House bill looks to extend breast cancer exam coverage, eliminate patient costs

A state representative wants to broaden that coverage in 2024 to include diagnostic breast exams.

Rep. Gina Curry, D-Delaware County, introduced House Bill 1944, a proposed amendment to the commonwealth's Insurance Company Law.

The bill's 23 co-sponsors, all Democrats, include House Speaker Joanna McClinton, D-Philadelphia/Delaware, and House Democratic Caucus Chair Mike Schlossberg, D-Lehigh.

Curry's proposal would add diagnostic exams as the minimum coverage required by insurance providers. It would also require coverage of multiple supplemental screenings, extending coverage authorized by Act 1 of 2023 which requires coverage of one screening annually.

An estimated 12,830 Pennsylvanians are expected to be diagnosed with breast cancer this year, according to the American Cancer Society. The group anticipates 1,870 will die from the disease in the commonwealth, the fifth-highest estimate in the nation.

Act 1 of 2023 provided supplemental MRI and ultrasound coverage for women with a personal history of atypical breast histologies, personal or family history of breast cancer, genetic predisposition for breast cancer, prior therapeutic thoracic radiation therapy, and extremely dense or heterogeneously dense breast tissue. It also requires coverage for BRCA-related genetic counseling.

The law took effect Jan. 1. Implementation for large group plans, those covering more than 50 employees in work-based plans, is underway and is expected to continue through July 1. Coverage under individual plans and small group plans, 50 employees or less, is slated to begin Jan. 1, 2025. The act doesn't cover self-insured plans, which are subject to federal law.

The positivity around the push to adopt Act 1 helped inspire the new proposal, Curry said Friday. And, so did personal experience. She said her mother had breast cancer and that she had her own breast cancer scare that ultimately resulted in a negative diagnosis.

In the process of exploring her own health, she said she was grateful to have had good insurance to largely cover much of the cost of imaging. Others aren't as fortunate.

"If I didn't have good insurance at that time or if I was unemployed, I wouldn't have gotten that diagnostic imaging that was necessary for many years after 2018," Curry said.

Act 1 was introduced by Senate President Pro Tempore Kim Ward, R-Westmoreland. She pushed for the legislation after surviving breast cancer herself and learning about different gaps in insurance coverage.

"Last year, Pennsylvania became the first state in the nation in the advancement of breast cancer early detection by passing Act 1. This landmark legislation covers all costs associated with genetic testing and counseling as well as breast MRI and ultrasounds for Pennsylvanians at high risk covered under state law," said Erica Clayton Wright, Ward's communications director. "This year, the implementation process begins. Our focus is to ensure that everyone in Pennsylvania understands what is now covered by this new law. As we move forward, we will identify opportunities and stumbling blocks that we will carefully and thoughtfully consider as we advance our next phase of early detection efforts with the hope to ultimately eradicate this deadly disease that affects 1 in 8 women in Pennsylvania."

House Bill 1944 would add diagnostic examinations, those conducted based on concerning results of a mammogram or when patients exhibit symptoms like a lump or pain in their breasts.

In a co-sponsorship memo for her bill, Curry cited a 2019 study commissioned by the Susan G. Komen breast cancer foundation that estimated the average out-of-pocket costs for diagnostic exams at $234 to $1,100. According to the memo, at least 20 states adopted laws similar to her proposal.

Nicole Reigelman, McClinton's press secretary, said Act 1 is an example of bipartisanship in state government. Still, she said even with expanded access, out-of-pocket costs remain a barrier for diagnostic breast exams and supplemental breast screenings. Curry's bill, she said, will fill the gap and save lives.

"This bill is newly introduced, and like any piece of legislation, it will require many discussions among lawmakers and stakeholders. As a co-sponsor, Speaker McClinton is proud to support the bill and to help advocate for its consideration and passage," Reigelman said.

Curry is a member of the House Appropriations Committee. Budget talks are on the horizon and she said she'll take time to pitch her proposal to colleagues including Republican lawmakers. She also intends to reach out to Senate Republicans.

"I think we can get this done," Curry said, noting that breast cancer is not a women's health issue on which Democrats and Republicans are split. "This is good, sensible legislation. When we talk about saving lives of women and potentially men, it's a space where we are doing a preventative action for the people of this commonwealth."