Several states propose legislation to bolster coverage for supplemental breast imaging
Lawmakers across several states have introduced legislation in the new year, requiring that commercial insurers cover supplemental breast imaging without patient cost-sharing.
Those proposing breast imaging-related measures so far in 2025 have included Connecticut, Florida, Hawaii, Indiana, Missouri, New York, South Carolina, Utah and Virginia, the American College of Radiology reported Wednesday.
Under the Affordable Care Act, health plans must cover screening mammography at no cost. However, some women with dense breasts or a genetic disposition to the disease may require ultrasound or MRI, which often are not reimbursable by insurers. This has resulted in patients receiving exorbitant bills for lifesaving additional exams, advocates note.
Most recently, Massachusetts Gov. Gov. Maura Healey in November signed legislation into law, closing this coverage gap. Breast care advocacy group Susan G. Komen on Jan. 8 said one of its top priorities this year is “advancing state and federal legislation that allows for early detection, diagnosis and treatment of breast cancer.”
“Our progress in saving lives from breast cancer is contingent upon breast health services being available and affordable to everyone,” Molly Guthrie, VP of policy and advocacy, said in a statement.
Last year, Komen’s Center for Public Policy helped advocate for the introduction of 41 bills across 34 states. Of those, 16 were signed into law. The organization on Wednesday also issued three separate announcements, touting the introduction of breast bills in North Dakota, Virginia and Indiana.
In Virginia alone, 8,180 people were diagnosed with breast cancer last year and 1,160 died of the disese. A Komen commissioned study found that coverage barriers can force women to pay $234 for a diagnostic mammogram or over $1,000 for a breast MRI. Another study in Radiology estimated that 1 in 5 patients would forego recommended follow-up breast imaging, if they had to pay a deductible.
“No one should be putting off care because of out-of-pocket costs—especially since we know breast cancer is much deadlier and more costly to treat if it goes undetected and spreads,” Virginia Delegate Shelly Simonds said in a statement. “We all know that the earlier cancer is detected, the better the prognosis—not to mention the huge cost-savings of an early diagnosis versus a late-stage one.”
ACR, Komen and others also have pushed for legislation in U.S. Congress to require nationwide coverage of supplemental breast imaging.
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.