Access to Quality Care

Susan G. Komen for the Cure is working with policymakers to ensure patient access to quality care for all patients, not just those who can afford it. Komen for the Cure is supporting a number of policy initiatives in this area, including patient access to state-of-the-art cancer treatments for Medicare beneficiaries and support for nurse education.

Breast and Cervical Cancer Prevention and Treatment Act
Nurse Reinvestment Act
Patient Navigator Services
Breast Cancer Patient Protection Act

Breast and Cervical Cancer Prevention and Treatment Act

In 2000, Congress enacted the Breast and Cervical Cancer Prevention and Treatment Act (BCCPTA), giving states the option to provide assistance through Medicaid to eligible women who are screened for and found to have breast cancer through the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). To qualify for Medicaid coverage under the Treatment Act, a woman must be under the age of 65, not already eligible for Medicaid, without creditable health care coverage, and in need of treatment for breast and/or cervical cancer or pre-cancerous conditions. To date, all 50 states and the District of Columbia have opted into the program.

The current Treatment Act system, however, is inherently unjust. The program gives states different options for defining Treatment Act eligibility. At a minimum, states offer Medicaid coverage only to those women who meet the necessary qualifications and who were screened through their state NBCCEDP-funded screening program. However, these programs reach less than 20 percent of eligible women due to funding constraints, meaning at least four out of five eligible women must be screened outside of the NBCCEDP-funded program and, therefore, are not eligible to receive treatment under this option. States were also given the option to cover additional low-income women who meet the necessary qualifications but who were not screened through the state-funded program. Regrettably, however, less than a third of the states are utilizing this more equitable coverage option. Therefore, many women who are eligible to receive treatment under the Treatment Act are denied treatment based simply on where they were screened.

Although some states give women denied treatment coverage based on their screening location the option to be re-screened through an NBCCEDP program, these women are forced to undergo the physical and psychological trauma of a second mammogram and/or biopsy. Further, re-screening results in inefficiencies and unnecessary delays which, therefore, delays treatment by critical months and wastes valuable resources that could be put toward treatment or screening of additional women. Most importantly, delays in treatment can affect a woman's prognosis and chances for survival. Overall, it is unethical to screen a woman and then provide her no viable options for treatment.

Susan G. Komen for the Cure is, therefore, challenging the states and the nation to change policies and eliminate the gap in the current Treatment Act by providing equal access to quality treatment to all eligible women under state Medicaid programs. The government can start saving lives now!

For our part, we are putting the full weight of Komen behind these problems and we pledge to invest another $1 billion in the next decade to reduce the breast cancer death rate and ultimately discover and deliver the cures. By the end of 2007, Komen will already have invested $1 billion in breast cancer research and community outreach programs, making us the world's largest provider of funds behind the federal government.

Komen remains concerned that the current budgetary climate may lead states to reduce or eliminate funding for this important program. Moreover, many states that have opted into the treatment program have not yet appropriated funding for the program.

Komen and its Affiliates are urging all states to fulfill the program's promise by providing sufficient funding to treat women diagnosed with breast or cervical cancer through the NBCCEDP.

Nurse Reinvestment Act

Oncology nurses play a vital role in the delivery of quality care for patients with breast cancer and other forms of cancer. These dedicated professionals are involved in the administration of chemotherapy and supportive medications, patient education, health promotion, pain and symptom management, psychosocial care, survivorship, end-of-life care and other essential services. However, our nation currently faces a critical shortage of qualified nurses and inadequate numbers of nursing school faculty to train the next generation of nurses. In the field of oncology nursing, this is particularly critical, given the aging of our population.

The Nurse Reinvestment Act, designed to address current and expected nursing shortages, was signed into law on August 1, 2002. The law includes several important initiatives to ensure an adequate nursing workforce well into the 21st century:

• A scholarship program for nursing students who agree to work in a shortage area for at least two years after completing their degree;
• Grants to develop and implement programs to train nurses who provide geriatric care;
• Student loan funds for Masters or Doctoral students who agree to serve as full-time nursing faculty after completion of their degree

Komen supports continuing the progress being made in addressing our nation’s nursing workforce shortage. In effort to continue educating and training additional nurses for the healthcare workforce of the future, Komen is urging Congress in 2007 to increase levels of funding as appropriate for the Nurse Reinvestment Act programs.

