HR-6314-119
Referred to the Subcommittee on Health.
Sponsored by Ritchie Torres (D-NY)
What it does
This bill would require all health insurers — including private group and individual plans, Medicare, Medicaid, TRICARE, the VA, and federal employee health plans — to cover annual low-dose CT (LDCT) lung cancer screenings at no cost to the patient. Coverage would apply to adults aged 50–80 whom a treating clinician determines to be at increased risk based on personal, environmental, or familial factors. Insurers would be prohibited from imposing prior authorization requirements, step-therapy protocols, frequency limits stricter than once per year, or documentation requirements beyond current evidence-based clinical guidelines.
Who benefits
Adults aged 50–80 with elevated lung cancer risk — including current and former smokers, people with occupational exposures (e.g., asbestos, radon), and those with a family history of lung cancer — who currently face cost-sharing barriers to screening. Patients on high-deductible health plans who currently pay out-of-pocket for screenings. Radiologists and imaging centers that would see increased demand for LDCT scans. Early-stage lung cancer patients who may receive diagnoses sooner, potentially improving survival outcomes. Veterans and active-duty military personnel covered under federal health programs.
Who is hurt
Private insurers and self-insured employers who would absorb the cost of screenings previously subject to cost-sharing, potentially passing costs on through higher premiums across their enrollee pools. Taxpayers who fund federal health programs (Medicare, Medicaid, VA, TRICARE) that would bear new mandatory coverage costs. Competing diagnostic or preventive services that may face indirect resource constraints if screening volumes increase significantly. Patients who do not meet the eligibility criteria (e.g., those under 50 or over 80, or those whose clinician does not determine them to be at increased risk) who would not benefit despite paying into the same insurance pools.
Supporters argue
Supporters argue that lung cancer is the leading cause of cancer death in the United States, killing more Americans annually than breast, prostate, and colorectal cancers combined, and that LDCT screening has been shown in the National Lung Screening Trial to reduce lung cancer mortality by 20%. They contend that cost-sharing and prior authorization requirements are documented barriers that suppress uptake of a proven, guideline-recommended screening — and that removing these barriers, as the ACA did for other preventive services, would increase early detection when treatment is most effective and least costly.
Opponents argue
Opponents argue that mandating zero-cost coverage across all insurance markets — including private plans and self-insured employers — without a defined funding mechanism shifts costs broadly onto premium payers and federal budgets, potentially raising premiums for all enrollees. They contend that the bill's eligibility standard, which relies on clinician discretion based on "personal, environmental, or familial risk factors" rather than a fixed smoking-history threshold, is vague enough to significantly expand the covered population beyond current USPSTF guidelines, making fiscal and utilization projections unreliable and potentially straining imaging capacity in underserved areas.
Constitutional context
Congress has broad authority to regulate insurance markets under the Commerce Clause (Art. I, §8, cl. 3) and to attach coverage conditions to federal health programs under the Taxing and Spending Clause (Art. I, §8, cl. 1). NFIB v. Sebelius (2012) affirmed Congress's power to regulate existing commercial activity in insurance markets, and the ACA's preventive services mandate has established a direct precedent for no-cost-sharing coverage requirements. Post-Loper Bright (2024), implementing regulations issued by HHS, DoD, VA, and OPM would face independent judicial review rather than automatic deference, meaning courts would scrutinize whether the agencies' eligibility definitions stay within the bill's statutory text.
Checks and balances
Congress gains authority to set coverage mandates across public and private insurance markets; HHS, DoD, VA, and OPM are directed to issue implementing regulations within 180 days, subject to judicial review under the post-Loper Bright independent-judgment standard.
Historical precedent
The ACA (2010) established a similar no-cost-sharing mandate for USPSTF-recommended preventive services, including lung cancer screening for high-risk smokers, though its scope and eligibility criteria differ from this bill's broader risk-based standard.