What #Texas Tells Us About the Latest Threats to Womens Health Care

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newyorker.com
What Texas Tells Us About the Latest Threats to Women’s Health Care

http://www.newyorker.com/news/news-desk/what-texas-tells-us-about-the-latest-threats-to-womens-health-care



By Jia Tolentino


In Texas, legislators have been systematically handicapping Planned Parenthood for years.




Photograph by Jim Scalzo / EPA / Redux

Among the various chances that congressional Republicans have taken in their effort to repeal and replace Obamacare, one of the riskier moves involves the federal defunding of Planned Parenthood. In both the House and the Senate, replacement legislation has included a provision that would cut off all federal Medicaid payments to Planned Parenthood for one year. (The bill would also bar federal tax credits from being used to purchase private health plans that cover abortion.) The provision is reportedly included even in the so-called skinny repeal. The Senate parliamentarian has determined that the provision violates the Byrd rule, which states that a reconciliation bill can only address matters that affect the federal budget; if the anti-Planned Parenthood provision cannot be passed under reconciliation, it would require sixty votes to pass. Many observers expect Senate Republicans to rework the language in the bill so that it can stay in reconciliation. Ted Cruz, meanwhile, has suggested that the parliamentarian’s ruling can be ignored.

That Republicans have taken things this far is a testimony to just how important defunding Planned Parenthood has become to many of them. Planned Parenthood operates more than six hundred clinics across the country, and a majority of its patients have incomes that fall near or below the federal poverty level; the organization receives around forty per cent of its revenue from federal funding, mostly through Medicaid. Cutting off those payments would be a drastic change for women’s health care in this country. For a glimpse of just how drastic it would be, we can look to Texas, where state legislators have been systematically defunding and handicapping Planned Parenthood for years. Currently, the Texas legislature is in special session, and three more anti-abortion measures have already been passed. One of them prevents local and state government agencies from contracting in any way—including via lease agreements—with clinics that are affiliated with abortion providers. As with the federal provision attached to the repeal of Obamacare, Planned Parenthood is not mentioned by name in this Texas bill. And yet, as Texas senators acknowledged last Friday, the bill only affects Planned Parenthood. (Calls to multiple state senators who sponsored the bill were not returned.)

The campaign against Planned Parenthood in Texas kicked off in 2011, a point when, as Lawrence Wright noted recently in the magazine, the organization was serving sixty per cent of the health needs of low-income women in the state. In the 2011 legislative session, which Texas Monthly called “the most aggressively anti-abortion and anti-contraception session in history,” the state government cut family-planning spending by two-thirds and approved a budget that, starting in 2013, banned Planned Parenthood from participating in the state’s women’s-health program, now called Healthy Texas Women. Federal law requires that states allow Medicaid patients their choice of “any willing provider,” and so Texas had to give up a nine-to-one federal funding match. Millions of dollars in spending for women’s health care were turned away. Then, this past May, Texas asked the Trump Administration for that federal funding back—a request that, if approved, would signal to other states that Planned Parenthood can be banned from Medicaid family-planning programs at will and with no financial repercussions. According to the New England Journal of Medicine, sixteen additional states have already proposed or approved similar bans.

It’s possible that, even if Planned Parenthood is defunded at the federal level by current Republican efforts, funding might be restored by subsequent legislation. But Texas provides a startling example of how quickly the women’s-health landscape can be wrecked by a withdrawal of resources—and how lasting that wreckage can be. Within months of the family-planning budget getting slashed in Texas, more than sixty women’s-health clinics had closed. Such effects can take years to undo, even if laws are reversed. In 2016, the Supreme Court overturned a Texas law that had halved the number of abortion clinics in the state. Only two clinics have reopened. The sprawl of Texas is almost incomprehensible—it’s the same distance from Houston, my home town, to El Paso as it is from Houston to Kansas City—and that sprawl means that rural clinic closures bring immediate and catastrophic consequences for poor women and women without cars. Teen abortions and teen births have both been increasing in Texas since 2011, and the maternal mortality rate in Texas doubled from 2010 to 2014. It’s now 35.8 deaths per hundred thousand live births—the worst maternal mortality rate you can find in the developed world.......

[Squinch]

1. "... worst maternal mortality...in the developed world." Republican family values at work.