Committee hears HB 1283 to eliminate cost sharing for diagnostic and supplemental breast imaging; insurers warn of premium impact

Representative Karen Carls opened the hearing on House Bill 1283, saying the bill would ensure follow‑up diagnostic and supplemental breast imaging and testing are provided at no cost share for patients when clinically necessary, including for high‑risk patients and those whose screening mammography requires additional imaging.

The nut: Supporters argued the measure removes financial barriers that keep insured patients from completing timely diagnostic work‑ups after screening mammograms and thereby improves early detection and reduces downstream treatment costs. Opponents, including business groups, said the mandate would raise employer and employee premiums and urged caution about expanding state‑regulated mandates to the private market.

Sponsor and advocacy testimony: Rep. Karen Carls said the North Dakota essential health benefits package already covers breast screening but that HB 1283 is a cost‑share bill designed to eliminate patient out‑of‑pocket costs for medically necessary diagnostic follow‑up imaging. Bobbie Will, policy and advocacy manager for Susan G. Komen, said 28 states have passed similar legislation and referenced a Novarost/Deloitte analysis attached to committee materials. Will summarized the fiscal studies and asked the committee to join other states that have adopted the change.

Clinical testimony: Dr. Christina Telos Sherstef, chief of staff and chief of radiology at Sanford Medical Center Bismarck and lead breast‑imaging physician, said she sees patients who decline diagnostic follow‑up because of cost and that delays in diagnostic imaging can allow cancers to progress to later stages. “As a radiologist on the front lines of breast cancer detection, every day I see the impact of the large out of pocket costs that women incur as a result of diagnostic breast imaging,” she told the committee.

Patient and nurse testimony: Several personal accounts reinforced clinical testimony. Mary Telet Pool, a nurse and breast cancer survivor, said diagnostic testing after screening “saved my life,” described the sequence of follow‑up procedures she underwent and urged lawmakers to eliminate the financial barrier for medically necessary tests.

Public health and advocacy groups: Ben Hanson, government relations director for the American Cancer Society Cancer Action Network (ACS CAN) in North Dakota, described the public health rationale: early detection improves outcomes and reduces later treatment costs. The sponsor and advocates referenced Deloitte and Novarast analyses estimating per‑member increases for PERS and commercial markets; Bobbie Will cited a Deloitte figure of roughly $7.48 per member per month in one analysis and Novarast estimates of $1.10–$2.40 per member per month in another for commercial markets, depending on methodology and population.

Business and insurer concerns: Andrea Fenig of the Greater North Dakota Chamber opposed the bill as drafted, citing the committee’s attached PERS fiscal note and an estimate of a 0.5 percent premium increase (roughly $4,070,000 for the PERS biennium) that would shift cost to employers if expanded beyond state plans. Blue Cross and other carriers — represented earlier in testimony — expressed concern that mandating coverage as written could increase premium costs for the commercially insured and asked for alternatives or targeted approaches rather than a broad mandate.

Pilot, PERS and process: Rebecca Fricke of PERS confirmed the bill was treated as an insurance mandate for the PERS pilot program; Deloitte’s analysis was attached and PERS’ consultant estimated a 0.5 percent premium impact for the plan (about $4,070,000 for the upcoming biennium). Witnesses and committee members discussed that the PERS pilot would generate data and that any extension to fully insured private plans would require separate legislative action after the pilot period.

Ending: The committee heard multiple medical experts, patients, and advocacy organizations in favor of HB 1283 and business and insurer representatives opposed or urging amendment; the hearing closed with committee requests for additional information on the Novarast/Deloitte analyses and on premium impacts before further action.