RESEARCH AND POLICY

Before the pandemic started, Texas led the nation’s healthcare uninsured rate, failing to provide insurance for 18.4% of  children, adults and women of childbearing age. This rate has risen to a whopping 29% as unemployment increases and the pandemic rages on. According to a 2020 study, approximately 659,000 Texans have joined the ranks of the uninsured, but that estimate will most likely rise as we get deeper into 2021. 

So, what do these health statistics mean and why does it matter?  

While access to healthcare is a complex and multifaceted issue, financial barriers are significant for individuals accessing medical services. The U.S. healthcare system is not affordable for most Americans without health insurance, which can be provided by some employers, through the government, or the Affordable Care Act (ACA) marketplace. Employer-based insurance is one of the more popular options. According to the Kaiser Family Fund (KFF), 49% of Americans receive health insurance from their place of work. With unemployment rates rising dramatically during the COVID-19 pandemic, many people have lost healthcare coverage along with their jobs, placing greater overall dependency on state-funded insurance and individual ACA healthcare plans. 

Studies show that individuals who have health insurance are more likely to use preventative care and have better health outcomes as compared to those without health insurance. Uninsured patients tend to wait until their conditions worsen before seeing a doctor, which can result in worse prognoses that require more costly and extensive treatment. While charity and community health programs serve uninsured patients, they alone cannot fill the increasingly high need for health services in their local communities. 

In addition to privately funded charity programs, the government offers public health insurance programs like Medicaid to help low-income adults access healthcare. Medicaid is fully funded by both the state and federal government, and Medicaid eligibility differs by state Eligibility criteria often depend on an individual’s income in comparison to the national poverty level. While the Affordable Care Act (ACA) attempted to expand Medicaid nationally, the Supreme Court ruled this provision unconstitutional. This 2012 ruling allowed each state (instead of the federal government) to decide if Medicaid eligibility should be expanded to adults making up to 138% of the federal poverty level ($17,609 in 2020). Placing the option of Medicaid expansion under the responsibilities of each state has resulted in the creation of coverage gaps in non-expansion states. Many of their residents remain uninsured because their income is too high to qualify for Medicaid but too low to afford subsidies for health insurance provided through the ACA marketplace. 

Texas is one of the only 12 states left to expand Medicaid and has the strictest eligibility requirements for Medicaid, which has left nearly 1.4 million Texans without health insurance who would have qualified had they lived in the other 38 states with Medicaid expansion. Many of nearly 800,000 individuals who fall in the coverage gap work in jobs below the poverty line, including childcare educators and cashiers. In fact, nearly three-fourths of the individuals who would qualify are workers, many of which are struggling with reliable employment during the pandemic. 

Many advocates suggest that Medicaid eligibility expansion is the best way to address Texas’ record high uninsured rate. Not only will millions of residents get health insurance, studies also show that Medicaid expansion is the budget-friendly solution to Texas’ abysmal health insurance disparities. The ACA requires the federal government to pay for 90% of Medicaid expansion, which would actually help save the state government money. 

The recent passing of Biden’s American Rescue Plan Act (ARPA) makes Medicaid expansion an even sweeter deal, providing Texas with an additional estimated $3-5 million “bonus” over a two year period. A substantial increase in federal money coupled with higher insured rates would lessen the financial burden on individual hospitals, decreasing the amount of uncompensated care and lowering the rising rates of hospital closures in rural areas. Studies in other states that expanded Medicaid revealed that other important health areas received more funding such as mental health programs. 

