Ask the Scholar
Document scope · 1 page
Scholar
Ask about this object, its catalog metadata, its source description, or the page inventory.
For page-specific OCR and visual context, open one of the page chats.
Scholar Source Context
Document identity
localId
34428525
label
Breast Reconstruction: Breast Reconstruction Advocacy Project
core
doc
dtoType
document
citationUrl
pageCount
1
Source metadata
id
34428525
sourceUrl
contentType
document
title
Breast Reconstruction: Breast Reconstruction Advocacy Project
citationUrl
collections
Records of the First Lady's Office (Clinton Administration)
Jennifer Klein's Files
imageCount
1
hasImages
yes
source
import
hasTranscription
no
Source extras
naId
34428525
levelOfDescription
fileUnit
otherTitles
42-t-7422560-20140536S-007-009-2016
recordType
description
ocrSource
nara-archive
Single page context
seq
1
pageIndex
0
type
document
mediaId
e9a024bc584d6573
ocrText
Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
SUBJECT/TITLE
DATE
RESTRICTION
AND TYPE
001. letter
constituent re breast reconstruction (1 page)
01/21/1996
b(6)
002. letter
constituent to POTUS re breast reconstruction (2 pages)
04/14/1997
b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Jennifer Klein
OA/Box Number: 13530
FOLDER TITLE:
Breast Reconstruction: Breast Reconstruction Advocacy Project
2014-0536-S
kc1557
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
P1 National Security Classified Information [(a)(1) of the PRAJ
b(1) National security classified information [(b)(1) of the FOIA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
b(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute [(a)(3) of the PRA]
an agency [(b)(2) of the FOIA]
P4 Release would disclose trade secrets or confidential commercial or
b(3) Release would violate a Federal statute |(b)(3) of the FOIA]
financial information [(a)(4) of the PRA]
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information |(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRAJ
b(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
personal privacy [(a)(6) of the PRA|
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions [(b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
b(9) Release would disclose geological or geophysical information
2201(3).
concerning wells |(b)(9) of the FOIA|
RR. Document will be reviewed upon request.
HEALTH
ADVOCACY
nomens
CLINTON LIBRARY PHOTOCOPY
4034 South Jefferson Avenue
Cincinnati, Ohio 45212-4020
Breast Reconstruction Advocacy Project
HEALTH
Robin Jennings
Executive Director
Women's Health Advocacy Projects
is a nonprofit organization that proactively
4034 South Jefferson Avenue
designs and supports projects which empower
WOMEN'S
PROJECTS
Cincinnati, Ohio 45212-4020
women's health care through legislation and
public education. It is committed to
Phone 513.351.WHAP
extraordinary health care for all women.
Fax 513.351.2039
CLINTON LIBRARY PHOTOCOPY
PHOTOCOPY
PRESERVATION
Turs.
IAN. 2/11996
D am writing this to see if maybe
you can help ME, as I Read the article
En my NEW WOMAN magazine.
that time D madr the decision to NOT
I had a mastectomy in May 1996 and at
have ReconstRuction at that time
after living with the mutilation and
problems associated with it, & went
to SEE a plastic surgron@ ReconstRuct ios
I am(was always) very large breasted and
hE Recommended a than-flap procedure
and Q Reduction of the other scrost to
a MORE normal size. after 5 MOS. of
waiting for the insurance CO. to Respon
after my many calls, they sent me a
for the Reduction of my normal breast
letter saying X don' & MEET the guidelin
but they would pay for the Reconstruction
of the other.
D have approled their decision but
tono avail. (D have been told tomado D
not MEET their guidelines dur to my
"idral") D have no problem with losing
weight, which is MORE than 50% of my
the weight, but if I do and then three
Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
SUBJECT/TITLE
DATE
RESTRICTION
AND TYPE
001. letter
constituent re breast reconstruction (1 page)
01/21/1996
b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Jennifer Klein
OA/Box Number: 13530
FOLDER TITLE:
Breast Reconstruction: Breast Reconstruction Advocacy Project
2014-0536-S
kc1557
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
P1 National Security Classified Information |(a)(1) of the PRAJ
b(1) National security classified information [(b)(1) of the FOIA]
P2 Relating to the appointment to Federal office |(a)(2) of the PRA]
b(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute [(a)(3) of the PRAJ
an agency |(b)(2) of the FOIA]
P4 Release would disclose trade secrets or confidential commercial or
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
financial information [(a)(4) of the PRA]
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA]
b(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
personal privacy [(a)(6) of the PRA]
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions [(b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
b(9) Release would disclose geological or geophysical information
2201(3).
concerning wells |(b)(9) of the FOIA]
RR. Document will be reviewed upon request.
[00]]
decide Astill don' t meet the guidelines,
I'm screwed.
Defeel like I'm getting My life back
together finally, but constantly living
with the problem of being SO lopsided
is starting to Cause me medical problems
as well as self-rsteem.
Dcannot have the RE-constRuction w/out
the Reduction, and D can't afford to
stuck. pay for the surgery myself so D am
You pay, D'm open to them
Df you have any suggestions on how
proceed
Thanksdar Certinencel
(b)(6)
Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
SUBJECT/TITLE
DATE
RESTRICTION
AND TYPE
002. letter
constituent to POTUS re breast reconstruction (2 pages)
04/14/1997
b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Jennifer Klein
OA/Box Number: 13530
FOLDER TITLE:
Breast Reconstruction: Breast Reconstruction Advocacy Project
2014-0536-S
kc1557
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)]
Freedom of Information Act - 15 U.S.C. 552(b)|
PI National Security Classified Information [(a)(1) of the PRA]
b(1) National security classified information [(b)(1) of the FOIA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA|
b(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute |(a)(3) of the PRA|
an agency [(b)(2) of the FOIA]
P4 Release would disclose trade secrets or confidential commercial or
b(3) Release would violate a Federal statute |(b)(3) of the FOIA]
financial information [(a)(4) of the PRA]
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA|
b(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
personal privacy |(b)(6) of the FOIA]
personal privacy [(a)(6) of the PRA
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions [(b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
b(9) Release would disclose geological or geophysical information
2201(3).
concerning wells |(b)(9) of the FOIA]
RR. Document will be reviewed upon request.
[002]
(b)(6)
President Bill Clinton
April 14, 1997
United States Congress
The White House
Washington D. C.
Dear Mr. President and Members of the U.S. Congress
My name is
(b)(6)
and I am a very recent breast cancer survivor.
I am a 41 year old mother of three young daughters. The doctors found cancer
in both of my breasts during a routine mammogram. In September 1996 I had
a radical bilateral mastectomy, which is a nice word for breast amrutation.
This surgery was terrifying, painful and ultimately, humiliating. I vas
devasted and in a great deal of pain both physically and emotionally after the
surgery. The surgery left me with two holes and scars instead of breasts.
I wanted to break every mirror in the house and I never wanted to go anywhere
again. Before the surgery, I called my insurance company to ask if they would
pay for reconstruction after the surgery which was written in their policy.
They told me "Yes, if it is written in the policy we will pay for it." Two and
a half months later they would not give approval, but kept hedging everytime
my husband, his company officials and Dr. Horner-Taylor's office talked to them.
I planned to have an abdominal hernia operation at the same time as the
reconstruction which would save the insurance company thousands of dollars.
Hernia operations are easily approved as are gallbladder, appendix, tonsilectomies
and other operations.
Fortunately, Dr. Horner-Taylor and T are the two most stubborn determined women
living in America today and refused to give up. We receive approval at 5 pm
the day before the surgery, which was scheduled for 11 am the next morning. We
found out that for three weeks the insurance company had lied to all of us saying
their "experts" had to make this decision. All of our paperwork was sitting in
a box the whole time. No one in the insurance company was reviewing it.
I had the reconstruction in Cincinnati even though we live in Greensburg, about
80 miles away. I had to have places for my children to go while I was in the
hospital and all kinds of arrangements to make before the surgery. The insurance
company doesn't care about me, my surgery or my children. They didn't want to pay
for the reconstruction. It turned to be a nine hour surgery and difficult for me
to recever from, however, now I have beautiful healthy looking breasts where
there was disfigurement and scars. Now I catch myself smiling in the mirror. I
can raise my girls feeling pretty and happy about my figure and help them build
healthy self esteem which is so essential to their character and their happiness.
