As the Senate is set to vote on whether to end all federal taxpayer funding for Planned Parenthood, the experience of Texas, which took similar action in recent years, could inform lawmakers.
Some of them will seek to accomplish their goal of defunding Planned Parenthood while not disrupting women’s access to family planning and health care.
The Lone Star State’s experience isn’t a mirror image of what could happen nationwide if Planned Parenthood lost its federal funding, but that state’s experience is illustrative of some of the challenges that might arise.
What Texas Did
Texas legislators first began excluding Planned Parenthood and other clinics with ties to abortion providers from taxpayer funding in 2011, banning them from the Medicaid Women’s Health Program, a mostly federally-funded state program that provides women with family planning and related screening services.
Once the ban was in place, Texas recruited other providers like physician groups and community clinics that did not have ties to abortion providers to make up for other women’s health services that Planned Parenthood and those other clinics provided.
Planned Parenthood and similar clinics provide many services besides abortions. In a statement, Planned Parenthood noted it provides 2.7 million men and women annually with birth control, cancer screenings, STI testing and treatment, and well-woman exams. In 2011, FactCheck.org backed up Planned Parenthood’s assertion that abortions represent 3 percent of its services.
Then, in 2012, the federal government ended its Medicaid funding of the Women’s Health Program, in which it provided $9 for every dollar the state spent.
That meant the state of Texas had to make up for those lost funds itself –- the program now receives 100 percent of its funding through the state’s General Revenue Fund.
The number of women served by clinics within the Texas Women’s Health Program dropped significantly between Fiscal Years 2011 and 2013, when the funding changes took effect. According to a Texas Health and Human Services Commission study, there was an average 25 percent drop statewide, with two of 11 HHSC regions reporting more than 50 percent drops.
As a result of this change, some Texas patients had trouble finding alternate sources of family planning and women’s health, in part because other providers in their area had not previously been providing specialized family planning services and had to first get expensive, time-consuming training in those areas.
“That high quality family planning is very difficult to integrate into primary care without specific programs to do that,” Dr. Janet Realini, the chair of the Texas Women’s Healthcare Coalition, a coalition of organizations working to assure access to preventive women’s care.
Realini did praise the state government, however, for “stepping up” and trying to compensate for the lost Medicaid funds.
Rep. Jim Keffer, a Republican state senator in Texas who worked on the defunding measures, also acknowledged that the state is still working to address lost provider capacity, including recently introducing a new website to help women access family planning programs.
"As Planned Parenthood has been going through their spiral here, we have been bolstering what Texas can offer through this other network,” Keffer said. “You can’t just close it off and wipe your hands of the situation because comprehensive women’s health care has to still be provided.”
A related issue is that some women might not go to a general practitioner -- even one that introduced family planning into their practice -- because they prefer going to a specialist.
"Some women prefer to go to dedicated family planning providers to get dedicated contraceptive services," said Amanda Stevenson, a researcher at the University of Austin's Texas Policy Evaluation Project working on the impact of excluding Planned Parenthood from the Women's Health Program in Texas.
Stevenson noted a 2013 review from the Guttmacher Institute, a reproductive health policy group, which found that women say they prefer going to specialists for this care because of "the respectful, confidential, affordable and high-quality care they receive from them."
Texas’ experience is not completely indicative of what might happen on a federal level, in part because the defunding would be targeted specifically at Planned Parenthood, not other family planning clinics.
The push by some in Washington to defund Planned Parenthood has escalated since The Center for Medical Progress released a series of videos which the anti-abortion group alleges shows former and current Planned Parenthood employees discussing prices for fetal body parts. Planned Parenthood president Cecile Richards maintains the organization has broken no laws, saying on ABC’s "This Week," “We have the highest standards. The care and health care and safety of our patients is our most important priority."
Federal funding for most abortions is already prohibited by law.
But while the national and local situations are different in some ways, they would likely share a similar challenge: how to take funding away from providers that thousands of women rely on, and reallocate that money in such a way that women still have access to specialized family planning and women’s health services with minimal disruption.
Members of Congress who are seeking to end taxpayer funding for the organization said they would reallocate all those funds to community health centers and clinics who could make up the difference and provide women’s health and planning services to any woman who previously relied on a Planned Parenthood.
Sen. James Lankford of Oklahoma, who is among those lawmakers who rejected the idea that other providers can’t make up the capacity that might be lost if Planned Parenthood were defunded, noted that there were exponentially more community health centers in his state than there were Planned Parenthood clinics which would lose money.
“We’re talking about adding additional funds to [community centers] that would come from the other areas,” he said. “So I think it’s a red herring to say they can’t afford it.”
In a written statement, Dawn Laguens, the Executive Vice President of Planned Parenthood Action Fund, disagreed.
“More than half of Planned Parenthood’s non-profit health centers are in rural or medically underserved areas, and millions rely on us each year for care. If this bill went into effect, blocking our health centers from serving patients who rely on publicly funded programs for health care, millions of people would struggle to access quality reproductive health care -- period. We’ve seen this in states before: When similar measures were passed in Texas, 54 percent fewer patients received care.”