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NEWS
The Destruction of
Texas Health Care
The GOP crusade against Planned Parenthood is
devastating basic care for Texas women
BY JORDAN SMITH
Carole Belver, executive director of
Community Action Inc. of Central Texas,
spent Tues day, Jan. 24, closing up the CAI
women’s health clinic in Elgin. As she
packed up supplies and prepared files to be
moved to Lockhart, the closest of the
group’s two remaining clinics, “the phone
was ringing off the wall,” she says. Three
staff members have been terminated, and
hundreds of clients have been left wondering
where they’ll go to receive basic reproductive
and preventative health care.
Belver doesn’t know what to tell them.
CAI, which until recently operated 13 clinics
in medium- and small-sized communities
in Central Texas, now has just two, in
Lockhart and San Marcos. “It’s horrible; it’s
just devastating,” she says. “And there’s
really no place for these clients to go.”
Indeed, CAI is among 12 women’s health
contractors operating 22 clinics statewide
that have been completely defunded as a
result of last year’s April Fools’ Day slashing
by Texas lawmakers of the family-planning
budget traditionally used to provide
low-income and uninsured women with
access to health services. As it stands, there
remains just $38 million of a roughly $100
million biennial budget to provide these
vital health services –
screenings for cervical and
breast cancers and for diabetes
and hypertension, as
well as access to birth control,
among other preventative
health services that
together make up a “wellwoman
checkup.” Since
2005, this money – federal
dollars passed back through
the state to fund services –
has paid for health care for
an average of 244,000 needy
women a year; with the
small pot that remains, just
$19 million this year, the Department of
State Health Ser vices estimates that just
60,000 low-income women will be able to
access basic health services in 2012.
Defunding Basic Care
Why lawmakers chose to decimate a budget
that had been barely keeping pace with
actual need for services – according to a
2008 Guttmacher Institute report, there are
some 1.5 million women in need of reproductive
health services in Texas – can be
summed up in two words: Planned Parenthood.
An increasingly aggressive political
campaign against the nearly 100-year-old
nonprofit is at the heart of the cuts.
“They haven’t
figured out that
this is going to be
devastating – and by
the time they do, it
will be too late.”
– Carole Belver,
Community
Action Inc.
18 T H E A U S T I N C H R O N I C L E FEBRUARY 3, 2012 a u s t i n c h r o n i c l e . c o m
Conservative lawmakers – and their backers
at Texas Right to Life and other antiabortion
groups – were nearly giddy about
the cuts last spring, proclaiming that slashing
the budget would cripple Planned Parent
hood, one of the state’s largest providers
of women’s health care, and thereby bring
an end to the “abortion industry.”
Yet the federal funds in question do not
cover abortion care, and thus none of
Planned Parenthood’s abortion services –
which, nationwide make up roughly 3% of
its work – are paid for through the state’s
family-planning budget. Instead, what
Republican lawmakers have done, with the
express blessing of Gov. Rick Perry, is hurt
Texas women, especially the women who
most desperately need a health care safety
net. “It was shocking; it was sort of unbelievable,”
says Paula Turicchi, senior vice
president for women and infants’ specialty
health at Parkland Health & Hospital
System in Dallas, the state’s single largest
provider of family planning services to
uninsured women. “The bottom line is that
the women who need services are the ones
who suffer the consequences.”
Moreover, compounding the outright
cuts, lawmakers also approved a new funding
matrix that first funds
“federally qualified health
centers” – one-stop medical
clinics intended to provide
the uninsured with a
medical home (although a
number of FQHCs across
the state actually subcontract
with smaller familyplanning
providers, including
Planned Parenthood
clinics, in order to provide
these services) – before
funding other providers.
Lawmakers arranged a
three-tiered system for
funding women’s health providers, with PP
on the lowest rung and with the expectation
that in fact there wouldn’t be money left to
fund any PP clinics. That outcome was
assured – but with just $19 million per year
left to spend, there also hasn’t been money
left for many providers other than FQHCs,
including veteran community providers.