I urge you, if you care about the vomen in America, to pass this bill and allocate
as much money as possible to breast cancer research. I also urge you to pray for
a cure. We need to help the 185,000 women who each year are diagnosed with breast
cancer in America. 44,000 of our mothers, grandmothers, sisters and daughters
are going to die in 1997 unless we stop this disease. Can America afford to lose
44,000 caretakers and nurturers every year?
Dr. Horner-Taylor is a great doctor and a wonderful human being who has fought
for her patients again and again and all the women in America. I'm glad you are
hearing her. Reconstruction gives women hope and a sense of being whole again.
It is very important that insurance companies pay for this procedure and without
a fight. It takes enough strength and determination to fight the disease. As
[002
(b)(6)
an American consumer I'm tired of the insurance companies getting away with
playing God.
I am doing everything in my power to fight this disease including raising money
for the American Cancer Society and writing articles and books about my experience.
I hope you will dc everything in your power too.
Sincerely,
(b)(6)
4.14.97
Early
breast
removal
effective
Preemptive move
cuts cancer risk
BY DANIEL Q. HANEY
The Associated Press
SAN DIEGO - The increasing-
ADVOCACY
ly common practice of surgically
HEALTH
removing both breasts while they
are still healthy is an effective, if
It was not, however, totally ef-
radical, way of preventing breast
fective. Even when the breasts are
cancer in women at high risk of the
removed, surgeons often leave be-
disease, a study finds.
hind tiny bits of breast tissue on
WOMEN'S
PROJECTS
the chest wall. These remnants
Until recently, bilateral prophy-
can still turn cancerous.
lactic mastectomy, as doctors call
it, was rare. But the development
Furthermore, undetected can-
of screening tests for the inherited
cer may sometimes have already
bad genes that can trigger breast
spread to other parts of the body
cancer has increased demand for
before the breasts are removed.
4034 South Jefferson Avenue
this approach.
"It's an extreme approach,"
Cincinnati, Ohio 45212-4020
When a woman discovers she
said Dr. Lynn C. Hartmann, study
has a high genetic susceptibility to
director. "For a woman who de-
Phone 513.351.WIIAP
cancer, there is little she can do
cides to proceed, at least she now
besides fre-
has some clear information instead
Fax 513.351.2039
'It's an
quent checkups
of a question mark."
or having her
Dr. Hartmann presented her re-
+ extreme
breasts re-
sults Sunday at a conference spon-
approach.
moved. Some
sored by the American Association
doctors are re-
for Cancer Research.
For a
luctant to offer
woman who
the genetic
decides to
screening test
because of un-
proceed, at
certainty about
least she now
whether a pre-
has some
emptive mas-
tectomy actual-
clear
ly works as well
information
as common
instead of a
sense would
suggest it
question
should.
mark.'
To help set-
- Lynn Hartmann
tle the issue,
doctors from
the Mayo Clinic
followed up on 950 women who
have had bilateral prophylactic
mastectomies, mostly because of a
strong family history of breast can-
cer. They found that it reduced
their breast cancer risk by 91
percent.
The Breast Reconstruction Advocacy (BRA) Project History
Founder and National Chairperson
Christine Horner-Taylor, MD, F.A.C.S.
In 1997 about 182,000 women will be diagnosed with breast cancer, making it the most
common form of cancer among women in the United States. Statistics show a woman's
lifetime risk of contracting breast cancer, if she lives to be 85, is I out of 9 or 11% of our
population. It is estimated that 46,000 women will die of breast cancer in 1997, making it
the second major cause of death among women after lung cancer.
Recent advances in breast cancer management have allowed most women to be treated
with the breast conserving technique of lumpectomy and radiation. However, a significant
percentage of women with breast cancer must undergo mastectomy, or amputation, of their
breasts to treat their disease most appropriately. Some women adapt well to the breast
amputation and some feel desperately mutilated. It is not a question of age or beauty, as
many older women are more devastated by the loss than a younger woman. Because of the
ADVOCACY
breast's role as a sexual organ, the breast plays an important role in the self image of
women. For many women, the loss of a breast as a result of breast cancer can also mean a
loss of part of their sexual identity. For these women, breast reconstruction is extremely
PROJECTS
important to restore their sense of wholeness and well being.
WOMEN'S
In 1993, two years after I started my plastic surgery practice, a 34 year-old patient came to
me requesting bilateral breast reconstruction following her bilateral mastectomies. The
insurance company denied the surgery, stating that it was not medically necessary. Soon
4034 South Jefferson Avenue
afterwards, another patient was denied coverage, this time the insurance company stated
there was no reason to restore an organ with no function. I felt that something needed to be
Cincinnati, Ohio 45212-4020
done--and became determined that we would pass both federal and state legislation to
Phone 513.351.WHAP
guarantee women coverage for breast reconstruction.
Fax 513.351.2039
18 states currently have laws requiring insurers to cover breast reconstructive surgery after
mastectomy. These states include California, Connecticut, Nevada, Arizona, Washington,
Michigan, Illinois, Florida, New Jersey, Maine, Minnesota, Maryland, Rhode Island,
Montana, Oklahoma, Indiana, Arkansas and New York. The remaining 32 states have
been organized to pass legislation in a nationally coordinated effort, with legislation
introduced or in the process of being introduced in over 20 states.
The BRA Project was introduced in the Fall of 1995. Each state has one plastic surgeon
designated as a coordinator. They are then supported by a multitude of organizations
including the American Cancer Society, and various different breast cancer support groups
and women's groups. Eight Regional Coordinators oversee approximately 5 states each,
maintaining contact with each of their State Coordinators to check on their progress and see
if there is any need for assistance. This design was created in order to produce a vehicle
for efficient communication. I created a grassroots manual which gives instructions in a
step-by-step fashion to lead individuals through the legislative process. The manual
includes sample legislation, letters to the editor, supporting journal articles, specific tips on
how to present the issues to legislatures, and a check list designed to take someone through
the entire process from getting the bill introduced to finally passing legislation.
We are working on the federal level to guarantee women access to breast reconstruction.
I have met on several occasions with The White House-the President (whose mother had
breast cancer) and the First Lady to discuss their support for the legislation. Senator
Edward Kennedy and Rep. Anna Eshoo have recently introduced the "Reconstructive
Breast Surgery Benefits Act of 1997."
HEALTH
ADVOCACY
NOMEN'S
PROJECTS
4034 South Jefferson Avenue
Cincinnati, Ohio 45212-4020
Phone 513.351.WHAP
Fax 513.351.2039
Women's Health Advocacy Projects (WHAP) is a non-profit/non-partisan
organization that proactively designs and supports projects which empower
women's health care through legislation and public education. It is committed
to extraordinary health care for all women.
In recent years, heightened awareness of longstanding biases against
women--in educational, economic, employment, and most important, health
related opportunities--has catalyzed an expanded focus on women's issues.
Past inattention to women's health issues in both the conduct of research and
clinical practice resulted in serious gaps in knowledge about causes, treatment,
and prevention of diseases in women. Women's Health Advocacy Projects is
BEALTH
pursuing a comprehensive and meaningful agenda for women's health to
redress these past inequities.
NOMEL'S
PROJECTS
Women's Health Advocacy Projects serves as a catalyst for national efforts,
coordinating activities of government and non-government organizations.
agencies and individuals by encouraging new ideas and mobilizing
partnerships. WHAP strives to "jump start" innovative, long term efforts that
4034 South Jefferson Avenue
will result in rapid progress in our fight for extraordinary health care for all
Cincinnati, Ohio 45212-4020
women.
Phone 513.351.WHAP
Fax 513.351.2039
Women's Health Advocacy Projects is chaired and founded by Christine
Horner-Taylor, M.D., F.A.C.S. In 1995, Dr. Horner-Taylor organized the
Breast Reconstruction Advocacy Project (BRA Project), a nationally
coordinated grassroots effort to pass legislation in each state requiring
insurance companies to pay for breast reconstruction following mastectomy.
