Commentary Health Systems

Congress’ Latest Attack on Planned Parenthood Would Hit Low-Income People Hardest

Susan Berke Fogel & Catherine McKee

If Congress prohibits Planned Parenthood from receiving federal funding, it will not only strip Medicaid enrollees of their preferred provider, but also will leave many enrollees with nowhere else to receive quality reproductive and sexual health services.

We’ve seen this play out before: Ideologically driven state legislators slash state funding for family planning or prohibit clinics affiliated with an abortion provider from receiving certain sources of public funding.

The motivations behind these laws have nothing to do with women’s health, and everything to do with further stigmatizing and punishing abortion providers and making abortion services unavailable. As Wayne Christian, a legislator in Texas—a state that has gone to great lengths to defund family planning service providers—said in an interview with NPR: “They’re sitting here, referring women out to receive abortions … Those are the clinics, including Planned Parenthood, we were targeting.”

States have enacted these laws despite the overwhelming need for publicly funded reproductive and sexual health services. Twenty million women in the United States need such services, but providers are only able to meet about 42 percent of that need.

And now, federal legislators are getting in on the action. Congressional Republicans are clamoring to pass legislation that would make Planned Parenthood ineligible for all federal funding. This would cut Planned Parenthood from Medicaid and Title X funds, as well as all government-run public health initiatives, such as Centers for Disease Control and Prevention programs like the National Breast and Cervical Cancer Early Detection Program, and HIV services supported by the Ryan White CARE Act.

The effect on access to a wide range of preventive services for low-income people would be devastating.

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As state attacks on Planned Parenthood have shown us, the consequences of such cuts disproportionately fall on the tens of thousands of low-income women, men, and adolescents who lose access to quality reproductive health care. In Texas, after the legislature dramatically reduced state family planning funding, redirected the remaining funding away from specialized family planning providers, and also prohibited clinics affiliated with an abortion provider from participating in the state family planning program, 55 percent of women in the state reported facing at least one barrier to accessing reproductive health services, including contraception and cancer screening.

In Indiana, legislators enacted a law prohibiting the state from entering into a contract or providing a grant of state or federal funds to any entity that performs abortions or operates a facility where abortions are performed. The funding restrictions forced a number of Planned Parenthood clinics to close, including the only publicly funded clinic in Scott County, which later became the center of an HIV epidemic that erupted in the state. Ironically, the shuttered clinic did not perform abortions, but did offer HIV education and testing.

When applied to Medicaid, such restrictions are a clear violation of the federal Medicaid Act, which guarantees enrollees the right to receive services from the qualified Medicaid provider of their choice. Federal courts have agreed. In preventing these restrictions from taking effect, courts have recognized the serious harm in forcing women to seek sensitive reproductive services from an alternate Medicaid provider—assuming they can even find one.

With states stymied in their efforts to remove Planned Parenthood from the Medicaid program, federal anti-choice legislators will include this assault on reproductive health access with provisions to repeal the Affordable Care Act, potentially leaving millions of people without access to any reproductive health care at all.

Medicaid is the single largest provider of reproductive health services to women of childbearing age. The program accounts for 75 percent of all public funding for family planning services. In 2015, more than 20 percent of all women ages 15 to 44 were enrolled in the Medicaid program.

Many women enrolled in Medicaid rely on specialized family planning clinics like Planned Parenthood for their health care. Six in ten women receiving contraceptive care at a publicly funded family planning clinic consider that provider their usual source of health care, and for four in ten women, the family planning clinic is their only source of care.

Further, women often prefer to access reproductive and sexual health services from specialized family planning providers. They make this choice for a variety of reasons, including their feelings that the providers treat them with respect, have expertise in reproductive health, and appropriately maintain their confidentiality.

Many women also elect to receive contraceptive care from Planned Parenthood clinics because they offer a broad scope of contraceptive methods, including long-acting reversible contraceptive (LARC) methods. This is critical, as research shows that when women have access to the contraceptive method of their choice, they are more likely to use the method correctly and consistently. In fact, the two-thirds of women who use contraception consistently and correctly throughout the course of any year account for only 5 percent of all unintended pregnancies.

Planned Parenthood clinics also excel at ensuring that women have timely access to family planning services. More than 80 percent of Planned Parenthood clinics dispense oral contraceptive supplies and refills on-site, and a similar percentage insert a LARC device during the same visit when the device was requested. This is critical, as making multiple trips to access health care can be difficult for women, and low-income women in particular. Moreover, many Planned Parenthood clinics offer same-day appointments and evening and weekend hours, making it easy for women to receive care quickly.

In addition, in many rural and underserved areas of the country, Planned Parenthood is the only place where individuals can receive publicly funded reproductive and sexual health services. In fact, one-fifth of all counties with a Planned Parenthood clinic have no other publicly funded family planning clinic.

As a result, if Congress prohibits Planned Parenthood from receiving federal funding, it will not only strip Medicaid enrollees of their preferred provider, but also will leave many enrollees with nowhere else to receive quality reproductive and sexual health services. Importantly, eliminating Planned Parenthood from the Medicaid program would disproportionately affect people of color, who make up nearly 50 percent of Planned Parenthood’s patients. Without access to the services that Planned Parenthood provides, the health and economic stability of millions of people will be in jeopardy.

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