What the Affordable Care Act provides for breast cancer
Women won’t pay higher health bills simply for being women, and they will be able to get the medical care they need, particularly for breast cancer, under the Patient Protection and Affordable Care Act (ACA), a leading women’s advocate says.
“The Affordable Care Act will help us realize the promise of access for all,” said Eleanor Hinton Hoytt, president and CEO of the Black Women’s Health Imperative in Washington, D.C., which was founded 30 years ago as the National Black Women’s Health Project.
Open enrollment began this week under the ACA. Uninsured and underinsured Americans will gain greater access to a medical home with preventive care that can reduce the risk of a host of conditions including breast cancer, the second leading cause of death among women.
“We know that prevention works, and mammogram screening is an essential health-care benefit,” said Hoytt, adding that Congressional efforts to stall or kill the ACA as part of a federal shutdown are “unconscionable.”
Black women are number two behind white women for developing breast cancer, but the gap is narrowing, according to a new study released this week for National Breast Cancer Awareness Month. They are the only group of women to show increases in breast cancer — up 0.2 percent each year between 2006 and 2010 — and they also have the highest death rate. The American Cancer Society published the study, “Breast Cancer Statistics, 2013,” in CA: A Cancer Journal for Clinicians and in a consumer version.
Under the new healthcare law, women who are 40 and older are entitled to coverage for mammograms. Those who have a family history of breast cancer or ovarian cancer can also receive free counseling and testing for mutations in the BRCA1 and BRCA2 genes. Women with mutations are five times more likely to develop breast cancer — a fact highlighted by actress Angelina Jolie’s double mastectomy earlier this year.
Women facing genetic tests ranging up to $4,000 and other costs associated with breast cancer won’t have to worry about annual or lifetime spending limits, beginning in 2014.
“You can now be insured with pre-existing conditions,” Hoytt notes. “You do not have to be afraid of being dropped from your insurance.”
John R. Seffrin, Ph.D., chief executive officer of the American Cancer Society, said in a statement that “people with cancer and their families have the security of knowing that soon they will no longer have to worry about whether they can get the care they need.”
However, Hoytt encourages African-Americans to push for more.
“We have not invested enough into researching, not just the high mortality rate, but also the lack of attention to the risk factors for black women and breast cancer,” she explained.
“We know that breast density is a major risk factor for black women, but that has not been embraced by the broader community,” she said. “Mammograms don’t readily identify small tumors in dense breasts.”
Hoytt would like to see greater access to advanced technology, such as three-dimensional mammography.
A key and controversial component of the health plan is the “individual mandate,” requiring citizens who can afford insurance to maintain basic coverage or pay a penalty. People could keep or obtain insurance through their employers or go through state exchanges being set up to provide subsidized coverage.
The mandate is also intended to reduce overall health-care costs to taxpayers across the board. It provides an incentive for insurance companies to cover the sickest and poorest patients by gaining a wider pool of healthy people to offset the cost of chronic illness. In addition, the ACA offers tax credits to help small businesses provide health insurance for their employees.
A major problem for African-Americans and poor residents will be a gap in coverage, because at least two dozen states have opted out of the expansion of Medicaid to uninsured adults under 65.
Census figures indicate that 50 million people are uninsured in the United States, an increase of 5 million from 2007 to 2009, the height of the recession. “Seventeen percent of black women are uninsured,” Hoytt said. This includes employed women who work at low-paying jobs that don’t come with health benefits.
While the U.S. Supreme Court lifted penalties for states opting out of the Medicaid expansion as part of its 5-4 decision last year to uphold the health plan, some poor residents will pay the price of their states’ inaction despite federal support. The ACA calls for the federal government to cover 100 percent of the Medicaid expansion for the first three years, leveling off to 90 percent.
Although imperfect, the ACA is sorely needed by African-Americans, Hoytt acknowledged. “The tricky part of this is not to make it a panacea, but it is our one chance to go on that journey to health equity,” she said.
“What the ACA gives us is access to affordable care, but it does not ensure that we get quality care,” Hoytt pointed out. “That’s upon the black community to mobilize and organize to support the ACA to make the health-care system what we need it to be. This will allow us to truly be partners in our care.”
Yanick Rice Lamb is an associate professor of journalism and interim assistant chair of the Department of Media, Journalism and Film at Howard University. Follow her on Twitter at @yrlamb.