Abbott asks for federal funds to reward Texas for bad governance
America is a nation of laws, and those laws should be respected. The point is often underscored by Republican elected leaders in debates over immigration.
Such leaders also stress, and I think most Americans would agree, that government officials should be smart with taxpayer money, that they should talk straight, that they should put the people before politics. Yet Gov. Greg Abbott essentially violates every single one of these principles in a recent letter to President Donald Trump, pressing him to reinstate tens of millions of dollars in federal funding for women’s health care in Texas.
In the Jan. 23 letter, Abbott asks his fellow Republican in the White House to approve a waiver request that would reverse “punitive” and “retaliatory” actions that Abbott claims the Obama administration took against Texas “for pursuing a culture that prioritizes not only the life of the unborn but of the women carrying them.”
With these federal funds, Abbott explains, Texas women will have access to critical screening and treatment for hypertension, diabetes and high cholesterol, which are the leading contributors to maternal deaths in our state.
Abbott doesn’t say it, but Texas is really counting on the influx of $90 million from the federal government because legislators already accounted for it in the budget. The fact that there’s been no answer on the waiver request from the folks at the federal Centers for Medicare and Medicaid Services is making some in Texas nervous.
Hence, Abbott’s letter — which would be a compelling plea if it weren’t so misleading.
You see, America is a nation of laws. And one of the laws governing the allocation of federal health care funding is that states should not exclude qualified providers from the program simply because they or their affiliates provide abortion services.
Starting in 2013, Texas willfully violated this law when it kicked Planned Parenthood out of the state-federal health program for low-income women. Federal law has long banned any public funding for abortion, but because Planned Parenthood offers abortion services at some of its clinics, the state deemed the organization unfit to receive funding for every other service and product it provides, from birth control pills to cancer screening.
State leaders knew that doing so would make the state ineligible for generous federal funding — $9 for every $1 the state spent. They did it anyway. They replaced the former state-federal program with a state-only program and put the full burden of paying for it on Texas taxpayers.
Principles can be pricey. For some people diametrically opposed to abortion rights, maybe the cost seemed worth it. The problem, of course, is that the decision cost more than dollars.
The move did not “prioritize” the lives of pregnant women — or any women for that matter.
In fact, it hurt women. To make a political point, Texas leaders were willing to tolerate sharp declines in access to health care for women.
New money for a bad mistake
Study after study has shown the devastating effects of excluding the biggest, most experienced providers and relying on many providers that simply can’t handle the volume.
Enrollment in state-run women’s health services dropped 24 percent, the percentage of women getting health care services plummeted 39 percent, and the share of women accessing contraception fell 41 percent, according to the Center for Public Policy Priorities, a nonprofit that advocates for low-income Texans.
In essence, Texas is attempting to get paid for its bad mistake — and CMS could set a dangerous precedent by saying yes.
Besides that, Texas’ waiver request doesn’t meet basic standards for such proposals.
Such waivers are intended to spur innovation; they’re supposed to be for experimental or pilot projects that states are testing with the hope that some will lead to successful reforms that could be replicated elsewhere. The only thing novel about Texas’ plan is that the state is seeking to be rewarded for skirting the law.
Under statute, a waiver must be likely to promote Medicaid’s objectives, including an increase in overall health coverage of low-income individuals, in access to providers, in quality of care and improvement of health outcomes.
Abbott, in his letter, was careful not to claim Texas’ plan would accomplish this. A presentation from last year on the Texas Health and Human Services website does claim that a goal of the Healthy Texas Women waiver is to “increase access” to various women’s health services.
The truth is that Texas’ plan doesn’t improve or increase much of anything, except the money in state coffers. It is not seeking to create, but only to supplant.
“It is a simple refinancing of an existing state program with federal dollars,” says Stacey Pogue, senior policy analyst at the Center for Public Policy Priorities. Costly wager
CMS, the federal agency, also requires such waivers to be budget-neutral, meaning they don’t increase the federal government’s financial burden. There is nothing budget-neutral about asking the federal government to pay millions of dollars it is not currently paying.
If Texas doesn’t get the funding, women’s health services will be covered by state funds.
And that’s what should happen here. Sure, the state desperately needs more federal funding for health care. But it should come only when state leaders acknowledge their mistakes and decide to follow federal rules intended to protect women.
Texas leaders, including then-Gov. Rick Perry, seem to have made a costly wager: They sacrificed women’s health and squandered taxpayer money for political gain, hoping maybe someday a friendly president would bail them out.
This isn’t leadership. It is not good government by any definition I know. It is wasteful, shortsighted and selfish. It should be condemned, not rewarded.