Sponsor
Sheila Cherfilus-McCormick
Representative · D-FL
Representative · D-FL
The bill broadens no‑cost testing for lipoprotein(a) and apolipoprotein B to improve early detection and prevention of cardiovascular disease—particularly helping seniors and low‑income patients—while likely increasing near‑term public and private healthcare spending and raising risks of overdiagnosis and state budget strain.
Patients with a family or personal history of cardiovascular disease — and people with otherwise undiagnosed high Lp(a) or ApoB — will receive covered testing, improving early detection and enabling earlier risk management.
Medicare and Medicaid beneficiaries (and, after 180 days, private plan enrollees who meet risk criteria) will not owe cost‑sharing for these tests, reducing out‑of‑pocket costs for seniors and low‑income people.
Heart attack survivors will benefit from stronger follow‑up and risk management emphasis, which could reduce the high five‑year post‑MI mortality risk.
Taxpayers, state governments, insurers, and insured families could face higher short‑term costs from increased testing and follow‑up, which may lead to higher premiums or greater state Medicaid spending.
Patients may experience increased anxiety, downstream follow‑up, and potential overdiagnosis or unnecessary interventions from more testing when clinical management of some elevated markers is still uncertain.
States required to adopt these tests in benchmark Medicaid plans lose flexibility to control costs, possibly straining state budgets and limiting other program choices.
Based on analysis of 3 sections of legislative text.
Requires private plans, Medicare, and Medicaid to cover Lp(a) and ApoB testing for people with specified cardiovascular risk and removes Medicare/Medicaid cost sharing.
Official title: To amend title XXVII of the Public Health Service Act and titles XVIII and XIX of the Social Security Act to require coverage of certain cardiovascular tests without cost sharing under group health plans, group and individual health insurance coverage, and the Medicare and Medicaid programs.
Introduced April 14, 2026 by Sheila Cherfilus-McCormick · Last progress April 14, 2026
Requires private group and individual health plans, Medicare, and Medicaid to cover testing for lipoprotein(a) (Lp(a)) and apolipoprotein B (ApoB) for people with specified cardiovascular risk factors or diagnoses, and eliminates beneficiary cost-sharing for those tests under Medicare and Medicaid. The coverage requirement takes effect for plan years and items/services furnished beginning 180 days after enactment. Also includes congressional findings about the prevalence and risk of elevated Lp(a) and ApoB and their role in predicting cardiovascular disease, but contains no additional program authorizations or direct appropriations.