Lucy Ramirez, executive director of the Nuestra Clinica Del Valle – a primary care center that specializes in women’s health and accepts WHP patients — told TAI that her female patients typically choose Planned Parenthood for their well-woman exams and pap smears. Of the patients that may start opting for her clinic in lieu of Planned Parenthood, Ramirez says they can probably handle “some” of the extra clients but certainly not everybody. For the ones that try to schedule an appointment, wait times to see a doctor will be long.

“Well, that’s exhausting and confusing,” said Gonzalez after making a round of calls in search of a new provider. “I’m pretty offended that some of these unavailable options are listed. Why are they making this more difficult for us?”

The young woman is skeptical that working, poor women in her impoverished community can easily navigate the database, let alone find a reliable mode of transportation to their appointments given the possibility of longer travel time.

“I really doubt many of these women, working multiple jobs and with little extra time on their hands, are going to be able to go through this list or even be able to drive to a new provider,” she says. “I’m lucky enough to have a car, but many of them don’t have cars, and public transportation in the area isn’t very reliable.”

In response to duplicate entries and inflated results, Stephanie Goodman, spokesperson for the Health and Human Services Commission, told TAI the agency is “looking at ways to improve the online search.”

“Many of the duplicate entries are because providers have multiple sites or register under multiple specialties. But some are because a provider may have entered their address different ways — maybe one entry includes ‘Drive’ on the address and another doesn’t,” said Goodman in an e-mail message. “We’re looking at ways to eliminate those types of duplicate entries.”

Overall, Goodman continues to assure Texans that the commission has been working to recruit new doctors and clinics into the program. Goodman says the state has increased the number of providers by 500 since the spring.

“We’re confident that we’ll continue to have enough providers to serve women in the program,” she said.

But according to the Houston Chronicle, Kyle Janek, the current head of the commission, said last week that he couldn’t “guarantee” that providers would be available for every woman in the program by Nov. 1.

As for those providers listed who say they don’t accept Women’s Health Program patients, Goodman says according to her records, they still completed the certification process to be part of the program and are able to bill for the service — even if they are currently not accepting new patients.

‘A domino effect’

Gonzalez and her fellow Hidalgo County residents have the most to lose when Planned Parenthood is forced to exit the program and are, therefore, the most reliant on the accuracy of the database.

Massive legislative budget cuts made last session (separate from the rule excluding Planned Parenthood from the WHP) slashed more than $74 million in family planning funds and crippled the network of providers. According to the non-partisan Legislative Budget Board, the cuts will lead to nearly 284,000 women losing services. In Hidalgo County alone — an already beleaguered and impoverished area along the Texas-Mexico border — four Planned Parenthood clinics were forced to close due solely to the budgetary cutbacks. The Hidalgo association lost $3 million in funding, amounting to nearly 50 percent of its budget, and reduced its staff by half. As one of the largest family planning providers in Texas, the cuts to Planned Parenthood in Hidalgo affected about 15,000 women, according to the association.

Patricio Gonzales, CEO of The Planned Parenthood Association of Hidalgo County. Photo by Mary Tuma.

Patricio Gonzales, CEO of the county’s Planned Parenthood system, says residents are heavily dependent on the clinics for care, and the need keeps growing in the face of more cuts. In 2010, about 23,000 clients, including men and teenagers, accessed health care at one of the centers, a 40 percent increase in four years. The dependence stems from the region’s status as a socioeconomically stunted area. The Hidalgo centers serve one of the poorest counties not just in the state but the country, with 90 percent of the clientele living at or below the federal poverty level. Overall, more than a third of Hidalgo County residents live in poverty.

“For our patients, Texas family planning is their safety net,” says Gonzales. “We are their only doctors for many, many years before they can get a job and get insurance and get ‘real’ doctors – we sometimes joke.”

A recent article published in the New England Journal of Medicine details the devastating effects family planning budget cuts have had on Texas clinics, including more than 50 closures and a reduction in hours and services. For example, clinics have reduced the number of birth control pill packs provided to patients per visit — a practice that, according to the researchers, “has been shown to result in lower rates of continuation with the method and that may increase the likelihood of unintended pregnancy.”

Gonzales says the study’s findings mirror the situation of the shredded health care network he oversees.

He says that in 2008, 6,056 women received birth control pill packs. But following the budget cuts in 2011, the number dropped to 5,201. Gonzales expects that number to fall even further this year.

“Because we are having to charge now, working poor women cannot afford to pay, so they are just not coming to us,” he says.

Still experiencing the heavy blow dealt by budget cuts, Gonzales says the dismantling of the Women’s Health Program will push the remaining clinics to the brink of shutting down.

According to a George Washington University study release earlier this month, more than 80 percent of the Women’s Health Program enrollees in the area come to Planned Parenthood, making it the largest provider for the program in the region. The second-largest provider serves less than 10 percent of the number of Planned Parenthood’s clients. Gonzales says that when his Planned Parenthood network is cut out of the program, it will be forced to stop seeing 6,500 patients.

Planned Parenthood centers in McAllen, Edinburg, and Weslaco — which heavily rely on the Women’s Health Program to stay afloat — and a clinic in San Juan survived last year’s budget cuts. But when the program is axed at the end of the month, Gonzales says at least half of the centers will likely close.

And if they do, health care facilities nearby cannot absorb the number of clients Planned Parenthood sees, says Gonzales.

“There is no feasible way the surrounding clinics can take in that many women. Where do they go? I can’t refer that many women to the county health department or the federally qualified health center. There is no way they can see that number of clients,” he says.

The October George Washington University study found that because of the high number of Women’s Health Program clients using Planned Parenthood clinics in Hidalgo County, other facilities in the area would need to increase their caseload by 531 percent in order to replace Planned Parenthood.

The study also found that non-Planned Parenthood clinics are “generally at, or close to, the limits of their capacity and will not be able to expand much, if at all, due to other resource or staffing constraints.”

The researchers single out the severe effects the strain would have on Hidalgo, writing that “problems would be particularly serious in poorer, less urban areas, like Hidalgo or Midland Counties, where there are fewer alternative providers.”

Moreover, the researchers point out that one reason so many women have chosen Planned Parenthood is that they simply “prefer Planned Parenthood facilities, whether because of their locations, the nature and quality of services provided, their reputations, the quality or attentiveness of staff, or for other reasons.”

“The bottom line is that you should have the freedom of choice to select your own provider and not be subject to a preapproved or preselected list,” says Patricio Gonzales.

Straddled with additional barriers to access, poverty-stricken clients are oftentimes unable to secure reliable transportation or pay for travel to clinics that are can see them. And so for many women in the border area, that means forgoing basic care.

“I’ve talked to a lot of women and they are just going without,” says Gonzales. “They are taking a risk of getting pregnant, taking a risk of not getting pap smears; a risk of not detecting cancer early; a risk of not getting treated for a sexually transmitted infection.”

“We are going to see a domino effect,” he adds. “When access to family planning decreases, pregnancy and abortion rates will rise. The health of the community is jeopardized and we all suffer down the road.”