Right there with them
The number of claims filed for medical and family planning services in the new state-run Texas Women’s Health Program has dropped since the state ousted Planned Parenthood from it and set up its own program without federal financing, according to figures from the Health and Human Services Commission.
Stephanie Goodman, a spokeswoman for the commission, wrote in an email that the program is “running at about 77 percent of the number of claims this year compared to last year.” She added that the agency expects to “see a similar trend with the number of women served,” though those numbers are more difficult to calculate.
“We expected to see a drop-off in the number of claims when we moved to the state program because we knew some women wouldn’t want to change doctors,” Goodman said. “We’ve been able to find new doctors for women who call us, and we’ve got the capacity to increase the number of women we’re serving in the state program.”
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While Planned Parenthood continues to provide services with community donations and other revenue, Danielle Wells, a spokeswoman with Planned Parenthood of Greater Texas, said many patients have expressed frustration “that politicians are telling them where they should and should not go for their health care.”
“We’re still hearing from patients who were in the program and were unable to locate a provider or schedule services in a timely manner,” she said. The exclusion of Planned Parenthood requires many women to travel farther to find an available provider, she said, and to make “tough decisions about paying out of pocket for care or simply putting off vital care that could potentially save lives.”
Amanda Stevenson, a research associate at the University of Texas at Austin’s Texas Policy Evaluation Project, a three-year study evaluating the impact of the 2011 women’s health policy changes, said determining whether women still have adequate access to care is complicated. While the health commission is working hard to enroll new providers to replace Planned Parenthood, she said women may delay care because they do not know which providers are available or end up paying out of pocket costs by continuing to seek services at a Planned Parenthood clinic.
“We’re seeing obviously that access is diminishing in places, particularly [those] that rely heavily on Planned Parenthood providers,” she said. But other areas of the state have not been as affected by the policy changes, she added, referencing a data application created by the researchers that shows how the 2011 policy changes and funding cuts have affected women’s health services regionally.
She also noted that more data is necessary to determine whether the percent reduction in claims represents a persistent trend.
“If things were getting better then we would expect consistent reduction in that proportion, but it’s not happening,” Stevenson said. “There might be a trend, and we might see it, but it’s not enough here to say that it is.”
To be as fair as I can to something that doesn’t deserve fair treatment, Planned Parenthood had previously served forty percent of the Women’s Health Program clients, but the decline in participation is now only about 23% of the pre-cutoff total, which means that at least some of the women who were directly affected by this bit of ideological bloodletting have since found an acceptable alternative. Hooray for small victories. Of course, they were all still forced to change doctors, and we have no way of knowing how much less convenient or more expensive these new arrangements are for them. And Lord knows the people that brought you this little catastrophe aren’t interested in finding out the answer to that. But again, as I said before, even if you could reasonably claim that access to health care is no worse than it was before, hundreds of thousands of women had their access to health care disrupted, for no good reason. And a lot of legislators plus our state leaders count that as a victory.
In related news, that ballyhooed restoration of family planning funds this session is less than meets the eye.
The Texas Women’s Healthcare Coalition has raised concerns that a bipartisan effort to restore access to family planning services by expanding a state-run primary care program isn’t shaping up as planned.
During hearings in the regular legislative session, David Lakey, the commissioner of the Department of State Health Services, told lawmakers that 60 percent of the $100 million allotted to expand the primary care program for women’s health care in the 2014-15 biennium would be used to provide family planning services and contraception. But the forms created by DSHS for health providers to apply to take part in the program do not explicitly state that 60 percent of providers’ services must go toward family planning.
In a letter sent Monday to DSHS and lawmakers, the coalition — which counts the Texas Medical Association, Texas Academy of Family Physicians and Texas Association of Community Health Centers among its 39 members — argued that the proposed rules don’t ensure that the program will achieve lawmakers’ intent of restoring access to family planning services.
“We’re concerned that this was really like a bait and switch,” Dr. Janet Realini, chairwoman of the coalition, said in an interview. Although she does not believe DSHS has intentionally disregarded the legislative intent to increase family planning services, she said, “the system to do that is missing an essential piece of direction for the contractors.”
Carrie Williams, a spokeswoman for DSHS, said the department received the coalition’s letter and is working to clear up misunderstandings about the program.
“We’ve been very open in developing and talking about this program, so it was disappointing to see these inaccuracies being promoted as fact,” Williams said in an email to the Tribune.
She added that family planning services are emphasized throughout the department’s materials on the program, but that the program does not exclusively provide family planning services.
“The 60 percent target for family planning was what we have been proposing all along. While that threshold is not explicitly stated in the materials, it has long been the plan and we have never indicated otherwise,” said Williams.
In its letter, the coalition recommended that the department explicitly prioritize family planning services by setting specific targets and performance measures for contractors. The state could save money and avert unintended pregnancies, the coalition argues, by setting performance targets for family planning services and giving funding priority to contractors that have demonstrated the ability to provide these types of services.
“I think putting it in the materials to let contractors know what you’re looking for is important,” said Realini.
In the private sector, we call that setting metrics. Metrics reflect goals and values. You can draw your own conclusions.