An important population in Texas affected by a potential Medicaid expansion are individuals who need women’s health services. With more than 1 in 4 women of reproductive age lacking health insurance in Texas (approximately 1.5 million women), many cannot access important preventative care. Medicaid expansion would allow nearly 761,300 women to obtain stable and affordable health insurance. While uninsured residents qualify for Medicaid if pregnant (Medicaid for Pregnant Mothers), coverage begins only once the parent confirms pregnancy and ends abruptly two months after childbirth. Studies show that consistent healthcare coverage allows mothers to reliably access important prenatal and postnatal care, which is vital to the health of both the mother and child. The inaccessibility of such services for many women in Texas is reflected in the terrible maternal and child health statistics (see previous blog for more information). Furthermore, Medicaid expansion correlates with an average of 7 less maternal deaths per 100,000 live births and 16 less maternal deaths per 100,000 among Black women (as compared to states that have not expanded Medicaid). A lower maternal mortality rate is incredibly important for women of reproductive age in Texas, especially among Black women who experience 3 times the risk of maternal mortality and morbidity as compared to white women. 

While women’s health programs exist in Texas, only Medicaid expansion would give comprehensive health benefits to the most women earning low incomes in Texas. As discussed in a previous blog, Healthy Texas Women (HTW) provides limited services to the women who qualify as well as limited choices in providers. While the HTW program emphasizes preventative care, patients cannot get counseling services or see many medical specialists like cardiologists and endocrinologists under the program. The only other public health insurance option is Medicaid for Pregnant Mothers, which, as stated before, individuals are only eligible for during their pregnancy and two months after. 

So, will Texas expand Medicaid? 

Health care reform is a top priority for the 2021 legislative session. Many advocates are hopeful that Medicaid expansion will become a reality. Texas has several options to pass Medicaid expansion: the governor or legislature can pass a bill, the legislature can pass an amendment that the public will then vote on, or the legislature can design their own Medicaid program with expansion using the Medicaid 1115 waiver. While Texas Democrats have supported Medicaid expansion since 2012, some Republican politicians are starting to change their minds. Bills containing Medicaid expansion with bipartisan support were filed by mid-March and while they were not included in this year’s “Texas House Plan on Healthcare,” TX House Speaker Dade Phelan has expressed his support for the addressing of Medicaid Expansion, which will most likely be debated on in a budget amendment later in this legislative session. 

How can you stay involved in these decisions? 

The implementation of Medicaid expansion and its positive effects on the health and safety of women across Texas lies in the Texas legislature’s hands, who are supposed to be governed “by the people.” Our involvement in this matter is crucial. You can follow the “Cover Texas Now” coalition of healthcare advocacy organizations and support their “Sick of It TX” campaign for Medicaid expansion. Sign up on their website to receive legislative updates and to become involved in any advocacy activities. Call your state representatives, Lieutenant Governor Dan Patrick, and Governor Greg Abbott. Together, we can help push for Medicaid Expansion in Texas. 

The United States is one of the few “developed” countries that denies its citizens access to affordable healthcare and has failed to provide much needed medical services during a worsening pandemic. Millions have lost their employer health insurance with the pandemic’s accompanying waves of job losses and lack of individual economic protections granted by Congress. With the highest uninsured rate in the nation and a higher unemployment rate than the national average, Texas fares worse than most states, particularly their recently unemployed low income workers who lack basic income and health care access. 

With all of this ongoing chaos, the Texas government still managed to continue its tradition of repressing access to reproductive care. In May of this year, the Health and Human Services Commission (HHSC) tried to cut $133 million in funding including $3.8 million from women’s health programs, citing budget restraints due to Covid-19. While state administrators suggested siphoning funds from programs that provided important preventative services (i.e. contraception, screenings, and assistance in enrollment into safety net programs), they left the funding for Texas’ anti-choice Alternatives to Abortion (A2A) program untouched. While outrage from reproductive health advocates and constituents pressured administrators to reverse their budget proposals, the prevailing A2A program serves as a reminder that the fight for accessible reproductive health care in Texas is far from over. 

