Planned Parenthood turns to states for a lifeline

Politico

3 days ago

Planned Parenthood is pushing governors and legislators in California, New York and other blue states to cobble together emergency funding that will allow them to keep the lights on should the spigot of federal money run dry.
The Republican budget proposal moving through Congress would in one fell swoop prohibit most abortion providers from getting any federal funding, including Medicaid dollars.
The push to defund Planned Parenthood in this way is only the latest existential threat to the organization that has been in Republican cross hairs for decades.
Although not mentioned by name in the mega-spending bill being pushed by Congressional Republicans, Planned Parenthood, the country's largest abortion provider, see it as a clear, intentional target. The proposed law would prohibit federal Medicaid funding from going to 'prohibited entities,' a category that includes tax-exempt organizations that primarily provide family planning but also abortions and receive over $800,000 per year from the government.
'All they needed to add was 'if your organization rhymes with wood,'' said Fabiola De Liban, the director of sexual and reproductive health at the National Health Law Program.
The stakes are particularly high for Planned Parenthood in California, where its leaders have conveyed to Gov. Gavin Newsom and lawmakers that they'll need more than $25 million each month in stopgap funds if the federal cuts are enacted. Planned Parenthood chapters in other states where abortion is legal would be left reeling as well: In Massachusetts, the group's clinics stand to lose $14 million, roughly half of their operating budget. In Oregon, they receive between $15 million and $18 million each year in Medicaid payments.
Federal law already prohibits states from using Medicaid dollars to pay for abortions. California, like other states, uses its own funds to cover the procedures. Now, by trying to block all Medicaid funds to abortion providers, Congressional Republicans are pursuing what critics say amounts to a 'backdoor abortion ban' in states where it remains legal.
'I don't think we need to be funding abortions, anything to do with it,' Rep. Tim Burchett (R- Tenn.) " I'd like to see us eliminate any funding for it. Let's roll. We need to do it.'
Planned Parenthood has said about a third of its 600 clinics would be at risk of closing if it could no longer bill Medicaid, most of which are in states where abortion is legal.
As they've fanned out in state capitols to hit up elected officials for help, Planned Parenthood leaders and other advocates for abortion access are running into mismatched deadlines and state budgets already stretched thin.
In California and Massachusetts, there are still a few weeks left to possibly shoehorn in some contingency funds before their budgets are finalized at the end of this month. But in New York and other states that have already passed budgets for the coming fiscal year, the groups have been left hoping state officials will step up with additional funding outside of the regular budget process.
Complicating matters for advocates in California is another budget battle they've fought over the state's $12 billion budget deficit that Newsom proposed closing in part by diverting over $500 million that was supposed to be reserved for Planned Parenthood. The group successfully lobbied the Legislature to restore the money in its budget plan and voiced optimism that the final budget hammered out between the governor and lawmakers won't include the funds shuffle.
'In a normal year that would be great, we'd consider all of that a win,' said Jodi Hicks, president of Planned Parenthood Affiliates of California. 'Unfortunately, we are having to plan at the same time for being defunded at the federal level.'
Hicks said she'd need about $27 million a month from state coffers to keep the group's 115 clinics open. She said she's talking to Newsom's office and the Legislature on plans for a short-term infusion that would give clinics a few weeks or months reprieve while Hicks and her team figure out a longer term solution that would also require at least some state funding. Newsom's office declined to comment.
Planned Parenthood clinics in New York asked for a similar emergency fund, but Gov. Kathy Hochul and legislative leaders rejected the idea, saying they would respond to the federal cuts if they are passed. New York stands to lose a total of more than $13 billion in Medicaid funding from cuts currently called for in Congress' bill, a number Hochul says the state would be unable to backfill.
Robin Chapelle Golston, president of Planned Parenthood Empire State Acts, said her advocacy group is working with the Hochul administration to determine what type of support the state could provide for reproductive health services if the federal cuts come down.
'If they kick us out of the Medicaid program, we are going to have to work closely with the state,' Golston said to POLITICO. 'We're already starting to push to have conversations with the [Department of Health] and Department of Budget, to really kind of discuss next steps…they know that we serve in a lot of healthcare deserts that will really devastate access to sexual reproductive healthcare across the state.'
The New York state budget included a $25 million grant to bolster access to medication abortion and an additional $4 million to support training clinics' staff. Dominique Lee, CEO of Planned Parenthood League of Massachusetts, said she is discussing the potential for a similar fund in the state.
Lee, Hicks, Golston and Planned Parenthood leaders in other states where abortion is legal have attended regular conference calls to discuss strategies for convincing state officials to come to their aid. While reproductive health systems in each state are different, Lee said there is a lot they have to learn from one another.
'My colleagues bring a great sense of community when we need it most, it's talking about practices, learning about public health policies,' Lee said. 'I think the biggest thing is just how we make sure that our doors stay open, we certainly don't want to abandon our patients, so we're like, 'How do we activate other funding sources?' '
The likelihood of Planned Parenthood being cut from federal funding remains uncertain. Congress is attempting to defund the group through budget reconciliation, a legislative process that can expedite budget decisions, but comes with restrictions on how it can be used. When Republicans attempted a similar move against Planned Parenthood in 2017, it was found to be outside the bounds of reconciliation. Rep. Eric Burlinson (R-Mo.) told POLITICO the decision was 'not just a policy.'
'It's an important part of the bill has a serious financial impact,' Burlison said.
Arizona's Rep. Andy Biggs agreed, saying the defund was necessary to pay for other programs.
'I think certainly you have to have it in, because it's a pay for, right?' Biggs said. 'There's a whole lot of spending going on, so there needs to be a whole lot of payfors going on.'
The threat to defund Planned Parenthood is part of a broader effort to restrict abortion access through the spending bill. Elsewhere in it are provisions to boot out private insurers that include abortion in their coverage plans from insurance marketplaces.
It's a little more complicated than just asking for money. Clinics will have to figure out how to provide care without billing one of their main payers, but will also have to untangle a host of other federal funding streams like grants and proceeds from provider taxes currently being used to fund family planning services.
In Oregon, Planned Parenthood is the main provider of all reproductive health care, and around 70 percent of its patients are on Medicaid. Already, state reimbursement rates only pay for about 45 percent of the cost of care, said Sara Kennedy, the CEO of Planned Parenthood Columbia Willamette in Oregon. She's spent the legislative session, which ends in June, trying to advocate for increased rates.
'I can understand why people are reluctant to have really detailed conversations or make any promises or pledges until we know for sure what's happening,' Kennedy said.
For now she's bracing for a period of uncertainty if the bill passes, when there are likely to be legal challenges and her clinics will continue to see patients while not being paid. Long term, she's hoping state agencies can pull together a funding program outside of Medicaid to cover low-income Oregonians.
In the long run, if clinics can't bill Medicaid, De Liban said there's no way states would be able to make up for all the lost money, especially not on an ongoing basis.
'The answer is very easy and it's also very complicated,' De Liban said. 'It's easy in the sense that they just need more money, and it's very complicated in that I don't know where the money's going to be coming from.'