Behind the Headlines: The Real Story of the Women’s Health Program

Until recently most Texans had probably never heard of the Women’s Health Program. It was one of those out-of-the-way, good-government programs that consumes a relatively small amount of money (about $40 million) but does copious social good: paying for health screenings and birth control for 130,000 low-income, uninsured Texas women.

Yet despite the obvious benefits, the program’s future has been in doubt for nearly a year. As early as last spring, some Republicans in the Texas Legislature made clear their desire to do away with it. Most Texas media outlets—the Observer included—have been covering the effort to preserve the Women’s Health Program for many months.

But in the past few weeks, this once little-known program has become the issue in Texas politics—bandied about like a beach ball between Texas Gov. Rick Perry and the federal government. Here’s the short version in case you haven’t been following along: Texas had to ask the federal government to renew the Women’s Health Program, which typically would be pro forma. Except this time Perry’s administration announced it would apply to renew the program only if it could bar Planned Parenthood. The Obama administration said Texas couldn’t do that. Texas did it anyway. The feds responded by essentially saying they wouldn’t renew money for the program—and they pay for 90 percent of it— unless Planned Parenthood was included. Texas said nuts to that.

And there you have it: The Women’s Health Program is expiring in a flurry of finger-pointing, with the feds announcing the program’s end yesterday. Democrats are calling its demise part of the Republican “war on women” (war on Planned Parenthood would be more accurate). Meanwhile, conservatives are shouting about the Obama administration favoring abortion and Planned Parenthood over women’s health (it would be more accurate to say the feds are favoring federal law).

Amid all the political posturing and spinning, it’s difficult to discern what’s actually going on here. Quite a few Texans, even those reading the headlines, still don’t really know what it is, including some folks in my office.

So let’s clear up some misconceptions with a few FAQs that might help you see through the political rhetoric.

1. Women’s Health Program—sounds like a fitness regimen at the Y. What the hell is this thing?

The goal of the program is to prevent unplanned pregnancies. Oh sure, there’s a lot more to it—it’s a Medicaid waiver program with strict eligibility rules and provides health screenings for a long list of ailments and so on. But at its core the Women’s Health Program exists to provide poor uninsured women with the birth control and family planning services they need to avoid unintended pregnancies. Simple as that.

2. OK, but why is that necessary?

The program came about to fill a gap in the health care system. Lower-income women who become pregnant are usually eligible for Medicaid, which will provide health insurance during their pregnancies, deliveries, and for a short time after they give birth. Medicaid pays for more than half the births in Texas. So that’s covered. The child will likely be eligible for Medicaid. So that’s covered. But what about the mother? A couple of months, after giving birth, the mother could well be uninsured. Medicaid’s eligibility is much stricter for adults who aren’t pregnant. You have to be really poor to qualify for Medicaid as an adult. So even though her child may be on Medicaid, the mother may have no health insurance—that means no access to preventive health care or birth control.

If the mother soon becomes pregnant again and it’s an unplanned pregnancy, then not only will Medicaid have to pay for another birth, but more importantly, the mother will have another child she can’t afford to care for. That can lead to all kinds of ugly outcomes—from child abuse to neglect to placing the child in the foster care system. None of that benefits the child or taxpayers.

So providing uninsured women with family planning services seems like a good idea. And that’s how the program started. States began by asking the federal government for a Medicaid waiver—essentially permission to spend Medicaid dollars outside the program’s traditional rules—to provide birth control to uninsured, non-pregnant women.

More than two-dozen states have done this, including Texas in 2005. The Texas Women’s Health Program is narrowly focused: women ages 18-44 (child bearing age) who earn less than about $1,700 a month on their own and who aren’t pregnant. If you become pregnant, you’re off the program. It will pay for women to be sterilized—cause that’s a pretty effective way to prevent pregnancies—but once a woman is sterilized, she’s booted off the program (cause she’s no longer a risk to become pregnant).

3. Ok, we get it—the goal is to prevent unplanned pregnancies. Yeesh. But how come we keep hearing about abortion and Planned Parenthood? What does the Women’s Health Program have to do with abortion?

Nothing. Except that by preventing unplanned pregnancies, the Women’s Health Program might reduce the number of abortions. But, otherwise, nothing.

