David Michael Miller
The latest bill passed by the state Legislature targeting Planned Parenthood would not “defund” the group of its Title X federal family planning dollars, as some have suggested. The state does not have the power to do so. But the Republican-backed bill, which Gov. Scott Walker is expected to sign, does bet on a long-term strategy that could result in the group losing millions of dollars in federal funding. Much depends on who wins the White House in November.
“I think, like many things, it will matter who will be in charge of the [U.S.] Department of Health and Human Services,” says Brian Larson, an attorney with the Wisconsin Legislative Council. “They administer these grants and [determine the] criteria.”
“My assumption would be that if we have a Republican president, the likelihood he ends this program will be quite high,” says Nicole Safar, policy director for Planned Parenthood of Wisconsin. “Or he makes it so that Planned Parenthood cannot apply for it,” she adds, noting that President Barack Obama has vetoed 19 attempts by Congress to kick the organization out of the Title X program, which provides low-income and uninsured men and women with family planning services and other preventative health care.
The bill, which passed the Assembly in September and the Senate on Jan. 20, requires that the state health department compete for Title X funds. But, says Larson, “It would be a mistake to infer that means DHS is kicking the other ones out of the picture.”
The legislation directs DHS to apply annually for the Title X funds, though the program is run on a three-year funding cycle. In Wisconsin, the next cycle begins in 2018, according to Planned Parenthood officials.
Safar says Planned Parenthood has been the Wisconsin recipient of Title X funds for the past 37 years. The state has never applied for the money.
If the state were to successfully win the grant, the bill further specifies that funds could not be distributed to groups that provide abortion.
The national family planning program started under President Richard Nixon, a Republican. Its funding is delivered as a block grant to organizations — and in some cases state agencies — in different regions around the country.
Planned Parenthood of Wisconsin this year received $3.4 million from the program, distributing $700,000 to First Choice Women’s Health Center in Janesville and Essential Health Clinic in La Crosse, which have nine clinic sites between them. Planned Parenthood distributed the remaining $2.7 million to nine of its 22 health clinics.
The clinics provide pregnancy testing, breast exams, cancer screenings, birth control and health education, among other services. According to the National Family Planning & Reproductive Health Association, the Title X program in Wisconsin served nearly 51,000 residents in 2012, and helped prevent 28,600 unintended pregnancies in 2010.
Clinics are prohibited from using federal money for abortion services, but anti-abortion advocates and lawmakers nevertheless insist Planned Parenthood, which also provides abortions, commingles its funds. This is one of the justifications given for stripping Planned Parenthood of public dollars.
Safar says Planned Parenthood has been audited annually by Title X, under both Democratic and Republican administrations, and there has never been a finding of misappropriation of funds for abortion services or an inappropriate commingling of funds.
Under the bill, the state Department of Health Services is instructed to distribute any Title X money it receives to the Wisconsin Well Woman Program and to public entities, including state, county and local health departments and health clinics.
But the Well Woman Program is a curious choice for providing family planning services since it serves women 45 years and up, an age when many are no longer able to get pregnant.
In an Oct. 1 letter, Sen. Jon Erpenbach (D-Middleton) and Sen. Tim Carpenter (D-Milwaukee) sought clarification of the legislation from Kitty Rhoades, secretary of the Department of Health Services. (The department did not respond to an Isthmus request for comment.)
The senators asked whether the department had met with any of the public entities that would be providing the services “to determine whether or not they are able or willing to provide care to an estimated additional 50,000 patients.” They also noted testimony to the Senate Health and Human Services Committee, on which they sit, that asserted that the Well Woman program does not have the capacity to handle current needs, let alone offer family planning services.
The senators also asked why the Department of Health Services has never applied for the grant money since the program began in 1970. “Why is now the appropriate time to do that?”
Rhoades writes in an Oct. 9 response that the Well Woman Program is “just one of the many options that may be considered as part of a statewide network of coverage to help ensure access to family planning services.”
As for the department’s sudden interest in running a statewide family planning program, Rhoades pointed the finger at state lawmakers. “As health care continues to change and states look to best practices for the delivery of care, legislators may seek greater diversity among the network of providers funded by the Title X Family Planning Program, and may therefore ask the Department to apply for this federal funding.”
Safar says there are some states, including Illinois, that are set up to provide family planning services to residents. But Wisconsin is not one of them.
“We provide services to 50,000 patients a year,” she says. “DHS has no idea how they would serve those patients. They don’t have the infrastructure to provide direct patient services. That’s why we’re here.”
Rhoades, in her letter to Carpenter and Erpenbach, writes her department would be up to the task and, along with the Department of Public Health, would continue working with local health departments, the Well Woman Program and other agencies to “develop a robust network of providers that would allow the Department to submit a competitive application.”
Among the groups opposing the Title X bill, however, are the Wisconsin Counties Association and the Wisconsin Primary Health Care Association, which represents health care centers around the state.
Before the Republican-controlled Legislature tried to siphon off federal funding from Planned Parenthood of Wisconsin, it identified and eliminated all of the organization’s state funding.
Walker’s 2011 budget cut roughly $1 million in annual state family planning dollars to the group, which also lost its Well Woman contract, worth roughly $138,000. As a result, Planned Parenthood was forced to close five of its clinics, all in rural parts of the state.
The state had argued that county health departments would step into the void, but that has not happened. Erpenbach and Carpenter also asked Rhoades if the state had urged counties to offer services. “Did they refuse?”
Rhoades did not answer the question, saying only: “The Department has worked to develop a statewide network that provides access to all Wisconsinites.”
Safar says that when the Legislature defunded Planned Parenthood of state money in 2011, it also changed the state’s women’s health program to exclude what is referred to as “all options pregnancy counseling.” That is not acceptable under Title X rules, she adds.
“One of its regulations is if a woman comes in with a positive pregnancy test, you are required to give her ‘all options pregnancy counseling.’” That includes information about pregnancy, adoption and abortion.
Says Safar: “I have real concerns that the state of Wisconsin would be able to comply with that regulation.”
Editor's Note: This article was corrected to note that Planned Parenthood distributes $2.7 million of its $3.4 million Title X grant to its own clinics and $700,000 to subcontractors in Janesville and La Crosse.
