If cancer strikes, financial chaos can follow. The high risk of cancer impacts lesbians extra hard since the costs of cancer usually hit immediately upon diagnosis. Often lesbian patients are whisked into surgery. If insurance is inadequate, money quickly vanishes simply to get treatment. There is little time to recoup; it's too late to prevent or prepare. The personal and out of pocket costs from this can truly be disastrous. The battle against cancer may succeed - but the financial fallout can kill quality of life and our ability to fight further battles ahead.

This is one reason why after learning to self-diagnose and getting regular gynecological exams, lesbians should build substantial borrowing power. This may take the form of an equity loan on the home, carefully cultivated personal borrowing facilities with banks, already existing credit arrangements on personally owned businesses, and high personal credit card limits. The key task upon diagnosis is to muster the cash to get treatment as soon as possible. How to pay for it is a problem we'll discuss under credit in the section on life-threatening illness below.

The cost curve for cancer is that most costs hit upfront, followed by a less costly but protracted and uncertain period of treatment and remission.

Unlike chronic illnesses, there is little chance for financial preparation, planning, or preventive measures. Since the essence of planning is advance time, little preventive action may be possible. This sudden, unanticipated cost can upset financial arrangements and plunge lesbian finances into debt. This is why lesbians have little choice but to do financial planning while they have the advantage of good health. There is no financial advantage once cancer is in the picture.

If treatment is successful, the long waiting period begins. If cancer is less a shame word today, it still eliminates most chances of get-ting insurance after the fact. Without domestic partnership benefits this can result in many lesbians being without insurance when they need it most. And that can in turn force impoverishment to qualify for medicaid. This is why having medical and disability insurance is the most responsible actions we can take to protect our lovers from the financial disaster of disease. Otherwise we become a financial drain - complicating an already difficult situation.

To be eligible for Medicaid in 1996 in New York, an individual may not have more than $4,850 in resources. Persons with resources in excess of that amount may transfer their assets to a friend, family member or trust. Transfers of assets will not affect eligibility for Medicaid home care under any circumstances. However transfers between non-married persons will affect eligibility when one is attempting to quality for Medicaid nursing-home coverage. (Caution: Before making transfers, consult an attorney familiar with the Medicaid law.) Since most medicaid reviews look only for married spouses, it is possible to transfer assets to a partner in order to qualify. However this needs to be accompanied by legal protections that do not make the assets subject to claims by medicaid - yet to ensure they're kept them for the benefit of their original owner. This can be very tricky. The real fallout can come in careers. One of the few advantages lesbians have over childbearing heterosexual women is the continuity they can bring to their careers. Cancer hits suddenly - often causing loss of a job. Uncertainty about remission can cancel out budding careers - especially with cancers occurring in the 40s. Cancer stories abound where employers fire employees with cancer, refuse to hire them, or will only bring them on in lower-level positions.

There are protections from the Americans with Disabilities Act and under the Family and Medical Leave Act. However the awards are small, the delays are large, and litigation may result in unemployability and a great diversion of resources exactly at the time when they are needed to offset the financial damage caused by the illness.

After cancer's initial cost onslaught the pattern of its costs approximate more closely the cost impact of other life-threatening illness such as HIV. Luckily much more progress has been made in mapping out actions to deal with the financial fallout with HIV. Many of those actions have been spelled out in columns here - and will continue to be dealt with in columns to come.