Breast cancer screening is preventive health care. So why do some insurance plans refuse to fully cover the imaging that patients need?   

The issue, which has frustrated patients for years, has now prompted congressional action. The newly reintroduced Access to Breast Cancer Diagnosis, or ABCD, Act would require federally regulated health plans to cover diagnostic and supplemental breast imaging — fully, with no out-of-pocket cost to patients.  

The access, reassurance and peace of mind would mark a far cry from the scenario that many women and men find themselves in today. Unfortunately, the reality for many patients is far more complicated — and expensive — than simply getting screened.   

Say, for example, that a patient visits her doctor for a routine breast cancer screening. The results come back inconclusive. The patient needs additional imaging, such as a diagnostic mammogram ultrasound, or MRI, to get a clear picture to determine her need for a biopsy, leading to a timely diagnosis. Under the status quo, that patient could face insurmountable out-of-pocket expenses and red tape.   

Now consider a similar scenario. A patient is at high risk for breast cancer, either due to family history, a genetic mutation or perhaps dense breast tissue. So, the doctor recommends supplemental imaging, such as an ultrasound or MRI, rather than a mammogram. Here too, a patient could face unmanageable out-of-pocket costs to get the imaging required.   

In the U.S. alone, 116 women are expected to die from breast cancer every day this year. We know that early detection and treatment can save lives. Why, then, do patients still struggle to get the imaging that could lead to timely answers and treatment?  

In short, it’s because insurance providers are required to cover annual screening mammograms — but not the diagnostic or supplemental imaging that many people may also need — at no cost to the patient. For these equally necessary, equally preventive services, patients may face hundreds or even thousands of dollars of out-of-pocket expenses.  

Studies show that people with high out-of-pocket costs are less likely to follow through with the recommended imaging. Patients who feel they have no choice but to delay diagnostics and care do so at their own peril. Without receiving diagnostic and supplemental imaging, breast cancer can spread to other parts of the body, making it deadlier and costlier to treat.   

The ABCD Act will help. By requiring federally regulated health plans to cover diagnostic and supplemental breast imaging at no cost, the legislation can ensure that more people get the timely diagnoses they need.   

That includes patients with high-deductible health plans. These patients are often young and ostensibly healthy people who don’t anticipate needing much care. If they need diagnostic or supplemental breast imaging, they face a deductible that is often thousands of dollars higher than that of their peers on traditional commercial health plans.   

The ABCD Act not only reduces cost burdens but also could reduce disparities in care. Evidence shows that Black patients with breast cancer who are covered under federally regulated health plans are diagnosed at a later stage, and they have a higher mortality rate compared to their white counterparts with the same insurance. And Hispanic patients, alongside patients with a household income under $35,000, are more likely to skip their recommended follow-up appointment, according to recent data.  

This bill would reduce financial barriers to ensure that patients do not forgo or delay essential breast imaging. Moreover, it would do so without adversely impacting costs or premiums. To date, similar legislation eliminating patient cost-sharing for diagnostic and/or supplemental imaging for state-regulated plans has passed in 29 states. Many of these states have conducted analyses of the effect this policy change has on premiums. The impact on premiums was negligible.   

Affordable access to diagnostic and supplemental imaging is imperative to improving breast cancer outcomes in the U.S. and is also a cost-effective approach. The alternative is late-stage care, which may be more expensive, more invasive and less effective for patients.   

Smart policy solutions can change and even save lives. The time to act is now — because cost should never be a barrier to care for breast cancer patients.   

Dr. Eileen Barrett is the president of the American Medical Women’s Association. Molly Guthrie is vice president of policy and advocacy at Susan G. Komen.