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[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 5428 Introduced in Senate (IS)]

<DOC>

118th CONGRESS
  2d Session
                                S. 5428

 To provide women with increased access to preventive and life-saving 
                           cancer screening.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                            December 4, 2024

Mrs. Murray (for herself, Mrs. Shaheen, Mr. Blumenthal, Mr. Booker, Mr. 
Van Hollen, Mrs. Gillibrand, Ms. Baldwin, Ms. Klobuchar, Ms. Rosen, Mr. 
    Wyden, Ms. Stabenow, Mr. Merkley, and Mr. Welch) introduced the 
 following bill; which was read twice and referred to the Committee on 
                 Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL

 
 To provide women with increased access to preventive and life-saving 
                           cancer screening.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Jeanette Acosta Invest in Women's 
Health Act of 2024''.

SEC. 2. PURPOSE.

    It is the purpose of this Act to provide women with increased 
access to preventive and life-saving cancer screening (including 
clinical breast exams and breast, cervical, ovarian, uterine, vaginal, 
and vulvar cancer screening), as well as access to appropriate care and 
early detection (including via diagnostic testing and treatment and 
provider education and awareness of best clinical practices), provided 
by leading women's health care providers who--
            (1) serve populations most at risk of lacking access to 
        preventive care; and
            (2) play an outsized role in the prevention and detection 
        of cancer in order to serve the goal of increasing access to 
        quality health screenings, care, and services, reducing health 
        care disparities and mortality rates among low-income women and 
        women of color, decreasing health care spending, and expanding 
        health literacy, access, and education about the benefits of 
        regular preventive cancer screening for women.

SEC. 3. FINDINGS.

    Congress finds as follows:
            (1) Breast cancer is the leading cause of cancer death in 
        women under the age of 54, and the American Cancer Society 
        recommends that women in their 20s and 30s have a clinical 
        breast exam at least every 3 years.
            (2) Ovarian cancer causes more deaths than any other cancer 
        of the female reproductive system, but it accounts for only 
        about 3 percent of all cancers in women.
            (3) The cancers that most frequently impact women include 
        breast, uterine, ovarian, and cervical cancer, and there were 
        355,937 new cases of these cancers in 2019.
            (4) Rates of incidence and death for gynecologic cancers by 
        race and ethnicity show that, while for some cancers, like 
        ovarian cancer, the rates of incidence and death are similar 
        among all races, for other cancers, like cervical cancer, women 
        of color have disproportionate incidence and mortality rates. 
        While the incidence of uterine cancer is similar for White 
        women and women of color, rates of death for uterine cancer are 
        2 times higher for Black women than for White women.
            (5) Cervical cancer incidence and mortality rates are 
        higher for women living in rural and underserved regions in the 
        United States. Women living in such areas face unique barriers 
        in accessing reproductive health care services to prevent and 
        treat cervical cancer, including a lack of practicing 
        gynecologists in rural areas and challenges around 
        transportation to preventive and follow-up appointments.
            (6) Prevention and cancer screening are the best approaches 
        to protecting women from cancer and ensuring early detection 
        and life-saving treatment. Many deaths from breast and cervical 
        cancers could be avoided if cancer screening rates and 
        diagnostic care and services increased among women at risk. 
        Deaths from such cancers occur disproportionately among women 
        who are uninsured or underinsured.
            (7) Due to enhanced screening, cervical cancer is now a 
        much more preventable and treatable cancer. It is also highly 
        curable when found and treated early.
            (8) Increased access to education; information, including 
        information on the human papillomavirus vaccine; and preventive 
        cancer screenings, resulting in timely and adequate treatment, 
        increase women's ability to survive cancer.
            (9) While more than 20 percent of cases of cervical cancer 
        are found in women over the age of 65, it becomes less likely 
        that women are tested for cervical cancer ever or within the 
        previous 5 years as their age increases.
            (10) Women's health care providers that are primarily 
        engaged in family planning services, such as Planned Parenthood 
        health centers, provide necessary screening tests, education, 
        and information to women, especially women of color who face 
        the highest risks of breast cancer and other gynecologic 
        cancers.
            (11) Access to preventive gynecological screening is also 
        critical for transgender men who have comparable rates of 
        susceptibility to cervical cancer as cisgender women, but often 
        have less access to preventive screenings.
            (12) Discrimination and racism in health care continues to 
        contribute to disparate rates of gynecological cancer in non-
        White women. Black, Indigenous, and other women of color die at 
        higher rates from cervical cancer than White women, even though 
        fewer women overall die from cervical cancer.
            (13) Black women with endometrial cancer often receive 
        surgery less often than White women and are more likely to be 
        diagnosed at an advanced stage of the disease, contributing to 
        disparities in mortality in Black women.

