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Test Those Breasts ™️
This podcast by Jamie Vaughn is a deep-dive discussion on a myriad of breast cancer topics, such as early detection, the initial shock of diagnosis, testing/scans, treatment, loss of hair, caregiving, surgery, emotional support, and advocacy.
These episodes will include breast cancer survivors, thrivers, caregivers, surgeons, oncologists, therapists, and other specialists who can speak to many different topics.
Disclaimer: I am not a doctor and not all information in this podcast comes from qualified health care providers, therefore does not constitute medical advice. For personalized medical advice, you should reach out to one of the qualified healthcare providers interviewed on this podcast and/or seek medical advice from your own providers.
Test Those Breasts ™️
Ep. 93: From Face Down in the Grass to Changing State Law: Gail Menasco's Rebellion
In this powerful episode, Jamie sits down with Gail Menasco, a breast cancer survivor, insurance advocate, and founder of the BRA Society, to unpack how one woman’s relentless fight for access to care led to real legislative change.
Gail shares her deeply personal story of being diagnosed at 38 and navigating a broken insurance system that nearly denied her the muscle-sparing surgery she needed. Instead of giving up, she researched surgical options, challenged insurance denials, switched jobs for better coverage, and ultimately pushed through Senate Bill 1137 in Oregon to expand access to breast reconstruction procedures for others like her.
📌 What You’ll Learn
- Why many insurance plans are quietly switching from PPOs to EPOs—and what that means for access
- What led Gail to write a bill and how she got it passed unanimously in the Oregon legislature
- The hidden cost of “ghost networks” and the real risk of balance billing
- The rise of the BRA Society and how it’s helping patients nationwide
- A breakdown of Senate Bill 1137—and what it could mean for future federal legislation
- How you can take action in your own state
💪 Call to Action
✔️ Visit brasociety.org for resources, advocacy tools, and grant info
📞 Contact your state and federal representatives, your story matters
💸 Donate to the BRA Society to expand grants for women needing out-of-area care
🗣️ Share your story, because stories fuel change
🎧 Also Mentioned
- Center for Restorative Breast Surgery (New Orleans)
- DIEP Flap vs. MS-TRAM vs. Apex technique
- The Women's Health and Cancer Rights Act (WHCRA)
Interview w/ Gail on Central Oregon Daily News
Interview with Dr. Elizabeth Potter
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I am not a doctor and not all information in this podcast comes from qualified healthcare providers, therefore may not constitute medical advice. For personalized medical advice, you should reach out to one of the qualified healthcare providers interviewed on this podcast and/or seek medical advice from your own providers .
Hello friends, welcome back to the Test those Breasts podcast. I am your host, jamie Vaughn. I'm a retired teacher of 20 years and a breast cancer thriver turned staunch, unapologetic, loud supporter and advocate for others, bringing education and awareness through a myriad of medical experts, therapists, caregivers and other survivors. A breast cancer diagnosis is incredibly overwhelming, with the mounds of information out there, and other survivors A breast cancer diagnosis is incredibly overwhelming, with the mounds of information out there, especially on Dr Google. I get it. I'm not a doctor and I know how important it is to uncover accurate information, which is my ongoing mission through my nonprofit. The podcast includes personal stories and opinions from breast cancer survivors and professional physicians, providing the most up-to-date information. At the time of recording Evidence, research and practices are always changing, so please check the date of the recording and always refer to your medical professionals for the most up-to-date information. I hope you find this podcast a source of inspiration and support from my guests. Their contact information is in the show notes, so please feel free to reach out to them. We have an enormous breast cancer community ready to support you in so many ways.
Speaker 1:Now let's listen to the next episode of Test those Breasts. Well, hello, friends, Welcome back to this episode of Test those Breasts. I am your host, jamie Vaughn, and today my guest is Gail Manasco. And Gail and I have actually known each other for what a couple of years now, and we met in the breast cancer circle and actually over at the breast center in New Orleans where we got our breast surgery. And I've interviewed Gail before about her story and about some cool things that she works on to advocate for others, and I'm really really pleased to have her back on the show to answer some questions and talk about a bill that just passed that she was very, very instrumental in, and so I'm excited to hear that. How are you doing, gail? It's been a long time I haven't recorded in such a long time and took a little hiatus from Test those Breasts and you are my first guest back on this new season.
Speaker 2:Thank you. Thank you for having me. I am doing well. It's funny. I mean, I was diagnosed two years ago and it honestly still feels like I'm on the journey, but just in a different way. I'm not having to go for scans all the time. You know, the doctor's appointments have calmed down, but I still feel like I'm in this journey because I needed to see policy change based on my experience with insurance.
