Jeanette Acosta Invest in Women’s Health Act of 2021

II 117TH CONGRESS 1ST SESSION S. 1063 To provide women with increased access to preventive and life-saving cancer screening. IN THE SENATE OF THE UNITED STATES MARCH 25, 2021 Mrs. MURRAY (for herself, Mr. VAN HOLLEN, Ms. BALDWIN, Mr. WYDEN, Mr. MERKLEY, Mr. BLUMENTHAL, Ms. KLOBUCHAR, Mrs. GILLIBRAND, Mrs. SHAHEEN, Mr. BOOKER, Ms. ROSEN, and Mr. PETERS) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To provide women with increased access to preventive and life-saving cancer screening. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Jeanette Acosta Invest 4 in Women’s Health Act of 2021’’. 5 SEC. 2. PURPOSE. 6 It is the purpose of this Act to provide women with 7 increased access to preventive and life-saving cancer 8 screening, including clinical breast exams and cervical, 9 VerDate Sep 11 2014 05:44 Apr 30, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1063.IS S1063 pbinns on DSKJLVW7X2PROD with BILLS 2 •S 1063 IS ovarian, uterine, vaginal, and vulvar cancer screening, pro- 1 vided by leading women’s health care providers who— 2 (1) serve populations most at risk; and 3 (2) play an outsized role in the prevention and 4 detection of cancer in order to serve the goal of in- 5 creasing access to quality health screenings, care, 6 and services, reducing health care disparities and 7 mortality rates among low-income women and 8 women of color, decreasing health care spending, 9 and expanding health literacy, access, and education 10 about the benefits of regular preventive cancer 11 screening for women. 12 SEC. 3. FINDINGS. 13 Congress finds as follows: 14 (1) Breast cancer is the leading cause of cancer 15 death in women under the age of 54, and the Amer- 16 ican Cancer Society recommends that women in 17 their 20s and 30s have a clinical breast exam at 18 least every 3 years. 19 (2) Ovarian cancer causes more deaths than 20 any other cancer of the female reproductive system, 21 but it accounts for only about 3 percent of all can- 22 cers in women. 23 (3) The cancers that most frequently impact 24 women include breast, uterine, ovarian, and cervical 25 VerDate Sep 11 2014 05:44 Apr 30, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1063.IS S1063 pbinns on DSKJLVW7X2PROD with BILLS 3 •S 1063 IS cancer, and there were 341,171 new cases of these 1 cancers in 2017. 2 (4) Rates of incidence and death for gynecologic 3 cancers by race and ethnicity show that, while for 4 some cancers, like ovarian cancer, the rates of inci- 5 dence and death are similar among all races, for 6 other cancers, like cervical cancer, women of color 7 have disproportionate incidence and mortality rates. 8 While the incidence of uterine cancer is similar for 9 White women and Women of Color, rates of death 10 for uterine cancer are 2 times higher for Black 11 women than for White women. 12 (5) Cervical cancer incidence and mortality 13 rates are higher for women living in rural and un- 14 derserved regions in the United States. Women liv- 15 ing in these areas face unique barriers in accessing 16 reproductive health care services to prevent and 17 treat cervical cancer, including a lack of practicing 18 gynecologists in rural areas and challenges around 19 transportation to preventive and follow-up appoint- 20 ments. 21 (6) Prevention and cancer screening are the 22 best approaches to protecting women from cancer 23 and ensuring early detection and life-saving treat- 24 ment. Many deaths from breast and cervical cancers 25 VerDate Sep 11 2014 05:44 Apr 30, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1063.IS S1063 pbinns on DSKJLVW7X2PROD with BILLS 4 •S 1063 IS could be avoided if cancer screening rates and diag- 1 nostic care and services increased among women at 2 risk. Deaths from these cancers occur disproportion- 3 ately among women who are uninsured or under- 4 insured. 5 (7) Due to enhanced screening, cervical cancer, 6 which used to be the leading cause of cancer death 7 for women in the United States, is now a much more 8 preventable and treatable cancer. It is also highly 9 curable when found and treated early. 10 (8) Increased access to education, information, 11 including information on the human papillomavirus 12 vaccine, and preventive cancer screening increase 13 women’s ability to survive cancer. 14 (9) While more than 15 percent of cases of cer- 15 vical cancer are found in women over the age of 65, 16 it becomes less likely that women are tested for cer- 17 vical cancer ever or within the previous 5 years as 18 their age increases. 