I 
111TH CONGRESS 
1ST SESSION H. R. 1691 
To require that health plans provide coverage for a minimum hospital stay 
for mastectomies, lumpectomies, and lymph node dissection for the treat-
ment of breast cancer and coverage for secondary consultations. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 24, 2009 
Ms. DELAURO (for herself, Mr. BARTON of Texas, Mr. ACKERMAN, Mr. 
ARCURI, Mr. BACA, Ms. BALDWIN, Mr. HILL, Ms. BEAN, Ms. BERKLEY, 
Mr. BERMAN, Mr. BERRY, Mr. BISHOP of Georgia, Mr. BISHOP of New 
York, Mr. BLUMENAUER, Ms. BORDALLO, Mr. BOREN, Mr. BOSWELL, 
Mr. BOYD, Mr. BRADY of Pennsylvania, Ms. CORRINE BROWN of Florida, 
Mr. BRALEY of Iowa, Mr. BURTON of Indiana, Mr. CAPUANO, Mr. 
CARDOZA, Mr. CARNEY, Ms. SHEA-PORTER, Mr. CARSON of Indiana, Ms. 
CASTOR of Florida, Mr. CHANDLER, Mrs. CHRISTENSEN, Mr. CLAY, Mr. 
CLEAVER, Mr. COHEN, Mr. CONNOLLY of Virginia, Mr. CONYERS, Mr. 
COOPER, Mr. COURTNEY, Mr. CROWLEY, Mr. CUELLAR, Mr. CUMMINGS, 
Mr. DAVIS of Illinois, Mr. DAVIS of Tennessee, Mrs. DAVIS of California, 
Mrs. HALVORSON, Mr. DEFAZIO, Ms. DEGETTE, Mr. DELAHUNT, Mr. 
DICKS, Mr. DINGELL, Mr. DOGGETT, Ms. EDWARDS of Maryland, Mr. 
DOYLE, Mr. EDWARDS of Texas, Mr. ELLISON, Mr. ENGEL, Mr. MASSA, 
Ms. ESHOO, Mr. ETHERIDGE, Mr. FARR, Mr. FATTAH, Mr. PALLONE, 
Mr. FRANK of Massachusetts, Mr. GERLACH, Mr. NYE, Mr. GONZALEZ, 
Mr. GORDON of Tennessee, Mr. AL GREEN of Texas, Mr. GENE GREEN 
of Texas, Mr. GRIFFITH, Mr. GRIJALVA, Mr. GUTIERREZ, Mr. HARE, Ms. 
HARMAN, Mr. HASTINGS of Florida, Mr. HIGGINS, Mr. HIMES, Mr. HIN-
CHEY, Mr. HINOJOSA, Ms. HIRONO, Mr. HOLDEN, Mr. HOLT, Mr. INS-
LEE, Mr. ISRAEL, Mr. JACKSON of Illinois, Ms. JACKSON-LEE of Texas, 
Mr. MATHESON, Mr. BARROW, Mr. SARBANES, Ms. EDDIE BERNICE 
JOHNSON of Texas, Mr. KAGEN, Mr. KANJORSKI, Ms. KAPTUR, Mrs. 
DAHLKEMPER, Mr. MEEK of Florida, Mr. KENNEDY, Mr. KILDEE, Ms. 
KILPATRICK of Michigan, Ms. KILROY, Mr. KIND, Mr. KLEIN of Florida, 
Mr. KUCINICH, Mr. LANGEVIN, Mr. LARSEN of Washington, Mr. LARSON 
of Connecticut, Ms. LEE of California, Mr. LEVIN, Mr. LEWIS of Georgia, 
Mr. LOBIONDO, Mr. LOEBSACK, Ms. ZOE LOFGREN of California, Mrs. 
CAPPS, Mrs. LOWEY, Mr. LYNCH, Mr. MACK, Mr. MAFFEI, Mrs. 
MALONEY, Ms. FUDGE, Ms. MATSUI, Mrs. MCCARTHY of New York, Ms. 
MCCOLLUM, Mr. MCDERMOTT, Mr. MCGOVERN, Mr. MCHUGH, Mr. 
MCINTYRE, Mr. MEEKS of New York, Mr. MELANCON, Mr. MICHAUD, 
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Mr. MILLER of North Carolina, Mr. GEORGE MILLER of California, Mr. 
MOORE of Kansas, Ms. MOORE of Wisconsin, Mr. MORAN of Kansas, Mr. 
MORAN of Virginia, Mr. MURPHY of Connecticut, Mr. MURTHA, Mrs. 
MYRICK, Mr. NADLER of New York, Mrs. NAPOLITANO, Ms. NORTON, 
Mr. OBERSTAR, Mr. OLVER, Mr. ORTIZ, Mr. PASCRELL, Mr. TONKO, Mr. 
PAYNE, Mr. PETERSON, Ms. PINGREE of Maine, Mr. PLATTS, Mr. PRICE 
of North Carolina, Mr. RANGEL, Mr. REYES, Mr. RODRIGUEZ, Ms. ROS- 
LEHTINEN, Mr. ROTHMAN of New Jersey, Ms. ROYBAL-ALLARD, Mr. 
RUSH, Mr. RYAN of Ohio, Ms. LINDA T. SA´NCHEZ of California, Ms. 
