UPDATE, February 3: Planned Parenthood filed an emergency lawsuit to prevent the state from excluding its clinics from Medicaid.
As a domestic violence survivor, Lisa felt scared and hopeless when, in an act of financial abuse, her abuser cut off her private health insurance plan. As a mother in survival mode, she had made her children’s health the first priority, but she also knew she needed to address the “unbearable” physical pain from when her abuser raped her following childbirth.
Without private insurance, Lisa enrolled in Medicaid and visited Planned Parenthood in Houston. There, they discovered her vaginal injury was a tear that needed immediate surgery, which she received at no cost through the government-run program. She later visited the clinic for Pap smears and yearly health exams.
“To say being able to use Medicaid at Planned Parenthood is vital is an understatement,” Lisa, whose last name has been withheld for privacy reasons, told Rewire News Group. “It saved me. There has to be somewhere women without financial resources can go in the middle of a pandemic for health care that is supportive and safe.”
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Now, that critical lifeline for Lisa and some 8,000 low-income Texans—it also includes access to breast and cervical cancer screenings, a full range of birth control, STI testing and treatment, and annual exams—has been ripped from them by the state of Texas amid an unprecedented global health crisis. Following a five-year legal battle, this past November the largely conservative Fifth Circuit Court of Appeals sided with state officials in keeping Medicaid patients away from Planned Parenthood—an ideologically motivated attack rooted in patently false claims.
Barring an unforeseen legal maneuver, the reproductive health-care network will be excluded from the public health insurance program as of the beginning of February.
In 2015, the Texas Health and Human Services Commission sought to terminate Planned Parenthood’s Medicaid enrollment based on highly edited and widely discredited videos released by the anti-choice Center for Medical Progress that accused Planned Parenthood providers of profiting off the sale of fetal tissue. Those activists faced multiple felony charges in California for invasion of medical privacy and were forced to pay Planned Parenthood $13.6 million in damages for the illicit sting operation. The health network was cleared in all 13 state investigations into the alleged misdoing.
Texas providers then sued the state for breaking federal Medicaid law under the Social Security Act, which ensures patients have a right to choose their own provider as long as that provider is qualified. In 2017, U.S. District Judge Sam Sparks ruled against the state, repeatedly noting the dearth of evidence produced by state attorneys. (Sparks, appointed by Republican President George H.W. Bush, went so far as to sharply admonish the state’s arguments, writing it was more akin to “the building blocks of a best-selling novel rather than a case concerning the interplay of federal and state authority through the Medicaid program.”)
Texas appealed the ruling, and the notoriously conservative Fifth Circuit, some three years later, sided with it, arguing beneficiaries have “no right under the statute to challenge a state’s determination that a provider is unqualified.” Arkansas is the only other state that has implemented a similar Medicaid ban, and that case remains in litigation. While the goal of Texas officials is to punish Planned Parenthood for providing abortion services, abortion care itself is barred from being covered by Medicaid as a result of the federal Hyde Amendment.
Anti-choice zealot Ken Paxton, the Texas attorney general facing long-running fraud indictments as well as an FBI investigation for abuse of office, continued to use the debunked videos as a reason to stop Planned Parenthood patients from using their chosen provider. “Undercover video plainly showed Planned Parenthood admitting to morally bankrupt and unlawful conduct, including violations of federal law by manipulating the timing and methods of abortions to obtain fetal tissue for their own research,” he said in November.
Paxton is also under fire for helping incite the white supremacist siege at the Capitol with a speech prior to the riot in which he asked Trump supporters to “not quit fighting” to overturn the 2020 election results. He stands as the sole attorney general in the country to not sign on to either of two letters condemning the violent insurrection. Instead, he falsely claimed the mob was infiltrated by antifa.
After the Fifth Circuit’s ruling, Planned Parenthood requested the state give patients at least six months to find a new provider, but Texas only offered until February 3, just a 30-day extension. Thousands of low-income patients are now scrambling to quickly find new health care while navigating a deadly pandemic. These patients, among the most vulnerable and disadvantaged, already face steep economic and logistical barriers, exacerbated by the effect of COVID-19. Medicaid recipients in Texas face stringent financial qualifications: A single mother with a dependent child must have a monthly income of under $196, well below the federal poverty guideline. The exclusion will hit women of color the hardest as Medicaid recipients are largely Latinx and Black, groups disproportionately affected by the pandemic.
“Blocking patients from their trusted providers at this extraordinary time is unthinkably cruel,” Dr. Bhavik Kumar, medical director for primary and trans care at Planned Parenthood Gulf Coast, told Rewire News Group. “We are forced to tell our patients, many of whom are low-income people of color, we can no longer see them and send them off to find a new provider in the middle of a global pandemic. I get the sense they feel abandoned; it’s unethical in my opinion.”
“When they ask, ‘Why?’ we don’t have a logical answer for them because it doesn’t make any sense,” he continued.
While the state contends patients will be able to easily find a new health provider, the reality on the ground shows otherwise. Due to low reimbursement rates and other factors, Texas has a shortage of Medicaid providers. Just 30 percent of OB-GYNs in the state accept new Medicaid patients, a 2016 Texas Medical Association survey found.
Unfortunately, Texas doesn’t need to look too far into the past to predict the adverse outcome of the state’s politically driven decision: After lawmakers in 2013 excluded 50,000 patients enrolled in the Medicaid-based Women’s Health Program from receiving care at Planned Parenthood, researchers saw a 35 percent drop in women accessing the most effective methods of birth control and a 27 percent increase in births among women who had previously been able to access injectable contraception through the program, according to a study in the New England Journal of Medicine. With little capacity to take on the displaced patients—despite the state’s assurance—the program served nearly 40 percent fewer patients.
Compounded with Planned Parenthood funding cuts in 2011, the reproductive health safety net was left in tatters. The clinics that remained open had more limited services, and patients who depended on Planned Parenthood had trouble finding another provider, said Kari White, University of Texas associate professor of social work and principal investigator with the Texas Policy Evaluation Project, a multiyear study that tracks the impact of the state’s reproductive health policies.
The state confused patients further by directing them to a faulty online database listing several providers that didn’t enroll Medicaid patients. Those who did find new care were often forced to make multiple medically unnecessary visits before getting birth control.
“The promise that there were enough—and enough qualified—providers to serve all these new patients didn’t come to fruition,” White said. “We heard from patients that never ended up getting the care they needed. And today, the idea that there are all these providers just waiting to take on this patient population does not align with the evidence.”
Juggling motherhood and legal proceedings to fully detach from her abuser, Lisa has yet to find a new health-care option. The providers she called said she’d have to wait up to six months for her next appointment—a stark difference from the immediate care she used to receive at Planned Parenthood. Her abuser transmitted a high-risk, potentially cancerous form of HPV to her, which she must monitor with regular checkups.
“I’m worried that I won’t be seen, that I’ll wait too long to find out if the HPV has decided to take over,” she said. “What happens to women when they have to wait six months for care during a pandemic and don’t even know they have cancer?”