The Medicaid Women's Health Program provides some 130,000 Texas women with vital medical care: family planning, birth control, cancer screenings and annual exams. And for that, of course, it must die. That, at least, has long been the case as far as Republican lawmakers are concerned. And after last week, the demise of the WHP looks more likely than ever, as does a nasty showdown between the feds and the state government.
We've written before about Republican lawmakers' hostility towards the WHP. To review: the governor's office and conservative legislators are not fans of the program because Planned Parenthood is one of the providers that takes part in it; in fact, about 40 percent of WHP clients use a Planned Parenthood clinic as their primary care doctor. Last legislative session, Republican lawmakers added language to the WHP rules banning family planning clinics that are "affiliated" with abortion providers from taking part in the program, something clearly aimed at cutting Planned Parenthood out. The only problem with that: The feds provide 90 percent of the money for the WHP, and federal Medicaid rules say you can't block qualified healthcare providers from participating in a Medicare or Medicaid program.
Medicaid itself doesn't pay for abortions. Ever. But the federal Centers for Medicaid and Medicare Services (CMS) already had to send a memo to all 50 states this summer reminding them that they're not allowed to block qualified providers. Despite that, Texas Health and Human Services Commissioner Tom Suehs signed a rule last week that does just that. The new rules formally ban healthcare providers with "abortion affiliates" from participating in the WHP.
What's not clear, at least right now, is how CMS and the federal government will choose to respond: cut all federal funding to the WHP, effectively killing it, or allow the rule blocking Planned Parenthood to go forward, allowing Texas to violate federal law and forcing nearly half of WHP clients to find new healthcare providers. Ozinal Alper, a spokesperson for CMS, will say only, "We are in contact with state officials but can't speculate at this point."
Governor Rick Perry's administration is clearly gearing up for the program's end and making sure to blame the president along the way. Allison Castle, a spokesperson for Perry, told the Texas Tribune: "The Obama administration is trying to force Texas to violate our own state laws or they will end a program that provides preventative health care to more than 100,000 Texas women. This boils down to the rule of law -- which the state of Texas respects and the Obama administration does not."
Groups across the state that oppose legal abortion say they are also Very Concerned about the possible demise of the WHP, which they too cast as the Obama administration's fault. In a statement, Texas Right To Life director Elizabeth Graham blamed it on "Obama's relentless support of unrestricted abortion." She writes:
"President Obama is playing politics with women's health by forcing his radical abortion agenda on low-income women in Texas. Women don't want to receive their health care services at abortion clinics, and President Obama has directed the CMS to shut down a program that serves low-income women unless the program includes abortion clinics; he has clearly overstepped the line.
Planned Parenthood, of course, sees it a little differently. ""Even as more than one-quarter of Texas women are uninsured, and women in Texas have the third highest rate of cervical cancer in the country, Governor Perry is determined to make a bad situation worse for women in the state of Texas," Planned Parenthood Federation of America President Cecile Richards said in a statement. "Texas would rather throw health care for hundreds of thousands of women overboard than allow Planned Parenthood to provide health care like breast and cervical cancer screenings, birth control, and STD prevention through public health programs."
Interestingly, ACLU of Texas, which doesn't usually weigh in on healthcare issues, is also unhappy with Perry. In a statement sent out to reporters last week, executive director Terri Burke said, "In a state that has decided to spend less on our children's educations, it isn't surprising that now it cuts state spending on health care for poor women. The result is that while the state thumbs its nose at $9 of federal money for every $10 spent on this critical preventive health care, public hospitals will end up picking up the tab."
CMS officials haven't set a timeline for how they'll respond to Texas' new rule; if they do nothing, its set to take effect March 14. Women using the WHP: Get your healthcare while it exists.
