Early Access to Screening Act
- Sponsor
- Rep. Lawler, Michael [R-NY-17]
- Committees
- Ways and Means Committee (primary)
- Last action
- Apr 28, 2026
Bottom line
This bill expands access to annual screening mammography for women aged 30 and above by eliminating cost-sharing under federal health programs and private insurance, aiming to promote earlier breast cancer detection.
What it actually does
This bill amends the Social Security Act (titles XVIII for Medicare and XIX for Medicaid) and the Public Health Service Act (title XXVII) to mandate no-cost coverage for annual screening mammography for women aged 30 and older. Effective January 1, 2026, it eliminates cost-sharing for these screenings under Medicare, makes them a mandatory benefit under Medicaid, and requires private health insurance plans to cover them without out-of-pocket costs.
Proponents argue
Proponents argue that early and regular screening mammography is crucial for detecting breast cancer at its most treatable stages, significantly improving patient outcomes and potentially reducing long-term healthcare costs associated with advanced cancer treatment. Expanding no-cost access to younger women (starting at 30) addresses current guidelines that may delay screening for some at-risk individuals, promoting health equity and proactive preventive care.
Opponents contend
Opponents might raise concerns about the potential increase in healthcare expenditures due to expanded coverage and the possibility of over-screening, leading to false positives, unnecessary biopsies, and associated patient anxiety. They may also argue that current screening guidelines are evidence-based and that lowering the age without strong clinical justification could strain healthcare resources and lead to unintended consequences.
The bill text is concise and straightforward, allowing for a quick and clear understanding of its provisions within a few minutes.
Section 2(a)(1)
Medicare Coverage Frequency for Screening Mammography
This provision updates Medicare rules for screening mammography. Starting January 1, 2026, it prohibits payment for screening mammography for women under 30 years of age. For women over 29, it allows payment for annual screening mammography, meaning a new screening can be performed 11 months after the previous one. This effectively lowers the age at which Medicare covers annual screening from current guidelines.
Supporters argue
Supporters argue this ensures Medicare beneficiaries have access to potentially life-saving early detection, aligning with a proactive approach to women's health by providing consistent annual screening.
Critics contend
Critics might argue this expands coverage beyond current evidence-based guidelines, potentially increasing Medicare costs without clear clinical benefit for all women in this younger age group.
Tradeoffs
This provision balances the desire for earlier detection and comprehensive coverage against potential increased costs and the risk of false positives in a younger population.
Section 2(a)(2)
Elimination of Medicare Cost-Sharing for Screening Mammography
This provision amends Medicare Part B payment rules to ensure that, starting January 1, 2026, screening mammography services for eligible women (over 29 years of age) are covered at 100 percent of the lesser of the actual charge or the fee schedule amount. This means beneficiaries will not incur any co-payments, deductibles, or similar cost-sharing for these annual screenings.
Section 2(b)(1)
Mandatory Medicaid Coverage for Annual Screening Mammography
This provision makes annual screening mammography for individuals over age 29 a mandatory covered benefit under Medicaid state plans, effective January 1, 2026. It also ensures that alternative benefit plans offered by states must include this coverage without imposing any cost-sharing. This expands access to preventive care for a significant population, particularly low-income women.
Section 2(b)(3)
Prohibition of Medicaid Cost-Sharing for Screening Mammography
This provision explicitly prohibits states from imposing any deduction, co-payment, or similar charge for annual screening mammography services provided to eligible Medicaid beneficiaries (over age 29), starting January 1, 2026. This applies to both standard Medicaid services and alternative cost-sharing arrangements, ensuring no out-of-pocket costs for this preventive service.
Section 2(c)
No-Cost Coverage for Annual Screening Mammography in Private Plans
This provision mandates that group health plans and health insurance issuers offering group or individual health insurance coverage must provide coverage for annual mammography screening for women over 29 years of age, without imposing any cost-sharing (such as deductibles, co-payments, or co-insurance). This change applies to plan years beginning on or after January 1, 2026.