Perry Continues Assault on Women's Health Care

Rick Perry (Photo by Jana Birchum)

As the Chronicle went to press Tuesday evening (a day early) this week, the Texas Women's Health Program was set to expire Wednesday, March 14, when the state's new rule on qualified affiliate providers officially takes effect. Barring some miracle – or the immediate fulfillment of Gov. Rick Perry's last-minute promise to somehow keep the program running – health care for hundreds of thousands of low-income, working-class, and uninsured Texas women has been ended.

Perry insists he wants to continue the WHP – but he doesn't want Texas women who participate in the preventative health care program to choose their own providers. Instead, in a pair of letters sent to President Barack Obama and to Texas Health and Human Services Commissioner Tom Suehs, Perry said the program will include only state-approved providers and clinics. To do otherwise, he wrote, would offend Texas' 10th Amendment sovereignty. As Perry sees it, the U.S. Constitution grants Texas the power both to discriminate among medical providers and to micromanage the lives of hundreds of thousands of Texas women. Perry's letters are the latest chapter in the dismal saga of Texas' official position on women's health care and on the future of the heretofore very successful WHP.

After signing off last year on lawmakers' gutting of the state budget that in 2011 provided preventative health care and family planning to roughly 214,000 women, Perry now says he intends to ask lawmakers to find enough money to continue the WHP – but without the 90% match from the federal government that made the roughly $35 million yearly cost of the program a financial boon for the state.

The WHP is a Medicaid-waiver program; it provides basic preventative, reproductive, and family-planning health care to uninsured Texas women who unless pregnant would not otherwise be eligible for Medicaid. The program is funded by a 90/10 match from the feds – for every $1 Texas contributes, the feds provide $9 (currently, $3.3 million in state funds draws $30 million from the feds). It's designed to reduce unintended pregnancies and the number of Medicaid-paid births (no small matter for Texas, where more than half of all births are paid for by Medicaid and cost $2.9 billion in 2009 alone) – and to stem the number of abortions. The latter is a goal professed by Perry, many state lawmakers, and their allies at Texas Right to Life and the Texas Alliance for Life. In practice, however, Perry and his supporters have the more specific and political goal to end Planned Parenthood's operations in Texas – to drive from the state one of the largest providers of women's health services, because nationally, PP is the largest provider of legal abortion services.

Yet the goal of reducing the number of abortions is shared by advocates for women's health – including those who work for Planned Parenthood. "Really, I don't know anyone who doesn't share that goal," says Sarah Wheat, co-interim CEO of Planned Parenthood of the Texas Capital Region. "That's the irony of this." Moreover, by law, none of the tax money that has gone to PP clinics pays for abortion care; it pays for preventative health care that helps to ensure healthy mothers and babies – cancer screenings, diabetes screenings, family planning counseling ... and birth control.

In 2010, according to HHSC, the Women's Health Program enrolled more than 183,000 Texas women; 106,711 actually received services that year. In 2011, the number of women who received services increased to 115,226 (the total number enrolled last year has not yet been compiled). But the current conflict between state and federal law has put health care for these women in jeopardy. If the WHP dies, following other severe budget cuts, more than 300,000 low-income and uninsured Texas women will be left without access to basic health care this year.

The new regulation signed by Suehs – redefining "affiliate" to mean that Planned Parenthood clinics not providing abortions are deemed affiliated with those clinics that do – conflicts with federal law, as confirmed last week by U.S. Health and Human Ser­vices Secretary Kathleen Sebelius. (The rule may also affect doctor groups and hospital systems participating in the WHP that also offer elective abortions.) Late last year, the feds told Texas that long-established federal law mandates patient "freedom of choice" among providers qualified to deliver health care and does not allow for discrimination. If Texas' request to ban PP were accepted, the precedent could allow states to discriminate against providers for any reason. Today it's PP, says Center for Public Policy Priorities' Anne Dunkelberg – tomorrow it could be any doctors who have somehow offended state lawmakers.

With a political backlash building, Perry says he's willing to forgo the federal money and keep the WHP alive solely through state funding. To maintain the current clients, that would require roughly $70 million over the biennium. With a $3.9 billion budget shortfall looming in 2013, says Dunkel­berg, $70 million is a drop in the bucket; nonetheless, Perry has not said where he intends to find the money. His office did not respond to a request for comment but released a statement insisting he will "move forward" to sustain the program and "will continue to fight this egregious federal overreach and defend life, our state's laws and the Tenth Amendment to the U.S. Constitution."

But beyond the funding question, without Planned Parenthood clinics – which in 2010 served 46% of WHP clients – it is unlikely there will be nearly enough providers to cover the women needing services. HHSC insists there are plenty of alternative providers but recently acknowledged that it has no empirical data to support that assertion. The uncertain future of the WHP has placed additional strain on providers already crippled by last April's family-planning budget cuts. Carole Belver, executive director of Community Action Inc., which had to close 11 of its 13 Central Texas clinics, said last month that without WHP money, her two remaining clinics are in danger. "I am too anxious [about] what all of this means," Belver wrote in an email, "and hope [Perry] really does have a workable plan as the biggest loser will be the low-income women of Texas."