Health insurance should help patients get the care they need. Yet for many women, coverage for medically necessary follow-up examinations can disappear precisely when a potential health problem requires further investigation.
Most women can get a routine screening mammogram without paying out of pocket. But when a screening identifies a possible abnormality, the next steps can carry significant out-of-pocket expenses. Diagnostic mammograms, breast ultrasounds, and MRIs may be medically necessary to determine whether a patient has cancer, yet patients can still face substantial costs for the follow-up care they need.
The bipartisan Access to Breast Cancer Diagnosis (ABCD) Act would address this coverage gap by requiring private health insurance plans to cover medically necessary diagnostic and supplemental breast examinations without deductibles, copayments, or coinsurance.
It is a targeted response to a real problem, and Congress should pass it.
The distinction between screening and diagnostic imaging matters. A screening mammogram is intended to identify potential problems in women who may have no symptoms. Diagnostic imaging is used to investigate an abnormal finding or evaluate a patient whose medical history or other risk factors warrant additional examination. Supplemental imaging can be particularly important for women with dense breast tissue or a family history of breast cancer.
These are not interchangeable services. Screening identifies a potential problem; diagnostic imaging helps determine what that problem means. Insurance coverage should recognize that the two are part of the same continuum of care.
The financial consequences extend well beyond the individual patient. In 2024, an estimated 1.1 million women delayed necessary diagnostic imaging because of cost. When patients postpone follow-up examinations, potentially serious conditions can go undiagnosed until symptoms worsen. Earlier diagnosis can mean more treatment options, less intensive interventions, and better chances of avoiding costly complications. The economic stakes are considerable, too. Advanced cancer brings greater demands on healthcare resources, more time away from work, lost productivity, and additional financial strain on families. Reducing the financial barriers to timely diagnosis is not just a matter of improving access. It is also a matter of avoiding costs that patients, employers, and the healthcare system may ultimately bear.
The problem also raises a broader question about how we structure insurance benefits. Healthcare policy frequently emphasizes prevention, but prevention cannot be separated from the diagnostic services that follow. Encouraging patients to get screened while leaving them exposed to substantial costs for medically necessary follow-up is an incomplete approach to preventive care.
The ABCD Act would make a sensible correction. It covers diagnostic mammograms, breast ultrasounds, and MRIs when medically necessary, including examinations prompted by an abnormal screening result or an elevated risk of breast cancer. It also recognizes that patients with high-deductible health plans should not have to choose between maintaining their coverage arrangements and obtaining necessary diagnostic care.
There are legitimate considerations whenever Congress requires insurers to cover additional services without cost-sharing. The underlying expense does not disappear. Insurers still pay for the examinations, and those costs are ultimately reflected in the broader economics of health coverage. But lawmakers should consider the full cost of delayed care, not just the immediate expense of an imaging appointment. If removing financial barriers helps patients obtain timely diagnoses and avoid more advanced disease, the investment could pay dividends through less intensive treatment, fewer complications, and reduced healthcare spending over time. The precise savings will depend on patient outcomes and how the policy is implemented, but the potential economic benefits deserve consideration alongside the cost of coverage.
The legislation also avoids an all-or-nothing approach to insurance oversight. It preserves insurers' ability to require timely prior authorization and impose appropriate utilization controls. The definition of covered examinations is tied to medical necessity and National Comprehensive Cancer Network guidelines. These provisions are important because expanding access should not mean abandoning clinical standards or encouraging unnecessary testing.
The bill also addresses a practical complication for people enrolled in high-deductible health plans. It provides a pathway for those plans to cover diagnostic and supplemental breast examinations before a deductible is met without jeopardizing eligibility for health savings accounts. That is a reasonable accommodation, particularly as more Americans rely on these plans to manage premiums and healthcare expenses.
None of this means the ABCD Act will solve every challenge in breast cancer care. It will not guarantee that patients can find an available specialist, eliminate disparities in access to screening, or make cancer treatment affordable. Nor should Congress assume that every additional insurance mandate is automatically justified. Coverage requirements deserve scrutiny, particularly when they affect premiums and the choices available to consumers.
But this legislation addresses a specific and identifiable problem with a relatively focused policy response. It does not establish a new federal healthcare program or dictate how physicians should practice medicine. It seeks to ensure that medically necessary diagnostic examinations are not subject to financial barriers that can interrupt the process of identifying a potentially serious disease.
The broader lesson extends beyond breast cancer. Preventive care is only as effective as the healthcare system that follows it. Policymakers should examine whether insurance coverage is coherent across the entire continuum of care, from initial screening to diagnosis and treatment. Patients should not be encouraged to take one step toward protecting their health only to encounter a financial obstacle at the next.
Good healthcare policy does not have to be sweeping to make a meaningful difference. Sometimes it means identifying a gap, addressing it carefully, and preserving reasonable safeguards along the way.
The ABCD Act meets that test. Congress should give patients a more straightforward path from an abnormal screening result to the answers they need. Lawmakers in both parties should move this legislation forward.
