Women’s Health and Cancer Rights Modernization Act of 2025
Summary
The Women’s Health and Cancer Rights Modernization Act of 2025 (H.R. 5813) aims to amend existing laws to require group health plans and health insurance issuers to provide comprehensive coverage for breast or chest wall reconstruction related to breast cancer treatment. This includes all modalities and types of reconstruction, surgery for symmetry, prostheses, and treatment of complications. The bill amends the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to enforce these coverage requirements.
Expected Effects
If enacted, the bill would expand insurance coverage for breast cancer patients undergoing breast or chest wall reconstruction. It ensures access to various reconstruction options and related treatments. It also mandates in-network provider availability and requires notices to enrollees regarding coverage.
Potential Benefits
- Ensured coverage for all stages of breast or chest wall reconstruction, including flat closure.
- Coverage for surgery and reconstruction to achieve symmetry.
- Coverage for custom fabricated breast prostheses and their replacements.
- Coverage for treatment of physical complications from mastectomy, surgery, radiation, and lymph node surgery, including lymphedema.
- Requires at least one in-network provider for each reconstruction modality and type.
Potential Disadvantages
- Potential increase in health insurance premiums due to expanded coverage requirements.
- Possible administrative burdens for health plans and insurers to comply with the new regulations.
- The bill does not address the underlying costs of healthcare, potentially leading to higher overall healthcare expenditures.
- The preemption clause may limit state-level innovations in healthcare coverage.
- The bill's effectiveness depends on the enforcement and oversight by the Secretary.
Most Disadvantaged Areas:
Constitutional Alignment
The bill appears to align with the general welfare clause of the US Constitution, as it aims to improve healthcare access for individuals undergoing breast cancer treatment. Specifically, it promotes the general welfare by ensuring comprehensive coverage for breast reconstruction and related services. The bill does not appear to infringe upon any specific constitutional rights or limitations.
Impact Assessment: Things You Care About ⓘ
This action has been evaluated across 19 key areas that matter to you. Scores range from 1 (highly disadvantageous) to 5 (highly beneficial).