[Congressional Record (Bound Edition), Volume 154 (2008), Part 15]
[House]
[Pages 20275-20280]
[From the U.S. Government Publishing Office, www.gpo.gov]




              BREAST CANCER PATIENT PROTECTION ACT OF 2008

  Mr. PALLONE. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 758) to require that health plans provide coverage for a 
minimum hospital stay for mastectomies, lumpectomies, and lymph node 
dissection for the treatment of breast cancer and coverage for 
secondary consultations, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                                H.R. 758

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Breast Cancer Patient 
     Protection Act of 2008''.

     SEC. 2. FINDINGS.

       Congress finds that--
       (1) the offering and operation of health plans affect 
     commerce among the States;
       (2) health care providers located in a State serve patients 
     who reside in the State and patients who reside in other 
     States;
       (3) in order to provide for uniform treatment of health 
     care providers and patients among the States, it is necessary 
     to cover health plans operating in 1 State as well as health 
     plans operating among the several States;
       (4) currently, 20 States mandate minimum hospital stay 
     coverage after a patient undergoes a mastectomy;
       (5) according to the American Cancer Society, there were 
     40,954 deaths due to breast cancer in women in 2004;
       (6) according to the American Cancer Society, there are 
     currently over 2.0 million women living in the United States 
     who have been treated for breast cancer; and
       (7) according to the American Cancer Society, a woman in 
     the United States has a 1 in 8 chance of developing invasive 
     breast cancer in her lifetime.

     SEC. 3. AMENDMENTS TO THE EMPLOYEE RETIREMENT INCOME SECURITY 
                   ACT OF 1974.

       (a) In General.--Subpart B of part 7 of subtitle B of title 
     I of the Employee Retirement Income Security Act of 1974 (29 
     U.S.C. 1185 et seq.) is amended by adding at the end the 
     following:

     ``SEC. 714. REQUIRED COVERAGE FOR MINIMUM HOSPITAL STAY FOR 
                   MASTECTOMIES, LUMPECTOMIES, AND LYMPH NODE 
                   DISSECTIONS FOR THE TREATMENT OF BREAST CANCER 
                   AND COVERAGE FOR SECONDARY CONSULTATIONS.

       ``(a) Inpatient Care.--
       ``(1) In general.--A group health plan, and a health 
     insurance issuer providing health insurance coverage in 
     connection with a group health plan, that provides medical 
     and surgical benefits shall ensure that inpatient (and in the 
     case of a lumpectomy, outpatient) coverage and radiation 
     therapy is provided for breast cancer treatment. Such plan or 
     coverage may not--
       ``(A) insofar as the attending physician, in consultation 
     with the patient, determines it to be medically necessary--
       ``(i) restrict benefits for any hospital length of stay in 
     connection with a mastectomy or breast conserving surgery 
     (such as a lumpectomy) for the treatment of breast cancer to 
     less than 48 hours; or
       ``(ii) restrict benefits for any hospital length of stay in 
     connection with a lymph node dissection for the treatment of 
     breast cancer to less than 24 hours; or
       ``(B) require that a provider obtain authorization from the 
     plan or the issuer for prescribing any length of stay 
     required under this paragraph.
       ``(2) Exception.--Nothing in this section shall be 
     construed as requiring the provision of inpatient coverage if 
     the attending physician, in consultation with the patient, 
     determines that either a shorter period of hospital stay, or 
     outpatient treatment, is medically appropriate.
       ``(b) Prohibition on Certain Modifications.--In 
     implementing the requirements of this section, a group health 
     plan, and a health insurance issuer providing health 
     insurance coverage in connection with a group health plan, 
     may not modify the terms and conditions of coverage based on 
     the determination by a participant or beneficiary to request 
     less than the minimum coverage required under subsection (a).
       ``(c) Notice.--A group health plan, and a health insurance 
     issuer providing health insurance coverage in connection with 
     a group health plan shall provide notice to each participant 
     and beneficiary under such plan regarding the coverage 
     required by this section in accordance with regulations 
     promulgated by the Secretary. Such notice shall be in writing 
     and prominently positioned in the summary of the plan made 
     available or distributed by the plan or issuer and shall be 
     transmitted--
       ``(1) in the next mailing made by the plan or issuer to the 
     participant or beneficiary; or
       ``(2) as part of any yearly informational packet sent to 
     the participant or beneficiary;
     whichever is earlier.
       ``(d) Secondary Consultations.--
       ``(1) In general.--A group health plan, and a health 
     insurance issuer providing health insurance coverage in 
     connection with a group health plan, that provides coverage 
     with respect to medical and surgical services provided in 
     relation to the diagnosis and treatment of cancer shall 
     ensure that coverage is provided for secondary consultations, 
     on terms and conditions that are no more restrictive than 
     those applicable to the initial consultations, by specialists 
     in the appropriate medical fields (including pathology, 
     radiology, and oncology) to confirm or refute such diagnosis. 
     Such plan or issuer shall ensure that coverage is provided 
     for such secondary consultation whether such consultation is 
     based on a positive or negative initial diagnosis. In any 
     case in which the attending physician certifies in writing 
     that services necessary for such a secondary consultation are 
     not sufficiently available from specialists operating under 
     the plan with respect to whose services coverage is otherwise 
     provided under such plan or by such issuer, such plan or 
     issuer shall ensure that coverage is provided with respect to 
     the services necessary for the secondary consultation with 
     any other specialist selected by the attending physician for 
     such purpose at no additional cost to the individual beyond 
     that which the individual would have paid if the specialist 
     was participating in the network of the plan.
       ``(2) Exception.--Nothing in paragraph (1) shall be 
     construed as requiring the provision of secondary 
     consultations where the patient determines not to seek such a 
     consultation.
       ``(e) Prohibition on Penalties or Incentives.--A group 
     health plan, and a health insurance issuer providing health 
     insurance coverage in connection with a group health plan, 
     may not--
       ``(1) penalize or otherwise reduce or limit the 
     reimbursement of a provider or specialist because the 
     provider or specialist provided care to a participant or 
     beneficiary in accordance with this section;
       ``(2) provide financial or other incentives to a physician 
     or specialist to induce the physician or specialist to keep 
     the length of inpatient stays of patients following a 
     mastectomy, lumpectomy, or a lymph node dissection for the 
     treatment of breast cancer below certain limits or to limit 
     referrals for secondary consultations; or
       ``(3) provide financial or other incentives to a physician 
     or specialist to induce the

