Budget Cuts and a Ban on Planned Parenthood Leads to Decline in Services for Texas Women

Data from the Department of State Health Services shows that from December 2011 through May 2012, the state's family planning program contractors served half as many clients as they did during the same period the previous year. A decline was expected after last year's budget cuts, but advocates say the drop does not bode well for the health of Texas women.

The mid-year family planning data shows that for the six-month period a total of 90,237 unduplicated clients were served with a portion of the roughly $19 million in funding available for the year. That is a 50% decline in clients served over same time period through May 31, 2011. A decline in clients served was expected precisely because of the funding cuts enacted by lawmakers last spring, says Fran Hagerty, CEO of the Women's Health & Family Planning Association of Texas.

On April Fool's Day 2011, lawmakers approved of a two-thirds cut to the biennial budget traditionally allocated to serve low-income and uninsured women who need access to reproductive and other basic health care. Since 2005, the family planning program had served an average of 244,000 women each year. Last year's cuts reduced the roughly $100 million budget to just $38 million over the biennium. While health policy experts – including within DSHS – anticipated a decline in the number of individuals served, Hagerty says the mid-year numbers, distributed to contractors this week, are likely but a harbinger of worse things to come.

The budget cuts were aimed at eliminating Planned Parenthood from receiving any funding to provide family planning services. That has worked – and has forced a number of other providers to close up shop too. According to a report from the Texas Policy Evaluation Project published last month in the New England Journal of Medicine the cuts have resulted in 53 clinic closures across the state and to reduced operating hours at 38 other clinics. Hagerty says the number of members in her group has been cut in half. In other words, the attack on Planned Parenthood is resulting in a wave of collateral damage.

Hagerty and others expect that the number of clients served in the second half of 2012 will again decline in part because at the beginning of the budget year DSHS continued to fund several Planned Parenthood providers in areas of the state where it was having difficulty recruiting other providers to apply for state funding. No Planned Parenthood clinics have received state family planning funds since March 31, says Sarah Wheat, vice president for community affairs for Planned Parenthood of Greater Texas. To make matters worse, the drastic cut in funding also prompted several other long-time non-Planned Parenthood providers to withdraw from the program and return funds to the state, says Wheat.

The numbers may also provide a glimpse into what will happen when the state officially bans Planned Parenthood from providing services to Women's Health Program clients. The state last year also sought to remove Planned Parenthood from that program, prompting the federal government to withdraw it's approval for the Medicaid-waiver the program has operated under. With the waiver, the federal government pays 90% of the cost for that program – saving the state more than $20 million per year. The state's move to ban a qualified Medicaid provider from the program conflicts with federal law and put the waiver in jeopardy. In response, Gov. Rick Perry said the state would go it alone, and pay for it alone, revamping the WHP rules and excluding Planned Parenthood. The plan has resulted in dire predictions about the number of women that, again, will be cut from services. Most recently, researchers from the George Washington University reported last week that Planned Parenthood clinics in five counties – including Hidalgo, one of the poorest, where access to health care is sparse – accounts for between half and four-fifths of the counties' WHP clients.

In the end, Hagerty says she's worried about what's to come, in part because the women who have fallen off the roles are not likely to be getting care elsewhere. "They're not going somewhere else – they didn't all of a sudden find money to go to a private physician," she said.