Breast cancer patients still face outdated insurance barriers, and new legislation aims to align coverage with today’s reconstructive standards.
The Women’s Health and Cancer Rights Act (WHRCA) was groundbreaking when it became law in 1998 because it guaranteed insurance coverage for breast reconstruction after cancer treatment. Yet, like other items from the 1990s — think VHS tapes, floppy disks, and pagers — it hasn’t kept pace with technology.
A lot has changed in 27 years. The internet connected us, smartphones moved information from our desktops into our pockets, and social media transformed how we engage with the world. Yet, WHRCA remained the same, stuck in time, leaving breast cancer patients with uneven access to necessary care.
Dr. Alicia Billington
Board-Certified Plastic Surgeon (St. Petersburg, Fla.); Federal Chair, American Society of Plastic Surgeons (ASPS) Legislative Advocacy Committee
“I had multiple patients having issues and getting denials,” said Dr. Alicia Billington, a board-certified plastic surgeon in St. Petersburg, Fla., and federal chair of the American Society of Plastic Surgeons (ASPS) Legislative Advocacy Committee. “The struggles with insurance far surpassed the struggles with breast cancer. These women come to me in tears because they are being denied coverage or frustrated with trying to navigate the system. They’re not crying about breast cancer. That’s just not how this is supposed to work.”
The ASPS is championing the update to the law because ASPS Member Surgeons have an unrelenting commitment to every patient’s right to the best reconstruction and recovery resources available. They should not be limited only to the level of care that was available in the 1990s.
Ensuring the best reconstructive care
The Advancing Women’s Health Coverage Act (AWHCA) updates the original legislation by closing gaps in coverage so patients have access to a full range of recovery options. It focuses on patient-centered care because every patient is unique and deserves access to the medical approach that will best support their health and quality of life. It also removes barriers to care during a vulnerable time. Patients often face insurer denials, delays, or significant out-of-pocket expenses that make necessary care inaccessible.
“I want the insurance companies to be on our team,” Billington said. “I don’t want this to be adversarial. I would like to extend the invitation to come work with us and make changes to help patients.”
It’s time the letter of the law matches its spirit. Breast reconstruction has advanced significantly during the past 30 years, but coverage hasn’t. Coverage should correlate to today’s standards of care, including new options such as breast-conserving surgery, implant-based reconstruction, complex revisional surgery, and custom prostheses. Modernizing the Act ensures insurers can’t deny or delay coverage for the full reconstructive journey, protecting patients’ rights so they can experience better well-being, autonomy, and quality of life.
The updated bill also strengthens comprehensive coverage for lymphedema or swelling of the extremities. This condition can occur after breast cancer because lymph nodes may be removed as part of treatment. About 20% of breast cancer patients face this complication.
It’s time for a reboot to take this law from the ’90s into the 21st century. These updates ensure no breast cancer patient is left in the past with outdated insurance coverage. The AWHCA will allow breast cancer patients to receive the best possible reconstructive care.
