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Here’s What We Know So Far About the Texas Women’s Health Program

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It’s been four years since former Texas governor Rick Perry signed a budget that basically ended funding for clinics in Texas that are affiliated with abortions providers, specifically clinics like Planned Parenthood.

The organization, which had received federal funding under the Medicaid Women’s Health Program for roughly five years, was the state’s biggest women’s health care provider, accounting for 40 percent of the WHP’s family-planning services. But after a protracted battle, the state effectively shut off funding for any organizations linked to abortion providers, prompting the federal government to turn off its own spigot of money for the Medicaid Women’s Health Program. Turning down the $9-to-$1 federal match left Perry and the Lege responsible for filling a gap of nearly $40 million needed to keep low-income women from losing access to affordable health care.

The solution? Create the state-funded Texas Women’s Health Program, which was launched on January 1, 2013. In order to make sure this new program is functioning properly and doing its promised duty of serving women and saving money, the Texas Health and Human Services Commission is required to initiate a biennual report on its effects and progress. Last week the first report was released, and we now have some hard data on how the Texas WHP is working.

The introduction to the six-page report states that despite slashing the family-planning budget by two-thirds, “it is the full intent of the Legislature” to take corrective measures if the report finds a more than 10 percent reduction in women enrolled compared to 2011. The report found that roughly 188,000 Texas women were enrolled in the health program in 2013, compared to just over 200,000 in 2011, a 9.1 percent drop.

The decrease in enrollees isn’t shocking. It was long-ago predicted that the change in the program, when accompanied by the 2011 cuts to the state family-planning budget, would mean far fewer women in Texas would have access to health care. In her 2012 cover story for Texas Monthly, Mimi Swartz refers to the 2011 meeting of the Legislature as “the most aggressively anti-abortion and anti-contraception session in history.”

There are some surprising figures though. For example, every region in Texas saw a drop in the number of clients served (not enrolled, but actually served) by the WHP, except the Upper Rio Grande Valley, which saw an increase in clients served, from 3,804 in 2011 to 4,716 in 2013.

Amanda Stevenson, a graduate researcher with the Texas Policy Evaluation Project, attributes this anomolous uptick to a significant cut in family planning funding from the Department of State Health Services. The Rio Grande Valley it one of the most impoverished and highly uninsured regions in the country, and to make sure women in the area could continue being covered, providers looked elsewhere for funding. “Because clinics in the Rio Grande Valley were so hard hit by the DSHS family planning grant cuts in 2011, those ultra-dedicated providers turned to the Women’s Health Program to continue serving women,” Stevenson says.  “They are very serious about doing a good job about providing these services to the women that need them in their communities.”

Another illuminating takeaway from the report is data on contraception claims, broken down by method of birth control:

When comparing to Fiscal Year 2011 we can see that, the claims for injections and condoms went up as a percentage of the total and claims for oral contraceptives went down as a percentage of total claims. It is important to note that this shift does not just reflect a change in utilization over time, but a shift from less effective methods (e.g., oral contraceptives) to very effective methods of contraception (e.g., LARCs and injectables).

This wording is tricky and somewhat misleading. While the proportions of claims per method shifted between 2011 and 2013, the overall number of claims decreased across the board by more than 50 percent. About 191,000 contraceptive claims were made in 2011 under the old Women’s Health Program; 88,000 claims were filed under the new, Texas-modified, Planned Parenthood-devoid program in 2013.

The sharp drop in oral contraceptive claims really illustrates how the loss of Planned Parenthood clinics made an impact on the WHP. In 2011 claims for the pill accounted for 31 percent of all contraceptive claims under the Women’s Health Program. In 2013 that percentage dropped to 16.8, a rapid decline that doesn’t jibe with the fact that oral contraceptives are still the most widely used form of birth control in the country. It would seem the dip is simply a matter of access. “Planned Parenthood administers a lot of oral contraceptives, and when you exclude a provider that provides more of a certain kind of method, that method is going to decrease,” Stevenson says.

So when the report highlights the small but encouraging shift from oral contraceptives to things like injections and IUDs, it doesn’t necessarily mean claims made for the pill decreased because women were switching to different methods because they could no longer go to Planned Parenthood under their health program. One can presume that some women stopped using birth control altogether or continued going to Planned Parenthood without filing a claim.

Stevenson adds that while the proportion of claims for Long-Acting Reversible Contraceptionor LARC, which includes IUDs—increased among clients served by WHP, Texas women are still largely underserved when it comes to IUD access.

A study by Stevenson’s policy evaluation group surveyed 803 women postpartum in Austin and El Paso during 2012 and found that the expressed desire for LARC is greater than the ability to actually receive those methods of birth control, particularly among young, low-income, uninsured women. “We have found, through interviews with providers, that the availability of LARC in general at sources of care for publicly subsidized family planning in Texas has been going down,” Stevenson says.