[[Page 20276]]

     physician or specialist to refrain from referring a 
     participant or beneficiary for a secondary consultation that 
     would otherwise be covered by the plan or coverage involved 
     under subsection (d).''.
       (b) Clerical Amendment.--The table of contents in section 1 
     of the Employee Retirement Income Security Act of 1974 is 
     amended by inserting after the item relating to section 713 
     the following:

``Sec. 714. Required coverage for minimum hospital stay for 
              mastectomies, lumpectomies, and lymph node dissections 
              for the treatment of breast cancer and coverage for 
              secondary consultations.''.
       (c) Effective Dates.--
       (1) In general.--The amendments made by this section shall 
     apply with respect to plan years beginning on or after the 
     date that is 90 days after the date of enactment of this Act.
       (2) Special rule for collective bargaining agreements.--In 
     the case of a group health plan maintained pursuant to 1 or 
     more collective bargaining agreements between employee 
     representatives and 1 or more employers ratified before the 
     date of enactment of this Act, the amendments made by this 
     section shall not apply to plan years beginning before the 
     date on which the last collective bargaining agreements 
     relating to the plan terminates (determined without regard to 
     any extension thereof agreed to after the date of enactment 
     of this Act). For purposes of this paragraph, any plan 
     amendment made pursuant to a collective bargaining agreement 
     relating to the plan which amends the plan solely to conform 
     to any requirement added by this section shall not be treated 
     as a termination of such collective bargaining agreement.

     SEC. 4. AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT RELATING 
                   TO THE GROUP MARKET.

       (a) In General.--Subpart 2 of part A of title XXVII of the 
     Public Health Service Act (42 U.S.C. 300gg-4 et seq.) is 
     amended by adding at the end the following:

     ``SEC. 2707. REQUIRED COVERAGE FOR MINIMUM HOSPITAL STAY FOR 
                   MASTECTOMIES, LUMPECTOMIES, AND LYMPH NODE 
                   DISSECTIONS FOR THE TREATMENT OF BREAST CANCER 
                   AND COVERAGE FOR SECONDARY CONSULTATIONS.

