Will there be a Missouri compromise in an abortion-related battle that threatens federal funding for health clinics offering family-planning information and referrals?
The key to any compromise amid the abortion politics may be HHS Secretary Tommy Thompson.
So far, the flap has cost 27 clinics state grants worth a total of $592,650 to provide services to 3,951 women for the three months ending Sept. 30. Of those 27 clinics, at least 19 receive federal funds. Sixty-three other providers that don't receive federal family-planning money signed the three-month contract extensions to handle 3,947 clients for $592,050, said Paula Nickelson, deputy director of the Missouri Department of Health's division of maternal, child and family health.
The contracts were extended for three months because the department's appropriation for fiscal 2002, which began July 1, did not become law soon enough for the department to solicit bids for the entire year, Nickelson said. The department will seek bids for the remaining nine months of the fiscal year later this year.
The conflict resulted from changes in the contract that providers must sign to receive grants under the state's family-planning program. In the appropriations bill for the state health department, the Missouri General Assembly included a provision that requires the contracts to prohibit clinics that receive the funds to offer information on and referrals for abortion services. That provision directly contradicts the federal family-planning program, known as Title X, which expressly requires clinics to offer abortion information and referrals to providers in order to receive the federal grants. Clinics that violate the state's contract language could be forced to return all of the grant money they receive from the state, and that penalty provision has scared off some clinics.
Joan Bialczyk, director of the health services division of the St. Louis County (Mo.) Department of Health, said the county is dropping the state program because "the new language is very problematic for clinics wishing to receive" both state and federal funding. The county will rely on property taxes collected specifically for healthcare to make up the loss of $265,500 in state money to continue the program at three clinics in the county.
Missouri legislators did leave a chance for compromise in the law-federally funded clinics may ignore the new contract language if they obtain a letter from HHS' Thompson stating that the clinic will lose federal funds if it follows the state's rules, Nickelson said.
The Missouri Family Health Council in Jefferson City, a not-for-profit family-planning group that oversees the Title X program in the state-distributing $4.3 million in federal fiscal 2000, which ended Sept. 30-wrote to Thompson to ask him to intercede.
"Without your help in this matter, we project the closing of at least 12 clinic sites and a loss of services to approximately 13,000 clients in the upcoming year," according to the letter, signed by the council's executive director, Susan Hilton. "We anticipate the loss of an additional 25 clinic sites in the Title X system resulting from the severing of subcontracts between local county health offices and Title X agencies, and a loss of approximately 30,000 clients in the Title X federal reporting system."
Thompson's office has received the letter, but no decision has been made on how or when to respond, HHS spokesman Campbell Gardett said. "This is a one-of-a-kind or first-of-a-kind request of the secretary," Gardett added. "It's not really clear whether some kind of letter from him would carry any weight that the law itself doesn't already carry, but we're still thinking about what is the right way to respond to this request."
The Kansas City (Mo.) Health Department decided to drop its women's health program because it refused to agree to the state's conditions and consequently was losing $90,900 in state funding. Four employees who work in the program will be either reassigned or laid off when the program ceases Aug. 3.
"When an individual patient sees a healthcare provider, they expect that provider not to be, in a sense, muzzled," said Rex Archer, M.D., director of the city's health department. "I don't think most patients would expect that when they come into a clinic, that the provider would not lay out all of the options available to them. I think the public expects to hear those."
Archer said the health department already had been considering dropping the women's program because other providers seemed to be meeting the needs of poor and indigent patients, but the state's action cinched the decision.
Only one clinic that receives federal funds, St. Louis Connect Care, re-signed with the state program, said Nickelson of the state health department. Connect Care officials declined to comment.