Steering Past the Potholes Despite Challenges, Tapestry Continues to Meet Critical Public-health Needs

For 37 years, Leslie Tarr Laurie says, Tapestry Health has played a pivotal role in providing critical health services across the Pioneer Valley and the Berkshires.

They range from the Women’s Health Network, which screens uninsured and underinsured women for breast and cervical cancer, to testing for HIV, chlamydia, and a host of other sexually transmitted diseases. Tapestry also provides a needle-exchange program (now in its 17th year) that has significantly curtailed the spread of disease among drug users.

In addition, Tapestry advises clients on a wide variety of infertility and birth-control products, “empowering women and couples so they can, on their own terms, make one of the most important decisions: if and when to be a parent,” said Laurie, the organization’s president and CEO. It also offers emergency contraception following unprotected sex, which can prevent an unplanned pregnancy — and grappling with the difficult issue of abortion.

“We feel like we’ve made an important mark — for instance, by lowering the incidence of HIV in our area,” Laurie said. “And I feel like our organization has, pretty quietly, made a really significant contribution to the health of women and families in this area.”

But some of that progress is being challenged by the implementation of health reform in Massachusetts, she said. She emphasized that she supports what the Commonwealth — and, more recently, the federal government — have done in trying to overhaul the health system, but worries about some unintended consequences that have arisen in the wake of those efforts.

Sticking Points

“Tapestry is one of the few organizations able to enroll people in health insurance,” Laurie noted. “We’re committed to seeing health care as a right.” Yet, some sticking points have emerged.

“We’re delighted to live in a state where everyone has access to health care,” she went on, but explained that it can be four to six weeks between the time an uninsured patient registers with Commonwealth Care through Tapestry and the time services are approved — and in the interim, community-based health centers cannot be reimbursed by the state for those services.

“Now, we can’t say to a woman, ‘come back in six weeks to get your birth-control pills,’ or ‘come back in six weeks for your pregnancy test,’” Laurie said. “We need to raise private dollars to make up the difference, and it’s like David and Goliath, where Tapestry has to raise money that will eventually help Blue Cross Blue Shield or Fallon. There’s something wrong with that equation.”

Another problematic feature of the Massachusetts health law is that dependents are able to stay on their parents’ insurance up to age 26. That in itself is not a negative, but privacy is — specifically, the parents will receive all information related to the care of the dependent.

“So, if a 23-year-old woman wants to get an HIV test, that information is given to the subscriber’s father or mother,” Laurie. “So you have a situation where someone doesn’t want to use their insurance because it will potentially violate their confidentiality” — and, in the worst case, perhaps decline a medical test that would have turned up something critical.

Other issues have to do with cost — particularly with the often-exorbitant co-pays demanded by the type of bare-bones coverage often purchased by college-age and 20-something Bay Staters.

“We’re on the right road, but there are a number of potholes on this road,” she said. “If they are not fixed quickly enough, even an organization with a 37-year history … well, it’s not like we have deep pockets, so it’s putting us at risk of not continuing in the manner we have for clients that come to us throughout the year.”

Funding remains a chronic issue, especially during tough economic times. Citing a Tapestry clinic in Berkshire County that was forced by budget cuts to close last year (it will soon reopen), Laurie said state leadership needs to understand the value of community-based health care when allocating public-health dollars.

“What we do is helpful not only to the people we serve, but also the pocketbook of the state, and it should be supported,” she said. “For example, every dollar spent on family planning saves four dollars next year. And we are the primary provider of HIV testing across Western Mass. What’s the matter with this picture, when we cut money from something so helpful and so effective?”

Pragmatic Approach

One of the characteristics that makes Tapestry so effective, Laurie said, is its pragmatic approach to sexuality, accepting that young people are having sex and seeking to make it safer.

Tapestry educates women on birth control and maks sure pregnant women are counseled on all their options, including abortion. With the advent of HIV and AIDS, she notes, being educated on proper contraception is even more crucial.

“We believe it is a responsible decision for someone who is sexually active to protect themselves from sexually transmitted diseases or pregnancy, especially if they’re not ready to be a parent,” she said.

AIDS has been around for about 30 years, and for much of that time it has been the focus of several Tapestry services, including not only education on HIV risk reduction and safe sex, but confidential testing and, for those who test positive, referrals to other agencies for further medical and support services.

Maintaining such services can be, quite literally, the difference between life and death.

“I do feel like, in some ways, we save lives,” Laurie said. “Sometimes it’s dramatic, and in other ways, it’s more by giving people a better quality of life.”

She’ll always be gratified by the results of Tapestry’s work, but says it’s impossible to say how that work will evolve over the next few decades.

“When we started, there was no AIDS,” she said. “And the notion that we could provide someone with an HPV vaccine to prevent cervical cancer — well, that wasn’t available. So, I don’t know what the next health hurdles will be, but I do know that Tapestry, with its deep community roots, will be at the front lines, making sure people in Western Mass. are treated in the manner in which those new hurdles demand.”