Open enrollment in Obamacare continues through the end of the year. The number of insured Texans has increased since the Affordable Care Act was put in place – but the percentage of uninsured people in Texas remains the highest in the country.
Uninsured Texas women do have some options for free or low-cost care such as breast and cervical cancer screenings, pelvic exams and some prenatal services. They’re offered under the state’s “Healthy Texas Women” program. State lawmakers reconfigured the program in 2011.
Joseph Potter studies reproductive health legislation and its effects on women’s health services at the Texas Policy Evaluation Project.
“In 2011, very suddenly, there was a massive cut in support for family planning services administered through the state,” Potter says.
When the Texas legislature slashed two-thirds of the funds the state received for the women’s health program, they also cut Planned Parenthood and many other providers out of the program. Potter says this was happening at a time when other states were moving towards greater planning services.
“Texas was going in the other direction,” Potter says.
The state picked up the tab because Medicaid was no longer willing to cover the costs of the women’s health program after Planned Parenthood was cut out. The funding then went to general revenue, which led to the creation of a Texas-specific program.
Lesley French is the Associate Commissioner for Women’s Health Services. She admits restructuring the program has been a process – there have been three different models in the past five years. But she says the most recent version, which was rolled out this July, received a record amount of funding.
“We’re excited because we are on a new day in women’s health,” French says. “The legislature funded the agency at $260 million – $170 million of it is going to Healthy Texas Women and the remainder is going to the revised family planning.”
This funding is going to 5,000 providers approved by the state.
“Clinics that we have partnered with range from small private groups all the way to our large hospitals,” French says.
That list of providers has been one of the most controversial aspects of changes to the women’s health program. Joseph Potter says the cuts in 2011 caused many clinics to close or reduce hours, which resulted in noticeable changes to the services they can provide.
“One of the major findings we had was that not only did they reduce hours but they reduced the supply and the availability of long-acting reversible contraception,” Potter says.
That means women’s health providers had limited access to contraception like IUDs and implants because those methods of birth control were the most expensive.
Whether or not the new program is equipped to address these issues remains to be seen. In part, it all boils down to a controversy over the allocation of state grants. The most recent round of grants from Texas Health and Human Services gave $18 million to health care clinics to help defray costs. Some of the money went to organizations that have an anti-abortion focus.
Two recent studies highlighted the problem of a specific concern – high maternal mortality rates in Texas. It’s a topic closely tied to access to prenatal care and Lesley French says it’s something the state is trying to address.
“We have known about this data since it was released back in 2012,” French says. “And so the legislature designated and created a task force on maternal mortality and morbidity to look at these issues.”
Paula Turricchi is on the Women’s Health Advisory Committee and is an Administrator for the Parkland Hospital in Dallas. She’s an advocate of systematized monitoring of the success of the Healthy Texas Women and Family Planning Programs to find out whether they’re working.
“Maybe there will be quality metrics that can be tracked for the programs to make sure that we are successful in providing excellent quality care,” Turricchi says. “How many patients are we actually taking care of?”
That type of data isn’t available yet because the programs are still being implemented, but French says it will be available before the 85th legislative session begins Jan. 10 and she’s optimistic it will show Texas can handle running things on its own.
“Women’s health is always a hot topic, but I think we have a good story to tell and we’ll keep working and improving,” French says.