Texas has one of the highest teen birth rates in the country, with almost 27,000 babies born to teen mothers in 2017, and the highest rate of repeat pregnancies among teens. Experts say poor access to reproductive health care for women and abstinence-only sex education are largely to blame.
A bill attempting to mitigate the problem — by adding contraception coverage to the state health program for low-income teens and children — received enough bipartisan support to pass the House, but has now hit a roadblock in the Senate with less than a week left in session.
About 400,000 minors in Texas have health insurance through the Children’s Health Insurance Program (CHIP), which covers children and teens whose families make less than $43,000 a year but more than the annual $30,000 income cutoff for Medicaid. States are required by federal law to include coverage for contraception under Medicaid, but not under CHIP. Texas is one of only two states in the country that refuse to cover contraception for non-medical reasons under CHIP, according to the Texas Campaign to Prevent Teen Pregnancy.
This session, state Representative Donna Howard, D-Austin, filed House Bill 800 to remove the limitation, so that CHIP would cover contraception for any reason for enrolled minors who have obtained parental consent.
“It would help about 50,000 young women to access contraception if we were able to allow CHIP to provide this coverage, which obviously would help lower [Texas’] high teen pregnancy rate,” Howard said at a hearing for the bill in March.
Howard’s bill would add coverage for oral contraception, as well as implants and intrauterine devices (IUDs), which doctors say are more effective than the pill at both preventing pregnancy and addressing medical issues like endometriosis, heavy periods and hormonal imbalance. Such devices are more expensive than oral contraception and often out of reach for low-income families.
Another selling point of the bill is its potential cost savings to the state: Almost 90 percent of teen births in 2017 were covered by Medicaid, according to the Texas Campaign to Prevent Teen Pregnancy, at a cost of $78 million to the state. The Legislative Budget Board estimates no significant fiscal impact from HB 800 and predicts that “savings may increase and become significant in future years.” The bill has the support of the Texas Medical Association, the Texas Academy of Family Physicians, the Texas Pediatric Society and the Texas Association of OBGYNs.
The legislation passed the GOP-controlled House by a vote of 81-64 on April 16, with 15 Republicans voting for it.
But Lieutenant Governor Dan Patrick, who supports abstinence-only education, has said that he doesn’t believe minors should be prescribed contraception without parental permission, even if they’ve been pregnant before. His office did not respond to a request for comment on HB 800.
Conservative lawmakers have been receptive in recent committee hearings to religious right activists who oppose the “sexualization” of kids that they say comes from teaching about contraception in schools. Houston Republican Representative Sarah Davis, a co-author of HB 800, attributed opposition from her GOP colleagues to Catholicism, which has banned the use of contraception among followers since 1968.
With time in the 86th Legislature running out, that religious hang-up may ultimately kill the legislation in the more-conservative Senate, where the bill has not moved since coming over from the House more than a month ago. A similar bill by Senator Jose Rodriguez, D-El Paso, failed to get a hearing in the upper chamber. The House version sat on Patrick’s desk for two weeks before he assigned it to the Senate Committee on Health and Human Services at the end of April. (Patrick’s priority bills often get referred within a few days.)
Howard said she is willing to go beyond the provision that requires parental permission and also add a minimum age, in order to gain the support of key Senate Republicans. But she’s so far been unable to reach a compromise. Still, she said, she’s hopeful that Senator Lois Kolkhorst, who chairs the Senate Committee on Health and Human Services, will give the bill the hearing and vote it needs to make it to the full chamber before the end of the session on May 27. Kolkhorst’s office did not respond to a request for comment.
Adding coverage for contraception would also help CHIP patients who are currently eligible to get it for medical reasons, but face hurdles anyway, said Dr. Celia Neavel, an adolescent health specialist in Austin who testified in favor of the bill.
“It’s a real hassle in my clinic, because [CHIP] won’t cover birth control for contraception’s sake. [CHIP] will cover it for medical reasons, but it’s tricky. Sometimes pharmacists will cover it, but sometimes they get confused,” she said in an interview with the Observer.
That’s what happened to Jazmine, a 17-year-old whose coverage switched from Medicaid to CHIP last year. Jazmine, who asked to be identified only by her first name, has suffered from painful, heavy periods since the age of 10. When she was diagnosed with fibroids last year, her doctor suggested she get an IUD to slow the growth of the benign uterine tumors that are contributing to her pain. But when she asked her doctor’s office if CHIP would cover the cost, she was told no — even though it should under current law.
“I don’t think that policymakers understand the amount of confusion this causes,” Neavel said. “[Passing this bill] would be such an easy and respectful thing to do.”