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 Unveil Reverse Robin Hood Healthcare Plan

February 27, 2017

House Speaker Paul Ryan and his lead colleagues have generated even more news about the Republicans’ plans to repeal the Affordable Care Act.

Still no legislation. Still spare details. And still, it seems, no genuine consensus, though a large majority now understand that simply repealing the ACA would be a disaster politically, as well as for the 20 million or so Americans who’ve gained health insurance coverage since the law kicked in.

Ryan, however, has released a policy brief that purports to set out the major elements of the House Republicans’ repeal-replace plan.

Needless to say, it aims to radically cut federal spending on health care. Beyond that, a New York Times headline captures the major thrust: “Republican Health Care Proposal Would Redirect Money From Poor to Rich.”

Here briefly are the major changes and how they’d make the shift. Long post, but on one of the biggest immediate threats to the well-being of low and moderate-income people in this country and our common — though obviously not universal — concept of equity.

End of Medicaid As We Know It

Many concerned parties, including yours truly, have animadverted before about Ryan’s plans to convert Medicaid to a block grant.

Basically, states would no longer receive partial reimbursements for the costs they incur in providing health care to the poor and near-poor people they’ve enrolled. They’d instead receive a fixed sum of money, coupled with even fewer requirements and restrictions on what they can do.

We can predict from the fate of other block grants that the fixed sum will either remain the same, regardless of increases in the number of very low-income people in need — or grow somewhat, but not enough to not enough to benefit everyone eligible or who would have been had the block grant not been created.

Ryan’s new plan includes this option, but leans toward a variation — per capita grants. These too use a formula to set states’ funding, but it’s based on the regular federal match that each received in a base year for people in specific categories, e.g., children, people with disabilities.

The grants would increase, based on the inflation rate. But the rate, as commonly measured, reflects the prices of goods and services consumers commonly pay for, e.g., food, fuel, housing, with medical expenses merely folded in.

As we all know, health care costs rise more. And they’re projected to rise considerably higher, boosted by aging baby boomers, new, high-priced drugs and other drivers.

In short, same basic result, achieved by something with less tarnished name — and with a further, predicable cost-shift to all the states and the District of Columbia that have expanded their Medicaid programs.

Specifically, the plan would fold in repeal of the higher federal government match for newly-eligible people enrolled in Medicaid programs. States would continue to have the it for some unspecified time so as “not to pull the rug out from” them or beneficiaries.

The rug would, however, be immediately pulled out from under adults deemed able to work, regardless of whether they do, but at a very low wage — or have any reasonable prospects of landing a non-poverty wage job.

Redirected Tax Credits

Under the current law, people who buy health insurance on an exchange get a tax credit that serves as a subsidy if their annual income is less than 400% of the federal poverty line — currently $97,400 for a four-person family. The subsidy goes directly to the company that provides the insurance the beneficiary chooses.

It’s greatest for those in the lowest income bracket and diminishes till it reaches the highest. So it ensures that very low-income people can afford comprehensive health insurance, while not spending federal money on people in upper-income brackets.

The Ryan plan would instead award tax credits directly to people who have no employer-sponsored health insurance or coverage under a government program.

They’d would be based only on age, with larger (unspecified) credits to older people. As the Times column suggests, this would seem to make some sense, since older people tend to need more medical care.

But it means is that some very wealthy people would get a larger benefit than many of the very poor, who not only need more help in affording health insurance, but often have more health care problems.

Expanded Health Savings Accounts

Our current system already offers people opportunities to sock money away tax-free for specific medical and dental needs by putting it into a Health Savings Account.

As with the better-known Individual Retirement Accounts, you can save only up to a maximum in any given year, but the cap is based on age, when you become eligible and the type of insurance you have (see below), rather than age and taxable earnings.

You’re not required to withdraw any money during a given year. So what you’ve invested continues to grow, assuming it’s invested well and that administrative costs don’t offset real-dollar gains.

And you don’t have to pay income taxes when you withdraw, if you spend the money for approved healthcare purposes — another difference from an IRA.

The biggest difference, however, is that you have to expose yourself and your family to budget and/or health risks because you can’t have an HSA unless your insurance plan is a high deductible, i.e., covers only what are sometimes referred to as catastrophic costs.

Current federal rules, for example, allow insurance companies to require high-deductible customers to pay as much as $7,850 for an individual or $15,700 for a family before they start covering costs.

HSAs are thus obviously beneficial to some people who can afford what they and any dependent family members need and still have money left over because they’ll owe less at tax time. But only those who can stash enough to cover thousands of dollars of healthcare costs.

The Ryan plan would allow people to contribute their maximum out-of-pockets to their HSAs. Another provision would allow spouses to contribute all or part of so-called catch-up contributions, i.e. those made in a given year to compensate for lower than maximum contributions previously.

Conservatives, including lead Congressional Republicans have long argued that healthcare costs would drop if people had “more skin in the game,” i.e., more to save or lose depending on whether they choose to seek health care and, if so, what sort and from whom.

This, as I think everybody knows, is profoundly unrealistic. We’ve neither the knowledge nor, in many cases, the time to choose healthcare services the way we choose, for example, large-screen TVs.

It’s nevertheless the theory underpinning the HSA expansion, with its inherent push toward high-deductible plans. And again, it’s effectively spending more on well-off people — in this case, by forfeiting tax revenues.

Undermining the ACA Before Full Repeal

Long as this post is, I haven’t covered all parts of the plan — most notably, the full repeal part.

Sufficeth it to say that it would roil the insurance market — by immediately eliminating the penalty for having no insurance, for example, and the penalty imposed on larger employers that don’t cover most of their full-time workers.

So if Obamacare isn’t failing now — as the policy brief misleadingly says it is — it surely would during the transition period the brief promises.

NOTE: Last Friday, two insider news sources posted a leaked draft of the House Republicans’ legislation. It generally tracks the measures I’ve summarized.