The funding for Planned Parenthood’s Lincoln South Health Center, a clinic where Brooke Thomas gets birth control shots every three months to deal with excruciating pain, is at risk. The Nebraska Legislature advanced a budget bill Tuesday evening that includes language that would deny Planned Parenthood and other local family planning clinics public funds. In a 38-6 vote, lawmakers voted to block federal Title X funding to clinics that perform, counsel, or refer abortion services.
This is especially frustrating for Thomas because “Planned Parenthood is not just for abortions,” she told ThinkProgress. But because local lawmakers believe the provider is synonymous with abortion and because they believe taxpayer dollars pay directly for abortions (they don’t), they’re looking to exclude two Planned Parenthood affiliates from Nebraska’s Title X program.
In practice, legislative bill 944 jeopardizes the health care Thomas and many like her receive. This money pays for Thomas’ Depo-Provera hormonal shots. If she were to go to her primary care doctor, she’d have to pay up to $150 for her shots — a cost she can’t afford.
Tuesday’s was the first of three votes, and should lawmakers advance a state budget that includes restrictive changes to the Title X grant requirements, funds for many clinics — not just Planned Parenthood — are at risk. One lawmaker, Democratic Sen. Kate Bolz, tried to amend the referral language in the budget bill because, for example, it could make community health centers ineligible for public funds. She withdrew the amendment at the last minute in the hopes of a compromise in the next round of debate.
Title X is the country’s only federal family planning program that provides reproductive health services to low-income people, and largely benefits people of color. These funds are competitive grants and currently 13 providers in Nebraska — which serve thousands of patients through dozens of clinics statewide — are the subrecipients of the Title X grant.
Nebraska’s Title X fight is a microcosm of an ongoing national debate over whether health clinics that provide abortion services should receive family planning funds. Title X funds are one of two ways Planned Parenthood receives federal or state dollars; these clinics are also compensated through Medicaid. In April 2017, President Donald Trump made it easier for states to exclude Planned Parenthood by rescinding an Obama administration rule that protected abortion providers’ public funds from conservative governors and legislatures. The Obama-era rule was intended to clarify that lawmakers could not exclude qualified providers “for reasons other than its ability to provide Title X services.”
If successful, Nebraska’s bill would be the first direct attack on Planned Parenthood’s Title X funds since April. Other states have continued to target the provider’s Title X funding since Trump signed legislation rolling back the Obama-era rule, according to Guttmacher Institute’s Kinsey Hasstedt. For example, South Carolina Gov. Henry McMaster (R) demanded state agencies cut off local funds to providers affiliated with abortions. In the executive order, which targets abortion providers in a variety of ways, McMaster said these providers should be disqualified from grants, contracts, or state-administered federal funds — like Title X. But what’s unclear is if any of this has happened said Hasstedt.
And, for years, states have thought of creative ways to exclude Planned Parenthood and other abortion providers from Title X and Medicaid-funded family planning programs. The clearest example of how harmful these political tactics can be for patients is in Texas, where exclusion meant many forwent birth control coverage, and as such, Medicaid-funded births skyrocketed.
“To assume that other providers are not only poised to meet the same high standard of care that Title X requires but that [they] also have the capacity to fulfill existing demand is foolhardy,” said Audrey Sandusky, director of advocacy and communications for the National Family Planning and Reproductive Health Association (NFPRHA), which represents some Nebraska subrecipients.
The Trump administration recently made federal changes to the Title X grant application program. The new funding announcement suggests it would prioritize faith-based clinics over current grantees. There was also minimal reference to contraception, which worried many current grantees.
“This is yet another example of the concerted effort to chip away at access to family planning care — something that millions of patients rely on to stay healthy,” said Sandusky in reference to all the ongoing changes.
Gov. Pete Ricketts (R) first proposed Nebraska’s Title X eligibility changes, saying it’s meant to reflect the state’s “pro-life” values. Advocates have since gone to protest at the state legislature, including one mother-daughter duo named Jann and Chelsea, respectively. Chelsea is a sexual assault survivor and used Planned Parenthood’s services for her screenings afterwards. The mother and daughter confronted state Sen. Robert Hilkemann (R), who had insisted that no one’s health care would be jeopardized on Tuesday before the budget vote. Hours later, Hilkemann voted to advance the budget bill.
Nebraska tried to exclude abortion providers from Title X funding in 2017, but removed the language from the budget bill between the first and second vote. The speaker has not yet scheduled the second vote on the current budget bill but the legislation needs to be finalized by April 18.
Correction: This post has been updated to clarify comments made by Guttmacher Institute’s Kinsey Hasstedt on states that targeted Planned Parenthood’s Title X funding. ThinkProgress said Arizona excluded Planned Parenthood from Title X funds when efforts to exclude the provider are still ongoing. We regret the error.