What’s Really At Stake In The Planned Parenthood Debate

Update (March 31, 2017): Senate Republicans voted down an Obama administration rule that protects Title X funding to abortion providers yesterday.

What does that mean for you? Well, if you're among the 4 million people (a third of whom go to Planned Parenthood) who get basic reproductive health screenings and birth control at a Title X clinic, it means you're at risk for losing your care.

Title X is a federally funded program that's been in place since the '70s. It gives money in the form of grants to clinics offering family planning services. Because the Republican Party is determined to cut off resources for Planned Parenthood and other abortion providers, one of President Obama's final actions before leaving office was a rule that said states cannot take Title X funding from clinics solely because they also provide abortions.

After Vice President Mike Pence broke a 50-50 tie in the Senate vote on the rule yesterday, Republican state legislators will be allowed to lock Planned Parenthood as well as other family planning clinics out of funding for purely political reasons — something they have shown themselves willing to do time and time again.

To be clear, this doesn't mean Planned Parenthood has been "defunded," but it does put a significant chunk of money at risk, especially if you live in a state that is hostile to reproductive healthcare. Keep reading for our up-to-date explainer about how Planned Parenthood is funded, and what this debate is really about.

Update (March 14, 2017): A new government report underscores what we've known all along: Defunding Planned Parenthood would be disastrous for women (and men, too) who rely on the provider for care, and it'd lead to many thousands more unplanned pregnancies and births.

The non-partisan Congressional Budget Office released their analysis yesterday, as part of a larger look at the House GOP's plan to repeal and replace Obamacare. The CBO estimates that the hardest hit group would be low-income people who live in areas where few healthcare providers exists. About 15% of those people would completely lose their care. This would lead to savings for taxpayers of about $178 million in 2017 and by $234 million over the 2017-2026 period.

However, blocking people from getting these services would result in thousands more unplanned pregnancies and births. Since 45% of births in the U.S. are paid for by Medicaid, CBO estimates that this would result in costs of an extra $21 million in 2017 and by $77 million over the 2017-2026 period. Keep reading for more about the effects of defunding Planned Parenthood.

In news that surprised no one but still managed to terrify many, House Speaker Paul Ryan confirmed that a measure to strip Planned Parenthood funding would be included in the bill to repeal the Affordable Care Act. This isn't the first time the GOP has tried to gut the provider. But with President-elect Trump taking the White House in two weeks, the measure is expected to actually move forward.

“Defunding” Planned Parenthood has become a rallying cry among anti-choice advocates and a surefire way to enrage any red-blooded pro-choicer. Both sides tend to throw the term “defunding,” around as if the government is just forking over $450 million a year to the organization that can be easily taken away or directed elsewhere. But guys, that’s not how it works. To truly understand this debate, you have to understand how taxpayer money actually makes its way to Planned Parenthood, and crucially, you have to understand the role Planned Parenthood plays in our healthcare system.

First, it’s worth repeating: Planned Parenthood is not some kind of pseudo-federal agency in charge of distributing birth control (nor is it an abortion mill, but more on that in a sec). Instead, it gets paid by the government in two ways: reimbursement payments for services rendered, as well as grant money earmarked for family planning services.

Most of the taxpayer money — an estimated $390 million, or 87% of the total paid out by government, per the Congressional Budget Office (CBO) — that Planned Parenthood gets comes through Medicaid payments. Medicaid, the health insurance program for low-income, elderly, and disabled people, is funded jointly by the federal as well as state governments.

Medicaid payments are issued the same way other insurers make payments to doctors' offices, through bills for specific services. Example: You get a pap smear at a clinic; said clinic bills your insurance for said pap smear, and then the insurance makes a payment to the clinic.

The rest of the taxpayer money, about 13% of that $450 million annual estimate, comes through Title X, a federally funded program that issues grants to clinics devoted exclusively to family planning services. (This is the funding that is currently protected by a new Obama administration rule that bars states from blocking federal funding to clinics solely because they perform abortions in addition to other services. This helps protect Planned Parenthood somewhat, though this rule, and in fact the whole program, could easily be changed by a Republican administration at any point later on, as well.)

Many community clinics and doctors' offices across the country get paid by the government in exactly the same way, via Medicaid reimbursements and Title X funding, explains Erica Sackin, political communications director at Planned Parenthood Action Fund. The only difference is that these clinics either don’t provide abortions, or they simply haven’t yet caught the attention of anti-choice advocates.

Here's why people go to Planned Parenthood.
Anti-choice advocates regularly repeat the myth that Planned Parenthood is nothing but an “abortion factory,” and they’ve been scarily successful at drumming up rage and disgust at Planned Parenthood’s mere existence because of it, despite the fact that abortion accounts for just 3% of all services performed at its clinics.

The vast majority of people go to Planned Parenthood, which operates more than 650 community health clinics across the country, to access preventive care, including pap smears, STI tests, and birth control, according to the organization’s annual report — and no federal or state funds go to abortions, unless the woman’s life is in danger or she was the victim of rape or incest. That has been the law of the land since 1977, with the passing of the (also controversial) Hyde Amendment.

Because roughly 40% of Planned Parenthood’s total income comes from payments from the federal government (with again, most of this being in the form of Medicaid payments) to provide low-income women with family planning and reproductive health care, the fear is that these women would simply have nowhere to go.

Opponents counter that “whole woman health care centers” are a better place to spend taxpayer dollars because they offer all the preventative services Planned Parenthood does, except for abortion.

This sounds sensible, perhaps, but first of all, “whole woman health care centers” do not exist. What does exist are Community Health Centers (CHCs) and Federally Qualified Health Centers (FQHCs). This network of community-based clinics is indeed important and they do provide family planning services, but they do so in addition to diverse things such as annual physicals, dental care, treatment of diabetes and cardiovascular disease. These clinics are already overburdened with all the various people they are designed to serve, and it’s unlikely that they will be able handle an influx of patients who need pap smears, STI tests, birth control, and prenatal care.

What about regular, stand-alone ob-gyn offices, you ask? Those are also unlikely to be able to handle the mass of new patients, not only because these doctors are less likely to even take Medicaid but also because there are simply not enough of them. “The closure of Planned Parenthood clinics would be gravely disappointing and damaging for patients and health care providers, alike,” says the American Congress of Obstetricians and Gynecologist’s Executive Vice President and CEO, Hal Lawrence, MD. “For women’s health-care providers, the closure of Planned Parenthood clinics would put immense pressure on existing private and unaffiliated public practices to accommodate an even larger population of patients. Increased demands on fewer practices affects patients by making it more difficult to see doctors quickly, particularly for routine visits, or delaying screening results as the volume increases, and staff struggle to keep up with the pace.”

The fact is, Planned Parenthood provides a specific and crucial service in our healthcare system by focusing solely on reproductive health, especially when it comes to birth control access, for low-income women. According to a 2015 analysis from the Guttmacher Institute, 36% of the close to 7 million women receiving contraceptive care from government-funded “safety net” providers went to Planned Parenthood in 2010. And even though there are technically more community health centers and FQHCs in total than Planned Parenthood clinics, in 21% of counties with a Planned Parenthood clinic, it is the only safety-net provider of family planning in the area.

In the end, this debate is much bigger than the abortion question. Medicaid and Title X already do not cover abortion services, much to abortion-rights advocates' dismay. What this is about is birth control, pap smears, STI tests, and sex education, and whether it’s in the public interest to make sure everyone has access to those things.