Dear Editor, We are responding to your cover story, “The New Texas Family Planning” by Jordan Smith [News], in the Jan. 27 Austin Chronicle. Community health centers, also known as Federally Qualified Health Centers (FQHCs), do not want to be caught up in any political fight that is occurring between the well-funded titans in family planning, Planned Parenthood, and state policymakers. Community health centers are the little guy in the health care safety net that provide comprehensive health care services to the most vulnerable in our state. Unfortunately, virtually every statement in your article regarding community health centers and the role they play in providing comprehensive health care services to women was misleading and factually incorrect. Your article states that “FQHCs have only been in existence since 1989” and implies that health centers have never provided family planning services before 2006 and are struggling to figure out how to provide this service. In fact, the community health center program has been around since the 1960s as one of the original War on Poverty programs. Nationally, community health centers serve more than 16 million people compared to the 2 million served nationally by Planned Parenthood. Last year, community health centers in Texas provided primary care services, including family-planning services, to more than 560,000 patients who were predominately uninsured, working poor. Approximately 67% of our patients are women of child-bearing age and children, 60% of our patients are uninsured and more than 86% of our patients live in poverty. This health care model, which requires that more than half of the members on their local governing boards be actual clinic patients, has proven itself to be a very cost-effective, high quality, comprehensive, consumer-based model of care. Due to this federal governance requirement, many of our health center board members are women who are actually patients of the centers. Who better to determine and drive the services being provided in their communities than the actual patients themselves? Since the inception of the health center program, these organizations have always provided family-planning services in addition to other primary health care services, mental health services, and dental care to predominately uninsured and low-income families. In fact, some health centers in Texas were originally family-planning programs that became FQHCs in order to meet the needs of their patients. Approximately one-third of the FQHCs have received family-planning funding from this same state program highlighted in your article for years. Many more centers have been the primary provider of family-planning services in communities in the state whether they received state funding or not. Thus, the funding included in the Deuell rider is not all new funding that is being diverted from Planned Parenthood but also includes many existing state contracts already in place at FQHCs. To imply, as Ms. Smith does, that the provision of a wide range of health care services, in addition to family-planning services, is a bad thing and to insinuate that only “family planning specialists” at Planned Parenthood clinics are qualified to offer these services is insulting to the medical professionals who work in health centers and is out of touch with reality and the needs of women in the state. It is a sad commentary on our health care system when family-planning advocates argue that their services are the only health care services some women receive and imply that this should continue. A Pap smear once a year is not health care. Do you realize what happens when family-planning agencies actually identify medical issues that need follow-up care after they perform family-planning screenings like Pap smears? In many communities, Planned Parenthood refers them to FQHCs to get the follow-up care that they need. Most of these referrals are uninsured women who other providers in the community are unwilling to serve. Even simple facts regarding FQHCs were misstated. For example, the article states that there are only “40 health centers” in the state and this small group of providers is taking all the family planning funding. In reality, there are 52 nonprofit FQHC corporations that operate more than 150 primary care sites throughout the state. Furthermore, in 2006, 23 community health centers received only 20% of the family planning funds awarded by the Texas Department of State Health Services (DSHS) compared to 28% of these funds that were awarded to 11 Planned Parenthood organizations. Health centers did not “take” all family planning funding from Planned Parenthood. In fact, Planned Parenthood continues to receive a larger proportion of these funds than health centers even with the Deuell rider in place. It is important to point out that in distributing these family-planning funds, DSHS engaged contractors in a competitive process, in which health centers participated as well as other providers, including Planned Parenthood affiliates. The state agency made these awards based on the quality of the proposal and allocated funding based on a need criteria determined by the state, as is required in the Deuell rider. In your “quote” of the Deuell rider, Ms. Smith conveniently left out most of the language in the rider including a directive to the state to award funding to communities in greatest need. This rider does not guarantee that health centers will automatically get funded. In fact, health centers were required to compete just like other types of providers and had to submit a strong proposal that met state identified needs and other requirements. Although some health centers did receive funding increases, so did some Planned Parenthood organizations. Both providers also received funding cuts. Although health centers did fare better in this process than in past years, nothing was handed to them. They competed like everyone else. Finally, it should also be stressed that state and federal funding for women’s health services, including family-planning services, is inadequate to meet the needs of women in the state. Buried in the body of the article is a statistic that the overall funding for family planning services was cut by 31.2% for these services. Therefore, many of the cuts experienced by family-planning providers, including both Planned Parenthood clinics and FQHCs, had nothing to do with the appropriations rider authored by Sen. Deuell regarding FQHCs but rather an overall reduction in funding for state family planning services. In numerous communities, reductions in funding experienced by Planned Parenthood clinics had absolutely nothing to do with FQHCs in the region taking their funding as implied by Ms. Smith and the Planned Parenthood representatives quoted in your article. Furthermore, the amount of funding Ms. Smith claims was awarded to the Austin FQHC is overinflated and is inaccurate. It is unfortunate that Ms. Smith did not take the time to get the real facts and information regarding FQHCs for this article. The interests of the community and the patients health centers serve are at the forefront of health center activities. The Chronicle has misrepresented the good work of community health centers and has missed a great opportunity to point out the need for concerned citizens to advocate for the need for overall funding increases for comprehensive women’s health services. Doesn’t it make sense to invest in safety net providers who will address all health care needs of women and not just provide one type of service? Health centers have been in the trenches providing much needed care, including family planning services, to the most vulnerable people in the state for more than 30 years. Next time, get your facts straight before you make misleading and disparaging remarks about the good guys. If you would like to obtain accurate information regarding FQHCs, please visit our Web site atwww.tachc.org.
Sincerely, Jose E. Camacho Executive director Texas Association of Community Health Centers Inc.
[Jordan Smith responds: Since I applaud the work of the Federally Qualified Health Centers, and beginning with the article’s subhead, report that “slashed budgets” are a major cause of the Texas health care crisis, I have no wish to quibble with Jose Camacho’s detailed defense of FQHCs – they perform excellent and necessary work, and I never reported otherwise. Sadly, most of Mr. Camacho’s complaints are about an article that I did not write. Rather, he builds an argument for inaccuracy based on what he asserts that I “implied” in the story, rather than on the substantive facts and a plain reading of the article. In one instance, Camacho is technically correct, in stating that some form of the FQHCs have been around since the Sixties (the first two community clinics opened their doors in 1965). However, the current generation of FQHCs are the product of several decades worth of legislative tinkering, and the contemporary clinics are the product of the most recent reconfiguration, which began in 1989 – and in fact, that’s how the history of the FQHC is explained by the U.S. Department of Health and Human Services.
The other “factual” corrections, concerning the precise current numbers of clinics vs. “sites,” do not alter the overall judgment that the clinics are insufficient to serve the statewide women’s population; indeed, they only reinforce the larger argument about the state’s cutbacks in health care. I adamantly agree with Camacho that overall federal and state funding for health care, and certainly for women’s health care, should be increased. But to write that the Chronicle somehow missed an opportunity to make that point makes me wonder whether Camacho actually read the story with which he so bombastically takes issue. He says he does not want to be “caught up in any political fight that is occurring between the well-funded titans in family planning, Planned Parenthood, and state policymakers.” Yet his letter seems clearly an attempt to enter that battle, and transparently on one side. Should he choose to visit the East Austin Planned Parenthood clinic, during its radically cutback hours to serve an already underserved population, he will find no well-funded titans there.]