Cuts to Planned Par­ent­hood have trou­bling im­pact on states

Modern Healthcare - - NEWS - By Shan­non Much­more

The po­lit­i­cal fight over the fund­ing of Planned Par­ent­hood could be felt in ru­ral Scott County, Ind., where this year there was a rush to get HIV tests af­ter 180 peo­ple tested pos­i­tive. But there was no place to get test­ing ser­vices.

The area’s sole HIV test­ing cen­ter closed its doors in 2013 dur­ing an early cam­paign against Planned Par­ent­hood.

The or­ga­ni­za­tion was then at­tacked by con­ser­va­tives who ral­lied against the clin­ics’ spo­radic prac­tice of per­form­ing abor­tions. The clinic in Scott County did not per­form abor­tions.

All sum­mer, Planned Par­ent­hood has been crit­i­cized af­ter un­der­cover videos showed staff mem­bers talk­ing about fe­tal tis­sue do­na­tion, the sale of which is illegal. Planned Par­ent­hood said the videos were heav­ily edited and de­nied any wrong­do­ing.

But a firestorm erupted and now con­ser­va­tive Repub­li­cans on the Hill are fol­low­ing In­di­ana’s lead. They say they will not vote for a fed­eral bud­get that in­cludes any Planned Par­ent­hood fund­ing.

The first of what is ex­pected to be sev­eral con­gres­sional hear­ings on Planned Par­ent­hood prac­tices was held last week, with strong state­ments from both sides of the aisle.

“I re­ally re­gret that these law­mak­ers want to in­sert them­selves into what should be a sa­cred is­sue in women’s lives,” said Betty Cock­rum, pres­i­dent and CEO of Planned Par­ent­hood of In­di­ana and Ken­tucky.

Cock­rum added that the po­lit­i­cal de­bate has hurt women in In­di­ana, which al­ready ranked poorly in of­fer­ing re­pro­duc­tive health ser­vices. In 2011, state law­mak­ers passed a bill de­fund­ing Planned Par­ent­hood. The move later was found un­con­sti­tu­tional by the courts.

But In­di­ana law­mak­ers have con­tin­ued to slash var­i­ous sources of Planned Par­ent­hood fund­ing at a time when the cost to op­er­ate a med­i­cal fa­cil­ity is ris­ing.

The In­di­ana Leg­is­la­ture has also re­stricted ac­cess to birth con­trol and blocked com­pre­hen­sive sex ed­u­ca­tion in its schools.

Cock­rum said that if those ef­forts were em­braced, Planned Par­ent­hood could help re­duce the num­ber of abor­tions.

She added that many women in the state, par­tic­u­larly the poor and those who live in ru­ral ar­eas and strug­gle with re­li­able trans­porta­tion, do not know where to find af­ford­able birth con­trol, pre­ven­tive care or sim­ple ac­cu­rate med­i­cal in­for­ma­tion. There are no other clin­ics to pick up the slack, she said.

A re­cent re­port pre­pared by the Guttmacher In­sti­tute found that Planned Par­ent­hood clin­ics con­sti­tute about 10% of all pub­licly funded fam­ily plan­ning cen­ters, but pro­vide care to about 36% of those seek­ing fam­ily plan­ning ser­vices.

They also serve 37% of clients in a fed­eral fam­ily plan­ning pro­gram, although they ac­count for only 13% of those clin­ics.

The Guttmacher re­port, re­quested by the Con­gres­sional Bud­get Of­fice, also showed that one-fifth of all coun­ties with a Planned Par­ent­hood fa­cil­ity had no other safety net fam­ily plan­ning clin­ics.

“And even where there are other safety net providers, they, on av­er­age, serve far fewer con­tra­cep­tive clients than do sites op­er­ated by Planned Par­ent­hood,” ac­cord­ing to the re­port.

In Louisiana, Repub­li­can Gov. Bobby Jin­dal, a 2016 pres­i­den­tial can­di­date, has tried to end the state’s Med­i­caid con­tract with its two Planned Par­ent­hood clin­ics, which also do not per­form abor­tions.

His ad­min­is­tra­tion’s ar­gu­ment rests on a pro­vi­sion in state law that al­lows can­cel­la­tion of a Med­i­caid provider agree­ment with a 30-day no­tice.

The Jus­tice Depart­ment called that claim “wholly with­out merit,” say­ing Louisiana can­not rely on a state law to jus­tify Planned Par­ent­hood’s ouster,

A re­cent re­port by the Guttmacher In­sti­tute found that Planned Par­ent­hood clin­ics com­prise about 10% of all pub­licly funded fam­ily plan­ning cen­ters, but pro­vide care to about 36% of those seek­ing fam­ily plan­ning ser­vices.

but must show that the clin­ics aren’t able to per­form Med­i­caid ser­vices or prop­erly bill for them. Fed­eral courts have over­turned pre­vi­ous at­tempts in Ari­zona and In­di­ana to dis­qual­ify Planned Par­ent­hood from re­ceiv­ing Med­i­caid re­im­burse­ments.

