The Women�s Community Clinic

SAN FRANCISCO (WOMENSENEWS)–Keewon Haller, a 28-year-old waitress at a sushi restaurant, hopes that she won’t have to go to the emergency room again. Haller doesn’t have health insurance and a trip to the hospital for sciatica last year cost her $700.

“The doctor just moved my leg up and down and up and down, that was it,” says Haller, who is originally from Korea. “If I had an accident and went to the emergency room, I would hope to die, I guess.”

Haller is one of an estimated 75,000 women in San Francisco alone without health insurance, according to U.S. Census figures. California has the highest percentage of uninsured women in the country, with about 20 percent uninsured compared to the national average of 15 percent, according to the Henry J. Kaiser Family Foundation. At the same time, experts say that all states are facing similar public health crises because of decreased tax revenues and budget shortfalls.

African American women face an especially bleak outlook, with double the rate for heart disease than the national average, and the lowest life expectancy rate of all racial and ethnic groups in California, according to the California Black Women’s Health Project.

Health care policy experts hoped that California’s $98 billion 2002-2003 fiscal budget, which passed on Sept. 1 after two months of bitter fighting, would include programs offering more access to health care for women, but two key provisions were ultimately excluded in an effort to make up a whopping $23.6 billion budget shortfall.

Healthy Families, which provides health coverage to low-income children in families that earn too much to be eligible for Medi-Cal (the state’s version of Medicaid, the federal health plan for low-income families) was to be expanded to include parents. Women would have benefited greatly from the program, observers say, because of the large number of single mothers in California. But the $143.3 million price tag, with half paid for in federal matching funds, caused the program to get the ax, according to the California Budget Project, an independent research group.

Also cut from the spending plan was an outreach effort to sign eligible people up for Medi-Cal. The program would have cost the state $29 million (and would have brought to the state another $29 million in federal matching funds), according to the California Budget Project. Two out of every three uninsured children and one in seven uninsured adults in California is eligible for, but not enrolled in, these public programs, according to the California HealthCare Foundation.

“Delays in Healthy Family expansion and these other cuts will disproportionately affect low-income women,” says Alina Salganicoff, vice president of women’s health policy at the Kaiser Family Foundation. “The magnitude of what California is experiencing with a $24 billion shortfall is bigger than what is happening in other states, but all states are making very difficult choices in public health.”

Because more African American women are likely to live in poverty, not expanding Healthy Families or Medi-Cal outreach in the 2003 budget will likely hit this group harder.

The fact that both programs ultimately did not make it into the California spending plan is no surprise, says Jean Ross, executive director of the California Budget Project.

“Given the depth of the state’s budget crisis, the cuts are not unexpected,” Ross says.

Free Clinics Turning Patients Away

Carlina Hansen, executive director of the San Francisco Women’s Community Clinic, is feeling the crunch. Her clinic, which serves between 20 and 40 women each night for reproductive health care needs, such as urinary tract infections, emergency contraception, Pap smears and sexually transmitted diseases, is turning away women on a nightly basis. Running on an annual budget of $300,000 from foundation grants and individual donations, Hansen’s clinic is one of the few in the city that offers free clinician visits and prescriptions. Cancellations and no-show rates are extremely low and most of the staff is composed of volunteers.

“We are in a state of emergency regarding health care in this country,” Hansen says. “At this point providing free health care to women is almost a radical idea.”

Hansen says that the majority of the clinic’s patients are like Haller: low-income working women who do not have health insurance through their employers or cannot afford the premiums on their own. Others are recently unemployed dot-com workers who have let their COBRA plans lapse because the rates are too high. And some women who visit her clinic cannot qualify for individual health-care plans because they have pre-existing conditions, such as an abnormal Pap smear.

“About 10 to 15 percent of Pap smears come back as abnormal,” Hansen says. “That’s no reason to exclude women from getting health care.”

Carolyn Banks, a 34-year-old graphic designer, waits for her appointment at the clinic. Banks has owned her own business for 11 years, but no longer qualifies for individual health insurance because she was treated for depression–a pre-existing condition. She is now looking into getting on a group plan through a Silicon Valley professional women’s association group.

And Trish Barrett, a 23-year-old waitress who just lost her job two days ago, has been coming to the clinic every three months for the past year because of an abnormal Pap smear. A legal immigrant from Ireland, she is visibly appalled by the American health-care system.

“If something were to happen to me, I’d be screwed,” she says. “I try not to think about it.”

Even Medicaid, the nation’s major health insurer of 47 million Americans–mostly low-income families, the elderly and the disabled–is becoming more difficult to use. Budget crunches are forcing states to reduce Medicaid benefits, including cutting or freezing payment rates to Medicaid doctors; increasing controls on prescription drugs; and eliminating women’s health services such as postpartum care, according to a July report by the Kaiser Family Foundation. At the same time, states are beginning to charge these neediest families co-payments for services.

Women Priced Out of Health Care More Often Than Men

Women’s health doesn’t just mean reproductive health. Nationwide, more women than men go without health care or prescriptions because they can’t afford them, despite the fact that more women than men have health insurance overall. One in four non-elderly women, or 24 percent, said they delayed care in the past year due to cost, compared to 16 percent of men. One in five non-elderly women, or 21 percent, did not fill a prescription because they could not afford it, compared to 13 percent of men, according to a May survey by the Kaiser Family Foundation.

In addition, women often need ongoing treatment more than men, requiring more doctor visits. About one-third, or 32 percent of the 4,000 women ages 18 to 64 surveyed by the Kaiser Family Foundation, had a health condition that required ongoing treatment, versus 24 percent of men. “Women are actually more likely to be insured than men because Medicaid offers them more avenues to qualify as mothers and pregnant women,” says Salganicoff of the Kaiser Family Foundation. “But women are poorer and so are less likely to be able to afford care–the cost is a bigger issue–and they are more likely to have chronic conditions than men.”

Like the many other women who rely on free clinics for their health care needs, Keewon Haller hopes to get health insurance by getting a more secure job. She is training to become a sushi chef. Or she may get coverage through her husband, provided he can find full-time work at a computer company. “It feels really insecure to not have health insurance,” she says. “But I’m working on it.”

Rebecca Vesely is a frequent contributor to Women’s Enews.

For more information:

The Women’s Community Clinic:

The Henry J. Kaiser Family Foundation:

California Black Women’s Health Project: