Senate Health and Welfare committee sends bill requiring coverage for supplemental breast screening to floor

Boise — The Senate Health and Welfare Committee voted to send House Bill 134 to the Senate floor with a "do pass" recommendation after sponsors and medical specialists testified that requiring private insurers to cover supplemental breast cancer screening for high‑risk patients could improve early detection and reduce downstream costs.

Representative Brooke Green, R‑District 18, and Representative Healy, R‑District 15, co‑sponsors of the bill, told the committee the measure would require Idaho health plans that are not Medicaid or self‑insured, ERISA plans to provide coverage for supplemental screening — including breast MRI, contrast‑enhanced mammography or screening ultrasound — for people clinically identified as high risk because of genetic mutations (BRCA1/2), prior chest radiation, very dense breast tissue or other specified factors. Representative Green said the bill’s eligibility criteria are intended to limit screening to patients who clinically require the tests.

The bill’s sponsors and three medical witnesses described clinical and economic rationales for the change. Dr. Barbara White, a fellowship‑trained breast radiologist in Meridian, testified that mammography alone detects approximately 70–80 percent of breast cancers and that adjunct modalities raise detection to about 95 percent, particularly for women with dense breast tissue. "Early detection saves lives and adjunct screening increases early detection," White said. Dr. Aime Smith, a breast cancer surgeon who runs a hereditary risk clinic, testified that roughly 6–10 percent of breast cancer patients have hereditary risk and that targeted supplemental screening is appropriate only for higher‑risk patients. Dr. Rhiannon Menon, a breast surgeon who treats patients statewide, told the committee many high‑risk patients forgo recommended enhanced screening because of out‑of‑pocket costs: "A diagnostic mammogram can be about $800 out of pocket, and an MRI is about $3,000 out of pocket."

Sponsors also discussed fiscal estimates. Representative Green said an initial fiscal note indicated a state cost between $300,000 and $600,000, but that the state regents' review suggested the cost to the state plan would be approximately $36,000 to $72,000. Green and Healy argued that the cost of one early detection that prevents extensive treatment would offset screening costs, noting examples of costs for advanced treatment cited in testimony.

Committee members asked whether insurers already provide the tests. Representative Green and medical witnesses said insurers do cover these tests in some circumstances, but often as diagnostic services that count toward a patient's deductible; that out‑of‑pocket requirement can deter patients from obtaining the recommended imaging. Representative Healy described the bill as moving the specified supplemental imaging into a preventive category for qualifying high‑risk patients so it would be covered outside the deductible structure.

Committee discussion included questions about narrowing eligibility to limit costs and avoid overuse. Dr. Smith and other witnesses emphasized that the bill targets patients meeting clinical risk criteria rather than expanding screening to average‑risk people, and they cited national society guidance for identifying high‑risk candidates.

A motion by Senator Lenny, seconded by Senator Keizer, to send House Bill 134 to the Senate floor with a "do pass" recommendation carried on a voice vote. The committee chair called for "ayes," and the committee responded affirmatively; no roll‑call tally was recorded in the transcript.

Votes at a glance

- House Bill 134 — Require private insurers (excluding Medicaid and self‑insured plans regulated under federal law) to cover supplemental breast cancer screening (MRI, contrast mammography, or ultrasound) for patients meeting the bill’s high‑risk criteria. Motion: send to floor with "do pass." Moved by Senator Lenny; seconded by Senator Keizer. Outcome: motion adopted on a voice vote. (No roll‑call tally recorded in the transcript.)

Next steps

The bill will be reported to the full Senate for consideration. Committee testimony and sponsor remarks stressed the measure applies only to clinically defined high‑risk patients rather than broad, population‑wide screening.