Under the Affordable Care Act, health benefit plans must provide, at a minimum, coverage with no cost sharing, for preventive or wellness services that have a rating of A or B in the current recommendations of the United States Preventive Services Task Force (USPSTF). The USPSTF recommends, at a B grade, screening mammography, with or without clinical breast examination, every one to two years for women age 40 years and older.

Beginning January 1, 2024, for health plans that include coverage of supplemental breast examinations and diagnostic breast examinations, health carriers may not impose cost sharing for such examinations. 

"Diagnostic breast examination" means a medically necessary and appropriate examination, including an examination using diagnostic mammography, digital breast tomosynthesis, breast magnetic resonance imaging, or ultrasound, that is used to evaluate an abnormality seen or suspected from a screening examination for breast cancer, or detected by another means of examination.

"Supplemental breast examination" means a medically necessary and appropriate examination, including an examination using digital breast tomosynthesis, breast magnetic resonance imaging or ultrasound, that is used to screen for breast cancer based an individual's personal or family medical history, or additional factors that may increase the individual's risk of breast cancer.

• Adds digital breast tomosynthesis to list of diagnostic and supplemental breast exams to be covered without cost-sharing.
• Amends current statutes requiring diagnostic mammography coverage to require the coverage without cost-sharing.

The committee recommended a different version of the bill than what was heard. PRO: Additional screening is often needed after a mammogram to determine if an abnormality is cancerous and to evaluate treatment options. Patient out-of-pocket costs can be high for supplemental screenings, and delaying care because of cost can result in worse health outcomes.

CON: The federal government is currently evaluating supplemental screening options. The state should wait for the federal review to be completed as well as further evaluate the fiscal impact to the state.

PRO: Screenings for cancer are so expensive that some women do not get screened. Lower to moderate income patients often skip diagnoses until major symptoms occur to avoid high out-of-pocket costs, which results in poorer health outcomes. Widespread screening mammography is available free of cost, but mammograms don’t catch all instances of breast cancer.
 
CON: There are several pieces of proposed legislation in the process that will affect healthcare costs. These should not be considered in isolation, but in tandem.