Speaker 2:And just to recap, two years ago I was diagnosed with very early stage breast cancer at the age of 38. Very early stage breast cancer at the age of 38. But mine had unique characteristics it was high-grade hormonal negative, had a much higher chance of recurrence and, at the ripe age of 38, the tumor board recommended mastectomy in lieu of radiation. I did not undergo chemo due to catching this very aggressive cancer early, but I did undergo double mastectomy and reconstructed using my own tissue with a deep flap. Um, but it's so, it's such. It's kind of a wild journey because, uh, when I was diagnosed I wanted to have a deep flap, when I was considering my reconstruction options, which is using tissue and blood vessels from your abdomen to reconstruct the breast, and local surgeons wanted to convert that deep flap to an MS tram and MS stands for muscle sparing. But an MS tram actually takes muscle. It just takes less muscle than the traditional tram flap which took more of your abdominal rectus muscle to reconstruct, and it just it didn't sit well with me and there was a lot of things that that local surgeon quoted to me. He quoted me like a 14 to 15 hour surgery. Told me I'd be hunched over on a walker for a couple of months and he wouldn't quote his success rate but he just quoted the national average. Told me it was impossible not to take muscle due to my blood vessel anatomy. Told me I'd be in the ICU for many days and in the hospital for more days after that and I had a higher risk of bulge or permanent hernia and I could have decreased core strength. And I'm an active woman and I'm a scuba diver paraglider, I like to go out and do things and I want to be able to engage my full abdominal rectus muscle. So it just didn't sit well some of the things that he was saying.
Speaker 2:But I just started joining support groups, asking questions, learning about better techniques, and I learned about the SIA, the superficial inferior epigastric perforator, which is like another blood vessel that they can take if you have multiple nonlinear perforators with inadequate blood supply, which those perforators are like, the blood vessels that they take. And I also learned about a different technique called Apex, which was pioneered at the Center for Restorative Breast Surgery in New Orleans, where if you have multiple nonlinear perforators with adequate blood supply, they can cut the blood vessel behind the muscle, bring it around, reconnect it and then move it to your chest, which preserves your abdominal strength and reduces the chance of permanent bulge under, you know, 1% is what I was quoted. But I actually got that CTA scan it's like a CT angiogram and I overnighted it to multiple facilities to get multiple opinions to make an informed decision. And I started to find that many surgeons were going to take part of my muscle and it just still didn't sit well with me. And it just still didn't sit well with me. But I finally got on a phone call with Dr Cabling at the Center for Restorative Breast Surgery and he said look, I'm skilled in the technique that you need. I will not take your muscle, we're not going to lay down any type of mesh and your risk of bulge will be under 1%. And I said sold.
Speaker 2:But the thing is I had an EPO plan, which you might be like. What's an EPO? I've heard of PPO and HMO insurance plans, but never an EPO. But there's a rise of EPO plans on the individual marketplace and it stands for Exclusive Provider Organization and what these EPO plans do is that they limit care to a certain region. And so my particular region worked in Oregon, washington, idaho and Utah and had no out-of-service area benefits and no out-of-network benefits. And I actually had the Robert Wood Johnson Foundation refresh their study of PPO plans in the marketplace and they have been declining in many states they're just non-existent. Many states they're just non-existent.
Speaker 2:And actually here in Oregon there is a Pacific Source PPO and that I've read the filing. They haven't put anything out to the people on their PPO plans, but I've read the filing. I see what's coming. As of January Pacific Source is going to change those PPO plans to EPO plans and increase the premium. So, like right now, a Pacific Source PPO will work in Oregon, idaho, montana, parts of Washington and then work as Aetna outside those states as in-network for non-emergency care.
Speaker 2:But with the EPO it restricts access to care. So if you go outside that area it can only be for emergency care, which cancer, reconstruction, mastectomy none of that is emergency, that's considered non-emergency. And so right now, with these specific source plans, even if you have to go out of network, there's an out of network, out of pocket maximum. But all that is about to go away and this has happened all across the United States.
Speaker 2:But I actually had a Blue Cross, blue Shield EPO plan at that time because they had changed all their PPO plans to EPOs and so I was only allowed to go within these certain states and I made the case of I could get a better surgery, I could get a six-hour surgery out of state, I could preserve my muscle out of state, but they didn't care. They didn't care that I had access to better techniques and I kept on calling the Women's Health and Cancer Rights Act and they're like, yeah, but that's still subject to insurance, networks and limitations, sorry, and it didn't do me any good because they're like an MS tram is close enough to a deep, close enough, and I'm like I would actually have to pay cash prices for my mastectomy and reconstruction, which is well over six figures. It's very expensive. I didn't have the money, I couldn't do it. I mean, who can? Yes, the elite rich, but I'm not in that category and so I had to go back to the drawing board, figure out what to do and I'm like, you know, I'm gonna have to get a new job and wait the waiting period and get on new insurance. And I had job offers from companies in my back pocket that I had turned down and I'm like, hey, are you guys still hiring? And the timing worked out impeccably and I took a new job. I took on a new role, took on a new job, took on new hours and I had to wait the waiting period and they were willing to work with me on the hours and that sort of thing so I could have surgery and still work for them, and I did.
