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birth control

More birth control by mail options

Good to see.

“We want women to see us and say, ‘These are people who believe that if you want birth control you should have it,'” said Hans Ganeskar, co-founder and CEO of Nurx, a California-based site founded in 2015 that can both dispense and prescribe by way of computer or app.

Nurx (pronounced New RX) became available to Texas women in June, bringing the total number of states it serves to 17.

Women answer a series of health questions or in some cases undergo video consultation, and then their prescriptions are written by a state-licensed doctor affiliated with the company. The prescription is then sent to a local pharmacy to handle delivery. With insurance, the cost is generally free; without, it is $15 for a one-month supply of pills.

A similar company, The Pill Club, entered the Texas market in early July. It, too, is a California-based startup touting the same message of accessibility and inclusiveness.

The Pill Club differs from Nurx in that it provides all prescriptions and products in-house, without involving local pharmacies.

While it is possible to get an online exam and first-time prescription in some states through The Pill Club, founder Nick Chang said the exam service is not yet available to Texas women. In states where it is unavailable, women upload an existing prescription. The cost is typically covered by insurance.

Chang, a Stanford Law School graduate who also attended medical school, said his company takes its cues from the many personalized niche shopping sites such as Birch Box with its makeup or the Dollar Shave Club.

“All of these things are being delivered, but not birth control. There’s something wrong with that,” he thought as far back as 2014, although his company did not officially launch until last year. It is now in 13 states.

Contraceptives have been available through online pharmacies long before these new, more hip entrants, but Chang said for reasons not entirely clear many women were not taking advantages of them.


At Prjkt Ruby (note the text message spelling), contraception comes paired with social conscience. Also launched in 2015, the service arrived in Texas earlier this year, chief marketing officer Daniel Snyder said.

It also offers its own in-house mail-order pharmacy and prescription services. In Texas, those come after a video consultation. But the company does not accept insurance, instead charging the $20-per-cycle prescription services by cash or credit card.

For every order of a three-month cycle, the company donates 75 cents to Population Services International, a nonprofit organization that supports access for birth control to women in developing nations.

“We’re like the TOMS Shoes of birth control,” said Snyder, referring to the shoe seller that donates either a pair of shoes or a portion of the profits from other items to those in need.

Despite the white-hot political glow that surrounds all things reproductive these days, online contraceptive marketing has mostly flown under the radar, even as they also fill the controversial morning-after pills, said Dr. Kristyn Brandi, an obstetrician-gynecologist in Los Angeles and an advocacy fellow for the Physicians for Reproductive Health.

Despite some initial reservations, she said, the potential boost to access outweighs potential safety concerns in misdiagnosis.

“A lot of the trouble with contraception is getting it,” she said.

Snyder agreed, adding it’s impossible to extract the current political climate from what it happening with his company. In the days after the November election, he said they experienced a noticeable surge in business.

“People were panicking,” he said.

Indeed they were. I noted the existence of Nurx after its appearance in Texas. I think there’s a lot to be said for this business model, but I continue to be worried that it’s just a matter of time before it’s in the crosshairs of the the anti-abortion fanatics. It hasn’t happened yet – several more ridiculous anti-abortion items were on the agenda for this special session, so perhaps Greg Abbott hasn’t been informed about birth control by mail – but I’m sure it’s just a matter of time. Until then, if this is something that might be good for you or someone you know, check it out.

Texas’ teen pregnancy rate is the result of bad policy choices

From the Rivard Report:

In Texas each year, about 35,000 young women get pregnant before they turn 20. Traditionally, the two variables most commonly associated with high teen birth rates are education and poverty, but a new study, co-authored by Dr. Julie DeCesare, shows that there’s more at play.

“We controlled for poverty as a variable, and we found these 10 centers where their teen birth rates were much higher than would be predicted,” she said.

DeCesare, whose research appears in the June issue of the journal Obstetrics & Gynecology, said several of those clusters were in Texas. The Dallas and San Antonio areas, for example, had teen pregnancy rates 50% and 40% above the national average.

Research shows teens everywhere are having sex. Gwen Daverth, CEO of the Texas Campaign To Prevent Teen Pregnancy, said the high numbers in Texas reflect policy, not promiscuity.

“What we see is there are not supports in place,” Daverth said. “We’re not connecting high-risk youth with contraception services. And we’re not supporting youth in making decisions to be abstinent. We’re just saying that is an approach we want to take as a state – whereas other states have put in more progressive policies.”

Daverth said California invested in comprehensive sex education and access to contraception. There, the teenage birth rate dropped by 74% from 1991 to 2015. The teen birth rate in Texas also fell, but only by 56%.

In South Carolina, young women on Medicaid who have babies are offered the opportunity to get a long-acting form of birth control right after they give birth. They’re also trying that approach in parts of North Carolina. And Colorado subsidizes the cost of long-acting birth control. There, both abortions and teen birth rates are dropping faster than the national average.

Texas makes it hard for teenagers to get reproductive health care, Daverth says.

In Texas, if a 17-year-old mom wants prescription birth control, in most cases she needs her parents’ permission. “Only [Texas] and Utah have a law that if you’re already a parent, you are the legal medical guardian of your baby, but you cannot make your own medical decisions without the now-grandma involved,” Daverth said.

That’s part of the reason, she notes, Texas has the highest rate of repeat teen pregnancies in the country.

Emphasis mine. That’s pretty much our state in a nutshell. The problem is that any effort to deal with this necessarily begins the acknowledgment of the realities of the situation – you know, like that teens have sex and that teens who have sex without access to contraception and good information about reproductive health are much more likely to become parents than teens who do have those things – and we’re no good at that. Shame and denial is so much easier, and we live with the results of that.

SCOTUS punts on birth control lawsuit


Zubik v. Burwell was supposed to be an epic showdown over the power of religious objectors to limit the rights of others. A sequel to the Court’s 2014 decision in Burwell v. Hobby Lobby, Zubik involved regulations expanding women’s access to birth control that the conservative justices appeared to endorse in Hobby Lobby — even as they struck down a more direct method of providing contraceptive coverage to working women.

At oral arguments, however, the four remaining conservatives seemed to have a change of heart. Even Justice Anthony Kennedy, the justice who signaled the loudest in Hobby Lobby that he would tolerate the kind of regulations at issue in Zubik, appeared openly hostile towards the Obama administration’s arguments. The case seemed to be barreling towards a 4-4 non-decision. If conservative Justice Antonin Scalia had not died last February, it is all but certain that the case would have ended in a crushing defeat for the administration and for many women who hoped to benefit from the administration’s birth control rules.

But that’s not going to happen — at least not yet. On Monday, the Supreme Court handed down a brief, three-page opinion that effectively punts the case until next year at the earliest (and, presumably, after someone has been confirmed to fill Justice Scalia’s seat). The opinion explicitly “expresses no view on the merits” of Zubik and a raft of related cases. Instead, it sends these cases back down to the lower courts to consider the views expressed by both parties in supplemental briefing requested by the justices themselves.


As the Supreme Court notes in Monday’s opinion, the administration “has confirmed that the challenged procedures ‘for employers with insured plans could be modified to operate in the manner posited in the Court’s order while still ensuring that the affected women receive contraceptive coverage seamlessly, together with the rest of their health coverage.’” However, that’s not the end of the story. The administration also explained to the Court that the justices’ proposed compromise may not work for employers that self-insure (that is, employers who pay out health claims directly to employees rather than joining them into a broader insurance pool).

In any event, the one thing that’s absolutely clear from the Court’s very brief, unsigned opinion inZubik is that it will not resolve any of the nuances of how employers should exempt themselves, what should happen to women who seek birth control after an employer exempts itself, and whether self-insurance or other situations present unique problems that call for a distinct rule. The Court wants this case to go away, at least for now.

See here for the background. This is just amazing. SCOTUSBlog provides some further analysis:

One reading of Monday’s developments was that the Court, now functioning with eight Justices, was having difficulty composing a majority in support of a definite decision on the legal questions. Thus, what emerged had all of the appearance of a compromise meant to help generate majority support among the Justices. With this approach, the Court both achieved the practical results of letting the government go forward to provide the contraceptive benefits and freeing the non-profits of any risk of penalties, even though neither side has any idea — at present — what the ultimate legal outcome will be and, therefore, what their legal rights actually are under the mandate.

Those uncertainties are now likely to linger through the remainder of President Obama’s term in office, which ends next January. The appeals courts may well order the filing of new legal briefs, and may hold new hearings, before issuing a new round of rulings on the controversy. However, the entire future of the ACA, including its birth-control mandate, may now depend upon who wins the presidential election this year and which party has control of Congress when it reassembles in 2017.

The three issues that the Court had agreed to rule on, and then left hanging at least for now, were whether the ACA mandate violates the federal Religious Freedom Restoration Act by requiring religious non-profits that object to contraceptives to notify the government of that position, whether the government had a “compelling interest” in assuring cost-free access to contraceptives, and whether the move by the government to go ahead and arrange access to those benefits for those non-profits’ employees and students was the “least restrictive means” to carry out the mandate.

Doing on Monday much the same that it had done in several temporary orders at earlier stages of this controversy, the Court accepted that the non-profits already had given the federal government sufficient notice of their objection to the mandate, and that the government could use that notice as the basis for going ahead to provide actual access, at no cost, to the employees and students of those institutions.

The unsigned opinion that the Chief Justice announced included an attempt to explain why the Court was bypassing a definitive ruling on the legal issues. It cited the replies that both sides had filed, after the cases had been argued, in reaction to a suggested compromise plan devised by the Court.

The Court on Monday interpreted those filings as containing concessions that move the two sides somewhat closer together, but at the least provided a basis for letting the federal appeals courts be the first to analyze the meaning and impact of those concessions. The Court expressed the hope that the two sides would use this new opportunity, in the appeals courts, to work toward common ground that would protect the religious sensibilities of the non-profit institutions at the same time that women of child-bearing age would not be deprived of contraceptive devices and methods.

“We anticipate,” the Court said, “that the courts of appeals will allow the parties sufficient time to resolve any outstanding issues between them.” That appeared to be an invitation for the lower courts at least to explore whether the two sides could reach agreement without prolonging the court battles. It conceded, though, that there may still be “areas of disagreement” between the two sides.

It may just be my cynicism showing, but I don’t expect any of the litigants to go seeking common ground. This was from the beginning an ideological fight, and they’re not going to settle for anything less than victory. As the Trib noted, the district court in Texas originally found for the plaintiffs, HBU and East Texas Baptist University, but the Fifth Circuit overturned that verdict. I have no idea what happens from here, but I look forward to a Supreme Court with either a Justice Merrick Garland or a President Clinton-named Justice getting the case again in the future. TPM, Dahlia Lithwick, Rewire, and Daily Kos have more.

Once more with SCOTUS and birth control

Here we go.

In another major case concerning Texas women’s reproductive care, the U.S. Supreme Court on Wednesday will consider if the right to religious freedom is broad enough to completely exempt nonprofits with religious objections to birth control from providing women access to it through their insurance plans.

The case, formally known as Zubik v. Burwell, pits religious nonprofit groups — including East Texas Baptist University and Houston Baptist University — against the federal government over a provision of the Affordable Care Act requiring some employers to provide contraceptive coverage to female workers.

The Texas case is among seven related lawsuits the high court agreed to hear together in which religious nonprofits argue the mandate infringes on their religious freedom. The Obama administration says the groups are offered a way around the requirement through a mechanism that still gives women access to free contraception.

Under the federal health care act, employers with 50 or more full-time employees are required to offer health plans with “minimum essential coverage,” including access to federally approved contraception for women, without co-payments or deductibles.

Religious nonprofits can seek “accommodations” to be exempted from the contraceptive mandate by submitting a form or notification certifying the organization’s objection on religious grounds. Doing so transfers the administrative duties of providing contraception coverage from the employer to the insurance company or a third party, which takes over handling the claims.

