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Republicans will likely bar states from providing Medicaid funds to Planned Parenthood when they vote to repeal the Affordable Care Act (ACA) early this year, if they use the reconciliation bill President Obama vetoed in 2016 as a guide. That would cause thousands of low-income women to lose access to care and raise state and federal Medicaid costs related to unplanned pregnancies.
Nearly 400,000 low-income women would have lost access to care under a one-year prohibition on Planned Parenthood funding that the House passed in 2015, according to the Congressional Budget Office (CBO).
Medicaid is the largest funder of family planning services, and Planned Parenthood is a major provider of those services for low-income women. In over two-thirds of counties with Planned Parenthood clinics, the clinics serve at least half of all women receiving publicly funded contraceptive services; in one-fifth of the counties, Planned Parenthood serves all such women. The women most likely to lose access to care under the House bill live in areas without other clinics serving low-income populations, CBO found.
Some states have tried to bar Planned Parenthood from their Medicaid programs by claiming it isn’t qualified simply because it provides abortions, separate from its participation in Medicaid. Courts have deemed these attempts unlawful, as Medicaid prohibits states from disqualifying providers for reasons unrelated to their ability to provide services in a professionally competent, safe, legal, and ethical manner, and the Centers for Medicare and Medicaid Services recently reaffirmed this prohibition in guidance to states. (Federal Medicaid funds can’t pay for abortions except in cases of danger to the life of the mother, rape, or incest.) But last year’s ACA repeal bill would have accomplished what those states had tried, by changing federal law to prohibit all states from including Planned Parenthood in their Medicaid programs.
Defunding Planned Parenthood would have devastating effects. Texas eliminated Planned Parenthood from its state family planning program in 2013 after an earlier round of cuts in funding for family planning services. Researchers studying the impact found a 35 percent drop in women using long-acting contraception and a 27 percent rise in births among women who had previously used injectable contraception. After Planned Parenthood health centers closed in Wisconsin and Texas, fewer women got breast exams and Pap tests, other research found.
Planned Parenthood saw 2.5 million patients in 2014. About three-quarters of them have incomes below 150 percent of the poverty line, and about 60 percent get their care through Medicaid or the federally funded Title X family planning program. If Republican leaders bar Planned Parenthood from Medicaid, they’ll leave many of these women without preventive and primary care, as well as family planning services.