Initiate a change to health policy regarding Medicare, where do I even begin? In utilizing the Congress.gov current legislation search function, there are no bills or amendments currently listed that address prophylactic mastectomies. So, to explore the process of policy change for breast cancer patients a current law Women’s Health and Cancer Rights Act (WHCRA) and bill Breast Cancer Patient Equity Act (H.R.1370 and S.562) will be used.
Who decides?
It takes more than a problem, even with a potential solution to garner legislative action. Most often it is the problems that are identified as important or urgent by policy makers that put into action (Longest, 2010). Additionally, legislators are influenced by the number of potential solutions, inciting interest groups (being positive or negative), and public opinion (Longest, 2010). However, the President can significantly influence what problems are focused upon through agenda setting and involvement (Kingdon, 2003). As Medicare is overseen by the federal government a bill or amendment would need to be approved by both the House and Senate, then signed into law by the President. More specifically, Centers for Medicare & Medicaid Services (CMS) is a federal agency within the Department of Health and Human Services, that was created to administer Medicare and Medicaid services, and continues to serve as the implementing organization (Longest, 2010). The WHCRA both state and government plans are regulated by CMS (CMS, n.d).
According to Levine (2017) bills are introduced by a sponsor, or two to be bi partisan, either in the House or Senate, and others can show their support by being co-sponsors, with more co-sponsors the bill may receive higher priority. Additionally, a companion bill may be utilized where the same bill is introduced by both the House and Senate (Levine, 2017).
Two Examples:
The Women’s Health and Cancer Rights Act (WHCRA) and the Breast Cancer Patient Equity Act are amendments to current approved legislation, not newly proposed bills. Each of theses bills can be followed on the Congress.gov page and were transferred from one committee or sub-committee to the next. The Breast Cancer Patient Equity Act appears to be a bill that was introduced at the same time in the House and Senate.
Overall, trying to find information about legislation that impacts breast cancer, was a daunting task, the websites are not user friendly and information was hard to find. Is there a better way to learn about breast cancer policy? One of the other impacts to legislation are special interest groups which in turn impact public opinion, another deciding factor for legislators. Longest (2010) describes special interest groups as organized and intensely focused on influencing development and implementation of policy.
Special Interest Groups
What happens every October? No, not Halloween. Everything goes PINK from the NFL to items in your local grocery store, porch lights to business lights, all to benefit breast cancer awareness. I would venture to say that it is these special interest groups that have had the greatest impact on educating the public, increasing awareness, and may be a better route when looking to impact policy regarding prophylactic mastectomy.
Here are two special interest groups to check out:
Susan G Komen – https://ww5.komen.org/
National Breast Cancer Foundation, Inc. – https://www.nationalbreastcancer.org/
References:
Centers for Medicare and Medicaid (n.d.) Women’s Health and Cancer Rights Act (WHCRA): The Center for consumer information & insurance oversight [webpage]. Retrieved from: https://www.cms.gov/CCIIO/Programs-and-Initiatives/Other-Insurance-Protections/whcra_factsheet
Good Morning America (2019). GMA’ goes pink for Breast Cancer Awareness Month . Retrieved from: https://www.youtube.com/watch?v=9bUTY5jElVI
Levine, R. A. (2017) The difference between a House and Senate Bill: How legislation becomes law [webpage]. Retrieved from: http://familybuilding.resolve.org/site/PageServer?pagename=advday_difference
Library of Congress (n.d.) Bill search on Congress.gov [webpage]. Retrieved from: https://www.congress.gov/search?q={%22congress%22:%22116%22,%22source%22:%22legislation%22}&searchResultViewType=expanded&KWICView=false
Library of Congress (n.d.) H.R.1370 – Breast cancer patient equity act [webpage]. Retrieved from: https://www.congress.gov/bill/116th-congress/house-bill/1370/titles?q=%7B%22search%22%3A%5B%22mastectomy%22%5D%7D&r=1&s=2
Library of Congress (n.d.) S.562 – Breast cancer patient equity act [webpage]. Retrieved from: https://www.congress.gov/bill/116th-congress/senate-bill/562/text?q=%7B%22search%22%3A%5B%22mastectomy%22%5D%7D&r=2&s=2
Longest, B. B. (2010). Health policymaking in the United States (5th ed.). Chicago, IL: Health administration press.
Kingdon, J. W. (2003). Agendas, alternatives, and public policies. New York, NY:Addison-Wesley educational publishers inc.
Rogers, K. (n. d.). Breast cancer awareness month. Encyclopedia Britannica [webpage]. Retrieved from: https://www.britannica.com/science/notifiable-disease
Preventative Mastectomy 
I first have to mention how incredibly impactful the video was in your blog this week. In under five minutes, media was able to produce an informative video that captured the attention of listeners and relayed critically important information. As you mentioned, special interest groups have been successfully bringing attention to this matter in a variety of different ways. I agree that a much larger impact can be made by educating and informing though special interest groups.
