Two of the Legislature's top public health leaders are defending Republican lawmakers’ pledge to end the entire Women's Health Program rather than allow Planned Parenthood to participate. The joint state-federal reproductive health program provides contraception and cancer screenings — but not abortions — to 130,000 poor Texans, many of them at Planned Parenthood clinics.
"I guess we all need to see what it looks like when we don’t have it, and then we may need to regroup at that point," said state Rep. Lois Kolkhorst, R-Brenham, the chairwoman of the House Public Health Committee. "If we lose the Women’s Health Program, obviously, it’s got to be the top of our list in 2013 to look at and open up the conversation again and move forward because it is a safety net for so many women."
In Austin Monday for an interim hearing on federal health reform, Kolkhorst told The Texas Tribune she believes there is still time for the state to negotiate a deal to extend the program, but that it would require the Centers for Medicare and Medicaid Services to back down and let the state have the "flexibility" to exclude Planned Parenthood. The Obama administration is unlikely to do so. Federal officials have repeatedly said Texas' effort to ban Planned Parenthood because some of its clinics perform abortions — none with government funding — violates the Social Security Act, and is against the law.
Kolkhorst's counterpart in the Senate, Jane Nelson, R-Flower Mound, blames the federal government for the anticipated demise of the program, which she praised for providing "critical preventive health services."
"If these services are interrupted, it will have a devastating impact on the health of Texas women — and the blame will lie squarely on the shoulders of the federal government, which has no authority to dictate which Texas providers can participate in our Medicaid program," Nelson said in a statement.
The Women’s Health Program — a Medicaid waiver first passed by the Legislature in 2001, vetoed by Gov. Rick Perry, and revived in 2005 — receives $9 from the federal government for every dollar the state invests. State Rep. Garnet Coleman, D-Houston, the author of the vetoed 2001 bill, believes the Obama administration worked “in good faith” to come to an agreement, but that Republican abortion opponents were unswayed by warnings that slashing family planning funding would lead to more unintended births, and rising costs. Medicaid already funds half of all deliveries in Texas.
“This rule essentially ends the Women's Health Program and jeopardizes the well-being of low-income women in this state by limiting their access to quality health care,” Coleman said in a statement, echoing the federal government’s concerns in a December letter to the state.
State Rep. Jessica Farrar, D-Houston, said Monday that she hopes the state reverses course.
“Cutting the Women's Health Program is morally wrong because Texas women will now face unnecessary disease and life-threatening conditions," she wrote in an email. "The decision came as a result of the retaliation against the federal government and the attempt to shut down Planned Parenthood by Texas Republican lawmakers."
Kolkhorst said she is among many Republicans who view any funding to Planned Parenthood as "collateralization" for its abortion services.
"I think the Legislature spoke pretty loudly and clearly on this issue," she said. "If you don’t like that legislative direction, we meet every two years to look at the policies and the statutes we put in place and the direction we’ve given to agencies."
For some GOP lawmakers, the issue gets deeply personal, and the line between party loyalty, allegiance to anti-abortion politics and public health is a tough balancing act. State Rep. Sarah Davis, a first-term Republican lawmaker from Houston, said she survived breast cancer because it was detected early.
“It pains me to think that there’d be another 32-year-old diagnosed with breast cancer and not be able to get screened or treated until stage 4, whereas I was treated at stage 1 and had a much better outcome,” she said.
Though she supported the Women’s Health Program during the session, Davis was visibly reluctant to discuss whether she would prefer to keep Planned Parenthood and its preventive services in the program in order to keep it going. The state estimates that 44 percent of Women's Health Program clients go to Planned Parenthood clinics for their well-woman exams, birth control and STD screenings.
“It’s a very tough one,” she said. “I think it’s a shame. We’re losing $40 million, and that’s our tax money we paid that we’re not getting back. And it’s going somewhere else outside of Texas.”
While Nelson promotes the Women’s Health Program’s effectiveness, she framed the current stalemate as an example of “yet another intrusion into state's rights, and I am disappointed that the (Obama) administration would jeopardize women's health to score political points with the extreme left.”
As of Tuesday, Health and Human Services Commission spokeswoman Stephanie Goodman said the agency had not received any official response from the federal government on the state's rule banning Planned Parenthood from the program. It takes effect March 14 — and a verdict from the U.S. Department of Health and Human Services is expected any day.
"We are hopeful that CMS will grant another extension of the program while we continue to work through our disagreement over provider qualifications," Goodman wrote in a prepared statement.
Meanwhile, HHSC's website is advertising for "new WHP providers" to sign up and get certified — presumably to serve the women previously treated by Planned Parenthood. The announcement encourages physicians, nurses and clinics to apply to become beneficiaries if they are enrolled in Medicaid and "do not perform elective abortions."