摘要：We examined the impact of legislation in Texas that dramatically cut and restricted participation in the state’s family planning program in 2011 using surveys and interviews with leaders at organizations that received family planning funding. Overall, 25% of family planning clinics in Texas closed. In 2011, 71% of organizations widely offered long-acting reversible contraception; in 2012–2013, only 46% did so. Organizations served 54% fewer clients than they had in the previous period. Specialized family planning providers, which were the targets of the legislation, experienced the largest reductions in services, but other agencies were also adversely affected. The Texas experience provides valuable insight into the potential effects that legislation proposed in other states may have on low-income women’s access to family planning services. Publicly funded family planning clinics have been a key component of the health care safety net for low-income women in the United States and will remain essential points of access under the Affordable Care Act. 1,2 Title X, the federal program dedicated to family planning, provides crucial infrastructural support for a network of clinics and subsidizes the cost of family planning services for uninsured women. In many states, Medicaid family planning waivers or state plan amendments constitute another source of support, and they reimburse clinics for services provided to eligible women. These programs can help fill gaps in coverage for those who lose other insurance because of changes in income or employment or other life events. 3 However, the degree to which low-income women can rely on publicly funded providers for subsidized family planning services has become increasingly dependent on policies enacted by state legislatures, which recently have taken on a large role in determining not only the amount of funding that goes to family planning but also the types of organizations that are eligible to receive it. Since 2010, several states have made significant cuts to their family planning budgets, and in 5 states, funding for family planning services was disproportionately reduced relative to other health programs. 4 Additionally, since 2011, 16 states have proposed legislation that effectively blocks specialized family planning providers from receiving any public funding such as Title X or bars those that also provide abortion services from receiving funds, including Medicaid. 5,6 This legislation may be aimed at defunding entities providing abortion care, such as Planned Parenthood, even though federal dollars cannot be used to pay for abortions in almost all cases. One of the most striking examples of legislation affecting the delivery of publicly funded family planning services took place in Texas, which in 2011 both dramatically cut and restricted participation in the state’s family planning program. We examined the impact of the 2011 legislation on family planning providers in Texas. We have reported on our findings from surveys and in-depth interviews with leaders at organizations across the state that received public funding before the legislation and our analysis of state administrative data. The Texas experience provides valuable insight into the potential effects that legislation proposed in other states may have on low-income women’s access to family planning services.