But the nonprofits argue they should be exempted from the requirement altogether because they are still “being forced to facilitate access” to contraceptives they oppose. In this case, the religious groups object to emergency contraceptives, including the so-called morning-after-pill, and intrauterine devices, which they liken to so-called “abortifacients” — or drugs that induce an abortion. (Health experts and scientists have disputed that claim.)

That parenthetical statement really understates the matter. People are free to believe what they want, but when those beliefs are contradicted by objective reality, I’m not sure why the law needs to accommodate them. Too bad I’m not on the Supreme Court.

Anyway. I’ve been following the HBU/East Texas Baptist lawsuit from the beginning – see here, here, and here for the basics, and remember that the full Fifth Circuit – yes, that Fifth Circuit – refused to uphold the initial lower court ruling in HBU’s favor.

Given the current composition of the Court, the fact that nearly every appeals court rejected the plaintiffs’ arguments, and the way things went with the HB2 case, there was a fair amount of optimism going into this one that the good guys would prevail. Unfortunately, it looks like perhaps the Bad Anthony Kennedy showed up for oral arguments.

In Burwell v. Hobby Lobby, the last major case brought by religious objectors to birth control, the Court’s five justice conservative majority effectively wrote the “substantially burden” requirement out of the law. As Justice Samuel Alito wrote for the Court in that case, the Hobby Lobby plaintiffs “sincerely believe that providing the insurance coverage demanded by the HHS regulations lies on the forbidden side of the line, and it is not for us to say that their religious beliefs are mistaken or insubstantial.”

It quickly becomes clear during the Zubik argument, however, that the Court’s four justice liberal bloc wants to put the words “substantially burden” back into the law. Justice Sonia Sotomayor notes that, under the conservatives’ truncated reading of RFRA, it is unlikely that a plaintiff would ever fail to show a substantial burden because “we’re not asking you to do anything except identify yourself.” Justice Stephen Breyer even goes so far as to wax philosophic about how much easier life was in the few years before RFRA was enacted.

Kennedy, however, wants no part of this project to make “substantially burden” mean something again. “It seems to me that there is a substantial burden” in this case, Kennedy tells Solicitor General Don Verrilli in an uncharacteristically candid moment. About a minute later, Kennedy is even more candid, disclosing that he believes that this entire case comes down to whether the government could have used a less restrictive alternative (the third prong of RFRA) to provide birth control to women whose employers object to birth control.

For most of Verrilli’s time at the podium, however, Kennedy is sphinx-like, saying little and revealing little about whether he believes the government has made its case. Chief Justice John Roberts and Justice Alito spend this period taking shots at Verrilli. At a major argument over abortion earlier this month, the Court’s conservative wing appeared stilted and unsure how to seize the offensive with Scalia absent from the bench. Today, with Scalia’s seat literally absent from the Courtroom and just eight chairs facing the audience and the attorneys, it was clear that Roberts and Alito had their mojo back.

In their briefs, the religious objectors argue that requiring them to fill out a form in order to receive a contraceptive plan is not the “least restrictive means” of ensuring access to birth control. The government could have created a new birth control entitlement program funded by taxpayers (an alternative that Kennedy briefly appears skeptical of), or they could have offered birth control-only plans in the Affordable Care Act’s health care exchanges to women whose employers refuse to provide them with contraceptive coverage.

Alito focuses on the later of these two opinions, in a series of questions for Verrilli that can fairly be described as combative and nasty. At one point, Alito demands to know how the government can claim that Obamacare’s exchanges are “so unworkable” that they cannot provide an alternative for women that need birth control-only plans. It’s the sort of remark that seems more at home on Fox News than in the Supreme Court of the United States, and its delivered in a tone that seems to betray Alito’s bitterness over the fact that he has twice tried and failed to gut Obamacare by judicial decree.

In response, Verrilli argues that offering birth control-only coverage in the exchanges would not be a workable solution. For one thing, it’s not currently legal to sell such single-subject plans in the exchanges. For another, it’s far from clear that any private insurer would agree to offer such a plan. And even if they did, there’s no guarantee that a woman would be able to buy a plan that included the same doctors she relies upon for other medical care. This could lead to a world where a woman’s regular physician would be unable to prescribe contraception or even counsel the woman on many issues related to her reproductive health. And it would add an additional layer of complication that would discourage many women from seeking out contraceptive care.

Roberts, meanwhile, embraces the religious objectors’ argument that the government is “hijacking employers’” health plans via its fill-out-the-form regulation. This proves to be a very effective argument for Roberts, largely because it appears to sway Kennedy near the end of Verrilli’s time at the podium. In response to Verrilli’s attempt to explain some of the details of how the fill-out-the-form rules operate, Kennedy snaps back “that’s why it’s necessary to hijack the plans!”

In contentious cases, Kennedy often appears to play the role of Hamlet, asking questions of both sides and giving off an air of uncertainty about how he will ultimately vote. But when Kennedy shows real emotion in one of his questions, or when he adopts the loaded language of one of the parties, that’s normally a good sign that he’s made up his mind. When the votes are cast and the Court’s decision is released, it’s a good bet that Kennedy will vote against Team Birth Control.

Yeesh. The good news from our perspective in Texas is that a 4-4 split would leave the Fifth Circuit ruling against the plaintiffs in place. That’s a small consolation for anyone in a state governed by the Eighth Circuit, which was the one to buy into that dumb argument, of course. Perhaps some day we can get a ninth Justice confirmed and settle this once and for all. In the meantime, this may be the best we can do. Have I mentioned that this election is super important? A transcript of the oral arguments is here, while TPM, SCOTUSBlog, Kevin Drum, and the Trib have more.

The easily predicted results of de-funding Planned Parenthood have resulted as predicted

Who’d a thunk it?

Right there with them

Right there with them

A new study released Wednesday reports that after anti-abortion Texas lawmakers blocked Planned Parenthood from participating in the Texas Women’s Health Program (TWHP) in 2013, fewer low-income women received the most effective kinds of contraception. The study, published in the New England Journal of Medicine, is also the first to analyze the subsequent significant rise in some Medicaid-covered deliveries after the provider’s ouster.

Comparing quarterly medical and pharmaceutical claims from 2011 to 2014, researchers with the Texas Policy Evaluation Project (TxPEP) found that 35 percent fewer patients received highly effective intrauterine devices (IUDs) and implants — known as long-acting, reversible contraception (LARC) — over the four-year period. Claims for the injectable Depo shot, which requires follow up every three months, decreased by 31 percent. Researchers found that the rate of Medicaid-covered deliveries among women in the Depo group then increased by 27 percent.

The reduction in claims, said lead author Amanda Stevenson, highlights the fact that despite recent state efforts to recruit more providers, and claims of successwithout Planned Parenthood, patients have lost services.

“The reproductive health safety net cannot just absorb all of the demand for highly effective contraception when you remove Planned Parenthood from the network,” Stevenson told the Observer. TxPEP’s findings, she said, “directly contradict” claims “that Planned Parenthood can be removed from federally-funded healthcare programs and other providers will just step up to pick up the slack.”


For this study, TxPEP focused on patient claims that reflect the eligibility criteria for enrollees in the TWHP: legal Texas residents between the ages of 18 and 44 and who live at or below 185 percent of the federal poverty line (an annual income of approximately $44,000 for a family of four). They also compared services in counties with and without a Planned Parenthood health center.

The study found that contraceptive claims decreased most dramatically in counties with Planned Parenthood clinics, while counties without a Planned Parenthood clinic were largely unaffected.

The percentage of women who returned for their birth control shot every three months illustrates the long-term impact of losing Planned Parenthood as a program provider. Before the exclusion, 56.9 percent of patients living in counties with a Planned Parenthood clinic received their follow-up injections. After the exclusion, just 37.7 percent of patients got their subsequent shots.

In addition to cutting family planning funding by more than $70 million, the 2011 Legislature also funneled what remained of the state’s available family planning dollars away from specialty reproductive health providers, including Planned Parenthood. That, compounded by the cuts, led to the closure of 82 family planning clinics statewide; about one third of those were Planned Parenthood health centers.

I don’t even know what else to say, so I’m just going to let this speak for itself. Just repeat after me: Nothing will change until our electoral results change.

Let the budgetary games begin

The House takes up the budget today, with over 300 amendments and riders queued up for votes. A couple of things to watch for as the debate goes on:

Killing vouchers.


Lawmakers in the Texas House will have a chance to draw a line in the sand over private school vouchers during the upcoming battle over the budget Tuesday.

An amendment filed by state Rep. Abel Herrero, D-Corpus Christi, would ban the use of state dollars to fund private education for students in elementary through high schools, including through so-called tax credit scholarships.

If passed, the measure — one of more than 350 budget amendments covering topics from border security to abortion up for House consideration — would deliver a blow to Lt. Gov. Dan Patrick.


If Herrero’s amendment fails, it would represent a dramatic change in sentiment for the chamber, which overwhelmingly passed a similar budget amendment during the 2013 legislative session. Patrick, a Houston Republican who served as state senator before taking office as lieutenant governor in January, led that chamber’s education panel at the time.

Rep. Herrero’s amendment from 2013 passed by a 103-43 vote. Neither Speaker Straus nor Public Ed Chair Rep. Jimmie Don Aycock is any more pro-voucher than they were last year, and neither is Dan Patrick any more beloved, so you have to feel pretty good about the chances this time, though it’s best not to count your amendments till they pass. If it does, that won’t fully drive a stake through vouchers’ cold, greedy heart for the session, but it’ll be a solid blow against them.

“Alternatives To Abortion”

As the Texas House prepares for a floor fight Tuesday over its budget, a flurry of amendments filed by Democrats seeks to defund the state’s Alternatives to Abortion program.

A group of Democratic lawmakers filed more than a dozen amendments to either reduce or eliminate funding for the program, which provides “pregnancy and parenting information” to low-income women. Under the program, the state contracts with the Texas Pregnancy Care Network, a nonprofit charity organization with a network of crisis pregnancy resource centers that provide counseling and adoption assistance.

Since September 2006, the program has served roughly 110,000 clients. The network features 60 provider locations, including crisis pregnancy centers, maternity homes and adoption agencies.

State Rep. Jessica Farrar, D-Houston, said she filed an amendment to defund the entire program because the state is giving more money to “coerce women” into a “political ideology instead of providing information and services” at a time when Texas women’s access to health services is being reduced.

The proposed House budget allocates $9.15 million a year to the program in 2016 and 2017 — up from $5.15 million in the last budget.

“I think it’s troublesome that here we are going to almost double funding for a program that has not proven to be successful in any way,” said Farrar, chairwoman of the Women’s Health Caucus in the House. An additional amendment by Farrar would require an audit of the program.

Several House Democrats filed similar amendments, including Borris Miles of Houston, Celia Israel of Austin and Chris Turner of Grand Prairie, whose amendments would transfer more than $8 million from the Alternatives to Abortion program to family planning services and programs for people with disabilities.

“These facilities have very little regulation, no accountability and no requirement to offer actual medical services,” Turner said, adding that funding could be used for other medical programs. “My amendments are an attempt to address our state’s real priorities and needs.”

Two Republicans, meanwhile, filed measures to boost the program’s funding.

I don’t expect Dems to win this fight, but it’s a fight worth having.

Other women’s health funding issues

The state currently administers three similar women’s health programs that cover things like annual well woman exams, birth control and cancer screenings for low-income women.

The newest program, the Expanded Primary Health Care Program, created in 2013, is slated to get the funding bump, bringing the total for women’s health services in the House version of the budget to about $130 million per year.

Here is the breakdown of funding for each program:

  • Texas Women’s Health Program: $34.9 million in 2016, $35.1 million in 2017
  • Expanded Primary Health Care Program: $73.4 million in 2016, $73.4 million in 2017
  • Family planning program administered by Department of State Health Services: $21.4 million in 2016, $21.4 million in 2017

In 2011, motivated by a never-ending quest to defund Planned Parenthood, the Texas Legislature slashed family planning funding by nearly $70 million, leaving about $40 million for preventive and contraceptive services for low-income women. A recent study by the University of Texas at Austin’s Texas Policy Evaluation Project, a research group that studies the effects of family planning budget cuts, found that more than 100,000 women lost services after the 2011 cuts and 82 family planning clinics closed. In 2013, the Legislature restored the $70 million and put it into the newly created Expanded Primary Health Care Program, which became a separate item in the state budget. Still, advocates and providers have consistently fought for more money, arguing that the state is only serving one-third of women eligible to receive services.


