By Max Baucus & Tom Daschle
June 22, 2021 at 5:00 am ET
One way to vastly improve American health care is through increased preventative screenings to identify early traces of a disease. We’ve seen that when implemented broadly, early cancer screenings for breast cancer, cervical cancer and colorectal cancer, for example, can drastically reduce patient diagnoses and mortality, narrow health disparities between racial and ethnic groups, and save patients and taxpayers money. But current challenges to the Affordable Care Act being waged in the courts, coupled with outdated regulations in Washington, have the potential to interfere with access to early screenings and put these advancements at risk.
Cervical cancer is an example of how routine screenings can drastically improve outcomes. Over the last 40 years, cervical cancer screenings have effectively cut diagnoses of the disease in half. From a cost perspective this is especially important as treating early-stage cervical cancer has been shown to be 11 times less expensive than treating the disease at a later stage. Even more significant, preventative screenings have a critical effect on survival rate. We know that the five-year survival rate for white women is 71 percent compared to only 56 percent for black women, in part because black women are less likely to get screened.
That’s why, when Congress passed the Affordable Care Act in 2010, lawmakers were especially focused on increasing access to preventative services such as cervical screenings, mammograms, and colonoscopies. In fact, the ACA mandated that insurance companies, and Medicaid in certain states, cover preventative care services recommended by the United States Preventive Services Task Force at no cost to patients. The USPSTF is an independent, nonpartisan group of health care experts who develop recommendations for preventative services.
But despite widespread agreement that access to preventative services will improve patient outcomes, there are still efforts to limit access to early cancer screenings. One such battle is playing out in Texas in Kelley v. Azar. In this case, the plaintiffs challenge the USPSTF’s authority to “unilaterally determine” the care that should be paid for by private insurers, arguing that the group is not appointed by the president or confirmed by the Senate. That’s why it’s imperative Congress take action to strengthen the regulatory standing of USPSTF, modernize the approach the Task Force takes to making recommendations, and support this effort through enhanced funding. By doing this, Congress has the opportunity to dramatically increase patient access to preventative services, which we know are critical to saving lives.
Real modernization requires that Congress establish a review process that better aligns to current innovation cycles. Right now, the statute requires only infrequent reviews, every five years. The National Comprehensive Cancer Network, which has adopted an ongoing and iterative review process to match the explosion in cancer treatment options, is a great model for the USPSTF. But updating the review process also requires that the Task Force have adequate funding – and dedicated staff from the Agency for Health care Research and Quality supporting Task Force volunteers – to provide more frequent assessments. While the previous administration proposed cutting the Task Force’s funding by about 40 percent in FY 2021 – in effect reducing the number of topics that can be reviewed by half – the Biden administration has an opportunity to take a different course.
The importance of paving the way for more early screenings cannot be overstated. The cancer community is developing new, innovative technologies every day to make it easier to identify and stop these deadly diseases before they strike. One promising area of innovation is the use of liquid biopsies – or blood tests – that enable widespread cancer screenings and are far less invasive and time-consuming than traditional tests.
Right now, there are large clinical trials using blood tests to screen asymptomatic, average-risk patients for colorectal cancer. These tests could be game changers in the battle to broaden the adoption of screening due to their ease of use and expected accuracy. And these blood tests are especially important in tackling diseases like colorectal cancer, where we still have not met the Centers for Disease Control and Prevention’s goal of screening 80 percent of the eligible population.
Relying on blood tests as a first step – as opposed to invasive colonoscopies, for example – can help us boost the current screening rate, which has stalled around 68 percent. And these blood tests can help us close the gap between white and Black, Hispanic and Native Americans where screening rates are a mere 62 percent, 50 percent and 54 percent respectively.
But while these advancements are exciting, the promise of blood-based cancer screening may be years away from patients if this pernicious challenge to the ACA’s preventative services clause is upheld, and the USPSTF is not modernized in a way that significantly shortens review cycles and allows the Task Force to expand its work.
The Biden administration has set forth an ambitious health care agenda that will build on the Affordable Care Act by expanding access to quality care, but it’s imperative that we prioritize no-cost preventative services. We look forward to a future where preventative screenings can help dramatically reduce all cancer diagnoses and mortality.
Max Baucus served as a United States senator from Montana from 1978 to 2014 and was an author of the Affordable Care Act. Tom Daschle served as a United States senator from South Dakota from 1987 to 2005, including as majority leader in 2001, and is the author of “Critical: What We Can Do About the Health-Care Crisis.”
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