Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
This bill (Access to Breast Cancer Diagnosis Act of 2025) requires group health plans and individual or group market issuers that provide diagnostic or supplemental breast examinations to eliminate patient cost-sharing for those services. It defines diagnostic and supplemental breast examinations consistent with National Comprehensive Cancer Network guidelines, allows prior authorization and other utilization controls, preserves stronger State protections, applies to grandfathered plans, and creates a safe harbor so HDHPs remain HSA-eligible despite lacking a deductible for these exams.
Progressives emphasize access and equity gains
Relative to its intended legislative type, this bill is a concise substantive policy statute that clearly defines a prohibition on cost-sharing for diagnostic and supplemental breast examinations and integrates that prohibition into related statutory regimes (ACA grandfathering and HSA/HDHP rules).
This bill (Access to Breast Cancer Diagnosis Act of 2025) requires group health plans and individual or group market issuers that provide diagnostic or supplemental breast examinations to eliminate patient cost-sharing for those services.
It defines diagnostic and supplemental breast examinations consistent with National Comprehensive Cancer Network guidelines, allows prior authorization and other utilization controls, preserves stronger State protections, applies to grandfathered plans, and creates a safe harbor so HDHPs remain HSA-eligible despite lacking a deductible for these exams.
The amendments apply to plan years beginning January 1, 2026.
Technically modest, broadly sympathetic public health change with built-in compromises; fiscal impacts and procedural hurdles create residual uncertainty.
Relative to its intended legislative type, this bill is a concise substantive policy statute that clearly defines a prohibition on cost-sharing for diagnostic and supplemental breast examinations and integrates that prohibition into related statutory regimes (ACA grandfathering and HSA/HDHP rules).
Progressives emphasize access and equity gains
These are examples from the analysis, not a ranked list of the most-affected groups.
Progressives emphasize access and equity gains
Likely strongly supportive: removes financial barriers for guideline-based diagnostic and risk-based supplemental breast imaging, improving early detection equity.
Concern about prior authorization misuse and narrow medical-necessity interpretation, but overall sees the bill as advancing access.
Generally favorable but pragmatic: supports removing patient cost-sharing for targeted breast diagnostics while seeking cost and implementation safeguards.
Wants evidence on fiscal and administrative impacts and assurances against gaming of utilization controls.
Skeptical: views the bill as a federal insurance mandate that reduces plan design flexibility and could raise premiums.
May accept narrow, evidence-based benefits but objects to applying mandate to grandfathered plans without stronger cost offsets.
Reached or meaningfully advanced
Reached or meaningfully advanced
Still ahead
Still ahead
Still ahead
Technically modest, broadly sympathetic public health change with built-in compromises; fiscal impacts and procedural hurdles create residual uncertainty.
The bill has not accumulated any surfaced votes yet.
Progressives emphasize access and equity gains
Technically modest, broadly sympathetic public health change with built-in compromises; fiscal impacts and procedural hurdles create residu…
Relative to its intended legislative type, this bill is a concise substantive policy statute that clearly defines a prohibition on cost-sharing for diagnostic and supplemental breast examinations and integrates that pro…
Go beyond the headline summary with full stakeholder mapping, legislative design analysis, passage barriers, and lens-by-lens tradeoff breakdowns.