Wrap Up For Now

Greetings policy watchers,

As we get closer to a vote on many of these issues that we’ve been discussing, we wanted to provide you with a quick summary of what we’ve discussed, and why it’s relevant.

Here’s a quick summary of what we’ve discussed in our previous posts:

• Health care is an increasingly prominent issue for debate, especially in relation to the preventative health care of women.  Minority women have a life expectancy that is 5 years less than white women, black and Hispanic women have less access to family planning resources resulting in more abortions, and over 1/10^th of all women receive either late or no prenatal care.  Add on top of that the $27 billion shortfall in the Texas government, and we’ve got a problem!
• Medicaid alone has a $7.6 billion shortfall, and in response to threats of cutting Medicaid services, Team TK attended the Cover Texas Now advocacy day.
•  In an effort to further understand the bills proposed about women’s preventative health care, Team TK chose 4 bills that we wanted to cover in more depth:

o        Senate Bill No. 834 – Supplemental Breast Cancer Screening

o        Senate Bill No. 1138 – Women’s Health Program

o        House Bill No. 1133 – Maternal Mortality

o        House Bill No. 1255 – Women’s Health, Family Planning, and Human Sexuality

• We provided the reader with a cheat sheet about each of the bills for quick reference, and then we analyzed the bills in more depth in our 4 part series.  Here are some take away points from our in depth analysis:

o        Among single mothers, more than 70% of pregnancies are unplanned.  The Women’s Health Program (which S.B. 575 is seeking to expand) helped save Texas more than $37 billion in averted births that would have been paid for by Medicaid.  That being said, we have to wonder if the Women’s Health Program isn’t trying to reinvent the wheel just because they don’t want to work with organizations that provide abortion services.

§         In an effort to understand this better, we attended the Women’s Health Program testimony to the Health and Human Services Committee.

§         We also found that the New America Foundation, a public policy think tank, firmly supports measures that expand preventative health care to women.

o        Dense breast tissue is a condition that affects over half of women and makes mammograms virtually ineffective at detecting the early stages of breast cancer.  In response, Henda’s Law makes it mandatory for physicians to notify their patients of dense breast tissue.  It’s a great place to start, but we hope that more proactive steps will follow, such as having insurance companies cover supplemental cancer screenings and making those options more affordable.

o        The Women’s Health, Family Planning, and Human Sexuality program is much needed. It reconfirms the need for expanded access to preventive health and family planning services. Also, the statewide mandates on sex education programs in public schools need to be severely modified to de-emphasis the preference for abstinence and be more comprehensive, for example to include other forms of contraception.  If this bill were to pass, it could potentially save the state millions in preventive care.

o        After analyzing H.B. No. 1133, the need for more research on health care problems, in particular maternal mortality, became very apparent. There is a problem of a lack of access to perinatal and intrapartum care services; also, some vulnerable populations are more likely to experience pregnancy-related deaths and severe maternal morbidity. Ideally, the creation of a multidisciplinary committee will help decrease the rates of maternal mortality and morbidity. 

§         We found that the Urban Institute, another public policy think tank, that they support further research and strategies focused on health care.

§         We also attended another legislative hearing with the Health and Human Services Committee regarding the bill, but they, unfortunately, did not have time to address the bill.

We hope you’ve learned as much as we have!  We’ll keep you up to date as new events unfold!

Until next time…

<3, Team TK

Analysis Part 4 of 4: H.B. No. 1133 – Maternal Mortality

Howdy policy watchers,

This is the last installment of our 4 part series examining the bills. We hope y’all have been enjoying the series, because we’ve been having a ball blogging bout the bills. Like the alliteration? So, this installment will examine H.B. No. 1133, which would create a Maternal Mortality and Morbidity Review Board. The Review Board would work toward helping to increase the prevention of maternal mortality and severe maternal morbidity.

