War on Women

What will it look like to have no federal Women’s Health Program in Texas? That’s what the state department of Health and Human Services began figuring out last week when Governor Rick Perry and Texas lawmakers opted to cut Planned Parenthood out of the Women’s Health Program in the state and instead move to a wholly state-funded system. The federal government has refused to continue the funding because Medicaid clients have, under federal law, the legal right to seek care wherever they choose, and the Obama administration considers the State of Texas to be violating federal law in their move to exclude Planned Parenthood.

A spokesperson for the Texas Health and Human Services Commission says that despite the fact that the federal government funded 90 percent of the Women’s Health Program, the change-over process “should be pretty smooth,” as they’re not “building a new program” but instead are changing the funding source from federal to state monies. The process will involve moving about $30 million from existing state funds to a new Texas Women’s Health Program over the next several months. The HHSC will submit a phase-out plan to the feds by April 16th and begin notifying WHP participants that they’ll need to find new providers.

According to the Austin American-Statesman, that may include referring those clients to other Medicaid plans. If that happens, women may actually be able to continue getting care at Planned Parenthood, because Planned Parenthood is still considered a “qualified provider” outside the Women’s Health Program in Texas–but only for now. A spokesperson for Governor Rick Perry told RH Reality Check this week that Perry may seek to exclude Planned Parenthood from all Medicaid programs.

“Governor Perry believes abortion providers and their affiliates, like Planned Parenthood, have no business receiving taxpayer dollars,” said Perry spokesperson Lucy Nashed, “and will support efforts to further accomplish that goal.”

Even if the HHSC doesn’t have to build a new program from scratch, they’ll still need new providers to come on board to accommodate the tens of thousands of women seen at Planned Parenthood clinics under the WHP. In 2010, for example, Planned Parenthood saw over 51,000 women who will now be funnelled to other doctors and clinics–out of a total of more than 105,000 clients.

The HHSC told RH Reality Check that it will set up a call-in line for women on the WHP that will help direct them to a new health care provider. Governor Perry’s office has repeatedly said that the 2,500 providers in Texas will be able to accommodate all the women currently on the WHP.

But, as this reporter learned first-hand last year, giving someone a list of potential providers is not the same as having those providers be ready and able to give them timely, accessible care. Public hospital systems in Texas are already overburdened, and not every federally-qualified health center can take on hundreds of new patients. Just in North Texas in 2010, for example, nearly 90 percent of providers saw an average of nine patients a year. Planned Parenthood and other large providers, like the county hospital system, saw an average of over 100 WHP patients per year.

“We need existing providers to know they’re going to have to take on new clients,” said Goodman, “and we’ll bring new providers into the mix.”

As for where the $30 million in state funds will come from–remember that last year, the Texas legislature cut existing state family planning funding by two-thirds–Goodman said it will come from “bits and pieces” inside the HHSC’s $25 billion-per-year budget. “We don’t anticipate any reduction in services,” in other areas, said Goodman.

All of this is happening, of course, because Texas passed a law in 2005 that bars abortion providers or their affiliates from receiving taxpayer dollars, and despite the fact that Planned Parenthood keeps its abortion services wholly separate from its other family planning and health services, Texas considers it an “affiliate.”

“We’re enforcing a law that’s been in Texas for years,” said Lucy Nashed at the governor’s office. Perry has been aggressive in blaming the Obama administration for cutting the WHP funds, even though he and conservative legislators instigated the dispute. In public statements about the program, the governor’s office has put their own political spin on the program and the effects it will have on Texas women.

In a March 9th press release, Perry’s office downplayed Planned Parenthood’s role in the WHP, making the following statements:

• Under federal law, states administer Medicaid and have the right to set the criteria for “qualified providers” in the program, not Washington. This is exactly what Texas has done, in accordance with Texas law. Texas law prohibits tax cheats, deadbeat parents or people suspected of serious abuse from participating as a provider in Medicaid, even though federal law does not. 

• There are more than 2,500 qualified providers in the WHP that operate more than 4,600 locations across the state.

• Planned Parenthood represents less than two percent of providers in the WHP.

• Planned Parenthood’s cost per client is 43 percent higher than most other providers, according to the Texas Health and Human Services Commission.

RH Reality Check contacted Perry’s office to find out if it wished the public to believe that Planned Parenthood might be a “tax cheat” or “suspected of serious abuse,” and were told by Nashed that despite the language in the release, “in this case it’s simply because they are an abortion affiliate.”

And while there may be 2,500 qualified providers, most of those providers saw a tiny percentage of clients compared to the tens of thousands seen at Planned Parenthood clinics–they may be “two percent” of the providers in the WHP, but they see about half the women in the program.

And while Perry seems to imply that Planned Parenthood’s services are especially costly–“Planned Parenthood’s cost per client is 43 percent higher than most other providers”–in fact, they’re just about in line with what federally-qualified health centers spend per client. According to Stephanie Goodman at the HHSC, the FQHC’s spent $246 per client in 2011, while Planned Parenthood spent less than twenty dollars more apiece, at $265 per client. All other providers spent $186 per client. 

The cost disparity, says Goodman, is probably due to the “number or types of services billed” by FQHC’s and Planned Parenthood, as “rates are the same across providers.” Which indicates not that Planned Parenthood mismanages funds or is more expensive than other providers, merely that they provide more and comprehensive services.

On Governor Perry’s official state website dedicated to the WHP issue, his office says that

In FY 2010, nearly 80 percent of women served received WHP services from non- Planned Parenthood providers,” which is true, but might lead readers to believe that Planned Parenthood saw only 20 percent of WHP clients. That’s not the case: that year, according to the HHSC, Planned Parenthood saw 51,952 WHP clients out of a total of 105,958, while 83,003 clients were seen at non-Planned Parenthood providers. It would be more accurate, then, to say that women in the WHP used a combination of Planned Parenthood and non-Planned Parenthood providers for different family planning services, and also that Planned Parenthood provided a significant portion of that care.

As the HHSC builds a new state-funded program, the fight over Planned Parenthood continues in court. Last Friday, Perry’s staunchly conservative ally, Texas Attorney General Greg Abbott, filed suit against the federal government, claiming in part that the government’s “decision to deny the waiver renewal represents an unconstitutional attempt to commandeer and coerce the State of Texas into repealing its law that withholds taxpayer money from elective-abortion providers.”

In the meantime, 130,000 Texas women will be left scrambling to make sure they can continue to see their regular doctors or hope a new provider has the time and resources to take them on. Whether that transition will be as smooth as the HHSC claims will become evident over the next several months.

This story also posted at RHRealityCheck.org and AndreaGrimes.blogspot.com and posted here under Creative Commons Attribution-Share Alike 3.0 United States License.
Andrea Grimes

Andrea Grimes

Andrea Grimes is a freelance journalist living in Austin, Texas. She studied new media at New York University and later attended the University of Texas at Austin for graduate school, finishing with a master's degree in cultural anthropology. She has three cats and loves brunch. Contact her at andrea dot grimes at gmail.