On Monday, the Congressional Budget Office released its estimate of the effect enacting the American Health Care Act, also known as Trumpcare, would have on the budget and access to health care. The CBO estimates that despite the massive tax cuts Trumpcare would give to the wealthy, it would result in a net reduction of the deficit of $337 billion over the next eight years – primarily by eliminating the Obamacare subsidies that enabled middle-income people to afford individual health plans and slashing funding for Medicaid. That would result in 14 million more people lacking insurance next year than would if Obamacare remained in place; that number would rise to 24 million within the decade.
The Trumpcare plan also involves a provision that would "defund" Planned Parenthood. More precisely, it would bar patients on Medicaid from using their insurance to get treatment at the country's largest provider of reproductive health care for low-income people. Republicans who want to shut down Planned Parenthood claim that Medicaid patients can just go elsewhere. The idea that we have the health infrastructure to absorb the 2.5 million patients Planned Parenthood treats each year was always laughable, but the CBO report is further proof that is not the case.
The CBO estimates that preventing Planned Parenthood from accepting Medicaid would save $178 million in Medicaid spending. If the anti-Planned Parenthood crusaders were correct that poor people can get treatment somewhere else, defunding the organization would not decrease Medicaid spending. The projected savings would come from people living in places that don't have other health care providers serving low-income people with things like pap smears, mammograms, testing and treatment for sexually transmitted infections and contraception.
But the CBO report isn't all good news for those who think depriving poor people of health care is a good way to reduce the deficit. It doesn't take an economics PhD to figure out that if you take away Planned Parenthood, people will likely have less access to contraception, and thus more pregnancies. The CBO estimates Medicaid will have to pay for several thousand more births, many of them to poor children who will themselves qualify for Medicaid.
But there is another set of hard-to-quantify costs that the CBO report doesn't address: those associated with delayed discovery and treatment of sexually transmitted infections and cancer. When Planned Parenthood clinics lose their funding or shut down, patients lose access to vital health services beyond contraception and abortion. We know this because the state of Texas has already tried this experiment. Defunding Planned Parenthood turned out not only to be expensive, but a recipe for a cruel and unnecessary public health crisis.
In 2011, Texas legislators slashed family planning funding by two-thirds and barred Planned Parenthood from receiving any of what remained. Texas law already barred clinics that perform abortions from receiving any funds, but Planned Parenthood – the largest provider of preventive reproductive health services in the state – had been able to operate by maintaining a separate legal entity for clinics where abortions were not performed or recommended. But Texas legislators decided to take the war on Planned Parenthood to the next level without much considering what that would do to patients: Because discriminating against Planned Parenthood isn't permissible under current law, the state lost its federal family planning money as well.
A 2013 fact-finding report from the Nuestro Texas campaign chronicled the devastating impact on Latina women living in poverty in the Lower Rio Grande Valley after 28 percent of the reproductive health clinics in the state closed and those that stayed open had to reduce services and increase fees. (The author of this article is a former employee of the Center for Reproductive Rights, one of the groups that's part of the Nuestro Texas campaign, but she had no involvement with the report.)
The stories in the report are tragic: A woman named Brenda went without having lumps in her breast examined because the waitlist for an appointment at her local clinic was so long and the $50 fee too expensive. Ida, who has HPV, which can cause cervical cancer, and cysts on her cervix that had to be surgically removed, had to choose between getting the Pap test her doctors recommended and buying her children food. Mayda didn't have hundreds of dollars for a mammogram, so she went four years after lumps were discovered in her breasts without knowing whether she had cancer. Daniela waited six months for a mammogram appointment, but the clinic didn't have the equipment by the time she got one. After her local clinic lost its funding, Fatima went on and off of birth control depending on when she could get some brought from Mexico. Many women reported traveling across the border for treatment, in fact; Adriana couldn't afford to have her ovarian cysts removed in the U.S. so she went to Mexico, swimming across the river to get back to her family each time because she is undocumented.
Texas’ cuts resulted in 144,000 women losing access to family planning services. Texas Republicans tried to restore the funding after Medicaid spending spiked because more women became eligible due to unintended pregnancies. But instead of giving it to the family planning clinics that survived, they directed the funds to primary care providers who often lack the capacity to meet reproductive health needs in rural and poor areas. Most primary care providers lack the expertise and efficiency of family planning clinics, so cancer screenings and long-acting contraception have become less available.
Texas lost 82 family planning clinics by 2014, a third of them Planned Parenthoods, and learned the hard way that once you dismantle your reproductive health infrastructure, it is very difficult to put things back together. Even after restoring funding, the state is serving half the women it did before the cuts.
The fact is, our government has outsourced much of the reproductive health safety net to Planned Parenthood. There is not another system with sufficient capacity, let alone name-recognition, where those in need can go for affordable care. This was illustrated when Louisiana tried to defend its attempt to defund Planned Parenthood in court by providing a list of 2,000 providers the state claimed provided family planning services – it included dermatologists, dentists and nursing home caregivers. The corrected list had only 29 providers on it.
Proponents of the Medicaid ban know perfectly well that thousands of patients will go without contraception or cancer screenings if their local Planned Parenthood closes – they just don't care. Because abortion opponents have little hope of recriminalizing abortion, they've used economic attacks to make abortion unavailable to the poor. If they have to take away additional medical care in service of that goal, so be it. Telling the poor to fend for themselves is what Trumpcare is all about.