       ``(a) Inpatient Care.--
       ``(1) In general.--A group health plan, and a health 
     insurance issuer providing health insurance coverage in 
     connection with a group health plan, that provides medical 
     and surgical benefits shall ensure that inpatient (and in the 
     case of a lumpectomy, outpatient) coverage and radiation 
     therapy is provided for breast cancer treatment. Such plan or 
     coverage may not--
       ``(A) insofar as the attending physician, in consultation 
     with the patient, determines it to be medically necessary--
       ``(i) restrict benefits for any hospital length of stay in 
     connection with a mastectomy or breast conserving surgery 
     (such as a lumpectomy) for the treatment of breast cancer to 
     less than 48 hours; or
       ``(ii) restrict benefits for any hospital length of stay in 
     connection with a lymph node dissection for the treatment of 
     breast cancer to less than 24 hours; or
       ``(B) require that a provider obtain authorization from the 
     plan or the issuer for prescribing any length of stay 
     required under this paragraph.
       ``(2) Exception.--Nothing in this section shall be 
     construed as requiring the provision of inpatient coverage if 
     the attending physician, in consultation with the patient, 
     determines that either a shorter period of hospital stay, or 
     outpatient treatment, is medically appropriate.
       ``(b) Prohibition on Certain Modifications.--In 
     implementing the requirements of this section, a group health 
     plan, and a health insurance issuer providing health 
     insurance coverage in connection with a group health plan, 
     may not modify the terms and conditions of coverage based on 
     the determination by a participant or beneficiary to request 
     less than the minimum coverage required under subsection (a).
       ``(c) Notice.--A group health plan, and a health insurance 
     issuer providing health insurance coverage in connection with 
     a group health plan shall provide notice to each participant 
     and beneficiary under such plan regarding the coverage 
     required by this section in accordance with regulations 
     promulgated by the Secretary. Such notice shall be in writing 
     and prominently positioned in the summary of the plan made 
     available or distributed by the plan or issuer and shall be 
     transmitted--
       ``(1) in the next mailing made by the plan or issuer to the 
     participant or beneficiary; or
       ``(2) as part of any yearly informational packet sent to 
     the participant or beneficiary;
     whichever is earlier.
       ``(d) Secondary Consultations.--
       ``(1) In general.--A group health plan, and a health 
     insurance issuer providing health insurance coverage in 
     connection with a group health plan, that provides coverage 
     with respect to medical and surgical services provided in 
     relation to the diagnosis and treatment of cancer shall 
     ensure that coverage is provided for secondary consultations, 
     on terms and conditions that are no more restrictive than 
     those applicable to the initial consultations, by specialists 
     in the appropriate medical fields (including pathology, 
     radiology, and oncology) to confirm or refute such diagnosis. 
     Such plan or issuer shall ensure that coverage is provided 
     for such secondary consultation whether such consultation is 
     based on a positive or negative initial diagnosis. In any 
     case in which the attending physician certifies in writing 
     that services necessary for such a secondary consultation are 
     not sufficiently available from specialists operating under 
     the plan with respect to whose services coverage is otherwise 
     provided under such plan or by such issuer, such plan or 
     issuer shall ensure that coverage is provided with respect to 
     the services necessary for the secondary consultation with 
     any other specialist selected by the attending physician for 
     such purpose at no additional cost to the individual beyond 
     that which the individual would have paid if the specialist 
     was participating in the network of the plan.
       ``(2) Exception.--Nothing in paragraph (1) shall be 
     construed as requiring the provision of secondary 
     consultations where the patient determines not to seek such a 
     consultation.
       ``(e) Prohibition on Penalties or Incentives.--A group 
     health plan, and a health insurance issuer providing health 
     insurance coverage in connection with a group health plan, 
     may not--
       ``(1) penalize or otherwise reduce or limit the 
     reimbursement of a provider or specialist because the 
     provider or specialist provided care to a participant or 
     beneficiary in accordance with this section;
       ``(2) provide financial or other incentives to a physician 
     or specialist to induce the physician or specialist to keep 
     the length of inpatient stays of patients following a 
     mastectomy, lumpectomy, or a lymph node dissection for the 
     treatment of breast cancer below certain limits or to limit 
     referrals for secondary consultations; or
       ``(3) provide financial or other incentives to a physician 
     or specialist to induce the physician or specialist to 
     refrain from referring a participant or beneficiary for a 
     secondary consultation that would otherwise be covered by the 
     plan or coverage involved under subsection (d).''.
       (b) Effective Dates.--
       (1) In general.--The amendments made by this section shall 
     apply to group health plans for plan years beginning on or 
     after 90 days after the date of enactment of this Act.
       (2) Special rule for collective bargaining agreements.--In 
     the case of a group health plan maintained pursuant to 1 or 
     more collective bargaining agreements between employee 
     representatives and 1 or more employers ratified before the 
     date of enactment of this Act, the amendments made by this 
     section shall not apply to plan years beginning before the 
     date on which the last collective bargaining agreements 
     relating to the plan terminates (determined without regard to 
     any extension thereof agreed to after the date of enactment 
     of this Act). For purposes of this paragraph, any plan 
     amendment made pursuant to a collective bargaining agreement 
     relating to the plan which amends the plan solely to conform 
     to any requirement added by this section shall not be treated 
     as a termination of such collective bargaining agreement.

     SEC. 5. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT RELATING 
                   TO THE INDIVIDUAL MARKET.

       (a) In General.--Subpart 2 of part B of title XXVII of the 
     Public Health Service Act (42 U.S.C. 300gg-51 et seq.) is 
     amended by adding at the end the following new section:

     ``SEC. 2754. REQUIRED COVERAGE FOR MINIMUM HOSPITAL STAY FOR 
                   MASTECTOMIES, LUMPECTOMIES, AND LYMPH NODE 
                   DISSECTIONS FOR THE TREATMENT OF BREAST CANCER 
                   AND SECONDARY CONSULTATIONS.

       ``The provisions of section 2707 shall apply to health 
     insurance coverage offered by a health insurance issuer in 
     the individual market in the same manner as they apply to 
     health insurance coverage offered by a health insurance 
     issuer in connection with a group health plan in the small or 
     large group market.''.
       (b) Effective Date.--The amendment made by this section 
     shall apply with respect to health insurance coverage 
     offered, sold, issued, renewed, in effect, or operated in the 
     individual market on or after the date of enactment of this 
     Act.

     SEC. 6. AMENDMENTS TO THE INTERNAL REVENUE CODE OF 1986.

       (a) In General.--Subchapter B of chapter 100 of the 
     Internal Revenue Code of 1986 is amended--
       (1) in the table of sections, by inserting after the item 
     relating to section 9812 the following:

``Sec. 9813. Required coverage for minimum hospital stay for 
              mastectomies, lumpectomies, and lymph node dissections 
              for the treatment of breast cancer and coverage for 
              secondary consultations.'';
       and
       (2) by inserting after section 9812 the following:

[[Page 20277]]



     ``SEC. 9813. REQUIRED COVERAGE FOR MINIMUM HOSPITAL STAY FOR 
                   MASTECTOMIES, LUMPECTOMIES, AND LYMPH NODE 
                   DISSECTIONS FOR THE TREATMENT OF BREAST CANCER 
                   AND COVERAGE FOR SECONDARY CONSULTATIONS.

