THE PROGNOSIS

Planned Parenthood is standing on the edge of a deep fiscal cliff as Congress seeks to ban it from the federal Medicaid program. But the women’s health and abortion provider has already weathered a rough few years, shuttering clinics around the country, reporting a reduction in some of its medical services – and now facing new, undercover videos from antiabortion activist David Daleiden.

According to its latest annual report released this week, Planned Parenthood provided more Pap tests, HIV and sexually transmitted infections screenings  – and slightly more abortions -- in its 2015/2016 fiscal year compared to the year prior. But in some other categories, including breast exams, HPV vaccinations, pregnancy tests and prenatal services, it provided fewer of those services than in years past.

And, the group is operating one-quarter fewer clinics than in 2005 – less than 650, compared to 860 clinics around the United States 12 years ago.

Punctuating the trend, the group has suffered a spate of closures over the past few weeks, as three Planned Parenthood affiliates announced they’re shuttering 13 health centers from Iowa to California and several states in between. Wyoming will join North Dakota as a second state with no Planned Parenthood location.

Planned Parenthood spokeswoman Erica Sackin attributed most of this to normal changes in patient demand that any provider might see from year to year. "Our core services and patient volume haven't changed much, though like any major health-care provider, there are some fluctuations," she told The Health 202. Sackin also noted that some smaller centers have consolidated into a single facility.

But the group remains a big political target. Because it’s the country’s largest abortion provider, providing women with 328,348 abortions last year, Planned Parenthood has always drawn the attention of antiabortion activists and lawmakers. That focus has only gotten hotter with Republicans in control of Washington.  

In April, the House passed a bill to repeal parts of Obamacare, which would also block Medicaid reimbursements from Planned Parenthood clinics as long as the organization continues to provide abortions. Medicaid dollars can’t legally be used for abortions, but conservatives argue the money is fungible. The Senate could take that provision out in its own health-care bill, but even some Republicans oppose that approach.

Planned Parenthood President Cecile Richards spoke Thursday about the challenge her organization is facing. "We will continue to fight to make sure this is a public benefit," Richards said, speaking at a Recode conference in California. Here are Richards' full remarks:

Conservatives, who have made defunding Planned Parenthood a top priority, seized upon the group’s latest report to press harder for it to be included in a final Obamacare bill. Here's what some of them have said recently:

Furthermore, a new set of undercover videos from Daleiden has further outraged conservatives. (Daleiden first targeted the group in 2015 with a series of videos highlighting how some of its clinics supplied aborted fetuses for medical research.) The latest footage, which for months was under gag order by a judge, features Planned Parenthood officials and doctors speaking in rather gruesome detail about their experiences with the abortion procedure.

"Posing as a representative from a biomedical firm, Daleiden and hired actors visited Planned Parenthood clinics, attended conferences and lunched with high-level officials. Wearing a hidden camera, he captured his subjects speaking in casual and often graphic terms about abortion procedures and methods for removing fetus parts so they can be extracted to meet the demands of researchers. Edited versions of the videos have been widely viewed online," reported my colleague Sandhya Somashekhar. "Planned Parenthood denied any wrongdoing, and multiple state investigations have failed to find evidence that the group violated any laws."

The footage was widespread online for only a day before a district judge ordered Daleiden and his attorneys to take it down and set a June 14 hearing to determine whether to hold Daleiden in contempt of an injunction barring him from releasing the videos.

Sackin declined to respond to specific statements made by Planned Parenthood officials in the latest videos, citing the ongoing legal battle. She provided The Health 202 with a statement saying "the malicious attacks on Planned Parenthood and on women’s health are baseless and this latest one is clearly intended to fuel attacks in Congress that would deny millions of women access to birth control and cancer screenings at Planned Parenthood health centers.

"It has been repeatedly shown, including by a federal court judge, that these videos do not show any wrongdoing," said the statement. "The only people who have broken the law are those behind this campaign of fraudulent and heavily edited tapes. This latest edited video is just another in a long line of discredited videos with false claims that have repeatedly been proven untrue."

Things aren’t just toxic at the federal level for Planned Parenthood. The group faces big challenges at the state level, too.

Dozens of GOP-led states have sought to close down access to taxpayer dollars for Planned Parenthood clinics. That led Planned Parenthood of the Heartland to announce last month that it’s closing four clinics across Iowa because of the recent budget signed into law by Gov. Terry Branstad (R), who pledged to “defund” it.

And then there’s Medicaid. While the Affordable Care Act extended the health-insurance program to millions more low-income women, giving nonprofits like Planned Parenthood more insured patients, the program is also known for poor reimbursement rates, forcing many providers to operate at a loss.

Planned Parenthood officials at the Rocky Mountain and Northern California affiliates have cited meager Medicaid reimbursements as a top reason they’re closing nine clinics in California, Colorado, New Mexico and Wyoming.

“We are thrilled to be able to see women who are on Medicaid, and we very, very much hope that continues,” Vicki Cowart, CEO at Planned Parenthood of the Rocky Mountains, told The Health 202. “But quite frankly, the reimbursement does not cover all of the costs.”

Cowart said four of the six locations her affiliate is closing will be consolidated with nearby centers to save on facility costs and operate more efficiently overall. She noted that’s a general trend with medical providers, especially as telemedicine gets more popular and fewer brick-and-mortar offices are needed. But the affiliate is also closing clinics in two rural areas -- in Farmington, N.M. and Casper, Wyo.

“Being a Planned Parenthood and keeping our business going is really complicated,” Cowart said.

