Women's Health and Cancer Rights Modernization Act: What It Means for Breast Cancer Survivors

A Fight That Doesn’t End at Treatment

For many women, completing their breast cancer treatment does not mark the end of the fight. Instead, it signals the beginning of a new struggle against the insurance system that is supposed to help them recover. Coverage often gets denied for the reconstructive techniques surgeons recommend, with modern micro-surgical or nerve-saving procedures often being classified as cosmetic or investigational [1]. Approximately 20% of patients experience denials for aesthetic flat closures [2], and procedures on the unaffected breast often get flagged as elective. The Women’s Health and Cancer Rights Modernization Act of 2025 is a direct response to these denials.

A 1998 Law in a 2025 Medical Landscape

The bill builds on the original Women’s Health and Cancer Rights Act of 1998, which was a turning point in the women’s healthcare landscape. Before it passed, there were no federal requirements for insurers to cover breast reconstruction after a mastectomy. The 1998 law changed this by requiring coverage for reconstruction, symmetry procedures on the other breast, prostheses, and treatment for complications, including lymphedema [3]. Written before microsurgical reconstruction, fat grafting, and the full range of modern techniques became standard practice, the law’s language never kept pace with the medicine it was meant to cover. Insurers have spent decades trying to exploit this gap by denying coverage for procedures not explicitly named in outdated policy language or using prior authorization requirements to delay and discourage care [4]. 

What the Modernization Act Covers 

The Modernization Act directly addresses the problem of insurance denials for modern treatment interventions. It expands mandatory coverage to include all recognized options (implant-based, tissue-based, microsurgical free flap procedure, fat grafting, and combined approaches) and ties that coverage to the Healthcare Common Procedure Coding System, the standardized coding framework used by clinicians [3]. This means any procedure that receives a recognized billing code is a covered procedure, including techniques developed after the law passes. It also explicitly required coverage for flat closure,  symmetry surgery on the unaffected breast, and custom prostheses [5]. The Women's Health and Cancer Rights Modernization Act of 2025 is designed to fix the coverage gaps the original law left behind and keep pace with advances in medicine as they develop.

H.R. 5813 was introduced in the House on October 24, 2025, by a bipartisan group of co-sponsors led by Representatives Kat Cammack (R-FL) and Debbie Dingell (D-MI), with support from the American Society of Plastic Surgeons, the Plastic Surgery Foundation, and Susan G. Komen, among others [6]. It has been referred to three House committees–Energy and Commerce, Ways and Means, and Education and Workforce–where it currently remains [7].

Coverage Beyond Paper

One of the bill’s most consequential provisions is one that gets the least attention: health plans must maintain at least one in-network provider for each covered modality [8]. Coverage that only exists in law or on paper is not real coverage. If a plan technically covers microsurgical reconstruction but has no in-network surgeons who perform it, a patient’s practical options are to pay out-of-network costs she cannot afford or settle for a different procedure. The in-network requirement is an attempt to ensure that a woman’s right to microsurgical reconstruction is always an insured option that does not exist only on paper.

Who Bears the Burden

Breast cancer is the most commonly diagnosed cancer among American women, and who gets adequate care depends heavily on race and income. In 2026, an estimated 321,910 women in the United States will be diagnosed with invasive breast cancer, with an additional 60,730 diagnosed with non-invasive ductal carcinoma in situ¹ [9]. There are already more than 4 million breast cancer survivors [9,10]. Not every woman with breast cancer requires a mastectomy, but many do and access to reconstruction is not equal. A 2025 meta-analysis found that women from racial minority groups were roughly 38% less likely to receive immediate breast reconstruction after mastectomy compared to white women [11]. Black women are more likely to die from breast cancer than women of any other racial or ethnic group, with a mortality rate 38% higher than white women despite a lower incidence rate [9]. These disparities reflect unequal access to specialists, insurance gaps, prior authorization burdens, and the compounding effects of systemic inequities in healthcare–the same forces the bill is trying to address.

What the Bill Leaves Out

The bill’s protections, however, do not extend to everyone who needs them. Women undergoing risk-reducing mastectomy, those with BRCA mutations or elevated genetic risk who chose surgery before a cancer diagnosis, are not explicitly protected. The bill covers reconstruction only “in connection with breast cancer treatment,” which may leave preventive cases in a coverage gray area [7]. Nerve repair to meaningfully restore sensation after mastectomy is also not included and 3D nipple-areola tattoos, a finishing component of reconstruction, remains inconsistently covered [11]. The bill also does not limit prior authorization requirements, which means insurers retain one of their primary tools for delaying and denying care, even for procedures the bill explicitly covers. And while the in-network access requirement is a step forward, one in-network provider across a wide geographic area is often not enough to constitute meaningful access for patients without the means or flexibility to travel. 

