Jeanette Acosta Invest in Women’s Health Act of 2021

I 117TH CONGRESS 1ST SESSION H. R. 2216 To provide women with increased access to preventive and life-saving cancer screening. IN THE HOUSE OF REPRESENTATIVES MARCH 26, 2021 Mr. GOMEZ (for himself, Ms. BARRAGA´N, Mr. BLUMENAUER, Ms. BROWNLEY, Ms. CLARKE of New York, Mr. COHEN, Mr. DANNY K. DAVIS of Illinois, Mrs. FLETCHER, Mr. GRIJALVA, Mr. HASTINGS, Mrs. HAYES, Mr. HIG- GINS of New York, Ms. NORTON, Ms. JACKSON LEE, Mr. JOHNSON of Georgia, Mr. LAWSON of Florida, Mrs. CAROLYN B. MALONEY of New York, Ms. MCCOLLUM, Mr. NADLER, Ms. PRESSLEY, Miss RICE of New York, Ms. SCANLON, Mr. SOTO, Ms. VELA´ZQUEZ, Mrs. WATSON COLE- MAN, Mr. WELCH, Ms. SA´NCHEZ, and Ms. WASSERMAN SCHULTZ) intro- duced the following bill; which was referred to the Committee on Energy and Commerce 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 VerDate Sep 11 2014 04:37 May 25, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H2216.IH H2216 kjohnson on DSK79L0C42PROD with BILLS 2 •HR 2216 IH SEC. 2. PURPOSE. 1 It is the purpose of this Act to provide women with 2 increased access to preventive and life-saving cancer 3 screening, including clinical breast exams and cervical, 4 ovarian, uterine, vaginal, and vulvar cancer screening, pro- 5 vided by leading women’s health care providers who— 6 (1) serve populations most at risk; and 7 (2) play an outsized role in the prevention and 8 detection of cancer in order to serve the goal of in- 9 creasing access to quality health screenings, care, 10 and services, reducing health care disparities and 11 mortality rates among low-income women and 12 women of color, decreasing health care spending, 13 and expanding health literacy, access, and education 14 about the benefits of regular preventive cancer 15 screening for women. 16 SEC. 3. FINDINGS. 17 Congress finds as follows: 18 (1) Breast cancer is the leading cause of cancer 19 death in women under the age of 54, and the Amer- 20 ican Cancer Society recommends that women in 21 their 20s and 30s have a clinical breast exam at 22 least every 3 years. 23 (2) Ovarian cancer causes more deaths than 24 any other cancer of the female reproductive system, 25 VerDate Sep 11 2014 04:37 May 25, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H2216.IH H2216 kjohnson on DSK79L0C42PROD with BILLS 3 •HR 2216 IH but it accounts for only about 3 percent of all can- 1 cers in women. 2 (3) The cancers that most frequently impact 3 women include breast, uterine, ovarian, and cervical 4 cancer, and there were 341,171 new cases of these 5 cancers in 2017. 6 (4) Rates of incidence and death for gynecologic 7 cancers by race and ethnicity show that, while for 8 some cancers, like ovarian cancer, the rates of inci- 9 dence and death are similar among all races, for 10 other cancers, like cervical cancer, women of color 11 have disproportionate incidence and mortality rates. 12 While the incidence of uterine cancer is similar for 13 White women and Women of Color, rates of death 14 for uterine cancer are 2 times higher for Black 15 women than for White women. 16 (5) Cervical cancer incidence and mortality 17 rates are higher for women living in rural and un- 18 derserved regions in the United States. Women liv- 19 ing in these areas face unique barriers in accessing 20 reproductive health care services to prevent and 21 treat cervical cancer, including a lack of practicing 22 gynecologists in rural areas and challenges around 23 transportation to preventive and follow-up appoint- 24 ments. 25 VerDate Sep 11 2014 04:37 May 25, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H2216.IH H2216 kjohnson on DSK79L0C42PROD with BILLS 4 •HR 2216 IH (6) Prevention and cancer screening are the 1 best approaches to protecting women from cancer 2 and ensuring early detection and life-saving treat- 3 ment. Many deaths from breast and cervical cancers 4 could be avoided if cancer screening rates and diag- 5 nostic care and services increased among women at 6 risk. Deaths from these cancers occur disproportion- 7 ately among women who are uninsured or under- 8 insured. 9 (7) Due to enhanced screening, cervical cancer, 10 which used to be the leading cause of cancer death 11 for women in the United States, is now a much more 12 preventable and treatable cancer. It is also highly 13 curable when found and treated early. 14 (8) Increased access to education, information, 15 including information on the human papillomavirus 16 vaccine, and preventive cancer screening increase 17 women’s ability to survive cancer. 18 (9) While more than 15 percent of cases of cer- 19 vical cancer are found in women over the age of 65, 20 it becomes less likely that women are tested for cer- 21 vical cancer ever or within the previous 5 years as 22 their age increases. 