At least two South Carolina congressman are ready to consider changing a federal law that now denies Medicaid coverage to men who need treatment for breast cancer.
And other advocates, including lawyers from the American Civil Liberties Union, are questioning the legality of the current eligibility guidelines.
Amid outrage from patient advocates Monday, U.S. Sen. Lindsey Graham and U.S. Rep. Tim Scott said they would consider amending the current rules if administrative actions fail.
"I certainly agree it is wrong to deny breast cancer coverage to a patient because he happens to be a man," said Scott, R-S.C.
"We'll see if there's an administrative way to fix the problem. If not, we'll look at it legislatively," said Kevin Bishop, a spokesman for Graham, R-S.C.
The federal Medicaid agency made the issue a priority Monday, a day after The Post and Courier published a story about a 26-year-old Cross man who was denied breast cancer treatment coverage because of a loophole that excludes men under the law.
"We are working with ... South Carolina to see what options may exist to address this situation," the U.S. Centers for Medicare & Medicaid Services said in a statement. "We are committed to ensuring that all individuals who should be eligible for this program have coverage."
The Breast and Cervical Cancer Prevention and Treatment Act, a federal law enacted in 2000, uses Medicaid funds to cover treatment for breast cancer or cervical cancer patients who otherwise wouldn't qualify for the state and federally funded health insurance program for the poor and disabled.
But federal guidelines for the breast and cervical treatment program say women must be diagnosed through "early detection" programs funded by the Centers for Disease Control and Prevention, a federal agency.
The Centers for Medicare & Medicaid Services neither recommends nor covers routine breast cancer screening for men, meaning they "may not be considered screened" under the treatment coverage program, according to its guidelines. In South Carolina, such screening is offered to uninsured women between the ages of 47 and 64 who meet certain income guidelines.
Breast cancer is rare among men, so limiting screening programs to women makes sense, said Sandra Park, an attorney with the ACLU Women's Rights Project in New York. But denying treatment to men who have already been diagnosed does not, she said.
"Once a man is diagnosed, he should not be denied treatment because he's a man and not a woman," Park said.
She pointed out that provisions of federal health care reform forbid discrimination based on sex.
"It raises questions about whether the program violates anti-discrimination provisions of the Affordable Care Act," she said.
Others put it more bluntly: "It's silly as hell," said former S.C. Sen. Kay Patterson, a Columbia Democrat. Patterson, an 80-year-old man who retired from the Legislature in 2008, was diagnosed with breast cancer in 2003. "If you discriminated like this against a female, people would be up in arms," he said.
Raymond Johnson, an uninsured construction worker from Cross, is the man at the center of the current debate.
Still reeling from his most recent chemotherapy treatment last week and unaccustomed to the spotlight, Johnson said he was interviewed by a variety of national media outlets Monday, including Fox News and national networks ABC and CBS.
"I'm glad the word is getting out there," he said.
Doctors and nurses coordinating Johnson's care at the Charleston Cancer Center said they won't back down until they see changes. Patient advocate Susan Appelbaum and oncologist Julia Saylors said medical bills for patients like Johnson are devastating.
"It's not something he'll be able to financially overcome," Saylors said.
Reach Renee Dudley at 937-5550.