Speaker 2:I had to take a new job and I got a PPO plan. But that PPO plan was still out of network. But written into that PPO plan were limitations that would only pay the hospital like $3,500 a day if I wanted to use those out-of-network benefits. It turns out where I was trying to go, that hospital does not charge $3,500 a day. So this is where you encounter balanced billing. So if your insurance won't pay what they're trying to get, you can be balanced billed, uncapped of what that could be. So what if I need to stay in the hospital more? What if there's a complication or I need to go back into surgery? I need to stay extra nights? I couldn't take on that risk of uncapped balance billing. I got a call from Blue Cross and they're like yeah, you could be balance billed upwards of six figures if you go.
Speaker 2:And I'm like, are you?
Speaker 1:kidding, and you had already just jumped through all those hoops.
Speaker 2:And I'm like, oh, are you? So I lost it. I was face down in the grass on my front yard. Yes, I have cancer. Yes, it's early stages, car early, but I don't know the full impact of everything until everything's gone off to pathology. I'm freaking out.
Speaker 2:I want to get my surgery. I've waited long enough and I'm pissed that I can't get the reconstruction of my choice and that insurance is forcing me into going flat because I did not want implants and that was just my choice. I know other people have good experience with implants, but for me I didn't want them and I wanted to be allowed the choice and I was a candidate for the surgery. It was just out of state, out of area, out of network and I couldn't get it. There was no way for me to get it and I cried face down in that grass. I felt like Barbie from the Barbie movie and I was hopeless, you know. But I had to keep fighting. I had to keep fighting for what I wanted and I'm writing letters to the billing team, you know. But, like I was part hopeless too. But my case wound up to the board of directors and got on the CEO's desk and they let me come. And I think because my insurance would still pay the surgeon and not the hospital. I think if my insurance wouldn't pay the surgeon, if it was still that EPO, they would have just said tough luck. They told me not to advertise what they were doing here. I'm talking on a podcast about it but they let me come and not balance bill me. I still paid my out-of-network, out-of-pocket maximum. I still had balance billing to pay because I was using out-of-network benefits. I still paid into the system, but they didn't get reimbursed adequately for my hospital stay because that reimbursement was well below even what Medicare would pay.
Speaker 2:I got my surgery. It was six and a half hours. They preserved my muscle. They took a photo. They showed that they kept my abdominal rectus muscle intact. I didn't have to hunch over a walker. I was able to stand up straight. I retained my core strength and I was able to get back to my hobbies. Even a few months after that phase two surgery I was able to even go scuba diving and get right back into paragliding as well. I did did it like I got the surgery, but it shouldn't have been that hard.
Speaker 1:You know, like that's not how the system should work, and I especially when you have breast cancer too like people who are going through any kind of illness, for that matter we should not have to jump through the hoops that you did, and I mean there are a lot of people who would not be able, just, you know, to go find another job and, you know, try to get some insurance and things like that. Not everybody has that access and I know that. Um, I know that your story touched Dr Cabling. You and I had the same surgeon at a center for restorative breast surgery and I know that that touched his heart and he was extremely impressed as well because of your tenacity and all of that. It's so much that when I was on my recovery bed, he said you need to reach out to Gail and hear her story, which is originally how we met, and I was super impressed.
Speaker 2:Because insurance can be really, really complex. Thank you, right. And during that process I was filing complaints with our state's insurance commissioner and learned that every state has an insurance commissioner and there's a Department of Financial Regulation here in Oregon and I was filing complaints and I was calling, and there's this guy, patrick, and Patrick would pick up the phone almost every time I called, because I am a problem solver there's a problem, let's solve it. You know, like, what can we do? How can we make this better? Right, and one day I'm just complaining about how this whole system worked and Patrick on the phone said well, gail, you're just going to have to make policy change. And I'm like, okay, fine, I'll go make policy change. And now I had a new direction. I needed to make policy change. And I had no idea how to make policy change. I knew the lyrics to I'm just a bill from schoolhouse rock and I can already tell you that it is missing many lyrics that should be included in that song so many other layers and I just right.
Speaker 1:And.
Speaker 2:I even I went to my local representative, you know, for my district and he and I sat down for coffee and I showed him, you know, the Apex technique and my story and the insurance. And then I never heard from him, you know, and it just the conversation ended and so I had to go to the representative next door to be like, hey, can you help me? And then even there was a senator running for um to be the representative or state senator for my district, and so he wasn't the senator yet. But I went to his Facebook page and there was a phone number and I called it and he picked up and I'm like, oh, I scored a cell phone and I was able to explain the problem and I'm like, okay, I'm just going to keep on being the squeaky wheel.
Speaker 2:I showed up to an American Cancer Society health policy forum up in Portland, drove to Portland, started meeting people there and just started sharing the problem and I wasn't sure what the solution was. But I just kept on being the squeaky wheel and just kept on talking to policymakers and meeting representatives, meeting representatives and finally multiple people said you should speak to the insurance commissioner or we should speak to the insurance commissioner on behalf of you, but I knew I was going to be the better one to explain the story and what went wrong. And finally, the representative next door, representative Levy. She made the introduction to his office and he, you know he said that he and his team love discussing insurance policy and I'm like finally yes, let's sink our teeth in the insurance policy Like I like I have been dying for this conversation.
