The State's Planned Parenthood Trap

Tomorrow (Thursday) the Health and Human Services Commission Medical Care Advisory Committee is set to hear public input on a proposed rule that would eliminate Planned Parenthood from providing services under the successful Women's Health Program.

Although there seems little doubt that the proposed rule will go through, and will be implemented later this year, whether it will actually get the blessing of the federal government is another story.

Indeed, in a not-so-unexpected move, on June 1, the administrator of the Department of Health and Human Services Centers for Medicare & Medicaid Services penned a memo to state officials in Indiana to say that their recently-enacted scheme to cut PP from receiving any federal Medicaid funding to provide basic health care services would not pass legal muster. "We assume this decision is not unexpected," Dr. Donald Berwick, the CMS administrator, wrote.

Indiana – as lawmakers have tried to do here in Texas – sought to cut PP out of funding because, in addition to the basic preventative care they provide to tens of thousands of low-income women in Indiana, the nearly 100-year-old nonprofit also provides, with private funds, legally protect abortion services. (No federal funds can be used to pay for abortion except in extremely limited circumstances.) Conservative lawmakers in Indiana (as is the case here in Texas, where this session the Republican supermajority has been significantly influenced by Texas Right to Life) have successfully argued – against reason, logic, and facts – that providing funding to PP actually funds the abortion "industry." The feds inserted a dash of reason into the debate last week, via Berwick's memo. The new Indiana law "would eliminate the ability of Medicaid beneficiaries to receive services from specific providers for reasons not related to their qualifications to provide such services," he wrote. "Medicaid programs may not exclude qualified health care providers from providing services that are funded under the program because of a provider's scope of practice." Although Indiana has indicated that it will go forward with its plan the writing seems to be on the wall. And there's no doubt that unless the state of Texas changes it's tune as it pertains to PP (don't hold your breath) Gov. Rick Perry will receive a similar letter from the federal agency, informing the state that it's plans to cut out PP as a provider in the Women's Health Program also won't cut muster.

In addition to making drastic cuts to the state's family planning budget – reallocating to cover holes in other program budgets roughly $62 million of the $99 million biennial funding to provide more than 250,000 women (and some men) each year with basic preventative health care services – the state, at the behest of Sen. Robert Deuell, R-Greenville, is reworking it's definition of the word "affiliate" in order to cut PP out of providing health services to women enrolled in the WHP, a Medicaid-waiver program that in 2008 alone saved the state $40 million in Medicaid costs. The program enrolls women for services who wouldn't otherwise be eligible for Medicaid unless they were pregnant. This is no small issue, considering that more than half of all the state's births are paid for by Medicaid – at a cost in 2009 alone of $2.7 billion. Currently, PP providers services for some 40% of program patients.

Nonetheless, the HHSC has drafted a new definition of affiliate that would ban the state from contracting for WHP services with any provider that also provides legally-protected elective abortion care. That means PP in general, regardless of whether individual clinics actually provide any abortion services, would be cut out from participation – a move that Attorney General Greg Abbott has said should be legal, but which seems questionable especially in light of the Indiana memo. The real question is what the state will do if it is told that this new plan to cut PP out of providing services doesn't fly: Unlike the plan to cut PP out of all Medicaid services in Indiana, Texas is seeking to cut PP out from a Medicaid-waiver program, a program that must be approved by the feds. The WHP got the nod of the federal government for it's first five years, but it seems unlikely it would do so again if the new restrictions are included. That would leave the state with a choice: dump the new definition of affiliate or dump the program. Given the mood of state lawmakers as it pertains to women's health issues, it seems safe to bet that the state would be more inclined to dump the program. The situation in Texas and Indiana is "definitely related," says Sarah Wheat, interim co-CEO of Planned Parenthood of the Texas Capital Region, "but how it all plays out, I don't know."