In an editorial published Wednesday in the Austin American-Statesman headlined “Women’s healthcare advancing under Republican leadership,” Texas state Sen. Jane Nelson (R-Flower Mound) touts what she sees as her, and her party’s, achievements in expanding family planning and cancer-screening care for Texas women. There is no GOP-led “war on women,” she writes, calling the “so-called” war “a purely political campaign designed to paint Republicans as anti-women.”
But the record shows that Sen. Nelson herself cast the first “no” vote against establishing the state’s Medicaid Women’s Health Program in 2005, and Nelson’s editorial deliberately obfuscates some of her party’s most damaging moves toward dismantling the family planning safety net in Texas.
Nelson has become the Texas GOP’s most prominent spokeswoman. She is the Texas senate’s highest-ranking member and the longest-serving chair of the state senate’s Health and Human Services Committee; she also enjoys a number of other top committee and conference committee appointments. When her name is on a bill—or when her vote is called—Republicans take note.
Here, we’ll parse Nelson’s true and not-so-true claims in a paragraph-by-paragraph analysis.
Sex. Abortion. Parenthood. Power.
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When I was first elected to the Texas Senate, Lt. Gov. Bob Bullock appointed me vice chair of the Health and Human Services Committee.
True: In 1999, Nelson was appointed to a split Health and Human Services Committee, with Nelson chairing “health services,” while Democrat Sen. Judith Zaffirini (D-Laredo) was appointed to lead “human services.”
Back then, health care was considered a “women’s issue.”
True-ish: Health care was certainly considered a “women’s issue” in 1999. But in light of the current legal battles over the Affordable Care Act’s birth control benefit, it’s clear that when “health care” involves care specific to people who may become pregnant, a great many Americans perceive it as a “women’s issue” that should be uniquely separated from “health care” writ large.
I never liked that term because, in my mind, all issues are women’s issues. We care about the same issues as men. But health care is of particular interest to women. Our bodies are different than men’s, and so are our health care needs.
True: Female bodies are indeed different than male bodies.
In this new role, it didn’t take long to recognize that our policies were behind the times when it came to meeting the needs of women. The Women’s Health Program didn’t exist. There was little in the way of education about the unique health care risks for women. Medicaid didn’t cover early treatment for breast and cervical cancer.
Barely true: Certainly the Medicaid Women’s Health Program (MWHP) did not exist in 1999, and women’s health and family planning was not an express focus for state lawmakers. But no concrete action was taken on the matter during Nelson’s first term on the Health and Human Services Committee. The New York Times has reported that in 1999, “family-planning advocates” coordinated an “orchestrated push” for state-funded contraception and well-woman exams, but failed.
Over the years, we changed all that. We expanded treatment options for low-income women battling cancer. We made sure mammograms were safe for women. We invested in prevention of breast and cervical cancer.
False: At least in terms of Nelson’s use of “we,” if she means to include herself and Republican lawmakers, writ large, in that designation. In 2001, Sen. Zaffirini authored a Medicaid reform bill, SB 1156, which in part directed the state to work with the federal government on a family planning program. Sen. Nelson was neither a co-author, sponsor, or co-sponsor of the bill. Three senate Republicans co-authored the bill with seven Democrats, and their house sponsors included three Democrats and one Republican. Most notably, Republican Gov. Rick Perry vetoed the bill.
In 2005, we created the Women’s Health Program, providing screenings, wellness checks and family planning services beyond the traditional Medicaid population.
False: In 2005, Sen. Gregory Luna (D-San Antonio) sponsored SB 747, which created the Medicaid Women’s Health Program (MWHP). Three Republican senators authored the bill, most notably John Carona (R-Dallas), along with Sen. Zaffirini. All of the bill’s senate co-authors were Democrats.
Nelson’s use of “we” in this case is especially misleading: She, as chair of the Senate Health and Human Services Committee, cast the first official “no” vote against the program at a hearing on March 22, 2005. Watch the record vote here:
Nelson only later supported SB 747 after other Republican lawmakers amended the bill to ensure that WHP patients would be barred from receiving emergency contraception and would receive information “emphasizing the health benefits of abstinence from sexual activity,” and after an amendment preventing “abortion affiliates” from providing MWHP services was attached to the bill. That “abortion affiliate” amendment would ultimately later lead to the ouster of Planned Parenthood from the MWHP in 2012 and the wholesale dismantling of the program. Lawmakers later created the Texas Women’s Health Program (TWHP), a program that, without Planned Parenthood, has seen a 77 percent decline in clients served—at an increased cost per client—compared to the original MWHP. In hindsight, Nelson’s voting record shows that she expressly supported the provisions of the bill that ultimately led to the demise of the program and a drastic decrease in services provided to low-income Texans most in need of affordable family planning care.
Today there are four main programs specifically tailored to women. They are expected to reach more than 400,000 women and have a combined budget of over $240 million.
