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Shapiro expands Pa. health insurance coverage for breast cancer screenings

PA Gov. Josh Shapiro has signed a law that requires health insurers to cover breast cancer screenings for high-risk patients.

Shapiro expands Pa. health insurance coverage for breast cancer screenings

IMAGE: Pa. Gov. Josh Shapiro holds up Senate President Pro Tempore Kim Ward’s hand as he signs the first bill of his tenure.

Stephen Caruso of Spotlight PA

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HARRISBURG — Insurers must cover the costs of breast cancer screenings for people at high risk of developing the disease under a new law Pennsylvania Gov. Josh Shapiro signed Monday.

“This is just the start. We have a lot more work to do, and this spirit of goodwill and compromise needs to continue,” Shapiro said at a signing ceremony in the Capitol, flanked by lawmakers from both major parties.

Advocates for health care access said the law — the first Shapiro signed since taking office in January — is a positive, though limited, step toward making crucial medical tests more affordable. They urged further action in this vein, something that typically requires lawmakers to negotiate with the commonwealth’s powerful health insurance industry.

The new law will allow people at higher risk of breast cancer to receive further genetic counseling, ultrasounds, and MRIs among other treatments without paying out-of-pocket costs. State-regulated insurers were already required to cover, but not entirely pay for, MRIs and ultrasounds under a 2020 law.

The coverage requirement only applies to private, state-regulated health insurance plans, though the state’s Medical Assistance program already has similar coverage.

According to the Susan G. Komen Center for Public Policy, 11 other states have passed laws removing copays or deductibles for imaging, while two more are poised to join that list soon.

However, no other state has mandated coverage of genetic testing for the BRCA genes, which indicate a higher chance of developing breast, ovarian, pancreatic, and prostate cancers.

The underlying bill was sponsored by state Senate President Pro Tempore Kim Ward (R., Westmoreland), a breast cancer survivor, and passed the General Assembly without a single dissenting vote.

At a celebratory bipartisan press conference last week, Ward and state House Speaker Joanna McClinton (D., Philadelphia), both clad in pink, celebrated the bill’s speedy and uncontroversial passage, and argued it portends future bipartisanship in the divided legislature as the state creeps closer to its June 30 budget deadline.

“I look forward to being able to stand here many times throughout this session and celebrate together because that’s what we’re here for,” McClinton said at the time. “We’re here to help people and improve their lives and create solutions for everyday problems.”

For Ward, the bill’s passage is personal; she was diagnosed with breast cancer in December 2020. Even under the state’s own insurance plan, which she receives as a senator, Ward ended up paying out of pocket for genetic testing after she learned she had breast cancer and doctors removed a small tumor.

After discovering she had a BRCA gene, which increased the odds that her cancer would recur, Ward moved forward with a mastectomy and hysterectomy.

“When you get a diagnosis of breast cancer — or any kind of cancer, really — you want answers,” Ward told Spotlight PA. “You don’t want to be turned around, you don’t want to have to fight for things that need to be done.”

As for what’s next, Ward declined to go into specifics, but said: “I don’t think we’re done.”

The bill’s passage is also notable due to its potential impact on the insurance industry, a powerful force in Harrisburg that spends millions of dollars on lobbying and campaign donations each year. Capitol sources noted that the industry was neutral on the bill in conversations with lawmakers.

The state insurance federation, an industry group, didn’t respond to a request for comment.

A 2019 report from the Komen Center on costs in six states found that patients on average pay a little less than $130 for an ultrasound; MRIs cost on average almost $1,200.

Advocates for patients and survivors were unable to say how much money the new law will cost insurance companies or provide an estimate for how many people will be newly eligible for no-cost testing.

Still, Pat Halpin-Murphy — a breast cancer survivor, former staffer for Gov. Bob Casey Sr., and president of the PA Breast Cancer Coalition — celebrated the law as a victory.

“Getting this passed, it’s nothing short of a miracle,” she told Spotlight PA, crediting Ward and McClinton’s leadership on the issue as the first two female leaders of their respective chambers.

Going forward, Halpin-Murphy said her organization’s focus will be on raising public awareness of the new law, so those at risk of developing breast cancer can be tested.

Health-care expenditures for Pennsylvanians totaled $148 billion in 2020, according to federal data compiled by the Kaiser Family Foundation, up more than $112 billion over the past two decades.

Patrick Keenan, director of policy with the Pennsylvania Health Access Network, a Philadelphia-based nonprofit that advocates for more affordable and equitable health care, noted that stark increase as a barrier to individuals seeking care.

According to a 2021 survey by the network, between one in four and one in five Pennsylvanians have delayed or skipped care, not scheduled a test, or not filled a prescription due to costs.

Looking at the survey, Keenan argued it is imperative that state lawmakers keep working on health-care affordability. As an example, he pointed to a decade-old law in Massachusetts that creates a benchmark for health-care cost growth tied to the state’s economic growth rate.

“No life-saving test should be out of reach for any patient,” Keenan told Spotlight PA. “Senate Bill 8 is a really important step. It has a targeted audience. And there’s so many other things that are out of reach, unaffordable, or avoided altogether because of cost. And that’s what we have to deal with.”

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