It’s been two and a half years since U.S. Sen. Mazie Hirono (D-Hawaii) announced she was fighting advanced kidney cancer. Despite the daunting diagnosis, Hirono is doing remarkably well.

She says it hasn’t impeded her hectic work schedule and if anything it’s emboldened her to advocate even more aggressively for health care reform.

A supporter of a single-payer health care system, also referred to as Medicare for All, Hirono says she was fortunate to have health insurance when her cancer was diagnosed.

“We all know that the earlier cancer is detected the more successful treatment will be, and my cancer had spread to my ribs and that was a very fast-growing cancer,” said Hirono, noting that if those cells had spread to other parts of her body it woudn’t have been good.

In April 2017, Hirono was preparing for eye surgery when during a routine preoperative physical her doctor detected an abnormality in a chest X-ray. After follow-up tests, she was diagnosed with kidney cancer. Because it had spread to a rib it was classified as stage 4.

Hirono, 72, says in retrospect she had been feeling some unusual symptoms, such as pain on the right side of her ribs which she dismissed as heartburn. For the uninsured, or underinsured, such symptoms are often ignored and routine health and cancer screenings put off.

Shortly after her diagnosis, Hirono underwent surgery to remove a kidney and later a lesion on her rib. In October 2017, she announced she had some small spots on her thyroid gland and would be undergoing immunotherapy, a cutting-edge treatment designed to help one’s immune system recognize and attack cancer cells.

She’s not cancer free, but Hirono says the immunotherapy was successful in controlling her cancer and attacking the most aggressive cells in her body. She hasn’t had to undergo any treatment since July 2018.

“My overall prognosis is quite good and my doctor expects it could be a number of years before I would need further treatment, if it all,” said Hirono.

Pushing for health care reform

Hirono was nearly 8 years old when she emigrated from Japan to Hawaii, where she was raised by a single mother whose job didn’t provide health coverage. She says that experience made her acutely aware of the holes in the U.S. health care system.

“Nobody in the family could afford to get sick. Nobody could go to the doctor. So it’s an awareness that I’ve had for a long time,” said Hirono. “For children to have to worry, as I used to have to worry, about my mother getting sick … . That used to be one of my greatest fears growing up: my mom would get sick and then she wouldn’t be able to go to work and then there is no food or money for rent.

“So it has always been something that I have understood. But of course with this diagnosis, it is much more personal.”

Hirono’s diagnosis came as President Donald Trump was working to repeal the Affordable Care Act, which among other reforms prohibited health insurers from denying coverage to people with pre-existing conditions and expanded Medicaid eligibility.

Under the law enacted by former President Barack Obama, the number of uninsured nationally fell from 13.3% in 2013 to about 8% in 2017, according to the Kaiser Family Foundation.

Hirono has become one of the most outspoken opponents of attempts to repeal the act. In June 2017 she took to the Senate floor, where she drew on her own experience of being diagnosed with cancer to deride a bill put forward by the Republicans to repeal the measure.

“It’s been brought home to me, knowing how extensive my medical care is, that if people didn’t have health insurance or Medicare or Medicaid, then literally people die,” she said. “So it’s been brought home to me in a very personal way.”

Hirono said that Democrats running for president need to focus more on the threats to the Affordable Care Act, rather than spending so much time debating Medicare for All.

The law is currently at risk of being substantially or completely repealed due to a court case that’s before the 5th Circuit Court of Appeals.

A ruling in the case, Texas v. Azar, could be handed down as early as this month and it’s not looking good for Democrats and supporters of the act. The Affordable Care Act woudn’t immediately be repealed if the court rules in favor of the law’s opponents, but it could be in real jeopardy next year if taken up by the Supreme Court.

If the high court ruled the act unconstitutional, health care experts say millions of people could lose their insurance coverage overnight.

“It’s clear that health care is a concern for people all across the country regardless of their political stripe or where they live,” said Hirono as she urged Democratic presidential candidates to focus on the “real and present danger.”