23 (10) Women’s health care providers that are 24 primarily engaged in family planning services, such 25 VerDate Sep 11 2014 04:37 May 25, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H2216.IH H2216 kjohnson on DSK79L0C42PROD with BILLS 5 •HR 2216 IH as Planned Parenthood health centers, provide nec- 1 essary screening tests, education, and information to 2 women, especially women of color who face the high- 3 est risks of breast cancer and other gynecologic can- 4 cers. 5 (11) Access to preventive gynecological screen- 6 ing is also critical for transgender men who have 7 comparable rates of susceptibility to cervical cancer 8 as cisgender women, but often have less access to 9 preventive screenings. 10 (12) Discrimination and racism in health care 11 continues to contribute to disparate rates of gyneco- 12 logical cancer in non-White women. Black, Indige- 13 nous, and other Women of Color die at higher rates 14 from cervical cancer than White women, even though 15 fewer women overall die from cervical cancer. 16 (13) Black women with endometrial cancer 17 often receive surgery less often than White women 18 and are more likely to be diagnosed at an advanced 19 stage of the disease, contributing to disparities in 20 mortality in Black women. 21 VerDate Sep 11 2014 04:37 May 25, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H2216.IH H2216 kjohnson on DSK79L0C42PROD with BILLS 6 •HR 2216 IH SEC. 4. STRENGTHENING ACCESS TO CANCER SCREENING 1 FOR WOMEN. 2 (a) IN GENERAL.—Part B of title III of the Public 3 Health Service Act (42 U.S.C. 243 et seq.) is amended 4 by inserting after section 317P the following: 5 ‘‘SEC. 317P–1. GRANTS FOR WOMEN’S HEALTH CARE PRO- 6 VIDERS. 7 ‘‘(a) IN GENERAL.—The Secretary is authorized to 8 make grants and to enter into contracts with public or 9 nonprofit private entities to expand preventive health serv- 10 ices, as provided for in the Preventive Services Guidelines 11 of the Health Resources and Service Administration that 12 were in effect on October 30, 2017, with an emphasis on 13 increasing access to critical, life-saving cancer screening, 14 Pap tests, human papillomavirus vaccination, and diag- 15 nostic tests for women with cancer symptoms, particularly 16 Women of Color. 17 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There 18 is authorized to be appropriated to carry out this section, 19 $20,000,000 for each of fiscal years 2022 through 2024.’’. 20 (b) FUNDING.—There is authorized to be appro- 21 priated to carry out programs related to breast and 22 gynecologic cancers under title XIX of the Social Security 23 Act (42 U.S.C. 1396 et seq.) and title X of the Public 24 Health Service Act (42 U.S.C. 300 et seq.), and the Na- 25 tional Breast and Cervical Cancer Early Detection Pro- 26 VerDate Sep 11 2014 04:37 May 25, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H2216.IH H2216 kjohnson on DSK79L0C42PROD with BILLS 7 •HR 2216 IH gram, such sums as may be necessary for each of fiscal 1 years 2020 through 2023. 2 SEC. 5. EXPAND CANCER SCREENING PROVIDER TRAINING. 3 Part B of title III of the Public Health Service Act 4 (42 U.S.C. 243 et seq.), as amended by section 4, is fur- 5 ther amended by inserting after section 317P–1 the fol- 6 lowing: 7 ‘‘SEC. 317P–2. WOMEN’S HEALTH CARE PROVIDERS DEM- 8 ONSTRATION TRAINING PROJECT. 9 ‘‘(a) ESTABLISHMENT OF PROGRAM.—The Secretary 10 shall establish a demonstration program (referred to in 11 this section as the ‘program’) to award 3-year grants to 12 eligible entities for the training of physicians, nurse practi- 13 tioners, and other health care providers related to life-sav- 14 ing breast and gynecologic cancer screening for women. 15 ‘‘(b) PURPOSE.—The purpose of the program is to 16 enable each grant recipient to— 17 ‘‘(1) provide to licensed physicians, nurse prac- 18 titioners, and other health care providers, through 19 clinical training, education, and practice, the most 20 up-to-date clinical guidelines, research, and rec- 21 ommendations adopted by the United States Preven- 22 tive Services Task Force in the area of preventive 23 cancer screening for breast and gynecologic cancers; 24 VerDate Sep 11 2014 04:37 May 25, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H2216.IH H2216 kjohnson on DSK79L0C42PROD with BILLS 8 •HR 2216 IH ‘‘(2) establish a model of training for physi- 1 cians, nurse practitioners, and other health care pro- 2 viders that specializes in women’s health care, with 3 a specific focus on breast and gynecologic cancer 4 screening, that may be replicated nationwide; 5 ‘‘(3) train physicians, nurse practitioners, and 6 other health care providers to serve rural and under- 7 served communities, low-income communities, and 8 communities of color in breast and gynecologic can- 9 cer screening; and 10 ‘‘(4) provide implicit bias, cultural competency, 11 and patient-centered communication training cov- 12 ering the ways in which structural racism and dis- 13 crimination manifest within the medical field and 14 perpetuate racial disparities in gynecologic cancer in- 15 cidence and death rates and how to communicate 16 with patients through a knowledgeable and culturally 17 empathetic lens. 18 ‘‘(c) ELIGIBLE ENTITIES.