[Congressional Record Volume 143, Number 143 (Wednesday, October 22, 1997)]
[House]
[Pages H8982-H8984]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
BREAST CANCER LEGISLATION
Ms. ESHOO. Mr. Speaker, first, I thank my colleague Rep. Rosa DeLauro
for organizing this special order during National Breast Cancer
Awareness Month and for her unwavering advocacy on behalf of breast
cancer patients.
Breast cancer touches the lives of thousands of American women, their
families, and their friends every year, forcing them to confront both
death and disfigurement. Over 180,000 American women are diagnosed with
breast cancer annually and 44,000 of them die from the disease. Another
85,000 American women have mastectomies as part of their treatment each
year, 25,000 of whom choose to have reconstructive breast surgery
because of the tremendous damage that mastectomy does to a woman's
body.
Fear of losing a breast is one of the main reasons many women do not
have preventive examinations for breast cancer--many don't know about
the possibility of reconstructive surgery.
Unfortunately, many insurance companies don't recognize the
importance of breast reconstruction. A recent survey shows that 84
percent of plastic surgeons had up to 10 patients denied coverage for
reconstruction of an amputated breast.
The unwillingness of some insurance companies to pay for
reconstructive breast surgery following a mastectomy defies all sense
of reason and compassion. Reconstructive surgery in these cases is not
cosmetic--it's part of the continuum of case necessary for the complete
recovery of patients.
On the first day of the 105th Congress, I introduced H.R. 164, the
Reconstructive Breast Surgery Benefits Act. This legislation says that
insurance companies that cover mastectomies must also cover
reconstructive breast surgery resulting from mastectomies, including
surgery to establish symmetry between breasts. Companies can't deny
coverage for reconstructive surgery by claiming it's cosmetic surgery.
At the same time, H.R. 164 doesn't force women to have the surgery
and it allows companies to impose reasonable charges for providing the
benefit.
Even though this initiative has won broad bipartisan support, no
hearings have been held on it. Nor have hearings been held on a related
piece of bipartisan legislation, H.R. 135, which would stop the
shameful practice of drive-through mastectomies.
That's why I welcome the online breast cancer care petition drive
which was launched last month to call for hearings on both breast
cancer bills.
Located on the Web at breastcare.shn.com, the petition gives breast
cancer patients and those who care about them a chance to log on,
learn, and leave their names in support of congressional action. The
petition will run through the end of this month.
Nearly 6,000 people from across the country have signed the petition
so far.
In addition to collecting signatures, the site allows people to leave
personal stories about their experiences with breast cancer. Hundreds
of people have done so, and anyone reading them can't help but be
moved.
At the end of the drive, the petition will be delivered in hard copy
to the appropriate committee and subcommittee chairmen to demonstrate
that these bills have broad support and deserve hearings.
In closing, I want to read to you just two of the comments that have
been left at the petition site. The people who have left them speak far
more eloquently about this issue than I ever could.
One woman wrote:
On January 17, 1997, I learned that my mother, the woman I
thought was a breast cancer survivor and success story, had
developed recurrent breast cancer. On February 4, 1997, my
mother was dead. My family has been devastated by the loss. I
have accomplished some of the dreams she and I shared
together, but cannot tell her. I was finally able to return
to live near her, but she's no longer there . . . I thank you
for providing me with this opportunity to let those in
government know how important it is to provide women with
adequate and acceptable care for this devastating disease.
On October 5, a woman left this message:
I was diagnosed with breast cancer 48 hours ago. I must
have more surgery in 24 hours. I am terrified. I don't want
to die. My grandmother, my mother, and my mother's sister all
had breast cancer. I am 53. I have a beautiful 26-year-old
daughter. I want her never to suffer with this.
Providing coverage for reconstructive breast surgery and stopping
drive-through mastectomies are two important issues related to breast
cancer. Until there's a cure for the disease, we must ensure that women
are given the best care possible to cope with breast cancer and its
treatment.
Mr. Speaker, I encourage people to visit the petition site,
breastcare.shn.com, and read these personal stories. They all have one
simple underlying theme: it's time for Congress to stop delaying and
start acting on these important pieces of legislation.
