Testimony on Senate Bills 575, 585, and 1854
Senate Health and Human Services
By Janet Realini, MD, MPH
April 28, 2011
Good morning, Chairman Deuell and members of the Subcommittee. Thank you for the opportunity to testify.
I am Janet Realini, MD, MPH, a family physician and a volunteer for the Healthy Futures Alliance. The alliance is a community coalition dedicated to reducing teen and unplanned pregnancies in San Antonio and Texas. I also am here on behalf 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. I am speaking in strong support of Senate Bills 575 by Sen. Van de Putte and 585 by Sen. Watson, both of which would continue and strengthen the Medicaid Women’s Health Program (WHP). I am speaking on SB 1854.
In 2007, Texas launched the Women’s Health Program as a pilot aimed at reducing Medicaid costs by providing low-income women access to family planning services, excluding abortion. To participate in WHP, a woman must be between the ages of 18 and 44, a U.S. citizen or a legal immigrant, and uninsured. She must have an income at or below 185 percent of the federal poverty level. WHP participants receive basic health care screenings — such as for cancer, high blood pressure, and diabetes — and birth control.
The premise behind WHP is simple: By helping women better plan and space their pregnancies, mothers and babies will be healthier, and Medicaid will be able to reduce pregnancy and neonatal-related expenditures. Mistimed pregnancies are costly in both human and economic terms. Among single young women, more than 70 percent of pregnancies in Texas are unplanned.
While most of the children born from unplanned pregnancies come to be wanted, loved, and cared for, the health risks are much higher for these pregnancies than for pregnancies that are planned. For example, unplanned pregnancies are associated with late prenatal care and with poor birth spacing, meaning pregnancies 18 months or less apart. Lack of prenatal care or too-close births contribute to low birth weight and/or premature babies. Babies born too soon or too small often have significant health problems, such as respiratory or developmental delays, contributing to higher medical costs at birth and as the child ages. In 2007, unplanned Medicaid births cost the state more than $1.2 billion.
According to the Legislative Budget Board, in 2009 it cost Texas Medicaid a combined $16,360 (all funds) for each delivery and first-year newborn health care costs. The average annual cost per woman participating in WHP is $241 (all funds), and Texas’ share is $24.
Since WHP’s inception, more than 235,000 Texas women have received family planning services. In the first two years of the program, because of births averted, Texas saved more than $37.6 million in general revenue (GR).
This represents a savings of more than $10 for every $1 of general revenue that Texas invested in the program.
As part of its biennial recommendations to improve government efficiency and effectiveness, the Legislative Budget Board recommended continuing and expanding the Women’s Health Program to achieve additional Medicaid savings and health gains. In addition to continuing WHP, the LBB recommended expansion of eligibility for the program to: 1) women whose income would fall below 185% of the federal poverty level if they were pregnant; 2) male clients under 185% of poverty seeking vasectomies; and 3) income-eligible teenage females who have given birth while on Medicaid. In addition, the LBB recommended establishing targeted outreach to women who have given birth on Medicaid before their post-partum coverage expires. SB 575 incorporates these LBB recommendations.
Continuing WHP is estimated by LBB to have a positive impact of over $83.7 million in General Revenue. SB 575, which includes expansions of WHP, is estimated by LBB to have a positive impact even larger: over $89.1 million in General Revenue. The LBB could not determine the fiscal effect of SB 1854 as introduced. However, if renewal of WHP includes language that reduces the availability of providers, it is certain to limit the positive fiscal impact of the program. Fewer WHP providerswould mean that state Medicaid costs will increase from current levels.
A key issue for the ability of the program to reach eligible Texas women—and to be able to save dollars—is the availability of enough participating providers. Currently, WHP reaches only about 15% of eligible women. Although any Medicaid provider is eligible to participate in the program, many have not participated. Any measure that decreases the number of participating providers is likely to reduce the number of women served by the program, decreasing savings from the program. Our organizations urge the Subcommittee to support language that will maximize WHP provider availability for the women of Texas.
Increasing the number of women who enroll in WHP after a Medicaid delivery is especially important. For a new mother, enrolling in WHP is not always a top priority when she’s trying to juggle all the demands of caring for a new baby. Women who have had a Medicaid-funded delivery are at particularly high risk for subsequent pregnancy, often so soon that risks of prematurity and low birth weight are elevated.
In addition to renewing WHP, SB 585 includes enhanced outreach to educate eligible Texans about WHP. Currently, the program is a “well-kept secret,” with only about one in six eligible women participating. Far higher savings and health benefits could be realized with greater participation in the program.
SB 585 also includes important language to promote evidence-based education regarding human sexuality in school districts where the curriculum is taught. Schools must still teach that abstinence is the preferred approach.
Without legislative action, the Texas Women’s Health Program will expire in December 2011. Both SB 575 and SB 585 extend WHP, thereby allowing Texas to continue reaping the program’s positive human and economic benefits.
We urge you to support legislation to continue and strengthen the Texas Women’s Health Program.
82nd Texas Legislature Testimonies