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Texas Considers How To Streamline Reproductive Health Services for Low-Income Women

Texas Considers How To Bolster Reproductive Health Services for Low-Income Women

July 21, 2014 — Texas lawmakers are weighing how to restore gaps in health care access for low-income women in the state, three years after they cut the state's family planning budget and rejected a federally funded women's health program in favor of a state-operated program, the Texas Tribune/New York Times reports (Ura, Texas Tribune/New York Times, 7/19).

Background on Family Planning Cuts

In 2011, the Texas Legislature cut the state's family planning budget by two-thirds and blocked funding to Planned Parenthood and other women's health clinics affiliated with abortion providers. As a result of the cuts, 76 of Texas' family planning clinics closed or stopped providing family planning services, according to a survey by University of Texas-Austin researchers.

To mitigate the effect of the 2011 cuts, Texas legislators during the 2013 session increased women's health funds to $214 million for the 2014-2015 state budget, up from $109 million in the previous budget. The funding was dedicated to expanding primary care, operating the Texas Women's Health Program and replacing the family planning grants that the federal government awarded to another organization to distribute (Women's Health Policy Report, 2/24).

Consolidation Efforts

State Sen. Jan Nelson (R) said at a February hearing of the state Senate Health and Human Services Committee that she was mulling whether to consolidate or streamline the six different state programs designed to offer health care services to low-income women. "We've got several different programs with different names, different benefits, different eligibility guidelines that I know have to be confusing to women out there because they're confusing to me," she said.

Nelson has suggested that she might consolidate the programs through use of the Sunset Advisory Commission, which allows lawmakers to make significant changes to agencies and programs to boost efficiency. According to the Tribune/Times, Nelson chairs the Sunset commission, which includes lawmakers and staff.

Meanwhile, Texas Health and Human Services Commission spokesperson Stephanie Goodman said that the commission has not yet received any specific directives from the state, but it has considered creating "one front door" for all services, which means that women would go to one provider for all their health care needs. In a report to the Sunset commission, HHSC suggested that if the Texas Women's Health Program joined the Texas Department of State Health Services, which oversees the majority of women's health services in the state, efficiency could be boosted.

According to the Tribune/Times, staff members on the Sunset commission are scheduled to publish their recommendations in October, while lawmakers on the panel will voice their proposals later in the year before submitting them to the full Legislature in January.

Reproductive Health Groups Voice Concerns

Meanwhile, several lawmakers and reproductive health groups have expressed concerns about implementing additional changes so quickly after having cut funds for the program, the Tribune/Times reports.

State Rep. Donna Howard (D) said, "I'm concerned about looking at streamlining before we've had an opportunity to get the new programs up and running in a way that mimics the kinds of successes we were seeing with the previous programs."

Similarly, Janet Realini, former chair and current steering committee member of the Texas Women's Healthcare Coalition, said that the current structure should be evaluated for efficiency before lawmakers make any further changes.

"We have mentioned in discussions that it would make more sense to look at studying things rather than changing them," she said. She added that the coalition estimates that more than one million Texas women are seeking state-subsidized health care services and that the current health care system and budget is able to meet the needs of just one-third of them.

Separately, Yvonne Gutierrez, executive director of Planned Parenthood Texas Votes, said that lawmakers' efforts to improve the system are futile without the structure and support of Planned Parenthood. "It's going to take a tremendous amount of time, a tremendous amount of infrastructure building and resources that I don't think the state had thought about when they dismantled these programs," she said (Texas Tribune/New York Times, 7/19).

Omnibus Antiabortion Law Shutters 50% of State Abortion Clinics

In related news, abortion-rights supporters report that just 20 of the state's 41 abortion clinics remain open one year after the enactment of HB 2, and that just six might be left after the law's final provision takes effect in September, Houston Public Media/NPR/Kaiser Health News' "Capsules" reports.

Most of the state's clinics shuttered under a provision in the law that requires abortion providers to obtain admitting privileges at nearby hospitals. On Sept. 1, another provision of the law takes effect that requires all abortion clinics to upgrade their facilities to ambulatory surgical centers.

Heather Busby, executive director of NARAL Pro-Choice Texas, said most clinics cannot afford to comply with the provision. "This would basically force all the clinics to become mini-hospitals" by adopting "a bunch of ... regulations that are not really appropriate or do anything to increase the safety of one of the safest procedures in the country," she said.

Busby estimated that just six or eight clinics in the state will remain open after the provision takes effect, unless a lawsuit blocks the rule. She noted that that there are currently no abortion clinics in all of East Texas or in the Rio Grande Valley and that the sole clinic in El Paso could close soon (Feibel, "Capsules," Houston Public Media/NPR/Kaiser Health News, 7/18).