Texas’ Women’s Health, UT Study: Other than that*, the story was true
*The authors of a study published in the New England Journal of Medicine admit to a narrow focus that ignored the multiple methods of funding Family Planning in Texas, looking instead at a single type of “provider” – Title X clinics like Planned Parenthood (“PP”) – and a single source of funding for a specific set of services: long-acting reversible contraceptives such as the IUD and implants and injectables.
Yet, in typical fashion, the reports about the study claim much more. For example, the Texas Tribune has an article out, “Texas disavows Controversial Women’s Health Study,” about the political fallout due to the skewed conclusions of the authors and the even more skewed editorializing in the media.
While the NEJM article (free article!) states in the “Methods” section that,
“After the exclusion, the provision of injectable contraceptives fell sharply in counties with Planned Parenthood affiliates but not in counties without such affiliates; subsequently, the numbers of claims in both groups of counties remained relatively stable during the next 2 years. In contrast, the provision of short-acting hormonal methods changed little in the two groups of counties in the quarter after the exclusion and declined steadily thereafter.” (Emphasis mine.)
The Tribune article reports that in answer to criticism:
Joseph Potter, one of the UT researchers who co-authored the study, said in an email that the paper addressed the “specific question” of how the exclusion of Planned Parenthood from the Texas Women’s Health Program affected women. Nothing raised in Traylor’s letter, he said, contradicted the researchers’ conclusions.
“We made no claims about access to reproductive health care as a whole in Texas,” he said, and he stood by the finding that claims for long-acting contraceptives fell after Planned Parenthood was excluded from the women’s health program.
The law in question, SB7, was passed with bipartisan support in 2011, a year when Texas, along with State budgets all over the Nation were tight. Although family planning was cut, no specific vendor was “excluded” and PP was not even mentioned in the legislation. Only because Planned Parenthood did not offer continuing, comprehensive care, that business would effectively be cut out.
The Obama Administration took great offense at our State’s attempt to take care of the whole woman and refused all Family Planning Title X money for Texas Medicaid.
Instead, Obama intervened to specifically direct $13 million of Title X funds to a private organization, the Women’s Health and Family Planning Association of Texas (“WHFP”) which funds only Title X clinics, almost all of which are now Planned Parenthood businesses), so no money was lost even at PP.
The State Health Services no longer managed those Medicaid matching dollars once allowed by a special Medicaid waiver. Instead, State funding for the Family Planning programs and the Texas Women’s Health Program, was replaced by State dollars and directed toward programs and doctors that offer continuing, comprehensive care, such as Federally Qualified Health Centers (FQHC), State, County and local clinics and hospitals, and fee for service doctors that participate with Medicaid. Women could be diagnosed and treated for a much broader spectrum of health problems and their families were welcome at the same clinics.
Senator Jane Nelson, Chair of the Senate Finance Committee and sponsor of the Bill, objects to the implication by the NEJM that the authors were writing on behalf of the State. In her letter to the Executive Commissioner of Texas’ Department of Health and Human Services, Chris Traynor, Senator Nelson noted,
“This study samples a narrow population within the Texas Women’s Health Program (TWHP) — which represented only 33 percent of the overall number of women enrolled in our women’s health programs in Fiscal Year (FY) 2014. This ignores hundreds of thousands of women being served through the Expanded Primary Health Care Program; the Family Planning Program; and the 628,000 women of child-bearing age receiving full Medicaid benefits, 75 percent of which received contraceptive services in FY 14. Women often rotate in and out of our state programs, so we must look across our entire system to determine whether we are truly meeting their needs. Just because a claim for service was not submitted to TWHP does not mean a woman went without that service.
The study also creates an impression that fewer Texas women are accessing long-acting reversible contraceptives (LARCs). That’s simply not true. Across our state programs, there were more claims for LARCs in FY 2014 than there were in FY 2012 when Planned Parenthood was still a provider.”
In other words, women with private insurance and women who never had access to PP had similar numbers.
And another thing: Potter, a sociologist at UTAustin and the co-author quoted above, was the one who told the LA Times that, “It’s not like there is a large, over-capacity of highly qualified providers of effective contraception out there just waiting for people to show up.”
On behalf of Texas’ Family Physicians, OB/Gyns, Pediatricians and Internists who accept traditional Medicaid and who had been unable to access the money in those competitive Title X grants awarded to PP, I’d like to inform him that yes, we have been waiting – for a chance to offer our patients this care.
But other than that ….