Do your tax dollars pay for abortions?

“I have no problem with Planned Parenthood’s cancer screenings, low-cost contraception, and STD testing and treatment — what I have a problem with is my taxes paying for people to end their pregnancies.”

It’s a natural assumption— Planned Parenthood provides abortion services, and the only story the news has had about the organization for the last 18 months has been around defunding. Federal dollars must pay for abortions, right?

Most Americans are unable to articulate the complicated payer system driving their healthcare. Sound like you? Join the club. State laws often vastly differ, all the terms are Medi-something, and for one damn reason or another, sexual and reproductive healthcare is always on the chopping block.

Is it because the nation is at war over abortion? Maybe publicly, but certainly not privately. If you were willing to read this far, you probably know the most popular fast fact: one in three American women will have an abortion in her lifetime. You might not know that 2 in 5 abortion patients identify as white (more than any other racial group), or that 62% reported a religious affiliation (the most popular being Catholic, followed by Protestant and Evangelical.) 59% of US abortions are obtained by women who are already mothers; surprised yet? The point I’m making here is that people who have abortions are people you know. So where does all the angst come from?

Buried in the old adage, perhaps: “There are three things that you should never talk about at the dinner table: religion, politics, and money.”

Yes — give me the dirt. What’s the size of the check that the US federal government hands Planned Parenthood each year?

$0. Zero. 
Zilch. Nada.

That’s right! Pie charts can be deceiving — right here in their very own annual report PPFA claims 43% of funding, over $500 million dollars, comes from “Government Health Services Grants & Reimbursements.” Is that not tax money?!

Planned Parenthood serves a variety of patients; some have commercial insurance, like United, Aetna, or Cigna, either through their employer or purchased through the Affordable Care Act (Obamacare). Some have no insurance and pay out-of-pocket on a sliding scale. The majority of patients served have Medicaid, a joint state- and federally-funded health insurance program for low-income people.

By low-income, I don’t just mean people living in poverty. I mean people between jobs. People who were laid off. People in college or graduate school. People working part-time while they care for a parent, relative, or child. People launching a small business. People with disabilities. Together with the Children’s Health Insurance Program, Medicaid provides health coverage to over 72.5 million Americans.

Planned Parenthood receives reimbursement from Medicaid when they provide clinical services to those qualified low-income people. If the patients stop coming, no services are performed, thus there would be nothing to request reimbursement on. In short, if the Medicaid patients stop coming to Planned Parenthood for care, Medicaid money (thus federal money/tax dollars) also stops coming. This is the exact same way payment would work if a Medicaid patient went for an identical Pap test at Cleveland Clinic or at Johns Hopkins; PP does not have any special arrangement with the government.

So no, no money is handed to Planned Parenthood — $500 million is earned, by providing high-quality clinical services.

How much of the earned reimbursement money goes toward covering abortion procedures?

Medicaid reimbursements are only available for non-abortion care. If a clinic (Planned Parenthood or otherwise) were to attempt to submit a Medicaid claim for abortion services, it would be simply be denied — unless the circumstances fell within the narrow boundary of the Hyde Amendment.

First implemented in 1976 (three years after Roe v. Wade), the Hyde Amendment forbade the use of federal funds for abortions except in cases of life endangerment. Clinton’s administration expanded this slightly 18 years later to include coverage for cases of rape or incest. It’s important to note that even in these extreme instances, federal money is only available to subsidize abortion procedures when a person uses Medicaid to pay (meaning their household’s income is at or below 100-133% of the federal poverty level. While the cap varies by state, nationally this is a total household income of less than $24,300 for a family of four.)

That’s right. Federal dollars, the ones that Republicans are working to stop flowing to Planned Parenthood as soon as possible, do not in any way, shape, or form pay for the overwhelming majority of abortions. Eliminating federal funding for Planned Parenthood would not reduce the number of abortions that PPFA performs because federal funding does not subsidize non-violent/non-life-threatening abortions at all, ever.

Another thing important to note? The motions to specifically defund Planned Parenthood are not working to edit the Hyde Amendment. People who qualified previously, based on income level and as a victim of a crime or life-endangerment, will continue to qualify for an abortion subsidy after Planned Parenthood is defunded. Spoiler alert: other providers offer and will continue to offer abortion care! Despite being the largest provider, Planned Parenthood only performs about a third of the abortions occurring annually in the US.

Some states have recognized the burden this places on low-income people to pay for abortion procedures they cannot afford out-of-pocket. A few have stepped up, and are assisting with subsidizing abortion care (this full list shows which ones as of January 1, 2017) but it is important to note that to repeal this funding would require action to Medicaid legislation at the state level, and will not be accomplished by the motions currently working their way towards Donald Trump.