Truthy: Nelson appears to be speaking of the following: the Texas Women’s Health Program, another state family planning program, the Expanded Primary Health Care Program, and a fund for breast and cervical cancer screenings, as laid out on page 11 of this February 2014 Department of State Health Services presentation. Those four programs do indeed have a combined budget of $240.1 million. At first glance, this appears to be a massive increase from the previous fiscal biennium’s $127.3 million budget. But what Nelson fails to mention is that she personally signed her name to a 2011 budget that slashed family planning funds by $67 million—meaning that any actual funding increase is more to the tune of $40 million, and of services paid for by the $100 million increase, only two-thirds of the primary care program must be family planning services. If Nelson claims that the funding increases are remarkable, it is true only because the previous budget cuts she herself endorsed were so substantial.
Women’s health has advanced under Republican leadership.
False: Over the last 15 years—under a decade and a half of statewide Republican leadership and strong GOP majorities in both the Texas house and senate—maternal mortality in the state has quadrupled. According to the Texas Policy Evaluation Project at the University of Texas, 59 reproductive health-care clinics—none of which provided abortion care and most of which were located in rural and underserved areas of the state—closed as a result of the 2011 budget cuts; only a handful have reopened as of 2014. Those that remain open or which have reopened must navigate a retooled contraceptive discount system that significantly negatively affects their ability to prescribe the most effective and long-acting forms of contraception.
From 2007 to 2012, the operative years of the Medicaid Women’s Health Program (MWHP) during which Planned Parenthood provided services to about half of the program’s clients, enrollment climbed and the state enjoyed a nine-to-one federal match in funds. The state lost that federal match when Republican lawmakers ousted Planned Parenthood from the MWHP—the provider’s exclusion violates federal law that allows patients to seek care wherever they choose—and enrollment plummeted by the tens of thousands. According to the Department of State Health Services, Texas’ state-funded family planning providers are currently seeing 77 percent fewer clients, at an increased cost of 17 percent per client, than they were before the 2011 budget cuts that Nelson signed off on. In 2013, the Department of State Health Services lost its long-standing claim to a federal Title X grant to an independent organization of Texas reproductive health-care providers who have taken on the work of attempting to repair some of the damage done by the 2011 budget cuts.
And safe, legal abortion in Texas is harder to access than ever today, in part thanks to Jane Nelson, who in 2011 co-sponsored the state’s mandatory ultrasound bill, which forces people seeking abortions to submit to a sonogram at least 24 hours before the procedure, and requires them to listen to their provider’s verbal description of the sonogram. In 2013, Nelson co-sponsored SB 1, the senate’s version of the omnibus anti-abortion bill that has reduced Texas to just 24 legal abortion providers, down from 44 in 2011. In September 2014, when the entirety of the bill goes into full effect, Texas will have just six legal abortion providers.
Sadly, our progress is being undermined by those trying to manufacture a so-called “War on Women” — a purely political campaign designed to paint Republicans as anti-women.
False: While in its literal sense, the use of the term “war” may be considered hyperbolic, in light of the demonstrable crisis in access to affordable reproductive health care in Texas, evidence clearly shows that when family planning and women’s health programs suffer in Texas, they do so at the hands of conservative lawmakers who, leaning ever more to the political right, have privileged political rhetoric against abortion (and “abortion affiliates”) over fiscally conservative, cost-saving family planning policies that serve low-income Texans and lessen the taxpayer burden statewide, in addition to reducing the need for abortion in the first place.
They claim funding, which was reduced during the recession, has not been restored. That is not correct. Not only did we restore funds, we increased them to an all-time high.
True and false: In saying family planning funding “was reduced,” Nelson again fails to mention that she signed off on the budget cuts. And while some specific family planning has been restored since the 2011 cuts, again, the new $100 million increase in funds that prompts Nelson to tout the “all-time high” is directed to the Expanded Primary Health Care Program (EPHC), which may or may not meet its family planning goals in its infancy. In fact, explicitly directed family planning funds are at a four-year low, down to $140.1 million from $201.4 million in fiscal year 2010-11.
They claim the funds approved last session will not enhance family planning. Untrue. We required that approximately two-thirds of the women served through these new resources will receive contraception and other family planning services.
Unknown: Certainly critics of the EPHC have expressed concerns that providers will be unable to make up the difference in clients lost due to family planning cuts; with the EPHC’s recent launch, it is simply too early to tell whether that will truly be the case.
They claim that excluding abortion providers and their affiliates continues to diminish our provider network. Not so. Over 3,000 providers are signed up for the Women’s Health Program — more than double the number participating in 2011.
True, but only through a very short lens: No abortion providers were ever involved in the provision of publicly funded family planning care in Texas; for them to do so would have been a violation of the nearly 40-year-old Hyde Amendment, which bars federal funds from going to abortion care. In 2012, Texas lawmakers deemed Planned Parenthood locations that do not provide abortion, and which keep their funding and operational structure wholly separate from their abortion-providing entities, to be abortion “affiliates,” which did indeed result in an initially drastically diminished provider care network, as Planned Parenthood provided services to about half of the MWHP’s 130,000 or so clients. Since the creation of the state’s replacement program, the Texas Women’s Health Program, the overall provider numbers may indeed have increased, but their individual capacity to efficiently handle the volume of clients at the same low cost as Planned Parenthood, has been questioned.