Ms. JACKSON-LEE of Texas, Mr. Speaker, I rise tonight to speak about
an issue of vital importance to the women of this Nation--breast
cancer. As a woman and a mother, I feel that there are few issues as
important to women's health as the breast cancer epidemic facing our
Nation. Therefore, I add my voice to supporting the DeLauro legislation
on breast cancer.
As you may know, breast cancer is the most commonly diagnosed cancer
in American women today. An estimated 2.6 million women in the United
States are living with breast cancer. Currently, there are 1.8 million
women in this country who have been diagnosed with breast cancer and 1
million more who do not yet know that they have the disease. It was
estimated that in 1996, 184,300 new cases of breast cancer would be
diagnosed and 44,300 women would die from the disease. Breast cancer
costs this country more than $6 billion each year in medical expenses
and lost productivity.
These statistics are powerful indeed, but they cannot possibly
capture the heartbreak of this disease which impacts not only the women
who are diagnosed, but their husbands, children, and families.
Sadly, the death rate from breast cancer has not been reduced in more
than 50 years. One out of four women with breast cancer dies within the
first 5 years; 40 percent die within 10 years of diagnosis.
Furthermore, the incidence of breast cancer among American women is
rising each year. One out of eight women in the United States will
develop breast cancer in her lifetime--a risk that was 1 in 14 in 1960.
For women ages 30 to 34, the incidence rate tripled between 1973 and
1987; the rate quadrupled for women ages 35 to 39 during the same
period.
I am particularly concerned about studies which have found that
African-American women are twice as likely as white women to have their
breast cancer diagnosed at a later stage, after it has already spread
to the lymph nodes. One study by the Agency for Health Care Policy and
Research found that African-American women were significantly more
likely than white women to have never had a mammogram or to have had no
mammogram in the 3-year period before development of symptoms or
diagnosis. Mammography was protective against later stage diagnosis in
white women, but not in black women.
We have made progress in the past few years by bringing this issue to
the Nation's attention. Events such as this October's Breast Cancer
Awareness Month, are crucial to sustaining this attention. There is,
however, more to be done.
It is clear that more research and testing needs to be done in this
area. We also need to increase education and outreach efforts to reach
those women who are not getting mammograms and physical exams.
We cannot allow these negative trends in women's health to continue.
We owe it to our daughters, sisters, mothers, and grandmothers to do
more. Money for research must be increased and must focus on the
detection, treatment, and prevention of this devastating disease.
Mrs. ROUKEMA. Mr. Speaker, I take this opportunity during Breast
Cancer Awareness Month to ask my colleagues' support for H.R. 135, the
Breast Cancer Patient Protection Act of 1997. This legislation would
require health
[[Page H8983]]
insurance companies to pay for at least a 48-hour hospital stay for
women who undergo a mastectomy.
I find it unbelievable that some HMO's are sending women home the
same day after having a mastectomy. This is not just a matter of
postsurgical complications, possible infection, and other medical
issues. This is one of the most anguish-filled, emotionally trying
crises a woman can ever face. To perform a mastectomy and then turn the
patient out the door shows callous indifference to the dignity of all
women.
Sometimes it seems that HMO's are making a concentrated attack on the
health concerns of women. First they were trying to discharge new
mothers 12 hours after giving birth. Now we have outpatient--drive-
through--mastectomies. What will come next? I will not settle for
third-world standards for health care for women in this country and
neither will the 184,000 women who contract breast cancer each year.
This is not legitimate cost-saving. This is cold, callous rationing of
care.
Some HMO's say outpatient mastectomies are not mandatory--that the
doctor and patient can decide how long to stay in the hospital. I would
like to believe that it is true. But we have already seen physicians
being coerced into providing lower levels of care when HMO's think they
are spending too much money. HMO's are often in a position to put a
doctor out of business overnight by taking his or her patients away. I
do not accept the rationalizations of the HMO's. Clearly, they need
regulatory direction.
With 184,000 new cases each year, breast cancer is the most common
form of cancer afflicting American women. My home State of New Jersey
has the fourth-highest number of breast cancer cases in the Nation and
the third-highest number of deaths from breast cancer. Those statistics
make the seriousness and scope of this tragic disease absolutely clear.
Someday, we may find a cure. But in the meantime, we must do everything
possible to ensure that women who contract breast cancer receive proper
medical treatment--and that proper care is placed ahead of insurance
companies' bottom line. Please support the Breast Cancer Patient
Protection Act of 1997.
