October 22, 2012
AUSTIN, Texas (The New York Times News Service) -- With only two weeks until Texas plans to take over the Women's Health Program without its biggest provider, Planned Parenthood, the state's top health official said he is confident -- but couldn't guarantee -- that enough clinics and doctors will be available to serve all 115,000 of the program's patients.
The federal government, which currently supplies 90 percent of the program's funding, balked at state attempts to exclude Planned Parenthood earlier this year, prompting Gov. Rick Perry to push for a state-run, state-financed program to provide contraceptives and other care to low-income women.
But with the Nov. 1 deadline approaching for Texas to launch its own version of the program, which will cost $36.3 million in 2013, state officials didn't issue final rules on how it would operate until this week.
Dr. Kyle Janek, head of the Texas Health and Human Services Commission, said the delay was needed to address concerns from key participants, particularly doctors who protested that an early version of the rules imposed a "gag order" preventing them from discussing any abortion-related topic with patients.
The new rules allow participating doctors to answer questions about abortion as long as they don't recommend that a patient undergo the procedure, Janek said Thursday.
The new rules also explicitly state what Texas officials have long claimed -- that the Women's Health Program will be canceled if a court compels Texas to include Planned Parenthood or any organization that provides abortions or promotes the procedure. "We'd have to shut the whole program down," Janek said.
With the rules now in place, Janek said, officials will next approach doctors, clinics and other providers about joining the program.
"You can't build a network until you know what the final rules are. Now we have to give providers the current scoop (and) rebuild the network," he said.
Until that work is done, Janek added, it would be premature to guarantee full coverage for the 115,000 low-income women who receive contraceptives and health screenings -- including tests for diabetes, cancer and sexually transmitted infections -- when Texas takes control of the program.
Planned Parenthood serves about 50,000 women a year under the program, and that organization's officials have voiced skepticism that there are enough providers to fill the void, particularly after steep cuts in state family planning spending have forced more than two dozen clinics to close or cut hours statewide. A recent study by George Washington University came to a similar conclusion.
But Janek said the state has already added 500 doctors and clinics to the program since spring. "I have every expectation that we'll be ready by Nov. 1," he said.
If the state isn't ready by then, Janek added, federal officials have indicated a willingness to temporarily continue the program as is to ensure continued coverage for patients.
Texas first moved to exclude Planned Parenthood from the program in February, prompting the organization to file a lawsuit that was denied by a federal appeals court in August. Planned Parenthood is still serving patients in the program while the 5th Circuit Court of Appeals weighs a motion to reconsider its ruling.
Sarah Wheat with Planned Parenthood of Greater Texas said the new rules continue state efforts to politicize women's health issues by targeting her organization.
"If the state cannot exclude one health care provider, they're willing to eliminate a lifeline for over 100,000 women? That's pretty revealing," Wheat said.
Dr. Michael Speer, president of the Texas Medical Association, said his initial reading of the new rules left him satisfied that his organization's complaint about a potential gag rule was addressed.
"The rule, as originally worded, seemed to say that if a patient asked anything about abortion, the physician was prohibited from discussing it," Speer said. "We're certainly happy."
The program's $36.3 million cost for 2013 will be partially paid by cutting overtime expenses and placing a freeze on hiring administrators in the state's health agencies. The Legislature will have to decide how to pay for the program after 2014, when costs are estimated to rise to $45.2 million.
The 2014 cost was $27.3 million higher than originally estimated to reflect Perry's refusal to expand Medicaid coverage under the Affordable Care Act, also known as Obamacare. The Medicaid expansion would have defrayed some of the program's cost to Texas, but Perry determined that expansion would cost more money in the long term.
Copyright 2012 The New York Times News Service. All rights reserved.