BILL ANALYSIS
AB 1640
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Date of Hearing: April 14, 2010
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Felipe Fuentes, Chair
AB 1640 (Evans) - As Introduced: January 11, 2010
Policy Committee: Health Vote:15-0
Urgency: No State Mandated Local Program:
No Reimbursable:
SUMMARY
This bill addresses recent budget shortfalls and eligibility
screening guideline changes for the Every Woman Counts (EWC)
program administered by the California Department of Public
Health (DPH). EWC provides breast cancer screening services to
women in families with incomes of less than 200% of the federal
poverty level (FPL) ($36,000 for a family of three).
Specifically, this bill:
1)Establishes an unspecified appropriation for DPH to fund EWC.
2)Expresses legislative intent to "fully meet the demand" for
EWC based on eligibility guidelines in place as of December
31, 2009 (including women 40 years of age and older).
3)Requires DPH to notify the Joint Legislative Budget Committee
at least 90 days prior to changing eligibility guidelines or
reducing screening services in EWC.
FISCAL EFFECT
1)An annual unknown appropriation in the range of $55 million
(90% special fund/10% federal fund) to provide breast cancer
screening services to approximately 240,000 women in
California. These figures reflect the range of actual spending
and screening caseloads over the past eight years.
Historically, the EWC program is funded primarily with state
special fund revenues generated by tobacco taxes. The
remaining support is provided by a grant from the federal
Centers for Disease Control.
2)The bill contains a blank appropriation.
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COMMENTS
1)Rationale . This bill responds to recent program changes
announced by DPH, effective January 1, 2010 that significantly
reduce access to the EWC program. These changes include an
increase in the minimum age for EWC screening from age 40 to
50 and a temporary enrollment freeze from January 1, 2010
through June 30, 2010. According to the author, these
immediate changes will deny 100,000 women access to critical
health screenings and were made without adequate notification
to advocates and the Legislature. Eligibility for EWC is based
on age, income, insurance status or coverage, and specified
financial barriers.
2)Recent Changes in Screening Guidelines . The United States
Preventive Services Task Force (USPSTF) is an independent
federal panel of experts in primary care and prevention that
systematically reviews the evidence of effectiveness and
develops recommendations for clinical preventive services. In
November 2009 the USPSTF changed routine breast cancer
screening recommendations to biennial screening mammography
for women aged 50 to 74 years. Previously recommendations
supported screenings for women over 40 years of age. USPSTF
recommendations for women outside the 50 to 74 years old age
band now depend on known risk factors such as family history.
Many patients and providers have been concerned about the
change in regular screening recommendations due to the number
of women diagnosed with breast cancer prior to 50 years of
age.
3)Possible Federal Health Reform Impacts . The recently enacted
Patient Protection and Affordable Care Act (P.L. 111-148)
contains several initiatives and provisions that may improve
access and coverage to low-income women in need of cancer
prevention screening services like those addressed in this
bill.
For example, the federal legislation establishes and funds
several national oversight bodies to increase prevention and
wellness services and efficacy. Some of these activities are
supported by more than $10 billion in appropriations, with
funding starting to flow in the current year. In the private
sector, beginning in 2010, health plans will be required to
AB 1640
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provide a minimum level of coverage without cost-sharing for
preventive services such as immunizations, preventive care for
infants, children and adolescents, and additional preventive
care and screenings for women.
4)Breast Cancer in California . According to DPH, the recent
action taken in EWC to freeze enrollment and narrow
eligibility was necessary due to unprecedented demand for
screening services and a reduction in supporting revenues. One
in nine women in California has a lifetime risk of being
diagnosed with breast cancer. The breast cancer death rate in
California has dropped 20% over the last two decades, but
California women are more likely to be diagnosed with breast
cancer today.
While the death rate for breast cancer has dropped, the gains
have not been shared equally among all women. Women of color
and low-income women are less likely to be diagnosed at an
early stage of cancer and receive effective treatment.
Therefore their survival rates are lower than other groups of
women. For example, African-American women, although less
likely to be diagnosed with breast cancer, have one of the
highest breast cancer death rates.
5)Related Legislation . SB 836 (Oropeza), in the current session
and pending in the Senate Appropriations Committee, also
addresses the current EWC shortfall and screening guidelines.
Analysis Prepared by : Mary Ader / APPR. / (916) 319-2081