Here is a list of other women’s health amendments and riders to watch for:

  • State Rep. Mary Gonzalez (D-Clint) filed an amendment that would allow teenagers who are 15 to 17 years old and already mothers to get contraception without their parents’ consent. Right now, state law requires that all teenagers under the age of 18 get their parent’s permission for birth control. The amendment mirrors Gonzalez’s House Bill 468, which she presented to the House State Affairs Committee in mid-March.
  • State Rep. Chris Turner (D-Arlington) has proposed a rider that would ensure sex education programs teach “medically accurate” information to public school students.
  • State Rep. Bryan Hughes (R-Mineola) proposes adding even more money to the Alternatives to Abortion program by taking almost $7 million from the Commission on Environmental Quality.
  • A House budget rider by state Rep. Sarah Davis (R-Houston) protects the state’s Breast and Cervical Cancer Services program that provides breast and cervical cancer screenings for uninsured women, under attack this session by conservative lawmakers hell bent on, you guessed it, defunding Planned Parenthood.

Some possible winners in there – in a decent world, Rep. Gonzalez’s bill would be a no-brainer – but again, fights worth having. Rep. Sarah Davis has received some liberal adulation this session for trying to do good on women’s health issues. That budget rider will be a test of whether she can actually move some of her colleagues or not.

Public education

An amendment by the House’s lead budget writer, Appropriations Committee Chairman John Otto would allocate $800 million more to certain public schools as part of a plan announced last week to diminish the inequities that exist among districts under the current funding scheme.


At the news conference Monday, Austin state Rep. Donna Howard said at least 20 percent of public schools still will receive less per-student funding than they did in 2011 under the proposal. That year, state lawmakers cut $5.4 billion from public education, restoring about $3.4 billion two years later.

“We aren’t keeping up as it is,” Howard said.

She also noted the plan also does not include the $130 million that had been earmarked for a bill containing Gov. Greg Abbott’s plan to bolster pre-K programs — an amount she described as insufficient considering it does fully restore funding to a pre-K grant program gutted in 2011.

Howard has filed a budget amendment that would allocate $300 million for pre-K.

Pre-K is one of Greg Abbott’s priorities this session, but his proposal is small ball. Rep. Howard’s amendment has a chance, but we’ll see if Abbott’s office gets involved.

And finally, same sex benefits, because of course there is.

Rep. Drew Springer (R-Muenster) is again trying to bar Texas school districts from offering benefits to the same-sex partners of employees.

Springer has introduced a budget amendment that would eliminate state funding for districts that violate the Texas Constitution, which prohibits recognition of same-sex partnerships.

The amendment is similar to a bill Springer authored two years ago, which cleared committee but was never considered on the floor. Under Springer’s budget amendment, the education commissioner, in consultation with the attorney general, would decide whether districts have violated the Constitution. Districts would have 60 days to correct the problem.

According to Equality Texas, Springer’s amendment is aimed at the Austin, Pflugerville and San Antonio school districts, which offer “plus-one” benefits that are inclusive of same-sex partners. But the group says those benefits are in line with a 2013 opinion from former Attorney General Greg Abbott, which found that such programs are only illegal if they create or recognize a status similar to marriage.

Yes, as noted, Rep. Springer has tried to meddle in this area before. I admit, I’m more worried about a budget amendment this year than a bill in 2013. Keep a close eye on that one.

There’s an app for birth control

I’m sure this won’t controversial at all.

“Isn’t there an app for that?”

Turns out there is, if what you’re after is birth control or a test for a sexually transmitted infection.

In the latest example of fast-growing “telemedicine,” video conferencing that virtually extends medical expertise, Planned Parenthood is rolling out a pilot project for real-time “office visits” that bring patient and medical provider face to face on a smartphone, tablet or personal computer.

Fueling the Planned Parenthood Care project, under way in Washington and Minnesota, is a “horrible statistic,” says Chris Charbonneau, president and CEO of Planned Parenthood of the Great Northwest: “People are sexually active for six to nine months before they get a really reliable birth-control method.”

One result: an estimated 52,500 unintended pregnancies in Washington in 2010, according to the state Department of Health.

Combine that with the prevalence of chlamydia, the most commonly reported sexually transmitted infection (STI) in the U.S., and gonorrhea — both primarily affecting people ages 15 to 24 — and Planned Parenthood hatched a plan to meet young people where they live: on their phones and mobile devices.

For now, the virtual visits create a streamlined process for getting mail-order birth control — and soon, test kits for two common sexually transmitted infections.

Along with convenience, the virtual visits provide a technological answer to this question, Charbonneau says: “How do we see people who either can’t or have difficulty walking into bricks-and-mortar sites, to at least get them started on birth control” or begin investigating a potential sexually transmitted infection?

The national Planned Parenthood organization chose Washington as one of the first states for the project because of its long history of support for women’s reproductive rights and its strong local chapter, according to the local organization.

Planned Parenthood hopes the project will expand next to Alaska and eventually go nationwide. Obstacles include state laws — and possibly some controversy in the wake of a telemedicine controversy in Iowa.


Some [anti-abortion] activists also worry that webcam visits, though solely for birth control, may ultimately lead to more abortions.

“We know how these things start,” says Dan Kennedy, CEO of Human Life of Washington. “Who is honestly going to believe that’s as far as it goes?”

I’m sure you can imagine how the “argument” will go from there. I’m posting this partly because it’s a great idea, and partly so we’re all familiar with the background when someone in the Lege inevitably files a bill to ban this. In the name of women’s health, of course. Tech Times has more.

We don’t need no (sex) education

Here’s the state of Texas leading the nation in yet another unflattering category.

In Texas and across the country, the rate of teenage births has declined significantly since its peak in 1991. Birth rates among teenagers in Texas dropped 43 percent between 1991 and 2012. In states like California and Connecticut, the drop was even larger, and nationwide, the rate declined 52 percent in that period.

But despite the improvements in the Lone Star State, it is faring worse than most. Texas has the nation’s fifth-highest birth rate among teenagers, behind Arkansas, Mississippi, Oklahoma and New Mexico. And Texas, where schools are not required to teach sex education, has the highest rate of repeat births among teenagers ages 15 to 19. Teenage birth cost Texas taxpayers $1.1 billion in health care, foster care and lost tax revenue in 2010, according to the National Campaign to Prevent Teen and Unplanned Pregnancy. Teenage mothers often drop out of school, specialists said, and their children are also likely to become teenage parents.

Gov. Rick Perry’s office said a drop in the birth rate among teenagers in the last decade corresponded with the state’s abstinence education program.

“Teen pregnancy is a multifaceted issue with many contributing factors,” a spokesman for Perry, Travis Considine, said. Among those factors, advocates said, are race, ethnicity and economic status.

Dr. Janet Realini, president of Healthy Futures of Texas, a nonprofit that works to prevent teenage and unplanned pregnancy, said that Texas’ often ineffective sex education helped explain the state’s comparatively high teenage birth rate. Other factors, she said, include the limited access to health care and insurance for the poor as well as the high rates of school dropouts and poverty.

“It’s this mentality that we’re Texas, we do it our way, we ignore science and kind of go with our gut,” said David Wiley, a professor of health education at Texas State University in San Marcos. “That Wild West mentality about public policy is not helpful.”

One state with similar demographics to Texas is faring much better: California, which cut its teenage birth rate by 64 percent from 1991 to 2012. Melissa Peskin, an assistant professor at the University of Texas School of Public Health in Houston, said Texas could lower its teenage birth rate by following California’s example in areas like sex education and access to contraception.

Others are not convinced. Jonathan Saenz, president of Texas Values, which promotes family values and abstinence-focused sex education, said California’s abortion rate is higher than Texas’.

“In Texas, since when did we think it was a good idea to adopt any policy from California?” Saenz said.

“I don’t think the proper measure is how do we compare to other states,” he added. “It’s undeniable that not only in our state but across the country, teen birth rates are at historic lows.”

The real problem, he said, is the glamorization of sexual activity.

Boy, you couldn’t come up with a better illustration of what Professor Wiley is talking about if you tried. Jonathan Saenz is the perfect distillation of the idiotic theocracy that our state is beholden to. If you need to be reminded what 2014 is all about, think about him.

Anyway. As you might imagine, the recent budget cuts that slashed family planning funds and forced the closure of dozens of clinics didn’t help. It was so bad even some Republicans are now dimly aware that there’s a connection between unprotected sex and pregnancy. As usual, we’re in the position of hoping we can maybe get back to where we were a few years ago, which is better than where we are now but still way behind where we should be given the state’s robust population growth. Which means we’ll fall even farther behind California, and Colorado, too. Happy now, Jonathan?

On a side note, according to the Trib this story is one entry in a 10-part series on the flip side of state leaders’ aggressive pursuit of the “Texas Miracle”. Other entries will be found here, and see also their Hurting For Work series for more. Kudos on the reporting here, because Lord knows there’s a ton of stories like these out there needing to be told.

Restricting abortion has always been about restricting abortion

Claims that it’s about “protecting women” have always been baloney.

In their successful push this summer for strict new regulations on abortion facilities and the doctors performing them, proponents of the legislation said it was needed because conditions at existing facilities made it unsafe for women seeking to terminate pregnancies.

But a Texas Tribune review of state inspection records for 36 abortion clinics from the year preceding the lawmakers’ vote turned up little evidence to suggest the facilities were putting patients in imminent danger. State auditors identified 19 regulatory violations that they said presented a risk to patient safety at six abortion clinics that are not ambulatory surgical centers in Texas. None was severe enough to warrant financial penalties, according to the Department of State Health Services, which deemed the facilities’ corrective action plans sufficient to protect patients.

And between 2008 and 2013, the Texas Medical Board, which regulates the state’s physicians, took action against just three doctors who performed abortions — all of them for administrative infractions that did not involve criminal practices or late-term abortions.

“The point of this legislation was to make abortion inaccessible. It wasn’t about safety,” said Amy Hagstrom Miller, chief executive officer of Whole Woman’s Health, which operates four abortion clinics and an ambulatory surgical center in Texas. “Because there is no safety problem around abortion in Texas.”


During his research on the impact of Texas’ 2011 family planning financing cuts, Dr. Daniel Grossman, a principal investigator on the University of Texas at Austin’s Texas Public Policy Evaluation Project, said he found no evidence that Texas’ licensed abortion facilities had unsafe conditions. The one safety issue he has identified is the practice of abortion self-induction — where women without easy access to abortion clinics try to terminate the pregnancy themselves.

“This additional burden is just going to be too much for some women,” Grossman said. “I think it’s very, very likely that abortion self-induction is going to go up and that’s definitely going to be bad for women’s health.”

Seven percent of women whom the researchers surveyed at abortion facilities in Texas attempted self-induction before going to the abortion facility. That rate was higher, 12 percent, in cities along the Texas-Mexico border. In comparison, a 2010 research article published in the American Journal of Obstetrics & Gynecology found 1.2 percent of women surveyed at abortion clinics nationally tried to self-induce an abortion.

The researchers identified 76 family planning clinics that closed since 2011 because of lost state financing, and 45 percent of women surveyed at abortion facilities said they were unable to access their contraception of choice in the three months before becoming pregnant.

“These abortion restrictions are going into place at a time when the whole family planning safety net really has been completely dismantled,” said Grossman. “In the middle of that, now women are going to find it harder and harder to access abortion.”