Jin­dal said that other clin­ics could make up for ser­vices lost from the closed Planned Par­ent­hood lo­ca­tions in Ba­ton Rouge and New Or­leans. Those sites saw nearly 10,000 pa­tients last year, most of whom were low in­come.

Lawyers for Louisiana said 2,000 fam­ily plan­ning providers in the state were avail­able to pick up Planned Par­ent­hood clients, but their list in­cluded den­tists and a plas­tic sur­geon. A new list had 29 providers, not all of whom pro­vide con­tra­cep­tion, and many of whom had long wait times.

A 2012 Gov­ern­ment Ac­count­abil­ity Of­fice re­port found that 38 states re­ported dif­fi­culty in find­ing providers that ac­cepted Med­i­caid. Some spe­cial­ists, in­clud­ing gyne­col­o­gists, were par­tic­u­larly elu­sive.

In Texas, leg­is­la­tors slashed fund­ing for all fam­ily plan­ning clin­ics by 70% in 2011. Although some of the money was re­stored, fam­i­lies still have trou­ble find­ing care, said Jose Ca­ma­cho, ex­ec­u­tive di­rec­tor and gen­eral coun­sel for the Texas As­so­ci­a­tion of Com­mu­nity Health Cen­ters.

“It de­stroyed all ser­vices for women,” he said.

Also in 2011, the state took over the Texas Women’s Health Pro­gram and banned Planned Par­ent­hood from par­tic­i­pat­ing. A Texas Health and Hu­man Ser­vices Com­mis­sion re­port from Jan­uary found that the health pro­gram served 30,000 fewer women af­ter Planned Par­ent­hood clin­ics were cut.

The states los­ing ac­cess to the ser­vices that Planned Par­ent­hood pro­vides aren’t gen­er­ally known for good health. Texas ranks 31st among the states in over­all health, ac­cord­ing to a study by the United Health Foun­da­tion. Large swaths of the state are even des­ig­nated as Health Pro­fes­sional Short­age Ar­eas. In 2012, Texas had the sec­ond high­est syphilis rate in the na­tion.

In­di­ana ranked 41st in that United Health Foun­da­tion sur­vey of over­all na­tional health. Louisiana was 48th.

None of those states chose to ex­pand Med­i­caid el­i­gi­bil­ity un­der the Af­ford­able Care Act.

Ad­vo­cates for the or­ga­ni­za­tion say there are few other providers of­fer­ing Planned Par­ent­hood’s ser­vices.

In fact, on some oc­ca­sions, hos­pi­tals have come to rely on Planned Par­ent­hood clin­ics to pro­vide ser­vices they can­not or will not pro­vide. In 2011, Swedish Med­i­cal Cen­ter in Seat­tle helped fi­nance a new Planned Par­ent­hood clinic next to the hos­pi­tal be­cause of its pend­ing agree­ment with a Catholic health sys­tem.

A re­port by the Amer­i­can Civil Lib­er­ties Union and Merger-Watch found that in 2011, about 1 in 9 hos­pi­tal beds in the coun­try were in a Catholic-spon­sored or af­fil­i­ated hos­pi­tal, many of which have tight re­stric­tions on the re­pro­duc­tive health ser­vices they pro­vide.

The at­ten­tion and anger tar­geted at Planned Par­ent­hood might be keep­ing some away from the clin­ics that do re­main open.

Last week, a flammable ob­ject was thrown through the win­dow of a clinic in Washington. No one was in­jured in the fire, but a Planned Par­ent­hood spokes­woman said the dam­age will keep the cen­ter closed for some time. The or­ga­ni­za­tion hopes to have a tem­po­rary lo­ca­tion iden­ti­fied soon.

But with more con­gres­sional hear­ings on the hori­zon, the ire sur­round­ing Planned Par­ent­hood is not likely to end soon and could even worsen.

House GOP lead­ers, who said they likely couldn’t over­come the pre­dicted pres­i­den­tial veto of de­fund­ing Planned Par­ent­hood, added that they don’t want to see a stale­mate lead to a gov­ern­ment shut­down. A bud­get agree­ment needs to be reached by the end of the month.

Dur­ing last week’s hear­ing, Repub­li­cans said no fund­ing should go to the or­ga­ni­za­tion, es­pe­cially when other needs haven’t been met.

“This is a ques­tion of pri­or­i­ties. I’d like to know what your pri­or­ity is. Planned Par­ent­hood or feed­ing hun­gry chil­dren?” Rep. Jim Sensen­bren­ner (R-Wis.) asked one of the wit­nesses.

AP PHOTO

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