October 23, 2018; Color Lines
Seven years ago, the Texas state legislature passed enormous budget cuts to women’s health in a concerted effort to defund Planned Parenthood. Shortly thereafter, legislation passed saying that no provider of abortion services could participate in its Healthy Texas Women network, the state Medicaid program. While there is little argument that the intention of the budget cuts was to defund Planned Parenthood, in reality, the legislation caused 25 percent of the state’s overall family planning clinics to close, not just Planned Parenthood clinics. Those that remained open struggled to stay afloat, being forced to reduce office hours or charge patients, essentially cutting off access to care for women.
Moreover, the legislation effectively blocked Planned Parenthood from participating in the state Medicaid network, which provided women’s health services for 40 percent of the state Medicaid network’s patients. Currently, less than half of the Planned Parenthood clinics that existed in 2011 remain today.
These sweeping changes alone were enough to cause devastation to women’s health efforts in Texas. In fact, Texas was used as a cautionary tale of what would happen if the federal government defunded Planned Parenthood. Now, a new report out of the Texas Observer indicates an alarming lack of access and oversight in the state. According to the Observer, “Almost half of the approximately 5400 providers in Healthy Texas Women didn’t see a single patient in the program in fiscal year 2017, according to data from the Texas Health and Human Services Commission (HHSC). Of the 2900 providers that did see patients, more than 700 saw just a single person. Only about 1500 saw more than five patients. Of the 27 providers that served 1000 or more, 11 were labs, which don’t actually see patients and advocates say skew the data.”
While the number of providers in the network has increased, it is merely a vanity metric. The number patients served in the network actually decreased. The Observer says, “Though the number of providers increased from just over 1300 in the predecessor program in 2011 to about 5400 in Healthy Texas Women in 2017, the average number of patients seen by each dropped from 150 to 85 during that time, as the state replaced large providers with small ones.” It should be noted that Planned Parenthood was a provider in the predecessor network, serving more than 40,000 patients each year in the state program.
Perhaps the most frustrating aspect of this situation is that the data seems purposefully shrouded in mystery. For instance, HHSC changed how patients are counted, making it difficult to accurately compare the number of patients served before and after Planned Parenthood was defunded. Without accurate data, advocates face an incredibly steep uphill battle to effect change. Meanwhile, over a million women who need access to these family planning services cannot obtain them.—Sheela Nimishakavi