Will the Senate AHCA bill require coverage for cancer screening? Nobody knows

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Senate Republicans don't plan to release a draft of their Affordable Care Act (ACA) replacement bill, as reported by Axios. The 13-member healthcare workgroup is on track to finish writing the bill June 12, according to two senior GOP aides, and plans to send it straight to the Congressional Budget Office (CBO) for scoring upon completion.

Keeping the legislation behind closed doors lengthens the uncertainty felt by insurers and care providers alike, especially regarding the state waiver program outlined in the MacArthur Amendment.

The amendment, which finally pushed the last few GOP holdouts to vote yes and get the American Health Care Act (AHCA) out of the House, allows states to apply for waivers freeing them from covering pre-existing conditions and essential health benefits (EHBs).

EHBs are a set of 10 services all insurance plans must cover under the ACA, including pregnancy and childbirth, mental health services and preventative screening.

While reporting has indicated the Senate won’t allow states to waive coverage for preexisting conditions, they will leave in the bill the ability for states to waive essential health benefits—with major implications for radiology.

First, states that waive essential health benefits will no longer require insurers to provide low-cost cancer screening including mammography and colonoscopy, potentially reducing screening utilization and early cancer detection. This would increase downstream cost of care and cancer mortality, according to a study published in Cancer.

While the CBO left screening out of its predicted exclusions—instead fingering mental health services, maternity care, and substance abuse treatment—the specter of reduced screening would be an unwelcome possibility for the industry.

Second, allowing states to waive essential health benefits could render the coverage for preexisting conditions useless. If you have cancer and your insurance policy doesn’t cover radiotherapy, then you’ve got coverage but no care—ironically a central talking point for Secretary of Health and Human Services Tom Price, MD, a strong supporter of the AHCA.

However, not one word of the Senate AHCA bill has been released yet. Imaging advocates such as the American College of Radiology were confident access to screening would be preserved, and with good reason: Preventative care is by far the most cost-effective way to practice medicine.

Either way, Senate Republicans want to vote on the bill before the July 4 recess, so it shouldn’t be long before it’s clear how much of the ACA they intend to repeal.