19 (10) Women’s health care providers that are 20 primarily engaged in family planning services, such 21 as Planned Parenthood health centers, provide nec- 22 essary screening tests, education, and information to 23 women, especially women of color who face the high- 24 VerDate Sep 11 2014 05:44 Apr 30, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1063.IS S1063 pbinns on DSKJLVW7X2PROD with BILLS 5 •S 1063 IS est risks of breast cancer and other gynecologic can- 1 cers. 2 (11) Access to preventive gynecological screen- 3 ing is also critical for transgender men who have 4 comparable rates of susceptibility to cervical cancer 5 as cisgender women, but often have less access to 6 preventive screenings. 7 (12) Discrimination and racism in health care 8 continues to contribute to disparate rates of gyneco- 9 logical cancer in non-White women. Black, Indige- 10 nous, and other Women of Color die at higher rates 11 from cervical cancer than White women, even though 12 fewer women overall die from cervical cancer. 13 (13) Black women with endometrial cancer 14 often receive surgery less often than White women 15 and are more likely to be diagnosed at an advanced 16 stage of the disease, contributing to disparities in 17 mortality in Black women. 18 SEC. 4. STRENGTHENING ACCESS TO CANCER SCREENING 19 FOR WOMEN. 20 (a) IN GENERAL.—Part B of title III of the Public 21 Health Service Act (42 U.S.C. 243 et seq.) is amended 22 by inserting after section 317P the following: 23 VerDate Sep 11 2014 05:44 Apr 30, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1063.IS S1063 pbinns on DSKJLVW7X2PROD with BILLS 6 •S 1063 IS ‘‘SEC. 317P–1. GRANTS FOR WOMEN’S HEALTH CARE PRO- 1 VIDERS. 2 ‘‘(a) IN GENERAL.—The Secretary is authorized to 3 make grants and to enter into contracts with public or 4 nonprofit private entities to expand preventive health serv- 5 ices, as provided for in the Preventive Services Guidelines 6 of the Health Resources and Service Administration that 7 were in effect on October 30, 2017, with an emphasis on 8 increasing access to critical, life-saving cancer screening, 9 Pap tests, human papillomavirus vaccination, and diag- 10 nostic tests for women with cancer symptoms, particularly 11 Women of Color. 12 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There 13 is authorized to be appropriated to carry out this section, 14 $20,000,000 for each of fiscal years 2022 through 2024.’’. 15 (b) FUNDING.—There is authorized to be appro- 16 priated to carry out programs related to breast and 17 gynecologic cancers under title XIX of the Social Security 18 Act (42 U.S.C. 1396 et seq.) and title X of the Public 19 Health Service Act (42 U.S.C. 300 et seq.), and the Na- 20 tional Breast and Cervical Cancer Early Detection Pro- 21 gram, such sums as may be necessary for each of fiscal 22 years 2020 through 2023. 23 SEC. 5. EXPAND CANCER SCREENING PROVIDER TRAINING. 24 Part B of title III of the Public Health Service Act 25 (42 U.S.C. 243 et seq.), as amended by section 4, is fur- 26 VerDate Sep 11 2014 05:44 Apr 30, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1063.IS S1063 pbinns on DSKJLVW7X2PROD with BILLS 7 •S 1063 IS ther amended by inserting after section 317P–1 the fol- 1 lowing: 2 ‘‘SEC. 317P–2. WOMEN’S HEALTH CARE PROVIDERS DEM- 3 ONSTRATION TRAINING PROJECT. 4 ‘‘(a) ESTABLISHMENT OF PROGRAM.—The Secretary 5 shall establish a demonstration program (referred to in 6 this section as the ‘program’) to award 3-year grants to 7 eligible entities for the training of physicians, nurse practi- 8 tioners, and other health care providers related to life-sav- 9 ing breast and gynecologic cancer screening for women. 10 ‘‘(b) PURPOSE.—The purpose of the program is to 11 enable each grant recipient to— 12 ‘‘(1) provide to licensed physicians, nurse prac- 13 titioners, and other health care providers, through 14 clinical training, education, and practice, the most 15 up-to-date clinical guidelines, research, and rec- 16 ommendations adopted by the United States Preven- 17 tive Services Task Force in the area of preventive 18 cancer screening for breast and gynecologic cancers; 19 ‘‘(2) establish a model of training for physi- 20 cians, nurse practitioners, and other health care pro- 21 viders that specializes in women’s health care, with 22 a specific focus on breast and gynecologic cancer 23 screening, that may be replicated nationwide; 24 VerDate Sep 11 2014 05:44 Apr 30, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1063.IS S1063 pbinns on DSKJLVW7X2PROD with BILLS 8 •S 1063 IS ‘‘(3) train physicians, nurse practitioners, and 1 other health care providers to serve rural and under- 2 served communities, low-income communities, and 3 communities of color in breast and gynecologic can- 4 cer screening; and 5 ‘‘(4) provide implicit bias, cultural competency, 6 and patient-centered communication training cov- 7 ering the ways in which structural racism and dis- 8 crimination manifest within the medical field and 9 perpetuate racial disparities in gynecologic cancer in- 10 cidence and death rates and how to communicate 11 with patients through a knowledgeable and culturally 12 empathetic lens. 13 ‘‘(c) ELIGIBLE ENTITIES.