Planned Parenthood will be staying in the Texas Women’s Health Program at least until the end of the year despite promises by Governor Rick Perry that they would be excluded as of November 1. CBS news reports:
“Health and Human Service Commissioner Kyle Janek said the program will not begin operating immediately and may not take effect until the end of the year since Texas expects federal funding to continue at least until Dec. 31.”
In an election year when partisanship and finger-pointing may be at an all-time high, Texas has been as visible as any state in the country. The state which produced the last president (George W. Bush) and his successor in the Governor’s mansion who also became a presidential candidate (Rick Perry), also showcases the already contentious issue of health care, providing conflict part and parcel of the nationwide debate.
With the passage of the he Patient Protection and Affordable Care Act (PPACA) commonly referred to as Obamacare and accusations of a GOP “War on Women,” the entire country has been divided up largely upon party lines and leave it to Texas to prominenty display an example of the wrestling match.
When hyperbole has become the new normal it has often become hard to distinguish what is legitimate from what is an exaggeration, Democrats and Republicans accuse each other of crimes so heinous one can only wonder why anyone would ever get into politics and the battle over the Texas WHS and Medicaid funding for Planned Parenthood has been a notable example.
State representative Donna Howard (D-Austin) sent a postcard to voters in her district stating “At Rick Perry’s urging, extremists in the Legislature denied critically needed health care to thousands of Texas women.”
Howard’s words conjure up imagery of sick women in desperate need of medical attention encountering blockades in front of a hospital. They echo months of sound bites and memes from liberals and Democrats all over Texas and beyond, who blame Perry and the Texas GOP for literally doing effectively that. Republicans of course have a different version and as with so many issues today, the truth lies beyond the partisan accusations. The battle not only showed up on the national stage and in other states but also represents the beginnings of a possible national showdown if Mitt Romney is elected president, as he himself pledged to end federal funding for Planned Parenthood.
As with the vast majority of controversial women’s health care issues this is another story which centers on abortion. Planned Parenthood is the nation’s largest abortion provider and derives approximately 15% of its revenue from abortions. However, abortions constitute only 3% of the services provided. So there seems to be a great deal that PP does which is of great benefit and is not controversial. While critics have argued those numbers, according to PP’s own website they operate nearly eight hundred health centers providing:
- services to 76 percent of their clients for the prevention of unintended pregnancy which results in avoiding more than 584,000 unintended pregnancies each year
- nearly 770,000 Pap tests and nearly750, 000 breast exams each year, critical services in detecting cancer.
more than four million tests and treatments for sexually transmitted infections, including HIV
- educational programs to more than1.1 million young people and adults each year.
More problematic for some Americans such as observant Catholics would be providing birth control although the majority of Catholics do not seem to object to the use of birth control by others and clearly there is a difference between birth control and abortion. What a larger percentage of taxpayers object to other than abortion itself is Planned Parenthood’s legislative role. By their own admission “Planned Parenthood has more than six million activists, supporters, and donors working for women’s health and safety and our fundamental reproductive rights.”
Essentially, as with public employee unions, conservatives object to their taxes being used to fund support for the Democratic Party and issues they do not believe in. And of course, while a few don’t wish to allow abortions at all, most do not wish to allow abortions without exception and 70% of Americans, pro-life or pro-choice, do not wish to not have them occurring at taxpayer expense and for pregnant women, Planned Parenthood’s service are overwhelmingly abortion in contrast to providing pregnant women with services such as prenatal care or adoption referrals.
The WHP is part of the state’s administration of Medicaid. On March 14, 2012 the Texas Legislature passed a law restricting funds to organizations linked to elective abortion providers stating that WHP providers “must certify that they do not perform or affiliate with an entity that performs or promotes elective abortions.” The rule was enacted despite the fact that fact that federal and state money are ostensibly already prohibited from being used for abortion.
It came as no great surprise when Texas decided to deny funding to Planned Parenthood a controversy ensued. The Obama administration countered that Texas’ plan to exclude Planned Parenthood from the program violates a federal law that lets Medicaid patients choose their own providers.
