The House on Thursday approved a resolution that would permit states to withhold federal family-planning funds from affiliates of Planned Parenthood and other healthcare providers that offer abortions. Abortion foes immediately hailed the measure, which is expected to pass the Senate, as a critical victory, while public health advocates worried that the cuts would blow a hole in the nation’s fragile family planning safety net.
The measure would overturn a rule, issued by Obama’s department of Health and Human Services, prohibiting states from withholding federal family-planning dollars from groups that provide abortions. States can only withhold those funds for reasons related to a provider’s ability to deliver family planning services, the rule says.
The Obama administration finalized the rule during his last weeks in office, and it took effect just two days before the inauguration of Donald Trump.
Planned Parenthood on Thursday seemed open to taking the issue to court. The group argues that because family planning grants are competitive – that is, they are supposed to be awarded based on a provider’s demonstrated abilities to distribute care – excluding Planned Parenthood is illegal under federal law.
“To date, every court to consider the issue on the merits has ruled that state politicians cannot block access to care at Planned Parenthood” through these types of cuts, a Planned Parenthood spokeswoman said.
The resolution targets Planned Parenthood’s participation in Title X, the federal program that allows medical providers to offer reproductive healthcare to millions of low-income Americans at little to no cost. States receive Title X funds as block grants and distribute the money on a periodic basis to the healthcare providers that are best qualified to provide family planning services.
Planned Parenthood receives more than $ 500m annually from the federal government, and about a quarter of that comes from Title X.
Planned Parenthood says it serves 1.5 million people through Title X, or more than one-third of the 4 million people who receive Title X services. Seventy-eight percent of those Planned Parenthood patients earn 150% or less of the federal poverty level, and about a third are black or Latina. The organization does not spend the funds it receives from states on abortion, but on services such as pap tests, HIV and STI screenings, breast exams and contraception.
Title X is a popular target for conservative lawmakers looking to slash government budgets. Republican governors in several states have attempted or succeeded in cutting the state’s family planning budget to nearly zero. And in 2015, Republicans on a House appropriations subcommittee offered a budget that would have eliminated Title X funds completely.
Healthcare providers are prohibited from spending Title X funds on abortion by federal law. But by choosing to single out Planned Parenthood, Republicans on Thursday portrayed the resolution as a referendum on abortion. The resolution’s sponsors, congresswoman Diane Black of Tennessee and Senator Joni Ernst of Iowa, have both cited misleading videos, which were edited to look like Planned Parenthood sold fetal parts for a profit, as a reason to strip Planned Parenthood of its federal funding.
The resolution is based on a little-used law that allows Congress, on a fast-tracked timetable, to overturn a new federal rule. It requires only 51 votes to pass the Senate, where Republicans control 52 seats, and Donald Trump is expected to sign.
Supporters of the measure denied that it would impact people who rely on Title X, because the money Planned Parenthood received would be rerouted to “comprehensive healthcare clinics”.
But public health advocates are skeptical that other providers are primed to absorb Planned Parenthood’s millions of patients.
Community health centers “have wait lists for the people they’re serving today, much less having to absorb all of Planned Parenthood’s patients as well,” Sara Rosenbaum, a professor of health policy at George Washington University, said recently. “The notion they can suddenly ramp up their capacity to absorb all of the services Planned Parenthood can offer … is absurd.”
A recent study of community health centers and similar clinics found that only about one in five large centers prescribe and dispense the full range of contraception. More often than not, these centers don’t stock common methods of contraception, such as birth control.
Healthcare providers are already prohibited by federal law from spending Title X funds on abortion. In 2000, under pressure from anti-abortion groups, the Clinton administration approved a rule requiring Planned Parenthood and other providers offering abortion to keep Title X funds “separate and distinct” from abortion activities.
Republicans have since then sought to cut Title X funding to Planned Parenthood altogether, arguing that organizations that provide abortions should not receive any material support from the government. Several proposals introduced to the House of Representatives under George W Bush failed. But those efforts gained steam under Obama, and in 2011, then-congressman Mike Pence attached a rider to defund Planned Parenthood to a critical spending bill and nearly triggered a government shutdown.
Many states controlled by Republicans have also taken action to strip Title X funds from Planned Parenthood.
The governors of Tennessee and New Hampshire, respectively, stripped $ 1.04m and $ 1.8m in Title X dollars from Planned Parenthood in 2011. The same year, the Kansas legislature blocked Title X dollars to the group.
Just as Republicans argued on Thursday, the governors in those states claimed that other healthcare providers would step up to care for Planned Parenthood’s patients. But those are questionable claims. A year after Kansas kicked Planned Parenthood of its Title X program, the number of Kansans receiving contraception, STI tests, and cancer screenings subsidized by Title X had fallen by more than 14,000.
Some efforts to kick Planned Parenthood out of Title X have proved vulnerable to challenges in court.
A federal judge ruled last summer that Florida could not block Title X funds to Planned Parenthood. Planned Parenthood’s Florida affiliates had been using the funds to provide healthcare screenings and finance a school dropout prevention program.
But others states have managed to make their cuts stick.
In Texas, eliminating Planned Parenthood from the public safety net had a particularly profound effect on rural communities. “I hate to say it, but I think an awful lot of women just opted to go without care,” said Mike Austin, the chief executive of Midland Community Healthcare Services. His clinic emerged as the only major alternative to Planned Parenthood in Midland-Odessa in west Texas after the cuts.
“We are seeing a subsequent rise in STDs and a subsequent rise in unplanned pregnancies,” Austin recently told the Guardian. “And I’m sitting here going, ‘See? I told you so. This is what happens.’”
House vote paves the way for states to defund Planned Parenthood
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