[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 1063 Introduced in Senate (IS)]

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117th CONGRESS
  1st Session
                                S. 1063

 To provide women with increased access to preventive and life-saving 
                           cancer screening.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 25, 2021

 Mrs. Murray (for herself, Mr. Van Hollen, Ms. Baldwin, Mr. Wyden, Mr. 
Merkley, Mr. Blumenthal, Ms. Klobuchar, Mrs. Gillibrand, Mrs. Shaheen, 
 Mr. Booker, Ms. Rosen, and Mr. Peters) introduced the following bill; 
     which was read twice and referred to the Committee on Health, 
                     Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
 To provide women with increased access to preventive and life-saving 
                           cancer screening.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Jeanette Acosta Invest in Women's 
Health Act of 2021''.

SEC. 2. PURPOSE.

    It is the purpose of this Act to provide women with increased 
access to preventive and life-saving cancer screening, including 
clinical breast exams and cervical, ovarian, uterine, vaginal, and 
vulvar cancer screening, provided by leading women's health care 
providers who--
            (1) serve populations most at risk; and
            (2) play an outsized role in the prevention and detection 
        of cancer in order to serve the goal of increasing access to 
        quality health screenings, care, and services, reducing health 
        care disparities and mortality rates among low-income women and 
        women of color, decreasing health care spending, and expanding 
        health literacy, access, and education about the benefits of 
        regular preventive cancer screening for women.

SEC. 3. FINDINGS.

    Congress finds as follows:
            (1) Breast cancer is the leading cause of cancer death in 
        women under the age of 54, and the American Cancer Society 
        recommends that women in their 20s and 30s have a clinical 
        breast exam at least every 3 years.
            (2) Ovarian cancer causes more deaths than any other cancer 
        of the female reproductive system, but it accounts for only 
        about 3 percent of all cancers in women.
            (3) The cancers that most frequently impact women include 
        breast, uterine, ovarian, and cervical cancer, and there were 
        341,171 new cases of these cancers in 2017.
            (4) Rates of incidence and death for gynecologic cancers by 
        race and ethnicity show that, while for some cancers, like 
        ovarian cancer, the rates of incidence and death are similar 
        among all races, for other cancers, like cervical cancer, women 
        of color have disproportionate incidence and mortality rates. 
        While the incidence of uterine cancer is similar for White 
        women and Women of Color, rates of death for uterine cancer are 
        2 times higher for Black women than for White women.
            (5) Cervical cancer incidence and mortality rates are 
        higher for women living in rural and underserved regions in the 
        United States. Women living in these areas face unique barriers 
        in accessing reproductive health care services to prevent and 
        treat cervical cancer, including a lack of practicing 
        gynecologists in rural areas and challenges around 
        transportation to preventive and follow-up appointments.
            (6) Prevention and cancer screening are the best approaches 
        to protecting women from cancer and ensuring early detection 
        and life-saving treatment. Many deaths from breast and cervical 
        cancers could be avoided if cancer screening rates and 
        diagnostic care and services increased among women at risk. 
        Deaths from these cancers occur disproportionately among women 
        who are uninsured or underinsured.
            (7) Due to enhanced screening, cervical cancer, which used 
        to be the leading cause of cancer death for women in the United 
        States, is now a much more preventable and treatable cancer. It 
        is also highly curable when found and treated early.
            (8) Increased access to education, information, including 
        information on the human papillomavirus vaccine, and preventive 
        cancer screening increase women's ability to survive cancer.
            (9) While more than 15 percent of cases of cervical cancer 
        are found in women over the age of 65, it becomes less likely 
        that women are tested for cervical cancer ever or within the 
        previous 5 years as their age increases.
            (10) Women's health care providers that are primarily 
        engaged in family planning services, such as Planned Parenthood 
        health centers, provide necessary screening tests, education, 
        and information to women, especially women of color who face 
        the highest risks of breast cancer and other gynecologic 
        cancers.
            (11) Access to preventive gynecological screening is also 
        critical for transgender men who have comparable rates of 
        susceptibility to cervical cancer as cisgender women, but often 
        have less access to preventive screenings.
            (12) Discrimination and racism in health care continues to 
        contribute to disparate rates of gynecological cancer in non-
        White women. Black, Indigenous, and other Women of Color die at 
        higher rates from cervical cancer than White women, even though 
        fewer women overall die from cervical cancer.
            (13) Black women with endometrial cancer often receive 
        surgery less often than White women and are more likely to be 
        diagnosed at an advanced stage of the disease, contributing to 
        disparities in mortality in Black women.

