legislature drastically slashed funds for family planning ser- vices by 66 percent (from $111.5 million to $37.9 million) and further stressed the women’s health infrastructure. The restored funds represent the legislature’s renewed in-
terest in preventing unintended pregnancies and connecting women to vital primary health care services. Physicians say celebrating is premature, however. Texas now has the chal- lenge of rebuilding the safety net and ensuring physician ca- pacity to serve women’s health needs. Even so, the restored funding levels only allow the state to serve about one-third of the women in need. ACOG President-Elect John C. Jennings, MD, says Texas will have to scramble to repair the damage the 2011 family plan- ning funding cuts caused. “The legislature did the right thing by working with medi- cine to restore women’s health funds. But in reality, we’re still a long way from being able to provide the majority of low- income Texas women with preventive health care,” said Dr. Jennings, chair of the Texas Medicine Editorial Board. Sen. Jane Nelson (R-Flower Mound) says the 2011 funding cuts, which she describes as “too severe,” inspired her as chair of the health and human services budget workgroup, to priori- tize women’s health funding this session. She adds that restor- ing women’s health funding signals a common interest among legislators to ensure access to preventive health care for low- income women. In fact, Senator Nelson’s Senate Health and Human Services Committee will study family planning access and programs before the legislature convenes in 2015. (See “Lawmakers to Study Family Planning Programs,” page 25.) “In the months ahead, we will continue to make a concerted effort to try and develop those common goals into legislative action,” she said.
In the midst of the study, Texas physicians will scrutinize
the programs’ impact on the health care system for low-in- come women.
“I’ll be looking for a reduction in unplanned pregnancies. I’ll be looking for an increase in women who can identify a health professional who cared for them between pregnancies. That is going to indicate to me that the state has been successful with this funding,” Dr. Hollier said.
Funding women’s health DSHS will receive $43 million in state funds for family plan- ning services such as STI testing and treatment, contraception, health exams for men and women, clinical breast exams, Pap tests, and cholesterol and diabetes screenings. On top of that, the budget also adds $100 million to expand women’s health services in the DSHS Expanded Primary Health Care Program, which contracts with community health clinics and nonprofit organizations to provide services for uninsured, poor Texans who don’t qualify for other state health programs. The Ex- panded Primary Health Care Program differs from the depart- ment’s traditional Primary Health Care Services Program in that it includes funding for family planning services. DSHS estimates $60 million of the $100 million increase will fund family planning services. Additional funds in the
Expanded Primary Health Care Program will allow DSHS to serve approximately 170,000 Texans annually by offering well- woman checks, cancer screenings, and family planning. Lawmakers also allocated $71.3 million to fully fund the
Texas Women’s Health Program (TWHP), operated by the Tex- as Health and Human Services Commission (HHSC). The pro- gram gives low-income women aged 18 to 44 access to birth control, basic preventive health screenings, and STI treatment. Before 2013, the federal government provided 90-percent funding for the program, but last year the state opted to forgo federal funding so that it could exclude Planned Parenthood and affiliates of abortion providers. Dr. Hollier says having more women’s health funding pro- grams calls for greater coordination. “These programs each have different participation require- ments and enrollment procedures. It would help to have stan- dardization among the programs and a coordinating entity,” Dr. Hollier said.
HHSC plans to hire a women’s health coordinator to as- sess and oversee women’s health services at HHSC, DSHS, the Texas Department of Family and Protective Services, the Texas Department of Aging and Disability Services, and the Texas Department of Assistive and Rehabilitative Services. “The women’s health coordinator will pursue ways to help women learn about the health services that exist and how to access them,” said Linda Edwards Gockel, HHSC press officer. Restoring women’s health funding this session marks a shift
in priorities for the Texas House and Senate, says Janet Realini, MD, chair of the Texas Women’s Healthcare Coalition Steering Committee. TMA and 29 other organizations are members of the coalition, which works to improve the health of women and their families by ensuring they have access to preventive care. Dr. Realini says the case for funding women’s health reso- nated with lawmakers for several reasons. “Many lawmakers from both parties were distressed by the collateral damage of the family planning cuts of 2011. Two- thirds of the clinics that closed were not Planned Parenthood clinics, and many communities have been coping with a dra- matic loss of preventive care,” she said. According to data from The University of Texas at Austin
Population Research Center, 56 clinics closed following reduc- tions in family planning funds. Rep. Sarah Davis (R-Houston) played a pivotal role in gar- nering bipartisan support for restoring family planning funds in the 2014–15 budget. A breast cancer survivor, she has a personal connection to women’s health. “I understand that early detection is key, and my experience as a cancer survivor motivates me to prioritize funding for women’s preventive health care,” she said. And it didn’t hurt that the state had money in the budget to work with this session. In 2011, lawmakers faced a $27 billion shortfall, but this time around, they had an $8 billion surplus that Representative Davis says made it easier to gain broad support for replenishing the funds. “I got a lot of calls from constituents who weren’t happy with the family planning cuts last session. I worked with leg-
November 2013 TEXAS MEDICINE 23
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