Because it only affects women

An Amy Schumer standup special I watched recently on Netflix had me thinking about the latest iteration of legislation that seeks to require Medicare to pay for custom breast forms. 

Schumer was talking about a common women’s health condition she was seeking treatment for.  

“Oh, we haven’t studied that yet,” she deadpans, “because it only affects women.”  

Cue Sen. Tammy Duckworth, D-Ill., who introduced the Breast Cancer Patient Equity Act. 

“It is absurd that the breast is the only human body part not currently covered by Medicare as a customized replacement,” she said.  

Just for fun, I backtracked through the HME News website to see if I could learn when I first wrote about this issue (and this legislation): 2011. Twelve years.  

For me, that means 12 years of revisiting the issue through successive sessions of Congress. For the women (OK, and men) who do the heavy lifting of lobbying for the passage of the bills, that’s also 12 years of, let’s call it, continuing education about why this matters so much.  

It also means 12 years of working with the bureaucracy that is CMS. Way back in 2018, CMS said for Medicare to pay for custom prosthetics, those prosthetics need to increase functionality. Because the agency doesn’t believe custom breast forms fit the bill, it also wanted examples of other custom prosthetics that don’t increase so-called functionality.  

“So, we gave them eye and ear (prosthetics),” Nikki Jensen, vice president of Essentially Women told me. “It looks like your other eye, but it doesn’t allow you to see. Same with an ear.”  

So then, the bureaucrats said the reason for paying for the eyes and ears was symmetry. Think about that for a minute. Symmetry.    

“They didn’t have an answer (when we protested),” says Jensen. “Just that it would take congressional action for them to change their policy.”  

Look, we can sit here and roll our eyes at the downplaying of issues that affect women. But women feel discriminated against by their insurers. They feel overlooked by the health system. That’s very real and that’s very wrong.  

We’re on the cusp of 2024. Why are we still fighting for this?