The only surprise in this to me is that the anti-abortion zealots feel the need to disguise their intentions by making phony claims about being concerned about women’s health. It’s only a mild surprise, since that does poll better, but still. It’s a fundamentally dishonest argument, and in a state that’s been busy forcing women’s health clinics out of business, it’s a deeply cynical one, too. BOR has more, and Nonsequiteuse has something you can do to help fight back.

Feds bypass the state on Title X funds

Very interesting.

The federal government announced [Monday] that it would no longer award a large slice of federal family-planning funds to the state of Texas. Instead, the feds will award the $6.5 million grant to the Women’s Health and Family Planning Association of Texas, a coalition of providers led by Fran Hagerty, to distribute to clinics for birth control, wellness exams, STD screenings and other family planning services.

The Observer reported in November that the coalition would apply directly to the federal government for the grant—called Title X (Title 10).

Before today, the sole grantee for Texas’ Title X funds had been the Texas Department of State Health Services. The health department had in turn distributed the grant money to family planning providers statewide. In 2011, the Title X grant had been part of $111.5 million available to the state for family-planning services.

But the 2011 Legislature slashed family planning funding by two thirds, causing more than 60 clinics to close and cutting in half the number of Texans receiving services through Title X, according to an annual review by the Texas Department of State Health Services.

The collateral damage wrought by this decision has been widespread. Many of the providers in Hagerty’s coalition had lost state family-planning funds and are struggling to stay open. Though they still received other government health funding, the loss of Title X grant money had been keenly felt. Unlike other state funding streams, the Title X grant had allowed providers to cast privacy protection over all of their clients. This is especially important for teens that would otherwise need parental consent to access birth control. The Title X grant also allowed clinics to buy pharmaceutical drugs at a steep discount, and gave them the flexibility to invest in staff and infrastructure. Losing the Title X money and the flexibility that came with it had seriously destabilized the family planning safety net across Texas and reduced low-income women’s access to birth control and preventive care.

The federal government in turn decided that Hagerty’s group would be a better steward of Title X.

The Texas Department of State Health Services had sponsored 40 providers that operated a total of 122 clinics. Hagerty’s coalition will distribute the Title X money to 34 contractors operating 121 clinics across the state, beginning next month. Hagerty said in an email that she doesn’t yet know how much the three-year budget will be due to uncertainty over federal budget cuts.

“WHFPT and [the Department of State Health Services] must work together to improve the health status of all Texans,” Hagerty wrote. “We are all ready and eager for this opportunity to provide family planning care for Texas families.”

Trail Blazers, the Trib, and the AusChron also reported on this, with the latter recapping some more of the history of this coalition and noting that Planned Parenthood is a member of it. I blogged about the Observer’s reporting in November as well. Not surprisingly, the powers that be in Texas didn’t take this well.

Gov. Rick Perry on Tuesday called a decision by the Obama administration to send a $6.5 million federal family planning grant to a Texas coalition of women’s clinics, rather than a state agency, “a clear attempt to circumvent the will of the Texas taxpayers and impose their own values on the people of Texas.”

His criticism of the White House at a Texas Faith and Family Day rally at the state Capitol was echoed by Lt. Gov. David Dewhurst, who claimed the decision would “line the pockets of Planned Parenthood.”


egarding the grant announced this week, Fran Hagerty, CEO of the Women’s Health and Family Planning Association of Texas, said she believes her group won the competition because it demonstrated it could serve more women than the state agency’s program. The association promised to serve some 160,000 women next year, while the state’s program reached only 65,000 last year because of rules limiting what kinds of health entities could access the funds. She also said that only two of the 34 clinics in her association are affiliated with Planned Parenthood.

“Nobody is making money off of anything,” Hagerty said. “It’s not possible. People do this work because they care.”

Hagerty noted that in 2011, the Texas Legislature cut $73 million from the budget’s family planning programs, forcing some 50 women’s health clinics across the state to close. Health and Human Services Commission analysts have estimated the family planning cuts would result in 24,000 more births to low-income mothers, at a cost of as much as $273 million more in spending by the state, mostly in Medicaid expenses, over the next budget cycle.

“We are hoping to go back and reopen clinics,” she said. None of the 34 clinics that will get the grant money provide abortions. “They provide high-quality family planning.”

Blake Rocap, legislative counsel for NARAL Pro-Choice Texas, praised the decision by the Obama administration and argued that rules adopted by the Legislature should not apply because “it’s not Texas’ money.”

“They submitted a more competitive bid than the state agency,” he said. “Is the state afraid of a little free-market competition?”

Ouch. As I said back then, this is good news for the coalition since it will not have to put up with the state’s BS for these funds. Lord knows, with the way the Lege continues to screw with Planned Parenthood and women’s health in general, any degree of freedom is good. I wouldn’t count on it long-term, since there’s no guarantee the federal government won’t someday be as reactionary and anti-woman as the 2011 Lege was, but it’ll do for now. The hysterical reaction from Perry et al is strong evidence that this was the right call.

You can’t undo the damage to women’s health

At the very end of this story, in which Rep. John Zerwas and Sen. Charles Schwertner, both of whom are physicians in real life, say that they (mostly) stand with Rick Perry on not expanding Medicaid, they also say this:

Regarding the budget cuts in the last legislative session to family planning and women’s health care, both lawmakers said they support an initiative this session to restore funding by way of primary care programs.

“We’re going to recommend a funding level for [women’s health] … at about 50 percent higher than what they had originally asked for,” Zerwas said.

That’s mighty big of them, isn’t it? We’ve also recently heard about some similar sentiments elsewhere in the Senate:

Health and Human Services Committee Chair Jane Nelson, R-Flower Mound, touted a recommendation Thursday to add $100 million for women’s health services to the Senate’s budget proposal.

The recommendation was adopted by a working group of senators who serve on the Senate Finance Committee. Nelson heads the working group.

“It’s time for us to unite behind solutions we can all agree are in the best interest of keeping Texas women healthy. I believe in the power of prevention, and our plan will ensure that Texas women have access to the best possible preventive services such as cancer screenings,” Nelson said in a statement.

She also said the state must expand its provider network, provide more access for women in rural areas of the state and “recognize that family planning is a critical component of our efforts to support the health of Texas women.”

Nelson said the Senate’s starting-point two-year budget contains about $114 million for women’s health. Her workgroup proposed adding $100 million for women’s health through the Community Primary Services Program.

That program is different from the family planning program, whose funding was slashed by about $73 million, or two-thirds, two years ago by the GOP-dominated Legislature.

We are also aware of a bipartisan legislative group that is rethinking those family planning cuts. Before anyone dislocates a shoulder patting themselves on the back, however, I’d like to point out that some things, once broken, can’t be fixed.

Now, seven months later, the clinics remain closed. Shaw, who still runs other programs at Hill Country Community Action, recently told me that only 110 clients have called the agency for directions to other providers. The receptionist refers patients to Round Rock or Waco. When I called those providers, I was surprised to find that they could offer me next-day appointments. Though 98 percent of Hill Country Community Action’s clients had received well-woman care for free, this is not the case at other clinics. No longer able to participate in the Women’s Health Program for political reasons, Planned Parenthood in Waco must now charge patients for care. A well-woman exam, for example, costs $99. Women’s Health Program clients can be seen for free in San Saba at a local Scott & White provider, but that clinic charges full-fee to those who don’t qualify: women under 18 or over 44 or who can’t prove that they are legal citizens. An office visit at the Scott & White clinic would cost $83. Similarly, Lone Star Circle of Care in Round Rock provides services on a sliding fee scale based on income. None of their services are free.

It was more difficult to track where other displaced clients had gone. A Scott & White staffer told me by phone that she hadn’t seen an increase in new patients since Hill Country Community Action closed its clinics. Similarly Lone Star Circle of Care, via an email from director of communications Rebekah Haynes, said that the number of patients the Round Rock clinic had seen from San Saba was relatively small. The Planned Parenthood health center in Waco had seen a significant uptick. Danielle Wells, assistant director of communications for Planned Parenthood of Greater Texas, said by email that in 2012, the Waco health center had served 10 to 15 times as many patients from the zip codes once served by Hill Country Community Action as the year before. Clearly, some displaced patients have found new providers, but others haven’t. Time will tell what effect the closures will have on the reproductive health of those others, but public-health policy analysts are expecting an increase in unintended pregnancies and the number of births covered by Medicaid.

Texas’ new family-planning infrastructure is in flux. The Texas Legislature has three months left in its 83rd regular session, and advocates are lobbying for lawmakers to restore money while public-health specialists are scrambling to study the impact of the state’s defunding of family-planning clinics. In San Saba, even if funding is restored, it would be difficult to reopen the clinics. The staff has mostly moved on to other jobs. Gina Woodward now works for her family business, having hung up her stethoscope for good. After months at home, Melody Ball started a job in another field this month. Eva McDuff is still without work. I asked Tama Shaw if she might revive the family-planning program if funds are restored from the state or federal government. “It would take too much startup money, because the facilities are gone,” Shaw said. “We couldn’t start up again. Everything is gone.”

Those are the last three paragraphs in a story about a small community clinic in San Saba that had to close its doors after getting shafted by the 2011 Lege; see also this story from last year about other clinics around the state getting devastated. Some services will be restored in some places for some people, but sometimes you can’t un-ring the bell, or perhaps more appropriately, you can’t un-fertilize the egg. Everyone who voted for those cuts in 2011, no matter what they do this session, will forever have that stain on them.

The birth control poll

The Texas Freedom Network would like you to know that Texans support having access to birth control.

A new statewide poll from the Texas Freedom Network Education Fund shows Texans believe that access to family planning and birth control is important and should not be limited by a woman’s income level, employer or medical provider. Voters support government taking action to ensure that Texas women can make their own decisions about family planning, including providing state funding for family planning and birth control programs in the state.

Support for state funding for providing access to family planning services and birth control for low-income women is both broad and deep, crossing political, racial, generational and geographic lines. Moreover, strong support exists for access to birth control among religiously observant Texans, including both Catholics and Protestants, as well as Born-again Christians.

Here’s the poll memo:

Texans believe that access to family planning and birth control is important and should not be limited by a woman’s income level, employer, or medical provider. Voters support government taking action to ensure that Texas women can make their own decisions about family planning, including providing state funding for family planning and birth control programs in the state.

Support for state funding for providing access to family planning services and birth control for low-income women is both broad and deep, crossing political, racial, generational, and geographic lines. Moreover, strong support exists for access to birth control among religiously observant Texans, including both Catholics and Protestants, as well as Born-again Christians.

Voters support efforts to make birth control more accessible to women, not less. Texans oppose the cuts to funding for family planning made by the state Legislature in 2011 and want to see funding restored. They also oppose allowing employers to deny their employees health care coverage for family planning services and birth control, and want to ensure that state funding for family planning goes to medical providers that offer a full range of family planning services, including birth control.

The results in this report are based on a statewide poll of registered Texas voters, conducted by Greenberg Quinlan Rosner and Chesapeake Beach Consulting for the Texas Freedom Network Education Fund. The survey reached a total of 604 registered voters in Texas and was conducted February 6 – 11, 2013. The margin of sampling error for the sample is +/- 3.99 percentage points at a 95 percent confidence level.

The poll was conducted jointly by Democrat Anna Greenberg and Republican Bob Carpenter. It has certainly accomplished the goal of getting media attention, as these Chron, DMN, Statesman, AusChron, and Hair Balls stories show. But only the Texas Observer notes the disconnect:

Despite the overwhelming evidence of support for family planning services, some legislators have filed bills that go after contraception. Rep. Jonathan Stickland (R-Bedford), for example, is pushing “Hobby Lobby” legislation, which would give tax breaks to companies, like Hobby Lobby, that face federal fines over their refusal to provide emergency contraception coverage to their employees through insurance.

Rep. Jeff Leach (R-Plano) filed HB 1057 last week, which would prevent abortion providers or their affiliates (like Planned Parenthood) from providing sex education materials for public schools.

But, according to [TFN President Kathy] Miller, this study only illustrates that lawmakers have lost sight of what Texans actually want. “Last legislative session, we saw some legislators openly declare war on contraception. Texans clearly want that war to stop,” Miller said.

