Health Policy Analysis: S.

1836: Defund Planned Parenthood Act of 2015

Carley Robinson

Introduction: This brief will seek to analyze to what extent healthcare access will be limited,
specifically for low income women, by the potential passage of S. 1836: Defund of Planned
Parenthood Act of 2015, and the intended and unintended consequences of this limitation. This
bill, introduced in July 2015 by Republican senator James Lankford, seeks to eliminate funding
for Planned Parenthood and its affiliates for a year, unless the organization abstains from
providing abortions, or providing funding to any entity that performs abortions. The specific
language of the bill is as follows:
This bill prohibits, for a one-year period, the availability of federal funds for any purpose
to Planned Parenthood Federation of America, Inc., or any of its affiliates or clinics, unless they
certify that the affiliates and clinics will not perform, and will not provide any funds to any other
entity that performs, an abortion during such period.
The restriction will not apply in cases of rape or incest or where a physical condition endangers a
woman's life unless an abortion is performed. The Department of Health and Human Services
and the Department of Agriculture must seek repayment of federal assistance received by
Planned Parenthood Federation of America, Inc., or any affiliate or clinic, if it violates the terms
of the certification required by this Act.
The controversial issue of abortion remains a divisive topic in American politics since the
ruling of Roe v. Wade by the Supreme Court in 1973. Although this decision made abortion
legal, for many Americans it remains a troubling practice. These constituents have deep moral
and ethical issues with tax dollars funding an organization that provides abortion. These
concerns cannot, and should not, be easily dismissed. There have been many pieces of
legislation in the house and the senate, both partisan and bipartisan, that have sought to hinder
access to abortion either by defunding Planned Parenthood directly, or be placing limitations on
abortion itself through trimester or physician admitting privilege restrictions. The careers of
many political leaders live and die on this issue.
Currently, Planned Parenthood is the most prolific and effective provider of reproductive
health services of all safety-net providers in the country. Therefor, eliminating federal funding
to this organization could impact quality, timeliness and access in counties where Planned
Parenthood is the leading, or only, safety net provider for these services.

History/Background: In 2010, 36 percent of the 6.7 million U.S. women receiving contraceptive
care from safety-net family planning health centers were served at Planned Parenthood
centers. Planned Parenthood health centers comprise 10 percent of publicly supported safety-
net family planning centers 36 percent of clients who obtain publicly supported contraceptive
services receive them from PP. By contrast: Health departments serve 27 percent FQHCs serve
16 percent, Sites operated by hospitals serve 8 percent Sites operated by other agencies serve
13 percent. Almost two-thirds (64 percent) of the 19 million women in need of publicly
supported contraceptive services and supplies live in counties with a Planned Parenthood
health center. 30 percent of these women live in counties where Planned Parenthood serves
the majority of those obtaining publicly supported contraceptive care from the family planning
safety net.

Planned Parenthood sites are particularly likely to help women who choose oral contraceptives
to get their pills without having to make an additional trip to a pharmacy. 92 percent of Planned
Parenthood health centers offer oral contraceptive supplies and refills on-site. Considerably
smaller proportions of sites operated by FQHCs and other types of agencies—37 percent and 55
percent, respectively—do so. Women are often able to get the care they need more quickly
from Planned Parenthood than from other types of safety-net providers. Planned Parenthood
sites are considerably more likely to offer a broad range of contraceptive methods than sites
operated by other types of agencies. Sixty-three percent of Planned Parenthood health centers
offer same-day appointments, compared to between 30 percent and 40 percent of sites
operated by other types of agencies. And the average wait for an appointment at a Planned
Parenthood health center is 1.8 days, whereas wait times at sites operated by other types of
agencies range from 5.3 to 6.8 days. Specifically, 91 percent of Planned Parenthood health
centers offer at least 10 of 13 reversible contraceptive methods, compared to between 48
percent and 53 percent of sites operated by other types of agencies.