       ``(a) Inpatient Care.--
       ``(1) In general.--A group health plan that provides 
     medical and surgical benefits shall ensure that inpatient 
     (and in the case of a lumpectomy, outpatient) coverage and 
     radiation therapy is provided for breast cancer treatment. 
     Such plan may not--
       ``(A) insofar as the attending physician, in consultation 
     with the patient, determines it to be medically necessary--
       ``(i) restrict benefits for any hospital length of stay in 
     connection with a mastectomy or breast conserving surgery 
     (such as a lumpectomy) for the treatment of breast cancer to 
     less than 48 hours; or
       ``(ii) restrict benefits for any hospital length of stay in 
     connection with a lymph node dissection for the treatment of 
     breast cancer to less than 24 hours; or
       ``(B) require that a provider obtain authorization from the 
     plan for prescribing any length of stay required under this 
     paragraph.
       ``(2) Exception.--Nothing in this section shall be 
     construed as requiring the provision of inpatient coverage if 
     the attending physician, in consultation with the patient, 
     determines that either a shorter period of hospital stay, or 
     outpatient treatment, is medically appropriate.
       ``(b) Prohibition on Certain Modifications.--In 
     implementing the requirements of this section, a group health 
     plan may not modify the terms and conditions of coverage 
     based on the determination by a participant or beneficiary to 
     request less than the minimum coverage required under 
     subsection (a).
       ``(c) Notice.--A group health plan shall provide notice to 
     each participant and beneficiary under such plan regarding 
     the coverage required by this section in accordance with 
     regulations promulgated by the Secretary. Such notice shall 
     be in writing and prominently positioned in the summary of 
     the plan made available or distributed by the plan and shall 
     be transmitted--
       ``(1) in the next mailing made by the plan to the 
     participant or beneficiary; or
       ``(2) as part of any yearly informational packet sent to 
     the participant or beneficiary;
     whichever is earlier.
       ``(d) Secondary Consultations.--
       ``(1) In general.--A group health plan that provides 
     coverage with respect to medical and surgical services 
     provided in relation to the diagnosis and treatment of cancer 
     shall ensure that coverage is provided for secondary 
     consultations, on terms and conditions that are no more 
     restrictive than those applicable to the initial 
     consultations, by specialists in the appropriate medical 
     fields (including pathology, radiology, and oncology) to 
     confirm or refute such diagnosis. Such plan or issuer shall 
     ensure that coverage is provided for such secondary 
     consultation whether such consultation is based on a positive 
     or negative initial diagnosis. In any case in which the 
     attending physician certifies in writing that services 
     necessary for such a secondary consultation are not 
     sufficiently available from specialists operating under the 
     plan with respect to whose services coverage is otherwise 
     provided under such plan or by such issuer, such plan or 
     issuer shall ensure that coverage is provided with respect to 
     the services necessary for the secondary consultation with 
     any other specialist selected by the attending physician for 
     such purpose at no additional cost to the individual beyond 
     that which the individual would have paid if the specialist 
     was participating in the network of the plan.
       ``(2) Exception.--Nothing in paragraph (1) shall be 
     construed as requiring the provision of secondary 
     consultations where the patient determines not to seek such a 
     consultation.
       ``(e) Prohibition on Penalties.--A group health plan may 
     not--
       ``(1) penalize or otherwise reduce or limit the 
     reimbursement of a provider or specialist because the 
     provider or specialist provided care to a participant or 
     beneficiary in accordance with this section;
       ``(2) provide financial or other incentives to a physician 
     or specialist to induce the physician or specialist to keep 
     the length of inpatient stays of patients following a 
     mastectomy, lumpectomy, or a lymph node dissection for the 
     treatment of breast cancer below certain limits or to limit 
     referrals for secondary consultations; or
       ``(3) provide financial or other incentives to a physician 
     or specialist to induce the physician or specialist to 
     refrain from referring a participant or beneficiary for a 
     secondary consultation that would otherwise be covered by the 
     plan involved under subsection (d).''.
       (b) Effective Dates.--
       (1) In general.--The amendments made by this section shall 
     apply with respect to plan years beginning on or after the 
     date of enactment of this Act.
       (2) Special rule for collective bargaining agreements.--In 
     the case of a group health plan maintained pursuant to 1 or 
     more collective bargaining agreements between employee 
     representatives and 1 or more employers ratified before the 
     date of enactment of this Act, the amendments made by this 
     section shall not apply to plan years beginning before the 
     date on which the last collective bargaining agreements 
     relating to the plan terminates (determined without regard to 
     any extension thereof agreed to after the date of enactment 
     of this Act). For purposes of this paragraph, any plan 
     amendment made pursuant to a collective bargaining agreement 
     relating to the plan which amends the plan solely to conform 
     to any requirement added by this section shall not be treated 
     as a termination of such collective bargaining agreement.

     SEC. 7. OPPORTUNITY FOR INDEPENDENT, EXTERNAL THIRD PARTY 
                   REVIEWS OF CERTAIN NONRENEWALS AND 
                   DISCONTINUATIONS, INCLUDING RESCISSIONS, OF 
                   INDIVIDUAL HEALTH INSURANCE COVERAGE.

       (a) Clarification Regarding Application of Guaranteed 
     Renewability of Individual Health Insurance Coverage.--
     Section 2742 of the Public Health Service Act (42 U.S.C. 
     300gg-42) is amended--
       (1) in its heading, by inserting ``, CONTINUATION IN FORCE, 
     INCLUDING PROHIBITION OF RESCISSION,'' after ``GUARANTEED 
     RENEWABILITY'';
       (2) in subsection (a), by inserting ``, including without 
     rescission,'' after ``continue in force''; and
       (3) in subsection (b)(2), by inserting before the period at 
     the end the following: ``, including intentional concealment 
     of material facts regarding a health condition related to the 
     condition for which coverage is being claimed''.
       (b) Opportunity for Independent, External Third Party 
     Review in Certain Cases.--Subpart 1 of part B of title XXVII 
     of the Public Health Service Act is amended by adding at the 
     end the following new section:

     ``SEC. 2746. OPPORTUNITY FOR INDEPENDENT, EXTERNAL THIRD 
                   PARTY REVIEW IN CERTAIN CASES.

