For years, Republican lawmakers have tried to defund Planned Parenthood. Now, it’s closer than ever to becoming reality.

The consequences could be significant: The organization’s clinics could lose between 30 and 40 percent of their funding. People on Medicaid would have fewer health-care options. And if clinics had to close their doors, studies suggest it would be tough for other health centers to pick up the slack.

The American Health Care Act — the House’s bill to roll back some of the Affordable Care Act — narrowly passed a vote in May and was sent to the Senate. Buried amid steep Medicaid cuts and regulatory changes was a provision stopping Medicaid funds from going to Planned Parenthood for one year. Additionally, Republican budget proposals since 2011 have included cutting Planned Parenthood off from Title X and other grants.

It’s not yet clear whether such a defunding could pass the Senate. Republicans hold a slim majority in the chamber, and Susan Collins of Maine and Lisa Murkowski of Alaska have already announced their opposition to that portion of the AHCA.

If one of these defunding measures did pass, though, it has the potential to devastate the organization, which provides health-care services to 2.4 million people each year.

PLANNED PARENTHOOD FUNDING,

2015-2016

41%

Government funding

33%

Private donations

Private insurance

reimbursements

23%

3%

Other

PLANNED PARENTHOOD FUNDING, 2015-2016

Private insurance

reimbursements

Government funding

Private donations

Other

41%

33%

23%

3%

Though Planned Parenthood-specific figures aren’t available, an analysis by the Guttmacher Institute, which favors abortion rights, found that for the average family planning clinic, the vast majority of its public funding comes from the federal government — and is, therefore, at risk. This breakdown closely mirrors the historical figures Planned Parenthood has provided.

FAMILY PLANNING GOVERNMENT

FUNDING, 2015

Primarily

federal

funding*

75%

Medicaid

Title X grants

10%

2%

Other federal

State

funding

State funding,

besides Medicaid

13%

*About 10 percent of family planning Medicaid funding

comes from the state

FAMILY PLANNING GOVERNMENT FUNDING, 2015

State funding

Primarily federal funding*

Medicaid

Title X

grants

State funding,

besides Medicaid

75%

13%

10%

Other federal

funding

2%

*About 10 percent of family planning Medicaid funding comes from the state

That means the AHCA alone would strip away 30 percent of the organization’s funding. And if Congress moved on a more comprehensive defunding, including federal grants, up to about 40 percent of the organization’s funding could disappear.

Most of this federal funding comes through Medicaid — the government reimburses the health centers for services given to Medicaid enrollees. Title X grants, the second-largest chunk of clinics’ public funding, tend to pay for overhead expenses such as rent and utilities, and to fill some of the gap left by Medicaid’s low reimbursement rate, according to Kinsey Hasstedt, a senior policy manager at the Guttmacher Institute. Clinics also receive smaller grants, typically aimed at specific programs such as sex education or HIV prevention.

Because of its size, exclusion from Medicaid would probably be the biggest hit. “Who knows how much state funding would be required to backfill that,” Hasstedt said. And it could have a serious impact on Medicaid recipients, who would need to find another place to receive care, including “low-income folks, folks living in rural communities, people of color,” according to Maya Rupert, the senior director of policy at the Center for Reproductive Rights.

That is, if such a place exists. “There just aren’t enough services that are available in some places. Planned Parenthood might be the only family-planning provider,” said Kelly Blanchard, the president of Ibis Reproductive Health, a reproductive health research organization. A new study put out by the Guttmacher Institute shows that other clinics would have to more than double their capacity to serve Planned Parenthood’s clients.

But some supporters of the defunding contest this point. Other health-care clinics “would be able to pick up [the slack], especially since they’d be getting more funding,” said Carol Tobias, the president at National Right to Life. “What Planned Parenthood does isn’t very time-consuming.” (In addition to pregnancy and sexually transmitted infection testing, which Tobias referred to as especially easy services to provide, Planned Parenthood also performs gynecological checkups, birth-control consultations and procedures, and cancer screenings, among other things.)  

Many state and local governments provide some funding for clinics — Planned Parenthood of New York City, for instance, gets 31 percent of its funding from the state and local governments — and some have indicated they would increase that support if defunding occurred.

One way to predict whether states would step up, according to Hasstedt, is to look at how they reacted to similar legislation introduced earlier this year. In response to a bill that allowed states to limit Title X funding to certain clinics, some states started working on legislation to defund or protect those clinics.

STATE GOVERNMENT RESPONSES

Laws defunding Planned Parenthood are:

enacted

pending

Laws protecting Planned Parenthood are:

enacted

pending

ME

WI

VT

NH

WA

ID

MT

ND

MN

IL

MI

NY

MA

OR

NV

WY

SD

IA

IN

OH

PA

NJ

CT

RI

CA

UT

CO

NE

MO

KY

WV

VA

MD

DE

AZ

NM

KS

AR

TN

NC

SC

DC

OK

LA

MS

AL

GA

TX

FL

HI

AK

STATE GOVERNMENT RESPONSES

Laws protecting Planned Parenthood are:

Laws defunding Planned Parenthood are:

enacted

pending

enacted

pending

ME

WI

VT

NH

WA

ID

MT

ND

MN

IL

MI

NY

MA

OR

NV

WY

SD

IA

IN

OH

PA

NJ

CT

RI

CA

UT

CO

NE

MO

KY

WV

VA

MD

DE

AZ

NM

KS

AR

TN

NC

SC

DC

OK

LA

MS

AL

GA

HI

AK

TX

FL

There’s significant doubt, though, whether this funding could be enough to make up the sum that clinics get from the federal government through Medicaid, much less from the federal government as a whole.  

Medicaid “is going to get hit in a lot of ways, so the state will have to prioritize parts of the system,” said Joan Malin, the chief executive of Planned Parenthood of New York City. “It’s not just us in play — it’s all health-care funding.”

That means that the family planning funding disparity across the country could get much worse. People in areas with less local-government funding or more economic need — most likely rural areas or those in Republican-led states — would not have access to the same level of care.

Though the AHCA’s funding freeze would last for only a year, these consequences could be enduring. Both sides discuss the defunding as a permanent change.

“The precedent the AHCA sets is a really difficult thing to ignore,” Rupert said. “As resilient and strong and committed as Planned Parenthood is, I don’t know what it would take to come back from this once [defunding] becomes the new normal.”  

Sources: Guttmacher Institute, Planned Parenthood Federation of America

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