To date, 18 states have passed the legislation. The remaining 32 states are to
introduce the legislation this spring, organized by WHAP as a national wave of
public outcry. Senator Edward Kennedy and Congresswoman Anna Eshoo
recently introduced the Federal Bill "Reconstructive Breast Surgery Benefits
Act of 1997.
This is the work of Women's Health Advocacy Projects--turning personal
experience with women's health into political action. Women need to have a
place at the table where decisions about women's health care are made.
Biography
Christine Horner-Taylor, MD, F.A.C.S. graduated Summa Cum Laude in 1980 from
Wright State University in Dayton, Ohio with a Bachelor of Science degree in Biology. In
1984 she graduated from the University of Cincinnati College of Medicine and began her
general surgery residency at Good Samaritan Hospital in Cincinnati. She completed the
5-year program in 1989 and went on to complete a 2-year residency in Plastic and
Reconstructive Surgery at Indiana University-Indianapolis. Dr. Horner-Taylor began her
private practice in Plastic and Reconstructive Surgery in 1991 with offices in Edgewood,
Kentucky and Lawrenceburg, Indiana. She is the President and CEO of Women
Physicians Assurance Company (WPAC), a company designed to empower women
physicians as a group, providing group discounts on insurance, products, and consulting
services. In addition, she is the President of two non-profit organizations. Women's
BEALTH
ADVOCACY
Health Advocacy Projects (WHAP), is a 501(c)4 that proactively designs and supports
projects which empower women's healthcare through legislation and education.
Comprehensive Health Institute (CHI) is a 501(c)3 organization committed to the
NOMEUS
integration of alternative healthcare modalities into our current healthcare system with a
focus on wellness.
Dr. Horner-Taylor is board certified by the American Board of Surgery and the American
4034 South Jefferson Avenue
Board of Plastic Surgery. She is a member of the American Medical Association,
Cincinnati, Ohio 45212-4020
Phone 513.351.WHAP
American Women's Medical Association, Association of Women Surgeons, American
Fax 513.351.2039
Holistic Medical Association, Ohio State Medical Association, Kentucky Medical
Association, Northern Kentucky Medical Society, Cincinnati Academy of Medicine, and is
Spokesperson for the American Cancer Society in Kentucky for Breast Cancer Issues. She
is a Fellow of the American College of Surgeons and is an active member of the American
Society of Plastic and Reconstructive Surgeons. Dr. Horner-Taylor has received the
American Cancer Society "Life Saver Award" and the 1997 Cincinnati YWCA Career
Women of Achievement Award.
Dr. Horner-Taylor has a commitment to government action that provides solutions for
women's healthcare issues. She is the founder and National Chairperson of the Breast
Reconstruction Advocacy Project, a grassroots effort to pass both State and Federal
legislation requiring insurance companies to cover breast reconstruction following
mastectomy. She has met with both President Clinton and the First Lady to discuss the
importance of a Federal Bill. Dr. Horner-Taylor worked with Rep. Anna Eshoo and
Senator Edward Kennedy in designing the "Reconstructive Breast Surgery Benefits Act
of 1997.'
BRA Project Status Report 4/21/97
Alabama - H217, S 318 and S 224 would require coverage for all stages of
reconstruction including symmetry in the manner chosen by
patient and physician. (Passed Senate)
Arizona - Passed - covers surgical services for reconstruction and at least
two external postoperative prostheses
Arkansas - Passed - Section 5 of Arkansas Health Care Consumer Act
provides benefits including prosthetic devices and
reconstructive surgery. Insurer may not restrict benefits for
hospital length of stay to less than 48 hours. Does not include
symmetry.
ADVOCACY
California - Passed - including symmetry
HEALTH
Connecticut - Passed - covers at least a yearly benefit of $500 for
reconstruction, $300 for prosthesis, and $300 for
WOMEN'S
PROJECTS
surgical removal of each breast due to tumor.
Florida - Passed - covers initial prosthetic device and reconstruction
Florida - HB 573 would require coverage for symmetry and more than one
4034 South Jefferson Avenue
prosthetic device. HB 453 would require coverage for any
Cincinnati, Ohio 45212-4020
"necessary" reconstruction
Phone 513.351.WHAP
Fax 513.351.2039
Hawaii - HB 620 and SB 1052 would require coverage for all stages of the
breast, including symmetry and notice to policyholders in writing
Illinois - Passed - covers initial prosthetic device and reconstruction
Indiana - Passed - requires coverage for prosthetic devices and
reconstruction
Kansas - HB 2297 would require coverage for reconstruction including
symmetry
Louisiana - HB 949, SB 390, SB 699 would require coverage for
reconstruction including symmetry
Maine - Passed - covers both breasts on which surgery was performed and
the other breast if patient elects reconstruction, in
manner chosen by patient and physician
Maryland - Passed - requires coverage including surgery to establish
symmetry, augmentation/reduction and mastopexy
Massachusetts - S 678 would require coverage for all stages of
reconstruction including surgery to establish symmetry
in manner chosen by patient and physician
Michigan - Passed - covers breast cancer rehab services, delivered on an
inpatient basis, including reconstruction
Minnesota - Passed - covers all reconstruction incidental to or following
injury, sickness or other diseases of the involved part, or
congenital defect for a child
Missouri - HB 129 would require coverage of prosthetic devices and
ADVOCACY
reconstruction necessary to achieve symmetry following
HEALTH
mastectomy
Montana - Passed - requires coverage of reconstruction following
NOMEUS
PROJECTS
mastectomy, including all stages of one reconstructive
surgery on the non-diseased breast to establish
symmetry, and the cost of prostheses
Nevada - Passed - covers at least 2 prosthetic devices and reconstruction
4034 South Jefferson Avenue
including augmentation mammoplasty, reduction
Cincinnati, Ohio 45212-4020
mammoplasty, mastopexy and symmetry
Phone 513.351.WHAP
Fax 513.351.2039
New Hampshire - HB 442 would require coverage of reconstruction,
including symmetry. (Passed House)
New Jersey - Passed - covers reconstruction including prostheses
New Jersey - All and A2550 would amend the existing law by specifically
covering surgery to restore and achieve symmetry. (Passed
Assembly and House)
New York - Passed - covers reconstruction including reconstruction on
healthy breast required to achieve reasonable
symmetry in manner determined by patient and
physician
North Carolina - HB 813 and SB 714 would require coverage of breast
reconstruction, including symmetry
Ohio - HB 159 and SB 47 would require reconstruction including
prosthesis
Oklahoma - Passed - would require coverage of reconstruction including
symmetry
Oregon - HB 2880 would require coverage for expenses related to
reconstruction and prosthetic services considered necessary for
adjunctive treatment SB 319 would cover symmetry
Pennsylvania - SB 155 would require coverage of prosthetic devices and
reconstruction
Rhode Island - Passed - covers prosthetic devices and reconstruction to
ADVOCACY
restore and achieve symmetry. Surgery must be
BEALTH
performed within 18 months of the original
surgery
WOMEN'S
PROJECTS
South Carolina - introduced in House requiring coverage for reconstrction
Tennessee - HB 223,HB 517, HB 697, HB1391, SB 237, SB 507, SB
1148 and SB 1590 would require coverage of reconstruction
including surgery to ensure symmetry
4034 South Jefferson Avenue
Cincinnati, Ohio 45212-4020
Texas - HB 262 and SB 217 would cover breast reconstruction, including
Phone 513.351.WHAP
surgery to restore and achieve symmetry, subject to the
Fax 513.351.2039
co-payment applicable to mastectomy (SB Passed)
Virginia - SB 948 would require coverage for reconstruction including
symmetry
Washington - Passed - covers reconstruction if mastectomy results from
disease, illness or injury. Amended to include
symmetry
West Virginia - HB 2116 would require coverage of reconstruction
including symmetry on the opposite breast, in manner
chosen by patient and physician
(Died in committee, will be re-introduced)
Wisconsin - AB 15 would require coverage of reconstruction.
