“We can’t keep cutting money and adding it back in.”


islators to prevent debate over family planning funding on the House floor. It was important to me and to other lawmakers that the money allocated to women’s health in the budget re- main in the budget,” Representative Davis said. She says she’ll fight to maintain family planning funding in


future sessions. “Preventive health care for women saves taxpayers money


and results in better health outcomes. And I believe the only way we can repair the damaged health care safety net is by maintaining a consistent stream of revenue for family planning programs. We can’t keep cutting money and adding it back in,” she said.


Repairing the safety net Dr. Realini says the restored women’s health funding is a sub- stantial step forward, but challenges lie ahead. “Texas built up the women’s health care safety net over the course of 40 years but tore it down in just two years. It will be a huge challenge for Texas to restore services for several reasons,” she said. It will take time for clinics that closed to reopen. Plus, the network of physicians is now smaller due to the exclusion of Planned Parenthood clinics from women’s health programs and reductions in services at other clinics serving low-income women. “Large hospital systems and clinics that receive funding from


multiple sources should be able to ramp up preventive services. It can be difficult for individual physicians and small clinics to prioritize prevention and achieve the efficiencies of the larger specialty clinics,” Dr. Realini said. Dr. Hollier worries clinic closures in rural areas won’t be


easily reversed. “The restoration of funding is too little, too late. I’m con- cerned about the complexity in the distri- bution of the funding and the adequacy of the provider networks. I’m worried about accessibility of patients to the net- works that we’re building,” Dr. Hollier said.


Whether Texas will have enough phy-


sicians to meet women’s health needs is unclear, Dr. Realini says.


“It will be important to monitor these


John C. Jennings, MD


programs with regard to provider capaci- ty and geographic reach,” Dr. Realini said.


24 TEXAS MEDICINE November 2013


HHSC data for the first half of this year indicate lower ser- vice levels in TWHP, for instance. As of June 1, HHSC had processed 79,663 TWHP claims,


compared with 103,339 in 2012 for the same period. Ms. Gockel says the agency is confident it can “provide services for every woman who enrolls in the program,” adding that the $71.3 million the legislature allocated to the program will allow HHSC to serve more than 110,000 women a year. “If the demand for services is higher, we’ll work with state leadership on our options,” she said. As of July, 2,636 physicians and providers participated in


TWHP. Of those, 173 are family planning clinics, 169 are feder- ally qualified health centers (FQHCs), 2,141 are physicians, 78 are rural health clinics, and 75 are physician assistants. Ms. Gockel says comparing the number of physicians and


providers to the previous year is difficult because 2012 data in- clude duplicates. HHSC said last year that the Women’s Health Program had 2,562 physicians and providers. (See “Steep Price to Pay,” July 2012 Texas Medicine, pages 18–25.) Since the exclusion of Planned Parenthood clinics, Ms.


Gockel says many other clinics in the program now serve a “significant number of women.” She cites a capacity survey HHSC conducted last year of TWHP providers in areas Planned Parenthood previously served. In 2012, Planned Parenthood and others served 80,127 women. The survey found that phy- sicians and providers in those areas can serve 147,513 TWHP clients this year. HHSC continues to recruit doctors and clinics to TWHP. She says HHSC has identified 4,000 OB-Gyns for potential recruitment in the program, for example.


Innovative funding approach Immediately following the 2011 legislative session, Dr. Lakey began meeting with legislators and their staff members throughout the state to develop a plan for funding women’s preventive health care, including family planning. “People weren’t happy with the cuts in 2011. We needed a solution. The feedback from lawmakers was that they felt comfortable focusing on funding for comprehensive care that addressed not only contraception but also prevention,” he said. Dr. Lakey says the $100 million investment the legislature made in the department’s Expanded Primary Health Care Pro- gram will help the state rebound from the big family planning cuts in 2011. Now, he says, DSHS needs to deliver on its prom- ise to save the state money while improving health. Had lawmakers opted not to restore funding for women’s


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