[Congressional Record Volume 145, Number 126 (Friday, September 24, 1999)]
[Senate]
[Pages S11440-S11441]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mrs. FEINSTEIN:
  S. 1641. A bill to amend the Employee Retirement Income Security Act 
of 1974, Public Health Service Act, and the Internal Revenue Code, of 
1986 to require that group and individual health insurance coverage and 
group health plans provide coverage of cancer screening; to the 
Committee on Health, Education, Labor and Pensions.


                 cancer screening coverage act of 1999

 Mrs. FEINSTEIN. Mr. President, today I am introducing a bill 
to require health insurance plans to cover screening tests for cancer. 
The bill requires plans to cover screening tests that are currently 
available and for which there is broad consensus on their value. To 
address future changes in scientific knowledge and medical practice, 
the bill allows the Secretary to change the requirements upon the 
Secretary's initiative or upon petition by a private individual or 
group. This bill is a companion to H.R. 1285, introduced by 
Representatives Carolyn B. Maloney and Sue Kelly.

  A major way to reduce the number of cancer-related deaths and 
increase survival is to increase screening rates. The American Cancer 
Society predicts that the annual cancer death rate this year--563,100 
Americans--will equal five Boeing 747 jumbo jets crashing every day for 
a year. Because early detection can save lives, requiring plans to 
cover detection tests can decrease the number of people who die each 
year from cancer.
  To put cancer deaths in perspective, the number of Americans that die 
each year from cancer exceeds the total number of Americans lost to all 
wars that we have fought in this century. The American Cancer Society 
estimates that over 1 million new cancer cases will be diagnosed in the 
United States this year, including 132,500 in California.
  Despite our increasing understanding of cancer, unless we act with 
urgency, the cost to the United States is likely to become unmanageable 
in the next 10-20 years. The incidence rate of cancer in 2010 is 
estimated to increase by 29 percent for new cases, and cancer deaths 
are estimated to increase by 25 percent. Cancer will surpass heart 
disease as the leading fatal disease in the U.S. by 2010. With our 
aging U.S. population, unless we act now to change current cancer 
incidence and death rates, according to the September 1998 report from 
the Cancer March Research Task Force, we can expect over 2.0 million 
new cancer cases and 1.0 million deaths per year by 2025. Listen to 
these startling statistics:
  One out of every four deaths in the U.S. is caused by cancer.
  This year approximately 563,100 Americans are expected to die of 
cancer--more than 1,500 people a day.
  There have been approximately five million cancer deaths since 1990.
  Approximately 12 million new cancer cases have been diagnosed since 
1990.
  The National Cancer Institute estimates that approximately 8.2 
million Americans alive today have a history of cancer.
  One out of every two men, one out of every three women will be 
diagnosed with cancer at some point in their lifetime.
  Too many Americans die each year from cancer. The tragedy is that we 
have tools available which can prevent much unnecessary suffering and 
death. Early detection--finding cancer early before it has spread--
gives a person the best chance of being treated successfully. Early 
screening for breast, cervical, prostate, and colorectal cancer can 
increase survival rates. Having insurance coverage for cancer 
screenings is a major way of encouraging people to get examinations and 
tests.
  Screening examinations, if given on an appropriate schedule by a 
health care professional, have proven their value. Screening-accessible 
cancers, such as cancers of the breast, tongue, mouth, colon, rectum, 
cervix, prostate, testis, and skin, account for approximately half of 
all new cancer cases. The five-year relative survival rate for these 
cancers is about 81 percent. According to the American Cancer Society, 
if all Americans participated in regular cancer screening, this rate 
could increase to more than 95 percent. For example, people can have 
colon cancer long before they know it. They may not have any symptoms. 
Patients diagnosed by a colon cancer screening have a 90 percent chance 
of survival while patients not diagnosed until symptoms are apparent 
only have a 8 percent chance of survival.
  Finding cancers in their early stages can mean that treatment is less 
expensive. Treatment of breast, lung, and prostate cancers account for 
over half of annual medical costs, which by National Institutes of 
Health estimates is $37 billion annually.
  A colon cancer screening costs approximately $125-$300.00. If a 
