The Silent Crisis and a Path Forward

Ohio Bill Aims to Close Health Equity Gap, Make Prostate Cancer Screening Accessible for All Men, Saving Lives and Dollars

The Silent Crisis and a Path Forward

Author: Anton Allensworth M.Ed.

Prostate cancer remains a significant threat to men's health across Ohio. This year alone, the American Cancer Society estimates that 10,820 new cases of prostate cancer will be diagnosed, and 1,160 men will tragically die from the disease.1 Despite the proven benefits of early detection in improving outcomes and reducing the burden of advanced illness, many Ohio men continue to face unnecessary financial barriers to life-saving screenings.

A crucial bipartisan legislative effort, Ohio House Bill 33 (HB 33) in the 136th General Assembly, seeks to dismantle these financial obstacles to preventive PSA (Prostate-Specific Antigen) screenings for high-risk men.2 The bill's primary objective is to ensure earlier diagnosis, which is expected to reduce overall treatment costs and significantly improve the patient's quality of life.4 Currently, HB 33 is pending in the Ohio House Insurance Committee, awaiting critical movement to advance through the legislative process.2 Its passage is vital for achieving true health equity across the state.

The Disparity:

Unequal Access to Life-Saving Screenings

Ohio has long recognized the importance of early detection for other prevalent cancers, establishing robust mandates for breast and cervical cancer screenings that often ensure coverage without significant cost-sharing. For breast cancer, state law mandates annual screening mammograms for women over 50 and offers coverage for high-risk women from age 35.5 Recent legislative efforts, such as House Bill 271, have aimed to expand this coverage to include supplemental screenings like ultrasound, MRI, and molecular breast imaging, as well as diagnostic examinations for high-risk individuals (those with dense breast tissue, a family history, or genetic predisposition), with the clear intention of removing cost-sharing for these vital services.8 Similarly, for cervical cancer, cytologic screenings (Pap tests) are mandated for coverage by health insurers and public employee benefit plans.6 Furthermore, the Ohio Breast and Cervical Cancer Project (BCCP) provides comprehensive screening and diagnostic services, and full Medicaid coverage for treatment, for eligible low-income, uninsured, or underinsured women, even covering cost-sharing if it exceeds zero.11 Federal law, through the Affordable Care Act, also upholds free preventive care for cervical cancer screening 15

In stark contrast, men in Ohio frequently encounter substantial financial hurdles when seeking preventive prostate cancer screenings. This disparity contributes to alarmingly low testing rates, with employer claims data indicating that only 40% to 45% of eligible men undergo PSA tests.4 The primary reason cited for this low participation is that employees are unwilling or unable to pay for the test.4 This financial barrier directly contributes to a concerning 42% increase in late-stage prostate cancer diagnoses, a trend that disproportionately impacts economically disadvantaged men and Black men, who are already less likely to be screened if they face higher deductibles, no coverage, or other financial obstacles to care.1

This stark contrast in mandated, often cost-free, coverage for women's cancer screenings versus the persistent financial barriers for prostate cancer reveals a systemic imbalance in Ohio's health legislation. It is not merely a matter of individual choices but reflects legislative priorities that have historically overlooked men's preventive health needs. The presence of comprehensive, mandated, and often cost-free coverage for female-specific cancers, juxtaposed with the absence of similar provisions for a prevalent male-specific cancer, points to an imbalance in legislative attention and resource allocation for preventive health. This situation suggests a broader legislative blind spot regarding men's health equity, where preventive measures for a significant disease like prostate cancer have not received the same policy-level support as those for breast and cervical cancers.

Moreover, the current lack of mandated, cost-free prostate cancer screening coverage is not a cost-saving measure; rather, it shifts a massive economic burden onto individuals, their families, and employers through significantly higher, catastrophic treatment costs for late-stage diagnoses. The personal experience of Timothy F. Hecker, an Employee Benefits Consultant and prostate cancer patient, vividly illustrates this financial impact. Diagnosed with Stage IV metastatic prostate cancer, his treatment since April 2020 has cost his employer's self-funded medical plan approximately $322,000 through the end of 2024, with his out-of-pocket costs at about $22,000 and rising.4 Hecker contrasts this with the estimated cost of early diagnosis at Stage 1, which would have been approximately $32,000 to $35,000 for a prostatectomy with minimal risk of recurrence.4 This comparison highlights a potential saving of nearly $300,000 per case. As Hecker asserts, "Every Insurance carrier and Employer will take those kinds of savings any day".4 This demonstrates that by not mandating cost-free preventive screening, the state's policy effectively allows this preventable financial burden to fall on private entities and individuals, rather than investing a smaller amount upfront for prevention, which would yield significant long-term savings for the entire healthcare ecosystem. This represents a false economy, where short-term "savings" on screening lead to much larger, unavoidable costs later.

