State Rep. Linda Featherston knows firsthand what it costs to survive breast cancer in Kansas. Diagnosed in 2022, she received her initial treatment around Christmas that year, and now she's backing a bill that would require insurers to cover all out-of-pocket costs when a patient is called back for follow-up breast imaging after an initial mammogram.
Featherston says the stakes are high in her home state. She said 2,600 women in Kansas will be diagnosed with breast cancer this year, a rate above the national average, and 400 will die, according to KSHB 41. Patients are often called back for additional mammograms, MRIs, ultrasounds and biopsies to diagnose breast cancer, and those follow-up tests frequently come with a separate bill — even for people who already paid for a screening mammogram.
The financial strain is well documented beyond Kansas. More than 70% of commercially insured patients incurred out-of-pocket expenses for follow-up diagnostic tests like a diagnostic mammogram, MRI, ultrasound or biopsy in 2023, according to the American Cancer Society Cancer Action Network. The same report estimated that more than 1 million women ages 40 to 75 experienced delays in follow-up testing and imaging in 2024 because of the associated costs, and roughly 378,000 additional women were likely to skip future mammograms altogether over cost concerns.
A Bill Stalled Behind Insurer Pushback
Featherston's bill, Senate Bill 409, would require insurers to cover all out-of-pocket costs tied to those follow-up scans. She believed the bill had the votes to pass and was anticipating a floor debate, per Radiology Business. Instead, the bill missed multiple key deadlines and was considered unlikely to advance during the 2026 session, the outlet reported.
Opposition reportedly came from Blue Cross and Blue Shield of Kansas, described as the state's largest insurer with more than 45% market share, which contended the legislation would increase costs. Supporters, meanwhile, pointed to Kansas's own experience expanding state employees' coverage for supplemental breast-cancer screening, which they said increased insurance costs by only about 0.03%, the same report noted.
Featherston argues that the math favors patients, not just emotionally but financially. She said early detection saves lives and money, framing follow-up imaging as care that patients need after already spending money to stay alive — patients, she said, should not have to choose between their health and paying their bills. She added that she hears colleagues describe Kansas as a pro-life state, and she believes saving women's lives counts as pro-life, too.
The Price Tag On Waiting
The data backs up Featherston's concern that cost drives delay. Research published via PubMed Central found that patients enrolled in plans with higher out-of-pocket costs underwent significantly fewer subsequent diagnostic breast procedures than those with lower out-of-pocket costs. The American Cancer Society Cancer Action Network has separately reported that an earlier breast cancer diagnosis would save more than $11,000 per patient, and that eliminating cost-sharing for follow-up tests nationwide could prevent more than 7,500 later-stage diagnoses while saving an estimated $2.2 billion in lifetime treatment costs.
Women elsewhere describe the toll in blunt terms. Julie Rudman, a breast cancer survivor and founder of the Breast Cancer Club, said she has met her out-of-pocket expenses every year, and the expenses keep coming. Kim Jones, a stage 3 breast cancer survivor who had most of her costs covered through Medicaid, said the costs were still large. Breast cancer is described as one of the most supported and most expensive illnesses to treat in the United States, and the high costs of care are described as financial toxicity.
Missouri's Head Start, And A Federal Bill In Limbo
Kansas isn't the first state to attempt this fix. Missouri passed a similar law in 2023, and the resulting Senate Bill 106 requires health insurance companies to pay the full cost of diagnostic breast imaging without charging patients a co-pay or deductible, effective January 1, 2024, according to KSHB 41's earlier reporting. That law, codified under the Missouri Revisor of Statutes, bars covered health carriers from imposing cost-sharing requirements for the specified diagnostic and supplemental breast-examination coverage.
Missouri's protections have limits. The law only applies to insurance companies operating under the Missouri constitution, which excludes Missouri residents whose insurance is based in another state, per KSHB's report. Estimates of how many other states have adopted similar coverage requirements diverge sharply: KSHB reported about a dozen states have a similar law, while Radiology Business cited Susan G. Komen's figure of around 30 states with comparable legislation.
Geography also shapes how much patients pay out of pocket. North Dakota had the highest average share of out-of-pocket costs across follow-up breast cancer diagnostic procedures at 51.8%, followed by South Dakota at 48.6%, according to the American Cancer Society Cancer Action Network. Delaware and New York sat at the opposite end, with average shares of 9.0% and 12.9% respectively.
A federal push is also underway. Members of the U.S. House of Representatives introduced H.R. 3037 and S. 1500, known as the Access to Breast Cancer Diagnosis Act, which would require private health insurance plans to cover the full cost of diagnostic and supplemental breast imaging. The bill's text, available through Congress.gov, states that covered plans would not impose cost-sharing requirements for those benefits, though the legislation remains under review.
KSHB 41 reporter Alyssa Jackson, who was diagnosed with breast cancer at age 26 last year, is covering the cost barrier as part of a month-long series for Breast Cancer Awareness Month. For now, Kansas women waiting on word about SB 409 face the same choice Featherston has spent her time in office trying to eliminate: pay for the follow-up scan, or risk waiting on a diagnosis that moving fast could change.