To help us better understand the importance of prenatal care, Team TK turned to the nonprofit think tank, Urban Institute, for some enlightenment. The Urban Institute is a think tank focused on providing nonpartisan economic and social policy research. Their mission statement is “The Urban Institute gathers data, conducts research, evaluates programs, offers technical assistance overseas, and educates Americans on social and economic issues – to foster sound public policy and effective government.” The Urban Institute is committed to deepening the public understanding of policy issues and has ten policy centers. The Urban Institute’s Health Policy Center is supposed to explore health care costs, access, and reform through extensive research and analysis of key health issues. When it comes to health care reform, the Urban Institute’s Health Policy Center recognizes that “enactment of the Patient Protection and Affordable Care Act brings extraordinary opportunities for greater security, affordability, adequacy, and equity in health insurance coverage.” Also according to an article from The Hill’s Healthcare Blog, the author Julian Pecquet promulgates that the “liberal Urban Institute” has published a study that indicated the health care reform would benefit hospitals and physicians. (If you want to read the actual article, check out our references below :) It seems pretty clear that the Urban Institute is a supporter of health care reform, but it is very cognizant of the many obstacles. The Urban Institute is more than willing to provide analytic support to policymakers about the health care reform.

Now that we know a little bit more about the Urban Institute and their stance on health care reform, let’s take a very brief look at some of their research on prenatal care, the core of H. B. No. 1133. In March 2009, the Urban Institute published a study that analyzed Medicaid outreach and enrollment strategies targeting pregnant women across the nation. This was a collaborative effort with the National Academy for State Health Policy and funded by the March of Dimes. The study found there was “considerable room for improvement in outreach efforts and enhanced prenatal care”(Hill et al., 2009). The study provided some policy recommendations to expand prenatal care. For example, they recommended that the time spent on determining a pregnant woman’s eligibility for a health care program should be minimized so she can become a part of a health plan and be provided prenatal services as soon as possible. This report has some very interesting information, and it hopes that state policymakers will be able to utilize the policy report.

Currently, the bill is stuck in the House Committee on Public Health. Ideally, there will be a few public hearings on it, there will be a vote, and it will be sent to the Senate and then to Governor Perry. In order to better understand the legislative process, we attended a morning meeting of the House Public Health Committee. The meeting was at 8 AM, April 20th, and it began with a quorum call (also known as roll call) by the corporal. Afterward, the very first thing that was addressed was the...heat. That's right the heat. It's okay to chuckle a bit, because we did. After it was decided that the AC would be fiddled with, the actual legislative proceedings began. First, the schedule of bills to be discussed was announced. It seemed like they had a lot planned for their short one hour meeting. It was actually called an "ambitious schedule". Then, some housekeeping items were attended to, and the committee got down to business. There was a long list of bills that had to be discussed, including H.B. No. 915 and H.B. No. 1266. It was announced that there was a change of events, and some bills, like H.B. No. 75, were no longer being discussed at the meeting due to time constraints. Both of the bills had to do with licensing advanced practice registered nurses being able to prescribe and order prescription drugs.Those bills were just two of very many bills that had to be discussed. There was a process, and the committee systematically went through the bills. Each bill would get considered, committee substitutes would be considered, available testimonies would be provided, and its fate would be decided. Most of the bills became "pending business" in the committee. There were a few bills that got voted on, and the members would vote "aye" or "nay". Of course, each vote was recorded. Before we knew it, the hour flew by and the meeting was adjourned! It was interesting to see how the legislature worked, but at the same time it was a bit disheartening. The 82nd Texas Legislature has over 900 bills to process, and so H.B. 1133 is just one of many. There's a very good chance that the bill will be in committee for awhile, and it might be "pending business" for the rest of the session.

So what to do in the meantime? There's plenty of other bills that have to do with health care to look out for and to keep up to date on. Also, get educated. There's plenty of research that's related to health care that could enhance your understanding of what's going on. Also, it wouldn't hurt to refresh your memory on how a bill becomes a law. Check out this Guide to the Texas Legislative Information it will explain all about the legislative process in easy to understand terms.

Well that concludes our 4 part series over the bills. We hope y'all learned something :) Team TK definitely learned a lot through the process of creating the 4 part series. No wonder legislators have so many interns! Keep posted for our next one AND make sure to stay political.

Team TK out!!