—To be eligible to receive 14 a grant under this section, an entity shall be— 15 ‘‘(1) an entity that receives funding under sec- 16 tion 1001; 17 ‘‘(2) an essential community provider, as de- 18 fined in section 156.235 of title 45, Code of Federal 19 Regulations (or any successor regulations), that is 20 primarily engaged in family planning; 21 ‘‘(3) an entity that furnishes items or services 22 to individuals who are eligible for medical assistance 23 under title XIX of the Social Security Act; or 24 VerDate Sep 11 2014 05:44 Apr 30, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S1063.IS S1063 pbinns on DSKJLVW7X2PROD with BILLS 9 •S 1063 IS ‘‘(4) an entity that, at the time of application, 1 provides cancer screening services under the Na- 2 tional Breast and Cervical Cancer Early Detection 3 Program of the Centers for Disease Control and 4 Prevention.’’. 5 SEC. 6. STUDY AND REPORT TO CONGRESS ON INCREASED 6 CANCER SCREENING FOR WOMEN. 7 (a) IN GENERAL.—The Secretary of Health and 8 Human Services (referred to in this section as the ‘‘Sec- 9 retary’’) shall conduct a study (and periodically update 10 such study) on increased access to women’s preventive life- 11 saving cancer screening across the United States, and, not 12 later than January 1, 2025, and every 5 years thereafter, 13 the Secretary shall submit a report to Congress on such 14 study. 15 (b) CONTENTS.—The study and reports under sub- 16 section (a) shall include— 17 (1) a 50-State analysis of breast and 18 gynecologic cancer rates among women, including by 19 geographic area, income, employment status, race, 20 ethnicity, and status of insurance coverage; 21 (2) a 50-State analysis of cancer screening pro- 22 vided by women’s health care providers, including 23 clinical breast exams, other screening for breast can- 24 VerDate Sep 11 2014 05:44 Apr 30, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S1063.IS S1063 pbinns on DSKJLVW7X2PROD with BILLS 10 •S 1063 IS cer, and screening for cervical cancer, ovarian can- 1 cer, and other gynecologic cancers; 2 (3) an analysis of the awareness and availability 3 of breast, cervical, ovarian, and other gynecological 4 cancer screening options for women with dispropor- 5 tionate rates of gynecological cancers, including Afri- 6 can-American women, Hispanic and Latina women, 7 women living in rural and underserved areas, and 8 other disproportionately impacted groups, according 9 to the 50-State analyses described in paragraphs (1) 10 and (2); 11 (4) an analysis of how structural racism im- 12 pacts access to cancer screening services, its correla- 13 tion to the development of breast, cervical, ovarian, 14 and other gynecological cancers, and how it exacer- 15 bates health care disparities for African-American, 16 Hispanic and Latina women, and other Women of 17 Color; 18 (5) in consultation with the Comptroller Gen- 19 eral of the United States, estimated Federal savings 20 achieved through early detection of breast and 21 gynecologic cancer; 22 (6) an analysis of how access to health care 23 providers trained under the program described in 24 section 317P–2 of the Public Health Service Act, as 25 VerDate Sep 11 2014 05:44 Apr 30, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S1063.IS S1063 pbinns on DSKJLVW7X2PROD with BILLS 11 •S 1063 IS added by section 5, in comparison to other health 1 care providers, increased early detection of cancer 2 and quality of cancer care for women who are less 3 likely to receive care, including African-American 4 women, Hispanic and Latina women, older women, 5 uninsured and underinsured women, and women liv- 6 ing in rural and underserved areas; 7 (7) recommendations by the Secretary with re- 8 spect to the need for continued increased access to 9 women’s health care providers, such as the entities 10 described in section 317P–2(c) of the Public Health 11 Service Act, as added by section 4, who provide pre- 12 ventive care, including life-saving cancer screening; 13 and 14 (8) recommendations for increasing screening 15 rates for women who are less likely to be screened 16 or treated for breast, cervical, ovarian, and other 17 gynecological cancers, including African-American 18 women, Hispanic and Latina women, older women, 19 uninsured and underinsured women, and women liv- 20 ing in rural and underserved areas. 21 VerDate Sep 11 2014 05:44 Apr 30, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S1063.IS S1063 pbinns on DSKJLVW7X2PROD with BILLS 12 •S 1063 IS SEC. 7. DEMONSTRATION PROJECT ON CO-TESTING FOR 1 HUMAN PAPILLOMAVIRUS AND CERVICAL 2 CANCER. 3 Part B of title III of the Public Health Service Act 4 (42 U.S.C. 243 et seq.), as amende [Text truncated for display. Full text available on Congress.gov.]