Planned Parenthood has been providing an estimated 44% of the services in the women’s health care program. Now that the state is establishing its own program, the question is, Who will provide these services? There are two basic problems: (1) How does the state recruit physicians into the program? Reimbursement rates haven’t improved. (2) How do patients know where to go for services? One possible answer to the latter question is FQHCs — Federally Qualified Health Centers. But the state cut funding to FQHCs last session, and the creation of new FQHCs has not kept pace with the demand. The existing facilities don’t have the capacity to pick up the slack, and they have staffing issues of their own. The state also pared back the residency training program that is the pipeline for new physicians who specialize in the services (not abortions) that used to be delivered by Planned Parenthood. Where will the state get the money to fund the program? That is probably the least of the concerns. Perry can find the money. The Women’s Health Program exists. It will change from a 90% Medicaid match program to a state-run program that foregoes federal dollars — all for the sake of politics. The state will also forfeit millions of dollars in federal family planning funds. The most likely outcome is that the 44% of the services that were being delivered by Planned Parenthood will have to be absorbed by emergency rooms. As most readers are well aware, this is the most expensive level of care, and the state will do what it has traditionally done in circumstances like this, which is push the burden down to the local level. County hospitals are going to have to eat the costs, with the result that local property taxes will rise in counties that have hospital districts. In other words, the shutting down of the federal program will result in a tax increase. It is not only the cost that is an issue. The obvious difference between Planned Parenthood and the emergency room, as a deliverer of services is that there is no continuity of care in the emergency room. The result could be an increase of acute episodes that are a significant cost driver in prenatal care. I asked Tom Banning, CEO of the Texas Academy of Family Physicians, for his view of the way forward: Here’s what he said: “As we transition from a federal-state partnership to a state-run program, perhaps the most significant challenge we will face is ensuring our delivery system has the capacity to care for the patients this program serves. Our physicians, federally qualified health centers and other access points to our health care system are already stretched thin, we must be diligent to make sure these patients get the care they need in a timely manner.” * * * * [A portion of this post has been removed to allow for new information that follows] Here are some additional concerns that women’s health advocates have about the as-yet undefined state program: 1. The biggest issue is, how is the women’s health program going to get providers? Family planning is not a lucrative practice. 2. Under the federal program, a broad selection of family planning options is available. Will the state allow these options to continue to be available, or will they get caught up in a political over which are acceptable and which are not? 3. The federal program has rules that guarantee confidentiality for women–for example, that their husband will not be notified. Will the state guarantee that confidentiality?