References

Hill, I., Hogan, S., Palmer, L., Courtot, B., Gehshan, S., Belnap, D., & Snyder, A. (2009). Medicaid Outreach and Enrollment for Pregnant Women: What Is the State of Art?. Washington, DC: The Urban Institute. Retrieved from http://www.urban.org/UploadedPDF/411898_pregnant_women.pdf

Pecquet, Julian (2010). Urban Institute touts healthcare reform’s benefits or hospitals and physicians. The Hill’s Healthcare Blog. Retrieved from http://thehill.com/blogs/healthwatch/health-reform-implementation/109281-urban-institute-touts-healthcare-reforms-benefits-for-hospitals-and-physicians

Texas Legislative Council (2010). About the legislative process in Texas. Retrieved from http://www.tlc.state.tx.us/gtli/legproc/process.html.

Urban Institute: http://www.urban.org/

Analysis Part 3 of 4: H.B. No. 1255 – Women’s Health, Family Planning, and Human Sexuality

Hello policy watchers,

Welcome to part 3 of our 4 part series analyzing the bills more in depth! We identified H.B. No. 1255 as one that is related to women health, family planning, and sex education. We personally feel that this bill is one that should be important to parents, educators, and most importantly women. However, it is currently stuck in the House Public Health Committee. Fortunately, there is an identical version of it in the Senate known as S.B. No. 585. S.B. No. 585 is authored by Senator Kirk Watson, former mayor of Austin. Watson is a Democrat and he currently represents District 14. After he introduced the bill, it was referred to the Senate Health and Human Services Committee. There has been a public hearing scheduled for April 28^th. During the public hearing, subcommittee will hold a meeting that will allow people an opportunity to provide public testimonies and to address any measure of the bill.

Before that public hearing, let’s discuss a couple of advantages and disadvantages of the H.B. No. 1255/S.B. No. 585.

Pro: As noted in Cheat Sheet Part I, the bill could potentially help expand women’s access to preventive health and family planning services through the demonstration project.

Con: In order to create a 7 year demonstration project, we need funding. Due to the current state affairs, legislators may be turned off by the high start up cost for this bill and vote against the bill.

Pro: The bill gives schools a chance to choose sex education programs that can help reduce unwanted pregnancies.

Con: By state law, abstinence has to be presented as the preferred method of contraception. Essentially, this bill does not replaced outdated programs with new ones; instead, it perpetuates the status quo.

At this point, you might be asking yourself, “So what does this all exactly mean? And what’s so bad about an abstinence-only sex education program? How can we strengthen this bill?”

Time to get into the nitty gritty details!! H.B. No. 1255/S.B. No. 585 essentially has two major components: women’s health program and sex education. In the Analysis Part 1 of 4: S.B. No. 575 – Women’s Health Program blog entry, the health and family planning component of H.B. No. 1255/S.B. No. 585 has been thoroughly covered. In that case, we’re going to focus more on the sex education component.

First, let’s take a look at the history and current status of sex education in Texas. In 1995, the 74^th Texas Legislature passed S. B. No. 1, which modified the Texas Education Code (TEC) to create statewide mandates for sex education, which can be read under the TEC Section 28.001. Essentially, the legislation decreed that the board of trustees of each school district has to create a local school health advisory council (SHAC). The main purpose behind the council is to make recommendations to the school district whilst ensuring that the local community values are being reflected in the health education instruction. The council has many duties, but we are interested in two in particular. The first one is that the council has to make recommendations on “appropriate grade levels and methods of instruction for human sexuality instruction” (TEC, 2011). The second duty is that the council has to advise the board of trustees in their selection of course materials and instruction related to human sexuality, sexually transmitted diseases, or HIV or AIDS. S.B. No. 1 set five constitutional requirements in regards to sex education curriculum. Four of which present abstinence from sexual activity and before marriage as the preferred choice, the emphasis of sex education curriculum, and as the most effective method from preventing pregnancy, STDs, HIV, and AIDS. In addition to the requirements, there are a few stipulations, such as schools are not allowed to distribute condoms. So, state law essentially requires any school district that provides sex education to emphasize abstinence. Also, if a school wants to change its sex education curriculum, they have to discuss it with their SHAC. If you are interested in learning more, then the nonprofit organization, the Texas Campaign To Prevent Teen Pregnancy, created a Texas State Policy Overview of sex education that’s very helpful. Click here to access it.

