Banned Parenthood?

State Sen. Bob Deuell wants Planned Parenthood's clinics out of the state’s Women’s Health Program, which provides family planning services — but not abortions — to impoverished Medicaid patients. And he says a 2005 law should exclude them already.

But for years, the state’s Health and Human Services Commission has allowed those clinics to continue participating, disregarding the legislative mandate for fear that barring them might be unconstitutional. Deuell has asked Texas Attorney General Greg Abbott to clear up the matter, hoping it will free up the agency to push Planned Parenthood out.

“My primary motivation is for the money to go to the 400-plus comprehensive care clinics in the state that provide more than just birth control and STD testing,” said Deuell, R-Greenville. “People say, ‘You just don’t like Planned Parenthood.’ That’s right, but it doesn’t take credibility away from what I’m trying to do.”

The 2005 legislation that created the Women’s Health Program is explicit: It states that participating clinics can’t “perform or promote elective abortions,” be “affiliates of entities that perform or promote elective abortions” or even refer medical problems to health care providers affiliated with abortion providers. Former Health and Human Services Commissioner Albert Hawkins didn’t apply the portion of the rule dealing with affiliates because agency attorneys advised him the provision could be unconstitutional.

While some Planned Parenthood clinics in Texas do perform abortions, those that provide family planning services under Texas’ Women’s Health Program do not — they screen Medicaid patients for breast and cervical cancer, STDs, and prescribe birth control, among other services. Since 2007, 40 Planned Parenthood clinics have received a combined $17.6 million through the Women’s Health Program, according to HHSC records.

A decision isn’t imminent. It could take Abbott months to hand down an opinion, and if he says the provision is constitutional, HHSC officials will likely enter a lengthy rule-making process. But state health officials have a lot riding on the outcome. If they adopt and follow the rule lawmakers intended — and it doesn’t align with federal Medicaid policy — they could risk losing big bucks: $18 million of the $20 million the state spent on the Women’s Health Program in 2009 came from the federal government, according a brief HHSC sent to the attorney general.

Planned Parenthood advocates say the clinics provide stellar reproductive health care and that they’re often the only family planning outfits available in Texas communities. And by all accounts, the program — launched in 2007 as a five-year pilot for impoverished women aged 18 and 44 — is effective. With just a fraction of eligible women currently enrolled, the program prevented 10,000 unplanned pregnancies in 2008 (through contraception and other family planning methods, not abortion), and it saved the state roughly $40 million a year, according to a recent HHSC study.

“There are so many real pressing problems facing this state,” said Rep. Ellen Cohen, D-Houston, an advocate for reproductive health clinics. “Why, when this has been working, and no state money has been going to any abortion services, are we spending the state’s time and resources researching this?”

Deuell — a family physician who opposes elective abortion but supports family planning when it’s wrapped into comprehensive health care — said the 2005 rule on clinics affiliated with those that provide abortions is clear-cut. But he said he and Hawkins had “a difference of opinion” on it. Deuell met with current HHSC Commissioner Tom Suehs about a month ago and expressed his opinion that the rule should be followed. As a lawmaker, Deuell couldn’t request an AG opinion until he was named a committee chair; that happened in a Senate shake-up in mid-July. (Deuell, who was already vice chair of the Senate Health and Human Services Committee, was named chair of the Senate Nominations Committee, responsible for confirming or rejecting the governor's appointments to boards and commissions.)

Suehs sent his own request to the attorney general last week, asking Abbott if HHSC could adopt and enforce a formal definition of the term “affiliate” for purposes of the Women’s Health Program. “Distribution of funds to affiliates of elective abortion providers has been the subject of litigation in Texas and elsewhere,” Suehs wrote. “This litigation led my predecessor to conclude that there may be constitutional issues.”

This is hardly the first time Planned Parenthood has found itself in lawmakers’ crosshairs. Over the last five years, the Legislature has diverted millions of dollars from Planned Parenthood and other women’s clinics — none of which provide abortions when they’re financed with state dollars — to expand family planning services at community health centers. The community health centers provide a broader range of services than the reproductive health clinics, including preventative care and screenings for everything from diabetes to hypertension. Some health care policy experts say they have limited enrollment, higher overhead and can be a lot less accessible, particularly to women who want the anonymity and intimacy of a women’s clinic.  

“In many places we’re the only source for family planning services,” said Sarah Wheat, director of public affairs for Planned Parenthood of the Texas Capital Region. “If somehow Planned Parenthood was prevented from being a family planning provider, it would have an incredibly devastating impact on women across the state.”