II 

116TH CONGRESS 

1ST SESSION S. 1735 

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

screening. 

IN THE SENATE OF THE UNITED STATES 

JUNE 5, 2019 

Mrs. MURRAY (for herself, Ms. BALDWIN, Mrs. GILLIBRAND, Mrs. SHAHEEN, 

Mr. BOOKER, Ms. HARRIS, Mr. WYDEN, Mr. MERKLEY, Mr. PETERS, 

Ms. ROSEN, Ms. KLOBUCHAR, and Mr. BLUMENTHAL) 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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Jeanette Acosta Invest 

5 in Women’s Health Act of 2019’’. 

6 SEC. 2. PURPOSE. 

7 It is the purpose of this Act to provide women with 

8 increased access to preventive and life-saving cancer 

9 screening, including clinical breast exams and cervical, 


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1 ovarian, uterine, vaginal, and vulvar cancer screening, pro2 vided by leading women’s health care providers who— 

3 (1) serve populations most at risk; and 

4 (2) play an outsized role in the prevention and 

5 detection of cancer in order to serve the goal of re6 ducing health care disparities among low-income 

7 women and women of color, decrease health care 

8 spending, and expand health literacy, access, and 

9 education about the benefits of regular preventive 

10 cancer screening for women. 

11 SEC. 3. FINDINGS. 

12 Congress finds as follows: 

13 (1) Breast cancer is the leading cause of cancer 

14 death in women under the age of 54, and the Amer15 ican Cancer Society recommends that women in 

16 their 20s and 30s have a clinical breast exam at 

17 least every 3 years. 

18 (2) Ovarian cancer causes more deaths than 

19 any other cancer of the female reproductive system, 

20 but it accounts for only about 3 percent of all can21 cers in women. 

22 (3) The cancers that most frequently impact 

23 women include breast, uterine, ovarian, and cervical 

24 cancer, and there were 331,394 new cases of these 

25 cancers in 2015. 


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1 (4) Rates of incidence and death for gynecologic 

2 cancers by race and ethnicity show that, while for 

3 some cancers, like ovarian cancer, the rates of inci4 dence and death are similar among all races, for 

5 other cancers, like cervical cancer, women of color 

6 have a disproportionate rate of incidence. While the 

7 incidence of uterine cancer is similar for White 

8 women and women of color, rates of death for uter9 ine cancer are 2 times higher for Black women than 

10 for White women. 

11 (5) Prevention and cancer screening are the 

12 best approaches to protecting women from cancer 

13 and ensuring early detection and life-saving treat14 ment. Many deaths from breast and cervical cancers 

15 could be avoided if cancer screening rates and diag16 nostic care and services increased among women at 

17 risk. Deaths from these cancers occur disproportion18 ately among women who are uninsured or under19 insured. 

20 (6) Due to enhanced screening, cervical cancer, 

21 which used to be the leading cause of cancer death 

22 for women in the United States, is now a much more 

23 preventable and treatable cancer. It is also highly 

24 curable when found and treated early. 


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1 (7) Increased access to education, information, 

2 and preventive cancer screening increase women’s 

3 ability to survive cancer. 

4 (8) While more than 15 percent of cases of cer5 vical cancer are found in women over the age of 65, 

6 it becomes less likely that women are tested for cer7 vical cancer ever or within the previous 5 years as 

8 their age increases. 

9 (9) Women’s health care providers that are pri10 marily engaged in family planning services, such as 

11 Planned Parenthood health centers, provide nec12 essary screening tests, education, and information to 

13 women, especially women of color who face the high14 est risks of breast cancer and other gynecologic can15 cers. 

16 SEC. 4. STRENGTHENING ACCESS TO CANCER SCREENING 

17 FOR WOMEN. 

18 (a) IN GENERAL.—Part B of title III of the Public 

19 Health Service Act (42 U.S.C. 243 et seq.) is amended 

20 by inserting after section 317P the following: 

21 ‘‘SEC. 317P–1. GRANTS FOR WOMEN’S HEALTH CARE PRO22 VIDERS. 