       ``(a) Notice and Review Right.--If a health insurance 
     issuer determines to nonrenew or not continue in force, 
     including rescind, health insurance coverage for an 
     individual in the individual market on the basis described in 
     section 2742(b)(2) before such nonrenewal, discontinuation, 
     or rescission, may take effect the issuer shall provide the 
     individual with notice of such proposed nonrenewal, 
     discontinuation, or rescission and an opportunity for a 
     review of such determination by an independent, external 
     third party under procedures specified by the Secretary.
       ``(b) Independent Determination.--If the individual 
     requests such review by an independent, external third party 
     of a nonrenewal,discontinuation, or rescission of health 
     insurance coverage, the coverage shall remain in effect until 
     such third party determines that the coverage may be 
     nonrenewed, discontinued, or rescinded under section 
     2742(b)(2).''.
       (c) Effective Date.--The amendments made by this section 
     shall apply after the date of the enactment of this Act with 
     respect to health insurance coverage issued before, on, or 
     after such date.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from New 
Jersey (Mr. Pallone) and the gentleman from Texas (Mr. Burgess) each 
will control 20 minutes.
  The Chair recognizes the gentleman from New Jersey.


                             General Leave

  Mr. PALLONE. Mr. Speaker, I ask unanimous consent that all Members 
may have 5 legislative days to revise and extend their remarks and 
include extraneous material on the bill under consideration.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from New Jersey?
  There was no objection.
  Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.
  I rise in strong support of the Breast Cancer Patient Protection Act 
of 2008, introduced by my good friend and colleague from Connecticut, 
Congresswoman Rosa DeLauro, and I know she's been working long and hard 
on this legislation. I am very pleased that we're bringing it up this 
evening.
  This legislation is very important. It would provide protections for 
women across America who suffer from breast cancer.
  Under the bill, doctors, in consultation with their patients, would 
decide the length of time the patient should remain in the hospital 
after having a mastectomy and other types of related procedures, and 
not the insurance company.
  This legislation does not mandate hospitalization, but instead, 
restores the right of patients to consult with their physicians and 
decide how long she should be hospitalized, based on medical 
appropriateness.
  Presently, 20 States have implemented minimum stay requirements to

[[Page 20278]]

varying degrees. As a result, some people may question why this 
legislation is necessary. This bill is not for the women who live in 
States or have insurance policies that provide these protections. It is 
for the women who do not. For these women, a Federal remedy is their 
only hope. Having access to appropriate medical care should not be 
dependent on the State that you live in.
  Mr. Speaker, for the thousands of American women diagnosed with 
breast cancer each year, this bill would help put an end to what has 
come to be known as drive-through mastectomies.
  In addition, the bill clarifies existing law on when a health insurer 
can or cannot issue a decision of non-renewal, discontinue or rescind a 
health insurance policy. The bill would also create a new consumer 
protection by setting up a new independent review process for consumers 
in the individual health insurance market in the event of a non-
renewal, discontinuation or rescission of a health insurance policy. 
Insurers would be required to continue coverage under such policy until 
completion of the independent review.
  Once again, I want to thank my colleagues who have worked so hard on 
both of these bills, particularly Ms. DeLauro, the bill's sponsor; and 
I also want to thank the chairman of the Energy and Commerce Committee, 
Mr. Dingell, who championed this cause during the patient's bill of 
rights debate, which some may remember--I certainly do. I also want to 
thank our friends in the minority, particularly Mr. Barton and Mr. 
Deal, for working across party lines to strengthen this bill. This is a 
very important bill, Mr. Speaker.
  I reserve the balance of my time.
  Mr. BURGESS. Mr. Speaker, I yield such time as he may consume to the 
ranking member of the full committee, Mr. Barton.
  Mr. BARTON of Texas. Thank you, Dr. Burgess.
  Mr. Speaker, I want to rise in strongest possible support for H.R. 
758, the Breast Cancer Patient Protection Act.
  As you know, as our distinguished subcommittee chairman Congressman 
Pallone has already said, this bill will guarantee that every woman in 
America in need of a mastectomy and certain other procedures related to 
breast cancer will have access to such care and, with her doctor's 
consent, will be allowed to stay in the hospital for up to 48 hours 
after that operation has been conducted. This is an important 
protection for every woman in America; and as Congressman Pallone said, 
while it is allowed in some States, it's not allowed in other States.
  One of the things in this bill that I want to speak briefly about, 
Mr. Speaker, is that for the first time we put into Federal law a 
provision that says if an individual has a policy that's not a group 
policy but an individual policy and that individual has to have a 
procedure and the insurer, in looking into the primary procedure, 
discovers that there was some inadvertent omission of information on 
the person's health record that's not directly related to the procedure 
in question, then that person's health insurance coverage cannot be 
canceled.

