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NEWS women’S health continued from p.21 continued on p.24Sarah wheatp h o t o s b y j o h n a n d e r s o nGov. rick Perryan FQHC, was granted funds for 2012.Accord ing to DSHS, in FY 2012 CommUnityCarespent $262,801 to see just over 1,000clients. (One direct consequence of thesemassive statewide cuts is a spike in thenumber and public cost of unplanned pregnancies;because of the family planningcuts alone, the state is anticipating the birthof roughly an additional 23,000 Medic aidpaidbirths that would not have occurredhad the women had access to birth control.)Although some lawmakers insist thatprioritizing FQHCs is a better use of funds,that change has neither expanded servicesnor saved the state any money. Sen. RobertDeuell, R-Greenville (who is also a doctor),insists that the health centers provide amedical “home” for patients and thus arebetter equipped to handle the whole patient.Should a woman come in for birth control,for example, the FQHC must also provideother services like dental, without regard tocost. Yet the state’s 69 FQHCs are burstingwith patients, and they have more complicatedbilling procedures and costlier overheadthan, say, a family planning clinic. It’snot surprising that these entities see fewerclients in the family planning program, orthat they spend more money to do so.In 2012, FQHCs received roughly $3.2 millionand served 15,555 clients – fewer thandid Parkland, even with its slashed budget.“For 10 years on [the House Approp riationsCommittee] I’ve argued that we should notput this money into FQHCs,” says AustinRep. Dawnna Dukes. “This does not supportthe women in need.”In other words, while legislators accomplishedtheir goal of excluding PlannedParenthood from the subsidized family planningprogram, in that process, providersother than PP, and thousands of patients,have been hurt. Since the funding cuts, 13Texas PP clinics have closed (and possibly a14th in San Antonio), leaving 63 in operationacross the state. But because of the fundingcuts, a greater number of non-PP providershave either closed their doors or reducedtheir hours and the number of clients theyserve. In all, as of this past fall, 54 providershad shut their doors – including 28 publicand private comprehensive health providersand 13 non-PP specialty family planningclinics. (According to testimony last week byUT-Austin sociology Professor Joseph Potter,another six clinics have since closed, bringingthe total to 60.) Another nine comprehensivehealth providers had to reduce theirhours of service, as did 29 family-planningclinics, according to research published inthe New England Journal of Medicine, partof a three-year study on the effects of cuts towomen’s health programs in Texas undertakenby researchers at UT’s PopulationResearch Center.The slashed family planning budget providedcare for just 75,160 clients in 2012,down 63% from the number served in 2011.In all, more than 127,000 people lost accessto health care last year. Unless somethingradical happens this year, the number ofwomen going without care is likely to persistor increase over the coming biennium,due at least in part to the demise of theMed icaid-funded Women’s Health Program.(The draft House budget adds roughly $8million back into the family planning budgetfor the next biennium. Whether thatmoney will remain, or even help, remains tobe seen.)Fantasy Health CareFor the overwhelmingly Republican legislativemajority, cutting the family planningbudget simply wasn’t enough. Toensure complete defunding of Planned Parenthood,a group of lawmakers, promptedby Deuell, insisted that the PP clinicsshould also be cut off from seeing patientsunder the Women’s Health Program, aMedicaid-waiver program that providedlow-income and uninsured women withaccess to family planning and basic healthservices. The feds provided $9 for every dollarspent by Texas. WHP rules had longincluded a prohibition on using abortionproviders, but that clause had never beforebeen used as a wedge to force out PP clinicsthat do not provide abortions.Under federal law, women have the rightto see the qualified provider of their choice,and former Health and Human ServicesCommissioner Albert Hawkins knew that tointerpret WHP rules otherwise would jeopardizethe federal funding. According to a2012 report on the program, in calendaryear 2010 the state spent just $3.6 millionon the program, and saved more than $54“We are on track to be one of these states where people justroll their eyes because what we’re doing makes no sense.”– Planned Parenthood of Greater Texas’ Sarah Wheatmillion in general revenue expenditureswhile averting an expected 8,215 unplannedMedicaid-paid births. In 2012 alone, PlannedParenthood saw more than 40,000 WHP clients,and the provider has historicallyserved 40-50% of all WHP clients.But in 2010, Deuell asked Attorney GeneralGreg Abbott if PP could be excluded as an“abortion affiliate” – and Abbott agreed that itcould. State officials spent more than a yearcrafting language to do just that – and thesame amount of time defending their right todo so in federal and state courts. Thus far, thecourts have agreed that it is unlikely that PPcan be excluded from a Medicaid-fundedWHP, and that the state can’t draw federalMedicaid dollars while discriminating amongMedicaid providers. As a consequence, thestate has opted to let the federal funding end,and to install a newly branded Texas Women’sHealth Program that is exclusively statemanagedand funded – enabling the state todetermine which providers women may see ifthey wish to continue receiving subsidizedcare. For the women this program is meant toserve – those between 18 and 44, uninsured,and at 185% of the federal poverty level, yettoo flush to receive traditional Medicaid unlesspregnant – this is really no choice at all.That is what Marcela Balquinta saysabout the state’s new program. Balquintalives in McAllen, where she works parttimeas a sexual violence prevention educationcoordinator. She has joined a lawsuitfiled in state court last month by PlannedPar ent hood that challenges the state’sexclusion of PP, where Balquinta has beenreceiving WHP services for four years. Thesuit argues that the exclusion conflicts withstate laws that, like federal law, prohibitdiscrimination among providers. The suitalso challenges a poison-pill provision inthe rules that would kill the program altogethershould PP prevail in court – a provisionadded by state health departmentofficials without the consent of state lawmakerswho last session rejected such adrastic measure. (See “Texas vs. PlannedParenthood,” below.)Should the state prevail and PP be barredfrom participation, it appears that there willsimply not be enough providers to absorbthe more than 40,000 women left withoutaccess to their provider of choice – let alonetake on additional clients should the programcontinue to grow. In 2007, 91,683women were enrolled; by 2011, that numberhad grown to 205,354. Not all of the womenwho could seek service actually do so in agiven year; in 2012, the number whoreceived services declined slightly – from106,093 in FY 2011 to 103,668 in FY 2012.The decline, argues Fran Hagerty, CEO ofthe Women’s Health and Family PlanningAssociation of Texas, is due directly to thefact that the WHP was designed to takeadvantage of the state’s previously robustnetwork of family planning providers; aftershredding the family planning budget andwith it the provider base, there is simply noway any program can pick up the slack, letalone increase services. “It’s supposed towork hand in hand,” she says. “You can’thave one without the other.”The state continues to insist that theTWHP can succeed without Planned Parenthood.On Jan. 7, it ratcheted up that optimismanother notch with the release of areport by the Health and Human Services22 T H E A U S T I N C H R O N I C L E JANUARY 18, 2013 a u s t i n c h r o n i c l e . c o m