The XX Factor

Texas Refusal To Comply With ACA Will Hurt Sexual Health Outcomes

Rick Perry
Gov. Rick Perry addresses the the annual Conservative Political Action Conference on Feb. 9, 2012 in Washington, D.C.

Photograph by Win McNamee/Getty Images.

Gov. Rick Perry is known for his love of playing footsie with the idea of secession, though he tends to couch that rhetoric by claiming that the breaking point is at some hypothetical future date, when those damn Yankees think of doing something as awful as they did last time, with their claims that slavery was an evil that shouldn’t be tolerated in a free society. And while we’re not at letting-the-abolitionists-have-their-own-political-party level, that rhetoric has its consequences. It’s no doubt why Perry was swift to announce that Texas is simply going to refuse to participate in two of the biggest pieces of the Affordable Care Act that would help the 25 percent of Texans that are currently uninsured get coverage: the state exchanges and the Medicaid expansion.

Of the two, the latter seems like it’s going to be the bigger issue. The federal government has protocols to set up exchanges for states that don’t do it, so Perry’s petulance won’t prevent people from getting insurance through an exchange. But refusing the Medicaid expansion will leave 1.8 million Texans who would otherwise be insured out in the cold. This is going to be bad for a whole host of reasons, but one that’s worth noting is that it’s going to be very hard to turn the ship around when it comes to Texas’ shockingly poor sexual health outcomes when you leave so many people uncovered.

While STD and unintended pregnancy rates are the result of complex factors, the aggressive lack of interest the Texas government shows in getting health care to its residents shouldn’t be discounted as a major part of why it’s so bad there. It’s a simple formula: When people don’t get treated for STDs, they’re more likely to pass them on. When women don’t have the money to go to a doctor, they’re unlikely to get onto some of the most effective forms of birth control. The results are startling. For instance, the chlamydia rate in Texas from 2003-10 rose from 310 cases out of 100,000 people a year to 467 cases per 100,000, which means a net gain of 50,000 cases, a 73 percent increase in cases. How much of this increase is due to people ignoring symptoms because they simply can’t afford to see a doctor?

Texas doesn’t do much better when it comes to teen pregnancy, either. The national teen pregnancy rate in 2005 was 70 pregnancies per 1,000 girls ages 15-19. In Texas? Eighty-eight pregnancies per 1,000 girls. Some of why that rate is so much higher becomes much more clear when you compare Texas contraception rates to the rest of the country. Texas teenagers reported using a condom the last time they had sex by about 3 percentage points under the national average. But the gap between Texas girls on the pill at last sex and girls nationwide is bigger, at six percentage points. Considering that 17 percent of Texas minors are uninsured compared to 10 percent of minors nationwide, that gap is utterly unsurprising. Getting onto the birth control pill is something that’s mostly available to those with insurance. The slow squeezing out of contraception funding in the state over the past few years certainly hasn’t done anything to make that situation better.