Access to Breast Cancer Diagnosis Act of 2025
- Bill Number
- S. 1500
- Origin Chamber
- Senate
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-04-28: Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
- Last Updated
- 2026-06-03T11:03:23Z
AI-Generated Summary
Purpose
The Access to Breast Cancer Diagnosis Act of 2025 aims to remove financial barriers to essential breast cancer screening and diagnosis by requiring health insurance plans to cover diagnostic and supplemental breast examinations without any out-of-pocket costs to patients, such as deductibles or copayments. This promotes early detection of breast cancer, particularly for at-risk individuals.
Key Provisions
- Coverage Requirement: Group health plans and health insurance issuers offering group or individual coverage must provide benefits for diagnostic and supplemental breast examinations without imposing cost-sharing requirements (e.g., deductibles, coinsurance, copayments, or out-of-pocket maximums) if the plan covers these services.
- Exceptions and Flexibility:
- Plans can still require prior authorization (pre-approval) or other reasonable controls to manage coverage.
- The law does not override state laws that offer stronger protections for these examinations.
- Definitions:
- Diagnostic breast examination: A medically necessary test (e.g., diagnostic mammography, breast MRI, or ultrasound) to evaluate an abnormality detected during screening or by other means, following guidelines from the National Comprehensive Cancer Network (a group of cancer experts that sets treatment standards).
- Supplemental breast examination: A medically necessary test (e.g., breast MRI or ultrasound) for high-risk screening when no abnormality is suspected, based on personal or family history or other risk factors like genetics.
- Application to Specific Plans:
- Extends to "grandfathered" plans (older plans exempt from some Affordable Care Act rules) by adding this coverage mandate.
- Includes a "safe harbor" for high-deductible health plans paired with health savings accounts (HDHPs/HSAs), allowing these plans to waive deductibles for these exams without losing tax-advantaged status.
- Effective Date: Applies to plan years starting on or after January 1, 2026.
Significant Changes to Existing Law
- Amends Subpart II of Part A of Title XXVII of the Public Health Service Act (part of the Affordable Care Act, or ACA) by adding a new section (2730) that mandates no-cost coverage specifically for diagnostic and supplemental breast exams, building on existing ACA rules for preventive services but extending protections to follow-up and high-risk screenings.
- Updates the ACA's grandfathered plan provisions to include this new requirement, closing a loophole for older plans.
- Modifies the Internal Revenue Code to exempt these no-deductible exams from HDHP rules, ensuring compatibility with tax benefits for savings accounts used for medical expenses.
- This introduces a targeted expansion beyond general preventive care mandates, focusing on breast cancer diagnostics without altering broader cost-sharing rules.
Potential Impacts
- On Citizens: Reduces financial hurdles for women undergoing breast exams, potentially leading to earlier breast cancer detection, better health outcomes, and less medical debt, especially for those with family history or higher risk factors.
- On Government Agencies: The Department of Health and Human Services (HHS) and other federal enforcers will oversee compliance through existing ACA mechanisms, possibly increasing administrative workload for audits and guidance but promoting public health goals.
- On Health Insurers and Plans: May raise short-term costs due to increased utilization of exams, but could lower long-term expenses by preventing advanced-stage cancers; insurers retain tools like prior authorization to control overuse.
- On International Relations: Minimal direct impact, though it aligns U.S. health policy with global efforts to improve women's cancer screening access.
Main Stakeholders Affected
- Patients and Individuals: Primarily women at average or elevated risk for breast cancer, who gain cost-free access to diagnostic follow-ups and supplemental screenings.
- Health Insurance Issuers and Group Health Plans: Employers and insurers must adjust policies to eliminate cost-sharing, affecting plan design and premiums.
- Healthcare Providers: Radiologists, oncologists, and imaging centers benefit from higher screening volumes but may face more prior authorization requests.
- Federal and State Governments: HHS enforces the rules; states with stronger laws retain flexibility.
- Advocacy Groups: Organizations focused on breast cancer awareness (e.g., those aligned with National Comprehensive Cancer Network guidelines) stand to support broader preventive care.
Notable Legal, Constitutional, or Political Implications
- Legal: Strengthens ACA frameworks by integrating with existing no-cost preventive services (like initial mammograms) while allowing state variations, reducing potential litigation over coverage denials; definitions tied to expert guidelines (National Comprehensive Cancer Network) provide clear, evidence-based standards to minimize disputes.
- Constitutional: No major challenges anticipated, as it involves federal regulation of interstate commerce in health insurance under Congress's Commerce Clause authority, similar to other ACA provisions upheld by courts.
- Political: Introduced with bipartisan sponsorship (Democrats and Republicans), it reflects consensus on women's health issues without broad fiscal controversy; effective date allows preparation time, potentially easing implementation debates in Congress.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (10)
Sen. Britt, Katie Boyd [R-AL], Sen. Capito, Shelley Moore [R-WV], Sen. Ossoff, Jon [D-GA], Sen. Wicker, Roger F. [R-MS], Sen. Schiff, Adam B. [D-CA], Sen. Whitehouse, Sheldon [D-RI], Sen. Gillibrand, Kirsten E. [D-NY], Sen. Fetterman, John [D-PA], Sen. Kelly, Mark [D-AZ], Sen. Warnock, Raphael G. [D-GA]
Recent Actions
- 2025-04-28: Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
- 2025-04-28: Introduced in Senate
Bill Versions
- Access to Breast Cancer Diagnosis Act of 2025 — issued 2025-04-28 — PDF (5 pages)