                              {time}  1930

  I had a situation in my district, Mr. Speaker, within the last 
several months where a woman had decided to move out of State to take 
care of her parents. And when she did that, she lost her group coverage 
and she converted her group plan to a private insurance plan.
  She moved, took care of her family, came back to Texas, and in a 
routine examination discovered that she had breast cancer. Her doctor 
recommended an immediate mastectomy. And when they went to schedule 
that, the insurance coverer began to go through her insurance 
application with a fine tooth comb and finally canceled it based on the 
proposition that she had failed to inform, in her private application, 
the fact that several years before she had been treated briefly for 
hypertension and taken some blood pressure medicine. She was no longer 
being treated and was no longer under medicine, but the fact that she 
failed to state on her original application that she had been in the 
past, the insurance carrier canceled her policy.
  Now this is a woman who has been diagnosed with breast cancer. As we 
all know, if the treatment option that is recommended by the doctor is 
a mastectomy, that should be done as quickly as possible, yet this 
insurance carrier looked for a reason and finally found a reason and 
canceled her policy. Under the bill before us, Mr. Speaker, that would 
no longer be possible. The coverage would continue in force. And if it 
was discovered that there was an intentional fraudulent omission, then 
the coverage could be canceled; but if that's not the case, if it's 
truly inadvertent, it's not directly related, then you cannot cancel 
the insurance policy.
  This bill and this amendment, if the other body passes it and it 
becomes law, literally can save tens of thousands of women's lives 
every year in America. So I am very honored to have played a small part 
in bringing this bill to the floor. And I am extremely pleased that the 
members of the Energy and Commerce Committee, on a bipartisan basis, 
included my amendment that I have just spoken about.
  I urge this passage in the strongest possible terms. I thank my 
friend, Dr. Burgess from Texas, for yielding me time.
  Mr. PALLONE. Mr. Speaker, I am very proud now to yield 5 minutes to 
the sponsor of the legislation, the gentlewoman from Connecticut (Ms. 
DeLauro), who really has worked for so many years championing this 
cause.
  Ms. DeLAURO. I thank the gentleman from New Jersey.
  After too many long years, this is a historic moment. After too many 
lost opportunities, this is our chance to make a difference and to take 
an important step toward meeting our commitment to the women of 
America.
  I want to thank my colleague, Chairman Dingell, with whom I 
introduced the very first version of the Breast Cancer Patient 
Protection Act over a decade ago. It is his partnership and that of our 
colleagues, Chairmen Pallone, Stark, Andrews, Miller, that helped to 
make this day and this vote possible.
  I want to say thank you to the ranking member of the full committee, 
Mr. Barton, for his support, and for the bipartisan support of this 
effort.
  More than 12 years ago, I first met Dr. Kristen Zarfos. She walked 
into my office in Connecticut and told me that HMOs were forcing her to 
discharge her patients before they were ready, sometimes just hours 
after mastectomy surgery. Dr. Zarfos' experience inspired me to get 
involved. Her tireless work with patients in my State of Connecticut 
and with a network of doctors she knew around the country gathered 
support for this bill from the grass roots all the way to the Congress.
  Today, a woman's chance of developing breast cancer in her lifetime 
is one in eight. Almost everyone knows someone who has suffered from 
this disease. If you have watched a loved one fighting for her life, 
you understand how important it is to have not only the loving support 
of family as I did during my fight against ovarian cancer, but also 
adequate recovery time in the hospital after surgery so you have the 
professional care to begin healing and to avoid infection.
  A mastectomy is not an easy surgery; it is physically and emotionally 
traumatic. That is what the Breast Cancer Patient Protection bill is 
all about. It says that when it comes to mastectomies and lumpectomies, 
adequate recovery time in the hospital should not be negotiable. The 
last thing any woman should be doing at that time is fighting with her 
insurance company.
  This bill does not mandate a 48-hour hospital stay if a patient 
chooses to go home sooner, nor does it set 48 hours as a maximum amount 
of time a woman can stay in the hospital. It simply ensures that any 
decision in favor of a shorter or longer hospital stay will be made by 
the patient and her doctor, and not an insurance company. It would also 
ensure women have access to second opinions and adequate hospital stays 
after having a lumpectomy.
  Some may argue that the time for a bill like this has already passed, 
that

[[Page 20279]]