SEC. 4. STRENGTHENING ACCESS TO CANCER SCREENING FOR WOMEN.

    (a) In General.--Part B of title III of the Public Health Service 
Act (42 U.S.C. 243 et seq.) is amended by inserting after section 317P 
the following:

``SEC. 317P-1. GRANTS FOR WOMEN'S HEALTH CARE PROVIDERS.

    ``(a) In General.--The Secretary is authorized to make grants and 
to enter into contracts with public or nonprofit private entities to 
expand preventive health services, as provided for in the Preventive 
Services Guidelines of the Health Resources and Service Administration 
that were in effect on October 30, 2017, with an emphasis on increasing 
access to critical, life-saving cancer screening, Pap tests, human 
papillomavirus vaccination, and diagnostic tests for women with cancer 
symptoms, particularly Women of Color.
    ``(b) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $20,000,000 for each of fiscal 
years 2022 through 2024.''.
    (b) Funding.--There is authorized to be appropriated to carry out 
programs related to breast and gynecologic cancers under title XIX of 
the Social Security Act (42 U.S.C. 1396 et seq.) and title X of the 
Public Health Service Act (42 U.S.C. 300 et seq.), and the National 
Breast and Cervical Cancer Early Detection Program, such sums as may be 
necessary for each of fiscal years 2020 through 2023.

SEC. 5. EXPAND CANCER SCREENING PROVIDER TRAINING.

    Part B of title III of the Public Health Service Act (42 U.S.C. 243 
et seq.), as amended by section 4, is further amended by inserting 
after section 317P-1 the following:

``SEC. 317P-2. WOMEN'S HEALTH CARE PROVIDERS DEMONSTRATION TRAINING 
              PROJECT.

    ``(a) Establishment of Program.--The Secretary shall establish a 
demonstration program (referred to in this section as the `program') to 
award 3-year grants to eligible entities for the training of 
physicians, nurse practitioners, and other health care providers 
related to life-saving breast and gynecologic cancer screening for 
women.
    ``(b) Purpose.--The purpose of the program is to enable each grant 
recipient to--
            ``(1) provide to licensed physicians, nurse practitioners, 
        and other health care providers, through clinical training, 
        education, and practice, the most up-to-date clinical 
        guidelines, research, and recommendations adopted by the United 
        States Preventive Services Task Force in the area of preventive 
        cancer screening for breast and gynecologic cancers;
            ``(2) establish a model of training for physicians, nurse 
        practitioners, and other health care providers that specializes 
        in women's health care, with a specific focus on breast and 
        gynecologic cancer screening, that may be replicated 
        nationwide;
            ``(3) train physicians, nurse practitioners, and other 
        health care providers to serve rural and underserved 
        communities, low-income communities, and communities of color 
        in breast and gynecologic cancer screening; and
            ``(4) provide implicit bias, cultural competency, and 
        patient-centered communication training covering the ways in 
        which structural racism and discrimination manifest within the 
        medical field and perpetuate racial disparities in gynecologic 
        cancer incidence and death rates and how to communicate with 
        patients through a knowledgeable and culturally empathetic 
        lens.
    ``(c) Eligible Entities.--To be eligible to receive a grant under 
this section, an entity shall be--
            ``(1) an entity that receives funding under section 1001;
            ``(2) an essential community provider, as defined in 
        section 156.235 of title 45, Code of Federal Regulations (or 
        any successor regulations), that is primarily engaged in family 
        planning;
            ``(3) an entity that furnishes items or services to 
        individuals who are eligible for medical assistance under title 
        XIX of the Social Security Act; or
            ``(4) an entity that, at the time of application, provides 
        cancer screening services under the National Breast and 
        Cervical Cancer Early Detection Program of the Centers for 
        Disease Control and Prevention.''.

SEC. 6. STUDY AND REPORT TO CONGRESS ON INCREASED CANCER SCREENING FOR 
              WOMEN.

