The Affordable Care Act requires most health insurance plans to pay for screening mammograms intended to facilitate early detection of breast cancer. But in at least 10% of cases, women are called back to get secondary scans, and the cost of diagnostic mammograms and other procedures is not fully covered by insurance.
Two similar bills advancing in the Iowa Legislature would require insurers to provide the same coverage for diagnostic procedures and other supplemental examinations as they do for regular screening mammograms.
“There are so many people who have breast cancer scares that need workups that are not currently covered by insurance and, because of that, delay their care, delay getting diagnosed, and end up often with far more advanced rates of cancer than would have been if we’d been able to get them the care they needed when they needed it,” state Rep. Megan Srinivas, a medical doctor and a Des Moines Democrat, said Feb. 21 before the Iowa House voted 97-0 to approve House File 2489. Rep. Ann Meyer, a Fort Dodge Republican, proposed the bill in January 2023.
About 1 in 8 women in the United States will at some point in their life get a breast cancer diagnosis.
Even in cases where women get a clean bill of health after a diagnostic procedure, under current law, they could be on the hook for hundreds or thousands of dollars in bills.
“This should be seen as a screening, not as a treatment,” said state Sen. Cherielynn Westrich, an Ottumwa Republican, at a committee meeting where senators advanced Senate File 2358. Sen. Sarah Trone Garriott, a West Des Moines Democrat, noted that over 40% of Iowa women have dense breast tissue; such women are more likely to need additional exams.
The House and Senate bills are nearly identical; the Senate version includes additional language specifying that insurers may not impose any form of cost-sharing for diagnostic procedures. Lobbyists for Wellmark Inc., the Des Moines-based health insurer, are registered against the Senate bill but as “undecided” on the House version. Most other lobbyists monitoring the bills are registered in favor of them.
Over 20 states have passed laws expanding required insurance coverage beyond screening mammograms, according to the industry journal Radiology Business.
“This is something that’s going to help a lot of Iowans, and this is something that could have helped me,” said state Rep. Tracy Ehlert, a Cedar Rapids Democrat. “When I was diagnosed with breast cancer last session, it was the MRI that actually caught it. It wasn’t my mammogram and ultrasound that I get on a regular basis.”
Both bills specify that the change would cover procedures starting Jan. 1, 2025. The full Senate has not yet taken up its bill. The same bill must pass in both chambers and be signed by Iowa Gov. Kim Reynolds to become law.
Categories: Government & PolicyHealth Care