Speaker 2:And we met. And then we met again and we met again and I remember the call where I actually got to meet Andrew Stolvey, the insurance commissioner, and I told him that I felt like I was meeting Beyonce because I just was so excited to meet with him and talk about this. And what was born from these meetings was my first bill Senate, bill 1137. And I wrote a bill with help. I had help, the DCBS helped me and I mean we were just getting into deadlines here. I was beyond deadlines of getting this done, but what happened is kind of during this process, I just started helping women all across the country navigate insurance. I learned from how insurance works and what it means and limitations and how the different plans work and who's in network with who, and I'm like I need to be more than a person. I'm going to file to be a nonprofit and put together a board and became a 501c3 nonprofit Bra Society.
Speaker 1:The Bra Society Bra.
Speaker 2:Society stands for Breast Reconstruction Advocate Society and started helping women who they're just getting denied. They've got botched surgeries and their local surgeons couldn't help them and what insurance was doing is sending them to ghost networks. It was saying that they had a list of surgeons that they could go to. And then they start calling and they're like no, we don't do that, we don't do that reconstruction, we can't help you. But there's places out of area, out of network, that could help them, but then they couldn't go. They're being quoted cash prices. And then there's this one woman who was a nurse and she kept on getting denied and I had to get in front of the surgeon that she was trying to go to walk with him down the hallway like, plead her case to him and got him to fly to a different state, to a place where he could do surgery in network under a different contract, and got her that surgery.
Speaker 1:These are the things, yeah, and I think that it's really important for a lot of people especially if they don't have experience with breast surgeries and things like that and under have an understanding of the different types of breast surgeries is that these insurance companies don't know what we know, what you know about the kinds of surgeries that we're looking for, and they can't just send you to any surgeon and say, oh, the this, this guy can do a deep flap surgery or whatever.
Speaker 2:Right or alternative flaps like S-gap, pap, t-dap, stack flaps, there's lap flaps, there's so many different kinds of flaps. And the thing is, if there's an inadequate network, insurance does not have to let you go out of area, out of network. They do not have to approve a single case agreement that allows you to go at a negotiated rate between insurance and the provider, at an in-network rate towards your in-network out-of-pocket maximum, and they don't have to rate towards your in-network out-of-pocket maximum, and they don't have to. And so we created Cinnabill 1137, which lists out a lot of different procedures.
Speaker 2:I went to many different websites, you know, looking for autologous breast reconstruction procedures. So breast reconstruction procedures using your own tissues that's autologous breast reconstruction, but specifically the ones on there are ones that don't compromise the muscle. And there's a lot of autologous breast reconstruction offered that do compromise the muscle, like the latissimus flap. But then there's been improvements over what is available to women that don't compromise the muscle. You know, you've got S-gap, pap, t-dap, stacked flaps. There's so many other things that don't compromise the muscle that are available, but they're so few and far between because there's only a few surgeons offering them. And then what I've learned, like many of these surgeons like Dr Srini Basit down in Southern California. She's out of network with all insurance and you're seeing more and more surgeons go out of network. So now you have to have out of network benefits. But if you're on a marketplace plan or an individual marketplace plan, chances are you don't have out-of-network benefits and so now you've got to pay those cash prices. If you don't have those out-of-network benefits, no insurance doesn't even help you, but they're doing that to get higher reimbursement rates. But they're doing that to get higher reimbursement rates.
Speaker 2:And so what my bill does is it lists out specific coverage for these flaps and techniques, including APEX and SIA, and if there's an inadequate network, it first encourages that single case agreement. And that's really important because that should be the first step is actually try to get that single case agreement. And this bill is actually going to help Oregon women get that single case agreement, because now you have a negotiated rate in between the provider and the insurance with the goal of not balance billing the patient Right, the insurance with the goal of not balance billing the patient right. Because now if a single case agreement doesn't go through now, the plan is it'll pay at the median in-network rate. Now the thing is that that may be lower than what they're willing to accept, and so now balance billing can come into effect, but at least there's something that insurance is paying. That's hopefully a good enough rate for providers to accept. But that's why the first thing that you want is a single case agreement to go through by listing these procedures. But the commissioner's office was unwilling to say, well, we'll just pay whatever rate that they've set, because now they can just overly inflate their rates, and so they couldn't do that, so they could pay out a median in network rate and then help advise of what should that be based on?
Speaker 2:But then the question is what is an inadequate network?
