Medicare loophole for screening colonoscopies is fixed — What does this mean for patients?

There’s no debate, 2020 was a difficult year. And we will certainly face our fair share of challenges in 2021. The global pandemic has shone a spotlight on health disparities that demand our attention to find and implement long-overdue solutions. While this country has a long way to go when it comes to health equity and ensuring access to care, we are making steps in the right direction.

The end-of-year package passed by Congress and signed by the president during the final days of 2020 contained a piece of legislation that takes one of those much-needed steps to improve equitable access to care — one we’ve been pushing for years. After nearly a decade of tireless advocacy from our organizations’ staff and volunteers, the Removing Barriers to Colorectal Cancer Screening Act, nicknamed the “Medicare Loophole” bill, finally made it across the finish line.

Colorectal cancer is estimated to kill more than 53,000 Americans this year alone. But with recommended screening, this disease is preventable. That’s one of the reasons the Affordable Care Act required that health insurance plans cover screening colonoscopies without cost sharing. But the law created a loophole when it came to Medicare coverage: if a polyp was found and removed, the procedure was no longer considered “screening” and the patient faced an unexpected charge which could amount to hundreds of dollars. The expense created a major barrier to this lifesaving screening for those who are most at risk for colorectal cancer. Since risk increases with age, we knew this loophole could be the difference between life and death.

To address the loophole, our organizations went to work right away. Volunteer advocates from Fight Colorectal Cancer (Fight CRC) and American Cancer Society Cancer Action Network (ACS CAN) shared their stories with members of Congress on the importance of cancer screening and the risk this loophole posed to seniors.

Our advocates are catalysts for real change. Take the 20-year-old daughter of a stage III colorectal cancer survivor, Libby, for example. Libby began advocating for this bill when she was in elementary school. She had formed a relationship with Sen. Sherrod Brown (D-Ohio), reaching out to his office every year to advocate for the bill. In 2019, she emailed Brown asking him to reintroduce the bill in the new Congress, she received a quick response confirming he would do it alongside several co-sponsors.

“Advocacy works!” said Libby and her family. Their story is one of many that show how advocates are essential when it comes to putting a face to a disease and getting legislators to see how their policies affect real people.

In the House, the fight is personal for Rep. Donald Payne, Jr. (D-N.J.). His father, Rep. Payne Sr., passed away from colorectal cancer while in office. Rep. Payne Jr. has been a sponsor and persistent champion of the bill and frequently reminds his colleagues that colorectal cancer is why he’s serving in Congress. An advocate’s personal story changes things and we hope this inspires others to keep sharing.

The first year the bill was introduced, it garnered 48 co-sponsors in the House. As of December 2020, the bill had 344 co-sponsors. That’s the power of relentless advocacy. Our volunteers never gave up and continued to carry this message to Capitol Hill until the job was done.

We are proud of the advocates who’ve stayed persistent to push this over the finish line. Because of their work, this bill will not only reduce suffering and death from cancer, but it will help reduce cancer disparities. Colorectal cancer is a largely preventable disease with screening, but it remains the No. 2 cancer-killer among men and women in the United States, and it disproportionately affects people of color. For colon cancer, the average age at the time of diagnosis for men is 68 and for women is 72. Eliminating cost sharing for colonoscopy screenings in Medicare means more Americans will have access to this lifesaving procedure.

Our organizations are grateful to everyone who advocated for this bill and for our senators and representatives who co-sponsored it each year and finally were able to get it passed. This March, Colorectal Cancer Awareness Month, we urge everyone to talk to their doctor about when and how they need to be screened.

Anjee Davis, MPPH, is president of Fight Colorectal Cancer and Lisa Lacasse is president of the American Cancer Society Cancer Action Network (ACS CAN).