Texas Gov. Rick Perry likes to hold out the Lone Star State as a model — his vision for the country. But while Texas' growing economy has been a reliable jobs producer, the state's health care system is straining.
Only 48 percent of Texans have private health insurance, and more than a quarter of the state's population has no insurance at all, more than any other state. To fill this gap, the state's hospital emergency rooms and dozens of women's health clinics have stepped in to serve the uninsured across Texas.
To understand the health care landscape in Texas, it helps to start with context, and perhaps nobody is better suited to explain it than Tom Banning. He is the CEO of the Texas Academy of Family Physicians, a group of about 6,000 doctors whose members reach into every part of the state.
"We've got universal health care in Texas, [but] the way we're financing it is beyond stupid," Banning says.
When Banning says Texas has universal health care, he means if you live in urban Texas and get sick, you can go to the county hospital emergency room.
"In terms of accessing basic primary and preventive care, I think we fall far short," he says.
Over the past eight years, citing budget constraints, Gov. Rick Perry and the Republican-controlled legislature have dropped hundreds of thousands of mostly poor and working-class Texans from the rolls of government-sponsored insurance like Medicaid and the Children's Health Insurance Program. Nearly 6.5 million Texans are now uninsured even though the majority of them have full-time jobs.
Premiums in Texas' unregulated health insurance industry have soared by 105 percent over the past 10 years, according to the federal Agency for Health Care Research and Quality. Texas employers have responded by raising employee deductibles, often dramatically, or by dropping their coverage entirely.
The Effect On Women's Health Care
For hundreds of thousands of Texas women and teens between the ages of 13 and 50, the 71 family planning clinics in the state serve as their gateway to health care, and for many of those women, visiting the clinics is the only time they see a nurse practitioner or a doctor.
Rosalinda Roman, 19, discovered the People's Clinic in East Austin after she got pregnant at age 16 and gave birth to a boy. Now, she comes to the clinic every three months to get her comprehensive well-woman exam and her contraceptive shot.
"I come here and I do my annual physical here. I also get birth control here [and] Depo shot," Roman says. "I don't know what I would do with a second child right now."
With the encouragement of staff at the clinic, Roman has gone back to school and is two months away from becoming a medical technician.
This year, the Texas legislature and Gov. Perry cut funding for family planning clinics by two-thirds. Dr. Celia Neavel runs the People's Clinic in East Austin and says it is a devastating blow.
"That particular funding was used obviously for birth control, but also Pap smears, breast cancer screening, for diabetes, thyroid disorders, anemia [and] high cholesterol," Neavel says.
A 'War On Birth Control'
These cuts are less about saving money and more about abortion and contraception. Evangelicals and Tea Party supporters are ascendant in Texas, and Perry is their champion. These cuts are evidence of their political power as well.
The goal is to get government money out of the abortion process, and if contraceptive services have to suffer a bit of collateral damage in the process, so be it. When The Texas Tribune asked state Rep. Wayne Christian (R-Nacogdoches), a supporter of the family planning cuts, if this was a war on birth control, he said "yes."
"Well of course this is a war on birth control and abortions and everything — that's what family planning is supposed to be about," Christian said.
Family planning clinics are routinely referred to by many Texas Republican legislators as "abortion clinics" even though none of the 71 family planning clinics in the state that receive government funding provides abortions. Texas and federal law prohibits that, but most women's health clinics will refer women or teens who want an abortion to a provider.
"They're sitting here, referring women out to receive abortions," Christian said in an interview with NPR. "Those are the clinics, including Planned Parenthood, we were targeting."
Perry's spokesman did not reply to requests for comment for this story, but Christian said there's no question the Texas governor is an advocate, enthusiastically signing this approach into law.
"Gov. Perry has supported the pro-life agenda consistently throughout his time in office," he said.
The State's Family Planning Solution
The budget cuts to family planning clinics won't in the end save Texas money. The state estimates nearly 300,000 women will lose access to family planning services, resulting in roughly 20,000 additional unplanned births. Texas already spends $1.3 billion on teen pregnancies — more than any other state.
In San Antonio alone, unplanned children born to teens would fill 175 kindergarten classrooms each year. What's particularly galling to family planning advocates is that part of the money, $8.4 million, that was cut from family planning will now go to Crisis Pregnancy Centers around the state. Crisis Pregnancy Centers are part of the pro-life movement's answer to family planning clinics.
The Downtown Pregnancy Center's office in Dallas is located inside First Baptist Church's building, historically one of the most conservative and powerful Baptist churches in North Texas. Although it looks similar to a doctor's office, it is not a medical clinic; there are no well-woman examinations, no contraception services, free or paid, and no Pap smears.
There are 165 Crisis Pregnancy Centers across Texas, and plenty won't take any state money. The Downtown Pregnancy Center doesn't. The centers are for women who are willing to keep their babies or give them up for adoption. But clinic president Caroline Cline says, heartbreakingly, only 1 to 2 percent are willing to let their babies be adopted. Cline says teens will say to her, "I'd rather abort than give my baby up for adoption."
"It's disappointing, it's very disappointing," she says.
The Crisis Pregnancy Centers put up billboards letting frightened pregnant teens know that these are places they can turn to for help, but that can lead to a bit of a misunderstanding. The clinic gets calls from people asking what kind of abortions they offer and how much abortions cost, Cline says.
Nevertheless, these young women are not turned away.
"We let them know that we don't refer for abortion or perform abortions here, but we're a great place to start," Cline says.
The fact that millions of dollars that once went to family planning clinics will, in the future, go to Crisis Pregnancy Centers across Texas causes no small amount of bitterness among those who staff the women's health clinics. It's a feeling they're probably going to have to get used to.