Access to Breast Cancer Diagnosis Act of 2025
- Bill Number
- H.R. 3037
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-04-28: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- Last Updated
- 2026-06-30T08:07:01Z
AI-Generated Summary
Purpose
The Access to Breast Cancer Diagnosis Act of 2025 aims to ensure that health insurance covers certain breast exams without patients paying out-of-pocket costs (known as cost-sharing). This helps people get follow-up tests for breast cancer detection more easily, building on existing laws that already cover basic screening mammograms for free.
Key Provisions
- No Cost-Sharing for Specific Exams: Group health plans and health insurance companies offering group or individual coverage must cover diagnostic breast examinations and supplemental breast examinations without requiring patients to pay deductibles (the amount you pay before insurance kicks in), coinsurance (a percentage of costs), copayments (flat fees per service), or similar expenses.
- Diagnostic breast examination: A medically necessary test (following guidelines from the National Comprehensive Cancer Network, a group of cancer experts) to check for breast abnormalities spotted during a routine screening or by other means. This includes mammograms, breast MRIs, or ultrasounds used for diagnosis.
- Supplemental breast examination: A medically necessary test (also per those guidelines) to screen high-risk people who show no abnormalities, based on personal or family history or other risk factors. This includes MRIs or ultrasounds.
- Flexibility for Insurers: Plans can still require prior approval (authorization before the test) or other reasonable limits to manage coverage, as long as they don't block necessary care.
- State Laws: The bill doesn't override stronger state protections for these exams.
- Application to Special Plans:
- Applies to "grandfathered" plans (older plans exempt from some Affordable Care Act rules).
- For high-deductible health plans paired with Health Savings Accounts (tax-advantaged savings for medical costs), there's a "safe harbor" rule: These plans won't lose eligibility just because they waive deductibles for these breast exams.
- Effective Date: Changes apply to health plan years starting on or after January 1, 2026.
Significant Changes to Existing Law
- Amends the Public Health Service Act (part of the Affordable Care Act framework) by adding a new section (2730) that extends no-cost coverage from preventive screenings to diagnostic and supplemental breast exams, which previously might have involved patient costs.
- Updates the Affordable Care Act to include these requirements for grandfathered plans.
- Modifies the Internal Revenue Code to protect high-deductible plans from tax penalties when covering these exams without deductibles, promoting broader access without disrupting tax benefits.
Potential Impacts
- On Citizens: Improves access to potentially life-saving follow-up tests, especially for women with risk factors, by removing financial barriers. This could lead to earlier breast cancer detection and better health outcomes, reducing delays in care.
- On Health Insurers and Plans: May increase short-term costs for covering more exams without patient contributions, but could lower long-term expenses through early intervention and fewer advanced treatments.
- On Government Agencies: The Department of Health and Human Services (HHS) will enforce coverage rules, while the Internal Revenue Service (IRS) will adjust tax guidelines for Health Savings Accounts. Minimal administrative burden, as it builds on existing systems.
- On International Relations: No direct impact, as this is a domestic health policy focused on U.S. insurance markets.
Main Stakeholders Affected
- Patients: Primarily women seeking breast cancer screenings or follow-ups, including those with family history or higher risk.
- Health Insurance Issuers and Employers: Companies providing group coverage and individual insurers must comply, potentially adjusting premiums or processes.
- Healthcare Providers: Doctors and facilities offering mammograms, MRIs, or ultrasounds benefit from increased patient access but may face more utilization reviews.
- High-Risk Groups: Individuals with high-deductible plans or grandfathered coverage gain clearer protections.
Notable Legal, Constitutional, or Political Implications
- Legal: Strengthens Affordable Care Act preventive care mandates by clarifying coverage for diagnostic steps beyond initial screenings, potentially reducing disputes over "medically necessary" claims. Aligns with National Comprehensive Cancer Network guidelines as a standard for appropriateness, providing a clear benchmark for courts.
- Constitutional: No major issues; it regulates interstate commerce in health insurance under Congress's established authority, without infringing on free speech, privacy, or state rights (explicitly preserves stronger state laws).
- Political: Introduced with bipartisan support (Democrats and Republicans), reflecting broad agreement on women's health issues. Could set precedent for expanding no-cost coverage to other diagnostic tests, influencing future health reform debates.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (48)
Rep. Fitzpatrick, Brian K. [R-PA-1], Rep. Wasserman Schultz, Debbie [D-FL-25], Rep. Doggett, Lloyd [D-TX-37], Rep. Moore, Gwen [D-WI-4], Del. Norton, Eleanor Holmes [D-DC-At Large], Rep. Stansbury, Melanie A. [D-NM-1], Rep. Moulton, Seth [D-MA-6], Rep. Hayes, Jahana [D-CT-5], Rep. Kennedy, Timothy M. [D-NY-26], Rep. Larson, John B. [D-CT-1], Rep. Tonko, Paul [D-NY-20], Rep. Clarke, Yvette D. [D-NY-9], Rep. McClellan, Jennifer L. [D-VA-4], Rep. Lawler, Michael [R-NY-17], Rep. Craig, Angie [D-MN-2], Rep. Bresnahan, Robert P. [R-PA-8], Rep. Kelly, Robin L. [D-IL-2], Rep. Kean, Thomas H. [R-NJ-7], Rep. Peters, Scott H. [D-CA-50], Rep. Landsman, Greg [D-OH-1], Rep. Tlaib, Rashida [D-MI-12], Rep. Van Duyne, Beth [R-TX-24], Rep. Lynch, Stephen F. [D-MA-8], Rep. Pocan, Mark [D-WI-2], Rep. McBath, Lucy [D-GA-6], Rep. Tenney, Claudia [R-NY-24], Rep. Gottheimer, Josh [D-NJ-5], Rep. Kim, Young [R-CA-40], Rep. Neguse, Joe [D-CO-2], Rep. Trahan, Lori [D-MA-3], Rep. Elfreth, Sarah [D-MD-3], Rep. Barragán, Nanette Diaz [D-CA-44], Rep. Raskin, Jamie [D-MD-8], Rep. Schrier, Kim [D-WA-8], Rep. LaLota, Nick [R-NY-1], Rep. Pingree, Chellie [D-ME-1], Rep. Morelle, Joseph D. [D-NY-25], Rep. Johnson, Julie [D-TX-32], Rep. Miller, Max L. [R-OH-7], Rep. Goldman, Daniel S. [D-NY-10], Rep. Davis, Donald G. [D-NC-1], Rep. Ross, Deborah K. [D-NC-2], Rep. Houlahan, Chrissy [D-PA-6], Rep. Van Drew, Jefferson [R-NJ-2], Rep. Stevens, Haley M. [D-MI-11], Rep. Leger Fernandez, Teresa [D-NM-3], Rep. Wilson, Joe [R-SC-2], Rep. Bacon, Don [R-NE-2]
Recent Actions
- 2025-04-28: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-04-28: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-04-28: Introduced in House
- 2025-04-28: Introduced in House
Bill Versions
- Access to Breast Cancer Diagnosis Act of 2025 — issued 2025-04-28 — PDF (5 pages)