Paying for the Displeasure of a Colonoscopy

Many states don't guarantee insurance coverage for colon cancer screening. How is that a good idea?

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Corrected on 3/18/08: An earlier version of this story suggested that a recent study by the American Cancer Society involved only men. The study involved men and women.

Colonoscopies are the butt of many a bad joke—and pun. No wonder: Just reading about what getting one entails is enough to make me squirm. So no matter how many medical experts and celebrity spokespeople try to reassure me that the colon cancer screening test is not so bad, I think they're lying. And you better believe that I would snatch at any excuse, even a crappy one—there I go again—to avoid this invasive test.

Given my aversion, which many others share, states would be smart to make getting the test as easy and affordable as possible. So it's disappointing that not even half of states require insurance companies to cover colon cancer screenings, according to a new analysis. The 2008 Colorectal Cancer Legislation Report Card released this week gives D's and F's to 26 states that either have no colon cancer screening law on the books or laws that recommend but don't require screening coverage. The upside is that screening laws are on the rise. The first was signed in 2000 in Virginia, with the help of then state Sen. Emily Couric—sister of Katie, whose husband died of colon cancer in 1998. Five states added laws in 2007, bringing the total to 24 (the District of Columbia also requires coverage). The report card is sponsored by a coalition of public-health groups, including the American Cancer Society and the American College of Gastroenterology.

Screening laws appear to be working. Between 2004 and 2005, the death rate for colorectal cancer declined 3 percent, one of the largest decreases of all leading cancers, according to the American Cancer Society. "I think we're starting to see the benefit of appropriate screening," says David Johnson, immediate past president of the American College of Gastroenterology.

Once seniors qualify for Medicare, colon cancer screening is a covered benefit. The laws are particularly important, therefore, for people between 50 and 64, when they still have private insurance. Screening laws that received A or B grades generally cover all health plan members age 50 and older and younger ones who are at high risk. The coverage includes a colonoscopy screening every 10 years and fecal occult blood tests every year, among other things. (It may not necessarily include the increasingly popular virtual colonoscopy, however.)

Unfortunately, screening laws do nothing to help the uninsured get the tests they need. It's easy to put off screening tests in the best of times, and at an estimated $800 to $1,600 per, it's exactly the kind of medical visit someone without insurance is going to sidestep, and hope for the best. A recent American Cancer Society study found that while nearly half of people with private insurance got recommended colon cancer screening, fewer than 20 percent of those without insurance did. It's not all that surprising, then, to learn that uninsured patients are more likely to be diagnosed with late-stage cancer than those with private insurance, as I reported recently in this story.

I see that my own state, New York, gets a grade of F for colon cancer screening, meaning it has no law requiring insurance providers to cover it. Maybe by the time I hit 50 that will change. I hope so. With this particular medical chore, I'll need all the help I can get to do the right thing.