As skin cancers become more fatal, Florida’s legislators reject full insurance coverage

Skin cancers in Florida are becoming more prevalent and more deadly.

While the majority are caught early, the Florida Cancer Data System shows about 630 people on average die in the state each year from melanoma, a particularly aggressive form of skin cancer. Nationally, the number of melanoma deaths is expected to increase by 4.4% in 2023, according to the American Cancer Society. Florida is the state with the second highest rate of new melanoma cases.

Dr. Ralph Massullo, a dermatologist from Lecanto, wants to improve the statistics. Massullo also is a Florida Representative, and in the spring legislative session he proposed a bill that would require insurers to fully pay for annual skin cancer screenings performed by licensed dermatologists without imposing any costs such as co-pays to patients.

The bill passed in the House of Representatives but failed to pass in the Florida Senate.

"We are going to bring it back next year and try it again," Massullo said.

At one point during the session, the state representative tried to initiate a compromise, making the requirement applicable only for the insurers of state employees. He envisioned it as a pilot program. That effort failed, too.

Massullo treats an increasing number of patients with skin cancers and believes something need to be done to remove barriers to screenings.

Co-pays and cost sharing increasingly have become a deterrent for people to do basic health screenings, mostly because a larger proportion of people are choosing high-deductible health insurance plans

"Skin cancer is one of the easier cancers to cure if caught early," Massullo said, "If caught late, particularly with melanoma, it can expensive to treat, and deadly."

A new treatment for skin cancer that has spread to other organs, Immunomodulators, has proved effective and extended the lives of people with melanoma, but it is expensive, Massullo points out. He says he tried to inform fellow legislators and insurers that paying for annual screenings is less costly than skin cancer treatment and also benefits an individual who has to go through surgery and chemotherapy if diagnosed in later stages.

Legislators, including Sen. Gayle Harrell who proposed a companion bill in the Senate to Massulo's, said the insurance lobby is strong in Tallassee and insurers do not like mandates to cover screenings.

In Illinois, a similar skin cancer screening bill was approved and went into effect in 2020. It requires health insurers to fully cover one annual screening for skin cancer without individuals having to pay any deductible, coinsurance, copayment, or any other cost-sharing requirements.

The push to get screenings fully covered comes as more people are diagnosed with skin cancer each year in the U.S. than all other cancers combined, according to the American Cancer Society. Men have a much higher rate of skin cancer than women, according to The U.S. Centers for Disease Control and Prevention.

While they may not cover screenings, most health insurers do cover skin cancer treatment.

Dr. Sima Jain, president of the Florida Academy of Dermatology, said her organization had pushed for this legislation and will continue to fight for its future passage.

"In Florida we see so much skin cancer, so much UV damage," said Jain, an Orlando dermatologist. "With skin cancer, it's visible; we don't need invasive testing. If we encouraged more screenings, think of how many skins cancers we could catch."

She believes a Floridian who sees a spot would be more apt to get it checked out if the visit was a fully covered expense.

Jain said going forward, her organization will continue to emphasize how this could save dollars and lives. "I was frustrated when the legislation didn't get passed, but tomorrow's another day, We will keep fighting."

Approved healthcare bills

Some healthcare bills approved in the 2023 Legislative session that will go into effect July 1:

Education and training for Alzheimer's and Dementia: Caregivers working at senior living facilities, adult day cares or in home health must undergo training to recognize the signs and symptoms of these diseases.

Telehealth revisions: Medicaid coverage for telehealth visits can now include audio-only calls, which had previously been excluded in Florida.

Healthcare Provider Accountability: Nursing home residents now have an extensive list of rights including the right to refuse medication and treatment, the right to civil and religious liberties and the right to be free from sexual abuse, exploitation or negligence. The bill also allows Florida's Agency for Health Care Administration to petition the court for an injunction to halt a provider's unlicensed activity and it can provide records to local law enforcement.

Prescription Drugs: Prescription drug makers must disclose medication price increases of more than 15% in a calendar year or more than 30% within three years. The information will be published on the Florida Health Finder website.

Proposed healthcare bills

Some of the bills that were proposed in 2023 but failed to become law.

Death with Dignity/End-of-life Options: Dying patients would have been able to decide for themselves if they want a healthcare provider to withholding life-saving medications or prescribe lethal medication to end their lives.

Dentistry: A framework for practicing dentistry via telehealth would have been established.

Nurse practitioners: Nurse practitioners would have been able to practice without physician supervision.

Physician Certifications for the Medical Use of Marijuana: Physicians would have been able to renew certifications for medical marijuana use via telehealth.