Senator Rodríguez, Senate colleagues question Health and Human Services fiscal and health policy
First, the fiscal note attached to the proposal states that the state-run WHP need only be funded for 14 months, at which point “all clients will be eligible for Medicaid following the expansion of the Medicaid program in January 2014.” But Governor Perry has very vocally rejected Medicaid expansion.
The Senators also note that excluding Planned Parenthood from the program limits access to women, particularly minority and low income women, for whom it is not easy to find other qualified providers. And portions of the rules interfere with the doctor-patient relationship, an unwarranted big government intrusion into private medical affairs that is at odds with the notion of limited government.
The letter closes with this statement:
In sum, the rules as written do not reflect the political realities regarding Medicaid expansion, lack transparency, and significantly diminish the existing WHP provider base. Inevitably, this will profoundly limit access to preventative health services that tens of thousands of Texas women rely upon.
The text of the letter is included below in full.
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Dear Commissioner Suehs:
We are writing to express several concerns with the proposed rules for the Texas Women’s Health Program (WHP), published July 6, 2012 at 37 Tex. Reg. 5074-5080.
First, as Members of the Legislature, we are concerned with the fiscal note’s assumption that the WHP need only be funded for 14 months, at which point “all clients will be eligible for Medicaid following the expansion of the Medicaid program in January 2014.” This assumption is in direct conflict with Governor Perry’s very vocal rejection of Medicaid expansion.
At the proposal’s estimate of $39 million for the full FY2013, the proposed program would appear to require nearly $160 million in general appropriations over FY2014-FY2018. This is a conservative estimate that only begins to address the impact to the state’s general revenue in funding the WHP beyond 2014, as it appears we will have to do, given the Governor’s stance on expansion of the state’s Medicaid program.
Furthermore, we are concerned with the lack of transparency in funding the state-run WHP. We understand that the Health and Human Services Commission (HHSC) has identified, and the Legislative Budget Board (LBB) and Governor’s Office have approved, the use of general revenue sources within HHSC’s current budget to cover the loss of $35 million per year in federal funds.
It appears HHSC will use the LBB/Governor’s Office-approved funds to both administer the program and to pay provider claims for services. However, this funding mechanism lacks an open and clear dialogue and has left many constituents, particularly the women served by the program, in the dark about the program’s future.
In addition to the aforementioned fiscal concerns, the actions taken by HHSC to dismantle the existing WHP reflect poor policy decision-making. With more than one out of four Texans lacking health insurance, we must do all that we can to maintain current cost-effective programs like the WHP, which in your own words, “pays for itself and saves the state about $20 million a year.”
According to numbers provided by HHSC, from FY2007 to FY2010, the state spent $6,740,840 on the WHP. For the same time period, the estimated net savings to the state were $87,840,258. Clearly, spending less than $7 million to save nearly $88 million has been a smart investment in women’s health.
The current program serves approximately 130,000 Texas women. Over 40 percent of women who received services through the WHP chose to rely on a Planned Parenthood health center for their services, which include lifesaving cancer screenings, well-woman exams, contraception, screening for diabetes and high blood pressure, and testing and treatment for sexually transmitted infections. As you know, Planned Parenthood is the single largest provider of care within the existing WHP. Notably, in 2010, nearly 90 percent of active WHP providers saw fewer than 100 clients over the course of the year.
Barring Planned Parenthood from either the federal program or the state’s version will have serious consequences for women’s health. Not only will more than 40,000 women be denied access to their provider of choice, but given the shortage of primary care providers throughout the state and the limited capacity of other types of providers, these women may not be able to find a WHP provider at all.
Researchers at the George Washington University School of Public Health found other providers would have to expand their WHP capacity five-fold to offset the loss of Planned Parenthood health centers. This is highly unlikely, especially after last year when Texas drastically cut its family planning funding and slashed access to care for an estimated 160,000 Texas women. To date, no credible evidence exists that shows other providers could increase their capacity to fill this void.
In the best-case scenario, these thousands of women may have to travel further to a provider and wait longer for appointments. Delays in seeking testing and treatment for breast and cervical cancer as well as certain infections will have devastating health consequences for low-income women.
As a case in point, at the end of 2009, El Paso lost one of its primary sources of affordable reproductive health care – Planned Parenthood. In the year following their closure, roughly 900 men and women lost health care and the rate of chlamydia increased by 24 percent, the rate of gonorrhea increased by 56 percent, and the rate of HIV cases increased by 43 percent. No other health care provider has been able to adequately cover all of the services provided in the past by Planned Parenthood.
Aside from the fact that existing WHP providers will likely not be able to fill the void left by Planned Parenthood, the Texas Medical Association, Texas Association of Obstetricians and Gynecologists, American Congress of Obstetricians and Gynecologists/Texas District, Texas Academy of Family Physicians, and Texas Pediatric Society have voiced concerns that the proposed rules of the state-run WHP amount to a “gag order” on doctors’ discussions with patients and interfere with their ability to effectively treat their patients.
If the proposed rules are not amended to address the concerns described by the representatives of these 47,000+ physicians in their August 3, 2012 letter, then in their estimation, “countless Texas physicians will be unwilling to participate in the program because it will force them to choose between practicing medicine in accordance with the standard of care and medical ethics, or in accordance with a rule created to serve a political ideology.”
In sum, the rules as written do not reflect the political realities regarding Medicaid expansion, lack transparency, and significantly diminish the existing WHP provider base. Inevitably, this will profoundly limit access to preventative health services that tens of thousands of Texas women rely upon. In the interests of preserving access to care for low-income women and saving the state tens of millions of dollars during a time of budgetary constraints, we ask HHSC to reconsider the exclusion of Planned Parenthood from the WHP, or at the very least, to address the above-mentioned fiscal questions and the issues raised by the physicians’ groups.
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