Guest Column: HHS Messes with Texas


Patrick Brennan is the 2011 William F. Buckley Fellow at National Review. This first appeared at National Review and is reprinted with permission.

While opposition to the HHS mandate has caused many liberals to accuse Republicans of a “war on women,” the Obama administration itself has just declared the first front in its own war on women’s health care. Its casus belli? The Texas government’s restriction on funding for abortion providers.

As of last week, President Obama’s Department of Health and Human Services has withdrawn $30 million worth of funding from a Texas Medicaid program that provides health-care services for low-income women. This HHS policy begins to confirm what conservatives have suspected all along: While the Obama administration has made it clearer than it would like to claim the mantle of “protecting women’s health,” its real aim is unfettered access to abortion and ubiquitous, free contraception.
The affected program, Texas’s Women’s Health Program (WHP), which provides family-planning services to low-income women who earn too much to qualify for regular Medicaid, is a waiver initiative that funds services beyond the purview of standard Medicaid. Texas is what is called a “pass through” Medicaid state, which means that state legislators set funding priorities for the state agencies that disburse federal funds. Texas adopted a rule last year to prevent any of the WHP funds from going to clinics that provide or refer for abortions — most notably, Planned Parenthood franchises, which had received 40 percent of the program’s funding.
But in December, the federal Centers for Medicare & Medicaid Services (CMS) informed the Texas Health and Human Services Commission that, in its opinion, Texas’s restrictions on the waiver program were unlawful. Essentially, CMS contends that Texas cannot restrict the distribution of its WHP funds because patients have the right to choose any Medicaid provider — and threatened to withdraw the funds entirely unless the restrictions were removed. The two parties agreed to a negotiation period ending March 14, and, after the federal government refused to make any concessions, all federal funding for WHP was withdrawn.
Governor Rick Perry has insisted that he will ensure that the program continues without federal support, at the state’s expense. The state may, unfortunately, be bearing this burden for a while: HHS’s funding withdrawal evinces a steadfast commitment to funding abortion providers, and the Texas government and Texans themselves are equally adamant that they will do everything they can to avoid such support.
Elizabeth Graham, director of Texas Right to Life, calls HHS’s funding cuts a “transparently political move.” Indeed, the showdown in Texas isn’t, broadly speaking, just about these specific Medicaid funds, but about the larger, highly effective efforts by Texas Right to Life and pro-life legislators to defund the state’s abortion industry — which, as Graham explains, is now “feeling the pain, and has decided to lash out.”
Recently, Texas conservatives have taken dramatic strides to ensure that federal women’s health-care funding didn’t specifically fund or encourage abortion — and thus dealt serious blows to the abortion industry in Texas. Over the past year, with legal help from advocacy groups such as Texas Right to Life, the Texas legislature has continually redirected “family planning” funds away from health-care providers that provide or refer for abortions to other clinics.
The legislature’s rules and funding priorities have reduced the federal funding for abortion providers in Texas by 37 percent over the past year, resulting in the closure of twelve Planned Parenthood branches. The funding has been merely redirected, and thus has in no way restricted poor women’s access to necessary and preventive care (as abortion proponents might have claimed).
But the redirections have put a serious financial strain on abortion providers. Planned Parenthood and other groups are thus loath to see more of their federal dollars snatched away, and, as Graham puts it, consider any more restrictions as “salt in the wound.” It looks now as if the federal government is stepping in specifically in order to bail them out. The state of Texas has done an exemplary job of proving that liberal concern for “women’s health” has as much to do with support for abortion providers as it does with ensuring equity and access.
HHS’s recent contraception mandate, its most infamous policy, isn’t primarily concerned with “women’s health,” despite claims to the contrary. Claims that free coverage of birth control is an essential health benefit because women take it for other hormonal or prescriptive reasons ring hollow, since, if the administration were actually so concerned with protecting particular women’s health issues, it could require coverage of all the relevant treatments, such as other treatments for certain kinds of cancer, rather than just those that happen to double as contraception. The HHS mandate is thus, on closer inspection, another politically tinged program trumpeted as a groundbreaking expansion of women’s health care.
Meanwhile, the Obama administration has indicated that it would reduce its support for health care in Texas rather than allow the state to decide that the money shouldn’t go to supporting abortion providers. Its agenda could not be clearer.

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