In the wake of a series of videos showing Planned Parenthood officials across the country discussing how they preserve the body parts and organs of aborted fetuses for medical research, a national debate is underway about whether Congress should defund the organization, which receives more than $500 million taxpayer dollars a year.
No matter what your view of Planned Parenthood, the controversy raises a difficult question: What can taxpayers do about federally funded programs they find objectionable? To whom should they appeal: state lawmakers or Washington, D.C.?
Here, the rest of the country can learn something from Texas. We defunded Planned Parenthood in 2011 and replaced it with a state-run, state-funded program. Voters in Texas decided they didn’t want their tax dollars going to support an organization that performs abortions, so state lawmakers took action.
But it wasn’t easy. Planned Parenthood gets much of its federal funding through the Medicaid program — and because states can’t simply choose which providers are eligible for Medicaid payments and which are not. States that have tried to pull Medicaid funding from Planned Parenthood have been stopped by the courts.
Rather than try to pull Medicaid funds from Planned Parenthood, Texas lawmakers took decisive action and opted out of the Medicaid Women’s Health Program altogether, freeing state health officials from the straitjacket of federal rules.
But the move provoked a heated debate in Texas, with accusations from Planned Parenthood supporters that conservative lawmakers were waging a “war on women” — a theme that came up repeatedly in last year’s gubernatorial election.
But the decision had nothing to do with a war on women and everything to do with freeing the state from federal Medicaid rules. In place of the Medicaid Women’s Health Program, the state legislature created the Texas Women’s Health Program, funded entirely with state tax dollars. And next year, the state will launch the Expanded Primary Health Care program for women, which will augment the Texas Women’s Health Program with additional services.
Critics say this state replacement is underfunded and lacks adequate provider participation. But together these two programs will receive about $100 million more in funding than the old Medicaid program did. They also have more providers. As of March 31, there were more than 4,380 providers statewide, compared to only 1,328 in the Medicaid Women’s Health program in 2011.
What’s more, if state officials discover that something isn’t working in these new programs, they can make changes in six to 12 months, instead of waiting years for federal bureaucrats to approve a waiver request.
That, of course, was the entire point.
As for the debate over defunding Planned Parenthood, states should take their cue from Texas and stop waiting for Congress to decide the question for them. That goes for more than just Planned Parenthood and Medicaid. States administer numerous programs whose rules are written by federal bureaucrats and whose budgets are padded with federal tax dollars.
This is a bedrock principle of federalism, after all: Power shouldn’t be centralized in the nation’s capital; it should be shared with the states. The co-mingling of finances and rule-making in programs like Medicaid has split accountability between state and federal authorities, with dismal results.
If voters really want accountability in major public programs, whether it’s ensuring that Planned Parenthood doesn’t receive public funding or changing the rules for Medicaid, they should start thinking about how to wrest those programs from federal control — just like we’ve done in Texas.