Planned Parenthood is first on the chopping block. Last month, House Speaker Ryan announced that the budget reconciliation bill dismantling major pieces of the Affordable Care Act will include a measure to defund Planned Parenthood. Budget reconciliation only requires 51 votes in the Senate. It cannot be filibustered. There are 52 Republicans and 48 Democrats in the Senate. Thus, unless we are able to get three Republican Senators to vote against the bill, we anticipate it will go to the President’s desk by mid to late March. That timing will turn on the timing of the repeal and replace Obamacare, which seems to be shifting every day.
For California, this move is devastating.
There are 115 Planned Parenthood health centers operated through 7 separately incorporated non-profits in California. They are a uniquely one-stop-shop where a patient can see a health care provider, have tests run, and get contraception or other medication – all without separate trips to a lab or a pharmacy. These health centers are located from the far northwest corner in Eureka to El Centro in the southeast near the Mexican border. They operate in the coastal towns from Santa Cruz to Santa Barbara, in the M cities of the Central Valley and in the low income communities of Los Angeles, San Francisco, San Diego, and Sacramento. Collectively, they provide health care services – primarily birth control; family planning; testing and treatment of sexually transmitted diseases, including HIV; life-saving cancer screenings; and abortion, but also some primary care – through 1.5 million patient visits each year. Planned Parenthood health centers serve patients regardless of the hue of their skin, their gender identity, or their zip code.
87% of Planned Parenthood patients are low income. They receive these services for free through MediCal, California’s Medicaid program. The federal government reimburses California for family planning services through a 90:10 match. This means the federal government pays 90% of the reimbursement, the state the remaining 10%. If this federal funding goes away, Planned Parenthood – and California – stand to lose $265 M each year. This represents almost 80% of Planned Parenthood 501(C)(3) affiliates’ operating revenues. If this funding source stops, so does our ability to provide health care services to the most vulnerable in our state. Those patients have nowhere else to go.
The Republicans claim that this money can go to other community clinics, who can offer the same care.
In California, this is simply not true.
The California Primary Care Association, which represents all community clinics, has told Congress that the capacity does not exist to absorb the 800,000 patients Planned Parenthood health centers see every year. In fact, eliminating Planned Parenthood would put untenable stress on remaining providers, who already are in short supply, and would require considerable capital investment.
Why then is Planned Parenthood targeted?
After all, their health centers primarily provide reproductive health care to young, low income women. The improved access to birth control – with no co-pays under the Affordable Care Act – and family planning counseling and education have been credited with dramatically reducing the rates of unintended pregnancy, teen pregnancy and abortion. The teen birth rate in California declined 71% the last 25 years. Abortion numbers are at historic lows. We all know the enormous benefits women, and their families, reap in access to education, employment, and economic security when they can control if, when, and how many children to have.
But Planned Parenthood health centers also provide abortion. It is a small part of the services they offer – less than 5% of their patient visits. They receive NO federal reimbursement for any abortion services. Since the mid-1970’s, direct federal funding of abortion has been banned. Low income women in California can get abortion care through MediCal, but 100% of that cost is paid for by the state.
So why then is Planned Parenthood targeted? The Republicans believe that abortion providers somehow use government funding of family planning services for abortion care even though that is prohibited. The theory is dead wrong. In California, we have the 49th lowest Medicaid reimbursement rates in the country. Planned Parenthood health centers' family planning reimbursement covers less than half of the cost of providing those services. It is ludicrous to suggest that Planned Parenthood, or any other health care provider, can use those funds to underwrite abortion services.
Nonetheless, it has been a long-standing strategy of the anti-choice movement to defund family planning providers – and specifically Planned Parenthood – as a means to end access to abortion in America. They also want to end access to contraception. On January 5th, Trump appointed as the White House health care policy director a woman who believes contraception causes abortion and miscarriages even though the American College of Obstetrics and Gynecologists has resoundingly rejected these baseless and irresponsible claims.
With a Republican-controlled Congress, Senate and Presidency, that strategy may well become a reality this year. If it does, it will evidence a complete disregard for the real-life effect on literally millions and millions of women and couples. One out of 5 women in America has visited a Planned Parenthood health center. One out of 3 women has had an abortion. If these health centers do not get federal reimbursement for the care they provide, Planned Parenthood health centers will close. Their patients will have nowhere to go. Closures mean longer wait times, increased crowding and women traveling hundreds of miles just to access basic care. Many will end their pregnancies on their own without medical assistance. Others will forego care. Poor women, in particular, cannot afford to take time off of school or work, arrange for childcare, and raise the funds for transportation and housing to see a clinician for contraception, STI testing, a breast exam or cancer screening. Birth rates, teenage pregnancy, sexually transmitted diseases will rise. Women, no longer able to control the destiny of their lives, will once again be stuck in the cycle of poverty.
Women have made tremendous advances in education, employment and economic security since contraception was legalized in 1965 and abortion became legal in 1973. The advent of better and more effective contraception in particular has led to dramatic declines in unintended pregnancies, teen pregnancies and abortion. Reproductive health care and justice is key to the advancement and economic security of women, and their families, in this country. But it depends on access to care and the availability of providers. We simply cannot let the incoming administration succeed in refusing to reimburse Planned Parenthood for its provision of basic health care services.
How can you get involved?
On the defunding fight, we have three main lines of attack:
First, is the federal political battle. We must get three or more Republican senators to vote against the bill so it does not go into effect. We urge everyone to contact their representatives and Senators and ask that they stand with Planned Parenthood and oppose any attempts to kill access to birth control and abortion. Even if we succeed this time, the battle will not be over. We fully anticipate Congress will continue to introduce bills.
Second, we can urge the State of California to push back – fight the federal government’s refusal to pay for services rendered and ask the State to backfill the loss of federal funding. The latter will be very difficult as all of the ACA expansion is at stake.
Finally, support your local Planned Parenthood health center and our state-wide advocacy office as we weather this storm. We need patient stories, volunteer help, donations. Stay informed. The simplest way to do this is to sign up to receive action emails. Remember, whether through making donations, volunteering or shouting your support from the rooftop – now is the time to make your voice heard. So much is at stake. Now, more than ever, is the time to stand with Planned Parenthood. Planned Parenthood has been here 100 years, and their doors will stay open.