There have been some rumblings in the BRCA+ community that the Affordable Care Act (ACA) is bad news for BRCA+ women. Specifically, some people have declared that under the ACA, BRCA+ women who have mastectomies are going to be denied reconstruction by their insurances companies. Such handwringing usually includes wailing that Barack Obama is a shockingly heartless man, whose supposedly anti-BRCA+ policies are especially appalling in light of the fact that his mother died from uterine and ovarian cancer.
I have little patience for this particular kind of right wing scaremongering and misinformation. So let’s clear things up: first of all, federal law requires insurance companies to pay for reconstruction for all mastectomy patients, including BRCA+ women. The ACA does not change this law in any way, shape, or form. In fact, nothing is really going to change for BRCA+ women who already have their test results and already have insurance. For these women, things are going to continue on pretty much as before. In other words, BRCA+ women who choose to have risk reducing surgery will have access to reconstruction.
The big change that’s going to come with the ACA is that BRCA+ women who did not previously have insurance will now have it. We’ve all heard of BRCA+ women who were afraid that they were going to be pushed off their parents’ insurance at the age of 26 and didn’t know how they were going to afford screening; or of BRCA+ women who are self employed and can’t afford insurance at all and wondering how they were going to afford an oopherectomy; or of BRCA+ women who were on their husband’s insurance and now the husband is unemployed. When Angelina Jolie’s essay on her surgeries was published in May 2013, some of the biggest criticisms came from women who said that surgery was only a realistic option for rich BRCA+ women like Jolie who could afford it. I’ve always thought that was untrue, but now, with the ACA, it is doubly untrue. The ACA will provide affordable health insurance to BRCA+ women who could not previously afford it–the poor, the self-employed, those employed at small businesses, part timers, or just those who are down on their luck: all will now have access to the same regular screening and surgical options that insured women have always had.
And there’s more: under the ACA, insurance companies must now count surveillance for breast and ovarian cancer as “preventative care,” which means fewer copay or deductible for BRCA+ women (it varies by state). This is really important because cancer screening can be really expensive, even with good insurance. At the same time, as this article points out, the ACA is going to make testing for BRCA mutations much more affordable, because genetic testing now falls under preventative care as well. This article is even more clear: “Under health reform, insurance policies must cover basic preventive services with no co-payment. The federal government recently clarified that this includes all physician-recommended BRCA testing along with counseling related to it.”
Bright Pink has a website that goes into more detail on how the ACA will affect BRCA+ women. You should definitely check it out.
In other words, Obamacare is a wonderful thing for both previously insured and uninsured BRCA+ women who will now have more power to make decisions that manage their risk.