With the hard-fought passage of the 2014-15 biannual state budget, Texas legislators appear to have learned a lesson from 2011’s family planning slash-and-burn session, which left tens of thousands of Texans without access to the reproductive health care they’d received in previous years and directly caused the closure of 59 family planning clinics in the state.
But whether the new designation of $100 million in health-care funds over the next two years will adequately address the family planning needs of Texans remains to be seen. Instead of funneling the money back to tailored providers of contraception and women’s health screenings, who are equipped to swiftly and efficiently provide reproductive health care, the state is launching a new care delivery program, sending the funds to primary care doctors and federally qualified health centers.
“It’s much more difficult for a comprehensive provider to really have the systems in place to efficiently provide the family planning care that some of the traditional providers have done,” said Dr. Janet Realini, chair of the Texas Women’s Health Care Coalition. But, she told Rewire, “That doesn’t make it impossible, it just makes a little steeper climb.”
Legislators have gone this route in part because they intend to refuse a federal Medicaid expansion, and because the state lost matching federal funds for the Medicaid Women’s Health Program when it barred abortion “affiliates” like Planned Parenthood from providing care under that program in the state.
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“Had we done the Medicaid expansion, we wouldn’t be having this discussion,” Texas Academy of Family Physicians CEO Tom Banning told Rewire. “These patients would have been covered by Medicaid expansion or exchanges.”
The new budget is a conservative work-around aimed at solving one of Texas’ most pressing problems: getting health care to Texas’ uninsured population, the largest by percentage of any state in the country. (Though the executive commissioner of Texas’ Health and Human Services Department does not believe that to be the case.)
“We got back, for the funding, what we lost in the last biennium,” Banning told Rewire, “but I don’t believe we made a substantial jump forward in terms of the growth of our population, to cover more people that are eligible.”
Texas would rather spend its own money, and more of it, on serving the same or a smaller population of people with a less efficient provider system—at least, for now. It may be that in years to come, a primary and preventative-focused care structure can deliver the same family planning care with the same efficiency Texans received in 2011 and before. That’s Dr. Realini’s hope, and she says she’s personally “optimistic.”
“This is an experiment,” she said. “We’ll see how it works.”
In the meantime, low-income Texans will be the state’s guinea pigs while it works out how providers will be reimbursed for services under a new system with four funding streams, up from two funding streams before the 2011 budget cuts: there’s the state’s new Texas Women’s Health Program, its replacement for the federal Medicaid Women’s Health Program, the state’s new primary health-care program, the state’s family planning program, and a federal Title X family planning grant that went not to the state, as it has for 30 years, but to the Women’s Health and Family Planning Association of Texas, a new coalition of 34 women’s health-care providers, including some Planned Parenthood locations.
But what’s frustrating for many reproductive rights activists in the state is that there wasn’t anything broken about Texas’ family planning system in the first place—at least, not to anyone besides conservative lawmakers who believe Planned Parenthood is an abortion mill and so went on a defunding crusade that did little to damage that organization as a whole but did much to close or weaken other family planning providers. Now, the state is solving a problem it not only created, but has exacerbated, over the past two years.
“We had such a huge devastation of the safety net, not just with Planned Parenthood but other family planning clinics, other family planning programs within institutions like the Baylor University Health System and Parkland [hospital in Dallas],” said Realini. “Even when you have other resources that are held by those organizations, with or without that, it’s going to take some time and effort to rebuild that capability. It’s not something you can just instantly turn on and off.”
Tom Banning says he’s optimistic that a new state funding stream to primary care doctors may increase the range of services provided to low-income patients who might otherwise only have received reproductive health care.
“One of the things that the legislature was really thoughtful about was trying to provide a program that was more holistic in nature,” said Banning. He says he’d like to see, going forward, how the state can “build upon” this new program.
“We are a very fiscally conservative state, and there are competing interests for the limited dollars that we’re willing to put into social health programs,” he said. “That’s going to be an ongoing challenge.”