Bill would expand coverage for breast cancer screening for Iowans

About a quarter of Iowans would no longer pay co-paymentss and deductibles for supplemental and diagnostic breast exams under legislation that unanimously passed the Iowa House and advanced March 12 in the Iowa Senate.

House File 318 eliminates cost-sharing requirements for supplemental breast examinations and diagnostic breast examinations, the same as for mammograms.

Supporters say the measure has the potential to save lives by reducing financial barriers to early cancer detection for Iowans who need a follow-up magnetic resonance imaging — or MRI — in addition to an annual screening for breast cancer. Insurers contend it would lead to increased health care costs, citing a fiscal analysis estimating a $443,000 to $1.4 million impact on the State of Iowa Plan and the Iowa Board of Regents insurance plan.

Jackie Cale, a lobbyist for the American Cancer Society Cancer Action Network, said out-of-pocket costs for follow-up imaging tests can average $234 for a diagnostic mammogram. A breast MRI can cost upward of $1,000.

"Unexpected and unaffordable care costs may cause individuals to forego or delay additional imaging," Cale told Senate lawmakers March 12 during a hearing. "The elimination of cost sharing is associated with increased cancer screening. We all know Iowa has an extremely high rate of cancer in this state, so we appreciate you bringing this bill forward, and we urge you to support it."

Iowa has the fastest-growing rate of new cancers in the nation and ranks second-highest in cancer rates — behind Kentucky — compared with other states, according to the Iowa Cancer Registry. The state's cancer incidence rate has increased in each of the last three five-year reporting periods.

Alimyon Allen, state policy manager at Susan G. Komen Foundation, said mammography alone cannot diagnose cancer — additional imaging is needed for accurate detection. Patients who delay follow-up imaging risk having cancer spread, making treatment more difficult and expensive.

Allen mentioned a study she said showed that 1 in 5 patients might skip follow-up imaging due to costs, telling lawmakers that it's essential to lower health care costs by ensuring early detection. While the legislation may increase insurance costs slightly, Allen said similar laws in 27 states have had minimal effects on premiums.Matt McKinney, a lobbyist representing the Federation of Iowa Insurers, said insurers are not against people accessing the services they need. However, the bill fails to address the actual cost of care, McKinney said.

As it stands, he said providers will continue to charge as they do now. Patients won't pay a cost share, leading to the costs being distributed among everyone in the plan. Consequently, health care insurance costs for everyone would increase, McKinney said.

A fiscal note from the nonpartisan Legislative Services Agency estimates the legislation would increase annual costs to the state ranging between $443,000 and $1.4 million. It is anticipated that the lower end of this range is more likely to occur, the agency said.

The state provides free preventive and screening mammograms, ultrasounds and MRIs in nearly all cases to covered state employees, with mammograms making up the majority of the preventive imaging services covered. The same services for diagnostic purposes apply plan-specific cost-sharing. Shifting the cost from plan members to the entire plan may result in increased insurance costs, according to agency.

It estimates about 25 percent of the state's population, or about 806,000 Iowans, would be covered under the legislation. That includes those with individual coverage, fully insured small- and large-employer groups, self-insured public employees and the State of Iowa Plan.

Those not covered under the bill include those covered by government-sponsored health insurance, those who receive insurance through an employer governed by the federal Employee Retirement Income Security Act of 1974 and those who are uninsured.

McKinney noted Iowa Medicaid, which is not covered under the bill, has cost-sharing requirements for some services — meaning members may be required to pay a portion of the cost. Cost sharing for most services is limited to nominal or minimal amounts, and the maximum co-payment that Medicaid may charge is based on what the state pays for that service.

Plans offered on the individual health insurance marketplace also require cost-sharing for health care services, including deductibles, co-payments and coinsurance, and can be reduced through reductions for those who qualify.

"And that is a mandate from the federal government, because we have to keep that cost-share in check," said Brandon Geib, a lobbyist representing Wellmark.

"And so our actuaries at Wellmark do a good job trying to align what the plan covers to match those different cost shares," Geib said. "But when the Legislature comes in and makes a certain service free — and, again, an important service — but when it's made free, something else has to get more expensive. And so we begin the process of picking winners and losers of which services matter more than others, and that's generally what this bill seems to be doing today."

McKinney likewise raised concern that the bill opens the door to eliminate cost-sharing requirements in the future for supplemental or diagnostic screenings for other cancers and chronic diseases.

"Where do you where do you draw the line? And that's where our concern exists," he told lawmakers.

All three members of a Senate subcommittee signed off Wednesday on advancing the bill to the Senate Commerce Committee.

"I think it's life saving, and that's my biggest concern — is making sure that Iowans are getting the testing that they need and we're doing as much as possible to help prevent loss of life," Sen. Janet Petersen, D-Des Moines said.

Sen. Kara Warme, R-Ames, said both her mother and father are breast cancer survivors, and as a result is at higher risk.

She said she's interested in looking further at the effects of similar laws in other states, to see whether early detection has helped lower overall treatment costs that might offset the cost of screening.

"So I think it warrants further discussion and investigation for sure," Warme said.