NOVEMBER
1995 $2.50
a
re
MAKEUP
LESSON:
SPLIT-
SECOND
HAIR
The No Brainer
High Style
Solution
SHOP-AT-HOME
COSMETICS
Lush
Fashion
Lips
Insiders
THE LATEST
& WHAT THEY'RE
ON INJECTIONS
WEARING
PUMPED UP
Men Who Crave Shoes
0751144
2
-Controversy
ber of reconstructive operations per-
formed nationwide declined last year,
Is Vanity
and many surgeons suggest this was a
result of these cutbacks.
Plastic surgeons are not the only
ones who claim that appearance has
become an easy target for cost cutters.
"It's become much worse," says Annette
Newman, owner of a boutique in Troy,
Michigan, that sells breast pros-
By Kathy Merrell
theses and other accessories for
women with cancer. As a result,
says Newman, many women must ei-
ther pay for their own breast prostheses
or accept only the cheapest products—
some don't have raised nipples, while
others are made of a shiny plastic that
doesn't even attempt to approximate
flesh. And women often have to pay out
More and more
of pocket for a wig after losing their
hair to chemotherapy.
insurers
Insurers do, admittedly, have tough
choices to make. "What if you are a wom-
are denying
an who wants a breast reconstruction,
and your sister can't even get prenatal
coverage for
care?" says Mark Zitter, president of the
Zitter Group, a San Francisco-based
reconstructive
health-care think tank. But some argue
that companies are too quick to judge
surgery
some procedures trifling or necessitated
purely by "vanity" when they are not.
and other
"With breast reconstruction we are not
Have a nice day:
enhancing the health of our pa-
"appearance-
Cost cutters
tients. We are trying to restore
not only shorten
some normalcy, and there is an
hospital stays
related'
but say по
aesthetic sense to that," says
to "vanity" work
Saul Berger, a plastic surgeon
treatments.
altogether.
with Kaiser-Permanente, a non-
profit HMO that does in fact pay for re-
construction after cancer surgery.
People who try to fudge the system
don't help matters. "You have to distin-
guish reconstruction from a face-lift,"
hen Hillary G., a
state hearing on Medicaid. "It comes
says Berger. "No health plan would con-
34-year-old Indiana
down to a woman's right to have a
sider it an obligation to restore to nor-
woman, sought ap-
complete body," says the doctor. "In
mal what something looked like ten
proval from Med-
the hearing I said, 'I bet you guys pay
years ago." Don't laugh: A couple years
icaid to have her
for penile reconstructions."
ago the television news program 20/20
breasts rebuilt fol-
As we all know, the nation's health-
aired an exposé of several dermatolo-
lowing a double
care system is in financial distress. Both
gists who were allegedly writing pre-
mastectomy. she was refused on the
government and private insurers have a
scriptions so that their patients could
grounds that the reconstructive part of
"party's over" attitude about cost cutting
get reimbursed for facials and makeup
her cancer surgery was "not medically
But with this fiscal zeal. some people
applications in their offices. Such fina-
necessary." "They said it was an opera-
say, has come a bias against appearance-
gling has given all medical procedures
tion being done on an organ with no
related problems, especially those expe-
that are perceived as cosmetic a bad
function," says Hillary's plastic sur-
rienced by women. "Insurance plans in
name-even when they are performed
geon, Christine Horner-Taylor. Hillary
some parts of the country are selective-
for reconstructive purposes.
went ahead and had the tumors in her
ly dropping reconstructive surgery for
And so, women have found them-
breasts removed without reconstruc-
women," says William B. Riley. presi-
selves fighting it out in the courts and at
tion and lived with scars for nine months,
dent of the American Society of Plastic
legislative hearings. Insurance coverage
until Horner-Taylor won a victory at a
and Reconstructive Surgeons. The num-
for postmastectomy breast reconstruc-
128
ALLURE NOVEMBER 1995
tion is now mandatory in 11 states, in-
there should be no discrimination if
to talk, and even then would only con-
cluding California, which further re-
you are overweight." One of her pa-
firm what is and is not covered on the
quires coverage for surgery performed
tients even lost weight to fall within the
company's standard plan.
on both breasts in order to make them
ideal but still suffered back, shoulder,
symmetrical-even if only one has
neck, and breast pain. She finally had the
he unspoken reality
been removed for cancer. It is illegal for
reduction when she was considered
is that the line has
insurers to deny payment for breast
thin enough in the eyes of her insurer.
to be drawn some-
prostheses in six states. And in Minne-
Eating disorders are still another
where. "Most Amer-
sota. an insurance provider must pay for
area in which the bias against appear-
icans support the no-
a wig when someone loses hair as a re-
ance-related conditions comes into play.
tion that everyone
sult of a medical condition.
For instance, anorexia nervosa is con-
should get the same
But the battle is far from won. Ore-
sidered a psychiatric disorder by many
care that a million-
gon's health plan, which is so comprehen-
insurance companies, and many policies
aire gets," says think-
sive in its basic coverage package for the
have little or no psychiatric coverage.
tanker Mark Zitter. "But we have to set
poor that it is often held up as a model
According to Joel Yager, a professor of
priorities. Self-image is a small part of
for a national health-care system, does
psychiatry at the University of New
the quality of life; general well-being is
not cover breast reconstruction. When
Mexico. research has shown that keep-
another. Perhaps you can look normal
the priorities were debated there. it was
ing severely malnourished anorexics
when you are dressed if you've lost a
argued, among other things, that a recon-
in the hospital until they slowly gain
breast." In the classic dispassionate
structed breast cannot provide milk and is
weight is one of the best ways of fight-
style of a bottom line-oriented thinker,
therefore nonfunctioning and unneces-
ing the disorder. "If you send someone
Zitter also points out that a problem
sary. The plan does pay for a nonfunction-
home partially treated, they are not
like anorexia (estimated to afflict ½ to
ing glass eyc. "It's a matter of a person
psychologically prepared to continue
1 percent of women under the age of 25)
being able to go out of their house."
their recovery," he says. "But no one
is not prevalent enough to capture the
explains Paige Sipes Metzler, execu-
wants to understand that from a pay-
attention of insurance companies-
tive director of the Oregon Health Ser-
ment point of view."
"they are a lot more worried about dia-
vices Commission. What a woman sees
"We couldn't ever say the diagnosis
betes and congestive heart failure."
when she takes off her clothes was. ap-
was anorexia, because they [insurers]
One thing is certain: Insurance poli-
parently, deemed unimportant.
would not cover treatment of it." says
cies are open to interpretation. Take the
The Virginia state legislature struck
Carlie Asbury of Manhattan, Kansas,
experiences of Jackie Ingersoll, owner
down a bill attempting to mandate cov-
whose daughter Stacey died as a result of
of Prostheses Hair Services in Houston.
When a customer who has
"What if you want
lost hair due to chemother-
apy is denied coverage for
one of Ingersoll's handmade;
a breast reconstruction,
custom-fit wigs, she'll call
the insurer herself. She says,
"If I am able to get a female
and your sister can't
on the phone I will say, 'Can
we just talk and forget about
company policies?" After
even get prenatal care?"
hearing an individual's story.
insurance representatives of-
ten find a way to pay-some-
erage for breast-reduction surgery for
the disorder in 1993. Asbury says her
times it's as easy as calling a wig a
women for whom it is considered med-
daughter was hospitalized for four and
"cranial prosthesis," which is then cov-
ically necessary. The plastic surgeon
five months at a time at a cost of as
ered along with other prostheses.
whose letter to the legislature prompted
much as $150,000 per stay. (Stacey was
In the end, the point is to give peo-
the bill, Patricia Gomuwka, found that
instead diagnosed as suffering from
ple the right to choose how they want
her patients were being denied coverage
clinical depression, which was partially
to look when illness or trauma or a
on the basis that they were overweight.
covered by the family's insurer.)
twist of genetic fate has taken them
Cigna HealthCare and Prudential Insur-
Of course, the health-care situation
out of the realm of what's considered
ance companies both use as a criterion
in this country is so complex that it's
normal. Michigan boutique owner An-
for coverage that a woman be within a
difficult to generalize. Most large em-
nette Newman, who often lectures on
certain percentage of her ideal body
ployers customize the standard con-
choosing a breast prosthesis, encour-
weight according to the Metropolitan
tracts offered by insurance companies,
ages women to complain when their
Life Insurance Company's height and
which means that it is the employer and
insurance companies won't pay for the
weight tables-the logic presumably
not the insurance company that decides
products they want. Says Newman,
being that a woman's breasts might be
what gets covered and what does not.
