While the State of Texas battles in court for what it says is its right to exclude Planned Parenthood from participating in the Medicaid Women’s Health Program (WHP) there, the Texas Health and Human Services commission is sending mixed messages to the more than 50,000 women who currently rely on Planned Parenthood for their care through the WHP.
Instead of waiting for the courts to decide whether Planned Parenthood, considered by the state of Texas to be an “abortion affiliate,” can participate in WHP, the state’s HHSC last week sent out a mailer to 100,000 low-income women enrolled in the program advising them that Planned Parenthood could no longer provide WHP services — despite the fact that it has not yet been excluded.
The mailer directed women to the new Texas Women’s Health Program website, which initially excluded Planned Parenthood from its provider listings, which have since been amended to include Planned Parenthood clinics. The site is meant to help WHP enrollees find doctors who will provide reproductive and contraceptive care, and at first glance appears to shore up Governor Rick Perry’s claims that the WHP would do just fine without Planned Parenthood, despite the fact that it provides services to half of the WHP’s members.
Governor Perry’s office and anti-choice lawmakers in the state have rallied behind the claim that “There are more than 2,500 qualified providers in the WHP that operate more than 4,600 locations across the state,” downplaying the significant role Planned Parenthood plays in bringing WHP access to low-income women. What Perry’s office doesn’t mention is that most of those providers are small clinics and individual doctors that aren’t currently equipped to take on the tens of thousands of women who will have to leave Planned Parenthood should the courts rule in favor of the State of Texas.
RH Reality Check set out to test the WHP’s non-Planned Parenthood provider listings over the past week and found that while initial searches of TexasWomensHealth.org turn up what appear to be hundreds of available providers, many of them don’t provide any kind of contraceptive care, don’t take Medicaid Women’s Health Program clients, or are simply misleading duplicate listings.
In Austin, for example, many WHP clients visit the Downtown Austin Clinic for contraceptives and cancer screenings. What if a resident of the 78702 zip code who formerly relied on Planned Parenthood had to suddenly find a new doctor?
We searched for providers within 30 miles of 78702, which turned up 137 doctors and clinics — initially, a very promising number. But once we weeded out the duplicates, we were left with just 49 individual providers, including those like the Austin Endoscopy Center. When we called to try to make a gynecological appointment there, we were understandably turned down: “This is a colon cancer center,” the operator told us. No women’s health care there.
Several times, locations listed on the Texas WHP website weren’t taking new Medicaid clients, were only taking those within a limited age range, or simply did not accept Medicaid Women’s Health Program patients. The People’s Community Clinic, which serves low-income and uninsured clients, told us they were only taking adolescents or pregnant women—and pregnant women are, by definition, excluded from the WHP.
The Austin Regional Clinic, which has several locations in Austin, looked promising until we were told, repeatedly, that they don’t accept Medicaid WHP clients—neither does the similarly situated Austin Diagnostic Clinic.
Ultimately, we were able to find nine providers within a 30-mile radius of our selected zip code that accepted the WHP and were taking new patients—some could see a patient for an annual exam as soon as the following day. Provided, of course, that clients are able to travel. The Lone Star Circle Of Care, which also focuses on under-served populations, had appointments in neighboring cities.
But for a WHP enrollee who may not have a car or who can’t afford to take a day or a half-day off from work, it may be a matter of having to make the difficult decision of choosing between several hours’ worth of pay—which could mean making rent or buying baby formula—or getting her annual exam.
And if Planned Parenthood is excluded from the WHP in Texas, there’s a good chance that WHP patients wouldn’t have the good luck we had in finding nine available providers if, as a George Washington University study predicts, existing providers simply will not be able to fill in the gaps left by Planned Parenthood. From the study:
In FY 2010, PPFA clinics accounted for approximately 49 percent of all WHP-financed care, furnishing services to 51,953 WHP clients out of 105,998 WHP clients served. Of the 1,469 providers that billed the WGP in FY 2010, 908 (62%) served 10 or fewer patients, while 368 (25%) served only one patient. The authors conclude that the WHP program lacks any reasonable access alternative.
Multiply just one RH Reality Check caller looking for care by 51,953, and it’s easy to imagine that a morning of phone calls to doctor after doctor—again, if a woman working and managing a family had the time to dedicate to it—might turn up no available appointments, or appointments that could only be made months in advance.
It’s also important to remember that our imagined Austin-based client lives in a major metropolitan area with public transportation and multiple hospitals and women’s health centers. WHP clients in other areas of Texas, especially those in rural towns, will have even fewer options.
We asked a Texas Planned Parenthood representative what area of Texas the group thought would suffer most if it could no longer participate in the WHP. The results were dismal: based on their research, nearly 80 percent of WHP clients get their care from family planning clinics, and they turned over a list of 25 cities that have no family planning clinics other than Planned Parenthood that serve WHP clients. The top four results–Edinburg, McAllen, San Juan and Weslaco, Texas—are all located near the Texas-Mexico border, an area that has been hit especially hard by clinics closing.
And if women in South Texas can’t see their Planned Parenthood doctors and nurses for WHP care, the Texas WHP website won’t be much help either: a search for doctors within the McAllen zip code on the WHP site turned up anesthesiologists, pediatricians, and a night clinic in their top results–plus one provider that did not take WHP clients.
Our take: if the State of Texas wants to exclude Planned Parenthood from the Women’s Health Program, they’re going to need to go beyond technical support for their website to invest huge sums of money increasing access to care throughout the state, replicating the system they are seeking to eliminate.