When one young mother delivered her daughter via C-section at Natividad Medical Center in 2006, her physician discovered moderate-size fibroid tumors in her uterus and advised her to have them removed.

But Onix Herrera, a working mother with no health insurance, couldn’t afford the $3,000 down payment required for what is considered an elective surgery. Instead she lived for four years as the tumors grew. According to the National Institute of Medicine, the benign tumors can cause pain, anemia, excessive menstrual bleeding and infertility. In 2010, looking as though she were nine months pregnant, Herrera returned to the hospital to inquire about the surgery. She had to wait another six months to get enough money to make the down payment through saving and borrowing money from family and friends.

Linda Ford, the president and CEO of Natividad Medical Foundation, was inspired to launch the Onyx Fund for Women to help cover the down payment costs for women in need of similar surgeries.

“I didn’t want anyone else to suffer like she had,” Ford said.

The foundation raised $30,000 in 30 days. And even though health-care reform has rolled out coverage this year to many low-income residents through expansion of Medi-Cal access and subsidized health insurance for the working poor, Natividad Medical Foundation isn’t ready to close down the nearly depleted fund.

Since 2010, the Foundation has provided down payment assistance for 50 women. The fund is now nearly depleted though needs remain.

When the Women’s Fund was created, the Hospital Foundation thought they would be able to provide many more than 50 surgeries.

“Part of the reason (the fund) is depleted is the women let it go so long that each surgery cost a lot more than we expected,” Ford said, noting that they had hoped most of the procedures could be handled as outpatient treatment. They had estimated $1,000 per patient, but the average surgery required hospitalization with the average cost at $3,500.

Because of ACA reforms, insurers are required to cover preventative screenings without co-pays. For women, these health checks include cervical cancer screening, mammograms, sexually transmitted disease screening and a variety of other tests or counseling related to preventing disease.

In Monterey County, Supervisor Jane Parker’s staff estimated 23,000 county residents became eligible for Medi-Cal with the expansion of health-care reform, while 44,000 had access to subsidized coverage through the new health insurance exchange.

But women may still need to pay a copay or deductible to receive treatment for any of the conditions not covered in the screenings. Ford said it has been difficult for the Foundation to estimate how having insurance will change what patients pay since there are so many different plans available, with varying co-pays and deductibles.

“I think it will be manageable – the amount they have to pay,” Ford said, “But, if not, we will still be here to help. We still have women in need.”

Some women have been approved for assistance from the Women’s Fund, but there are not enough funds to cover all of those in need. Ford said the doctors at Natividad Medical Center have access to request forms to refer patients to the Onyx Women’s Fund. One doctor did just that for Rosa, a King City resident who withheld her last name.

Rosa suffered from heavy menstrual bleeding and anemia for nine months.  She scheduled surgery to treat her condition twice but each time she cancelled because she didn’t have the necessary down payment. When a doctor at the Laurel Women’s Clinic at Natividad told her of the Onyx Women’s Fund, she was scheduled her appointment and got her surgery two weeks later.

“I’m so glad I was at the right hospital at the right time with the right doctor,” she said in a press release, after her surgery.

Health-care reform may be hurting safety net hospitals that have borne the brunt of uninsured patients in the past. Ford said it is not clear yet what financial impact reform would have on the south Salinas Hospital.

In 2011, the state received federal funding of $1.09 billion to cover medical expenses for uninsured residents. In 2014, $500 million will be cut from that budget with expectations of increasing the cut each year.

In 2012, the Monterey County board of supervisors expressed support for “efforts that prevent reductions in DSH funding to meet the cost of care for beneficiaries until the fruits of health care reform – fewer uninsured and higher levels of compensation for care – are realized.” Before Covered California was implemented in January, safety net hospitals such as Natividad Hospital made up only 3 percent of all hospitals in the state but provided care to 50 percent of uninsured patients.

A subset of the population Monterey County and statewide is not eligible for insurance through Covered California – undocumented immigrants. The the Public Policy Institute of California released a report titled “Unauthorized Immigrants in California” in 2011 that estimated 62,000 undocumented immigrants were living in Monterey and San Benito counties in a mostly rural-agricultural communities. Through Covered California citizens, legal residents and immigrants with certain types of visas are eligible for coverage. But in Monterey County potentially 13.5 percent of the population could still be without medical insurance and seeking treatment at safety net hospitals.