Sunday, October 28, 2012

Why Vote Against Prop 1?

Among the many arguments for a medical school in Austin, the most compelling is the expansion of access to care for uninsured people. In Texas, according to State Health Facts, 24% of all people are uninsured. Texas has among the narrowest Medicaid eligibility in the nation, leaving a full quarter of our population without the ability to access simple preventive services like flu shots and wound care. That means far too many people come to emergency rooms for care that is either totally preventable or could be cheaply provided by a primary healthcare provider, if only the person had one.

But another population of Texans is uninsured at even higher rates--women.  Seventeen percent of non-elderly women nationwide are uninsured but, in Texas, 26% of women have no health insurance, an issue not addressed anywhere in Prop 1's slick mailers or on its website.

The issue of women's health in Texas is not some Summer's Eve commercial--Medicaid funded births represent a huge proportion of state healthcare costs, and Texas is in court again for trying to exclude Planned Parenthood from the Women's Health Program, which decreases Medicaid funded births by providing contraceptives to women in need. If the state succeeds in excluding the #1 provider of family planning services to poor women, 45,000 women will be left with NO healthcare provider and potentially increasing the costs to the state by billions of dollars.

Austin's medical school can't solve a statewide problem but Prop 1, as written, won't even solve the problem locally. Prop 1's website claims that it would fund clinics where uninsured people in Travis County--many of whom are women of childbearing age--could get care. But Prop 1 would also fund, in part, a teaching hospital to be run by Seton, the Catholic operator of Brackenridge/University Medical Center, Austin's safety net hospital. The consultants Austin paid to tell us that the place is on its last legs decreed, in April, that the building has got to go and Seton has committed $250 million to build a new facility that it will operate.

Even though it is a publicly-funded, safety net hospital, because Brackenridge is operated by Seton, it does not provide family planning services of any kind, emergency contraception to rape victims, or tubal ligation to women who have delivered babies and prefer not to have more. Women seeking these services must go to the "hospital within the hospital," otherwise known as the 5th floor, and see different doctors. For tubal ligation, this increases both risks to the patient and costs. There is no reason to believe these services would be provided in the new facility and, indeed, Prop 1's website does not mention women's health or family planning at all.

Planned Parenthood of Greater Texas has endorsed Prop 1, but they haven't explained why. Even if Planned Parenthood would somehow benefit from Prop 1 (though it is not clear from the proposition that they would) no Planned Parenthood clinic operates an emergency room to see rape victims or performs tubal ligations. Twenty seven percent of American women choose tubal sterilization at some point, and to refuse women this option when they have chosen to have no more children is not acceptable for a hospital paid for with public funds.

I fully support the right of Seton and its parent company, Ascension Health, to operate their hospital according to their values, which prohibit the practice of women's healthcare as actually needed by women patients. But I do not support Austin taxpayers and Austin residents paying to operate a religious hospital, literally under direction from the Vatican, that refuses to provide the care actually needed by uninsured Texans.

Austin's residents need access to health care. But Travis County's health needs include care for women, full stop. Kirk Watson, the patron of this proposal, is a veteran advocate of women's health in Texas but Prop 1 just doesn't deliver. I'm voting no.


  1. I think this post could use some basic journalism. Call Planned Parenthood and ask them why they are supporting Proposition 1. Otherwise you are using scare tactics and throwing the baby out with the bathwater, as they say. Not responsible reporting, in my book.

    1. Thanks for your comment. This piece isn't hard journalism--it's an explanation of why I, as a voter in Travis County, am voting against Prop 1. But you're absolutely right that the coverage of this issue by actual journalists--like those at the Statesman and the Chronicle--could use some basic reporting about women's health services and why Planned Parenthood has endorsed this Proposition. I fundamentally disagree that women's health services are 'the bathwater'--women represent more uninsured Texans than men and to exclude these services is unacceptable.

  2. Planned Parenthood has explained their endorsement of Prop 1:

    One component of that is a $400,000/year contract for health exams.

  3. Thanks Becca. In the endorsement I read they didn't explicitly say why they were in favor, and what you link to says this: "Central Health signed a $400,000/year contract with Planned Parenthood to pay for health exams for our eligible, uninsured clients, creating a lifeline to ensure that clients seeking basic health services are not turned away."
    That statement refers to a contract that Central Health has already signed with PP in the wake of it being excluded from the WHP--it doesn't reflect a contract/agreement as a part of Prop 1. I imagine that whatever relationship currently exists between CH and PP would continue, but that doesn't satisfy the need for hospital-based women's health services that Seton won't provide.