,,ii #aagth ,,congress #ast ,session ,s4 #ajfc ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,march #be1 #bjba ,mrs4 ,murray 7for herself1 ,mr4 ,van ,hollen1 ,ms4 ,baldwin1 ,mr4 ,wyden1 ,mr4 ,merkley1 ,mr4 ,blumenthal1 ,ms4 ,klobuchar1 ,mrs4 ,gillibrand1 ,mrs4 ,shaheen1 ,mr4 ,booker1 ,ms4 ,rosen1 and ,mr4 ,peters7 introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to provide women with increased access to preventive and life-saving cancer screening4 #a4 ,short title ,this ,act may be cited as the ,jeanette ,acosta ,invest in ,women's ,health ,act of #bjba4 #b4 ,purpose ,it is the purpose of this ,act to provide women with increased access to preventive and life-saving cancer screening1 including clinical breast exams and cervical1 ovarian1 uterine1 vaginal1 and vulvar cancer screening1 provided by leading women's health care providers who-- 7#a7 serve populations most at risk2 and 7#b7 play an outsized role in the prevention and detection of cancer in order to serve the goal of increasing access to quality health screenings1 care1 and services1 reducing health care disparities and mortality rates among low-income women and women of color1 decreasing health care spending1 and expanding health literacy1 access1 and education about the benefits of regular preventive cancer screening for women4 #c4 ,findings ,congress finds as follows3 7#a7 ,breast cancer is the leading cause of cancer death in women under the age of #ed1 and the ,american ,cancer ,society recommends that women in their #bjs and #cjs have a clinical breast exam at least every #c years4 7#b7 ,ovarian cancer causes more deaths than any other cancer of the female reproductive system1 but it accounts for only about #c percent of all cancers in women4 7#c7 ,the cancers that most frequently impact women include breast1 uterine1 ovarian1 and cervical cancer1 and there were #cda1aga new cases of these cancers in #bjag4 7#d7 ,rates of incidence and death for gynecologic cancers by race and ethnicity show that1 while for some cancers1 like ovarian cancer1 the rates of incidence and death are similar among all races1 for other cancers1 like cervical cancer1 women of color have disproportionate incidence and mortality rates4 ,while the incidence of uterine cancer is similar for ,white women and ,women of ,color1 rates of death for uterine cancer are #b times higher for ,black women than for ,white women4 7#e7 ,cervical cancer incidence and mortality rates are higher for women living in rural and underserved regions in the ,united ,states4 ,women living in these areas face unique barriers in accessing reproductive health care services to prevent and treat cervical cancer1 including a lack of practicing gynecologists in rural areas and challenges around transportation to preventive and follow-up appointments4 7#f7 ,prevention and cancer screening are the best approaches to protecting women from cancer and ensuring early detection and life-saving treatment4 ,many deaths from breast and cervical cancers could be avoided if cancer screening rates and diagnostic care and services increased among women at risk4 ,deaths from these cancers occur disproportionately among women who are uninsured or underinsured4 7#g7 ,due to enhanced screening1 cervical cancer1 which used to be the leading cause of cancer death for women in the ,united ,states1 is now a much more preventable and treatable cancer4 ,it is also highly curable when found and treated early4 7#h7 ,increased access to education1 information1 including information on the human papillomavirus vaccine1 and preventive cancer screening increase women's ability to survive cancer4 7#i7 ,while more than #ae percent of cases of cervical cancer are found in women over the age of #fe1 it becomes less likely that women are tested for cervical cancer ever or within the previous #e years as their age increases4 7#aj7 ,women's health care providers that are primarily engaged in family planning services1 such as ,planned ,parenthood health centers1 provide necessary screening tests1 education1 and information to women1 especially women of color who face the highest risks of breast cancer and other gynecologic cancers4 7#aa7 ,access to preventive gynecological screening is also critical for transgender men who have comparable rates of susceptibility to cervical cancer as cisgender women1 but often have less access to preventive screenings4 7#ab7 ,discrimination and racism in health care continues to contribute to disparate rates of gynecological cancer in non-,white women4 ,black1 ,indigenous1 and other ,women of ,color die at higher rates from cervical cancer than ,white women1 even though fewer women overall die from cervical cancer4 7#ac7 ,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 disease1 contributing to disparities in mortality in ,black women4 #d4 ,strengthening access to cancer screening for women 7a7 ,in general ,part ,b of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdc et seq47 is amended by inserting after section #cag,p the following3 #cag,p-#a4 ,grants for women's health care providers 7a7 ,in general ,the ,secretary is authorized to make grants and to enter into contracts with public or nonprofit private entities to expand preventive health services1 as provided for in the ,preventive ,services ,guidelines of the ,health ,resources and ,service ,administration that were in effect on ,october #cj1 #bjag1 with an emphasis on increasing access to critical1 life-saving cancer screening1 ,pap tests1 human papillomavirus vaccination1 and diagnostic tests for women with cancer symptoms1 particularly ,women of ,color4 7b7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section1 #bj1jjj1jjj for each of fiscal years #bjbb through #bjbd4 4 7b7 ,funding ,there is authorized to be appropriated to carry out programs related to breast and gynecologic cancers under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 and title ,x of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj et seq471 and the ,national ,breast and ,cervical ,cancer ,early ,detection ,program1 such sums as may be necessary for each of fiscal years #bjbj through #bjbc4 #e4 ,expand cancer screening provider training ,part ,b of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdc et seq471 as amended by section #d1 is further amended by inserting after section #cag,p-#a the following3 #cag,p-#b4 ,women's health care providers demonstration training project 7a7 ,establishment of program ,the ,secretary shall establish a demonstration program 7referred to in this section as the program7 to award #c-year grants to eligible entities for the training of physicians1 nurse practitioners1 and other health