In Women's Health Fight, Cancer Care Could Be Collateral Damage

Kathleen Riley has had 14 rounds of chemotherapy and seven surgeries since she first found a lump in one of her breasts in April.

It’s a regimen Riley says she wouldn’t have started if it weren’t for the medical team at Memorial Health System of East Texas. Unable to afford a mammogram after discovering the lump, Riley, 47, received a free cancer screening at the system's Livingston facility, a private specialty clinic that participates in the joint state-federal Breast and Cervical Cancer Services program. Doctors there helped her enroll in Medicaid to cover costs related to treating her cancer, including a double mastectomy performed two weeks ago.

“It saved my life,” Riley said of the cancer screening program. The disease "would’ve killed me within the year.”

Riley fears future women might not be so lucky. 

The conservative Texas Senate, in its running effort to put Planned Parenthood clinics out of business, is considering changing how funding is distributed through the cancer screening program for poor, uninsured women.

Under the chamber's proposed plan, public entities like state, county and community health clinics would get first crack at the cash. “Non-public entities” that provide screenings as part of “comprehensive” primary and preventive care would come in second place.

And private specialty clinics like the Livingston facility would only get cancer-screening funding if there's money left over. That includes Planned Parenthood — whose family planning and cancer-screening clinics are a target of GOP lawmakers even though they are prohibited from performing abortions if they receive tax dollars. 

The Senate’s chief budget writer, state Sen. Jane Nelson, R-Flower Mound, has said the proposed tiered funding is intended to ensure that facilities unaffiliated with abortion providers are funded first. 

But under the proposed funding revisions, at least 34 providers not affiliated with Planned Parenthood — nearly one-fifth of those currently using program dollars — would be moved into the second or third tier for funding. 

“There’s not going to be anything left by the time it gets to us,” said Carol Belver, executive director of Community Action Inc. of Central Texas, whose three clinics screened a combined 625 women in the San Marcos area last year. Though her clinics provide primary care, the cancer screenings are offered as a separate service — leaving Community Action in the bottom tier for funding.

“We’re the collateral damage,” she added. 

The screening program, which is primarily funded with federal dollars, served 33,599 Texas women in fiscal year 2014 — 57 percent of whom were Hispanic. 

In some rural parts of the state, the funding change could leave the sole program provider in the area with little to no funding for cancer screenings. In Amarillo, for example, four Haven Health clinics are the only program providers, but they would all likely fall into the third tier for funding.

Patricia Jones, director of community-based care for Memorial Health System of East Texas, which treated Riley, said Memorial is the only program contractor with clinics in Livingston, Lufkin and San Augustine.

“We’ve had this funding almost 20 years, and if we were to lose that funding, you have 350 ladies who lose this access to a complex system,” Jones said. “You’d have 20 cancers that wouldn’t have been diagnosed as early as they were.”

In Abilene, Amy Fulcher, the women’s health case manager at the Abilene Diagnostic Women's Health Clinic, said that if her organization lost program funding, poor women seeking cancer screenings through the program would have to travel at least 150 miles in any direction. Her clinic is the only provider in town.

“This whole situation is very frustrating because it started as a target against Planned Parenthood,” Fulcher said.

For years, the Republican-led Legislature has worked to keep Planned Parenthood and other organizations even loosely affiliated with abortion providers from receiving state dollars for health care for poor women. In 2011, lawmakers ousted the organization from the joint state-federal Medicaid Women’s Health Program, leading the federal government to withdraw its match. It's unclear whether the feds will take similar action this year if the Legislature approves the changes to the cancer-screening program.

For now, Planned Parenthood clinics continue to receive funding from the cancer-screening program, serving 10 percent of the women who participate in the program. 

Democrats have accused Republicans of playing politics with women’s access to life-saving procedures, and are promising to put up a fight.

"The approach is problematic, if for no other reason [than] it's not making decisions based upon health care — it's making decisions for women's health based on politics,” said state Sen. Kirk Watson, D-Austin.

Asked about the negative effect the funding changes could have on clinics that aren’t affiliated with Planned Parenthood, Nelson said she was looking into it.

"I am still investigating this issue to ensure we proceed in a way that preserves access to services for women," she said in a statement.

For now, the future of the program remains unclear. That leaves Riley, the cancer patient, to worry about the fate of other women in Texas who cannot afford cancer screenings.

“It’s very scary for the women that are going to come up after me that aren’t going to be able to get the help they need,” Riley said. 

Disclosure: Planned Parenthood was a corporate sponsor of The Texas Tribune in 2011. A complete list of Tribune donors and sponsors can be viewed here. 

This story was produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.