[Congressional Record Volume 150, Number 43 (Wednesday, March 31, 2004)]
[Senate]
[Pages S3459-S3460]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. ROBERTS (for himself and Mr. Kennedy):
  S. 2265. A bill to require group and individual health plans to 
provide coverage for colorectal cancer screenings; to the Committee on 
Health, Education, Labor, and Pensions.
  Mr. ROBERTS. Mr. President, I ask unanimous consent that the 
following bill, the Eliminate Colorectal Cancer Act, be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 2265

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE; FINDINGS.

       (a) Short Title.--This Act may be cited as the ``Eliminate 
     Colorectal Cancer Act of 2004''.
       (b) Findings.--The Congress finds the following:
       (1) Colorectal cancer is the second leading cause of cancer 
     deaths in the United States for men and women combined.
       (2) It is estimated that in 2004, 146,940 new cases of 
     colorectal cancer will be diagnosed in men and women in the 
     United States.
       (3) Colorectal cancer is expected to kill 56,730 
     individuals in the United States in 2004.
       (4) When colorectal cancer is diagnosed early, at a 
     localized stage, more than 90 percent of patients survive for 
     5 years or more. Once the disease has metastasized, 92 
     percent of patients die within 5 years. Yet, only 37 percent 
     of colorectal cancer cases are diagnosed while the disease is 
     still in the localized stage.
       (5) If all men and women age 50 and over practiced regular 
     colorectal cancer screening, without any new scientific 
     discoveries, the United States could see up to a 50 to 90 
     percent reduction in deaths from this disease.
       (6) Currently, many private insurance health plans are not 
     providing coverage for the full range of colorectal cancer 
     screening tests. Lack of insurance coverage can act as a 
     barrier to care.
       (7) Assuring coverage for the full range of colorectal 
     cancer tests is an important step in increasing screening 
     rates for these life saving tests.

     SEC. 2. COVERAGE FOR COLORECTAL CANCER SCREENING.

       (a) Group Health Plans.--
       (1) Public health service act amendments.--The Public 
     Health Service Act (42 U.S.C. 201 et seq.) is amended by 
     adding at the end the following:

              ``TITLE XXIX--MISCELLANEOUS HEALTH COVERAGE

     ``SEC. 2901. COVERAGE FOR COLORECTAL CANCER SCREENING.

       ``(a) Coverage for Colorectal Cancer Screening.--
       ``(1) In general.--A group health plan, and a health 
     insurance issuer offering group health insurance coverage, 
     shall provide coverage for colorectal cancer screening 
     consistent with this subsection to--
       ``(A) any participant or beneficiary age 50 or over; and
       ``(B) any participant or beneficiary under the age of 50 
     who is at a high risk for colorectal cancer.
       ``(2) Definition of high risk.--For purposes of subsection 
     (a)(1)(B), the term `high risk for colorectal cancer' has the 
     meaning given such term in section 1861(pp)(2) of the Social 
     Security Act (42 U.S.C. 1395x(pp)(2)).
       ``(3) Requirement for screening.--The group health plan or 
     health insurance issuer shall cover methods of colorectal 
     cancer screening that--
       ``(A) are deemed appropriate by a physician (as defined in 
     section 1861(r) of the Social Security Act (42 U.S.C. 
     1395x(r))) treating the participant or beneficiary, in 
     consultation with the participant or beneficiary;
       ``(B) are--
       ``(i) described in section 1861(pp)(1) of the Social 
     Security Act (42 U.S.C. 1395x(pp)(1)) or section 410.37 of 
     title 42, Code of Federal Regulations; or
       ``(ii) specified by the Secretary, based upon the 
     recommendations of appropriate organizations with special 
     expertise in the field of colorectal cancer; and
       ``(C) are performed at a frequency not greater than that--
       ``(i) described for such method in section 1834(d) of the 
     Social Security Act (42 U.S.C. 1395m(d)) or section 410.37 of 
     title 42, Code of Federal Regulations; or
       ``(ii) specified by the Secretary for such method, if the 
     Secretary finds, based upon new scientific knowledge and 
     consistent with the recommendations of appropriate 
     organizations with special expertise in the field of 
     colorectal cancer, that a different frequency would not 
     adversely affect the effectiveness of such screening.
       ``(b) Notice.--A group health plan under this section shall 
     comply with the notice requirement under section 714(b) of 
     the Employee Retirement Income Security Act of 1974 with 
     respect to the requirements of this section as if such 
     section applied to such plan.
       ``(c) Non-Preemption of More Protective State Law With 
     Respect to Health Insurance Issuers.--This section shall not 
     be construed to supersede any provision of State law which 
     establishes, implements, or continues in effect any standard 
     or requirement solely relating to health insurance issuers in 
     connection with group health insurance coverage that provides 
     greater protections to participants and beneficiaries than 
     the protections provided under this section.

