Sponsor
Sheila Cherfilus-McCormick
Representative · D-FL
The bill expands no‑cost testing for Lp(a) and ApoB to improve early detection and prevention of cardiovascular disease, particularly for high‑risk and publicly insured groups, while increasing short‑term costs for payers and governments and risking overdiagnosis and downstream care burdens.
People at elevated cardiovascular risk (those with family or personal history, and heart disease patients) gain broader access to lipoprotein(a) and apolipoprotein B testing, enabling earlier detection and targeted follow-up interventions.
Medicare, Medicaid, and many private-plan enrollees will receive these tests without cost-sharing, reducing out-of-pocket costs for older adults, low-income people, and many middle-class families.
Requiring coverage across payers could improve population-level risk stratification and prevention, potentially lowering future heart attack and stroke rates and easing long‑term burden on health systems.
Expanding testing and mandated coverage will raise near‑term costs for health plans, state Medicaid programs, and taxpayers, which could translate into higher premiums or state budget pressure.
Wider testing of markers with uncertain incremental benefit may increase follow‑up care, overdiagnosis, and patient anxiety, creating additional downstream medical costs and utilization.
Requiring states' benchmark Medicaid plans to include these tests reduces state flexibility to control costs and may strain state Medicaid budgets.
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 factors and eliminates Medicare/Medicaid cost sharing for those tests.
Representative · D-FL
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) as a preventive service for people with specified cardiovascular risk histories or diagnoses, and eliminates cost sharing for those tests under Medicare and Medicaid. The coverage requirement starts for plan years and Medicare/Medicaid items furnished 180 days after enactment and makes Medicaid coverage for eligible individuals mandatory under the program rules amended by the bill.