Created in 2006, the A2A program funnels some state funding into maternity homes and adoption centers, but directs most of its money to crisis pregnancy centers (CPCs). An apt name — CPCs do target pregnant people in crisis, but only to dissuade people from having abortions. CPCs direct most of their funding to counseling rather than their other stated services such as maternity clothing, diapers, and childbirth classes. Instead of objectively showing their patients their available options, counseling largely consists of staff members pushing a Christian anti-choice rhetoric through medical lies and victim blaming. CPCs also don’t have medical supplies or personnel; while many lure in unsuspecting pregnant clients with free ultrasounds, the ones provided by CPCs don’t meet the mandated ultrasound required the day before an abortion procedure. 

If advocates and legislators alike know the A2A program lacks credibility, couldn’t they force the program to provide accurate reproductive healthcare services and education? Sadly, the answer is no. The state government provides very little oversight for the A2A program, requiring its  contractors to only submit the number of clients they serve and anecdotal “success” stories. Little evaluative information is given regarding measures of benefits, services, and cost-effectiveness, which is usually mandatory for other state health programs. 

Despite controversies surrounding the A2A program, the state legislature continues to increase its funding every session. Beginning with a budget of $5 million in 2006, the A2A program has received approximately $170 million in total through 2021. State legislators have redirected funds from important safety net programs like Temporary Assistance for Needy Families (TANF) and vital state entities like the Texas Commission for Environmental Quality (TCEQ) to these anti-choice centers. As A2A funding increases rapidly each biennium, attacks on preventative care and reproductive health care continue at a similar rate. Since the state government slashed their family planning funding to one-third of its original size in 2011 and cut Planned Parenthood from the Medicaid program, about 80 clinics have shut down or stopped providing family planning services, leaving over 50,000 people without any source of preventative healthcare. 

Texas also leads the nation in “abortion deserts.” As of 2018, only 21 clinics provided abortions compared to the 170 active CPCs scattered throughout Texas. With the highest uninsured rate for women of child bearing age in the US and abysmally high rates of maternal mortality and morbidity, Texas’s continued support for nonmedical, ideologically-driven clinics is dangerous, particularly for the most vulnerable. 

People with uteruses have never had full bodily autonomy, especially people of color. The Texas government and medical system serve as a historical testament to that through their continual failure to care for millions across the state. So what can Texas do to provide its citizens with proper preventative and reproductive healthcare? Much of the state’s healthcare environment depends on upcoming Supreme Court hearings, where the dissolution of the Affordable Care Act is on the table. With hearings regarding Medicaid payments to abortion providers and the potential reversal of Roe v. Wade, access to reproductive care also hangs in a limbo. In the upcoming 87th session, the least that the Texas legislature can do is stop funneling state tax dollars into the already bloated, dangerous A2A program and stop diverting funds from important safety net programs like TANF. Anti-choice religious ideology does not belong in state government and most importantly, in reproductive healthcare settings. Preventative and reproductive healthcare should be a guarantee for every individual, regardless of their anatomy, race, or income status.

Featured: Protect Reproductive Rights Sticker 

Texas has some of the worst health statistics, especially for women. 

According to research compiled by United Health Foundation, Texas ranks 48th in women’s health, 49th in women with dedicated healthcare providers, and 50th in women’s health policies. Approximately 30% of women ages 18-44 lack health insurance, and of the women who have public health insurance, such as Medicaid and Medicare, only 16% of them felt their needs were met. 

Pretty terrible, right? But what does the “Healthy Texas Women” program have to do with this? 

Healthy Texas Women is the Medicaid program offered by the Texas government to individuals with an income of less than $302 per month. The program formed in 2013 after the Texas legislature combined the Texas Women’s Health Program and Expanded Primary Health Care for Women Program to better streamline health care services for more women. This was after the state gutted the Medicaid program in 2011, taking away two-thirds of the state’s family planning budget and terminating state contracts with Planned Parenthood. 

Because the Texas government cut their largest provider of women’s health services (approximately 40% of the women on Medicaid) due to claims that Planned Parenthood affiliates performed abortions, the Obama administration cut federal funding to the state’s Medicaid program. Federal law dictates that women must be able to freely choose their provider, which the Texas government ignored. This decision decimated their source of funding for Medicaid, cutting their budget in half. Texas would have to find ways to serve more of their low income women with a lot less money — hence the conception of Healthy Texas Women.

