As the state rolls out its revised Texas Women's Health Program, a central question remains: how to find enough providers to serve the nearly 111,000 women currently enrolled in the program. The current numbers suggest real trouble – but if one Houston-based crisis pregnancy center and Gov. Rick Perry have their way, providers will be made available.
Indeed, being a part of the WHP is a goal for Cynthia Wenz, CEO of The Source for Women in Houston, a CPC that's in the midst of transforming itself into a women's health center. It's a transformation that Gov. Perry supports. "The Source for Women clinics, in fact, will be a part of Texas' own Women's Health Program, and Planned Parenthood will not be," Perry said in a speech delivered to supporters of The Source at a ribbon-cutting ceremony this week in Houston. Whether The Source will also help to transform the provider base for the Texas WHP remains to be seen.
At issue in part is the state's banning of Planned Parenthood clinics from the program. Although the PP clinics in the WHP do not provide abortions, the state considers them "affiliates" of those non-WHP PP clinics that do provide abortion care. When the federal government, which originally provided 90% of the WHP funding, concluded that excluding PP clinics would violate federal law, Perry decided that the state would remake the WHP as a state-run program, keep the ban on PP, and find a way to come up with the $30-plus million in funding previously provided by the feds.
To be eligible for the WHP, a woman cannot be pregnant, and in 2010, PP clinics provided care to nearly 50% of all WHP clients.
According to new analysis done by the Center for Public Policy Priorities, that remained true in state fiscal year 2011, when PP clinics accounted for 47% of all WHP claims coming from providers that are required each year to certify their eligibility to provide WHP services (hospitals and labs aren't required to do this). Even more troubling is that it isn't just PP clinics that will be leaving the WHP. This year providers were asked to certify eligibility for the program by May 1 – including confirming that they are not affiliated with an abortion provider. In addition to the 28 PP clinics that did not recertify this spring, 71 other providers – including federally qualified health centers, physicians, and family planning clinics – also failed to recertify for the program, according to the CPPP analysis. All together, those 99 providers handled roughly 61% of all WHP claims filed in 2011.
More globally, although 1,928 providers recertified for the program this spring, just 515 actually provided services in 2011, accounting for the remaining 39% of paid claims. (The 1,928 excludes labs and hospitals, neither of which are required to certify.)
If the current proposed rules for the WHP are accepted by the state, providers and advocates for the program fear that number could shrink even more, thanks to the inclusion of a "gag rule" that would forbid doctors from any discussion of abortion with their patients. As written, the rule would even forbid doctors from providing information about abortion to their clients who are not enrolled in the WHP. It is a proposed rule that lawmakers, policy analysts, advocates, and doctors alike have told the state health agencies is a major problem because it conflicts directly with medical ethics.
If doctors are forced to choose between adherence to fundamental medical ethics and participation in the WHP, a program that provides basic reproductive health and family-planning care to low-income women, the WHP stands to lose. "We strongly oppose any interference into a physician's ability to use his or her medical judgment as to the information that is in the best interest of his or her patient," Texas Medical Association President Michael Speer and Texas District of the American Congress of Obstetricians and Gynecologists Chair Lisa Hollier wrote in comments to the Department of State Health Services on behalf of their organizations and the Texas Association of Obstetricians and Gynecologists, the Texas Academy of Family Physicians, and the Texas Pediatric Society, which together represent more than 47,000 doctors and medical students. "Because of the proposed rules, we are very concerned about the future viability of this important program. If adopted as proposed, the rules will undoubtedly dramatically decrease the number of physicians willing to participate in the [Texas WHP].”
How the doctors’ response – and the new numbers – might affect the proposed gag rule remains uncertain. "We're looking at potential changes to address those concerns," Health and Human Services Commission spokeswoman Stephanie Goodman wrote in an email. "We hope to have any revisions ready by early October." Even if the gag rule is eliminated, will there be enough providers willing to agree to the state’s terms? Indeed, it appears there may be a major new player – at least in Houston.