care providers related to life-saving breast and gynecologic cancer screening for women4 7b7 ,purpose ,the purpose of the program is to enable each grant recipient to-- 7#a7 provide to licensed physicians1 nurse practitioners1 and other health care providers1 through clinical training1 education1 and practice1 the most up-to-date clinical guidelines1 research1 and recommendations adopted by the ,united ,states ,preventive ,services ,task ,force in the area of preventive cancer screening for breast and gynecologic cancers2 7#b7 establish a model of training for physicians1 nurse practitioners1 and other health care providers that specializes in women's health care1 with a specific focus on breast and gynecologic cancer screening1 that may be replicated nationwide2 7#c7 train physicians1 nurse practitioners1 and other health care providers to serve rural and underserved communities1 low-income communities1 and communities of color in breast and gynecologic cancer screening2 and 7#d7 provide implicit bias1 cultural competency1 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 death rates and how to communicate with patients through a knowledgeable and culturally empathetic lens4 7c7 ,eligible entities ,to be eligible to receive a grant under this section1 an entity shall be-- 7#a7 an entity that receives funding under section #ajja2 7#b7 an essential community provider1 as defined in section #aef4bce of title #de1 ,code of ,federal ,regulations 7or any successor regulations71 that is primarily engaged in family planning2 7#c7 an entity that furnishes items or services to individuals who are eligible for medical assistance under title ,,xix of the ,social ,security ,act2 or 7#d7 an entity that1 at the time of application1 provides cancer screening services under the ,national ,breast and ,cervical ,cancer ,early ,detection ,program of the ,centers for ,disease ,control and ,prevention4 4 #f4 ,study and report to ,congress on increased cancer screening for women 7a7 ,in general ,the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary7 shall conduct a study 7and periodically update such study7 on increased access to women's preventive life-saving cancer screening across the ,united ,states1 and1 not later than ,january #a1 #bjbe1 and every #e years thereafter1 the ,secretary shall submit a report to ,congress on such study4 7b7 ,contents ,the study and reports under subsection 7a7 shall include-- 7#a7 a #ej-,state analysis of breast and gynecologic cancer rates among women1 including by geographic area1 income1 employment status1 race1 ethnicity1 and status of insurance coverage2 7#b7 a #ej-,state analysis of cancer screening provided by women's health care providers1 including clinical breast exams1 other screening for breast cancer1 and screening for cervical cancer1 ovarian cancer1 and other gynecologic cancers2 7#c7 an analysis of the awareness and availability of breast1 cervical1 ovarian1 and other gynecological cancer screening options for women with disproportionate rates of gynecological cancers1 including ,african-,american women1 ,hispanic and ,latina women1 women living in rural and underserved areas1 and other disproportionately impacted groups1 according to the #ej-,state analyses described in paragraphs 7#a7 and 7#b72 7#d7 an analysis of how structural racism impacts access to cancer screening services1 its correlation to the development of breast1 cervical1 ovarian1 and other gynecological cancers1 and how it exacerbates health care disparities for ,african-,american1 ,hispanic and ,latina women1 and other ,women of ,color2 7#e7 in consultation with the ,comptroller ,general of the ,united ,states1 estimated ,federal savings achieved through early detection of breast and gynecologic cancer2 7#f7 an analysis of how access to health care providers trained under the program described in section #cag,p-#b of the ,public ,health ,service ,act1 as added by section #e1 in comparison to other health care providers1 increased early detection of cancer and quality of cancer care for women who are less likely to receive care1 including ,african-,american women1 ,hispanic and ,latina women1 older women1 uninsured and underinsured women1 and women living in rural and underserved areas2 7#g7 recommendations by the ,secretary with respect to the need for continued increased access to women's health care providers1 such as the entities described in section #cag,p-#b7;c7 of the ,public ,health ,service ,act1 as added by section #d1 who provide preventive care1 including life-saving cancer screening2 and 7#h7 recommendations for increasing screening rates for women who are less likely to be screened or treated for breast1 cervical1 ovarian1 and other gynecological cancers1 including ,african-,american women1 ,hispanic and ,latina women1 older women1 uninsured and underinsured women1 and women living in rural and underserved areas4 #g4 ,demonstration project on co-testing for human papillomavirus and cervical cancer ,part ,b of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdc et seq471 as amended by section #e1 is further amended by inserting after section #cag,p-#b the following3 #cag,p-#c4 ,demonstration project on co-testing for human papillomavirus and cervical cancer 7a7 ,in general ,the ,secretary1 in coordination with the ,director of the ,centers for ,disease ,control and ,prevention and the ,administrator of the ,health ,resources and ,services ,administration1 shall establish a #b-year demonstration project on increasing the co-testing of human papillomavirus and cervical cancer screenings to develop models for increasing the rates of co-testing among women with disproportionate rates of cervical cancer1 including ,african-,american and ,hispanic and ,latina women4 7b7 ,use of funds ,entities receiving funds under this section shall use such funds to-- 7#a7 increase access to co-testing of human papillomavirus and cervical cancer among patients with disproportionate rates of cervical cancer1 including ,african-,american and ,hispanic and ,latina women2 7#b7 support culturally and linguistically appropriate delivery models to such patients1 including through the provision of interpretation services2 or 7#c7 provide other services to improve health outcomes with respect to such patients4 7c7 ,prioritization ,priority for funding available under this section shall be given to entities serving low-income1 uninsured1 and medically underserved populations or populations with historically low rates of such co-testing1 such as older women4 7d7 ,eligible entities ,to be eligible to receive a grant under this section1 an entity shall be an entity described in section #cag,p-#b7;c74 4