"The only way we are going to get any
big simply because she is fat. Says Go-
Prudential was the only major insurer
changes made is if we make it known
muwka, "If this is a provided benefit,
contacted by this reporter that agreed
that we're not satisfied."
130
ALLURE NOVEMBER 1995
ELLC
HOW
TO
HOW TO KEEP WARM AND LOOK GREAT
KEEP
WARM
AND
LOOK
GREAT
SPECIAL:
THE
PAMPERED
BODY
CLINTON
SOAKS,
VS. DOLE:
MASSAGES,
DON'T VOTE
WRAPS,
UNTIL YO J
SCRUBS
READ THIS
10
02492
0 274921 9
OCTOBER 1996
USA $300
CANADA $3.50
health
shots in health care, and they're often
looking for the path of least expense. In
breast reconstruction, that means they
may pay for an implant, but not a pro-
cedure that uses a patient's own tissue.
They might pay for reconstruction, but
not the finishing touches, like creating
the proper folds underneath so that the
new breast actually looks like a breast,
not a blob. Or they may not cover
surgery on the other breast to make sure
the two are symmetrical.
Besides being patently cruel to women
already suffering from the trauma of
breast cancer, the kinds of restrictions
some HMOs are imposing on sub-
scribers can be dangerous to women's
health, says Linda G. Phillips, MD, chief
of plastic surgery at the University of
Texas Medical Branch, in Galveston. Fear
of losing a breast-and any chance of re-
constructing it-can lead to deadly pro-
crastination in getting a lump diagnosed.
Managing Cost, Not Care
More than half of Americans with pri-
vate insurance now belong to some kind
of managed-care plan,
including health-main-
your money or
tenance organizations,
When they
life
and the numbers are
growing. But because it's
your
still a relatively new
form of health coverage,
should be
there's little hard evi-
dence on how it will
fighting an
ultimately affect women's
his is what happens: A wo-
health care. In theory, managed care is
illness, many
man does her monthly
supposed to improve health care by
breast exam, and she comes
doing more to prevent people from get-
women
across a lump. "Cancer!"
ting sick in the first place (covering
are finding
flashes through her mind;
annual checkups and routine screenings)
images of a scarred chest where her breast
and by ensuring that a patient's doctors
themselves
used to be follow. After the biopsy, the
work closely to coordinate care. It's sup-
doctor tells her that yes, it is breast cancer,
posed to eliminate the overutilization fos-
doing battle
and she will need surgery, but that it's now
tered by the old system, when traditional
possible to reconstruct a breast almost
indemnity plans would pay for any pro-
with their
identical to the one lost. Then the doctor
cedure a doctor claimed was medically
calls the patient's HMO. And that's
necessary (remember the run on hys-
HMOs. By
when, many women are discovering,
terectomies in the '80s?). And it's sup-
E.B. Boyd
their problems are only just beginning.
posed to bring down health-care costs
LISA SPINDLER
HMOs are increasingly calling the
and produce the lower premiums >
222
health
employers have long demanded. But
Center in New York. "If you could get
when HMOs won't pay a plastic sur-
all the population to participate in pre-
geon to make finishing touches on a re-
ventive-screening behavior, you would
constructed breast (like repositioning a
certainly see a decrease in cancer-related
nipple that doesn't look right after the
deaths across the country."
first surgery), the gap between theory
and reality has grown too large.
The Art of the Appeal
Women who've just had a normal
WHY
The key to getting good health care in
birth are now being required to leave
the new system is to be proactive. Do
the hospital within twenty-four hours,
your homework about your own needs,
even if their doctors think they should
whether you have chronic problems like
stay longer (most believe at least forty-
allergies or a sudden, debilitating pain.
your LIPS
Women can no longer put
blind faith in their doctors
and insurers to give them the
treatments they need.
need
eight hours is essential). In other cases,
Ask questions about proposed treat-
HMOs are compelling doctors to use
ment plans. If your health plan turns
labs they feel are potentially substandard
down what you and your doctor think
to read tests like Pap smears.
is a legitimate request-an appoint-
Which is not to say that women
ment to see a sports-medicine specialist
should throw up their hands (and throw
after you've suffered an injury at the
out their insurance forms) in despair.
gym, a prescription for a brand-name
UNDERWEAR.
"People are afraid of managed care be-
medication instead of its cheaper gener-
cause it sounds very restrictive," says
ic sibling-appeal the decision. A pa-
Suzanne Delbanco, a researcher at the
tient who can make a strong argument
Henry J. Kaiser Family Foundation in
in her favor-say, pointing out that the
Menlo Park, California. "But the alarms
service she's requesting is recommended
that are being raised about the dangers of
by a national medical organization like
managed care and the cost-cutting don't
the American College of Obstetricians
hold up when you take a close look at it."
and Gynecologists-stands a better
Indeed, in terms of basic health-care
chance of overturning a denial.
services, managed care is doing as well
Women's health advocates are gaining
as, or better than, traditional insurance.
ground with HMOs. Christine Horner-
Virtually all HMOs cover annual gyne-
Taylor, MD, a member of the American
cological exams, but only half of tradi-
Society of Plastic and Reconstructive
tional plans do, according to a study by
Surgeons, is spearheading a campaign to
the Kaiser Family Foundation and the
get state legislatures to force HMOs to
Alan Guttmacher Institute in New
Color alone can't protect
NIVEA
pay for full breast reconstruction, and
181
the most vulnerable
York. Most HMOs pay for at least some
more than half of all states have passed
NIVEA
skin on your face. Nivea
CARL
contraceptives, compared with only half
laws requiring insurers to give new
Lip Care helps keep lips
of indemnity plans. And almost all
mothers at least two days in the hospital.
smooth and protects
Daily
HMOs cover routine cancer screenings
But just as women can no longer put
against sun damage. So
Care
like Pap tests and mammograms.
blind faith in their doctors and insurers
Daily UVA/UM
before putting on lipstick,
protection
More preventive care means fewer
to give them the treatment they need,
apply common sense.
Protects and
women will develop serious cases of
they can't wait for new laws to make
conditions
breast cancer, cervical cancer, and other
sure they get adequate health care. In
NIVEA®
preventable diseases, says William
the cost-conscious world of managed
Hoskins, MD, chief of gynecology at
care, self-education is as important as
LIP CARE
the Memorial Sloan-Kettering Cancer
self-examination.
AGENDA MEETING4//97
I. Introductions
II. Breast Reconstruction Advocacy Project Briefing
III. Who are key players in House and Senate
How do we get it on fast track
How to insure priority handling by Eshoo/Kennedy
IV. National Exposure
V.
Susan Blumenthal
Healthy Women 2000 - Breast Cancer Conference
HEALTH
ADVOCACY
Panel Discussion - Breast Reconstruction with Eshoo and
Dr. Horner-Taylor
VI. NBCC Conference
NOMEN'S
PROJECTS
VII. How else can we work together
4034 South Jefferson Avenue
Cincinnati, Ohio 45212-4020
Phone 513.351.WHAP
Fax 513.351.2039
Fact Sheet: the Kennedy-Eshoo Reconstructive Breast Surgery Benefits Act
The Reconstructive Breast Surgery Benefits Act (H.R. 164) would amend the Public Health Service Act and Employee
Retirement Income Security Act to DO the following:
Require health insurance companies that provide coverage for mastectomies to cover reconstructive breast surgery that
results from those mastectomics (including surgery to establish symmetry between breasts):
Prohibit insurance companies from denying coverage for breast reconstruction resulting from mastectomies on the basis
that the coverage is for cosmetic surgery:
Prohibit insurance companies from denying a woman eligibility or continued eligibility for coverage solely to avoid
providing payment for breast reconstruction:
Prohibit insurance companies from providing monetary payments or rebates to women to encourage such women to
accept less than the minimum protections available under this Act:
Prohibit insurance companies from penalizing an attending care provider because such care provider gave care to an
individual participant or beneficiary in accordance with this Act: and
Prohibit insurance companies from providing incentives to an attending care provider to induce such care provider to
give care to an individual participant or beneficiary in a manner inconsistent with this Act.
