II 118th CONGRESS 2d Session S. 5428 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.

1. Short title This Act may be cited as the Jeanette Acosta Invest in Women’s Health Act of 2024 . 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. 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. 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: 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. . 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: 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. . 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. 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: 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). .