Family planning budgets in crisis before Planned Parenthood controversy

Abortion opponents, outraged by a series of hidden-camera videos that depict Planned Parenthood employees discussing fetal tissue donation, have called for Congress to investigate Planned Parenthood and strip the organization of the more than $500 million in federal funding it receives each year. But the controversy over federal funding for Planned Parenthood surfaced long before the videos emerged.

The group's critics in Congress, in an attempt to block any taxpayer money from going to Planned Parenthood, have sought for years to eliminate a federal family planning program.

Last month – even before the release of controversial videos shot by anti-abortion activists – the House of Representatives' appropriations committee voted to cut all funding for the Title X Family Planning Program, which pays for services such as contraception, cancer screenings and HIV tests for low-income women. It was the fourth proposal to defund the program since 2011, according to the National Family Planning and Reproductive Health Association. Planned Parenthood centers make up 13% of the 4,168 health centers funded by Title X, according to the Guttmacher Institute, which researches reproductive health.

"The committee's position is that federal tax dollars should not be used for Planned Parenthood," said Jennifer Hing, committee spokeswoman.

Title X money is not used to pay for abortions and many of the clinics that receive such funds don't provide abortion. Some critics of the Title X program oppose funding clinics that provide abortion, even if federal money goes for other services, such as treating sexually transmitted infections, said Susan Fogel, director of reproductive health at the National Health Law Program. The fear is that funding these clinics in any way ultimately frees up money for abortion, she said.

The full House of Representatives has not yet voted on the appropriations bill, which would also need to be approved by the Senate.

Congress already has cut Title X funding sharply.

Since 2010, Congress has cut $31 million from Title X, about 10% of the program's budget. Title X-funded clinics served 667,000 fewer people in 2013 than in 2010, according to the National Family Planning and Reproductive Health Association. In the same time period, North Dakota lost 33% of its family planning centers; Louisiana lost 21%; New Hampshire lost 24%; and Maryland lost 26%, the association said.

Cuts to family planning have also come at the state level. In 2010, New Jersey eliminated all state funding, $7.5 million a year, for family planning. Six of the state's 57 family planning centers closed, while others trimmed their hours.

In 2011, Texas cut its budget for family planning centers by two-thirds, the national family planning association said. Since then, 82 health centers have closed. Some of the Texas centers were run by Planned Parenthood – which was barred from receiving state money – but others were not. None provided abortions, said Amanda Stevenson, a researcher with the Texas Policy Evaluation Project, a group of researchers who are studying the impact of reproductive health measures passed by the legislature. Although Texas lawmakers have since restored some the family planning budget, many health centers have remained closed, Stevenson said.

More than half of women in the state say they continue to experience barriers to reproductive health services, a May survey from the research project found. While 38% of women surveyed said they can't afford care, 15% say there are simply no reproductive health services in their community.

"The 2011 cuts were devastating to the women's health safety net," said Aimee Arrambide, a policy associate at the Texas Women's Healthcare Coalition. "A lot of communities lost the only providers they had."

The remaining health centers that serve low-income people haven't been able been able to absorb the additional patients, Arrambide said.

At People's Community Clinic in Austin, which does not provide abortions, "the demand for family planning services continue to go up and up and up," said Mary McDowell, the clinic's chief operating officer. The clinic is no longer accepting new adult patients and now has to turn people away, McDowell said.

More women could lose access to reproductive healthcare if Congress strips funding from Title X or Planned Parenthood, said Georges Benjamin, executive director of the American Public Health Association. A bill introduced this week by Sen. Joni Ernst, R-Iowa, would take away Planned Parenthood's federal money, but allow that money to go to other health centers.

"This legislation would ensure taxpayer dollars for women's health are actually spent on women's health – not a scandal-plagued political lobbying giant," said Senate Majority Leader Mitch McConnell, R-Ky., who has scheduled a vote on the bill for Monday.

The bill calls for no reduction in overall federal spending on women's health, according to a statement from Ernst's office.

The Family Research Council, which opposes abortion, praised the legislation.

"By freeing-up these scarce federal dollars, women who need healthcare will be able to obtain a range of services at community health centers, hospitals, primary care physicians and other organizations," said Arina Grossu, director of the Family Research Council's Center for Human Dignity.