23 ‘‘(a) IN GENERAL.—The Secretary is authorized to 

24 make grants and to enter into contracts with public or 

25 nonprofit private entities to expand preventive health servVerDate Sep 11 2014 22:02 Jun 10, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1735.IS S1735

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1 ices, as provided for in the Preventive Services Guidelines 

2 of the Health Resources and Service Administration that 

3 were in effect on October 30, 2017, with an emphasis on 

4 increasing access to critical, life-saving cancer screening, 

5 Pap tests, human papillomavirus vaccination, and diag6 nostic tests for women with cancer symptoms, particularly 

7 women of color. 

8 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There 

9 is authorized to be appropriated to carry out this section, 

10 $20,000,000 for each of fiscal years 2020 through 2023.’’. 

11 (b) FUNDING.—There is authorized to be appro12 priated to carry out programs related to breast and 

13 gynecologic cancers under title XIX of the Social Security 

14 Act (42 U.S.C. 1396 et seq.) and title X of the Public 

15 Health Service Act (42 U.S.C. 300 et seq.), and the Na16 tional Breast and Cervical Cancer Early Detection Pro17 gram, such sums as may be necessary for each of fiscal 

18 years 2020 through 2023. 

19 SEC. 5. EXPAND CANCER SCREENING PROVIDER TRAINING. 

20 Part B of title III of the Public Health Service Act 

21 (42 U.S.C. 243 et seq.), as amended by section 4, is fur22 ther amended by inserting after section 317P–1 the fol23 lowing: 


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1 ‘‘SEC. 317P–2. WOMEN’S HEALTH CARE PROVIDERS DEM2 ONSTRATION TRAINING PROJECT. 

3 ‘‘(a) ESTABLISHMENT OF PROGRAM.—The Secretary 

4 shall establish a demonstration program (referred to in 

5 this section as the ‘program’) to award 3-year grants to 

6 eligible entities for the training of physicians, nurse practi7 tioners, and other health care providers related to life-sav8 ing breast and gynecologic cancer screening for women. 

9 ‘‘(b) PURPOSE.—The purpose of the program is to 

10 enable each grant recipient to— 

11 ‘‘(1) provide to licensed physicians, nurse prac12 titioners, and other health care providers, through 

13 clinical training, education, and practice, the most 

14 up-to-date clinical guidelines and research adopted 

15 by the National Academies of Sciences, Engineering, 

16 and Medicine in the area of preventive cancer 

17 screening for breast and gynecologic cancers; 

18 ‘‘(2) establish a model of training for physi19 cians, nurse practitioners, and other health care pro20 viders that specializes in women’s health care, with 

21 a specific focus on breast and gynecologic cancer 

22 screening, that may be replicated nationwide; and 

23 ‘‘(3) train physicians, nurse practitioners, and 

24 other health care providers to serve rural commu25 nities, low-income communities, and communities of 

26 color in breast and gynecologic cancer screening. 


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1 ‘‘(c) ELIGIBLE ENTITIES.—To be eligible to receive 

2 a grant under this section, an entity shall be— 

3 ‘‘(1) an entity that receives funding under sec4 tion 1001; 

5 ‘‘(2) an essential community provider primarily 

6 engaged in family planning, as defined in section 

7 156.235 of title 45, Code of Federal Regulations (or 

8 any successor regulations); 

9 ‘‘(3) an entity that furnishes items or services 

10 to individuals who are eligible for medical assistance 

11 under title XIX of the Social Security Act; or 

12 ‘‘(4) an entity that, at the time of application, 

13 provides cancer screening services under the Na14 tional Breast and Cervical Cancer Early Detection 

15 Program of the Centers for Disease Control and 

16 Prevention.’’. 

17 SEC. 6. STUDY AND REPORT TO CONGRESS ON INCREASED 

18 CANCER SCREENING FOR WOMEN. 

19 (a) IN GENERAL.—The Secretary of Health and 

20 Human Services (referred to in this section as the ‘‘Sec21 retary’’) shall conduct a study (and periodically update 

22 such study) on increased access to women’s preventive life23 saving cancer screening across the United States, and, not 

24 later than January 1, 2025, and every 5 years thereafter, 


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1 the Secretary shall submit a report to Congress on such 

2 study. 

