Texas Family Planning (Still) Costs More, Serves Fewer Women

In fiscal year 2013 – for the second year in a row – the number of women served by the state's family planning budget dropped dramatically, while costing the state significantly more money per patient.

According to documents from the Department of State Health Services filed with the State Health Services Council agenda for Nov. 20, the state's budget for reproductive health and family planning for uninsured, low-income women served just 47,322 clients, a drastic 77% decrease over the 202,968 clients served in 2011 – the last year the program was fully funded.

Indeed, in 2011 state lawmakers approved a budget that stripped two-thirds of the roughly $100 million biennial budget to serve low-income women – providing Pap smears, breast cancer and other preventive screenings as well as birth control – leaving in the pot just roughly $38 million for the two-year budget cycle ending Aug. 31, 2013.

The stated goal of the budget slashing – and a concurrent budget amendment that allowed lawmakers to decide which providers would be given the remaining funds – was to deny Planned Parenthood's family planning clinics any access to state funds. That worked unevenly (Planned Parenthood was granted funds for a while, even after the cuts, because in particular areas of the state, there were no other providers interested in joining the program), but in the process forced closure of numerous other, non-Planned Parenthood, clinics across the state. According to research from the Texas Policy Evaluation Project at UT, 76 clinics have closed as a result of the budget cuts, and another 55 providers have reduced their hours.*

Not surprisingly, that in turn meant a reduction in the number of patients served: In 2012 the program served 127,808 fewer women than it had in 2011, for a total of just 75,160 women served. This year, even more women have been dropped from service, with an additional 27,838 women disappearing from the state's rolls – a two-year loss of 155,646 clients.

The news is grim, considering that there are an estimated 1.7 million low-income women in Texas in need of access to family planning, according to the Guttmacher Institute. Texas has among the highest percentage of women of child-bearing age that are without health insurance – including a whopping 50% of all Latina women of child-bearing age – and is a state with one of the highest rates of cervical cancer in the country, according to 2010 statistics.

Yet, as the number of women served by Texas' family planning program continues its precipitous decline, the cost to serve the reduced roll continues to increase. The average cost-per-client in 2011 was $205.93, according to DSHS. In 2012, that increased to $236.54 per client, rising again this year to $240.10 per client – for a 17% cost increase in just two years.

Despite the seeming overall bleakness of the current women's health landscape, there are, in fact, bright spots, including that the number of women served via a new nonprofit group administering federal Title X family-planning funding – funds that previously were granted to DSHS for distribution, before the wholesale shredding in 2011 of the women's health safety net – has been healthy and is on the rise. According to Fran Hagerty, CEO of the Women's Health and Family Planning Association of Texas, which was granted the Title X funding in March, in just the first seven months of their two-year federal contract the WHFPT network of providers has seen more than 80,000 clients.

Those funds have also been used to reopen four clinics closed because of the 2011 cuts – including a Planned Parenthood family-planning clinic in Mission, in the Rio Grande Valley, that had been closed for the last two years.

Hagerty said that her group has also consulted with providers to learn how they believe the grant money should be spent – aside from direct contributions to the network's 30 providers who run 120 clinics across the state. Feedback from providers has led to the creation of a specific fund to encourage clinics to provide highly effective, long-acting reversible contraception or “LARCs,” which include IUDs, and injectable and implantable forms of birth control, and another "special medical fund" to help pay for sterilizations and colposcopy. "This has been a momentous opportunity to support these providers and what they're doing," Hagerty said. These are steps that "don't take much effort and don't require too much money, but that make all the difference" in being able to effectively, and efficiently, serve women in need. In all, she said, the news from her side of the fence is "all good; all really good news."

Whether the state will have any similar bragging rights as it continues into the new budget cycle remains to be seen. According to DSHS, the state will have roughly $21.6 million to fund the family planning program in fiscal year 2014 (and an additional, roughly $63.6 million in the "community primary care services" budget, a portion of which should fund family planning), though there remain questions about whether the increase of funding – returned to the state budget this spring by lawmakers – will actually help to turn around the the two-year downward spiral.

*An earlier version of this post reported that 59 clinics had closed and 37 providers had reduced hours. According to updated research from Tx-PEP, provided by researcher Joseph Potter, the cuts have now caused 76 clinics to close and 55 more to reduce hours.