You Can't Take the Baby Out of This Bathwater

Last week, Republicans and Democrats in the Texas Legislature reached an impasse on a five-year-old women's health-care program set to expire in December. Though none of the money went to abortions or abortion referrals, Republicans will not renew the program without an amendment that would prevent Planned Parenthood from receiving any of the funding. Democrats, though, won't vote for the measure. That means 120,000 uninsured women are likely to lose their health care.

Planned Parenthood serves about 40 percent of the women treated in the Medicaid Women's Health Program (WHP), which has provided more than 235,000 women with birth control and cancer screenings since 2007 and saved the state millions in Medicaid costs by preventing thousands of unwanted births. But Planned Parenthood has become a target (again) in the renewed anti-abortion fight, despite being one of the largest nationwide women's care networks.

The Republican state senator who proposed the amendment, Robert Deuell, also included in his bill (SB 1854) a trigger that would shut down the program entirely if Planned Parenthood successfully sues to be able to continue participating in it. This case in Texas shows why trying to sever women's health care from abortion will always end up hurting women, and no one demonstrates that better than Deuell.

Deuell isn't your average anti-abortion, anti-Planned Parenthood legislator; he supports providing family planning for poor women. He told the Houston Chronicle last month, "I don't want to cut access to family planning. I don't want to decrease access. One way to stop abortions is to prevent unwanted pregnancies." The actual effect of his policies, however, undermines the force of that statement.

Before he filed SB 1854, two Democratic representatives had already filed bills extending and expanding WHP. Instead of supporting their efforts or filing a similar bill in the Senate, however, Deuell put forward a proposal that probably seemed more likely to pass in the Republican-controlled Legislature but would also severely reduce the reach of the program.

This isn't the first time Deuell's efforts to ostensibly support women's health have threatened to actually undo the programs he says he cares about. And Deuell's emphasis on moving care away from abortion-related clinics has proved counterproductive.

In 2005, Deuell successfully passed a budget rider mandating that the $20 million allocated for family planning over two years go to public-health clinics rather than more specialized clinics like Planned Parenthood. As a doctor, Deuell has worked in the type of clinic his rider shifted family-planning funds to, and he is currently in the process of applying for state certification to participate in WHP. He is pro-life and says he is only hostile to Planned Parenthood because the organization takes women out of general clinics that provide a wider range of services.

In practice, though, sending women to general-care clinics for these services was a colossal failure. The number of women covered by public family-planning funds dropped precipitously. Before Deuell's rider, 670,000 women were receiving care each year through public funding; just two years later, that number had dropped to 371,000. Dozens of Planned Parenthood and independent clinics shut down, marooning women in rural areas without care. Nevertheless, Deuell pushed a more draconian version of the original rider in 2009. (It didn't pass.)

The rider never had its intended effect, anyway, because general clinics aren't equipped to efficiently increase reproductive health-care services. According to the Austin Chronicle, for example, it costs a public clinic $219 to provide the same care Planned Parenthood provides for $168. When Deuell's rider was in effect, public clinics actually returned millions of dollars that they simply couldn't use.

No other provider can absorb all of Planned Parenthood's patients. In 2010 alone, through 80 clinics, the organization served more than 260,000 women, men, and teens, providing hundreds of thousands of cancer screenings as well as testing and treatments for sexually transmitted diseases.

Perhaps more important for Texas, Planned Parenthood provides care to uninsured women. According to the Legislative Research Group, a left-leaning research caucus in the Texas House, the Lone Star State has the highest rate of uninsured in the country and ranks 49th in percentage of the poor covered by Medicaid. Texas' high poverty rate, low level of educational attainment, and large Hispanic population -- which traditionally has twice the uninsured rate as white Americans -- all contribute to the state's 26.1 percent uninsured rate.

But these aren't the only factors. Employers in Texas are less likely to provide health insurance for individuals and particularly for families. In 2000, 80 percent of uninsured Texans had at least one family member who worked full-time. As a result, Texas has the second highest birth rate and the third highest teen birth rate; the majority of births in Texas are covered by Medicaid. In normal economic times, defunding Planned Parenthood would be devastating to Texas women. In a recession, it's worse. "The number of women needing our services is higher than ever," says Sarah Wheat, co-CEO of Planned Parenthood of Austin. With women and their partners losing their jobs, and therefore their medical insurance, demand, she adds, is really high. Not only do women need more services during a recession, but programs helping them are vulnerable to more cuts than those coming from the well-meaning Deuell.

In the next week, the Legislature will come to a budget agreement that will likely cut millions of dollars that fund public services from health care to education. That includes family-planning services; the Senate's budget decreases family planning by 11 percent, while the House budget decreases funding by 66 percent. With dramatic reductions awaiting Texas clinics, the Women's Health Care program is necessary to help absorb these cuts. Instead, Texas is about to lose what is perhaps its most successful public program. As with recent hits to family-planning services, Deuell's name is all over this one.

The raids on family-planning funding this year have shown that there will always be lawmakers who sincerely wish to eradicate family-planning services. But there are others, like Deuell, who sincerely hold the contradictory preference of making family planning available but running Planned Parenthood out of town. It's a nice, pro-contraception, anti-abortion theory, but in real life, this denies thousands of women reproductive care. Deuell has spent his public career trying to separate Planned Parenthood from quality women's care, only to prove it cannot be done. "All these proposals -- there's so much irony," Wheat says, "but it's a loss for women in Texas."

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