Political analysts say the bill is unlikely to become law.
While the Republican-led House may pass the measure, it will almost certainly fail in the Senate. That's because Senate Democrats will block the bill, and Republicans don't have the 60 vote super-majority needed to advance the legislation. The Senate is made up of 54 Republicans, 44 Democrats and two independents who generally side with the Democrats.
Even if Congress does pass the bill, President Obama would be certain to veto it, and Republicans don't have the votes to override a veto, said John Pitney, a professor of politics at Claremont McKenna College in California.

The vote will force members of Congress to go on the record on Planned Parenthood, however, which could help lawmakers shore up their political bases, Pitney said.

"This is Kabuki theater," Pitney said. "You know exactly what the moves are going to be in advance."

If the bill were to pass, transferring family planning money from one health provider to others isn't as simple as it sounds, said Benjamin, who called the proposal "ludicrous."

That's because, in many areas, Planned Parenthood – which serves 2.7 million people a year – is the only source of family planning services. That's especially true in rural areas, Benjamin said. Cutting back on family planning services can put both women and their communities at risk, Benjamin said.

Since January 2013, funding reductions have forced the closure of five health centers in Indiana, including one in rural Scott County. Today, Scott County is the epicenter of the worst HIV outbreak in the state's history. As of last week, county health officials had confirmed 175 cases, most linked to intravenous abuse of the powerful painkiller Opana. Treating those infected in the epidemic will cost more than $100 million, according to the Centers for Disease Control and Prevention.

Before it closed, Scott County's Planned Parenthood clinic provided HIV testing and referrals to care in an area with a shortage of doctors and scant medical resources. Like the other Indiana health centers that have shut down, it did not perform abortions.

Sara Hall, a 23-year-old flight attendant in Jeffersonville, Ind., says she has depended on Planned Parenthood for seven years. She first sought birth control there when she was 16, she said, and received regular care there during several years when she didn't have health insurance. Visits cost her only $20. If Planned Parenthood hadn't been available, "I wouldn't have had a doctor to see," said Hall, who gained health insurance two months ago. "I don't know where I would've gone. It would've meant I wouldn't get the care I needed."

Family planning clinics are a lifeline for many low-income and rural women. Four in 10 women who go to family planning centers describe the clinics as their only source of medical care, according to the Guttmacher Institute, which researches reproductive health. Studies show a growing need for family planning and preventive services.

The number of low-income women who need publicly funded family planning services rose 5% from 2010 to 2013, an increase of 918,000 people, Guttmacher found. Women are considered in need of publicly funded care if they are teenagers or if their incomes are less than 250% of the federal poverty level, which is $11,770 for a single person.

Women who can't find affordable family planning services sometimes end up in the emergency room, Howard Mell, spokesman for the American College of Emergency Physicians, said. Other women go without care altogether.

Yet investing in family planning can have big dividends, said Stephanie Teal, medical director for family planning at the Colorado Department of Public Health and the Environment.

Every $1 invested in Title X programs saves $7 by preventing the expense of pregnancies and associated medical costs, Guttmacher found.

In 2013, publicly funded family planning services helped women prevent 2 million unintended pregnancies and 693,000 abortions, Guttmacher found. Without those services, rates of unintended pregnancies, unplanned births and abortions would have been 60% higher, the research found.

In Colorado, the Susan Thompson Buffett Foundation gave the state $23 million over six years to provide free or low-cost contraception to low-income women. The teen birth rate dropped 40% from 2009 to 2013, while the teen abortion rate fell 42%. The abortion rate for all women fell 34%, Teal said.

"The abortion rate has been going down since the 1990s, but this was just a plummet," Teal said. "The foundation was really pleased with the program. We showed them we can solve this social problem."

Although the grant focused on reducing unwanted pregnancies, Teal said it could qualify "an anti-poverty program," because it allowed many young women to continue their education, instead of dropping out of school.

An economic analysis by the health department found that the contraception program allowed Colorado to save $50 million to $110 million in direct Medicaid costs from 2010 to 2013, Teal said.

Earlier this year, after the private foundation's grant ran out, Colorado's governor asked the state legislature to continue paying for the program at a cost of $5 million a year.

Lawmakers voted no.

Contributing: Erin Kelly, Susan Davis in Washington.