Bill eliminating supplementary breast exam costs clears Virginia legislature on third push

The Virginia General Assembly passed a measure Thursday prohibiting health insurance carriers from imposing cost sharing for diagnostic and supplemental breast examinations. 

The passage comes after three consecutive attempts from Del. Shelly A. Simonds, D-Newport News. 

House Bill 1828 is recommended this year by the Health Insurance Reform Commission. 

“I am happy to report that it has been sent to the HIRC and has finally passed through the HIRC process,” Simonds told the House Labor and Commerce subcommitteepanel on Jan. 21. 

Simonds was inspired to introduce this legislation because of her mother, who missed a screening over the pandemic and later was diagnosed with breast cancer, she said. Her mom was able to get treatment and is now cancer-free. 

“But I knew firsthand how important it was to get screened and to not skip those vital mammograms,” Simonds said.

She met with people from the breast cancer organization Susan G. Komen Foundation, and said she realized that Virginia had not yet passed this type of legislation.

“Under the Affordable Care Act, there is no copay required for the first screen, mammogram screen,” Simonds said. “There's no out-of-pocket cost for the first one.” 

The bill aims to tackle secondary screenings like MRIs, ultrasounds and more detailed types of screenings for abnormal mammograms.

HB 2133 bill from Del. Karen Keys-Gamarra, D-Fairfax, was incorporated into this bill. Senate Bill 1436 from Sen. Russet Perry, D-Leesburg, is a duplicate bill, which incorporates SB 1238, by Sen. Tara Durant, R-Fredericksburg. 

Simonds' bill has received support from colleagues and advocates around health care and cancer treatments, but there has been some opposition. 

“The pushback from the insurance industry has been that they don't want these costs defrayed for other policyholders,” Simonds said. 

Doug Gray, the executive director of the Virginia Association of Health Plans, gave public testimony in opposition of the premise of the bill. 

“I'm not naive on where this bill is going but I do want to remind you that if you continue down the path of waiving cost shares by disease, you will have a long list of diseases in front of you,” Gray told the House Labor and Commerce subcommittee panel.

The general concern about waiving cost shares by disease is that there is no discussion of need, which creates a bigger impact on the premium for everyone, according to Gray. 

“I think the question that is now going to be brought front and center, not by this bill, but by the secondary bill to waive cost shares for all folks with cancer, is it discriminatory to pick one disease above others in terms of how you treat it?” Gray said.  

The Virginia Breast Cancer Foundation worked closely with Simonds to make headway with this legislation over the last few years. 

“The reason we started working on this bill a few years ago is that we get a lot of calls to our office where people are frustrated they can't afford the bill that they received for their follow-up mammograms,” said policy director Kirsta Millar, who worked with Simonds. 

This bill will only apply to health insurance plans that are regulated by the commonwealth, so once it’s signed by the governor the foundation plans to roll out education and outreach, according to Millar.

“There will be a budget associated with this to help the state insurance companies,” Simonds said.

The proposed legislation could have an annual fiscal impact of half a million dollars because diagnostic breast examinations are not covered, according to the bill’s fiscal impact statement. The employer share of the cost is approximately 50% of the general fund impact and 50% of the nongeneral fund impact.

The State Corporation Commission won’t see any financial impact from this bill because it does not create, modify, or remove any statutory responsibilities, according to the bill’s fiscal impact statement.

The bill passed both chambers unanimously and will go into effect on Jan. 1, 2026.

“I suspect that HIRC will be quite busy because there are a lot of areas of medicine where we've got increased out-of-pocket costs that are going to continue to be unaffordable for lots of Virginians,” Simonds said.