So you now know the guidelines for sex education programs in Texas. However, are the guidelines working? We believe the answer lies within a report titled “Just Say Don’t Know: Sexuality Education in Texas Public Schools”. This report was a result of a partnership between the Texas Freedom Network Education Fund and two professors of heath education at Texas State University, David Wiley and Kelly Wilson. Dr. Wiley and Dr. Wilson conducted a two year research project; the project’s goal was to make “a comprehensive study of sexuality education in all of Texas’ public school districts”. The two researchers were able to attain information from over 96% of the Texas’ public school districts (990 districts). From the review and evaluation of their research, they gathered six key findings, which are presented in addition to recommendations in the Just Say Don’t Know: Sexuality Education in Texas Public Schools report. The key findings were:

1. Most Texas students receive no instruction about human sexuality apart from the promotion of sexual abstinence. (More than 94% of public school districts!)
   
2. Most school districts do not receive consistent or meaningful local input from their School Health Advisory Councils regarding sexuality education. (More than 80% of public school districts!)
3. Sexuality education materials used in Texas schools regularly contain factual errors and perpetuate lies and distortions about condoms and STDs.
4. Shaming and fear-based instruction are standard means of teaching students about sexuality.
5. Instruction on human sexuality in Texas often promotes stereotypes and biases based on gender and sexual orientation.
6. Some Texas classrooms mix religious instruction and Bible study into sexuality education programs.

What did Dr. Wiley and Dr. Wilson have to say after their extensive research? “Based on the documents provided by Texas school districts, it is the professional opinion of the authors of this report that our schools are failing Texas families by turning out generations of sexually illiterate young people at a time of high rates of teen pregnancy and STDs.”

After Team TK read the report, we felt a mix of emotions. Shock, indignation, disgust, worry, fear, but most importantly motivation. Team TK is motivated to spread the word. The sex education programs in Texas do not work! And we need to do something about it, fast.

I know some of you readers might be feeling a bit overwhelmed at all of the bad news about the failures of our sex education system. However, there is a silver lining. There has been increased attention to the importance of family planning services and more comprehensive sex education. This law asks for sex education programs to be based off evidence-based research. Maybe there is a chance for change. If anything, H.B. No. 1255/S.B. No. 585 can lay the groundwork for future laws and improvement. Stay optimistic readers, change is possible. Also, stay tuned for the last installment of our 4 part series!

Much love,

Team TK

P.S.

Throughout our analysis, we mentioned a lot of different articles and reports. In case anyone was curious where we got our information from, we compiled a short reference section. Hope y’all find this useful!

References:

Texas Campaign To Prevent Teen Pregnancy (2010). Texas State Policy Overview. Retrieved April 23, 2011 from http://www.txcampaign.org/media/98UJHY765SQ/docs/en_US/e361e0cb53b4335dce796aeb47e4b88ae5e6f1f6/43H07C044HLO/Policy%20Overview%20REVISED.pdf

Texas Education Code, Chapter 28 Section 004 “Local School Health Advisory Council and Health Education”, April 28, 2009. Retrieved April 23, 2011 from http://www.statutes.legis.state.tx.us/SOTWDocs/ED/htm/ED.28.htm#28.004

Wiley, D. & Wilson, K (2009). Just Say Don’t Know: Sexuality Education in Texas Publich Schools. Austin, TX: Texas Freedom Network Education Fund. Retrieved April 23, 2011 from http://www.tfn.org/site/DocServer/SexEdRort09_web.pdf?docID=981

P.S.S.

For those who are really interested about sex education in Texas, then check out www.txcampaign.org/ The Texas Campaign To Prevent Teen Pregnancy is dedicated to the prevention of teen pregnancy through the use of education. The website also has a lot of great information, such as Teen Pregnancy and STI Rates.

Analysis Part 2 of 4: S.B. No. 1381 – Supplemental Breast Cancer Screening

Hi policy watchers,

Welcome to part 2 of our 4 part series analyzing the bills more in depth!  Next we’ll delve into S.B. No. 1381, which addresses awareness of dense breast tissue and the need for supplemental breast cancer screening.

