[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.

                          ____________________