Proceed With Caution

In a once-in-a-decade review, the state's Health and Human Services Commission has come under the microscope of Sunset Advisory Commission auditors. The Sunset staff appears to be picking up where a 2003 bill – shrinking the HHSC's 12 agencies to five – ended. Their report recommends that the Texas Departments of Aging and Disability Services, State Health Services, Assistive and Rehabilitative Services, and Family and Protective Services be consolidated under the umbrella of the HHSC.

According to the Sunset proposal, the move would save costs, increase efficiency, and reduce waste. Opinions on the idea are mixed, however. Arlene Wohlgemuth, former state rep. (author of the 2003 bill) and executive director of conservative think tank Texas Public Policy Foundation, unsurprisingly commends the consolidation. Anne Dunkelberg with the Center for Public Policy Priorities is more cautious; she supports several of the 15 recommendations but fears that diverting limited staff resources to a major reorganization will "challenge and disrupt" care for the direct needs of Texans. The restructuring, she wrote, also holds the potential to "further dilute any remaining accountability to the public at large," as Sunset suggests nixing advisory committees.

Reproductive health advocates are raising similar cautions about possible reforms to family planning funds. Nestled in the 212-page plan to overhaul the HHSC is a recommendation to consolidate the three women's health care programs (the Expanded Primary Health Care, Family Planning, and Texas Women's Health programs) into one, in an effort to streamline a system that "wastes resources" and is "unnecessarily complicated," according to Sunset.

Considering a network already ravaged by draconian legislative budget cuts and grappling with a drop in thousands of preventative care clients as a result of the ideologically driven 2011 "affiliate ban" that excluded predominant provider Planned Parenthood from a Medicaid program, health leaders told the Sunset Committee: Tread carefully.

Testifying before the committee on Nov. 13, Dr. Janet Realini, chair of the Texas Women's Healthcare Coalition, comprised of nearly 50 organizations, said that while the coalition does not oppose consolidation per se, they have "serious concerns" about the impact on provider capacity and patient access. For instance, the plan recommends a fee-for-service-only approach (rather than a cost-reimbursement model), which the TWHC expects will translate into a loss of several (likely rural) providers, who would not be financially able to participate in the program. If implemented, the recommendation could be the "nail in the coffin" for beleaguered clinics, as one provider described to Realini.

With a system able to serve only 30% of women in need of publicly funded contraceptive services, and a health care landscape that has seen nearly 80 family planning clinics close due to budget cuts, Texas women's health care can't afford to lose any more providers, Realini stresses. "We have a fragile system that's been beat up in a couple of different ways; we're still trying to rebuild," she told the Chronicle. "So we need to make sure we don't cause unintended harm while trying to streamline things."

Echoing Realini's mixed reaction to the recommendations, Amanda Stevenson with the Texas Policy Evaluation Project (a multiyear study analyzing the impact of the state's cuts to family planning) urged Sunset to increase access to long-acting methods of contraception (including subsidizing male vasectomy) and to cover all Texas residents, regardless of immigration status. NARAL Pro-Choice Texas offered up its caveats, as well, including covering women at 250% of the poverty line (instead of the recommended 185%) and scrapping the affiliate ban rule.

The largely Republican Sunset Commission (comprised of 10 appointed legislators and two public members) will vote on the proposal Dec. 10; if approved, it would move to the Legislature for enactment in the upcoming session.