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Abortion and the Economic Argument Behind the Political One

The state's abortion and health care policies intersect in the budget — even though that might not always be part of the debate — and the budget is where the impact of decisions on abortion and Medicaid will be revealed.

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Six years ago, a major anti-abortion bill stalled in the Texas House after a $1 billion price tag was attached.

There were major differences in that bill and the one that passed this year. The 2007 legislation was a “trigger bill” that would have outlawed abortions in Texas if the U.S. Supreme Court had overturned its Roe v. Wade ruling.

The Legislative Budget Board estimated that ending abortions would result in the births of nearly 65,000 more babies per year. At the time, about 55 percent of births in Texas were paid for with Medicaid (it rose to 56 percent by 2009, the most recent year available), and the agency’s estimate was that the cost to the state and federal governments would start at just over $1 billion in every two-year budget.

The author of that bill, former state Rep. Warren Chisum, R-Pampa, still thinks that price tag was inflated for political reasons. “There’s more than one way to kill a bill,” he said. “Back in those days, a fiscal note was the way to do it.”

Even though Chisum chaired the House Appropriations Committee and was a member of the budget board, his legislation never made it to the floor for a vote.

And even if the logic of that budget board analysis was correct, this year’s legislation, signed this month by Gov. Rick Perry, doesn’t ban all abortions in the state. It outlaws most abortions after 20 weeks, requires abortion clinics to meet higher medical standards than current law dictates, requires doctors to be present to administer abortion-inducing drugs and requires doctors performing abortions to have admitting privileges at nearby hospitals.

The 2007 bill would have ended all abortions, and it’s relatively easy to put a number to that. In 2011, the most recent year for which figures are available, 70,003 pregnancies were terminated in Texas, according to the Department of State Health Services. The new Texas law will make it more difficult for women in some parts of the state to obtain abortions and might close some of the clinics that now provide abortions, but it is much more difficult to say how many babies might be born that would not have been. Only a handful of the state’s abortion clinics currently meet the new standard, prompting opponents to argue that the legislation will limit access to abortion facilities while leaving the procedure itself legal.

Without that number of babies in hand, it is difficult to estimate a cost to the state — if there is one, and if people want to talk about it.

“Sometimes, you scratch your head at the logic,” Sen. Glenn Hegar, R-Katy, one of the sponsors of this year’s legislation, said when asked about that earlier fiscal note and why no cost was attached to his bill.

These debates slide back and forth between economic and human costs — sometimes about the money, sometimes about the people who would be helped.

And sometimes, as in the back-and-forth this year over Medicaid expansion, both sides invoke money and lives. Opponents argued that the expansion would lock the state into an unaffordable health care plan (there’s your money argument) that would result in a dangerous disruption of the state’s health care system (the health argument). Proponents said it would be silly to turn down a program that would cover much of the largest uninsured population in the country (the health argument) and pump big bucks into the state’s medical economy (the money thing).

The state didn’t expand its Medicaid program, and you’ll still find legislators across the spectrum thinking about the consequences, good or bad.

This summer’s debate on abortion restrictions turned entirely on politics. It wasn’t about the money.

Close watchers of the Legislature will tell you that all of the testimony, debate, passion and eloquence served only to solidify positions that were already in place. Not a single legislator voted in a way that surprised other legislators. The vote count was never in question, and it never changed.

The fiscal note on the bill did not attempt to estimate the number of babies that will be born — or that would not have been born, if any, without the new legislation — and what it will cost taxpayers to deliver them. It concludes that “no significant fiscal implication to the state is anticipated.”

The answer will be evident within a year, as public health officials watch changes in the birth and abortion rates in the state. That will be just in time for the next conversation about the budget, and about Medicaid expansion.

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Politics 83rd Legislative Session Abortion Budget Medicaid Texas Legislature Women's Health Program