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Letter to Barack Obama, President of the United State,- Correct Unfair Medicare Policy for Polyp Removal During Life-Saving Cancer Screenings


Location: Washington, DC

Congressman Donald M. Payne, Jr. (NJ-10), Senator Sherrod Brown (D-OH), and Congressmen Joe Courtney (CT-02), Henry Waxman (CA-33), Sander Levin (MI-09), Frank Pallone (NJ-06), and Jim McDermott (WA-07) led a letter to President Barack Obama requesting a change in Medicare coverage of polyp removal during a colonoscopy screening. Under the current healthcare law, a private insurer cannot impose cost-sharing with respect to a polyp removal during a colonoscopy performed as a screening procedure. However, Medicare beneficiaries are responsible for paying a coinsurance fee when a colorectal cancer screening colonoscopy also involves the removal of precancerous polyps during the preventive screening. As a preventive measure of colorectal cancer, Members expressed that "[they] believe that this Medicare policy is counterproductive, inconsistent, and unfair to Medicare beneficiaries who have no way of knowing whether or not this preventive measure will result in a coinsurance payment." As such, they have requested that the Administration remedy this inconsistency.

Please see the entire letter below.

May 30, 2014

President Barack Obama
The White House
1600 Pennsylvania Avenue, NW
Washington, DC 20500

Dear Mr. President:

Colorectal cancer is the third leading cause of cancer deaths in the United States. This year, approximately 140,000 adults (two-thirds of whom are age 65 and older) will be diagnosed with colorectal cancer and more than 50,000 will die from the disease. These statistics are disturbing because colorectal cancer is one of the most preventable cancers thanks to highly-effective screening tools, including colonoscopy. Regular colonoscopy screenings can be the difference between life and death. Yet, about one in three adults between the ages of 50 and 75 -- about 23 million people -- are not getting screened as recommended.

The Administration's interim, final regulations (OCIIO-9992-IFC) recognize the important role that preventive screenings can play in preventing colorectal cancer. The interim rule with the clarifying guidance provides that a plan or issuer cannot impose cost-sharing for polyp removals that occur during a colonoscopy performed as a screening procedure. We support this rule but are troubled by the fact that Medicare's policy of requiring coinsurance for polyps removed during a screening is contrary to this rule.

Specifically, under current law, Medicare beneficiaries are not liable for cost-sharing (coinsurance or deductible) for services that have an "A" or "B" rating from the U.S. Preventive Services Task Force (USPSTF). Colorectal cancer screening is a preventive service that has an "A" rating from the USPSTF. According to the USPSTF, "screening for colorectal cancer reduces mortality through detection and treatment of early-stage cancer and detection and removal of adenomatous polyps." Yet the removal of precancerous polyps -- which occurs during the screening -- still requires that Medicare beneficiaries pay a coinsurance fee.

The Administration has promoted screening colonoscopies to Medicare beneficiaries as a preventive service not requiring cost sharing. However, more than three years after implementation of the preventive benefits provisions of the Affordable Care Act, Medicare beneficiaries remain liable for coinsurance if a polyp is removed during a screening colonoscopy.

We believe that this Medicare policy is counterproductive, inconsistent, and unfair to Medicare beneficiaries who have no way of knowing whether or not this preventive measure will result in a coinsurance payment.

Polyp removal is the preventive component of colorectal cancer screening colonoscopy. That is why we urge the Administration to treat screening colonoscopies with polyp removal consistently for both those who utilize private insurance and those insured under Medicare.

We ask that you work with us to explore every administrative avenue to ensure beneficiaries have access to this life-saving preventive service. We look forward to hearing from you regarding this important issue.


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