“Gail’s Law” provides no-cost coverage to secondary screenings to women at greatest risk for cancer, missed diagnoses
[Madison, Wis.] – Today, leading women’s health advocates praised a Gail’s Law, a new bill authored by Sen. Rachael Cabral-Guevara (R- Appleton), Rep. Amanda Nedweski (R- Pleasant Prairie), and Rep. Cindi Duchow (R-Town of Delafield). The legislation – which receives a hearing in the Senate Health Committee – eliminates patient cost-sharing for supplemental screenings for women with dense breast tissue and other high-risk factors, and diagnostic screenings for women who require follow-up examinations, ensuring greater access to life-saving care. This bipartisan legislation is co-sponsored by 58 Wisconsin state lawmakers.
SB-264/AB-263 is named after the late Gail Zeamer, a fierce women’s health champion and breast cancer fighter who played a pivotal role in passing Wisconsin’s Breast Density Notification Bill in 2017 and fought tirelessly for increased access to life-saving breast cancer screenings. In states where similar bills have been passed, the impact on insurance premiums has been minimal, with an increase of just $0.04 to $0.07 per member per month.
State Policy Coordinator for the Wisconsin Breast Cancer Coalition Dawn Anderson said, “Gail Zeamer played a critical role in saving lives here in Wisconsin, inspired by her own breast cancer journey. For far too long, Wisconsin women with dense breast tissue or at greater risk for breast cancer have not received the same quality screening as those who don’t have dense breast tissue. Gail’s Law will ensure that a policy that benefits one group of women, benefits all women.”
Wisconsin health insurers are currently required by law to cover one annual mammographic screening for women starting at age 50, and two mammographic screenings for women aged 45-49 who meet specific criteria, with no out-of-pocket costs. However, mammograms are not equally effective for all women. It is estimated that nearly 50% of women have dense breast tissue, which makes them 4-to-6-times more likely to develop breast cancer – and makes cancer more difficult to detect on a standard mammogram. In fact, traditional mammograms can miss up to 50% of breast cancers in dense breast tissue, leaving women vulnerable to late cancer diagnoses, which means more invasive and more expensive treatment options.
Out-of-pocket costs for supplemental or diagnostic screenings across the country can range from $234 to over $1,000, creating financial barriers that deter patients from receiving timely, critical care, and delaying an early diagnosis. 1 in 5 patients would reportedly skip recommended follow-up imaging to avoid paying a deductible. Gail’s Law addresses this by making life-saving screenings more accessible to those at increased risk.
The Facts
- Over half the country has passed legislation to eliminate patient cost-sharing for secondary screenings for individuals with dense breast tissue and other high-risk factors.
- In Wisconsin, 5,920 women are expected to be diagnosed with breast cancer in 2025, and 690 are projected to die from the disease.
- Failure to detect cancer early allows it to grow and spread, making future treatment more expensive and complicated.
- When breast cancer spreads to places like the lung, liver, and bone, patients have a 30% chance of survival versus a 99% survival rate when breast cancer is detected early at the localized stage.
- Early, effective detection prevents debilitating costs for intensive, long-term treatments, like chemo, radiation, and immunotherapy. An early cancer diagnosis costs 2-4x less to treat than a late-stage diagnosis.
The Early Detection Saves Lives Coalition is dedicated to increasing critical access to essential breast cancer imaging in Wisconsin. Visit EarlyDetectionWI.com to learn more.
