The Texas Department of State Health Services got an earful today from lawmakers and women’s health advocates at a public meeting in Austin to discuss proposed rules for the Texas Women's Health Program — specifically, the state’s plan to sacrifice 90 percent of federal funding for the program in order to exclude Planned Parenthood and prevent participating physicians from discussing abortion in any capacity with patients.
“Try to get the politics out of the way and do what’s best for Texas women,” said state Rep. Donna Howard, D-Austin, before an eruption of applause from the audience. She emphasized a point reiterated by others testifying at the hearing: that the Women’s Health Program provides cancer screenings, birth control and wellness exams for 130,000 low-income women but does not provide abortions.
One of the proposed rules for the program states that a participating physician could not “promote elective abortions” by providing “counseling concerning the use of abortion as a method of family planning” — even outside the scope of the Women’s Health Program. Physician groups, including the Texas Medical Association, the Texas Association of Obstetricians and Gynecologists and the Texas Academy of Family Physicians, oppose the proposed rule, arguing it will put a “gag order” on physicians that could interfere with patient-physician relationships.
“We strongly oppose any interference into a physician’s ability to use his or her medical judgment as to the information that is in the best interest of his or her patient,” the groups wrote in a letter to DSHS.
“Because of the proposed rules, the future viability of the Texas Women’s Health Program is at risk,” said state Rep. Sarah Davis, R-Houston, explaining that physicians considering participating in the program would be forced to choose between following best medical practices or a political ideology. Davis, who survived breast cancer after being diagnosed at age 32, said during her testimony that she sought public office to defend the doctor-patient relationship, which her personal experience taught her was sacred. She said the proposed rules threaten poor women’s access to life-saving cancer screening.
Texas is currently setting up the Texas Women’s Health Program, a state-financed version of the federally backed Women’s Health Program. In 2011, the Texas Legislature approved a plan to oust Planned Parenthood and other providers affiliated with abortion-providers from the Women’s Health Program. When the federal government disapproved of the state’s plan and said funding would be cut off if Texas proceeded, Gov. Rick Perry pledged to forgo $35 million in annual federal funds and find state money to run the program, at least through the end of 2013.
Some Planned Parenthood clinics are still participating in the Women’s Health Program, but a panel of three federal judges said in August that the state could proceed with ousting them from the program. Planned Parenthood filed a petition today asking the federal 5th Circuit Court of Appeals to reconsider that decision. Although Planned Parenthood clinics account for fewer than 2 percent of the providers participating in the program, 45 percent of women participating in the program chose to receive care at Planned Parenthood.
Opponents of the state’s decision to knock Planned Parenthood and other providers out of the WHP worry the state will not be able to provide an adequate health network. But the state and proponents of the reformed Texas Women’s Health Program say that won’t be a problem, as Planned Parenthood clinics make up a small portion of the 2,500 providers enrolled in the program.
Also testifying at today's hearing were proponents of the rule, including Abbey Johnson, who became an outspoken advocate for the anti-abortion movement after working for eight years at Planned Parenthood, and Chris Maska, the general counsel for Texas Alliance for Life.
“They desperately want you to believe that they [Planned Parenthood] are the only provider that women have access to for gynecological care,” Johnson said. “They are not an organization that can be trusted with our tax dollars, and they should not be trusted by Texas women.”
Joseph Potter, a professor of sociology at the University of Texas at Austin, disagreed.
“The overall situation is extremely stressed and many providers are close to the edge of survival,” said Potter, who is conducting a three-year study on the impact of reduced state funding for family planning services in Texas. While his research is far from complete, Potter said a survey of providers formerly funded by DSHS found 33 of 208 health clinics have closed since the cuts, 39 have reduced hours of operation and many have reduced distribution of contraceptives or added payment requirements.
“Further reducing the number of providers will lead to even deeper reduction to women’s access to contraception than has already occurred,” he said.
State Sen. Kirk Watson, D-Austin, brought up financial concerns about the program in his testimony, from how the program will be financed long-term to the amount of savings lost by potentially reducing the effectiveness of the program. Citing numbers by HHSC, Watson said the state spent $6.7 million on its 10 percent share of the Women’s Health Program funding from 2007 to 2010, which in turn generated a net savings of $87 million. “Clearly spending less than $7 million to save over $87 million is a smart investment in women’s health,” he said.
Although the state plans to fully implement the Texas Women’s Health Program on Nov. 1, it’s still unclear how the program will be financed. The current plan says the state will fund the program through general revenue, then roll participants in the Texas Women’s Health Program into Medicaid when the program undergoes a widespread expansion in 2014, as was formerly required by the Affordable Care Act.
But, as Watson testified, “the rules as written do not reflect the political realities of Medicaid expansion.” The U.S. Supreme Court ruled after the program rules were prepared that states can forgo federal funding and choose not to expand Medicaid, which Perry has pledged he will do.