ANNAPOLIS – Maryland legislators are considering a bill to provide poor, uninsured women undergoing mastectomies with coverage for breast reconstructive surgery.
Under the bill, sponsored by Delegate Joan Pitkin, D-Prince George’s, and Delegate James Malone, D-Baltimore County, women in the state Breast Cancer Program would have access to reconstructive surgery. The program already provides free screening, diagnosis and treatment of breast cancer to eligible women.
“If you are dealing with a patient who has participated in this program, you must stop at some point and address the issue of how the patient, whose screening, diagnosis, and treatment services have been provided for free up to this point, intends to pay for her reconstruction if she desires it,” Pitkin said.
The exemption of breast reconstruction coverage causes women not to choose the best treatment option, said Marsha Bienia, director of the cancer program for the Department of Health and Mental Hygiene. For example, a woman may opt to have a lumpectomy over a mastectomy because she doesn’t have insurance to cover reconstruction.
“It is unethical to be able to diagnose a breast cancer, have a mastectomy and not provide for the mastectomy,” said Dr. George Grace, a plastic and reconstructive surgeon at St. Agnes Comprehensive Breast Center in Baltimore. “It’s unfair to the patient.”
In 1996, the General Assembly passed a bill, which mandated insurers, non- profit health plans, and HMOs include reconstructive surgery after a mastectomy as an important part of breast cancer treatment. Two years later, the Legislature passed a bill providing $2.6 million for screening, diagnosis and treatment of breast cancer to women with little or no health insurance beginning at age 40. However, there was no mention of breast reconstruction.
Bienia said the issue was one of limited funding.
“We thought that it was better to treat more women than to provide breast reconstruction,” she said.
The bill brings Maryland law in line with federal law. The 1998 Federal Breast Reconstruction Law provides for the same level of benefits under public programs that the federal and state laws mandate to breast cancer patients who have private insurance.
With a fiscal note of $350,000, the bill would cover reconstruction using an implant and tissue flap reconstruction, in which muscle and skin from the back or abdomen is used to form the breast. The cost ranges from $2,500 to $6,200 per implant.
Every year, 3,500 Maryland women are diagnosed with breast cancer and more than 800 die from the disease. Maryland has the 10th highest breast cancer death rate in the nation.
Under Maryland’s program, 180 women get mastectomies each year. Bienia estimates half of these would qualify for the breast reconstruction coverage.
Although Pitkin is not a breast cancer survivor, she has been a champion of breast cancer issues since the 1980s, when she pushed for the state to provide educational brochures. She was involved in the state mastectomy insurance bill and the state funding legislation.
“If you’re going to treat it,” she said, “you’re also going to reconstruct it.”