The Metastatic Breast Cancer Access to Care Act HR 2178/S 1374 is in motion. This important legislation, if passed, would waive the 24-month waiting period for Medicare eligibility and the 5-month waiting period for Social Security Disability Insurance benefits for those with metastatic breast cancer. Congress is on break in August, so this is the perfect time to reach your representative. We asked attorney Jennifer Berzok who works with the National Breast Cancer Coalition to explain the legislation.
Before explaining the MBC Access to Care Act, would you please give a brief snapshot of eligibility for Social Security Disability benefits and Medicare as they are now?
Individuals diagnosed with metastatic breast cancer automatically qualify for disability benefits from the Social Security Administration (SSA) as long as they meet SSA’s technical qualification rules. To earn Social Security Disability Benefits (SSDI), the individual must have been employed within the last 10 years and currently be unable to work due to his or her disability. Once an individual is approved for SSDI, there is a 5-month waiting period to begin receiving benefits. Following approval of SSDI, individuals with metastatic breast cancer are eligible for Medicare coverage based on their disability. Eligibility for Medicare includes individuals over the age of 65, and those with two specific diseases, End-Stage Renal Disease or ALS. Individuals under age 65 with disability other than ESRD or ALS must have received SSDI benefits for 24 months before gaining eligibility for Medicare. This would include individuals diagnosed with metastatic breast cancer.
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What does the MBC Access to Care Act propose to change about this process?
HR 2178/S. 1374, the Metastatic Breast Cancer Access to Care Act would amend the Social Security Act to eliminate the waiting periods for disability insurance benefits and Medicare coverage for individuals with metastatic breast cancer.
HR 2178 was introduced in the House by Reps. Peter King (R-NY) and Cathy Castor (D-FL) and currently has more than 100 cosponsors. S. 1374, also bipartisan, was introduced in the Senate by Senators Martha McSally (R-AZ) and Christopher Murphy (D-CT).
The House bill has been referred to the House Committee on Ways and Means and the Senate bill has been referred to the Senate Finance Committee. NBCC advocates worked very hard to get this bill introduced and continue to build bipartisan support for this legislation.
What are the main benefits to those living with metastatic breast cancer if this legislation is passed?
Metastatic breast cancer is cancer that has spread from the breast to the bones, lungs or other distant parts of the body. 90% of breast cancer deaths are the a result of metastatic disease. There are some metastatic breast cancer treatments that may extend survival, but no cure. Individuals who qualify are under 65 and diagnosed with metastatic breast cancer already qualify for SSDI and Medicare. However, based on the limited life expectancy of individuals with metastatic disease, an average of 3 years, the waiting periods for receiving these benefits should be waived.
There are federal precedents for this proposal. In 2001, Congress passed legislation to add Amyotrophic Lateral Sclerosis (ALS) as a qualifying condition for automatic Medicare coverage, thus waiving the 24-month waiting period. More recently, legislation has been introduced which would build on that precedent to allow patients with ALS who quality for SSDI to immediately be eligible for SSDI (thus waiving the 5-month waiting period) making them automatically eligible for Medicare as well. NBCC believes that both automatic SSDI and Medicare coverage should also apply to metastatic breast cancer patients who qualify.
Who can people contact if they have questions about this legislation or how to get involved?
People can email at [email protected]. I’m happy to help.
About Jennifer Katz Berzok: Jennifer Berzok is an attorney who has spent most of her career working on health care policy. Jennifer has been involved with the National Breast Cancer Coalition in some capacity for two decades, both internally as a Manager of Government Relations and as an outside Government Relations Consultant. One of her proudest achievements in working for the Coalition was helping to enact the Breast Cancer Cervical Cancer Treatment Act, which was signed into law by President Clinton in 2000. In addition to working with NBCC, Jennifer worked on Capitol Hill as a legislative assistant to Congressman (now Senator) Sherrod Brown (D-OH). She also served as the Director of Government Relations for the Biotechnology Industry Organization (BIO).