What about shifting public opinion? Medicaid shouldn’t pay for ANY abortions as long as the majority of Americans are against it.

  1. Separation of church and state, y’all.
  2. The majority of American’s aren’t against abortion.

I can hear your gasps from here. **What?!** Then why is it always in the news?! Why is it always in my face?!

Here’s the objective truth. The vast majority of Americans believe that these violent or life-threatening circumstances justify a legal abortion. The latest Gallup polls on these specific issues (June 2011, which feels outdated to me) indicate:

  • 83% of Americans support abortion if the mother’s life is in danger
  • 75% support abortion in the case of a pregnancy that resulted from rape/incest

Americans just generally support the legality of abortion — and we need to recognize a small, radicalized group of citizens have monopolized the public conversation to the extent that this truth is what sounds crazy.

That broad support is not a recent trend. Here’s over 40 years of history:

US opinion on abortion has not changed drastically since the passage of Roe vs. Wade. In 1977, 77% of Americans believed abortion should be legal in some or all cases. Today, that number is 79%.

OKAY, I get it, you’ve proven your point. But now there are $500 million dollars unaccounted for— if not abortion, what does the federal money reimbursed to PPFA pay for?

According to their 2014–2015 annual report, here’s what:

  • 364,000 breast exams
  • 272,000 Pap tests (screenings for cervical cancer and other diseases)
  • 4.22 million STI tests, treatments, and vaccinations
  • 1.2 million pregnancy tests
  • contraceptive for 2.9 million people
  • sex education for 1.5 million people
  • a hell of a lot more that keeps these clinics, frequently located in poor or rural communities where other healthcare providers are financially unwilling to go, humming with activity.

At the end of the day, it’s the cancer screenings, contraceptive, sex ed, and STI care that will be severely restricted by defunding Planned Parenthood, with no impact on abortion whatsoever.

In summary, your tax dollars almost never pay for abortions. When they do, the person’s physical and mental health depend on it.

Since 1976, taxpayer money has not paid for the abortion of anyone with commercial insurance or anyone who is completely uninsured. It has only helped subsidize care for Medicaid-qualified low-income people whose lives were at medical risk should they carry the fetus to full term (ex. ectopic pregnancies.)

Coverage was expanded slightly in 1994 to include pregnancies which were the result of rape and incest, yet the same low-income restrictions remain in place to this day. In 2017, the annual income cap for a single person to qualify for Medicaid is as low as $11,880. If their income is higher, even by the smallest margin, they must afford the procedure on their own — be they a victim of a crime or not.

Defunding Planned Parenthood, then, will have no direct impact on their abortion services — the subset of people able to use Medicaid to subsidize their procedure due to their circumstance would not change.
The Planned Parenthood services people with Medicaid insurance will be excluded from after a defunding include: birth control and contraceptive counseling, cancer screenings, STI testing and treatment, sex education, and the entire gamut of sexual and reproductive healthcare services the organization provides.

Now — wouldn’t you like to ring up your Congressman and share what you’ve learned?

Thanks for your time and humor; all thoughts are a dictation of my inner monologue plus a bit of Googling, and most importantly, all mistakes are mine to own. Let me know if you see any.

Appendix A
I purposefully used the words person and the pronouns they/their throughout this article because uterus-haver was not only a bit too long, but also probably improper English. Women have abortions, but so do trans and non-binary people. The exception to this usage is when I summarized the Guttmacher research; their statistics are based on the total number of US women, and to edit their wording without recalculating the percentage would muddy the accuracy.

Appendix B
I recognize that there is a bill, H.R.7 — No Taxpayer Funding for Abortion and Abortion Insurance Full Disclosure Act of 2017, making its way through Congress regarding the Hyde Amendment. The title of this bill is deceiving in that it does not expand the powers of the Hyde Amendment as outlined above — it simply makes Hyde (currently re-approved each year as a budget rider) into permanent law, requiring future Congressional legislation to alter. It’s safe to say that this law is named in an intentionally deceitful way, to trick the public into believing that federal money currently pays for a wide range of abortion procedures.

H.R.7 does eliminate subsidies for those who purchase private ACA plans that cover abortion. Those subsidies wouldn’t simply be lost once the person uses the coverage on an abortion, it would apply to the plan in total. This makes those plans much more expensive regardless of whether or not the person ever receives an abortion while on the plan, which makes the plans much less likely to be purchased — incentivizing the insurance companies to remove abortion coverage from the plan altogether. For more information on this bill, there’s a nice summary here by Vox.