Senators Revisit Efforts to Expand Women's Health

The Politics of Prevention

The Politics of Prevention is an occasional series on the effects of state policy on women's health services.

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With abortion rights advocates gathered nearby, the Senate Health and Human Services Committee met in the Capitol on Thursday to discuss Texas’ efforts to expand access to women’s health services across the state.

“I still see so much misleading data being circulated to Texas women,” said state Sen. Jane Nelson, R-Flower Mound, the chairwoman of the committee. “One of the things I’d like to do today is just set the record straight.”

Although cuts to family planning services in 2011 had a substantial impact on the availability of women’s health services, Nelson — who voted for that budget — said lawmakers have worked since then to increase funding and capacity to provide family planning and women’s health services statewide. She said that Texas set new records for the level of funding for women’s health services in the 2014-15 budget and that the state has greater provider capacity than ever before.

The Health and Human Services Commission’s funding for women’s health services in the 2014-2015 biennium increased to $240 million from $109 million in the previous biennium.

The increase comes after funding specifically for family planning was cut to $43.2 million from $111.2 million in the 2010-11 budget, with the bulk of that decrease resulting from the federal government’s decision not to renew a contract with the Department of State Health Services to distribute family planning grants. The budget cuts also came with a steep decline in family planning services. In 2011, service capacity for family planning totaled almost 203,000 clients. That number is projected to drop to 65,000 in 2015.

(When the federal government declined to renew the state contract, it instead awarded $13 million in Title X funds to the Women's Health and Family Planning Association of Texas, a consortium of statewide reproductive health providers including Planned Parenthood, to distribute over three years.)

The number of clients in the family planning program has declined, Nelson said, but some women are still receiving those services through other programs. 

Nelson cited the $100 million growth in the expanded primary health care program, which provides primary care such as wellness exams, cancer screening and diabetes and heart treatments. The Department of State Health Services projects that the program will serve 170,000 clients through fiscal year 2015. Nelson said at least 101,000 women who lost access to family planning because of previous budget cuts could access those services through the new program.

Evelyn Delgado, assistant commissioner of DSHS, said that the number would be closer to 102,000, and that they had contracted with 55 health care entities to provide services through the program. (Use this Tribune interactive to see the full list of providers, the amount of money awarded by region and the estimated number of women each provider intends to serve.)

As a result of the 2011 cuts to family planning services, 76 family planning clinics — a third of which were operated by Planned Parenthood — closed due to lost state and federal funds, according to the Texas Policy Evaluation Project, a three-year research initiative at the University of Texas at Austin.

Dr. Christine Sebastian, an obstetrician-gynecologist from Austin, told a crowd gathered outside the hearing that it would take the state years to rebuild provider infrastructure following the closure of those clinics. “The damage really has already been done,” she said. While lawmakers have added record levels of funding, she questioned how much the state has actually achieved.  

In addition to the family planning and expanded primary care program, Texas lawmakers financed a state-run version of the Texas Women's Health Program for $36 million a year in the 2014-15 budget. That move came after the Republican-led Legislature in 2011 ousted Planned Parenthood clinics from the Women’s Health Program, prompting the federal government to stop providing its $9-to-$1 match for the program in 2013. 

Amy Camp, a Planned Parenthood patient, told a crowd outside the Senate hearing that she she previously relied on the Women’s Health Program but now chooses to pay out of pocket for services and continue going to Planned Parenthood, rather than enroll in the Texas Women’s Health Program. She said she trusted the care she received from Planned Parenthood.

“However, there are many Texas women who have been left with no choice at all,” she said.

Camp was among a crowd of abortion rights advocates who gathered Thursday to protest strict abortion regulations lawmakers approved in the 2013 special session and the lingering effects of 2011 cuts to family planning services. The new regulations, which took effect in November, ban abortions after 20 weeks of gestation, and require that physicians follow FDA standards, rather than common evidence-based protocols, for administering drug-induced abortions. The regulations also require doctors providing abortions to obtain hospital-admitting privileges within 30 miles of the abortion facility. Abortion clinics will be required to meet the same standards as ambulatory surgical centers beginning in September. Five of the 22 remaining abortion facilities in Texas currently meet those standards.

“If you really want to reduce the number of abortions in this state, you don’t do it by limiting access,” state Sen. Leticia Van de Putte, D-San Antonio, told the crowd. “You do it by making it unnecessary in the first place.”

While she hopes the Legislature’s efforts to expand funding for women’s health services are successful, Van de Putte, a candidate for lieutenant governor, said the state’s decision to oust Planned Parenthood in 2011 from state programs continues to hurt the state’s provider network. State lawmakers, she said, could approve policies that would expand women’s reproductive choices.

For example, the state’s limited Medicaid program cuts off services for women two months after they give birth, she said.

She also touted a bill that she proposed to give teen mothers the ability to seek contraception and other reproductive health care on their own. It failed to pass the Senate. Van de Putte criticized her colleagues who did not support the bill because they believed parents should know whether their teenage children are having sex.

“Most parents know that if your daughter has a baby, she’s probably had sex,” Van de Putte said. 

This story was produced with the support of the Dennis A. Hunt Fund for Health Journalism, a program of the USC Annenberg School of Journalism's California Endowment for Health Journalism Fellowships, and in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.