When Jazmine Johnson was in high school, she suffered intense periods that were so debilitatingly painful that they affected her school performance.
Her health insurance at the time was provided by the Texas Child Health Insurance Program, known as the CHIP, which provides health care to low-income families who earn too much but earn too much to qualify for Medicaid. CHIP provided coverage for your medicine, doctor’s appointments, and other medical needs, but unlike Medicaid, it doesn’t normally cover the cost of birth control, which Johnson needed to regulate his menstrual cycle.
“I started having to miss school,” said Johnson, who is now 19 and a junior at the University of Texas at San Antonio. “I tried to focus a lot on getting scholarships and making sure the grades were okay. But it’s hard to focus on the things you’d like in high school when you can’t even get out of bed for a week a month. “
Texas, a state with the ninth-highest teen pregnancy rate in the nation, is one of two states in which the state child insurance program does not cover contraceptives to prevent pregnancy for low-income teens. The program makes exceptions for teens seeking birth control for medical issues such as anemia, endometriosis, and intense periods, but requires several levels of insurance authorization to verify that it is not used to prevent pregnancy.
“What we hear over and over again from both CHIP providers and customers is that even when they have a documented medical need, (CHIP) creates so much bureaucracy and documents and demonstrates that medical need,” said Jen Biundo, director of policies and data for the Texas Campaign to Prevent Teen Pregnancy.
Johnson, who grew up in Jefferson, said that while her medical condition made her eligible for CHIP coverage, she struggled to keep birth control constantly replenished due to all the paperwork. Finally, he sought a family planning clinic for a more permanent solution.
To access birth control, low-income teens have to resort to more limited state programs. The Healthy Texas Women program, which provides free health care coverage during pregnancy, may offer birth control for teens with CHIP, but they should give up all other types of health coverage. They could also use Texas ’family planning program, which provides low-cost reproductive care and planning care, but should be able to travel to one of about 200 clinics across the state.
Critics of the restrictions say this costs Texas taxpayers much more money, as the state pays in full for the Healthy Texas Women program. In comparison, the federal government accounts for more than 75% of all services covered in the child health care plan.
The last session, a bill to expand CHIP to cover contraceptives passed the Texas House with bipartisan support, but it died after the Senate failed to pass it. This session, House Bill 835, a similar bill written by Rep. Donna Howard, D-Austin, has not even received a committee hearing in the House, and it may be too late. On Friday at midnight, members of the House must give preliminary approval to bills written by their members, with the exception of local and consent calendar bills.
“We’re one of two states that doesn’t,” Howard said. “There’s no logical reason or rational reason. It certainly doesn’t make tax sense not to include it.”
Howard said there has been no articulated reason for the bill’s lack of movement, but he has seen backtracking on bills that give minors too much power without including parental consent. But Howard’s bill would require parental consent to access contraceptives to their children.
“There’s just the feeling that every time you talk about minors, if you don’t have the consent of the minors’ parents, you’re going to be exaggerating, ”Howard said.
Proponents of the bill also point to the effectiveness of birth control to prevent teenage pregnancy.
In 2018, nearly 1,600 Texas teens enrolled in CHIP experienced a pregnancy, according to a report from the Texas Campaign to Prevent Teen Pregnancy. Adolescent pregnancy has steadily declined over the past 30 years across the country, in part due to higher rates of birth control use.
Biundo said that because minors near family planning clinics can still access birth control, the problem with CHIP is not a question of whether contraceptives should be restricted to teens. This is how much the state wants to pay.
“We basically just leave a lot of federal money on the table,” Biundo said of the money the federal government would equalize for birth control under the CHIP program instead of state programs.
Biundo said Texas family planning clinics also focus on population centers and that 74% of Texas counties do not have any of these clinics.
Texas pediatrician Maria Monge said the lack of easy CHIP coverage has directly affected her patients. One of Monge’s twelve-year-old patients was rushed to the emergency room for heavy menstrual bleeding and hospital doctors prescribed birth control. But because CHIP took too long to provide coverage, the patient’s bleeding got worse and she had to receive a blood transfusion two weeks later.
“This is a health equity issue more than anything else,” Texas Monk pediatrician said. “We have patients who, because of the way hormones are not covered but require authorization, need blood transfusions. While private insurance, for these same drugs, almost never requires the same level of examination.”
Because of the mosaic of programs that provide birth control and the authorization of delay insurance that can cause, Erika Ramirez, the director of policy and advocacy for the Texas Women’s Healthcare Coalition, said the bill is important for women’s health 2019.
“Browsing through various programs is a barrier to access and puts the burden on the young woman and her family,” Ramirez said.
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