When the Missouri state legislature returns from its recess, the Senate will consider a budget that includes language pulling all state funding to Planned Parenthood affiliates.
“The taxpayers in the state have made it very clear; they do not want their tax dollars going to support abortion services. That’s the purpose of the language,” said Rep. Marsha Haefner, R-Oakville, as she defended the measure before it passed the House earlier this month.
Existing state law already forbids public funding for an abortion in Missouri, unless the mother’s life is in danger. Instead, the proposal would strip funding for preventive care like pelvic exams, birth control and treatments for sexually transmitted diseases — and only for Planned Parenthood’s patients who are covered by Medicaid. Meanwhile, other women’s health providers in St. Louis say they would be hard pressed to meet the need, should those patients come to them instead.
Let’s break down the legalese.
"No funds from these sections shall be paid to any entity that performs abortions not necessary to save the life of the mother or that counsels women to have an abortion not necessary to save the life of the mother.”
The language closely mirrors a section of a state law enacted in 1986 that prohibits the use of public funds to perform or assist in an abortion, or to counsel a woman to have one, except to save the life of the mother. In addition, a 1983 statute forbids all health insurers operating in the state of Missouri from covering an abortion, except to “prevent the death of the female upon whom the abortion is performed.” That means regardless of income or insurance status, women seeking to terminate a pregnancy will likely pay the costs out-of-pocket, which can range from $470 to $1,320. (The lower end is for medication-induced abortions, which can be prescribed for up to nine weeks of gestation).
The key difference is that Ross’ amendment pulls funding from any organization that provides abortions, instead of simply targeting the procedure itself. At this time, Planned Parenthood is the only licensed abortion provider in the state of Missouri, and would therefore lose any funds it gets through the state appropriations process.
Follow the money
Missouri’s Medicaid program gets both state and federal appropriations, and covers people who are pregnant, disabled or have very low incomes. Planned Parenthood receives at least $505,000 in Medicaid payments each year through the state's program for preventative services, according to data from the Department of Social Services and a managed care provider. Two other managed care companies, WellPoint and Centene, did not provide requested information.
The funding at stake covers preventive care for about 7,000 regular patients in Missouri, both men and women, said Mary Kogut, the CEO of Planned Parenthood of the St. Louis Region and Southwest Missouri.
“Services like birth control, [sexually transmitted infection] testing and treatment, well-woman care, Pap smears, pelvic exams, breast exams. Those are the women that we’re concerned about right now,” Kogut said.
The prevention services side of Planned Parenthood of Greater St. Louis took in $9.7 million in total revenues in 2013, according to their latest Form 990 — the majority from program service costs, grants and donations. Kogut said the organization is still working through how it would address the potential cuts.
“I want to make sure our doors are open every day, make sure that we’re accessible,” Kogut said.
Filling the gap
Should the amendment become law, House Republicans have said Planned Parenthood’s patients could instead go to the state’s publicly funded health centers, which cannot provide abortions but do offer OB-GYN care. That logic, Kogut argues, violates federal law giving Medicaid clients the right to choose their own provider. Planned Parenthood affiliates in other states have advanced that view, which is supported by the Obama administration, in their court battles over similar legislation.
In St. Louis, doctors at some of those public clinics — called federally qualified health centers--have serious doubts about whether they could handle the additional patient load. Reimbursements for Medicaid-covered services follow the patient, so funding would only transfer from Planned Parenthood to those centers if the patients actually went.
“I think we could absorb some of them, but actually our space would be the main limitation. I think wait lists would be longer, even for our existing patients,” said Dr. Melissa Tepe, the chief medical officer for Affinia Healthcare and a practicing OB-GYN. Affinia operates four clinics in St. Louis.
OB-GYN's at Affinia can prescribe birth control, the morning-after pill, and treatment for sexually transmitted infections — just like the doctors at Planned Parenthood. But Tepe and her colleagues are also in high demand for prenatal care, labor and delivery, and specialized surgeries for women who don’t have health insurance at all. According to providers, the only Medicaid-covered service available at Planned Parenthood but not at St. Louis’ federally qualified health centers is a vasectomy. Planned Parenthood staff perform about 65 each year.
At Family Care Health Center in Carondelet, Dr. Abbe Sudvarg said federally qualified health centers simply don’t have the resources to offer the kind of drop-in care that's Planned Parenthood's specialty. Emergency contraception, for example, must be taken within 72 hours of having unprotected sex. If a woman went to Family Care, Sudvarg said, she would have to be seen by a doctor before receiving the prescription. For existing patients, that shouldn’t be a problem — but by the time a new patient could get in for an appointment, it might be too late.
“For someone who calls in and just wants a woman’s health appointment and contraception, it depends on the day they call. They might get a two-week waiting list, they might get a two-month waiting list,” Sudvarg said. “Unless you happened to be lucky and somebody had cancelled.”
Further, it's not clear whether the amendment’s language would also pull Medicaid funds from physicians who counsel women considering an abortion, but do not perform them. That would include scores of OB-GYN's and family practitioners, including Tepe and Sudvarg.
“I give options counseling. I tell women where they can go to get the services they desire,” Sudvarg said. “Because I believe that as long as abortions are safe and legal, that women have the right to make that choice, I would continue to do what I, as a healthcare provider, believe is best for the patient.”
This amendment is one of dozens of bills the legislature has filed targeting Planned Parenthood, often with the stated intention of reducing abortions. Providers find them counterproductive.
“I don’t know anyone who doesn’t want to decrease the abortion rates. But the way to do that is to provide good birth control so that we lower the unintended pregnancy rates,” Tepe said.
Rep. Robert Ross, the sponsor of the amendment, did not return multiple requests for comment on this story.
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