The Politics of PreventionMore in this series
The state Senate Health and Human Services Committee will hold a hearing Thursday to assess Texas’ efforts to expand access to women’s health services across the state. But abortion rights advocates say an essential issue has been left off the agenda — the impact of strict abortion regulations that the Legislature passed last year.
“It’s hard to imagine how committee members can really discuss something as important as women’s health care when the hearing agenda makes no mention of important components of that care, like women’s access to abortion care services and responsible sex education for teens,” Kathy Miller, the president of Texas Freedom Network, said in an email to The Texas Tribune. The Texas Freedom Network is a grassroots lobbying organization that says it works to defeat conservative policies backed by "the religious right."
Sen. Jane Nelson, R-Flower Mound, the chairwoman of the committee, scheduled the hearing to discuss the progress of Texas’ $100 million expansion of a primary care program for women’s health services, and the state-run Texas Women’s Health Program. Nelson said in an email that the committee "will be having a thorough discussion of every aspect" of the state's efforts to provide women's health care.
In the wake of 2011 budget cuts passed by Republican lawmakers that cut two-thirds of family planning financing, lawmakers increased spending on women's health services to $214 million in the 2014-15 budget from $109 million in the previous biennium. In her announcement, Nelson, who voted for the 2011 budget and for the abortion regulations passed last year during a special session, commended state lawmakers’ work to expand women’s access to health services in 2013.
“Now we need to educate women about how to navigate the system, improve our reach to women in underserved areas and ensure that family planning remains a priority," she said.
According to NARAL Pro-Choice Texas, the new abortion regulations have caused 16 clinics to close or stop providing abortion services since the rules took effect in November. In an explanation of the rules, the Department of State Health Services wrote that the state could be reasonably skeptical of allegations of future harm, given abortion providers’ failure to prove in a federal lawsuit that particular clinics would be forced to close if the admitting-privileges requirement went into effect.
Abortion rights advocates argue that the reduced access to legal abortion procedures has endangered women's safety, as women could seek illegal procedures, and imposes on women's constitutional right to abortion. Proponents of the new regulations say they improve safety standards to protect women's health at facilities that perform abortions.
Whole Woman’s Health and other abortion providers in Texas have challenged two provisions of the new rules in federal court: a requirement that physicians follow FDA standards, rather than common evidence-based protocols, for administering drug-induced abortions, and a requirement that physicians who perform abortions obtain hospital-admitting privileges within 30 miles of the abortion facility.
In addition, the new regulations ban abortions after 20 weeks of gestation. Abortion clinics will also be required to meet the same standards as ambulatory surgical centers beginning in September. Only five of the 22 remaining abortion facilities in Texas currently meet those standards.
On Friday, the Texas Medical Board suspended the first physician accused of violating the new rules. According to the medical board, Dr. Theodore Herring performed 268 abortions between Nov. 6 and Feb. 7 in Houston without first obtaining hospital admitting privileges within 30 miles of an abortion facility.
The Texas Freedom Network, NARAL Pro-Choice Texas, Whole Woman’s Health and other abortion rights advocates are encouraging their supporters to attend Thursday's Senate hearing and protest lawmakers’ decision not to discuss what they call “essential components to women’s health care and recent legislative attacks on that care in Texas.”
Meanwhile, Nelson said she’d like to use the Senate hearing to explore “whether the various programs serving women can be consolidated into one seamless system."
Currently, women’s health services for uninsured and poor women come from three main funding streams — the Texas Women’s Health Program, the expanded primary care program and family planning grants.
In 2011, the Republican-led Legislature ousted Planned Parenthood clinics from the Women’s Health Program, prompting the federal government to stop providing its $9-to-$1 match for the program in 2013.
As a result of the 2011 cuts to family planning services, 76 family planning clinics, a third of which were operated by Planned Parenthood, closed due to lost public financing, according to the Texas Policy Evaluation Project, a three-year research initiative at the University of Texas at Austin. Although Texas continued the Texas Women’s Health Program with state financing, records show enrollment has declined, as have claims for birth control and wellness exams.
The federal government also decided not to renew a contract with the Department of State Health Services to distribute family planning grants and instead awarded $13 million to the Women's Health and Family Planning Association of Texas, a consortium of statewide reproductive health providers including Planned Parenthood, to distribute over three years.
Ultimately, the Health and Human Services Commission estimated an additional 24,000 babies would be born as a result of unintended pregnancies, costing the state Medicaid program at least $103 million.
The Department of State Health Services awarded $45.5 million to 55 agencies to expand primary care services for women in fiscal year 2014. (Use this Tribune interactive to see the full list of providers, the amount of money awarded by region and the estimated number of women each provider intends to serve.)
Despite the state’s progress, the budget will still meet only a third of the need for subsidized family planning services in Texas, according to the Texas Women’s Health Coalition, which represents 39 medical trade associations and advocacy groups.
This story was produced with the support of the Dennis A. Hunt Fund for Health Journalism, a program of the USC Annenberg School of Journalism's California Endowment for Health Journalism Fellowships, and in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.