Why did US Secretary of Health and Human Services Kathleen Sebelius choose not to renew the Womens Health Program?

Updated, 5:37 p.m. 

The federal government will not renew the Women's Health Program, U.S. Health and Human Services Secretary Kathleen Sebelius said in Houston on Friday, the day after Gov. Rick Perry announced Texas would continue the program with or without the Obama administration's help.

On a tour of Houston's Ben Taub hospital, Sebelius said the state had been "put on notice" that the waiver program was ending, according to a report in The Houston Chronicle. 

The news was not unexpected — Texas had been waiting for formal word from the federal government for weeks. 

Perry's office released a statement chiding Sebelius for making the announcement on a hospital tour, as opposed to telling the state formally. 

"The fact that the Obama Administration would announce its decision to deny care for more than 100,000 low income women during a press event before giving official notice to the state is a clear demonstration of the political motivation behind this decision," Perry spokeswoman Allison Castle said. "We await official word from the Administration on this matter and in the meantime, at Gov. Perry’s direction, the state continues to move forward to ensure low-income women will not lose access to this preventative care."

Original story:

By vowing that he would find the money to fund the Women’s Health Program without the federal government’s help, Gov. Rick Perry advanced two of his goals. He found a legal way to force Planned Parenthood clinics — which were not performing abortions — out of the program. And he gained ammunition in his state’s rights fight against the Obama administration.

But his pronouncement, made the week before the federal government was expected to cut off funding to the program over a new Texas rule that excludes Planned Parenthood clinics — left many questions unanswered.

Though Perry says the state has the medical capacity to continue to treat the more than 100,000 women enrolled in the program without Planned Parenthood clinics, other health leaders vehemently disagree. And Perry didn’t say where cash-strapped Texas will find the roughly $30 million per year the federal government provides to help low-income women on Medicaid receive birth control, cancer screenings and STD tests.

"Given the number of women that are looking for services as a result of the financial cuts" of the last legislative session, said Jose Camacho, executive director of the Texas Association of Community Health Centers, "there's no way that health centers that have undergone similar cuts will be able to build that type of capacity very quickly." 

After the political firestorm of the last few weeks, the debate over the Women’s Health Program has shifted — and it’s advantage, Perry. No longer can his opponents argue he’d rather eliminate health care for more than 100,000 poor women than allow Planned Parenthood clinics to participate in the program.  Now, they must make a math argument: that without Planned Parenthood clinics, the program won’t have the capacity to operate as well as it does now.

At first glance, the statistics seem to bolster this argument. Today, 45 percent of the people enrolled in the program — some 50,000 low-income women — get care at Planned Parenthood, even though those clinics make up less than 2 percent of the program's 2,500 approved providers. The question is whether non-Planned Parenthood providers can make up the difference.

The state says yes. Though Planned Parenthood treats 45 percent of the program’s clients in a given year, officials with Texas’ Health and Human Services Commission say many of those women are also familiar with non-Planned Parenthood providers — and stop in to get care there, too. Almost 80 percent of women enrolled in the program get services at non-Planned Parenthood providers, agency spokeswoman Stephanie Goodman said, because many women seek care at multiple places in a given year.

“Women can go and receive care at over 2,500 places besides Planned Parenthood in the state of Texas,” said Abby Johnson, a Planned Parenthood clinic director turned anti-abortion activist who is featured on the governor’s website. Johnson said the state's network of hundreds of Federally Qualified Health Centers — comprehensive health clinics for the poor and uninsured — should prevent women from falling through the cracks. 

But opponents argue that without Planned Parenthood clinics, the program will simply not have the capacity — and that women in remote corners of the state will suffer most. Of the 2,500 providers, the overwhelming majority are individual doctors unlikely to want to take on more government-subsidized patients, not clinics that specialize in women’s health and treat large numbers of patients. (Use this Texas Tribune map to see where current providers are, and what type they are.) Camacho said the Federally Qualified Health Centers are already cash-strapped and can't just take women for family planning; they must have the resources to treat them for everything from mental illness to dental problems. 

These opponents also say Texas would be better poised to run a program without Planned Parenthood if Republican lawmakers hadn’t slashed the state’s family planning budget in the last legislative session, forcing clinics and providers to shut their doors or markedly curb services.

“Building new capacity would take both time [during which women would suffer] and money [which is in short supply],” the liberal Center for Public Policy Priorities wrote in a policy paper on Thursday.

It’s still unclear where Texas will find the money to continue the program. Goodman said it’s too soon to say, and that health officials will “look at any areas where spending may be lower than projected to see if there are any savings that can be used for this program.”

It’s more likely, opponents argue, that the $30 million tab will just be added to Texas’ existing Medicaid shortfall — and be dealt with in the next legislative session.

Goodman said all Women’s Health Program providers would have to certify that they aren’t affiliated with an abortion provider by April 30, or they’ll be removed from the program on May 1. She said the state wouldn’t know exactly how many clinics are disqualified until that process is complete. 

Dr. Bruce Malone, the president of the Texas Medical Association, said Perry's decision to rescue the program from extinction was the right one, even without federal funding. He said his organization's doctors will "cooperate any way we can to make sure those services are provided." 

"We're just ecstatic the program will be funded," he said. "It's not going to be a totally smooth transition, because of the way the programs were organized. But it's certainly a great improvement over what was announced a few months ago." 

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SAN ANTONIO, Texas (Reuters) - The Obama Administration on Thursday said it would begin shutting down a program that provides health care for more than 100,000 low-income women in Texas because the state will not allow funding for clinics that provide abortion services.

U.S. President Barack Obama makes a statement next to Secretary of HHS Kathleen Sebelius about contraceptive care funding in the press room of the White House in Washington, February 10, 2012. REUTERS/Larry Downing

The move follows an announcement last week by Health and Human Services Secretary Kathleen Sebelius that the federal government would withdraw funding for Texas’ “Women’s Health Program” after state lawmakers last year enacted the abortion funding prohibition.

“Because the state is implementing a restriction in the freedom of choice of providers in their Women’s Health Program that is not permitted under federal law, we have no choice but to not renew their program,” said Cindy Mann, the director of the Centers for Medicare and Medicaid Services, a federal agency that administers the government-run healthcare programs for the elderly and poor.

“We both agree that this has been a very valuable program for women in Texas, and we very much regret taking this step,” Mann said.

Texas is the first state to have its Medicaid Family Planning Demonstration Program canceled by the federal government. The program provides basic medical services, including breast and cervical cancer screening, and birth control, for 130,000 of the state’s poorest women,

The conflict began when the Texas Legislature inserted a ‘poison pill’ into the Medicaid funding bill passed in 2011, which mandates that no funding under the program go to any facility that provides abortion services, even if no state money directly paid for abortions.

If the federal government did not agree to the waiver, the language requires that the program be discontinued.

Mann said that was unacceptable.

“The language would restrict women’s ability to choose which provider they see for critical services, because that provider offers other services which are not part of the program, nor even paid for by the program,” Mann said.

Texas Governor Rick Perry, a Republican, decried the move.

“It is the height of political posturing for the Obama Administration to put the interests of abortion providers and their affiliates, like Planned Parenthood, over the well-being of more than 100,000 low-income Texas women,” Perry said in a statement Thursday.

“I will not stand by and let this administration abandon these Texas women to advance its political agenda,” Perry said. “Texas will fund these services with or without the federal government.”

The federal government pays about 90 percent of the cost of the program.

Mann said the administration will begin a two-stage process of winding down federal participation in the Texas program over nine months, to “minimize any disruption in coverage for women enrolled in the program.”