[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.
____________________