Texas Women's Healthcare Hit by Controversy

The twin shocks hitting Texas' family planning programs are illuminated in three outstanding videos produced by the Texas Tribune.   Reporter Thanh Tan skillfully details both the huge budget cuts to the DSHS Family Planning program and the multifaceted threats to the Women's Health Program (WHP).  

The third and latest video, "State Government and Family Planning," is posted today.  It reviews the history of government support for family planning, and how bipartisan support for birth control has now become a partisan issue. 

     

Impact of the Cuts

The first Texas Tribune video focuses on the consequences of the Legislature's deep cuts to the Department of State Health Services (DSHS) Family Planning program.  With the $73 million (66%) cuts, the number of funded providers has dropped from 70 to 40, and nearly all of the funded providers are each receiving much less than last year.  At least 150,000 fewer women will be served by the program each year.

Community Action of Central Texas is an example of an agency that lost all state funding, causing it to close 3 rural clinics and lay off 11 staff members.  This agency provides family planning, along with STD and cancer screening, but it has never provided abortions.  Because it is no longer state funded, Community Action has lost its ability to purchase contraceptives at public-health prices, so its birth control costs are up 100%.  In the video, staff members express concern that the women they have cared for will have a difficult transition to other providers.

Along with Planned Parenthood clinics, Community Action is considered by the state to be a "specialty clinic," and is in the lowest priority group for funding.  The tiered system created by the 2011 Texas Legislature gave highest priority to public clinics, such as county hospitals and Federally Qualified Health Centers (FQHC's).  

The video also features the Texas Policy Evaluation Project, led by University of Texas professor Joseph Potter.  Designed to measure the actual impact of the budget cuts, this study is collecting data on unplanned pregnancy, Medicaid births, abortion trends, and access to birth control after a woman has a baby.  Clinic director interviews will help to outline the immediate impact of the cuts on services. 

Contraception as Collateral Damage

The second Texas Tribune video, "Texas vs. Planned Parenthood," details how preventive care and birth control have been hit hard by the crossfire of the "culture war." 

This video focuses on west Texas where, in the midst of an oil and population boom, Planned Parenthood of West Texas, which provides preventive services to women in 50 counties, lost state funding and closed clinics, e.g., in Odessa.   Other area providers, such as Midland Community Healthcare Services and Texas Tech Health Sciences Center, with their own family planning funding severely cut, are not able to absorb the estimated 4,000 patients displaced from Planned Parenthood.

The Legislature's deep cuts to the DSHS Family Planning budget, along with its 3-tiered funding priority system, have been successful in excludeing Planned Parenthood clinics from the DSHS program.  The cuts have resulted in the closure of clinics (both Planned Parenthood clinics and non-Planned Parenthood family planning clinics) that provided preventive care and birth control, but not abortions. In addition, nearly all the agencies that did receive funds have experienced dramatic cuts in their family planning funding.

In the video, State Representative Wayne Christian of Center appears to consider any family planning clinic an abortion clinic.  In reality, there are many family planning clinics that are not Planned Parenthood clinics and that do not provide abortions.  By law, neither federal nor state dollars can be used for abortion-related services.  However, Rep. Christian is not convinced by Planned Parenthood's legal and financial separation of abortion services from preventive services, and he seems not to be aware of that some family planning clinics are not related to Planned Parenthood.

The shocks to Texas women's access to contraception are not seen as unfortunate "collateral damage" by everyone.  Unlike the vast majority of Americans and the vast majority of evangelicals who favor access to birth control, some people consider contraception unacceptable in its own right.  In the Texas Tribune video, one protester against Midland Planned Parenthood stated that "birth control is really against the natural law."

WHP: What Now?

The future of the Texas Women's Health Program (WHP) is still uncertain, and a ruling from the federal appeals court may come soon. 

Since 2007, WHP has been a Medicaid program which provides preventive care, screenings, and birth control (but not abortions) to about 130,000 women each year -- women who would be eligible for Medicaid, if they were pregnant.  The program has been 90% funded with federal dollars, about $35 million per year.

At the behest of the Governor and the Texas Legislature, the Texas Health and Human Services Commission (HHSC) is now enforcing a rule excluding affiliates of abortion providers (i.e., Planned Parenthood clinics) from participating in the program.   However, the federal Medicaid statute does not allow such exclusion of willing providers, and the federal HHS will withdraw its funding from the program by November 2012. 

Planned Parenthood is suing the state in federal court to reverse its exclusion from WHP, citing its constitutional rights to free speech and free association.  On April 30, a temporary injunction was granted, prohibiting the state from excluding Planned Parenthood until the case could be heard.  Texas Attorney General Greg Abbott appealed to the 5^th Circuit Court of Appeals, which issued an emergency stay of the injunction.  By May 4, the injunction was reinstated by a 3-judge panel of the 5^th Circuit.  This back-and-forth left Planned Parenthood still able to participate in WHP, at least for now.

This struggle has been confusing for many.  Rick Casey's recent San Antonio Express-News columns summarize the back and forth, and dispute the assumption that the state would be required to immediately discontinue WHP if a court holds that Texas may not exclude Planned Parenthood. 

The Express-News editorial board admonished HHSC for sending out flyers before the case is decided to over 100,000 WHP clients, telling them to find providers other than Planned Parenthood.

The Governor has vowed to find state funding to continue WHP, even without federal dollars. However, it will be enormously difficult to assure there are enough providers to see the 55,000 WHP clients who have been served by Planned Parenthood each year.