Reproductive justice advocates have long puzzled over the irreconcilable dissonance inherent in legislative efforts to target family planning services within the context of a larger anti-choice agenda.
On its face, it makes no sense. If you oppose abortion, you should probably support increased access to family planning services. If you’re a self-righteous fiscal conservative who begrudges every penny of his taxed income spent on the social safety net, you should probably support increased access to family planning services. If your religious convictions have you wringing your hands at the idea of pre-marital sex, take a minute to look at abstinence-only education’s abysmal track record. Yep, you should probably support increased access to family planning services as well.
Even as they continue to fight the ugly fight against Roe through TRAP legislation and increasingly draconian fetal pain/heartbeat/personhood bills, there is absolutely no excuse for those who inveigh against abortion to oppose family planning services. This should be self-evident, so why isn’t it? For conservative legislators, perhaps the symbolic rewards associated with burnishing one’s red meat credentials by de-funding local Planned Parenthoods and attacking the fictitious “abortion industry” outweigh the perceived benefits of pragmatism. This certainly appears to be the case in Texas, where the reality-challenged ideologies of Republican state legislators have resulted in trial-by-fire for anti-family planning legislation. Now we know what happens when states de-fund Planned Parenthood, and it isn’t pretty.
Over the past two years, legislators in Texas have taken great pains to cut Planned Parenthood out of its women’s health programs and, in so doing, have incited a public health crisis. In 2011, they slashed $73 million from the state’s family planning budget, leaving more than 127,000 women without access to, well, woman care and forcing the closure of over 50 clinics throughout the state. They passed up $30 million in annual federal Medicaid reimbursements to their Women’s Health Program so they could de-fund Planned Parenthood without violating federal Medicaid requirements, leaving the program’s 130,000 low-income members at risk for further cutbacks.
According to most measures, the public health consequences for Texas women have been severe. In a survey of 300 pregnant Texas women seeking abortions, the Texas Policy Evaluation Project found that nearly half reported being “unable to access the birth control they wanted to use” in the months before they became pregnant due to factors such as cost, inability to find a clinic, lack of insurance, and inability to obtain a prescription. The Planned Parenthood clinics that Texas Republicans forcibly excluded from the state’s Women’s Health Program previously served nearly 50% of the program’s enrollees. These clinics had provided important primary care services in addition to contraceptive counseling. Without Planned Parenthood providers, remaining clinics in the state-funded Women’s Health Program have been buckling under the pressure of budget cuts and the influx of displaced patients. Many providers have been forced to cut back their hours of operation and hike up patient fees.
In a state that already boasts some of the nation’s poorest health outcomes, these ideologically motivated cuts have been nothing short of disastrous. One in three Texas women of childbearing age lacks health insurance, and in 2011 half of all pregnancies in the state were unplanned. The state’s health commission predicts that Texas will see nearly 24,000 unplanned births between 2014 and 2015 thanks to these cuts. This will raise Medicaid costs by up to $273 million, which is bad news for taxpayers.
Finally, in a particularly salty twist for Republican state legislators, their Herculean anti-choice efforts have had zero net effect on the number of abortion providers in the state of Texas, because as it turns out, none of the 53 clinics that have been shuttered since September 2011 were providing abortions in the first place. Texas has never permitted abortion clinics to participate in the Women’s Health Program, and, lest we forget, the majority of Planned Parenthood facilities do not provide abortion services. Those that do offer abortion services never use public funds to do so except in cases of life endangerment, rape, or incest, so abortion clinics have been relatively unaffected by the cuts.
The situation in Texas is looking more and more like a classic lose-lose-lose situation. Decreased access to health care means Texas women lose; the costs associated with this manufactured public health crisis mean Texas taxpayers lose; and, ironically, in their failure to eliminate any abortion clinics, the anti-choice legislators lose as well. In an effort to backpedal, Republican state senators recently proposed adding $100 million for women’s health services back into the state’s primary care program. It’s certainly a step in the right direction, but as Planned Parenthood of Greater Texas Vice President for Community Affairs, Sarah Wheat explains, "It’s hard to put back together a system that’s been dismantled."