The Chapman University School of Law seemed to echo Howard’s sentiment, reporting
“By withholding funding from organizations like Planned Parenthood that provide other services such as cancer screening, birth control, and gynecological exams, Texas is preventing women from obtaining necessary preventative services.“
Cindy Mann, director of the federal Center for Medicaid and CHIP Services told the Texas Tribune that under federal law, Medicaid beneficiaries must be able to choose their own providers. “Neither the federal government nor the state government is permitted to stop people from getting services from their trusted source of care.”
It seems implicit that a patient cannot use Medicaid to pay for services at a provider that does not accept it any more than another individual can use his/her insurance for up-front payment at an out-of-network provider, but perhaps more to the point, the Sexual Education and Information Council states the administration denied the Texas’ request for a waiver “because it violates federal rules, including those in the Social Security Act, which prohibit Medicaid programs from excluding particular providers.”
Rick Perry’s official position is that it is in fact federal law which dictates the state can determine who can accept Medicaid. The governor’s website reads:
“Under federal law, state leaders are left to administer the program and set criteria for who is considered a qualified provider. Consistent with state and federal law, the Texas Health and Human Services Commission has developed the program to ensure continued access to care by qualified providers across Texas.
The Obama Administration, however, has rejected the state’s waiver application because Texas law excludes abortion providers and their affiliates, like Planned Parenthood, from a list of qualified providers. This is despite the fact Planned Parenthood represents less than 2 percent of enrolled providers statewide.”
Despite the prospect of losing the 90% of the $40 million the federal government provides, Governor Perry has indicated the state will continue providing the services WHP provided, until Congress or the courts reverse the decision. Perry’s website goes on to say:
“Under federal law, states administer Medicaid and have the right to set the criteria for “qualified providers” in the program. Texas law prohibits tax dollars from funding abortion providers and their affiliates and has since the program’s inception. Texas law prohibits tax cheats, deadbeat parents or people suspected of serious abuse from participating as a provider in Medicaid, even though federal law does not.”
The governor’s office continues:
- There are more than 2,500 qualified providers in the WHP.
- Planned Parenthood represents less than two percent of providers in the WHP.
- Planned Parenthood’s cost per client is 43 percent higher than most other providers, according to the Texas Health and Human Services Commission.
- In FY 2010, nearly 80 percent of women served received WHP services from non Planned Parenthood providers.”
Which unfortunately also means 20% of these women only went to PP.
Does Planned Parenthood have some sort of special allure for the Obama administration? They obviously don’t send money to the other side of the aisle.
Kellie Fiedorek of Americans United for Life, a pro-life advocacy group, commented in July 2012 on how the Obama administration continues to fund Planned Parenthood despite rules against funding abortion and despite the growing federal debt.
In comments made via Fox News, Fiedorek highlighted several instances when the administration supported Planned Parenthood with generous grants including a $3.1 million in federal funds to Planned Parenthood affiliates in New Jersey as well as other situations similar to Texas:
“Last summer the Obama administration threatened to pull $4.3 billion in Medicaid funding from Indiana after the state’s legislature voted to prohibit all health care contracts with and grants to any “entity,” including Planned Parenthood, that performs abortions or operates a facility where abortions are performed.”
But the administration appears to have gone much further:
“Just months later, the Obama administration flagrantly disregarded New Hampshire’s decision to cancel a $1.8 million contract with Planned Parenthood in favor of contracting with health care facilities that offer women full-service care. Ignoring the will of the residents of New Hampshire, the administration directly awarded a $1 million contract to Planned Parenthood of Northern New England.”
Fiedorek cites instances where the administration has circumvented state decisions to discontinue funding for Planned Parenthood even when the states opt to go with other providers of more comprehensive care.
“The Obama administration contracted directly with Planned Parenthood in Tennessee after state officials stopped taxpayer funds from going to organizations that provide abortions. And just last week, the Obama administration overrode North Carolina’s decision to redirect funds away from Planned Parenthood, and directly awarded $426,000 in federal grants to Planned Parenthood affiliates in the state.”
Planned Parenthood is certainly represented as being a sole source of health care for women in some communities and if that is true, defunding it without sufficient alternatives does provide a logistical problem for many women.
CEO Cecile Richards has stated that Indiana’s law denying funding to abortion providers would prohibit “nearly 10,000 women from accessing preventive health care.”
