Health Care: Diminishing Returns

With the continuing damage inflicted upon women's health care since the 2011 session, including the dramatic impact of omnibus anti-abortion HB 2, some 2015 lawmakers will be trying to mitigate the destruction – while others will surely take the opportunity to further restrict abortion providers and reproductive health care.

Rep. Mary González, D-Clint, is among the former: After Republicans booted Planned Parenthood from the Medicaid-based Women's Health Program with an abortion "affiliate ban" rule, the number of participants have continued to decline. In an effort to make the preventative care program more inclusive, González has filed legislation (HB 468) that, in certain defined cases, would lower the age of client eligibility from 18 to 15 years old.

But if another lawmaker has his way, the "affiliate ban" will extend into the classrooms. Rep. Jeff Leach, R-Plano, filed HB 205, to prevent organizations that perform or are affiliated with abortion providers from teaching sexual education or family planning instruction. On the flip side, Democrats (Rep. González's HB 78 and Sen. Rodney Ellis' SB 88) opposed to strict abstinence-only education are looking to reinforce the medical accuracy and scope of sex ed in Texas schools.

A couple of early bills are proposing solutions to virtually non-existent problems: Rep. Allen Fletcher, R-Cypress, filed a bill (HB 113) that would prohibit performing an abortion based on the sex of the fetus, while Rep. Debbie Riddle, R-Spring, would mandate (HB 416) abortion facilities complete training on detecting human trafficking clients – although providers like Planned Parenthood already check for signs of domestic violence and human trafficking. (Notably, the rule applies only to abortion centers and not all medical clinics.)

As for health care overall: In their obstinate refusal to expand Medicaid under the Affordable Care Act, state Republican leaders have effectively denied coverage to some one million Texans stuck in the "coverage gap." While solutions for a possible block grant Medicaid plan have been tossed around – including reportedly by Gov.-elect Greg Abbott – Democratic lawmakers aren't waiting. Rep. Trey Martinez Fischer, D-San Antonio, and Sen. Ellis have filed legislation to work around the refusal – HB 116 and SB 89 would deliver medical assistance to anyone who qualifies for Medicaid under the ACA.

As she and others have tried (and failed) in sessions past, Sen. Jane Nelson, R-Flow­er Mound, hopes to drug test recipients of the Temporary Assistance for Needy Families (TANF) program with SB 54; in the House, Rep. Ken King, R-Canadian, filed the companion.

And expect debate over the Sunset Advis­ory Commission's recommendation to consolidate the Health and Human Services Commission and the four agencies it oversees into a single behemoth agency – a plan that includes consolidating the Texas Women's Health Program and the Expand­ed Primary Health Care Program and housing the Family Planning Program under the new agency. Recommended by Sunset in December, the plan now needs legislative approval. Health advocates warn that the disruption to the already fragile Texas social safety net could threaten the care of vulnerable populations.