The Washington PostDemocracy Dies in Darkness

The Health 202: Funding for Planned Parenthood went up – yes, up – during the Trump administration

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with Alexandra Ellerbeck

There is one antiabortion pledge President Trump hasn’t kept: his promise to defund Planned Parenthood.

Instead, federal funds to the women’s health-care and abortion provider grew during the first two and a half years of his administration. 

Government reimbursements and grants to Planned Parenthood hit record levels in the group’s fiscal years starting in 2017 and 2018, according to its most recent financial disclosure, even as the administration and Republicans in Congress and around the country endeavored — mostly unsuccessfully — to cut the provider out of government revenue streams wherever possible. Planned Parenthood won't release its next fiscal report until the end of the year. 

That reality has mostly flown under the radar, even as Trump has been praised by abortion rights opponents as being the friendliest president to their cause.

But Marjorie Dannenfelser, who is president of the antiabortion Susan B. Anthony List and has emerged as one of Trump’s most vocal supporters, told me she and her colleagues are “very aware” and “not happy” about the dollars.

“I think there is a great desire to get the executive branch to do something about it, but there is very little that can be done,” said Dannenfelser, who co-chairs a coalition of antiabortion activists supporting Trump’s reelection bid.

The funding increases stem largely from the Medicaid program.

Medicaid payments have long formed the bulk of federal funds flowing to Planned Parenthood, reimbursing its clinics for providing birth control and preventive services to low-income Americans. The provider reported $616.8 million in government revenue in its most recent report, which was for the 2018-2019 fiscal year. That's up from $543.7 million when Trump took office in 2017. About half of Planned Parenthood's patients are on Medicaid, according to the organization. 

Medicaid doesn’t pay for abortions, but Republicans have still repeatedly tried to cut abortion providers from the program entirely, arguing all funds are fungible. And they’ve mostly been thwarted.

The 2017 House and Senate health-care bills repealing Obamacare would have effectively stripped Medicaid dollars from Planned Parenthood. But the legislation ultimately died amid heavy political opposition and the inability of Republicans to come up with a replacement to the health-care law that would cover as many people. 

GOP-led state legislatures have passed bills cutting off abortion providers' access to Medicaid funding, but courts have mostly blocked such legislation. Last week the Supreme Court turned down South Carolina’s request to hear a case over its legislation blocking Medicaid funding for abortion providers, which was knocked down by a lower court.

The Trump administration did manage last year to push Planned Parenthood clinics out of the federal family planning program. 

It approved stricter rules about Title X recipients referring for abortion services. The rules, finalized in August 2019, ban grantees from referring for abortions and require clinics to “establish and maintain physical separation” from the provision of abortion. Planned Parenthood announced shortly afterward that it would no longer participate in the program.

That loss of revenue to Planned Parenthood, about $60 million, may not be reflected until the 2019-2020 fiscal report. When asked what the report might show, Planned Parenthood spokeswoman Lauren Kokum responded “we cannot predict what future revenues will be.”

And the rules could be reversed if Democratic president nominee Joe Biden wins the White House.

Julie Downey of Planned Parenthood Action Fund said Biden should issue an executive order on the first day of his presidency “committing to reproductive health care, rights and justice.”

"As part of this EO, he would have the opportunity to roll back some of the most harmful policies of the Trump Administration, including the Title X domestic gag rule," Downey wrote in an email.

But Audrey Sandusky, communications director for the National Family Planning and Reproductive Health Association, suggested it would take longer for a potential Biden administration to undo the Trump-era rules around Title X.

“The reality is that undoing harm caused by the rule will take more than a snap of the finger, so over the course of weeks and months, we hope to work with a new administration to restore quality and stabilize provider networks,” Sandusky wrote.

The increase in Planned Parenthood's Medicaid dollars isn’t something either side of the abortion wars is talking much about.

Antiabortion advocates, overjoyed at Trump’s embrace of their priorities, have been emphasizing the promises he followed through on — not the ones he didn’t. One of those promises was to appoint abortion-opposing judges, a standard that appears to be met by Supreme Court nominee Amy Coney Barrett, a Catholic mother of seven who has expressed opposition to abortion on numerous occasions.

Senate Majority Leader Mitch McConnell (R-Ky.) plans to hold a vote on her confirmation on Monday, moving to put a third Trump appointee on the nation’s highest court. Republicans, intent on installing Barrett on the court before the Nov. 3 election, probably will hold a rare weekend session to debate the nomination, my colleagues report.

Planned Parenthood doesn't have incentive to highlight the Medicaid payments, either. Presenting itself as a continually embattled target of conservative ire, it has seen its fundraising surge under the Trump administration. It took in $591 million in donations in 2018, an increase of more than 50 percent over 2014 levels.

That's hardly a new phenomenon. For decades, groups involved in abortion rights battles have alternately benefited and suffered depending on which political party controlled the nation's political institutions. 

