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“Collateral damage”

How’s that war on women going?

In the year since deep cuts to family planning funding took effect, the impact has become apparent. An Observer review of state records has found that 146 clinics have lost state funds, clumped mainly in the Panhandle, Central Texas and on the border with Mexico. More than 60 of those clinics have closed their doors forever. The number of organizations that help poor women plan pregnancy has shrunk by almost half. As in San Saba, low-income women in many areas of Texas now face a long drive, or worse, lack of access to birth control and health screenings.

This isn’t news to conservative state lawmakers. After all, in its 2011 session, the Texas Legislature cut the state’s family planning program by two-thirds. Public health experts warned lawmakers at the time that by defunding Texas’s family planning system, clinics would close and a spike in disease, pregnancies and abortions would follow. Regardless, they slashed the budget. Lawmakers were quite clear about their motivation: They hoped to drive abortion providers out of business. Their specific target—Planned Parenthood—also provides family planning and preventive health care to low income women. In their zeal to attack Planned Parenthood, politicians designed a funding formula that caused collateral damage. They defunded many other family planning clinics that aren’t connected to Planned Parenthood and don’t offer any abortion services.

In fact, of the more than 60 clinics that have closed across Texas, only 12 were run by Planned Parenthood. Dozens of other clinics unconnected to Planned Parenthood nonetheless lost state funds and have closed, leaving low-income women in large areas of the state without access to contraception.

It gets worse. The federally qualified health centers—which lawmakers said could provide family planning services to low-income women and make up for the cuts—have themselves experienced a funding crunch and are struggling to absorb demand. The result is that costs have shifted to patients, and exceptionally poor women now make hard choices about paying for their well-woman care. Some will find the cash, but an alarming number won’t. Indeed, the bipartisan Legislative Budget Board estimated that last year’s cuts would lead to more than 250,000 women losing services and 20,000 additional births covered by Medicaid. When The Texas Observer asked providers what they thought about the cuts, several mentioned the same phrase. They said in hoping to punish Planned Parenthood, politicians had gone too far, with devastating consequences for women’s health. Lawmakers, they said, had thrown the “baby out with the bath water.” In this story, the first in an occasional series, we examine what happened to the family planning providers who have fallen from favor.

The simplest answer to this is that this isn’t a problem to the legislators who committed this assault on Planned Parenthood. If this were only about stopping abortion, then the news that many clinics that are unaffiliated with Planned Parenthood and which do not offer abortion services have been driven out of business would be a cause for concern. If there’s been any remorse about these developments, or any desire to correct them, I sure haven’t heard about it.

You would think that these providers that the state has managed to kill would have been good replacements for Planned Parenthood to deliver Women’s Health Program services. The state continues to demonstrate that it has no idea how to replace Planned Parenthood in it reckless and misguided zeal, but it is willing to lie about its plans.

In a May letter to the governor’s office and the Legislative Budget Board, outgoing HHSC Commissioner Tom Suehs offered a funding mechanism for the program that included implementing cost-saving measures throughout the agency, a hiring freeze and enhancing efforts to recover funds from Medicaid fraud.

But opponents of efforts to oust Planned Parenthood from the program say the state was banking on paying for much of it another way — with the federal health reform Republican state leaders so revile. They point to legal filings and fiscal notes state officials prepared in July indicating they could fold Women’s Health Program clients into Medicaid starting in 2014, the year the Affordable Care Act calls for a widespread expansion of the safety net health care program. The U.S. Supreme Court has ruled that the Medicaid expansion is optional, and Perry has vowed that Texas will not do it.


Planned Parenthood is awaiting an October hearing in district court over whether its clinics can stay in the Women’s Health Program. A separate case is moving through the U.S. Court of Appeals for the Fifth Circuit. In March, Republican Texas Attorney General Greg Abbott sued the U.S. Department of Health and Human Services for pulling back funding over Texas’ decision to eject clinics affiliated with abortion providers from the program.

On Thursday, state Rep. Jessica Farrar, D-Houston, wrote a sharply worded letter to Abbott after learning his office had submitted a July 9 briefing to the appeals court that twice referenced the state’s intent to move WHP clients into Medicaid after the expansion of the program takes effect in 2014. She pointed out that was the same day Perry notified federal authorities that Texas would not extend the program. Farrar requested that Abbott “correct or withdraw” those statements.

State Rep. John Zerwas, an anesthesiologist and Simonton Republican, said the state is caught in a difficult situation because Planned Parenthood is “a very cost-effective provider.” However, he said lawmakers were willing to walk away from federal funds to make a bigger point: They are against abortion and any organization that may refer women for the procedure.

“We have to look at who’s elected to the Legislature and their philosophies and beliefs, and we have to be respectful of those,” he said.

Being respectful of the women who are directly affected by these political games is at best a secondary concern. You can read Rep. Farrar’s letter here. These problems are entirely of the Republicans’ making. They had no thought for the consequences when they did what they did, and they have no idea how to get out of the situation they’ve put themselves and everyone else in. TM Daily Post has more.

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  1. […] which is where it was lost in the first place. At this point, either all of the predictions about how badly access to health care will be affected by cutting out Planned Parenthood will come true, or the […]

  2. […] more, so go read it and when you’re done go back and read the earlier story about the devastating effect of the family planning cuts on Texas health providers. This […]

  3. […] funding for the WHP after it was decimated in 2011, but the damage has already been done. Some sixty clinics closed their doors statewide after the 2011 budget cuts. and the number of clinics funded by the Texas Department of […]

  4. […] here for some background. As I said before, even if a sufficient number of new clinics eventually opens […]