Women's Health Program Canceled in Texas?

Dear Cheasty,

Over the past few days I’ve heard some stuff in the news about Texas and how we’re going to cancel our Women’s Health Program. I don’t understand. In the first place, what is the WHP, exactly? Also, depending on who is talking, I can’t really tell whether the Federal government is changing things or if Texas is changing things. What’s going on?

Worried about Women’s Health

Dear WAWH,

You are right to be worried about women’s health in Texas. What’s happening in the Legislature right now is going to land us in some seriously expensive trouble if this program goes the way of the dodo bird. The threat to cancel the Women’s Health Program is part of a larger attack on women’s health, and it poses a serious threat to women in Texas.

The Women’s Health Program is a small part of the larger Federal Medicaid program.  It provides free annual screenings (pap smears, breast exams) and free birth control to low-income  women in about half the states  around the country. In Texas, the WHP serves 114,000 women right now. State participation is optional (states sign up for 5 year cycles), and the Feds pay a 90-10 matching rate for participating states. That is, for every $10 Texas spends on the WHP, the Feds chip in $90– an utterly fantastic bonus for Texas’s struggling health care infrastructure.

Another great thing about this program is how inexpensive it is – WHP literally pays for itself! By spending only $250 a year per client, from 2007-2009 the WHP saved over $120 million in the cost of Medicaid-covered unintended pregnancies (which average $11,000 per birth

In a state that keeps slashing services because our revenues have shrunk, that’s a lot of extra money we’ll have to shell out if we cancel the program, and a lot of women who will go without even basic access to health care as a result. And, the Texas Legislature already cut off family planning budget for over 150,000 Texas women back in September 2011, through budget cuts at the State Health Department. So, if Texas also shuts down the Women’s Health Program, they will reduce the total number of women who we help get access to pap smears, breast exams, and birth control by over 80%.

So what’s the problem? Why are we having this conversation?

Well, WAWH, the answer is pretty simple – this is about politics, plain and simple. The Texas Legislature has passed laws designed to ban Planned Parenthood from participating in the Women’s Health Program. Why? Because Planned Parenthood is the number one target for abortion opponents.

But does the WHP pay for abortions? Nope. Not even close. In fact, no federal dollars can be spent on abortion in any program except in cases of rape, incest, or when the woman’s life is endangered, and WHP never covers abortions at all. In fact, to make it perfectly clear that family planning money did not support abortions, several years ago Planned Parenthood legally separated its health clinics from its abortion clinics so that there would be no such confusion.

But the Legislature decided this separation was not enough, and directed the state agency that runs Medicaid to write rules that go even further.  Texas’s new WHP rules cut out any family planning provider that has any ties or shared name with an abortion provider, even if they are legally and physically separate.

This is utter nonsense. Federal Medicaid law – on the books since the law was first passed in 1965 (thanks, President Johnson!) – clearly states that within Medicaid programs, states cannot restrict people’s right to choose their own provider. This has long been understood to mean that states will not restrict particular institutions or practitioners from participating in Medicaid programs, as long as those institutions or practitioners meet the licensing requirements set by the state.

But Texas isn’t trying to change our licensing requirements. The Lege is only saying that Planned Parenthood clinics – which are completely legal and do meet all of the state’s licensing requirements! – can’t participate in the Medicaid Women’s Health Program.  This is not the Obama administration vs. Texas. This is clear, long-standing Federal Medicaid law, and it is our Texas lawmakers who are trying to move the goalposts.

As I mentioned before , this aggressive attack on family planning services in Texas is NOT merely confined to this WHP issue. In the last Legislative session, Texas already slashed and burned funding for women’s health. Other state budget cuts to family planning already took effect in September 2011, and cut off care for 150,000 Texas women through Health Department family planning programs—entirely unrelated to the Women’s Health Program. And these cuts affected many family planning providers who are not Planned Parenthood, among them health centers, clinics, and hospitals.

So what is the Legislature thinking? Do Texas’s elected officials understand the importance of the WHP to caring for low-income women in Texas? You bet your britches. As Senator Jane Nelson (Republican Chair of the Senate Health and Human Services Commission and a proponent of the Planned Parenthood exclusion) accurately noted, “If these services are interrupted, it will have a devastating impact on the health of Texas women.”

If the Women’s Health Program is shut down as expected, it will eliminate care for at least another 114,000 women. That’s a total reduction of over 270,000 women served in Texas.  In 2011 Texas served about 332,000 women. This year we will only serve about 61,000. Clearly, there is a larger agenda against women’s health and family planning that needs to have some light shined upon it.

So, WAWH, that’s the scoop. This is politics at its worst – election-year posturing that in the end will hurt the poorest and least powerful among us: low-income women and their families.

But in the long run, Texans, it’ll hurt all of us. We as taxpayers will bear the burden of paying higher Medicaid costs for the unintended pregnancies that result from this reduction of family planning funds, and we’ll pay the higher costs of health care for the thousands of women who don’t catch breast, cervical, or uterine cancer at its early stages and end up needing major medical interventions, all paid for by Medicaid. The Women’s Health Program, which chips in $90 Federal dollars for every $10 that Texas chips in, is one of the best preventive plans our state has, and to walk away from this sort of good fiscal and public health policy is folly.

Stay tuned, WAWH. Call your legislators. Let the Texas Legislature know you won’t stand for their political posturing on such an important issue.

To a well and healthy Texas,
Cheasty Anderson