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.