S.B. No. 1381, more commonly known as Henda’s Law, is named after Henda Salmeron.  Henda Salmeron is a Dallas real estate agent, who is a breast cancer survivor and is tirelessly working to raise awareness about dense breast tissue and the need for further breast cancer screenings.   According to news stories about Henda’s Law, Henda Salmeron did not find out that she had breast cancer until it had already advanced to Stage 2, despite having had a recent mammogram that did not pick up on the cancerous mass, because of dense breast tissue (Cutler, 2011). 

What’s the extent of this problem?  According to a recent article, dense breast tissue affects more than 50% of women (Chilkov, 2011).  Among that 50%, mammograms fail to detect the early stages of breast cancer 75-80% of the time (Chilkov)!  Yikes!  This is even more true for women who are postmenopausal and on hormone replacement therapy.  If someone is on hormone replacement therapy, odds are, she has dense breast tissue, meaning that it is even more likely that the early stages of breast cancer will go undetected (Chilkov).

So tell me, why are we not more worried about this?  Why have I never heard about it before?  As health care stands currently, health care providers “do not yet regularly use a woman’s breast density to assess her breast cancer risk. This is mainly due to the lack of an agreed-upon standard for assessing breast density” (Susan G. Komen Breast Cancer Foundation as cited in Salmeron, Dense Breast Tissue, 2011).  Henda’s Law would raise awareness of dense breast tissue and the risk it entails, and has the support of the American Cancer Society and the Susan G. Komen Breast Cancer Foundation (Cutler, 2011). 

To put this all in perspective, watch this video that Henda Salmeron put together:

So we’ve established that this is a big issue and that awareness needs to be raised.  That’s all fine and dandy, but where does awareness end and action begin?  Hypothetically, the bill doesn’t cost any money and it raises awareness.  The problem is that further screenings, which currently include MRIs and sonograms, are usually not covered by most insurance plans (Salmeron, D.E.N.S.E., 2011).  The hope is that this law will push insurance companies to cover alternative methods of screening for breast cancer (Tongish, 2010).  Insurance companies may choose to lobby against this bill for that reason, but a similar law has passed in Connecticut and comparable bills are being pushed for in other states around the country (Tongish).   Until then though, MRIs can cost up to $3,500 (Compare MRI Cost, n.d.) and sonograms can cost up to $1,000 (Ultrasound Costs and Pricing Information, n.d.).  That might not break the bank for a successful high-end realtor, but that is far out of reach for many Americans, and especially those who are most vulnerable.  Our concern is not so much with the bill itself, but rather with what happens with the bill after it is passed. 

Henda’s Law is an important and necessary piece of legislation that will garner little conflict among the general public.  Threats to the bill come from insurance companies who fear what new services will need to be provided as a response.  When all is said and done though, we wonder how quickly awareness will lead to action.  Will insurance companies start providing alternative methods of breast cancer screening?  Will we provide these same services to our more vulnerable populations?  Will alternative methods of screening be covered by Medicaid and Medicare?  As it stands right now, we only foresee it really impacting middle and upper class populations.  With this knowledge, we need to be sure that it does not stop there.

As you can see, Henda’s Law is an intriguing piece of legislation, but it is incomplete and needs to be viewed as a starting point for more to come.  I hope this has raised YOUR awareness of dense breast tissue, and that in that sense, the bill is already fulfilling its goal.

Until next time…

TK Out!

References

Chilkov, N. (2011, January 11). Breast Cancer Risk: A Screening 3 Times Better Than Mammograms . HuffPost Health. Retrieved from http://www.huffingtonpost.com/nalini-chilkov/breast-cancer-risk_b_806269.html

Compare MRI Cost. (n.d.). Retrieved April 25, 2011, from http://www.comparemricost.com/

Cutler, M. (2011, April 10). Breast Cancer Bill May Become Law. KDFW FOX4 Dallas-Fort Worth. Retrieved from http://www.myfoxdfw.com/dpp/news/Dallas-Woman%E2%80%99s-Breast-Cancer-Bill-May-Become-Law

Salmeron, H. (2011). D.E.N.S.E. In Dense Breast Tissue: You NEED To Know! Retrieved April 25, 2011, from http://densebreasttissue.net/d-e-n-s-e/

