Impact of Texas family planning affiliation regulation

As a federal appeals court considers the legality of Texas' family planning "affiliation regulation," a new report provides a preliminary assessment of the impact of the Texas rule on preventive care access by low-income women.

"An Early Assessment of the Potential Impact of Texas' "Affiliation" Regulation on Access to Care for Low-income Women," released by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative, reports on the impact of Texas' "affiliation rule" on access to cancer screening, preventive health care, and family planning services by low-income women. Specifically, the report finds that the affiliation rule - which would bar Planned Parenthood Federation of America (PPFA) clinics from participating in the state's Medicaid expansion family planning program because of their affiliation with an entity that performs and advocates for legal abortions - jeopardizes access to care for nearly 52,000 low- income women. The study reports that PPFA clinics represent the single largest source of health care for clients enrolled in the Texas Women's Health Program (WHP) and that their exclusion would eliminate women's access to 16 of 26 of the state's largest WHP providers. In FY 2010, PPFA clinics accounted for approximately 49 percent of all WHP-financed care, furnishing services to 51,953 WHP clients out of 105,998 WHP clients served. Of the 1,469 providers that billed the WGP in FY 2010, 908 (62%) served 10 or fewer patients, while 368 (25%) served only one patient. The authors conclude that the WHP program lacks any reasonable access alternative.

The report also examines the capacity of the state's community health centers to scale up their services to compensate for the loss of PPFA clinics. The authors conclude that it would be virtually impossible for health centers to fill the need given cutbacks in state family planning funding and the magnitude of the demand for health center services in the state with the nation's largest proportion of uninsured residents.

"Essentially, health centers would have to grow their WHP participation 12-fold - from fewer than 4,000 WHP patients to nearly 56,000 - to offset the loss of PPFA clinics from the program," noted Associate Professor Peter Shin, Ph.D, M.P.H., the report's lead author. Sara Rosenbaum, JD, Harold and Jane Hirsh Professor of Health Law and Policy, added, "given the size of the uninsured population and the demands already placed on health centers, growth of this magnitude in a short time period is simply impossible.

Julio Bellber, president and CEO of the RCHN Community Health Foundation, said, "Texas' health centers represent a vital source of care for nearly 1 million of the state's poorest and most medically underserved residents of all ages. But given the pressing needs and the extent of medical underservice in the state, the survival of the entire health care safety net is essential."