[[Page S3460]]

       ``(d) Definitions and Enforcement.--The definitions and 
     enforcement provisions of title XXVII shall apply for 
     purposes of this section.''.
       (2) ERISA amendments.--
       (A) In general.--Subpart B of part 7 of subtitle B of title 
     I of the Employee Retirement Income Security Act of 1974 (29 
     U.S.C. 1185 et seq.) is amended by adding at the end the 
     following new section:

     ``SEC. 714. COVERAGE FOR COLORECTAL CANCER SCREENING.

       ``(a) Coverage for Colorectal Cancer Screening.--
       ``(1) In general.--A group health plan, and a health 
     insurance issuer offering group health insurance coverage, 
     shall provide coverage for colorectal cancer screening 
     consistent with this subsection to--
       ``(A) any participant or beneficiary age 50 or over; and
       ``(B) any participant or beneficiary under the age of 50 
     who is at a high risk for colorectal cancer.
       ``(2) Definition of high risk.--For purposes of subsection 
     (a)(1)(B), the term `high risk for colorectal cancer' has the 
     meaning given such term in section 1861(pp)(2) of the Social 
     Security Act (42 U.S.C. 1395x(pp)(2)).
       ``(3) Requirement for screening.--The group health plan or 
     health insurance issuer shall cover methods of colorectal 
     cancer screening that--
       ``(A) are deemed appropriate by a physician (as defined in 
     section 1861(r) of the Social Security Act (42 U.S.C. 
     1395x(r))) treating the participant or beneficiary, in 
     consultation with the participant or beneficiary;
       ``(B) are--
       ``(i) described in section 1861(pp)(1) of the Social 
     Security Act (42 U.S.C. 1395x(pp)(1)) or section 410.37 of 
     title 42, Code of Federal Regulations; or
       ``(ii) specified by the Secretary, based upon the 
     recommendations of appropriate organizations with special 
     expertise in the field of colorectal cancer; and
       ``(C) are performed at a frequency not greater than that--
       ``(i) described for such method in section 1834(d) of the 
     Social Security Act (42 U.S.C. 1395m(d)) or section 410.37 of 
     title 42, Code of Federal Regulations; or
       ``(ii) specified by the Secretary for such method, if the 
     Secretary finds, based upon new scientific knowledge and 
     consistent with the recommendations of appropriate 
     organizations with special expertise in the field of 
     colorectal cancer, that a different frequency would not 
     adversely affect the effectiveness of such screening.
       ``(b) Notice Under Group Health Plan.--The imposition of 
     the requirements of this section shall be treated as a 
     material modification in the terms of the plan described in 
     section 102(a), for purposes of assuring notice of such 
     requirements under the plan; except that the summary 
     description required to be provided under the third to last 
     sentence of section 104(b)(1) with respect to such 
     modification shall be provided by not later than 60 days 
     after the first day of the first plan year in which such 
     requirements apply.''.
       (B) Technical and conforming amendments.--
       (i) Section 731(c) of the Employee Retirement Income 
     Security Act of 1974 (29 U.S.C. 1191(c)) is amended by 
     striking ``section 711'' and inserting ``sections 711 and 
     714''.
       (ii) Section 732(a) of the Employee Retirement Income 
     Security Act of 1974 (29 U.S.C. 1191a(a)) is amended by 
     striking ``section 711'' and inserting ``sections 711 and 
     714''.
       (iii) The table of contents in section 1 of the Employee 
     Retirement Income Security Act of 1974 is amended by 
     inserting after the item relating to section 713 the 
     following new item:

``Sec. 714. Coverage for colorectal cancer screening.''.

       (b) Individual Health Insurance.--
       (1) In general.--Part B of title XXVII of the Public Health 
     Service Act (42 U.S.C. 300gg-41 et seq.) is amended by 
     inserting after section 2752 the following new section:

     ``SEC. 2753. COVERAGE FOR COLORECTAL CANCER SCREENING.

