For young women just starting out in a new city and in need of primary reproductive care, Planned Parenthood is a trusted and necessary provider. The same is true for wary teenagers and women of limited financial means all over America who want to be responsible about preventing pregnancy and sexually transmitted diseases but face limited options for care. For mothers, single women, poor women, middle class women and teenagers alike, the 865 Planned Parenthood clinics around the country provide a safe, affordable and easily accessible haven for essential care, including access to contraceptives, preventive services like Pap screening for cervical cancer and testing for sexually transmitted diseases. And although many of these clinics do offer safe abortions; when you include both the surgical and non-surgical kind, abortion makes up just 3 percent of all the services proffered each year by Planned Parenthood.
That 3 percent was enough to convince Governor Mitch Daniels of Indiana (a former hopeful in the upcoming Republican presidential race) to sign into law this month the first bill to eliminate all federal and state Medicaid funding for 28 Planned Parenthood clinics that provide care to 9,300 women covered by Medicaid in in his state. Of course it’s true that the Hyde amendment already prohibits federal support for abortion in Indiana (as it does in all states). And Indiana is one of 33 states that also prohibits state Medicaid funding for the procedure except in the case of rape, incest or life endangerment. So by passing—and already enforcing—a law that denies coverage to poor women using Planned Parenthood, Indiana is not really battling abortion, but instead singling out one of the top providers of women’s health care and effectively blocking access to preventive reproductive care and family planning services.
It seems that this action and the threat of proposed similar laws in a half-dozen or so other states has finally roused a sleeping giant. The Obama administration signaled this weekend that it plans to challenge the Indiana law that seeks to cut off Medicaid funding for Planned Parenthood services. The White House is making it clear to the state, and also to a half-dozen others like North Carolina, New Hampshire and Texas that any changes made to state Medicaid programs are subject to federal review and according to the New York Times, “Administration officials said the Indiana law imposed impermissible restrictions on the freedom of Medicaid recipients to choose health care providers.”
If a state Medicaid program like Indiana’s does not comply with federal law and regulations, “federal officials can take corrective action, including ‘the total or partial withholding’ of federal Medicaid money,” according to the Times. Faced with groaning budgets, states like Indiana might decide that the threat of losing up to $4 million in federal family planning dollars through Medicaid might be a powerful enough incentive for Gov. Daniels to overturn the new law. But if he doesn’t back down and Obama resorts to withholding federal Medicaid funding for the state, the real losers will be Indiana’s poor people—especially women of child-bearing age. That’s because the federal government pays some 90 percent of the share of Medicaid outlays for government-funded family planning programs.
The Obama administration must stand strong against Gov. Daniels and this heavy-handed ideological attack on an important provider of women’s reproductive care. This is clearly not just about abortion, but an attack on family planning and women’s sexual health in general. According to the New York Times, Planned Parenthood of Indiana reports that it provided services last year to 85,000 patients, including 9,300 women covered by Medicaid, most of whom received contraceptives. In its annual report, Planned Parenthood of Indiana said it also performed 5,580 abortions, 21,150 pregnancy tests, 26,500 Pap tests for cervical cancer and 33,000 tests for sexually transmitted diseases.
Indiana legislators haven’t accused Planned Parenthood of providing inferior or fraudulent services; the non-profit organization has not been found to accept kickbacks, it hasn’t defrauded Medicaid or Medicare or proved substandard care—circumstances that might warrant such a ban to protect patients and fight wasteful spending. In contrast, IV infusion clinics, dialysis centers and long-term care facilities (among other health providers that depend on government reimbursement for their services) have all been subject to high-profile investigations into just such abuses. But no one has suggested that Medicaid patients should be prohibited from frequenting these facilities which are often for-profit businesses.
The “vendetta” against Planned Parenthood began earlier this year when Rep. Mike Pence (R-Ind.) introduced House legislation designed to end all funding under Title X (which covers reproductive health services) for the organization and its affiliates. Pence’s bill easily passed the GOP-heavy House in February but was taken off the table earlier this month when both parties agreed to a budget compromise designed to keep the federal government funded for the rest of the fiscal year.
Dead on arrival as national policy, the vendetta filtered down, like so much anti-choice legislation before it, into the conservative micro-politics of the states. This year has seen a cavalcade of new intrusions into women’s reproductive freedom at the state level; including longer waiting periods before abortion, mandatory—but medically pointless—sonograms performed so that women can “get to know” the fetus they are aborting, mandatory scripted discussions about the psychological trauma of terminating a pregnancy, increased taxes and onerous reporting requirements on clinics and an outright ban on some forms of rarely performed, but necessary, abortions. Some states like New Jersey and Texas have cut or eliminated funding completely for family planning services—in some cases redirecting the money to abstinence-only programs.
These state policies are whittling away at rights provided by Roe vs. Wade and other hard-won Supreme Court cases that have upheld a woman’s right to privacy in making decisions about reproductive issues. The recent attacks on Planned Parenthood take this piece-meal attack strategy into a different, even more onerous realm of singling out specific providers.
Have legislators in Indiana or the half-dozen other states considering similar funding bans ever spent time at a Planned Parenthood clinic? Have they actually talked to their extended female family members and friends about their experience with these providers? Here is a place where women from all walks of life can go to receive affordable, judgment-free and culturally sensitive care, education and yes, legal abortion services. It may surprise these legislators to know that one of every three women in the U.S. will have an abortion by age 45—and three-quarters of these women describe themselves as “religious.” Many are already mothers.
Apart from the ideological battle, cutting funding for family planning is extremely short-sighted in terms of health care costs. According to a new report from the Guttmacher Institute, in Indiana for example, some 61% of unintended births were publicly funded in 2006 at a cost of $252 million. The report, which looks at trends in the U.S. as a whole as well as by individual state, found that two-thirds of all births resulting from unintended pregnancies—more than one million births—are publicly funded. The cost of those births alone (and thus the potential savings from effective family planning), is estimated at $11.1 billion.
“At a time when policymakers everywhere are looking for ways to cut costs under Medicaid, these findings point clearly to a way to achieve that goal by expanding access to health care, not cutting it,” says Adam Sonfield, one of the Guttmacher study authors. “Investing in publicly funded family planning to help women avoid unintended pregnancy has a proven track record: In the absence of the services provided at publicly funded family planning centers, the costs of unintended pregnancy would be 60% higher than they are today.”
Elizabeth Nash, who tracks state legislation for the Guttmacher Institute told Fox News;
"We need to be funding these services. To deny this kind of care to women, it really says that legislators don't care for women's health or their families." This is the message that needs to be communicated to the public; efforts like Gov. Daniels’ plan to defund Planned Parenthood in Indiana and to gut family planning programs in other states show a serious lack of concern and are an affront to women and their families everywhere.