Health needs could go unfilled if Planned Parenthood funds cut, some say

Feb. 26--Despite protests and a partisan-fueled debate at the statehouse, a bill that would cut funding from Planned Parenthood of the Heartland -- the state's largest reproductive health care provider -- is moving closer to Gov. Terry Branstad's desk.

And some are left asking what providers will be able to patch up the holes created in the safety net.

Senate File 2 would discontinue a federal Medicaid waiver that provides millions of dollars in funding to family planning providers across the state, including Planned Parenthood, and instead create a new state-funded program that would exclude facilities that provide abortions from receiving the funds.

The program would begin July 1, the start of the fiscal year.

Since its creation in 2006, more than 80,000 Iowa women have received Pap smears, birth control and cancer screenings through the Iowa Family Planning Network, including more than 12,000 last year. The waiver helps extend these important reproductive health services to men and women who often fall in the gap between private insurance and Medicaid eligibility.

Planned Parenthood -- which received nearly $1 million in funding through the Family Planning Network in fiscal year 2016 -- administered services to more than 30,000 people last year, with nearly 50 percent of its patients at or below the federal poverty level.

Abortions comprise only 3 percent of its total services. No state or federal dollars are used to fund abortions.

"Planned Parenthood has been a health care provider in Iowa for many, many decades," said Cecile Richards, president of Planned Parenthood Federation of America in a telephone interview with The Gazette. "And the need for our services has only grown."

The politics of it

The bill -- which passed through the Senate on a party-line vote and is now in the hands of the House Human Resources Committee -- lays out a system of providers eligible to receive funds, including Federally Qualified Health Centers, state and county health centers, and private providers.

Republicans argue that freeing up those funds will help encourage existing Medicaid providers to participate in the program.

"There are zero Planned Parenthood clinics in" my senate district, said Sen. Amy Sinclair, a co-sponsor of the legislation, during a late-January committee meeting discussing the bill. "And I would suggest that is true for many other rural Senate districts as well.

"So anyone in my district would have to drive to one of those clinics, all located in urban areas, to access care for their needs under the current system."

But Planned Parenthood of the Heartland and the state's Democrats say that those providers don't offer the same specialized care that can accommodate its high-volume of patients.

"(Sen.) Brad Zaun suggested that women should visit, quote 'women's resource centers' to receive family planning services," said Planned Parenthood spokeswoman Rachel Lopez during a recent media call. "He cited Inner Visions, Informed Choices, Birthright, Bethany Christian, Birthwell and Agape, and claims they provide the services that Planned Parenthood."

Planned Parenthood had an intern call the organizations to make an appointment and request birth control, Lopez said. Each organization told the intern it does not offer birth control services.

"At Birthright, when Tess asked if they could provide birth control, the receptionist snapped, 'We're pro-life.' As if birth control and the pro-life movement are mutually exclusive," Lopez continued.

Under the current, joint federal-state program, any Medicaid provider already is eligible to participate in the waiver. Excluding Planned Parenthood does not mean providers necessarily will jump in to fill that void, experts say.

"That's a highly oversimplified version that doesn't reflect the reality of the health care system or how Medicaid works," said Kinsey Hasstedt, a senior policy manager at the Guttmacher Institute, which studies reproductive health issues. "To exclude Planned Parenthood does not free up dollars. What you're really doing is restricting options."

Texas

One only has to look south to Texas to see what kind of impact legislation such as Senate File 2 can have.

"What we saw in my home state of Texas was politicians, strictly for political reasons, shut down a health care program," Planned Parenthood's Richards said. "Women lost access to family planning services, cancer screenings and STD screenings."

Starting in 2011, the state took steps to bar abortion providers such as Planned Parenthood from participating in a program aimed at giving low-income women family planning services. It's a move, that in the years following, research has shown hurt the state's family planning safety net.

The funding changes forced dozens of clinics to close in 2012, according to researchers at the Texas Policy Evaluation Project, which studies the effect of family planning funding cuts and restrictions.

Those that have remained open have reduced their hours, patient loads and available services.

Research by the Guttmacher Institute shows that Texas's family planning program in 2013 served less than one-quarter of the women it helped in 2011. And that care became more expensive when you take knowledgeable providers out of the network -- the cost to the state to provide family planning care jumped from $206 per client to $240.

Access to birth control also took a hit. A 2016 New England Journal of Medicine article showed that there was a 35.5 percent reduction in Texas women obtaining long-acting, reversible contraceptives -- such as the implant or an intrauterine device -- and a 31 percent drop in women obtaining injectable contraceptives.

"Women are not coming to Planned Parenthood to make a political statement," Richards said. "They're coming to receive care."

Provider Network

It can be hard to replicate Planned Parenthood's highly specialized services, the Guttmacher Institute's Hasstedt said. The organization not only sees a high volume of patients, but it offers access to same-day appointments and after-hours care, she said.

"Not every community health center site provides family planning services," she added. "And those that do may not be able to deal with the volume that Planned Parenthood deals with."

Federally Qualified Health Centers (FQHC) serve high-need, low-income populations of every age. They offer needed primary care services.

Some, including Cedar Rapids's Eastern Iowa Health Center, do have robust reproductive health services, but that isn't always the case in other locations, Hasstedt said. What's more, not every Iowa community that has a Planned Parenthood clinic also has an FQHC. Burlington, Sioux City and Cedar Falls do not, though nearby Waterloo does.

Planned Parenthood offers a broad range of contraceptives from the pill to long-acting reversible birth control, such as intrauterine devices or the implant. And the provider is more likely to offer same-day insertion or have dispense pills on-site.

According to a 2017 Guttmacher Institute article, 81 percent of Planned Parenthoods offer same-day insertion, compared with 29 percent of health departments and 25 percent of FQHCs.

Eighty-three percent of Planned Parenthoods dispense oral contraceptives on-site compared with 76 percent of health departments and 34 percent of FQHCs.

Meanwhile, 78 percent of Planned Parenthood health centers offer extended evening or weekend hours versus 57 percent of FQHCs and just 18 percent of health departments.

"This move restricts where (women) can go and limits providers who can participate," she said.

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