Senate committee considers bills to expand access to birth control and breast cancer screenings

The Senate Health Committee considered a bipartisan bill that would allow pharmacists in Wisconsin to prescribe birth control and another bipartisan bill that would require health insurance policies to cover supplemental screenings and exams for people at an increased risk of breast cancer. 

Senate Bill 211, co-authored by Sen. Mary Felzkowski (R-Irma) and Rep. Joel Kitchens (R-Sturgeon Bay), would allow Wisconsinites over the age of 18 to receive a birth control prescription from a pharmacist rather than a primary care physician. 

“The debate today is not whether birth control should be legal. That train left the station a long time ago,” Felzkowski told the committee. “The debate today is, is it safe and who can prescribe it? That’s the debate today.” 

Currently patients seeking birth control must make an appointment with a doctor or advanced practice nurse, answer a mandatory list of questions regarding their health and then if it is safe for them to take hormonal birth control, they are given that prescription to take to a pharmacy to be filled. 

The bill aims to give patients greater access to birth control by allowing them to get the prescription from a pharmacist without having to first visit a doctor. Patients would need to receive a blood pressure screening and fill out a questionnaire before receiving a prescription.

As a rural legislator, Felzkowski said the bill would be particularly helpful for her constituents. 

“I have areas in my district where it’s two to two and a half hours to see an OB-GYN. We have a doctor shortage up north, so if you’re running out of your birth control prescription, you need to see a doctor,” Felzkowski said. “That’s not always attainable or the cost of the transportation and taking off work is a little bit prohibitive. Yet, we know that most people in the United States, as well as Wisconsin, live within five miles of a pharmacy, so that access becomes a lot more attainable.” 

The policy has been considered in 2019 and 2021 legislative sessions, but stalled each time in the Senate. Last session, the bill did not receive a hearing after being referred to the Senate Organization Committee. 

The Assembly already passed the bill last month for a third session in a row, where representatives expressed concerns about whether the bill would make progress in the Senate. 

The bill was initially announced this session alongside a Republican bill that would update Wisconsin’s 1849 abortion ban to include rape and incest exceptions during the first trimester and clarify the “life of the mother” exception already included in the law. Republican lawmakers who support the bill say it would help to reduce the number of abortions.

But the bill is opposed by Wisconsin’s major anti-abortion groups, several of whom testified on Wednesday including Wisconsin Family Action and Pro-Life Wisconsin. 

Senators on the committee who spoke were not receptive to the arguments by opponents. 

One opponent, Elizabeth Anderson, an emergency medicine physician and president of a local branch of the Catholic Medical Guild, said she was concerned about the side effects of birth control and whether the bill would encourage patients to skip going to see their primary care physicians. 

Sen. Rachael Cabral-Guevara (R-Appleton), who is a nurse practitioner, asked Anderson about whether she sees more side effect visits in the emergency room from birth control or from ibuprofen and advil. Anderson said that she has seen many patients from side effects from birth control. Cabral-Guevara responded by describing her own experience with patients.

“During the time that I have been honored to have patients, I have seen so many more side effects from people coming in on large doses of magnesium, ibuprofen, and supplements. I have so many people coming in with potassium supplements,” Cabral-Guevara said. “When it comes to birth control, I’ve had one in 15 years.” 

Cabral-Guevara said it’s difficult to make the argument that the bill shouldn’t be passed due to the side effects of birth control when medications like ibuprofen are available over the counter. 

Matt Sande of Pro-Life Wisconsin, beyond his moral objection to birth control, suggested that lawmakers would be contributing to the state’s workforce shortage by passing the bill. 

“My question is at a time when state government should be developing and promoting policies that incentivize natural population growth,” Sande said, “why would the bill authors attempt to do the opposite by pushing wide and easy access to contraceptives?”

Felzkowski responded to Sande’s statement, saying, “it was just indicated that the bill authors are trying to reduce the labor population in the state of Wisconsin.” 

“I didn’t say you were trying to do that,” Sande said. 

“Please don’t interrupt me,” Felzkowski said. “The bill authors believe in medical and independent freedom to make informed, educated choices for individuals based on what their goals and wants in life are.

Expanding access to screenings for women with higher risk of breast cancer

Lawmakers also considered Senate Bill 121, which would require health insurance policies to provide coverage for supplemental breast screenings for people who have dense breast tissue or are at an increased risk of breast cancer. 

“Under no circumstances should cancer be allowed to spread undetected after a reading or after getting a screening such as a mammogram,” co-author Cabral-Guevara said. “This bill would close the critical loophole for many patients here in our state.”

Insurance policies in Wisconsin are already mandated to provide coverage for two mammograms for women between the ages of 45 and 49 and annual screenings for women over the age of 50. Yet policies don’t necessarily provide additional coverage for women who have dense breast tissue or are at a higher risk  and may need additional screening or further diagnostic services. 

According to the American Cancer Society, women with dense breast tissue have a higher risk of breast cancer compared with women with less dense breast tissue, and dense breast tissue can make it harder for radiologists to see cancer on mammograms.

The average out-of-pocket costs for additional diagnostic or supplemental breast screenings can range from $234 to $1,021, according to Susan G. Komen, the world’s leading breast cancer organization. 

The bill would require that coverage include no patient cost-sharing or co-payment. 

Cabral-Guevara said the bill is about early detection. 

“At affordable price with early detection, we can reduce the number of women who will succumb to cancer, breast cancer,” Cabral-Guevara said. “These screenings — when we’re using mammograms, ultrasounds and MRIs — can detect cancer in dense breast tissue.” 

She said that she is “feeling very hopeful” about the bill and believes the bill will be heard in the Assembly.

The bill is supported by many organizations, including the American Cancer Society Cancer Action Network, Wisconsin Medical Society, Wisconsin Nurses Association, Wisconsin Radiological Society and Milwaukee Professional Firefighters Association. 

Linda Hansen, an advocate with the Wisconsin Breast Cancer Coalition, told the committee that she has stage four terminal cancer, and that “the doctors were very clear with me when I got the diagnosis, it’s going to kill me.” 

“The only question is when,” Hansen said. She said when she learned that she had dense breast tissue her OB-GYN told her it wasn’t important. 

“I believed him,” Hansen said. “I shouldn’t have.” She said that while it’s was too late for her and many of the women who already have breast cancer, the bill would help younger generations. 

“It’s too late for us,” Hansen said. “This bill is going to help women below the ages of 50, below the ages of 40. It’s going to help my three daughters. It’s going to help my sister, my three nieces and my granddaughters.” 

Groups that registered against the bill include the Wisconsin Association of Health Plans, America’s Health Insurance Plans and the Alliance of Health Insurers. 

R.J. Pirlot, executive director of the Alliance of Health Insurers, said the group opposes the bill because research isn’t clear on the exact method for conducting extra screenings on women with dense breast tissue and because of the potential for overuse of these screenings. 

Pirlot pointed to the recent draft recommendation by the U.S. Preventive Services Task Force on breast cancer screening, which recommended moving to screenings every two years for women over 40, but did not make recommendations for additional screenings for women with dense breast tissue. He said current research is unclear about what type of additional screening should be done for women with dense breast tissue, whether that’s an ultrasound or MRI, and it also doesn’t show how often additional screenings should be performed. 

Pirlot also said the bill could potentially lead to increased health insurance costs.

“The cost of the enhancement imaging, which can be 10 to 15 times more expensive than a mammogram, will be paid for by all insured, raising costs for everyone,” Pirlot said. “The legislation potentially encourages overly utilization of imaging without the necessary research to show net actual benefits for women with dense breast tissue.”