The availability of those methods at publicly subsidized family planning clinics in Texas went down further after the 2013 introduction of WHP. To cope with the decreased state funding, clinics were forced to start limiting the types of birth control they offered—specifically options like IUDs, which carry high upfront costs. 

Another purpose of the report is to outline savings and expenditures. According to the report, the monthly caseload average of 115,400 women costs the state $31.67 million. But the savings is harder to pin down, in part because the “lag of nine months for the realization of the births.” The report, however, does publish the health commission’s estimations: 

The monthly caseload average in Fiscal Year 2013 of 115,440 women will represent a reduction of 8,359 births in Fiscal Year 2014. At an estimated cost of $11,193 per birth, HHSC estimates a total savings of $93.6 million for Medicaid. Of this total, $55.5 million are federal funds savings and $38.1 million in savings for the state. 

Subtract that cost from the savings, and the commission estimates that the state will net $6.4 million. 

But there’s still that gaping difference in the number of women enrolled in the two programs in 2011 and 2013. If those women are no longer being served and contraception claims are down across the board, could there be a substantial increase in publicly subsidized births? Stevenson predicts that that will be the case. When the final numbers are released, they will likely show a significant increase in Medicaid-funded birth costs compared to 2011. This prediction was also made back in 2011 by the Legislative Budget Board. They released a memo warning that reduction of family planning–related expenditures as proposed by legislation in HB 1 would lead to more than $200 million in Medicaid birth costs. The predicted cost to the state’s General Revenue fund, which now entirely funds the new Women’s Health Program, was more than $98 million.

Even though these numbers are only initial figures, they reveal a pretty significant decrease in the population served by the WHP. In response to these low numbers, the report says that the Texas Health and Human Services Commission “undertook corrective measures to expand client outreach,” including a “target[ed] mailing effort,” as required by the same piece of legislation that mandates they compile a biennual report. 

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  • yessir

    So the TX Lege’s hatred of Planned Parenthood is costing TX taypayers a lot of money and adding to the welfare rolls. Praise Jesus!

    • Madrigalian

      You should be ashamed.

  • Lucy Pine

    “…. would mean far fewer women in Texas would have access to health care.”

    1. Not true – We still have ACCESS to health care. I can’t imagine any one of the incredible, TOP TIER (considering what MANY in the rest of the world have) Emergency clinics in Texas turning away a woman (me) because I don’t have insurance – “medicaid” or am not enrolled in the Texas Women’s Health Program (or AM enrolled but it doesn’t cover “the pill”). If a Texas Woman has a true life or death (or emergency) health need, she’ll get it. And she’ll figure out how to pay for it later – because she’s awesome and can do it. That’s an incredible thing that many women in the world would literally die for … to not die.

    There are thousands of elderly women and sick children who (if I AM going to subsidize through taxes) – I’d much rather support by paying for their life threatening, crushingly expensive illnesses (or SAVE the money for when there’s a REAL need in our state) … than for a hundred thousand women to get “free” contraception/abortions because they don’t want babies, acne, or even the possibility of a baby (but want to have sex). I really am sorry about this – but how selfish. … And it is extremely condescending, and seems a very low expectation of Texas women.

    If you actually ASK women if they’d rather state funding go toward their getting “the pill” (or an abortion) for “free” OR … money go toward a woman who’s in daily agony because of an illness she has, who needs expensive medicine to help regulate her digestive organs … and a nurse to help administer the medicine when needed … Or a women who has ovarian cancer and would sure love some relief from the pain by having “free” medication to help her through …. I almost GUARANTEE a Texas Woman will say – Please Please … Help HER! SHE needs it MUCH more than I do. And if she doesn’t – I must admit, my belief is she’s being a selfish citizen holding all other caring citizens hostage to her selfishness.

    ANYWAY –
    I think what you’re meaning to say is that we won’t have “free” (to us/me) contraceptions or abortions specifically … Is that right? We still have INCREDIBLE coverage for all sorts of health “needs” – most beautifully – free emergency care (a HUGE and awesome GIFT).

    “About 191,000 contraceptive claims were made in 2011 under the old Women’s Health Program; 88,000 claims were filed under the new, Texas-modified, Planned Parenthood-devoid program in 2013.”

