One simple test could end up saving thousands of women’s lives. Yet, for those without health insurance, the test comes too late. According to the American Cancer Society, this year alone an estimated 40,170 women will lose their lives to breast cancer. Meanwhile, it is estimated that 4,000 breast cancer deaths could be prevented just by increasing the percentage of women who receive breast cancer screenings to 90 percent.

Breast cancer often can be treated with early detection. That's why health insurance that pays for mammograms is especially important. But mammography rates declined between 2003 and 2005, with a notable decrease for Hispanic women (from 65 percent to 59 percent) and African-American women (from 70 percent to 65 percent). An estimated one in five women over 50 has not received a mammogram in the past two years.

Everyone needs health insurance to keep healthy, yet women are disproportionately underinsured. An estimated 21 million women and girls went without health insurance in 2007, according to the U.S. Census Bureau. And a recent congressional report found that 18 percent of all women not eligible for Medicare are uninsured, which translates to 28 percent of 19 to 24 year olds and 26 percent of single mothers without insurance.

Why are so many women left uncovered? Perhaps it’s because many medical situations faced by women are treated as pre-existing conditions, including breast cancer. The National Cancer Institute estimated that in 2004 approximately 2.4 million women had a history of breast cancer. But without continuing coverage, cancer survivors face steep risks.

A recent report by the Department of Health and Human Services found that breast cancer patients with employer-based insurance had total out-of-pocket costs averaging $6,250 in 2007, higher than out-of-pocket spending for patients with asthma, diabetes, chronic obstructive pulmonary disease or high blood pressure.

Why are women falling behind in insurance coverage faster than men? According to the Department of Health and Human Services, various factors restrict women's access to health care, which include a vast array of "pre-existing conditions” such as breast cancer, pregnancy, caesarian section and domestic violence. In addition, women are less likely to be employed full time, which makes them less likely to be eligible for employer-based health benefits. In fact, fewer than half of women have the option of obtaining employer-based coverage.

Any health care reform proposal should take that into consideration and include access to comprehensive care, including preventative care such as mammograms. Americans, men and women alike, understand this need. A recent poll commissioned by Moving Forward, a values-based research initiative developed by the Women Donors Network and the Communications Consortium, found that a strong majority of voters -- 87 percent -- think insurance companies should be required to cover women’s preventive care and screenings, such as contraception, Pap tests for cervical cancer and breast cancer screenings.

Public health experts recommend health insurance coverage be universal and available to all regardless of work status, place of residence, health status or other factors unrelated to need. Reform should be aimed at achieving quality outcomes and eliminating disparities as well as at being affordable. Coverage also needs to be continuous from birth until end of life without interruptions or delays, as gaps in existing coverage allows women to fall through the cracks.

Reform will bring health care to more American women and their families than ever before in our nation's history. Women would do well to learn more about their stake in health care reform. One good resource is www.WomenandHealthCareReform.org. As we end National Breast Cancer Awareness month, the best thing we can do to end breast cancer is to make sure all health insurance coverage is universal -- not limited by exclusions due to pre-existing conditions -- and includes preventative care and basic services such as breast and cervical cancer screenings. Let's create a system that provides health care, not just sick care.



Wolf is a board member of Living Beyond Breast Cancer and Women Donors Network and leads WDN’s effort on reproductive and other health issues.