The Psychological Gap

Mental health is another component that this bill does not address. Between 30 and 50 percent of breast cancer survivors experience symptoms of depression or anxiety, with elevated risks persisting for at least ten years after diagnosis [12]. Body image disturbance after mastectomy is even more common, with one study reporting the experience having occurred in more than 90% of survivors [13]. These are predictable, documented outcomes of mastectomy, yet the psychological dimension of recovery remains entirely outside the law’s reach. 

 Progress, and What Remains

Taken together, these gaps matter most for the women already facing the steepest barriers. The same populations bearing the highest burden of breast cancer mortality, low-income women, women in rural areas, and women of color, and the same groups that are disproportionately affected by coverage denials, thin provider networks, and the absence of wraparound support[14]. The Modernization Act does not solve all of this. However, it does establish, for the first time in 27 years, that the law governing breast cancer care should reflect the medicine actually being practiced. 

References

1. American Society of Plastic Surgeons. State advocacy. 2025. Available from: https://www.plasticsurgery.org/for-medical-professionals/health-policy/modernizing-breast-reconstruction-coverage/state-advocacy

2. Bhaskara M, Hulsman L, Ahmed S, Sidhu AS, Fathauer C, Rinne E, et al. Evaluation of aesthetic flat closure: a scoping review. JPRAS Open. 2025;46:69–82. https://doi.org/10.1016/j.jpra.2025.08.024

3. McLoughlin J, Wilson J, Brown M. New legislation advances breast cancer care into modern age. ACS; 2026. Available from: https://www.facs.org/for-medical-professionals/news-publications/news-and-articles/bulletin/2026/april-2026-volume-111-issue-4/new-legislation-advances-breast-cancer-care-into-modern-age/

4.  American Society of Plastic Surgeons. Health legislation update brings breast cancer care into the modern age. 2025. Available from: https://www.plasticsurgery.org/news/press-releases/health-legislation-update-brings-breast-cancer-care-into-the-modern-age

5. Centers for Medicare and Medicaid Services. Women's Health and Cancer Rights Act (WHCRA). 2013. Available from: https://www.cms.gov/CCIIO/Programs-and-Initiatives/Other-Insurance-Protections/whcra_factsheet

6. Representative Kat Cammack. Cammack, Dingell unveil bipartisan bill to advance women's healthcare coverage and care for breast cancer survivors. 2025. Available from: https://cammack.house.gov/media/press-releases/cammack-dingell-unveil-bipartisan-bill-advance-womens-healthcare-coverage-care

7. Cammack R. Actions - H.R.5813 - 119th Congress (2025-2026): Women's Health and Cancer Rights Modernization Act of 2025. Congress.gov; 2025. Available from: https://www.congress.gov/bill/119th-congress/house-bill/5813/all-actions

8. Department of Financial Services. Health care provider rights and responsibilities. n.d. Available from:  https://www.dfs.ny.gov/consumers/health_insurance/rights_responsibilities

9. Breastcancer.org. Breast cancer facts and statistics. 2022. Available from: https://www.breastcancer.org/facts-statistics

10. Shockney L. Breast cancer facts and statistics. National Breast Cancer Foundation; 2023. Available from: https://www.nationalbreastcancer.org/breast-cancer-facts/

11. Shurjeel Uddin Qazi A, Muhammad Hassaan Wajid Q, Muhammad Bilal Shahid T, Javed S, Saeed M, Eesha Razia N, et al. Racial disparities in immediate breast reconstruction after mastectomy: a systematic review and meta-analysis. Plastic Surgery. 2024. https://doi.org/10.1177/22925503241255142

12. Burgess C, Cornelius V, Love S, Graham J, Richards M, Ramirez A. Depression and anxiety in women with early breast cancer: five year observational cohort study. BMJ. 2005;330(7493):702. https://doi.org/10.1136/bmj.38343.670868.d3

13. Thakur M, Sharma R, Mishra AK, Singh K, Kar SK. Psychological distress and body image disturbances after modified radical mastectomy among breast cancer survivors: a cross-sectional study from a tertiary care centre in North India. Lancet Reg Health Southeast Asia. 2022;7(100077). https://doi.org/10.1016/j.lansea.2022.100077

14. Malhotra P. Understanding breast cancer racial disparities. Breast Cancer Research Foundation; 2025. Available from: https://www.bcrf.org/about-breast-cancer/breast-cancer-racial-disparities/

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¹In situ (Latin for 'in its original place'): a stage of cancer in which abnormal cells remain confined to their original location and have not invaded nearby tissue or spread elsewhere.