Four years after Texas gave up millions of dollars in federal Medicaid funds so it could ban Planned Parenthood from participating in a family planning program for low-income women, the state is asking the Trump administration for the money back.
The request presents an important early test for the administration of President Trump, who recently appointed an anti-abortion official to oversee federal family planning programs. Under President Obama, federal health officials would not allow Medicaid funds to flow to the Texas program after it excluded Planned Parenthood, because federal law requires states to give Medicaid beneficiaries their choice of “any willing provider.”
If the administration agrees to restore the funding for Texas, it could effectively give states the greenlight to ban Planned Parenthood from Medicaid family planning programs with no financial consequences.
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The reduced funding in Texas has led to a drop in women receiving services through the program. The Texas program had an average monthly enrollment of about 79,000 last year, according to the state, down from 126,000 before it cut out Planned Parenthood and other abortion providers. In the first 18 months after the change — which resulted in a loss of $35 million a year in federal Medicaid funds — thousands of women stopped getting long-acting birth control, and Medicaid pregnancies increased by 27 percent, according to a research paper published last year in The New England Journal of Medicine.
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In its draft waiver application, the state said it hoped that by turning Healthy Texas Women back into a Medicaid waiver program, it would improve access and participation. The application noted that Texas had the nation’s highest birthrate, with more than 400,000 births in 2015, more than half of which were paid for by Medicaid. It also noted than more than one-third of pregnancies in the state were reported as unintended, and that Texas had one of the highest teen birthrates in the country.
The Way Texas Treats Women
Restoring federal money to Texas would not necessarily bring new health centers to underserved areas where Planned Parenthood and other clinics have closed. Moreover, Planned Parenthood is a trusted provider, known for offering comprehensive and nonjudgmental care. Any program that excludes it, even if fortified with federal money, would unfairly restrict women’s options.
Several states have already followed Texas in directing family planning funds away from Planned Parenthood. This year, Missouri established a program that excludes the group. The governor of Iowa recently signed a bill to do the same.
Now the Trump administration is planning to export this bad reproductive health policy around the world. On Monday, the State Department issued rules expanding the so-called global gag rule, or Mexico City policy, which bars organizations overseas from receiving United States aid if they discuss abortion. Under previous Republican administrations, the policy, established by President Ronald Reagan, applied only to family planning funds, used to pay for contraception and other reproductive health services. The new rules apply to all United States aid for health services, meaning groups could lose money for malaria prevention or AIDS treatment. For instance, $6 billion in funding for H.I.V./AIDS prevention, which goes mostly to groups in Africa, could be lost.
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