The Defunding of Women's Health Care in Texas May Force Rural Clinics to Close

We keep hammering away at this same general point, but really: It's been a terrible year for family planning providers in Texas. First the Legislature moved $73.6 million out of the state family-planning budget for the next two years . At the same time, they changed to a tiered funding structure that meant clinics that "only" provide family planning services are now third in line to receive what little money is left over, after public community clinics and federally qualified health centers. Then the fight between Texas and the feds over whether Planned Parenthood could legally be barred from the state's Medicaid Women's Health Program ended with the federal government pulling their money from the program, which was 90 percent of the WHP's funding.

The end result? Family planning and women's health services have been cut so deeply it's doubtful they can ever fully recover. Planned Parenthood has been badly hurt, but they're not the only ones. A rural clinic director we spoke to recently is bracing herself for the possibility that she'll have to close all of her family planning clinics for good, a situation many similar community health agencies now face. And with a clientele that's very young and very poor, the director knows exactly what that closing her clinics will mean: "These women just won't be seen. They'll get pregnant or be sick."

Tama Shaw is the director of Hill Country Community Action Association, a rural agency based in San Saba. Community action agencies exist to provide services to very low-income families -- things like child care, elder assistance and help paying for utilities. When we first spoke with Shaw in October, she had just lost 55 percent of the Title XX money she once received from the state. If any more money was lost, she feared all five of the rural family planning clinics HCCAA oversees would have to close. Then the WHP fight happened, and that fear looked a lot more like a reality.

"If there's no money to replace the WHP, we shut down," she says bluntly. Charging the clients more money to make up some of the difference is out of the question. Nearly all of her family planning patients currently pay nothing to be seen, because they're simply too poor: 100 percent below the poverty line or more. "We just couldn't charge our clients enough to stay in business without federal assistance."

Stand-alone family planning clinics like the ones Shaw oversees provide free breast cancer and STD screenings, hemoglobin tests, urinalysis, birth control and HIV testing. They're the most endangered because unlike federally qualified health clinics, they don't get much other federal funding. But that means when clinics like Shaw's are gone, FQHCs and other clinics and hospitals will be suddenly be overrun with patients.

"They won't have the capacity to handle all the women out there who'll need services," Shaw says. "Particularly in our rural area, the local clinics refer their patients to us for family planning."

During the fight over family planning cuts, she testified in front of a state committee and explained that this would be the situation for many rural clinics. "They're just packed full. You sit and wait and wait. It's just going to get worse." She predicts a much higher rate of unwanted pregnancies and STDs, especially given that close to a third of her clients are teenagers. "It's going to be a rude awakening when the state wakes up one day and there are millions and millions of dollars needed to take care of the births to women eligible for Medicaid and they don't have the funds to pay for that."

The other issue is that for some of the areas Hill County Community Action serves, there isn't even a local FQHC. "They'd have to travel and these people can't afford to travel." Even if the patients somehow find a way to travel to the nearest big hospital or FQHC and wait to be seen, they'll now have to pay for birth control out of pocket, Shaw says. That just isn't an option for her patients, despite the myth that there's one type of birth control, and that it always costs $9 at Wal-Mart. "I don't know of hardly any birth control pills that are $9 anymore," Shaw says. "And if you want any kind of permanent birth control, like an IUD, that's a lot more money."

Governor Perry continues to promise that he'll somehow find $34 million or so in the state budget to resurrect the WHP as an entirely Texas-funded (and Planned Parenthood-less) operation. The feds have given the state until April 16 to come up with a plan for that program, as they continue shutting down the federal WHP over the coming months.

Shaw's not putting her faith in Perry's plan, and is instead preparing for the worst. She says her agency has a little bit of money socked away, but would still need to raise a lot of private funds to keep afloat. That doesn't look good either.

"We are out begging for money for our senior program already," she says. "There's no way people in the rural communities are going to see the importance of family planning. I go around preaching and touting it all the time and I get blank stares. It's kind of the mindset of rural Texas, I think. If you mention those words, abortion pops in everybody's mind. The first thing you have to tell them is we're not related, we don't do that. That's just because of the media. When people hear family planning, they think abortion."

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Anna Merlan
Contact: Anna Merlan

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