The CDC (2019) has reported that breast cancer is …
“the most common cancer in women, no matter your race or ethnicity”
This statistic alone speaks volumes to the importance of the issue. Major health organizations such as Mayo Clinic even stand behind preventative mastectomies and explain that if you have BRCA1 or BRCA2 gene mutation, obtaining a prophylactic mastectomy reduces chances of acquiring future breast cancer (Mayo Clinic, 2019)
Undergoing this surgery is not easy by any means. However, greatly reducing your risk of getting breast cancer by getting this surgery is something that many women are willing to do. Below is a link to a video of an inspiring young lady who shares her story of her journey getting this surgery.
https://www.health.com/condition/breast-cancer/breast-cancer-after-mastectomy-at-39
References
Center of Disease Control (2019). Breast cancer: Statistics. Retrieved from
https://www.cdc.gov/cancer/breast/statistics/index.htm
Mayo Clinic. (2019). Preventive (prophylactic) mastectomy: Surgery to reduce breast cancer risk. Retrieved from
https://www.mayoclinic.org/tests-procedures/mastectomy/in-depth/prophylactic-mastectomy/art-20047221
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Great Blog and interesting facts about why prophylactic or preventative mastectomy are vital and equally significant in need of legislation that impacts breast cancer. According to the Centers for Disease Control and Prevention (CDC, 2020), each year in the United States, about 245,000 cases of breast cancer are diagnosed in women and about 2,200 in men. Moreover, the National Cancer Institute denotes that preventative mastectomy in women who carry a BRCA1 or BRCA2 gene mutation may be able to reduce the risk of developing breast cancer by 95% in addition to women with a strong family history of breast cancer, it can reduce the risk of breast cancer development by up to 90% (Peppercorn et al., 2017). Hence, the question is which legislature or actors out there are sole advocates for policies or legislature for breast cancer? It appears various organizations and public interest groups advocate for this matter.
The World Health Organization (WHO, 2020) promotes breast cancer control within the context of comprehensive national cancer control programs that are integrated to noncommunicable diseases and other related problems. Here, a comprehensive cancer control entails prevention, early detection, diagnosis and treatment, rehabilitation and palliative care. In addition the CDC works with public, non-profit, and private partners to address breast cancer in women younger than 45 years of age through a variety of activities, including the Bring Your Brave campaign, the Advisory Committee on Breast Cancer in Young Women and the Cancer Genomics Program. These activities develop best practices in education, surveillance, policy and systems change approaches.
It is understandable that breast cancer is a political issue. As we are aware, the federal government is the largest funder of biomedical research and laws regulate and support access to care and health care systems, moreover third-party payors are subject to state and federal regulations. In fact, every aspect of breast cancer is touched by public policy therefore it is essential that those who influence that policy are educated and trained and have no agenda other than to save lives, and to end breast cancer. To ensure this, the National Breast Cancer Coalition (NBCC, 2020) informs, trains and directs patients and others in effective advocacy efforts. Nationwide, the women and men they have trained are shaping breast cancer public policy by participating in legislative, scientific and regulatory decisions; promoting critical analysis of breast cancer information and media coverage; and actively working to change all systems that impact their mission to end breast cancer.
The NCCC have launched their 2020 Legislative and Public Policy Priorities depicting all the areas they aim to tackle going forward.
Their legislative priorities focus on the $150 Million for the Department of Defense (DOD) Breast Cancer Research Program (BCRP) for FY2021, mainly based on the NBCC’s grassroots advocacy on continued funding for this successful program since the DOD BCRP was created in 1992 to eradicate breast cancer by funding innovative, high-impact research through a partnership of scientists and consumers; the Metastatic Breast Cancer Access to Care Act, a bill aimed to waive the 24 month waiting period for Medicare eligibility and the 5 month waiting period for Social Security Disability Insurance benefits for individuals with Metastatic Breast Cancer and the Preservation of the Medicaid Breast and Cervical Cancer Treatment Program, solely based on when Congress enacted the Breast and Cervical Cancer Treatment Act in 2000 after years of NBCC grassroots lobbying and influence. The NBCC persists on being committed to ensuring all women and men screened and diagnosed with breast cancer through federal screening programs have access to the treatment they need.
The Public Policy Priorities addresses Guaranteed Access to Quality Care for All, mainly on safeguarding access to quality, evidence-based health care as a top priority of NBCC for many years by endorsing and advocating for the passage and implementation of ACA in 2010 which marked important steps forward in access to quality health care for individuals with, and at risk of, breast cancer and Ensuring the Participation of Educated Patient Advocates in Science Research and all Levels of Health Care Decision Making, where the NBCC continues to work to ensure that educated patient advocates who represent a constituency, have a meaningful “seat at the table” in all levels of health care decision making which affects their lives.
Overall raising general public awareness on the breast cancer problem and the mechanisms to control as well as advocating for appropriate policies and programs are key strategies of population-based breast cancer control.
References
Centers for Disease Control and Prevention (CDC, 2020). Breast Cancer. Accessed from https://www.cdc.gov/cancer/breast/index.htm.
National Breast Cancer Coalition (NBCC, 2020) Legislative and public policy priorities. Accessed from http://www.breastcancerdeadline2020.org/get-involved/public-policy/public-policy.html.
Peppercorn, J., Horick, N., Houck, K., Rabin, J., Villagra, V., Lyman, G., & Wheeler, S. (2017). Impact of the elimination of cost sharing for mammographic breast cancer screening among rural US women: A natural experiment. Cancer, 123(13), 2506-2515. doi: 10.1002/cncr.30629.
World Health Organization (WHO, 2020) Breast cancer: prevention and control. Accessed from https://www.who.int/cancer/detection/breastcancer/en/index3.html.
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Thank you both for the informative and interesting replies. I appreciate your discussion and insight regarding the work being completed by the National Breast Cancer Coalition.
I do want to clarify that insurance and Medicare do cover preventative mastectomy for women with high risk genetic mutation (BRCA1 and BRCA2). However, most of the women in this category are too young to be on Medicare.
Where preventative mastectomy may not be covered and is not covered by Medicare, are for women who have breast cancer in one breast and choose to have prophylactic mastectomy of the unaffected breast. For Medicare a prophylactic mastectomy is a “cosmetic” surgery.
I agree, that the decision to have one or both of your breasts removed would be difficult for most women. Breasts often symbolize femininity, nurturing, and being sexy, not to mention being a key part of our body image. I believe that most women will agree that a mastectomy is not “cosmetic”.
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