tape 1999, 2001, 2004, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention,1998, 2000, 2005.
2 Lewin Group, Short-Term Cost Impact of Colorectal Cancer Screening. Unpublished data.
3 Agency for Health Care Policy and Research. Women's Use of Preventive Screening Services: A Comparison of HMO Versus Fee-for-Service Enrollees. July 1997.
4 Faulkner LA, Schauffler HH. The Effect of Health Insurance Coverage on the Appropriate Use of Recommended Clinical Preventive Services. Am J Prev Med 1997;13(6):453-8.
5 J.D. Lewin and D.A. Asch, "Barriers to Office-Based Screening Sigmoidoscopy: Does Reimbursement Cover Costs?" Annals of Internal Medicine, vol. 130, no. 6 (Mar. 1999), pp. 525-30.
6 Mohr P., Mueller C., et al. "The Impact of Medical Technology on Future Health Care Costs." Health Insurance Association of America. , p. A4-58;59. February 28, 2001.