To further illustrate this disparity, the following table provides a comparison of cancer screening coverage in Ohio:

Cancer Type

Target Population/Risk Factors

Key Screening Methods

Current Cost-Sharing Status (Private Insurance)

Medicaid/BCCP Coverage

Breast

Adult women (various age/risk tiers); High-risk (dense tissue, family history, genetic predisposition)

Mammography (2D/3D); Supplemental (Ultrasound, MRI, Molecular Breast Imaging); Diagnostic Exams

Mandated coverage, often no cost-sharing for screening mammograms. Supplemental/Diagnostic for high-risk intended to be cost-free by HB 271, but some plans may vary. 5

Comprehensive coverage for screening and diagnostic services; full Medicaid for treatment for eligible women. 5

Cervical

Adult women (21-64 years)

Cytologic screening (Pap test); HPV testing

Mandated coverage, often no cost-sharing (supported by ACA). 6

Comprehensive coverage for screening and diagnostic services; full Medicaid for treatment for eligible women; BCCP covers cost-sharing for underinsured. 11

Prostate

Men, especially high-risk (family history, genetic alteration)

PSA test; Digital Rectal Exam

Often subject to co-pays, deductibles, or other cost-sharing. 4

Not explicitly detailed in research as comprehensive or cost-free under Medicaid in the same way as women's cancers.

HB 33 Goal (Prostate)

High-risk men

PSA test; Digital Rectal Exam

Proposed: Zero cost-sharing for preventive screenings. 8

N/A (Focuses on private insurance)

Ohio HB 33: A Path to Equity and Healthier Futures

Ohio House Bill 33 directly addresses this inequity. The bill mandates that health insurers cover preventive prostate cancer screenings for high-risk men without imposing cost-sharing requirements such as deductibles or co-pays.8 High-risk is specifically defined by a family history of prostate cancer in a first-degree relative or the diagnosis of a genetic alteration or cancer associated with an increased risk of prostate cancer.8 The legislation also ensures annual screenings and specifies that covered procedures include PSA tests and digital rectal examinations.8

The profound benefits of HB 33 are multifaceted. Removing financial barriers is projected to double testing rates, leading to a significant increase in overall survivability for men diagnosed with prostate cancer.4 Early diagnosis is the core benefit, as it dramatically reduces overall treatment costs. Late-stage treatment is, on average, $309,000 more expensive compared to early-stage disease, with each prevented death saving an estimated $125,200.1 Beyond the financial aspect, early detection leads to a significantly improved quality of life for patients, sparing them from the debilitating effects of advanced cancer.4 Employers and insurance carriers also stand to gain substantial financial savings by preventing catastrophic medical claims that arise from late-stage diagnoses.4

The proposed legislation aligns Ohio with the majority of states that already require private insurers to cover prostate cancer screening for high-risk men. Experiences in other states, including Kentucky, Maryland, Tennessee, Texas, and Virginia, have shown no significant impact on premiums or state budgets after implementing similar legislation, with some even anticipating long-term savings due to improved screening access.1

Beyond individual health and direct financial savings, the passage of HB 33 represents a strategic shift towards a more proactive and efficient public health model. By reducing the incidence of costly late-stage prostate cancer, it frees up healthcare resources—such as hospital beds, specialized staff, and advanced equipment—that would otherwise be consumed by complex, long-term treatments. This enables the healthcare system to address other health challenges more effectively, potentially reducing wait times and improving access for other conditions. It signifies a commitment to preventive care as a foundational investment in societal well-being, moving the healthcare system from a reactive, crisis-management mode to a more proactive, preventative, and ultimately more sustainable model.

The Imperative for Action

The human toll of delayed prostate cancer diagnosis—lost lives, diminished quality of life, and emotional strain on families—is immeasurable. The economic burden, as demonstrated by Mr. Hecker's case, is staggering and preventable. Removing financial barriers to preventive PSA screenings and achieving early diagnosis is truly a "win for the Man, his loved ones, the employer, and the insurance company".4 It is a common-sense measure that benefits individuals, families, businesses, and the state's economy.