SCHAKOWSKY, Mr. SCHIFF, Ms. SCHWARTZ, Mr. SCOTT of Georgia, Mr. 
SCOTT of Virginia, Mr. SERRANO, Mr. SESTAK, Mr. SHERMAN, Mr. 
SIRES, Mr. SKELTON, Ms. SLAUGHTER, Mr. SMITH of Washington, Mr. 
SNYDER, Mr. SPACE, Ms. SPEIER, Mr. SPRATT, Mr. STARK, Mr. STU-
PAK, Ms. SUTTON, Mrs. TAUSCHER, Mr. TAYLOR, Mr. THOMPSON of 
California, Mr. TIERNEY, Mr. TOWNS, Ms. TSONGAS, Mr. VAN HOLLEN, 
Ms. VELA´ZQUEZ, Ms. WASSERMAN SCHULTZ, Mr. WEINER, Mr. WELCH, 
Mr. WEXLER, Mr. WILSON of Ohio, Mr. WITTMAN, Mr. WOLF, Ms. 
WOOLSEY, Ms. TITUS, Mr. ALTMIRE, Mr. RUPPERSBERGER, Mr. 
MCNERNEY, Mr. CLYBURN, Ms. MARKEY of Colorado, Mr. HALL of 
Texas, Ms. KOSMAS, Mr. ROGERS of Alabama, Mr. FILNER, Mr. 
SOUDER, and Mr. POLIS of Colorado) introduced the following bill; which 
was referred to the Committee on Energy and Commerce, and in addition 
to the Committees on Ways and Means and Education and Labor, for 
a period to be subsequently determined by the Speaker, in each case for 
consideration of such provisions as fall within the jurisdiction of the com-
mittee concerned 
A BILL 
To require that health plans provide coverage for a minimum 
hospital stay for mastectomies, lumpectomies, and lymph 
node dissection for the treatment of breast cancer and 
coverage for secondary consultations. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Breast Cancer Patient 
Protection Act of 2009’’. 
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SEC. 2. FINDINGS. 
Congress finds the following: 
(1) According to the American Cancer Society, 
excluding cancers of the skin, breast cancer is the 
most frequently diagnosed cancer in women. 
(2) According to the American Cancer Society, 
an estimated 40,480 women and 450 men died from 
breast cancer in 2008. 
(3) According to the American Cancer Society, 
in 2008 an estimated 182,460 new cases of invasive 
breast cancer were diagnosed in women, and an esti-
mated 1,990 invasive breast cancer cases were diag-
nosed in men; and in addition, an estimated 67,770 
new cases of in situ breast cancer occurred in 
women in 2008, and of these, approximately 85 per-
cent were ductal carcinoma in situ. 
(4) According to the American Cancer Society, 
most breast cancer patients undergo some type of 
surgical treatment, which may involve lumpectomy 
(surgical removal of the tumor with clear margins) 
or mastectomy (surgical removal of the breast) with 
removal of some of the axillary (underarm) lymph 
nodes. 
(5) The offering and operation of health plans 
affect commerce among the States. 
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(6) Health care providers located in a State 
serve patients who reside in the State and patients 
who reside in other States. 
(7) In order to provide for uniform treatment 
of health care providers and patients among the 
States, it is necessary to cover health plans oper-
ating in one State as well as health plans operating 
among the several States. 
(8) Research has indicated that treatment for 
breast cancer varies according to type of insurance 
coverage and State of residence. 
(9) Currently, 20 States mandate minimum in-
patient coverage after a patient undergoes a mastec-
tomy. 
(10) Breast cancer patients have reported ad-
verse outcomes, including infection and inadequately 
controlled pain, resulting from premature hospital 
discharge following breast cancer surgery. 
SEC. 2. AMENDMENTS TO THE EMPLOYEE RETIREMENT IN-
COME SECURITY ACT OF 1974. 
(a) IN GENERAL.—Subpart B of part 7 of subtitle 
B of title I of the Employee Retirement Income Security 
Act of 1974 (29 U.S.C. 1185 et seq.) is amended by add-
ing at the end the following: 
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‘‘SEC. 715. REQUIRED COVERAGE FOR MINIMUM HOSPITAL 
STAY FOR MASTECTOMIES, LUMPECTOMIES, 
AND LYMPH NODE DISSECTIONS FOR THE 
TREATMENT OF BREAST CANCER AND COV-
ERAGE FOR SECONDARY CONSULTATIONS. 
‘‘(a) INPATIENT CARE.— 
‘‘(1) IN GENERAL.—A group health plan, and a 
health insurance issuer providing health insurance 
coverage in connection with a group health plan, 
that provides medical and surgical benefits shall en-
sure that inpatient (and in the case of a 
lumpectomy, outpatient) coverage and radiation 
therapy is provided for breast cancer treatment. 
Such plan or coverage may not— 
‘‘(A) insofar as the attending physician, in 
consultation with the patient, determines it to 
be medically necessary— 
‘‘(i) restrict benefits for any hospital 
length of stay in connection with a mastec-
tomy or breast conserving surgery (such as 
a lumpectomy) for the treatment of breast 
cancer to less than 48 hours; or 
‘‘(ii) restrict benefits for any hospital 
length of stay in connection with a lymph 
node dissection for the treatment of breast 
cancer to less than 24 hours; or 
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