Outcomes: The immediate and intentional outcomes of the bill are to limit the number of
abortions by specifically targeting Planned Parenthood as a symbol of abortion access.
Additionally, law makers are seeking to provide solace, or peace of mind, to those tax payers
who have moral disagreements with abortion by ensuring that their dollars are not used toward
this procedure. This money could then be recouped back into the federal budget and
theoretically repurposed towards less controversial governmental services. To-date, ten states
have already defunded Planned Parenthood: Alabama, Arkansas, Kansas, Louisiana, New
Hampshire, North Carolina, Texas, Utah, Ohio, and Wisconsin.
The unintended outcomes would be the significant impact on access to healthcare,
information and contraception for women and girls. This could have the inverse effect of the
original spirit of the bill by causing more unwanted pregnancies or unsafe abortions. By limiting
access to Planned Parenthood, health care costs in those affected counties could rise as other
providers must step in to fill the resulting gap in care.
To examine the impact of these outcomes more closely, research from Texas analyzed
the effects following Planned Parenthood defunding in the state in 2013.
“Women stopped using the most effective types of contraception and more babies were
born on the government's tab after Texas cut off funding from Planned Parenthood clinics”.
After the Planned Parenthood exclusion, there were estimated reductions in the number of
claims from 1,042 to 672 (a reduction of 35.5 percent) for long-acting, reversible contraceptives
and from 6,832 to 4,708 (a 31 percent reduction) for injectable contraceptives. During this
period in counties with Planned Parenthood affiliates, the rate of childbirth covered by
Medicaid increased by 1.9 percentage points (a relative increase of 27 percent from baseline)
within 18 months after the claim. It is likely that many of these pregnancies were unintended,
since the rates of childbirth among these women increased in the counties that were affected
by the exclusion and decreased in the rest of the state. The study estimated that between
100,000 and 240,000 women aged 18 to 49 in Texas have tried to self-induce abortion since the
law went into effect, using such methods as herbs, teas and medications obtained in Mexico
without prescription. “Texas women are forced to go to multiple and unnecessary visits at
clinics that are now farther away, take more days off of work, losing income, find childcare, and
arrange and pay for transportation for hundreds of miles."

Stakeholders: On either side of this issue are pro-choice and pro-life groups that continually
lock horns over abortion access. Add to that politicians and law makers that represent the
sizable number of Americans that fundamentally disagree with abortion and would like to see
their tax dollars spent elsewhere. Planned Parenthood itself as an organization has an obvious
interest in the future of this bill as well. In counties where Planned Parenthood’s services are
limited, the other providers in the area will also be impacted when called upon to step in and
take on the rise in need.
However, the true stakeholder in this debate are low-income women who will bear the
brunt of this decision. Looking again at Texas, it was noted that "poverty, limited resources, and
local facility closures limited women's ability to obtain abortion care in a clinic setting and were
key factors in deciding to attempt abortion self-induction," the Texas Policy Evaluation Project
found. The wellbeing of this demographic is directly placed in jeopardy if they are forced to
make uninformed or dangerous decisions due to a lack of access to quality care and accurate
information about reproductive health.
Recommendations: It should be noted that Planned Parenthood, like most non-profit
organizations, does not depend on federal funding to operate. Furthermore, it can be argued
that tax dollars should not be used to support any organization that large portions of tax payers
disagree with.
However, tax payers do not have the privilege of paying only for those things with which
they agree. It is the recommendation of this brief that federal funding for all safety-net
providers, including Planned Parenthood, remain in place. Although the concerns of the pro-
life community are valid and recognized by this brief, the evidence overwhelmingly
demonstrates that limiting access to quality reproductive healthcare will have significant
negative impacts on the health of women, specifically if they are low-income. Moreover, the
spirit of the bill will dissipate in the wake of the resulting rise in healthcare costs, unwanted
pregnancies and unsafe abortions, for which the bill seeks to reduce in the first place.
It should also be noted that abortion, although controversial, is legal in the United
States. It is the position of this brief that the punishment of an organization that provides
abortion for the sake of political symbolism does not justify jeopardizing the health of
thousands of women who will also be punished, in effect, despite the fact that they are simply
exercising their rights under the law.