In the United States. colorectal cancer (CRC) is the second leading cause of death related to cancer. Estimates indicate that 49,190 American individuals will die from CRC in 2016.
The burden of CRC is greatest in the Medicare population. About 70% of CRC deaths occur in Medicare age eligible people and the average age of people dying of CRC is 73 years.
The Affordable Care Act (ACA) in part aimed to increase access to CRC screening by mandating coverage without cost sharing; however, Medicare insurers who lack additional insurance may be unable to afford CRC screening and treatment. According to a commentary recently published the journal Gastroenterology, this policy puts people in low socioeconomic status bear a disproportionate share of this burden. The manuscript is titled “Colorectal Cancer Health Disparities and the Role of US Law and Health Policy.”
“Study after study shows that screening saves lives,” said Chyke A. Doubeni, MD, MPH, chair and the Presidential Associate Professor of Family Medicine and Community Health at the Perelman School of Medicine at the University of Pennsylvania, and lead author of the commentary in a recent news release. “Yet many of those in the group most affected by this deadly disease are unable to afford the screening they critically need. We must renew efforts to ensure equitable access to and use of disease prevention, detection, and treatment services for colorectal cancer.”
Presently, in the U.S there are about 55.5 million Medicare beneficiaries. A survey conducted by the Kaiser Family Foundation in 2010, revealed that 14% Medicare beneficiaries lacked additional coverage.
However, ACA the did not tackle provisions in section 1834(d)(3)(D) of the Balanced Budget Act (BBA) of 1997, which disallows Medicare from waiving the beneficiary’s share of coverage for the cost of screening (usually 20%) when a diagnostic procedure such as biopsy or polypectomy is performed during the course of a screening endoscopy.
“Congress looks at screening the wrong way,” Doubeni said. “Now when you do a test, find a polyp, lesion, or positive result, the test is classified as a diagnostic with costs that can inhibit low-income patients without co-insurance from acting on it.”
These legal restrictions hinder the goal of eliminating (and may exacerbate) longstanding disparities in mortality from CRC for Medicare beneficiaries. For low-income individuals without supplemental coverage for the coinsurance, cost-sharing may be an insurmountable barrier. A disproportionately great percentage of low-income beneficiaries from Medicare lack Medigap or supplemental insurance, even among retirees.
A previous study showed that 63% of CRC deaths in 2010 could have been avoided if those patients had been screened. In addition, increasing screening from 58% in 2013 to 80% by 2018 in the U.S. is estimated to lower the incidence of CRC by 17% and lives lost to colon cancer by 19%.
Existing insurance policies rise needless health care costs, the authors note. In 2013, Medicare spent $2 billion on about 3.8 million colonoscopies, but in 2010 spent $7.3 billion on colon cancer treatment.
