A stalled bill to require better insurance coverage for breast cancer screenings led to a campaign that helped oust North Carolina’s most powerful politician.
Senate leader Phil Berger lost his primary in March to Rockingham County Sheriff Sam Page by just 23 votes. When the margin is that close, every factor that influenced at least 23 voters could be considered a deciding element in the race.
Some have tied Berger’s loss to opposition in Rockingham County to a proposed casino that the senator supported. But it’s not the only aspect of Berger’s legislative record that came under criticism during the primary.
Viewers of Triad TV stations likely saw an ad funded by the Piedmont Accountability Coalition during the campaign, blaming Berger for blocking legislation to force insurance plans to cover supplemental breast cancer screenings. Piedmont Accountability was one of two anti-Berger PACs that spent far more than Page's campaign.
The speaker in the ad is Sheila Mikhail, who also provided the majority of the money raised by the group for its campaign — over $200,000. She’s founded and led several biotechnology companies in North Carolina, including Ask Bio and M34, which develops gene therapies to treat neurological diseases.
She’s also founded the nonprofit Breast Cancer Ruckus to advocate for better breast cancer screenings. She joined the WUNC Politics Podcast to talk about that advocacy and how it got her involved in the state’s most-watched Senate primary.
When did you learn that North Carolina doesn't require insurance coverage for supplemental breast cancer screenings, and that it maybe needs legislative attention?
"Unfortunately, it was through my own diagnosis. In 2022, I was getting out of the shower and I noticed a small dimple on my left breast. At the request of my daughter, I went in and had a diagnostic mammogram done, and it was very difficult to see anything, because I had this dense tissue, but they thought I had breast cancer.
"I knew that was a problem because I had had a screening mammogram just a few months earlier, which was all clear — no indication of cancer. I went back and asked the oncologist for some kind of supplemental screening. Eventually I was told to get a breast MRI to access that, though I was told I would have to pay $1,300. Luckily, I could whip out my Visa and get access to that test. Thank God for that, because that test demonstrated that I had a very large tumor that went totally undetected by the 3D mammograms."
There was legislation in the both the House and Senate last year, and it did pass the House, to require insurance coverage of supplemental screenings on parity with a mammogram — so you wouldn't have to pay the same cost, in your case $1,300, to get the supplemental screening. Is that the goal with making legislative changes?
"We need to make sure that women don't have a financial barrier to get access to the necessary test to find their breast cancer in time — that is the supplemental screening — but also to change the standard of care here in North Carolina, because unfortunately, insurance coverage dictates what women are given in terms of breast cancer testing."
Did you talk to any of the senators, and what sort of reaction did you get when you tried to make the case to folks on the Senate side that this bill was worthy of considering?
"I got a complete blanket statement that they will not impose any mandates on insurance companies. I develop drugs, and as a drug development company, I've got a whole bunch of mandates on me, dealing with the FDA. But for some reason, insurance companies are very special and protected by our state Senate."
The opposing argument that I've heard in this debate over the screening bill is that these kind of mandates for insurance companies could potentially drive up the premiums and the overall cost. Do you buy that argument at all?
"That's complete BS. And the reason for that is studies have been done. Medicaid in our state covers supplemental screening because they've determined that it's much cheaper to pay a few hundred dollars to give women access to an ultrasound or breast MRI and find their cancer early, when it is cheaper and easier to treat. A lot of red states in the South cover it: Florida, Texas, Georgia, Alabama, Tennessee, Louisiana — they've all determined that it is cost-effective to cover the supplemental screening."
What made you decide to go beyond normal forms of policy advocacy and get involved financially in this primary race with Senate leader Phil Berger?
"It became quite clear to me that while he was leading the Senate, the bill was never going to pass. So it was like, 'OK, we just have to get rid of him.' I met with Sam Page, and I didn't think I was going to have anything in common with him. But quite the contrary, he's very thoughtful. His family has had some dealings with breast cancer, he saw the detrimental impact on a young family. Sam was very educated about a lot of things, the power of insurance companies, the unnecessary role of PBMs (pharmacy benefit managers), and we had a lot in common.
"I think Phil Berger lost the race because of his actions like the casino, being out of step with his own constituency. But that being said, I know I had at least 23 votes in favor of Sam Page. I have a list of names, and I know I contributed at least 23 votes."
You appeared in the ad yourself. What kind of reaction did you get from that?
"I believe in this cause, and if you believe in something, you put your name on it, you don't back away, you don't hide in the shadows.
"I've already had a little bit of retribution. I've had to get off certain boards that I was appointed to, economic boards where I was providing some expertise on entrepreneurship and building biotech companies... People are scared about retribution from Phil Berger and his cronies, so I had to get off those."
Listen to the full interview with Mikhail on the WUNC Politics Podcast
