Texas' Plans for Women's Health Program Raises Questions About Medicaid Expansion, Opposition From Medical Groups

August 7, 2012 — Texas Gov. Rick Perry's (R) plan to end the Medicaid Women's Health Program as a way to prevent funding from going to Planned Parenthood conflicts with his decision to opt out of the Affordable Care Act's (PL 111-148) Medicaid expansion, The Hill's "Healthwatch" reports (Baker, "Healthwatch," The Hill, 8/6).

Texas' Women's Health Program, which receives 90% of its funding from the federal government, provides low-income women with family planning and other preventive health services. Texas passed a law barring participation in the program by Planned Parenthood and other affiliates of abortion providers, prompting the federal government to cut off funding because federal law guarantees that women covered by the Medicaid program have the right to choose their own health care providers.

Billy Millwee, the state's Medicaid director, said Texas will continue with the current program through the end of October before launching an entirely state-funded program (Women's Health Policy Report, 4/19). Perry has said that the new program will not require much funding because "all clients will be eligible for Medicaid following the expansion of the Medicaid program" under the ACA.

However, Planned Parenthood recently noted in formal comments on the state's plan that Perry has said publicly that Texas will not participate in the Medicaid expansion. The organization also questioned whether the state has the authority to eliminate the existing Women's Health Program and its federal contributions, noting that the Texas legislature has yet to set aside money to fund the state-funded alternative ("Healthwatch," The Hill, 8/6).

Rule Banning Doctors From Discussing Abortion With Patients Draws Ire

Meanwhile, Texas medical groups are voicing opposition to a proposed rule that would prohibit physicians in the Women's Health Program from discussing abortion with their patients, the Texas Tribune reports. The proposed rule states that providers must not "promote elective abortions" and defines "promote" as including counseling and referrals to abortion providers, as well as the display of abortion-related materials.

In a letter to the Department of State Health Services on Friday, the Texas Medical Association, the Texas division of ACOG, the Texas Association of Obstetricians and Gynecologists, the Texas Academy of Family Physicians and the Texas Pediatric Society -- representing a total of 47,000 physicians and medical students -- wrote that the rule would threaten the doctor-patient relationship and jeopardize medical ethics. The proposal also could cause doctors to leave the program, they argued.

"The relationship between patient and physician is based on trust and creates the physician's ethical obligations to place the patient's welfare above his or her own personal politics, self-interest and above obligations to other groups," the letter stated.

Texas health officials said in a written statement that they would carefully review the groups' input. "We understand that doctors have certain professional obligations to their patients, and we want to ensure that the rule allows doctors to meet those obligations," Texas Health and Human Services Commission spokesperson Stephanie Goodman said (O'Connor, Texas Tribune, 8/6).