This session we have seen an all out assault on women's health driven by the erroneous assumption that family planning is synonymous with abortion. This narrow construction ignores the comprehensive nature of family planning, which is central to women and children's health before, during and after pregnancy. Eliminating these services will have huge repercussions on the demand for (i.e., the cost of) state services, access to care and the number of unintended pregnancies.
Let’s be clear about what family planning actually means. According to the Department of State Health Services, the state’s family planning budget — which is a combination of state and federal dollars — helps fund more than 300 sites across the state. Most of this money goes toward reducing expenditures for Medicaid-paid births and providing reproductive health care to low-income and uninsured women who are U.S. citizens. Family planning services are offered by a range of providers and can take many forms, whether it's providing contraception, screening for breast or cervical cancer or conducting a postpartum evaluation.
Probably the most well-known program is a family planning waiver called the Medicaid Women's Health Program (WHP). Texas ranks highest in the nation in the number of its residents who are uninsured women between the ages of 18 to 44, creating a huge need for this program, which matches $9 from the federal government for every $1 the state contributes. During the first two years of its implementation, Texas saved $37,640,727 and served 141,506 clients. If the Legislature does not reauthorize the WHP this session, as it appears will be the case, these women will lose access to family planning and basic health services, and the state will leave significant federal dollars on the table — meaning other states will get the money set aside for Texans.
According to the Legislative Budget Board (LBB), 26 other states had Medicaid waivers for family planning services as of June 2009, and studies comparing the various waivers have found that the WHP is structured to include several design features that are considered best practices. In fact, the LBB recommended expanding eligibility for the WHP and establishing an outreach program to encourage pregnant women in the Medicaid program to enroll before their postpartum coverage expires.
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Much of the rhetoric surrounding the family planning budget cuts appeared to be an effort to defund Planned Parenthood. However, most amendments debated on the House floor would have significantly reduced family planning funding altogether for local health departments, medical schools, hospitals, and community and rural health centers. This is the proverbial throwing the baby out with the bath water.
While Planned Parenthood's nonprofit health centers do serve almost half of the women participating in the WHP, none of the funds they receive are used to pay for abortions because the law already requires that Medicaid providers must be legally separate organizations from abortion providers. To clarify this mandate, a ruling from the 5th Circuit Court of Appeals has defined separation requirements for Medicaid providers that include audits to ensure compliance. In addition, WHP providers are paid on a per patient, per procedure basis and are only reimbursed for certain, specified family planning healthcare services.
The fact is that Texas already has a shortage of health care providers who are willing to accept Medicaid patients and half of all births in the state are covered by Medicaid. Each Medicaid birth costs taxpayers more than $16,000 in Medicaid coverage for prenatal care, delivery and first-year health coverage for the child, while care provided through the WHP costs approximately $250 per patient.
Eliminating funds for family planning services is not a responsible or compassionate choice. It will shift the burden of care to our already overloaded local hospitals and leave the women who depend on these services with few options. Unfortunately, fewer options can mean unintended consequences for these women and their families and, ironically, unintended consequences for those pushing the funding cuts: an increase in the number of abortions.
State Rep. Donna Howard, D-Austin, was vice chairwoman of the House Administration Committee in the 82nd legislative session.
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