As Texas cuts family-planning funding, more goes to crisis-pregnancy services

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Tuesday, September 20, 2011 at 10:19 am

Image by Matt MahurinWith presidential hopeful Texas Gov. Rick Perry’s blessing, as of this month, Texas women’s health clinics and hospitals that provide medical and reproductive health services to low-income, uninsured women across the state have collectively lost approximately $74 million in state funding. Meanwhile, a state network of crisis pregnancy centers (CPCs), whose predominant function is to counsel women against abortions, has been allocated even more money in the latest state budget.

Ever since CPCs began receiving taxpayer money through the Alternatives to Abortion (AA) program in a 2005 budget rider, that pot of money has grown from $2.5 million to $8.3 million, a 232 percent increase over six years. In that time period, family-planning funds were slashed by 66 percent. To compare, the state’s subsidized family-planning program has served approximately 220,000 women annually in comparison to roughly 18,000 women serviced by the subsidized anti-abortion counseling program, according to data provided by the respective agencies that oversee these programs.

Texas is only 20 days into its new health-services funding system for the poorest women in the state, and clinics that fared the worst in the funding cuts have scrambled to continue to serve their clients in the short term. And given the Texas system, the state’s low-income women still have another two years before a new budget is devised.

Family planning vs. crisis pregnancy: A funding pattern

During the 2005 Texas Legislative Session, lawmakers approved a budget rider drafted by Sen. Tommy Williams (R-The Woodlands), which for the first time allowed $5 million over the biennium to be disbursed to CPCs. In 2009, the amount was nearly doubled, to $9 million over the biennium.

Nonprofit Texas Pregnancy Care Network (TPCN) was created that same year and is charged by the Texas Health and Human Services Commission (HHSC) to manage and disburse taxpayer dollars to about 30 crisis-pregnancy and maternity centers. Under the Alternatives to Abortion program, fund recipients are forbidden from referring patients to health care providers that also provide abortions (or that associate with organizations that provide abortions).

Ever since Texas CPCs began receiving public money, reproductive-rights advocates in the state have been noticing a pattern: When family planning funding is cut in the state budget, money that goes to this anti-abortion-rights program increases.

This year, the Texas Legislature raised Alternatives to Abortion funding from $8 million to $8.3 million over the next two years. Meanwhile, family planning groups’ state funds went from $111 million to $38 million.

“We can’t prove a cause-and-effect correlation,” said Sara Cleveland, executive director of NARAL Pro-Choice Texas, a state affiliate of the nation’s largest reproductive-rights advocacy organization. ”Those two funds are not technically tied; [the legislators] could have just handed over [that money] to the oil and gas companies,” she told TAI, with a laugh. “But generally when money for [the Alternatives to Abortion program] goes up, money for family planning goes down.”

Even though Cleveland said there is not an explicit correlation between funding for CPCs and funding for family-planning clinics, for the past five years, her NARAL affiliate has published reports analyzing how money in the Alternatives to Abortion program has been spent and consistently refers to AA as a diversion of money away from family-planning organization to CPCs.

In the latest NARAL report (PDF), published in March 2011, the three authors, which include Cleveland, write:

Over the past five years, this rider has diverted $18 million dollars from preventive women’s health and family planning services and funneled them into an experimental new ‘Alternatives to Abortion’ program.  This program and its primary contractor, the Texas Pregnancy Care Network, have proven themselves to be a taxpayer-funded failure – at a high cost to Texans. … [T]he program was designed to siphon funding from established family-planning providers – who provide actual medical and reproductive health services for low-income and uninsured women – and funnel it largely into controversial, nonmedical counseling services.

The report uses state records, investigative newspaper stories and TPCN’s own data in drawing the conclusion that AA is a “taxpayer-funding failure.” Among the most recent findings:

  • By allocating $18 million to Alternatives to Abortion instead of comprehensive women’s health care, the state has forgone as much as $162 million in federal matching grants.
  • AA provides no new services as evidenced in the contract prepared by the Health and Human Services Commission: “HHSC recognizes that many organizations in Texas already provide support services that promote childbirth and alternatives to abortion.”
  • In FY 2010, TPCN fell nearly 20 percent short of its projected client goal but was rewarded a 60 percent budget increase in 2009.
  • Between $4,000-$5,000 is invested annually in the 1-888-LIFE-AID toll-free referral hotline, which is shared with and maintained by the Real Alternatives program in Pennsylvania, the model for Texas’ Alternatives to Abortion. The TPCN reported only 91 calls to this referral system throughout the entirety of FY 2010, which means the state is investing thousands of dollars in a shared hotline that receives just 7-8 calls per month.

Cleveland said NARAL’s reports are cyclical, timed to distribute to state lawmakers to inform their budgetary decisions. The report failed to sway leaders this year, which Cleveland attributes to the fact that both state House and Senate Republican hold super majorities.

“We will continue to do research and investigate various CPCs that are members of the Alternatives to Abortion program, tracking how the money is spent,” she said, noting that an updated report will be produced and delivered to legislators before the 2013 budgetary cycle.

Another report (PDF), released by HHSC last month documented how much money the state’s Medicaid-funded Women’s Health Program saved Texas: $20 million. The report (PDF) also demonstrated how the program averted about 6,700 unplanned pregnancies in 2009.

By the time this report was released, however, the 2012 state budget was already finalized. The $38 million was then redistributed among family-planning providers in a targeted three-tiered funding system that intentionally placed Planned Parenthood clinics last in line for money by stipulating that only facilities that provide “comprehensive medical care,” known as “federally qualified health centers,” could qualify for first-tier funding.

