[Congressional Record Volume 140, Number 146 (Saturday, October 8, 1994)]
[Extensions of Remarks]
[Page E]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: October 8, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
     COLORECTAL CANCER SCREENING PROVISIONS OF HEALTH CARE REFORM 
                              LEGISLATION

                                 ______


                         HON. ALCEE L. HASTINGS

                               of florida

                    in the house of representatives

                        Friday, October 7, 1994

  Mr. HASTINGS. Mr. Speaker, I rise today to express my support for the 
development of a screening program for colorectal cancer (CRC), and to 
make clear my interest in continuing to work on this important issue. 
Although the 103d Congress will adjourn without enacting comprehensive 
health care reform legislation, I am hopeful that the progress we have 
made over the past 2 years toward the establishment of a national CRC 
screening program will provide the starting point for action next year. 
I would like to discuss today a number of issues that need to be 
addressed in developing such a program.
  CRC accounts for about 15 percent of all cancers diagnosed in the 
United States, and about 12 percent of all cancer deaths. More than 
150,000 Americans will develop CRC this year, and more than 57,000 
Americans will die of the disease. Because CRC mostly strikes 
individuals over the age of 50, the impact is particularly significant 
in States with a high percentage of senior citizens, such as Florida. 
According to the American Cancer Society, about 10,200 new cases of CRC 
will be diagnosed in Florida this year, and more than 3,800 Florida 
residents will die from the disease.
  The data also show, however, that many of the deaths could have been 
avoided through early detection. According to the American Cancer 
Society, the 5-year survival rates are 92 percent for colon cancer and 
85 percent for rectal cancer, when the cancer is detected at an early, 
localized stage. However, after the cancer has spread regionally, to 
involve adjacent organs or lymph nodes, the survival rates drop to 61 
percent and 51 percent, respectively. For those persons with distant 
metastasizes, 5-year survival rates are less than 7 percent.
  A number of the health care reform bills that we considered this year 
included provisions that would have added CRC screening as a covered 
benefit under the Medicare program, and required that CRC screening be 
included in the ``basic benefit'' package for all Americans. The goal 
of these provisions was to assure that the health care coverage for all 
Americans over the age of 50 would include periodic screening for CRC. 
Some of the bills also included a more comprehensive screening program 
for individuals at high risk for CRC.
  While I strongly support the intent of these provisions, I have been 
concerned that the language of some of the bills is overly narrow and 
restrictive in the types of CRC screening that would be covered under 
the program. Specifically, some of the bills would have allowed 
reimbursement only for a flexible sigmoidoscope procedure for 
individuals in the general population, and a colonoscopy for those at 
high-risk for CRC. In doing so, these bills would have excluded 
coverage for CRC screening through such established, cost-effective 
procedures as the barium enema, as well as through other new screening 
technologies that may be developed in the future.
  I was working on an amendment to the CRC screening provisions of 
pending health care reform legislation at the time the House stopped 
its consideration of these bills. The amendment would have removed the 
procedure-specific bias in the pending bills by providing coverage for 
the range of screening procedures recommended by the major medical 
groups. This proposal would have brought the legislative language more 
in line with the CRC screening recommendations of such respected groups 
as the American College of Physicians, the American College of 
Radiology, and the Blue Cross-Blue Shield Association of America.
  In order to control the cost of the CRC screening program, my 
amendment also would have established a single payment level for 
screening individuals who are not at high risk for CRC. This is 
analogous to the Medicare screening program through mammography, under 
which each eligible individual receives a fixed amount that can be 
applied to an authorized procedure. I believe that the physician and 
patient should determine the specific CRC screening procedure to be 
used for each individual patient--not the Federal Government.
  Mr. Speaker, I look forward to working with my colleagues on 
legislation that will provide the basis for a comprehensive and 
effective CRC screening program for all Americans. Prevention, and 
early detection, are the best and most cost-effective means to cut the 
mortality rate from this deadly disease. I regret that this Congress 
will not be able to accomplish this important objective, but it should 
be high on the agenda next year.

                          ____________________