The XX Factor

Texas Is Hell-Bent on Ending Reproductive Health Care Access for Poor Women

University of Texas students rally in favor of reproductive rights in Austin, Texas. 

Photo by Jana Birchum/Getty Images

Texas just took steps to end reproductive health care access for the poorest of the state’s poor mothers. This morning, the Office of the Inspector General of the Texas Health and Human Services Commission sent a letter to the state’s Planned Parenthood affiliates, informing them that they were being cut out of the state’s Medicaid program. The justification was the undercover videos made by anti-abortion group the Center for Medical Progress. “Earlier this year, you committed and condoned numerous acts of misconduct that reveal repeated program violations and breach the minimum standards of care required of a Medicaid enrollee,” it said.

The state’s action may not be legal. On Monday morning, a U.S. district judge in Louisiana temporarily blocked a similar effort, ruling that Medicaid patients risked irreparable harm if they couldn’t access Planned Parenthood’s services. Under federal law, states can’t ban organizations such as Planned Parenthood from Medicaid simply because they perform abortions—if they could have, Texas would have done it already. To kick a group out of a state Medicaid program, the state has to show fraud or criminality, and none of the investigations into Planned Parenthood sparked by the CMP videos have turned up any. So the inspector general’s effort should be stayed.

If it stands, however, it is unlikely to have much of an effect on Texas Planned Parenthood. The people who will be hurt are Texas’ poorest women.

That’s because government funding for Planned Parenthood in Texas has already been gutted. In 2011, the state cut Planned Parenthood out of its Medicaid Women’s Health Program, a joint federal-state program that covered many women who earned too much to qualify for ordinary Medicaid. Prior to that year, Planned Parenthood served almost half of the program’s 119,083 beneficiaries. In order to keep those women from using Planned Parenthood, Texas had to turn its back on federal matching funds of $9 for every $1 kicked in by the state—nearly $40 million. Texas also banned Planned Parenthood from its Breast and Cervical Cancer Services program.

Thus the only government funding that still goes to Planned Parenthood in Texas comes from those who qualify for ordinary Medicaid. And in Texas—which has the strictest standard in the country—that’s only families earning less than 19 percent of the federal poverty level, or $3,760 for a family of three. Childless adults don’t qualify at all. “It’s not going to be a big blow to Planned Parenthood,” says Joe Potter, a sociologist at the University of Texas at Austin and chief investigator for the Texas Policy Evaluation Project.* “They’ve already had their big blows.”

A Medicaid cutoff would, however, be a blow to extremely poor mothers in Texas, even if the inspector general’s letter claims otherwise. “Your termination and that of all your affiliates will not affect access to care in this State because there are thousands of alternate providers in Texas, including federally qualified health centers, Medicaid-certified rural health clinics, and other health care providers across the State that participate in the Texas Women’s Health Program and Medicaid,” it says.

In fact, however, alternate providers have already shown themselves unable to fill the gap left by the state’s defunding of Planned Parenthood. A study published earlier this year in the American Journal of Public Health found that Texas’s legislation dramatically reduced access to reproductive health care. “Overall, 25 percent of family planning clinics in Texas closed,” it said. Those that remained offered fewer services, particularly long-acting contraceptives that require more clinical expertise to administer. “In 2011, 71 percent of organizations widely offered long-acting reversible contraception; in 2012–2013, only 46 percent did so. Organizations served 54 percent fewer clients than they had in the previous period.”

None of this, needless to say, has anything to do with abortion, late-term or otherwise. It’s a way for Republicans to make an anti–Planned Parenthood gesture, no matter who gets hurt.

*Correction, Oct. 19, 2015: This post originally misspelled Joe Potter’s last name.