[Congressional Record Volume 147, Number 64 (Thursday, May 10, 2001)]
[Senate]
[Pages S4842-S4845]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mrs. FEINSTEIN:
  S. 868. 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 and group health plans provide 
coverage of cancer screening; to the Committee on Health, Education, 
Labor, and Pensions.
  Mrs. FEINSTEIN. Mr. President, today I am introducing a bill to 
require health insurance plans to cover screening tests for cancer. 
Congresswomen Carolyn Maloney and Sue Kelly are introducing a companion 
bill in the House today.
  The bill requires plans to cover screening tests including 
mammography and clinical breast examinations for breast cancer, ``pap'' 
tests and pelvic examinations for gynecological cancers, colorectal 
screening for colon and rectum cancers, and prostate screening for 
prostate cancer.
  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 provision is included because we do not yet have screening 
tests for many cancers, including brain tumors, leukemia Hodgkin's 
disease, and ovarian, liver and pancreatic cancers. These are often not 
detected until they produce symptoms, at which point the cancer may 
have advanced significantly.
  The American Cancer Society has described ``screening'' as ``the 
search for disease in persons who do not have disease or who do not 
recognize that they have symptoms of disease,'' Screening, as defined 
by the American medical Association, is ``health care services or 
products provided to an individual without apparent signs or symptoms 
of an illness, injury, or disease for the purpose of identifying or 
excluding an undiagnosed illness, disease or condition.'' One of the 
most common screening procedures is the mammogram, which millions of 
women get annually to determine if there are suspicious lesions or 
lumps in their breasts.
  A major way to reduce the number of cancer-related deaths and to 
increase survival is to increase cancer screening rates. The American 
Cancer Society, (ACS), predicts that 563,100 Americans will die of 
cancer this year. With appropriate screening, one-third of cancer 
deaths could be prevented, says ACS.
  Screening is the greatest single tool for finding cancers early. 
Cancers found early are cancers that do not grow or metastasize and are 
cancers that can be treated more successfully than those that are found 
late. Early detection can extend life, reduce treatment, and improve 
the quality of life. 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 change of survival.
  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. If all Americans had 
regular cancer screenings, the five-year survival rate for cancers of 
the breast, tongue, mouth, colon, rectum, cervix, prostate, testis and 
skin could grow from 81 percent to 95 percent.
  Screening costs less than treatment. For example, Medicare pays from 
$100 to $400 for a colorectal cancer screening test. The cost of 
treating colorectal cancer from diagnosis to death costs over $51,000, 
according to the Institute of Medicine.
  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 
says that over 1.3 million new cancer cases will be diagnosed in the 
U.S. this year.
  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. That more than 1,500 Americans will die each day from 
cancer. 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.

  One of the tragedies of cancer is that we have tools available which 
can prevent much unnecessary suffering and death. But cancer must be 
prevented and it must be found early.
  Deaths from colorectal cancer could be cut in half if most people 
over 50 had refuting screenings, for a disease that claims 56,700 a 
year.
  Experts cite several barriers that prevent many Americans from 
getting cancer screenings. These include a lack of insurance coverage, 
inadequate insurance coverage, inability to pay for screenings, a fear 
of discomfort, and the fact that most of American health care is 
complaint drive, not preventive.
  Insurance coverage is a major factor in whether people have 
preventive screenings. In other words, 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. In 
Medicare, for example, a study reported in Public Health Reports in 
October 1997, found that Medicare coverage increased the use 
of mammograms.

  According to an 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.
  The bill we are introducing, by requiring plans to cover screenings, 
can reduce death, reduce suffering and reduce costs.
  I urge my colleagues to support this bill.
  A summary of the bill follows:

       Summary of the Comprehensive Cancer Screening Act of 2001

       Requires private health insurance plans to cover cancer 
     screenings consistent with professionally-developed and 
     recognized medical guidelines, specifically: mammograms and 
     clinical breast examinations (for breast cancer); ``pap'' 
     tests and pelvic examinations (for gynecological cancers); 
     colorectal screening (for colon and rectum cancers); prostate 
     cancer screening (for prostate cancers).
       Authorizes the U.S. Secretary of Health an Human Services 
     by regulation to modify or update the coverage requirements 
     to reflect advances in medical practice or new scientific 
     knowledge, for all cancers as screenings are developed, based 
     on the Secretary's own initiative or upon the petition of an 
     individual or organization.

[[Page S4845]]

       Prohibits health insurance plans from: denying eligibility 
     for the purpose of avoiding the requirements of the bill; 
     providing monetary payments to encourage individuals to 
     accept less than the minimum protections available; 
     penalizing or reducing reimbursement because a provider 
     provides care consistent with these requirements; providing 
     incentives to a provider to encourage the provider to provide 
     care inconsistent with the requirements.
       Requires plans to provide subscribers full information on 
     the extent of coverage, including covered benefits, cost-
     sharing requirements, and the extent of choice of providers.
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