patient is not diagnosed with colon cancer until symptoms are apparent, 
care during the remaining 4-5 years of life can cost up to $100,000. 
Similarly, the initial average cost of treating rectal cancer that is 
detected early is about $5,700. This is approximately 75 percent less 
than the estimated $30,000-$40,000 it costs to treat rectal cancer that 
is further along in its development.
  The cost of lost productivity due to cancer is $11 billion annually, 
while the cost of lost productivity due to premature death is $59 
billion annually. We can't afford not to screen.
  Insurance coverage is a major determinant in whether people obtain 
preventive screenings. In short, when screenings are covered by plans, 
people are more likely to get them. In California, screening rates for 
cervical and breast cancer are lower for uninsured women, who are less 
likely to have had a recent screening and more likely to have gone 
longer without being screened than women with coverage.
  According to a University of California-Los Angeles Center for Health 
Policy Research study from February 1998, in California women ages 18-
64, 63 percent of uninsured women had not had a Pap test during 1997 
versus 40 percent of insured women. Additionally, approximately 67 
percent of uninsured Californian women ages 30-64 had not had a 
clinical breast examination during 1997, compared to 40 percent for 
insured women in the same age group.
  In 1997, Congress added cancer screening coverage under Medicare for 
certain cancers, such as breast and cervical. Medicare beneficiaries 
now receive cancer screenings without having to pay out-of-pocket for 
such tests. Americans under the age of 65 who are privately insured 
deserve the same health care. Under Medicaid, preventive services are 
optional benefit. States can choose to cover them or not so coverage 
varies state to state.
  All Americans deserve access to cancer screening, regardless of 
whether one has health insurance because they are an employee of the 
Department of Defense, a Medicare beneficiary, or a veteran. Certainly 
individuals who have private health insurance through their employers--
56 percent of Californians have private health insurance--should be 
guaranteed access to life-saving and life-prolonging cancer screenings. 
Offering coverage for cancer screening simply makes good sense.
  The bill requires plans to cover screenings according to current 
guidelines:
  Annual mammograms for women ages 40 and over and for women under 40 
who are at high risk of developing breast cancer.
  Annual clinical breast exams for women ages 40 and over and for women 
between the ages of 20 and 40 who are at high risk of developing breast 
cancer.
  Clinical breast exams every three years for women who are between the 
ages of 20 and 40 and are not at high risk for developing breast 
cancer.
  Annual pap tests and pelvic examinations for women ages 18 and over 
or women who are under the age of 18 and are or have been sexually 
active.
  Screening procedures for men and women ages 50 and over or under age 
50 and at high risk for developing colorectal cancer, including annual 
screening fecal-occult blood test and screening flexible sigmoidoscopy 
every 4 years.
  Men and women at high risk for colorectal cancer (in any age group) 
may receive a screening colonoscopy every 2 years.
  Annual digital rectal examination and/or annual prostate-specific 
blood test for men ages 50 and over or males who are at high risk.
  The bill authorizes the Secretary of Health and Human Services to 
modify coverage requirements to reflect changes in medical practice or 
new scientific knowledge, based both on the

[[Page S11441]]

Secretary's own initiative or upon petition of an individual or 
organization.
  Cancer touches virtually every American in some way. The 
Comprehensive Cancer Screening Act can be one way to alleviate the fear 
and reality of cancer felt by millions of Americans. We all want to 
believe that when a family member is diagnosed with cancer, he or she 
will get care of the highest quality and that their medical team will 
conquer this disease. Early detection, while it does not prevent cancer 
from occurring, can stop cancer before it spreads, extend life, reduce 
treatment costs, and improve the quality of life for cancer patients. 
By requiring private health plans to cover cancer screening as a 
preventive measure, my bill is cost effective and could ease the cancer 
burden felt by America due to lost productivity related to cancer 
deaths and illness.
  It is long past due for this Congress to send a strong message to 
insurance companies. Cancer screening is an important prevention 
measure and should be covered under all insurance plans. America cannot 
afford not to screen.

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