    Great! Of course there’s a drop. When I’m offered something “free”, I’ll often try it or take it. Take away the “free” (make me pay for it) and, “eh, I don’t really need it”. Texas found something that was excess in the budget and cut it. I told them I really don’t need it; others have greater emergency needs. Great. … I say cut as much funding as possible when it comes to contraception and giving birth (it’s beyond me why a hospital delivery – $11k roughly – is fully covered while a birthing center – $4k roughly – isn’t covered at all … IF taxes are going to pay for a delivery, at least give a woman the option to take the less expensive, organic approach). That’s IF state taxes are going to be paying for births in the first place. … It’s not an emergency by any means (have roughly 9 months to prepare for it), it’s not something that NEEDS to be in a hospital if all goes smoothly … most private, personal insurances don’t pay for giving birth. Again, women are pretty remarkable when you release them to be… I’d say go farther and don’t cover births unless an emergency does arise from it. In that case (an emergency during childbirth) – Absolutely – pay for everything to help keep baby and mother alive. EVERYTHING. … And bring flowers to them and cook and clean for them and call them to let them know they are loved and we’re rooting for them. … Who knows, we may just have the time and money to do that if we’ve saved enough from cutting out the superfluous.

    “In 2011 claims for the pill accounted for 31 percent of all contraceptive claims under the Women’s Health Program. In 2013 that percentage dropped to 16.8, a rapid decline that doesn’t jibe with the fact that oral contraceptives are still the most widely used form of birth control in the country.” …. “One can presume that some women stopped using birth control altogether or continued going to Planned Parenthood without filing a claim.” ….

    Again, GREAT – That would be the presumption. And that’s great. Stopped using because didn’t need. And didn’t need because 1: stopped having sex because don’t want to get pregnant. 2: stopped using as a way of controlling hormones so as to not get acne …it’s a byproduct of the intent for these drugs. Medicaid doesn’t pay for Stri-vectine, Proactive, or for men to try and keep their skin clear. There are other ways to prevent acne. I believe money could be used wiser. 3: stopped using because they are ready and DO want to get pregnant (great! and congratulations!) or 4: used other contraceptive options exclusively and was a little more careful about sex always having in mind the possibility of getting pregnant. OR … Great, they ARE able to pay for it themselves. Wonderful. Feels nice to be able to pay for something yourself. (eh – Who knows – maybe the producers of the pill will start charging less in order to get more women to buy it. just a thought).

    LASTLY, If the decline in use of “the pill” … use of Planned Parenthood means taxpayers paying more in the end for births – Well, 1: you think women are saying, “you’re not going to pay for my birth control and so I’m going to have a baby and make you pay for that… That’ll show you”…. ? Perhaps there IS that mentality. And if that IS the mentality, it’s an incredibly selfish woman who would be holding Texas hostage by “threatening” to give birth? I’m going to assume that most Texas women are kind and want to be responsible. I’ll find a way of being both those things .. and I’ll find it a lot more quickly and with more integrity without “free” being thrown at me right and left…..

    I guess to really be fair to women, I’d really rather not have my hospital birth paid for by medicaid. I’d say don’t pay for visits to Planned Parenthood, don’t pay for the pill, don’t pay for births. Again, Texas Women are remarkably strong – they can plan their own families. They can control themselves. They can plan for and pay for their own child. I’m not saying they may not need help – Absolutely. We need each other. … But I’d much rather feel “indebted” to my family, my friends, my colleagues in helping bring my baby into the world – than I would want to be indebted to “the state” … and I’ll definitely manage my finances when it comes to giving birth much better than the state can (a hospital is so expensive for giving birth and if there’s no emergency – I don’t need a hospital).

    Anyway, sorry lengthy : / Those are my thoughts. I don’t know exactly what you were getting at in this article. It didn’t seem to say much except that you don’t know if cutting Planned Parenthood funding is actually saving Texans money and that some women aren’t getting healthcare. Maybe we don’t know yet if these particular cuts are saving money in “longish run” (thinking even farther ahead as investments go…. those babies will grow up to be citizens, Texans … contributors hopefully to society) … There would be one way it definitely would save money though and that would be to cut funding for births. It’s not needed. And then, Texas Women have incredibly blessed lives- ALL walks of life and ALL women. We have access to world-class healthcare when we really NEED it.

  • Madrigalian

    The liberal progressive democrats running our federal government should be ashamed. Ashamed of themselves and this administration, using women’s health funds to extort the state of Texas to use tax payer money to fund abortions. Texas is doing the right thing, refusing to be blackmailed, standing up for states rights, listening to the people of the state and doing their level best to make up for the federal governments malfeasance in the mean time. It is particularly sad to hear how women are suffering because democrats want to force you (me and mine) to pay for other people’s abortions.

    • GladBreitbartsDead

      Yeeeeeee-hawwwwwwww!

    • gwaltluv

      Using taxpayer money to pay for abortions is against the law. PP doesn’t engage in that. You should be ashamed for taking away womens’ choice to think for themselves and make their own decisions about reproductive rights.