As promised, we’ll be digging into the legislation affecting women’s preventative health care further. This is the first installment of a 4 part series that will exam each bill in more depth. We chose to start off with S.B. No. 575, which expands the purview of the Women’s Health Program (WHP) and extends its life for 3 more years, because it is a great example of past legislation that has been effective, and should be continued, but that also has some flaws.
Because we view the proverbial glass as half full, let’s start off with the strengths of the legislation and the reasons that it should continue. To get a better understanding of the legislation, Team TK attended the Texas Medical Association (TMA) testimony to the Senate Health and Human Services Committee regarding the Women’s Health Program. Janet Realini, MD, MPH, spoke on behalf of TMA to present findings on why the program should be extended and expanded. Her testimony was enlightening and convincing to say the least. If you’re interested in reading a transcript of her testimony, click here.
Realini started her testimony off by stating the original purpose of WHP, which was to reduce the pregnancy and neonatal-related expenditures on Medicaid by helping women to access better family planning resources (TMA Testimony: SBs 575 and 585 on the Women’s Health Program, 2011). Off the bat, she cited a statistic from a Texas DSHS communication that on average, between 2004-2006, among single mothers “more than 70 percent of pregnancies in Texas are unplanned” (as cited in TMA Testimony: SBs 575 and 585 on the Women’s Health Program, 2011). Further, according to the Legislative Budget Board (LBB), it cost Texas Medicaid “a combined $16,360 for each delivery and the newborn’s first-year health costs” (2009 as cited in TMA Testimony: SBs 575 and 585 on the Women’s Health Program). To contrast this shocking number, the average cost for women participating in WHP is $241 per year (of which Texas is only responsible for $24). Since WHP began, in the first 2 years of the program, WHP saved Texas more than $37.6 million because of births averted” (Texas Health and Human Services, Medicaid Women’s Health Program Implementation Report, December 2010, as cited in TMA Testimony: SBs 575 and 585 on the Women’s Health Program). Sounds pretty good to me; wouldn’t you agree? Beyond the cash value, think of how many women are now able to avoid poverty and are able to better prepare for having children before they start families!
Because of the success of the WHP, the Legislative Budget Board actually recommended expanding WHP to include women whose income would fall below 185% of the poverty line if they were to have a child, to men with incomes under 185% of the poverty line who are seeking vasectomies, and to income-eligible teenage females who gave birth while on Medicaid (LBB, 2011 in TMA Testimony: SBs 575 and 585 on the Women’s Health Program, 2011). Way to be proactive!
In addition to having the support of the Texas Medical Association, the Texas Academy of Family Physicians, the Texas Association of Obstetricians and Gynecologists, the Texas Chapter of the American Congress of Obstetricians and Gynecologists, and the Texas Pediatric Society, the extension and expansion of WHP is estimated to produce a savings of “$64.5 million in fiscal year 2012, $66.2 million in fiscal year 2013, and $25.3 million in fiscal year 2014” (LBB, 2011 as cited in TMA Testimony: SBs 575 and 585 on the Women’s Health Program, 2011). According to the Henry J. Kaiser Family Foundation, in 2006, ¾ of the adult Medicaid population is made up of women (even though the only women who qualify are either pregnant, mothers of children who are 18 years or younger, disabled, or over the age of 65) (Kaiser Family Foundation, 2010). Further, the New America Foundation, a public policy think tank that supports the expansion of preventative health care, documented that the average return on investment for preventative health care was $3.14 for every $1 spent (Kenen,2008)! Imagine how much we could reduce Medicaid costs if we expanded this program even further!