Mr. FROST. Mr. Speaker, I am pleased to rise in recognition of the
month of October as Breast Cancer Awareness Month. This year alone,
180,000 women in this country will be diagnosed with breast cancer.
Although there is no cure, the best way known to prevent breast cancer
is through early diagnosis and treatment.
Two bills have been introduced to combat breast cancer. House
Resolution 135, the Breast Cancer Patient Protection Act, guarantees
that women who must undergo surgery for the treatment of breast cancer
get the hospital stay they need and deserve. This legislation requires
a woman to receive a minimum hospital stay of 48 hours for a
mastectomy, and 24 hours for a lymph node removal. This will enable
women and doctors to determine how long they need to stay in the
hospital and not the insurance companies.
The other bill is House Resolution 164, the Breast Surgery Benefits
Act, which targets insurance coverage for breast reconstruction. It
requires group and individual health insurance plans to provide
coverage for reconstructive breast surgery if they provide coverage for
mastectomies. This bill will protect many of the mastectomy patients
that are denied coverage for breast reconstruction each year.
Breast cancer is a serious problem facing every woman in the United
States today. I believe that breast cancer deserves more attention and
that is why I am a cosponsor of both of these bills. Breast cancer is
not going to go away and we must, in any way that we can, protect our
women from the dangers of it.
Mrs. MALONEY of New York. Mr. Speaker, it is my pleasure to join my
colleagues, Rosa DeLauro, Anna Eshoo, and others tonight to salute
October as Breast Cancer Awareness Month.
We know, all too well, the devastating facts:
With nearly 200,000 cases of breast cancer diagnosed last year,
breast cancer is the most common cancer among women.
I was pleased earlier this year, Congress enacted, as part of its
balanced budget, my bipartisan bill, the Breast Cancer Early Detection
Act, to allow for annual mammograms for Medicare women.
By including my bipartisan bill, this budget agreement makes a wise
investment that will save women's lives.
But there is more that needs to be done.
Once breast cancer is diagnosed, sometimes it is too late.
But sometimes, when treatment is available, a woman can undergo a
mastectomy which may save her life.
Unfortunately, very often, we've seen women who have been forced to
leave the hospital with drainage tubes still attached. And just like
the drive-thru delivery bill, a national outcry forced us to look at
the safety of women who were sent home hours after a radical
mastectomy.
I am proud to be an original cosponsor of H.R. 135, the Breast Cancer
Patient Protection Act.
This bill will eliminate these so-called drive-through mastectomies
by requiring insurance companies to provide at least 48 hours of
inpatient hospital care following a mastectomy and a minimum of 24
hours following a lymph node dissection for the treatment of breast
cancer.
I am also proud to be a cosponsor of H.R. 164, the Reconstructive
Breast Surgery Benefits Act, introduced by Representative Anna Eshoo.
This bill would require health insurance companies to cover
reconstructive breast surgery if they already pay for mastectomies.
I am pleased to stand with my colleagues in support of the one out of
every eight women who will get breast cancer in her lifetime.
Right now, thousands of women are signing an electronic petition. The
online petition drive will enable breast cancer patients to become
activists on behalf of the legislation that would provide them with the
kind of health care they deserve.
Many have shared their personal stories. One New York woman wrote:
On August 25, 1997 a lumpectomy showed that indeed, I did
have breast cancer. An axillary lymph node dissection showed
that the cancer has traveled to my blood stream. I am 34
years old. I am undergoing chemotherapy, and will also to
have radiation. It is absolutely necessary for you in
government to help women all across the country and to take
this disease seriously. We depend on our government to
protect us, even when a devastating illness has befallen us.
My mother's two best friends died of breast cancer, one
when I was too young to remember, and the other when I was
18. It was devastating for everyone and we are convinced that
it was the love of family and friends that helped one friend
fight 10 years with this disease. Coming from a family in
which no woman has ever developed breast cancer, the pop
culture leads me to believe that I am not at risk. Only
through doing research on my own have I learned that every
woman is at risk regardless of age, family history, or
geographical location. This is a silent killer that must be
stopped. Our world desperately needs its mothers, sister,
aunts and friends.
I was not in any high risk group for developing breast
cancer. Yet I was diagnosed with breast cancer in November
1996. I was shocked and it is still very hard for me to
accept this diagnosis. I opted for a mastectomy with
reconstruction. I am still in the process of reconstructive
surgery. I also underwent seven months of chemotherapy.