Meet the new The Source for Women, a longtime CPC that is in the midst of remaking itself into a "pregnancy medical clinic," that proposes to be a federal Medicaid-eligible provider and will step into the Texas WHP to provide well-woman checks and other reproductive health services.
The Source CEO Wenz is a former accountant, event planner, and general manager in television post-production. On the phone from Houston, her excitement about the new direction for The Source is palpable. Moving into reproductive health care makes good business sense, she said. When Planned Parenthood moved into its large new digs in Houston, she said, The Source had a choice: stick with the old-model CPC, an entity often criticized for providing questionable counseling advice without providing any medical services, or become a direct player in women's health care. The choice, she said, was obvious. "Let's just talk business," she said, and forget about politics and abortion. If she were the head of Blockbuster, she said, and Netflix arrived on the scene, the question would be, "how do we make our business model sustainable?"
According to Wenz, The Source for Women will now have nurse practitioners on staff, and will provide pap smears, sexually-transmitted disease testing and treatment (treatment for STDs is not currently part of the WHP, but Wenz said The Source will treat those diseases). Exactly what types of birth control will be provided, she said, has not yet been decided. "Our goal,” she said, “is to serve our demographic," low-income women, and that demographic needs birth control. However, The Source will not provide anything it considers an abortifacient – including emergency contraception. According to unspecified “medical standards,” Wenz said, that's what EC is – although there is plenty of scientific dispute with that position.
What about birth control pills? That hasn't yet been decided. Wenz said only that The Source is "absolutely addressing the birth control issue," and that its board is in the process of determining the parameters of its "prescriptive authority."
And can The Source meet with HHSC approval? A provider would not be required to provide an entire list of services just to be eligible for Texas WHP funding, HHSC's Goodman wrote in an email. (And, under the current rules, emergency contraception is not covered by WHP, which is a program designed to provide basic preventative health services, as a means of preventing unwanted pregnancy.) However – and it's a major condition – all providers must be enrolled in the federal Medicaid program. Wenz said The Source is in the middle of doing just that. In fact, she said The Source has been moving toward becoming an eligible provider since she took the helm in 2009.
While The Source may be devising a new mission, it isn't abandoning its heritage. The list of services the group provides may have expanded – its website earlier this week included a note that it does not provide "reproductive health care services," "birth control," "pap smears," or "mammograms" – The Source intends to continue drawing dollars from the state as a participant in the Alternatives to Abortion program.
That program, created by budget rider in 2005, moved money from the traditional family-planning budget to fund CPCs in order to "promote childbirth." Initially funded with a $5 million biennial allocation, lawmakers in each subsequent session have increased the A2A budget, even as it has drastically cut funding for women's health care. In fiscal year 2011, The Source received just under $85,000 in state A2A funds, to provide "counseling" and various classes, including on childbirth and pregnancy. For the first quarter of FY 2012, the group billed for nearly $29,000 in A2A funds. The Source will continue to be a part of that program, said Wenz. The A2A makes up just a small portion of their funding, provided by "six revenue streams," she said. "It is a small percentage [of funding], but you bet, [I'll take] every revenue stream I can."
Among those supporting The Source's makeover is Perry, who on Tuesday spoke at the group's ribbon-cutting ceremony. "Here in Texas, we've worked hard to strengthen our abortion laws, empower families, and protect our children's future," reads the text of Perry's speech. "We've banned the use of your tax dollars for abortion procedures in Texas, and expanded that ban to include those affiliated with abortion providers in the case of our Women's Health Program," he continued. "We've stood strong … and proclaimed the truth that protecting the rights of abortion providers and protecting women's health are not the same thing. The Source for Women clinics, in fact, will be a part of Texas' own Women's Health Program, and Planned Parenthood will not be."
Copyright © 2013 Austin Chronicle Corporation. All rights reserved.