The Future of the Texas Women’s Health Program

Starting Nov. 1, the state of Texas’s Women’s Health Program will no longer receive Federal Medicaid dollars. This means that in less than a month, Texas will have to almost completely foot the bill for its Texas Women’s Health Program, a program that provides women living below the poverty line with insurance for free gynecological exams, cervical cancer screenings, and birth control. The federal government has covered 90% of the cost associated with the program since its inception in 2007.

Texas plans to raise $40.1 million over the next year to pay for the new state-run program, which is supposed to serve the same purpose as the federally-funded program. Right now, legislators plan to pay for the women’s wellness care with general revenue until 2014, when Medicaid will expand under the Affordable Care Act and supposedly absorb the costs. This plan may not work out, however, if Texas’s governor, Rick Perry, refuses to accept funds to expand Medicaid. Perry has made several statements to the public stating that he has no intention of expanding Medicaid in Texas.

The changes to the Texas Women’s Health Program will go into effect a little over a year after the state experienced a major reduction in family planning funding. In 2011, the state funding that went to family planning clinics in Texas was reduced by two-thirds. Because of these funding cuts, 53 family planning clinics in the state had to close their doors, and 38 had to reduce their hours.

Many of the clinics that closed were in border towns and rural areas of the state, where teenage pregnancy rates are often highest and the need for increased family planning healthcare is arguably the greatest. According to NPR, last year’s cuts affected around 300,000 women in Texas and may have contributed to approximately 20,000 unplanned pregnancies.

2011′s family funding cuts were a part of the state’s overall austerity measures in response to the recession but also a part of a war waged on Planned Parenthood by socially conservative legislators, including Rick Perry. Planned Parenthood clinics received 25% of state family planning funds prior to 2011 and have had to struggle and fundraise to keep many of their clinics open over the past year. Conservatives have been open about the correlation between family funding cuts and their distaste for Planned Parenthood.

Although one could argue that last year’s family planning cuts have more to do with balancing the state’s budget than shutting down Planned Parenthood, the adjustments to the Texas Women’s Health Program are undeniably a direct result of the state government’s fight against the well-known women’s wellness clinics.

Earlier this year, Texas legislators attempted to ban Planned Parenthood clinics as well as any medical providers associated with abortion from the Texas Women’s Health Program. Much to the dismay of these legislators, the U.S. Health and Human Services Department asserted that it would discontinue its financial support for the program if the state proceeded with the bans. Governor Perry reacted by refusing federal funds. Starting next month, the state can exclude whomever it wants from its women’s health initiatives.

Interestingly, none of the Planned Parenthood clinics that participated in the Texas Women’s Health Program provided abortions. They are being shunned from participation because they’re loosely associated with the minority of Planned Parenthood locations in the U.S. that do perform abortions and because they sometimes refer women to medical providers that terminate pregnancies.

The Texas Tribune estimates that around 45% of current Texas Women’s Health Program participants turn to Planned Parenthood for women’s wellness exams and contraceptives. A representative from the Texas Health and Human Services Commission told me that Texas women will simply have explore their other options once Planned Parenthood is excluded from the program. Unfortunately, their other options may be limited.

Long-term funding is definitely a concern for the Texas Women’s Health Program, but it’s not the most imminent concern. Getting enough medical providers on board to meet the state’s family planning needs is most pressing, as things get down to the wire this month.
In order to participate in the Texas Women’s Health Program, health providers have to sign a clause that states they won’t discuss abortions with patients, even when those patients ask about it. I spoke with the president of the Texas Medical Association, Dr. Michael Speer, who expressed quite a bit of concern over this clause.

“The Texas Medical Association believes it’s a first amendment violation. All healthcare matters, including abortion, should be between the woman and her physician. We’ve spoken out strongly against the proposed changes. I think that many of the providers who previously participated in the Women’s Health Program aren’t going to anymore. I know that around 400 practices haven’t submitted their annual applications to the program because of this clause,” Dr. Speer told me.

The state of Texas has recruited 500 new medical providers to join the Texas Women’s Health Program to take the place of Planned Parenthood, according to Bloomberg. These new providers are mostly private practices, not clinics. They often can’t see as many patients as clinics can. Because of this, they may not be able to fill the void, especially if hundreds of practices drop out of the program, as Dr. Speer predicts they will.

“As far as I can tell, with people not sending in forms and clinics not being reproduced, I don’t see how the state will be able to make up for what they’re losing. The individual doctor’s office can’t see these folks like Planned Parenthood can. These are small practices that the state is asking to gear up. I’d love for the state to come forward and reproduce access, but I haven’t seen any evidence that it’s going to happen,” Dr. Speer said.

A shortage of providers would mean that many Texas Women’s Health Program participants would have to wait longer and travel farther for birth control, gynecological exams, and cancer screenings. Randall Ellis, the Vice President of Public Affairs at Legacy Community Health Services, spoke to me about the issue. Legacy Community Health Services runs a group of community health centers in Houston and will be a part of the Texas Women’s Health Program this year.

“When you’re living in poverty, having to find another doctor and get to another doctor becomes a hassle. You may be an hourly wage worker, and you may not have time to take off from work to drive to a doctor whose office is an hour away. People in these remote, rural locations will have to travel. Some of them will have to lose personal income to obtain services that should be more easily accessible to them,” Ellis said.

All in all, the Texas Women’s Health Program’s future is uncertain. Its financial future is uncertain, and so are its logistics. For the past five years, the program has worked. According to a Texas Health and Human Services report, it decreased Medicaid costs by approximately $90.2 million and prevented around 8,215 unplanned births in 2010 alone. At this point, no one can say whether or not the program will continue to work.

According to Randall Ellis, “The real tragedy here is that the infrastructure that we’ve built will be decimated. It’ll be torn apart. We were able to do what we needed to do before. These huge changes based on ideology are destroying the infrastructure, destroying what we spent so much time building.”

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