Sponsors (11)
Introduced April 10, 2025 by Amy Klobuchar · Last progress April 10, 2025
The bill expands no-cost, flexible breast imaging access and standardizes eligibility to improve early detection and equitable care, but it increases public and private spending, risks overuse and false positives, and creates administrative burdens for states and some plan enrollees.
Medicare, Medicaid, TRICARE, VA, and Medicare Advantage beneficiaries will receive breast screening and diagnostic imaging with no cost-sharing, reducing out-of-pocket expenses and financial barriers to care.
Women and people at increased breast cancer risk gain no-cost access to screening and diagnostic imaging with no limits on frequency, improving chances of early detection and treatment.
Clinicians can order breast imaging based on individual risk factors (age, race, family history) even when a patient is not formally labeled 'increased risk,' expanding individualized access to earlier evaluation.
Taxpayers, federal programs, and private insurers will face increased spending to cover more imaging and eliminate cost-sharing, which could lead to higher taxes, premiums, or overall insurer costs.
Women and other patients could experience increased imaging use because of the no-frequency-limit policy, raising risks of false positives, unnecessary follow-up procedures, additional radiation exposure, and anxiety.
States may need to change laws or benefits and incur administrative and legislative costs to comply, potentially causing short-term gaps or implementation burdens for Medicaid benchmark plans.
Based on analysis of 2 sections of legislative text.
Adds a required coverage category forcing group/individual plans and Medicare inpatient services to cover breast cancer screening and diagnostic imaging (no frequency limits) using ACR/NCCN criteria and clinician judgment.
Revises the federal preventive services rule to add a required coverage category for breast cancer screening and diagnostic imaging for people with increased breast cancer risk and for others when a clinician determines imaging is needed. It reorganizes and relabels parts of the underlying statute for clarity, specifies covered imaging modalities (e.g., 2D/3D mammography, ultrasound, MRI, molecular breast imaging), and requires coverage without frequency limits, using the latest American College of Radiology or National Comprehensive Cancer Network criteria/guidelines to define increased risk.