Navigating the murky waters of colorectal cancer screening and health reform

Abstract

The Affordable Care Act (ACA) mandates that both Medicaid and insurance plans cover life-saving preventive services recommended by the US Preventive Services Task Force, including colorectal cancer (CRC) screening and choice between colonoscopy, flexible sigmoidoscopy, and fecal occult blood testing (FOBT). People who choose FOBT or sigmoidoscopy as their initial test could face high, unexpected, out-of-pocket costs because the mandate does not cover needed follow-up colonoscopies after positive tests. Some people will have no coverage for any CRC screening because of lack of state participation in the ACA or because they do not qualify (e.g., immigrant workers). Existing disparities in CRC screening and mortality will worsen if policies are not corrected to fully cover both initial and follow-up testing.

FIGURE 1—

Percentage of respondents aged 50–75 years, by test type and selected characteristics, who reported (a) being up-to-date with colorectal cancer screening, (b) having a colonoscopy within 10 years, and (c) having FOBT within 1 year: Behavioral Risk Factor Surveillance System, United States, 2012. Note. FOBT = fecal occult blood testing; GED = graduate equivalency diploma. Data were weighted to the age, gender, and racial/ethnic distribution of each state’s adult population with intercensal estimates and were age standardized to the 2012 Behavioral Risk Factor Surveillance System population. Up-to-date was defined as FOBT within 1 year, or sigmoidoscopy within 5 years with FOBT within 3 years, or colonoscopy within 10 years. Source. Centers for Disease Control and Prevention.