Letter To The Editor: “This Isn’t About Vanity”

Rossalyn Ripper

When I was diagnosed with HER2+ breast cancer in 2025, I prepared for the physical fight — surgeries, chemotherapy, the unknown. What I wasn’t prepared for was how much the thought of losing my hair would take from me before treatment even began.

People often call scalp cooling “cosmetic.”

But in Maryland, lawmakers are beginning to recognize what patients like me and others have always known: it is anything but.

More Than Hair — A Question of Access to Care

Chemotherapy-induced hair loss is not a trivial side effect. It is one of the most visible and emotionally devastating parts of cancer treatment. It strips away privacy and identity at a time when patients are already at their most vulnerable.

For some patients, the fear of hair loss is so overwhelming that it influences treatment decisions. That alone should force us to reconsider how we define “medical necessity.”

Because when a side effect impacts whether a patient will undergo life-saving treatment, it is not cosmetic — it is clinical.

The Science Behind Scalp Cooling

Scalp cooling systems are U.S. Food and Drug Administration-cleared medical devices designed to reduce hair loss during chemotherapy by constricting blood vessels and limiting the amount of chemotherapy that reaches hair follicles.

This is not a beauty treatment. It is a medical intervention grounded in science. And yet, for years, access has depended largely on a patient’s ability to pay out of pocket — often thousands of dollars.

Maryland Steps In: SB0272 and HB0393

That reality is exactly what two Maryland bills aim to change. Senator Dawn Gile (District 33) and Delegate LaToya Nkongolo (District 31) are sponsoring Senate Bill 0272 and House Bill 0393, which are companion bills introduced in the 2026 Maryland General Assembly legislative session that would require many health insurance plans in the state to cover scalp cooling for cancer patients undergoing chemotherapy.

The legislation mandates that insurers, HMOs and nonprofit health plans that already cover chemotherapy must also cover scalp cooling systems used to preserve hair during treatment. If passed, the requirement would apply to policies issued or renewed beginning January 1, 2027.

These bills represent a critical shift: recognizing scalp cooling not as an optional add-on but as part of comprehensive cancer care.

During 2025, the Maryland Health Care Commission evaluated whether Maryland should require insurance coverage for scalp cooling, analyzing medical effectiveness, social impact, and financial cost. It revealed that scalp cooling is a clinically supported treatment that reduces chemotherapy-induced hair loss by limiting drug exposure to hair follicles, that hair loss is one of the most feared side effects of chemotherapy, and that the cost to insurers is very low, with the estimated premium impact being in the 0.00%-0.05% range. Pennies per member per month. Costs are comparable to a prosthetic wig, which is already covered by insurers in Maryland.

Why This Legislation Matters

Right now, too many patients are forced into impossible choices:

• Pay out of pocket to preserve a sense of identity
• Or endure one of the most visible markers of illness without support

That is not equitable care.

By requiring insurance coverage, Maryland is acknowledging that the psychological and emotional toll of cancer treatment matters. It is recognizing that dignity is not a luxury.

And importantly, these bills align with growing medical consensus. Even organizations like the Oncology Nursing Society have supported insurance coverage, noting that scalp cooling should be considered medically necessary — not cosmetic.

My Experience

When I chose to use scalp cooling, it wasn’t about trying to look good. It was about trying to feel like myself in a moment when everything else felt out of control. It allowed me to walk into a room without immediately being identified as “the cancer patient.” It gave me a sense of normalcy during one of the most abnormal times of my life.

That is not vanity. That is survival.

A Turning Point

Maryland’s SB0272 and HB0393 are more than insurance bills. They are statements about how we value patients.

They say:

• Emotional well-being matters
• Identity matters
• Access to supportive care should not depend on income

Cancer takes enough from us. The ability to preserve a part of ourselves — when science allows it — should not be dismissed or denied. Because this was never about hair. It was about humanity.