But … the number of women served by the Healthy Texas Women program actually decreased, continuing the decline in clients that began after 2011. From 2011 to 2016, enrollees decreased by 24% and the number of health care services accessed fell by 39%. In 2018, only 70% of women in the program used the healthcare services offered, and most of the providers under the program have not actually served any of the clients. In fact, the Texas Health and Human Services Commission billed only 10% of the program’s providers. 

Unintended pregnancies seemed to increase under this program, directly contradicting one of its main goals. Under the Healthy Texas Women program, there was a 35% decrease in the women getting IUDs and other long-acting contraceptives, which is cited as one of the most effective types of birth control. Injectable contraceptive admission decreased by 31% and Medicaid-paid births rose by 27%. 

A coincidence? I think not. 

But instead of advocating for reform to the program, the Trump administration has decided to reward Texas’s anti-choice rhetoric, pledging to reinstate federal funding to Texas’s Medicaid program. With an addition of $69 million from the federal government, the Healthy Texas Women program will reallocate the state budget, but will not change the amount of money set aside for the program. Texas is also one of the 14 states that did not expand Medicaid under the Affordable Care Act, denying coverage to millions of women within its borders. 

With 3 in 10 women in Texas classified as low-income and 1 in 5 uninsured, it is incredibly dangerous that the Healthy Texas Women program is being rewarded for its incompetence. Many worry that the re-instated funding for Texas will be used as an example for other states in their quest to restrict accessibility to family planning and reproductive care by low income individuals. 

Ideology has no place in healthcare. The Health Texas Women program needs to be reformed to better serve its constituents. Expanding Medicaid and renewing contracts with Planned Parenthood affiliates would be a start, but much more needs to be done. Texas women deserve better. 

 

Featured Image: Harriet Lee-Merrion, The New York Times

Welcome to the new year, friends!

Yesterday, as I watched Elizabeth Warren empower her fellow female democratic candidate in the last debate, I thought of you all. In this day and age, health and policy are often times inseparable, so it is important that we stay informed about the policies that could affect our healthcare coverage and access. A couple of years ago, Jimmy Kimmel hosted a segment where he asked locals if they preferred Obamacare or the Affordable Care Act (spoiler alert: they are the same thing). Alas, most people chose the latter. Thinking back to the second hand embarrassment of watching that episode, I wanted our empowering readers to be informed voters and advocates for the upcoming election. Thus, here is a summary of the healthcare policies that the democratic candidates of 2020 advocate for:

Image: NPR 

There are three broad approaches to healthcare in the 2020 election. The single-payer system (Medicare for All), the public option backers, and those advocating for a mix of the two. Here is a list of the candidates and what healthcare plan they hope to implement if elected:

SANDERS advocates for Medicare for All, a system that eliminates private insurance. The single entity that would pay for healthcare is the federal government. Coverage would expand to cover all people, including benefits that are not covered by current Medicare, such as long-term care. Deductibles, coinsurance, co-pays and surprise medical bills would be prohibited. Sanders plans to fund this policy through an employer-side payroll tax, which is a tax based off of the salary of the employee. He claims there should be no limits on abortion from the federal goverment. 

WARREN also backs Medicare for All. She would fund it with higher taxes on the wealthy, and no new taxes for the middle class. Compared to Sander’s funding plan, Warren hopes to fund Medicare for All through employer contributions. This means that companies with over 50 employees calculate current average health insurance spending and pay 98 percent of that to the government. Thus, there is no direct tax to middle class health insurance consumers. She hopes to invest in federal funding to help tackle the opioid crisis, and plans to strengthen healthcare in rural communities through higher reimbursements to rural hospitals. She claims there should be no limits on abortion from the federal goverment, and she wants to repeal funding restrictions on abortion while preventing states from passing laws to restrict abortion access. 

