Women’s Health and Cancer Rights Modernization Act of 2025
Sponsored By: Representative Cammack, Kat [R-FL-3]
Introduced
Summary
This bill would create a federal baseline requiring comprehensive coverage for breast or chest wall reconstruction after breast cancer treatment, and it would set rules on in-network access and written notice to patients about that coverage. It covers reconstruction methods, prostheses, complication care, and lymphedema supplies and ties decisions to consultation between the patient and their physician.
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- Families and patients: Would require plans to cover all stages and types of reconstruction, including immediate and delayed implants, flap techniques, structural fat grafting, flat closure, reconstruction of the opposite breast for symmetry, custom prostheses, and treatment of complications and lymphedema. Cost sharing must be consistent with other benefits.
- Employers, insurers, and plans: Would apply across group health plans, employer-sponsored plans, self-insured plans, and individual coverage by amending federal health statutes to require the same standards. Plans may still negotiate provider reimbursement.
- Providers and access: Would require at least one in-network provider for each reconstruction modality and variation, and written notices at enrollment and annually. The Comptroller General must report within one year on access gaps, including microsurgical reconstruction. The rules would apply to plan years beginning on or after enactment, with a special rule for collective bargaining plan amendments.
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Bill Overview
Analyzed Economic Effects
6 provisions identified: 3 benefits, 0 costs, 3 mixed.
Full breast reconstruction coverage during cancer care
If enacted, health plans that cover breast cancer treatment would have to cover full breast or chest wall reconstruction when you choose it. This would include mastectomy or breast-conserving surgery, all reconstruction methods (implants, flap surgeries, fat grafting, combined methods), and flat closure. It would also cover symmetry surgery on the other breast, custom prostheses and replacements, and treatment of complications like lymphedema. Lymphedema compression items defined in Medicare law would be covered without the January 1, 2024 date limit. These rules would apply to plan years starting on or after enactment.
Workplace health plans must cover reconstruction
If enacted, employer health plans, including self-insured plans, would have to follow the same breast reconstruction coverage rules. This would align plans under ERISA and the tax code with the new coverage list. The change would start with plan years beginning on or after enactment.
Stops plans from dodging coverage
If enacted, plans could not deny, drop, or block enrollment just to avoid covering reconstruction. Plans also could not punish doctors or pay them less to steer care away from what the law requires or from accepted medical standards. These protections would apply to plan years beginning on or after enactment.
In-network access and yearly coverage notices
If enacted, your plan would need at least one in-network provider for each covered reconstruction type and method. Coverage would be decided with you and your doctor, and only if you are a medical candidate. Plans could still apply deductibles and coinsurance like other benefits. Plans would have to give written notice about this coverage when you enroll and every year after. These rules would start for plan years beginning on or after enactment.
State protections kept; plans can negotiate
If enacted, stronger state laws on reconstruction coverage would stay in place; the federal rule would not override them. Plans could still negotiate payment rates with providers. These clarifications would apply to plan years beginning on or after enactment.
When these coverage rules would start
If enacted, all changes would apply to plan years beginning on or after the date of enactment. For union plans, amending a plan only to follow the new rules would not end the collective bargaining agreement. The bill would also adjust how an existing Public Health Service Act sentence applies for those future plan years.
Sponsors & CoSponsors
Sponsor
Cammack, Kat [R-FL-3]
FL • R
Cosponsors
Rep. Dingell, Debbie [D-MI-6]
MI • D
Sponsored 10/24/2025
Rep. Hinson, Ashley [R-IA-2]
IA • R
Sponsored 10/24/2025
McBath
GA • D
Sponsored 10/24/2025
Rep. Kim, Young [R-CA-40]
CA • R
Sponsored 10/24/2025
Rep. McClain Delaney, April [D-MD-6]
MD • D
Sponsored 10/24/2025
Van Duyne
TX • R
Sponsored 10/24/2025
Rep. Perez, Marie Gluesenkamp [D-WA-3]
WA • D
Sponsored 10/24/2025
Rep. Pettersen, Brittany [D-CO-7]
CO • D
Sponsored 10/24/2025
Lee (FL)
FL • R
Sponsored 11/4/2025
Maloy
UT • R
Sponsored 11/4/2025
Stansbury
NM • D
Sponsored 11/4/2025
DesJarlais
TN • R
Sponsored 11/18/2025
Rep. Frankel, Lois [D-FL-22]
FL • D
Sponsored 11/18/2025
Roll Call Votes
No roll call votes available for this bill.
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