The legislation would broaden insurance coverage to encompass diverse breast reconstruction options, codify protections for all approved procedures, and mandate coverage for modern reconstructive techniques.
A bipartisan group of lawmakers has introduced the Advancing Women’s Health Coverage Act, legislation designed to close insurance gaps that can delay or deny coverage for breast and chest wall reconstruction after cancer.
Backed by the American Society of Plastic Surgeons (ASPS), The Plastic Surgery Foundation (The PSF), and patient advocacy groups including Susan G. Komen, the proposal would update the Women’s Health and Cancer Rights Act of 1998. Supporters say the measure would ensure patients have access to comprehensive reconstructive options following mastectomy and can choose the procedures that best meet their needs.
The bill was introduced with bipartisan sponsorship from Reps Kat Cammack (R-FL), Debbie Dingell (D-MI), Beth Van Duyne (R-TX), Lucy McBath (D-GA), Ashley Hinson (R-IA), April McClain Delaney (D-MD), Young Kim (R-CA), Brittany Pettersen (D-CO), Laurel Lee (R-FL), Melanie Stansbury (D-NM), Celeste Maloy (R-UT), and Marie Gluesenkamp Perez (D-WA).
“These changes ensure no breast cancer patient is left behind when it comes to accessing the best possible reconstructive care,” says C. Bob Basu, MD, MBA, MPH, president of ASPS. “This legislation empowers patients with the reconstruction and recovery resources they deserve.”
Developing the Legislation
ASPS and The PSF have worked for a decade to develop this legislation, according to a press release from ASPS. Technology and surgical approaches have advanced significantly since the original bipartisan bill’s passage 27 years ago, but the letter of Women’s Health and Cancer Rights Act has not kept pace with medical progress, the associations say. The lack of modernization, according to the ASPS and The PSF, has opened gaps in coverage and permitted insurance loopholes to persist. Patients can face insurer denials, delays, or out-of-pocket expenses that make necessary reconstructive care inaccessible. This bill aims to address these barriers to protect patients’ rights and improve their quality of life.
“The updates are not just about procedures, but about patient autonomy and choice,” says Babak Mehrara, MD, president of The PSF, in a release. “Modernization ensures breast cancer patients are fully supported with care from diagnosis through recovery.”
More patients are seeking breast and chest wall reconstruction options as part of their recovery journey. According to the 2024 ASPS Procedural Statistics Release, breast reconstruction remained one of the most frequently performed procedures in the United States, totaling 162,579 cases, a 3% rise from 2023.
“Access to reconstructive surgery after mastectomy is an essential part of mastectomy care for those patients who make the deeply personal decision to choose reconstruction. For over 25 years, the Women’s Health and Cancer Rights Act has ensured patients have coverage for reconstructive surgery, but it is past time that our laws reflect the rights of patients to full, modern mastectomy and post-mastectomy care,” says Molly Guthrie, vice president of policy and Advocacy at Susan G. Komen, in a release.
She continues, “Modernizing this law to guarantee affordable access to needed services after mastectomy—whether that be chest wall reconstruction, breast reconstruction, or the use of breast prostheses—is an important opportunity for all stakeholders to come together and support the breast cancer community.
Updates of the Advancing Women’s Health Coverage Act
These updates are part of the Advancing Women’s Health Coverage Act:
- Expanded access to advanced reconstruction: Ensures access to complex revisional procedures and up-to-date surgical techniques, including implant-based reconstruction, tissue-based surgery, a procedure that uses the patient’s own tissue to rebuild breasts or the chest, as well as “going flat.”
- Inclusion of breast-conserving surgery: Extends coverage to patients undergoing lumpectomy.
- Custom prostheses: Guarantees coverage for personalized prosthetic devices to support patients who choose an alternative to reconstruction.
- Full treatment of lymphedema: Requires insurance coverage for updated care of this debilitating complication that affects up to 20 percent of breast cancer patients.
- Insurer accountability: Prevents insurers from offering only the minimum coverage.
“Women should be fighting cancer rather than insurance companies. Every woman battling breast cancer deserves access to the best care modern medicine can offer—not limits based on outdated insurance codes & bureaucratic red tape,” says Rep Cammack in a release. “For too long, survivors have been denied coverage for proven reconstructive options that restore confidence, dignity, and quality of life. This bill puts patients back in charge, ensuring their recovery, health, and confidence aren’t dictated by a system stuck in the 1990s.”
Breast cancer affects 1 in 8 women in the United States. Studies show breast or chest wall reconstruction significantly improves patients’ quality of life by enhancing their psychological, social, and sexual well-being after breast cancer surgery. The legislation’s protections apply to all patients, regardless of the type of reconstruction they choose.
ID 96377424 | Breast © Bongkochrut Rojanatreekoon | Dreamstime.com
