Working to bridge the Texas-sized gap.
by Amanda Williams
The resiliency and strength of Texas women has been tested time and time again as public lawmakers endlessly debate women’s healthcare, for better or for worse. Though some may consider this merely a game of politics or moral grandstanding, the decisions made in the House and Senate chambers of our capitol building have a very real impact in Texans’ lives, especially among low-income families.
In a state where 2.4 million adult women have no health insurance of any kind, the need for affordable and accessible care is, well, Texas-sized.
Currently there are nearly 1.3 million Texas women ages 20–44 who are reportedly in need of preventive and wellness care. While this number has continuously grown over the years, the state’s capacity to care for these women has generally decreased.
Over the past decade, women’s healthcare has been at the forefront of some of the most extreme battles over state appropriations. Beyond countless abortion restrictions, we’ve seen a slew of cuts to family-planning funding—the most extreme being in 2011 when the Texas Legislature cut the family-planning budget by two-thirds, forcing over 70 clinics to close their doors in some of the most underserved parts of the state.
During the last legislative session in 2013, there was a notable attempt to repair that damage. Legislators allocated $71.3 million into a newly reformed Texas Women’s Health Program (TWHP). That program had been intentionally restructured in 2011 to exclude providers like Planned Parenthood, who are affiliated with abortion services, despite the fact that they are also a leading provider of family-planning services and that this would cost the state a $9-to-$1 match from the federal government. Lawmakers arrived at a bipartisan compromise to restore women’s healthcare services by allocating $100 million into a state-operated extended primary healthcare program, with 60 percent earmarked for family planning and 40 percent for other primary care such as wellness exams, cancer screening, and diabetes and heart treatments. And lastly, the 2013 funding changes resulted in $32.1 million in state funding being awarded to the Women’s Health and Family Planning Association of Texas, the agency responsible for distributing money to qualifying providers in Texas.
Because these funds are now going primarily to non-family-planning-specific sites, like community-based clinics and Federally Qualified Health Centers (FQHCs), many advocates have expressed concern over whether or not these providers are adequately equipped to address the family-planning needs of all Texans. Although this remains to be seen, one thing is certain: in spite of drastic funding and program administration changes, the funding allocated for these programs still addresses only one-third of the need in Texas.
At Legacy Community Health Services, we do our best to bridge the gap between the healthcare needs of all Texans and what they can afford, because we believe healthcare is a human right. We currently have 11 locations throughout the Houston, Beaumont, and Baytown area. As an FQHC, we were able to avoid funding cuts and have actually experienced an increase in funding for reproductive healthcare and family-planning services over the years. However, we have had to make adjustments to accommodate the influx of clients we serve as a designated FQHC facility.
In 2012 we served 19,405 self-identified women; in 2013 that number jumped to 31,424. Last year we performed 7,254 Pap smears, 133,777 well-woman exams, and administered 13,833 STI tests. We also provide family-planning services, including contraception, and educate our clients on the importance of protected sex and preventive care.
Lizette Tienda, community relations manager at the Legacy Southwest Clinic, says they have had to extend operating hours and even stay open for an additional day each week in order to meet their clients’ needs. Some providers can now see up to 125 clients in one day. “We’re seeing more and more clients requesting our services, but we’re also trying to adapt to our patient’s busy schedules and economic situations,” Tienda says. “The majority of the women we see are low-income mothers who have trouble getting a ride to the clinic or can’t take off from work during the day.”
Tienda says that besides transportation, another common barrier among their clients is lack of health insurance coverage due to immigration status. “Many of our clients are undocumented and aren’t eligible for state or federal programs unless they’re pregnant,” she says. “For some, the stigma of being undocumented [is often] the reason our clients didn’t come to us sooner.”
To ensure that we provide services to those in need, Legacy offers sliding-scale fees for those without insurance or for those who are ineligible. Tienda says the majority of the clients at Legacy Southwest are indeed paying on a sliding scale.
