Breast Cancer, Healthcare, and Politics — Yes, I’m Going There

A social justice installation by the Center for Social Change (CSC) in Miami. Photo taken by Naomi Ross; published by the author.

Over the last few months, the general focus of this blog has been to address the many failures surrounding the pink-ribbon breast cancer awareness movement. To summarize, the cause-related marketing pink ribbon campaigns have become a money-generating machine that unbenownst to the general public, priorities profit over people. The pink ribbon also promotes a false sense of restoring optimism, femininity, and hope that many women diagnosed with breast cancer simply don’t have. And in the wake of the movement’s overzealous optimism, the breast cancer awareness movement seemingly underscores the reality that 40,000 women still die from this disease every year.

A few weeks ago I began to introduce effective strategies towards moving away from the pink ribbon movement. However, all that post proved was that there was a more fundamental problem at play. In order to move away from the pink ribbon, we have to be sure that we don’t fall into the trap of merely replacing the pink ribbon with another arbitrary symbol. The issue regarding the pink-ribbon movement stems much deeper than just the actual ribbon itself. At the end of the post, I hinted at proactive steps that need to be taken in order to restructure the breast cancer awareness movement away from the pink ribbon and instead, towards a direction that will ensure more practical, sustainable, and long-term progress in treating and curing the disease.

And those steps, my friends, are undoubtedly political. 

Now I know that not everyone wants to make breast cancer political. We live in unprecedented times where the country is becoming increasingly politicized. But to pretend that breast cancer isn’t political would be only kidding ourselves. And so rather than living in delusion, I want to get down to business and get real about breast cancer politics.

[Besides, this is what being a #breastcancerfeminist is all about!]

Now before I go any further, I do want to make one other thing crystal clear. The purpose of this blog is NEVER to outright endorse any politicians or politically-affiliated organizations. However, this blog will openly support public policy that protects women’s health and more specifically, breast cancer research, screenings, and treatment, while also encouraging readers like yourself to become civically engaged in defending causes related to women’s health. I can’t imagine that all of you will agree with me, but I will not silence my views in the name of playing it safe in the breast cancer space. It’s time to be bold. 

With that in mind, I want to talk to you all today about the Affordable Care Act (ACA), AKA Obamacare, and what that means for breast cancer patients. Now I’ll admit, health care policy has always kind of freaked me out because of how complicated it is. So to start us all off, I want to break down the basics about how the implementation of the ACA has affected breast cancer screenings nationwide.

Breast cancer screenings fall under the umbrella of services that are considered to be preventive care. Prior to the ACA, women had to pay largely out-of-pocket for mammogram services, approximately 20% in coinsurance. If you’re already lost saying, “Whoa whoa stop, what is coinsurance?” don’t worry because I’m unashamed in saying that I definitely needed to research what exactly that meant too. In short, when you’ve maxed out your deductible for a medical service, your coinsurance is a percentage that you pay out-of-pocket as a percentage of your outstanding bills. That being said, women had to pay their deductible as well as 20% of their outstanding bills. For women that live below or on the cusp of the poverty line, those payments serve as a barrier to preventive care.

Upon enactment of the ACA, those out-of-pocket expenses, including deductibles and coinsurance were waived, making mammograms much more accessible for women across all income levels. According to a recent study conducted by the medical journal Cancer this past January, among Medicare recipients over the age of 70, mammographs increased among women from all income levels. Although women from lower income levels still were screened disproportionately less, the socioeconomic gap among women receiving mammographs decreased. “Although the future of the ACA is now questioned, the findings do support, at least for mammography, that elimination of financial barriers is associated with improvement in cancer screening,” said lead author of the study Dr Gregory Cooper in an article for Medscape.

Although this study is limited in its ability to demonstrate definitively that the elimination of out-of-pocket expenses alone caused the increase in mammographs, as opposed to other factors like health differences among the patients or increased awareness of breast screenings, the study overall shows a positive sign for the affect that the ACA has had on mammographs.

To learn more about this study, follow these links to its coverage in CNN and Medscape, as well as the study’s summary by clicking here.

In addition to breast cancer screenings, the ACA has eliminated a majority of our-of-pocket expenses for genetic counseling for women that are shown to be at risk of carrying a breast cancer mutation, namely BRCA1 and BRCA2. As someone that was deemed at-risk for carrying a breast cancer related genetic mutation, prior to the protections offered by the ACA, the prices for genetic testing were astronomical and as a result I delayed testing. But when I underwent my genetic testing about two months ago (admittedly with a different health insurance provider) aside from my co-pay and other fees that totaled to around $100, my health insurance covered everything. According to lab that processed my genetic tests, if I had paid out-of-pocket, my fee would’ve been over $6,000! Yikes! The ACA and its provision to improve preventive coverage for women nationwide that like me, can’t afford those out-of-pocket expenses, is a huge help in eliminating financial barriers to healthcare.

Keeping all this in mind, when the announcement came from the White House and Capitol Hill about the American Health Care Act (AHCA), that served as the Republican alternative to the ACA, women’s health advocates and allies were deeply troubled. The provisions of the AHCA allowed it permissible to potentially reverse the ACA’s protected coverage of preventative care along with nine of the other “essential benefits” deemed by ACA (for more read this NPR article and this NBC news report).

Now some people, particularly men, will often argue that they should do away with the ACA because if they’re not going to use a service like breast health screenings then why should they have to cover on their health care premiums coverage for something they’ll never use? Ignoring for a second that men are in fact susceptible to being diagnosed with breast cancer, health insurance serves as essentially a buy-in pool, so the more people buying-in reduces the cost for everyone. I take the stance that healthcare ought to be treated as a right, not a privilege, and I see no issue with the ACA’s consideration of preventative care like breast cancer screenings as an essential right.

I also can’t ignore that as a blogger currently based in Miami, according to the Center for Medicare & Medicaid Services (CMS) during the allotted period of November – December 2016,  the Miami/Ft. Lauderdale region led the nation in ACA enrollment. According to Dan Chang from the Miami Herald, the majority of the 1.7 million Floridians that currently are enrolled under the ACA will no longer be able to afford their health coverage. I don’t even want to imagine the amount of women in South Florida that would avoid breast health screenings if the AHCA passed!

To conclude for today, I’d like to quote Plato, you know, a pretty famous dude, no big deal, as having written, “one of the penalties of refusing to participate in politics is that you end up being governed by your inferiors.” Look I’m not going to lie, when the AHCA was revoked from the House vote a few weeks back, I rejoiced. For now, the ACA has been saved. And that’s in large part due to everyday folks calling and writing to their elected officials demanding them to not support the AHCA. They participated in politics and as a result, the ACA won. But theres a real chance that Republican bloc will most likely try to vote out the ACA again. And as breast cancer feminists armed with knowledge, we must be ready to fight not in the name of breast cancer awareness, but in the name of affordable health coverage for all women. We must be ready to hold our elected officials accountable to our health concerns. We must hold town halls, marches and rallies in support of women’s health coverage. And when the time comes, we must be ready to go to the polls and elect leaders that will support our health concerns. We are more than pink ribbons, we are lives that must be protected and in some cases, saved. 

3 comments

    • No I only paid my co-pay, my insurance company is covering all the costs associated with the actual genetic testing, which totals to the $6K figure I cited in my post. If the insurance company has negotiated with the lab to
      reduce the overall invoice I’m not aware of at this time, but I can provide a follow-up if you’re curious. I hope that answers your question!

      Like

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