Idaho bill to require coverage of supplemental breast cancer screening to at-risk patients advances

BOISE — A bill that would require private Idaho health insurers to cover supplemental breast cancer screenings for high-risk patients has advanced to the House floor.

On Monday, House Health and Welfare Committee members voted 13-2 to pass House Bill 134. Co-presented by Reps. Brooke Green, D-Boise, and Dori Healey, R-Boise, the legislation would require private Idaho health insurers to provide coverage for supplemental breast cancer screenings for patients who do not benefit from standard mammograms. Examples include patients who are genetically predisposed to cancer, patients with BRCA1 or BRCA2 gene mutations or those with dense breast tissue. BRCA1 and BRCA2 are "genes that produce proteins that help repair damaged DNA," according to the National Cancer Institute.

The sponsors opted to exclude Medicaid coverage because of recent scrutiny by the Legislature over Medicaid costs, Healey said.

Healey, an advanced practice registered nurse, spoke to the bipartisan collaboration between herself and Green, arguing the current obstacles to screening are a "much higher issue than politics."

"Despite this clear medical necessity, many private insurance companies do not cover this, forcing women to either pay thousands of dollars out-of-pocket, or go without these screenings altogether," Healey said. "We found this as an unacceptable gap in health care, and it's one we knew we had to address."

Green herself has been absent for much of the current session, due to her own ongoing battle with cancer. She argued that preventative care saves lives and finances in the long run.

"This bill's targeted application ensures imaging only is used for patients who are clinically required, maintaining our evidence-based and cost-effective principle of preventative care," Green said. "Failing to cover these services creates gaps in the preventative care process, undermining the initial benefits of that initial screening."

As of 2024, Idaho ranks 50th in the nation for breast cancer screening, with over 9,600 Idahoans living with an active diagnosis, according to the Idaho Department of Health and Welfare. One in eight women in the U.S. will be diagnosed with breast cancer in her lifetime, making the disease the most common cancer diagnosis for women in the country, as found by the National Breast Cancer Foundation.

Not a seat was left empty in the committee room as members of the public came to testify in overwhelming support, with all registered testifiers speaking in favor of passing the bill. Emotions were high as many shared their own personal stories and struggles with breast cancer, the loss of family and friends and the high cost of treatment.

Dr. Barbara White, a diagnostic breast radiologist based in Meridian, spoke to the life-saving effects of preventative care, and the unfortunately high costs that have led many of her own patients to turn down treatment.

"Every day I hear from women that they are forced to turn down adjunct screening because of the out-of-pocket costs," White said. "Let me be clear, if we detect one case of early breast cancer through adjunct screening, the financial cost of that screening is more than justified through the savings from chemotherapy alone. We need to understand that the cost of not providing adjunct screening is far higher than the cost of screening itself."

Amber Mausling, a Boise resident, detailed her harrowing experience as a patient trying to receive answers about her own health.

"I know firsthand how critical enhanced breast screening options are, because my life was put at risk due to their absence," Mausling said.

Mausling went to a doctor in 2023 after she experienced bleeding from her right breast, consequentially going through a monthslong back-and-forth process of tests and unfruitful basic screenings.

Despite this, Mausling said she was never offered advanced screening options by doctors.

"I waited 10 months for a diagnosis, all while my cancer remained undetected," Mausling said. "Time that I did not have was wasted, prolonging my fear, anxiety and ultimately delaying the treatment I needed. Had I been given access to an MRI, or other advanced screening options from the start, my diagnosis could have come much sooner, and I might have avoided 16 rounds of chemotherapy and a bilateral mastectomy."

Questions from committee members primarily focused on the bill's fiscal impact, a concern which Rep. Lucas Cayler, R-Caldwell, said led to his decision to vote against the bill.

"From the standpoint of fiscal conservatism, I stand opposed to legislation that expands government mandate into private health care, and anything that grows the need to fund more tax dollars," Cayler said.

Rep. Lori McCann, R- Lewiston, argued that fiscal and social responsibility go hand in hand with the bill.

"I too have been touched by cancer," McCann said. "For me, the fiscal responsibility is to save lives. If this grows government then so be it. It is that important."

HB 134 now heads to the House chamber for full consideration.