BENNET supports Medicare X, a plan expanding Obamacare and offering low-cost health insurance choices for people and small businesses. This plan provides another health insurance option that people could buy, starting from rural areas and slowly expanding until everyone has the option to use it. He claims there should be no limits on abortion from the federal goverment. 

BIDEN hopes to expand Obamacare, adding a public health insurance option like Medicare. He plans to allow a premium-free option for those that would fall under Medicaid in certain states that do not recognize its current expansion. Biden’s stance on abortion has changed over time, the most recent indication being his vote on a late-term abortion ban in 2003.

BUTTIGIEG has a “Medicare for All Who Want It” plan where Americans can buy into the public plan. Similar to the Biden plan, those in states that refused to adopt the Medicaid expansion will be covered. He plans to keep private insurance around because he believes the public plan will influence private insurers to lower prices. If this does not happen, the plan will naturally become Medicare for All. He would reimburse providers for providing free care. He claims there should be no limits on abortion from the federal goverment.

DELANEY wants to keep private insurance and Medicare in tact, adding a public option for consumers under 65.

GABBARD supports Medicare for All, but also wants to keep private insurance — making her stance unclear. She claims there should be no limits on abortion from the federal goverment.

STEYER also wants a public insurance option, hoping to naturally drive out private insurers without forcing the public option on consumers.

YANG advocates for a transition to Medicare for All through subsidized public insurance. He wants to keep private insurance in tact, but hopes to provide most of the funding through the federal government. He claims there should be no limits on abortion from the federal goverment.

KLOBUCHAR also supports the public insurance option. She wants to prioritize mental health through early interventions and advocates for increased funding for schools and physicians to implement such efforts. She believes in implementing limits on abortion in the third trimester unless the woman’s health is at risk.

BLOOMBERG wants a Medicare-like public option administered by the federal government. This plan would be paid for by consumer premiums. 

PATRICK advocates for a competitive public insurance option that is modeled after Medicare.

The democratic candidates all have a goal for decreasing healthcare prices, whether it’s a single payer system, public option or a mix of the two. They also want to decrease drug prices through various tactics, such as importing cheaper drugs internationally, revoking branded drug patents, or allowing Medicare negotiations with pharmaceutical companies. 

Now that you are more informed about the health policies of our 2020 democratic candidates, you can handle any debate discussion, interview, or talk-show host that may come your way! Be sure to stay updated on the policies of the candidates as the election draws near. Consider what policies you would want to implement if you were president, and while you wait for your term in office, vote for the candidate supporting your policies because your vote matters. 

Art by: Milo Mars

Should women have the luxury of accessing depoliticized healthcare or must we tend to our bodies while contending with an incessant legislative agenda? Does “fighting the good fight” take precedence over our physical wellbeing? 

When your bodily autonomy is up for question, the area between public advocacy and personal health becomes unclear. 

This past July, Planned Parenthood ousted former president Leana Wen, citing differences in priorities and management styles. Wen is a proponent of depoliticizing Planned Parenthood and its services, but the organization isn’t ready to chart a new course. A New York Times article reported that Planned Parenthood’s board of directors “felt it needed a more aggressive political leader to combat the current efforts to roll back access to abortions.” 

Meanwhile, nine states have passed early abortion bans as of this summer. Access is waning and the need to normalize women’s health couldn’t be more urgent. However, political aggression is not the solution. Progress is the need of the hour, and politics stands in its way. 

Planned Parenthood’s actions against Wen speak to prioritization of publicity and political statements at the cost of the communities it serves. 

Wen, in her New York Times op-ed, pointed to a positive shift in public perception regarding abortion during her tenure at Planned Parenthood. A poll published in early June reported that 77% of Americans believed that the Supreme Court should Uphold Roe v. Wade. Still, her efforts to integrate women’s health into mainstream healthcare were undermined, and she was asked to leave. 