States are beginning to address the issue, but the truth is that drive-
through mastectomies continue to today.
  At the Energy and Commerce Subcommittee hearing this spring--and I 
thank, again, the gentleman from New Jersey (Mr. Pallone)--breast 
cancer patient Alva Williams testified that she had a mastectomy on 
March 6, 2006 and was sent home several hours after surgery. Her 
insurance company would not cover an overnight stay. Ms. Williams had 
family to take care of her at home, but they had no medical training. 
She developed an infection in her incisions. Recovering from the 
infection caused Ms. Williams' chemotherapy treatments to be delayed by 
6 weeks.
  All across the Nation women continue to suffer the same way that Alva 
Williams suffered, physically and emotionally, and yet without the care 
they should rightfully be getting for the insurance premiums that they 
have paid. And all across this Nation people everywhere are saying, 
``No more.''
  Twenty-three million Americans have signed Lifetime Television's 
petition calling for the Breast Cancer Patient Protection Act's 
passage. Now with 222 cosponsors in the House and Senators Snowe and 
Landrieu leading 19 cosponsors in the Senate, strong bipartisan support 
exists for these most basic patient protections.
  I urge my colleagues to support the Breast Cancer Patient Protection 
Act. Make this day a powerful turning point. We have a tremendous 
opportunity today to make it clear to women, to cancer patients, and to 
their families that we value your health.
  I again thank my colleagues, and urge the support of this bill.
  Mr. BURGESS. Mr. Speaker, this is an important bill. It raises a 
fundamental question, who should make a medical decision? Is it the 
insurance company? Is it the HMO? Is it the United States Congress? Or 
is it a Federal agency? The answer to that question is ``none of the 
above,'' it is the patient's physician, in consultation with the 
patient and her family. And this rightfully puts the decision back 
where it should have been all the time. Patient, in consultation with 
physician or family, should make the appropriate decision.
  There is nothing in this bill that says a 48-hour stay is required or 
mandated. There is nothing in this bill that says a 48-hour stay is a 
maximum length of time.
  I also want to thank the ranking member, Mr. Barton, of the full 
committee for bringing the important amendment that would disallow an 
insurance company for rejecting an patient's claim based on an 
inadvertent error in the application process. This amounts to a 
clerical error that might seriously jeopardize a patient's health or 
leave a patient who was not expecting a very large medical expenditure 
to suddenly be facing one. And certainly, given the status of today's 
economic climate, that would be an intolerable occurrence as well.
  I thank the author of the bill for bringing it forward. I thank the 
subcommittee chairman for bringing it to the floor.
  Mr. Speaker, I yield back the balance of my time.
  Mr. PALLONE. Mr. Speaker, I yield 3 minutes to the gentlewoman from 
California (Ms. Woolsey).
  Ms. WOOLSEY. Thank you, Mr. Pallone, and to the other side of the 
aisle, for bringing this wonderful bill before us, H.R. 758, the Breast 
Cancer Patient Protection Act.
  Breast cancer is the second leading cause of cancer death among women 
and the leading cause of cancer death among women under the age of 40.
  Marin County, in my district, just north of the Golden Gate Bridge in 
San Francisco, has the highest rate of breast cancer in the United 
States of America. Marin's rates are approximately 40 percent higher 
than national average, and about 30 percent higher than the rest of the 
Bay Area.
  My constituents are personally involved in our need to increase the 
funding for research so that we can learn more about what is causing 
breast cancer and how best to treat it.
  We must also pass H.R. 758, the Breast Cancer Patient Protection Act, 
so that we can ensure that doctors are the ones making the decisions 
about medical care, not health insurance companies, not clerks.
  This bill, H.R. 758, will prohibit drive-through mastectomies. It 
will ensure that women receive the best possible care. The last thing a 
patient and her family needs to be dealing with when trying to fight 
breast cancer is battling with a health insurance company, battling 
about covering necessary medical treatment.
  Again, Mr. Speaker, I urge my colleagues to support H.R. 758, the 
Breast Cancer Patient Protection Act, to leave the decisions about the 
medical care of breast cancer patients to doctors and their patients, 
not health insurance companies.
  Mr. PALLONE. Mr. Speaker, I yield myself such time to close very 
briefly.
  I cannot stress enough how important this legislation is. We 
obviously need to put an end to the drive-through mastectomy. And 
although it may be the case that they have been eliminated in a number 
of States, they have not been nationally. I would urge my colleagues to 
support this legislation.
  Ms. JACKSON-LEE of Texas. Mr. Speaker, I speak today on an important 
bill that I believe in, H.R. 758, the Breast Cancer Patient Protection 
Act of 2007. This bill is important to people facing this horrible 
disease, and it is time that we protect those who are the most 
vulnerable among us.
  Patients who have breast cancer face a very tough road ahead. The 
medical realities are enough to frighten anyone and these patients face 
financial realities as well. With an ever corporatizing of the American 
health care system, it's more of an in and out process. Even those with 
excellent healthcare are pushed out of hospitals with great speed. 
Worse yet, those who do survive face an uphill battle making sure they 
can get the follow up they need to assure a long and healthy life.
  This bill will show support for those with breast cancer that they 
are not alone. Worried that while they are recovering from major 
surgery, their insurance company will look at the bottom line, and no 
longer pay for hospital stays. This bill will require insurance 
companies to pay for the stays as long as the doctor thinks is 
necessary. As I am sure all of my colleagues know, you cannot get an 
insurance company to do anything without regulation.
  This legislation will also remove the doctor's biggest challenge, 
needing insurer's permission before doing what they believe is 
medically necessary. There is nothing worse about our healthcare system 
today then the thought that it's not your doctor making the decisions 
for your care, but it's the insurance company that pays him or her. 
It's an unfortunate reality that doctors must choose between caring for 
their patients and keeping their practice and families afloat. This 
bill will at least give these doctors back the right to have the option 
of always putting their patients first.
  Last, this bill also provides for secondary consultations by 
specialists in the appropriate medical fields to confirm or refute a 
diagnosis of cancer. While the vast majority of cancer diagnoses are 
correct, with the small numbers that are ``false positives'' this bill 
will allow for patients to double check their status before undergoing 
very expensive and dangerous treatment.
  I am reminded of the American political commentator, journalist, and 
author, Molly Ivins of Texas. Diagnosed with breast cancer when she was 
55, she didn't look down on her situation and feel sorry for herself. 
She instead looked at it as an opportunity saying, ``One of the things 
I said was that I had been in great hopes I would become a better 
person as a result of confronting my own mortality, but it actually 
never happened. I didn't become a better person.'' After two 
mastectomies, Molly toured around the country speaking out about breast 
cancer awareness, tragically she later died of the disease.
  Almost everyone has had, or knows someone who has breast cancer, it's 
our mothers and daughters, sisters and friends who face this disease, 
and it's time we honor them, by protecing those who come after them. I 
also pay tribute to the work of Sister's Network in supporting this 
bill.
  Mr. Speaker, we need to make sure that doctors are making the right 
diagnosis, that they are making the choices in care and not the 
insurance companies and that the health and care of these patients are 
in the right hands. I urge passage of this bill.
  Mr. LARSON of Connecticut. Mr. Speaker, I rise today in strong 
support of H.R. 758: the ``Breast Cancer Patient Protection Act of 
2008.'' I would like to commend my colleague, Congresswoman Rosa 
DeLauro who has

