As of Friday afternoon, the Lege budget conferees have agreed to leave in place the nearly $62 million in cuts to the state’s family planning program, a move that advocates believe will mean dozens of small clinics will have to shutter their operations – and will result in more than 200,000 women left without access to basic health services.
And although lawmakers have now reauthorized the successful Medicaid-waiver Women’s Health Program, it is unclear whether there will be enough providers left to maintain the more than 100,000 clients currently in the program. In short, cutting off funding for family planning could have the effect of stripping the life out of the WHP.
The compromise budget plan leaves just $37.9 million in family planning funding for the biennium, down from the roughly $99 million originally allotted for those services, which last year provided services to nearly 260,000 clients. Family planning funding covers basic reproductive health screenings, including Pap smears, as well as screenings for breast cancer, hypertension, and diabetes, and screenings for communicable diseases like HIV. Although none of the money, pass-through federal funds, may be spent on abortion, foes of family planning services successfully framed the defunding as a way to keep money away from medical providers that also provide abortion care – namely their arch foe, Planned Parenthood. While Texas Right to Life has dubbed the budget gutting as a victory for “life,” the reality is that Planned Parenthood will not be closing its doors; instead, the nearly 100-year-old nonprofit will simply be unable to provide preventative health care for the neediest Texas women. Moreover, the cuts mean that many small providers, including independent health clinics, will likely shut their doors this summer, says Fran Hagerty, CEO of the Women’s Health and Family Planning Association of Texas, which represents many of the state’s smaller women’s health providers.
Also included in the budget is a rider by Sen. Tommy Williams, R-The Woodlands, which devises a matrix for allocating the funds that remain, just under $19 million per year. According to that rider, the funds must first be allocated by the Dept. of State Health Services to “public entities” – including county and city health departments, local community clinics, and Federally Qualified Health Centers (FQHCs) – that provide family planning services in addition to other health services; remaining funds can then be awarded second to “non-public” entities that provide “comprehensive primary and preventative care as a part of their family planning services”; and, third, if any of the money remains, it can then be allocated to non-public providers of family planning services – in other words, to Planned Parenthood and other specialized providers. The thinking, of course, is that there won’t be any money left for the third tier. The problem, however, is that at this low level of funding there isn’t even enough money to cover the needs of the providers in the first group. In 2010, there were 25 “public” contractors and 26 FQHC contractors; together these two groups were allocated nearly $28 million last year to provide these basic health services to low-income Texas women (and some men). “It’s almost impossible to accept,” says Hagerty. “Everybody loses.”
Equally troubling is the ripple effect the massive budget cut could have on the WHP. The WHP provides family planning services for women who wouldn’t otherwise be eligible for Medicaid unless they are pregnant. In 2008, the program saved the state more than $40 million in Medicaid costs and reduced Medicaid births by more than 10,000. More than half of Texas births are paid for by Medicaid at a cost in 2009 alone of $2.7 billion. It looked like the WHP might die because of a poison pill measure written by Sen. Robert Deuell, R-Greenville, that would shut down the program altogether if Planned Parenthood were to successfully sue over the state’s attempts to keep PP from providing services under the program. Currently, Planned Parenthood serves some 40% of WHP clients. If the state is successful at keeping PP out of the mix, it is completely unclear who would be left to serve WHP clients, says Hagerty. Many of the providers under WHP are also recipients of family planning funding; without their allocation of federal tax money to provide those services, many won’t be able to remain in business to serve WHP clients; and the larger providers, like Dallas’ Parkland Hospital, will also be taking a hit, making the future of their programs bleak. “The little guys will close,” she said. “And the big guys, like Parkland, will be a skeleton of what they once were.” If the WHP is indeed crippled by the broader cuts to family planning, the state could be cutting off well over 300,000 low-income Texans from access to basic health services.
Meanwhile, the budget compromise actually includes a revenue increase for the Williams-created Alternatives to Abortion program, which provides “counseling” and “support” to women in crisis pregnancy, to encourage women to carry their pregnancies to term – often with support from Medicaid. The program was created by a budget rider in 2005, with an initial $5 million stake pulled from family planning funds. Each session since, the program has gotten a budget increase; this year lawmakers are throwing an additional $300,000 at the program, pushing it’s biennial budget up to $8.3 million. The program provides no medical services whatsoever, but does provide referrals to other government programs. According to the compromise budget, this money should provide “services” for roughly 16,000 women per year; in contrast, last year the state’s FQHCs received roughly $7.6 million to provide actual medical care to more than 30,000 women.
You can find more on the Lege’s assault on women’s health here.
This article appears in May 27 • 2011.