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?


House Republicans Set to Promote Single Motherhood

August 3, 2015

Seems the House will vote next month on budgets for the agencies lumped together as Labor, Health and Human Services and Education. Some increases, many cuts. Two of the latter would deny low-income women safe, reliable, affordable contraception.

There’s something extremely perverse about limiting women’s opportunities to postpone childbearing until they feel ready to fulfill — alone or with a spouse or partner — the heavy-duty responsibilities of motherhood.

Especially perverse, given all the expressed concern about single mothers, their dependency on welfare, how they’re breeding criminals, etc.

Labor-HHS-Education Overview

The House bill would cut total spending for the programs it includes by $3.7 billion. On top of cuts made since 2010, they’d have $29 billion (16%) less in real dollars, the Center on Budget and Policy Priorities reports.

Republicans claim they’ve got no choice because the Budget Control Act caps spending on domestic programs subject to annual appropriations.

They could, of course, have adjusted the cap — or done away with it altogether — by adopting a more balanced approach to deficit reduction, as the President’s proposed budget would and Senate Democrats seem ready to insist on.

Cap aside, it’s still the case that the Appropriations Committee foisted the largest dollar cut — and the second largest percent cut — on Labor-HHS-Education.

Predictable Defunding of Health Care Reform

HHS would take a $216 million hit, as compared to its current budget. By far and away the largest part reflects a near-total block on spending related to the Affordable Care Act — a significant source of expanded health insurance coverage for birth control, as well as other preventive services.

Were the budget to become law, which it won’t, HHS could no longer operate health insurance exchanges in the 34 states that haven’t created their own — or in three others that use its infrastructure.

Hard to see how this wouldn’t mean loss of the subsidies that make health insurance affordable for low and moderate-income people — or the related measures that limit out-of-pocket costs for health care.

Low-income individuals and families could also wind up without affordable health care, including no-cost family planning services, because the Republicans’ bill effectively bars HHS from covering most of the costs of newly-eligible people in states that have expanded their Medicaid programs.

Hammering another nail into the coffin, the House bill would prohibit HHS from enforcing certain consumer protections.

These are intended to prevent insurance companies from denying coverage or charging higher premiums, based on health conditions or gender. They also require most companies to cover birth control, as well as numerous other preventive services at no extra charge.

Renewed Direct Attack on Family Planning Services

The Labor-HHS-Education bill would zero out funding for Title X of the Public Health Service Act — the source of grants to nonprofits and public agencies that provide free or low-cost family planning and certain other preventive services, e.g., screenings for sexually-transmitted diseases and for cervical and breast cancer.

They can’t use the funds for abortions. But earlier zero-funding efforts leave no doubt that House Republicans intend to cripple Planned Parenthood, which, as we all know, does perform abortions, using privately-donated funds and, in some limited cases, funds it can claim from Medicaid.

Now, I’m hardly the first to observe that if you object to abortions, then you should want women to have the option of effective, affordable birth control.

For women (and men) with incomes below the poverty line, Title X-funded services, including contraception, must, in most cases, be free. Somewhat over 70% of Title X family planning clients qualified in 2013, the latest year we’ve got official figures for.

Folding in the near-poor, we see that defunding Title X would jeopardize family planning and other reproductive health services for more than 4 million people, mostly women.

Roughly 3.5 million of them either began or continued using some form of contraception as a result of their last visit to a Title X center. Some who didn’t were pregnant or wanted to be.

Anti-Anti-Poverty Choice

Brookings Institution economist Isabel Sawhill has persuasively argued that encouraging and enabling women to deliberately choose motherhood, rather than just “drifting” into it is a more realistic poverty prevention strategy than the patently unsuccessful efforts to promote marriage.

The end result would be fewer poor single mothers — thus fewer children growing up in poverty, with all the disadvantages that entails. Fewer women forced to compromise education and career goals too. Fewer at risk of depression and perhaps abuse.

Yet LARCs (long-acting, reversible contraceptives) — the surest protections against unplanned pregnancies — can reportedly cost as much as $1,000, counting only one followup visit after the initial insertion procedure.

That’s a formidable barrier for low-income women — or rather, would be without effectively enforced ACA requirements, expanded Medicaid coverage and family planning services covered by Title X.

What Next?

It’s doubtful that the final budget for the upcoming year will deny all funds to Title X. The Senate’s Labor-HHS-Education bill — still in an earlier stage than the House bill — would allocate $257.8 million to the program.

This, however, would represent a cut of roughly $27.8 million. Even level funding would almost surely mean less available for services because program costs rise, much as our own living costs do.

What next year’s budget will look like is anybody’s guess, especially because the President has said he’ll veto any spending bill that reflects the caps.

Meanwhile, Senate Republicans — not quite all, however — have decided to make a cheap political gesture, before the pseudo-scandal stales, by denying federal funds of any sort to Planned Parenthood — the largest of our nonprofit family planning providers.

“[H]ard to see other clinics stepping in to fill the gap,” Vox health care blogger Sarah Kliff remarks. Indeed. We probably won’t see that sort of gap, however — at least, not right away.

But we won’t see enough funding for affordable family planning and other preventive healthcare services either.

UPDATE: I’ve learned that the Senate Labor-HHS-Education bill has cleared the full Appropriations Committee. So it is as far along as the House bill.