Jonathan Cohn

Romney, Texas, and the 'War on Women'

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Republicans and their allies reject the suggestion that they are waging a war on women. Fine. How about we call it a war on women's health?

During a local television interview in Missouri on Tuesday, GOP presidential front-runner Mitt Romney said “Planned Parenthood, we’re going to get rid of that.” As Steve Benen notes, Romney was reiterating a previous promise to “Eliminate Title X family planning programs benefiting abortion groups like Planned Parenthood.”

Romney isn't alone: His presidential rivals have pledged to the same thing. If you want to know what such a change would entail, take a look at Texas and what one of his Romney’s former rivals, Governor Rick Perry, is doing to something called the "Women's Health Program."

The program provides funding for clinics that offer medical care, including reproductive services, to women. The state has long prohibited funds from flowing to abortion providers, but last year Perry and his allies in the legislature decided to go one step farther and eliminate funding for clinics "affiliated" with abortion providers. The main target of this move was Planned Parenthood, which keeps the 14 clinics performing abortion legally and financially separate from the 51 that do not. 

The state operates the Women's Health Program through Medicaid, which means the federal government provides 90 percent of the funding and sets parameters for how Texas may operate it. The Obama Administration rejected Perry's request. Perry responded by announcing that Texas would sever the federal ties altogether, even though it means sending $35 million back to Washington. The change takes place today, officially, although it will take some time for the money to dry up.

Romney, Perry, and their many allies targeting Planned Parenthood would like to make this issue about abortion, plain and simple. But it’s not. Planned Parenthood has become a backbone of the nation’s medical safety net, providing a wide array of medical services to women – in many cases, precisely because they are equipped to deal extensively with reproductive issues. (If you’re a man and you don’t understand why that might be important, find a woman you know and ask her.)

Writing in the Daily Beast, Michelle Goldberg told the story of Tena Price, a 51-year-old who had to drop her health insurance when the small electronics business she ran with her husband lost a major contract:

…she went several years without a Pap smear or a mammogram. Birth control was less of a concern as she got older, but she took the pill to help with her heavy, painful periods, and to make the supply last, she tried alternating one month on, one month off. “I found out thatI don’t know if it’s because I’m olderbut that doesn’t work very well for your body at all,” she says. “And so I called Planned Parenthood and said I need help.”

Since contacting Planned Parenthood last year, she has received an annual exam, a year’s worth of birth-control pills, and a voucher for a free mammogram at a radiology clinic. “They did cholesterol testingheart disease runs in my family,” she says. “And menopause is coming, so hopefully I will get some guidance through that. Without them, at this point, I would have none of that.

That story isn’t atypical. The Women’s Health Program serves 130,000 people in Texas, with Planned Parenthood caring for more than 50,000 of them. What will happen to them? Emily Ramshaw of the Texas Tribune provides some answers:

...though Planned Parenthood treats 45 percent of the program’s clients in a given year, officials with Texas’ Health and Human Services Commission say many of those women are also familiar with non-Planned Parenthood providers and stop in to get care there, too. Almost 80 percent of women enrolled in the program get services at non-Planned Parenthood providers, agency spokeswoman Stephanie Goodman said, because many women seek care at multiple places in a given year. ...  [Abby Johnson, a Planned Parenthood clinic director turned anti-abortion activist who is featured on the governor’s website] said the state's network of hundreds of Federally Qualified Health Centers comprehensive health clinics for the poor and uninsured should prevent women from falling through the cracks.

But opponents argue that without Planned Parenthood clinics, the program will simply not have the capacity and that women in remote corners of the state will suffer most. Of the 2,500 providers, the overwhelming majority are individual doctors unlikely to want to take on more government-subsidized patients, not clinics that specialize in women’s health and treat large numbers of patients. [Jose Camacho, executive director of the Texas Association of Community Health Centers] said the Federally Qualified Health Centers are already cash-strapped and can't just take women for family planning; they must have the resources to treat them for everything from mental illness to dental problems. 

Having spent some time in Texas and visited some of those clinics, I can vouch for what Camacho says: Existing community clinics do great work, but the the demand for services overwhelms the supply.

Granted, Planned Parenthood has a sophisticated fundraising and political operation. It's already raising money to help fill the gap. But it probably won't be enough. And while Perry has promised to replace the federal funding his state is relinquishing, that money may not materialize. And this latest move comes on the heels of another, even larger reduction in state funding for family planning. According to Anne Dunkelberg, associate director of the Center for Public Policy Priorities in Texas, that reduction reduced services for an estimated 150,000 women. Meanwhile, 6 million Texans have no health insurance and another 4 million are on Medicaid, which means they have insurance but can struggle to find providers willing to see them – making places like Planned Parenthood, which welcomes both the uninsured and Medicaid populations, all the more essential.

If opponents of abortion rights insist upon defunding any clinic that has even a vague association (but no formal relationship) with an abortion provider, they have an obligation to provide services in some other way. But Perry and the Texas legislature just cut Medicaid funding by $2 billion, in a move that Dunkelberg says has become all too typical:

Finding major solutions to access to care for Texans has not been a priority for state leadership, in any quarter, over the last decade. … avoiding any kind of revenue increase and reducing the size of government has been a higher priority for all of the current Texas leadership than making serious progress toward reducing the 1 in 4 uninsured.

And this could be a preview of things to come nationally, if Romney were to become president. He has called for dramatic cuts in federal spending that would, almost inevitably, hammer the health care safety net. Romney has also vowed to repeal the Affordable Care Act – which would, first and foremost, provide health insurance to 30 million people.

In that sense, I suppose, it’s not entirely a war on women’s health that the Republicans have been waging. It’s also a war on health generally.

Update: In comments, reader/blogger John Althouse Cohen reminds me that Planned Parenthood also provides services to men.

follow me on twitter @CitizenCohn

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