AHH, OOF and OUCH

AHH: Rep. Steve Knight got a grilling yesterday, but not of the tasty kind. At a raucous town hall, the vulnerable California Republican who voted for the GOP health-care bill was regularly mocked, jeered and interrupted by a crowd that seemed unsatisfied with his answers, Politico's Rachael Bade reports.

“I am angry and disappointed that you voted to repeal the Affordable Care Act, then replace it with garbage,” one angry constituent said, as the crowd whooped. “I feel that your vote to repeal Obamacare was a vote for political capital with [Speaker Paul D.] Ryan (R-Wis.) — not to help provide a good health care system for the citizens of this district. You represent the people of the 25th district of California; you do not represent the first district of Wisconsin!”

"The comment came during Knight’s first public town hall since backing House Republican’s Obamacare replacement," Rachael writes. "Knight spent the entire evening warding off attacks from left-leaning constituents furious about his vote, fighting to maintain his composure during a sometimes tense give-and-take."

OOF: Here's the latest politician to be candid about the steep challenges Senate Republicans face in agreeing on a health-care bill. Sen. Richard Burr of North Carolina said yesterday that the Senate probably won’t reach a deal to repeal and replace the ACA when it returns from a recess next week, the Wall Street Journal reports. "It’s unlikely that we will get a health-care deal,” Burr told WXII 12 News. He said that the House-passed GOP health plan was “dead on arrival,” and that “I don’t see a comprehensive health-care plan this year.”

OUCH: Literally. Minnesota’s measles outbreak has exceeded the total number of cases reported in the entire United States last year, with no sign of slowing, my colleague Lena Sun reports. It's hitting the Somali American community especially hard, where vaccination rates have dropped dramatically.

"Health officials worry that the holy month of Ramadan, which began Friday night and brings Muslims together in prayer and festivities, will accelerate the spread of the highly infectious and potentially deadly disease, which is plaguing the close-knit Somali American community," Lena writes. "Minnesota health officials are working closely with faith leaders in an unprecedented effort to spread the message that parents should get their children vaccinated and keep them home if they show symptoms of the disease."

"The imams are up against the anti-vaccine movement, which in recent years has targeted the Somali American community with misinformation linking the measles-mumps-rubella vaccine to autism, a claim that extensive research has disproved. Somali American children in Minnesota had a vaccination rate of 92 percent in 2004, higher than the state average, but that rate has dropped to 42 percent, leaving children vulnerable to disease."

PRICE CHECK

--Yesterday, The Health 202 wrote about White House Office of Management and Budget Director Mick Mulvaney and his sharp comments about the Congressional Budget Office -- the nonpartisan agency that lawmakers have trusted for decades to project the costs and impact of legislation. The CBO's day has probably "come and gone," Mulvaney told the Washington Examiner, when asked about its projection that the House GOP health-care bill would cost 23 million people their insurance.

Ex-CBO directors slammed Mulvaney's comments, saying they're short-sighted and ignorant of the important role the agency has played. Doug Holtz-Eakin, who directed the CBO under George W. Bush, tweeted this:

Alice Rivlin, the CBO’s founding director, criticized Mulvaney's comments, too. “I think it is unfortunate and that Mulvaney damages his own credibility by blaming the CBO,” Rivlin told the Hill.

So did Peter Orszag, a Democrat who served as both OMB and CBO director, who noted that Mulvaney was himself guilty of some gimmicks in the White House's recent budget proposal. "Director Mulvaney's comments are particularly astonishing given the $2 trillion double count that was embodied in the budget he just released," Orszag told the Hill.

--Two top groups funded by the powerful, conservative Koch brothers are sending Health and Human Services Secretary Tom Price a letter today, pressing him to take quicker executive steps to change Obamacare. Republicans had talked earlier in the year about a "phase two" for the effort to repeal and replace the law, which involves rule changes by HHS and other federal agencies, Americans for Prosperity and Freedom Partners note in their missive.

Their message to Price: Congress is being a turtle, but you don't have to be. "While the pace of Congress’ work to repeal Obamacare is slow, there are several other Phase II actions your office can take that do not depend on, and should not wait for, final passage of a bill," the groups write. Among their asks: More opt-outs for states from ACA requirements through expanding use of the law's 1332 waivers and easing of its regulations on short-term insurance plans and actuarial value minimums.

HEALTH ON THE HILL

--If you really wanted to overhaul the health-care system, you'd remove the tax exemption for employer-sponsored coverage. It's unlikely Congress will ever have the political will to do that, yet Republicans have considered it here and there. In the Senate, that idea is surfacing as members work on their own version of healthp-care legislation, the Wall Street Journal reports.

"The move could raise billions in revenue that could be used to help stabilize the fragile individual insurance market," Stephanie Armour and Kristina Peterson write. "But it could be politically risky, since it could expand the impact of GOP health proposals from Medicaid recipients and those who buy insurance on their own to the roughly 177 million people who get coverage through their employers."

INDUSTRY RX
STATE SCAN
REPRODUCTIVE WARS
DAYBOOK
 

 

Today   

  • A rally is planned today outside Sen. Lindsey Graham's (R-S.C.) office in Columbia, S.C. to urge him to support defunding Planned Parenthood.
  • Sen. Chuck Grassley (R-Iowa), who suggested a repeal of Obamacare was unlikely, has scheduled a town hall this morning in Greenfield, Iowa. 

Coming Up

  • Rep. Darrel Issa (R- Calif.) will have another town hall on Saturday. 
  • Congress returns Monday from a week-long recess, and Senate Republicans hope to return with at least a partial draft of their health-care bill. 
SUGAR RUSH