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Biomarker-testing mandate debated in Ohio House Health Committee; amendment adopted to track use and costs
Summary
House Bill 8 would require health plans and Medicaid to cover biomarker testing; the committee adopted an amendment requiring annual reporting on tests and costs, while proponents cited life-saving cases and opponents warned of premium increases and gaps for self-insured plans.
House Bill 8, which would require coverage of biomarker testing by health plans and Medicaid, prompted sharply divided committee testimony on whether mandated coverage is a clinical necessity or a cost risk for employers and insurers.
Dr. Barbara Marsh of the Lung Cancer Research Foundation, a proponent, told members her husband faced treatment delays after an insurer denied biomarker testing, describing a process that involved three biopsies and appeals before Ohio State clinicians obtained results that later informed targeted therapy. "Mandating insurance coverage for biomarker testing will expedite diagnoses, remove financial barriers, expand access to essential diagnostic tools, and create a more equitable effective health care system," Marsh said.
Opponents including Cameron Garsick of NFIB and Megan Richwine of the Ohio Association of Health Plans warned that a statutory mandate could raise prices and premiums, and that many private-sector self-insured plans are exempt from state mandates. NFIB requested explicit safeguards such as an initial reimbursement cap and noted uncertainty about costs for future tests; health-plan representatives said their members already cover many biomarker tests under medical-necessity rules and that removing that discretion could reduce plans' ability to negotiate price and manage care.
The committee accepted an amendment offered by Representative White to require the Department of Insurance and Medicaid to provide specific, regular reporting within 90 days of enactment and annually thereafter on types of biomarkers ordered and payments, producing a baseline for legislative oversight of price and utilization trends. Committee members asked proponents and opponents for actuarial data from other states and analysis of premium impacts; those materials were not available in the hearing and were requested for follow-up.
No vote to advance the bill was taken during the hearing; committee members left the record open for written testimony provided in the packet.
