GOP health plan aims to topple Planned Parenthood, limit Medicaid

March 11--DECATUR -- As Republican leaders continue to move toward repealing the Affordable Care Act and replacing it with the new American Health Care Act, local health care professionals await the fallout.

The new law passed through the House Energy and Commerce and Ways and Means committees this week. Republican leaders are aiming for passage by the full House in the next couple of weeks, and from there the legislation would go to the Senate.

Crossing Healthcare director Tanya Andricks said she knows Republicans are trying to push the new law through as fast as they can but hopes lawmakers take the time to consider the nonpartisan Central Budget Office's (CBO) report before voting.

"The CBO hasn't put a price tag to this yet," Andricks said. "My concern is that the house will rush to vote with no price tag. I'm hoping they at least wait until the CBO weighs in."

Andricks said she's looked through the House Republicans' proposed bill and there are items that concern her. While it would increase funding to Federally Qualified Health Centers like Crossing, it would come at the expense of Planned Parenthood.

The bill would prohibit for a year any funding to Planned Parenthood, a major provider of women's health services, restrict abortion access in covered plans on the health exchange and scale back Medicaid services used by many low-income women, among other changes.

Planned Parenthood is the largest single provider of reproductive health services, including abortion, in the U.S. In 2016, Planned Parenthood reported seeing 2.47 million patients. In 2014, Planned Parenthood provided 324,000 abortions, almost half the U.S. abortions.

In Illinois, 60,000 patients made 110,000 office visits in 2015. Last year at the Planned Parenthood Decatur office, there were 2,262 patients and 4,823 office visits.

Planned Parenthood in Decatur does not perform surgical abortions, but it does offer the abortion pill (medication abortion), pre- and post-abortion patient education, post-abortion follow-up exams and referrals for other abortion services, as needed.

Julie Lynn, manager of external affairs at Planned Parenthood Illinois, said currently all 16 of its locations are open and providing services. She said "defunding" is a misnomer: "There is no blank check that Planned Parenthood gets from the federal government," she said. "It's not a line item in the federal budget."

Planned Parenthood is reimbursed from the federal government through its patients who use Medicaid. And because Medicaid already can't be used for abortions, the only services that would be blocked are health care services.

"For some people, Planned Parenthood is their only health provider, and it will be devastating if this happens and people couldn't go where they wanted to for health care," Lynn said. "A lot of people simply won't be able to get that care."

There will be a place those in Decatur can go -- Crossing -- though Crossing won't perform abortions, and it remains to be seen if it will be able to handle the patient load caused if Planned Parenthood should close.

Under the Hyde amendment, federal funding isn't available to provide abortions. Planned Parenthood doesn't use the federal funding it currently receives under Title X to perform abortions, but the new bill proposes a one-year freeze on funding to any medical facility providing abortions.

Federally Qualified Health Centers such as Crossing don't provide abortion, which is why, Andricks said, the Republicans want to shift the funding the federal government gives to Planned Parenthood to FQHCs.

Though Crossing already offers some of the services Planned Parenthood provides, matching everything wouldn't be easy. In addition to abortion services and referrals, Planned Parenthood offers a wide variety of birth control methods, HIV and other sexually transmitted disease testing, men's, women's and transgender reproductive health services, cervical cancer screening, breast exams, colonoscopies, pregnancy tests and rape crisis counseling.

"There are a lot of people who rely on Planned Parenthood -- it's a place they know they can go and that they trust," Lynn said. "It would be unfortunate if that option was taken away from. If that meant someone didn't receive a cancer screening and they didn't find out they had cervical cancer until much later, that would be terrible."

Andricks said Crossing would do its best to pick up the slack.

"If this happens, we'll provide services for the people who need them," Andricks said. "We already provide family planning and women's health. If Planned Parenthood was defunded, we would do a community needs assessment to see if Macon County had an increased need and we would increase our level of service if necessary."

But, Andricks said, she's yet to hear how the increase of federal dollars to FQHCs would be administered, so she doesn't know how much Crossing will be able to expand its services.

U.S. Sens. Lisa Murkowski of Alaska and Susan Collins of Maine have both said that a prohibition on Planned Parenthood funding shouldn't be part of the bill. Last month, before the legislation was released, Murkowski told the Alaska state legislature that she doesn't believe that taxpayer money should go toward abortions but added, "I will not vote to deny Alaskans access to the health services that Planned Parenthood provides."

Support from Collins and Murkowski will be crucial if the bill moves to the Senate, since there are 52 Republicans and the GOP will need 50 votes to pass it, with Vice President Mike Pence providing the tie-breaking vote.

Republicans are hoping to move quickly to pass it. Republican leaders want to vote on the legislation March 23, despite unified opposition from Democrats, criticism from some conservatives who don't think it goes far enough and several health groups who fear millions of Americans would lose coverage and benefits.

Under the new bill, the ACA Medicaid expansion, which was adopted in 31 states and Washington, D.C., would end on Dec. 31, 2019. At that point, expansion beneficiaries would remain enrolled but would become ineligible if they drop out of the program for 30 days.

"If you have insurance through Medicaid expansion, you're grandfathered in; they're not going to take it away," Andricks said. "But the devil is in the details. Some low-income people see changes in their income levels from year to year because their job situation is transient. They might move around and the state loses track of them and they fall off. Then when they come back, they're no longer eligible.

"It happens all the time where the state doesn't have the correct address and someone has to reapply. Normally, we fill out the paperwork and get them back active. But, with the new law, if you go dormant, you might not get it back.

"Ultimately, this will reduce the number of people with Medicaid coverage. Then you're going to have people presenting who can't pay, and the rate of uncompensated care increases and that's a big problem for hospitals. In the end, we all pay for health care."

The new bill would also put more responsibility for Medicaid in the individual states' hands by capping the amount the federal government funds states for Medicaid.

Andricks said there are states that plan might work well in, but Illinois isn't one of them.

"For states that are competent and do a good job, this could be a good thing," Andricks said. "At the state level, local needs are better understood and with more freedom with how the money is administered, it can get to the places it needs to go better.

"But in Illinois, where we haven't had a budget in how long, the level of ownership at the state level scares me, quite honestly. If this goes into effect, we absolutely have to raise the bar in what we expect from our legislators in the state government."

The Associated Press contributed to this story.

***

Subscribe to the Herald & Review

Reporting like this is brought to you by a staff of experienced local journalists committed to telling the stories of your community. Support from subscribers is vital to continue our mission.

Become a subscriber?

Get breaking news right in your inbox.

___

(c)2017 the Herald & Review (Decatur, Ill.)

Visit the Herald & Review (Decatur, Ill.) at www.herald-review.com

Distributed by Tribune Content Agency, LLC.