Women in Texas Losing Options for Health Care in Abortion Fight

By Pam Belluck and Emily Ramshaw, The New York Times

09 March 12

eticia Parra, a mother of five scraping by on income from her husband's sporadic construction jobs, relied on the Planned Parenthood clinic in San Carlos, an impoverished town in South Texas, for breast cancer screenings, free birth control pills and pap smears for cervical cancer.

But the clinic closed in October, along with more than a dozen others in the state, after financing for women's health was slashed by two-thirds by the Republican-controlled Legislature.

The cuts, which left many low-income women with inconvenient or costly options, grew out of the effort to eliminate state support for Planned Parenthood. Although the cuts also forced clinics that were not affiliated with the agency to close — and none of them, even the ones run by Planned Parenthood, performed abortions — supporters of the cutbacks said they were motivated by the fight against abortion.

Now, the same sentiment is likely to lead to a shutdown next week of another significant source of reproductive health care: the Medicaid Women's Health Program, which serves 130,000 women with grants to many clinics, including those run by Planned Parenthood. Gov. Rick Perry and Republican lawmakers have said they would forgo the $35 million in federal money that finances the women's health program in order to keep Planned Parenthood from getting any of it.

Although Texas already bars clinics that take such money from performing abortions, the new law is intended to prevent any state money from benefiting Planned Parenthood. "Planned Parenthoods across the country provide abortions, are affiliated with abortion providers, or refer women to abortion providers," said Lucy Nashed, a spokeswoman for Mr. Perry.

Wayne Christian, a Republican state representative said, "I don't think anybody is against providing health care for women. What we're opposed to are abortions." He added, "Planned Parenthood is the main organization that does abortions. So we kind of blend being anti-abortion with being anti-Planned Parenthood."

The situation in Texas is mirrored in several other states that have tried to eliminate various methods of financing Planned Parenthood.

Abortion also undergirds the Republican presidential candidates' opposition to federal financing for Planned Parenthood, a private nonprofit group that offers a variety of reproductive health services and is the nation's largest provider of abortions. And critics of contraception coverage under the new federal health care law say that some birth control methods are essentially abortion drugs, an assertion scientists largely dispute.

As the case in Texas illustrates, such battles are affecting broader women's health services. Some women have lost the only nearby clinic providing routine care.

Nationally, the newest target is Title X, the main federal family planning program. All four Republican presidential candidates support eliminating Title X, which was created in 1970 with Republican support from President Nixon and the elder George Bush, then a congressman.

Like other federal financing, Title X does not pay for abortions. Only some of it covers birth control. Title X also provides money for cervical and breast cancer screening, testing for H.I.V. and other sexually transmitted diseases, adolescent abstinence counseling, infertility counseling and other services.

Planned Parenthood receives about a quarter of Title X's $300 million budget and sees about a third of Title X patients. The remaining money goes to clinics, community health centers, hospitals and state agencies.

Mitt Romney's fiscal plan proposes eliminating Title X because it "subsidizes family planning programs that benefit abortion groups like Planned Parenthood."

Rick Santorum, in a recent debate, acknowledged, to boos, that in Congress he voted for appropriations bills that included Title X money. He pledged to rectify that if elected, saying, "I've always opposed Title X funding."

President Obama supports Title X, which serves five million low-income people.

"People think Planned Parenthood equals family planning the way Kleenex equals tissue, and it's not true," said Clare Coleman, president of the National Family Planning and Reproductive Health Association, a nonprofit, nonpartisan organization of family planning providers. Title X supports many other providers, she said: "In a lot of states there is no state money for family planning. So Title X is the ballgame."

A 2009 Congressional Research Service report cited federal estimates that Title X helps prevent nearly a million unintended pregnancies annually. Reproductive health experts say that saves money, that every dollar spent on family planning saves about $4 in maternity and infant care.

Some experts also say the financing helps prevent about 400,000 abortions annually. Opponents of Title X and government financing of family planning say these effects are exaggerated.

"Eliminating Title X would not outlaw contraception," said a spokesman for Ron Paul. "People would simply have to pay for contraceptives with their own money or money donated by private sources."

The battle intensified in February when the House of Representatives voted to eliminate Title X and eliminate federal financing for Planned Parenthood. The Senate defeated the bill, but the issue remains alive.

Several state legislatures recently voted to stop some Planned Parenthood financing: Title X money in Kansas and North Carolina, Medicaid in Indiana, other family planning and breast cancer screening funds in Wisconsin. In three of the states, judges blocked the laws, at least temporarily, ruling that Planned Parenthood had been illegally excluded even if it was not named. (Wisconsin's cuts have not been challenged in court.)

New Hampshire canceled a state contract with Planned Parenthood last year, but the federal government awarded the organization a similar contract. Recently, the New Hampshire House of Representatives voted to essentially strip Planned Parenthood of family planning money by creating a tiered system in which Planned Parenthood and other women's clinics could receive financing only in the unlikely possibility that the state could not give it to government-run clinics or to hospitals. The Senate has not voted on the bill.

Texas enacted a similar tiered system and also sliced its two-year family planning budget from $111 million to $38 million, cuts that the nonpartisan state Legislative Budget Board estimated would eliminate services for nearly 284,000 women, lead to 20,500 additional births and cost Medicaid about $230 million. The board had recommended expanding family planning as a way of saving money.

Now, the Medicaid-financed Women's Health Program is in jeopardy. Texas signed regulations prohibiting clinics affiliated with groups that provide abortions from receiving funds, even though the clinics do not perform abortions themselves. The federal government says excluding qualified providers in this way is illegal, requiring it to withhold $35 million — about 90 percent of the program's financing — if the regulations, which take effect on Wednesday, are not rescinded.

That would effectively end the program, increasing the number of women without services to about 400,000. Already, Planned Parenthood of Hidalgo County, which is on the Texas-Mexico border, has closed four of eight clinics, including the one in San Carlos, and trimmed services.

The closest clinic to San Carlos is 16 miles away in Edinburg. There, a receptionist informs callers not to expect appointments soon. Wait times have grown to up to four weeks.

Many San Carlos patients struggle to reach Edinburg from their homes in impoverished neighborhoods called colonias. Maria Romero, a housecleaner with four children, who had a lump in her breast discovered at the San Carlos clinic, has no way to get there.

Ms. Parra, 33, the mother of five, managed to borrow a car to get to Edinburg after a pap smear at the San Carlos clinic indicated she might have cervical cancer. Further tests showed she was cancer-free.

Both women worry about getting birth control pills; the clinic may now have to charge them up to $20 for a month's supply.

"I will have to go without," Ms. Parra said as she left an English class at a community center and was walking to pick up her two youngest children from a Head Start program. "If I get pregnant again, God forbid."