On March 14th, 2012, at least 300,000 low-income and uninsured Texas women will have no or greatly-reduced access to basic preventive and reproductive health care due to the loss of federal funding for the Medicaid Women's Health Program in the state. The program has been under threat for months as lawmakers fight over whether it's legal to exclude Planned Parenthood from the program.
On Friday, U.S. Health and Human Services Secretary Kathleen Sebelius told reporters in Houston that the federal government would not extend its waiver, which provided about 90 percent of the cost of the program. It is against federal law to exclude "qualified providers" from providing Medicaid care, and while the federal government considers Planned Parenthood "qualified," the state of Texas does not. Since 2005, legislators in Texas have sought specifically to block Planned Parenthood from participating in the Women's Health Program in Texas, when they voted into place a state law, only just now enforced, that bars "affiliates" of abortion providers from receiving funds. Planned Parenthood uses no taxpayer dollars to provide abortions and keeps its abortion services wholly financially separate from its non-abortion services.
In a statement released Friday, Governor Rick Perry's office stuck the Obama administration with the blame for not renewing the Women's Health Program, neglecting to mention that there would be no reason to defund the program had Perry and his conservative allies in Texas not sought to defy federal law in the first place. Perry has said that Texas will continue to fund what would very likely amount to a significantly stripped-down version of the program with state funds--despite the fact that state legislators already devastated the state family planning budget last year.
"We're questioning the governor saying he's going to continue the funding with state money," Planned Parenthood of North Texas representative Kelly Hart told RH Reality Check, "and why the state would want to go forward to spend more money to provide care to fewer women." Hart says Planned Parenthood expects to be able to provide WHP care until they're phased out in late April so that "more women can have that last chance to get their annual exam."
The Center for Public Policy Priorities, based in Austin, has issued a report urging the State of Texas not to make this unnecessary and less effective state-funded move in lieu of continuing to let the program work as it always has. Quite simply, family planning programs don't need to be fixed because they were not broken.
"Our family planning programs are programs that have high ratings [because] they connect women that are uninsured with basic health care check-ups that go along with their family planning, and [in addition] the sometimes life-saving outcomes that go along with that," CPPP Associate Director Anne Dunkelberg explained to RH Reality Check.
She adds that, of course, family planning programs also "reduce unintended pregnancies dramatically." Fewer unintended pregnancies mean fewer abortions.
By seeking to illegally exclude Planned Parenthood from the WHP, the State of Texas has effectively guaranteed a significant reduction in women's access to basic reproductive care and an increase the number of unintended pregnancies, and thereby abortions.
"One thing about the Medicaid Women's Health Program is that it promises to serve every qualifying woman who shows up," said Dunkelberg. A state-funded program would "need to ensure there's enough funding available to take care of all these women," and it's unlikely that Texas could or would do so, particularly because state legislators slashed family planning funds by two-thirds last year.
The 2011 state family planning cuts left 180,000 women without access to contraception and reproductive health services like cancer screenings. The Women's Health Program serves an additional 130,000 women, bringing the total number of women without access to basic reproductive health care to 310,000. Some estimates put the number closer to 400,000. The Texas Legislative Budget Board has estimated that this will result in up to 21,000 additional births in the state--children born to families who are already in need of government assistance and who would otherwise have sought to avoid an unintended and unwanted pregnancy.
It's hard to argue that the Obama administration is to blame for denying health care to hundreds of thousands of Texas women when Gov. Perry and conservative Texas legislators already took these significant, cost-increasing steps last year, despite the widely-accepted reasoning that family planning in Texas saves taxpayers $3.74 for every $1 spent.
Conservative lawmakers in Texas have argued that there are plenty of alternatives to Planned Parenthood in Texas, like Federally Qualified Health Centers and small-scale providers, though an RH Reality Check investigation conducted by this author last year revealed that the "alternatives" only operate as such for a very small, very mobile group of women. Without Planned Parenthood, which has the resources to provide comprehensive reproductive health care to a large number of patients in many, many locations across the state, women are left with long waits, at non-specialized clinics and, if they don't have cars or time off from work, difficulty accessing the care that may only be available counties away from their home and work.
Kelly Hart at Planned Parenthood of North Texas told us:
"Yes, there are a large number of providers that have been part of the Women's Health Program that have been reimbursed for providing care, but the vast majority of them see less than 25 patients a year."
A given Planned Parenthood clinic may see hundreds or thousands.
At a rally held for Planned Parenthood in Austin last week, interim CEO Sarah Wheat told RH Reality Check that their patients in the WHP were upset, frightened and angry that they could lose their access to reproductive care--and this was before the official ruling.
One of those patients is Delia Henry, an Austin woman in nursing school. "I don't know what my next step will be if the program is cut," said Henry, a WHP who says she goes to Planned Parenthood for contraception, annual exams and screenings. She says she worries about women who rely on WHP who are already mothers.
"You're taking a chance on kids' moms, what are they going to do?" she asked. A non-traditional student, Henry says many of her classmates are just out of high school. "They work jobs but not enough hours to get insurance, what are they going to do? This is a great part of their life and they're not going to have that education and that safety net," that Planned Parenthood provides.
Facing the fact that her access to reproductive care may disappear, Henry made a joke that may be unfunny because it's true: "If you talk to me at another time, I guess I'll be pregnant."