Memorandum in Opposition

For Immediate Release: May 24, 2021

Re:      A.2085-A (Dinowitz)/S.906-B (Sanders) – AN ACT to amend the insurance law, in relation to providing insurance coverage for colorectal cancer early detection

This legislation, A.2085-A/S.906-B, would require health insurance providers to cover the costs of colon screening in men and women age 50 and older. New York’s health plans support a variety of cancer screenings, including screening for colorectal cancers; however, the New York Health Plan Association (HPA) opposes the legislation.

While well intentioned, the bill is unnecessary as plans currently provide coverage of screenings for a range of methods to detect and diagnose colorectal cancer. Additionally, creating new health insurance coverage mandates results in increased costs for individuals and employers purchasing health insurance in New York.

Colon (colorectal) cancer is one of the most common cancers in New York State and the second leading cause of cancer deaths among men and women combined. It is also one of the most frequently diagnosed cancers – and screening can often find colorectal cancer early, when it is small, has not spread, and might be easier to treat.

Managed care plans are founded on principles that emphasize primary and preventive care. As part of their comprehensive approach to health care, HPA member plans have long sought to educate their members about the importance of appropriate screenings to detect cancers as well as numerous chronic health conditions. Plans encourage members to follow evidence-based screening guidelines, including the colorectal cancer screening guidelines recommended by the United State Preventive Services Task Force. Moreover, plans continually evaluate and update their care delivery protocols to follow best practices and evidence-based medical information. Mandating into statute specific treatments or levels of coverage fails to take into account when the science changes or guidelines evolve, requiring health plans to cover services that are outdated and, potentially, harmful to patients.

Further, mandating coverage of specific services disproportionately affect small and medium-sized employers. Forcing employers to include benefits they and their workforce may not want or need exacerbates the challenge they face to find affordable health care options. Mandated benefit bills pertain only to fully-insured policies, which are generally those purchased either by individuals who buy coverage on their own or receive it through a small or medium-sized business. Large companies typically “self-insure,” providing employee health benefits by directly paying health care claims to providers, which are governed by the Federal Employee Retirement Income Security Act (ERISA) and therefore not subject to state mandated benefits. This exemption offers self-insured employers greater control over the particular benefits they cover for their employees.

One reason large employers typically self-insure is to avoid covering certain mandated benefits. Today, more than 50 percent of the commercial market in New York is covered under a self-insured plan. As more employers self-insure, state laws mandating specific types of benefits and services affect an increasingly smaller portion of the privately insured marketplace and fall largely on small and medium-sized employers.

We believe A.2085-A/S.906-B is unnecessary and, more importantly, would result in burdensome and costly requirements that ultimately would lead to higher health care premiums. For all these reasons, the New York Health Plan Association urges your opposition to this proposal.