Depending on how you look at it, Texas’ latest move in its fight against Planned Parenthood is either refreshingly honest or disturbingly cruel. Four years ago, Texas refused $35 million in federal Medicaid dollars for the privilege of excluding Planned Parenthood from a family-planning health program that serves low-income patients. Now, the state is admitting that it’s deprived women of necessary care and asking Donald Trump to give that money back—without the requirement, enforced under the Obama administration, that states allow Medicaid patients to use those funds wherever they wish, including Planned Parenthood.
Medicaid’s “free choice of provider” provision is one of the only things standing between Planned Parenthood and the GOP’s repeated efforts to “defund” it by preventing patients on Medicaid from getting care at its clinics. Texas is hoping that Trump, who once made the laughably daft suggestion that Planned Parenthood stop performing abortions in exchange for keeping its Medicaid patients, will show about as much deference to this longstanding rule as he has to other health-care protections for low-income Americans. If he does agree to restore Medicaid funds for Texas’ family-planning program, other states led by anti-abortion elected officials will surely follow suit and cut Medicaid patients off from the care they’ve been receiving from Planned Parenthood’s health centers.
The New York Times reports that Healthy Texas Women, the family-planning program, offers many of the same services Planned Parenthood does: HIV tests, cancer screenings, contraception, STI treatment, and basic screenings for cholesterol and blood pressure. Patients who qualify are women of reproductive age who make up to 200 percent of the poverty line but don’t qualify for Medicaid. Until Texas booted Planned Parenthood and other health-care providers that perform abortions in 2013, forcing the state to turn away all Medicaid dollars that went to the program, 90 percent of Healthy Texas Women's budget came from the federal government and it served an average of 126,000 patients a month. That was free money for the state, which subsequently had to try to fill in the gaps from elsewhere in the its budget. Last year, monthly enrollment was down to 79,000 patients. A study published in the New England Journal of Medicine last year found that, in the year-and-a-half after Texas stopped including clinics that provided abortions in its program, contraceptive use fell dramatically and childbirth among Medicaid patients rose in counties that had Planned Parenthood affiliates. Those affiliates had lost funding, and thousands of women could no longer see the doctors who were prescribing them birth control.
In Texas’ application to regain Medicaid funding for its program, state officials write that Texas has one of the country’s highest teen birth rates and the highest total birthrate, with more than half of births in the state funded by Medicaid. The application pleads that if Healthy Texas Women became a Medicaid program again, more women would be able to access the care they need. In other words, Texas is admitting that its callous attack on women’s health-care providers deprived Texans of necessary care. If Trump allows Texas to get around the Medicaid free-choice provision, he will be rewarding state health officials for selling out women’s bodies for political points and signaling to other states that it could be a winning move for them, too.
While it tries to reinstate its Medicaid waiver program without abortion providers included, Texas is simultaneously fighting to block all Medicaid funds from trickling into Planned Parenthood. A federal court has halted that attempt for now. But Texas has already caused irreparable harm with its political health-care divestments. The state ended a 28-year HIV-prevention contract with Planned Parenthood Gulf Coast in 2015, diverting its $600,000 grant to three county health departments in the Houston area. The Houston clinic that received the bulk of that grant was in a county with an HIV rate nearly twice as high as the Texas average; in the five months after the grant switcheroo, it didn’t complete a single HIV test. Indiana’s recent HIV outbreak began in a similar scenario, when the only provider of HIV tests in the area—a Planned Parenthood health center—closed due to funding cuts.
A previous move against Planned Parenthood found Texas cutting its family-planning budget by two-thirds in 2011, causing the closure of 82 health clinics, only a third of which were Planned Parenthood–affiliated. Two years later, according to a University of Texas study, the state’s women’s health program served less than half its previous number of patients. Researchers commissioned by the legislature itself argued that the action would result in more than 20,500 extra unplanned births, costing the state and country hundreds of millions of Medicaid dollars. In the Congressional Budget Office’s evaluation of the GOP’s atrocious Obamacare replacement proposal, it too estimated that the bill’s one-year defunding of Planned Parenthood would result in thousands of extra births from interrupted contraceptive care. By politicizing health care, Texas lawmakers are making sure their constituents get fewer HIV tests and more unplanned pregnancies, just so the minority of people who hate Planned Parenthood have one reason to smile at women’s expense.