NARAL Pro-Choice America flourished financially during the Reagan and H.W. Bush administrations but saw donations decline as Bill Clinton ran for office and went out of his way to reassure the abortion rights movement, according to Mary Ziegler, a professor at Florida State University who wrote the book “Abortion and the Law in America.” It was a similar story for Planned Parenthood, which had to slash its budget by one-half between 1990 and 1992.

Ahh, oof and ouch

AHH: British scientists will infect healthy volunteers in coronavirus challenge trials.

“The research, led by scientists at Imperial College London and funded by the British government, is a gutsy gambit, given that people will be submitting themselves to a deadly virus with no surefire treatment,” William Booth and Carolyn Y. Johnson report.

Beginning in January, British researchers will infect fewer than 100 healthy young adults with the novel coronavirus to determine how much virus is necessary to spark an active infection. The researchers hope to enlist more volunteers in the spring to be inoculated with vaccine candidates and then exposed to the virus. The vaccines in question have yet to be selected.

“The United States is moving more cautiously, with leading government researchers saying human challenge trials might be too risky or unnecessary,” Booth and Johnson write. “But the British scientists say that the potential payoff is massive — that accelerating vaccine development by even three months could save hundreds of thousands of lives globally.”

Christopher Chiu, an Imperial College immunologist and lead investigator on the research, told The Post that the challenge trials should be able to show a vaccine’s effectiveness within 10 weeks.

Challenge trials have a long history in medicine, but many scientists are reluctant to infect volunteers with a virus that does not have a surefire treatment and could cause long-term effects. Despite that fact, more than 38,000 people around the world have signaled an interest in volunteering by signing up with the vaccine advocacy group 1Day Sooner.

OOF: Nearly 300,000 more people in the United States have died during the coronavirus pandemic than expected in a typical year.

Two-thirds of the 299,028 excess deaths that occurred from late January to early October have been directly attributed to covid-19. While some of the other deaths probably were caused by covid-19, even if the illness was not listed on the death certificate, analyses by The Post and researchers at Yale University have found that deaths from heart attacks, diabetes, strokes and other diseases may have increased as people became more fearful of seeking care in hospitals or were unable to receive care, Lenny Bernstein reports.

“The report comes with just two weeks left in a presidential campaign whose central issue is President Trump’s handling of the pandemic. Trump has sought at every turn, including in remarks Monday, to minimize the virus’s impact, despite a covid-19 death toll that is likely to be the third-leading cause of mortality in the United States this year, behind heart disease and cancer,” Bernstein writes.

The report found a surprising increase in excess mortality among adults ages 25 to 44. The rate of excess death among this age group increased by 26.5 percent, more than any other age group. The virus also hit African Americans and Latinos especially hard, underscoring the disparate impact of covid-19.

“Among racial groups, the majority of people killed by covid-19 are White. But for people of color, and especially Latinos, the new report emphasizes just how big a difference the pandemic has made in mortality,” Bernstein writes. “For Whites, that means an excess death rate of 11.9 percent over a normal year. For Latinos, it is 53.6 percent, for Blacks 32.9 percent and for Asians 36.6 percent.”

OUCH: The White House is looking to slash funding for health programs in cities Trump has deemed “anarchist.”

“New York, Portland, Ore., Washington, D.C., and Seattle could lose funding for a wide swath of programs that serve their poorest, sickest residents after the president moved last month to restrict funding, escalating his political battle against liberal cities he’s sought to use as a campaign foil,” Politico’s Brianna Ehley and Rachel Roubein report.

Trump sent an order on Sept. 2 directing federal agencies to restrict funding to cities that promote “lawlessness.” The memo accuses the cities of not doing enough to crack down on riots stemming from protests around racial justice.

In response to this memo, the Department of Health and Human Services sent a list to the White House budget office on Friday detailing 185 programs in New York, Portland, D.C. and Seattle that could be subject to cuts under the new directive. Among those listed are a $1.8 million grant to Oregon’s Multnomah County to help community and migrant health centers care for covid-19 patients, a $423,000 grant for universal hearing screenings for D.C. newborns, and funding for nutrition and mental health care for the elderly in New York.

“The HHS list offers the most detailed picture yet of the administration’s efforts to quickly comply with the Trump directive and the potentially large cuts facing these cities even as the pandemic strains local budgets. It isn’t immediately clear what criteria the budget office will use to evaluate the grants — or how or when cuts may be made,” Ehley and Roubein write.

Officials in New York and Seattle have threatened litigation if the administration blocks funds.

The FDA pushes back

The FDA has asserted its independence from the White House.

The Food and Drug Administration successfully pushed new guidelines for any emergency use approval of a coronavirus vaccine, thwarting White House officials who told FDA Commissioner Stephen M. Hahn that the guidance was unnecessary and he should drop it, the New York Times’s Sheila Kaplan, Sharon LaFraniere, Noah Weiland and Maggie Haberman report.

Instead, Hahn published the guidelines, which required two months of follow-up safety data from any vaccine, in briefing materials sent to an advisory committee, which will weigh evidence from the vaccine trials. After that, the White House abruptly cleared the guidelines.

