As the state again seeks federal funding — this time, under a Republican president — for its women’s health program after the controversial decision to kick out abortion providers in 2013, the governor is disbanding an advisory committee aimed at helping low-income women get good care.
Gov. Greg Abbott, saying the panel had “successfully fulfilled its mission,” vetoed legislation that would have kept it running for at least another two years. It will now expire in September.
After learning her committee was not re-authorized, vice chairwoman Dr. Janet Realini said she was disappointed.
“We’re not yet where we need to be in terms of access to contraceptives and other preventive health care in Texas,” said Realini, who also chairs the San Antonio-based Texas Women’s Healthcare Coalition, a nonpartisan group that promotes preventive care for women. “I think it’s just unfortunate to stop the committee at this point.”
In 2013, the Legislature voted to exclude Planned Parenthood and other abortion providers from what was then called the Women’s Health Program, which was 90 percent funded by federal Medicaid dollars. Until then, Planned Parenthood had provided routine care, such as pregnancy tests and infection screenings, to more than 40 percent of the low-income women enrolled in the program. (By law, no federal or state money can be spent on abortions.)
The Legislature’s action left many women scrambling to find new doctors and other health-care providers. It also meant the state had to forfeit $40 million in federal dollars because under the Obama Administration, states could not disallow qualified providers, such as Planned Parenthood.
After the federal cuts forced the state to self-fund its health program, Texas legislators in 2015 authorized the Women’s Health Advisory Committee to oversee the consolidation of state programs into what is now called Healthy Texas Women.
Through the Healthy Texas Women program, low-income women who are not pregnant and between 15 to 44 (minors can participate only with parental consent) are eligible for pregnancy testing, STD testing, breast and cervical cancer screenings, contraceptive counseling and other services.
Realini said Texas women continue to face many serious health issues that could benefit from the input and guidance of experts on the committee that Abbott nixed. One of the most severe is the state’s maternal mortality crisis. Between 2011 and 2012, 189 Texas mothers died within a year of giving birth, according to a July 2016 report from a state task force.
The continuance of the nine-member committee had overwhelming support in the state House and unanimously support in the Senate.
One expert focused on the family-planning needs of Texas women said the point of the committee is to get a small group of experts and knowledgeable people to decipher and explain to the Health and Human Services Commission how to make the state’s programs more efficient and easy to run.
“You can say you don’t need the committee if everything’s running smoothly … But that’s hardly the case right now,” said Joe Potter, a University of Texas at Austin researcher and lead investigator for Texas Policy Evaluation Project, a reproductive health research group.
“The need for that kind of advice, or back and forth, has not diminished in any way,” he said. “It’s a question of getting the providers’ point of view into the decision process.”
Before forfeiting federal funds in 2013, the Texas Legislature, in an effort to squeeze Planned Parenthood and other abortion providers, cut the state’s two-year family planning budget from $111 million to $38 million in the 2012-13 budget. Through a three-tiered system, state officials also prioritized community health centers and primary care clinics over clinics that specialized in family planning.
At the time, amily-planning clinics across the state closed or reduced their hours.
“It’s pretty (easy) to close clinics, but to open them back up again and to build new systems of care — that takes time,” Realini said. “We’re encouraged that the state is supporting family planning, but right now, we’re not where we need to be.”
The advisory committee’s demise comes as the state is seeking a waiver that would allow the state to regain some of the federal matching funds it forfeited.
Since President Donald Trump, who campaigned on further restricting abortion, entered the White House, Texas is testing whether it can exclude abortion providers or organizations supporting abortions from its women’s health program and still get federal Medicaid funding.
If the Trump Administration checks off on the waiver for Texas, other states could follow suit.
For the past few weeks, the state has held public comment meetings to allow people to share their concerns about the waiver application.
On the final day of the period, Potter and other researchers in his group sent a letter to the HHSC urging the agency to consider three recommendations to increase access to family planning services, including coverage for men to get vasectomies.
The commission only has a draft application available now. But once all public comment has been compiled, the commission is expecting to send its finalized waiver application to the federal government Friday, spokeswoman Christine Mann said. After that, the federal government will hold its own 30-day period for public comment on the waiver application.