Senate committee hears bill to eliminate PERS cost-sharing for diagnostic, supplemental breast imaging

The Senate Industry and Business Committee held a hearing on House Bill 1283, a bill sponsored in the House to prohibit cost-sharing for diagnostic and supplemental breast imaging for members of the North Dakota Public Employees Retirement System (PERS). Proponents said the change would remove a financial barrier to follow-up care after screening mammograms and improve early cancer detection; PERS staff and some business groups warned of premium impacts and described the bill as requiring a PERS pilot and further review before any broader rollout.

Representative Karen Carls, the House sponsor, told the committee the measure would ensure “essential breast cancer screenings including follow-up and supplemental imaging are provided at no cost share for those who need them regardless of gender.” She and other proponents emphasized the bill does not add coverage but eliminates cost sharing for services already included in the state’s essential health benefits benchmark.

Nut graf: Testimony from physicians, patient advocates and public-health groups described cases in which individuals delayed or declined medically recommended diagnostic imaging because of costs. PERS staff described the statutory process that requires a two-year pilot for any coverage change that is treated as a mandate and provided an actuarial estimate of premium impact for the PERS plan.

Medical experts described everyday clinical consequences of cost barriers. Dr. Christina Teleshereseth, chief of radiology at Sanford Medical Center in Bismarck, said clinicians see several patterns that can delay diagnosis — patients skipping screening because they fear follow-up costs, omitting symptoms at intake, or failing to return for recommended diagnostic tests. “To be diagnosed, this woman must pay what feels to some like not only an obstacle to good health, but a ransom,” she said, adding that breast imaging follows federally mandated protocols that guide what diagnostic workup is required after an abnormal screening mammogram.

Patient testimony underlined that point. Mary Tellepool, a registered nurse and breast cancer survivor who described undergoing diagnostic mammography, stereotactic and ultrasound biopsies and MRI, said the diagnostic testing “saved my life” and argued patients should not face a choice between paying rent and paying for medically necessary tests.

Advocates provided jurisdictional and fiscal context. Bobby Wills of Susan G. Komen said 28 states have enacted similar policies and that in many of those states the estimated fiscal impact was negligible; in North Dakota, PERS’ retained actuary estimated an increase in premiums of about 0.5 percent, which PERS staff said equates to just over $4 million in the 2025–27 biennium.

Ben Hansen of the American Cancer Society Cancer Action Network and Courtney Coble of the North Dakota Medical Association supported the bill on clinical and equity grounds, while Andrea Fenig of the Greater North Dakota Chamber opposed section 2 of the bill that requires PERS to draft legislation to apply the change to the private market in a later session, arguing mandates on private employers raise costs and that those costs are eventually passed to employers and employees.

Rebecca Fricke, executive director of PERS, testified in a neutral capacity about the statutory pilot process. She described Century Code provisions that require a PERS pilot for proposals that are treated as mandates and the obligation to report results and, if applicable, draft a rollout bill in the next legislative session. Fricke said the consultant retained by PERS estimated the 0.5 percent premium increase by analyzing PERS claims experience and membership.

Committee members asked for clarifications about scope and numbers: supporters and witnesses said diagnostic “callback” rates after screening mammograms average about 10 percent nationwide (and North Dakota’s rates are consistent with that figure), and that supplemental imaging is more common for higher‑risk patients. Witnesses also noted Medicaid and the state’s North Dakota Women’s Way program currently provide diagnostic and supplemental imaging at no cost for eligible enrollees.

The committee took no final action at the hearing. Committee staff accepted written materials and testimony; PERS is required under current law to evaluate pilot results and report to the legislature if the statute is enacted. The hearing closed with no vote on the bill.

Ending: The record includes consultant analyses and state and multistate comparisons submitted by proponents and by PERS; the committee will consider those materials and the required PERS pilot/analysis if the bill advances out of committee.