By Jessie Hellmann - 07-09-17 10:30 AM EDT
Texas is on the verge of setting a new national precedent for states looking to defund Planned Parenthood.
If the Trump administration approves a new request from the Texas government, the state will be allowed to exclude Planned Parenthood and other abortion providers from receiving some federal family planning dollars. That would likely clear the way for other states to do the same.
"This would have implications nationwide if this gets approved," said Jennifer Popik, federal legislative director with National Right to Life, an anti-abortion group that has affiliates in all 50 states.
"For an administration with a pro-life focus, this is something they could do to divert funding from Planned Parenthood."
The push in Texas is the latest salvo against the women's healthcare provider, which stands to lose federal funding for one year under the Republican healthcare bill that is now being considered in the Senate.
Republicans have long tried to block Planned Parenthood from being reimbursed by the government for medical services. Most of the federal money is paid out through Medicaid, the healthcare program for the poor.
The GOP's principal objection to Planned Parenthood is that it provides abortions, though the Hyde Amendment prohibits the use of federal funds for the procedure.
President Trump has indicated he would support efforts to block federal funds to Planned Parenthood. He signed a bill passed by Congress in April that rolled back an Obama-era rule that banned states from withholding separate federal family planning funds, known as Title X Funding, from providers for political reasons.
Texas is essentially seeking federal Medicaid funding it lost four years ago when it excluded Planned Parenthood and other abortion providers from participating in a family planning program for low-income women who are not otherwise eligible for Medicaid.
The Obama administration halted the funding to Texas - about $35 million a year - stating that federal law requires states to allow Medicaid patients their choice of "any willing provider," including those that provide abortions.
Texas in turn created its own state-funded program, called "Healthy Texas Women." Now the state is asking the Trump administration for the federal money back, while still exempting abortion providers.
If approved, the program would take effect for five years beginning Sept. 1. The federal comment period is open until Aug. 4, after which the Centers for Medicaid and Medicare Services (CMS) would make a decision.
"If CMS were to approve this waiver and offer federal funding for this program, it would open the floodgates for this to be implemented in other states," said Kinsey Hasstedt, a senior policy manager at the Guttmacher Institute, a liberal reproductive rights group.
"It would offer a stamp of approval to violate decades-old Medicaid policy and federal law, which prohibits excluding Medicaid providers from these programs. ... It would be a huge shift in how Medicaid is run."
Since 1972, family planning services have been a mandatory benefit for Medicaid recipients, with healthcare providers reimbursed by the federal government at a 90 percent matching rate, according to the Kaiser Family Foundation.
In the 1990s, several states, led by California, sought waivers to create programs to serve low-income women not eligible for Medicaid.
Now 26 states have similar family planning programs, which are mostly funded by the federal government.
Two states - Iowa and Missouri - recently created their own state funded programs that exclude Planned Parenthood.
Republican lawmakers in Iowa agreed this year to give up millions of federal dollars to create a state-run family planning program that excludes abortion providers and their affiliates. Four Planned Parenthood centers in the state are now closed because of the lost funding.
Missouri lawmakers, meanwhile, decided in April to reject more than $8 million in federal funding the state was going to receive for its family planning program, and will create a state-funded program that bans abortion providers.
The reduced funding in Texas has led to some negative consequences, including a drop in women receiving services. The state also has the fourth-highest birth rate in the U.S.
State officials hope that getting the federal money back will improve the Healthy Texas Women program.
"Increasing access to women's health and family planning services is a priority in Texas," officials wrote in their application.
"The [Healthy Texas Women] demonstration seeks to increase access to family services to avert unintended pregnancies."
But experts warn that more money will not help the problem, as community health centers in the state are already facing limited resources and facilities.
Sara Rosenbaum, a professor of health law and policy at George Washington University, and her colleagues concluded in an analysis that Texas's proposal would diminish access to care for low-income women because health centers cannot grow fast enough to replace services provided by Planned Parenthood and other centers.
And that could be an issue for other states that look to exclude Planned Parenthood from their family planning programs.
"The notion that you can step down the availability of care and that there's plenty to take its place is just fundamentally wrong," Rosenbaum said.
In Texas specifically, "health centers would have to more than double their capacity overnight, and that's just not possible."
If the Texas request is approved, the issue could end up the courts.
Federal law says Medicaid beneficiaries may go to any provider who is "qualified to perform the service," and there are questions about whether Texas's proposal would violate that.
Courts have previously sided with Planned Parenthood in cases where states have tried to block the organization from receiving Medicaid funding.
"We are very concerned about this proposal and how it might be received by this administration, which has been very hostile to women's health and to women healthcare providers like Planned Parenthood," said Mara Gandal-Powers, senior counsel at the National Women's Law Center.
"We're very concerned, but it's hard to go down the road of what might happen."
In a statement, Planned Parenthood spokeswoman Danielle Wells called the proposal an "underhanded attempt to cut off care at Planned Parenthood with devastating consequences for our patients.
"Texas paints a grim picture of what health care access could look like nationwide if the Trump administration approves this waiver."