Salmeron, H. (2011). Dense Breast Tissue. In Dense Breast Tissue: You NEED To Know! Retrieved April 25, 2011, from http://densebreasttissue.net/ dense-breast-tissue/

Tongish, D. (2010, September 14). Proposal would require Texas insurance companies pay for better breast cancer screening. The 33-KDAF-TV. Retrieved from http://www.the33tv.com/news/kdaf-dallas-lawmaker-calls-for-mandatory-breast-cancer-screening-story,0,3973680.story

Ultrasound Costs and Pricing Information. (n.d.). Retrieved April 25, 2011, from http://www.compareultrasoundcost.com/

Analysis Part 1 of 4: S.B. No. 575 – Women’s Health Program

Greetings policy watchers,

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.x

TMA 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.

Introducing a 4 Part Series – The Bills

Dear policy watchers,

Did y'all like the Cheat Sheets? We hope y'all did cause we had a lot of fun creating them. Now, we would like to dig even deeper into the four bills. We’re going to look at the bills from different angles so that y'all will have an even better idea of what’s going on at the Capitol. Remember, it is our civic duty as Texan citizens to keep informed, especially when it come to our health. So stay tuned for the first installment of our 4 Part Series - The Bills. 

Much love from Austin, Texas,
TK

The Cheat Sheet Part II

Dear policy watchers,

The second half of the cheat sheet is ready! Enjoy! <3 TK

:: The Cheat Sheet Part II::

S.B. No. 575 – Women’s Health Program

Primary Author: Leticia Van de Putte is a member of the Democratic Party. She holds a seat in the Texas Senate for District 26, which includes large portions of San Antonio and Bexar County. Senator Van de Putte has been a pharmacist for more than 31 years.

Summary: This bill seeks to expand the Women’s Health Program demonstration project. It extends the Women’s Health Program to include preventative health and family planning services.

Eligible participants will receive services including:
• Medical history recording and evaluation
• Physical examinations
• Health screenings, including screenings for diabetes, cervical cancer, breast cancer, sexually transmitted diseases, hypertension, cholesterol, and tuberculosis
• Counseling and education on contraceptive methods
• Provision of contraceptives
• Risk assessment
• Referral of medical problems to appropriate providers

Eligible participants include:
• An individual who has a net family income that is at or below 185% of the federal poverty level, and who is at least 18 years old or who is younger than 18 and has given birth while receiving benefits under the medical assistance program
• A woman who is at least 18 years old and participates in or receives benefits from the medical assistance program, financial assistance under chapter 31, the nutrition assistance under chapter 33, SNAP or WIC, or another state administered program that requires documentation of income and restricts eligibility based on income
• A woman who is at least 18 years old and is presumed eligible for one of the programs listed above pending completion of the program’s eligibility process
• A woman who is at least 18 years old and is a member of a family that contains at least one person who participates in one of the above programs
• A woman who is not pregnant, but who if she were to have a child, would have a net family income below 185% of the FPL

The department would identify women eligible for the program during a demonstration project for women, following pregnancy, who participated in a medical assistance program. The department would work to help women maintain continuous coverage, and will help her identify other services that she would be eligible for.
The department will submit a report on December 1st of each year to the legislature for review.

This bill would extend the program through September 2014 (the original program expires September 2011).
A new addition to the original program would be a preventative health outreach program. This would include providing an initial screening to determine eligibility, ensuring that women receiving other services would receive information about the program, and working with hospitals and other entities to provide information on the services. The program would include monitoring, evaluation, and reporting, and will use that information to report to the legislature on things such as the cost of the program and problems encountered in the process.

This act would take effect August 31, 2011.

Potential Implications: Much of this bill is already in place, and the bill is requesting for a 3 year extension of the program, while also adding the outreach program. The bill has many strengths, including the provision of family planning and preventative care to women who are at or below 185% of the FPL, or who would be if they had a child. The outreach program seeks to expand who will learn about the services by targeting people already receiving services that would qualify them for the program. That being said, there are some concerns about leaving other parts of the bill as it is. Most prominently, the bill provides counseling and education and the provision of contraceptives, but it will not education about or provide emergency contraception. Second, referrals cannot be made to any organization that provides or contracts with an organization that provides abortions.