We need to make sure mastectomies and reconstructive surgery are
safe, and covered.
I thank my colleagues for organizing this special order, and I salute
the women who are facing these issues every day.
You are our inspiration, and we will continue fighting for you.
Mr. DINGELL. Mr. Speaker, I am pleased today to join with my
colleague from Connecticut [Ms. DeLauro], to urge our colleagues to
cosponsor the Breast Cancer Patient Protection Act of 1997. This
legislation seeks to ensure that women and doctors--not insurance
company bureaucrats--decide how long a woman who has a mastectomy
should remain in the hospital.
For any woman, learning that she has breast cancer is one of her most
frightening experiences. Learning she must have a mastectomy, a
surgical procedure that will alter her body and her life, can be
devastating.
For an insurance company to dictate to a woman, facing one of life's
greatest challenge, that she must leave the hospital whether she is
ready or not, is the ultimate insult.
Late last year, I came to a more precise understanding of the trauma
a woman faces when she learns she must have a mastectomy. A member of
my staff in Michigan, Connie Shorter, practically awoke 1 day to the
stunning and agonizing reality that she had cancer. As if physical and
psychological pain of the disease were not already too much to cope
with, soon Connie would discover the pain of a process which neither
she nor her doctor could control.
Earlier this year, Ms. Shorter was asked to the White House to join
with First Lady Hillary Rodham Clinton in relating the difficulties
associated with drive-thru mastectomies. There are no words better than
Connie's own as she told her story to the First Lady:
What makes this awful situation worse is that I was
discharged eight hours after two major surgeries. I was
appalled to learn that this is routine, and I learned very
quickly why. Being sent home only a few hours after surgery
was not because of my medical condition or because of my
doctor's specific recommendation.
Coming home was not easy. From the moment a woman walks in
the hospital door in the morning for her unwanted mastectomy,
until she is wheeled out that afternoon, she feels she has
been through one of the world's most painful physical and
psychological wars, a very personal loss and incredible
physical battle * * * after my experience, I could not feel
more strongly that a woman and her doctor are the only two
people who should decide when she should leave the hospital
after surgery.
[[Page H8984]]
Every medical specialty organization in this country challenges the
right of insurance companies to interfere in the decision of what
treatment is medically necessary or appropriate for a patient. Whether
that patient is a young woman giving birth to a baby, or having surgery
to treat breast cancer, the insurer has no right to be in the middle,
between the patient and the doctor. And in no case should a patent be
sent home less than 24 hours after a mastectomy so that an insurance
company or hospital can save money.
Representative DeLauro and I, along with many other Members, placed
this issue on the table at the end of the last session because we
wanted every Member of this body to think about this matter before the
convening of the 105th Congress. We spent several months researching
the best, most effective way to accomplish the goals we laid out last
year. This legislation is consistent with the Kennedy-Kassebaum health
insurance reform bill and with the MOMS bill passed last Congress,
providing 48-hour maternity stays.
H.R. 135 goes where many angels have feared to tread, into the
hallowed halls of a well-heeled industry that is trying to make cost,
rather than care, the driving principle of our health care system. This
legislation just says ``no.'' It says to anyone who is not the patient
or the patient's doctor: ``No, you may not dictate when a patient must
leave the hospital.''
Mr. Speaker, I am very happy to report that almost a year after her
surgery, Connie Shorter is a breast cancer survivor, and remains a
vital and effective member of my senior staff. More important, she
remains a loving, caring and giving spouse, mother, and grandmother,
and we all expect her to continue in all these roles for a very long
time.
As Connie's story reveals, the devastation of breast cancer is too
great to allow Congress to ignore the risks of inadequate medical care.
The difficulties, both physical and psychological, associated with
mastectomy are too complex. This legislation seeks to ensure that
insurance snafus and mindless refusals do not make these difficult
situations impossible.
Today, H.R. 135 has almost 200 cosponsors from both sides of the
aisle. In addition, a nationwide campaign on the Interned has begun to
push us to give this bill and other crease cancer legislation the
hearings they deserve. I urge my colleagues who have not already
cosponsored this legislation to do so now, and express the hope that
Congress will listen to respond to the women of America who seek better
and more reliable treatment for breast cancer.
____________________