Cancer bureaucracy
Low-income women in Arizona diagnosed with cancer can get treatment through the NBCCTP. Should it matter where they got diagnosed?
I moved back to Arizona from Los Angeles about eleven years ago. I was reestablishing myself and working a couple of part-time jobs with no health benefits. Not a big deal to me; I was used to it and was not going to let it stop me from getting my annual exam. I “grew up” at Planned Parenthood and learned how important it was to get yearly checkups.
But by 1999, in my mind I had outgrown Planned Parenthood, so I looked into other affordable healthcare alternatives in Phoenix. A friend told me about the Well Woman HealthCheck Program. I made a call and was screened over the phone for eligibility: I was within the age limit, a legal resident, had no health insurance and earned below the required income level for my household of one. I qualified for the program.
I made an appointment and without a hitch, got an essential checkup that included a Pap test, pelvic and breast exams – and most importantly, peace of mind. For a highly appreciated nominal fee, I found out I was good to go for another year. I counted my blessings.
If only all screenings ended in such positive results. Not all women are so fortunate. Excluding skin cancers, breast cancer is the most diagnosed form of cancer, affecting 1 in 4 women in the United States, according to the American Cancer Society. Among Hispanic women, breast cancer is the most commonly diagnosed and leading cause of cancer death. And Hispanic women have been historically less likely to get cervical cancer screenings, or Pap tests, compared to non-Hispanic white women, although they’ve stepped it up in recent decades. Hispanic women 18 years and older have gone from 64 percent in 1987 to close to 75 percent in 2005 in receiving cervical cancer screenings. And as would be expected, uninsured women are less likely to have had a recent Pap test, compared to women who have healthcare coverage, an obvious deterrent in early detection of cancer.
According to a 2009 community report published by Phoenix Affiliate of Susan G. Komen for the Cure, 22 percent of females in the Phoenix Affiliate area – Apache, Coconino, Gila, La Paz, Maricopa, Mohave, Navajo, Pinal and Yavapai counties – are uninsured.
The cancer fight
In 1990, Congress passed and President Bill Clinton signed the Breast and Cervical Cancer Mortality Prevention Act, from which the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) was created to assist in the fight against breast and cervical cancers. Over the last 20 years, the Centers for Disease Control and Prevention (CDC), in collaboration with government agencies, has funded and administered the program in states across the country, finally reaching all 50 states in 1997. Since then, the NBCCEDP has served more than 3.7 million women.
As was my case about a decade ago, women who qualify for the Well Woman HealthCheck Program are low-income and underserved women under 65 (and over 40 for mammograms) who are legal residents, lacking health insurance and bring in an annual income at 250 percent of the federal poverty level (FPL).
In 1993, the Well Woman HealthCheck Program (WWHP) was established in Arizona as part of the NBCCEDP and the Office of Chronic Disease Prevention and Nutrition Services at the Arizona Department of Health Services (ADHS). For the first nine years of the program, the CDC was the sole funding source for the WWHP. In 2003, the program was approved by the state legislature to receive funds from the State of Arizona, enabling the program to increase the number of women screened by nearly one-third. “We continue making sure that the state-funded portion of the program doesn’t get cut by the legislature,” says Sen. Amanda Aguirre, who passed a bill in 2005 to increase funding for the WWHP by establishing a special-edition breast cancer license plate. A contribution of $17 of every $25 registration fee goes to WWHP.
Since 1995, the program has provided over 35,000 mammograms and nearly 30,000 Pap tests to over 22,000 Arizona women, who likely could not afford these services otherwise. WWHP also has outreach programs to educate women on the importance of early detection. Virginia Warren, office chief of ADHS health-check programs, says the program is doing exceptionally well. “The [WWHP] program actually met 100 percent of goals set by the CDC to help people through the screening process,” says Warren, “and if diagnosed, into the treatment setting.”