Speaker 2:You know how do you determine an inadequate network, and what's interesting in Oregon is that Senate Bill 822 just passed that talks about network inadequacy, and through multiple rulemaking sessions they're going to be really defining what does network inadequacy mean? And I've been invited to join in on those conversations to talk about what does network inadequacy mean? Is it wait times? Was the provider to patient ratio, or maybe distance to provider patient ratio, or maybe distance to provider offering it? You might call deep lab providers, but they may not be able to get you in for a year. That shouldn't be considered an adequate network if you can't get in for a year.
Speaker 2:But those rules have not been established yet and I'm really excited to be a part of that conversation to learn and get into the definition of network adequacy. But Senate Bill 1137 is different from the Women's Health and Cancer Rights Act because the Women's Health and Cancer Rights Act really talks about breast reconstruction but it's not listing out specific procedures. It's not listing out specific techniques. So insurance companies didn't have to give you a single case agreement but this now strengthens that.
Speaker 2:Right, it's a start, and so this, by listing these specific procedures as well as revisions. It includes like tattooing and that sort of thing too. This helps strengthen that argument. Now, to let a woman go out of area, out of network and network rates, is the goal is to increase access, and now this is an Oregon law, but there's an opportunity to go federal and talk at least about coverage for these specific things. Now, when you get into reimbursement rates at a federal level, if they're reimbursing at a lower rate, then that's going to reduce access because you're going to have less surgeons that will accept these patients.
Speaker 2:So many times they are denying. I had a local woman who needed a reduction in lift before her mastectomy and insurance company denied it twice, calling it cosmetic, and the surgeon who's even doing it doesn't do cosmetic plastic surgery, you know. And and then I'm like no, we fight, we fight, we put on like our fighting armor and we fight, you know, and helped her, you know, fill out a complaint form to the insurance commissioner, got them talking to insurance to help facilitate that peer-to-peer. But providers know how to provide even more information than what's required to get things approved and most people don't fight a denial. And this is where we need to change the narrative we fight, you get denied again. We fight again. Let's, let's keep fighting, let's go to the next level and, and if the final level is making policy change, then let's go. Let's go do that.
Speaker 2:My experience I got a crash in policy.
Speaker 1:Yeah, what I? Yeah, I've always thought. I remember watching a documentary quite a few years ago and they were talking about insurance and these people were testifying people who used to work for insurance companies and they used to say we were literally trained to deny first and I think that so many people don't fight it that they always win. So now you're coming along and you've got the bra, you got bra society, so you're advocating through that nonprofit. How does that work? How do people find you? How do people um obtain your services?
Speaker 2:Yeah, yeah. So here at Broad Society we're also giving grants to local women who need to travel for surgery, whether it's aesthetic flat closure or mastectomy or implant-based reconstruction, autologous breast reconstruction, construction anybody who's having to travel for surgery, whether it's driving three hours or taking a plane ticket. We are providing grants to those local women to help offset those travel costs, because we want to directly help the woman and even if we're introducing policy change that allows them to travel, but now they've got to pay for that extra tank of gas or pay for that hotel or pay for that plane ticket. That becomes very expensive already when they're probably having to reduce their hours at work or have less income or pay their out-of-pocket maximums.
Speaker 2:And right now finances get very tight, whether you're a previvor or a cancer patient, because you're hitting your out-of-pocket maximums which can be still very high and so a lot of this has just been through word of mouth, support groups, through word of mouth support groups going to my local cancer center, friends. But the thing is we are very smallly funded right now. It's just been some friends and family that have donated. So I can't expand that grant program until we get more funding. So that's the next thing. I'm that's a whole other going to Salem and educating lawmakers how the bill works, why it's needed.
Speaker 2:But what was passed unanimously in the Senate Health Care Committee the ways and means, the joint ways and means we got it through there. Everybody voted yes to committees and on the floor votes, everybody voted aye, yes, so we didn't have any nays. Now, behind the scenes, I got some opposition of I won't name who. It got a little scary there because you've got providers and places really caring about reimbursement rates and um, which I understand. But the goal was to have a fair reimbursement rate. But I did add an amendment encouraging the single case agreements and change some things. But I really started to see how money plays in healthcare.
Speaker 1:And.
Speaker 2:I had to seek out some legal counsel and it got wild there. So on paper it looks just this beautiful, all the yes all around on the bill, but behind the scenes, yeah, I got phone calls from a lot of important people and lawyers and I had to learn quickly and try to provide something that increases access for patients that also encourages a fair reimbursement rate. So, yeah, things got a little hairy there.
Speaker 1:You ruffled some feathers, I did I did, but I kept going.
