Texas’ fast-expanding, controversial Alternatives to Abortion program, which pays private counselors to discourage women from terminating their pregnancies, is on track to more than double its funding with a $41 million infusion — and one anti-abortion nonprofit is primed to win big on the state’s largesse.
Eighty Republican state lawmakers took the unusual step last month of writing a letter to the Texas Health and Human Services Commission, which oversees the anti-abortion program, directing administrators to expand funding to a particular provider. The Texas Pregnancy Care Network has done such a good job connecting expectant and adoptive parents with counseling and other services, the lawmakers wrote, that the health commission should increase payments to the provider without considering offers from other potential contractors.
The intent of the Texas Legislature, they wrote, is to “continue to support the current program contractors.”
“The Legislature would not have made the increase in appropriations had we not believed the Program was already extremely successful,” reads the letter, which The Texas Tribune obtained under open records law.
Expanding funding to the Texas Pregnancy Care Network without considering bids from competitors would represent a departure from established business procedure. During previous expansions of the Alternatives to Abortion program, the Texas Health and Human Services Commission required contractors to submit applications for state funds. But the lawmakers said doing so caused “unnecessary delays,” which “thwarted the legislative intent to greatly expand the existing program.”
The Texas Pregnancy Care Network is the largest contract recipient under the Alternatives to Abortion program, which was modeled after a Pennsylvania anti-abortion program. The Texas Pregnancy Care Network funnels money to subcontractors, which provide counseling and job training. They also offer items such as car seats and infant formula for children up to 3 years old.
The letter was submitted with little fanfare or publicity — and appeared to catch some officials unawares. A spokesman for the Legislative Budget Board said the legislative agency, which provides oversight for contract procurement, did not receive a copy. Several state lawmakers — including Democrats and Republicans who serve on the Legislature’s budget-writing committees — said they had not seen the letter until the Tribune shared a copy with them.
“We're holding this program to a different standard than every other program,” said state Rep. Donna Howard, an Austin Democrat who serves on the House Appropriations Committee.
State Rep. Sarah Davis, a West University Place Republican and the lead budget writer on health and human services for the Texas House, joined Howard in writing a separate letter to the Health and Human Services Commission on Monday urging it to follow a competitive bidding process for Alternatives to Abortion, also known as A2A.
“Despite any subsequent pressure HHSC may have received to the contrary, state law generally requires procurement through a competitive bidding, and HHSC’s own policy mirrors this requirement,” Davis and Howard wrote. “As such, we urge you to follow through with re-procuring the future A2A contracts in compliance with general law and HHSC’s own policy.”
John McNamara, executive director of the Texas Pregnancy Care Network, said in an email that a bidding requirement from the Texas Health and Human Services Commission "hampers the growth, reach and outcomes of the Program." In past two-year budget cycles, he said, the nonprofit did not receive funding until about nine months into a 24-month contracting period.
If new funding becomes available, "dozens" of new subcontractors in areas such as the Hill Country, West Texas and East Texas will be able to join the anti-abortion network, said McNamara, who added that his organization did not ask lawmakers to submit a letter of support.
Tax records for the nonprofit from 2017 show it depends on state funding for virtually all of its revenue. McNamara’s total compensation for the year was about $194,000, records show.
Andy Schoonover, executive director of Austin LifeCare, a local outfit that receives referrals from the Texas Pregnancy Care Network, said demand for its services has grown “rapidly,” up 21% in 2019, compared with the previous year.
“There is a tremendous need for help, support and education for pregnant women and young families,” he said.
Information about the exact number and kinds of services paid for by the Alternatives to Abortion program is hard to come by because, compared with traditional women’s health programs, state law does not require extensive reporting on the private contractors providing anti-abortion counseling. The health commission’s 2018 annual report found the program served about 37,000 unique clients who received nearly 149,000 unspecified services.
The Alternatives to Abortion program, created to “promote childbirth,” dates to 2006; its funding has grown explosively since then. State lawmakers authorized more than $38 million for program in the 2018-19 budget cycle. In 2020 and 2021, the program’s base funding will grow to nearly $60 million, with an additional $20 million authorized if the health commission determines that the program shows a need for more. (The health commission, which reports to Gov. Greg Abbott, has previously recommended the program be expanded.)
Howard, the Austin Democrat, questioned why some Republican lawmakers were eager to expand funding for the anti-abortion program but not for women’s health services with more proven track records. For example, lawmakers shot down proposals this year that would have expanded state-funded health insurance coverage for women up to a year after they give birth. The state’s task force on maternal mortality had recommended the coverage expansion.
“We've given [Alternatives to Abortion] all this new funding, and there's no data to support it,” Howard said.
This budget cycle, for the first time, the health commission will be required to report more data about how funds are spent in the anti-abortion program. A directive added to the 2020-21 budget will require the state to track the geographic, age and gender breakdown of clients served, as well as unspecified “outcome measures.”
This isn't the first time the Texas Health and Human Services Commission's awarding of contracts to private vendors has raised eyebrows. Last year, Abbott penned a letter to former commissioner Charles Smith excoriating him for a “failure to ensure the integrity” of the state’s procurement process. That was over an award granted to a health insurance company to administer the Children’s Health Insurance Program in rural parts of the state. And the previous commissioner, Kyle Janek, stepped down amid controversy over a $20 million no-bid contract awarded in 2013 to a software company.