Current Status: Received by the Secretary of State 2/9/2011, filed 2/9/2011, read first time 2/17/2011, referred to Health and Human Services 2/17/2011, scheduled for public hearing on 4/5/2011, considered in public hearing 4/5/2011, testimony taken in committee 4/5/2011, referred to s/c by chair 4/5/2011, scheduled for public hearing in s/c on 4/13/2011, subcommittee meeting cancelled 4/13/2011

For more information, click here.

S.B. No. 1381 – Supplemental Breast Cancer Screening

Primary Author: Rodney Ellis is a member of the Democratic Party. He holds a seat in the Texas Senate for District 13, which includes parts of Houston, and parts of Harris and Fort Bend counties.

Summary: Also known as Henda’s Law, this bill requires that all mammography reports contain the following statement:

“If your mammogram demonstrates that you have dense breast tissue, which could hide abnormalities, and you have other risk factors for breast cancer, you might benefit from supplemental screening tests, which can include a breast MRI examination or other forms of screening that may be suggested by your ordering physician.

“Dense breast tissue in and of itself is a relatively common condition. Therefore, this statement is not provided to cause undue concern, but rather to raise your awareness of the limitations of mammography testing and to promote discussion with your physician regarding the presence of other risk factors in addition to dense breast tissue that may warrant supplemental screening.

“A report of your mammography results, which contains information about your breast density, has been sent to your physician’s office, and you can contact your physician if you have any questions or concerns regarding this report.”

Potential Implications: This bill seeks to education women about what mammograms may miss, which in and of itself is great and nothing to be argued over. Where potential problems could fall though, is that there is the hope that the bill will ultimately lead to other bills requiring insurance companies to offer alternative methods of screening, which the insurance companies will likely have a problem with (Tongish, 2010).  The other area of concern is that this bill really only helps those who can afford supplemental screening, which is not an option for many of our most vulnerable populations.

Current Status: Received by the Secretary of State 3/9/2011, filed 3/9/2011, read first time 3/22/2011, referred to Health and Human Services 3/22/2011, co-author authorized 4/11/2011

For more information, click here.

References

Senator Leticia Van de Putte: District 26. (n.d.). Retrieved April 23, 2011, from Senate of Texas website: http://www.vandeputte.senate.state.tx.us/

Senator Rodney Ellis: District 13. (n.d.). Retrieved April 23, 2011, from The Senate of Texas website: http://www.ellis.senate.state.tx.us/dist13.htm

S. S.B. No. 575, 82nd Leg. Sess. Leg., 82(R) (Tex. 2011), http://www.capitol.state.tx.us/tlodocs/82R/billtext/pdf/SB00575I.pdf#navpanes=0.

S. S.B. 1381, 82nd Leg. Sess. Leg., 82(R) (Tex. 2011), http://www.capitol.state.tx.us/tlodocs/82R/billtext/pdf/SB01381I.pdf#navpanes=0.

Tongish, D. (2010, September 14). Proposal would require Texas insurance companies pay for better breast cancer screening. The 33-KDAF-TV. Retrieved from http://www.the33tv.com/news/kdaf-dallas-lawmaker-calls-for-mandatory-breast-cancer-screening-story,0,3973680.story

The Cheat Sheet Part I

Dear policy watchers,

As promised, we made a little easy to understand cheat sheet of four bills that we, The Texas Women Health Watch, feel are important to Texan women. The cheat sheet is in two parts. Here’s the first part and keep an eye out for the posting of the second part. Enjoy! <3 TK

:: The Cheat Sheet Part I::

H.B. No. 1133 – Maternal Mortality

Primary Author: Armando Walle. Walle is a member of the Democrat Party. He is a House of Representative for District 140, which includes Houston.

