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George Washington University, School of Public Health and Health Services, Department of Health Policy


Geiger Gibson/RCHN Community Health Foundation Research Collaborative Policy Research Brief No. 29


Plan-B pill; Contraceptives; Women's Health; Low-income Populations; Community Health Centers; Disparities


This analysis provides an initial assessment of the implications for low-income women of Texas' "affiliation regulation," which would bar Planned Parenthood Federation of America (PPFA) clinics from participating in the Texas Women's Health Program (WHP). In 2010, more than 183,000 women were enrolled in the WHP, which provides health screening, family planning and birth control to low-income women, and nearly 106,000 received care through the program. In our analysis of WHP provider data, we find:

  • Planned Parenthood (PPFA) clinics are by far the dominant source of care under the WHP. In FY 2010, PPFA clinics accounted for approximately 49 percent of all WHP-financed care, furnishing services to 51,953 WHP clients out of 105,998 WHP clients served. Of the 1,469 providers that billed the WHP in FY 2010, 908 (62%) served 10 or fewer patients, while 368 (25%) served only one patient.
  • By contrast, in the same year the state's community health centers served 10,130 WHP clients. Although health centers are the major source of care for the state's poorest residents and provide family planning services to thousands of traditional Medicaid beneficiaries, they attract fewer numbers of Medicaid expansion beneficiaries served through the WHP, who tend to be somewhat less poor.
  • In order to offset the loss of PPFA clinics in WHP, health centers would have to expand their WHP capacity five-fold, from slightly more than 10,000 patients to over 62,000 patients. Such an expansion in a short time period is virtually impossible, particularly given the simultaneous and steep loss in family planning grant funding experienced by health centers along with other family planning programs throughout the state.
  • The state's estimates of the impact of the loss of PPFA capacity under its affiliation rule appear to contain numerous methodological flaws. The estimates may overstate remaining provider capacity in communities in which WHP clients reside, do not take into account the fact that unlike PPFA clinics, many WHP providers treat only a handful of patients, and may count reference laboratories as sources of direct patient care.

As a result, we estimate that the affiliation rule may jeopardize family planning, cancer screening, and preventive health care for approximately 52,000 women currently served by PPFA clinics under the WHP.


Released May 2, 2012. Revised May 4, 2012.

Commissioned Report.

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