House GOP Defunds Planned Parenthood, Endangers Low-Income Women

March 13, 2017

Nicholas Kristof wrote a presciently timely column for the next-to-the last Sunday New York Times. He recounts a visit to a women’s health clinic in small town in Maine, including what he observed during a consultation.

A teenager had come to the clinic because she felt itchy in her vaginal area. The nurse practitioner takes swab, diagnoses a yeast infection, but has also tested for sexually transmitted diseases.

She then talks to the teenager about birth control methods, including a long-acting reversible contraception. The young woman likes that, learns it’s fully covered by her insurance.

The nurse practitioner also gives her some condoms and tells her to always insist that her prospective sexual partner use one to protect her from STDs.

In short, as Kristof says, this is health care at its best, preventing both unwanted pregnancies and diseases.

Indirectly, poverty also, since the poverty rate for single-mother families is consistently the highest of any household type the Census Bureau reports — 36.5% last year and even higher for families with color, except Asian-Americans.

The Maine clinic apparently receives federal funds — either through the state’s Medicaid program, a Title X family planning grant or both. So it — —and the women who depend on it — are in big trouble because it provides abortions.

No federal funds used for these because laws already prohibit that. But the clinic probably can’t survive on donations and what it receives from health insurance companies for serving patients who’ve got the coverage the House Republicans’ Affordable Care Act repeal-replace bill would provide.

The bill won’t let people use the tax credits they’ll get to help pay their insurance premiums for a policy that covers abortions, except in the same limited cases the Medicaid prohibition carves out,

And, as you’ve probably read, it denies federal funding to Planned Parenthood, though initially for only one year. This perhaps to evade a stumbling block to swiftly passing the bill with only a simple majority in the Senate, rather than the usual 60 votes.

In the meantime, knowing the bill won’t pass swiftly anyway — if at all in its current form — the House passed and the Senate’s expected to pass a measure that overturns an Obama administration rule which effectively prohibits states from denying Title X funds to family planning projects because they provide abortions.

Well, none of this will make much difference to well-off women who live in cities or major suburban areas. They’ll have ob-gyns or other clinics they can go to. If they need an abortion, they can readily get one from their ob-gyn or another competent physician — and pay for it out of their own pockets.

But low-income women — and perhaps many not-so-low who live in small, rural towns — will no longer have a nearby clinic for tests that detect cancer as well as other diseases, counsel on how to prevent them and on safe, reliable birth control. Nor the procedure to insert a LARC — and replace it when necessary.

Planned Parenthood operates the largest network of women’s health clinics in the country — nearly 650, serving every state and the District of Columbia. They provide services to about 2.5 million women and men a year. Nearly 80% were poor or near-poor two years ago.

A tiny fraction of the funds it disburses go for abortions — 3%, as measured by services. Roughly a third help prevent untended pregnancies. Most of the remainder test, provide treatment and/or help prevent diseases.

Notwithstanding what some Republicans have said, other community clinics can’t readily meet these needs if the freed-up funds were available to them. Nor new clinics spring up all over the country.

Planned Parenthood is 100 years old now. You don’t get the resources to build or expand facilities, find and hire specialized health professionals to fully staff them, ensure stocks of testing equipment and supplies, etc. in a couple of years.

All these attacks on Planned Parenthood — and now apparently a broader attack on women’s health clinics — are a sop to the active pro-life movement.

What a cleverly chosen name, I’ve often thought, since it casts Americans who believe women should have the freedom to choose when and if to become mothers as against life.

Well, let’s consider the life of a low-income woman who can’t get regular Pap, other cervical cancer or breast cancer exams, plus instructions on how to monitor for breast lumps herself.

Or the life of a woman who doesn’t find out she has HIV/AIDS until she contracts some life-threatening infection — and perhaps by then has passed the disease on to a partner or a baby she’s borne.

How about a woman who’s decided that she’s unready — financially, emotionally or otherwise — to become a mother? She perhaps plans to enroll in a college-level program that will prepare her for a fulfilling, well-paying career — or is already in one.

She may, in fact, still be in high school and with no family member to care for a baby — or the money or the transportation to put him/her in an infant daycare program or even one nearby that’s not fully booked. She’s likely to drop out of high school, as 90% of pregnant teens do.

Her life may turn out okay, but the prospects are significantly dimmer. As I already said, she’s at high risk of poverty. What kind of life will that child have? Many studies tell us that children born and raised in poverty are at high risk for a host of problems and likely to remain poor long after.

None of this is to say that the self-labeled pro-lifers are wrong to publicly opposing abortions. If I believed that people were legally murdering others, I would speak out too, join with others to protest, call for an end to it.

But when human life begins, the value of preserving fetuses likely to die at birth or survive severely damaged, the countervailing weight of harms to the expectant mother and the like are matters of personal belief, often based on sectarian religious teachings.

The Supreme Court acknowledged women’s Constitutional Right to abortion more than 44 years ago. The federal government has nevertheless long curbed that right by prohibiting uses of federal funds for abortions.

Now, even if the House Republican leadership can’t push through its bill and the efforts to fashion a more acceptable substitute drag on, we can expect more proposals to defund Planned Parenthood — if not in Congress (though likely), then by states, 10 of which have already moved to do so.

And we can’t, I think, trust the new administration to intervene in defense of equitable funding for organizations that can provide the services Medicaid covers, given Trump’s bifurcated view on the Planned Parenthood issue.

A call to action then in defense of low-income women by the majority of voters who believe that abortion should remain legal in all or most cases. Because what’s a legal right if you’re too poor to exercise it?


Right To Choose Becomes a Middle-Class Privilege Again

December 20, 2009

I’m old enough to remember when abortions were illegal. I also remember how panicked I was when, as a college sophomore, I thought I was pregnant. I had hopes for a professional career. The college I went to didn’t even allow pregnant students to attend–let alone support them with the scholarship aid I depended on.

But my panic didn’t have to do with the prospects of becoming an unwed mother at nineteen. It was more the prospect of discovery–and of having to tell my mother what she already suspected I’d been up to.

Because I knew that middle-class girls like me could–and did–get abortions. Clean, safe procedures performed in doctors’ offices or hospitals. All you had to do was ask around to find a sympathetic ob-gyn–and come up with the money.

I’m writing this because we seem to be headed back to those bad old days. They’re already a reality for poor women who depend on Medicaid. The same is true for federal employees, since health insurance plans available to them don’t cover abortions except in cases of rape, incest or where necessary to save the woman’s life. For women serving overseas in the military, only risk to life triggers coverage.

Now Senator Ben Nelson (D-NE) has been placated by an amendment to the Senate health care bill that would allow states to prohibit abortion coverage under any insurance plan in the exchanges they will administer. Presumably at least some of the 17 states that already cover the costs of abortions for poor women will take a pass. But what about the rest?

Granted, the Nelson “compromise” isn’t as punitive as the House bill, which would establish the same prohibition nationwide. But the administrative complexities it establishes, e.g., separate accounts for prospective abortion services, seem likely to deter insurers from offering coverage, even where permissible. Whether they do or not, it appears that women with subsidized coverage would have to pay the full cost.

So once again, women who can afford to pay for abortions performed by qualified doctors in safe, sanitary conditions will get them if they choose. The rest … Well, just read what one ob-gyn remembers from the bad old days we’re reverting to.

We’re told that we shouldn’t let the perfect be the enemy of the good, that we won’t get a better health care bill if we ditch this one, that there will be opportunities to improve the new system over time.

I can’t argue with that. But when Congress passes this give-with-one-hand, take-away-with-the-other thing it’s created, you won’t see me dancing in the streets.