The Reconstructive Breast Surgery Benefits Act would NOT
Require a woman to undergo reconstructive breast surgery:
Apply to any insurance company that does not offer benefits for mastectomies:
Prevent an insurance company from imposing reasonable deductibles. coinsurance. or other cost-sharing in relation to
reconstructive breast surgery benefits:
Prevent insurance companies from negotiating the level and type of reimbursement with a care provider for care given
in accordance with this Act: and
Preempt state laws that require coverage for reconstructive breast surgery at least equal to the level of coverage
provided in this Act.
WRITE YOUR SENATORS and CONGRESSPERSON TODAY!
Letters are more effective when they come from your own point of view in your own words. Here are some possible
points to include in your letter:
1 am one of your constituents
Please support the Kennedy-Eshoo Reconstructive Breast Surgery Benefits Act of 1997 to guarantee insurance
companies cover the cost of reconstructive breast surgery following mastectomies.
Please write me back! Will you vote to support this important bill?
The address for your Congressperson is:
The address for your Senators is:
U.S. House of Representatives
U.S. Senate Office Building
Washington, D.C. 20515
Washington, D.C. 20510
Be sure to include your return address. If you have questions regarding the Act or where your representative stands. please
contact:
Robin Jennings
Women's Health Advocacy Projects
Women's Health Advocacy Projects is a
non-partisan-nonprofit organization that
BEALTH
513/351-WHAP (9427)
proactively designs and supports projects
513/351-2039 (fax)
which empower women health care through
HOMELS
PROJECTS
legislation and public education. It is
4034 South Jefferson Avenue
committed to extraordinary health care for
Cincinnati. Ohio 45212-4020
all women.
FACTS ON WHY WE NEED
HEALTH
ADVOCACY
BREAST RECONSTRUCTION
AVAILABILITY
WOMEVS
PROJECTS
Breast cancer is the most common cancer in American women, afflicting
182.000 women per year striking 1 out of 9 and kills 46,000 a year. Coping
with this disease is a medical and emotional struggle since it carries with it
the fear of disfigurement in a society that places great value on physical
appearance. Many of these women will require mastectomy or amputation
of their breast to treat their disease.
Some women adjust well to their amputated breast while others feel desperately mutilated, losing their
sexuality, self esteem and self worth. Breast reconstruction for these women is extremely important to restore their
sense of wholeness and well being in society family and interpersonal relationships.
Some insurance carriers are denying coverage of breast reconstruction, considering the procedure not
medically necessary. These carriers will cover reconstruction of other body parts clearly demonstrating
discrimination against the female breast. Most insurance companies will not cover procedures on the opposite
breast to provide symmetry for the reconstruction. If these women are not financially able to pay for the surgery
they will have no option to have their bodies restored to wholeness.
There is no known cause or cure for this silent breast cancer epidemic for the 2.8 million victims in America.
Early detection and treatment is the best means we have available to enhance survival. If women know that they
cannot be reconstructed because of lack of insurance coverage, then they may have greater fear in
participating in early detection programs. Therefore we may see women with more advanced stages of disease
and decrease survival.
Women should have access to breast reconstruction if they desire it. That access should be available regardless
of timing in relationship to the onset of the deformity or absence of their breast.
Insurance carriers coverage should not discriminate against the female breast for reconstructive coverage.
To support women, Legislative efforts and enactment of laws that include insurance coverage for breast
reconstruction is necessary. Rep. Anna Eshoo and Sen. Edward Kennedy have introduced the Reconstructive
Breast Surgery Benefits Act of 1997 to guarantee insurance companies cover the cost of reconstructive breast
surgery that results from mastectomies for which coverage is already provided. In addition. her initiative would
secure insurance coverage for all stages of reconstructive breast surgery performed on a nondiseased breast to
establish symmetry with the diseased breast is performed.
"The Reconstructive Breast Surgery Benefits Act would guarantee that women with breast cancer are not
victimized twice--first by the disease. then by their insurance companies." said Rep. Eshoo. "In 1995. an estimated
182.000 American women were diagnosed with breast cancer. and 85,000 of them underwent a mastectomy as part
of their treatment. Reconstructive breast surgery often is an integral part of the mental and physical recovery of
women who undergo this traumatic. disfiguring procedure. Unfortunately. insurance companies don't always see it
that way. Even though many of them are willing to pay for mastectomies. they sometimes balk at covering breast
reconstruction. My legislation would put an end to this shortsighted practice."
UNITED
STATES
Anna Eshoo
+
4
73
CONGRESS
U.S. House of Representatives
NEWS
14th Congressional District of California
FOR IMMEDIATE RELEASE
CONTACT: Lewis Roth
January 8, 1997
(202) 225-8104
Eshoo Initiative To Guarantee Insurance Coverage For
Reconstructive Breast Surgery
Washington, D.C.--Rep. Anna Eshoo (D-CA) has introduced the Reconstructive Breast Surgery
Benefits Act of 1997 to guarantee insurance companies cover the cost of reconstructive breast
surgery that results from mastectomies for which coverage is already provided. In addition, her
initiative would secure insurance coverage for all stages of reconstructive breast surgery
performed on a nondiseased breast to establish symmetry with the diseased one when
reconstructive surgery on the diseased breast is performed.
"The Reconstructive Breast Surgery Benefits Act would guarantee that women with breast cancer
are not victimized twice--first by the disease, then by their insurance companies," said Rep.
Eshoo. "In 1995, an estimated 182,000 American women were diagnosed with breast cancer,
and 85,000 of them underwent a mastectomy as part of their treatment. Reconstructive breast
surgery often is an integral part of the mental and physical recovery of women who undergo this
traumatic, disfiguring procedure. Unfortunately, insurance companies don't always see it that
way. Even though many of them are willing to pay for mastectomies, they sometimes balk at
covering breast reconstruction. My legislation would put an end to this shortsighted practice."
According to the American Society of Plastic and Reconstructive Surgeons (ASPRS), a
significant number of women with breast cancer must undergo mastectomy or amputation of a
breast in order to treat their disease appropriately. The two most common types of reconstruction
--tissue expansion followed by an implant insertion and flap surgery--can restore the breast
mound to a natural shape. Most breast reconstruction requires a series of procedures that may
include an operation on the opposite breast for symmetry.
Even though studies show that fear of losing a breast is a leading reason why many women do
not participate in early breast cancer detection programs, many general surgeons don't even
present reconstruction as an option for mastectomy candidates. Unfortunately, many women are
unaware that reconstruction is an option following mastectomy, and they put off testing and/or
treatment for breast cancer until it is too late.
(more)
A recent ASPRS survey (with an error range of +/-1.9%) indicates that 84% of respondents had
t
to to patients who were denied insurance coverage for breast reconstruction of the amputated
breast. or those surgeons who support state legislation to address this problem and reported
denied coverage, the top three procedures denied most often were symmetry surgery on a
mandiseased breast, revision of breast reconstruction, and nipple areola reconstruction. The top
five states of residence of those patients reporting denied coverage are Florida, California, Texas,
Pennsylvania, and New York.
California and Florida also are among the 13 states that have passed laws requiring breast
reconstruction coverage after mastectomy. However, state laws alone, such as the California and
Florida laws, do not provide adequate protection for women because states do not have
jurisdiction over interstate insurance policies provided by large companies under the Employee
Retirement Income Security Act (ERISA). As a result, even women in states that have attempted
to address this issue are still at risk of being denied coverage for reconstructive surgery.
