Thursday, April 28, 2011

Family planning in Texas drama summary

In addition to the big fights everyone knew were coming this legislative session (over the budget, over redistricting), there have been numerous other smaller, but significant, battles. One of those has been over family planning.

Texas provides family planning services (which generally include cancer screenings, sexually transmitted disease tests, vasectomies for men and prescription contraception for women) through the Medicaid program and the Department of State Health Services (DSHS) and, both of whose services could be completely abolished or severely curtailed this session.

On the Medicaid family planning side, the state has the Women's Health Program. This program is a Medicaid waiver, meaning the state waives some Medicaid eligibility requirements in order to provide family planning services to clients who, if they were pregnant, would be on full Medicaid. In order to encourage the states to do this sort of thing, the federal government pays 90% of the costs of these services. In contrast, the federal government only pays for about 40% of regular Medicaid services for Texas, including pregnancy services (which average about $16,000 per pregnancy).

Quite a few states have these family planning waivers, and in all of them (Texas included) they've proven to save both the state and federal governments money. The Texas program needs to be renewed in state law this year, though, and that renewal has gotten hung up on whether the state would exclude Planned Parenthood from participating as a provider.

Planned Parenthoods only account for a small percentage of all Medicaid providers, but they see a large proportion of the Women's Health Program clients. Both federal and state laws prevent any clinic or affiliate that does abortions from receiving any tax money. In spite of this, activists and members who all know better have stoked a concern that the Women's Health Program is a stealth form of funding for "the abortion industry."

The Health and Human Services Commission, which runs Medicaid for the state, has estimated that letting the program expire will add about $88 million (in state money) to the cost of Medicaid over the next two years. In addition, the Legislative Budget Board estimated that expanding eligibility to include about 100,000 new adult women who don't qualify for the program, but would qualify for full Medicaid if they were pregnant, would save the state an extra $5 million over the next two years. These are women who, by the spirit of the law, should be in the program but, by the letter of it, are excluded.

Several members, both Democrats and Republicans, introduced or were joint authors on bills to at least renew the program. Several of these bills also included provisions to increase participation and/or expand program eligibility to further realize savings. None of these bills have been voted out of a committee in either chamber.

The Senate Health and Human Services Committee created a special subcommittee to draft a bill that would find the "common ground" between those who want to save the program, and those who express concern that it's secretly funding abortions. This week, that subcommittee voted to send a bill to the full committee that would extend the program (though make no other changes to it) but exclude all Planned Parenthood clinics from participating. The bill also has a provision that would cancel the Women's Health Program completely if Planned Parenthood (or anyone else, for that matter) sues the state over that exclusion. The committee is scheduled to vote on that bill next week.

House committees have considered a number of bills on the Women's Health Program, but so far haven't voted on any of them.

Family planning services via the Department of State Health Services (DSHS) are paid for by a small amount of state funds but mainly by one of three sources of federal funding, known as Title V, Title X, and Title XX.

Title X funds, which all come from the federal government, are strictly for family planning services. Money from Titles V and XX, though also mostly federal, can be used on a range of services; there's no requirement that any of it be spent on family planning.

When the budget bill was introduced in the House, the combined funding for family planning services through DSHS for the next two years was about $67 million (and approximately $99 if you include the Tittle X funds that they state doesn't have any discretion over). Before passing the bill out of the House, though, Republicans passed a series of amendments that transferred almost all Title V and Title XX money out of family planning services and into other programs and services. Total family planning spending was reduced about $62 million dollars.

So far, the Senate, where Republicans and Democrats are having much more trouble than in the House agreeing on a budget, has not made the same cuts. Presuming its budget preserves all or most of the introduced funding levels, the $62 million difference between the House and Senate budget bills will somehow have to be resolved by the Conference Committee.

If you assume that it costs about the same to provide family planning services to a client in the DSHS program as it does Medicaid (about $240 a client a year) then the $62 million cut from the House version of the bill would mean about 258,000 fewer low-income people in Texas would get family planning services.

If you analyze this the same way the state's Health and Human Services Commission evaluates the success of the Women's Health Program then, without those preventive services, the birth rate among those 258,000 people (presuming they're mostly women) would add approximately $120 million in state Medicaid costs over the new two to three years.*

*Presuming these pregnancies are all covered by the regular Medicaid program and not Emergency Medicaid, which pays for births in indigent, non-citizen populations. These costs might be slightly less on average, but this population may have a slightly higher birthrate.


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