    (a) In General.--The Secretary of Health and Human Services 
(referred to in this section as the ``Secretary'') shall conduct a 
study (and periodically update such study) on increased access to 
women's preventive life-saving cancer screening across the United 
States, and, not later than January 1, 2025, and every 5 years 
thereafter, the Secretary shall submit a report to Congress on such 
study.
    (b) Contents.--The study and reports under subsection (a) shall 
include--
            (1) a 50-State analysis of breast and gynecologic cancer 
        rates among women, including by geographic area, income, 
        employment status, race, ethnicity, and status of insurance 
        coverage;
            (2) a 50-State analysis of cancer screening provided by 
        women's health care providers, including clinical breast exams, 
        other screening for breast cancer, and screening for cervical 
        cancer, ovarian cancer, and other gynecologic cancers;
            (3) an analysis of the awareness and availability of 
        breast, cervical, ovarian, and other gynecological cancer 
        screening options for women with disproportionate rates of 
        gynecological cancers, including African-American women, 
        Hispanic and Latina women, women living in rural and 
        underserved areas, and other disproportionately impacted 
        groups, according to the 50-State analyses described in 
        paragraphs (1) and (2);
            (4) an analysis of how structural racism impacts access to 
        cancer screening services, its correlation to the development 
        of breast, cervical, ovarian, and other gynecological cancers, 
        and how it exacerbates health care disparities for African-
        American, Hispanic and Latina women, and other Women of Color;
            (5) in consultation with the Comptroller General of the 
        United States, estimated Federal savings achieved through early 
        detection of breast and gynecologic cancer;
            (6) an analysis of how access to health care providers 
        trained under the program described in section 317P-2 of the 
        Public Health Service Act, as added by section 5, in comparison 
        to other health care providers, increased early detection of 
        cancer and quality of cancer care for women who are less likely 
        to receive care, including African-American women, Hispanic and 
        Latina women, older women, uninsured and underinsured women, 
        and women living in rural and underserved areas;
            (7) recommendations by the Secretary with respect to the 
        need for continued increased access to women's health care 
        providers, such as the entities described in section 317P-2(c) 
        of the Public Health Service Act, as added by section 4, who 
        provide preventive care, including life-saving cancer 
        screening; and
            (8) recommendations for increasing screening rates for 
        women who are less likely to be screened or treated for breast, 
        cervical, ovarian, and other gynecological cancers, including 
        African-American women, Hispanic and Latina women, older women, 
        uninsured and underinsured women, and women living in rural and 
        underserved areas.

SEC. 7. DEMONSTRATION PROJECT ON CO-TESTING FOR HUMAN PAPILLOMAVIRUS 
              AND CERVICAL CANCER.

    Part B of title III of the Public Health Service Act (42 U.S.C. 243 
et seq.), as amended by section 5, is further amended by inserting 
after section 317P-2 the following:

``SEC. 317P-3. DEMONSTRATION PROJECT ON CO-TESTING FOR HUMAN 
              PAPILLOMAVIRUS AND CERVICAL CANCER.

    ``(a) In General.--The Secretary, in coordination with the Director 
of the Centers for Disease Control and Prevention and the Administrator 
of the Health Resources and Services Administration, shall establish a 
2-year demonstration project on increasing the co-testing of human 
papillomavirus and cervical cancer screenings to develop models for 
increasing the rates of co-testing among women with disproportionate 
rates of cervical cancer, including African-American and Hispanic and 
Latina women.
    ``(b) Use of Funds.--Entities receiving funds under this section 
shall use such funds to--
            ``(1) increase access to co-testing of human papillomavirus 
        and cervical cancer among patients with disproportionate rates 
        of cervical cancer, including African-American and Hispanic and 
        Latina women;
            ``(2) support culturally and linguistically appropriate 
        delivery models to such patients, including through the 
        provision of interpretation services; or
            ``(3) provide other services to improve health outcomes 
        with respect to such patients.
    ``(c) Prioritization.--Priority for funding available under this 
section shall be given to entities serving low-income, uninsured, and 
medically underserved populations or populations with historically low 
rates of such co-testing, such as older women.
    ``(d) Eligible Entities.--To be eligible to receive a grant under 
this section, an entity shall be an entity described in section 317P-
2(c).''.
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