Mass. Senate passes bill expanding coverage for breast cancer screenings
Photo I Courtesy of National Cancer Institute/State House News Service
The new bill requires health insurers, including MassHealth, to cover diagnostic exams for breast cancer.
Legislation expanding access to more rigorous follow-up breast cancer screenings and exams, particularly for patients with abnormal results or dense breast tissue, cleared the Senate Monday after winning House approval in July.
The Senate-passed bill (H 4918) requires health insurers, including MassHealth, to cover diagnostic exams for breast cancer, digital breast tomosynthesis (DBT) screening, and "medically necessary and appropriate screening" with breast MRIs and ultrasounds.
Women are able to access preventive screening mammograms due to the Affordable Care Act. But lawmakers and cancer advocates say patients who need additional screenings and exams may be forced to forego doctors' orders due to steep out-of-pocket costs, which could tally hundreds or thousands of dollars.
Sen. Joan Lovely, who said she has dense breast tissue and needs 3D mammography in order for radiologists to properly screen her, said the bill will save lives by catching breast cancer early.
"This bill prohibits any increase in patient cost-sharing, as in deductibles and copayments for these diagnostic exams, and does not require pre-authorization," Lovely said prior to the Senate vote. "So really, this does really open up this latest technology to everyone who might need a 3D mammography, which is really state of the art."
The House passed its version of the bill in late July. The bills are largely similar, though the House version would take effect on Jan. 1. 2025, compared to the Senate implementation date of Jan. 1, 2026.
The bill is endorsed by the Dana-Farber Cancer Institute, Susan G. Komen breast cancer organization, the Massachusetts Radiological Society and the American Cancer Society, Lovely said.
The society describes DBT as "modern mammography" that "acquires volumetric imaging of the breast" and "provides a clearer and more accurate view compared to traditional mammography." DBT offers clearer and more accurate images for women with dense breast tissue, provides earlier detection of small breast cancers, and results in fewer unnecessary biopsies and tests, according to MRS.
Sen. Mike Rush said one in 10 women require follow-up screenings after initial mammograms. Rush said many patients cannot afford those out-of-pocket costs, as he invoked a $1,000 price tag, based on a Susan G. Komen study.
"These costs create huge health disparities across income and racial lines," Rush said. "Women with lower incomes or whose work insurance may provide less comprehensive coverage, which is disproportionately true of women of color, may delay or never pursue a follow-up. We know how important it is to identify and begin treatment quickly when fighting cancer, and any failure or delay in catching these signs can be fatal. No woman should have to die because they had to choose between paying to keep a roof over their head or food in their children's mouth, and their medically necessary cancer screenings."
More than 4,000 women in Massachusetts have died from breast cancer since 2016, Rush said. He called the bill "morally necessary and fiscally responsible," pointing to a study from the Center for Health Information and Analysis that found the insurance change could raise monthly premiums by 19 to 33 cents for members.
Sen. Walter Timilty said the expanded insurance coverage would enable Massachusetts to better care for vulnerable residents, and he also touted the life-saving reach of the bill.
"It is how we are judged: How do we treat those in our society who are ill, who are suffering, and do not have the means to provide for their own medical care?" said Timilty.
Senators on Monday also passed legislation (S 2970) requiring health insurance coverage of different types of therapy, including applied behavioral analysis (ABA) therapy, for individuals with Down syndrome. The House has not taken up the bill yet.
Sen. Julian Cyr said ABA therapy allows children with intellectual disabilities and learning differences to develop skills such as speaking, playing, making friends, feeding, dressing and going to the bathroom, as well as manage challenging or unsafe behaviors like self-injury. For now, he said access to the therapy is limited to children whose parents are able to navigate the complex health insurance system or afford to pay out of pocket.
"The average course of treatment for ABA services includes between 10 and 20 hours per week, for a total across about 12 months, which would, at roughly $120 an hour, result in quite a hefty price tag for families who are paying privately," Cyr said. He added the bill would promote "equitable access of this transformative therapy."
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