SEC. 4. STRENGTHENING ACCESS TO CANCER SCREENING FOR WOMEN.

    Part B of title III of the Public Health Service Act (42 U.S.C. 243 
et seq.) is amended by inserting after section 317P the following:

``SEC. 317P-1. GRANTS FOR WOMEN'S HEALTH CARE PROVIDERS.

    ``(a) In General.--The Secretary is authorized to make grants and 
to enter into contracts with public or nonprofit private entities to 
expand preventive health services, including the cancer screening 
services required to be covered by group health plans and health 
insurance coverage pursuant to section 2713(a)(4). In awarding such 
grants, the Secretary shall seek to increase access to critical, life-
saving cancer screening, cervical cytology (commonly referred to as 
`Pap tests'), human papillomavirus tests, human papillomavirus and Pap 
cotests, human papillomavirus vaccinations, and diagnostic tests for 
women with cancer symptoms, particularly women of color.
    ``(b) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $20,000,000 for each of fiscal 
years 2025 through 2027.''.

SEC. 5. EXPANDING CANCER SCREENING PROVIDER TRAINING.

    Part B of title III of the Public Health Service Act (42 U.S.C. 243 
et seq.), as amended by section 4, is further amended by inserting 
after section 317P-1 the following:

``SEC. 317P-2. WOMEN'S HEALTH CARE PROVIDERS DEMONSTRATION TRAINING 
              PROJECT.

    ``(a) Establishment of Program.--The Secretary shall establish a 
demonstration program to award 3-year grants to eligible entities for 
the training of physicians, nurse practitioners, physician assistants, 
and other health care providers related to life-saving breast and 
gynecologic cancer screening for women, including appropriate follow-up 
care and screening for abnormal results.
    ``(b) Purpose.--The purpose of the program under this section is to 
enable each grant recipient to--
            ``(1) provide to licensed physicians, nurse practitioners, 
        physician assistants, and other health care providers, through 
        clinical training, education, and practice, the most up-to-date 
        clinical guidelines, research, and recommendations adopted by 
        the United States Preventive Services Task Force in the area of 
        preventive cancer screening for breast and gynecologic cancers, 
        including for women with dense breast tissue;
            ``(2) establish a model of training for physicians, nurse 
        practitioners, physician assistants, and other health care 
        providers that specialize in women's health care, with a 
        specific focus on breast and gynecologic cancer screening and 
        follow up care, that may be replicated nationwide;
            ``(3) train physicians, nurse practitioners, physician 
        assistants, and other health care providers to serve rural and 
        underserved communities, low-income communities, and 
        communities of color in breast and gynecologic cancer screening 
        and follow up care; and
            ``(4) provide implicit bias, cultural competency, and 
        patient-centered communication training covering the ways in 
        which structural racism and discrimination manifest within the 
        medical field and perpetuate racial disparities in gynecologic 
        cancer incidence and mortality rates and how to communicate 
        with patients through a knowledgeable and culturally empathetic 
        lens.
    ``(c) Eligible Entities.--To be eligible to receive a grant under 
this section, an entity shall be--
            ``(1) an entity that receives funding under section 1001 or 
        section 1003;
            ``(2) an essential community provider, as defined in 
        section 156.235 of title 45, Code of Federal Regulations (or 
        any successor regulations), that is primarily engaged in family 
        planning;
            ``(3) an entity that furnishes items or services to 
        individuals enrolled in a State Medicaid program or waiver of 
        such a plan; or
            ``(4) an entity that, at the time of application, provides 
        cancer screening services under the National Breast and 
        Cervical Cancer Early Detection Program under title XV.''.

SEC. 6. STUDY AND REPORT TO CONGRESS ON INCREASED CANCER SCREENING FOR 
              WOMEN.