A fact sheet about the Reconstructive Breast Surgery Benefits Act is available at
www-eshoo.house.gov/reconstructivefax.html on the World Wide Web or by contacting Lewis
Roth at (202) 225-8104.
###
U.S. House of Representatives
Congress
105th
Session
First
Date
April 8, 1997
Pursuant to Clause 4 of rule XXII of the rules of the House of Representatives, the following
sponsors are hereby added to H.R. 164
1.
Rep. Patsy Mink (D-HI)
2.
Rep. Louise Slaughter (D-NY)
3.
Rep. Martin Frost (D-TX)
4.
Rep. Linsey Graham (R-SC)
5.
Rep. Eleanor Holmes-Norton (D-DC)
6.
Rep. George Miller (D-CA)
7.
Rep. Jack Quinn (R-NY)
8.
Rep. Ellen Tauscher (D-CA)
9.
Rep. Julia Carson (D-IN)
10.
Rep. Zoe Lofgren (D-CA)
11.
Rep. John Lewis (D-GA)
12.
Rep. Eni Faleomavaega (D-AS)
13.
Rep. Carolyn Maloney (D-NY)
14.
Rep. Bobby Rush (D-IL)
15.
Rep. William D. Delahunt (D-MA)
16.
Rep. Sam Gejdenson (D-CT)
17.
Rep. Maurice D. Hinchey (D-NY)
18.
Rep. James A. Traficant (D-OH)
19.
Rep. David Bonior (D-MI)
20.
Rep. Vic Fazio (D-CA)
21.
Rep. Sidney Yates (D-IL)
22.
Rep. Lane Evans (D-IL)
23.
Rep. Nancy Pelosi (D-CA)
24.
Rep. Henry Waxman (D-CA)
25.
Rep. Sheila Jackson-Lee (D-TX)
26.
Rep. James L. Oberstar (D-MN)
27.
Rep. Loretta Sanchez (D-CA)
28.
Rep. Steve Rothman (D-NJ)
29.
Rep. Ronald Dellums (D-CA)
30.
Rep. Gary Ackerman (D-NY)
31.
Rep. Jon Fox (R-PA)
32.
Rep. Bart Gordon (D-TN)
33.
Rep. Robert Menendez (D-NJ)
34.
Rep. Bart Stupak (D-MI)
35.
Rep. Robert Matsui (D-CA)
04/21/97 13:48
5
003/005
36.
Rep. Dale E. Kildee (D-MI)
37.
Rep. William J. Coyne (D-PA)
38.
Rep. David McIntosh (R-IN)
NEW ADDITIONS SINCE APRIL 8
39.
Rep. Mike McIntyre (D-NC)
40.
Rep. Sherrod Brown (D-OH)
41.
Rep. Nick Lampson (D-TX)
Anna G. Eshoo, Original Sponsor
This list does not include the 4 originals: Reps. Eshoo (Sponsor), DeLauro, Towns and
McGovern
Senator Edward M. Kennedy
of Massachusetts
INTRODUCTORY STATEMENT FOR
KENNEDY-ESHOO RECONSTRUCTIVE
BREAST SURGERY BENEFITS ACT OF 1997
For Immediate Release:
Contact: Jim Manley
April 17, 1997
(202) 224-2633
Today I am introducing the Reconstructive Breast Surgery Benefits Act of 1997. An
identical bill is being introduced by Representative Anna Eshoo in the House of Representatives.
Our purpose in introducing this legislation is to improve the lives of thousands of women who
suffer from breast cancer.
Breast cancer is the most common form of cancer in American women, affecting one
woman out of every nine. Nearly three million American women are living with the disease, and
46,000 die from it each year. Over 180,000 more women will be diagnosed with breast cancer this
year, and nearly half of the women will suffer the loss of one or both breasts in order to survive.
Reconstructive surgery or use of a prothesis can help women cope with the consequences
of this deadly illness. Every woman deserves the opportunity to have these important options
available if breast cancer strikes. It is also a distressing fact that some women avoid early detection
procedures, for fear that it may result in the loss of a breast if cancer is detected. For these
women, breast reconstruction surgery should be available as a part of treatment, since its
availability can alleviate fears about the disease and encourage life-saving early detection and
treatment.
Many insurers classify this important medical procedure as cosmetic, however, and deny
coverage for it. In addition, as many as 25% of women who undergo breast cancer treatments are
affected by lymphedema, a complication resulting from mastectomy. Many insurers also refuse to
cover treatment and management of this condition. This legislation will end these types of
discrimination.
Currently, 12 states have laws that require coverage for breast reconstruction following
mastectomy. Nine states require coverage for prosthesis. This legislation will extend these
protections to all women.
This bill will amend the Public Health Service Act and the Employee Retirement Income
Security Act in order to accomplish the following important actions.
It requires insurers and companies that provide coverage for mastectomy to provide
coverage for reconstructive breast surgery, prosthesis and other treatments which may be
necessary as a result of surgical complications, including lymphedema.
-MORE-
110.437
P.3/3
APP. 17. 1997 1:00PM
SENATOR KENNEDY ON INTRODUCTION OF KENNEDY-ESHOO ACT 2-2-2
It prohibits monetary payments or rebates that encourage a woman to accept less than the
minimum medical protection available.
Finally, it prohibits insurers using penalties or incentives to encourage providers to furnish
levels of care inconsistent with this legislation.
This bill has been endorsed by major national organizations involved in the diagnosis and
treatment of breast cancer, including the American Cancer Society, the National Breast Cancer
Coalition, the National Women's Health Network, and the national medical and nursing groups
concerned with this disease.
Our goal is to end the cruel and arbitrary practice that unfairly discriminates against breast
cancer patients and their needs. I look forward to early action by Congress, and I hope that it will
receive the overwhelming bipartisan support it deserves.
-30-
Bill Summary & Status for the 105th Congress
Item 2 of 9
PREVIOUS BILL 1 NEXT BILL
PREVIOUS BILL:ALL 1 NEXT BILL:ALL
HOME I HELP
S.609
SPONSOR: Sen Kennedy, (introduced 04/17/97)
TITLE(S):
OFFICIAL TITLE AS INTRODUCED:
A bill to amend the Public Health Service Act and Employee Retirement Income Security Act of
1974 to require that group and individual health insurance coverage and group health plans
provide coverage for reconstructive breast surgery if they provide coverage for mastectomies.
STATUS: Floor Actions
***NONE***
STATUS: Detailed Legislative History
Senate Action(s)
Apr 17, 97:
Read twice and referred to the Committee on Labor and Human Resources.
STATUS: Congressional Record Page References
04/17/97 Introductory remarks on Measure (CR S3354)
COMMITTEE(S):
COMMITTEE(S) OF REFERRAL:
Senate Labor and Human Resources
AMENDMENT(S):
***NONE***
SUBJECT(S):
***NONE***
11 COSPONSORS:
I of 2
4/21/97 2:34 PM
04/21/97 13:48
0
005 005
http://www.congress.gov..s:2./temp/-bdJgaH.@@@L
http://www.congress.gov/cgi-lis/bdquery/D7d105:2:./temp/-bdJgaH.@@@.
Sen Mikulski - 04/17/97
Sen Daschle - 04/17/97
Sen Dodd - 04/17/97
Sen Harkin - - 04/17/97
Sen Wellstone - 04/17/97
Sen Murray - 04/17/97
Sen Boxer - 04/17/97
Sen Moseley-Braun - 04/17/97
Sen Feinstein - 04/17/97
Sen Ford - 04/17/97
Sen Inouye - 04/17/97
DIGEST:
***NONE***
Fact Sheet:
Organizations Endorsing the Reconstructive
Breast Surgery Benefits Act
American Cancer Society (Atlanta, GA) fights breast cancer through research, information, and support services.
The Society's Breast Cancer Network of people and programs works to save lives in communities around the country.
The National Breast Cancer Coalition (Washington, D.C.) is a grassroots effort in the fight against breast cancer.
