LCA Petitions States to Adopt Benchmark Health Plans With Lung Cancer Screening
LCA Undertakes Aggressive Nationwide Campaign to Educate State Health Leaders and Health Insurance Exchange Boards of the Lifesaving Benefit and Cost Effectiveness of Scientifically Validated Low Dose CT Screening
Washington, D.C. [September 26, 2012] – Today, Lung Cancer Alliance (LCA) completed its nationwide outreach to every state and territory that has established a state health insurance exchange pursuant to the Affordable Care Act. Through this outreach, LCA is urging state health officials to include in their benchmark health plans coverage for low dose CT screening for those at risk for lung cancer.
In 2010, the National Cancer Institute’s (NCI) National Lung Screening Trial (NLST) proved that low dose CT screening provided a mortality benefit (when compared to X-ray) of at least 20% in certain former and current smokers, ages 55-74. The current overall mortality benefit for mammography is 15% today.
In addition, recent peer reviewed findings by the actuarial firm, Milliman, Inc., also demonstrated that screening those at risk is cost effective from a commercial payers perspective. The federal government is currently updating its screening recommendation for lung cancer based upon this new data – but to date has not released its new rating which would help guide state decision making in this arena.
“The good news,” said Laurie Fenton Ambrose, President & CEO of Lung Cancer Alliance, “is that we now have NCI’s scientific backing of the mortality benefit of low dose CT screening for those at high risk of lung cancer. The bad news is that the timing of this breakthrough is caught between arbitrary, bureaucratically set, timing deadlines by the US Department of Health and Human Services regarding which screenings would be covered as an Essential Health Benefit.”
Fenton Ambrose continued, “There is no agility in the part of the federal government to respond rapidly to life-saving breakthroughs and expedite implementation into public health. Just because the federal government cannot move swiftly enough is no reason to deny a benefit that could literally save tens of thousands of lives a year.”
Pursuant to the Affordable Care Act, states may either establish their own health exchanges or use the federal health exchange. To date, only about a quarter of the states have established their own exchanges. These states must select a benchmark plan that will establish the minimum benefits that any plan offered on the state exchange must cover.
“By choosing a benchmark plan that covers low dose CT screening, state health officials will be leading the way in translating scientifically validated low dose CT screening for lung cancer into tangible, life saving benefit responsibly, safely and cost-effectively,” Fenton Ambrose continued.
Coverage of lung cancer screening by state exchanges raises important equity concerns. The majority of Americans receive their health care benefits through employer sponsored plans. Data suggests that a substantial percentage of people who will rely on State Health Exchanges will tend to be of lower income and/or are currently uninsured.
These same populations could be at greater risk for lung cancer since the currently uninsured population smokes at nearly double the rate of those who have access to private insurance coverage (32.1% versus16.8%). Failure to cover lung cancer screening for at risk populations that will rely on State Health Exchanges will mean that the majority of this population will not be screened at all, since the out of pocket cost of appropriate screening could be preclusive. And, if this population is not screened, then they will continue to die from lung cancer at a higher rate.
Fenton-Ambrose concluded, “As a national advocacy organization committed to the wellbeing of tens of thousands of people at high risk for this lethal disease, we are committed to ensuring that every person who can benefit from NCI’s validated low dose CT screening have access to such screening, even if it means engaging the health leaders in each and every state.”