4. Doesn’t the Women’s Health Program pay Planned Parenthood to do abortions?

No. Taxpayer money can’t pay for abortions.

5. But Texas Comptroller Susan Combs sent out a statement last week in which she said excluding Planned Parenthood from the Women’s Health Program was good because, “As Comptroller, I have consistently opposed using taxpayer dollars to fund abortion services.”

This is a highly misleading statement. Taxpayer dollars don’t fund abortions (or whatever an “abortion service” is). There are very strict rules to prevent it. And Susan Combs knows it.

6. OK, that’s the official story. But Planned Parenthood is probably shifting money around under the table to pay for all kinds of things. The Women’s Health Program money may be intended for birth control, but once Planned Parenthood gets it, the money probably supports abortion some how, right? Wink, wink.

It’s basically impossible for Women’s Health Program money to contribute to abortion in any way. Remember, no pregnant women can even be on the program. And even if Planned Parenthood wanted to game the system, that would be difficult. Medicaid (the Women’s Health Program included) is a fee-for-service system. That means a woman who has signed up for the Women’s Health Program goes to an approved medical provider (a hospital or, until recently, Planned Parenthood) and receives a screening or birth control or other family planning service. The hospital or clinic then bills the state and gets reimbursed.

But—and here’s the key part—if the patient wasn’t eligible or the medical service provided wasn’t on the approved list, then the state won’t pay the bill. In other words, the government controls what services the program pays for. If Planned Parenthood tried to game the system, it wouldn’t get paid.

And Medicaid rates being what they are—which are incredibly low—hospitals and clinics aren’t making money off the deal. The Women’s Health Program money can pay only for screenings and family planning and nothing else. No abortion anywhere in sight.

But don’t take my word for it. I asked Stephanie Goodman, spokesperson for Texas’ Health and Human Services Commission, “If patients can’t be pregnant on the program, and it’s fee for service, and government money can’t pay for abortions anyway—then am I right in assuming that WHP funds couldn’t ever pay for an abortion?”

Her answer: “Correct.”

7. Then what was Susan Combs talking about?

Good question. We called her spokesperson to ask. He hasn’t responded.

8. So is this really about attacking Planned Parenthood?

Seems so. In late February, the state implemented a rule that technically forbids any entity (or its affiliates) that provides abortions from participating in the Women’s Health Program. That could leave hospitals in a tough spot. Many hospitals provide abortions.

But state officials didn’t want any part of taking on the hospitals, so the hospitals were specifically exempted. That pretty much leaves Planned Parenthood as the target. Perry has said as much.

9. And what’s wrong with excluding Planned Parenthood?

Well, it provides more than 40 percent of services in the Women’s Health Program. It’s not clear who or what would step in to provide that care if Planned Parenthood is excluded.

But there’s a larger legal question. The Obama administration contends that Planned Parenthood is a qualified Medicaid provider, and the state can’t simply exclude qualified providers simply cause it doesn’t like them. The feds say that violates federal law. Texas AG Greg Abbott disagrees and argues that Texas can exclude whoever it wants.

10. Didn’t the Legislature already cut family planning funding last spring?

Yes, but that’s a different program. The Legislature cut funding for the state family planning program by two-thirds. That’s an entirely different program that provides family planning services, though a lot fewer than it used to. The two programs offer similar services, but they’re two different pools of money.

11. Rick Perry says that Texas will create its own version of the Women’s Health Program without the federal money. Can Texas do it?

We’ll find out. Goodman, the HHSC spokesperson, says the state intends to cover all the women who were eligible for the Women’s Health Program. It doesn’t cost that much. Texas could easily make up the loss of $40 million in federal funding. But the state has to set up a new system. As part of Medicaid, the Women’s Health Program had everything all ready to go—established providers, rates, payment system. Texas will have to do all that now outside the Medicaid system and without any authority from the Legislature, which doesn’t meet till next year. State officials told the Austin American Statesman yesterday that the details aren’t that complicated. We’ll see. It’s possible the new state system won’t be ready when the Women’s Health Program expires.

If Texas does succeed with its go-it-alone strategy and excludes Planned Parenthood, then you have to suspect that other conservative states will try it too.