Call to Action: Your Voice Can Make a Difference!

House Bill 33 is currently awaiting action in the Ohio House Insurance Committee. It needs your support to move forward. Ohioans are urged to contact their state representatives immediately. Ask them to prioritize House Bill 33 and vote to move it out of the House Insurance Committee and onto the floor for a full vote. Your advocacy is crucial to ensure this vital legislation can be signed into law by the Governor, bringing equitable, life-saving prostate cancer screening to all Ohio men. The act of urging citizens to contact their representatives is not merely a symbolic gesture but a direct mechanism to influence the legislative process, translating public sentiment into political will and providing the necessary momentum for the bill to proceed.

Works cited

1. 5.6.25 OH HB 33 House Insurance Committee Hearing Testimony - ZERO Prostate Cancer, accessed June 28, 2025, https://search-prod.lis.state.oh.us/api/v2/general_assembly_136/committees/cmte_h_insurance_1/meetings/cmte_h_insurance_1_2025-05-06-0930_423/testimony/6130/uploaded-doc/

2. HB33 | Ohio 2025-2026 | Require insurance coverage for certain prostate cancer screening, accessed June 28, 2025, https://trackbill.com/bill/ohio-house-bill-33-require-insurance-coverage-for-certain-prostate-cancer-screening/2643273/

3. OH HB33 | 2025-2026 | 136th General Assembly | LegiScan, accessed June 28, 2025, https://legiscan.com/OH/bill/HB33/2025

4. Ohio House Bill 33 Prostate Cancer Testing as Preventive Zero Cost ..., accessed June 27, 2025, https://search-prod.lis.state.oh.us/api/v2/general_assembly_136/committees/cmte_h_insurance_1/meetings/cmte_h_insurance_1_2025-05-06-0930_423/testimony/6145/uploaded-doc/

5. Section 5164.08 - Ohio Revised Code | Ohio Laws, accessed June 28, 2025, https://codes.ohio.gov/ohio-revised-code/section-5164.08/9-29-2013

6. Ohio Revised Code § 3923.53 (2021) - Public Employee Benefit Plan. - Justia Law, accessed June 28, 2025, https://law.justia.com/codes/ohio/2021/title-39/chapter-3923/section-3923-53/

7. Section 1751.62 | Screening mammography - Ohio Laws, accessed June 28, 2025, https://codes.ohio.gov/ohio-revised-code/section-1751.62/3-22-2005

8. OH HB271 | BillTrack50, accessed June 28, 2025, https://www.billtrack50.com/billdetail/1892526

9. State Law Insurance Map | DenseBreast-info, Inc., accessed June 28, 2025, https://densebreast-info.org/legislative-information/state-law-insurance-map/

10. Section 5164.08 Breast cancer and cervical cancer screening. - Ohio Revised Code, accessed June 28, 2025, https://codes.ohio.gov/assets/laws/revised-code/authenticated/51/5164/5164.08/9-23-2022/5164.08-9-23-2022.pdf

11. Breast and Cervical Cancer Project - Ohio Department of Medicaid, accessed June 28, 2025, https://medicaid.ohio.gov/families-and-individuals/citizen-programs-and-initiatives/breast-and-cervical-cancer-project

12. Ohio Breast and Cervical Cancer Project - Ohio Department of Health - Ohio.gov, accessed June 28, 2025, https://odh.ohio.gov/wps/wcm/connect/gov/9c9e3300-1c53-4bd3-8567-38fac636570e/BHIW_BCCP+Provider+Manual.pdf?MOD=AJPERES&CONVERT_TO=url&CACHEID=ROOTWORKSPACE.Z18_K9I401S01H7F40QBNJU3SO1F56-9c9e3300-1c53-4bd3-8567-38fac636570e-oRXTZjX

13. Section 3701.144 | Ohio breast and cervical cancer project., accessed June 28, 2025, https://codes.ohio.gov/ohio-revised-code/section-3701.144

14. Rule 3701-10-01 | Breast and Cervical Cancer Project Cost Sharing. - Ohio Laws, accessed June 28, 2025, https://codes.ohio.gov/ohio-administrative-code/rule-3701-10-01

15. Supreme Court upholds key part of Affordable Care Act's free preventive health care requirements | PBS News, accessed June 28, 2025, https://www.pbs.org/newshour/politics/supreme-court-upholds-key-part-of-affordable-care-acts-free-preventive-health-care-requirement