At least five states have introduced legislation requiring insurers to cover Digital Breast Tomosynthesis, also known as 3D mammography. The economic and clinical benefits of DBT are well-established, but the passage of the bills may come down the legislative climate of the individual states, according to Eugenia Brandt, Director of State Affairs for the American College of Radiology.

“In red states there may be a mindset against a legislature overreaching,” she said. “It’s not a breast cancer issue, they just don’t like insurance mandates—I would say Texas is one of those states.”

The states include Maryland, New Hampshire, New Jersey, New York, and Texas.

Further complicating the roadmap for this legislation is the widely varying legislative procedure between states. Texas’ state legislature only meets for 60 days every other year, creating a narrow window for legislation to make it out of committee and onto the floor. Other states meet year round, said Brandt, but competing issues could suck the air out of the room.

“If Texas brought a bathroom bill, for example, it would probably stall everything else,” she said. “It depends on what else is happening in the chamber.”

There is an upside—breast cancer issues tend to be bipartisan, according to Brandt, and the cost savings are a powerful argument in favor of the legislation.

According to a study published in the Journal of the American College of Radiology, DBT could save $200,000 per year in a large state-wide Medicaid program, chiefly through reducing the number of women recalled for additional follow-up imaging. There’s also evidence DBT facilitates earlier diagnosis of cancer—when treatment is cheaper—and alleviates the stress and anxiety faced by women during the weeks leading up to a follow-up exam.

“As Medicaid programs continue to evolve, and as DBT becomes more widely adopted for routine breast cancer screening, results from this study will assist policymakers and financial stakeholders in examining ways to address disparities and barriers to accessing value-based preventive care by some of the nation’s most vulnerable citizens,” the authors wrote.