BILL ANALYSIS Ó
AB 1795
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Date of Hearing: March 15, 2016
ASSEMBLY COMMITTEE ON HEALTH
Jim Wood, Chair
AB 1795
(Atkins) - As Introduced February 4, 2016
SUBJECT: Health care programs: cancer.
SUMMARY: Changes provisions of the Every Woman Counts program
(EWC) and the Breast and Cervical Cancer Treatment program
(BCCTP) within the Department of Health Care Services (DHCS)
regarding eligibility for screenings, period of treatment, and
eligibility of coverage after reoccurrence of cancer.
Specifically, this bill:
1)Requires DHCS to provide breast cancer screening and
diagnostic services to individuals that meet existing
eligibility requirements and are either a) symptomatic, as
defined; or b) 40 years of age or older.
2)Defines "symptomatic" to mean an individual presenting with an
abnormality or change in the look or feel of the breast,
including, but not limited to, a lump, a hard knot, thickening
or swelling of the breast tissue, a change in the color, size,
or shape of the breast, or any discharge from the nipple.
3)Deletes existing limits on the period of coverage for
treatment of breast cancer (18 months) and cervical cancer (24
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months) and instead requires coverage for both cancers to
remain for the duration of treatment, as long as the
individual continues to meet all other eligibility
requirements.
4)Requires that a patient be eligible for coverage if diagnosed
with a reoccurrence of breast cancer or cervical cancer for
both new cancer sites or the same cancer site, as long as the
individual continues to meet all other eligibility
requirements.
EXISTING LAW:
1)Establishes the Medi-Cal program, administered by DHCS, under
which the aged, blind, disabled, and qualified low-income
persons receive health care benefits.
2)Requires DHCS to provide breast and cervical cancer screening
and treatment for low-income individuals.
3)Establishes the Breast Cancer Control Program, administered by
DHCS through the EWC program, to provide breast and cervical
cancer screening services under the Centers for Disease
Control and Prevention (CDC) grant at the level of funding
budgeted from state and other resources during the fiscal year
in which the Legislature has appropriated funds for this
purpose.
4)Requires that a provider or entity that participates in the
National Early Detection Program may provide screening
services to an individual only if the individual's family
income has been determined not to exceed 200% of the federal
poverty level.
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5)Under federal law, creates the National Breast and Cervical
Cancer Early Detection Program (NBCCEDP) and authorizes the
CDC to administer grants to states for screening services for
underserved eligible women, 40 years of age and older.
FISCAL EFFECT: This bill has not been analyzed by a fiscal
committee.
COMMENTS:
1)PURPOSE OF THIS BILL. According to the author, this bill is
needed to ensure that women have timely access to receive the
necessary services to detect and treat their cancers early.
The author asserts that changes are needed to allow low-income
women in California who are uninsured or underinsured to
receive complete treatment for breast and cervical cancer,
provide that she is not turned away if she is later diagnosed
with the same cancer, and allow women under age 40 who are
symptomatic for breast cancer to receive necessary screening
services.
2)BACKGROUND.
a) Every Woman Counts Program. In 1990, the CDC created
the NBCCEDP through Public Law 101-354. This law
authorized CDC to grant funds to states to screen a
reasonable number of low income, uninsured women for breast
and cervical cancers, provide referrals for follow-up and
medical treatment for women with abnormal test results,
develop and disseminate information for preventing breast
and cervical cancers, improve the training of health
professionals in preventing these cancers, and monitor the
quality of screening procedures. The mission of the EWC
program is to save lives by preventing and reducing the
devastating effects of cancer through early detection and
diagnostic services. EWC provides free clinical breast
exams, mammograms, pelvic exams, and Pap tests to
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California's low income uninsured and underserved women.
These screening services facilitate early detection that
may prevent untimely cancer deaths. Each year, EWC
provides care for approximately 300,000 individuals. EWC
is funded, in part, by $.01 of the tax on each pack of
cigarettes sold in California.
b) Breast and Cervical Cancer Treatment Program. The BCCTP
provides cancer treatment and services for eligible
low-income California residents who are screened by the EWC
or Family Planning, Access, Care and Treatment program and
found to be in need of treatment for breast and/or cervical
cancer. BCCTP provides coverage for breast and cervical
cancer treatment and services related to cancer diagnosis.