Patient Navigator Services

Susan G. Komen for the Cure is committed to ensuring that all breast cancer patients have access to a qualified patient navigator to help guide them through the complicated structure of the American health care system. Through its Affiliates, Komen has funded numerous programs across the country that provide these critical services to breast cancer patients.

Patient navigators are trained, culturally sensitive health care workers who provide support and guidance to breast cancer patients through the cancer care continuum. They help "navigate" the patients through the maze of doctors' offices, clinics, hospitals, outpatient centers, insurance and payment systems, patient-support organizations and other segments of the health care system. For breast cancer patients, a patient navigator can provide personalized education on breast surgery options, chemotherapy and radiation therapy. Navigators can facilitate communication with physicians and other health care professionals.

Patient Navigation Services are critical to address the barriers to quality cancer care, particularly for minority and underserved patients who often do not speak English, have low literacy skills, are uninsured, and/or live long distances from treatment centers. These patients may have difficulty assessing quality care and have trouble coordinating their cancer care. Without patient navigators, these patients experience disjointed treatment, inadequate patient-doctor communication, difficulty with follow-up appointments and poor adherence to treatment regimes.

The Patient Navigator Outreach and Chronic Disease Prevention Act of 2005 (Patient Navigator Act) established a competitive grant program through the Health Resources and Service Administration to provide patient navigators to those in need. In June 2005, the bill passed by a voice vote in the House and by unanimous consent in the Senate. Representatives Robert Menendez (D-NJ) and Deborah Pryce (R-OH) sponsored the bill in the United States House of Representatives and Senators Kay Bailey Hutchison (R-TX) and Jeff Bingaman (D-NM) sponsored the companion bill in the Senate. President Bush signed the bill into law on June 29, 2005.

The legislation authorized $25 million over five years to fund the Patient Navigator grant program. However, no funds have been appropriated from these critical services to date. Susan G. Komen for the Cure asks Congress to appropriate $15 million for the Patient Navigator grant program in 2008, as authorized by the Patient Navigator Act.

Komen continues support efforts to increase and enhance patient navigator programs in the 110th Congress.

Breast Cancer Patient Protection Act

Komen continues to educate Members of Congress about the importance of strong protections for breast cancer patients in managed care and other settings. In recent years, there has been growing concern about "drive-through" mastectomies reportedly resulting from managed care plans' refusal to cover adequate inpatient hospital stays subsequent to mastectomy, lumpectomy, and lymph node dissection. In response, a number of states have enacted legislation requiring insurers and health plans to cover an inpatient post-mastectomy hospital stay of at least 48 hours, unless the patient chooses a shorter length of stay.

In the 110th Congress, Representative Rosa DeLauro (D-CT), Representative Jo Ann Davis (R-VA), and Senator Olympia Snowe (R-ME) have introduced "Breast Cancer Patient Protection Act of 2007" bills in the United States House of Representatives and the United States Senate. The legislation attempts to ensure that decisions are made jointly by physicians and patients when concerning the length of hospital stay subsequent to mastectomy, lumpectomy or lymph node dissection for the treatment of breast cancer. The legislation mandates coverage for secondary consultations to confirm or refute the diagnosis of breast cancer. It also prohibits health plans and insurers from covering inpatient hospital stays of less than 48 hours post-mastectomy or breast conveying surgery (such as lumpectomy) or less than 24 hours after lymph node dissections (unless the patient chooses a shorter length of stay).

Representative Davis has also introduced the "Women's Health and Cancer Rights Conforming Amendments of 2007." This legislation requires group health plans to provide coverage for reconstructive surgery following mastectomy for all stages of reconstruction of the breast on which the mastectomy was performed. It also requires group health plans to cover surgery and reconstruction of the other breast to produce a symmetrical appearance as well as prostheses and physical complications of mastectomy, such as lymphedemas.

Komen supports efforts to ensure an adequate length of hospital stay as an important component of quality breast cancer care.