A Year In Exile

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The House Republicans are voting on their proposal to amend the Affordable Care Act and their first order of business is to exclude Planned Parenthood from participating in Medicaid or any other federal program. But they do so in an obtuse way, by defining a “prohibited entity.” In short, the Republicans have set parameters around size, focus on family planning and reproductive health, and status as an essential community provider in such a way that applies to only one medical provider in the country: Planned Parenthood. Even stranger, the exclusion is to last only one year.

This is not unexpected, as the leadership in Congress and the anti-choice movement have been proposing this for many years. But what do they expect to achieve by removing Planned Parenthood from the Medicaid program, especially in light of the fact that there is no federal funding for abortions, a statute that was established in 1976 under the Hyde amendment?

The only result of defunding Planned Parenthood from Medicaid reimbursements for services rendered will be that millions of women, men and teens across the country, and tens of thousands right here in Nassau County, will be blocked from accessing lifesaving cancer screenings, essential prenatal care, and critically-important preventive services at Planned Parenthood.

It’s obvious that they want to put Planned Parenthood out of business because we believe that healthcare is a right—not a privilege—and that women deserve access to the full range of reproductive health care, including safe and legal abortion.

But why only a year? It really makes no sense unless the ultimate goal is to force all doctors to choose between participating in Medicaid or providing abortions and thereby marginalizing family planning providers and stigmatizing the women for whom they provide care.

In most states, it is difficult to attract high-quality doctors to participate in Medicaid, and it is extremely unusual to exclude a provider except in cases of fraud or extreme negligence. Planned Parenthood health centers are the model of a safety net provider: we deliver free or low cost care for patients without insurance; we are located in low-income, marginalized communities, communities of color and offer many educational and public health services; our staff is both racially and culturally diverse; and, yes, we provide abortions. No other doctor, clinic or hospital that provides these services is being excluded from Medicaid, even though many provide exactly these services—including abortion care.

Every doctor, clinic or hospital will clearly see what is as stake: stop performing abortions or run the risk of joining Planned Parenthood as a “prohibited entity” and be excluded from the Medicaid program. For a hospital with millions of dollars in billings, the choice will be obvious. And for private doctors and clinics that serve Medicaid patients, they will either have to stop performing abortions or devote their entire practice to this service. That is why the exclusion is for a year: change and you can come back.

However, this is a bargaining chip that Planned Parenthood will never accept.
For our patients, this will divorce abortion services from family planning, compromising the quality of care and sending us back to a time when abortions were performed secretively and unsafely.

Planned Parenthood is the leading advocate for family planning, contraception, women’s health care and, yes, access to abortion services. As such, we are the main target of those who oppose abortion. We are used to these outrageous attacks and expect to stand in the line of fire for the next four years.

But make no mistake, this is not about Planned Parenthood, per se. Indeed, it’s about the millions of Medicaid beneficiaries who rely on our providers for family planning, health education, and prenatal services who will be severely harmed. They will have to search for care elsewhere—in some communities Planned Parenthood is the only provider for miles, and in many cities and towns, the wait to obtain family planning services could be months.

This attack on Planned Parenthood is just the start of a broader effort against all abortion providers, and from there, who knows? Restricting who participates in Medicaid could become a powerful lever to control the type of care that low-income and marginalized individuals receive in America, the results of which could spark public health and economic crises.

—JoAnn D. Smith, Planned Parenthood of Nassau County president and CEO

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