In 1991, the Coalition was formed with one mission, to eradicate breast cancer through action and advocacy.
The Breast Cancer Fund (San Francisco, CA) was founded in 1992 to innovate and accelerate our country's
response to the breast cancer epidemic. Its mission is to raise awareness and funding for cutting-edge research,
education, patient support, and advocacy.
Breast Cancer Action of San Francisco (San Francisco, CA) serves as a catalyst for the prevention and cure of
breast cancer. Its goals are to make breast cancer a national priority through education and advocacy; to promote and
refocus research into the causes, prevention, treatment, and cure of breast cancer; and to empower women and men to
participate fully in decisions relating to breast cancer.
The American Society of Plastic and Reconstructive Surgeons (Arlington Heights, 11.) represents 97% of the
nearly 5,000 board certified plastic surgeons in the United States. Plastic surgeons provide highly skilled surgical
services that improve both the functional capacity and quality of life of patients, including reconstructive procedures
following mastectomies.
The American College of Surgeons (Chicago, IL) is a scientific and educational association of surgeons that was
founded in 1913 to improve the quality of care for the surgical patient by setting high standards for surgical education
and practice.
The Breast Reconstruction Advocacy Project (Edgewood, KY) is a grassroots effort to pass legislation in each state
and federally requiring insurance companies to cover breast reconstruction following mastectomy for breast cancer.
The Y-ME National Breast Cancer Organization (Chicago, IL) has a commitment to provide information and
support to anyone who has been touched by breast cancer.
The Community Breast Health Project (Palo Alto, CA) is working to improve the lives of people touched by breast
cancer by acting as a clearinghouse for information and support, providing volunteer opportunities for breast cancer
survivors and friends dedicated to helping others with the disease, and serving as an educational resource and a
community center for all who are concerned about breast cancer and breast health. The Community Breast Health
Project is grass-roots, patient-driven, and committed to providing services free of charge.
The American Society of Plastic and Reconstructive Surgical Nurses (Pitman, NJ) is a 25 year old national
organization of 1,600 plastic and reconstructive surgical nurses that has contact with breast reconstruction patients
every day. Its Image Reborn program now has 15 support groups around the country for women going through or
considering options for breast reconstruction.
The Association of Women Surgeons (Westmont, II.) is a nonprofit, international organization founded in 1981 to
inspire, encourage, and enable women surgeons to realize their professional and personal goals. It currently has 1,350
members and is growing every year as it helps women surgeons at various stages in their careers--from residency
through retirement.
The Bay Area Breast Cancer Network (San Jose, CA) was started in 1990 by breast cancer survivors to increase
awareness of breast cancer through education, support, and advocacy. This service and advocacy organization works
to affect public policy at the state and federal level for breast cancer health issues and related research funding.
Organizations Endorsing Breast Reconstruction
Legislation
American Cancer Society
American Medical Association
American Medical Women's Association
American Society of Plastic and Reconstructive Surgeons
American Society of Plastic and Reconstructive Surgical Nurses
Association of Women Surgeons
Kentucky Nurses Association
American Nurses Association
Ohio State Medical Association
Cincinnati Women's Political Caucus
American College of Radiology
Susan G. Komen Breast Cancer Foundation
National Breast Cancer Coalition
BRA Project Status Report 4/21/97
Alabama - H217, S 318 and S 224 would require coverage for all stages of
reconstruction including symmetry in the manner chosen by
patient and physician. (Passed Senate)
Arizona - Passed - covers surgical services for reconstruction and at least
two external postoperative prostheses
Arkansas - Passed - Section 5 of Arkansas Health Care Consumer Act
provides benefits including prosthetic devices and
reconstructive surgery. Insurer may not restrict benefits for
hospital length of stay to less than 48 hours. Does not include
symmetry.
California - Passed - including symmetry
BEALTH
ADVOCACY
Connecticut - Passed - covers at least a yearly benefit of $500 for
reconstruction, $300 for prosthesis, and $300 for
INOMEN'S
PROJECTS
surgical removal of each breast due to tumor.
Florida - Passed - covers initial prosthetic device and reconstruction
Florida - HB 573 would require coverage for symmetry and more than one
4034 South Jefferson Avenue
prosthetic device. HB 453 would require coverage for any
Cincinnati, Ohio 45212-4020
"necessary" reconstruction
Phone 513.351.WHAP
Fax 513.351.2039
Hawaii - HB 620 and SB 1052 would require coverage for all stages of the
breast, including symmetry and notice to policyholders in writing
Illinois - Passed - covers initial prosthetic device and reconstruction
Indiana - Passed - requires coverage for prosthetic devices and
reconstruction
Kansas - HB 2297 would require coverage for reconstruction including
symmetry
Louisiana - HB 949, SB 390, SB 699 would require coverage for
reconstruction including symmetry
Maine - Passed - covers both breasts on which surgery was performed and
the other breast if patient elects reconstruction, in
manner chosen by patient and physician
Maryland - Passed - requires coverage including surgery to establish
symmetry, augmentation/reduction and mastopexy
Massachusetts - S 678 would require coverage for all stages of
reconstruction including surgery to establish symmetry
in manner chosen by patient and physician
Michigan - Passed - covers breast cancer rehab services, delivered on an
inpatient basis, including reconstruction
Minnesota - Passed - covers all reconstruction incidental to or following
injury, sickness or other diseases of the involved part, or
congenital defect for a child
Missouri - HB 129 would require coverage of prosthetic devices and
reconstruction necessary to achieve symmetry following
BEALTH
ADVOCACY
mastectomy
Montana - Passed - requires coverage of reconstruction following
mastectomy, including all stages of one reconstructive
surgery on the non-diseased breast to establish
symmetry, and the cost of prostheses
Nevada - Passed - covers at least 2 prosthetic devices and reconstruction
4034 South Jefferson Avenue
including augmentation mammoplasty, reduction
Cincinnati, Ohio 45212-4020
mammoplasty, mastopexy and symmetry
Phone 513.351.WHAP
Fax 513.351.2039
New Hampshire - HB 442 would require coverage of reconstruction,
including symmetry. (Passed House)
New Jersey - Passed - covers reconstruction including prostheses
New Jersey - All and A2550 would amend the existing law by specifically
covering surgery to restore and achieve symmetry. (Passed
Assembly and House)
New York - Passed - covers reconstruction including reconstruction on
healthy breast required to achieve reasonable
symmetry in manner determined by patient and
physician
North Carolina - HB 813 and SB 714 would require coverage of breast
reconstruction, including symmetry
Ohio - HB 159 and SB 47 would require reconstruction including
prosthesis
Oklahoma - Passed - would require coverage of reconstruction including
symmetry
Oregon - HB 2880 would require coverage for expenses related to
reconstruction and prosthetic services considered necessary for
adjunctive treatment SB 319 would cover symmetry
Pennsylvania - SB 155 would require coverage of prosthetic devices and
reconstruction
Rhode Island - Passed - covers prosthetic devices and reconstruction to
ADVOCACY
restore and achieve symmetry. Surgery must be
HEALTH
performed within 18 months of the original
surgery
WOMEN'S
PROJECTS
South Carolina - introduced in House requiring coverage for reconstrction
Tennessee - HB 223,HB 517, HB 697, HB1391, SB 237, SB 507, SB
1148 and SB 1590 would require coverage of reconstruction
including surgery to ensure symmetry
4034 South Jefferson Avenue
Cincinnati, Ohio 45212-4020
Texas - HB 262 and SB 217 would cover breast reconstruction, including
Phone 513.351.WHAP
surgery to restore and achieve symmetry, subject to the
Fax 513.351.2039
co-payment applicable to mastectomy (SB Passed)
Virginia - SB 948 would require coverage for reconstruction including
symmetry
Washington - Passed - covers reconstruction if mastectomy results from
disease, illness or injury. Amended to include
symmetry
West Virginia - HB 2116 would require coverage of reconstruction
including symmetry on the opposite breast, in manner
chosen by patient and physician
(Died in committee, will be re-introduced)
Wisconsin - AB 15 would require coverage of reconstruction.