Funding for Women's Healthcare in Texas
These are excerpts from a very recent edition of NPR's Fresh Air, hosted by Terry Gross. Her first guest was Carolyn Jones. For the entire transcript, to hear the interview, or for the link, please see: http://www.npr.org/2013/01/22/169059701/we-have-no-choice-a-story-of-the-texas-sonogram-law
GROSS:... Let's broaden that discussion into what the Texas state legislature has been doing in the area of women's reproductive health care. In the 2011 session, the legislature cut the state's family planning program by two-thirds. What was the program, and who was most affected? What services were most affected?
JONES: The program - this would have been the state family planning budget; and before the 2011 legislature, it accounted for about $112 million. And that pot of money funded family planning and well-women services for about 220,000 of the poorest men and women in Texas. And not only did that provide birth control but also well-women exams and STD screenings, and breast cancer and cervical cancer screens. So it was really quite a comprehensive program.
During the 2011 legislature, that budget was slashed by two-thirds. It brought it down to about $40 million. Now, the reason that this money was slashed was because the conservative legislature wanted to starve Planned Parenthood of any state funding. And in a very unfortunate development, the legislature had somehow conflated abortion with family planning.
And these are not big chains, family planning chains across Texas. Many of them are actually small, mom-and-pop providers out in the rural areas, working with very small communities. You know, what we discovered at the Texas Observer was that within about six to eight months of these cuts happening, more than 60 family planning clinics across Texas were forced to close.
GROSS: Now, you write that many clinics that didn't close rely on funding from another endangered source in Texas, the Women's Health Program. What is that program?
JONES: That's right. The Women's Health Program, before the 1st of January of this year, was a federally funded program aimed at - again - the poorest men and women in Texas. I think it covered about 115,000 men and women. And it provided them with contraception and well-women care, and breast and cancer screening. As I said, it was federally funded; which means that for every $1 that Texas spent on this service, the federal government spent another 9. So as you can imagine, this was a good program for us to have in Texas.
Now, Planned Parenthood was the dominant provider of women's health program services in Texas. Forty-five percent of the clients in this program were seen by Planned Parenthood providers. And because this is Texas - and the conservative legislature have a vendetta against Planned Parenthood - in the 2011 legislature, they decided they needed to do whatever they could, to get Planned Parenthood out of Texas. So another way that they chose to do that was to exercise another law that meant that - it was called the affiliate rule - which claimed that Planned Parenthood would not be able to access federal funds because they were affiliated with abortion providers.
So Texas tried to exercise this affiliate rule. The federal government said it was not legal to remove one of the providers from the program. And it was then litigated in court; back and forth, between Planned Parenthood and the state of Texas, about whether they can or cannot be within this program. On the 31st of December, the federal government said that they would not be able to provide federal funding towards a fund that had evicted one of the providers.
And so the state of Texas said they would happily walk away from that 9-to-1 federal match because they really did not want to have to have Planned Parenthood in the program itself. So on the 31st of December, we lost the federal funding for that program. On the 1st of January this year, it became an entirely Texas-funded program. So it's now called the Texas Women's Health Program.
GROSS: Is there an estimate of how much money Texas is walking away from?
JONES: Yes, I think in - over a two-year period, it will probably cost Texas $70 million that they wouldn't have had to have spent if they'd stayed within the Medicaid program.
GROSS: We've talked about cuts to women's reproductive health care. We've talked about counseling against having abortion. What effect do you think all of this is having on the quality of women's health care and access to women's health care in Texas?
JONES: Well, we already know that at least 60 clinics across Texas have closed. We also know that even those clinics that still receive state funding, it was much less than what they were receiving before. So where they were providing family planning services for free, now they must share the costs with the patients. And that's very tough for these women, these low-income women who are in dire economic straits as it is. The other impact that we're seeing is that the family planning clinics that are still able to stay open, they aren't able to offer some of the more expensive yet more effective contraceptive options. So that's reducing women's choices as well.
Something else we're seeing, too, is that the Texas Health and Human Services Commission - the state agency that's responsible for all of this - they've already started their projected budget for 2014 and 2015. And they have projected 24,000 extra births as a result of these cuts to the family planning budget. And they have said that their budget will need, probably, about $273 million in order to cover the costs of all of these extra births. Now, this has more than doubled the size of the family planning budget that was slashed so dramatically in 2011.
We won't yet see exactly how many births there are, for a while. We won't see the impact of women whose cancer screenings - who weren't picked up in time. Those will come later. But, I mean, if the state agency itself is already projecting for so many extra births and so many greater costs, I think we can be sure that the collateral damage from those decisions made in 2011, will be far-reaching - and very damaging for women and men in low-income state, across Texas.
GROSS: The state of Texas is funding a program called Alternatives to Abortion, and this is a state program that funds crisis pregnancy centers....
GROSS: Since Texas has cut funding to family planning centers and to clinics that provide abortions, where is the money for the Texas Alternatives to Abortion program coming from?
JONES: The money came, interestingly, from the family planning budget. So during the - the one that was slashed so heavily in the last legislative session. Each session that goes by - the Alternatives to Abortion program has been running since 2005; it gets more and more money siphoned towards it. So that money is coming out of a program that is designed to prevent unwanted pregnancies, and is now going towards a program that's designed to promote childbirth and prevent abortion. It's sort of missing out the middle bit - which is, you know, the trying to help women prevent the pregnancies that would lead them to have an abortion, or lead them to end up in a crisis pregnancy center.
GROSS: In discussing alternatives to abortion, does the state allow the crisis pregnancy centers to discuss birth control with women who, after they deliver the baby, they can - if they so choose - not get pregnant again in the near future, until they're ready?
JONES: The terms of the contract are pretty sparse. So no, the state does not require the crisis pregnancy centers to discuss family planning with their clients. And in fact, that many of the crisis pregnancy centers - but they choose to discuss it anyway, and many of the crisis pregnancy centers promote abstinence as the only form of birth control. And this has much to do with the sort of religious affiliation of many of these crisis pregnancy centers; where they believe that chastity is actually the only effective form of birth control. And in fact, there are a few crisis pregnancy centers who believe that abstinence is also the only form of birth control for women who are married.
So that's quite an extreme position to take. And anyone who is at a crisis pregnancy center is, by definition, sexually active. So for these centers to promote abstinence as the only way to prevent future pregnancies is very irresponsible, from a public health perspective; and very troubling that the state does not require these centers - that are receiving state funding - to actually give them scientifically valid information about preventing future pregnancies. And not only is this concerning for women in that they're not receiving the information they need about preventing future unwanted pregnancies, but it's also, they're not giving them information about preventing things like sexually transmitted infections.
Again, these centers, crisis pregnancy centers will talk about the dangers of sexually transmitted disease; but again, they'll say that the only way that they can prevent getting a sexually transmitted infection is to abstain from having sex. But in fact, for teens and women in their 20s and 30s, that's not a realistic choice for many people. And again, it's - you know, very worrying, from a public health perspective, that these centers are promoting this information and in fact, they are receiving state funding to do so whilst at the same time, the evidence-based centers that were providing women with medically accurate information about their health, are being de-funded.
GROSS: But Texas doesn't mandate that these crisis pregnancy centers have an abstinence-only approach.
JONES: No, not according to the contract that these centers have with the state. It's not mandated. But it's also - there's nothing included in there, that says that they should give them accurate advice, either....