New Assaults in War on Women's Health Care

On Thursday, June 9, members of the state Health and Human Services Commis­sion's Medical Care Advisory Committee voted to approve a new agency rule that would ban Planned Parenthood from participation in the successful Women's Health Program.

The 15-member committee, a federally mandated body that reviews and makes recommendations regarding agency rules that affect Medicaid programs, voted unanimously (with one abstention and one absence) to allow the agency to go forward with redefining the word "affiliate" in an effort to squeeze the state's Planned Parent­hood clinics out of state-funded reproductive health care services for low-income women.

At issue is which providers will be able to serve the clients of the WHP, a Medicaid-waiver program created by lawmakers in 2005. Last year, Sen. Robert Deuell, R-Greenville, requested an opinion from Attorney General Greg Abbott about whether it would be legal to ban PP from providing any services through the program – under the theory that because some PP clinics provide legal abortion services (none funded with public money), even those clinics that don't would be banned because, essentially, they're part of the same parent nonprofit. Abbott signed off on that, saying he didn't see that it would violate federal law governing Medic­aid funding; that prompted the HHSC to draft its new rule. Kay Ghahremani, deputy director of policy development for the HHSC, told members the new definition is simply a way to "implement the existing statutory prohibition against [funding] abortion providers ... or their affiliates." The agency's legal arm had been concerned about the affiliate provision passing legal muster, but with the nod from Abbott, the agency was empowered to move it through, she said.

The WHP serves low-income women, ages 18-44, who wouldn't be poor enough to qualify for Medicaid services unless they were pregnant – it's an attempt to reduce the number of Medicaid-paid births by providing family-planning and preventative health services to those women. This is no small matter: Texas has one of the highest percentages of Medicaid-paid births, costing the state $2.7 billion in 2009 alone. The program has been successful so far, reducing the number of program-paid births by more than 10,000 in 2008; currently, the program averages about 120,000 clients per month, according to the HHSC.

According to Ghahremani, almost 30% of current clients are served at PP clinics. That means a large number of clients would have to find a new provider. But Ghahremani told the committee that HHSC doesn't foresee any problems with provider availability: 98% of clients will live within 10 miles of another provider. Whether those providers will actually be in a position to pick up those clients remains to be seen – the assessment that dumping PP would cause "very little drop in access," Ghahremani said, "doesn't address the capacity of those providers" that would remain. Indeed, with the massive cuts to the family-planning budget, women's health care advocates are concerned that smaller providers – including those family-planning clinics that HHSC does not believe will be directly affected by the new affiliate rule – won't be able to keep their doors open without the infusion of federal funds traditionally allocated to providing family-planning and preventative health services. Lawmakers have so far approved a plan that would cut some $62 million from the $99 million biennial budget that provided health care to more than 250,000 women last year.

Although several committee members had pointed questions, they seemed convinced by Ghahremani's assurance that the agency would keep an eye out for any gaps in coverage created by adoption of the rule.

Meanwhile, the House last week amended the big Medicaid and health "collaboratives" bill (Senate Bill 7) to include a new round of amendments that seek to further reduce access to legally protected abortion care and women's health services. The most onerous of the amendments was offered by Rep. Bill Zedler, R-Arlington, which would require a woman seeking abortion to provide a host of personal information about her background, educational attainment, marital status, methods of birth control used, and the reasons she is seeking to terminate her pregnancy – including whether she was "coerced or forced to have the abortion." The information would be collected and submitted to the Department of State Health Services and posted publicly (in aggregate form) "in order to assess the quality and efficiency of health care." Such content, when offered in bill form in previous sessions, had died because of privacy concerns.

Also adopted last week was an amendment to SB 7 by Rep. Wayne Christian, R-Center, that would withhold state funding for any public hospital district that uses funds to support abortion care. This is a new version of a bill Christian filed this session that took specific aim at Travis County's Medical Assistance Program, which is administered by Central Health. The program, which has been around since the 1970s, seeks to provide the same access to health services for low-income clients that paying clients can access – including counseling, family planning, birth control, and pregnancy termination. It's the fact that Austin's MAP provides abortion care assistance that has Christian up in arms. His bill would have banned any local taxpayer funds from supporting abortion services; the new amendment doesn't directly attack local control of tax funds but provides that any hospital district which chooses to spend its money that way is barred from receiving any state funds. How this might affect Central Health isn't yet entirely clear.

In other women's health news, on Monday, the Center for Reproductive Rights filed suit in federal court in Austin, challenging the new ultrasound-before-abortion law less than a month after Gov. Rick Perry signed it. For more, see the Chronicle Newsdesk blog at austinchronicle.com/newsdesk.