Healthcare in the US: A Tale of Unintended Consequences

Photo credit : Patrick Michels texasobserver.com

This blog has been written by Jennifer Barnes, intern with 2020 Public Services team

Today, the Healthcare Insurance Marketplace is going live. Its feels like a distant memory now, but in June of this year, Democratic Senator Wendy Davis stood up in her pink trainers and delivered an incredible 11 hour filibuster in the Texas Senate against a bill that would take us back decades (to before the landmark Roe V. Wade decision) in our fight for women’s health. After all of the media attention, the twitter support, and the hundreds of confiscated tampons, we seem to have forgotten about the impact the passing of this legislation will have on the lives of Texas women.

As a Texan woman currently on an internship with the RSA, I wanted to share insight into the Texan example of how policy making can result in perverse incentives and unintended consequences. I hope that this post is enough to pique your interest in the current happenings in Texas as well as the wider healthcare debate in America.

House Bill 2 disregards the challenges that women face when it comes to affordable health care by:

While Texas has become the 13^th state to pass legislation banning abortions after the widely debated 20 week mark, it is arguably the latter three requirements that are most cause for concern. Presented in the rhetoric of raising standards, these stipulations instead eradicate options. The passing of this bill is predicted to close dozens of clinics across the state (with the highest closure estimates predicting all but 5 of the state’s 42 abortion providing clinics), most notably those in disadvantaged, rural areas where alternative healthcare options are limited.

"Governor Perry and other state leaders have now taken sides and chosen narrow partisan special interests over mothers, daughters, sisters and every Texan who puts the health of their family, the well-being of their neighbors, and the future of Texas ahead of politics and personal ambitions."- Wendy Davis

To understand the likely impact of the changes that House Bill 2 will bring it is important to understand how medical services for women in Texas, and elsewhere in the US, are funded.

Contrary to popular perception, pregnancy terminations form a very small part of what the major women’s clinics actually do.  For Planned Parenthood, for example, the organisation that runs the majority of abortion providing clinics, abortions are only 3% of the medical services provided.  But they are financially crucial.  30-50% of Planned Parenthood’s surpluses are generated from termination services.  What this means is that as the system currently stands, many of the cancer screening, sex-education, STD, pre-natal care and pregnancy prevention services that are accessible to low income women will potentially become more difficult to fund if the legislation succeeds in driving down the number of abortions.

Alternatively, if clinics are required to invest in expensive unnecessary upgrades to surgical standards to perform abortions, they will have to choose between closing or stopping their abortion provisions entirely. Planned Parenthood gets about half of its funding from government, but there are strict limitations on how it can be used. Title X funds are the only federal funds devoted to family planning and by law these funds cannot be used for abortions. If the state increases funding for family planning provisions outside of abortions, the clinics will likely survive, but will no longer offer terminations.

This funding atmosphere has created a complicated and unbalanced relationship between terminations and other women’s wellness provisions, and wrongfully reduces this conversation to one of economics, not value read more on ThinkProgress.

Pretend for a minute that you’re Cathy, a sexually active 16 year old girl in Texas living in a conservative town where everyone knows everyone and you all go to church together on Sundays. Your church and your high school teach abstinence-only and therefore your sexual education is lacking, but you become sexually active anyway.

If this is your reality, then the likelihood that you would be willing to buy condoms from the local pharmacy (where the pharmacist is friends with your father) is slim to none.  It’s quite unlikely that you’ll go to the clinic for birth control and free condoms.  If your closest clinic is up to two hours’ drive away, it becomes vanishingly unlikely. If you become pregnant and have spent the first few months working up the courage to face what’s happening, the 20 week mark will significantly limit your options even if you do make the drive.

This isn’t an unlikely story in many areas of rural Texas. Here, a young girl is strongly deterred from accessing birth control and receiving an abortion due to logistics and circumstances over which she is powerless. Here, the passing of House Bill 2 achieves the pro-life agenda and significantly reduces access to abortion.

Regardless of your thoughts on the morality of early termination, an alternate scenario is enlightening:

Now consider that you’re Julia, a single mother, working two jobs to pay your bills. You work part-time jobs without health insurance and you can only just afford the premiums even after the Affordable Health Plan takes effect. While you are eligible for the Texas Women’s Health programme, the doctors taking part in it have taken their quota of Medicaid patients so this option becomes almost worthless to you. Even if you have a health insurance plan, your deductible (the amount of money you must spend before the insurance company begins to pay for your health services) is enormous, leaving clinics like Planned Parenthood the only places you can go for affordable reproductive health needs and screenings.

The local clinic shuts down and you don’t have the time or energy to drive to the city for an exam when you start noticing mild symptoms. The gas money to get there is too much and the childrens’ schedules are too busy on top of your multiple shifts…so you ignore the symptoms. When the pain becomes too much to bear you hire a babysitter that you can’t afford and go to the closest clinic, 100 miles away. By then, it’s clear that you have advanced cervical cancer.

Supporters of this legislation ignore the reality that for many women, clinics like Planned Parenthood are one of their only affordable options for reproductive care. In many geographic areas, for those who earn too much for government Medicaid assistance but lack private insurance, Planned Parenthood truly is one of their only options. The story isn’t that Planned Parenthood supports pre-marital sex and abortions, the story is that Planned Parenthood supports women and their freedom over their bodies.

The passing of this bill limits women’s freedoms: freedom of choice is nonexistent when there are no options.