I’m not surprised by this poll result, and I do hope it gets a lot of attention. But, and I hate to be a wet blanket here, the fact is that many Republican legislators have nothing to fear, or at least they believe they have nothing to fear, from it. Not to put too fine a point on it, but when was the last time someone lost an election in Texas for being wrong on birth control? Far as I can tell, the next time will be the first time. Lord knows, there are plenty of Republicans who’ll be on the ballot in 2014 that should take heed of this, starting with our promiscuously litigious Attorney General/Governor wannabee Greg Abbott, who’s been busy amicus-briefing the federal courts over the Obama administration’s contraception mandate for employers, including Hobby Lobby. But until someone actually does lose an election over this, why should we expect anything or anyone to change? Someone needs to start convincing some of those Republican women to reconsider some of the people they’ve been voting for.

The war on women continues apace

Honestly, I’m surprised that it’s taken as long as it has for this to happen.

Right there with them

Abortion clinics in Texas may soon face harsh new state requirements that pro-choice advocates say could greatly reduce access to abortion.

Sens Bob Deuell (R-Greenville), Donna Campbell (R-New Braunfels) and Charles Schwertner (R-Georgetown) filed a bill this morning that would require abortion clinics to meet the same conditions as ambulatory surgical centers.

The measure, Senate Bill 537, would force abortion clinics to follow the Texas Administrative Code for surgical centers, a 117 page document outlining everything from laboratory, nursing and anaesthesiologist requirements to radiological and construction procedures. Most of this code has little to do with the services provided by abortion clinics.

Filed by three pro-life doctors, legislation like this has been viewed as an underhanded tactic, which, in other states (like Alabama), has been criticized for threatening to close abortion clinics that don’t have the capacity or funding to meet such strict new requirements.

However, Sen. Deuell contends that the legislation is simply a method of increasing safety and health among Texas women. “Just as a medical doctor,” he said, “it came to me that they’re not under the same standards as any other surgical clinics and that we need to put them under that just for the safety of the patients.”

Deuell was adamant that the bill isn’t a pro-life tactic to close abortion clinics or make abortion less accessible. “It has nothing to do with abortions being done or not done.” He continued, “They’re legal, so they’re being done, and it is a surgical procedure, and it needs to be done in a place that has the same standards as a surgical center. Simple as that.”

He also asserted that the legislation would actually improve women’s health and accessibility to abortion providers. “The pro-choice movement talks about wanting to take abortions out of the back alley so they can be done properly. If you’re not certified as a surgical center, then that gets more toward the back alley and not in mainstream medicine, which is where it needs to be,” Deuell said.

Yes, I’m sure this just now came to Sen. Deuell. Of course, by his own reasoning, if he’s so concerned about women’s health, this should have been the very first bill he ever filed in the Senate. I mean, just think about all those poor women, having to get abortions in clinics that don’t measure up to his standards for cleanliness and safety for all these years. It’s scandalous, really. Of course, anyone who is content to let thousands of people die through his or her inaction or out of political spite really has no standing to claim “concern” for anyone’s health. The term “pro-life” is such a travesty these days, Jonathan Swift would be embarrassed to use it.

Not that any of that matters, I suppose. If this passes the Senate it will easily become law, and I have no reason to believe the courts will block it. As such, there are three people in the state that can prevent this from happening: Senators Eddie Lucio, Carlos Uresti, and Judith Zaffirini. It was their support of the awful sonogram bill that allowed it to clear the two-thirds bar in the Senate and make its way to Rick Perry’s desk. It took all three of them to enable its passage, since Jeff Wentworth stood with the other nine Democrats to hold this off. Depending on whether this abomination comes to the Senate floor before or after the SD06 special election is resolved, we may need two or all three of them to say no, this is going too far. This would be an excellent time to call their offices and make your voice heard, especially if you live in their district. It’s up to them to decide who they want to stand with.

Somewhat ironically, that news story cam out at the same time as this one.

Doctors, hospitals, clinics, health care groups, faith organizations and family planning associations urged lawmakers Wednesday to restore funding cut from women’s health programs for contraceptives and health screening.

At the forefront of their fight are two women who serve on the House Appropriations Committee, Republican Rep. Sarah Davis, of West University Place, and Democratic Rep. Donna Howard, of Austin. Both appeared at a Capitol news conference hosted by the Texas Women’s Healthcare Coalition.

Howard cited state estimates that thousands more unplanned births to low-income women as a result of family planning cuts will cost Texas millions more in Medicaid payments.

The state has projected 6,480 more Medicaid births at a cost of $33 million in the current fiscal year due to the reduction in family planning expenses. In the next two-year budget period, an extra 24,000 births are anticipated at a cost of $103 million.

Davis, a breast cancer survivor who is on an Appropriations subcommittee overseeing health and human services, said, “It’s really no longer the time to be playing politics with women’s health.”

In the Statesman, Rep. Davis is quoted saying that some of her Republican colleagues who voted for the cuts “didn’t realize they would hurt other kinds of clinics”, which is a polite way of saying that they’re deeply ignorant. They were told at the time exactly what would happen, they just chose not to believe it. It’s nice to hear that they may be slightly less willfully dumb this time around, but their concern for women’s health remains at best highly selective.

Smaller WHP provider list back up

Maybe they got it right this time.

Right there with them

A revised list of Texas Women’s Health Program providers — with 965 fewer doctors and clinics — has returned to the state’s website.


The HHSC had previously stated that the Texas WHP had 3,500 participating providers, roughly 1,000 more than the number of providers that participated in the former Medicaid WHP. That list has shrunk to 2,448 doctors and clinics, as 965 providers said they would not accept WHP patients, despite being certified for the program. The contact information for 700 other providers has also been updated on the state’s website.

“HHSC added the provider search back to the Texas Women’s Health Program website late Friday after thousands of calls were made to verify the information,” Linda Edwards-Gockel said in an email. “The search is now set up to display first those health care providers who can serve the greatest number of clients.”

State Rep. Jessica Farrar, D-Houston, said in an email that she remains skeptical of the list’s accuracy. Farrar requested a list of all WHP providers and the number of patients they can serve from the HHSC under the Public Information Act, but the agency is still processing her request. “After briefly going through part of the list for Houston providers, my staff already found numerous duplicates.”

Going from 3,500 providers to 2,448 is a reduction of thirty percent. If I’m reading this correctly, there are now as many providers in the replacement WHP as there were in the original, except that the single largest provider by far is no longer allowed in. Would someone please remind me how it is that this program could possibly be an adequate alternative to the perfectly functional one we used to have? Assuming that this “corrected” list of doctors and clinics is now in fact complete and accurate, which is not a sure bet. We’ve had our fun error-checking the HHSC’s work, but the real issue is still how many of the women who depend on this program will actually be able to receive adequate health care through it? We can’t lose sight of that. Trail Blazers has more.

From the “Babies and other hazards of sex” department

Rep. Donna Howard has more tact than I do.

Who knew?

When state lawmakers passed a two-year budget in 2011 that moved $73 million from family planning services to other programs, the goal was largely political: halt the flow of taxpayer dollars to Planned Parenthood clinics.

Now they are facing the policy implications — and, in some cases, reconsidering.

The latest Health and Human Services Commission projections being circulated among Texas lawmakers indicate that during the 2014-15 biennium poor women will deliver an estimated 23,760 more babies than they would have as a result of their reduced access to state-subsidized birth control. The additional cost to taxpayers is expected to be as much as $273 million — $103 million to $108 million to the state’s general revenue budget alone — and the bulk of it is the cost of caring for those infants under Medicaid.

Ahead of the next legislative session — where lawmakers will grapple with another tough budget, including an existing Medicaid financing shortfall — a bipartisan coalition is considering ways to restore some or all of those family planning dollars, as a cost-saving initiative if nothing else.

“I know some of my colleagues felt like in retrospect they did not fully grasp the implications of what was done last session,” said state Rep. Donna Howard, D-Austin, who said she has been discussing ways to restore financing with several other lawmakers in both parties.

“A lot of us are talking about this,” she said. “I think there is some effort they’ll be willing to take to restore whatever we can.”

In other words, some of Rep. Howard’s colleagues are just now beginning to grasp the idea that more babies are the inevitable result of a public policy to restrict access to birth control. I’d suggest that we add the subject to the STAAR tests, but it’s too late for these august members of the Texas Legislature. Before you ask, this dawning revelation will not lead to any letup in the anti-Planned Parenthood jihad, because providing family planning funds to the leading provider of family planning service is beyond the pale. If we’re lucky, perhaps there will be another great epiphany in two years’ time.

News flash: Birth control prevents unwanted pregnancies

I know, I’m as shocked as you are.

Right there with them

Free birth control led to dramatically lower rates of abortions and teen births, a large study concludes. The findings were eagerly anticipated and come as a bitterly contested Obama administration policy is poised to offer similar coverage.

The project tracked more than 9,000 women in St. Louis, many of them poor or uninsured. They were given their choice of a range of contraceptive methods at no cost — from birth control pills to goof-proof options like the IUD or a matchstick-sized implant.

When price wasn’t an issue, women flocked to the most effective contraceptives — the implanted options, which typically cost hundreds of dollars up-front to insert. These women experienced far fewer unintended pregnancies as a result, reported Dr. Jeffrey Peipert of Washington University in St. Louis in a study published Thursday.

The effect on teen pregnancy was striking: There were 6.3 births per 1,000 teenagers in the study. Compare that to a national rate of 34 births per 1,000 teens in 2010.

There also were substantially lower rates of abortion, when compared with women in the metro area and nationally: 4.4 to 7.5 abortions per 1,000 women in the study, compared with 13.4 to 17 abortions per 1,000 women overall in the St. Louis region, Peipert calculated. That’s lower than the national rate, too, which is almost 20 abortions per 1,000 women.

In fact, if the program were expanded, one abortion could be prevented for every 79 to 137 women given a free contraceptive choice, Peipert’s team reported in the journal Obstetrics & Gynecology.

The findings of the study, which ran from 2008 to 2010, come as millions of U.S. women are beginning to get access to contraception without copays under President Barack Obama’s health care law. Women’s health specialists said the research foreshadows that policy’s potential impact.

“As a society, we want to reduce unintended pregnancies and abortion rates. This study has demonstrated that having access to no-cost contraception helps us get to that goal,” said Alina Salganicoff, director of women’s health policy at the Kaiser Family Foundation.

“It’s just an amazing improvement,” Dr. James T. Breeden, president of the American College of Obstetricians and Gynecologists, said of the results. “I would think if you were against abortions, you would be 100 percent for contraception access.”

You would think so, wouldn’t you? But of course the same so-called “pro-life” zealots in our Legislature also spent the last session slashing funds for family planning services, thus doing their best to ensure that we have a maximal unwanted pregnancy rate. Sen. Dan Patrick once told Paul Burka that even if he opposed the sonogram bill, he ought to “celebrate if a life was saved because a woman, who chose to see the sonogram, or hear the heartbeat, decided to keep her child, or put it up for adoption”. You’d think people like that would want to take every reasonable step they could to reduce the number of abortions, but clearly their definition of “reasonable” doesn’t include family planning or contraception. Instead, this is what we get from the “pro-life” lobby:

Jeanne Monahan of the conservative Family Research Council suggested contraceptive use can encourage riskier sexual behavior.

“Additionally, one might conclude that the Obama administration’s contraception mandate may ultimately cause more unplanned pregnancies since it mandates that all health plans cover contraceptives, including those that the study’s authors claim are less effective,” Monahan said.

It’s about the sex, you see. It’s always been about the sex. If you’re going to have the kind of sex that the Family Research Council doesn’t approve of, then you deserve whatever consequences you suffer as a result.

Health care access continues to shrink in Texas

Who needs family planning services? I mean, every kid is born to people who want and can care for them, am I right?