According to the funding allocations
released this month by DSHS, 12 contractors,
operating 22 clinics statewide, have
been completely defunded. Among those
are not only a number of Planned Parenthood
clinics – including Austin’s Downtown clinic
on East Seventh Street – but also other
stand-alone family-planning clinics and
I L L U S T R A T I O N B Y J O H N A N D E R S O N A N D J A S O N S T O U T
venerable community health clinics, such
as Austin’s People’s Community Clinic and
El Buen Samaritano Episcopal Mission.
The severe funding cuts and tiered system
mean that great swaths of Texas may be left
without local providers. CAI, a contractor
with the state for more than 40 years, had
been receiving more than $750,000 per year
to deliver women’s health care to clients
across Central Texas. Now that they’ve been
defunded – along with the other Central
Texas providers – there remains just one provider,
CommUnityCare, to serve the majority
of Central Texas women. “I’m just wringing
my hands; it’s just horrible,” says Belver.
State lawmakers “have successfully torn
down an infrastructure that took so many
years to build,” she continued. “There’s no
talking sense to these people. They’ve got it
‘all figured out,’ and yet they haven’t figured
out that this is going to be devastating – and
by the time they do, it will be too late.”
Bleak Outcomes
And the already bleak landscape for
women’s health care in Texas is likely going
to get even worse, unless state officials with
the Health and Human Services Commission
can successfully negotiate with the federal
government’s Centers for Medicare &
Medic aid Services to allow for the renewal
of the successful Women’s Health Program,
a Medicaid-waiver program that provides
women’s health care services to clients who
would not otherwise be eligible for Medicaid
unless pregnant. In 2011, that program
served more than 184,000 women in addition
to the 215,442 unique clients served
last year with the traditional family-planning
budget. However, the future of the
program is in jeopardy, after Sen. Robert
Deuell, R-Greenville, pushed HHSC to
redefine who can provide services under
the WHP – a move crafted, again, to cut
Planned Parenthood from funding. As with
the traditional family-planning budget, PP
is a major player in the WHP; in 2008, it was
the WHP’s largest provider. And though
BY THE NUMBER S
22: Clinics statewide that have been
completely defunded
$38 million: Remaining biennial budget for
family planning, down from $100 million
60,000: Women whom the Department
of State Health Services estimates can
be served with that amount, compared
with the average 244,000 served annually
since 2005
184,000: Women served by the Women’s
Health Program in 2010 – and now in
danger of losing service because of the
state’s anti-Planned Parenthood dispute
with the feds (2011 estimate: 185,000-
200,000)
11: Planned Parenthood clinics closed
statewide – none of which provided
abortion services
33,974: Screenings for sexually transmitted
infections annually provided by those
11 clinics
Texas might like to cut PP out of the loop,
the feds aren’t as amenable; Medicaid forbids
states from discriminating against
qualified providers. To women’s health
advocates, the attempt to exclude PP does
just that – which will likely mean the program
will disappear, bringing the number
of women left without health care in 2012
ever-closer to the half-million mark. “This
is so much more than just [hurting] Planned
Parenthood,” says Sarah Wheat, co-interim
CEO of Planned Parenthood of the Texas
Capital Region. “And it’s so depressing.”
As a result of all these drastic policies,
health care advocates say the state is likely
to see more providers close and many more
women left without basic health care. That
outcome will also increase the number of
unplanned, Medicaid-paid births; the number
of cancers detected in later stages of
disease; and, inevitably, the number of
abortions. “The obvious list is undetected
cancers, higher rates of sexually transmitted
diseases, unwanted pregnancies that
end up in more Medicaid-paid births, more
children enrolled in CHIP [the Children’s
Health Insurance Program] and more needing
Head Start and other educational programs,”
says Fran Hagerty, CEO of the
Women’s Health and Family Planning
Assoc i ation of Texas. “All of the social services
and educational programs that we
can’t afford now, we’ll be taxing more.”
While cuts to the state’s budget for women’s
health is alarming providers across the
state, Perry, on the presidential campaign
trail, boasted to Politico about the state’s
targeting of PP: “I was really proud to be
able to sign legislation that we worked on
with our Legislature to defund Planned
Parenthood in the state of Texas,” he said.
“There are 12 abortion clinics that aren’t
open in the state of Texas today because our
members of the Legislature had the courage,
the wisdom to do that.”
Perry’s bragging may please his hardcore
conservative base – but it’s false. Eleven
Planned Parenthood clinics across the state