Janet's Law
The Minerva Project • December 5, 2025
The WHCRA, or “Janet’s Law,” was passed as part of an 1999 omnibus bill, and contained protections for patients seeking breast reconstruction after mastectomy. This allowed patients with breast cancer, or at risk for breast cancer, to have reconstruction fully covered by their healthcare plan if they chose to get a mastectomy, making reconstructive and preventative measures more accessible. However, the law doesn’t address the nuanced realities of breast surgery, including partial mastectomies (lumpectomies), flat closures, or deformities caused by the diagnosis process (like through biopsies).
In November, a revision to the WHCRA was introduced to Congress, which seeks to close the gaps in coverage for many of the above procedures. However, it conditions these benefits on a breast cancer diagnosis, providing coverage to services only “in connection with breast cancer treatment,” making it difficult for high-risk patients who have undergone preventative mastectomies to receive coverage for breast reconstruction. Although often framed as cosmetic or non-essential, this restriction has broader and potentially harmful consequences of incentivizing high-risk patients to delay preventative surgery until after diagnosis, when the cancer may be more advanced. This is especially significant for those with hereditary risk, including BRCA mutation carriers who have markedly higher lifetime cancer risks.
The Modernization Act also ties reconstruction coverage to Level I medical billing codes, which maintains older procedures for breast reconstruction. Over the past few years, physicians have been fighting for the coverage of S-codes, Level II codes that allow surgeons to bill for newer, complex microsurgical techniques, which are neater and potentially safer through preservation of muscle. The new revisions may undermine years of advocacy that have helped recognize these new techniques.
Healthcare legislation is inherently complex and requires collaboration among policymakers, clinicians, and patients. However, the recent revisions to the WHCRA were developed with limited physician and surgical input, setting a concerning precedent for regulating clinical care without sufficient medical expertise. While the Modernization Act has yet to be passed through the House of Representatives, it is important that there is meaningful involvement from those on the front lines of patient care so that the legislation does not restrict access rather than improving it.