Fifteen family-planning agencies received no funding, according to Texas Department of State Health Services (DSHS) spokesperson Carrie Williams, who told TAI, via email, that 56 agencies were sent family-planning contract renewals for the first three months of 2012, offering dollar amounts significantly lower due to the program’s two-thirds budget reduction.

Williams explained that DSHS’s methodology took into account geographic access and the new prioritization requirements. In all, the reduction will affect services for about 180,000 (out of about 200,000) people each year, Williams said, noting that the “people who are served with our dollars fall under the 185 percent poverty level.”

Texas is divided into 11 regions. For the first three months of 2012, regions 5S/6 — which encompasses Harris County, Houston and Galveston — will receive the most money, at $1.9 million. In contrast, regions 4/5N — which encompasses Cherokee, Jasper-Newtown, Texarkana-Bowie and Titus Counties — will be receiving the least, at $204,516.

“The Legislature put the worst possible system in place,” said Sarah Wheat, interim co-CEO of Planned Parenthood of the Texas Capital Region, referring to the new tiered system. “They couldn’t have chosen a worse way to deliver services.”

She points out that many rural communities in the state do not have large hospitals or centers with comprehensive medical coverage but do have smaller Planned Parenthood or other clinics that offer birth control and testing for cervical cancer and STDs. In Austin, where Wheat is based, she said three clinics received no funding from the state — a Planned Parenthood affiliate and two community clinics.

Wheat told TAI she believes an estimated 300,000 women will be affected by these changes. She said Planned Parenthood has solicited donations to keep clinics opening, but already some have begun closing throughout the state. The current strategy is to keep seeing patients in the short term. But impacts of these funding shortages are really long-term, Wheat said.

“I don’t think anybody expected such dramatic and negative policy changes,” Wheat said.

The state’s health department, meanwhile, was tasked to help family-planning providers manage in these uncertain fiscal times.

“We know some agencies are feeling a crunch, and we’re working toward as smooth of transition as possible,” Williams said. “Our role is to use the dollars we get in the most efficient way possible.”

Family planning vs. crisis pregnancy: A difference in service

Texas’ family-planning providers (now 15 agencies fewer) include Planned Parenthood affiliates, health clinics, hospitals and county health departments. (Within these agencies are other clinics that serve women throughout the state; in 2010 DSHS funded approximately 300 clinic sites.)

By contrast, the Alternatives to Abortion program has historically funded between 20 and 30 organizations which include mostly stand-alone faith-based crisis pregnancy centers, as well as a handful of adoption agencies and maternity homes. (According to NARAL’s report [PDF], there are more than 200 CPCs in the state.)

In the new fiscal year, 56 family-planning agencies are sharing $17 million in public funding to service between 200,000 and 300,000 women annually.

In the new fiscal year, 33 CPCs (44 individual sites) are sharing $4.15 million in public funding to service about 1,500 women per month, according to TPCN’s own program data. TPCN notes the CPCs in the Alternatives to Abortion program have served 150 counties in the state’s 11 regions. (As of December 2010, there was no contracted service provider in Region 10.)  But since 2006, the program has only served about 43,000 women, falling below the program’s five-year target goal. Overall the centers, have received just under 200,000 client visits. The average cost per client served in fiscal year 2009-2010 was $299.84; the average cost per client visit in that same time period was $62.50.

Through Titles V, X and XX, a broad range of contraceptive devices and related procedures are made available to women, including: disease testing (breast and cervical cancer, STDs, cholesterol, diabetes); STD testing; contraception (FDA-approved condoms, pills, IUDs, sterilization and contraceptive implants); and counseling (abstinence, fertility-awareness, breast-feeding, birth-control options).

According to DSHS, the purposes of family-planning services are to help parents control when and how many children they want, to decrease the rate of unintended pregnancies in the state and to improve the health status of Texas communities.

The types of services generally provided by the subsidized CPCs — as documented by a TPCN site-visit report previously obtained by The Texas Independent — include “counseling and mentoring”; education classes on pregnancy, childbirth, parenting and adoption; assistance with food, shelter, clothing and medical care; and referrals to other community resources.

The report revealed that the vast majority of CPCs in this program offered mostly counseling and referrals — anecdotes were recorded detailing how women were swayed against having abortions — and that the maternity homes generally offered more comprehensive assistance such as food, long-term shelter, and assistance with continuing education, procuring employment and child-care services.

Cleveland told TAI that NARAL’s own reporting found the subsidized maternity homes to provide “real services to women.” She does not think same about the CPCs.

“The most egregious [revelation], as far as we’re concerned, is [CPC counselors giving women] medically inaccurate information,” said Cleveland, citing, for example, the claim that a direct relationship exists between breast cancer and abortion, and that abortions lead to what Cleveland calls a “fictitious” post-abortion stress syndrome intended to emulate post-traumatic stress disorder. ”We don’t think it is okay to lie to women.”

TAI was unable to reach TPCN for comment.

The Texas Independent previously reported that even though over the past five years, evaluators have found violations at state-funded subcontractors for the Alternatives to Abortion program — which reimburses nonprofits, typically faith-based groups — HHSC has never conducted its own review during the life of the program.

The Texas Independent’s reporting revealed certain CPCs were consistently cited for not separating out religious material from publicly funded material, for billing errors and for employing counselors without proper public safety clearance — but these problems were never corrected or enforced.

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