Any day now, Ohio will take steps to "defund" Planned Parenthood. Both chambers of the Republican-dominated state legislature have passed a new bill targeting $1.3 million in state and federal grants to Planned Parenthood — not for abortion, but for services like maternal health and HIV tests. The bill is on John Kasich's desk, and he's expected to sign it.
Like several other states, Ohio rushed to cut funding for Planned Parenthood after an anti-abortion group released deceptive videos alleging that Planned Parenthood "sells baby parts." This is the case even though Ohio Attorney General Mike DeWine found no evidence that Planned Parenthood did what the videos claimed. Although DeWine did claim that Planned Parenthood improperly disposed of fetal remains, those claims were recently debunked by a local news investigation.
But Ohio is different from other states trying to defund Planned Parenthood. It's trying a new method of cutting Planned Parenthood's funding — one that some officials fear could have devastating unintended consequences for public health.
The proposed law is written so poorly that it could screw up Ohio's public health system
Ohio could actually risk defunding its public health departments in the process of trying to defund Planned Parenthood. This would affect everything from health inspections to birth and death certificates, not to mention sexual and reproductive health care.
The new proposal aims to "defund" Planned Parenthood in a very indirect way that leaves room for a lot of collateral damage. The bill doesn't actually name Planned Parenthood, even though its sponsors made clear that Planned Parenthood is the target. Instead, the bill would deny various grants (more on those later) to any entity that "performs" or "promotes" abortion.
But the bill goes even further than that — it also denies funding for contracting or affiliating with an organization that promotes abortion. This is where things get messy.
Kelli Arthur Hykes, the director of public health policy at Columbus Public Health (CPH), told Vox this bill could effectively defund her local health department, which serves Ohio's most populous city and its nearly 800,000 residents. CPH contracts or affiliates all the time with organizations that "perform" or "promote" abortion — not Planned Parenthood, but hospitals and insurance companies.
Hospitals, some of which provide what the bill calls "nontherapeutic" abortion care (for any purpose other than saving a woman's life, including rape, incest, or health issues), have to coordinate with CPH on everything from containing potential Ebola outbreaks to inspecting the cafeterias. And CPH routinely bills insurance companies, most of which provide at least one plan that covers abortion. CPH also coordinates with rape crisis centers, which counsel women on their abortion options, in order to distribute funds from the Violence Against Women Act.
"It's kind of a Catch-22 when it comes to the local health department," Hykes said.
The grants targeted by the bill fund programs that address things like infant mortality and testing for sexually transmitted infections (STIs). Losing funding for those programs could have a devastating impact on the community, Hykes said: "In Columbus we lose five kindergarten classes worth of kids every single year to infant mortality before their first birthday. Any impact on those types of critical outreach could have huge effects."
Hykes added that CPH served more than 11,000 clients last year just in its sexual health and HIV clinics. Also, Columbus is currently experiencing a syphilis outbreak.
But Hykes says the bill's effect on funding could be even worse. The Ohio Department of Health could interpret the bill to mean that all state funds, not just those specific grants, should be barred from promoting or associating with abortion. Losing all funds from the state health department would cut Columbus Public Health's budget in half overall, and by 80 percent for clinical services.
Hykes says she doesn't think legislators intended this when they wrote the bill, and she doesn't know for sure how or whether this application of the law would be enforced. But she says she and other stakeholders are confident that if this law passes as is, "there is going to be a time where it's illegal to do the work that we're required to do."
The proposal targets programs that screen for cancer, keep babies healthy, and educate teens about domestic violence
Unintended consequences aside, the bill's intended consequences are also bad news for public health.
Other states have tried defunding Planned Parenthood by going after the organization's Medicaid funding, but that's a legally dicey proposition that has already landed many of these states in court.
Instead, Ohio is trying to "defund" Planned Parenthood by kicking it out of various state and federal grant programs that specifically aid public health. These programs include:
- The "Healthy Moms, Healthy Babies" program that supports mostly black mothers before, during, and after pregnancy. The program is aimed at reducing abysmally high infant mortality rates in Ohio, which are the highest in the nation for black Americans.
- Several federal programs that help low-income people access breast exams, Pap smears, and screenings and treatment for STIs and HIV.
- Funds from the Violence Against Women Act that educate high-school-age youth, including youth who are in jail or foster care, on domestic violence, intimate partner violence, and healthy relationships.
Targeting these programs doesn't close Planned Parenthood clinics or make them stop providing abortions. All it does is make it harder for Planned Parenthood to provide public health services.
In 2014 alone, Planned Parenthood says the programs targeted in this new bill helped its Ohio clinics perform about 47,000 STI tests and 3,600 HIV tests, serve nearly 2,800 new or expectant mothers through various infant mortality prevention programs, and provide comprehensive sex education and domestic violence prevention for more than 600 young people in the juvenile and foster care systems.
Planned Parenthood of Greater Ohio CEO Stephanie Kight told Cleveland.com that while the funding cut would be a "big blow," Planned Parenthood won't turn away patients and will find other ways to pay for services. It won't be easy, however.
The irony in this approach is that these grants are competitive — and the state of Ohio consistently awards them to Planned Parenthood after a rigorous review process by the state of Ohio. Columbus Public Health gets these grants too, but Hykes isn't excited about not having to compete with Planned Parenthood; to the contrary, she worries about the consequences of taking high-quality Ohio health care providers out of the running for arbitrary reasons.
"John Kasich's administration is identifying Planned Parenthood as the best provider in certain communities, and our state legislature is undermining that competitive process," Hykes said. "The bottom line is that in many communities, Planned Parenthood is the organization that can provide the best care and the best services at the best price for a taxpayer."
There's no way other providers could take over these services for Planned Parenthood
The bill's sponsors insist that no funding for women's health will actually be cut, because the funds will just be "redirected" to other qualified providers like community health centers that don't provide abortions.
"We firmly believe the little more than a million dollars going to Planned Parenthood in 2015 is better spent on community health care providers who don’t talk about selling baby parts for profit," said Fortney, the Ohio Senate majority spokesperson.
The bill's supporters also circulated a list of those providers. But as the Guardian's Molly Redden reported, that list included irrelevant entries like dentist's offices, school nurses, senior centers, addiction treatment centers, and a food bank. It also included numerous duplicate entries that made the list look longer than it really is.
Some of the entries are, of course, actual qualified providers. Columbus Public Health is one of them. But Hykes says there's no way Columbus Public Health could take on the extra patient load if Planned Parenthood had to close or cut its services. Her department might be able to grow 10 percent in the next couple of years, and that "doesn't even come close" to being able to serve the number of people that Planned Parenthood does in Columbus and Franklin Counties.
Cleveland.com talked to several other community health providers about whether they could take over the services that Planned Parenthood provides. Some said they might be able to take over some functions. But they opposed arbitrarily cutting the services of any qualified health provider, especially one that already has a relationship with a specific, vulnerable population in a specific community.
It's common for proponents of defunding Planned Parenthood to argue that women can and should "go somewhere else" for their care. But as Vox has previously reported, this simply isn't true. It doesn't matter that there are a lot more community health centers than Planned Parenthood locations, or that they serve more patients total — Planned Parenthood clinics tend to serve a much higher number of patients, and often play a role in community health that can't easily be replaced.
"They're so opposed to abortion access that they are willing to defund programs that are potentially lifesaving ... simply because the entity that delivers those services also happens to use other private dollars to provide abortion care," said Kellie Copeland, executive director of NARAL Pro-Choice Ohio.