“Something else we’re seeing is a high number of teen pregnancies,” Tienda explains. “Our Community Health Workers are conducting outreach in local high schools to reduce those rates, but we also want to make sure that pregnant teens are aware of our services and know that we’re there for them.”
Legacy Southwest Clinic began offering free pregnancy tests for their clients in 2010, and Tienda says they can administer over 400 in one month.
According to the Guttmacher Institute, Texas had the third-highest teen pregnancy rate in the country in 2010, and the highest prevalence of repeat teen births. With the recent trends in Texas family-planning funding and the extreme bias for abstinence-only education in Texas public schools, this comes as no surprise.
Kathy Hinze, nurse practitioner and senior director of obstetrics and gynecology at Legacy, agrees with Tienda that the lack of insurance and low incomes are important barriers to mothers seeking care. “Many of our clients who don’t have funds, insurance, or aren’t enrolled in any kind of assistance program think that they have to have everything in place before they can get care,” Hinze says. “This can be problematic, especially because women who don’t get the care they need while pregnant are more likely to deliver a low birth-weight baby, or there’s a higher risk of complications. We try to help them, no matter what.”
Legacy’s OB/GYN department is not only dedicated to initiating early prenatal care as soon as possible, but to providing the best prenatal and postnatal patient education through a plethora of programs and classes for mothers and mothers-to-be. They even provide monthly baby showers with local partners to help alleviate the cost of baby supplies.
Despite all of the needs that Legacy has been able to successfully address, we know that there are many Texans not getting the care they need. Until the Texas Legislature acts responsibly on healthcare in this state, more and more needs will go unmet.
Last summer, during a special legislative session, the filibuster of Senate Bill 5, an anti-abortion omnibus bill, attracted national attention. Led by Senator Wendy Davis, thousands of reproductive-rights activists took the capitol by storm and sparked a statewide movement unlike any this state has ever seen. Though activists celebrated a brief victory with the defeat of SB 5, the Republican-dominated Legislature successfully passed the bill in its newest form, House Bill 2, during a second special session. Because of its highly restrictive ambulatory surgical and admitting privileges requirements, all but six abortion providers are scheduled to close when the law is fully enacted next month. Many of those providers had been offering family-planning services.
Other “women’s health champions,” as they are called—representatives Jessica Farrar, Senfronia Thompson, and Donna Howard—are aiming to continue the momentum of the “People’s Filibuster” by holding a statewide listening tour this month.
Scott Daigle, Rep. Donna Howard’s chief of staff, states, “There are many citizens who have strong feelings, who are still energized, and who were unable to come to Austin to voice their concerns and testify during the consideration of the bill. We want to make sure we give them an opportunity to be heard.”
Advocates are also hoping that the tour will act as a reminder of the importance of voting in the November elections and taking action at the state level. “Grassroots activists can move the [pro-women’s health] agenda forward by educating people about the harmful effects of women’s health policies enacted in the last several sessions, and show them that elections have consequences on state policy,” Rep. Farrar says. “They can work to get more people engaged on these issues to ensure higher voter turnout.”
As Legacy continues to see more and more patients every year, the impact of state and federal healthcare policies has become much clearer. Now is the time to take advantage of opportunities for making our voices heard. Whether it’s at the listening tour this month, at the polls in November, or in Austin during the next session, our legislators need to be hearing from us. When we act together, we have the power to ensure that all Texans have access to affordable, quality healthcare—no matter what their sex, gender, ethnicity, immigration status, income, or zip code happens to be. And frankly, that is a sure way to save Texans’ lives.
What: Women’s Health Champions listening tour in Houston
When: August 12
Where: The Montrose Center
More info: visit the Women’s Health Champions of the Texas House Facebook page at facebook.com/#!/TXWomenFight.
Amanda Williams is the public affairs field specialist at Legacy Community Health Services and is on the board of directors for the Lilith Fund for Reproductive Equity. She has a master’s degree in social work with a political specialization. You can find her on Twitter @fullfrontalfem.