Women's Preventive Health Awareness Campaign (HR 2355, 114th Congress)

The Policy

What it does

Provides a national women’s preventive health outreach and educational campaign, and specifically addresses genetic counseling and BRCA testing. 

Synopsis

Women’s preventive care is built upon well-woman visits, doctor’s visits which provide a full checkup in addition to preventive health services, screening tests, medical history documentation, counseling, education, and other treatments to keep women healthy. Well-woman visits have been shown to identify disease risk factors, promote wellness, and decrease the likelihood or delay the onset of diseases or conditions such as breast cancer. In light of these benefits, HR 2355 seeks to raise awareness about women’s preventive health and clarify how providers and insurers should implement women’s preventive services to ensure that women are provided the care they need.

Section 4 of the bill amends Section 2713 (42 U.S.C. 300gg-13) of the Public Health Service Act (42 U.S.C. 201 et seq.) by adding a new subsection that aims to clarify coverage for women’s preventative health services. The new subsection outlines a few requirements:

  • When a health care provider determines a woman requires additional well-woman visits to obtain necessary preventive services recommended by the guidelines of the Health Resource and Services Administration (HRSA), those preventive services must be covered by health insurance without patient cost sharing (defined elsewhere as costs paid out of pocket by patients through co-payments, coinsurance, and deductibles.)
  • For a well-woman visit, additional office visit or facility fees are to be waived so that coverage can be provided without imposition of any cost sharing, in accordance with prior provisions of the Public Health Service Act.
  • Reasonable coverage limitations may apply when preventative service guidelines or recommendations do not specify details like frequency, method, or treatment for the services.
  • If there is not an in-network provider with the capacity to provide a certain preventive service, a woman’s insurance must cover receiving that service from an out-of-network provider, without imposing cost sharing.
  • Efficient care and the delivery of multiple screening and prevention services are permissible during a single visit as a reasonable management technique.
  • For preventive health services related to mitigating the risk of disease, a woman shall be treated as high risk if she has a family history of the disease or if a healthcare provider determines that she is high risk.

HR 2355 § 4(d)(8) instructs that a woman considered by her healthcare provider to be at high risk for the breast cancer susceptibility gene BRCA shall receive both BRCA testing and genetic counseling, in accordance with the recommendation of the United States Preventive Services Task Force, and her insurance must cover such services without cost sharing. In addition, other sections of the bill identify further preventive health service coverage for HIV testing, breastfeeding support, and contraception.  

Context

<p>The 2010 <a href="https://www.hhs.gov/healthcare/about-the-law">Affordable Care Act</a> (ACA) requires health insurers to cover certain women’s preventive services without imposing cost sharing; these include mammograms and cervical cancer screenings, among others.</p>

<p>After the passage of the ACA, the U.S. Department of Health and Human Service's (HHS) Health Resources and Services Administration (HRSA) updated their <a href="http://www.hrsa.gov/womensguidelines/">guidelines on Women’s Preventive Services</a>. These guidelines explain which additional preventive services must be covered by insurance without cost sharing. HR 2355 seeks, in part, to clarify if <em>BRCA</em> testing and genetic counseling for high-risk patients should also be covered at no cost. These services are currently not discussed in the HRSA guidelines, although they are considered in the <a href="https://www.uspreventiveservicestaskforce.org/Page/Name/recommendations"... of the United States Preventive Services Task Force</a>. Therefore, HR 2355 would employ these latter recommendations to require that <em>BRCA</em> testing and genetic counseling, among other services, are delivered to high-risk women at no cost.</p>

The Science

Science Synopsis

Around 12% of women will develop breast cancer sometime during their lives. Mutations to the BRCA1 and BRCA2 genes account for 3–5% of all breast cancers and 20–25% of hereditary breast cancers.

The BRCA genes are human tumor-suppressing genes, meaning they produce a tumor-suppressor protein to help repair damaged DNA in a cell. When working properly, these proteins fix the DNA damage, thus preventing the formation and growth of tumors. When tumor suppressor genes are mutated or altered, as can occur in harmful BRCA1 and BRCA2 mutations, the proteins they should produce may not function properly or be created at all, so DNA damage cannot be repaired. This outcome could potentially result in DNA changes that lead to cancer. Inherited mutations (i.e., mutations that are handed down from parent to child) in BRCA1 and BRCA2 are associated with an increase in the risk of female breast cancer, among other cancers.

According to recent estimates by the National Cancer Institute, 55–65% of women with a harmful BRCA1 mutation and 45% of women with a harmful BRCA2 mutation will develop breast cancer by the age of 70. Harmful BRCA1 and BRCA2 mutations can be inherited from mother or father. Harmful mutations in BRCA1 and BRCA2 are associated with higher prevalence in people of Ashkenazi Jewish descent, but mutations in these genes are seen in all racial and ethnic groups.  

The BRCA gene test analyzes DNA, gathered from a blood or saliva sample, to identify mutations in either BRCA1 or BRCA2. The test is usually offered to people who are likely to have the inherited mutation(s) based on familial history or who have a certain types of breast cancer. A positive BRCA1 or BRCA2 gene mutation test result indicates that person has inherited a harmful mutation and has an increased risk of developing breast cancer. Additionally, both men and women who inherit harmful BRCA1 or BRCA2 may pass the mutation to their children, regardless of the parent developing cancer.  

Direct medical harms of BRCA genetic testing are minimal, but results have a potential to negatively affect a person’s social and family life, emotions, finances, and healthcare choices. 

Relevant Experts

Gretchen Genevieve Kimmick, MD

  • “Thanks to research in genetics, we now recognize genetic changes, called deleterious mutations, in the BRCA1 and BRCA2 genes that are associated with [a] many-fold increase in risk of breast, ovarian and other cancers. Identifying these familial deleterious mutations in BRCA1 or BRCA2, by testing cells from the inside of the mouth or blood, helps us identify people at risk for cancer and whose life might be prolonged with preventive surgery or more intense screening. We need to be able to offer all women who are at high risk for these deleterious mutations testing.”

Andrew Berchuck, MD

  • “Prophylactic removal of the fallopian tubes and ovaries in BRCA mutation carriers has the potential to prevent many of the highly lethal cancers that arise in these organs. So identification of all women who carry these mutations is a high priority.”
  • Relevant work: Berchuck, A. 2012. “Genetic testing in ovarian cancer: getting better, and maybe not just for disease susceptibility anymore.” Obstetrics & Gynecology 120 (2 Pt 1): 221-222. doi: 10.1097/AOG.0b013e3182602599

Noah Kauff, MD


The Debate

Endorsements & Opposition

There are currently no publicly reported endorsements or opposition to this bill.