For many of the women considered to be at high risk for breast cancer, the cost of examinations that go beyond routine screening mammograms can cost hundreds or thousands of dollars in out-of-pocket expenses.
A bill pending in the Alaska Legislature aims to change that, at least for patients covered by private health insurance policies.
The measure, House Bill 285, would prohibit insurers from requiring cost-sharing from patients needing more extensive diagnostic examinations.
Routine screening mammograms that are appropriate for most women are already fully covered as prevention coverage — without any copayment allowed by insurers — under the federal Affordable Care Act.
But for the approximately 15% of women who are classified at high risk, more intensive diagnostic imaging is recommended, said Rep. Zack Fields, D-Anchorage, the bill’s sponsor. Diagnostic testing can also be a next step for screened patients whose mammograms reveal possible problems, he said.
Diagnostic tests include more enhanced mammography of dense tissue or other trouble spots or examination through magnetic resonance imaging, ultrasounds or some other advanced technology, according to the bill’s text.
But many Alaska patients who should get those tests are skipping them, Fields said.
“We’re losing a significant number of people who can’t afford the cost share,” he said in an interview. It appears that about 1,400 Alaskans who should get the diagnostic screenings are foregoing them because of cost, he said.
Fields’ bill applies only to state-regulated private insurers, not to government insurance. And it would not apply to high-deductible policies with health savings accounts.
Fields said his office was contacted about the issue by the Susan G. Komen Foundation, a nonprofit organization that raises money to combat breast cancer. The foundation is promoting the policy around the country.
Several state legislatures have already passed similar legislation for state-regulated insurance policies, and bills are pending in some others, Fields said.
On the national level, there is a bipartisan bill pending in both houses of Congress that would mandate that federally regulated insurers cover diagnostic breast imaging without out-of-pocket costs to patients.
The Alaska bill has been heard twice in the House Labor and Commerce Committee.
At a March 13 committee hearing, the second held so far on the measure, lawmakers heard testimony in support of the bill, including from cancer survivors and from representatives of health organizations.
Emily Nenon, Alaska government relations director of the American Cancer Society Cancer Action Network, was among the health organization representatives. She said women run into trouble when, during routine screening, they learn they are at high risk or that they need a more detailed diagnosis. “Those costs can scare the patient away, and we want to catch cancers as early as we can,” she said.
Also expressing support was Pam Ventgen, executive director of the Alaska State Medical Association. She described the enhanced screening that is recommended for high-risk patients, which goes well beyond routine mammograms. Such supplemental imaging, she said, catches cancers earlier, saving lives and reducing total medical costs.
Although the bill had not yet moved out of the committee and did not have a cosponsor as of March 14, Fields said he is optimistic about its chances.
“I’m actually fairly confident that it is one of the things we’re going to get done,” he said. “I don’t know if we’re going to get it done this session, but I think if people look at the data, it is very compelling to pass the bill.”
The cost-sharing problem can be borne by some men as well, Fields has pointed out in information presented to the committee. About 1% of breast cancer patients are men, according to the U.S. Centers for Disease Control and Prevention.
There is a companion measure in the Senate, Senate Bill 222, but it had not gotten a hearing as of March 14.
