One in eight women in the United States will develop breast cancer during their lifetime.

According to the American Cancer Society, an estimated 4,900 women in Alabama will receive a breast cancer diagnosis this year alone.

ABOUT THE CAUSE

Alabama faces a critical healthcare access crisis affecting the state’s approximately 4,800 annual breast cancer patients.

While the Women’s Health and Cancer Rights Act (WHCRA) of 1998 requires health plans to cover breast reconstruction after mastectomy, loopholes in this federal law and in the Affordable Care Act have made way for insurers to develop and implement administrative and financial practices which effectively bar access to these medically necessary services. This regulatory gap has tangible consequences for Alabama’s breast cancer patients:

Inadequate Provider Networks: Patients cannot access specialized breast reconstruction surgeons within network, particularly for complex microsurgical procedures like deep inferior epigastric perforator (DIEP) and other free flap reconstruction.

Single Case Agreement Obstruction: When patients identify qualified out-of-network surgeons, insurers deny or delay single case agreements without meaningful recourse.

Steering Practices: Pressure and financial incentives push patients toward specific providers or less expensive procedures regardless of medical appropriateness.

Payment Games: When surgeons do accept out-of-network cases, inadequate reimbursement or payment delays discourage future acceptance of patients.

Prior Authorization Obstruction: Unreasonable delays, repeated requests for information, and denial of medically appropriate procedures prevents patients from receiving adequate care.

No Accountability: Patients lack effective appeal mechanisms or enforcement tools when access is denied.

The result: Alabama women either forego reconstruction entirely, accept suboptimal procedures, travel out of state for care, or incur devastating out-of-pocket costs. This is unacceptable in a state where federal law (WHCRA) already mandates comprehensive breast reconstruction coverage.

The Alabama Legislature has the authority and opportunity to close this regulatory gap and ensure that no Alabama woman is denied comprehensive breast cancer care because of insurance barriers.

We urge the Alabama Legislature to pass comprehensive legislation in the 2026 session.

COMPREHENSIVE BREAST RECONSTRUCTION ACT

The Comprehensive Breast Reconstruction Act (HB453) focuses on three core priorities: access, education, and provider sustainability.

ACCESS

Women who undergo breast cancer surgery deserve full access to reconstruction care throughout their recovery. Patients should be able to choose their surgeon, medical approach, and reconstruction options based on what is best for their health and well-being.

By recognizing the inherent network inadequacy, the Comprehensive Breast Reconstruction Act ensures that insurance providers cannot deny coverage based solely on network status or lower-cost alternatives. This legislation would give patients greater agency in making informed decisions about their reconstruction care and allow them to pursue the options with their physician that best meet their individual needs.

EDUCATION

The bill supports patient education by ensuring women have a clear understanding of their reconstruction options. Patients should receive comprehensive information about available procedures, potential limitations, and financial considerations.

The Comprehensive Breast Reconstruction Act promotes transparency and informed decision-making around initial reconstruction, revision procedures, nipple reconstruction, symmetry surgeries, flat closure options, and post-operative care so that patients can make choices with confidence and clarity.

PROVIDER SUSTAINABILITY

Alabama is currently facing a shortage of specialized breast reconstruction surgeons. Low reimbursement rates, particularly from major insurers, have made it difficult for many providers to sustain these specialized services. As a result, attracting and retaining qualified reconstruction specialists in the state has become increasingly challenging.

The Comprehensive Breast Reconstruction Act aims to create greater balance and accountability in the contracting process between insurers and providers. By addressing reimbursement challenges and supporting provider sustainability, the legislation seeks to strengthen access to high-quality surgical care for patients across Alabama.

WHAT THIS LEGISLATION ACCOMPLISHES

Closes Loopholes: Every Alabama woman, regardless of insurer, administrator, corporate structure, or Medicaid status, will have meaningful access to comprehensive breast reconstruction services. The Comprehensive Breast Reconstruction Act ensures that insurance providers cannot steer or deny access based on network status or lower-cost treatment alternatives.

Enables Robust Enforcement: Multiple enforcement avenues (Insurance Commissioner, Attorney General, private actions) ensure comprehensive accountability.

Addresses Racial Disparities: By ensuring access regardless of insurance type, this legislation particularly benefits communities experiencing higher breast cancer mortality.

Protects State Employees: Alabama’s 350,000+ Public Education Employees’ Health Insurance Plan-covered employees and state employees will have comprehensive coverage.

Establishes National Leadership: Alabama will become a national model for comprehensive breast reconstruction access protection.

CALL TO ACTION

Every day this regulatory gap persists, Alabama women face barriers to reconstructive care during the most vulnerable time in their lives. They are told they cannot access the surgeon they have carefully chosen. They are steered toward less appropriate procedures. They face prior authorization delays during already stressful cancer treatment. They incur devastating out-of- pocket costs that should be covered by insurance. They are denied comprehensive reconstruction even though federal law says they’re entitled to it.

The data is clear. The legal framework is sound. The solution is comprehensive. The time to act is now:

Share this initiative with your community
Sign our petition
Stay informed as the legislation moves forward
Show up at the Capitol
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Call upon our legislators

The Access Gap

1 in 8

Women will develop breast cancer in their lifetime.

4,900+

Alabama women are diagnosed with breast cancer every year.

0

Specialists currently practicing breast reconstruction surgeons in Montgomery — Alabama’s state capital.

AL

This is not just a rural issue or an urban issue — access gaps affect women across Alabama.

ABOUT ACCESS4ALABAMA

Protecting Patient Choice

Access4Alabama is a statewide advocacy organization dedicated to advancing policies that protect patient choice, strengthen access to medically necessary care, and promote transparency and fairness within Alabama’s healthcare system. The organization works alongside patients, physicians, community leaders, and policymakers to remove systemic barriers that limit access to specialized services and to ensure Alabamians receive timely, comprehensive, and appropriate care.