Instead of using abortion politics as leverage to advance their cause, Planned Parenthood should care for women by considering their health before their civic value; by classifying its services as necessary rights instead of political strategy. 

This year has seen a devastating regression in reproductive health rights. America bears the highest maternal mortality rate in the developed world, and our plight will only intensify with increasingly limited access to women’s healthcare. 

Women are in danger in this climate of extremism. When a woman seeks care from Planned Parenthood, she faces the risk of assault by protestors outside the clinic. Restrictive policies, including the Title X Gag Rule passed a few weeks ago, impede women’s roles as decision makers. Safety and access as it relates to women’s health have been consistently under siege, even after the establishment of Planned Parenthood over a century ago. Addressing this by treating women’s health services as part of holistic healthcare should be the organization’s immediate concern. 

Planned Parenthood’s political approach isn’t working anymore. Women’s health is, first and foremost, a public health issue. When I walk into Planned Parenthood, I’m not looking to make a political statement. I’m looking to access my fundamental right to healthcare. 

 

Featured image: Tracy Emin, My Abortion (1990)

 

Earlier this year, the Trump administration issued a new abortion rule that bars healthcare clinics that perform abortions or provide abortion referrals from receiving Title X funds. The rule was officially enforced yesterday. Here’s a quick rundown on what’s happening and what all of this means for reproductive and women’s health.

Title X is a federal grant program dedicated solely to providing family planning services and related reproductive health services including birth control, STI screenings and breast/cervical cancer screenings for low-income patients.

As the only federal grant program dedicated to these services, Title X is crucial for the health of millions of Americans. Nearly 4,000 clinics nationwide receive Title X funding, allowing them to provide services for around four million people a year. The program is especially important for underinsured or uninsured low-income people of color who often use Title X-funded clinics.

In March 2019, the Trump administration issued a domestic abortion “gag” rule. This rule was fully enforced yesterday (on September 18th, 2019).

The new rule states that health clinics can’t receive certain funding from Title X if they provide abortions or refer patients to other health centers that provide abortions. The rule is meant to create seperation between facilities, programs and any other health services using Title X funds from those that provide abortions. The rule still allows providers to offer “nondirective counseling” on abortion, which means doctors can still go over treatment options with patients in order to make sure they get all of the information they need to make the best decision about their health. However, nondirective counseling would prohibit a doctor from telling a patient where they could go to get an abortion, even if the patient requested this information.

So what does this all mean?

This rule has left facilities receiving Title X funding in a predicament. They can either stop receiving funding from Title X or stop providing abortion services and referrals to patients. If a clinic provider wants to talk to patients about ways to access a safe and legal abortion, they can’t receive Title X funding for other health services they provide like affordable birth control or STI screenings.

Note: Federal law already prohibits the usage of Title X funds to pay for an abortion, and federal Medicaid funding also doesn’t cover abortions except in rare circumstances. Under this rule, Title X-funded facilities can no longer provide abortion services and receive Title X funding for other non-abortion services at the same time — even though none of these funds were used to cover abortion services in the first place.

In August, Planned Parenthood, which treats 40% of all Title X patients in the country, decided to withdraw from the federal program, instead of stopping abortion services and referrals in their clinics. Planned Parenthood is not the only one. Main Family Planning and Public Health Solutions, a group of clinics in Maine and New York, respectively, also announced they would leave the Title X program.

This new rule not only impacts a patient’s ability to receive information about accessing a safe and legal abortion, but also has devastating consequences on those who rely on Title X for comprehensive preventative care and women’s health services. Before Trump’s gag rule, health clinics used Title-X funds to cover 720,000 Pap tests, almost 2 million breast exams and more than 4 million STD tests. Furthermore, funds from the program were also used to prevent about 1 million unintended pregnancies annually, through birth control and other contraception. With so many clinics leaving the Title X program, many low-income patients will now have to travel further distances, endure longer wait times and take time off of work to receive care. The new rule will deny many women the healthcare they need and is a huge step backwards for reproductive and women’s health.