Texas gives millions to sketchy anti-abortion program as health care for women suffers

Texas is set to shower $100 million on the state’s “Alternatives to Abortion” program in its 2022-2023 budget, even though it’s murky what participating organizations do with the money. At the same time, the state is further restricting abortion, with a six-week gestational ban and a law that allows a person who provides an abortion past six weeks to be subject to lawsuits filed by anyone who wants to do so. 

The Alternatives to Abortion program was set up in 2005, at which point it got a few million dollars and was accessed by fewer than 12 people, what some would consider a startlingly bad rate of return on the state’s investment.

Since then, that investment has increased by leaps and bounds, often at the expense of other state health programs. In 2017, for example, the state shifted $20 million to it from an air-quality program. 

Sixteen years on and millions of dollars later, it still isn’t clear what gets done with all that money — and that’s by design.

In a deep dive on the program, the Texas Tribune found that it wasn’t until 2017 that the state required any reporting about how the contractors who receive money from the program spend it. How subcontractors are selected is secret, and the state keeps no statistics on how many abortions they predict they have prevented.

It’s a setup that is ripe for fraud, and that fraud has already happened.

The Heidi Group, a rising star in Texas’ anti-abortion world several years ago, took over $6 million in funds from the state. The program was supposed to provide family planning services to families with lower incomes, but instead it used the money for things like cruises, lobbying, and gift cards. When it took the money, the group asserted it would serve 70,000 people every year, but it only ended up serving a few thousand. The group was required to pay $1.5 million back to the state. 

Not only does the state keep the process of how it chooses contractors secret, it also collects only minimal data on how many people are served and what the outcomes for those people are. Texas says that, in this instance, it is solicitous of people’s privacy.

One proponent of the program, GOP state Rep. Matt Krause, says that they do not collect any data to protect women from the “burden” of sharing personal information. This solicitousness for the privacy and convenience of program participants stands in stark contrast to how Texas treats women who obtain abortions.

The state requires doctors to submit extensive information each month — 16 different pieces of data — about each abortion performed. Abortion providers have to report every abortion, report detailed demographic data about each patient, the type of procedure, the date of the procedure, the duration of the pregnancy, the number of abortions the patient previously had, and the date of the patient’s last menstrual cycle, to name some.

The data a provider is required to collect if the patient is a minor is even more extensive. Providers must report whether authorization for the abortion came from a parent or guardian or via a judicial bypass process, whether the provider made arrangements for the minor’s court appearance, and whether the patient became pregnant while in foster care. 

Results reported by individual programs that receive money under the Alternatives to Abortion program voluntarily are not required to be as specific. Contractors under the program are not classified as medical providers, so they don’t need to specify what services are provided.

When they do provide details — on parenting classes, or the distribution of diapers and other supplies — the numbers don’t always add up.

In 11 months from September 2019 to August 2020, the Texas Pregnancy Care Network said that around a dozen women received more than 1,000 counseling services and classes per month. The Texas Tribune calculated that meant “that on average they each would have taken at least 16 classes and gone to 16 counseling sessions” every day of that month. 

Those class numbers might be accurate in some instances, given that some of the sessions are only four minutes long.

Another group reported that, since joining the program three years ago, it had facilitated only 18 adoptions. 

While Texas has been generous to the Alternatives to Abortion program, it continues its efforts to starve women’s health programs.

 The state tried to use the coronavirus pandemic as an excuse to cut funding for women’s health programs, though that was later walked back.  

It has refused to accept Medicaid expansion to cover more people even though it has the highest rate in the country of uninsured women ages 18-44. Though the state’s maternal mortality rate has improved in recent years, Black mothers still die there at twice the rate of white mothers. 

In the end, giving millions to the lightly regulated Alternatives to Abortion program hasn’t solved the state’s actual challenges when it comes to women’s health.