Recent efforts in Congress to strip Planned Parenthood of federal funding for women’s health services would affect any funding Planned Parenthood clinics might receive through serving regular Medicaid clients, Medicaid waiver programs, and programs for breast and cervical cancer screening — even though none of this funding pays for abortion services.
Just how much damage this proposed legislation would inflict on the health of low-income women and teens, and especially their access to contraception, is debatable. The bill’s sponsors and our state’s senators have claimed that there would be no damage, and that the funding could simply and easily be transferred to alternate providers such as community health centers.
But Texas’ experience during the past four years calls that claim into question and could serve as a guide to what might happen nationally.
The Texas Legislature in 2011, 2013 and this year has done a thorough job of defunding the clinic systems in Texas affiliated with Planned Parenthood. The first step involved cutting the funding that the Department of State Health Services (DSHS) provided for family planning and related women’s health services by two-thirds, and instituting an allocation system that gave lowest priority to dedicated family planning providers, including but not limited to Planned Parenthood clinics.
The second step involved removing Planned Parenthood from the state’s Medicaid waiver program, the Women’s Health Program. Some of the funding for family planning was eventually restored in the next session, but through programs from which Planned Parenthood would be excluded.
My colleagues and I at the Texas Policy Evaluation Project have been investigating the impact of the initial cuts and the prioritization of comprehensive health care providers, as well as the ban that excluded Planned Parenthood from the Women’s Health Program. The former clearly had a devastating effect on all but a few providers.
The drastic budget cuts caused many clinics to close, and those that remained open had to curtail their services, especially providing the more expensive and more effective contraceptive methods such as IUDs and implants. Many Texas lawmakers, including Republican legislators, now realize that these massive cuts adversely affected women and were a mistake.
The more challenging question is how well alternate providers who were not major providers of family planning did at covering the gap that these initial cuts created.
Our initial analysis showed not all federally qualified health centers or other providers of comprehensive care at the community level are interested in taking up the bureaucratic and financial challenges, especially the low reimbursement rates, that are entailed in becoming a family planning provider under either the Texas Women’s Health Program or the contract programs administered by DSHS. And many of them simply do not have the trained personnel and experience in women’s health care that the former providers had.
There have also been problems for the women who are faced with finding a new provider.
Finding a new provider and securing a timely appointment is often a major challenge, especially in small cities such as Midland or in the Rio Grande Valley, where alternate providers are few and far between. Additionally, women may have to make multiple visits, undergo a series of exams and be charged copayments before actually getting a renewal of their contraceptive method.
And, of course, not everyone is willing to change providers. For example, a substantial number of users of injectable contraception returned to Planned Parenthood clinics after the ban even though doing so meant that they would have to pay about $100 for their next shot. In reproductive and sexual health, trust is important, especially for teens and people in small communities.
What have these problems meant for Texas women? In short, fewer have received contraceptive services, fewer use highly effective methods, some have had unintended pregnancies, and some have had abortions they would not have had if not for these policies.
Going forward, if Congress were to strip Planned Parenthood of federal funding, many of the challenges that Texas is currently facing would now be on a much grander national scale.
Joseph Potter is a professor of sociology and the principal investigator of the Texas Policy Evaluation Project at The University of Texas at Austin.
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