Months before Texas’ near-total abortion ban went into effect in September, officials succeeded in their years-long effort to kick Planned Parenthood out of the state’s Medicaid program. The move left thousands of poor Texans without access to birth control and other vital reproductive health services this year. Now, citing the new anti-abortion law, state legislators are urging the Biden administration to intervene.
In letters sent Monday and obtained by the Observer, 71 Democratic members of the Texas Legislature are asking the Biden administration to enforce Medicaid’s federal requirement that patients have a free choice of provider, and ensure that Governor Greg Abbott reinstates Planned Parenthood in the low-income health program. Senate Bill 8–which bans abortion after about six weeks and has eradicated the majority of abortion access in Texas for more than three months–compounds the many existing barriers to reproductive health services for the state’s poorest patients. Many Texans have had to travel as far as California and Ohio for the procedure, or forgo care altogether. “Lives are at risk, and we are calling on the federal government to provide assistance where our state leadership has failed to put Texans first,” the lawmakers write. “Public health should not be treated as a political weapon.”
This February, following a five-year court battle, Texas officials blocked Medicaid patients from obtaining basic preventative health care at Planned Parenthood clinics across the state, citing widely discredited “sting” videos by an anti-abortion group. The ideologically-motivated move left some 8,000 low-income Texans scrambling to access breast and cervical cancer screenings, birth control, STI testing and treatment, and annual exams, amid a deadly global pandemic. While Texas officials argued Planned Parenthood patients would be able to easily find a new Medicaid provider, in reality many struggled. Just 30 percent of OB-GYNs in the state accept all new Medicaid patients, according to a 2016 Texas Medical Association survey, in part due to low state reimbursement rates.
Reproductive health advocates and lawmakers say limited health care access, the COVID-19 pandemic, and SB 8 have all taken a disproportionate toll on Black and Latinx communities. “The Texans most severely impacted by the Medicaid exclusion are the same group of people being disproportionately impacted by Senate Bill 8: low-income women and women of color, many of whom are struggling and living paycheck to paycheck,” says Dyana Limon-Mercado, executive director of Planned Parenthood’s political arm. “They are not able to access things like birth control at their preferred provider, and at the same time, not able to access abortion in their home state.”
Barring Medicaid patients from receiving services at Planned Parenthood is the latest maneuver in the state’s longtime effort to strip public funding from abortion affiliates, despite the fact that abortions are largely barred from Medicaid coverage under federal law. Over the last decade, GOP lawmakers have decimated the reproductive health safety net for the state’s poorest residents while simultaneously restricting abortion access.
In 2011, Texas lawmakers slashed family planning funding by two-thirds, causing one-fourth of the state’s family planning clinics to shutter or halt services. And in 2013, they excluded Planned Parenthood and other abortion affiliates from the state’s Medicaid-funded women’s health program, booting 50,000 low-income patients from receiving care at their preferred provider. At the time, the Obama administration found that Texas’ actions violated federal law, so state officials decided to eschew the $30 million federal matching grant and run the program themselves. Years later, Texas won back those funds under the Trump administration.
The removal led to tens of thousands of patients losing access to care including long-acting contraception. Within 18 months, Texas saw a 27 percent increase in Medicaid-supported births, according to a 2016 study in the New England Journal of Medicine. Planned Parenthood previously served 40 percent of patients in Texas’ women’s health program. While the state reassured that other providers could readily absorb the displaced clients, around 45,000 fewer patients accessed preventative health services in the first years of the new program.
Despite Texas being home to the highest number of uninsured residents–and the highest number of uninsured women of reproductive age–in the U.S., efforts to broaden health coverage failed at the hands of Republican legislators this year. An estimated 5 million Texans are uninsured, about 1.5 million of whom would be eligible for coverage if the state expanded Medicaid. Of those who would be eligible, 75 percent are people of color and more than 324,000 are women of reproductive age.
In the letters sent this week to President Joe Biden and U.S. Health and Human Services Secretary Xavier Becerra, Democratic legislators from the Texas House and Senate write that the termination of Planned Parenthood from the Medicaid program places Texas in “direct conflict” with federal law and with the Biden administration’s warning earlier this year that states cannot withhold that funding from the reproductive health provider.Sara Rosenbaum, professor of health law and policy at George Washington University, points to the U.S. Department of Justice’s ongoing lawsuit against SB 8 as evidence that the Biden administration understands the importance of increased family planning resources in Texas at this time. “It is evident that Texas invented a host of bogus charges to push Planned Parenthood out of the program,” she says. “And there’s no doubt in my mind that the Biden administration now has the power and authority to intervene and bring the state into compliance with federal law.”