About 15 percent of Houston-area clinics that received state funding for family planning services closed their doors because of budget cuts last fiscal year, and another 30 percent have reduced service hours, according to a study published this week.

Following a political firestorm in the 2011 legislative session, state family planning funds were cut from $111.5 million to $37.9 million for the biennium, cutting services to as many as 180,000 women in Texas a year, according to state health department officials. The number of clinics funded by the Texas Department of State Health Services has dropped from 300 to 136 since the Legislature slashed funding, state officials said.

“Ostensibly, the purpose of the law was to defund Planned Parenthood in an attempt to limit access to abortion, even though federal and state funding cannot be used for abortion care anyway. Instead, these policies are limiting women’s access to a range of preventive reproductive health services and screenings,” a team of academics from the University of Texas at Austin’s Population Research Center wrote in the New England Journal of Medicine article.

That report can be found here, via this Trib story that notes a total of 53 such clinics closed their doors statewide.

In addition, the report states, many clinics are now charging for services that were previously free, raising prices for other services and restricting access to more effective methods of contraception that are more expensive.

To meet the requirements of the new priority funding system, the Department of State Health Services told the researchers that the state stopped funding 35 of 76 family planning clinics in the 2012-13 biennium. The budgets of family planning clinics that still received funding were reduced by up to 75 percent. As a result, about half of the clinics that closed — 25 — were family planning clinics, according to the report.

Well-woman exams and contraception “remain out of reach for some of the poorest women,” sociologists conclude in the report. “The organizational leaders we spoke to reported that women who can pay the newly instated fees are choosing less-effective methods, purchasing fewer pill packs, and opting out of testing for sexually transmitted infections to save money.”

State Rep. Bryan Hughes, R-Mineola, said at The Texas Tribune festival on Saturday that many programs took financial hits last session because of the state’s budget shortfall. Funding that was cut from family planning “went to pretty noble places,” such as programs for children with autism. He also said the tiered funding system lawmakers implemented has brought new women’s health providers to his rural district.

But state Rep. Donna Howard, D-Austin, disagreed with Hughes. She said family planning providers in her district have told her that many clients can no longer afford to see them because they have to charge for services that were free before.

“We have the highest uninsured rate in the country,” Howard said at the festival. “If we want people who do not have the means to provide their own health care to be able to be healthy productive citizens, then, absolutely, we need to be looking at supporting family planning.”

And the Republicans, led by Rick Perry and Greg Abbott, are doing everything they can to ensure that Texas maintains that national lead in uninsured population. Again, there is nothing in the Republicans’ decade-long control of the state to indicate that they consider this to be a problem. And you have to love Speaker wannabe Hughes‘ excuse for cutting family planning: It was either that, or we stick it to the autistic kids. Because there were absolutely no other possible options available to them.

Former Trib writer Thanh Tan, now living in Seattle, puts all this into a national context.

And what are the consequences of cutting off family planning funds to women in a state like Texas? The Legislature’s own non-partisan budget team predicts at least 20,000 additional Medicaid births, for one thing. We’ll have to wait and see whether that actually happens. The National Latina Institute for Reproductive Health has reported higher-than-normal rates of diagnoses and death from cervical cancer along the Texas-Mexico border. It’s worth noting that cervical cancer is treatable if detected early. The greater challenge is convincing women to get screened in the first place.

So why do I care about this issue so much, even though I’m no longer living in Austin?

Overall, the left-leaning Center for Public Policy Priorities points to Census data that shows the U.S. added 2 million kids in the last 10 years– half of that growth came from Texas. One in 11 kids in the U.S. is a Texan. They’re growing up in an education system that lawmakers underfunded this biennium by $5.4 billion. The textbooks they’re learning from are highly controversial. Public schools only teach abstinence, even as the teen pregnancy rate ranks 4th in the nation.

For now, Texas is responsible for all those kids. But someday, they will grow up. Like me, they may even head to the Pacific Northwest. Therefore, I believe we all have an interest in ensuring that Texas women are healthy and become parents when they are ready. I admire those who choose to follow through with an unplanned pregnancy and become parents. But in too many cases, the consequences can be disastrous. I’ll never forget the experience of walking through an emergency shelter in San Antonio that was filled to capacity with abused and neglected children. The executive director told me it was a daily struggle to convince some kids they didn’t have to stuff their pockets with food.

Many opponents of family planning in Texas say they made the tough decision to reduce funding because of budget woes. Others deny birth control works. Most Republicans in the Legislature accuse Planned Parenthood of using the funds to prop up their abortion services. It’s all balderdash — claims based on political ideology over reason and science.

Federal studies have shown that for every dollar the state invests in family planning, more than $3 is saved. Helping women plan and space their pregnancies often means that they and their children will not be born into subsidized health care or have to rely on the state for basic nutrition needs. It’s a way to break the cycle of poverty, promote self-sufficiency and save taxpayers’ money in the long run.

Yeah, too bad we’re not doing any of that. We must love poor people in Texas, we do so much to ensure we have a steady supply of them.

Yvonne Gutierrez: Republican support for women’s health?

The following is from a series of guest posts that I will be presenting over the next few weeks.

Right there with them

We all know there is a lot at stake for the 2012 election cycle. All eyes are on Washington but the old adage is true — all politics is local. State Legislative races are crucial. Especially when it comes to women’s health care – the most popular political whipping boy (or girl, rather) of late.

The 2011 convening of the State Legislature produced dismal outcomes across the board, most notably in women’s health care. The state’s family program was slashed by two-thirds. The cut will actually cost taxpayers nearly four times as much – in excess of $230 million – in additional Medicaid costs.

Additionally, not a single bill was passed that would renew and expand the successful Texas Women’s Health Program (WHP). The health care program brings in $9 in federal dollars for every $1 Texas pitches in and was highly recommended by the nonpartisan/bipartisan Legislative Budget Board. So why no bill? Because Planned Parenthood is the most utilized and trusted provider in the program that makes health care accessible to more than 100,000 women statewide. The Texas Health and Human Services Commission (HHSC) drafted and approved a rule that would exclude Planned Parenthood from the program. The rationale for the rule: Planned Parenthood clinics that receive WHP and do not provide or promote abortion (because it is against the law and has been for more than three decades) share a name with entities that do and are therefore “affiliated”.

Planned Parenthood is rightly challenging the rule in the courts stating that it is a violation of constitutional freedoms of speech and association. Planned Parenthood family planning clinics can’t be excluded from any federal or state family planning program simply because completely separate legal and financial corporations provide legal abortion services with private dollars.

Now, the state of Texas is spending precious dollars on defending their unconstitutional rule. Dollars that could have been spent on oh, I don’t know, health care for low income Texans. Meanwhile Governor Perry maintains he will set up his own state women’s health program. He’s instructed state officials to find nearly $40 million to set up the state program because he’s been warned that restricting a woman’s choice of eligible providers will make Texas ineligible for the $9 to $1 match. True to form, Governor Perry is blaming this all on the Federal government. He’s deliberately leaving out the “minor” details of multiple extensions the Center for Medicaid Services provided HHSC so Texas could fix the proposed rule.

Luckily for the 130,000 Texas women enrolled in the WHP, a judge put a hold on the state’s rule allowing women to continue getting their WHP care from Planned Parenthood while the case is litigated. The Fifth Circuit Court of Appeals will rule on the State’s appeal to the hold any day now.

It was blatantly obvious what happened last session. A contingent of right wing legislators highjacked the State’s support for family planning and turned into an anti-abortion debate. In turn, family planning funds were slashed and low-income women lost access to their ability to prevent unintended pregnancies. Because these legislators are the majority, they won. The few moderate Republicans who were actually in leadership and support family planning were railroaded.

What is the leading cause of abortion? Unintended pregnancies. Mission accomplished?

Despite these clear anti-women’s healthy bullying tactics within the Republican party, a recent New York Times opinion editorial piece ironically accuses Planned Parenthood of “making an enemy of someone who has failed to pass its purity test.”

Former CNN anchor Campbell Brown (whose spouse is Romney advisor, Dan Senor) chastises Planned Parenthood for not engaging and supporting Republican members of the US Congress and Senate – as though Republican members and candidates are begging for a Planned Parenthood endorsement.

The fact of the matter is Planned Parenthood is a non-partisan organization. Planned Parenthood is the leading nonprofit provider of nonjudgmental reproductive health care. We provide well woman exams, birth control, lifesaving cancer screenings, HIV testing and counseling and basic health care services to nearly 3 million women across the U.S.

The Planned Parenthood Action Funds in Texas – our political arm – educate voters and our political action committees support candidates who will support women’s health care. Republican or Democrats. Women or Men. Bottom line: It’s about women’s health.

We all know Tea Party extremists who infiltrated the Republican party threw bipartisanship overboard a while ago. Republican candidates who support commonsense family planning – like the Mitt Romney who ran for U.S. Senate in 1994 — are rare these days. The reality today is Republicans don’t want support from Planned Parenthood without cover. They know they’ll be attacked from within the party. The Republican party has been dominated by right wing rhetoric and evangelical tyranny. Plain and simple. Support for something as noncontroversial as birth control is now tantamount to support for so-called “abortion on demand”. Politicians are running scared.

The real Republican Party (the one that actually started the federal Title X family planning program in the 1960’s) needs to wake up. Women – all women – are watching and they don’t want access to pap tests and breast exams eliminated so that right-wing men can pound their chests in victory. And yes, Campbell Brown, Planned Parenthood does want to continue to support Republicans who support women’s health. We’re still here. They just need to show up.

Yvonne Gutierrez is the Political Director for the Planned Parenthood Gulf Coast Action Fund.

And then they went right back to not caring about women

Such a delightfully cynical little stunt.

Yeah, right

Thirteen Republican members of the Texas congressional delegation wrote a letter to President Obama protesting the administration’s decision to phase out funding for the Texas Women’s Health Program.

The administration took the action after the Texas Legislature voted to ban all state funding to Planned Parenthood to protest the group’s abortion services. None of the federal money in question is used for abortion services, and the U.S. Department of Health & Human Services says Texas is not permitted to discriminate against health-services providers.

“We are concerned that your decision to deny this waiver is not being driven by concern for the health of Texas women, but by your insistence at [sic] supporting a pro-abortion agenda, something the Texas Legislature has statutorily forbidden the state of Texas from following,” the lawmakers wrote.

Of course, none of these gentlemen (the list of signatories did not include the lone woman among the GOP Congressional delegation, Rep. Kay Granger) made a peep of protest when the Republicans in the Legislature slashed spending on the Women’s Health Program and blocked bills that would have continued it. I certainly don’t recall any of them protesting when the Bush Administration denied the same waiver request back in 2005; back then, Texas acceded to the federal government’s edict and life went on. And of course on matters like the sonogram bill and the Blunt Amendment and every petty little attack on women’s health that this Congress has become reviled for they took or would have taken the anti-woman side. And as a sign that the divide on this is more than just partisan, here’s another Texas Republican woman who didn’t sign on to this letter:

During an interview on MSNBC [Thursday] morning, Sen. Kay Bailey Hutchison (R-TX) voiced rare support for Planned Parenthood, noting that the organization provides much-needed preventive care to low-income women. The outgoing Texas senator also condemned a recently-enacted Texas law that prohibits Planned Parenthood from participating in the Medicaid program and providing health care services to some 130,000 women.

There’s a transcript and video there and at the Trib. While it’s true as Kaili Joy Gray says that KBH hasn’t exactly been a staunch advocate for reproductive freedom – I don’t recall her making any noise about those other items, either – she has been better than many of her male peers, however low a bar that is to clear. And it must be noted, this is an opportunity for her to stick a shiv into Rick Perry, which I’m sure was irresistible. Nonetheless, she now stands apart on this, and by doing so clearly shows how far out these yokels are. Nicely done, Senator.

What radicals?

I was reading this Patricia Kilday Hart column about how nobody outside Texas paid attention to the sonogram bill until the Virginia brouhaha and the Doonesbury series, which is a good albeit frustrating read, when I came across this bit that was frustrating for an entirely different reason:

In the Texas Legislature, votes like Davis’ – outside party lines – are increasingly rare, according to research conducted by Dr. Mark Jones of Rice University’s Baker Institute.

