Honest Numbers? Nelson Spins Texas Health Care

Pro-choice and Planned Parenthood supporters at the Capitol for last week's hearing on women's health care (Photo by Jana Birchum)

Convening a hearing last Thursday, Feb. 20, of the Senate's Health and Human Services Committee on the state of women's health care in Texas, chair and Sen. Jane Nelson, R-Flower Mound, said it was her intention to use the time to "set the record straight."

"I realize that 2011 was a difficult budget year and that reductions made to family planning had an impact on access to services," she began, "but we also made significant investments and significant progress since then. I still see so much misleading data being circulated to Texas women and one of the things I want to do today is set the record straight. I want to get honest numbers out there."

To say that 2011 was a difficult year for women's health care is putting it mildly; here are just a few "honest numbers": In an attempt to "defund" Planned Parenthood, lawmakers in 2011 cut two-thirds of the roughly $100 million in funds traditionally earmarked for providing reproductive health and family planning care for low-income and uninsured women. Nelson voted in favor of those budget cuts, which withheld funds from Planned Parenthood, but also hurt many other smaller family planning clinics – and ultimately ended services for more than 100,000 women. According to the Texas Policy Evaluation Project (created by UT-Austin's Population Research Center to analyze the impact of policy decisions on the women's health system), more than 70 clinics across the state shuttered operations. According to the Department of State Health Services, the number of women receiving family planning care plummeted, from 202,968 served in fiscal year 2011 to just 48,796 in 2013 – a 76% decrease.

While state officials, including Nelson, argue that the state has sought to repair the damage by infusing new money into the system – notably $100 million over the 2014-15 biennium put into the Enhanced Primary Health Care Program – it remains unclear whether that will help to get women back into care, let alone increase the number of women served. According to the Guttmacher Institute, in 2010 there were nearly 1.7 million women in Texas in need of contraceptive services – meaning, before the cuts, the program was serving just 12% of the women in need.

Nonetheless, Nelson told the hearing audience that with the EPHCP funding, and an infusion of $43.2 million into the traditional family planning budget (the one gutted in 2011) "women's health in Texas is now funded at record levels." That depends entirely on how you look at it – especially following the effects of the state's ideologically driven exclusion of Planned Parent­hood. Certainly, the state is now spending more general revenue on women's health than it ever has – because prior to 2009, all family planning money came from federal dollars, and in 2014-15 all funds will come from the state. Additionally, the Medicaid Women's Health Program was 90% federally funded. That money was withdrawn after Planned Parenthood, the program's largest provider, was excluded under the new rules for the Texas Women's Health Program. State revenue now pays the tab on that program, too – $72.4 million in the current biennium. That means that program also continues to serve fewer women than it did as originally designed. (See "Beats Nothing," Feb. 21.)

Moreover, contrary to Nelson's assertion, it doesn't appear that funding for family planning will actually increase this biennium. Although $100 million was included for the EPHC Program, that money treats all women over 18, including those beyond child-bearing age, and for all primary services, not only for reproductive needs. DSHS Commissioner David Lakey told the Committee last week that the state expects only 65% of those funds – or $65 million – will actually go to providing family planning services. Combined with the $43.2 million in state funds earmarked specifically for family planning services, the state says it will provide $108.2 million over the biennium for family planning care – that is, less than the $111.2 provided before the cuts, in the 2010-11 biennium.

Nelson also told the Committee that as a result of the new funding, "we have the capacity to serve more women in Texas than ever before." That assertion too may be a term of art. While the total budget for the EPHCP is expected to serve 170,000 women, fewer than 111,000 of those may be family planning clients; combined with the 65,000 the state expects to see via the traditional family planning budget, the total would still fall well short of nearly 203,000 women served by the family planning budget in the year before the budget cuts.

State officials remain publicly insistent that capacity and funding for women's health are at record levels, and that they are committed to serving as many women as possible. This is possible, in part – more than one state official told the committee last week – by looking to groups outside state government who are serving women in need, and specifically, the nonprofit Women's Health and Family Planning Association of Texas. Last year, the Assoc­i­ation won the authority to distribute federal family planning dollars to clinics across the state, funds that for more than 30 years had been awarded to DSHS for allocation. By not discriminating among qualified providers (i.e., including Planned Parenthood), in just its first year of administering the funds, WHFPT CEO Fran Hagerty said her providers will have served more than 130,000 as of March 31 – nearly twice the number of clients the state was able to serve with the same funding stream in 2012. (In fact, WHFPT got less money than the state was allocated. In 2012, DSHS had nearly $19 million to allocate, while WHFPT, because of federal budget cuts, got just $13.7 million to use over the last year.)

Sen. Nelson said the state is making "huge steps in the right direction" for women's health and family planning, and that there is "no doubt in my mind" that the Legis­lat­ure remains interested and passionate about the issue, which she intends to keep on the front burner. "I'm confident we can achieve great things for the women in this state," she said.