Speaker 2:Yeah, I was asked to stand down and not testify at the hearing and it'd been a really hard day of getting texts and phone calls and telling me to pull the bill down and I'm like I'm not, I'm not pulling the bill down. I mean, I've met with our states. I've met with DCBS many times, I've spoken to the insurance commissioner. We've brought experts in and there's also time to make tweaks and amendment. But I learned there was bigger things at play beyond what this does for Oregon women that I can't go to, I can't talk about too. I can't talk about um, as I'm not naming names or or the bigger things at play, but but I learned, I learned I learned a lot in this process and I'm glad I stuck to my guns. I'm glad I went to the hearing, um, and what was really cool was that Dr Elizabeth Potter actually showed up to that hearing in support. So she showed up remotely she's able to testify remotely and showed her support of the bill and how it increases access. She's been a very strong advocate online and exposing how insurance works and I see a vision. You know, I honestly hate the amount of profits in health care and people just getting reduced access to healthcare in the process. I mean even just with these EPO plans. You know you've got I'm about to lose significant access to healthcare and if I get a recurrence or something goes in my brain and I want to get to an MD Anderson or a Mayo or Johns Hopkins, I won't be able to unless I can prove that network and adequacy and really know the law for a single case agreement. But if there's a guy offering something similar down the street they're going to say, well, there you go. But the reduction in PPO plans is a huge impact, especially for small business owners. Or you know you've got entrepreneurs who need to shop the individual marketplace, who don't have access to these PPO plans. You also have the recent bill that just passed in Washington that sweepingly reduces so much access from many different points of view. There's so much that just happened and you're about to have a lot of people lose access to Medicaid. They're about to lose access to their cancer care, their cancer screenings, and there's so much more red tape that's being put down. And if I've learned anything about red tape and more paperwork is you have people diagnosed with things and they don't have the mental energy to figure out what's that next step? Or, oh, I now need to submit this every six months, or now, this open enrollment period is now a lot shorter. Or, hey, these enhanced premium tax credits are going away. That actually made my health insurance somewhat affordable, and now you're going to see a massive increase in what patients are paying for their insurance premiums. For my family of three, we pay close to $1,800 a month for an individual marketplace plan, and that same plan is about to increase by 4%. And then I now won't have access to non-emergency care across the US. And this bill hurts average Americans. It hurts lower and middle class Americans and the amount of people that are about to lose their health care I don't know. There's predicted like 17 million or so.
Speaker 2:And just from the Medicaid cuts, from the advanced premium tax cuts going away that aren't being extended that was brought in with, I believe, the Inflation Reduction Act.
Speaker 2:These premium tax credits helped people afford these marketplace plans, which are crucial. They're absolutely crucial, and it's going to be so many entrepreneurs, small business owners, but then you also a group of people that's going to be heavily impacted are going to be the people who are older Americans who don't qualify for Medicare yet, you know, like a 60-year-old, you know still working, but now they've been saving hundreds of dollars a month but their salary hasn't been going up. And so now you're going to take away these tax credits, and now theirs is about to go up to be unaffordable. So you're going to have all these people that just drop out of their health insurance coverage because they just can't afford these monthly premiums, right? And so what happens? When you've got these people who now don't have health insurance because they can't afford it, and now they have a heart attack, they need to go to the emergency room, they're going to go to the emergency room and now the hospital is not going to get reimbursed for that patient's care. It comes back to reimbursement.
Speaker 1:And think about that's going to fill up the emergency rooms.
Speaker 2:It's going to tank hospital.
Speaker 1:Right exactly.
Speaker 2:Your wait times in emergency rooms are about to go sky high because you did have people on Medicaid who had a primary care provider. They had a point person for their care and now they're having to use the emergency room and now the hospital's not getting reimbursed. And so now you think about these hospitals in rural areas that aren't getting reimbursed and maybe had a much higher Medicaid population. I'm not saying that everybody's going to lose their Medicaid, but by the additional red tape, you're going to see people lose their coverage as well as people losing coverage just due to just higher premiums. Well, and it's not sustainable and I'm worried about the hospitals. Actually, people losing coverage is due to just higher premiums.
Speaker 1:It's about to happen. It's not sustainable. I'm worried about the hospitals actually.
Speaker 2:It's not sustainable.
Speaker 1:Yes.
Speaker 2:We have a supply and demand problem.
Speaker 1:There's all kinds of layers. This keeps me up at night it keeps me up at night.
Speaker 2:Yes, and and it's ridiculous, this is absolutely ridiculous that here we are, america and the United States of America, and we say how great our country is, but then we're not caring for our people. And I honestly believe that healthcare should be a right. Yes, I think you know if, if you get robbed, you can call 911. You know we have access to these services. And if you need cancer care, you should have access to these services. You need cervical screening care? You should have access to that. If you need a mammogram or you need a biopsy, you should have access to that. And so many other countries are providing that for their people. They are investing in their people, they're investing in their people's education, they're investing in their people's health, and we are taking that away.
Speaker 2:Yes, and I honestly believe that there could be a vision for a single payer system that works, a single payer system that provides spare reimbursement rates, a single-payer system that doesn't decide who they want to give insurance contracts to or not. I watched a video from Dr Potter recently about. She didn't name who, but she said that there was two insurance companies that will refuse to go in and network with her, I think because of how she's spoken out against insurance companies and that shouldn't be the case. No Right, that shouldn't be the case. No Right, that should not be how this works. They shouldn't be able to retaliate against you because of you speaking out and just reducing access yeah.
