[Congressional Record Volume 143, Number 1 (Tuesday, January 7, 1997)]
[Extensions of Remarks]
[Pages E1-E2]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




 INTRODUCTION OF THE RECONSTRUCTIVE BREAST SURGERY BENEFITS ACT OF 1997

                                 ______
                                 

                           HON. ANNA G. ESHOO

                             of california

                    in the house of representatives

                        Tuesday, January 7, 1997

  Ms. ESHOO. Mr. Speaker, I rise today to introduce the Reconstructive 
Breast Surgery Benefits Act of 1997 to guarantee that insurance 
companies cover the cost of reconstructive breast surgery that results 
from mastectomies for which coverage is already provided. In addition, 
the legislation would secure insurance coverage for all stages of 
reconstructive breast surgery performed on a nondiseased breast to 
establish symmetry with the diseased one when reconstructive surgery on 
the diseased breast is performed.
  In 1995, an estimated 182,000 American women were diagnosed with 
breast cancer, and 85,000 of them underwent a mastectomy as part of 
their treatment. Reconstructive breast surgery often is an integral 
part of the mental and physical recovery of women who undergo this 
traumatic, disfiguring procedure. Unfortunately, insurance companies 
don't always see it that way. Even though many of them are willing to 
pay for mastectomies, they sometimes balk at covering breast 
reconstruction. This legislation would put an end to this shortsighted 
practice and guarantee that women with breast cancer are not victimized 
twice--first by the disease, then by their insurance companies.
  According to the American Society of Plastic and Reconstructive 
Surgeons [ASPRS], a significant number of women with breast cancer must 
undergo mastectomy or amputation of a breast in order to treat their 
disease appropriately. The two most common types of reconstruction--
tissue expansion followed by an implant insertion and flap surgery--can 
restore the breast mound to a natural shape. Most breast reconstruction 
requires a series of procedures that may include an operation on the 
opposite breast for symmetry.
  Even though studies show that fear of losing a breast is a leading 
reason why many women do not participate in early breast cancer 
detection programs, many general surgeons don't even present 
reconstruction as an option for mastectomy candidates. Unfortunately, 
many women are unaware that reconstruction is an option following 
mastectomy, and they put off testing and/or treatment for breast cancer 
until it is too late.
  A recent ASPRS survey--with an error range of 1.9 
percent--indicates that 84


[[Page E2]]

percent of respondents had up to 10 patients who were denied insurance 
coverage for breast reconstruction of the amputated breast. Of those 
surgeons who support State legislation to address this problem and 
reported denied coverage, the top three procedures denied most often 
were symmetry surgery on a nondiseased breast, revision of breast 
reconstruction, and nipple areola reconstruction. The top five States 
of residence of those patients reporting denied coverage are Florida, 
California, Texas, Pennsylvania, and New York.
  California and Florida also are among the 13 States that have passed 
laws requiring breast reconstruction coverage after mastectomy. 
However, State laws alone, such as the California and Florida laws, do 
not provide adequate protection for women because States do not have 
jurisdiction over interstate insurance policies provided by large 
companies under the Employee Retirement Income Security Act [ERISA]. As 
a result, even women in States that have attempted to address this 
issue are still at risk of being denied coverage for reconstructive 
surgery.

  The Reconstructive Breast Surgery Benefits Act would amend the Public 
Health Service Act and ERISA to do the following: require health 
insurance companies that provide coverage for mastectomies to cover 
reconstructive breast surgery that results from those mastectomies, 
including surgery to establish symmetry between breasts; prohibit 
insurance companies from denying coverage for breast reconstruction 
resulting from mastectomies on the basis that the coverage is for 
cosmetic surgery; prohibit insurance companies from denying a woman 
eligibility or continued eligibility for coverage solely to avoid 
providing payment for breast reconstruction; prohibit insurance 
companies from providing monetary payments or rebates to women to 
encourage such women to accept less than the minimum protections 
available under this act; prohibit insurance companies from penalizing 
an attending care provider because such care provider gave care to an 
individual participant or beneficiary in accordance with this act; and 
prohibit insurance companies from providing incentives to an attending 
care provider to induce such care provider to give care to an 
individual participant or beneficiary in a manner inconsistent with 
this act.
  On the other hand, the Reconstructive Breast Surgery Benefits Act 
would not: Require a woman to undergo reconstructive breast surgery; 
apply to any insurance company that does not offer benefits for 
mastectomies; prevent an insurance company from imposing reasonable 
deductibles, coinsurance, or other cost-sharing in relation to 
reconstructive breast surgery benefits; prevent insurance companies 
from negotiating the level and type of reimbursement with a care 
provider for care given in accordance with this act; and preempt State 
laws that require coverage for reconstructive breast surgery at least 
equal to the level of coverage provided in this act.
  Mr. Speaker, women who have breast cancer suffer enough without 
having to worry about whether or not their insurance companies will 
cover reconstructive surgery. I urge my colleagues in helping to give 
these women peace of mind and the coverage they need by supporting the 
Reconstructive Breast Surgery Benefits Act.

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