—To be eligible to receive 19 a grant under this section, an entity shall be— 20 ‘‘(1) an entity that receives funding under sec- 21 tion 1001; 22 ‘‘(2) an essential community provider, as de- 23 fined in section 156.235 of title 45, Code of Federal 24 VerDate Sep 11 2014 04:37 May 25, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H2216.IH H2216 kjohnson on DSK79L0C42PROD with BILLS 9 •HR 2216 IH Regulations (or any successor regulations), that is 1 primarily engaged in family planning; 2 ‘‘(3) an entity that furnishes items or services 3 to individuals who are eligible for medical assistance 4 under title XIX of the Social Security Act; or 5 ‘‘(4) an entity that, at the time of application, 6 provides cancer screening services under the Na- 7 tional Breast and Cervical Cancer Early Detection 8 Program of the Centers for Disease Control and 9 Prevention.’’. 10 SEC. 6. STUDY AND REPORT TO CONGRESS ON INCREASED 11 CANCER SCREENING FOR WOMEN. 12 (a) IN GENERAL.—The Secretary of Health and 13 Human Services (referred to in this section as the ‘‘Sec- 14 retary’’) shall conduct a study (and periodically update 15 such study) on increased access to women’s preventive life- 16 saving cancer screening across the United States, and, not 17 later than January 1, 2025, and every 5 years thereafter, 18 the Secretary shall submit a report to Congress on such 19 study. 20 (b) CONTENTS.—The study and reports under sub- 21 section (a) shall include— 22 (1) a 50-State analysis of breast and 23 gynecologic cancer rates among women, including by 24 VerDate Sep 11 2014 04:37 May 25, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H2216.IH H2216 kjohnson on DSK79L0C42PROD with BILLS 10 •HR 2216 IH geographic area, income, employment status, race, 1 ethnicity, and status of insurance coverage; 2 (2) a 50-State analysis of cancer screening pro- 3 vided by women’s health care providers, including 4 clinical breast exams, other screening for breast can- 5 cer, and screening for cervical cancer, ovarian can- 6 cer, and other gynecologic cancers; 7 (3) an analysis of the awareness and availability 8 of breast, cervical, ovarian, and other gynecological 9 cancer screening options for women with dispropor- 10 tionate rates of gynecological cancers, including Afri- 11 can-American women, Hispanic and Latina women, 12 women living in rural and underserved areas, and 13 other disproportionately impacted groups, according 14 to the 50-State analyses described in paragraphs (1) 15 and (2); 16 (4) an analysis of how structural racism im- 17 pacts access to cancer screening services, its correla- 18 tion to the development of breast, cervical, ovarian, 19 and other gynecological cancers, and how it exacer- 20 bates health care disparities for African-American, 21 Hispanic and Latina women, and other Women of 22 Color; 23 (5) in consultation with the Comptroller Gen- 24 eral of the United States, estimated Federal savings 25 VerDate Sep 11 2014 04:37 May 25, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H2216.IH H2216 kjohnson on DSK79L0C42PROD with BILLS 11 •HR 2216 IH achieved through early detection of breast and 1 gynecologic cancer; 2 (6) an analysis of how access to health care 3 providers trained under the program described in 4 section 317P–2 of the Public Health Service Act, as 5 added by section 5, in comparison to other health 6 care providers, increased early detection of cancer 7 and quality of cancer care for women who are less 8 likely to receive care, including African-American 9 women, Hispanic and Latina women, older women, 10 uninsured and underinsured women, and women liv- 11 ing in rural and underserved areas; 12 (7) recommendations by the Secretary with re- 13 spect to the need for continued increased access to 14 women’s health care providers, such as the entities 15 described in section 317P–2(c) of the Public Health 16 Service Act, as added by section 4, who provide pre- 17 ventive care, including life-saving cancer screening; 18 and 19 (8) recommendations for increasing screening 20 rates for women who are less likely to be screened 21 or treated for breast, cervical, ovarian, and other 22 gynecological cancers, including African-American 23 women, Hispanic and Latina women, older women, 24 VerDate Sep 11 2014 04:37 May 25, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H2216.IH H2216 kj [Text truncated for display. 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