Speaker 2:Exactly. This isn't how this should work. And when I see the health equity firms making so much money and profits and providing the profits to shareholders and looking at the profits of big insurance companies, it makes me sick. When I've got women messaging me that their surgery got denied and they're being offered cash pay for these surgeries, it's not how it should work. This is not what living in America should be. And you've got other countries just taking pity on us and hearing how these women can go get deep flaps for free in other countries.
Speaker 2:It's just not how it should be and it's time to stand up. It is it's time to build a better vision and it's time to go to Washington. It's call your legislators, it's call your representatives. Are you getting denied for surgery? Do you not have access to an adequate network? Then it's time to make policy change. It's time to call your representatives and make that change. And I see a system where physicians can get paid a fair reimbursement rate and where patients have access to care and that's medically necessary. This shouldn't be rocket science to take out some middlemen and create a system that actually works. It's not based on greed and corporate profits.
Speaker 1:Well, and when I was, you know, when I was a kid, I remember very well. All the way through high school and college I was always taught you know, go to school, get a good job, get some good insurance. You know, go work for the state, do what you can, then get your retirement and you'll be all good.
Speaker 1:And now we're seeing people who have worked all their lives and are in these jobs that you know they've got, these insurance are being denied and or they retire and they're not getting the benefits from insurance. Medicaid is going to be disappearing I am hearing that it's going to affect Medicare as well and so this disillusion, this disillusionment of how things are supposed to be, is astounding, and so I feel like we should put some calls to action in our show notes to be part of the solution. You are one person and we need other people working on this in every single state, absolutely.
Speaker 2:Absolutely. And if I can make policy change without having a background in making policy change, then other people can too. Let's stand up, let's join our voices, and when people are getting denied, it's time to fight back. And people need to be calling their representatives If they're unable to get the surgeries that they need and if they're unable to get the cancer care that they need, or if they aren't having access to healthcare that they can actually afford.
Speaker 2:Tell your story, because stories hold power. It's your story is what makes change right, and the more stories that they hear, then this is how we get change going. But it's more than a story. It's hey, here's a problem and here's a solution. Here's a solution that I envision. Here's a solution that I envision. And then you can see hey, did some other state kind of do a very similar solution? You know, states like to borrow policy from other states and have a template. That's how bigger organizations are getting policy change done by introducing legislation in one state and then using that for other states and then to even make federal change.
Speaker 2:But talk to your federal senator representatives. There's people picking up the phone and there's people taking meetings and the thing is you need to find out who is your federal congressman or congresswoman, who is your federal senator, and then who is your state house representative, who is your state, you know, senator, and knowing who are those people, hey, and who are the people next door? If these people aren't taking my meeting or if they don't care, who does care? And then you can start to see what other bills do they support? You know they put their names. They sponsor different bills and then you can even talk to to those people too.
Speaker 2:And I just spent time cold calling in the different offices and setting up 15 minute meetings in person, meetings with with representatives of the Capitol, meetings with with representatives of the Capitol. And I showed up and I did 12 meetings one day with senators at the Capitol and and had 15 minute meetings and just went boom, boom, boom, boom. And what I did is share a story and the problem and the solution, and it's like part of this is becoming a very good storyteller, but, but quickly, because you don't have a lot of time to meet with them. Um, but it's time to be in together, you know, and have have a day, let's go to Capitol Hill, let's, and then let's work to get the right legislation introduced in other states and and there's so much change that can happen, you can't just say, well, we're just going to reapply the healthcare system overnight, it's not going to happen.
Speaker 2:But, what can we do, what are the small changes and what is like your issue? You know, like even my oncologist said to me, Gail, can you help me get cold capping covered? And I'm like sure, yeah, why not? You know, let's, let's figure, let's figure that one out. You know, and then I found bill language in New York around cold capping and I'm like, oh, looky, there there's a template. Oh, here, let's talk to these legislators, let's see can we copy this? And and understanding when your sessions are like in Oregon they do a long session every other year and then there's just a 30-day short session in between. And so, learning when is your state's session? And showing up, showing up to policy meetings, showing up, and you may not know what you don't know, and each state is different on how that works. But you kind of learn by doing right, and I think you just have to not be afraid to not know all the answers right and just keep on talking and keep on showing up and see where that gets you.
Speaker 1:Yeah, and well, in all the connections that I have you're one of my connections that if I ever have a question about different kinds of surgeries or what kind of questions to ask surgeons or you know policy and insurance anytime I have questions, I'm always like I got to call Gail Cause you're like, you're like an on-brought society.
Speaker 1:Yeah, you're a broad society, and I know it's not easy to be a revolutionary. You are, though, you, and you've learned so much throughout this process, and it's really helpful for people like me, because people tend to call me a lot and ask me questions, and these are things that I know that I can reach out to you because of your experience, and therefore I learn and we can kind of take it from there. So I just, you know, really appreciate your, first of all, having the bra society. That's, that's, uh, totally awesome, and I'll put your donation link in the show notes as well so that people can donate and because I definitely know how hard it is to get funds for a nonprofit.