Jones has data to prove what most of us know by gut instinct: The Texas Legislature has become a more polarized institution in recent decades.

In the past, lawmakers of both parties would overlap on the conservative-liberal spectrum. Now, both parties are dominated by their extremist wings. Moderate Republicans oppose ideologically charged issues like the sonogram bill “at their peril,” Jones says.

Oh, for Pete’s sake. Please, Professor Jones, tell me who these people are that have radicalized the Democratic Party. I mean, I don’t know who you talk to, but I know an awful lot of folks who will laugh in your face if you suggest the Democratic Party has moved appreciably to the left in recent years. Tell me also what positions the Democratic Party has taken that are noticeably more extreme than they used to be, and what legislation they have been pushing to further those radical ends.

These questions are easy to answer for the Republican Party. For who the radicals are, start with Dan Patrick, Debbie Riddle, Wayne Christian, and most of the people that got elected in the 2010 wave. Oh, and Rick Perry, David Dewhurst, Greg Abbott, and now Susan Combs, too. Just compare the David Dewhurst who is running for US Senate to the one who presided over the Texas Senate in 2003, as a for-instance. The GOP as a whole has gone from a position of generally opposing abortion to a full-fledged attack on birth control and family planning, and from a position of generally supporting lower taxes and fewer regulations to opposing any tax increase on anything for any purpose, pushing huge tax cuts for the wealthy, cutting public education, and seeking to end Medicare. There’s quite a bit of polling data to suggest that they are sprinting towards a cliff by embracing these more radicalized stances, but even Republicans with a mostly moderate history are doing so because it’s what their base is demanding and they fear their primaries more than they fear their Novembers.

My point is there’s just no comparison. The Democratic Party has moved left on some things, most notably marriage equality, but it’s been a gradual shift that’s in line with previously held views on civil rights, and more to the point it’s consistent with national polling. The Republicans have moved way, way more to the right, and it’s happened almost entirely in the last two years, despite a plethora of polling evidence that should warn them against it. The “both sides do it” trope is ludicrous on its face. Why is this so hard to recognize?

Mockery is the best medicine

Business Insider comes across the Facebook fun.

Women aren’t too happy with Rick Perry’s stance on family planning funding. Today, they let him know the best way they could, with some well-directed Internet snark.

Posts asking Perry’s advice about everything from menstruation to menopause flooded the governor’s Facebook wall this morning. They’ve since been taken down, and new posting has been disabled, but screenshots document the whole episode.

Click here to see their screenshots. The only think wrong with this report, which was written Monday, was that the hijinx had started several days earlier, as Nonsequiteuse had been documenting. Sadly, that fun came to a halt yesterday, as Team Perry finally figured out that social media is a two-way street (a lesson you’d think they’d have learned by now) and shut off the ability to post on his wall. Perry’s spokeperson whined about how mean everyone was, but they were pwned, plain and simple. Well done, ladies.

Bye-bye, WHP

Thanks, Rick!

Federal health officials announced Thursday what state leaders have predicted for weeks: that they are halting funding for Texas’ Women’s Health Program.

Cindy Mann, director of the federal Center for Medicaid and CHIP Services, said Texas left her agency no other choice by forging ahead with a rule designed to force Planned Parenthood clinics out of the program

“We have no choice but to not renew their program,” Mann said. “… We very much regret that the state of Texas has taken this course.”


Mann said under federal law, Medicaid beneficiaries must be able to choose their own providers. “Neither the federal government nor the state government is permitted to stop people from getting services from their trusted source of care,” she said.

She said CMS will begin a gradual phase-out of the program, so funds won’t be cut off immediately. If Texas takes over the program and no women lose services within the next three months, she said, federal support will be terminated. If not, they might extend the support longer. Mann said the state must submit a transition plan to the federal government for approval by April 16.

Here’s the letter, and here’s a letter signed by State Reps. Garnet Coleman, Carol Alvarado, and Sylvester Turner thanking Director Mann for not cutting us off completely right away. Unfortunately, there’s also this:

Asked if local governments could skip the state level and coordinate directly with the federal government to continue to get support, Mann said no. She said money for Medicaid programs flows through the state.

Which means that the workaround Coleman and others proposed the other day won’t work. Which means we’re stuck with Perry’s phony promise, which he intends to pay for by cutting other HHS programs. If he’s going to be forced to do something for a bunch of people he couldn’t care less about, then by God someone’s gonna get hurt for it. Remember when Rick Perry pretended to care about cervical cancer?

A few years ago, in the name of fighting cervical cancer, Gov. Perry signed an executive order mandating HPV vaccinations for Texan girls. In a September 2011 presidential debate, Perry stated that “Cervical cancer is a horrible way to die” – yet he is moving to end cervical cancer screenings covered by WHP for over 130,000 Texan women. We are asking him why. The women of Texas are waiting for your response, Rick. And no, we aren’t talking about abortion – don’t change the subject – we are talking about cancer. We are talking about women’s lives.

Of course, he only pretended to care about it because it was a means to help one of his cronies, but it would be nice if some other people asked him about that. Or, if that’s too serious for you, you could head over to Facebook and ask him some questions about lady parts, since he’s such an expert about that. When you get bored with that, mosey on over to the page of Rep. Sid “Patrick” Miller, the “arthur” of the sonogram bill, and poke him with a stick, too. In the grand scheme of things it won’t really accomplish anything, but it’ll make you feel better, and Lord knows these idiots deserve it. Postcards has more.

Trying to find a way with the WHP

I admire and applaud the effort. I abhor the fact that it was needed.

Leading Houston Democrats in favor of a seemingly doomed health care program for low-income women are pushing to bypass the state to keep federal money flowing to Planned Parenthood.

U.S. Rep. Sheila Jackson Lee and state Rep. Garnet Coleman said Monday they are negotiating with U.S. Health and Human Services in hopes of finding alternative funding for the program, which provides health screenings and contraceptive services to 130,000 Texas women on Medicaid.

“It would be a look-alike program but not be the same thing,” said Coleman.

The Medicaid Women’s Health Program is due to end in Texas on March 31, the result of the state’s decision to exclude clinics affiliated with abortion providers, even those that do not provide abortions. Federal regulations say a state can’t exclude qualified providers from the program.

Coleman and Lee said the alternative might involve the federal government allocating money to local entities, such as counties, hospital districts or federally qualified health clinics. They noted that school districts have been allowed to apply for federal grants independently rather than through the state.

U.S. Rep. Gene Green said he will look at alternatives but acknowledged that “I doubt I could do much with this Congress.” He said he’s hopeful things will be more favorable after the election.

The main way that this would differ from Perry’s empty promise is that it would allow the existing providers (read: primarily, but not exclusively, Planned Parenthood) to continue doing their work instead of forcing thousands of women to find new doctors who may or may not ever materialize to take on that un-lucrative business. It also ensures that we don’t have to depend on Perry’s alleged commitment to women’s health, which was something he certainly did not have last year when it counted.

Last spring, I watched with dismay as the Texas House, led by Republican lawmakers, slashed – from $111 million to only $38 million – the only other program providing contraception for poor Texas women, administered by the Department of State Health Services.

Perry stood by silently as GOP lawmakers took the ax to the program, despite budget analysts reporting that the program would save the state millions of dollars by preventing unwanted children who would be delivered into this world on Medicaid’s dime.


Perry hasn’t really had an epiphany that contraception for the poor is a worthwhile, even “cost-effective,” program. He’s warring with President Barack Obama because the federal government won’t go along with his administration’s attempt to prevent Planned Parenthood from participating in the program.

“Why would the Obama Administration take away access to health care for low-income Texas women?” Perry asks on his website. “Because this administration puts funding for abortion providers and affiliates ahead of funding for women’s cancer screenings and other preventative health care.”

He conveniently fails to mention that no money that goes to Planned Parenthood can be used to provide abortions. It’s already illegal.

The money pays only for cancer screenings and contraception that poor women need. But Perry, the governor who is against the government picking your health care provider, has decided he gets to pick the health care provider for poor women.

That would be because, as the sonogram saga showed, Perry thinks women are incapable of making these decisions on their own. Women may disagree about that, but who cares what they think? Not Rick Perry, that’s for sure.

The bottom line is simply this.

Fran Hagerty, the head of the Women’s Health and Family Planning Association of Texas — which represents non-Planned Parenthood providers in Texas, including clinics, hospitals and medical schools — said she seriously doubts Gov. Rick Perry will be able to keep the pledge he made last week to maintain the roughly $30 million-per-year program without federal help. She said the “monstrous” family-planning funding cuts of the last legislative session, made before the Women’s Health Program was jeopardized, have eroded trust and have forced clinics to shut their doors.

“The funds made available to family planning providers through the Women’s Health Program is what is keeping most of them going at this point,” she said in a statement. “No one trusts Gov. Perry to find state money to fund them at the same level as the Medicaid program.”

Emphasis mine. No one should trust Rick Perry to care about funding the Women’s Health Program. His record on this issue is quite clear and has been for a long time. Once the spotlight is off and he no longer has to pretend he’s the good guy and the Obama administration is the bad guy, he’ll revert to form. Indeed, he already is, with his ludicrous funny-money funding proposal. Burka, who agrees with this assessment, and Trail Blazers have more.

It’s time to go on the offensive for women’s health

I believe that just as Democrats must make the 2012 elections in Texas about public education, they must also make them about health care, in particular access to health care for women. There’s some polling data to suggest this will be effective.

Fifty-nine percent of likely Texas voters oppose Gov. Rick Perry’s efforts to keep Planned Parenthood out of the joint state-federal Women’s Health Program, while 38 percent approve, according to a new poll from Public Policy Polling.

But the poll — released as the reproductive health program circles the drain — is likely to have critics. It was sponsored by Planned Parenthood, whose clinics currently provide reproductive health care for 40 percent of the low-income women in the program.

And some of the language in the poll questions is hotly debated by Republican lawmakers and abortion opponents, who say they are following federal law — not breaking it — by excluding from the Medicaid waiver program Planned Parenthood and other clinics under the same organizational umbrella as abortion providers.


Public Policy Polling’s survey of 562 likely Texas voters last week found that women strongly opposed the effort to keep Planned Parenthood out of the program, 57 percent to 37 percent. According to the poll, which has a margin of error of +/-4.1 percent, more than half of Texas voters view Perry and other state lawmakers’ response to the Women’s Heatlh Program unfavorably.

“Texas voters are sending a clear message to Governor Perry: they think the Women’s Health Program is important and that he should leave it alone,” wrote Tom Jensen, director of Public Policy Polling. “And they think it’s wrong to use Planned Parenthood as a political piñata and deny low-income women access to critical cancer screenings, birth control and screenings for diabetes and hypertension.”

The poll questions, however, seem to lay the blame for the near-demise of the program at Texas lawmakers’ feet. For example, they say that a “new Texas rule will end the Medicaid Women’s Health Program altogether.” Abortion opponents argue it’s the Obama administration that is ending the program by refusing to withstand the Texas rule.

You can see the polling memo here. I don’t have crosstabs or the wording of the questions, so I can’t go into any depth about this. It’s only one data point, and I’m sure that differently worded questions could well lead to different results. But that’s just another way of saying that it’s important to define the issue in a way that resonates with the voters. Clearly that can be done. It won’t play everywhere in the state, but for sure there are some districts in which there should be plenty of traction.

More to the point, this fits right in with the greater narrative of the sustained national assault on women’s health – and women in general – by the Republican Party. The winds have shifted, with Rush Limbaugh losing advertisers left and right after his disgusting statements about Sandra Fluke, and Sen. Lisa Murkowski publicly renouncing her vote on the Blunt Amendment after getting an earful back home. There’s energy on the progressive side in engaging this fight, with people taking to the streets in Austin.

