Texas Governor Signs Budget Eliminating Funding For Planned Parenthood Cancer Screenings

2016-17 Texas State Budget Contains Provision Preventing Planned Parenthood From Receiving Money For Cancer Screenings. On June 20, Texas Gov. Greg Abbott (R) signed the state's 2016-17 budget, which included a provision to “prevent Planned Parenthood from participating in the joint state-federal Breast and Cervical Cancer Services (BCCS) program.” According to the Texas Tribune:

By approving the two-year state budget, Abbott green-lit a provision that will prevent Planned Parenthood from participating in the joint state-federal Breast and Cervical Cancer Services program, which provides cancer screening for poor, uninsured women in Texas. The governor's endorsement of the provision, which was expected, came as Planned Parenthood leaders vowed to maintain their presence in Texas despite lawmakers' efforts to cut their funding.

“It's really incredible how low the governor and some of the state legislators will go when you start throwing women out of cancer screening programs and making it impossible for them to continue to go get services where they have before,” Cecile Richards, president of Planned Parenthood Federation of America, said in an interview with The Texas Tribune on Saturday.

In an effort to boot Planned Parenthood from the cancer program, lawmakers wrote a provision into the state budget to prohibit clinics affiliated with abortion providers from receiving funding for breast and cervical cancer screenings. Under state law, the 17 Planned Parenthood clinics participating in the program were already prohibited from performing abortions if they accepted taxpayer dollars. [Texas Tribune, 6/20/15]

Blocking Funds For Planned Parenthood Cancer Screenings Will Cut Off Care For Thousands Of Texans And Disproportionately Hurt Low-Income Women And Latinas 

Texas Tribune: Uninsured Texas Women “Will Soon Be Unable To Obtain Government-Subsidized Breast And Cervical Cancer Screenings” From Planned Parenthood. In an August 10 article, the Texas Tribune outlined the impact of the upcoming change and pointed out that clinics which provide abortion services were “already prohibited by state law” from receiving taxpayer money. The article pointed out that in 2014, Planned Parenthood provided cancer screenings for 2,938 Texas women through its Breast and Cervical Cancer Services program, amounting to “910 clinical breast exams, 278 mammograms and 1,854 Pap smears”:

The 17 Planned Parenthood clinics participating in the Breast and Cervical Cancer Services program, or BCCS, were already prohibited by state law from performing abortions if they accepted taxpayer dollars. Planned Parenthood officials had said the budget rider was part of Republicans' efforts to put the organization out of business in the state.

In fiscal year 2014, Planned Parenthood served 2,938 of the 33,635 total women who received services from BCCS providers -- about 9 percent.

That year, Planned Parenthood clinics received a combined $1.2 million in funding for providing Texas women with a total of 910 clinical breast exams, 278 mammograms and 1,854 Pap smears.

From those screenings, health workers at Planned Parenthood Gulf Coast, which serves the Houston area, and Planned Parenthood Greater Texas, which serves North and Central Texas, helped 161 women apply for coverage under the Medicaid for Breast and Cervical Cancer program, which covers costs associated with cancer treatment for low-income women. [Texas Tribune, 8/10/15]

The Nation: Latinas Comprise 57 Percent Of The 30,000+ Women Who Benefit From Screening Program. A June 4 article in The Nation explained that cutting off funding for cancer screenings at Texas Planned Parenthoods will disproportionately harm Latinas, who say they feel more comfortable seeking care from the trusted health care provider than other types of clinics. The article noted that of the 33,559 Texan women who used the BCCS in 2014 to find possible early signs of cancer, 57 percent were Latina:

Texans are at especially high risk of developing certain reproductive cancers, according to a report from the National Latina Institute for Reproductive Health (NLIRH) and the Center for Reproductive Rights. The incidence of cervical cancer there is 17 percent higher than the national average, according to the report. Latinas in Texas are the most likely to be diagnosed with it, and Latinas living along the border are 31 percent more likely to die of cervical cancer, compared to women living in non-border communities, Ana Rodriguez DeFrates, Texas policy director of NLIRH, told me. These high mortality rates are associated with the difficulty immigrant women face in getting regular screenings--exactly what Planned Parenthood has been able to offer as a provider through its participation in the Breast and Cervical Cancer Services (BCCS) program. According to news reports, last year the screening program served 33,599 Texans, 57 percent of whom were Latina.

Under the current BCCS program, Planned Parenthood provides 10 percent of screenings statewide. Proponents of the budget change argue that women who need screenings will simply need to look to other clinics in the program. But Rodriguez DeFrates of NLIRH, who testified before the state Senate budget committee on the issue, said that's not so easy. “Latinas we talk to view Planned Parenthood as a trusted provider,” Rodriguez DeFrates said. It's a hard-won trust the organization has gained over time, in part by employing promotoras, health workers focused on the kind of community outreach that builds lasting relationships. “To have that provider eliminated from a program that is designed to address the disproportionate deaths from very preventable forms of cancer that occur in black and brown communities.... It's mind boggling.”

