Bipartisan bill would require insurers to cover supplemental breast imaging nationwide
Members of Congress in both chambers have introduced bipartisan legislation requiring insurers to cover supplemental breast imaging nationwide with no patient cost-sharing.
Under current law, payers must pony up for annual mammograms but not follow-up tests, such MRI or ultrasound, required for dense breast tissue or other reasons. The Access to Breast Cancer Diagnosis Act aims to remedy this, eliminating a financial barrier to imaging access.
Reps. Debbie Dingell, D-Mich., Debbie Wasserman Schultz, D-Fla., and Brian Fitzpatrick, R-Pa.—co-chairs of the House Cancer Caucus—are leading the effort in the lower chamber. Sens. Jeanne Shaheen, D-N.H., and Katie Britt, R-Ala., meanwhile, reintroduced the U.S. Senate version Monday.
“Access to lifesaving diagnostic testing should never depend on a person’s ability to pay. When it comes to breast cancer, early diagnosis is critical—and financial barriers can be deadly," Rep. Fitzpatrick said in a statement April 28. "The Access to Breast Cancer Diagnosis Act ensures that no woman is left behind simply because she cannot afford the care she needs.”
The legislation is endorsed by breast cancer care advocacy group Susan G. Komen. A study commissioned by the organization found that women can pay out-of-pocket costs ranging from $234 for a diagnostic follow-up mammogram to over $1,000 for a breast MRI. The latter often is recommended among women who are at high risk for the disease, have dense breasts, or received unclear initial screening results. These added costs lead to 1 in 5 women opting to forgo additional testing if they don’t have the funds, a study in Radiology found.
“This legislation will help make timely access to needed imaging more affordable so that breast cancers are caught early, and more lives can be saved,” said Molly Guthrie, VP of policy and advocacy at Dallas-based Komen, which is rallying with over 200 participants in Washington this week to push for the bill’s passage. In addition, Guthrie and colleagues also want Congress to support restored funding for the Breast Cancer Research Program at the Department of Defense. Plus, they’re pushing to preserve access to early detection programs by supporting increased funding for the National Breast and Cervical Cancer Early Detection Program.
Lawmakers also previous introduced the “ABCD Act” in 2023, 2021, 2020 and 2019, but it failed to find passage. Absent a national solution to this issue, about 30 states have passed local legislation requiring insurers to cover supplemental breast imaging, including Arkansas earlier this month.
Update Wednesday, April 30: The Radiology Business Management Association also voiced its support for the legislation late Tuesday. About 70% of women 65 and older report consistent mammogram screenings over the past three years, according to an October 2024 survey commissioned by RBMA’s Radiology Patient Action Network (RPAN). However, 30% said they had fallen behind due to financial constraints. Another 10% had forgone recommended secondary screening due to out-of-pocket costs.
“Early detection is crucial for breast cancer outcomes, and financial barriers pose a direct threat to women's lives,” RBMA Co-executive Director Linda Wilgus told Radiology Business. “RBMA support the bipartisan Access to Breast Cancer Diagnosis Act that aims to eliminate these barriers, ensuring that all women regardless of their financial situation can access the care they need. RPAN has been heavily involved in the passage of similar legislation on a state-by-state basis.”
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.