The results
of this week’s Supreme Court hearings on the Affordable Health Care for
American Act (AHCAA) may well represent the most important battle in the enduring
war over the reach of states’ power relative to the power of the federal
government, since the legal challenges over discrimination and the Civil Rights Act of 1964. But the adjudication of constitutionality
of the AHCAA is not the only ongoing conflict in federal-state relations, or
even the only dispute over federalism in the area of healthcare.
Enter Texas. Bastion of the preeminence of states rights since its admission as a state to the United States.
The Texas legislature, in an indefatigable quest to assert the dominance of its state laws in the field of healthcare (particularly on issues related to abortion), has decided to begin enforcing the provision of an existing law to exclude organizations that provide abortions or "affiliates of abortion providers" from participating in the Texas Women’s Health Program.
When the Women’s Health Program was originally adopted in 2005, the language of the bill precluded abortion providers and their affiliated clinics from receiving reimbursement for services to poor women. However, state health institutions did not initially enforce this provision, so certain Planned Parenthood clinics were able to participate in the program as long as they did not carry out abortions, with these non-abortion providing Planned Parenthood clinics serving nearly half of the program’s patients.
Enter Texas. Bastion of the preeminence of states rights since its admission as a state to the United States.
The Texas legislature, in an indefatigable quest to assert the dominance of its state laws in the field of healthcare (particularly on issues related to abortion), has decided to begin enforcing the provision of an existing law to exclude organizations that provide abortions or "affiliates of abortion providers" from participating in the Texas Women’s Health Program.
When the Women’s Health Program was originally adopted in 2005, the language of the bill precluded abortion providers and their affiliated clinics from receiving reimbursement for services to poor women. However, state health institutions did not initially enforce this provision, so certain Planned Parenthood clinics were able to participate in the program as long as they did not carry out abortions, with these non-abortion providing Planned Parenthood clinics serving nearly half of the program’s patients.
Though this
law has existed since 2005, and the state’s enforcement of the letter of the
law to exclude Planned Parenthood began in early 2012, this issue
became a fully-fledged struggle between the federal government and the state of
Texas when the White House announced its removal of financial support for theWomen’s Health Program by halting Medicaid funding for the program on March 15.
Medicaid funding makes up 90% of the financial support of the Texas program by most estimates, and is the basis for federal
influence in state regulation of care providers for Medicaid beneficiaries. The
use of Medicaid funding in this program
invokes federal influence and the influence of the Social Security Act, which stops states from
limiting patient access to eligible care providers, with the intention of
protecting patient choice and access. Now, the text of the Social
Security Act is the primary basis for the Obama administration’s challenge to
this Texas law to protect poor women’s access to health care, and protect Planned
Parenthood from specific discrimination.
In response, Texas has filed a lawsuit against the Obama administration's decision to pull federal funding for Texas' Women's Health Program, with the goal of a federal policy reversal and the restoration of Medicaid funding to the program. This lawsuit is one of many complaints Texas has pending against the Federal government, making Texas the perfect example of a strong advocate for states rights locked in an ongoing struggle to harmonize its views of appropriate federal-state relations with those of the central government.
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