“Dr. Hahn had been overruled by the White House before, most notably when the agency caved to the president’s desire to authorize the malaria drug hydroxychloroquine to treat Covid-19 despite a lack of evidence,” Kaplan, LaFraniere, Weiland and Haberman write. In August, Hahn made an embarrassing mistake during a news conference, exaggerating the evidence behind blood plasma treatment for covid-19 during a news conference with the president.

After that, it appeared that Hahn made a more concerted effort to protect the agency’s reputation for independence and shield top scientists from potential interference. 

“In what might be the final months of the Trump administration, and close enough to the election to make his firing unlikely, Dr. Hahn seems to be trying to save the F.D.A. from the fate of its sister agency, the Centers for Disease Control and Prevention, whose scientists have been stripped of much of their authority and independence in responding to the pandemic,” Kaplan, LaFraniere, Weiland and Haberman write.

On the Hill

Pelosi and Mnuchin are still negotiating over a coronavirus deal, even as McConnell argues against it.

“Prospects for an economic relief package in the next two weeks dimmed markedly on Tuesday after Senate Majority Leader Mitch McConnell (R-Ky.) revealed that he has warned the White House not to strike an agreement with House Speaker Nancy Pelosi before the Nov. 3 election,” Jeff Stein and Erica Werner report.

McConnell, who has not been part of the negotiations between Pelosi and Treasury Secretary Steven Mnuchin, said at a closed-door Senate GOP lunch that the top House Democrat was not negotiating in good faith and warned that a deal could disrupt the Senate confirmation of Amy Coney Barrett to the Supreme Court.

The move throws a wrench in the prospects for further stimulus after apparent progress in negotiations on Monday, with Pelosi pointing out an agreement over language on racial disparities in the virus’s impact. Pelosi has said the sides must agree on a proposal at the end of this week to vote next week. 

McConnell, for his part, has said he would bring any deal passed by the House and approved by the president to the Senate floor, but he did not commit to doing so before the election. While Trump has urged big spending on a relief package, many Senate Republicans have expressed concern that a large stimulus could hurt them with fiscally conservative voters.

McConnell is set today to try to advance a much leaner $500 billion bill that includes jobless benefits and small-business funding but does not include $1,200 stimulus checks.

Senate Republicans have tried to remain distant from Trump’s attacks on Fauci.

“With the coronavirus surging nationwide, in record-setting new caseloads and a worrisome rising death toll, the president’s allies see little use in attacking Fauci, the government’s top infectious disease specialist, as the party struggles to win over voters and keep the Senate majority two weeks before the election,” the Associated Press’s Lisa Mascaro reports.

Trump on Monday lambasted Anthony S. Fauci, the nation’s top infectious-disease doctor, during a call with campaign staff. The president said that “people are tired of hearing Fauci and all these idiots” on the virus.

On Tuesday, Trump claimed that he was not at odds with Fauci, while also accusing the public health expert of not being “a team player” in a telephone interview with “Fox & Friends.”

But Senate Republicans have declined to join in with the president’s attack.

While McConnell did not condemn Trump’s remarks, he acknowledged that the virus was surging in his home state of Kentucky and urged people to wear masks and practice social distancing — echoing recommendations made by public health officials, including Fauci. Even Trump ally Sen. Kevin Cramer (R-N.D.) suggested the president could “have put it more eloquently.” 

Sen. Mitt Romney of Utah, a rare vocal critic of Trump among congressional Republicans, for his part, called the president’s statements “really unfortunate,” lauding Fauci as “an esteemed professional” who had earned the trust of the public.

Coronavirus latest

  • An arthritis drug, tocilizumab, that initially showed promise in early trials has failed to produce consistent results in treating covid-19 in three larger trials, Ben Guarino reports.
  • Despite a ban on ads that discourage people from getting vaccinations, some ads that falsely claim vaccines cause autism or that vaccines for diphtheria, tetanus and pertussis don’t work remain on the platform, HuffPost’s Jesselyn Cook reports.
  • Manufacturers and scientists want to create a consumer labeling system that shows how protective masks are against the coronavirus, but to do so, they will first need to overcome disagreements between industry players, Yeganeh Torbati and Jessica Contrera report.
  • The nation’s coronavirus hot spots are increasingly rural communities with minimal hospital capacity. Across the Midwest and Great Plains, rural hospitals are running out of beds or finding themselves with a shortage of workers when health professionals catch the virus, Stateline’s Christine Vestal reports.
  • The U.S. trial of AstraZeneca’s coronavirus vaccine could restart this week after the FDA concluded a review of a serious illness in a study participant. The trial was paused in early September after a participant fell ill with what was suspected to be a rare spinal inflammatory disorder. The U.K., Brazil, India and South Africa also paused vaccine trials but have since resumed them, Reuters’s Julie Steenhuysen and Marisa Taylor report.

Sugar rush