After years of NBCC grassroots lobbying and influence, Congress enacted the Breast and Cervical Cancer Treatment Act (P.L. 106-354) in 2000. This law expanded access to health care for thousands of underserved women. The Act authorized enhanced matching funds to states to provide Medicaid coverage to uninsured or underinsured women diagnosed with breast or cervical cancer through a federal screening program. All 50 states, the District of Columbia, 5 U.S. territories, and 12 American Indian/Alaska Native tribal organizations opted into the Breast and Cervical Cancer Treatment Program (BCCTP). NBCC remains vigilant in ensuring that the program endures, and that eligible women continue to receive the lifesaving screening and treatment they deserve.
Before the BCCTP, women diagnosed through the federal Centers for Disease Control and Prevention (CDC) screening program—ineligible for Medicaid coverage yet unable to afford insurance on their own—were falling through the cracks. Following diagnosis, the legacy system left them to rely on an unreliable system of dwindling charity care. NBCC recognized this system’s injustice and continues to believe that a federally funded program to screen and diagnose women with breast cancer must include a treatment component.
Since 1991, the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) funded programs served more than 5.8 million women. The program provided more than 15.1 million breast and cervical cancer screening examinations and diagnosed 71,107 invasive breast cancers and 4,863 cervical cancers.
In May 2009, GAO published a report looking at the status of the Breast and Cervical Cancer Treatment Act entitled, “Source of Screening Affects Women’s Eligibility for Coverage of Breast and Cervical Cancer Treatment in Some States.” The report identified the screening source requirements as a barrier to women’s eligibility for treatment in some states. A follow-up report was published in October 2020, “Federal Programs Provide Screening and Treatment for Breast and Cervical Cancer.” GAO analysis of CDC data showed that as a result of Medicaid expansions enacted though the Affordable Care Act, some low-income women had additional
resources for screening and treatment beyond the NBCCEDP, accounting for the reduction in the number of women screened through the program from 2011 through 2017. There were additional barriers listed in the 2020 report like the 2009 report including certain requirements to qualify for the program.
Under the BCCTP, states must extend Medicaid eligibility to women or men whose screening or diagnostic services were paid specifically with CDC funds. States can be more generous in expanding Medicaid coverage under the BCCTP but cannot fall below this minimum standard.
While implementing health care reform through the Affordable Care Act increased access to breast and cervical cancer screening for low-income, underserved women, efforts to cut expanded insurance coverage and eliminate cost-sharing threaten their access to screening and treatment. Even with adequate health insurance, many women will still face significant obstacles to obtaining breast and cervical cancer screening and treatment due to geographic isolation, limited health literacy or self-efficacy, inconvenient times to access services, and language barriers.
We must not move backward in our progress, even in the face of budget challenges. We must critically examine the impact of any changes to Medicaid, Medicare, or other existing laws based on the effect these changes will have on overall access to quality care. NBCC remains committed to ensuring all women and men diagnosed with breast cancer have access to the treatment they need.