Beyond no-cost screening: Ensuring completion of the colorectal cancer screening continuum after Kennedy V. Braidwood

The 2025 Kennedy v. Braidwood Supreme Court decision upheld the Affordable Care Act mandate requiring insurance coverage of preventive services with an A/B rating from the U.S. Preventive Services Task Force (USPSTF) without cost-sharing. This ruling preserved access to essential preventive care, including colorectal cancer screening, a leading cause of cancer-related mortality despite the availability of effective, evidence-based screening methods. The recent elimination of out-of-pocket costs for follow-up colonoscopy after positive stool testing resulted in an absolute increase of 1.48% in follow-up procedures, highlighting the impact of financial barriers on the completion of the screening continuum. Yet nonfinancial barriers such as limited transportation, language barriers, and scheduling challenges persist. Patient navigation services addressing these barriers have demonstrated substantial improvements in screening adherence and diagnostic completion but remain inconsistently covered. Recent federal policies about breast and cervical cancer screening have expanded the definition of screening to include follow-up care and navigation services, now requiring coverage of these services by private insurers and Medicaid without cost-sharing. Colorectal cancer screening coverage should similarly expand to include these critical support services. Aligning policy with the realities of patient access will enhance screening uptake, reduce disparities, and strengthen the cost-effectiveness of colorectal cancer prevention efforts.