Congressional Approval Will Eliminate CRC Screening Barrier for Seniors

H.R. 1570 – Removing Barriers to Colorectal Cancer Screening Act of 2020 has been passed by Congress. The bill—which passed the House vote on December 9, 2020, and the Senate on December 21, 2020, and will become law once signed by the President—will be phased in over the next eight years. This bill has been devised to improve colorectal cancer (CRC) screening rates within the Medicare population, which in turn will allow earlier diagnosis and improve health outcomes. The Colon Cancer Foundation was a co-signee on a letter drafted by 35 other organizations and led by the American Cancer Society Cancer Action Network, urging Congressional leaders to include this bill in the end-of-year funding package.

The bill modifies cost-sharing requirements for CRC screening among seniors enrolled in Medicare such that they will no longer be required to pay coinsurance if a polyp is discovered and removed during a regular screening colonoscopy. While the 2010 Affordable Care Act ensured that Medicare fully covers preventive screening for colorectal cancer, removing a polyp found during a routine screen makes it a diagnostic procedure, which adds a cost-sharing responsibility on the patient. As a result, the patient may end up having to pay 20% of the cost for removing the polyp as co-insurance, and this surprise bill may amount to several hundred dollars, depending on the facility where the procedure was conducted. For seniors living on a fixed income, this unexpected cost could be a financial burden.

When caught early, removing a polyp not only improves patient outcomes and quality of life, but also saves downstream costs for the health care system as a whole. However, prior knowledge of the cost-sharing requirement associated with polyp removal during a routine screening procedure could deter individuals from going in for their regular screening and raise the risk of a polyp or a potential tumor going undetected.

Cindy Borassi, Interim President, Colon Cancer Foundation, said, “This is a big win and significant step toward correcting the “colonoscopy loophole.” By addressing and eliminating the loophole of financial obligations in case a polyp is detected during a screening procedure, we are ensuring that our seniors will continue to make their preventive care a priority and undergo this routine yet potentially life-saving screening test without cost. Once made into law, H.R. 1570 will also help reduce advanced colorectal cancer cases among our Medicare enrollees.”