I don’t know about you, but all of these numbers sound great and all, but the social worker in me is far more interested in finding out what this actually means for the participants of the program. According to Realini’s testimony, the WHP has helped more than 235,000 women receive services since its inception (TMA Testimony: SBs 575 and 585 on the Women’s Health Program, 2011). Women who have unplanned pregnancies experience significantly greater mood disturbances than do women who have planned pregnancies (Grussu, Quatraro, & Nasta, 2005). Particularly this includes greater anxiety, depression, irritability, weariness and confusion (Grussu, Quatraro, & Nasta, 2005). According to the Centers for Disease Control and Prevention (CDC), “unintended pregnancy is associated with an increased risk of morbidity for women, and with health behaviors during pregnancy that are associated with adverse effects” (2010). Further, according to the CDC, unplanned pregnancy and teen birth have a lot to do with high school drop out rates among girls. “Only about 50% of teen mothers receive a high school diploma by age 22, versus nearly 90% of women who had not given birth” (Perper, Peterson, & Manlove, 2010, as cited in CDC, 2011). Moreso, “the children of teenage mothers are more likely to have lower school achievement and drop out of high school, have more health problems, be incarcerated at some time during adolescence, give birth as a teenager, and face unemployment as a young adult” (Hoffman, 2008 as cited in CDC, 2011).
If all of this doesn’t have you begging for renewal of the bill, especially during our current economic fiasco, I don’t know what will!
All that being said, Team TK does have a few concerns about the bill. First and foremost, this bill restricts any sort of partnership or referral to organizations that support abortions (or to an organization that is associated with another organization that supports abortion). This eliminates many organizations from participating, such as Planned Parenthood, Austin Women’s Health Center, Whole Woman’s Health, and others that are already successful programs that provide many, many other services outside of abortion. We have to wonder if the WHP isn’t trying to re-invent the wheel by refusing to work with programs that already have vast and important experience in assisting with family planning resources. Yes, WHP is spurring significant savings, but could there be more if this restriction was removed?
Our second concern is that the services are not extended to girls under the age of 18 unless they have already given birth under Medicaid. This is extremely problematic for the reasons listed above (higher high school drop out rates, children having lower school achievement, more health problems, etc.). Again, we have to wonder if costs to the state could be even further cut by extending the resources to more people. Even more significantly, shouldn’t we be providing these services to those who are most at-risk in our population BEFORE they give birth? Just sayin’.
Whew! Who knew that renewing and expanding a bill by just a bit can have so many elements? We hope that this “brief” analysis has given you a better perspective on this important bill. Stay tuned for more!
<3, Team TK
P.S. For more information on the intricacies of the program, and how it’s been working so far, click here to view the Medicaid Women’s Health Program Implementation Report.
References
Centers for Disease Control and Prevention [CDC]. (2010, April 30). Unintended Pregnancy. Retrieved April 24, 2011, from Department of Health and Human Services website: http://www.cdc.gov/reproductivehealth/unintendedpregnancy/index.htm
Centers for Disease Control and Prevention [CDC]. (2011, April 21). About Teen Pregnancy. Retrieved April 24, 2011, from http://www.cdc.gov/TeenPregnancy/AboutTeenPreg.htm
The Henry J. Kaiser Family Foundation. (2010, December). Women's Health Insurance Coverage [Fact sheet]. Retrieved April 25, 2011, from http://www.kff.org/womenshealth/upload/6000-09.pdf
Kenen, J. (2008, October 22). COST: A Worthwhile Wellness Investment? Retrieved April 25, 2011, from New America Foundation website: http://www.newamerica.net/blog/new-health-dialogue/2008/cost-worthwhile-wellness-investment-7888
Pietro Grussu, Rosa, M., & Maria, T. (2005). Profile of Mood States and Parental Attitudes in Motherhood: Comparing Women with Planned and Unplanned Pregnancies. Birth: Issues in Perinatal Care, 32(2), 107-114. doi:10.1111/j.0730-7659.2005.00353.xTMA Testimony: SBs 575 and 585 on the Women’s Health Program , 82(R) Leg., 82nd Legis. Sess. (Tex. 2011) (statement of Janet Realini, MD, MPH), http://www.texmed.org/Template.aspx?id=21131.
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