Texas Policy Evaluation Project
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Legislators Should Seize Opportunity To Restore Family Planning Budget Cuts

By TxPEP lead investigator Joseph E. Potter

Featured in the Austin-American Statesman, April 6, 2013

Two years ago, the Texas House cut funding for the state’s family planning program by two-thirds, from $111 million to $37.9 million, effective September 2011. The 2011 budget cuts caused more than 55 family planning clinics across the state to close and left remaining providers with less funding and more patients in need of care.

Last week, the Texas House took an important step toward restoring those cuts. As the Legislature moves forward with the budget for the next biennium, I would like to share some of what our research team has learned about the devastating impact of the previous session’s cuts to women, and to taxpayers, across the state.

Following the 2011 budget cuts, clinics funded by the Department of State Health Services served only 90,826 women in state fiscal year 2012 — down from 234,710 women served in fiscal 2010. This decline will lead to an additional 20,000 Medicaid births, which will cost about $231 million in medical expenses alone, with the state having to cover 42.6 percent of those costs, or about $98 million.

We have developed a web app that provides local estimates for every county, Public Health Region, Senate district, and House district in the state. Legislators may consult this web app to see the impact in their district on clinic closures, women served, and the additional costs generated by local unintended births (www.prc.utexas.edu/txpep).*

But beyond the decline in women served and the likely increase in medical costs associated with additional unintended births, we have identified other negative impacts of the funding cuts. Of these, one of the most concerning is a shift in the type of contraception provided to low-income women. The latest scientific studies show that the best way to reduce unintended pregnancy and abortion is by promoting and facilitating access to long-acting reversible contraceptives such as IUDs, implants, and the shot. But family planning providers in Texas have been forced to cut back on the provision of these methods due to their higher up-front costs. Women who want these methods are often being asked to pay a larger fee, an expense that few women served by these programs can afford. One provider we spoke to said that it seemed as if Texas had been transported back to the late 1970s when the pill was the only available method.

Detecting the full impact of the family planning budget cuts on abortion in Texas is complicated because the funding cuts went into effect at the same time as the sonogram law, which was also passed in the last session. This law increased the cost to women of accessing abortion care and made providing abortion much more difficult, but it has had little or no effect on the decisions of women viewing the ultrasound. Another striking finding from our interviews with women seeking abortions is that 45 percent reported difficulty accessing their preferred method of contraception in the three months before getting pregnant.

Another measure taken by the previous Legislature is only now making itself felt. It was not until January that the rules preventing Planned Parenthood from participating in the Women’s Health Program went into effect. The state has argued that there are sufficient providers available to replace the excluded clinics and that there will be no consequences for the women who have to find a new provider. This claim seems to be based on the idea that any physician or health clinic can provide the needed services, and that finding a new provider is simple. Neither is true.

Most doctors and nurses have limited if any experience providing IUDs or implants, and only a few providers actually stock these methods. Even if a woman can find a new provider in her area, she may have to undergo another physical exam, wait for the contraceptive method to be ordered, and then return for another visit to receive the method. Not only are these multiple visits a costly inconvenience for women, but replacing skilled family planning providers with less experienced clinicians will also lead to fewer women using the most effective methods of contraception and higher numbers of unintended pregnancies and abortions.

There is no escaping the damage to women’s health done by the measures taken by the previous Legislature. However, lawmakers have an opportunity to reverse much of that damage, both by funding reproductive health services for men and women and ensuring that providers with the skills and experience needed to deliver those services are not excluded from the new programs.

*App no longer available online. Please contact ldixon@prc.utexas.edu for more information. 

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