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Texas Women Ponder Next Steps as Law Cuts Health Options

Losing access to a Fort Worth, Texas, health-care clinic affiliated with Planned Parenthood has Alexis Lohse worried.

The 31-year-old Texas Christian University student and married mother of two daughters said trying to find an alternative provider is a “scary prospect.”

She’s just one among more than 126,000 low-income women who may face the same dilemma by Nov. 1. That’s when funding for services by Planned Parenthood affiliates will end because other operations tied to the nonprofit group offer abortions.

The state will spend $40.1 million on its Women’s Health Program through September 2013 and bar funding for groups connected even indirectly to abortion providers. The cutoff follows a showdown over the ban that pitted Governor Rick Perry, the state’s longest-serving chief executive, against the U.S. Health and Human Services Department and Medicaid. The health- insurer for the poor has paid 90 percent of the program’s cost.

“The Texas Legislature, with a vigorous and open debate, said we are not going to spend Texas taxpayer money on abortion,” Perry, a Republican, said during a Sept. 21 forum sponsored by the Texas Tribune, an online news outlet. State officials, including Perry, have said they won’t put off imposing the ban while pending lawsuits over it are resolved.

Long Wait

Lohse may end up going to a general-medical clinic that has a long waiting list for appointments. Tens of thousands of women served by the program may confront a similar situation, since lawmakers previously cut state family-planning aid by two- thirds, or $73 million, leading dozens of providers to close or reduce hours.

Critics such as state Representative Donna Howard, an Austin Democrat, say the cuts reduced potential replacements for Planned Parenthood affiliates in the program. Those clinics handled 43 percent of its patients, said Stephanie Goodman, a state Health and Human Services Commission spokeswoman.

Started in January 2007 to help reduce costs associated with births paid for by Medicaid, the program doesn’t cover pre- natal services or abortions, according to a May commission report to the Legislature. It reduced expected births by 8,215 in 2010, saving Medicaid $90.2 million, the report shows.

The program provides services that include contraceptives, well-woman examinations and screenings for breast and cervical cancer, sexually transmitted diseases and other conditions. It covers women 18 to 44 with incomes of 185 percent or less of the federal poverty level. About three-quarters of its clients are under 30 years of age.

Cut Off

Responding to the abortion-related ban, federal administrators cut off the state program, saying Texas can’t block federally approved groups such as Planned Parenthood from providing services underwritten by Medicaid, the health- insurance system for low-income Americans.

Planned Parenthood-affiliated clinics that participate are legally and financially separate from the organization’s abortion operations, said Sarah Wheat, a spokeswoman for Planned Parenthood of Greater Texas, which includes clinics in the Austin, Waco and Dallas-Fort Worth areas.

“When you come after Planned Parenthood, basically, you are coming after our clients,” Wheat said at a clinic near downtown Austin. The provider served 2,300 program clients last year and has a sign outside declaring, “This clinic is open!”

Taxpayer Cost

The state’s position will cost taxpayers more than $30 million a year in foregone Medicaid subsidies, state figures show.

“It’s a political agenda, determined to completely derail Planned Parenthood,” even though none of the program clinics performed abortions, Wheat said.

Texas plans to run the program on its own terms, with its own taxpayer dollars, cutting out Medicaid, which is jointly funded by the states and the U.S. government.

Perry has made holding down state spending a central theme of his 12 years as governor. He also has attacked the federal government for encroaching on how Texas tax dollars are used.

In a March lawsuit against Health and Human Services Secretary Kathleen Sebelius in U.S. district court in Waco, state Attorney General Greg Abbott called the Medicaid funding cutoff “an unconstitutional attempt to commandeer and coerce the state of Texas into repealing its law that withholds taxpayer money from elective-abortion providers.” No trial date has been set for the suit.

Lawsuits Fly

In April, Planned Parenthood sued Texas, asserting that the state ban violates its First Amendment right to free speech. A federal appeals court in August upheld Texas’s right to enforce its restriction. The organization is seeking a new hearing.

State Representative John Zerwas, a Republican from Simonton, near Houston, and an anesthesiologist, said he’s confident that the Legislature will keep funding the program.

“I do have some concerns about the relative access to providers,” Zerwas said. “I haven’t yet seen real solid data that access will be beefed up enough” to replace Planned Parenthood affiliates.

Out of 240 clinics surveyed by the Population Research Center at the University of Texas, 53 closed and 38 cut hours after previous cuts in family-planning aid, according to a report last week in the New England Journal of Medicine.

Data need to be collected on the effects of the earlier cutbacks, Representative Zerwas said before he had seen the New England Journal article. “The last thing we want to do is cut family planning and then see an uptick in unwanted pregnancies, adding to the Medicaid rolls or leading to abortion,” he said.

Widespread Effects

Some affected operations served parts of Texas with high participation rates in the Women’s Health Program. A dozen were Planned Parenthood affiliates, mostly in southern and western areas of the state, Wheat said.

“I think it’s going to be tough to plug the hole with other providers,” Representative Howard said. “When you have a program with a nine-to-one match that was saving millions of dollars and you pull the rug out from under these women, it is not fiscally responsible.”

The state has recruited about 500 new providers in recent months, said Goodman, the commission spokeswoman, bringing the total to 3,000 physicians, clinics, laboratories and others.

“When we lose a group of clinics that are serving a large number of women, we’re obviously concerned,” Goodman said, referring to the changes that will take effect Nov. 1. “We’re doing everything we can” to make sure that no clients are left without care, she said.

85% Cut

Community Action Inc. in San Marcos has two remaining family-planning and women’s health clinics for low-income clients in rural areas near Austin and may be able to add clients, said Carole Belver, the nonprofit’s health services director. Just a few years ago, it had 13.

“I had to reduce hours for some of my already slim staff” after the earlier family-planning cuts, Belver said in August from San Marcos, about 30 miles (48 kilometers) south of Austin. “It’s worse than bad. We’re just barely making it.”

Perry deserves credit for stepping in when Medicaid refused to fund the program under the state’s new rules, said Joe Pojman, executive director of the Texas Alliance for Life.

“He has put his political reputation on the line by stating that this program will continue, with a seamless transition,” Pojman said. “We think it’s more efficient for the state and probably means better care for the women.”

Lohse, the Fort Worth student, isn’t so sure. With a husband who’s also in school and working part-time, she holds down two part-time jobs while she works on a degree in politics. She said she can’t afford to get sick.

“It will go from the Women’s Health Program being a really accessible way for me to get health care and stay healthy to being really, really hard,” Lohse said.

To contact the reporter on this story: Kathy Warbelow in Austin at kwarbelow@bloomberg.net.

To contact the editor responsible for this story: Stephen Merelman at smerelman@bloomberg.net.

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