3 (b) CONTENTS.—The study and reports under sub4 section (a) shall include: 

5 (1) A 50-State analysis of breast and 

6 gynecologic cancer rates among women, including by 

7 geographic area, income, race, and status of insur8 ance coverage. 

9 (2) A 50-State analysis of cancer screening pro10 vided by women’s health care providers, including 

11 clinical breast exams, other screening for breast can12 cer, and screening for cervical cancer, ovarian can13 cer, and other gynecologic cancers. 

14 (3) An analysis of the awareness and avail15 ability of breast, cervical, ovarian, and other gyneco16 logical cancer screening options for women with dis17 proportionate rates of gynecological cancers, includ18 ing African-American women, Hispanic and Latina 

19 women, and other disproportionately impacted 

20 groups, according to the 50-State analyses described 

21 in paragraphs (1) and (2). 

22 (4) In consultation with the Comptroller Gen23 eral of the United States, estimated Federal savings 

24 achieved through early detection of breast and 

25 gynecologic cancer. 


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1 (5) Analysis of how access to health care pro2 viders trained under the program described in sec3 tion 317P–2 of the Public Health Service Act, as 

4 added by section 5, in comparison to other health 

5 care providers, increased early detection of cancer 

6 for women. 

7 (6) Recommendations by the Secretary with re8 spect to the need for continued increased access to 

9 women’s health care providers, such as the entities 

10 described in section 317P–2(c) of the Public Health 

11 Service Act, as added by section 4, who provide pre12 ventive care, including life-saving cancer screening. 

13 (7) Recommendations for increasing screening 

14 rates for women who are less likely to be screened 

15 or treated for breast, cervical, ovarian, and other 

16 gynecological cancers, including African-American 

17 women, Hispanic and Latina women, and older 

18 women. 

19 SEC. 7. DEMONSTRATION PROJECT ON CO-TESTING FOR 

20 HUMAN PAPILLOMAVIRUS AND CERVICAL 

21 CANCER. 

22 Part B of title III of the Public Health Service Act 

23 (42 U.S.C. 243 et seq.), as amended by section 5, is fur24 ther amended by inserting after section 317P–2 the fol25 lowing: 


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1 ‘‘SEC. 317P–3. DEMONSTRATION PROJECT ON CO-TESTING 

2 FOR HUMAN PAPILLOMAVIRUS AND CER3 VICAL CANCER. 

4 ‘‘(a) IN GENERAL.—The Secretary, in coordination 

5 with the Director of the Centers for Disease Control and 

6 Prevention and the Administrator of the Health Resources 

7 and Services Administration, shall establish a 2-year dem8 onstration project on increasing the co-testing of human 

9 papillomavirus and cervical cancer screenings to develop 

10 models for increasing the rates of co-testing among women 

11 with disproportionate rates of cervical cancer, including 

12 African-American and Hispanic and Latina women. 

13 ‘‘(b) USE OF FUNDS.—Entities receiving funds under 

14 this section shall use such funds to— 

15 ‘‘(1) increase access to co-testing of Human 

16 papillomavirus and cervical cancer among patients 

17 with disproportionate rates of cervical cancer, in18 cluding African American and Hispanic and Latina 

19 women; 

20 ‘‘(2) support culturally- and linguistically-ap21 propriate delivery models to such patients, including 

22 through the provision of interpretation services; or 

23 ‘‘(3) provide other services to improve health 

24 outcomes with respect to such patients. 

25 ‘‘(c) PRIORITIZATION.—Priority for funding available 

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1 income, uninsured, and medically underserved populations 

2 or populations with historically low rates of such co-test3 ing, such as older women. 

4 ‘‘(d) ELIGIBLE ENTITIES.—To be eligible to receive 

5 a grant under this section, an entity shall be an entity 

6 described in section 317P–2(c).’’. 

Æ 


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