S.8553.A – Coverage for Follow Up Lung Cancer Screenings

Re:      S.8553-A (Addabbo) – AN ACT An act to amend the insurance law and the social services law, in relation to mandatory health insurance coverage for lung cancer screening

This legislation, S.8553-A, would require health insurance providers to cover follow-up screening for lung cancer when recommended by a health care provider, and prohibits insurance companies from imposing cost-sharing for follow-up screenings for lung cancer.  While well intentioned, the bill is unnecessary as health plans currently provide coverage for lung cancer screenings in accordance with the United State Preventive Services Task Force (USPSTF).

Health plans support and promote the use of evidence-based, best practices as it relates to cancer screenings, and develop coverage criteria of which modalities are “medically necessary” based on these best practices.  For example, health plans encourage members to follow recommended preventive screening guidelines, including those recommended by the USPSTF.  Moreover, provisions of the Affordable Care Act require coverage of preventive services, which include screening for cancers, without any cost sharing.

Further, creating new health insurance coverage mandates results in increased costs for individuals and employers purchasing health insurance in New York. 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.

Legislation that proposes to restrict cost-sharing amounts misses the mark to keep coverage affordable for all consumers and fails to address the escalating costs of health care overall. Various types of cost-containment and cost-sharing mechanisms help to control health care costs and keep monthly premiums at a minimum. Restricting or limiting cost-sharing levels increases monthly premiums and places an additional financial strain on small businesses and working families.  Rather than limiting cost-sharing, the focus should be on measures to promote greater transparency surrounding necessary services like lung cancer screening and making health care services more affordable for New Yorkers.

At a time when many New Yorkers are struggling to afford the health insurance coverage they have, this bill is ill advised and duplicates existing benefits.

For these reasons, we urge you to reject S.8553.