A showdown between two states and the Obama administration over eliminating Planned Parenthood's status as a Medicaid provider could mean thousands of women will find themselves without access to reproductive care.
Officials in Alabama and Louisiana have alerted Planned Parenthood facilities that they intend to dissolve their Medicaid provider agreements. In addition, New Hampshire's Republican-led Executive Council voted to end state funding for the organization.
The collective impact of these moves is troubling, advocates and legal experts say.
“What's the alternative for these women who will not have their reproductive healthcare needs covered by the state?” Lynn Paltrow, executive director of National Advocates for Pregnant Women, said. “No one should assume they'll be able to get those needs met somewhere else.”
The defunding actions are in response to a series of videos released by the anti-abortion group Center for Medical Progress, in which Planned Parenthood staff discuss providing fetal remains for research.
The CMS has reportedly informed Alabama and Louisiana that they are violating federal law requiring that Medicaid beneficiaries be able to obtain services, including family planning. Because New Hampshire's Executive Council isn't attempting to block the spending of federal funds, its action isn't subject to federal oversight. The CMS did not respond to requests to provide the correspondence with Alabama and Louisiana.
If those two states don't heed the administration's concerns, they put themselves at risk of losing their federal Medicaid funding for family planning, legal experts say. But if history is any guide, the states may not care.
After Texas dropped Planned Parenthood as a Medicaid family planning provider in 2012, it willingly walked away from receiving millions in federal funds for its women's health program. Since then, reproductive healthcare options for low-income women have decreased in the state.
“The bottom line of this is that the people that are being harmed by this in this fight between the states and Planned Parenthood are the low-income people who are seeking family planning services,” said Susan Berke Fogel, the director of reproductive health at the National Health Law Program.
Advocates also say it's troubling that Republican lawmakers assert that women relying on Planned Parenthood can simply go to a community health center or another provider.
“Wouldn't patients be better served if that money was redirected to community health centers?” Sen. Den Fischer (R-Neb.) said Aug. 3 during a Senate floor session in which she argued for stripping federal funding for Planned Parenthood. “I believe the answer is yes. These health centers deliver many—and sometimes more—of the health services provided by Planned Parenthood.”
But community health centers and other providers may not have the capacity or be able to provide the same breadth of services to take on all the Medicaid-eligible women now cared for at Planned Parenthood, said Karen Davenport, director of health policy at the National Women's Law Center.
The nonpartisan Congressional Budget Office affirmed that view in an Aug. 3 report assessing federal legislation aimed at defunding Planned Parenthood.
“Most of the Medicaid services that would have been obtained from Planned Parenthood Federation of America would instead be obtained from other health clinics and medical practitioners—but not all of them,” according to the report. “Some of the services …include those that help women avert pregnancies and deliveries. Reduced use of such services would be expected to lead to additional births, increasing federal spending, primarily for Medicaid.”
Jonathan Chapman, executive director of the Louisiana Primary Care Association, which represents more than 30 community health centers, said that while his members could largely step in and help Medicaid beneficiaries no longer able to go to Planned Parenthood, the scope of family planning services does vary by site.
Also, he said, Louisiana physicians may struggle to fill the gap if the CMS strips the state of its federal family planning funds.
“It would be detrimental and be an additional burden to the state that is already facing shortfalls,” Chapman said.