Speaker 1:But also I would like to put maybe a list of five things that people can do in their own state to help out with this situation. Simple things that they can do, whether it be picking up them, making a phone call or if they happen to be going to Washington. Farrell and I my husband and I were just in Washington for an event, and what did we do? We decided to stop at the Capitol to visit our Mark Amaday, our congressman. Of course, he wasn't there, but we did go by there and we talked to one of his guys there about education and about what we're concerned about as far as you know SNAP and nutrition for kids and things like that. And it really was. It was like a 15 minute meeting that we had and we set our piece, and so any person can do that.
Speaker 2:Absolutely, absolutely.
Speaker 2:And I did not understand before, you know last year, how important state legislature is, because that is the laws that are affecting your state, in your community, and those people can be very accessible to you, especially if you're a constituent of them, because you can request a meeting and their office will meet with you and that's where, if you can state the problem, share your story, state the problem and a potential solution, that right there is huge because while my representative didn't fully understand breast reconstruction at the time or that insurance policy, they were able to immediately refer me to the experts in insurance policy and actually really talk about how it could work and potential solution to the problem.
Speaker 2:But then they were on board with those discussions and what came out of those meetings. And and if I can do that, other people can do that. And if you are unable to leave, you can do phone meetings, you can do zoom meetings and even your federal centers will have a person who represents your area, like here in central Oregon. I have someone here that I can speak to and meet with and go to the town halls. I was just at a roundtable for Representative Bynum earlier this week and asking questions regarding the impact of mastectomy and reconstruction with the recent bill that just passed and start. Start showing up, because your voice does matter.
Speaker 2:And and at first I'm like, well, no one's going to, no one's going to care that I couldn't preserve my muscle during reconstruction or you know. But it actually they. They did care and my story made an impact. And these stories hold power and I just encourage people to find out who are your state and federal representatives in the House and the Senate and tell your story to them and reach out to the Broad Society. We should be banding together and working together to make policy change that helps women facing breast cancer or high risk of breast cancer.
Speaker 2:And you know, like something that's been brought to my attention is that the Women's Health and Cancer Rights Act doesn't really apply to anybody having a lumpectomy and maybe had a lumpectomy, but WICRA doesn't apply WICRA short for Women's Health and Cancer Rights Act and there's changes that can be made at a federal level. But then there's also changes that can be made at a state level and each state even has a different version of WICRA Like Oregon's version of WICRA is different from Louisiana's version of WICRA and there's an opportunity to see who's doing it right or how can we improve upon this or how can we make it better. You know, there's even like techniques for sensation, preserving mastectomies or resensation techniques, and I was actually trying to get that added to my bill, but it didn't go through on this round. But then I'm going to try again.
Speaker 1:Sounds like you're going to be working on a bill every time.
Speaker 2:You know I mean, this is my volunteer work and this is how I'm taking all this knowledge I've learned and using it to better the lives of other people around me. I got my surgery, but it didn't have to end there. I'm still on my journey and I was always taught to leave the world a better place. Be the change right. We all saw those inspirational quotes growing up, and this is my chance to be the change and make things better for the people behind me who are now needing to navigate insurance and stand up and tell these women's stories, as well as my own.
Speaker 1:Yeah Well, it is greatly appreciated, I know, among the breast cancer community and we just really appreciate your knowledge, your experience and your continued education along the way. So, gail, thank you so much. I so appreciate your being here. Thank you for Bra Society. Thank you for, you know, getting that bill passed and giving us some morsels of things to think about in our own states and how we can be part of the solution as well, because I built, I just feel like everyone deserves that, but we also all have to be part of the solution. So, thank you so much. Is there anything you'd like to leave us with before we disconnect?
Speaker 2:Go to brasocietyorg. I've got a blog there questions to ask your surgeons for aesthetic flap closure you know, not putting on a shirt at a guest post for that. We've got questions to ask for deep flap. We've got some alternative flap information there what to pack for surgery. So there's some great resources on brasocietyorg. Check it out and don't be afraid to speak up and share your story awesome.
Speaker 1:Thank you, gail, and I'm going to actually include your other interviews that we've done together in the show notes so that people can go back and listen to some other information about you and your life and your experience, and so thank you so much and to my audience. I appreciate your joining me. I know it's been a few months, but I'm back and in action and I will see you next time on the next episode of test those breasts. Bye for now, friends. Thank you so much for listening to this episode of test those breasts. I hope you got some great much needed information that will help you with your journey.
Speaker 1:As always, I am open to guests to add value to my show, and I'm also open to being a guest on other podcasts where I can add value. So please reach out if you'd like to collaborate. My contact information is in the show notes and, as a reminder, rating, reviewing and sharing this podcast will truly help build a bigger audience all over the world. I thank you for your efforts. I look forward to sharing my next episode of Test those Breasts.
