This Tiny, One-Sentence Bill Limits Americans’ Access to Routine Health Care

Maybe you missed it. I certainly did.

Even as I’ve tried to keep up with the lunacies emerging from the Trump administration, I somehow failed to notice the passage, a little over a month ago, of House Joint Resolution 43.

While Americans have been watching the drama surrounding the American Health Care Act, the GOP’s Obamacare-replacement plan, the House of Representatives voted 230–188 to overturn a rule that protected health care for more than 4 million people who rely on Title X, the nation’s family planning program. Extremists in Congress were trying to make it easier for state politicians to block women from getting birth control and other preventive care.

Cut to what’s happening right now — the American Health Care Act (AHCA)—which would decimate women’s health care altogether. One of the many disastrous provisions is the so called “defunding” of Planned Parenthood — which really just means the blocking of low-income patients from receiving health care at Planned Parenthood health centers.

Maybe, like me, you need a primer on how federal funds make their way to Planned Parenthood. Here’s how Planned Parenthood gets paid for the preventive care services it offers patients who qualify for Medicaid:

In short, Medicaid patients get free or reduced-cost preventive care; the clinic bills the state Medicaid program; Medicaid reimburses the clinic; the federal government reimburses the state.

I want to emphasize that Medicaid covers routine, preventative health services and screenings, but not abortion. Thanks to the Hyde Amendment, for more than 40 years Medicaid has been prevented from reimbursing clinics for abortion services. The vast majority of Planned Parenthood’s services are related to birth control, cancer screening, and tests and treatments for sexually-transmitted infections.

The Obama administration recognized ongoing Republican efforts to defund reproductive health and preventive care clinics that also provide abortion services. Anticipating threats to these health care centers during the Trump administration, in December the Department of Health and Human Services finalized a rule that ensures states cannot withhold Title X federal family planning funds from Planned Parenthood.

HJ Res. 43 overturns this rule, allowing states to withhold reimbursements for a wide range of preventive and reproductive health services offered by clinics that also provide abortions.

While both proponents and opponents of HJ Res. 43 refer to it as a bill to “defund Planned Parenthood,” that’s not an entirely accurate characterization. Rather, the bill restricts Medicaid patients’ autonomy in determining where they receive preventive and reproductive health care.

Ah well, you might be thinking, that sucks for low-income patients of Planned Parenthood. But there are plenty of other places where people can get this kind of care, right?

If, like me, you live in a decent-sized city — even in a red state — chances are there’s another place you or your loved ones might access relatively affordable, routine gynecological care, sexual health services, cancer screenings, and birth control. If, however, you rely on Medicaid, or if you live in a smaller city or in a rural area, your choices are likely significantly more limited. In fact, in many places, Planned Parenthood is either the only family-planning provider that accepts Medicaid or it serves more than half of low-income patients seeking these services.

Patients can’t count on local clinics to pick up the slack if Congress cuts reimbursements to Planned Parenthood. Community health centers (CHCs) and federally qualified health centers (FQHCs) tend not to provide a full range of federally-approved contraceptive methods, and when they do, patients may face delays in receiving contraception. Only 30 percent of CHCs offer birth control on the same day as a patient’s visit, whereas almost all Planned Parenthood locations do. Furthermore, 83 percent of Planned Parenthood’s health centers fill birth control pill prescriptions on site; only one-third of FHQCs offer that service.

In addition to offering a broader scope of services than local clinics, Planned Parenthood health centers deliver them on a massive scale. Each year, Planned Parenthood:

• helps prevent approximately 579,000 unintended pregnancies.
• conducts more than half a million cancer screenings — more than 270,000 Pap tests and more than 360,000 breast exams.
• provides more than 4.2 million tests and treatments for sexually-transmitted infections, including more than 650,000 HIV tests.
• delivers educational programs and outreach to 1.5 million young people and adults.

Remember all those scary stories Republicans told us about the Affordable Care Act when it was being developed and first implemented? They spun tales of spiraling costs, no longer being able to see your chosen physician, not being able to access specialists when you wished, and crazy long wait times for appointments. And of course death panels — let us not forget the death panels.

Funny story.

That nightmare scenario is exactly what this effort to “defund” Planned Parenthood amounts to. It makes preventive and reproductive health care inaccessible to vast numbers of women. It prevents them from seeing specialists in family planning. Hundreds of thousands of women—as well as the men, trans people, and genderfluid folks Planned Parenthood also serves—will go without cancer and STI screenings. Let me be absolutely clear: teenagers and adults will get sick and die.

All of this pain and suffering emerges from the GOP’s desire to prevent women from accessing abortion services. And yet, HJ Res. 43 will increase the number of abortions. Without access to sexual health counseling and affordable, easy-to-get contraception, women will experience greater numbers of unintended pregnancies.

Furthermore, if Planned Parenthood ends up having to close some of its health centers due to a sudden decrease in Medicaid reimbursements, women wanting to end their pregnancies will not have access to emergency contraception or safe abortion. Desperate women will return to the days of back-alley “solutions.” By forcing abortion services underground, the GOP is ensuring girls and women will end up injured, infertile, or dead.

Even if you’re a well-heeled Planned Parenthood patient with private health insurance, you’re going to be affected by a sharp decline in the organization’s funding because an inability to accept Medicaid eventually may force it to close many clinics. If you’re not a Planned Parenthood patient, you may find it more difficult to get appointments at your usual health care center; the providers there will need to accommodate all those former Planned Parenthood patients.

HJ Res. 43 has been forwarded to the Senate for its consideration, and the AHCA is up for a vote this week. Lawmakers, however, shouldn’t be in the business of restricting access to cancer screenings and reproductive care. Let’s leave family planning to the experts. Call your senators and tell them to oppose HJ Res. 43, and call both your senators and representative and ask them to vote no on the AHCA.