Thursday, March 22, 2001

Advocates push for women's treatment

Free program uncovers cancers, but paying for cure another story

By Tim Bonfield
The Cincinnati Enquirer

        Fairmount resident Edyth Dudley thanks God every day for helping her doctors put her breast cancer into remission.

        She's still praying for an answer about what to do with thousands of dollars in uncovered medical bills.

        “I was worried about those bills,” Ms. Dudley said. “I really prayed about it. But finally I just had to step out on my faith and let God do his work and not worry about those bills.”

[photo] Edyth Dudley's cancer was discovered in a free screening program, but the cost of treatment has become her own burden.
(Glenn Hartong photo)
| ZOOM |
        Ms. Dudley is one of more than 8,000 Ohio women without health insurance who received subsidized mammograms in 1999 through the National Breast and Cervical Cancer Early Detection Program. She also was among 77 women that year whose tests revealed breast cancer.

        Ohio is among many states that offer the screening program but do not pay for treatment when those tests reveal cancer. As a result, women like Ms. Dudley face a double shock: the news that they have breast cancer and the burden of getting stuck with the bill.

        Advocacy groups are working to change that.

        “There's a federal law that allows (these) women to be eligible for Medicaid. But it's up to states to opt in, and so far Ohio hasn't chosen to opt in,” said Elyce Turba, vice president of the Breast Cancer Alliance of Greater Cincinnati.

        Ms. Turba is part of a statewide coalition of cancer advocacy groups urging state lawmakers to extend Medicaid coverage specifically to uninsured women with cancers diagnosed through the screening program. Ms. Turba testified in Columbus two weeks ago before a House subcommittee considering a budget amendment to fund the extended Medicaid coverage.

        Testimony continued Wednesday on this and other health funding issues. The committee plans to make recommendations next week.

        “The purpose of the screening program is to save lives. Yet screening must be coupled with treatment,” Ms. Turba said.

        Supporters say the proposal would cost about $400,000 a year. But the chairman of a state House subcommittee looking at the proposal says it is unclear where the money would come from in a tight budget year.

        In addition to the mammogram recipients, the screening program paid for 7,548 women to receive pap smears to check for cervical cancer. Four women were found to have cervical cancer.

        Except for a few women who have not sought care, women diagnosed through the program have been able to get treatment, Ms. Turba said. However, without insurance, they can wind up personally liable for medical bills that can range from $20,000 to $50,000 per case.

        Some have been able to get hospitals and doctors to write off at least some of their services as charity.

        But many end up hounded by collection agencies and some women have been forced into bankruptcy. Others have paid medical bills by quitting their jobs, which reduces their income enough so that they qualify for Medicaid.

        In fact, the level of financial risk a woman faces can depend on the county where she lives and the charity of the doctors and hospitals she uses.

        Ms. Dudley, 58, is single and works at a nursing home. As a part-time employee, she does not get health benefits. She earns too much to qualify for Medicaid, the state health plan for the poor, yet she doesn't make enough to afford a private, individual health policy.'

        So, she has lived without health coverage for years.

        The American Cancer Society recommends that all women should get annual mammograms starting at age 40. Like many women with no insurance and limited incomes, Ms. Dudley skipped those tests.

        During a self-exam in 1999, she found a lump in her breast.

        Concerned, she went to her doctor at the Crossroads Health Center in Over-the-Rhine, who sent her to University Hospital's Barrett Cancer Center. About two weeks later, she got a mammogram (covered by the special program). The scan revealed a mass.

        That day, doctors performed a biopsy that to determine whether the mass was cancerous. Two days later, the biopsy confirmed she had breast cancer.

        “I was totally devastated,” Ms. Dudley said.

        She ultimately received more than eight weeks of chemotherapy, a lumpectomy and 30 radiation treatments. During her chemo treatments, she needed hospital care twice because her white blood cell count had dipped to alarming levels.

        The treatments put her cancer into remission.

        The bills were left to be worked out later.

        Some of Ms. Dudley's medications were covered because doctors were able to enroll her in a clinical trial. In addition, Ms. Dudley qualified for Medicaid coverage and for food stamps for six months when she missed a lot of work.

        Her hospital care was covered because Hamilton County is among the few counties nationwide that has a tax levy for indigent care.

        However, those funds don't cover outpatient doctor fees. That meant Ms. Dudley got a stack of bills from oncologists, radiologists, a surgeon and others. She estimates that the bills exceed $10,000.

        Some of the doctors have agreed to accept whatever Ms. Dudley can pay. Some have not.

        Meanwhile, every time Ms. Dudley sees a doctor for a follow-up exam or test, there is one more bill to work out.

        “I'm paying two collection agencies, and they don't know what to do with the oncology bill,” she said.

        To Ms. Turba, the best answer would be for Congress to address the entire uninsured issue. However, she'll settle for simplifying the red tape faced by uninsured women with breast cancer.

        “We're inviting women into a spider's web,” Ms. Turba said. “It doesn't make much sense.”

        So far, 13 states, including Indiana, have either approved plans to extend coverage for treatment or introduced legislation to do so. No formal bills on this topic have been introduced in Ohio or Kentucky. But in Ohio, breast cancer advocates want to win coverage by convincing a health and human services subcommittee to recommend a budget amendment.

        The proposal would extend Medicaid coverage for treatment for any woman who is diagnosed with cancer through the special screening program. The federal government would pay about 71 percent while Ohio would pay about 29 percent.

        The breast cancer alliance contends it would cost about $1.4 million to provide one year of care to the women diagnosed with cancer through the screening program. Ohio's share would be about $400,000.

        The subcommittee has not voted on the cancer coverage issue, but plans to make recommendations next week, said Chairman James Hoops, R-Napoleon. He would not predict the proposal's chances.

        “I think (the screening pro gram) is a very important, very good program. It's not a case of objecting to the program,” Mr. Hoops said. “It's more a case of, where are the dollars going to come from?”

        Ohio faces a tight budget, caused by lower sales tax revenue, heavy demand for education spending, and a shortfall in the Medicaid budget even before adding new programs, Mr. Hoops said.

        Despite these factors, Ms. Turba said there are lots of ways to find $400,000, including cutting back on the budget for Ohio's bicentennial celebration.

        Regardless of how it's done, Ms. Dudley said, there ought to be a simple way to help the uninsured.

        In the meantime, she wanted to thank family and church members for their prayers and support.

        “No matter what happens, I know that it is my faith in the Lord Jesus Christ that will be bring me through,” Ms. Dudley said.

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