Hundreds of California clinics that provide low-income women with free mammograms and cervical exams are fighting to stay open this summer because of changes in patient eligibility rules and a state budget that is already weeks late with no deal in sight.
Gov. Arnold Schwarzenegger froze enrollment into the Every Women Counts program as of Jan. 1. At the same time, the minimum age to receive mammograms was increased from 40 to 50 years old.
Funding for the program comes mainly from tobacco taxes that California voters allotted for health and environmental programs with the passage of Proposition 99 in 1988.
According to the Department of Public Health, in past years tobacco taxes from Proposition 99 have provided sufficient funding for the EWC program, but will not do so this year.
In previous years the program was guaranteed reimbursement by the state even when the budget was not passed, because the funding came from Proposition 99, which operates continuously whether a budget is in place or not. This allowed clinics to stay open and serve women throughout the summer months.
But this year, enrollment will not be reopened until a budget is drafted and the state decides how much funding to set aside for the program. As a result, women who were enrolled in the program prior to the eligibility changes will be able to receive follow-up screenings but no new screening are being scheduled.
And, since the budget has yet to pass, the state will not guarantee that all expenditures made in budget-less summer months will be reimbursed.
Clinics must either shut down until funding is restored or choose to float their program from reserves with the hope that they will be reimbursed by the state when a budget finally passes.
The California Health Collaborative manages EWC programs throughout the Bay Area and Northern California and will likely close next week because of the stalled budget, managers said.
Paying for operating costs until the budget is approved is risky since it could be weeks before the budget is passed and it is unknown how much the state will give EWC out of the general fund.
“It’s very expensive to float this,” said Barbra Clifford, a manager with the collaborative. Since July 1st the program has been struggling to survive without state funding. The Collaborative will be able to reopen when the budget passes, “the minute we get a contract,” Clifford says.
Others are not so lucky. The Elizabeth Center in downtown Los Angeles will close its doors permanently in August, according to its director. The clinic, which screened approximately 13,000 women for breast cancer last year, has only screened 2,900 women since January 1. To meet its costs and keep its doors open, the clinic must serve 1,000 women a month and has not been able to do so since enrollment was frozen.
Donald Cook, the managing director of the Elizabeth Center, worries that many women will go without screenings when the clinic closes. “When we go down, we don’t know where the women will go,” he says.
Cook stressed the importance of cancer screenings, calling them, “the only weapon we have against cancer.” According to the American Cancer Society, while women whose first-stage breast cancer is caught early are all but certain to survive, only 86 percent of women whose cancer reaches stage 2 before it is found will live for five years.
Heidi Souverille, the Community Health Supervisor at the UC Davis Cancer Center, said the cuts have been “devastating.” Communities that rely on the services provided by EWC will have to find new providers or go without the screening.
“The thing about breast cancer is that it can be a very treatable disease if it is caught early,” Souverille says.
Women who qualify for EWC are uninsured or their insurance does not cover screenings. “Medicare and Medicaid don’t pick up until diagnosis,” Souverille says, so many women depend on EWC for regular screenings. Many low-income women may not get diagnosed as early because of their insurance coverage and the new limitations on the EWC.
Assemblywoman Noreen Evans, D-Santa Rosa and Assemblyman Pedro Nava, D-Long Beach, are sponsoring AB 1640, which would unfreeze new enrollments and reduce the age requirements for mammograms back to age 40. The bill made it through the Assembly and is currently pending in the Senate.
The bill also attempts to direct more of the EWC funding to screenings and away from other non-clinical program activities like outreach and education, in an effort to avoid limiting eligibility and deliver the most cancer screenings possible.