       ``(a) In General.--The provisions of section 2901(a) shall 
     apply to health insurance coverage offered by a health 
     insurance issuer in the individual market in the same manner 
     as it applies to health insurance coverage offered by a 
     health insurance issuer in connection with a group health 
     plan in the small or large group market.
       ``(b) Notice.--A health insurance issuer under this part 
     shall comply with the notice requirement under section 714(b) 
     of the Employee Retirement Income Security Act of 1974 with 
     respect to the requirements referred to in subsection (a) as 
     if such section applied to such issuer and such issuer were a 
     group health plan.''.
       (2) Technical amendment.--Section 2762(b)(2) of the Public 
     Health Service Act (42 U.S.C. 300gg-62(b)(2)) is amended by 
     striking ``section 2751'' and inserting ``sections 2751 and 
     2753''.
       (c) Effective Dates.--
       (1) Group health plans.--The amendments made by subsection 
     (a) shall apply with respect to group health plans for plan 
     years beginning on or after January 1, 2005.
       (2) Individual health insurance.--The amendments made by 
     subsection (b) shall apply with respect to health insurance 
     coverage offered, sold, issued, renewed, in effect, or 
     operated in the individual market on or after January 1, 
     2005.
       (d) Coordinated Regulations.--The Secretary of Labor and 
     the Secretary of Health and Human Services shall ensure, 
     through the execution of an interagency memorandum of 
     understanding among such Secretaries, that--
       (1) regulations, rulings, and interpretations issued by 
     such Secretaries relating to the same matter over which both 
     Secretaries have responsibility under the provisions of this 
     section (and the amendments made thereby) are administered so 
     as to have the same effect at all times; and
       (2) coordination of policies relating to enforcing the same 
     requirements through such Secretaries in order to have a 
     coordinated enforcement strategy that avoids duplication of 
     enforcement efforts and assigns priorities in enforcement.

  Mr. KENNEDY. Mr. President, it is a privilege to join my colleagues 
in introducing the Eliminate Colorectal Cancer Act of 2004. I 
especially commend Senator Roberts for his leadership, assistance, and 
support on this important legislation. This bipartisan bill is being 
introduced on the final day of National Colorectal Cancer Awareness 
Month, as a sign of our intention to do all we can to see that more 
effective action is taken as soon as possible to combat this deadly 
disease. Our goal in this is to give every American with health 
insurance the right to access a full range of screening tests for 
colorectal cancer.
  The statistics are staggering. Colorectal cancer is the second 
leading cause of cancer deaths among men and women in America. Last 
year, 148,000 people were diagnosed with colorectal cancer, and 56,000 
mothers, fathers, daughters, and sons died from the disease. Tragically 
these deaths are taking place despite the fact that this form of cancer 
is curable 90 percent of the time if detected early.
  We know that screening can discover this cancer early, in fact, so 
early that growths can be identified and removed before they become 
cancerous. For no other disease are the guidelines for screening better 
defined and nationally recognized as the best way to prevent deaths 
from this cancer.
  Screening for colorectal cancer will save lives, and it will also 
avoid thousands of dollars in later treatment costs for each patient. 
The Institute of Medicine estimated that such screenings cost less than 
1 percent of later treatment for this cancer. Screening for colorectal 
cancer is obviously the right thing to do, and it is also the cost-
effective thing to do.
  The real tragedy is that fewer than half of those who fit the 
guidelines for screening are actually screened within the right 
timeframes, if at all. As a result, only 37 percent of colorectal 
cancers are diagnosed at the early, most curable stages.
  Many citizens are aware, at least vaguely, that they should probably 
be screened, but they can't afford it, because it is not covered by 
their health insurance. In our view, no American should be denied 
access to these lifesaving screening procedures simply because their 
health insurance company will not pay for it.
  Every American with insurance should have access to screening 
procedures that will prevent cancer. By requiring insurers to cover 
colorectal cancer screening, we will save thousands of lives each year, 
and save money too.
  Some argue that it is wrong to require insurers to cover a test for a 
specific disease. Yet the evidence is clear that screening makes 
colorectal cancer preventable, treatable, and beatable.
  National Colorectal Cancer Awareness Month has brought new attention 
to the fact we can eliminate a disease that causes immeasurable 
suffering and sadness in the lives of millions of Americans. With this 
legislation, we can save hundreds of thousands of lives over the next 5 
years.
  The need is clear and so is the solution. As National Colorectal 
Cancer Awareness Month comes to a close, let us do the right thing and 
work together to approve the Eliminate Colorectal Cancer Act of 2004.
                                 ______