Sep 212011

What’s Going to Happen when the Clinics Close?

I’ve had a lot of conversations this past week regarding my data visualization tracking STDs, HIV, and AIDS in Texas from 2006 to 2010 (see

One of the bigger questions that may have been overlooked in my accompanying blog post is what is going to happen over the next two years as state budget cuts take effect? Consider the chart below that shows the increase in reported STD cases over the past five years.

Granted, combining Chlamydia, Gonorrhea, Syphilis, and HIV into one lump and not taking overall population growth into account may be misleading, so consider the chart below that shows the number of STDs and HIV cases, incident rates, and percentage changes from 2006 to 2010.

Even without drilling very deep it looks like Texas is having a lot of trouble just containing the spread of STDs and HIV.  To be fair, one of the reasons the number of Chlamydia cases has increased so much is that the Texas department of State Health Services has adopted new technology and screening techniques which in turn has led to much better detection and reporting.

That said, we pretty much see all the trend lines moving upward.

So why should we be very worried?

The numbers shown above reflect a state healthcare system that had previously budgeted over $50 million per year for family planning initiatives, including education, screening, and treatment for STDs and HIV / AIDS.  These funds have been severely cut (see

So, what’s going to happen when clinics close and those clinics that do remain open have to cut staff and shorten office hours?

(To explore the interactive visualizations, click here.)


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 Posted by on September 21, 2011 4) Health and Social Issues, Blog  Add comments

  One Response to “Is Trouble Brewing in Texas?”

Comments (1)
  1. Thank you, Steve, for this thoughtful (and though provoking) analysis. You raised the $231 million dollar question when you asked about the consequences of the recent legislative action to redirect federal funds away from family planning (which some ignorant Texas politicians call the “abortion industry”).

    Nothing could be further from the truth! By strictly enforced law (state contractors are audited at least once every 2 years) no funds, either state or federal, can be used for abortion. Hear me when I say, not one organization that contracts with the state of Texas to provide family planning services do abortions or ever have. In fact, most believe as I do, that abortion is not a part of family planning. Family planning is about the prevention of pregnancy, not the termination of pregnancy.

    What was happening with Texas’ family planning program prior to the recent cuts? Let’s take a quick look at 2010.

    2010 DSHS Contractors
    By Provider Type Number
    of Contractors Total
    Awarded Total (unduplicated) Clients Served
    26 $ 7,861,897 30,623
    (health departments/medical schools)
    25 $ 20,083,335 85,736
    9 $ 12,668,101 73,331
    18 $ 9,749,904 44,705
    78 $ 50,363,237 234,395

    In Texas, our state health department contracts with four different types of organizations for family planning services. Together, using federal Title X, V, and XX funds, they provided preventive health care to over 234,000 women and men in 2010. It is interesting to note which organizations did most of the work. While the Department of State Health Services (DSHS) contracted with more FQHCs (26) than any other type of provider – – they saw the fewest patients. Contrast that with the nine (9) Planned Parenthood organizations in our state who served 31% of the clients that year.
    During the recent legislative session, a group of radical social conservatives, supported by the Texas Right to Life and Texas Alliance for Life (both organizations have taken credit for this travesty), succeeded in redirecting two-thirds of the federal family planning dollars to other programs. It’s important to note that this action had no impact on the state budget what so ever. These are federal rather than state dollars that will now be spent elsewhere.

    Based on an average annual cost per family planning client of $205, DSHS estimates that in 2012 approximately Based on an average cost per client of $205, DSHS estimates that approximately 301,691 fewer men and women would be served by family planning programs in the 2012-13 biennium as a result of the approximately $61.7 million reduction. What are the results of fewer clients served?

    1. An increase in Medicaid births (including costs for prenatal, delivery, and first year infant care).
    2. An increase in the number of cases and rate of incidence for STDs (including HIV/AIDS).
    3. An increase in the number of abortions.

    These numbers will be fairly easy to track. For instance, in 2009, the average cost of a Medicaid-paid birth and subsequent infant costs was over $11,000. According to an analysis completed by the Texas Legislative Budget Board, the increase in births as a consequent of the family planning budget cuts will cost Medicaid an additional $231,117,948 in 2012.

    Other costs will be much harder, if not impossible, to calculate. The hardship on woman and families resulting from an unwanted pregnancy, the emotional and financial cost of a pregnancy termination, the cost of undetected cancer and sexually transmitted infections, are costs too complex and long term to be determined.

    As I watch clinics close, dedicated professionals lose their jobs, and non-profit organizations that have served their communities for decades be wiped away, I feel sickened that some legislators and anti-choice groups are celebrating this destruction (and using to is an a fundraising tool).

    Texas leads the nation in citizens without health insurance. Texas leads the nation in repeat teen pregnancies. Low income citizens are the fasting growing population in our state. In the face of these challenges, Governor Perry and his ring-wing supporters at the Capitol have done everything in their power to decimate a vital part of Texas’ healthcare safety net. If I wasn’t so angry, I’d cry.

    Fran Hagerty, PhD, CEO –
    Women’s Health & Family Planning Association of Texas

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