    (a) In General.--The Secretary of Health and Human Services 
(referred to in this section as the ``Secretary'') shall--
            (1) conduct a study (and periodically update such study) on 
        increased access to women's preventive life-saving cancer 
        screenings across the United States; and
            (2) not later than 2 years after the date of enactment of 
        this Act, and every 5 years thereafter, submit a report to 
        Congress on such study.
    (b) Contents.--The study and reports under subsection (a) shall 
include--
            (1) an analysis of breast and gynecologic cancer rates 
        among women across all 50 States, the District of Columbia, and 
        the territories, including by geographic area, income, 
        employment status, race, ethnicity, and status of insurance 
        coverage;
            (2) an analysis of cancer screenings provided by women's 
        health care providers across all 50 States, the District of 
        Columbia, and the territories, including clinical breast exams, 
        other screening for breast cancer, and screening for cervical 
        cancer, ovarian cancer, and other gynecologic cancers;
            (3) with respect to women with disproportionate rates of 
        gynecological cancers, or who are less likely to receive 
        screenings and care, and broken down by categories of such 
        women that include African-American women, Hispanic and Latina 
        women, older women, uninsured and underinsured women, and women 
        living in rural and underserved areas--
                    (A) an analysis of the awareness, availability, and 
                uptake of breast, cervical, ovarian, and other 
                gynecological cancer screening options;
                    (B) an analysis of how access to health care 
                providers trained under the program described in 
                section 317P-2 of the Public Health Service Act, as 
                added by section 5, in comparison to other health care 
                providers, increased early detection of cancer and 
                quality of cancer care for such women; and
                    (C) recommendations for increasing screening rates 
                for such women who are less likely to be screened or 
                treated for breast, cervical, ovarian, and other 
                gynecological cancers;
            (4) an analysis of how structural racism impacts access to 
        cancer screening services, correlates to the development of 
        breast, cervical, ovarian, and other gynecological cancers, and 
        exacerbates health care disparities for African-American, 
        Hispanic and Latina women, and other women of color;
            (5) in consultation with the Comptroller General of the 
        United States, estimated Federal savings achieved through early 
        detection of breast and gynecologic cancers;
            (6) recommendations by the Secretary with respect to the 
        need for continued increased access to women's health care 
        providers, such as the entities described in section 317P-2(c) 
        of the Public Health Service Act, as added by section 5, who 
        provide preventive care, including life-saving cancer 
        screenings; and
            (7) an evaluation of the demonstration project on co-
        testing for human papillomavirus and cervical cancer under 
        section 317P-3 of the Public Health Service Act, as added by 
        section 7, including the results of the demonstration project 
        and a recommendation on whether expansion of the co-testing 
        model described in such section 317P-3 would be advised in 
        order to promote early intervention, screening uptake, and 
        reduce cervical cancer deaths and racial and ethnic 
        disparities.

SEC. 7. DEMONSTRATION PROJECT ON CO-TESTING FOR HUMAN PAPILLOMAVIRUS 
              AND CERVICAL CANCER.

    Part B of title III of the Public Health Service Act (42 U.S.C. 243 
et seq.), as amended by section 5, is further amended by inserting 
after section 317P-2 the following:

``SEC. 317P-3. DEMONSTRATION PROJECT ON CO-TESTING FOR HUMAN 
              PAPILLOMAVIRUS AND CERVICAL CANCER.

    ``(a) In General.--The Secretary, in consultation with the Director 
of the Centers for Disease Control and Prevention and the Administrator 
of the Health Resources and Services Administration, as appropriate, 
shall establish a 2-year demonstration project on increasing the 
cervical cancer screening co-testing of human papillomavirus and 
cervical cytology (commonly referred to as `Pap tests') to develop 
models for increasing the rates of co-testing among women with 
disproportionate rates of cervical cancer, including African-American 
and Hispanic and Latina women.
    ``(b) Use of Funds.--Entities receiving an award under this section 
shall use such award to--
            ``(1) increase access to co-testing of human papillomavirus 
        testing and cervical cancer among patients with 
        disproportionate rates of cervical cytology, including African-
        American and Hispanic and Latina women;
            ``(2) support culturally and linguistically appropriate 
        delivery models to such patients, including through the 
        provision of interpretation services; or
            ``(3) provide other services to improve health outcomes 
        with respect to such patients.
    ``(c) Prioritization.--In making awards under this section, the 
Secretary shall give priority to eligible entities serving low-income, 
uninsured, or medically underserved populations (as defined in section 
330(b)(3)) or populations with historically low rates of such co-
testing, such as older women.
    ``(d) Eligible Entities.--To be eligible to receive a grant under 
this section, an entity shall be an entity described in section 317P-
2(c).''.
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