To stop Planned Parenthood clinics from receiving public financing, Texas' Republican leaders gambled that the state could operate a contraception and cancer-screening program for low-income women without tens of millions of federal dollars.
But with the exclusion of about 40 Planned Parenthood clinics — none of which performed abortions — from the Texas Women's Health Program in 2013, records showed that claims for birth control and wellness exams dropped, as did enrollment numbers.
State health officials reintroduced the Medicaid Women's Health Program as the Texas Women's Health Program in January after the federal government discontinued its $9-to-$1 match for the program — a decision the Obama administration made when state lawmakers began enforcing rules they said made clinics even loosely affiliated with abortion providers ineligible to receive taxpayer dollars. (By law, none of the providers in the program performed abortions.)
The new state-financed program got off to a rocky start. In some parts of Texas, the state's health agency struggled to find providers to replace Planned Parenthood clinics, which provided 40 percent of Women's Health Program services in 2012.
"There can still be some pockets where we don't have a provider and we did before," said Dr. Kyle Janek, the Texas health commissioner. "Planned Parenthood may have been the only game in that area."
During the first six months of this year, there were 38 percent fewer reimbursement claims for birth control than there were during the first six months of 2012, according to a Texas Tribune analysis of data provided by the Texas Health and Human Services Commission. The number of wellness exams, meanwhile, decreased by 23 percent. Program enrollment figures have also declined to 110,900 in May from 127,000 in January 2012. Figures from May were the most recent available.
Cecile Richards, the president of the Planned Parenthood Federation of America, called the figures "troubling."
"Despite all the promises from state officials that women's health care needs would be met," she said, "it's clear they aren't."
But Dr. Janek argued that the claims numbers were misleading. He said birth control distributed by the program has not declined as much as initial claims data suggested, because the majority of providers that replaced Planned Parenthood clinics were physician groups that directed patients to pharmacies to fill prescriptions, rather than distributing the drugs themselves, as family planning clinics do. The program's pharmacy data for 2013 is not complete, and the state could not provide information on how many birth control prescriptions were filled.
"We think when you add all those up for birth control, both those delivered at the pharmacy and those given by the provider's office, we've got an increase, not a decrease," Dr. Janek said.
The Women's Health Program claims for long-acting, reversible birth control methods like intrauterine devices and hormonal implants, which must be inserted by the provider, declined by 17 percent in the same time period. Dr. Janek said that was the result of the state not paying providers enough to cover the procedure, something health officials have rectified by raising reimbursement rates for copper IUDs by $200 and hormonal implants by $75.
"We've changed that, so I expect the second six months and thereafter will tell a different story," he said.
Dr. Janek said that while he was happy with the state-run program's progress, he would not be satisfied "until we do better." The state is conducting targeted outreach to encourage more women to enroll; health officials said that when they sent mailers in October and November to women whose families were registered for other state programs, enrollment promptly increased by more than 9,000 women.
While Republican state leaders work to improve capacity in the state-run program, many family planning clinics have struggled. Seventy-six family planning clinics closed after the 2011 legislative session, when Republican lawmakers with Planned Parenthood in their cross hairs cut two-thirds of the state's family planning budget, set up a tiered system to shift remaining dollars away from reproductive health clinics, and ousted Planned Parenthood and other clinics from the Women's Health Program.
baaronson@texastribune.org
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