Texas is seeking permission from the federal government for the return of federal family planning money it lost four years ago. It lost those Medicaid funds after it excluded Planned Parenthood and other clinics affiliated with abortion providers from the state's women's health program. If President Trump's administration agrees, Texas could serve as an example to other states wishing to defund Planned Parenthood clinics.
In 2011, the Republican-dominated Texas legislature signaled its intention to end Planned Parenthood's participation in what was then known as the Medicaid waiver program serving the state's low-income women. Ninety percent of the program's funding came from the federal government. But the Obama administration opposed Texas' plan because Federal law requires states to fund "any willing provider." This is to keep states from discriminating against health care providers for ideological, racial or religious reasons.
Texas decided to forgo federal funding so it could exclude Planned Parenthood from the list of providers from which women could choose to get health care. Texas then created a state program, now known as Healthy Texas Women, and Planned Parenthood is not allowed to participate. The tens of millions of dollars in federal Medicaid funding that it lost each year was the price Texas had to pay for sticking to its guns.
But now that Trump is calling the shots, Texas wants that federal money back — while still being allowed to bar Planned Parenthood. And Texas may well have a good chance. The president recently appointed anti-abortion proponents to oversee the nation's family planning programs. If Texas is successful, abortion rights advocates worry that the state will pave the way for other Republican dominated states to set up similar exclusions, and not have to suffer the financial penalties Texas endured to boot.
Carrie Williams, spokeswoman for the Texas Health and Human Services Commission told The New York Times, "This is a new administration and we're looking at what funding opportunities may exist for us."
The prospect has health care advocates worried. Dr. Georges Benjamin is the executive director of the American Public Health Association. He says it's already forbidden to use federal dollars to fund abortions, but if Texas gets its waiver, abortion rights proponents across the country would be supporting Texas' program through their tax dollars.
"I don't want my federal dollars used for discriminatory practices," Benjamin says. "You're now forcing other states, and other people who may have a different view on this issue to pay for the discriminatory practices that the state of Texas is trying to have, which will ultimately result in poorer health outcome for women."
Benjamin says one of the main arguments for the Hyde Amendment, which prohibited federal funding for abortions in 1977, was that forcing anti-abortion proponents to fund abortion providers was an undemocratic violation of their deeply held religious beliefs. Providing Texas a waiver to receive federal Medicaid funds while excluding Planned Parenthood turns that argument on its head, he says. Abortion proponents across the country would have to see their tax dollars used to fund a Texas program that discriminates against abortion providers.
In its waiver application, Texas made the case for increased federal funding by pointing out it has the highest rate of pregnancy in the nation, one of the highest teen pregnancy rates and that fully a third of the women who get pregnant in the state do so unintentionally.
AUDIE CORNISH, HOST:
The state of Texas excluded Planned Parenthood in 2011 from its women's health program. That meant foregoing millions of dollars in federal Medicaid money. More than 80 women's health clinics, most of them not Planned Parenthood, were forced to close in the aftermath. And now Texas wants the Trump administration to open up those federal Medicaid funds once again but still be allowed to restrict their use. From Dallas, NPR's Wade Goodwyn has the story.
PAULA TURICCHI: I want to welcome everyone to the seventh meeting of the Women's Health Advisory Committee. My name is Paula Turicchi.
WADE GOODWYN, BYLINE: Yesterday was the big day at the Texas Capitol for the state to lay out its plan to apply for permission from the federal government so that it can start getting federal Medicaid money again. Lesley French with the Texas Health and Human Services Commission spelled it out.
LESLEY FRENCH: Now, the goals of the HTW demonstration are to increase women's health and family planning services. In addition, the goals will include implementation of a state policy that favors child birth and family planning services that do not include elective abortions or the...
GOODWYN: With President Trump placing anti-abortion activists in charge of federal funding for family planning, Texas sees an opportunity to regain what it lost when the state decided to defund all Planned Parenthood clinics entirely. And that's federal Medicaid money which made up 90 percent of its program's financing. If the administration agrees, other states are expected to follow suit, except they won't have to endure the penalties taxes suffered. Dr. Georges Benjamin is the executive director of the American Public Health Association. Benjamin says federal dollars are already forbidden to fund abortions, but if Texas gets its waiver, abortion rights proponents across the country would be forced to participate in Texas' inequitable funding program.
GEORGES BENJAMIN: I don't want my federal dollars being used for discriminatory practices. You're now forcing other states who may - and other people who have - may have a different view on this issue to pay for the discriminatory practices that the state of Texas is trying to have which will ultimately result in poor health outcomes for women.
GOODWYN: In its application, Texas noted it has the highest birth rate in the nation, one of the highest teen birth rates and that fully a third of the state's pregnancies are unintended. Wade Goodwyn, NPR News, Dallas. Transcript provided by NPR, Copyright NPR.