Texas works to market health program without Planned Parenthood

Look up right now and you might see one of the 36 pink billboards dotting Texas cities urging women to go to the state for their reproductive health needs.

But marketing the Healthy Texas Women Program isn’t the average public health outreach campaign — it’s a test for Texas legislators. The program marks the state’s second attempt at reimagining how to provide reproductive health and family planning services for low-income women without the involvement of Planned Parenthood or other organizations that provide abortions at some of their locations. Some critics say not enough women are aware of the program. 

For the 2017 budget year, the program has an average enrollment of 141,000 women. That's less than the 176,577 who were enrolled in a previous version of the program in 2015. And it's less than the 207,041 who were enrolled in the Medicaid Women's Health Program in 2011, when groups like Planned Parenthood were allowed to provide services. Meanwhile, the number of women eligible for the program has grown.

State Rep. Jeff Leach, R-Plano, said he asked his wife, other women staffers in his office, neighbors and friends if they had heard of the Healthy Texas Women Program and that they said no. He is proposing giving the Health and Human Services Commission more money to market the program.

“We need awareness,” Leach said. “They’re doing a great job, but they need more resources.”

Under the program, low-income women ages 18 to 44 are eligible for services including pregnancy testing, STD testing, breast and cervical cancer screenings, contraceptive counseling, postpartum depression screenings, as well as help with chronic diseases like diabetes, high blood pressure and high cholesterol. Fifteen- to 17-year-olds are also eligible if a parent signs them up. The program does not offer abortion services. 

State Rep. Jessica Farrar, D-Houston, chairwoman of the Texas House Women’s Health Caucus, said “marketing is not the correct solution” for making the Healthy Texas Women Program successful.

“Increased funding for marketing for Healthy Texas Women highlights the simple fact this program has not yet, and never will, replace Planned Parenthood,” Farrar said, adding that people already know and trust Planned Parenthood.

A look at Healthy Texas Women's $2.5 million marketing budget for the 2017 budget year shows a $506,625 contract with Fleishman-Hillard to do design and content development for outreach efforts. The Health and Human Services Commission spent another $455,000 to get 176 bus ads and 36 billboards up statewide in 13 cities including El Paso, Lubbock, Bryan College-Station, Dallas/Fort Worth, Beaumont and Houston.

Agency officials dropped $490,000 for 1,770 television spots statewide and another $437,500 for 7,721 radio announcements. They’ve also spent $367,500 on digital pamphlets and factsheets to give to providers and patients. In 2016, the agency spent $319,200 to redesign the website with better search engine optimization, updated photos, a screening tool for applicants and a “find a doctor” search section.

Kelli Weldon, assistant press officer for the commission, said in an email that “the metrics for success” for the state’s outreach campaign are based on program enrollment and website traffic. Between July 2016 and March 2017, the program website had more than 1 million page views.

“We want women to know about the services available to them, so marketing is an important aspect of the HTW program,” Weldon said. “Our outreach efforts highlight the strength of Texas women and the importance of proactively managing your health.”

Weldon said the commission could not say how many women have received services in the program because that data is not complete until several months after the date of service. The commission could not provide the number of women who said they enrolled in the Healthy Texas Women Program because they saw an advertisement.

Leach said Texas Health and Human Services Commission officials told him they needed more money for outreach. 

The commission has requested $265.7 million for the program and other family planning programs for the 2018-2019 budget cycle. Weldon said the commission did not request additional money for outreach efforts.

"We provided information about how we currently market the program and explained that we'll follow direction from the Legislature regarding dollars that are appropriated to us for the program," Weldon said of the commission's interaction with Leach. 

State agencies cannot lobby for additional funds outside of their formal agency budget requests. 

Leach proposed an amendment to the state budget earlier this month that would take $10 million from the Texas Lottery Commission to give to the Healthy Texas Women Program for marketing. House members voted to adopt the amendment, but it's unclear if the measure will become law. House and Senate lawmakers must now reconcile their versions of the state budget.

Reproductive rights advocates say Texas women are still feeling the ripple effects of state legislators’ attempts to take over women’s health services. They point to the state’s $73.6 million cut to family planning programs in 2011. The state took bolder steps in 2013 by forgoing participation in the Medicaid Women’s Health Program to create the Texas Women’s Health Program to exclude abortion providers.

Joe Pojman, executive director for Texas Alliance for Life, said "low-income women deserve better care than Planned Parenthood is willing or able to provide." He said he found more than 150 providers within 20 miles of Planned Parenthood's South Austin Health Center by using the Healthy Texas Women Program's online search tool.

"We don't think agencies that promote abortion or are synonymous with abortion should be ambassadors for the state's women's health programs," Pojman said. "That's not consistent with the state's mission to promote childbirth as an alternative to abortion."

Thousands of Texas women have also lost services and may not have found a new doctor after dozens of women's health clinics closed after the Texas legislature passed House Bill 2 in 2013. The law required Texas facilities performing abortions to have minimum sizes for rooms and doorways; pipelines for anesthesia; and hospital admitting privileges within 30 miles of the clinic. The U.S. Supreme Court struck down the law last summer, but many abortion providers have not been able to reopen.

Whole Woman's Health, the plaintiff in the high court's case, recently reopened its Austin clinic.

Yvonne Gutierrez, executive director for Planned Parenthood Texas Votes, said she has seen the Healthy Texas Women Program billboards, but so far she said the state has not proven its approach is effective. She said the state has failed to create a program that could match the robustness of the Medicaid Women’s Health Program.

“They’ve been trying this for several years, but every time they’ve gone through an iteration of this they’ve not been able to make it work,” Gutierrez said. “Why is this taking you so long if it was supposed to be so easy to do this without Planned Parenthood?”  

Read related Tribune coverage:

• The Texas Tribune spoke to Whole Woman's Health founder and CEO Amy Hagstrom Miller ahead of the reopening of the organization's Austin location. 
• Planned Parenthood affiliates in Texas and around the country are vying for funding and survival now that Republicans control both chambers of Congress, the White House and many state legislatures. 
• Showing multiple clips from a video released in 2015 by the anti-abortion group Center for Medical Progress, state attorneys and witnesses said the footage was grounds for dismissing Planned Parenthood from Medicaid.
• Following a directive from the Legislature, the Texas Health and Human Services Commission announced Wednesday that it would combine two of the state's main women’s health programs to create the “Healthy Texas Women” program on July 1.
• A high-ranking official at the Texas Health and Human Services Commission is resigning after he co-authored an unflattering study that found the state’s exclusion of Planned Parenthood from a family planning program restricted women’s access to health care.

Disclosure: Planned Parenthood has been a financial supporter of The Texas Tribune. A complete list of Tribune donors and sponsors can be viewed here.