Whither family-planning funds?
Even as the state budget for health and human services is expected to constrict over the next biennium, a consequence of the tightening economy, there is at least one player that's poised to see a fairly hefty budget increase: The controversial Alternatives to Abortion program could see a $1.5 million increase in funding if the state Health and Human Services Commission, which oversees the program, has its way. The additional dollars would represent a 30% budget hike over the last biennium.
The Alternatives program was created through a 2005 rider by Sen. Tommy Williams, R-The Woodlands, as a way to "encourage" childbirth. Under the program, a pass-through entity, the Texas Pregnancy Care Network, contracts with the state to provide funds to so-called "crisis pregnancy centers," which are tasked with promoting childbirth and steering women away from abortion. The program has been controversial since its inception because it siphons funding from established family-planning providers, including Planned Parenthood, which provide actual medical and reproductive services for low-income and uninsured women, and funnels it to CPCs, which, by definition, are unregulated, provide no medical services, and offer only a narrow field of counseling – specifically restricted to childbirth and adoption options. Under its contract with Health and Human Services, the Texas Pregnancy Care Network (an entity apparently created to take advantage of the new funding option offered by the Williams rider) wrote its own performance measures regarding the number of women it would serve and how those women would "feel" about their interactions with the CPCs, how many services would be provided, and how many CPC providers would contract with TPCN.
Unfortunately, TPCN has failed to meet most of its own goals. For example, the group initially identified more than 200 CPCs eligible to become TPCN contractors and said between 25 and 50 would be signed up in the first year of the contract. In its first year, TPCN signed up just one CPC; in 2007 and 2008, the group downgraded its target number of contractors but still has been unable to tap more than 16 operating at 20 sites across the state. And although the program was intended to have statewide coverage, to date there are large swaths of Texas without any participating CPCs, says Blake Rocap, legislative counsel for NARAL Pro-Choice Texas.
Nonetheless, the Texas Pregnancy Care Network continues to spend roughly 40% of its entire $2.5 million annual budget on administrative costs, including a generous salary for its executive director, attorney Vincent Friedewald, whose pay rose from $93,372 in 2007 to just more than $100,000 in 2009. These overhead expenses, says Sarah Wheat of Planned Parenthood of the Texas Capital Region, are hard to justify in the current economic climate. "It's sort of like what's happened on Wall Street," she said. "They're not meeting any of their benchmarks – they're underperforming, but they're rewarding themselves with raises and benefits." Friedewald, who says his group "would welcome the additional funds," contends that the "demand" for client services is "now exceeding" the funds the group has available to reimburse CPCs for their services. (At press time, Friedewald had not responded to additional questions about TPCN's large administrative budget.)
It's not just TPCN's Alternatives to Abortion set-aside that Wheat and other health advocates find troubling. When Williams sold his rider to the Senate Finance Committee in 2005, Sen. Robert Deuell, R-Greenville, authored a measure that took $10 million over the biennium from the family-planning budget to first fund "federally qualified health centers." While the idea behind the move – to bundle family-planning health services in with other health-care services provided by community care providers – is a good one, there haven't been enough federally qualified health centers using the funding opportunity to spend the entire $10 million. Meanwhile, however, taking those funds from the overall pool of available family-planning money (most in the form of federal welfare dollars) has forced traditional women's-health-care providers to cut back and reduce their client loads. According to Health and Human Services figures, the number of women served by family-planning money has declined each year since 2006, when the funding set-asides went into effect, while the unspent dollars from the $10 million federally qualified health centers set-aside has risen. In just the first year after the set-aside took effect, more than 200,000 women lost access to family-planning services.
At present, the federally qualified health centers set-aside is budgeted at flat funding – although family-planning advocates are hoping lawmakers will tweak the program to make the set-aside more effective. Doing that, they say, might actually help meet Deuell's stated initial goal of increasing access to family-planning and reproductive services for poor women, says Fran Hagerty, CEO of the Women's Health and Family Planning Association of Texas. The state is currently only serving 17.5% of women in need of reproductive health services. It's uncertain whether lawmakers will try to reconfigure funding for women's health this session. When the Health and Human Services Commission's budget was taken up by the Senate Appropriations Committee earlier this month, not one senator questioned the funding increase for the Alternatives to Abortion program. When the House Appropriations Committee considered the increase, only Rep. Ellen Cohen, D-Houston, questioned Health and Human Services Commissioner Albert Hawkins about the program – questions that he could not immediately answer. Cohen intends to ask more questions, now that she's been named to the House Appropriations Subcommittee on Health and Human Services. "Look, we're not talking about abortion here," she said. "The question is: Is this a good use of $5 million when we have so many different needs?"