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Colonoscopies on states' agendas

Fifteen states are considering mandates that insurers cover all forms of colon cancer screenings.

By ASSOCIATED PRESS
Published March 27, 2007

WASHINGTON - Sam Monismith was prepped and ready to begin his colonoscopy when health workers brought the university professor awkward news: His insurance wasn't going to cover the colon cancer check. They wanted a signed promise to pay, or the test was off.

Monismith hesitated only briefly - and the test uncovered nine polyps, precancerous growths in his colon. Because doctors removed them on the spot, the bill switched from a cancer screening that insurance wouldn't pay into a surgical procedure it did.

"The irony of it is if I hadn't had any polyps, I would have had to pay," said Monismith, 54, of Harrisburg, Pa. "I'm just glad I got the test."

Insurers say that Monismith is a rarity and that most insurance does cover colon cancer screening once people hit 50, when the risk starts to rise. Still, cancer advocacy groups have begun a push to ensure that the last holdouts cover all four government-recommended options - from the $20 annual stool sample to once-a-decade colonoscopies that can exceed $1,000.

By the American Cancer Society's count, 15 states are considering legislative mandates; 19 other states have long had such laws.

The legislative tussle actually highlights tougher issues: Insurance aside, people are reluctant to get checked for the nation's No. 2 cancer killer. Nearly 42-million Americans over 50 aren't getting screened.

And studies suggest that people prefer the pricey colonoscopy, but is it really the better test?

Dr. Arden Morris, a colon cancer surgeon at the University of Michigan, says people are less willing to do fecal testing - many "think it's really gross" - or other options that don't give as full a view of the colon.

"On the other hand, if everybody who's eligible gets a colonoscopy, we're going to break the bank," Morris said. "Then who gets screening when we don't have money left?"

Some 153,760 Americans will be diagnosed with colorectal cancer this year, and more than 52,000 will die. The government says up to 60 percent of those deaths could be prevented if everyone over age 50 underwent routine screening.

The government backs four screening options. Most used are annual at-home fecal tests to detect hidden blood in the stool and once-a-decade colonoscopies, where doctors use a long, flexible tube to visually inspect the colon. (The others are sigmoidoscopy, an exam of the lower colon only, and a less-used barium enema, repeated every five years.)

The good news: Deaths are declining faster for colorectal cancer than for any other cancer, a 5.7 percent drop between 2003 and 2004 that scientists credit to small upticks in screening. A study published in December found an almost sevenfold increase in routine colonoscopies once Medicare started covering them in 2001.

America's Health Insurance Plans, an industry group that opposes the mandates, argues that almost every insurer already covers some colon screening. A 2004 congressional inquiry, the latest available data, surveyed a few dozen insurers in states without mandates. Just 16 percent of small-employer plans and 31 percent of large-employer plans did not cover all four options. Least likely to be covered were colonoscopies and barium enemas.

[Last modified March 27, 2007, 01:28:04]