Tanene Allison, Planned Parenthood Texas Votes' communications director, emphasized the importance of name recognition. She said she hears a similar story from many low-income and uninsured women who have had life saving interventions due to early cancer detection at one of Planned Parenthood's health centers: They find a lump. They agonize over where to turn, since they don't have a regular healthcare provider. Finally, someone they know says, 'What about Planned Parenthood?'

“Once they remember Planned Parenthood, it's an entry point to the BCCS program. These women likely don't know BCCS as a program. They are not able to research providers in a program they've never heard of,” Allison said. “It's hard to gauge how challenging it will now be for these women to figure out where to go.” [The Nation, 6/4/15]

Center for Reproductive Rights and National Latina Institute For Reproductive Health: Latinas In Texas Face “A Higher Incidence Rate Of Cervical Cancer” Than Whites Or African-Americans. A January 2015 joint report from the Center for Reproductive Rights and the National Latina Institute For Reproductive Health revealed that Texas Latinas face higher incidences of cervical cancer than “their white or black peers” and die in greater numbers from the disease:

While cervical cancer has been on the decline for U.S.-born women, research shows that the disease--which can be prevented through routine gynecological care and is highly treatable when caught early--is becoming more prevalent among certain racial and ethnic groups with high immigrant populations, especially Latinas. In Texas, the incidence of cervical cancer is 17% higher than the national average, and Texas Latinas have a higher incidence rate of cervical cancer than their white or black peers. The death rate from cervical cancer is also higher in Texas than it is nationally.

Racial and ethnic disparities in cervical cancer are especially wide in counties that border Mexico. Women living in counties bordering the Texas-Mexico border are 31% more likely to die of cervical cancer compared to women living in non-border counties. For the last decade in which data is available, the incidence rate of invasive cervical cancer in Hidalgo County for Latinas was higher than both the statewide rate for Latinas and the state-wide rate for non-Hispanic white women. Additionally, the incidence rate for Latinas in Hidalgo County was more than double the rate for the county's non-Hispanic white women.

Most cervical cancer in the United States develops in women who have never been screened or have not been screened for five years. Texas Latinas ages 21-64 are less likely than Latinas nationally and less likely than white or black women in Texas to have received a Pap test within the last three years. Barriers to screenings are particularly high for some individuals, including lesbian and bisexual women, as well as transgender men, due to homophobia and transphobia within the health care profession and lack of training on the health needs of the LGBT population.

Wide disparities exist in screenings for other types of reproductive system cancers, including breast cancer. As of 2012, Texas Latinas ages 40 and older were less likely than white or black Texas women and less likely than Latinas nationally to report having a mammogram in the past two years. Although the overall incidence and death rates of breast cancer are lower in Texas than they are nationally, Latinas in Texas have higher incidence and death rates than do Latinas nationally. [Center for Reproductive Rights and National Latina Institute For Reproductive Health, January 2015]

Texas Policy Evaluation Project's Joseph Potter: Systematic Cuts To Planned Parenthood In Texas Have Already “Adversely Affected Women.” In an August 12 op-ed for The Dallas Morning News, the Texas Policy Evaluation Project's principal investigator, Joseph Potter, wrote that many lawmakers in Texas -- even Republicans -- have now come to regret systematically defunding Planned Parenthood. Writing that the cuts have “caused many clinics to close, and those that remained open had to curtail their services,” Potter explained that the moves have “adversely affected  women” in the state:

The Texas Legislature -- in 2011, 2013 and this year -- has done a thorough job of defunding the system of Texas clinics affiliated with Planned Parenthood. The first step involved cutting funding that the Department of State Health Services (DSHS)provided for family planning and related women's health services by two-thirds, and instituting an allocation system that gave lowest priority to dedicated family planning providers -- including but not limited to Planned Parenthood clinics. The second step involved removing Planned Parenthood from the state's Medicaid waiver program, the Women's Health Program. Some of the funding for family planning was eventually restored in the next session, but through programs from which Planned Parenthood would be excluded.

My colleagues and I at the Texas Policy Evaluation Project have been investigating the impact of the initial cuts and the prioritization of comprehensive health care providers, as well as the ban that excluded Planned Parenthood from the Women's Health Program. The former clearly had a devastating effect on all but a few providers.

The drastic budget cuts caused many clinics to close, and those that remained open had to curtail their services, especially providing the more expensive and more effective contraceptive methods such as IUDs and implants. Many Texas lawmakers, including Republican legislators, now realize that these massive cuts adversely affected women and were a mistake. [The Dallas Morning News, 8/12/15]