An Early Assessment of the Potential Impact of Texas’ “Af-
filiation” Regulation on Access to Care for Low-income Women discusses the impact of Texas’ abortion affiliation regulation on preventive care access by low-income women. The report finds excluding Planned Parenthood clinics from the WHP jeopar- dizes access to care for nearly 52,000 low-income women. The report’s authors conclude the WHP program lacks any reason- able access alternative. The report examines the capacity of the state’s community health centers to ramp up their services to compensate for the loss of Planned Parenthood clinics. The authors conclude that it would be “virtually impossible” for health centers to fill the need, given cutbacks in state family planning funding and the magnitude of the demand for health center services in the state. Mr. Camacho says health centers would need to augment their WHP capacity to offset the loss of Planned Parenthood clinic capacity under the WHP. He adds, “We’re going to try” to fill the access to care gap. He recognizes, however, that doing so will be challenging. FQHCs have taken funding hits that Mr. Camacho says
make expanding capacity impossible. Operational funds for Medicaid have been reduced 10 percent, and family planning funding for health centers has decreased 54 percent (from $7.8 million to $3.6 million). “There are huge gaps. There is so much capacity that needs
to be replaced, and it’s difficult to imagine that any health system or private practice could step in and fill those gaps,” he said. “We’re identifying gaps in services and examining the ability of FQHCs to respond to demand,” he said. In the meantime, he says, women will have to wait in line for care until the funding is available to increase capacity.
difficult for Texas physicians to accept new Medicaid patients. “All referrals to specialists for Medicaid patients have to go
through primary care physicians. My practice had to hire one employee who does nothing but handle precertification for ul- trasounds and referrals,” he said. He says physicians who specialize in women’s health are particularly reluctant to accept new Medicaid patients. “From an obstetrician’s perspective, a lot of these patients
seek prenatal care later in their pregnancies and have in- creased risk for preterm labor,” said Dr. Zeid, a member of TMA’s Select Committee on Medicaid, CHIP, and the Uninsured. That said, Dr. Zeid emphasizes Texas physicians want to
ensure all women have access to preventive health care. Dr. Zeid accepts new Medicaid patients and WHP enrollees in his practice and says he will continue doing so for the foreseeable future. His practice, made up of two physicians and four non- physician practitioners, handles about 725 Medicaid visits per month and about 30 WHP visits per month. “The main reason I’m committed to seeing new Medicaid and WHP patients goes back to an experience I had early in my career. I was practicing in another town where women would have no access to health care at all if I didn’t see them. Disease doesn’t discriminate based on patients’ insurance sta- tus; we shouldn’t either,” he said. Family planning programs that provide access to screenings and birth control are vital for low-income women, Dr. Zeid says.
“By cutting funding for these services, you’re cutting a large portion of the female population off from their only source of preventive health care. We could wind up burdening our state health care system with preventable diseases. We could even see women showing up in the emergency room with advanced stage cervical cancer because they had no medical home where they could get Pap smears,” he said.
“texans need to stand up for access to preventive care and birth control. we need to work to reverse the cuts to the family planning program.”
Nevertheless, Ms. Goodman says, HHSC is “confident that many of those providers [family planning clinics and others] are ready to take on more WHP patients. We’ll continue to build the capacity for the program to ensure that we can pro- vide these family planning services to every woman enrolled in the program.”
Compounding the situation, preliminary TMA data shows the number of Texas physicians accepting new Medicaid pa- tients declined from 42 percent in 2008 and 2010 to 30 per- cent in 2012. Dr. Zeid says the fee structure and administra- tive burdens, such as precertification for ultrasounds, make it
24 TEXAS MEDICINE July 2012
prevention saves money HHSC implemented the WHP in 2007.
The HHSC 2010 Annual Savings and Performance Report for the Women’s Health Program says the “federal gov- ernment’s purpose for allowing family planning waivers is to limit expendi- tures for Medicaid-paid births.” At press time, HHSC didn’t have
data on the number of births to WHP clients for 2010. But the agency says in 2009 the program achieved a reduction of 6,721 expected births, decreasing Medicaid costs approxi- mately $75.2 million in state and federal funds. After paying costs associated with the program, savings for all funds totaled about $46 million and about $19.9 million in general revenue. That’s a return on investment of nearly 20 to 1. Dr. Realini says the premise behind the WHP is simple: “By helping women better plan and space their pregnancies, moth- ers and babies will be healthier, and Medicaid will be able
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68