BCCTP provides treatment coverage for approximately 9,000
individuals each year, through both federal and state
funding. Currently, the state-funded BCCTP is not aligned
with the federally-funded BCCTP, causing gaps in service
and treatment for women diagnosed and treated through the
state-funded program. Under the state BCCTP, treatment
coverage is limited to 18 months for breast cancer and 24
months for cervical cancer, while federal funding has no
time limit and remains in effect for the duration of
treatment. State-funding for BCCTP does not allow coverage
to a woman who is re-diagnosed with the same cancer at the
original cancer site, while the federally funded program
does.
c) Breast cancer in younger women. The U.S. Census of 2000
estimates that more than 250,000 women 40 years of age and
younger are living with breast cancer, nationally. The
Young Survivors of Breast Cancer report that it is the
leading cause of cancer death in women ages 15 to 54. Many
young women are unaware that they are at risk for breast
cancer. In 2003, the American Cancer Society estimated
that, while breast cancer in young women accounts for a
small percentage of all breast cancer cases, over 11,100
young women age 40 and under would be diagnosed in the next
year and close to 1,400 would die. Young women are often
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diagnosed at a later stage than their older counterparts,
and their cancers are generally more aggressive and result
in lower survival rates.
d) Changing medical guidelines. Health organizations
regularly review and, when new scientific findings warrant
it, update their guidelines. The U.S. Preventive Services
Task Force (USPSTF) serves as an umbrella organization,
issuing evidence-based guidelines for prevention,
detection, and treatment of various health conditions.
Other organizations often follow the task force's lead,
endorsing its guidelines as issued or adapting them based
on their own reading of the science. Guidelines and common
medical practice shift over time, and well-respected
medical professional societies are not always in agreement.
In the last decade three key groups - the American College
of Obstetricians and Gynecologists, the American Cancer
Society, and the USPSTF - have changed their
recommendations to different ages for starting regular
mammograms: 40, 45, and 50 years of age respectively.
While mammograms save lives, they can also cause harm, and
each group does a different job of balancing the pros and
cons. As technology advances and more studies are done,
screening guidelines will continue to change.
3)SUPPORT. According to Susan G. Komen California Affiliates,
sponsor of the bill, these changes in the EWC and BCCTP
specified in this bill are necessary to ensure that women have
timely access to necessary services to detect and treat their
cancers early. Health Access states that despite expansion of
Medi-Cal under the Patient Protection and Affordable Care Act
and subsidized health coverage through Covered California,
many low income Californians remain uninsured and uninsured;
limited benefit programs such as BCCTP and EWC continue to be
an important resource for them.
4)PREVIOUS LEGISLATION.
a) AB 49 (Buchannan), Chapter 351, Statutes of 2014,
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established the breast cancer awareness special interest
license plate program, to generate funds to raise awareness
of early breast cancer screening. Requires the proceeds
from the license plate sales to be deposited in the Breast
Cancer Control Account to fund EWC programming.
b) SB 1348 (Cedillo) of 2008, would have required DPH to
provide breast cancer screening services to women who are
38 years of age and older and who meet other eligibility
standards for breast cancer screening services under
existing state and federal law. SB 1248 died in the Senate
Appropriations Committee.
c) AB 478 (Friedman), Chapter 660, Statutes of 1993,
established a $.02 tax on each pack of cigarettes sold,
with the revenue deposited in the Breast Cancer Fund and
the proceeds to be divided equally between the Breast
Cancer Research Account and the Breast Cancer Control
Account.
d) AB 2055 (Freidman), Chapter 661, Statutes of 1993,
established the Breast Cancer Control Account for purposes
of breast cancer research, detection services and
education. AB 2055 also modified the allocation of tobacco
tax funds so that 50% of the funds are devoted to research
and 50% for early detection services for uninsured and
underinsured women.
5)POLICY COMMENT. This bill codifies the current CDC guideline
that recommends screening mammograms for women 40 years of age
or over. State law is currently silent regarding what age to
start regular screenings. The EWC program reports that they
cover screenings for individuals 40 years of age or older
because it is the CDC guideline, which in part funds the EWC
program. However, medical guidelines shift over time and
guidelines for recommended cancer screenings have been the
subject of much conversation in recent years. Specifically,
the age at which breast cancer screening is recommended has
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been a matter of scrutiny, with different health organizations
recommending different age guidelines. By codifying the
current CDC recommendation, the state could potentially be
compelled to cover screening at age 40 without federal funding
if the CDC shifts the age for screening, and funding, in the
future. As this bill moves forward, the author may wish to
consider removing reference to age in the bill, since this age
is already current practice of EWC based on federal
guidelines.
REGISTERED SUPPORT / OPPOSITION:
Support
Susan G. Komen (sponsor)
American Cancer Society Cancer Action Network
American Federation of State, County and Municipal Employees,
AFL-CIO
Black Women for Wellness
Brown Temple Christian Methodist Episcopal Church
California Health Collaborative
California Association for Nurse Practitioners
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California Health Executives Association of California
California Nurses Association
Cambodian Family Community Center
Cancer Support Community Benjamin Center
Cancer Support Community San Francisco Bay Area
Central City Community Health Center
County Health Executives Association of California
Health Access California
Health Center Partners of Southern California
Hope Wellness Center
Junior Leagues of California
North Orange County Regional Health Foundation
Planned Parenthood of Orange and San Bernardino Counties
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Sacramento Community Cancer Coalition
Samoan National Nurses Association
Serve the People Community Health Center
St. Mary Medical Center Foundation
Numerous Individuals
Opposition
None on file.
Analysis Prepared by:Dharia McGrew / HEALTH / (916) 319-2097