Women's Health: 'Everybody Loses'

The legislative budget conferees agreed last week to leave in place nearly $62 million in cuts to the state's family planning program authorized by the House in April, a move that advocates believe will shutter dozens of small clinics – and leave 200,000 women without access to basic health services. And although lawmakers have reauthorized the successful Medicaid-waiver Women's Health Program, it is unclear whether there will be enough providers left to keep up with the more than 100,000 clients currently in the program. In short, cutting off funding for family planning could strip the life out of the WHP.

The compromise budget plan leaves just $37.9 million in family planning funding for the biennium, down from the roughly $99 million originally allotted, which last year provided services to nearly 260,000 clients. Family-planning funding covers basic reproductive health screenings, including Pap smears, as well as screenings for breast cancer, hypertension, diabetes, and communicable diseases like HIV. Although none of the money, pass-through federal funds, may be spent on abortion, foes of family-planning services successfully framed the defunding as a way to keep money away from providers that also provide abortion care – namely their arch foe, Planned Parenthood. While Texas Right to Life has dubbed the budget gutting as a victory for "life," the reality is that Planned Parenthood will not be closing its doors; instead, the nearly 100-year-old nonprofit will simply be unable to provide preventative health care for the neediest Texas women. Moreover, the cuts mean that many small providers, including independent health clinics, will likely shut their doors this summer, says Fran Hagerty, CEO of the Women's Health and Family Planning Association of Texas, which represents many of the state's smaller women's health care providers.

Also included in the budget is a rider by Sen. Tommy Williams, R-The Woodlands, which devises a matrix for allocating the funds that remain: less than $19 million per year. According to the rider, the funds must first be allocated by the Department of State Health Services to "public entities" – including county and city health departments, local community clinics, and federally qualified health centers – that provide family planning services in addition to other health services; remaining funds can then be awarded to "non-public" entities that provide "comprehensive primary and preventative care as a part of their family planning services"; then, if any money remains, it can then be allocated to nonpublic providers of family-planning services – in other words, Planned Parenthood and other specialized providers. The thinking, of course, is that there won't be any money left for the third tier. In fact, at this low level of funding, there isn't even enough money to cover the needs of the providers in the first group. In 2010, there were 25 "public" contractors and 26 FQHC contractors; together these two groups received nearly $28 million to provide basic health services to low-income Texas women (and some men). "It's almost impossible to accept," says Hagerty. "Everybody loses."

Equally troubling is the ripple effect the massive budget cut could have on the WHP, which provides family-planning services for women who wouldn't otherwise be eligible for Medicaid unless they were pregnant. In 2008, the program saved the state more than $40 million in Medicaid costs. Before last week's reauthorization of WHP, it appeared the program might die altogether because of a poison-pill measure written by Sen. Robert Deuell, R-Greenville, which would have shut down the program in the event that Planned Parenthood successfully sued over the state's attempts to keep it from providing services under WHP. Currently, Planned Parent­hood serves some 40% of WHP clients. If the state succeeds in keeping PP out of the mix, it is unclear who would be left to serve WHP clients, says Hagerty. Many WHP providers also get family-planning funding; without their federal tax money allocation to provide those services, many won't be able to remain in business to serve WHP clients, and the larger providers, like Dallas' Park­land Hospital, will also be taking a hit, making the future of WHP's programs bleak. "The little guys will close," she said. "And the big guys, like Parkland, will be a skeleton of what they once were." If the WHP is indeed crippled by the broader cuts to family planning, the state could be cutting off well over 300,000 low-income Texans from access to basic health services.

Meanwhile, the budget compromise actually includes a revenue increase for the Williams-created Alternatives to Abortion program, which provides "counseling" and "support" to women in crisis pregnancies, to encourage them to carry their pregnancies to term – often with Medicaid support. The program has gotten a budget increase each session since its creation in 2005 (with an initial $5 million stake pulled from family-planning funds); this year lawmakers are throwing in an additional $300,000, pushing its biennial budget up to $8.3 million. The program provides no medical services, but does provide referrals to other government programs. According to the compromise budget, this money should provide "services" for roughly 16,000 women a year; in contrast, last year the state's FQHCs got roughly $7.6 million to provide actual medical care to more than 30,000 women. (For more on the Legislature's attack on women, see "The War on Women's Health," April 22.)