But Fiedorek says the statistics prove otherwise:
“According to their own statistics, Planned Parenthood clinics in Indiana serve less than 1 percent of the state’s Medicaid patients, while providing more than 50 percent of the state’s abortions. Clearly, the overwhelming majority of Indiana women receiving Medicaid were getting their basic health care elsewhere.”
Many are likely receiving care at community health centers which, according to the National Association of Community Health Centers (NACHC), provide comprehensive medical care.
But Texas is not Indiana. It’s a much larger state geographically with numerous rural and remote areas and apparently struggles with adequate levels health care for everyone.
The Vindicator, a small newspaper published in South Liberty County near Houston writes:
“Texas already faces a dismal health care record with some of the highest rates of sexually transmitted infections in the United States and a large number—34 percent statewide and 66 percent in rural areas—of uninsured women of childbearing age as well as the third-lowest ranking in the country for primary care physicians per 100,000 residents.”
It seems clear that Perry and Texas legislators believe that other clinics are available and ready to provide a wider range of services than Planned Parenthood at a lower cost and without the possibility of comingling the funds with abortion.
However, Andrea Grimes of Reproductive Health Reality Check investigated and found the available providers lacking:
“I searched for WHP providers within thirty miles of the zip code 78702, which contains a busy Austin Planned Parenthood clinic that would not be able to see WHP patients if the new rules are adopted and enforced. That search returned 181 results. Does that mean it returned 181 gynecologists ready to see Medicaid patients? Not at all.
Nearly six hours of those kinds of conversations later, I found 13 clinics or doctors that take the Medicaid Women’s Health Program. Not 181.
Excluding Planned Parenthood from the Women’s Health Program absolutely reduces access to quality care.”
Essentially, Perry and Republican legislators are stuck between a rock and a hard place but they join the Democrats in playing political football with women and the Texas taxpayer: women, because their access to care truly would be limited in some instances and the Texas taxpayer because Perry has promised to keep the WHS program funded using only state funds. The Texas economy has held up better than most of the country but $40 million is still a lot of money and even if the state foots the bill, without more clinics available, it will clearly be more difficult for many women to access reproductive health care.
But if they truly are at times the only viable option, is cutting Planned Parenthood such a bad idea? Is the pro-life community overly critical of Planned Parenthood, especially when they do provide important services for so many women?
Oddly, a number of ardent supporters of Planned Parenthood seem to also be critical of a healthcare industry that is in any way driven by the profit motive. It wasn’t so long ago that former Defense Secretary and Vice President Dick Cheney was accused of being the poster child for crony capitalism, allegedly leading us into war for a payday from oilfield services giant Halliburton. It is certainly a possibility whether any endeavor, from war to green energy to healthcare to something ostensibly “for the children,” can have an agenda that is not necessarily in the public’s best interest.
Abby Johnson worked at Planned Parenthood’s Bryan, Texas, and clinic for eight years and was clinic director for more than two. Her book, Unplanned: The Dramatic True Story of a Former Planned Parenthood Leader’s Eye-Opening Journey across the Life Line“ Is a scathing and detailed critique of PP’s agenda, practices and bottom line: profit.
In an article written for the Hill, Johnson concluded:
“I joined Planned Parenthood because I wanted to help poor women with real health care needs. I still do — that’s why I left. Planned Parenthood doesn’t care about women’s health care needs, it cares about abortion.”
Donna Howard’s hyperbolic accusation presumes an agenda which seems far more sinister and deliberate than is likely the case. Unfortunately in Texas and perhaps other states, someone appears to be ready to pull the plug without a viable Plan B. Conservatives are understandably opposed to abortion but unwilling or unable to find solutions that make sure there is an ounce of prevention that reduces the need for a pound of cure. Similarly in this case, the number of providers in the WHS database may appear adequate on the surface but apparently appearances can be deceiving and it is incumbent on the Texas legislature to make sure there is an adequate backup plan before they pull the plug on Planned Parenthood.
It is a sad reality that there are those who will profit from things most of us abhor—war, death, crime and even abortion. If Planned Parenthood is in fact more pro-abortion that most of us our comfortable with and the Obama administration and others are still more than likely to support them, the only alternative is to find ways to build up a network of providers who truly are focused on comprehensive health rather than doing more abortions to increase profits. In a country which lacks universal health care (with or without Obamacare), creating an infrastructure that offers adequate access to healthcare for all women may take time, and that’s something many of them simply don’t have.