[[Page 20280]]

fought passionately for issues like these since she entered the 
Congress.
  Put simply, this bill protects the health of women and ensures they 
have the time they need to recover from difficult medical procedures. 
With passage of this legislation no longer will women have to feel 
pushed out the door following breast cancer treatment. There are too 
many stories of women across the country who ave suffered from not 
being given the proper time to recover from breast cancer surgery for 
Congress to stand idle.
  According to the Connecticut Department of Health, in 2004, 29 
percent of all new diagnosed cases of cancer in Connecticut were breast 
cancer. This was more than any other type of cancer diagnosed in women 
in the State.
  While we need to continue to be vigilant in the fight against the 
causes of breast cancer we must also ensure that those seeking 
treatment are given the protections to allow for them to properly 
recover. I again commend my colleague Ms. DeLauro and repeat my firm 
support of this legislation.
  Ms. SLAUGHTER. Mr. Speaker, today I rise in support of the Breast 
Cancer Patient Protection Act and urge its passage.
  Breast cancer is so pervasive it touches every American family. One 
in eight women can expect to be diagnosed with breast cancer during her 
lifetime, and it remains the number one cause of death in women between 
the ages of 30 and 54. In my congressional district there are almost 
1,500 incidences of breast cancer and nearly 300 women die ftom this 
disease every year.
  Breast cancer surgery is not easy, physically or emotionally--but all 
too often women find themselves forced by their insurance companies to 
leave the hospital before they are ready--sometimes just hours after 
surgery.
  One woman ftom New York said: ``I was one of those women that was 
forced out of the hospital after having a double bilateral mastectomy 
with four drainage tubes still attached. It was the most barbaric thing 
ever done to me.''
  Rushing a woman through a hospital stay and pressuring her to return 
to her normal life almost immediately, hampers her recovery at the 
least and may put her in grave danger. That is why it is imperative 
that we pass the Breast Cancer Patient Protection Act.
  This bill would help ensure that patients have adequate support after 
breast cancer surgery by: Guaranteeing a minimum hospital stay of 48 
hours for a woman having a mastectomy or lumpectomy, and 24 hours for a 
woman undergoing a lymph node removal; requiring health plans to 
include notice of these benefits in their monthly mailing and yearly 
information packet sent to plan participants; and requiring plans to 
cover a second opinion should the patient seek one.
  We must also support research into better breast cancer detection 
methods. Mammographies miss too many women and cannot suffice as our 
gold standard.
  Women diagnosed with breast cancer across this country deserve the 
best care possible--their lives depend on it.
  Mr. VAN HOLLEN. Mr. Speaker, I rise in strong support of the Breast 
Cancer Patient Protection Act of 2008.
  Over two million women living in this country have been treated for 
breast cancer. This commonsense legislation would allow a woman and her 
doctor to decide--rather than the insurance company--whether she needs 
to have adequate time of at least 48 hours to recuperate in the 
hospital from a mastectomy or lumpectomy, or whether she has enough 
support to get quality care at home. As someone who has lost their 
mother to breast cancer, the last thing women undergoing these invasive 
procedures should have to deal with is fight with their insurance 
company.
  Mr. Speaker, I urge my colleagues to support this compassionate bill. 
It will ensure that women suffering from this terrible disease have 
access to appropriate health care.
  Mr. HOLT. Mr. Speaker, I rise in support of the Breast Cancer Patient 
Protection Act, and I am proud to be a cosponsor of this important 
bill. In New Jersey, 132 of every 100,000 of our mothers, daughters, 
and grandmothers were diagnosed with breast cancer between 2000 and 
2004. It is difficult to find a person who doesn't know someone who is 
affected by it.
  Despite the prevailing medical standard of two to four days to 
recuperate and gain physical and emotional strength after breast cancer 
surgeries, ``drive-by mastectomies'' increasingly have become the norm. 
Women have been regularly faced with being sent home from the hospital 
a few hours after surgery by HMOs that refuse to pay for longer stays.
  This bill would guarantee a minimum hospital stay of 48 hours for a 
woman having a mastectomy, and 24 hours for a woman undergoing a lymph 
node removal. Importantly, this bill will ensure that any decision to 
have a shorter hospital stay will be made by the patient and her 
doctor--not an insurance company more concerned with the bottom line 
than the health of the patient.
  Forcing women to leave the hospital too soon after surgery is 
dangerous and demeaning. This bill will provide breast cancer patients 
undergoing one of the most physically and emotionally traumatic 
experiences of their lives, the care and dignity they deserve. I urge 
my colleagues to join me in supporting this bill, and I hope the Senate 
acts quickly to get this bill to the President's desk.
  Mr. DINGELL. Mr. Speaker, H.R. 758, the ``Breast Cancer Patient 
Protection Act'', would require that insurance companies cover a stay 
of at least 48 hours in the hospital for women undergoing mastectomy 
and other procedures when the physician, in consultation with the 
patient, deem them to be medically necessary.
  This section of the bill was largely written to parallel section 2704 
of the Public Health Service Act, Standards Relating to Benefits for 
Mothers and Newborns, which prevents drive through deliveries. Certain 
superfluous and unnecessary provisions, however, were deleted from H.R. 
758 as reported by the Committee on Energy and Commerce on September 
23, 2008, because the protections already exist in law.
  Mr. PALLONE. Mr. Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from New Jersey (Mr. Pallone) that the House suspend the 
rules and pass the bill, H.R. 758, as amended.
  The question was taken.
  The SPEAKER pro tempore. In the opinion of the Chair, two-thirds 
being in the affirmative, the ayes have it.
  Mr. PALLONE. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX and the 
Chair's prior announcement, further proceedings on this motion will be 
postponed.

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