These claims are irresponsible, politically motivated and hinder our ability to enroll women in these programs. No one should be discouraged from receiving the health care they need because of this misinformation. The services are there. The funding is there.
False: It was Republican-fueled funding cuts and the party’s crusade against Planned Parenthood that hindered the state’s ability to enroll women in family planning programs. In October 2013, a spokesperson for the Texas Health and Human Services Commission admitted as much to the Houston Chronicle, saying that “Planned Parenthood not only served many of the clients, they also helped their patients enroll in the Women’s Health Program.” With regards to misinformation, the Department of State Health Services itself spread a great deal of it in the run-up to the dismantling of the MWHP by advising enrollees to call colonoscopy centers for pap smears. Today, it may be true that between the partially restored family planning funding and the primary health-care expansion that services and funding are available; whether Texans can avail themselves of services offered, again, remains to be seen. If Texans do not or cannot receive services, it will be because Republican lawmakers—and some anti-choice Democrats—intentionally fractured a cost-effective safety net that saved taxpayer dollars and helped Texans plan their families.
We recognize there is more work to do. At our recent hearings, we identified four areas of focus to enhance women’s health: improve education, make it easier to navigate the system, expand our reach in underserved areas and strengthen family planning.
True: The senate Health and Human Services Committee met in February 2014 to discuss what Nelson described as “legislative achievements in women’s health care.”
We will work across the aisle on areas of common ground — without abandoning our principles. We budget within our means. We don’t agree that embracing Obamacare is the right way to expand women’s health care. We oppose using public funds to pay for abortions. These positions are often twisted to mean things they don’t, but the truth is these views are held by most Texans.
True, inasmuch as an opposition to the Affordable Care Act and a stated goal of general fiscal conservatism are an accurate representations of Republican party positions. But it bears repeating that the Hyde Amendment, passed in 1976, already expressly bans public federal funding for abortion, except in extremely limited cases involving rape or incest or the health of the pregnant person. According to the Center for Medicaid Services, only 150 abortions nationwide were funded by Medicaid in 2012. And with regard to Texans’ views on abortion legislation, a 2013 poll conducted by the University of Texas and the Texas Tribune found that only 38 percent of Texans would like to see the kind of stricter abortion restrictions favored by Nelson and her cohorts in the GOP. And while Republicans do oppose the ACA, the attendant Medicaid expansion offered by the federal government, which has been outright refused by Gov. Rick Perry and his GOP allies, would allow an estimated one million Texans—in a state with the highest rate of uninsured adults in the country—to access affordable health care, including family planning services.
Since I became the 10th woman ever elected to the Texas Senate, women’s health has come a long way, and there are more women making decisions about our health care policies than ever before. Seven women now serve in the Senate. Three of us served on the four-person panel that wrote the Senate’s health and human services budget last session.
True: Texas women now hold seven of 31 senate seats. Four of them are Democrats.
That budget, championed by Republicans, included a historic commitment to women’s health. Not only does my party care deeply about the rights, respect and needs of Texas women, Republicans have delivered results for women since becoming the majority party.
False: Republican lawmakers only came around to the idea of increasing family planning funds when they were assured that funds would be funneled through non-specialty primary care providers, and it’s important to remember that the “historic commitment” came after a historic decimation of the family planning safety net in 2011. In the wider view, it would be difficult to say that any part of Texas’ 2013 budget was roundly “championed” by Republicans, despite the fact that they ruled the legislature with a sound majority. Even the right-leaning Texas Public Policy Foundation at one point described the “great Texas budget debate of 2013” thusly: “four conservative senators joined 30 conservative House members in voting against the budget; never had so many members of the majority party voted against the budget.”
Nelson closes her editorial with this:
Women can’t be defined by a narrow list of political wedge issues. We can be anything we want, including proud Red State women who are fighting for women’s health.
Taken as a whole, Texas lawmakers’ efforts in dismantling the state’s family planning safety net make it clear that if any group can be said to be driving “political wedges” into legislation that affects women, it is the Republican party, which has used its opposition to legal abortion—and its party members’ enthusiasm for relegating Roe v. Wade to a historical footnote—to play ping-pong with the most marginalized, lowest-income Texans’ ability to access affordable reproductive health care.
The only Texas women who can be “anything [they] want” are the Texas women who, like Jane Nelson, have the money, means, and privilege to do so. And that group remains as exclusive as ever, especially in light of the fact that Texas Republicans continue to oppose the adoption of a state version of the Lilly Ledbetter Fair Pay Act that was proposed by state Sen. Wendy Davis in 2013—a bill that Sen. Jane Nelson also voted against.