Honolulu, Hawaii


RE: H.B. No. 481

H.D. 2

S.D. 1




Honorable Ronald D. Kouchi

President of the Senate

Thirtieth State Legislature

Regular Session of 2019

State of Hawaii




Your Committee on Commerce, Consumer Protection, and Health, to which was referred H.B. No. 481, H.D. 2, entitled:




begs leave to report as follows:


The purpose and intent of this measure is to:


(1) Amend the existing health insurance mandate to specify that coverage for low-dose mammography includes coverage for digital mammography and breast tomosynthesis; and


(2) Require the State Auditor to perform an impact assessment report and report any findings to the Legislature prior to the Regular Session of 2020.


Your Committee received testimony in support of this measure from the Hawaii State Commission on the Status of Women, Hawaii Medical Association, Hawaii Women's Coalition, Hawaii Women's Healthcare, Hawaii Radiological Society, Planned Parenthood Votes Northwest and Hawaii, and eight individuals. Your Committee received comments on this measure from the Department of Commerce and Consumer Affairs, Hawaii Employer-Union Health Benefits Trust Fund, Office of the Auditor, Hawaii Medical Service Association, and Hawaii Association of Health Plans.


Your Committee finds that breast cancer is one of the most common kinds of cancer in women. Nearly one in eight women born today in the United States will get breast cancer sometime during her life. Digital mammography provides images of the breast in many different angles, providing greater accuracy in finding abnormalities and determining which abnormalities seem potentially worrisome. Women who undergo screening with a combination of three-dimensional and two-dimensional mammography are less likely to be called back for more testing due to suspicious findings that turn out not to be cancer. Digital mammography and breast tomosynthesis are technologies that have been shown to be more effective for patients with dense breast tissue and can help in the early detection and treatment of breast cancer. This measure will enable women from all socio-economic sectors to take advantage of this evidence-based technology that, according to testimony received by your Committee, all other states except Hawaii have incorporated as a benefit covered by insurance companies.


Your Committee notes that coverage for low-dose mammography is not a new benefit that would be subject to an impact assessment report. Breast tomosynthesis is simply an advancing technology within the existing mammography mandate that should also be covered under the same benefit. Your Committee believes it is inappropriate to require an impact assessment whenever a new technology comes out to modernize an existing covered benefit. Such attempts to delay action pose a risk to the health of patients who would benefit from advancing technologies or methodologies.


Accordingly, your Committee has amended this measure by:


(1) Removing language that would have required the State Auditor to conduct an impact assessment report;


(2) Inserting an effective date of July 1, 2019;


(3) Inserting a repeal date of June 30, 2024; and


(4) Making technical, nonsubstantive amendments for the purposes of clarity and consistency.


As affirmed by the record of votes of the members of your Committee on Commerce, Consumer Protection, and Health that is attached to this report, your Committee is in accord with the intent and purpose of H.B. No. 481, H.D. 2, as amended herein, and recommends that it pass Second Reading in the form attached hereto as H.B. No. 481, H.D. 2, S.D. 1, and be referred to your Committee on Ways and Means.


Respectfully submitted on behalf of the members of the Committee on Commerce, Consumer Protection, and Health,