Momentum builds as Vermont becomes 23rd state to pass legislation bolstering breast imaging reimbursement
With the passage of bills in multiple states, momentum continues to build in the movement to ensure greater coverage for breast imaging services.
Vermont lawmakers recently approved H.621, which mandates that insurers cover follow-up screening exams via MRI and other modalities. The Affordable Care Act already requires that payers cover regular mammography screenings. However, some women with dense breasts or other factors may need additional exams such as ultrasound or MRI.
“Thousands of Vermonters require diagnostic and supplemental breast imaging every year, yet many forgo them due to out-of-pocket costs. Not anymore,” Molly Guthrie, VP of policy at Susan G. Komen, an organization that advocates on breast cancer issues, said in a statement issued April 25. “This life-saving legislation means they will now receive the breast imaging they require, leading to an earlier breast cancer diagnosis and often better health outcomes.”
Gov. Phil Scott (R) signed the legislation on April 25 following its passage in the Vermont House earlier in the month. Nearly half of U.S. states now have laws in place removing the cost for medically necessary breast imaging, with Kentucky and Mississippi also enacting legislation in 2024. Over 20 states have introduced legislation addressing this issue during the 2024 sessions, according to Susan G. Komen. And a national version is now pending in Washington, D.C., eliminating cost for patients insured by federally regulated health plans.
In 2024, more than 630 people will be diagnosed with breast cancer in Vermont while over 80 will die, SGK estimated. “Exorbitant” out-of-pocket costs for to follow-up imaging procedures continue to keep women from catching the disease early. These charges can range from $234 for a diagnostic mammogram to over $1,000 for a breast MRI, according to a recently commissioned study. About 1 in 5 patients said they would forgo recommended follow-up if they had to pay a deductible, another study in Radiology found.
“Diagnostic breast imaging is an important tool in detecting cancer and should be available to all Vermonters who need it. Cost should not prohibit people from accessing potentially life-saving care,” Democratic Rep. Melanie Carpenter, who introduced the bill alongside independent Rep. Laura Sibilia, said earlier this year. “I am thankful for the opportunity to work with Rep. Sibilia and others to find solutions.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.