[Congressional Record Volume 147, Number 163 (Thursday, November 29, 2001)]
[Senate]
[Pages S12153-S12154]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




    NATIVE AMERICAN BREAST AND CERVICAL CANCER TREATMENT TECHNICAL 
                         AMENDMENT ACT OF 2001

  Mr. BINGAMAN. Mr. President, last evening, the Senate passed by 
unanimous consent S. 1741, the Native American Breast and Cervical 
Cancer Treatment Technical Amendment Act of 2001, which I had 
introduced with Senator McCain and 23 other bipartisan cosponsors.
  S. 1741 is identical to S. 535 and was introduced as a freestanding 
bill to address a jurisdictional concern raised with the committee 
referral of the initial bill. Due to the importance of the legislation, 
I am pleased that the entire Senate saw fit to allow this bill to be 
reintroduced and passed by unanimous consent yesterday.
  The legislation makes a simple, yet important, technical change to 
the Breast and Cervical Cancer Treatment and Prevention Act of 2000 by 
clarifying that American Indian and Alaska Native women should not be 
excluded from receiving coverage through Medicaid for breast and 
cervical cancer treatment.
  The Breast and Cervical Cancer Prevention and Treatment Act of 2000 
gives States the option to extend coverage for the treatment of breast 
and cervical cancer through the Medicaid program to certain women who 
have been screened through the National Breast and Cervical Cancer 
Early Detection Program, or Title XV of the Public Health Service Act, 
and who do not have what is called ``creditable coverage,'' as defined 
by the Health Insurance Portability and Accountability Act of 1996, or 
HIPPA.
  In referencing the HIPPA definition of ``creditable coverage,'' the 
bill language inadvertently precludes coverage to Native American women 
who have access to medical care under the Indian Health Service, or 
IHS. HIPPA included a reference to IHS or tribal care as ``creditable 
coverage'' so that members of Indian Tribes eligible for IHS would not 
be treated as having a break in coverage, and thus subject to pre-
existing exclusions and waiting periods when seeking health insurance, 
simply because they had received care through Indian health programs, 
rather than through a conventional health insurance program. Thus, in 
HIPPA, the inclusion of the IHS or tribal provision was intended to 
benefit American Indians and Alaska Natives, not penalize them.
  However, use of the HIPPA definition in the recent Breast and 
Cervical Cancer Treatment and Prevention Act has the exact opposite 
effect. In fact, the many Indian women, who rely on IHS or tribal 
programs for basic health care, are specifically excluded from the 
law's new eligibility under Medicaid. Clearly it was not the intent of 
Congress to specifically discriminate against low-income Native 
American women and to deny them much needed health treatment to combat 
breast or cervical cancer.
  The legislation resolves these problems by clarifying that, for 
purposes of the Breast and Cervical Cancer Prevention and Treatment 
Act, the term ``creditable coverage'' shall not include IHS-funded care 
so that American Indian and Alaska Native women can be covered by 
Medicaid for breast and cervical cancer treatment, as they are for all 
other Medicaid services. Since a number of States are currently moving 
forward to provide Medicaid coverage under the State option, the need 
for this legislation is immediate to ensure that some American Indian 
and Alaska Native women are not denied received life-saving breast and 
cervical cancer treatment due to a Congressional drafting error.
  In addition, this bill would also reduce the administrative burdens 
this language places on states. Under administrative guidance, some 
Native American women can be enrolled on the program depending on a 
determination of their ``access'' to IHS services, which depends on 
certain documentation obtained by Native American women seeking breast 
and cervical cancer treatment from IHS. In order to determine the 
Medicaid eligibility of Native American women who are screened as 
having breast or cervical cancer through the Title XV program each 
year, states are having to put together a whole set of regulations and 
rules to make these special ``access'' determinations.
  During this year, almost 50,000 women are expected to die from breast 
or cervical cancer in the United States despite the fact that early 
detection and treatment of these diseases could substantially decrease 
this mortality. While passage of last year's bill makes significant 
strides to address this problem, it fails to do so for certain Native 
American women and that must be changed as soon as possible.
  In support of Native American women across this country that are 
being diagnosed through CDC screening activities as having breast or 
cervical cancer, this legislation will assure that they can also access 
much needed treatment through the Medicaid program while also reducing 
the unnecessary paperwork and administrative burdens on states.
  I would like to thank all Senators for their support and specifically 
thank

[[Page S12154]]

Chairman Inouye and Senator Campbell of the Committee on Indian Affairs 
and Chairman Baucus and Senator Grassley of the Finance Committee for 
agreeing to move the bill. In addition, I would like to thank the 
bill's cosponsors, which include Senators McCain, Daschle, Baucus, 
Clinton, Domenici, Feingold, Kennedy, Johnson, Murray, Stabenow, 
Wellstone, Harkin, Miller, Snowe, Inouye, Smith of Oregon, Cantwell, 
Inhofe, Landrieu, Cochran, Boxer, Murkowski, Mikulski, and Grassley for 
their help in getting the bill passed.
  I would also like to thank Sara Rosenbaum at George Washington 
University for bringing this problem to our attention and for her vast 
knowledge on this issue and Andy Schneider for his technical advice and 
counsel on correcting the problem.
  In addition, this bill would never have passed without the 
outstanding support and efforts by Fran Visco, Jennifer Katz, Wendy 
Arends, Alana Wexler, Joanne Huff, and Vicki Tosher at the National 
Breast Cancer Coalition, Wendy Selig, Licy Docanto, Brian Lee, and 
Janet Thomas of the American Cancer Society, Dawn McKinney and Laura 
Hessburg of the American College of Obstetricians and Gynecologists, 
Leigh Ann McGee of the Cherokee Nation, Jacqueline Johnson of the 
National Congress of American Indians, and the many Indian health 
organizations that have helped with the passage of this legislation as 
well.
  I urge the House to immediately take up and pass this legislation and 
for the President to sign it into law to ensure that Native American 
women are not inappropriately denied treatment for their breast and 
cervical cancer. As states proceed with the implementation of last 
year's bill, any further delay and failure to act could unnecessarily 
threaten the lives of Native American women across this country.

                          ____________________