You and me both

Austin musician Marcia Ball is not a political activist. But after hearing that the state Women’s Health Program would lose federal funding as a result of the Legislature’s decision to exclude Planned Parenthood from the state Medicaid program, she organized a protest that drew hundreds of people to the state Capitol today.

“I just got fed up,” Ball said. “I suspected there were many people like me, including Christians and people of all ages, who think it’s a mistake to defund low-income women’s basic health care. All this defunding for political gain is hurting hundreds of thousands of low-income women.”

The rally drew progressive political activists, local musicians, state representatives and women’s health clinic employees. Passing cars honked in support as protesters held up signs with slogans such as “Don’t Mess with Texas Women” and “I’m a Christian and I Believe in Science, Birth Control, and Tolerance.”

“I’ve been protesting [for women’s rights] since the ’60s and ’70s, when I was at UT,” said Anita Quintanilla. “I thought by the ‘80s, we wouldn’t have to be protesting for women’s rights. I have a 21-year-old daughter, and I hoped she wouldn’t have to worry about women’s rights. I’m fighting for her.”

Trail Blazers, from whom I snagged that photo, Texas Politics, and BOR have more on this. The Republican counter-argument continues to be that the impending loss of the Women’s Health Program is the fault of the Obama administration and that it’s the Republicans who really want to protect it. State Rep. Mike Villarreal makes short work of that.

Today State Rep. Mike Villarreal responded to recent statements by Governor Rick Perry and other Texas Republican leaders expressing their support for the Women’s Health Program (WHP) and blaming the Obama Administration for the program’s expected termination this month.

“The idea that Texas Republicans have supported the Women’s Health Program is laughable. It has no connection to reality,” said Rep. Villarreal. “Anyone who paid attention to the last legislative session knows that Texas Republicans consistently demonstrated their hostility towards the Women’s Health Program and other family planning programs. Republican-dominated committees in the House and Senate blocked ten different bills to continue the Women’s Health Program.”

During the 2011 legislative session, Republicans blocked the following bills to continue the WHP, which was scheduled to expire December 31, 2011:

  • HB 419 by Rep. Villarreal: blocked in House Human Services Committee after a hearing
  • HB 1255 by Rep. Strama: no hearing in House Public Health Committee
  • HB 1478 by Rep. Woolley: blocked in House Public Health Committee after a hearing
  • HB 2299 by Rep. Coleman: delayed in the House Human Services until the last month of the legislative session, and then blocked in the Local and Consent Calendars Committee
  • HB 3256 by Rep. Strama: no hearing in House Public Health Committee
  • SB 325 by Sen. Van de Putte: no hearing in Senate Health and Human Services Committee
  • SB 575 by Sen. Van de Putte: blocked in Senate Health and Human Services Committee after a hearing
  • SB 585 by Sen. Watson: blocked in Senate Health and Human Services Committee after a hearing
  • SB 1138 by Rep. Rodriguez: blocked in House Public Health Committee after a hearing
  • SB 1854 by Sen. Deuell: delayed in the Senate Health and Human Services Committee until the last month of the session, and then blocked on the Intent Calendar

The program was only allowed to continue into 2012 based on a determination that its inclusion in the state budget constituted legislative direction to renew the program beyond 2011.

During committee debate on Rep. Villarreal’s HB 419, Republican Representative Jodie Laubenberg challenged the suggestion that contraception would reduce unplanned pregnancies and state Medicaid costs. Expressing her disbelief, Rep. Laubenberg said, “We’re going to save on the non-babies that are being born? We’re going to prevent baby births? This has got to be government math. Basing it (the estimated savings) on the speculation that you are going to save money by non-babies, by non-Medicaid baby births.”

The Women’s Health Program provides contraception, cancer screenings, and other basic health services to uninsured low-income Texas women. It does not provide abortions. The Medicaid waiver program is expected to be discontinued this month because Republican leaders prohibited the participation of Planned Parenthood, violating the federal law against indiscriminately excluding health care providers. Nearly half of Women’s Health Program clients receive services through Planned Parenthood, which does not provide abortions at WHP clinics. According to estimates from the Health and Human Services Commission, in calendar year 2009 the WHP averted 10,300 Medicaid-paid births, saving the state $20 million in general revenue after accounting for the state’s $3 million investment. The estimate does not include the significant long-term savings.

During the legislative session Republican legislators also targeted the family planning program at the Department of State Health Services. No program faced more cuts during the budget debate on the House floor. During that debate Republicans passed the following seven amendments to cut funding to the program:

  • An amendment by Rep. Weber to cut $9.3 million
  • An amendment by Rep. Christian to cut $6.6 million
  • An amendment by Rep. Bohac to cut $14.4 million
  • An amendment by Rep. Murphy to cut $1.4 million
  • An amendment by Rep. Miller to cut $21.2 million
  • An amendment by Rep. Zedler to cut $1.8 million
  • An amendment by Rep. Laubenberg to cut $9.2 million

The program received $111 million in 2010-2011. Budget-writers proposed a reduction to $99 million for 2012-2013 as part of across-the-board budget cuts. After the series of Republican amendments, the final funding level stood at $37 million for 2012-2013. The Legislative Budget Board estimates that the reduction in funding will result in 20,000 additional unplanned births and an additional $98 million in state general revenue expenditures during the current biennium.

During debate on his amendment to cut family planning funding, Republican Rep. Randy Weber argued that contraception increases abortions, saying, “The study I was fixin’ to cite shows that contraception does not eliminate crisis pregnancy but actually they had the highest rate.” According to the Houston Chronicle and others, the study shows the opposite of what Rep. Weber stated.

Generally speaking, when you have to tell lies to support your argument, you’re losing the argument. Like I said, it’s all about defining the issue. I’m delighted to see people pumped up and energized, but what really needs to happen is for those of us who already get it to do what we can to bring people who haven’t been voting our way on board. We can be as passionate as we want, we’re not going to get anywhere without changing minds and habits. We have the issues, we have the motivation, and we have the energy. We need the numbers.

Help keep access to birth control

As you know, it’s been a rough year for advocates of reproductive freedom, here and elsewhere in the country. There’s a lot of work to be done, starting with the next election, to repair the damage and move things forward again, but in the meantime we need to make sure we don’t suffer a self-inflicted wound first. New regulations are being written about how companies who provide health insurance to their employees, which under the Affordable Care Act includes benefits for birth control. Her Votes sums it up:

Birth control coverage with no co-pays? Without a doubt one of the most popular benefits of the Affordable Care Act, the preventive care provisions for women require nearly every health insurance provider to cover contraception without any cost sharing.

Until now. Maybe. Because there’s a full court press from the Conference of Catholic Bishops (yes, reportedly even the Archbishops are weighing in) pressuring the White House to dramatically expand this refusal clause.

The Catholic bishops want to exempt the health insurance of every religiously-connected or affiliated institution from this requirement, and millions of Americans would lose this benefit – students, teachers and staff at religiously-connected schools and universities; social workers, nurses, and other staff (and their families) at religiously-affiliated hospitals that employ thousands of people, huge organizations like Catholic Charities, and many more – regardless of the religious beliefs of those employees and students.

Although the pro-choice community opposed having any exemptions from contraceptive coverage, the guidelines issued by HHS Secretary Kathleen Sebelius contained a narrow exemption that applied primarily to houses of worship. But the bishops want more. Much more.
If the bishops have their way, at least six million women with health insurance will lose this new contraceptive coverage benefit, for no reason other than where they work or go to school.

We must keep the Affordable Care Act strong, and preventive care for women is critical.

They have a ton of links to various essays and calls to action about this so you can get up to speed. An email sent out by Planned Parenthood explains what you can do to help.

Continue to contact the White House. Direct contact with the White House remains our utmost priority. We need your help in continuing to activate your grassroots organizers, volunteers, and allies to make calls to the White House until the president ends this campaign. Place grassroots calls to the PPFA patch-through line by texting BCREFUSAL to 69866 or by calling 202-559-1164 If your friendly member of Congress has not yet directly contacted the White House, it would be helpful if you could make another push to ask them to reach out to senior White House staff. Likewise, any calls your board, donors, and other community leaders can make to key White House officials are much appreciated. If you have questions about whom specific donors should contact, please contact Amy Taylor ( Your Regional Field Manager is also available to answer questions and assist with any additional aspect of this campaign.


  • President Obama should reject efforts to take away the birth control coverage benefit from millions of Americans who work at religiously affiliated hospitals, universities, schools, or organizations. These are nurses, teachers, janitors, and other workers who should not be discriminated against and denied a benefit that the vast majority of Americans will receive. There is already an unfair refusal provision in the women’s preventive benefit, which Planned Parenthood opposes.
  • Expanding the existing refusal provision to religiously affiliated hospitals and other entities would amount to the single most damaging refusal provision around birth control that has ever been implemented. It would create a dangerous precedent that singles out birth control and undermines a fundamental tenet of the Affordable Care Act — that every person in this country deserves a basic standard of health care coverage. In fact, such an expansion would set a standard only rivaled by the refusal provision that President George W. Bush put into place near the end of his administration, a regulation that President Obama fortunately rescinded.
  • Birth control without co-pays is one of the most popular benefits of the Affordable Care Act. Seventy-one percent of American voters, including 77 percent of Catholic women voters, support the requirement that health plans cover birth control without co-pays.

A decision could be coming any day now, so please take a moment to make a call and let your feelings be known. Thanks very much.

Even in Midland

Fact-based sex education replaces mythical thinking in Midland. And they said it couldn’t be done.

In the spring, public school students in Midland will cross what until very recently was the political third rail of sex education. For the first time, they will be taught about contraception — and how to practice safe sex.

The West Texas town is known for oil and Republican presidents, not progressive social policy. But after watching the teen pregnancy rates creep up year after year — 172 pregnant girls were enrolled in the town’s public schools last year — many in the community realized something needed to change.

“These are girls as young as 13 that are pregnant, some of them are on their second pregnancies,” said Tracey Dees, the supervisor of health services in the district of just under 22,000 students, adding that many of them reported having sexually transmitted infections as well.

Eighteen months ago, with input from parents, staff and other community leaders, the school board decided to implement a new curriculum for seventh and eighth-graders — one that emphasizes that waiting to have sex is best, but also teaches students about condoms and birth control. Midland is just one of a number of schools, from West Texas to the suburbs of Houston, that are moving toward “abstinence-plus” education at the urging of their health advisory committees made up of community members.

“We’re getting calls from all over the state,” said Susan Tortolero, the director of the University of Texas’ Prevention Research Center in Houston who developed the curriculum being used in Midland. “It’s like we’re beyond this argument of abstinence, abstinence plus. Districts want something that works.”

What a novel idea. There’s a part of me that’s never quite understood why this is controversial. I mean, why wouldn’t you want your kids to have the best information? How can you expect them to make good decisions otherwise? I’m glad that even in places like Midland, people are starting to get that. It’s just a shame that so many kids had to be poorly served in the meantime.

Family planning saves money

It does a lot more than that, of course, but in these times we may as well highlight the financial aspect of it.

A state and federal program that provides free family planning and related health screenings to low-income women ages 18 to 44 saved Texas $40 million in 2008 — a financial boon during cash-strapped times, advocates said Tuesday.

State Rep. Mike Villarreal and Healthy Futures of Texas President Dr. Janet Realini unveiled the findings of a recent Health and Human Services Commission study that examined the cost savings of the Medicaid Women’s Health Program.

The program, which began in 2007, is aimed at reducing Medicaid-paid births and unplanned pregnancies. The state invested $2 million a year, which the federal government matched.

“In the end, we prevented 10,000 unplanned pregnancies and reduced state and federal Medicaid spending on childbirths by $113 million per year,” said Villarreal. “That’s smart government. But this is not just about dollars and sense. It’s about changing lives. This program helps women delay pregnancy until they’re ready to care for a child.”

You can read the full report here (PDF). As Rep. Villarreal says on his blog, this really ought to be a no-brainer. I don’t know what else there is that needs to be said.