The current administration’s proposed repeal and replacement of the
Affordable Care Act is on the minds of a lot of women in Orange County.
Politics aside, every day in my office patients ask me questions about
what the future holds for women with breast cancer and those who are undergoing
screenings for early detection.
I can understand their worry, which unfortunately is piled upon their anxieties
about their battle with breast cancer.
While many in my profession have debated the merits of the ACA and its
changes to how we as physicians and surgeons practice medicine, most doctors
do believe the law improved health care for women, particularly in providing
incentives for preventive screenings. The law made it affordable for Orange
County women (and men) to get preventive tests, such as mammography or
On Monday, the administration released its proposed new health bill that
would replace President Obama’s Affordable Care Act. At this point,
few details have been released so it’s hard to know if the ACA’s
preventive-health related items will remain intact or be repealed. I am
hoping that many of the positive provisions in the ACA remain intact,
particularly as we have seen good outcomes for women’s health, such as:
- A rise in mammography screenings. A study from University Hospitals Cleveland
Medical Center found that at least for mammography, eliminating out-of-pocket
expenses has greatly increased the population of people who are getting screened.
- Two years following the introduction of the ACA, the mammography rate increased
among Medicare beneficiaries across all economic classes, according to
the study, which was published in the American Cancer Society’s
- While the study showed that mammography rates increased across the board,
the most important aspect of the study showed that low-income women got
screenings too, improving access for a hard-to-reach and engage population.
Right now, under the ACA, mammography is lumped into preventive care and
not subject to co-pays. These routine tests don’t prevent breast
cancer but can help detect it sooner when it’s more treatable. I
believe that some women will skip their mammogram if they have to pay
out of pocket, particularly those living in underserved communities of
The ACA also provides support for breast feeding and working mothers. Some
provisions allow for breast pumps and professional lactation services.
Studies have shown that breastfeeding lowers moms’ lifetime risks
of breast cancer.
More worrisome to many breast cancer patients was the potential repeal
of ACA regulation that covered pre-existing conditions. Before the ACA,
you could be denied health care coverage because you had a pre-existing
condition like breast cancer. I am pleased to see that in the proposed
new replacement bill announced Monday this provision remains intact. Quite
simply, it saves lives.
I anticipate reviewing this administration’s replacement bill for
the fine details. I hope that preventive care — given its value
in the health care system and its importance for women in particular —
remains a top priority for all of our legislators regardless of party
affiliation. In the battle against breast cancer, which will claim about
40,000 daughters, moms and grandmothers this year in the United States,
there should be no party lines. We have the most advanced technology and
tools to find it early; let’s not leave them unused.
Michele Carpenter, MD, is an Orange County breast cancer surgeon and is
current chief of staff of St. Joseph Hospital, Orange.