The treatment setting is what has been a topic of controversy as of late. A bit of background: In 2002, Congress passed the National Breast and Cervical Cancer Treatment Program (NBCCTP). In Arizona, this means women diagnosed with cancer through the WWHP can receive comprehensive treatment through the NBCCTP provided by the Arizona Health Care Cost Containment System (AHCCCS).
But there’s one catch. State legislators voted on implementing funding for the program by going with an “Option 1” policy, which means low-income and uninsured women with breast or cervical cancer who do not get diagnosed through WWHP are not qualified for Arizona’s Medicaid support for cancer treatments. In other words, if your uninsured hermana Veronica takes advantage of a free mammogram at a health fair in the Bashas’ parking lot and she’s diagnosed with breast cancer, she can potentially forfeit financial support through ACCCHS.
The Phoenix Affiliate of Susan G. Komen for the Cure is calling attention to this disparity. Phoenix affiliate mission manager Mary Dokes says, “If a woman is diagnosed with breast cancer outside of the Well Woman HealthCheck Program, and would qualify for AHCCCS assistance, she would not be able to receive treatment through AHCCCS … Komen believes all women should have equal access to quality treatment regardless of where she was diagnosed.”
Warren says this “gap” is addressed at the county level. When a woman is being screened for the WWHP, “it is a main talking point to the patients,” she says. Maricopa County WWHP manager Abby Trujillo Maestas confirmed this. “It’s one of the first things we tell them.”
Warren adds, “If someone has a screening at a health fair or another free event and there is an issue of concern, they are then referred into the system for further screening and diagnosis – meaning their diagnoses will be through WWHP and eligible for Option 1 treatment.”
This would seem to quell Komen’s concerns, but what about the women who don’t know about WWHP, and may not be comfortable with even getting screened in the first place, because of finances, cultural differences or fear? These women are who concern Dokes and others, Trujillo Maestas included.
To make up for this Option 1 gap, Komen has contracted with counties in Arizona to provide grants to women caught between cancer and health care. In 2009-2010, $1.2 million was awarded for treatment grants for underinsured and/or uninsured women.
Just a few weeks ago, Komen made the difference for a young woman with cancer who had lost her job, had no home, yet did not qualify for AHCCCS. “Komen took care of her mastectomy and reconstruction,” says Trujillo Maestas, “but Komen can’t do it all alone,” she adds. “We as Arizonans need to take this seriously.”
Asked if the Option 1 gap for the breast and cancer treatment program was up for another vote anytime soon, in light of the push from Komen and others, Aguirre replied, “The [WWHP] has to follow the CDC federal guidelines for what … is covered under the Treatment Act. So this will need federal legislation to change it, not state [legislation].”
In the mean time, the senator wants all women to be aware of these programs. “Early detection works!” she says, “So I encourage all women, especially those women who are uninsured, to contact their local WWHP.”
Reaching all women in Arizona is the key. Those who know about the WWHP and other programs for underserved, uninsured women can spread the word via word of mouth, social networks, PTA meetings, blogs, etc., and help the fight against cancer through early detection.
“Breast cancer needs to be addressed from every direction,” says Trujillo Maestas. “We need to make sure women have access to treatment.”
Get in the cancer fight
Closing the gap – the Komen petition
The Susan G. Komen for the Cure Phoenix Affiliate continues its effort to end breast cancer and close the gap for women of color, rural women and low-income women by advocating to increase access to early detection services for all women in Arizona.
Susan G. Komen for the Cure is passionate about getting this law changed. You can help by calling your legislator to let them know how you feel about this issue or go to www.komenphoenix.org and fill out the on-line petition.
Contact WWHP:
1-888-257-8502
www.wellwomanhealthcheck.org
Show you support while driving
Next time you’re due for new license plates, or even if you’re not, consider the Pink Ribbon/Cancer Awareness plate. The cost is a $25 initial application fee/ $25 annual renewal. No special requirements. Available to everyone.
$17 goes to WWHP. You can even personalize it with a maximum of six characters. Also available with a disability symbol.
Go to www.azdot.gov and click on Special Plates under Driver and Vehicle Services.
