It's been a good 14 minutes since the state twisted its rusty knife into the already-wounded gut of women's healthcare. But fear not: There's a huge, ugly storm brewing between the state and federal governments over the Medicaid Women's Health Program (WHP), and the fight appears likely to end with the program's demise and more than 100,000 poor women losing access to healthcare in the next year alone.
The fight, of course, centers on abortion -- even though the program in question doesn't pay for abortions and never has.
Texas wants rules that would prohibit patients from using family-planning clinics that are "affiliated" with abortion clinics. It can't legally make that rule. But conservative politicians tried to do it anyway.
The program was created in 2007. It provides family planning and primary care services to low-income, uninsured women, and it served nearly 125,000 people in 2010 alone. It's an especially crucial part of the safety net in Texas, where about 28 percent of women are uninsured, according to the U.S. Census Bureau -- the highest percentage in the country. For many of these women, an annual exam at a family planning clinic is the only medical care they receive.
It's also incredibly cheap, at least for Texas. The feds cover a full 90 percent of the program's costs; the state chips in just one dollar for every nine Uncle Sam does. And according to the Texas Health and Human Services Commission, it's served 235,000 women so far and saved the state more than $37.6 million during its first two years by helping women avoid otherwise costly unplanned pregnancies. It also saves the state money: The Legislative Budget Board estimated that the WHP would net the General Revenue Fund around $83.7 million.
"It's a successful program, reaching women with healthcare they wouldn't otherwise receive," says Sarah Wheat, the interim co-CEO at Planned Parenthood of the Texas Capitol Region in Austin. "It saves the taxpayers funds as well. The program is a success by every measure."
Except one, presuming you're a conservative politician: Last year, more than 40 percent of WHP patients received their care at a Planned Parenthood. And for that, it must be stopped.
Conservative politicians throughout the state have made their dislike of Planned Parenthood blindingly clear, as we pointed out in a recent cover story -- so much so that they cut a full two-thirds, or $73 million, from the state family planning budget for the next two years in a roundabout effort to dismantle the non-profit.
They also wrote language into the laws governing WHP saying that any family planning clinic that is "affiliated" with an abortion provider will be excluded from participation in the program. That law sent Planned Parenthood lawyers and advocates scrambling to figure out the definition of "affiliate." But Planned Parenthood's family planning clinics, just like every other family planning clinic in the state, do not provide abortions. That's done through a separately affiliated sister organization, with a separate board and a separate bank account. Government money doesn't pay for abortions, no matter how often conservative pols insist that it does.
This is coming up now because WHP is what's called a "waiver" program, not a permanent part of the state's healthcare system. Back in 2007, it was created to be a five-year program, set to expire on December 31 of this year. Programs like this across the country have faced efforts by conservative politicians to cut out Planned Parenthood, beginning with Indiana. In early June, the Centers for Medicaid and Medicare Services (CMS), which oversees these programs, sent a memo to all 50 states reminding them that they can't do that. It's a violation of the Social Security Act, specifically Title VIII, Sec. 1802, which guarantees that a patient can obtain health services from any qualified agency. Disqualifying the agency based on the practices of their affiliates, the feds say, is illegal.
"You can't pick and choose who's a Medicaid provider," Planned Parenthood's Wheat says. "There's a freedom of choice within Medicaid. Any provider who wants to participate can."
Last week, the feds informed state officials (again) that they can't exclude family planning clinics with abortion-providing affiliates from the WHP. Public health advocates in the state fear that Texas lawmakers' quest to run Planned Parenthood out of business will push it axe the program altogether, despite its resounding success.
"At this point, given the legislative direction, I fear [the state] will eliminate the program rather than allow participation by abortion providers or their affiliates," Fran Hagerty, chief executive of the Women's Health and Family Planning Association of Texas , told the Houston Chronicle. "That'll wipe out family planning clinics reliant on Medicaid funding."
State officials, as well as conservative politicians across the state, insist that waiver programs don't have to comply with the Social Security Act. Tom Suehs, HHSC's executive commissioner, called the fed's decision "inconsistent with federal law that gives states the authority to establish qualifications for Medicaid providers."
Besides, conservatives say, the whole squabble is really the fault of Obama administration and Planned Parenthood, for being so damned stubborn about the abortion thing. State Senator Robert Deuell, R-Greenville, offered what he clearly considers a very simple solution to the whole dilemma.
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"The problem could be solved tomorrow if Planned Parenthood just renounces abortions and just does family planning and comprehensive care, which they're capable of," Deuell, who's a doctor, told the Texas Tribune. "Then we could provide a lot of family planning, and there wouldn't be abortions and this problem would go away."
Rick Perry didn't miss a chance to ding the president either, and even managed to remember what he was talking about for the duration of his soliloquy. (Yes, it was prepared, but still.) He issued a statement accusing the Obama administration of "playing politics," adding: "We are committed to protecting life in Texas, and state law prohibits giving state dollars to abortion providers and affiliates -- a fact the Obama administration ignores. I strongly urge the administration to do the right thing and grant this waiver, so Texas women can access critical preventative health services, including breast and cervical cancer screenings, rather than making them pay the price for its pro-abortion agenda."
But that appears unlikely, which leaves Planned Parenthood reps just hoping against hope that the program will somehow be saved.
"It's fiscally responsible and morally sound," says Kelly Hart, public affairs director at Planned Parenthood North Texas. "It protects the health of uninsured women who would otherwise have no place else to turn to. We would like to see this resolved so women can get the healthcare they need."