Summary: This bill would take effect September 1^st of 2011, and through Chapter 34 of the Health and Safety Code it would create a Maternal Mortality and Morbidity Review Board. Maternal morbidity is defined as a pregnancy-related health condition; it can happen during the pregnancy, labor, delivery, or within a year of giving birth. A severe maternal morbidity is defined as maternal morbidity that became life-threatening. The review board would be an advisory committee consisting of members from a variety of fields and backgrounds. The members of the board shall include:

• 4 obstetricians
• a midwife
• a registered nurse
• a family practice physician
• a mental health professional
• a pathologist
• either an epidemiologist, biostatistician, or researcher of pregnancy-related deaths
• a social worker or social service provider
• a community advocate
• a medical examiner or coroner
• a representative of the Department of State Health Services’ family and community health programs
• the state epidemiologist for the Department of State Health Services or the epidemiologist designee

In total, the review board shall consist of 15 members. The majority of the members shall be appointed by the Commissioner of State Health Services, and they will be chosen with an emphasis on racial, ethnic, and linguistic diversity. The review board will meet at least four times a year. The review board will have two main duties:

• to study and review maternal mortality and severe maternal morbidity
• to create recommendations for the prevention of maternal mortality and severe maternal morbidity

In order for the review board to fulfill their duties, they will develop standard procedures and criteria for their review and consult with other professionals, state professional associations, and institutions of higher education. During their identification and review of the maternal mortality and morbidity cases, the review board will obtain cases without the patient’s identifying information to ensure confidentiality. The review board and the Department of State Health services shall create a joint report over the review board’s findings. The joint report will also include the review board’s recommendations to help decrease the maternal mortality and severe maternal morbidity rate in Texas. The joint report will be submitted to the governor, lieutenant governor, speaker of the house, and appropriate legislative committees. In addition to the joint report, the review board may print research reports and statistical studies over maternal mortality and morbidity.

Potential Implications: Currently, there are some women who lack access to perinatal and intrapartum care services. The lack of resources may contribute to pregnancy-related deaths and severe maternal morbidity. Ideally, the review board’s recommendations in their joint report will highlight the need for more available perinatal and intrapartum care services. The review board could potentially help standardize and perinatal and intrapartum care around the state.

Current Status: Referred to the House Public Health Committee (as of February 28^th)

For more information, click here.

H.B. No. 1255 – Women’s Health, Family Planning, and Human Sexuality

Primary Author: Mark Strama. Strama is a member of the Democrat Party. He is a House of Representative for District 50, which Austin.

Summary: This bill would take effect September 1^st of 2011 and would be authorized under Section 32.0248 of the Human Resources Code. The act would create a 7 year demonstration project through the medical assistance program for women’s health care services. If a woman is eligible, she may be a part of the demonstration project and therefore have access to health and family planning services. The commission shall try to boost participation in the demonstration project through education, outreach, and other methods. The demonstration project is meant to help reduce federal and state spending, lower STD rates, and decrease unintended pregnancy rates.

In addition to the demonstration project, each school district’s Board of Trustees will consult with the local school health advisory council on human sexuality instruction, otherwise known as sex education. The Board of Trustees will choose an evidence-based human sexuality curriculum. The course materials will cover human sexuality, STDs, HIV, and AIDs. In adherence to state law, the materials will heavily emphasis abstinence and waiting for marriage as the preferred method to prevent pregnancy or the contraction of diseases. However, the curriculum must include instruction on contraceptives and how to properly use condoms. It is up to the Board of Trustees’ discretion whether the program shall be abstinence-only or a more comprehensive sex education curriculum. At the beginning of each year, school districts shall send a written notice to parents about the school’s sex education program and what it shall entail. Parents shall have the right to review the curriculum materials and to remove their child from any part of the class without academic penalty.

Potential Implications: Ideally, this bill could help expand women’s access to preventive health and family planning services through the demonstration project. However, it is not clear what the eligibility requirements are for women to participate. Also, the method of outreach is unclear. While the demonstration project sounds beneficial to women with all of the available preventive health and family planning services, it needs effective marketing for the targeted population to even be aware of the project. Hopefully, the Public Health Committee adds clarifications to the bill to strengthen it and give it a real chance at the hearing.

Currently it is state law that sex education programs give a preference to abstinence as a contraceptive method. Therefore, the sex education component of the bill may simply perpetuate the use abstinence-only education, which has been indicated to be ineffective at reducing pregnancy rates. The goal of the bill is to reduce costs and unwanted pregnancies, but because of the state law that goal may be hard to reach. Hopefully, this bill may generate discussion on the state’s current sex education programs and whether it’s effective or not.

Current Status: Referred to the House Public Health Committee (as of March 1^st)

For more information, click here.